Journal of Telemedicine and Telecare最新文献

Existing challenges in surgical education (See one, do one, teach one) as well as the COVID-19 pandemic make it necessary to develop new ways for surgical training. Therefore, this work describes the implementation of a scalable remote solution called "TeleSTAR" using immersive, interactive and augmented reality elements which enhances surgical training in the operating room. The system uses a full digital surgical microscope in the context of Ear-Nose-Throat surgery. The microscope is equipped with a modular software augmented reality interface consisting an interactive annotation mode to mark anatomical landmarks using a touch device, an experimental intraoperative image-based stereo-spectral algorithm unit to measure anatomical details and highlight tissue characteristics. The new educational tool was evaluated and tested during the broadcast of three live XR-based three-dimensional cochlear implant surgeries. The system was able to scale to five different remote locations in parallel with low latency and offering a separate two-dimensional YouTube stream with a higher latency. In total more than 150 persons were trained including healthcare professionals, biomedical engineers and medical students.

Introduction: Previous analyses suggest that ethnic and racial differences exist in acute stroke care including thrombolytic treatment rates. The current study evaluates ethnic or racial differences in acute stroke treatment within a multi-state telestroke program.

Methods: Acute telestroke consultations seen in the Emergency Department in 203 facilities and 23 states were extracted from the Telecare by TeleSpecialists^TM database. Cases were reviewed for age, race, ethnicity, sex, last known normal time, arrival time, treatment with thrombolytic therapy, door-to-needle (DTN) time, and baseline National Institutes of Health Stroke Scale score. Race was defined as Black, White, or Other; ethnicity was defined as Hispanic or non-Hispanic.

Results: The current study included 13,221 acute telestroke consultations consisting of 9890 White, 2048 Black, and 1283 patients classified as Other. A total of 934 patients were Hispanic and 12,287 patients were non-Hispanic. There were no statistically significant differences noted in thrombolytic treatment rates when comparing White (7.9%) patients with non-White patients (7.4%), p = 0.36, or comparing Black (8.1%) with non-Black patients (7.8%), p = 0.59. In addition, there were no statistically significant differences in treatment rates comparing Hispanic (6.3%) with non-Hispanic (7.9%) patients, p = 0.072. We noted no measurable differences in DTN times by race or ethnicity.

Conclusions: Contrary to previous reports, we failed to detect any significant differences in thrombolytic treatment rates and DTN times by race or ethnicity among stroke patients in a multistate telestroke program. These findings support the hypothesis that telestroke may mitigate racial and ethnic disparities which may be attributable to local variability in stroke procedures or access to healthcare.

Objectives: Sepsis is associated with significant mortality. Telehealth may improve the quality of early sepsis care, but the use and impact of telehealth applications for sepsis remain unclear. We aim to describe the telehealth interventions that have been used to facilitate sepsis care, and to summarize the reported effect of telehealth on sepsis outcomes.

Data sources: We identified articles reporting telehealth use for sepsis using an English-language search of PubMed, CINAHL Plus (EBSCO), Academic Search Ultimate (EBSCO), APA PsycINFO (EBSCO), Public Health (ProQuest), and Web of Science databases with no restrictions on publication date.

Study selection: Included studies described the use of telehealth as an intervention for treating sepsis. Only comparative effectiveness analyses were included.

Data extraction and synthesis: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines, two investigators independently selected articles for inclusion and abstracted data. A random-effects subgroup analysis was conducted on patient survival treated with and without telehealth.

Results: A total of 15 studies were included, involving 188,418 patients with sepsis. Thirteen studies used observational study designs, and the most common telehealth applications were provider-to-provider telehealth consultation and intensive care unit telehealth. Clinical and methodological heterogeneity was significantly high. Telehealth use was associated with higher survival, especially in settings with low control group survival. The effect of telehealth on other care processes and outcomes were more varied and likely dependent on hospital-level factors.

Conclusions: Telehealth has been used in diverse applications for sepsis care, and it may improve patient outcomes in certain contexts. Additional interventional trials and cost-based analyses would clarify the causal role of telehealth in improving sepsis outcomes.

Background: Real-world hepatocellular carcinoma (HCC) surveillance uptake remains suboptimal, despite evidence that surveillance is associated with lower cancer-related mortality in patients with cirrhosis and chronic hepatitis B. We aimed to examine the impact of telehealth consultations on HCC surveillance rates within a specialist liver clinic.

Methods: We conducted a retrospective observational study within an Australian outreach liver clinic within a culturally diverse community, comparing standard consultations before the COVID-19 pandemic to telehealth consultations during the pandemic. The primary outcome was surveillance uptake defined as the percentage of time up-to-date with surveillance (PTUDS) with the 6-month interval following each scan considered up-to-date.

Results: Over 18 months of follow-up for each cohort, the median PTUDS was 86.5% in the standard consultation cohort and 85.5% in the telehealth consultation cohort (p = 0.12). HCC diagnoses did not differ between groups and hospitalisation and mortality rates were low. Using multivariate regression, increasing age, the need for an interpreter and being born in South-East Asia independently predicted PTUDS in the standard consultation cohort, whereas being born in Australia or New Zealand was predictive of a lower PTUDS. Current alcohol use and distance from the clinic predicted a lower PTUDS in the telehealth consultation cohort. In both groups, missed clinic attendances were strongly predictive of a lower PTUDS.

Conclusion: Telehealth hepatology consultations effectively coordinate HCC surveillance and are associated with similar outcomes to standard consultations. Its implementation should be widely considered given its advantages with regards to accessibility for patients.

Introduction: Restrictions on face-to-face (F2F) healthcare services during the recent COVID-19 pandemic necessitated novel provision of care for Ponseti-treated clubfoot patients. This retrospective review compares the effectiveness of telemedicine (TM) using live-stream videoconferencing compared to conventional F2F review, in two cohorts of 78 patients attending routine follow-up, during Ponseti-treated clubfoot bracing in their first 5 years.

Methods: Rates of compliance, recurrence of deformity, and type of intervention provided were compared between cohorts. The TM cohort was re-evaluated F2F as part of routine follow-up care. Attendance rates were compared between cohorts and with an equivalent time period the previous year.

Results: There was no significant difference in the rate of compliance between cohorts (77% in the TM group, 74% in the F2F group), or in the rate of recurrence. Subsequent F2F review of the TM cohort showed that compliance had improved in some patients, indicating successful TM intervention. There were no missed cases of recurrence. TM follow-up appointments offered similar rates of management of skin problems, brace adjustment, and provision of exercises. At least one element of intervention was provided in 64% of the TM group, and 72% of the F2F group. TM connection was successful in 74% of booked appointments. The number of patients attending was similar to F2F bookings one year prior.

Discussion: The use of TM for routine follow-up of Ponseti-treated clubfoot patients can be as clinically effective as F2F assessment, and has potential for integration into routine follow-up care.

Objectives: To compare the effects of physical therapy via telerehabilitation on the improvement in cardiopulmonary function, physical factors and psychological factors in patients with coronavirus disease 2019 (COVID-19).

Methods: Thirty-two patients with COVID-19 were randomly assigned to intervention and control groups. Both groups received online guidance and a leaflet on cardiopulmonary rehabilitation. Additionally, participants in the intervention group received physical therapy training via video call, which included pulmonary training and various exercises. Cardiopulmonary exercise testing, quality of life, functional capacity, cognitive function, lower body strength and endurance and psychological aspects (anxiety, depression and insomnia) were assessed.

Results: The physical therapy programme delivered via telerehabilitation significantly improved cardiopulmonary function in patients with COVID-19 at the 3-month follow-up compared with the control group. Additionally, the physical therapy programme had beneficial effects on functional capacity, depression symptoms and quality of life.

Conclusion: A physical therapy programme via telerehabilitation can be delivered to patients with COVID-19 in their own homes to improve cardiopulmonary function after 3 months of follow-up.

Introduction: Telehealth has the potential to improve access to mental health care, especially for people living in rural and remote regions. Yet, telehealth accessibility remains a challenge in Australia, and there is a scarcity of appropriate, psychometrically sound tools for evaluating telehealth use by mental health service users. The aim of this study was to adapt and validate a scale for measuring factors associated with mental healthcare telehealth use.

Methods: A 39-item scale was adapted from the Theoretical Domains Framework questionnaire (TDFQ); a 14-domain framework for measuring implementation of evidence-based practice in health research and service delivery. Since use of the TDFQ in the service user and telehealth space is novel, we adapted and piloted the TDFQ using a rigorous and iterative consultation process and analysis. The study sample included 208 people who use mental health services (52% male). Preliminary analysis identified 32-items for inclusion in the exploratory factor analysis. Internal reliability and construct validity were also analysed.

Results: The resulting 21-item telehealth adaption of the TDFQ includes four factors, each with good internal reliability: satisfaction and habit (6 items), knowledge and training (5 items), benefit and value (6 items), and emotionality (4 items). Both the total scale and individual factors were positively associated with telehealth use.

Discussion: The telehealth adaption of the TDFQ is a psychometrically sound tool for assessing factors associated with the use of telehealth by people who use mental health services.

Introduction: Telemedicine, propelled by recent technological advancements, has transformed healthcare delivery, notably benefiting patients with chronic non-communicable diseases (NCDs) such as systemic arterial hypertension and diabetes mellitus. This meta-analysis of randomized clinical trials aimed to assess the efficacy of telehealth-based interventions on disease control rates and clinical parameters among NCD patients, including systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) levels.

Methods: We conducted searches in PubMed, Scopus, Web of Science, and the Cochrane Database for interventional studies that compared tele-monitoring with usual care in patients with hypertension and type 2 diabetes mellitus. Odds ratios with 95% confidence intervals (CIs) were computed.

Results: Our meta-analysis included 75 studies, encompassing a total of 106,261 patients, with 50,074 (47.12%) receiving usual care and 56,187 (52.88%) receiving tele-monitoring care. The telemedicine group was associated with a statistically significant reduction in SBP (mean difference (MD) -4.927 mmHg; 95% CI -6.193 to -3.660; p < 0.001; I² = 90%), DBP (MD -2.019 mmHg; 95% CI -2.679 to -1.359; p < 0.001; I² = 54%), FBG (MD -0.405 mmol/L; 95% CI -0.597 to -0.213; p < 0.001; I² = 32%), and HbA1c (MD -0.418%; 95% CI -0.525 to -0.312; p < 0.001; I² = 76%).

Conclusions: Our meta-analysis shows that telehealth technologies notably enhance blood pressure and blood glucose control. This supports integrating telemedicine into clinical protocols as a valuable complementary tool for managing hypertension and diabetes mellitus comprehensively.

Background: The COVID-19 pandemic led to widespread adoption of telemedicine, which has persisted in healthcare delivery.

Objective: We aimed to characterize telemedicine use in ambulatory cardiology clinics over two years following the onset of the COVID-19 pandemic.

Methods: Retrospective cross-sectional study from 16 March 2020 to 27 June 2022 in a single-center ambulatory cardiology clinic and telemedicine visits. Mixed effects logistic regression was used to model the association of diagnosis class (based on International Classification of Disease 10th Revision codes) with whether an encounter was scheduled as telemedicine, adjusting for age, sex, race, ethnicity, date, and zip code. This was performed for telemedicine and in-office encounters across 15 University of California Los Angeles (UCLA) Health System ambulatory cardiology clinics.

Results: The analysis included 76,127 patients (49.60% women, age 61.5 ± 17.30 years, 57.27% white, 12.25% Hispanic, 81.79% with zip code in a UCLA Health service area) over 255,674 encounters. Each patient had a median of two encounters (range 1-81). Of all encounters, 29,154 (11.40%) were scheduled as telemedicine. Telemedicine was more likely used in the management of chronic conditions, especially metabolic disorders (adjusted OR [aOR] 2.36, 95% CI 2.19-2.54) and cardiomyopathies (aOR 2.16, 95% CI 1.99-2.34), than for evaluation of undifferentiated signs/symptoms. Telemedicine was less likely used for general exam/screening (aOR 0.49, 95% CI 0.44-0.56) and heart transplant (aOR 0.51, 95% CI 0.40-0.64).

Conclusion: Among the outpatient encounters in this study, the most established use case for telemedicine in cardiology was for care of chronic cardiovascular conditions among nontransplant patients, suggesting that future telemedicine expansion should be targeted toward the most appropriate clinical scenarios.

Aims: To assess whether telemonitoring improves outcomes in patients with chronic heart failure.

Methods and results: A literature search was conducted on studies of randomized controlled trials involving non-invasive telemonitoring and heart failure using Medline, Embase, and Cochrane Library. The primary outcomes were all-cause mortality, all-cause hospitalization, and hospitalization for heart failure. Secondary outcomes were length of stay, health-related quality of life as assessed by validated questionnaires, healthcare costs and cost-effectiveness, and self-care behaviors. We performed a meta-analysis using a random effects model for the primary outcomes. The effect measure was odds ratio with corresponding 95% confidence interval, and heterogeneity among studies was assessed using the Higgins I² value. We screened 212 references, and 34 randomized controlled trials were included in this review. A total of 16179 participants with heart failure were included. Non-invasive telemonitoring reduced all-cause mortality by 18% (OR 0.82, 95% CI 0.71 to 0.95; participants = 15,211; studies = 28; I²= 34%; GRADE: moderate-quality evidence) and heart failure hospitalization by 20% (OR 0.80, 95% CI 0.69 to 0.94; participants = 7491; studies = 18; I²= 31%; GRADE: moderate-quality evidence). Non-invasive telemonitoring didn't demonstrate significant benefit on all-cause hospitalization (OR 0.93, 95% CI 0.82 to 1.05; participants = 11,565; studies = 25; I²= 49%).

Conclusion: Telemonitoring programs in patients with heart failure were associated with a reduction in all-cause mortality and heart failure hospitalization without harmful events.