Online Telemedicine Research Articles

'The abortion gave me my life back': the long-term impact of access to self-managed medication abortion through telemedicine on women's lives in legally restricted countries.

Approximately 753 million women (38%) of reproductive age live in countries with restrictive abortion laws. To overcome these legal constraints, women access safe self-managed medication abortions through telemedicine abortion services. This study aimed to explore the long-term impact of accessing a self-managed medication abortion through telemedicine service on women's lives in countries with restrictive abortion laws. We conducted interviews with eleven women (from eleven different countries) who accessed a self-managed medication abortion through online telemedicine between 2014 and 2018 in a legally restricted country. We analysed interviews thematically. Three key themes were developed: (1) access to abortion positively impacted life plans; (2) the negative influence of the legally restricted environment wore off and their well-being improved; (3) participants are now using their own experiences to help others by either sharing information or facilitating access to abortion. In summary, our findings highlight the positive impact of access to self-managed medication abortion and underline the importance of ensuring access to abortion for everyone.

IoT-Based Heartbeat Rate-Monitoring Device Powered by Harvested Kinetic Energy.

Remote patient-monitoring systems are helpful since they can provide timely and effective healthcare facilities. Such online telemedicine is usually achieved with the help of sophisticated and advanced wearable sensor technologies. The modern type of wearable connected devices enable the monitoring of vital sign parameters such as: heart rate variability (HRV) also known as electrocardiogram (ECG), blood pressure (BLP), Respiratory rate and body temperature, blood pressure (BLP), respiratory rate, and body temperature. The ubiquitous problem of wearable devices is their power demand for signal transmission; such devices require frequent battery charging, which causes serious limitations to the continuous monitoring of vital data. To overcome this, the current study provides a primary report on collecting kinetic energy from daily human activities for monitoring vital human signs. The harvested energy is used to sustain the battery autonomy of wearable devices, which allows for a longer monitoring time of vital data. This study proposes a novel type of stress- or exercise-monitoring ECG device based on a microcontroller (PIC18F4550) and a Wi-Fi device (ESP8266), which is cost-effective and enables real-time monitoring of heart rate in the cloud during normal daily activities. In order to achieve both portability and maximum power, the harvester has a small structure and low friction. Neodymium magnets were chosen for their high magnetic strength, versatility, and compact size. Due to the non-linear magnetic force interaction of the magnets, the non-linear part of the dynamic equation has an inverse quadratic form. Electromechanical damping is considered in this study, and the quadratic non-linearity is approximated using MacLaurin expansion, which enables us to find the law of motion for general case studies using classical methods for dynamic equations and the suitable parameters for the harvester. The oscillations are enabled by applying an initial force, and there is a loss of energy due to the electromechanical damping. A typical numerical application is computed with Matlab 2015 software, and an ODE45 solver is used to verify the accuracy of the method.

A Case of Headache Treated by Online Telemedicine in Collaboration With a Midwifery Home

A Case of Headache Treated by Online Telemedicine in Collaboration With a Midwifery Home

Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women’s Health Organization Decision

The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Abortion restrictions following the Dobbs decision. Provision and use of medications for a self-managed abortion. In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.

Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Advance Provision of Mifepristone and Misoprostol via Online Telemedicine in the US

This cross-sectional study examines trends in the demand and characteristics and motivations of individuals who requested advance provision of abortion medications.

Experiences with misoprostol-only used for self-managed abortion and acquired from an online or retail pharmacy in the United States

ObjectivesThis study aimed to understand individual experiences with medication abortion using misoprostol-only among people living in the United States. Study designWe conducted 31 semistructured anonymous in-depth interviews with individuals who used misoprostol-only for self-managed medication abortion. Participants were recruited from Aid Access, an online telemedicine organization that provided prescriptions for misoprostol to eligible people in all 50 states in May and June 2020 when a combined mifepristone and misoprostol regimen was unavailable. We coded transcripts with a flexible coding approach and focused on perceptions and experiences with use. ResultsParticipants were knowledgeable about misoprostol. Previous abortion experiences shaped perceptions of misoprostol-only by allowing comparison to the mifepristone and misoprostol regimen. Most participants expressed an unwavering desire for an effective abortion method, regardless of the medications or regimen. Individual physical experiences with misoprostol, including bleeding, cramping, nausea, and diarrhea, varied in intensity and duration. Participants proactively managed symptoms with self-care strategies and drew extensively from their prior experiences with menstruation, miscarriage, abortion, and childbirth. Clear instructions and information on potential complications and what to expect throughout the abortion fostered a sense of preparedness, and personalized interactions with an online help desk brought comfort. ConclusionsMisoprostol offered an essential abortion method for study participants. This regimen was physically challenging for some, and there is potentially a greater need for communication and support for individuals using misoprostol-only regimens. Prior reproductive experiences informed participant’s knowledge, preparedness, pain management, and ability to both recognize and manage potential complications. ImplicationsAs restrictions on mifepristone continue, more people may use misoprostol-only regimens. All regimens can be supported with detailed instructions, clear expectations, information on signs of potential complications, and personalized support. To achieve reproductive autonomy, people must have access to a range of abortion care options that meet their needs.

Evolving cardiovascular genetic counseling needs in the era of precision medicine.

In the era of Precision Medicine the approach to disease diagnosis, treatment, and prevention is being transformed across medical specialties, including Cardiology, and increasingly involves genomics approaches. The American Heart Association endorses genetic counseling as an essential component in the successful delivery of cardiovascular genetics care. However, with the dramatic increase in the number of available cardiogenetic tests, the demand, and the test result complexity, there is a need not only for a greater number of genetic counselors but more importantly, for highly specialized cardiovascular genetic counselors. Consequently, there is a pressing need for advanced cardiovascular genetic counseling training, along with innovative online services, telemedicine, and patient-facing digital tools, as the most effective way forward. The speed of implementation of these reforms will be of essence in the translation of scientific advancements into measurable benefits for patients with heritable cardiovascular disease and their families.

A profile of patients' and doctors' perceptions, acceptance, and utilization of e-health in a deprived region in southwestern China.

E-health has the potential to promote health accessibility, performance and cost-saving. However, the adoption and penetration of e-health in underprivileged areas remains insufficient. We aim to investigate patients' and doctors' perception, acceptance, and utilization of e-health in a rural, spatially isolated and poverty-stricken county in southwestern China. A retrospective analysis based on a cross-sectional survey of patients and doctors in 2016 was conducted. Participants were recruited through convenience and purposive sampling, and questionnaires were self-designed and validated by investigators. The utilization, intention to use and preference of four e-health services were evaluated, including e-appointment, e-consultation, online drug purchase, and telemedicine. Predictors of utilization and intention to use e-health services were investigated by multivariable logistic regression. A total of 485 patients were included. The utilization rate of any type of e-health services was 29.9%, ranging from 6% in telemedicine to 18% in e-consultation. Additionally, 13.9%-30.3% of respondents as non-users revealed their willingness to use such services. Users and potential users of e-health services were inclined to specialized care from county, city or province hospitals, and they were most concerned with the quality, ease of use and price of e-health service. Patients' utilization and intention to use e-health could be associated with education and income level, cohabitants, working location, previous medical utilization, and access to digital device and internet. There remained 53.9%-78.3% of respondents reluctant to use e-health services, mainly due to perceived inability to use them. Of 212 doctors, 58% and 28% had provided online consultation and telemedicine before, and over 80% of county-hospital doctors (including actual providers) indicated their willingness to provide such services. Reliability, quality and ease of use were doctors' major concerns regarding e-health. Doctors' actual provision of e-health was predicted by their professional title, number of years in work, satisfaction with the wage incentive system, and self-rated health. Nevertheless, their willingness to adopt was only associated with the possession of smartphone. E-health is still in its infancy in western and rural China, where health resources are most scarce, and where e-health could prove most beneficial. Our study reveals the wide gaps between patients' low usage and their certain willingness to use e-health, as well as gaps between patients' moderate attention to use and physician's high preparedness to adopt e-health. Patients' and doctors' perceptions, needs, expectations, and concerns should be recognized and considered to promote the development of e-health in these underprivileged regions.

Accessing abortion in a highly restrictive legal regime: characteristics of women and pregnant people in Malta self-managing their abortion through online telemedicine

ObjectiveTo examine the numbers and characteristics of women and pregnant people in Malta seeking at-home medical abortion using online telemedicine from 2017 to 2021.DesignPopulation-based study.SettingRepublic of MaltaParticipantsBetween 1 January 2017...

Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States.

To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service. We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.

An Analysis of Factors Influencing the Intention to Use “Untact” Services by Service Type

Since COVID-19, social distancing has become common, and the demand for untact services has increased rapidly, resulting in an economic phenomenon centered on untact worldwide. Due to social distancing, the untact service area is expanding not only to shopping but also to online learning, home training, and telemedicine, and untact services are expected to expand to more diverse areas in the future. This study investigates four types of untact services: online lectures, online meetings related to work and study, online seminars, and online performances, and the effects of concerns about untact services on the intention of use have been examined using a path analysis model. As a result of the analysis, the perceived usefulness had a positive effect on the user’s continuous intention to use untact services. However, depending on the type of untact service, it can be confirmed that the factors that affect the intention to continue using the service differ from each other. Practitioners can use the results of this study when designing untact services in the future.

Actual Telemedicine Needs of Japanese Patients with Neurological Disorders in the COVID-19 Pandemic.

Objective During the coronavirus disease 2019 (COVID-19) pandemic, many social activities have moved online using applications for digital devices (e.g. computers, smartphones). We investigated the needs of telemedicine and trends in medical status and social care situations of Japanese patients with neurological disorders in order to estimate their affinity for an online telemedicine application. Methods We designed an original questionnaire for the present study that asked participants what problems they had with hospital visits, how the COVID-19 pandemic had affected their lives, and whether or not they would like to receive telemedicine. Patients The present study included volunteer caregivers, participants with Parkinson's disease (PD), epilepsy, stroke, dementia, immune-mediated neurological disease (IMMD), spinocerebellar degeneration (SCD), amyotrophic lateral sclerosis (ALS), headache, myopathy, and other neurological diseases from Okayama University Hospital. Results A total of 29.6% of patients wanted to use telemedicine. Patients with headaches (60.0%) and epilepsy (38.1%) were more likely to want to use telemedicine than patients with PD (17.8%) or stroke (19.0%). Almost 90% of patients had access to a digital device, and there was no association between favoring telemedicine, ownership of a digital device, hospital visiting time, or waiting time at the hospital, although age was associated with motivation to telemedicine use (52.6 vs. 62.2 years old, p <0.001*). Conclusion We can contribute to the management of the COVID-19 pandemic and the medical economy by promoting telemedicine, especially for young patients with headaches or epilepsy.

Self-managed medication abortion in South Korea: A retrospective records review of the uptake of medication abortion through online telemedicine prior to decriminalization

ObjectivesTo examine the uptake of medication abortion through online telemedicine in South Korea prior to decriminalization of abortion beginning in 2019. Study designWe conducted a descriptive cross-sectional analysis of medication abortion consultations submitted to Women on Web, an online telemedicine service, from South Korea between 2013 and 2019. ResultsThe uptake of medication abortion through Women on Web increased every year between 2013 and 2019, adding up to 12,115 consultations across 7 years. The median age was 25 and the median gestational age was 37 days. Individuals reported financial constraints (66.2%) as the most common reason for wanting an abortion. This was followed by not wanting a child at this point (64.7%) and wanting to finish school (34.6%). ConclusionsThis study illustrates the uptake of medication abortions via Women on Web between 2013 and 2019, prior to decriminalization of abortion in South Korea. ImplicationsThis study attests to the use of online telemedicine for medication abortion, despite the legal restrictions prior to decriminalization of abortion in South Korea.

The impact of the Covid-19 pandemic on the quality of care in Israeli hospitals

The study goal was to assess the impact of the COVID-19 pandemic on strategies used by Israeli hospitals to improve quality of care, patient safety, patient experience and clinicians’ well-being. Leaders of public hospitals in Israel were asked to complete questionnaires regarding the impact of COVID-19 on quality. Fourteen of 29 public hospitals participated. Statistically significant differences were noted in the impact of COVID-19 on infection control and clinician well-being by hospital ownership, but no other differences were found, The COVID-19 pandemic had mixed impacts on most domains. Positive impacts were noted to some extent in patient safety and infection control, while waiting times for outpatients and clinicians’ well-being were more likely to be negatively influenced. The most common topics which were advanced during the COVID-19 pandemic were infection control, performance in national quality indicators, reporting of adverse events and near-miss events and care of diabetes, patient and family support in the COVID-19 unit, care in the emergency department, care of labor and delivery, supplying information for patients and the development of online services and telemedicine.

P012Acceptability of self-managed medication abortion using misoprostol-alone provided via a hybrid telemedicine and pharmacy pick-up model in the US

<h3>Objectives</h3> To examine the acceptability of self-managed medication abortion using misoprostol-alone acquired from an online or local pharmacy in the US. <h3>Methods</h3> Between November and December 2021, we conducted 32 semi-structured in-depth interviews with individuals who used misoprostol-alone to self-manage an abortion in June 2020. We recruited participants from Aid Access, an online telemedicine organization that provided self-managed abortion assistance and prescriptions for misoprostol from a local or online pharmacy for eligible people in all 50 states. Interviews were transcribed and thematically coded to assess individual satisfaction with acquiring and using misoprostol. <h3>Results</h3> Participants were initially hesitant to trust Aid Access, but having a pharmacy prescription sent by a physician legitimized the service. From internet searches and previous abortion experiences, participants had extensive knowledge of misoprostol's efficacy and utility. Participants who used the in-person pharmacy pick-up model had both confidence in the familiarity of the process and concerns about intrusive questioning from the pharmacist. Although rare, some did experience pharmacist pushback or refusal. Participants who used the online pharmacy model were concerned about shipping times but had positive and informative interactions with the pharmacists. Across both models, participants desired more extensive options for emotional support. <h3>Conclusions</h3> Participants had high levels of knowledge about misoprostol and familiarity with the pharmacy as a healthcare institution. Despite some unmet emotional needs and negative encounters with pharmacists, overall, this process was acceptable to participants and has the potential to expand medication abortion access in the restrictive policy landscape of the US.

The First Case Series From Japan of Primary Headache Patients Treated by Completely Online Telemedicine.

Background Since March 2020, the coronavirus disease 2019 pandemic has increased the need for telemedicine to avoid in-person consultations. Online clinics for most diseases officially started in Japan in April 2022. Here, we report the cases of eight Japanese headache patients treated by completely online telemedicine for three months from the first visit. Methodology From the medical records between July 2022 and October 2022, we retrospectively investigated eight consecutive first-visit primary headache patients who consulted our online headache clinic via telemedicine and continued to see us via telemedicine only. The Headache Impact Test-6 (HIT-6) score, monthly headache days (MHD), and monthly acute medication intake days (AMD) were investigated over the observation period. Results A total of eight women were included, and the median (interquartile range) age was 30 (24-51) years. The median HIT-6 scores before, one, and three months after treatment were 63 (58-64), 54 (53-62), and 52 (49-54), respectively. MHD before, one, and three months after treatment were 15 (9-28), 12 (3-17), and 2 (2-8), respectively. AMD before, one, and three months after treatment were 10 (3-13), 3 (1-8), and 2 (0-3), respectively. Significant reductions in HIT-6 and MDH were observed three months after the initial consultation (p = 0.007 and p = 0.042, respectively). AMD was not significantly decreased at three months (p = 0.447). Conclusions This is the first report of Japanese patients treated by completely online telemedicine for three months from the first visit. HIT-6 and MDH can be significantly decreased at three months by only telemedicine. Online telemedicine is expected to be widely used to resolve unmet needs in headache treatment.

Requests for Self-managed Medication Abortion Provided Using Online Telemedicine in 30 US States Before and After the Dobbs v Jackson Women’s Health Organization Decision

This study assesses changes in online telemedicine requests to self-manage abortions with medications before vs after the Dobbs v Jackson Women’s Health Organization Supreme Court decision overturning Roe v Wade.

Some features of the coronavirus infection course in bronchial asthma patients

The outbreak of a new coronavirus infection was officially recognized by the World Health Organization as a global pandemic since March 11, 2020. The pandemic is currently gradually receding, the number of patients is also steadily decreasing. However, these circumstances are not grounds to believe that the virus has been definitively and irrevocably defeated. For this reason, the world medical community is still concerned about the coronavirus impact on the course and outcome of various chronic bronchopulmonary diseases. Bronchial asthma has been recognized as one of the leading forms of human somatic pathology throughout the history of mankind and medicine. It is quite natural that the focus of the researchers' attention turned out to be questions about the SARS-CoV-2 virus impact on patients suffering from bronchial asthma, starting with the peculiarities of the course of combined pathology and ending with the peculiarities of therapy and subsequent rehabilitation. The issues of coronavirus infection and bronchial asthma pathogenesis were considered. The research data on some features of the development and course of a new coronavirus infection in patients with this profile were analyzed and summarized. The low coronavirus infection prevalence among patients with an allergic bronchial asthma form compared with other phenotypes is shown among such features, data on the effect of eosinophilia on the course of infection are presented, and the basic therapys positive effect using inhaled glucocorticosteroids and/or monoclonal antibodies (biological therapy) in severe asthma, is shown in the form of a protective effect that provides a lighter coronavirus infection course. The main features of patient management suffering from bronchial asthma in the conditions of a pandemic are the organization of stable medical control in online telemedicine once monthly, regular examinations in accordance with the severity of the course of the disease and the correction of basic therapy to achieve complete control over the course of asthma.

The Impact of COVID-19 on the Daily Life and Medical Practice of Otolaryngology Physicians.

Introduction The coronavirus disease 2019 (COVID-19) has made otolaryngologists more susceptible than their counterparts to its effect. Objective This study aimed to find if COVID-19 had a different impact on ear, nose, and throat (ENT) physicians' of various categories (residents, registrars, and consultants ) regarding many aspects of the quality of life (protection, training, financial, and psychological aspects). Methods We included 375 ENT physicians, of different categories (residents, registrars, and consultants), from 33 general hospitals and 26 university hospitals in Egypt. The study was conducted using a 20-item questionnaire with a response scale consisting of three categories: yes, no, and not sure. It covered infection control and personal protective equipment (PPE) usage; medical practice and safety; online consultation and telemedicine,; webinars and online lectures; COVID-19 psychological, financial, and quarantine period effects; and future expectations. Results The results of the questionnaire showed that COVID-19 had a statistically significant impact on the daily life of the responders. There were statistically significant differences among the three involved categories, based on their answers. Conclusion This study showed a statistically significant difference regarding the impact of COVID-19 on many aspects of the quality of life (protection, training, financial, and psychological aspects) of ENT physicians of various categories (residents, registrars, and consultants), and these effects may persist for a long time.