Journal of Telemedicine and Telecare最新文献

Introduction: Meta-analysis shows that home tele-monitoring (HTM) improves glycaemic control in patients with type-2 diabetes mellitus (T2DM) up to 12 months, but their health outcomes after HTM cessation remains unclear. This study aimed to determine the health outcomes of these patients 18 months after completing 6 months of HTM, compared to standard care.

Methods: Patients with T2DM were enrolled in an open-labelled randomised controlled trial, aged 26 to 65 years, and suboptimal glycaemic control (HbA1c = 7.5%-10%). Patients in the intervention group (n = 165) undertook HTM using the OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) HTM system for 6 months followed by usual care for another 18 months, while control group (n = 165) had usual care for 24 months. The OPTIMUM HTM system includes in-app video-based tele-education, tele-monitoring of the blood pressure (BP), capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based telecare by the investigators. They were assessed using the Self-Care Inventory Scale (SCIR) and medication adherence (Medication Adherence Report Scale 5) at baseline, 6-month and 24-month time-points.

Results: The data from 146 (intervention) and 152 (control) patients, with comparable baseline demographic profiles were eventually analysed. The decrease in HbA1c over 24 months was comparable between intervention and control group. Those in the intervention group were more likely to maintain their glycemic control (HbA1c ≤ 8%) (adjusted odds ratio (AOR) = 1.9, 95%confidence interval (CI) = 1.1-3.2; p = 0.028), had higher SCIR score (p = 0.004), and less likely to "never forget" (p = 0.022), or "stop medications" (p = 0.048), at 24-month time-point as compared to subjects in the control group.

Conclusion: The glycaemic control of patients with T2DM continued to be maintained for another 18 months after 6 months of HTM, which were attributed to sustained self-care behaviour and medication adherence.

Background: There is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services.

Methods: We searched Medline, Embase and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson's disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated.

Results: Nine randomized controlled trials were included; eight evaluated video and one evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI -0.4 to 0.6, p = 0.70). For people with Parkinson's disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI -1.2 to 2.5, p = 0.49). Four trials investigated interventions for speech sound disorder, voice disorder and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery.

Conclusions: Evidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson's disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction and economic outcomes.

Introduction: Ukraine's health and trauma system has been detrimentally impacted since the start of the Russian invasion in February 2022. Use of telemedicine became critical to providing timely medical care. As such, the aim of this study was to describe telemedicine's use in the health and trauma system of Ukraine following the full-scale invasion.

Methods: We conducted qualitative key informant interviews with military and civilian health care workers using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on telemedicine use. Thematic content analysis was used to derive key telemedicine themes from interviews.

Results: We conducted 36 key informant interviews. Most respondents described using telemedicine through informal means of communication such as messaging apps to meet patient care needs. Concerns and challenges with use of telemedicine included weapons targeting, internet connections and safety of communications from Russian hackers. A unified system for telemedicine would greatly improve use in country both during and post conflict.

Discussion: Telemedicine use has rapidly increased in Ukraine during the current conflict particularly in the scope of providing trauma care when numerous specialties are needed. Development of a unified, secure telemedicine system with mechanisms for integrating multinational medical support would aid in providing swift medical care to persons injured in the conflict or unable to access a specialty provider in their proximity.

Background: The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions.

Methods: Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated.

Results: Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty.

Discussion: Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0-0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

Background and objective: Obesity and its associated health challenges represent a pressing global concern. Telemedicine interventions offer a promising solution for effective weight loss support. This study examines the impact of telemedicine interventions on weight loss support.

Methods: We conducted a search of PubMed, Scopus, and Web of Science, starting from their inception. Both researchers systematically selected articles and extracted data using a designated data collection form. To assess the risk of bias in the included studies, we employed the Mixed Methods Appraisal Tool. Publication bias was evaluated through funnel plots and Egger's and Begg's tests. Utilizing the gathered data, we computed the standardized mean differences (Hedges's g) between the treatment and control groups. We estimated heterogeneity variance using the Q test and I² statistic. The analysis was carried out using Stata 17.0.

Results: Out of a total of 2626 retrieved articles, 30 studies were included in the analysis. Telemedicine interventions can cause weight loss in people (Hedges's g = 0.09, 95% CI: -0.13, 0.39; p-value < 0.001). The type of telemedicine intervention and target population were a significant moderator of the heterogeneity between studies (p < 0.05).

Conclusion: This study highlights the potential of telemedicine interventions as valuable tools in weight loss programs. Embracing these technologies can enhance the effectiveness of weight management strategies for diverse populations.

Background: While telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations.

Methods: We included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities.

Results: Our cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5-14.9; p < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4-1.0; p < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6-1.3; p < 0.001) per 100 index encounters compared to in-person visits.

Conclusions: Contrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.

Introduction: Telemedicine has been shown to be a safe and effective modality to assess and treat patients with acute stroke who present to a community hospital. There are no previous reports on using telemedicine to treat patients with acute stroke who present to a comprehensive stroke center. We report here the outcomes of patients with acute stroke treated in 2021 at our comprehensive stroke center using telemedicine versus an in-person assessment.

Methods: Patients with acute ischemic stroke who were treated after either a telemedicine or in-person assessment at our hospital in 2021 were identified by a retrospective chart review. The primary outcomes collected were door-to-needle (DTN) time for alteplase (tPA) administration, door-to-puncture (DTP) time for endovascular thrombectomy, symptomatic intracranial hemorrhage (sICH) rates and 3-month mortality.

Results: There were 302 patients with acute stroke treated at our hospital in 2021. Of these, 18.2% (n = 55/302) were treated using telemedicine. There were no differences in any of the outcomes between patients treated using telemedicine versus an in-person assessment: DTN (35.5 min (n = 42) vs 33 min (n = 182), p < 0.76), DTP (86.5 min (n = 30) vs 85 min (n = 134), p < 0.97), sICH (0% (n = 0/55) vs 1.6% (n = 4/245, p < 0.59) or 3-month mortality (20.6% (n = 7/34) vs 22.1% (n = 40/181), p < 0.29).

Discussion: To the best of our knowledge, this is the first study to report on outcomes for acute stroke patients treated using telemedicine at a comprehensive stroke center. In this study, there were no differences in outcomes between patients treated using telemedicine versus an in-person assessment.

Background: Telehealth services were used by healthcare centers during the COVID-19 pandemic in order to identify and manage patients at the forefront of the healthcare system. As one of these technologies, tele-triage refers to the assessment of a patient's health status through telephone or another means of communication and recommending treatment or providing appropriate referrals in emergency rooms and primary care offices. This study aimed to perform a systematic review of the evidence on the effectiveness of tele-triage, as one of these technologies, during the COVID-19 pandemic.

Methods: Medline (via PubMed), Scopus, and Web of Science databases were searched for relevant English articles published since the pandemic's onset until December 30, 2021. Studies investigating the tele-triage's effect on patient safety, clinical outcomes, and patient satisfaction were included. Data on study characteristics, intervention characteristics, and their effects on study outcomes were extracted separately by two authors. A narrative synthesis of the included studies was ultimately performed.

Results: Out of the 6312 retrieved studies, 14 met the inclusion criteria. The tele-triage intervention was offered by an algorithm-based system in eight studies (57.14%) and by healthcare providers in six other studies (42.86%) to determine the patient's level of care. According to the results, tele-triage interventions during COVID-19 can reduce unnecessary emergency room visits (by 1.2-22.2%), improve clinical outcomes after intervention (such as would closure in diabetic feet), reduce mortality and injuries, and ensure patient satisfaction with tele-triage (53-98%).

Conclusions: This study found that tele-triage interventions reduced unnecessary visits, improved clinical outcomes, reduced mortality, and injuries, increased patient satisfaction, reduced healthcare provider workload, improved access to primary care consultation, and increased patient safety and satisfaction. Therefore, tele-triage systems are not only suitable for providing acute and emergency care remotely but they are also recommended as an alternative tool to monitor and diagnose COVID-19.

Introduction: Despite proven benefits, patients with coronary heart disease (CHD) typically fail to participate in sufficient physical activity (PA). Effective interventions should be implemented to help patients maintain a healthy lifestyle and modify their present behavior. Gamification is the use of game design features (such as points, leaderboards, and progress bars) to improve motivation and engagement. It shows the potential for encouraging patients to engage in PA. However, empirical evidence on the efficacy of such interventions among patients with CHD is still emerging.

Purpose: The aim of the study is to explore whether a smartphone-based gamification intervention could increase PA participation and other physical and psychological outcomes in CHD patients.

Methods: Participants with CHD were randomly assigned to three groups (control group, individual group, and team group). The individual and team groups received gamified behavior intervention based on behavioral economics. The team group combined gamified intervention with social interaction. The intervention lasted for 12 weeks, and the follow-up was12 weeks. The primary outcomes included the change in daily steps and the proportion of patient days that step goals were achieved. The secondary outcomes included competence, autonomy, relatedness, and autonomous motivation.

Results: For the individual group, smartphone-based gamification intervention significantly increased PA among CHD patients over the 12-week period (step count difference 988; 95% CI 259-1717; p < 0.01) and had a good maintenance effect during the follow-up period (step count difference 819; 95% CI 24-1613; p < 0.01). There are also significant differences in competence, autonomous motivation, body mass index (BMI), and waist circumference in 12 weeks between the control group and individual group. For the team group, gamification intervention with collaboration didn't result in significant increases in PA. But patients in this group had a significant increase in competence, relatedness, and autonomous motivation.

Conclusion: A smartphone-based gamification intervention was proven to be an effective way to increase motivation and PA engagement, with a substantial maintenance impact (Chinese Clinical Trial Registry Identifier: ChiCTR2100044879).