International Journal of Telemedicine and Applications最新文献

Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption.

Background: Heart rhythm disorders are common and may be associated with serious complications. The quality of the ECG signal is crucial to detect and classify arrhythmias. Most available devices for assessment arrhythmias do not allow for remote monitoring. The Norwegian ECG247 Smart Heart Sensor is a new remote patch monitor developed to simplify the assessment of arrhythmias. This study was aimed at evaluating the quality of the ECG signal from the ECG247 Smart Heart Sensor compared to standard 12-lead ECG.

Methods: ECG recordings with ECG247 Smart Heart Sensor and a standard 12-lead ECG recorder were performed in 97 volunteers at Sorlandet Hospital, Arendal, Norway, in 2019. All ECGs were analysed by two independent cardiologists.

Results: A total of 97 participants (53% men, age 48 (±14) years) were included in the study. The ability for both systems to use recorded ECG data for arrhythmia detection was good (100%). The quality of the P-wave (mean score 1.1 vs. 1.5) and the QRS complex (mean score 1.0 vs. 1.0) from the ECG247 Smart Heart Sensor and that from the 12-lead ECG were comparable (scale: 1: extremely good, 9: not accepted). Noise artefacts were a minor issue in all recordings.

Conclusions: The ECG quality from the ECG247 Smart Heart Sensor was comparable to the ECG quality from the standard 12-lead ECG. The ECG247 Smart Heart Sensor may enable easy and remote diagnostics of heart rhythm disorders. This trial is registered with NCT04700865.

Objective: To describe the clinical indications and the impact of implementation of specific teleophthalmology referral guidelines in a large rural village vision centre network in India.

Methods: This cross-sectional vision centre-based study included 1,016,284 patients presenting between January 2017 and March 2020. Patients who were referred for a teleophthalmology opinion were included as cases. The data were collected using the eyeSmart EMR app on a smart tablet. A training intervention was done to reinforce the implementation of targeted teleophthalmology referral guidelines.

Results: Overall, 63,703 (6.3%) patients were referred for a teleophthalmology opinion and were included for analysis. The median age was 41 (IQR: 26-59) years, and adults (88.4%) were commonly referred for a consult. The two most common age groups were between 31-40 years (17.4%) and 21-30 years (16.3%), and the majority of patients were male (59.1%). The most common clinical indication was cornea and anterior segment disorders (71.05%). The most common queries for teleophthalmology referral before versus after the reinforcement of implementation of guidelines were red eye (33.4% vs. 45.6%) followed by cataract (21.2% vs. 8.1%). There was an increase in the red eye (<0.001) and a decrease in cataract (<0.001) which was statistically significant. The proportion of patients for whom a teleophthalmology consult could have been requested but not sent was minimal (2.3%).

Conclusion: Implementation of targeted teleophthalmology referral guidelines enables an effective triage to seek opinion for more pertinent ocular diseases that require care. Adult male patients with cornea and anterior segment disorders are most commonly referred for a teleophthalmology opinion.

The impact of COVID-19 on healthcare services has been profound. One major impact has been underutilization of traditional healthcare services by patients. In 2020, the Saudi Ministry of Health (MoH) started offering general COVID-19 enquiries, education, and medical and psychological consultations around the clock via their 937-Call Center. Given this major change, there was a need to understand the impact of the COVID-19 pandemic on Call Center services, specifically medical consultations, to suggest future recommendations for patient care optimization. This descriptive study analyzed routinely collected data on the 937-Call Center service between March 2020 and September 2020. Data were reviewed, coded, verified, and analyzed using SPSS v22. There was a 296% increase in the number of calls received by the 937-Call Center in 2020 compared to the same period in 2019. The majority of calls received in 2020 were general medical enquiries (98.41%), but about three million COVID-19-specific enquiries were also received in 2020. The increased number of calls was managed by accepting volunteers to handle calls: an average of 236 volunteers per month, handling about 20% of the total call volume. The majority of volunteers were physicians but with the presence of pharmacists, psychologists, and specialized healthcare workers such as nutritionists. Utilization of the 937-Call Center increased during the COVID-19 pandemic, suggesting that it has been an effective strategy for combatting the COVID-19 pandemic in Saudi Arabia. Further research is recommended to investigate the impact of COVID-19 on public awareness of the 937-Call Center and other health-related mobile apps.

The declaration of the COVID-19 pandemic necessitated rapid implementation of telehealth across all neurological subspecialties. Transitioning to telehealth technology can be challenging for physicians and health care facilities with no prior experience. Here, we describe our experience at the Neurology and Sleep Disorders Clinic at the University of Missouri-Columbia of successful transition of all in-person clinic visits to telehealth visits within a span of 2 weeks with a collaborative effort of clinic staff and the leadership. Within a month of launch, 18 clinic providers with no prior telehealth experience conducted 1451 telehealth visits, which was the 2nd highest number of telehealth visits conducted by any department at the University of Missouri-Columbia Health Care system. Lack of connectivity, poor video/audio quality, and unavailability of smart devices among rural populations were the important shortcomings identified during our telehealth experience. Our study highlighted the need for expansion of high-speed internet access across rural Missouri. We hope our experience will help other health care facilities to learn and incorporate telehealth technology at their facilities, overcome the associated challenges, and serve patient needs while limiting the spread of the COVID-19.

Technological innovation plays a crucial role in digital healthcare services. A growing number of telehealth platforms are concentrating on using digital tools to improve the quality and availability of care. Virtual care solutions employ not only advanced telehealth technology but also a comprehensive range of healthcare services. As a result, these can reduce patient healthcare costs as well as increase accessibility and convenience. At the same time, the healthcare service provider can leverage healthcare professionals to get a better perspective into the needs of their patients. The objective of this research is to provide a comprehensive design blueprint for a large-scale telehealth platform. Telehealth is the digital healthcare service combining online services and offline access for healthcare facilities to offer various healthcare services directly to patients. This design blueprint covers the digital healthcare ecosystem, new patient journey design for digital health services, telehealth functionality design, and an outline of the platform infrastructure and security design. Ultimately, telehealth platforms establish a completed digital healthcare service and new ecosystem that provides better care for every patient worldwide.

Objective: Rheumatoid arthritis (RA) is a chronic autoimmune condition associated with a potential for deformities. It is one of the common conditions to seek health care. Hence, the present study was conducted to assess the telemedicine services for patients suffering from rheumatoid arthritis during the COVID-19 pandemic in an Asian Indian population.

Methods: A prospective study was conducted (March 2020-June 2020) in the telemedicine department of a premier northern Indian tertiary care institution. Out of the total patients enrolled (N = 7577) in telemedicine services, 122 rheumatoid arthritis patients (1.6%) were followed for 1 month to assess change in functional status by modified Health Assessment Questionnaire (mHAQ). Telephonic interviews of the enrolled patients were conducted to determine the level of understanding of advice given by consultants, barriers during the consultation, and satisfaction with teleconsultations for rheumatology clinics.

Results: For the native people, language of the clinicians was the main barrier (20%) in telerheumatology. Saving of time and money was observed as beneficial factors for patients. More than three-quarters of all rheumatoid arthritis patients were ready to use teleconsultation in the near future. A similar proportion of patients were in support for the recommendation of these services to other persons.

Conclusion: We report the successful use of telemedicine services in the evaluation and management of rheumatic diseases in the current COVID-19 pandemic situation.

Tracking movements of the body in a natural living environment of a person is a challenging undertaking. Such tracking information can be used as a part of detecting any onsets of anomalies in movement patterns or as a part of a remote monitoring environment. The tracking information can be mapped and visualized using a virtual avatar model of the tracked person. This paper presents an initial novel experimental study of using a commercially available deep-learning body tracking system based on an RGB-D sensor for virtual human model reconstruction. We carried out our study in an indoor environment under natural conditions. To study the performance of the tracker, we experimentally study the output of the tracker which is in the form of a skeleton (stick-figure) data structure under several conditions in order to observe its robustness and identify its drawbacks. In addition, we show and study how the generic model can be mapped for virtual human model reconstruction. It was found that the deep-learning tracking approach using an RGB-D sensor is susceptible to various environmental factors which result in the absence and presence of noise in estimating the resulting locations of skeleton joints. This as a result introduces challenges for further virtual model reconstruction. We present an initial approach for compensating for such noise resulting in a better temporal variation of the joint coordinates in the captured skeleton data. We explored how the extracted joint position information of the skeleton data can be used as a part of the virtual human model reconstruction.