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International Journal of Circumpolar... Dec 2023In Antarctica, it is extremely difficult to organise medical evacuations in winter. Antarctic physicians are often alone and must be prepared to perform surgery and... (Review)
Review
In Antarctica, it is extremely difficult to organise medical evacuations in winter. Antarctic physicians are often alone and must be prepared to perform surgery and dentistry, even if they are not specialists. This scoping review summarises epidemiological data on the types of surgical procedures performed in Antarctica and identifies gaps in the literature in this area. We searched PubMed and Google Scholar, without language restriction, for papers published between 1 January 1904, and 1 February 2022. Of the 35 papers on 12 Antarctic programs, very few were retrospective observational epidemiological studies; the majority were medical reports. The search identified 41 surgical procedures or reasons for surgical consultation, 19 different reasons for medical evacuations, and 12 causes of death that may have required surgical management. The diagnostic classifications used and the prevalence of each reported surgical speciality were heterogeneous. The most cited specialities were orthopaedics, dentistry, and digestive surgery. Telemedicine was integrated into on-site care or medical evacuation decisions. The current literature is poor, and most studies do not apply to surgical issues. The heterogeneous data collection methodologies limit their interpretation. A standardised diagnostic classification and detailed and systematic epidemiological registers will help define the contours of surgical management in Antarctica.
Topics: Humans; Antarctic Regions; Retrospective Studies; Telemedicine; Environment; Seasons
PubMed: 37476913
DOI: 10.1080/22423982.2023.2235736 -
Yearbook of Medical Informatics Aug 2023In this synopsis, the editors of the Clinical Information Systems (CIS) section of the IMIA Yearbook of Medical Informatics overview recent research and propose a... (Review)
Review
OBJECTIVE
In this synopsis, the editors of the Clinical Information Systems (CIS) section of the IMIA Yearbook of Medical Informatics overview recent research and propose a selection of best papers published in 2022 in the CIS field.
METHODS
The editors follow a systematic approach to gather relevant articles and select the best papers for the section. This year, they updated the query to incorporate the topic of telemedicine and removed search terms related to geographic information systems. The revised query resulted in a larger number of identified papers, necessitating the appointment of a third section editor to handle the increased workload. The editors narrowed the initial pool of articles to 15 candidate papers through a multi-stage selection process. At least seven independent reviews were collected for each candidate paper, and a selection meeting with the IMIA Yearbook editorial board led to the final selection of the best papers for the CIS section.
RESULTS
The query was carried out in mid-January 2023 and retrieved a deduplicated result set of 5,206 articles from 1,500 journals. This year, 15 papers were nominated as candidates, and four were finally selected as the best papers in the CIS section.Including telemedicine in the query resulted in a substantial increase in the number of papers found. The analysis highlights the growing convergence between clinical information systems and telemedicine, with mobile health (mHealth) technologies and data science applications gaining prominence. The selected candidate papers emphasize the practical impact of research efforts, focusing on patient-centric outcomes and benefits, including intelligent mobile health monitoring systems and AI-assisted decision-making in healthcare.
CONCLUSIONS
Looking ahead, the field of CIS is expected to continue evolving, driven by advances in telemedicine, mHealth technologies, data science, and AI integration, leading to more efficient, patient-oriented, and intelligent healthcare systems and overall improvement of global healthcare outcomes.
Topics: Humans; Artificial Intelligence; Data Science; Information Systems; Medical Informatics; Power, Psychological; Telemedicine
PubMed: 38147856
DOI: 10.1055/s-0043-1768756 -
Journal of Medical Internet Research Dec 2023Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also brings a serious economic burden to society. However, it is difficult for patients with knee OA to access rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies for the improvement of knee OA, but the effect of different telerehabilitation strategies on knee OA is not clear.
OBJECTIVE
The aim of this systematic review and meta-analysis was to identify telerehabilitation strategies attributing to the improvement of pain and physical function outcomes in patients with knee OA.
METHODS
We reviewed and analyzed telerehabilitation strategies from randomized controlled trials (RCTs) comparing telerehabilitation with conventional treatment or usual care. For each strategy, we examined whether RCTs that applied the telerehabilitation strategy resulted in a significant improvement in pain or physical function compared with conventional treatment or usual care.
RESULTS
We included 6 RCTs (n=734) incorporating 8 different telerehabilitation strategies. The duration of the interventions ranged from 1 to 48 weeks, and sample sizes ranged from 20 to 350 patients. The results showed that RCTs that provided telerehabilitation were found to be more effective than conventional treatments for improving pain (P=.003; standardized mean difference [SMD] -0.21, 95% CI -0.35 to -0.07), but not physical function (P=.24; SMD -0.09, 95% CI -0.25 to 0.06). Furthermore, this systematic review and meta-analysis indicated that there is no significant correlation between different telerehabilitation strategies and the pain and physical function of patients with knee OA.
CONCLUSIONS
This systematic review and meta-analysis showed that telerehabilitation programs could relieve pain but not improve physical function for patients with knee OA. These results indicated that telerehabilitation is beneficial for the implementation of home rehabilitation exercises for patients with knee OA, thereby reducing the economic burden of health. However, there were limitations in terms of the number of search results and the number of studies that were eligible for this review and meta-analysis. Therefore, the results need to be interpreted with caution, and more high-quality studies with large samples are needed to focus on the long-term outcomes of telerehabilitation for patients with knee OA to address this limitation.
Topics: Humans; Osteoarthritis, Knee; Telerehabilitation; Pain; Exercise Therapy; Telemedicine
PubMed: 37982411
DOI: 10.2196/40735 -
BMC Health Services Research Nov 2023Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine...
BACKGROUND
Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine programs. We developed a novel semi - structured survey instrument to systematically describe the characteristics and implementation processes of telemedicine programs in primary care.
METHODS
In the context of a larger study aiming to describe telemedicine programs in primary care, a survey was developed in 3 iterative steps: 1) literature review to obtain a list of telemedicine features, facilitators, and barriers; 2) application of three evaluation frameworks; and 3) stakeholder engagement through a 2-stage feedback process. During survey refinement, items were tested against the evaluation frameworks while ensuring it could be completed within 20-25 min. Data reduction techniques were applied to explore opportunity for condensed variables/items.
RESULTS
Sixty initially identified telemedicine features were reduced to 32 items / questions after stakeholder feedback. Per the life cycle framework, respondents are asked to report a month in which their telemedicine program reached a steady state, i.e., "maturation". Subsequent questions on telemedicine features are then stratified by telemedicine services offered at the pandemic onset and the reported point of maturation. Several open - ended questions allow for additional telemedicine experiences to be captured. Data reduction techniques revealed no indication for data reduction.
CONCLUSION
This 32-item semi-structured survey standardizes the description of primary care telemedicine programs in terms of features as well as maturation process. This tool will facilitate evaluation of and comparisons between telemedicine programs across the United States, particularly those that were deployed at the pandemic onset.
Topics: Humans; United States; COVID-19; Telemedicine; Surveys and Questionnaires; Pandemics; Primary Health Care
PubMed: 37978511
DOI: 10.1186/s12913-023-10130-5 -
International Journal of Circumpolar... Dec 2023Injury in Antarctica can have a significant impact when considering transfer timelines of several weeks. Medical support to the British Antarctic Territory (BAT) is... (Review)
Review
Injury in Antarctica can have a significant impact when considering transfer timelines of several weeks. Medical support to the British Antarctic Territory (BAT) is provided by deployed healthcare professionals and the utilisation of "reach-back" with telemedicine. This is paired with robust training and familiarisation with a system of modularised deployed equipment.This paper examines the current telemedicine strategy, infrastructure modularisation, and influence from military practice by the British Antarctic Survey Medical Unit (BASMU) for medical care at extreme reach. Current telemedicine practices and utilisation, as well as modular equipment capabilities across the BAT were reviewed to provide an outline of care delivery.Requests varied from expert advice to remote supervision of clinical procedures. Integration of commercially available solutions enabled real-time display of patient physiology. The deployment of modular resources has improved equipment availability and greater standardisation between sites. The sending of case notes and digital x-rays has been generally sufficient but, when greater supervision was required, limited data transfer bandwidth was a challenge.An ongoing review of deployed equipment capabilities may also enhance the ease with which remote support can be offered but an uplift in telemedicine capability will likely require infrastructure upgrades to maintain data transfer from 8000 miles away.
Topics: Humans; Antarctic Regions; Health Personnel; Military Personnel; Telemedicine; Delivery of Health Care
PubMed: 37389990
DOI: 10.1080/22423982.2023.2230633 -
JMIR MHealth and UHealth Apr 2024Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and the efficacy of telemedicine remains unclear.
OBJECTIVE
This study aimed to evaluate the impacts of telemedicine on the burden, anxiety, depression, and quality of life of informal caregivers of patients in palliative care.
METHODS
A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials published from inception to March 2023. Two authors independently screened the studies and extracted the relevant information. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, whereas 95% prediction intervals (PIs) were calculated using R (version 4.3.2) and RStudio.
RESULTS
A total of 9 randomized controlled trials were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (standardized mean differences [SMD] -0.49, 95% CI -0.72 to -0.27; P<.001; 95% PI -0.86 to -0.13) and anxiety (SMD -0.23, 95% CI -0.40 to -0.06; P=.009; 95% PI -0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD -0.21, 95% CI -0.47 to 0.05; P=.11; 95% PI -0.94 to 0.51) or quality of life (SMD 0.35, 95% CI -0.20 to 0.89; P=.21; 95% PI -2.15 to 2.85).
CONCLUSIONS
Although telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers.
Topics: Humans; Palliative Care; Caregivers; Quality of Life; Stress, Psychological; Telemedicine; Randomized Controlled Trials as Topic
PubMed: 38602303
DOI: 10.2196/54244 -
BMC Health Services Research Oct 2023The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation....
BACKGROUND
The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service.
METHODS
An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis.
RESULTS
Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers.
CONCLUSIONS
Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.
Topics: Humans; State Medicine; Cross-Sectional Studies; COVID-19; Pandemics; Reproducibility of Results; Telemedicine; Physician-Patient Relations; Language; Health Personnel
PubMed: 37853448
DOI: 10.1186/s12913-023-10100-x -
Journal of General Internal Medicine Aug 2023Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary...
Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources.
Topics: Humans; United States; Pandemics; COVID-19; Telemedicine; Internal Medicine; Policy
PubMed: 37095331
DOI: 10.1007/s11606-023-08190-8 -
Journal of Medical Internet Research Feb 2024Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence... (Review)
Review
BACKGROUND
Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear.
OBJECTIVE
We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders.
METHODS
We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively.
RESULTS
Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits.
CONCLUSIONS
Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs.
TRIAL REGISTRATION
PROSPERO CRD42022347366; https://osf.io/pxedm/.
Topics: Humans; Delivery of Health Care; Musculoskeletal Diseases; Osteoarthritis; Telemedicine; Telerehabilitation; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 38306156
DOI: 10.2196/50090 -
BMC Medical Informatics and Decision... Nov 2023A large collection of dialogues between patients and doctors must be annotated for medical named entities to build intelligence for telemedicine. However, since most...
BACKGROUND
A large collection of dialogues between patients and doctors must be annotated for medical named entities to build intelligence for telemedicine. However, since most patients involved in telemedicine deliver related named entities in informal and long multiword expressions, it is challenging to tag their telemedicine dialogue data. This study aims to address this issue.
METHODS
With the telemedicine dialogue dataset for obstetrics and gynecology taken from haodf.com, we developed guidelines and followed a two-round procedure to tag six types of named entities, including disease, symptom, time, pharmaceutical, operation, and examination. Additionally, we developed four deep-learning models based on this dataset to establish a benchmark for named-entity recognition (NER).
RESULTS
The distilled obstetrics and gynecology dataset contains 2,383 consultations between doctors and patients, of which 13,411 sentences were from doctors, and 17,929 were from patients. With 63,560 named entities in total, the average number of characters per named entity is 4.33. The experimental results suggest that LatticeLSTM performs best on our dataset in terms of accuracy, precision, recall, and F score.
CONCLUSION
Compared with other datasets, this dataset offers three novel facets. This study offers intricately tagged long multiword expressions for medical named entities. Second, this study is one of the first attempts to mark temporal entities in a medical dataset. Third, this annotated dataset is balanced across the six types of labels, which we believe will play a considerable role in expanding telemedicine artificial intelligence.
Topics: Humans; Artificial Intelligence; East Asian People; Language; Telemedicine; Data Curation
PubMed: 37974215
DOI: 10.1186/s12911-023-02365-3