Telemedicine and e-Health最新文献

Introduction: Infertility and assisted reproduction treatment (ART) are frequently accompanied by the experience of emotional disorders. Psychological interventions are available for infertile populations, but the barriers of current face-to-face models of care difficult their dissemination. This systematic review (PROSPERO: CRD4202340179) aims to summarize how technologies are used in telemedicine psychological programs to manage emotional disorders in women undergoing fertility treatments. Methods: Searches were conducted in December 2023 in six different databases. Two independent researchers conducted the searches, extracted the information, and assessed the quality of the studies (NHLBI tool). Results: Nineteen studies including 2,520 participants met eligibility criteria. Interventions were provided mostly to women who were undergoing in vitro fertilization/intracytoplasmic sperm injection (n = 11). Emotional disorders most frequently addressed were anxiety and depression (n = 11). The majority of the psychological programs were based on cognitive-behavioral therapy (n = 6), emotional writing (n = 3), acceptance and commitment therapy (n = 3), or positive reappraisal (n = 3). Many interventions were based on the use of internet (n = 5), diaries (n = 3), self-administered manuals (n = 2), short message service (n = 1), or face-to-face sessions (n = 5) supported by the inclusion of phone calls, emails, or audios. There is a lack of preventive interventions (n = 1). Conclusions: To the best of our knowledge, this is the first systematic review that explores the use of all kinds of technologies to provide psychological interventions to manage emotional disorders during ART. Results derived from this work may guide the development of future telemedicine services to provide psychological interventions.

Background: The COVID-19 pandemic exposed significant frailties of the U.S. healthcare system, especially inequities facing rural areas during surges when critical access and small community hospitals could not transfer patients to referral centers that were already overcapacity. Many clinicians suffered moral injury from managing these patients beyond their scope of practice or from the need to triage care. Methods: The National Emergency Tele-Critical Care Network (NETCCN) sought to provide a lifeline of free, ad hoc consultation to clinicians who needed help - a critical care "911" system - by using mobile devices and easy-to-use applications designed to help clinicians rapidly communicate with experts. Results: NETCCN provided 1,863 days of coverage to 60 hospitals in 17 states and U.S. territories at a fraction of the cost of boots-on-the ground emergency support. Conclusions: We review our experience delivering this support and provide recommendations to guide future development and integration of telemedicine programs into the National Disaster Medical System.

Objectives: Telemedicine use increased substantially with the COVID-19 pandemic. Understanding of the impact of telemedicine modality (video vs. phone) on post-telemedicine acute care for higher risk conditions is limited. Methods: We conducted a retrospective study of telemedicine visits, comparing video with telephone, for selected diagnoses with potentially higher illness acuity, evaluating post-telemedicine emergency department (ED) and hospitalization rates. In a large, multicenter cohort of adult patient-initiated primary care telemedicine visits from March 1, 2020, to July 31, 2021, we evaluated 7-day ED and hospitalization rates for higher acuity diagnostic categories (cardiac, gastrointestinal, and respiratory) by telemedicine modality, provider familiarity, and patient sociodemographic and clinical characteristics. Results: Among 431,705 telemedicine encounters, 128,129 (29.7%) were video visits and 303,576 (70.3%) were telephone visits. Adjusting for patient and appointment factors, telephone encounters for cardiac conditions were associated with significantly higher 7-day ED visit rates than video encounters (5.5% vs. 4.9%, respectively) but similar hospitalization rates (0.7% vs. 0.8%, respectively); for gastrointestinal conditions, post-telemedicine adjusted ED and hospitalization rates were comparable between telemedicine modalities (4.0% for ED and 1.2% vs. 1.3% for hospitalization, respectively); among respiratory conditions, video encounters were associated with higher ED and hospitalization rates than telephone encounters (ED: 5.9% after video vs. 5.2% after phone; hospitalization: 1.9% after video vs. 1.5% after phone). Telemedicine encounters with patients' own primary care provider (PCP) were associated with lower adjusted rates of ED use across all conditions and modalities. Conclusions: Short-term ED and hospitalization rates following primary care video or telephone visits for selected acute, high-risk conditions varied by condition and PCP familiarity. Nuanced use of video visits may confer benefits triaging to downstream acute care.

Introduction: Interprofessional electronic consultations (eConsults) can reduce health care utilization and improve access to specialty care. However, health care utilization and access impacts of eConsults for headache disorders remain incompletely characterized. Methods: We conducted a retrospective, 1:3-matched cohort study comparing patients referred for in-person headache evaluations to patients who had a headache-related eConsult. The cohorts were propensity score-matched by age, sex, race, preferred language, provider specialty, insurance status, and medical comorbidities. Our primary outcome was the presence of one or more headache-related ambulatory encounters in the 12 months following the index referral date. We used univariable and conditional logistic regression models to ascertain the associations between referral type and outcome. Results: We identified 74 and 222 patients with eConsult and in-person referrals, respectively. Over the follow-up period, the proportion of patients with the primary outcome was significantly greater in the eConsult cohort than the in-person cohort (46.0% vs. 43.2%, p < 0.0001). A greater proportion of the in-person cohort had one or more ambulatory headache encounters in the 12 months preceding their referral than the eConsult cohort (10.8% vs. 5.4%, p < 0.0001). In the adjusted analysis, eConsult usage was not associated with significantly increased odds of the primary outcome (adjusted odds ratio [aOR] 1.1, 95% confidence interval [CI] 0.6-2.0, p = 0.71), although patients with one or more ambulatory neurology encounters in the preceding 12 months had significantly increased odds of the primary outcome (aOR 3.1, 95% CI 1.2-7.9, p = 0.015). Conclusion: Compared to in-person referrals, eConsult use for headache was not associated with significantly increased odds of having subsequent ambulatory headache-related encounters.

Background: Telemedicine has emerged as a promising solution to address the challenges of providing continuous care to breast cancer patients, particularly in remote areas. This study aims to assess the acceptability of using telemedicine for breast cancer follow-up. Methods: A cross-sectional study utilizing a self-administered survey was conducted from January to March 2024 among 450 breast cancer patients at the Universiti Malaya Medical Center, Malaysia. Partial least-squares structural equation modeling was used to identify factors such as demographics, patients' characteristics, experience with telemedicine, attitudes, and concern of telemedicine use influencing willingness to use telemedicine for breast cancer follow-up. Results: Of the total 450 complete responses received, nearly half (49.3%) reported being somewhat likely to seek telemedicine for breast cancer follow-up, while only 11.1% reported being very likely. Comfort with telemedicine emerged as the strongest predictor of willingness to use it (β = 0.757, p < 0.001). A higher level of concern significantly negatively impacted willingness (β = -0.138, p < 0.001). However, attitudes toward telemedicine (β = 0.059, p = 0.144) were not significantly associated with its use. Among demographic factors, only age (β = 0.074, p = 0.018) was significantly positively associated with the willingness to use telemedicine, while education levels were found to have a significant inverse association (β = -0.076, p = 0.034). Conclusions: Improving comfort with telemedicine and addressing various concerns about its use for breast cancer follow-up through educational programs and support services are essential. Tailoring communication and support for different age groups and education levels can also enhance acceptance and utilization.

Background: The use of e-health interventions to promote physical activity (PA) among older adults has significantly increased in recent years. This review aims to comprehensively summarize the various e-health modalities and strategies used to encourage PA in aging adults. Methods: A systematic search of Medline, Embase, CINAHL, AMED, and PubMed databases was conducted to identify studies on e-health interventions targeting PA promotion in individuals aged 50 and older, published between 2012 and 2023. Information pertaining to study characteristics and e-health intervention specificities was extracted using a standardized data collection form. A narrative synthesis approach was employed to synthesize the data collected from the included studies. Results: Of 4,915 studies initially retrieved, 81 met the eligibility criteria. The findings reveal a diverse array of methods and interaction modes utilized to stimulate PA in aging adults, regardless of their medical conditions. Asynchronous methods such as web-based programs, mobile apps, and activity monitors were used in 71.6% of the studies and were most frequently employed for initiating behavior change components. Synchronous interaction modes mainly included videoconferencing and were predominantly featured in studies where real-time supervision and demonstration of exercises were integral to PA programs. There was a lack of information to guide the selection of the most effective e-health intervention format for motivating older adults to engage in regular exercise. Conclusion: This review underscores the versatility of e-health interventions, showcasing a wide spectrum of methods and interaction modalities. Future studies should compare these different modalities and methods while also identifying their barriers and facilitators. This will help in selecting the most suitable interventions for older adults.

Background: Despite positive perceptions of telemedicine, there's a recognized need for stronger evidence on its safety and effectiveness. This study aims to evaluate telemedicine's current status in diagnosing and treating peripheral vestibular symptoms. Methods: Systematic searches across multiple databases assessed methodological quality using Physiotherapy Evidence Database scale and Revised Cochrane Risk of Bias tool for randomized trials 2.0. Results: Findings reveal significant improvements in vertigo-related disability with virtual vestibular rehabilitation (mean difference [MD] = -12.6; 95% confidence interval [CI] = -23.61, -1.59; p < 0.01; I² = 76%) albeit with high heterogeneity. However, pooled analysis on vertigo severity across three studies did not show a significant effect (MD = -0.41; 95% CI = -0.64, -0.17; p < 0.78; I² = 0%). Conclusions: Evidence suggests telemedicine holds promise in diagnosing and managing peripheral vestibular disorders, potentially alleviating symptoms and improving disability. Nonetheless, caution is warranted due to review limitations, emphasizing the need for further research to optimize telemedicine's benefits for patients experiencing vestibular symptoms.

Purpose: Current literature broadly demonstrates the effectiveness and feasibility of telepractice services for people with aphasia. However, the examination of telepractice assessments for people with aphasia is limited. The purpose of this systematic review was to examine the current use of telepractice assessment protocols for people with aphasia. Specifically, the review sought to: (a) identify the assessments utilized in the aphasia telepractice literature; (b) appraise critically the quality of such investigations; and (c) evaluate critically the psychometric properties of the standardized tests used. Methods: A review of the literature published in English since 2000 was conducted in January 2023 by searching MEDLINE, EMBASE, PsychInfo, CINAHL, and Scopus databases. A total of 2,429 articles were screened. Two reviewers assessed records independently finding 11 articles eligible for inclusion. Data extraction was conducted once and validated by a second reviewer. Quality appraisal was carried out for the included studies as well as for the standardized testing measures used in these studies. Results: There was a lack of variation among the telepractice assessment protocols and aphasia tests used across all the included studies. That is, there was limited investigation of screening tests, discourse analysis, extralinguistic cognitive measures, and the use of patient-reported measures. Study characteristics lacked high-quality and free-of-bias examinations. Most standardized tests that were utilized exhibited poor validity and reliability properties. Conclusions: Overall, the current systematic review pointed to the need to investigate a wider range of aphasia assessment protocols that can be offered via telepractice. Moreover, more robust research designs are necessary to examine the variety of assessment tests and/or procedures that are available for in-person aphasia assessment services. Finally, given that many tests used in the included studies had psychometric property issues, the current review raised concerns regarding the use of these tests in research and clinical practices.