Telemedicine reports最新文献

Background: The growing crisis of musculoskeletal (MSK) disease is overwhelming health care systems and straining payors worldwide. Current telemedicine programs that focus solely on exercise therapy are not structured to deliver comprehensive care. In contrast, physician-led integrated practice units (IPUs)-multidisciplinary medical teams designed around patient-centered, holistic care-offer an innovative path forward.

Methods: We analyzed the clinical outcomes of 2,851 patients treated in our digital MSK IPU.

Results: Pain (scale, 0-10) improved in 75.2% of all patients from 4.7 to 2.6 and in 84.2% in those with severe pain (≥7) from 7.7 to 4.1. Functional status (Single assessment numeric evaluation [SANE] scale, 0-100) in 2,018 patients, significantly improved in 68.9% from 54.6 to 73.7. Even more compelling, in 274 patients with severe functional compromise (SANE ≤20), scores improved 599.0% from 7.9 to 55.1.

Conclusion: Our results underscore the power of a telemedicine-based IPU to deliver significant reductions in pain and dramatic functional gains, even for patients starting with severe limitations. As the demand for MSK care continues to surge, a digital MSK IPU is a promising model to support both access to care and quality clinical outcomes.

Background: Despite the growing global shift toward digital health solutions, the adoption of telehealth technologies in Bangladesh remains a concerning issue. Psychological factors such as lack of digital literacy, trust, and familiarity may significantly hinder the uptake of telehealth, particularly in developing countries where digital integration in health care is still evolving.

Objective: This study aims to identify and evaluate the psychological barriers-specifically lack of familiarity (LOR), lack of digital literacy (LDL), and lack of trust (LT)-that influence user resistance (UR) to adopting telehealth technologies in Bangladesh. Furthermore, women among different age groups have been used as an independent construct to explore how age influences the resistance to adopting telemedicine technology.

Methods: One hundred and fifty respondents were administered a structured questionnaire based on a Likert scale. Constructs were measured using items validated through factor analysis. Reliability was confirmed via Cronbach's alpha. Multiple regression analysis was conducted to test the hypothesized relationships between psychological factors (LOR, LDL, LT) and UR.

Results: The model explained 47.6% of the variance in UR (R ² = 0.476, p < 0.001). Both LDL (β = 0.359, p < 0.001) and LT (β = 0.410, p < 0.001) were found to be significant predictors of resistance. However, LOR (β = 0.078, p = 0.201) did not significantly influence UR. All constructs demonstrated strong internal consistency (Cronbach's α > 0.76). The Kruskal-Wallis test indicated that age significantly affects women's resistance to adopting telemedicine. Subsequent pairwise comparisons among age groups revealed that older women exhibit higher levels of resistance compared with their younger counterparts.

Conclusion: The findings suggest that enhancing digital skills and building trust are critical to reducing resistance and promoting the adoption of telehealth in Bangladesh. While unfamiliarity alone does not deter adoption, it becomes a barrier when compounded by low digital literacy and trust concerns. Targeted interventions such as digital literacy training and transparent communication about data security could facilitate greater acceptance and integration of telehealth technologies in the country.

Background: Few studies have assessed the potential of telemedicine to improve end-of-life care quality in rural and remote areas. We investigated health care services needed for end-of-life care at home and examined their associations with willingness to die at home, testing the hypothesis that telemedicine facilitates at-home death in rural and remote settings.

Methods: A cross-sectional survey was conducted with a target population of 6,382 residents aged ≥20 years living in designated rural and remote areas of Shunan City, Yamaguchi, Japan. Stratified random sampling was employed to select survey participants, resulting in 3,767 individuals who were mailed self-administered questionnaires. First, we assessed health care services needed for end-of-life care at home (telemedicine, home doctor visits, home nursing care, home personal care services, home support services, and senior day care). Multivariable logistic regression analysis was then performed to determine which services were independently associated with willingness to die at home.

Results: Of 3,767 eligible participants, 1,884 (50.0%) responded, and 1,451 were included in the analysis. Among them, 608 (41.9%) were male, 1,166 (80.3%) were aged ≥60 years, and 733 (50.5%) expressed a wish to die at home. Home doctor visits were the most frequently selected service (776 participants [53.5%]), while telemedicine was selected by 193 (13.3%). After adjustment for all measured variables, telemedicine (adjusted odds ratio, 1.41 [95% confidence interval, 1.01-1.98], p = 0.045) and home doctor visits (adjusted odds ratio [OR], 1.50 [95% confidence interval, 1.19-1.90], p < 0.001) were independently associated with willingness to die at home.

Discussion: These findings suggest that physician-provided services are central to enabling at-home death. Integrating telemedicine with traditional home doctor visits may improve end-of-life care and facilitate at-home death in rural and remote settings.

Background: The COVID-19 pandemic brought profound changes to health care systems worldwide. This study examines the adaptive responses of a sleep medicine practice that successfully pivoted to telemedicine, remote diagnostics, and agile operations, resulting in sustained growth and improved patient accessibility.

Methods: We analyzed organizational and cultural elements enabling responsiveness, including telemedicine infrastructure, adaptive leadership, quality-focused processes, and effective communication. Objective outcomes were assessed by analyzing patient demographics, telemedicine visits, and sleep testing patterns during three phases: pre-pandemic (June 1, 2018 to March 8, 2020), acute COVID-19 (March 9, 2020 to April 19, 2020), and post-acute COVID-19 (April 20, 2020 to December 31, 2021).

Results: Across 105,199 encounters, monthly sleep medicine visits and testing declined ∼50% during acute COVID-19, but rebounded to surpass baseline in the post-acute phase. Virtual visits increased significantly, replacing many face-to-face encounters. Home sleep apnea test use rose sharply, driven by disposable WatchPAT tests, while polysomnography use decreased. Testing volumes increased overall post-acute compared with pre-pandemic. Patients served during acute and post-acute phases were younger, more often female, non-White, and postgraduate-educated (all p < 0.001). Nonlocal patients increased during the post-acute phase, reflecting telemedicine expansion.

Conclusions: Proactive telemedicine investments, adaptive leadership, quality-focused processes, and effective communication enabled this practice to adapt successfully during the pandemic. These resilience strategies provide a model for navigating future health care challenges, underscoring telemedicine and e-health's critical roles in maintaining care delivery during crises.

Background: Prematurity is one of newborns' leading causes of neurological damage. Although physical therapy reduces possible sequelae, there is insufficient scientific evidence on these treatments because they are delivered through telemedicine.

Objective: To compare how newborns treated with the Bobath approach (BA) and those under conventional treatment scored at the end of 6 months of monitoring neurological warning signs and overall movement quality during the COVID-19 pandemic, given that all treatments were delivered through telemedicine.

Materials and methods: This analytical study involved 20 patients managed with the BA and 20 patients undergoing conventional treatment (n = 20). Three examinations and two treatment blocks were performed. The telemedicine sessions carried out through the Zoom platform were mainly focused on the relative training of hands-off techniques. Male and female newborns at high neurological risk were included.

Results: Our findings show that both treatment arms delivered by telemedicine are effective (p = 0.6).

Conclusion: Studies with larger sample sizes are necessary to investigate the impact of telemedicine on the economy and travel time.

Background: Previous studies demonstrated the reliability and accuracy of teledermatology in outpatient settings. It is cost effective and can enhance accessibility to specialist care, leading to better patient outcomes. Few studies have investigated inpatient teledermatology, and local data are lacking. This study aimed to determine whether store-and-forward teledermatology is accurate and reliable for inpatient dermatology consultations in Asians.

Methods: During the study period from April to June 2022, consecutive inpatient dermatology consultations were collected at a tertiary referral center in Hong Kong. For each recruited patient, after assessment by an in-house dermatologist, another dermatologist who would practice store-and-forward teledermatology would assess the same patient separately. The primary outcome measured was the concordance of the preferred diagnoses. Factors affecting concordance were evaluated.

Results: A total of 190 Asian patients were recruited. The concordance between the teledermatologist and inpatient dermatologists was 80% for the preferred diagnosis, with a kappa coefficient of 0.75 (95% confidence interval (CI) 0.71-0.78). The concordance of differential diagnoses was 97.4%, with a kappa coefficient of 0.76 (95% CI 0.73-0.8). The diagnostic accuracy rates were 68.8% (53/77) for inpatient dermatologists and 59.7% (46/77) for the teledermatologist. Better quality of clinical photographs (p < 0.001) was associated with agreement on the preferred diagnosis.

Discussion: Inpatient teledermatology in real-world settings has been found to be reliable and accurate in Asians. Its utilization should be encouraged to enhance specialist accessibility and improve patient care.

The role of continuous glucose monitoring (CGM) in glycemic control among individuals without diabetes is not well understood. Specifically, the feedback generated may serve as a promising technology for obesity and lifestyle management among people without diabetes. In this case study, we used a CGM system to continuously measure sensor glucose levels in an adult female with BMI >30 without diabetes, capturing over 4,000 automated sensor recordings. The participant received real-time glucose readings via a smartphone app, which displayed values in a line graph. A shaded area indicated glucose levels exceeding the upper normoglycemic range, and an audio alert was triggered for high excursions (>140 mg/dL). We analyzed the percentage of daily time out of range (%TOR) across 16 days and evaluated whether standalone CGM feedback could reduce %TOR over the wear period. The participant reported checking the app multiple times per day every day. A notable reduction in average daily %TOR was observed, decreasing from 9.2% in the first sensor phase to 1.9% in the second. The median daily number of high-glucose excursions declined from 1.5 to 0.0. These findings suggest that standalone CGM offers feedback associated with glycemic control and can bring daily %TOR to under the recommended target of 5% in an individual with a metabolic risk but without diabetes. CGM may play a key role in obesity and lifestyle management by linking glucose tracking with behavior modification strategies, amplifying feedback necessary for contingency-shaped problem solving.

Background: Interstitial lung disease (ILD) is a heterogeneous group of lung parenchymal diseases. Idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP) are typical idiopathic interstitial pneumonias associated with significant morbidity, mortality, and reduced quality of life. Exercise training is effective for patients with various ILDs. Telerehabilitation is effective for chronic conditions and feasible in Finland via the Health Village website. We aimed to introduce the Health Village's telerehabilitation protocol for patients with IPF or NSIP.

Methods: We created a digital care pathway for patients with ILD on the Health Village website. It includes lectures, tasks, instructional videos, and guidance sessions conducted by five domain experts: a pulmonologist, physiotherapist, nutrition therapist, palliative care nurse, and social worker. We randomly selected 20 patients with ILD from Helsinki University Hospital to test the digital pathway. Each participant underwent telerehabilitation for approximately 6 months.

Results: Statistically significant changes were observed in variables evaluating exercise and functional capacity. The average improvement in the 6-min walking distance was 30 m (p = 0.004). The 1-min sit-to-stand test showed an average increase of five repetitions (p < 0.001). No statistically significant differences were found in the other measures of functional capacity or quality of life. The feedback highlighted satisfaction with the telerehabilitation.

Conclusions: Telerehabilitation through the Health Village pathway improved exercise and functional capacity in ILD patients, indicating its feasibility as an alternative to conventional rehabilitation. With notable physical performance improvements, telerehabilitation is a practical addition to conventional care and a viable alternative to in-person rehabilitation.

Introduction: Telemedicine, particularly remote monitoring, offers a promising approach to enhance health care. This study evaluated the impact of the Operations Center for Discharged Patients (COD19) telemonitoring service on COVID-19 patient mortality during the pandemic, exploring telemedicine's potential in managing severe health emergencies.

Patients and methods: A retrospective analysis was conducted on COVID-19 patients in home isolation, divided into telemonitoring and non-telemonitoring groups. All-cause mortality was the primary outcome. The COD19 provided active surveillance for the telemonitoring group.

Results: The study included 6,017 patients: 2,431 telemonitored and 3,586 non-telemonitored. Telemonitored patients were older and had more comorbidities, including cardiovascular and metabolic diseases, and a higher risk of hospitalization. Critically, mortality was significantly lower in the telemonitored group (1.3% vs. 2.9%, p < 0.001). Multivariable analysis confirmed telemonitoring's significant reduction of death risk, while age, sex, and comorbidities increased it.

Conclusions: Proactive at-home telemonitoring correlates with reduced mortality in COVID-19 patients. The COVID-19 pandemic highlighted telemedicine's potential as a vital strategy for emergency health care readiness.

Background: Telemedicine offers patients and physicians the opportunity to advance health care delivery to active duty and retired military personnel. Assessing the efficacy and feasibility of performing post-surgery follow-up assessment through telemedicine at a large military hospital, while examining patient and provider experience and satisfaction with the telemedicine follow-up visit and estimating patients' willingness-to-use and willingness-to-pay for telemedicine consultations may help to shape the future use of telemedicine in the military settings.

Methods: We administered surveys to 96 unique patients who agreed to perform a follow-up telemedicine visit, rather than a traditional face-to-face visit, after undergoing a minor surgery at a large army military hospital in the southeast region of the United States. We also administered a survey to six physicians.

Results: Most of the patients strongly agreed (86.5%) or somewhat agreed (10.8%) that their medical problems were adequately addressed during the telemedicine visit. Most physicians were either satisfied (7.5%) or extremely satisfied (75.5%) with the overall experience. Less than half of the patients were willing to use a similar telemedicine visit for a fee in the future and only two patients were willing to pay $100 for such visit.

Conclusion: After minor surgery, follow-up telemedicine visits may be an effective, efficient, and convenient alternative to face-to-face visits for active duty and retired military personnel.