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The Laryngoscope Apr 2021Review the published literature of telemedicine's use within otorhinolaryngology (ORL), highlight its successful implementation, and document areas with need of future... (Review)
Review
OBJECTIVE/HYPOTHESIS
Review the published literature of telemedicine's use within otorhinolaryngology (ORL), highlight its successful implementation, and document areas with need of future research.
STUDY DESIGN
State of the Art Review.
METHODS
Three independent, comprehensive searches for articles published on the subject of telemedicine in ORL were conducted of literature available from January 2000 to April 2020. Search terms were designed to identify studies which examined telemedicine use within ORL. Consensus among authors was used to include all relevant articles.
RESULTS
While several, small reports document clinical outcomes, patient satisfaction, and the cost of telemedicine, much of the literature on telemedicine in ORL is comprised of preliminary, proof-of-concept reports. Further research will be necessary to establish its strengths and limitations.
CONCLUSIONS
Particularly during the coronavirus disease of 2019 pandemic, telemedicine can, and should, be used within ORL practice. This review can assist in guiding providers in implementing telemedicine that has been demonstrated to be successful, and direct future research. Laryngoscope, 131:744-759, 2021.
Topics: COVID-19; Humans; Otolaryngology; Telemedicine
PubMed: 32942340
DOI: 10.1002/lary.29131 -
Schizophrenia Bulletin Mar 2019The rapid rise and now widespread distribution of handheld and wearable devices, such as smartphones, fitness trackers, or smartwatches, has opened a new universe of... (Review)
Review
The rapid rise and now widespread distribution of handheld and wearable devices, such as smartphones, fitness trackers, or smartwatches, has opened a new universe of possibilities for monitoring emotion and cognition in everyday-life context, and for applying experience- and context-specific interventions in psychosis. These devices are equipped with multiple sensors, recording channels, and app-based opportunities for assessment using experience sampling methodology (ESM), which enables to collect vast amounts of temporally highly resolved and ecologically valid personal data from various domains in daily life. In psychosis, this allows to elucidate intermediate and clinical phenotypes, psychological processes and mechanisms, and their interplay with socioenvironmental factors, as well as to evaluate the effects of treatments for psychosis on important clinical and social outcomes. Although these data offer immense opportunities, they also pose tremendous challenges for data analysis. These challenges include the sheer amount of time series data generated and the many different data modalities and their specific properties and sampling rates. After a brief review of studies and approaches to ESM and ecological momentary interventions in psychosis, we will discuss recurrent neural networks (RNNs) as a powerful statistical machine learning approach for time series analysis and prediction in this context. RNNs can be trained on multiple data modalities simultaneously to learn a dynamical model that could be used to forecast individual trajectories and schedule online feedback and intervention accordingly. Future research using this approach is likely going to offer new avenues to further our understanding and treatments of psychosis.
Topics: Ecological Momentary Assessment; Humans; Machine Learning; Neural Networks, Computer; Psychotic Disorders; Telemedicine
PubMed: 30496527
DOI: 10.1093/schbul/sby171 -
PloS One 2021The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.
Topics: Data Management; Humans; Telemedicine
PubMed: 34048494
DOI: 10.1371/journal.pone.0252409 -
Journal of the American Board of Family... 2022Telemedicine has been implemented in many health systems by necessity, yet evidence is sparse about its appropriate use for the delivery of primary care. We sought to...
INTRODUCTION
Telemedicine has been implemented in many health systems by necessity, yet evidence is sparse about its appropriate use for the delivery of primary care. We sought to understand what clinicians and patients consider to be appropriate use of telemedicine in primary care to inform future development of a framework that should be valuable to diverse stakeholders.
METHODS
We conducted in-depth, structured interviews of patients, clinicians who deliver primary care, and other select informants. They were asked to discuss optimal, acceptable, and suboptimal uses of telemedicine for delivering care relative to in-person care delivery. Audio was transcribed and paired reviewers analyzed the content to identify the key concepts that motivated the informants. The reviewers did thematic analysis to organize the concepts into unifying themes.
RESULTS
Our 18 key informants generated 103 unique concepts. The unique concepts aggregated into themes suggesting the clinical situations in which telemedicine is appropriately used in primary care and clinical situations in which it should be avoided. We also learned of motivators toward expanded, or at least continued, use of telemedicine and motivators away from telemedicine's continued use. The informants expressed their expectations regarding decision making about telemedicine use and who should make these decisions.
DISCUSSION
These key concepts and themes are expected to be a valuable starting point for the development of a framework to inform appropriate use of telemedicine in primary care.
Topics: Delivery of Health Care; Humans; Primary Health Care; Telemedicine
PubMed: 35641038
DOI: 10.3122/jabfm.2022.03.210229 -
Diabetes & Metabolic Syndrome 2020With restrictions on face to face clinical consultations in the COVID-19 pandemic, Telemedicine has become an essential tool in providing continuity of care to patients.... (Review)
Review
BACKGROUND AND AIMS
With restrictions on face to face clinical consultations in the COVID-19 pandemic, Telemedicine has become an essential tool in providing continuity of care to patients. We explore the common pitfalls in remote consultations and strategies that can be adopted to avoid them.
METHODS
We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 including 'COVID-19', 'telemedicine' and 'remote consultations'.
RESULTS
Telemedicine has become an integral part to support patient's clinical care in the current COVID-19 pandemic now and will be in the future for both primary and secondary care. Common pitfalls can be identified and steps can be taken to prevent them.
CONCLUSION
Telemedicine it is going to play a key role in future of health medicine, however, telemedicine technology should be applied in appropriate settings and situations. Suitable training, enhanced documentations, communication and observing information governance guidelines will go a long way in avoiding pitfalls associated with remote consultations.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Health Services Needs and Demand; Humans; Pandemics; Patient Acceptance of Health Care; Pneumonia, Viral; Quarantine; Referral and Consultation; SARS-CoV-2; Telemedicine
PubMed: 32534432
DOI: 10.1016/j.dsx.2020.06.007 -
PloS One 2023In March 2020, the Botswana Ministry of Health and Wellness approved a National eHealth Strategy. Although a milestone, the strategy does not mention telemedicine. There...
INTRODUCTION
In March 2020, the Botswana Ministry of Health and Wellness approved a National eHealth Strategy. Although a milestone, the strategy does not mention telemedicine. There is need to address this by developing an evidence-based adjunct strategy for telemedicine to facilitate its introduction and adoption. To do so, several stages of a published eHealth Strategy Development Framework were mimicked. This allowed situational awareness to be created through exploring behavioural factors and perceptions that might influence the adoption of telemedicine in Botswana. The study aim was to explore current issues, concerns, perceptions, attitudes, views, and knowledge of patients and healthcare professionals regarding health-related issues and telemedicine that might influence implementation of telemedicine in Botswana and thereby inform future development of a telemedicine strategy.
METHODS
An exploratory survey study was conducted using different survey questionnaires for patients and healthcare professionals, each using a mix of open- and closed-ended questions. These questionnaires were administered to convenience samples of healthcare professionals and patients at 12 public healthcare facilities in Botswana; seven clinics (three rural; four urban), and five hospitals (two primary, two district, and one tertiary), selected to align with the country's decentralised healthcare structure.
RESULTS
Fifty-three healthcare professionals and 89 patients participated. Few healthcare professionals had actively used telemedicine for clinical consults and self-education using telephone calls, cell phone apps, or video conferencing (doctors 42%, nurses 10%). Only a few health facilities had telemedicine installations. Healthcare professional preference for future telemedicine uses were e-learning (98%), clinical services (92%), and health informatics (electronic records (87%). All healthcare professionals (100%) and most patients (94%) were willing to use and participate in telemedicine programmes. Open-ended responses showed additional perspective. Resource shortages (health human resources and infrastructure) were key to both groups. Convenience, cost effectiveness, and increased remote patient access to specialists were identified as enablers to telemedicine use. However inhibitors were cultural and traditional beliefs, although privacy, security and confidentiality were also identified. Results were consistent with findings from other developing countries.
CONCLUSION
Although use, knowledge, and awareness of telemedicine are low, general acceptance, willingness to use, and understanding of benefits are high. These findings bode well for development of a telemedicine-specific strategy for Botswana, complementary to the National eHealth Strategy, to guide more systematic adoption and application of telemedicine in the future.
Topics: Humans; Botswana; Telemedicine; Delivery of Health Care; Health Personnel; Health Facilities
PubMed: 36795740
DOI: 10.1371/journal.pone.0281754 -
Journal of General Internal Medicine Dec 2019
Topics: Humans; Patient Acceptance of Health Care; Primary Health Care; Telemedicine
PubMed: 31342331
DOI: 10.1007/s11606-019-05201-5 -
World Journal of Gastroenterology Aug 2019Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that... (Review)
Review
Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.
Topics: Cell Phone; Computers, Handheld; Gastroenterology; Health Plan Implementation; Humans; Liver Cirrhosis; Mobile Applications; Patient Reported Outcome Measures; Professional Practice Gaps; Quality Improvement; Telemedicine
PubMed: 31413523
DOI: 10.3748/wjg.v25.i29.3849 -
Telemedicine Journal and E-health : the... May 2015The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and... (Review)
Review
OBJECTIVE
The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications.
MATERIALS AND METHODS
A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.)
RESULTS
Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicine's potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated.
CONCLUSIONS
Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.
Topics: Diabetes Mellitus; Disease Management; Empirical Research; Evidence-Based Medicine; Female; Humans; Male; Telemedicine; United States
PubMed: 25806910
DOI: 10.1089/tmj.2015.0029 -
Canadian Journal of Rural Medicine :... 2020
Topics: Canada; Humans; Rural Health Services; Telemedicine
PubMed: 32611870
DOI: 10.4103/CJRM.CJRM_33_20