International Journal of Telemedicine and Applications最新文献

Securing telehealth IoT infrastructure is essential to provide high-level medical care and prevent cyberattacks. A vulnerable stage in IoT telehealth is while the patient is being transported to a healthcare facility, the transporter could be an ambulance or an air ambulance. In this paper, we propose a multifactor authentication scheme to secure the system when the patient is in transit to the healthcare facility. We apply this scheme to an ambulance, using physical unclonable functions (PUFs) embedded in the ambulance to facilitate authentication and secure key exchange. We validated the security of the proposed scheme using formal and informal security analysis. The analysis supports our claim that the proposed scheme protects against many types of attacks.

Objective: To examine the factors associated with the first use of telehealth during the COVID-19 pandemic using Andersen's Model of Healthcare Utilization. Andersen's Model of Healthcare Utilization allowed the categorization of the independent variables into the following: (1) predisposing factors, including sociodemographic variables and health beliefs; (2) enabling factors, including socioeconomic status and access to care; and (3) need for care, including preexisting or newly diagnosed conditions and reasons to seek out care or to utilize a new mode of care.

Methods: Potential respondents (n = 4,077) were identified for recruitment from a volunteer registry in Arkansas. Recruitment emails provided a study description, the opportunity to verify meeting the study's inclusion criteria and to consent for participation, and a link to follow to complete the survey online. The online survey responses were collected between July and August of 2020 (n = 1,137).

Results: Telehealth utilization included two categories: (1) utilizers reported the first use of telehealth services during the pandemic, and (2) nonutilizers reported they had never used telehealth. Lower odds of reporting telehealth utilization during the pandemic were associated with race (Black; OR = 0.57, CI [0.33, 0.96]) and education (high School or less; OR = 0.45, CI [0.25, 0.83]). Higher odds of reporting telehealth utilization included having more than one provider (OR = 2.33, CI [1.30, 4.18]), more physical (OR = 1.12, CI [1.00, 1.25]) and mental (OR 1.53, CI [1.24, 1.88]) health conditions, and changes in healthcare delivery during the pandemic (OR = 3.49, CI [2.78, 4.38]).

Conclusions: The results illustrate that disparities exist in Arkansans' utilization of telehealth services during the pandemic. Future research should explore the disparities in telehealth utilization and how telehealth may be used to address disparities in care for Black Arkansans and those with low socioeconomic status.

Introduction: Synchronous telemedicine using teleconferencing may play a role in clinical care. In a tertiary care center, video conferencing-enhanced virtual clinics were established via a new application platform. They were introduced during COVID-19 pandemic to connect patients to trained health-care providers via a secured line. While maintaining patients' privacy, they were theorized to offer effective communications and continuous clinical care. In this cross-sectional cohort study, we ought to examine the impact of service and the assistance they may offer to cardiac patients in the outpatient setup.

Methods: A prospective cohort study looking at all video-conferencing virtual clinics' visits during the pandemic with primary focus on cardiac outpatient clinic, addressing primary endpoints of need for admission or emergency visits from cardiac demises during the pandemic and secondary endpoint of patient satisfaction based on patients' experiences.

Results: A total of 6000 live care video-based chats were made over 10 months period from March 10^th, 2020, to January 30^th, 2021, among which 277 patients were evaluated in the virtual cardiac clinic, of these 193 (69.7%) were males, with mean age of 48 ± 15.60 (22.3%), patients were requested to present to clinic for further evaluation and testing, 20 (7.2%) patients were asked to visit the emergency room, of whom 8 (2.8%) patients were hospitalized. All 8 were admitted for high-risk findings that require immediate medical attention, 4/8 underwent cardiac catheterization, mean duration of admission was 2 ± 1 days. When compared to regular walk-in care, there was a statistical difference in admission rate and emergency visits p = 0.001 and p = 0.0001, respectively, both were statistically higher in the virtual clinic. The satisfaction rate in a 5-scale grading system was 97% of 4 and above recommending the continuation of the service beyond pandemic time.

Conclusions: Video-enhanced virtual cardiology clinic works safely and efficiently during COVID-19 pandemic with a difference in admission rate and ER visits when compared to walk-in clinic. It can be used during nonpandemic time to reduce load on hospital and clinic crowdedness. It also decreases the chances of COVID-19 transmission indirectly by reenforcing physical distance.

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.