Telemedicine and e-Health最新文献

Background: Mobile health (mHealth) has an emerging potential for remote assessment of traumatic dental injuries (TDI) and support of emergency care. This study aimed to determine the diagnostic accuracy of TDI detection from smartphone-acquired photographs. Methods: The upper and lower anterior teeth of 153 individuals aged ≥ 6 years were photographed using a smartphone camera app. The photos of 148 eligible participants were reviewed independently by a dental specialist, two general dentists, and two dental therapists, using predetermined TDI classification and criteria. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and inter-rater reliability were estimated to evaluate the diagnostic performance of the photographic method relative to the reference standard established by the dental specialist. Results: Of the 1,870 teeth screened, one-third showed TDI; and one-seventh of the participants had primary or mixed dentitions. Compared between the specialist's reference standard and four dental professionals' reviews, the diagnostic sensitivity and specificity for TDI versus non-TDI were 59-95% and 47-93%, respectively, with better performance for urgent types of TDI (78-89% and 99-100%, separately). The diagnostic consistency was also better for the primary/mixed dentitions than the permanent dentition. Conclusion: This study suggested a valid mHealth practice for remote assessment of TDI. A better diagnostic performance in the detection of urgent types of TDI and examination of the primary/mixed dentition was also reported. Future directions include professional development activities involving dental photography and photographic assessment, incorporation of a machine learning technology to aid photographic reviews, and randomized controlled trials in multiple clinical settings.

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

Background: Augmented reality enables the wearer to see both their physical environment and virtual objects. Holograms could allow 3D video of providers to be transmitted to distant sites, allowing patients to interact with virtual providers as if they are in the same physical space. Our aim was to determine if Tele-Stroke augmented with Holo-Stroke, compared with Tele-Stroke alone, could improve satisfaction and perception of immersion for the patient. Methods: Kinect cameras positioned at 90-degree intervals around the hub practitioner were used. Cameras streamed real-time optical video to a unity point-cloud program where the data were stitched together in a 360-degree view. The resultant hologram was positioned in 3D space and was visible through the head-mounted display by the patient. Radiology images were shared in Tele-Stroke and via hologram. Likert satisfaction questions were administered. Wilcoxon signed-rank testing was used. Results: Each of the 30 neurology clinic participants scored both Tele-Stroke and Holo-Stroke. Out of these, 29 patients completed the assessments (1 failure owing to computer reboot). Average age was 52 years, with 53.3% of the patients being female, 70.0% being White, and 13.3% being Hispanic. Likert scale score median "Overall" was 32 Tele-Stroke versus 48 Holo-Stroke (p < 0.00001), "Immersion" was 5 versus 10 (p < 0.00001), "Beneficial Technique" was 6 versus 10 (p < 0.00001), and "Ability to See Images" was 5 versus 10 (p < 0.00001). Discussion: Holo-Stroke 3D holographic Tele-Stroke exams resulted in feasibility, satisfaction, and high perception of immersion for the patient. Patients were enthusiastic for the more immersive, personal discussion with their provider and a robust way to experience radiology images. Though further assessments are needed, Holo-Stroke can help the provider "be there, not just see there!"

Introduction: The outbreak of the novel coronavirus disease-19 posed significant challenges globally, impacting various sectors and health care systems profoundly. In response, telemedicine has emerged as a vital solution to address health care demands and resource shortages. However, there is a lack of comprehensive research on telemedicine usage among health care consumers in urban and rural areas of Taiwan. Methods: This study aimed to investigate the usage, attitudes, and intentions of telemedicine utilization among health care consumers in Taiwan, integrating the Technology Acceptance Model and Theory of Planned Behavior. A cross-sectional study was conducted from April 2023 to May 2024, involving 1,053 participants who utilized telemedicine services. Structured questionnaires were used for data collection, and statistical analyses were performed using SPSS 21.0 software. Results: The results revealed significant disparities in telemedicine utilization between urban and rural areas, with urban residents exhibiting higher levels of perceived ease of use, perceived usefulness, attitude toward use, trust, and intention to use telemedicine. Regression analysis indicated a significant association between urban residence and male gender with telemedicine utilization, contrary to previous research findings. These disparities may stem from differences in health care accessibility and cultural norms prevalent in urban and rural areas. Conclusions: Further investigation into gender differences and interventions to promote telemedicine usage among females, particularly in urban areas, are recommended. This study provides valuable insights for future research and health care policy formulation.

Background: Given the growing population of older adults globally, e-Health plays an indispensable role in the chronic disease management of multimorbidity. However, qualitative evidence that synthesizes the experiences of older adults with multimorbidity using e-Health service is currently lacking. The objective was to explore the experiences and perceptions of e-Health care in community-based settings among the older adults with multimorbidity. Methods: Seven electronic databases including PubMed, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, China National Knowledge Infrastructure, and Chinese BioMedical Literature were searched, and the search was limited to studies from inception to September 1, 2023. Screening, data extraction, and quality appraisal were conducted independently by two reviewers. Thomas and Harden's thematic synthesis methodology was applied to synthesize the original themes. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the confidence of synthesized themes was evaluated by the Confidence in the Evidence from Reviews of Qualitative Research approaches. Results: Ten studies with moderate methodological quality met eligibility criteria and were included finally. Studies were conducted in four countries with 235 participants who were living with multiple chronic conditions. Among the 10 included studies, 37 credible findings were extracted and interpreted into 3 synthesized themes and 12 subthemes: (1) advantages and benefits perceived during e-Health service, (2) multidimensional challenges and negative experience posed by e-Health service, and (3) preferences, suggestions, and expectations for future e-Health improvement. The confidence in the majority of the three final synthesized themes was rated between "low" and "moderate" scales. Conclusions: The findings of this study provide new insights into implementing tailored e-Health care for older adults with multimorbidity. Further research should emphasize on realizing the potential value of e-Health service based on users' needs and perspectives to promote age-friendliness in geriatric practice.

Objective: To determine patients' perspectives on home monitoring at emergency department (ED) presentation and shortly after admission and compare these with their physicians' perspectives. Methods: Forty Dutch hospitals participated in this prospective flash mob study. Adult patients with acute medical conditions, treated by internal medicine specialties, presenting at the ED or admitted at the admission ward within the previous 24 h were included. The primary outcome was the proportion of patients who were able and willing to undergo home monitoring. Secondary outcomes included identifying barriers to home monitoring, patient's prerequisites, and assessing the agreement between the perspectives of patients and treating physicians. Results: On February 2, 2023, in total 665 patients [median age 69 (interquartile range: 55-78) years; 95.5% community dwelling; 29.3% Modified Early Warning Score ≥3; 29.5% clinical frailty score ≥5] were included. In total, 19.6% of ED patients were admitted and 26% of ward patients preferred home monitoring as continuation of care. Guaranteed readmission (87.8%), ability to contact the hospital 24/7 (77.3%), and a family caregiver at home (55.7%) were the most often reported prerequisites. Barriers for home monitoring were feeling too severely ill (78.8%) and inability to receive the required treatment at home (64.4%). The agreement between patients and physicians was fair (Cohens kappa coefficient 0.26). Conclusions: A substantial proportion of acutely ill patients stated that they were willing and able to be monitored at home. Guaranteed readmission, availability of a treatment team (24/7), and a home support system are needed for successful implementation of home monitoring in acute care.

Background: The availability and utilization of telehealth services have been rapidly increasing in the past decade, which paved the way for ophthalmological care to be offered more easily and conveniently. However, the proficiency of telehealth in the context of ophthalmical care still requires further studies to prove its effectiveness. This study examined the proficiency of general practitioners in a telemedicine platform in identifying red flag symptoms, suggestive of retinal detachment, and devising optimal management strategies. Methods: Our cross-sectional study used chat-based consultations on Altibbi Telemedicine platform (2018-2023) to study ophthalmical patients presenting with "blurred vision" or "blindness." Those endorsing red flag symptoms were categorized as having "positive symptomatology" and those reporting none as having "negative symptomatology." Management plans were classified as referral or reassuring. Statistical analysis was performed using IBM's Statistical Package for Social Sciences to examine associations between symptomatology and other variables. p values below 0.05 were considered statistically significant. Results: Five hundred and fifty (n = 550) patients with a mean age 22.5 ± 13 years were included. Patients expressing positive symptomatology were more likely to be referred relative to those expressing negative symptomatology (81% vs. 61%, p < 0.001). No significant difference was found between genders and referral (p = 0.053) or age and referral (p = 0.231). Multivariate regression showed a significant correlation between positive symptoms and referral (adjusted odds ratio [aOR]: 2.0; 95% confidence interval [95% CI]: 1.3-3.3), none between gender (aOR: 1.5; 95% CI: 0.9-2.2) or age (aOR: 1.0; 95% CI: 0.9-1.1) and referral odds. Conclusion: The telemedicine platform studied is effective in referring cases with red flag symptoms to urgent care, regardless of age and gender.

Background: The rise of virtual healthcare underscores the transformative influence of digital technologies in reshaping the healthcare landscape. As technology advances and the global demand for accessible and convenient healthcare services escalates, the virtual healthcare sector is gaining unprecedented momentum. Saudi Arabia, with its ambitious Vision 2030 initiative, is actively embracing digital innovation in the healthcare sector. Methods: In this narrative review, we discussed the key drivers and prospects of virtual healthcare in Saudi Arabia, highlighting its potential to enhance healthcare accessibility, quality, and patient outcomes. We also summarized the role of the COVID-19 pandemic in the digital transformation of healthcare in the country. Healthcare services provided by Seha Virtual Hospital in Saudi Arabia, the world's largest and Middle East's first virtual hospital, were also described. Finally, we proposed a roadmap for the future development of virtual health in the country. Results and conclusions: The integration of virtual healthcare into the existing healthcare system can enhance patient experiences, improve outcomes, and contribute to the overall well-being of the population. However, careful planning, collaboration, and investment are essential to overcome the challenges and ensure the successful implementation and sustainability of virtual healthcare in the country.

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.