Advances In Telemedicine Research Articles

The Role of Healthcare Administration and Policy in Improving Access to Dialysis for ESRD Patients in CKD: Challenges and Solutions

End-Stage Renal Disease (ESRD) presents a critical challenge within the spectrum of Chronic Kidney Disease (CKD) and represents the final stage of CKD, necessitating timely and consistent access to dialysis for patient survival. However, access to dialysis remains significantly constrained in many regions due to a combination of systemic, financial, and infrastructural barriers. This article explores the pivotal role that healthcare administration and policy play in overcoming these challenges to enhance dialysis accessibility for ESRD patients. Multifaceted barriers are there regarding access to dialysis, including the economic burden of treatment, limited availability of dialysis centers, and disparities in healthcare delivery. The analysis then shifts to the policy landscape, discussing existing healthcare policies aimed at expanding dialysis services, as well as gaps that persist in current frameworks. The role of healthcare administration is also scrutinized, particularly in terms of resource allocation, service delivery optimization, and patient education. Through case studies and comparative analysis, it was identified that successful strategies from various regions that have effectively improved access to dialysis. These include public-private partnerships, subsidies, and advancements in telemedicine. The article concludes by offering policy recommendations and administrative strategies tailored to address the unique challenges faced by ESRD patients, emphasizing the need for a collaborative, patient-centered approach in healthcare planning and implementation. By highlighting these key areas, this article aims to provide actionable insights for policymakers, healthcare administrators, and other stakeholders committed to improving dialysis access and, ultimately, patient outcomes for those suffering from ESRD.

Various Approaches and Future Prospective for Therapies for Diabetes: A Review

The global prevalence of diabetes mellitus disease marked by increased blood glucose levels, has reached epidemic proportions. This review provides a comprehensive assessment of the current landscape of diabetes therapies and outlines future prospects for improving the management and treatment of this condition. The current scenario highlights a multifaceted approach to diabetes management, with a focus on lifestyle interventions, oral antidiabetic drugs, insulin therapy, and emerging technologies like continuous glucose monitoring and closed-loop systems. While these approaches have significantly improved the lives of people with diabetes, several challenges persist. These include medication adherence, hypoglycemia risk, and the financial burden of diabetes care. Innovative treatments that improve glucose regulation, improve cardiovascular health, and help patients lose weight—like SGLT-2 inhibitors and GLP-1 receptor agonists—have showed promise in treating these issues. The future prospects for diabetes therapies are exciting, with ongoing research into cell-based therapies, including pancreatic islet transplantation and stem cell-derived beta cells. Personalized medicine approaches, driven by genetics and artificial intelligence, hold the potential to optimize treatment regimens and predict individual responses to various therapies. Furthermore, advancements in telemedicine and digital health technologies will enhance patient self-management and remote monitoring.

Advancements in Telemedicine: Enhancing Public Health Outcomes through the Implementation of 5G Networks for Ultra Low Latency Communication

With the introduction of 5G networks, a new era emerges in telemedicine, dramatically improving public health outcomes with fewer telecommunications networks. The proliferation of 5G communications networks that enable seamless remote access, routine patient monitoring, and expedited treatment on mobile devices is the driving force behind improved patient care and public health risk variety detection and maintenance. High infrastructure costs, wide adoption, and data privacy and security Despite the compelling potential of 5G in telemedicine, some barriers to adoption have been proposed for Integrating Smart Automated Healthcare Analysis (I-SAHA), using artificial intelligence (AI) and machine learning (ML). Using these, I-SAHA can analyze health information as its peak rapidly and reliably, albeit with insights related to diagnosis by physicians and prognosis. In the context of telemedicine in a 5G application, this study investigates the performance of I-SAHA applications through an in-depth simulation analysis. Through its simulation, I-SAHA demonstrates that increased speed and accuracy in remote health assessment can lead to more dynamic, personalized health care. Additionally, 5G networks enable real-time transmission of vital health information to ensure prompt medical intervention with minimal intervention. The results show how telemedicine can benefit from 5G networks and how I-SAHA applications can improve healthcare. This approach has the potential to expand access to better health care by reducing existing barriers and improving public health outcomes through innovative research on telecommunications.

Enhancement of Health Services: Advanced Security Mechanism for Telemedicine in Public Health Practice

The sudden advancement of telemedicine in the healthcare industry presents potential hazards such as cyber-attacks and network susceptibilities, in addition to difficulties in patient privacy, data protection, and public health monitoring. To avoid illegal access, digital watermarking and precise medical image transfer are essential. Thus, for telemedicine in public health action, we introduce a unique security mechanism termed wavelet crypto fast decomposition with penguin optimization (WCFD-PO). Rivest-Shamir-Adelman (RSA), wavelet transforms (WT), and fast random singular value decomposition (FRSVD) encryption algorithms make up the suggested security methodology. By using the methods WT and FRSVD, one can decrease computing complexity and increase robustness. The PO approach offers a better-optimized scale factor in the fewest groups and repetitions as compared to the RSA approach, which is used for encrypting the watermarked image. The proposed mechanism is implemented by employing a Python application. Comprehensive testing indicates that our novel approach functions better than the current techniques, demonstrating the technique's higher efficiency. With the assistance of secure telemedicine solutions, this investigation offers physicians and tech programmers insightful information that will boost public health management.

XDTEncoder: A Deep Explainable Arrhythmia Classification Framework for Smart Healthcare

In the context of smart healthcare, the integration of multimedia and digital twin technologies has driven significant advances in telemedicine. Electrocardiogram (ECG) signals, as a part of multimedia healthcare data, provide crucial digital information about the electrical activity of the heart, which is essential for diagnosing arrhythmias and ensuring a healthy life. Arrhythmia classification is a fundamental step in analyzing ECG signals and a critical problem for diagnosing heart diseases. One key challenge in arrhythmia classification is the lack of high accuracy for classifying arrhythmia heartbeats, and another key challenge is the lack of interpretability of decision-making models. This study aims to develop a novel approach to improve the performance of arrhythmia classification while providing explainable diagnostic decision paths. We propose XDTEncoder, an explainable arrhythmia classification framework that leverages multi-level features to classify arrhythmia heartbeats while offering an explainable diagnostic decision path. XDTEncoder is novel in three aspects. (1) It constructs a human-machine collaborative knowledge representation based on the Encoder-Decoder paradigm, which allows our model to classify arrhythmias while producing decision paths for cardiologists. (2) XDTEncoder compares two encoding methods (the binary tree encoding method and the Huffman encoding method) to embed the diagnostic decision tree into the arrhythmia classification framework. (3) XDTEncoder fuses multi-level features to improve the performance of arrhythmias classification. Evaluation on 5 types of arrhythmias in the MIT-BIH database demonstrates that our new approach outperforms state-of-the-art classifiers while providing interpretability.

The innovation and challenge of artificial intelligence in the whole process management of fundus disease

Artificial intelligence (AI) has demonstrated revolutionary potential and wide-ranging applications in the comprehensive management of fundus diseases, yet it faces challenges in clinical translation, data quality, algorithm interpretability, and cross-cultural adaptability. AI has proven effective in the efficient screening, accurate diagnosis, personalized treatment recommendations, and prognosis prediction for conditions such as diabetic retinopathy, age-related macular degeneration, and other fundus diseases. However, there is a significant gap between the need for large-scale, high-quality, and diverse datasets and the limitations of current research data. Additionally, the black-box nature of AI algorithms, the acceptance by clinicians and patients, and the generalizability of these algorithms pose barriers to their widespread clinical adoption. Researchers are addressing these challenges through approaches such as federated learning, standardized data collection, and prospective trials to enhance the robustness, interpretability, and practicality of AI systems. Despite these obstacles, the benefits of AI in fundus disease management are substantial. These include improved screening efficiency, support for personalized treatment, the discovery of novel disease characteristics, and the development of precise treatment strategies. Moreover, AI facilitates the advancement of telemedicine through 5G and the Internet of Things. Future research should continue to tackle existing issues, fully leverage the potential of AI in the prevention and treatment of fundus diseases, and advance intelligent, precise, and remote ophthalmic services to meet global eye health needs.

Use of Technology to Improve Adherence in Allergy/Immunology

The integration of technology into health care has shown significant promise in enhancing patient adherence, particularly in the field of allergy/immunology. This article explores the multifaceted approaches through which digital health interventions can be used to improve adherence rates among patients with allergic diseases and immunologic disorders. By reviewing recent advancements in telemedicine, mobile health applications, wearable devices, and digital reminders, as well as smart inhalers, we aim to provide a comprehensive overview of how these technologies can support patients in managing their conditions. The analysis highlights the role of personalized digital health plans, which, through the use of artificial intelligence and machine learning algorithms, can offer tailored advice, monitor symptoms, and adjust treatment protocols in real time. Moreover, the article discusses the impact of electronic health records and patient portals in fostering a collaborative patient-provider relationship, thereby enhancing communication and adherence. The integration of these technologies has been shown to not only improve clinical outcomes but also increase patient satisfaction and engagement.

Abstract PO4-27-02: Pandemic Shifts: How did elective breast cancer care change?

Abstract Introduction: As the COVID-19 pandemic began, concerns arose that timely utilization of elective breast cancer care would decrease due to state moratoriums, travel restrictions, or fear, resulting in poorer long-term outcomes. Advances in telemedicine provided a new avenue for care; however, rapid implementation brought concerns about variable uptake and disparities. To support longitudinal clinical and epidemiological studies, this analysis described elective breast cancer care utilization during the first year of the pandemic, including patient, hospital, and geographic barriers and facilitators. Methods: The Multidisciplinary Breast Reconstruction Research Program team reviewed all breast cancer surgeries and procedures at The University of Texas MD Anderson Cancer Center during the pre-pandemic (March 1, 2019 to February 29, 2020) and pandemic (March 1, 2020 to February 28, 2021) periods. The team identified procedures that were deemed elective or preference-sensitive, and summarized the timeline of pandemic milestones and changes, including the implementation of telemedicine appointments. A data analyst summarized the distributions of completed, canceled, rescheduled, and never completed procedures. T tests and analyses of variance tested differences between the pre-pandemic and pandemic year. Generalized linear models assessed patient, hospital, and geographic factors that correlated with successful access to, and completion of, procedures. Two focus groups reviewed data and informed the interpretation of results. Results: During the first pandemic year, 30 breast care procedures were identified that were postponed during March-April, July-August, and December-January. Surprisingly, no decrease in overall utilization of elective care procedures was observed; in fact, 19% more elective breast cancer care surgeries and procedures were scheduled (4752 pre-pandemic vs 4003 pandemic) in 13% more episodes of care (2723 pre-pandemic vs 2415 pandemic). As expected, rescheduling of procedures increased 98% (from 14% pre-pandemic to 27% pandemic); however, the majority of procedures were able to be completed by the end of the year (72% pre-pandemic, 73% pandemic). Telemedicine did not significantly mediate successful completion, as the majority of procedures were prophylactic or reconstructive surgeries. However, extended hours (p = 0.03) and proximity to the hospital facilitated access and successful completion of care (p< 0.01). The most common procedures that were not able to be performed within the first year of the pandemic were autologous breast reconstruction, revision, and mastopexy. Notably, patients reported slightly improved rates of anxiety and depression during the initial pandemic year (11% vs 14%, p = 0.04), possibly due to relative privation or comparison bias. Clinicians and patients/survivors noted several “lessons learned” that may inform access and preference-sensitive care delivery. Conclusions: Despite three periods of state-mandated discontinuation of elective care procedures, the majority of patients were able to access and successfully complete elective breast cancer care during the first year of the COVID-19 pandemic. Future studies and initiatives may use this information to explore innovations in care delivery and short- and long-term effects on health outcomes. Citation Format: Haoqi Wang, Greg Reece, Mary Catherine Bordes, Mia Markey, Aubri Hoffman. Pandemic Shifts: How did elective breast cancer care change? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-02.

Novel Technologies in Artificial Intelligence and Telemedicine for Glaucoma Screening.

To provide an overview of novel technologies in telemedicine and artificial intelligence (AI) approaches for cost-effective glaucoma screening. A narrative review was performed by summarizing research results, recent developments in glaucoma detection and care, and considerations related to telemedicine and AI in glaucoma screening. Telemedicine and AI approaches provide the opportunity for novel glaucoma screening programs in primary care, optometry, portable, and home-based settings. These approaches offer several advantages for glaucoma screening, including increasing access to care, lowering costs, identifying patients in need of urgent treatment, and enabling timely diagnosis and early intervention. However, challenges remain in implementing these systems, including integration into existing clinical workflows, ensuring equity for patients, and meeting ethical and regulatory requirements. Leveraging recent work towards standardized data acquisition as well as tools and techniques developed for automated diabetic retinopathy screening programs may provide a model for a cost-effective approach to glaucoma screening. Leveraging novel technologies and advances in telemedicine and AI-based approaches to glaucoma detection show promise for improving our ability to detect moderate and advanced glaucoma in primary care settings and target higher individuals at high risk for having the disease.

Exploring healthcare providers’ perspectives on virtual care delivery: insights into telemedicine services

BackgroundThe rapid advancement of technology has led to a concurrent advancement of telemedicine, that is the delivery of medical services over a long distance using technological methods. The consistently growing numbers of COVID-19 cases warranted the use of telemedicine as an alternative method of care-delivery. This study aims to evaluate perceptions of healthcare services provided virtually among healthcare providers (HCPs) in Kuwait and to assess their acceptance and intention to implement such services.MethodsAn exploratory mixed methods design was conducted, where in phase one HCPs’ perceptions towards telemedicine were explored through an online questionnaire and the quantitative data were summarized by descriptive analysis using SPSS. Scores for usefulness and for attitude toward the use of telemedicine were calculated. Then semi-structured interviews were conducted in phase two and the qualitative data were analyzed thematically.ResultsIn phase one, 421 HCPs answered the questionnaire. In terms of telemedicine knowledge, 15.4% of HCPs had previously used telemedicine technology and 39% already knew about it. Additionally, 42.3% preferred to use telemedicine, and 88.5% had a moderate to high usefulness score. Telemedicine’s ease of use was perceived positively. Attitude median score was 73 with an IQR of 16 (63–79). Half of the participants intend to use telemedicine.In phase two, twenty-two interviews were conducted resulting in six themes; HCPs’ acceptance of telemedicine, facilitators and motives for telemedicine implementation, skills and training required to conduct telemedicine, barriers limiting the use of telemedicine, strategies to overcome the barriers, and benefits of telemedicine.ConclusionMost of the HCPs favor telemedicine integration into Kuwait’s healthcare system as their perceptions of telemedicine were overall positive, paving the way to develop implementation strategies.

Smart Devices in Optometry: Current and Future Perspectives to Clinical Optometry.

There is a huge unmet need for eye care with more than a hundred million people living without basic eye care services and facilities. There is an exigency to deploy adequate resources in terms of manpower and equipment to address this. The usage of smart devices in optometry and eye care practice has been gaining momentum for last half a decade, due to the COVID-19 pandemic and technological advancements in telemedicine. These smart devices will help facilitate remote monitoring of important visual functions, ocular signs and symptoms, thus providing better eye care services and facilities and promoting outreach services. Smart devices in optometry exist in the form of gadgets that can be worn in the wrist, and spectacle-mounted or head-mounted devices. On the other hand, with the ubiquitous nature of smartphones, a large number of smartphone applications have been developed and tested for advanced optometry and primary eye care practice, which may potentially reduce the burden of inadequate resources and the unmet need for eye care. This article aims to give an overview of the current trends and future perspectives on the application of such smart devices in optometric practice.

A Systematic Review of Digital Ophthalmoscopes in Medicine.

Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs, including smartphone (SP), desktop, and handheld ophthalmoscopes, and evaluate their applications. A literature review was performed by searching PubMed (pubmed.ncbi.nlm.nih.gov), Web of Science (webofknowledge.com), and Science Direct (sciencedirect.com). All English-language papers that resulted from the search terms "digital ophthalmoscope", "screening tool", "glaucoma screening", "diabetic retinopathy screening", "cataract screening", and "papilledema screening" were reviewed. Studies that contained randomized clinical trials with human participants between January 2010 and December 2020 were included. The Risk of Bias in Systematic Reviews (ROBIS) tool was used to assess the methodological quality of each included paper. Of the 1307 studies identified, 35 met inclusion and exclusion criteria. The ROBIS tool determined that 29/35 studies (82.8%) had a low risk of bias, 3/35 (8.5%) had a moderate risk of bias, and 3/35 (8.5%) had a high risk of bias. The continued adoption of DOs remains uncertain because of concerns about the image quality for non-mydriatic eyes and the confidence in data captured from the device. Likewise, there is a lack of guidelines for the use of DOs, which makes it difficult for providers to determine the best device for their practice and to ensure appropriate use. Even so, DOs continue to gain acceptance as technology and practice integration improve, especially in underserved areas with limited access to ophthalmologists.

Transforming Hematology and Oncology Follow-Up Care: Innovations in Telemedicine

In recent years, advancements in telemedicine have revolutionized the way healthcare is delivered, particularly in the field of hematology and oncology. This poster explores the cutting-edge innovations that empower doctors to enhance remote monitoring and post- treatment support for hematology and oncology patients. leading to improved outcomes and quality of life.

Transforming Clinical Information Systems: Empowering Healthcare through Telemedicine, Data Science, and Artificial Intelligence Applications.

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. 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. 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. 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.

The Use of Radio and Telemedicine by TMAS Centers in Provision of Medical Care to Seafarers: A Systematic Review.

Objective: From medicine via radio to telemedicine, personalized medical care at sea has improved significantly over the years. Currently, very little research has been conducted on telemedicine services and tools at sea. This study aims to review real-time case studies of seafarers' personalized treatment via telemedical devices published in medical journals. Methods: A literature search was conducted using three libraries such as PubMed (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), BioMed Central, and Google Scholar. The Medical Subject Headings (MeSH) were used for information retrieval and document selection was conducted based on the guidelines of preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 flowchart. Selected articles were subjected to quality checks using the Newcastle-Ottawa scale (NOS). Results: The literature search produced 785 papers and documents. The selection was conducted in three stages such as selection, screening, and inclusion. After applying predefined inclusion and exclusion criteria, only three articles on real-time medical assistance with telemedical tools were identified. It is reported that medical attention is delivered to seafarers in real time thanks to advancements in telemedicine, satellite technology, and video conferencing. Conclusions: By improving the quality of medical care and reducing response times for medical emergencies at sea, lives have been saved. There are still several gaps despite these advancements. Medical assistance at sea should therefore be improved to address many of the still unsolved issues.

RENAL2: Wired Room: Digital Sound, Image and Motion Analysis for Enhanced Medical Diagnostics from A Patient Encounter

Background: In-person health care encounters are critical for obtaining patient data needed for accurate diagnosis. However, in recent years with increasing patient-to-doctor ratios, physicians are spending less time face-to-face with their patients, often restrained by requirements of electronic health care record (EHR) entry. We developed a system to supplement in-person health care encounters with both real time audio/visual data capture and analysis, thus streamlining patient-physician interactions, as well as allowing for aggregation of data that may otherwise be lost. Method: A machine-vision-based motion tracking program - Google MediaPipe was utilized for the motion subsystem. Time invariant cross correlation was used to compare MediaPipe’s ability to measure joint angle and angular acceleration to an established system MOCA 2.0 - previously advanced by our group as a smartphone-based motion tracker. A Python-based sound analysis program was developed and utilized to process audio data into signal components for statistical analysis. Regression analysis of signal components was run to identify audio samples with speech and cough from those without. Two trials with six subjects were conducted with subject performing a range of movements: speaking and generating a cough. Results: Initial motion tracking analysis across 2 trials with 6 subjects showed a 98.3% (±0.5) correlation between joint angle measurements between MediaPipe and MOCA 2.0. The reliability of acceleration measurements was less robust. Sound analysis, using amplitude range, identified speech and cough with 94.5% accuracy. Conclusion: A patient encounter room, wired and equipped with motion and sound detection systems was designed. The system demonstrated ability to capture and process a range of data otherwise lost with conventional health provider encounters. Further development of the system is focus on enhanced signal processing to isolate patient from ambient noise, and to allow on-boarding of a catalog of correlation between digital signatures and physiological conditions, to generate and refine digital biomarkers. New digital biomarkers many not only augment the in-person diagnostic process, but may provide a useful foundation for significant advances in telemedicine and remote patient monitoring.

Factors Affecting Awareness About E-Health Services in Saudi Arabia.

Aim Telemedicine or using e-health applications was maximized during the COVID-19 pandemic. This study aimed to explore awareness and satisfaction with several e-health services provided by the Ministry of Health (MOH), including Seha, Moed, 937 Services, and Wasfati. Methods A population-based social media survey assessed awareness and satisfaction with these applications.The survey gathered information on demographic and socioeconomic characteristics. Binary logistic regression was used to highlight factors that affect awareness of and satisfaction with these servicesandthus could be a target for future development. Results Overall, 1333 surveys were completed; most (70%) of the participants were female, 44% were between the ages of 18 and 24 years, 83% were of Saudi nationality, and 70% had university degrees or above. Awareness was greatest with the 937 Services, Seha, Moed, and Wasfatiapplications. Satisfaction was the highest with the Moed application. Factors affecting awareness and satisfaction included age, sex, nationality, and education. Conclusion Awareness of and satisfaction with the four major e-health applications were high. This indicates the readiness of the Saudi population to embrace advances in telemedicine in alliance with the Saudi 2030 vision.

53. Clinical Uses of Cuffless Blood Pressure Monitoring Devices Using Photoplethysmography as A Promising Ambulatory Telemonitoring Tool: A Systematic Review and Meta-Analysis

Introduction: As check-ups in healthcare facilities are much arduous during the pandemic including blood pressure (BP) control, an alternative is urgently needed to replace the use of disturbing cuff-based office and ambulatory BP monitoring (BPM) devices. With the advancement of telemedicine, real-time checking and reporting of blood pressure may be potentially achieved using photoplethysmography (PPG) technology in cuffless devices. Therefore, this study evaluated the accuracy of these devices compared to the cuff-based BPM devices. Methods: This systematic review and meta-analysis was conducted based on the PRISMA 2020 guideline through multiple databases using Rayyan according to the prearranged inclusion and exclusion criteria, yielding six clinical studies to be included in the final review and analysis. Results: Overall fixed-effect meta-analysis of all studies (total of 319 subjects) presented small differences between cuffless and cuff-based devices, showing promising accuracy according to the current medical instrumentation guideline both in measuring systolic BP (SMD: 0.23 mmHg [95% CI: 0.07–0.39], p = 0.004; I2 = 0%, p = 0.55) and diastolic BP (SMD: 0.27 mmHg [95% CI: 0.11–0.43], p = 0.0007; I2 = 39%, p = 0.14). Discussion: PPG itself is a noninvasive technology, consisting of an infrared-emitting light source and a photodetector to measure the blood-reflected light intensity. Despite its ease in equipment, it measures BP accurately without being influenced by various positions and activities. Moreover, the data can be accessed real-time by both users and healthcare providers. Conclusion: In summary, cuffless PPG BPM devices have the potential in becoming a telemonitoring device for ambulatory patients for its accuracy. Its presence may be the answer to current restriction towards healthcare access during the COVID-19 pandemic. Therefore, in order to further confirm our findings, more clinical studies with various settings are encouraged to be held.

Complementary Medicine and Expressive Arts Therapy: Adjuvant for Recovery Following Neurosurgical Procedures.

Art as a way of healing is primordial in many cultures. Expressive Arts Therapy (ExAT) uses art, music, dance, and writing to help individuals navigate their healing journey. Patient self-expression as a mode of recovery has been observed in patients with Parkinson's disease, epilepsy, Amyotrophic Lateral Sclerosis (ALS) and cancer. Complementary medical approaches such as acupuncture and mindfulness have also demonstrated benefits in patients suffering from neurological injury. Complementary medicine and ExAT are not mainstream approaches following neurosurgical procedures. There are very few systematic studies evaluating the benefits of expressive arts in neurosurgery. Advances in telemedicine and mobile applications may facilitate the incorporation of complementary medicine and ExAT into patient recovery. The purpose of our study is to explore the use of complementary medicine and ExAT in neurosurgical recovery. We start with a brief introduction of ExAT followed by available treatments offered. We discuss the benefits of multidisciplinary care and emerging technologies and how they can facilitate incorporation of complementary medicine and ExAT in neurosurgery. Finally, we review several clinical studies that have demonstrated success in using complementary medicine. Our goal is to provide alternative approaches to neurosurgery recovery so that patients may receive with the best care possible.

Greek reflections on global neurosurgery

IntroductionLarge populations in middle- and low-income countries in Africa, Asia, and Central and South Americas face a dramatic neurosurgical crisis. However, large social groups in high-income countries face similar limited access to neurosurgical services. Proper identification of such a problem, analysis of the underlying causes, and proposal of potential solutions may not only address the problem at a national level, but may also provide valuable reflections on the efficient management of global neurosurgical crisis. Research questionTo evaluate if special social groups face similar problems in Greece. Material and methodsThe structure of the Greek health system was examined. The national census along with the registry of practicing neurosurgeons of the Greek National Society, as well as the national health map were searched. ResultsA series of socio-economic factors, language barriers, cultural and religion differences, geographical barriers, the COVID-19 pandemic aftermath, along with the inherent malfunctioning of the Greek health system have led to this national neurosurgical crisis. Discussion and conclusionAn extensive redrawing of the Greek health map, reorganization of the national health system, along with adaptation of all recent advances in telemedicine may alleviate the health burden in these populations. The results of this local reformation may be applied to a global level for managing the ongoing health crisis. Moreover, the development of a European taskforce by the European Association of Neurosurgical Societies (EANS) may well facilitate the development of realistic and efficacious global solutions, and contribute to the global effort for providing high-quality neurosurgical services worldwide.