Impact Of Telemedicine Research Articles

Quality of Life Among Patients with Heart Failure with Reduced Ejection Fraction Receiving Telemedicine Care in Vietnam.

Background: Telemedicine is an effective method to monitor patients at home and improve outcomes of heart failure (HF), especially HF with reduced ejection fraction (HFrEF). However, little is known about the impact of telemedicine on the quality of life (QoL) among outpatients with HFrEF in lower-middle-income countries (LMICs). Methods: In this single-center, prospective, randomized, controlled, open, and parallel-group clinical trial in northern Vietnam, patients with HFrEF were allocated to either telemedicine or control groups. Participants in the experimental arm underwent a home-based telemedicine program with regular telephone follow-ups and consultations. Participants in the control group received usual care. Both groups were followed for 6 months. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline. The analysis was conducted on an intention-to-treat basis. Results: A total of 223 participants were randomized into two groups-the telemedicine group and the usual care group. Of the 223, 170 patients [mean age: 61.5 ± 15.0 years; female: 122 (71.8%)] completed follow-up and were included in the final analysis (87 in the telemedicine group and 83 in the usual care group). At baseline, the MLHFQ scores were equivalent between the two groups (median [interquartile range]: 81 [73-92] vs. 81 [74-92]; p = 0.992). After 6-month follow-up, the telemedicine group showed greater improvement in MLHFQ total scores than the usual care group (mean change in MLHFQ score: -15.5 ± 14.0 vs. -1.3 ± 6.2; difference in change: -14.2 [95% confidence interval, CI: -17.5, -11.0]; p < 0.0001). Similar results were found for the MLHFQ physical dimension score (difference in change: -5.8 [95% CI: -7.4, -4.1]; p < 0.0001) and the MLHFQ emotional dimension score (difference in change: -3.2 [95% CI: -4.2, -2.2]; p < 0.0001). Conclusions: In this study, a telemedicine intervention significantly improved QoL compared with usual care among patients with HFrEF in an LMIC.

The Impact of Telemedicine on Chronic Disease Management: A Post-Pandemic Analysis of Patient Outcomes and Accessibility

This study explores the impact of telemedicine on chronic disease management, focusing on patient outcomes and healthcare accessibility in the post-pandemic context. Using a qualitative research approach, the study examines how telemedicine has transformed the management of chronic conditions, especially for patients facing geographical or mobility barriers. Data were collected through in-depth interviews with patients, healthcare providers, and policy experts to gain insights into the experiences and challenges associated with telemedicine for chronic care. The findings reveal that telemedicine has improved patient accessibility to healthcare services, enabling consistent monitoring and timely interventions, which positively impact patient health outcomes. However, the study also identifies challenges, including technological barriers and limitations in patient-provider communication, that may affect care quality and patient satisfaction. Despite these issues, telemedicine is seen as a valuable supplement to traditional healthcare, enhancing healthcare access, especially for underserved populations. This research provides key insights for healthcare policymakers and practitioners in improving telemedicine practices, ensuring that they address accessibility gaps without compromising quality. The study concludes that, with strategic improvements, telemedicine holds significant potential to transform chronic disease management and make healthcare more equitable.

Utilization of telemedicine for diagnosis and follow-up within foot and ankle orthopaedic surgery: A narrative review of the literature.

Telemedicine has seen increasing adoption in healthcare over the past two decades, with proven clinical efficacy in several medical specialties. Orthopedics surgery has shown potential benefits from telemedicine implementation. This review aims to evaluate the impact of telemedicine on clinical outcomes and patient and physician preferences in foot and ankle orthopedics, providing insight into the potential role of telemedicine within this subspecialty. Multiple databases were searched for relevant articles on telemedicine in foot and ankle orthopedics. Inclusion criteria encompassed articles on telemedicine use and foot and ankle orthopedic care. Data included patient demographics, reasons for visits, duration of telemedicine, and outcomes. Analysis involved descriptive statistics, and a narrative approach to describe outcomes. Out of 218 articles, 12 met the inclusion criteria, comprising a total of 1,535 patients. Telemedicine visits were used for follow-up care, opinion consultations, monitoring, postoperative care, and treatment of various orthopedic conditions. Clinical outcomes demonstrated equivalence to in-person care. Patients expressed satisfaction with telemedicine but preferred in-person visits for future appointments. Physicians held neutral attitudes towards telemedicine, with concerns about the lack of physical examination. This review highlights the benefits of telemedicine in foot and ankle orthopedics. Telemedicine provides an alternative to in-person visits, improving patient access to care and offering cost and time savings. However, patient and physician preferences for in-person visits suggest a need to address concerns related to physical examination limitations. Telemedicine can supplement traditional care, but further research is required to explore its applicability in new patient consultations and optimize physician engagement.

THE IMPACT OF TELEMEDICINE ON ACCESS TO PRIMARY CARE

The COVID-19 pandemic has driven the implementation of telemedicine as a solution for maintaining access to healthcare, transforming the primary care landscape in many parts of the world. In Brazil, telemedicine has established itself as an essential tool for overcoming geographical and social barriers, facilitating access to basic care for populations that traditionally faced difficulties in accessing health services. This study seeks to investigate the impact of telemedicine on access to primary care, analyzing its main challenges and opportunities in the context of post-pandemic primary care. This study seeks to analyze the impact of telemedicine on access to primary care, exploring the main challenges and opportunities that arise with this modality of care. It also aims to identify practices and policies that can strengthen the implementation of telemedicine in Primary Care, ensuring that remote care is effective, safe and inclusive. This is a literature review, based on a qualitative approach, using the Scielo, Google Scholar and PubMed databases. To refine the research, the health descriptors “telemedicine”, “primary care”, “COVID-19”, and “equity in access to health” were selected, with a time frame between 2021 and 2023. Through a literature review, the study explores recent data on telemedicine in primary care, focusing on the main opportunities it offers, such as improved access and efficiency of services, as well as the challenges, including limited technological infrastructure in poor regions, privacy and confidentiality issues, and the need for adequate training for health professionals. Telemedicine enables more agile care and coverage of a larger population, but still faces obstacles related to digital accessibility and maintaining quality and continuity of care, especially for vulnerable groups. Telemedicine has therefore proved to be a strategic tool for expanding access to primary care, offering a viable alternative for reducing gaps in primary care. However, in order to maximize its impact, it is essential to overcome the technological challenges, guarantee information security and train health professionals in this new type of care. The continued use of telemedicine in the post-pandemic context presents an opportunity to strengthen the Unified Health System (SUS) in Brazil, expanding the reach of primary care and promoting greater equity in access to health.

Effectiveness of Telemedicine and Remote Monitoring in Reducing Postpartum Hemorrhage Rates: A Meta-Analysis

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited access to healthcare. Telemedicine and remote monitoring technologies offer potential solutions for early detection and management of PPH. This meta-analysis aimed to evaluate the effectiveness of these technologies in reducing PPH rates. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published between 2013 and 2024 investigating the impact of telemedicine and remote monitoring interventions on PPH rates. Randomized controlled trials (RCTs) and observational studies with a control group were included. The primary outcome was the incidence of PPH (blood loss ≥500 ml after vaginal delivery or ≥1000 ml after cesarean delivery). Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Publication bias was assessed using funnel plot asymmetry and Egger's test. Six studies involving 4200 women met the inclusion criteria. The pooled analysis demonstrated a statistically significant reduction in PPH rates in the intervention groups compared to the control groups (RR 0.56; 95% CI 0.47-0.67; p&lt;0.00001). The funnel plot was symmetrical, and Egger's test was not statistically significant (p=0.45), suggesting no evidence of publication bias. Telemedicine and remote monitoring interventions are associated with a significant reduction in PPH rates. These findings support the integration of these technologies into postpartum care to improve maternal outcomes, particularly in resource-constrained settings.

Telemedicine: Future of the healthcare system and its impact on patient satisfaction: A literature review

ABSTRACT Background and Objectives: The utilization of telemedicine has increased dramatically since the onset of the COVID-19 pandemic. In this review, we examined studies published within the past five years that investigated the impact of telemedicine on patient satisfaction. Methods: Four investigators utilized PubMed and Google Scholar to find studies published within the past five years that assessed patient satisfaction with telemedicine in the field of adult primary care, using either the Press Ganey or CAHPS surveys. Studies that compared cost and quality of care between telemedicine and in-patient healthcare were also included to address the secondary aims of this study. Results: A total of 11 studies out of the 405 that were investigated were selected for this review. Five studies found no significant difference in patient satisfaction between telemedicine and in-person medicine, with one of those showing a patient preference for telemedicine. One study demonstrated significantly higher satisfaction with in-person medicine vs. telemedicine. Another study found that most physicians and patients reported no perceived difference in quality of care between telemedicine and in-person visitation. One study found no difference in patient satisfaction with telemedicine between immigrants and non-immigrants. Another study showed that patients have higher satisfaction when using telemedicine with their PCP vs. an unfamiliar provider. Two studies found telemedicine to be cost-effective. Conclusions: Our review concludes that patient satisfaction with telemedicine is not inferior to that with in-person visits. However, further research should be conducted to determine various factors that may affect patient perception and satisfaction.

THE IMPACT OF TELEMEDICINE ON PATIENT OUTCOMES, ACCESS TO CARE, AND PATIENT SATISFACTION IN FAMILY MEDICINE: A SYSTEMATIC REVIEW

Telemedicine has emerged as a transformative strategy in healthcare, particularly in family medicine, since it improves patient outcomes, increases access to care, and influences patient happiness. This systematic review aimed to synthesize current evidence on the impact of telemedicine in these areas. The review included studies from multiple databases that focused on telemedicines function in family medicine throughout the last decade. The findings show that telemedicine considerably improves access to healthcare services, especially in underserved and rural areas. Patients benefit from shorter travel times and better scheduling flexibility, which has been especially important during the COVID-19 pandemic. However, the effects on patient outcomes are variable. While some studies show lower mortality rates and shorter hospital stays in telemedicine-supported care, others show an increase in acute care visits for illnesses that might be treated in outpatient settings. Patient satisfaction is generally high, particularly about the convenience of telemedicine, but this is offset by worries about the quality of care in non-face-to-face contacts. Physician perspectives differ, with some expressing displeasure with the perceived lower quality of telemedicine visits compared to in-person consultations. These findings imply that, while telemedicine has enormous potential for improving healthcare delivery in family medicine, it must be carefully integrated into existing healthcare systems to maximize its benefits. Future research should focus on hybrid care models and solutions for addressing gaps in telemedicine access and outcomes.

Impact on healthcare costs of adding telemedicine to a multidisciplinary disease management program for heart failure: a sub-analysis of the iCOR trial

Abstract Background Impact of telemedicine on heart failure outcomes has shown conflicting results. Little is known about the effect of these programs on mid-term healthcare costs. Purpose To evaluate the cost-efficacy of a comprehensive telemonitoring program within the vulnerable post-discharge period after an acute heart failure admission. Methods The insuficiència cardiaca Optimizació Remota (iCOR) trial was a single-centre, randomized, open-label study designed to evaluate the efficacy of the addition of telemonitoring and teleintervention to a specialized multidisciplinary nurse-led heart failure (HF) program. Adult patients with a recent hospital admission for acute HF and an acceptable social support and cognitive ability were recruited. This sub-analysis evaluates the effect of telemedicine on mid-term healthcare costs, including clinical events, drugs and devices, technology purchase and maintenance, outpatient care, days of hospitalization, procedures and complementary tests. t-test via bootstrap estimation is used to compare differences between the telemedicine (TM) and the usual care (UC) groups. Results 81 patients were assigned to the TM group and 97 patients to the UC group. Mean age was 74 years, more than 50% had HF with preserved ejection fraction and 25% were frail. Baseline characteristics were well-balanced between groups. Among the TM subgroup, adherence was very high (&amp;lt; 1% of missed biometric daily transmissions). During 6 months of follow-up, mean total healthcare cost per patient was 7949 euros (€) in the UC cohort and 4383 € in the TM cohort (relative risk reduction [RRR] of 45%; between-group differences 3546 €, 95% confidence interval 627-6464 €, bootstrap achieved significance level 0.022). This result was consistent across several subgroups (age, sex, frailty, left ventricular ejection fraction, educational level) and mainly driven by a 63% RRR in costs of hospitalization (which accounted for two-thirds of the total costs) in the TM cohort. 20 patients required HF admissions in the TM group, compared to 51 patients in the TM group (p &amp;lt; 0.001). This was associated with a 59% RRR in the need for diagnostic procedures. Total number of days of hospitalization per patient decreased from 12.2 in the UC group to 4.2 days in the TM group (p = 0.003), impelled by a reduction in HF and cardiovascular days of hospital stay. On the contrary, ambulatory care costs increase two-fold in the TM group compared to UC group. Nevertheless, these costs only accounted for a 19% of the total costs. Cost of devices needed to implement TM supposed 698 € per patient. Use of TM was associated with a 355 € increase in the cost of ambulatory neurohormonal treatment for HF. Conclusions TM implementation during the vulnerable phase after an acute HF admission was associated to a 45% RR reduction in mean total healthcare cost per patient. This result was driven by an almost two-thirds decrease in costs of hospitalization.UC and TM total healthcare costs

Telemedicine in Eye Care During the COVID-19 Pandemic: A Review of Patient & Physician Perspectives.

There has been an increase in the adoption of telemedicine during the COVID-19 pandemic. This review used systematic search and review criteria to assess the literature on patient and physician perspectives toward telemedicine for vision care during the pandemic. We conducted a comprehensive search on PubMed, Embase, and Scopus using relevant MeSH terms to identify peer-reviewed studies examining telemedicine use in eye care during the pandemic. The search strategy encompassed three key concepts: COVID-19 or pandemic, telehealth or telemedicine, and eye care. Further screening of references and similar articles was conducted to identify additional relevant studies. We identified 24 relevant studies published between 2020 and 2022. Of these, 15 focused on patients' perspectives, while 12 explored physicians' perspectives. Predominantly cross-sectional in design, these studies were mainly conducted during the initial wave of the pandemic (March 2020 to June 2020), primarily in urban locations and hospital settings. Patients were satisfied with telemedicine and considered it equally effective to in-person visits. Patients believed telemedicine was convenient, improved eye care access, and a beneficial triage tool. Physicians acknowledged telemedicine's convenience for follow-up assessment and its ability to expand the capacity for emergency cases. However, both patients and physicians voiced concerns about the absence of ancillary examination and technological challenges. Our review highlights the positive impact of telemedicine in eye care during the pandemic. Nonetheless, most studies were limited in sample size. They did not delve into potential disparities based on race/ethnicity, socioeconomic status, and geographic location, factors that could influence patient attitudes toward telemedicine. Further research is warranted to validate the findings from our selected studies and explore factors that influence the implementation of telemedicine, particularly across various eye care subspecialties.

The Impact of Telemedicine during the COVID-19 Pandemic on Diabetes Management and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus (GDM)

Background/Objectives: Gestational diabetes mellitus (GDM) can lead to various complications for both the mother and the child. Many factors influence the onset of the disease including GDM in a previous pregnancy, overweight and obesity, as well as the increasing age of women who become pregnant. The aim of this study was to assess the impact of telemedicine during the COVID-19 pandemic on diabetes management and pregnancy outcomes in women with gestational diabetes mellitus (GDM). Methods: A retrospective analysis was conducted. We compared two groups of GDM women from the pandemic and pre-pandemic periods in terms of pregnancy course and obstetric outcomes. Results: It was observed that women with GDM in the pandemic group were significantly more often overweight and significantly less often obese before pregnancy than women in the pre-pandemic group. GDM was diagnosed significantly earlier but in later pregnancies in the pandemic group than in the pre-pandemic group. The course of pregnancy in both groups was similar and the percentage of pregnancies with the delivery of neonates &gt; 4000 g did not differ significantly. The number of caesarean sections and spontaneous deliveries was also similar in both periods. No differences were found in anthropometric parameters in newborns and neonatal and maternal complications. Conclusions: The occurrence of the COVID-19 pandemic and the necessity of employing telemedicine tools in the medical care of women with GDM did not significantly impact diabetes management and the pregnancy outcomes achieved.

The Adoption and Impact of Telemedicine on Health Equity: A Narrative Review From the Jamaican Context

The Adoption and Impact of Telemedicine on Health Equity: A Narrative Review From the Jamaican Context

Telemedicine Rounding Support for Public Health System Pediatric Intensive Care Units in Brazil can Improve Outcomes.

There are discrepancies in resources and expertise available between pediatric intensive care units (PICUs) in Brazil that likely significantly impact the clinical outcomes of patients. The goal of this study was to evaluate the impact of telemedicine rounding support in two public PICUs located in the North and Northeast regions of Brazil. Our intervention involves telehealth rounds connecting two "level II" PICUs with specialist doctors from a hospital of recognized excellence. A before-and-after study was carried out to evaluate telemedicine's impact on PICUs between December 2018 and July 2019. Nine hundred and forty patients were evaluated during this period (426 pre-telemedicine, 514 post-telemedicine). The intervention occurred through telerounds between the command center and the ICUs assisted by telemedicine. In unit A, the implementation of telemedicine reduced the mortality rate from 18.86% to 9.29%, while in unit B, it decreased from 10.76% to 9.72%. There was no change in the median length of stay in unit A, but in unit B, it increased from 6 to 8 days. Logistic regression analysis confirmed a significant reduction in mortality in unit A (odds ratio (OR) 0.50; 95% confidence interval (CI) 0.29-0.86). The study found a positive correlation between adherence to telemedicine recommendations and mortality reduction across both units. This suggests that telemedicine can effectively improve outcomes in PICUs, particularly in regions with limited health-care resources.

Telemedicine in Pediatric Respiratory Care: Benefits, Challenges, and Future Directions

This study explores the impact of telemedicine on pediatric respiratory care, focusing on its benefits, challenges, and future directions. A mixed-methods approach was employed, involving 150 pediatric patients with chronic respiratory conditions such as asthma and cystic fibrosis, who were randomly assigned to either telemedicine or traditional care groups. The telemedicine group used a digital platform for video consultations, remote monitoring, and health management over a 12-month period. Quantitative data on clinical outcomes, including emergency department visits and hospitalizations, were collected from electronic health records, while patient-reported outcomes were assessed through surveys. Qualitative data were gathered via semi-structured interviews with patients and caregivers. Results indicated that the telemedicine group experienced significantly fewer emergency visits and hospitalizations, higher quality of life scores, better treatment adherence, and greater patient satisfaction compared to the traditional care group. Average oxygen saturation and peak flow rates were also higher in the telemedicine group, and more frequent monitoring alerts were noted.

Telemedicine in Post-ExposureProphylaxis to Biological Material During the COVID-19 Pandemic: Impact on Care and Outcome Indicators.

Introduction: The restrictions on face-to-face care for exposure to biological material during the COVID-19 pandemic required alternatives to maintain outpatient assistance. This study evaluated the impact of telemedicine on care and outcome indicators of a reference service for exposure to biological material during the COVID-19 pandemic. Methods: This pre- and post-study compared the effectiveness of telemedicine in the Hospital Correia Picanço in Recife (Pernambuco, Brazil) before (August 2018 to January 2019 [P1]) and during the COVID-19 pandemic (August 2020 to January 2021 [P2]). Individuals above 18 years old exposed to biological material who sought the service during P1 or P2 were included in the study. Results: A total of 4,494 cases were assessed (1,997 in P1 and 2,497 in P2), mostly because of sexual exposure (62.3%). The mean age was 32.2 ± 9.2 years, most individuals were male (64.9%), originated from Recife (56.6%), and the education level was up to 12 years (53.7%). P2 presented 43% more attendances and shorter intervals between the exposure and first attendance (51%), first testing (28%), and discharge (10%) than P1 (p < 0.05), and cases had no difference in discharge rate (p = 0.339). Cases of sexual exposure had the highest dropout rate in both periods. Conclusion: Telemedicine maintained similar outcomes to face-to-face care and improved the indicators, increasing the mean monthly attendance and reducing the time between exposure and follow-up.

Impact of Telemedicine on Women's Sexual Dysfunction: A Systematic Review and Meta-Analysis

Context: Sexual satisfaction is crucial for women's overall well-being; however, traditional interventions often face challenges such as high costs, limited access, inadequate specialized care, and discomfort during counseling sessions. Telemedicine presents a promising solution to these issues. Objectives: This systematic review and meta-analysis evaluate the efficacy of telemedicine interventions in improving sexual function and satisfaction among women. Evidence Acquisition: We searched SCOPUS, Web of Science, and PubMed for relevant articles published up to January 2024. The search strategy and keywords were crafted using the PICO approach to align with the study's objectives and ensure a comprehensive and structured review. The quality of the included studies was assessed using the Jadad scale. The primary outcome measures were sexual desire, arousal, lubrication, orgasm, pain, satisfaction, and overall Female Sexual Function Index (FSFI) scores. A random-effects model was employed for the meta-analysis, and the I-square index was used to assess heterogeneity. Results: The systematic review identified six studies from an initial pool of 4,174 that demonstrated a positive effect of telemedicine interventions on all domains of the FSFI questionnaire, except for the pain domain and overall sexual function scores in women. The effects of telemedicine on sexual desire [standardized mean difference (SMD) = 0.92, 95% CI = 0.51, 1.32], sexual arousal (SMD = 0.97, 95% CI = 0.42, 1.53), vaginal lubrication (SMD = 0.41, 95% CI = 0.23, 0.59), orgasm (SMD = 0.40, 95% CI = 0.21, 0.58), sexual satisfaction (SMD = 0.74, 95% CI = 0.48, 1), and total FSFI (SMD = 1.03, 95% CI = 0.49, 1.58) were found to be significant. However, the effect on pain was not statistically significant (SMD = 0.15, 95% CI = -0.10, 0.40). Conclusions: This study supports the effectiveness of telemedicine in improving women's sexual satisfaction and function. However, due to limitations in the included studies, such as small sample sizes, lack of randomization, and lack of blinding in some cases, more comprehensive studies are recommended. Future research should address these methodological limitations to provide stronger evidence on the effectiveness of telemedicine interventions for women's sexual health.

Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System.

Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019-September 10, 2020) and the post-implementation period (September 11, 2020-December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45-2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as "good." In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as "good."

Implications of telemedicine

This article explores the transformative impact of telemedicine on spine surgery, tracing its evolution from historic roots to its expansion during the COVID-19 pandemic. The widespread adoption of telemedicine is discussed, highlighting some of its benefits such as increased patient accessibility and satisfaction. Despite its advantages, telemedicine introduces complex legal considerations, specifically concerning licensure, malpractice and data security. The article examines the challenges spine surgeons face when practicing telemedicine across state borders, the nuances of malpractice liability in virtual settings, and the importance of maintaining high standards of care. It also highlights the importance of adhering to HIPAA regulations, ensuring secure data transmission, and navigating reimbursement complexities. This article should serve as a thorough guide for spine surgeons navigating the evolving telemedicine landscape, balancing innovation with patient safety and legal accountability.

Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial

ABSTRACT Introduction Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs). Methods An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days. Results A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups. Conclusion Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care. Clinical trial registration ClinicalTrials.gov NCT05260710 and ReBEC – RBR-7×j4wyp.

The clinical effectiveness of telemedicine for managing type 2 diabetes in India: a meta-analysis of the impact of telemedicine with clinic visits.

Telemedicine has emerged as a promising solution for enhancing Type 2 diabetes management, which aims to reduce healthcare costs and improve patient outcomes. Despite its potential benefits for diabetes management in India, knowledge of its clinical effectiveness is scarce. This meta-analysis examines the clinical effectiveness of telemedicine versus physical consultation in managing Type 2 diabetes in India. The meta-analysis adhered to the PRISMA-P guidelines and was registered with PROSPERO (CRD42023400562). PubMed and EMBASE were searched for eligible studies from 1st January 2012 to 30th June 2022. Included were studies on Type 2 diabetes patients in India comparing telemedicine (Intervention) with physical consultation (conventional) regarding effect on HbA1c changes. Risk of bias for randomised studies of Intervention (RoB-2) was used for study quality assessment. We found four articles that met the eligibility criteria, all reporting quantitative HbA1c change. The telemedicine interventions included video consultation, health systemcomputer-generated telephonic messages and a Video-Based Lifestyle Education Programme. Upon pooling the results from these studies, an overall analysis indicated a non-statistically significant reduction in HbA1c levels following the intervention compared to conventional treatment (pooled difference in means = -0.03, 95% CI = -0.23 to 0.17, Z = 0.30 P = 0.76). Likewise, there was no statistically significant difference in secondary outcomes (Body Mass Index, body weight and lipid profile) between both treatment groups. Enhancing telemedicine approaches may hold promise in improving type 2 diabetes management in India, although the existing evidence remains inconclusive. Further research involving long-term telemedicine interventions would help to provide more substantial evidence on the clinical effectiveness of telemedicine for Type 2 diabetes management in India. The online version contains supplementary material available at 10.1007/s40200-024-01471-x.

Telemedicine in Acute Trauma Care: A Review of Quantitative Evaluations on the Impact of Remote Consultation.

There is extensive literature describing the application of telemedicine techniques to trauma care. However, there is a paucity of articles showing quantitative assessment of its safety and efficacy. This structured review examines articles with quantitative assessment of telemedicine's impact in acute trauma care. Medline and CINAHL databases were searched for peer-reviewed articles that quantitatively assess the impact of telemedicine on diagnostic accuracy, clinical decision-making, emergency department length of stay, transfer rates, and mortality in initial trauma management. Only 9 of the 408 screened articles met the criteria for quantitative assessment. Telemedicine appears to be preferentially used for more severely injured patients. Limited quality evidence supports procedural interventions at remote sites. Telemedicine may help abbreviate pre-transfer length of stay. However, its impact on diagnosis and mortality remains unclear. Telemedicine's potential to enhance the quality and efficiency of trauma care, especially for resource-scarce areas, warrants continued quantitative research.