Remote Assessment Research Articles

Neuro-oncology anywhere: A decentralized approach to clinical trials in brain tumors and beyond.

TPS1647 Background: The majority of patients with primary and secondary central nervous system (CNS) malignancy develop cognitive impairment, fatigue, and mood-related symptoms. Radiotherapy has been shown to contribute to symptom burden often limiting quality of life and functional status. The development of interventions mitigating neurocognitive toxicity requires an accurate assessment of function and symptom burden. Formal neuropsychological evaluation is resource and time intensive, and often challenging to incorporate in routine clinical practice. There is a critical need to accurately assess cognition without causing undue burden to cancer patients while evaluating the efficacy of interventions that can be scaled and implemented at a population level. Methods: To adequately assess the neurocognitive function and related symptoms in patients with CNS malignancy we have designed an open-label decentralized clinical trial that will randomize patients who received intracranial radiation for primary or metastatic brain tumors in a 1:1 allocation to a therapy targeting radiation-related toxicity (metformin shipped to patient home) plus health promotion with a wearable device vs. health promotion with a wearable device alone. Participants will be stratified based on tumor type (glioblastoma vs. other glioma vs. brain metastases vs. meningioma) and age (<70 vs. 70+ years). Participants will be provided a wearable device for monitoring health status. Participants will undergo serial remote cognitive assessments with the Mayo Test Development Through Rapid Iteration, Validation and Expansion platform (Mayo Test Drive). Remote reported symptom collection via patient surveys and remote neurologic examination by telehealth will also be incorporated. Cognitive assessments and symptom surveys will be designed for completion on a smartphone, tablet, or computer device. Health data will be collected from the wearable device, including the number of steps per day and sleep quality/duration. Participants receiving metformin will utilize device apps to report medication adherence and adverse events. Study-related laboratory assessments will be completed remotely and transmitted electronically. This decentralized clinical trial will provide real-world cognitive and quality-of-life data for patients with primary and metastatic brain tumors while providing preliminary data on the effectiveness of device-based health promotion with or without metformin for treating radiation-related cognitive decline. Results gained from this study will guide future trials in neuro-oncology and other fields. This study is expected to open in March 2024.

Adoption of decentralized trial elements in cancer clinical trials supporting FDA approvals during COVID-19.

e13802 Background: The COVID-19 pandemic significantly disrupted the conduct of cancer clinical trials. Facilitated by emergency FDA guidance, many sponsors integrated decentralized clinical trial (DCT) elements to prioritize patient safety and maintain access. The FDA’s Oncology Center of Excellence, in collaboration with the Clinical Trials Transformation Initiative (CTTI), assessed the adoption of DCT elements in registrational cancer clinical trials conducted during the pandemic that resulted in an FDA approval. Methods: CTTI sent trial sponsors a recruitment email with a link to an online survey and the name of the trial that resulted in an FDA approval. Sponsors were asked to select the DCT elements used in that trial prior to and in response to the pandemic, challenges faced when implementing these approaches, and the likelihood of using the approaches in the future. Data were collected from December 6, 2022 to January 17, 2023. Descriptive statistics were used to summarize sponsor responses. Results: Out of 52 eligible studies, 19 surveys were completed from 13 unique sponsors (37%; 12 pharmaceutical companies and 1 chose not to disclose). Sixty-three percent of sponsors identified as a large pharmaceutical company with a market cap of over $10 billion. The majority of cancer clinical trials (89%) occurred both in the United States and abroad, with almost all sponsors (95%) incorporating at least one DCT element during the pandemic. The most widely adopted DCT elements were remote site monitoring (89%), telemedicine (68%), remote laboratory assessments (63%), remote distribution of investigational product (58%) and local imaging assessments (47%). The main challenges in implementing DCT elements included site institutional policies (83%), site challenges with technology adoption (61%) and site regulatory restraints (56%). Many sponsors intend to incorporate some degree of decentralization in future cancer clinical trials, with remote site monitoring (95%), remote collection of patient-reported outcomes (68%), telemedicine (68%), and electronic informed consent (58%) being deemed "highly likely" or "likely" for future adoption. Conclusions: The COVID-19 pandemic accelerated the use of DCT elements in cancer clinical trials. This study represents the first systematic evaluation of the use of DCT elements in cancer clinical trials intended for regulatory submission and provides proof of concept that cancer trials with DCT elements can generate data suitable for FDA review and marketing approval. The appropriate use of DCT elements holds promise to expand clinical trial access and reduce patient burden. Further characterization and mitigation of clinical site-level challenges is warranted to encourage continued adoption of DCT elements in cancer clinical trials.

Usability and feasibility of the open-source GeRI platform for remote assessments in older adults with prostate cancer.

e13664 Background: The Geriatric Remote Initiative (GeRI) is an open-source tool to collect patient-generated health data for older adults with cancer. It comprises a WiFi-enabled Raspberry Pi tablet, a Bangle.js 2 wrist accelerometer, and Mi Body Composition Scale 2 for data collection. Following the initial phase where feedback from older cancer survivors and caregivers refined a demonstration GeRI platform, this study deployed a live version of GeRI in advanced prostate cancer patients to evaluate its feasibility and usability. Methods: In this single-arm pilot feasibility and usability study, we evaluated GeRI among ten advanced prostate cancer patients aged ≥65 years undergoing androgen deprivation (ADT) across varied frailty risk categories. Participants interacted with GeRI for ≥12 weeks. Data collection comprised demographics, clinical information, and vulnerability assessment (Cancer and Aging Research Group [CARG] score) from in-clinic surveys. Biometric (wearable/scale) and electronic patient-reported outcomes data from the tablet were securely transmitted to the institution’s HIPAA-compliant cloud. Usability was evaluated using the System Usability Scale (SUS), aiming for an average score of 68 or higher. Feasibility was achieved if ≥6 participants completed at least 50% of all prompted interactions with the system components (surveys, wearable, and weight/bioimpedance) throughout a 12-week study period. Results: Ten men with metastatic hormone-sensitive prostate cancer [median age: 73 years; 40% minority; median of 3 months of ADT exposure (IQR: 2-4.5); 80% had intensified ADT with 60% getting concurrent prostate-directed radiation] engaged with GeRI for a median of 104 days (IQR: 93-131). 40% were vulnerable with a CARG>5. System usability, evaluated by SUS, yielded a mean score of 84 (SD: 12.5). All participants met the feasibility criterion. Deficiencies in obtaining complete 48-hour accelerometry data from 7 participants were noted with only 1 being due to persistent non-wear of the wearable and the remainder due to transmission failure. Conclusions: The GeRI platform exhibited exceptional usability and met all feasibility benchmarks in a geriatric oncology setting, highlighting its potential despite technical hurdles in accelerometry data collection. Further deployment of GeRI is underway [or planned] through an expanded program focusing on other cancer types, including head and neck, and more robust biometric data collection.

Continuous Associations between Remote Self-Administered Cognitive Measures and Imaging Biomarkers of Alzheimer’s Disease

BackgroundEasily accessible and self-administered cognitive assessments that can aid early detection for Alzheimer’s disease (AD) dementia risk are critical for timely intervention.Objectives/DesignThis cross-sectional study investigated continuous associations between Mayo Test Drive (MTD)–a remote, self-administered, multi-device compatible, web-based cognitive assessment–and AD-related imaging biomarkers.Participants/Setting684 adults from the Mayo Clinic Study of Aging and Mayo Clinic Alzheimer’s Disease Research Center participated (age=70.4±11.2, 49.7% female). Participants were predominantly cognitively unimpaired (CU; 94.0%).MeasurementsParticipants completed (1) brain amyloid and tau PET scans and MRI scans for hippocampal volume (HV) and white matter hyperintensities (WMH); (2) MTD remotely, consisting of the Stricker Learning Span and Symbols Test which combine into an MTD composite; and (3) in-person neuropsychological assessment including measures to obtain Mayo Preclinical Alzheimer’s disease Cognitive Composite (Mayo-PACC) and Global-z. Multiple regressions adjusted for age, sex, and education queried associations between imaging biomarkers and scores from remote and in-person cognitive measures.ResultsLower performances on MTD were associated with greater amyloid, entorhinal tau, and global tau PET burden, lower HV, and higher WMH. Mayo-PACC and Global-z were associated with all imaging biomarkers except global tau PET burden. MCI/Dementia participants showed lower performance on all MTD measures compared to CU with large effect sizes (Hedge’s g’s=1.65–2.02), with similar findings for CU versus MCI only (Hedge’s g’s=1.46–1.83).ConclusionMTD is associated with continuous measures of AD-related imaging biomarkers, demonstrating ability to detect subtle cognitive change using a brief, remote assessment in predominantly CU individuals and criterion validity for MTD.

Outcome After Self-Triage App Referral in Urgent Direct-to-Consumer Telemedicine Encounter.

Background: The quantification of self-triage effectiveness, guided by mobile applications, in urgent direct-to-consumer telemedicine (TM) encounters requires further investigation. The objective of this study was to evaluate the outcomes of referral guidance provided by a symptom-based self-management mobile application decision algorithm in the context of remote urgent care assessments. Methods: An observational retrospective single-center study was conducted from May 2022 to December 2023. The inclusion criteria encompassed individuals aged >18 years old, and those spontaneously seeking virtual emergency care through the EINSTEIN CONECTA application. Patients experiencing connectivity issues, preventing completion of the encounter, were excluded. The primary outcomes included the rate of patient concurrence with the algorithm's recommendation for seeking in-person emergency care and the referral rate to face-to-face assessment among cases evaluated through TM. The application's algorithm employs scientific evidence based on symptoms to recommend referrals to emergency departments (EDs). Results: Out of 88,834 patients connected to the TM Center, self-triage obviated the need for virtual physician assessment in 53,302 (60%) encounters. A total of 35,532 patients were remotely evaluated by 316 on-duty physicians, resulting in 1,125 ICD-coded diagnoses. Among these, 21,722 (61.1%) were initially advised by self-triage to visit the ED, with subsequent medical assessment leading to in-person referrals in 6,354 (29.3%) of the evaluations. Of the 13,810 patients recommended to continue with virtual care post-self-triage, 157 (1.1%) were referred for in-person assessment. Conclusions: Self-triage effectively reduced the need for physician encounters in approximately three-fifths of TM consultations. Despite being based on scientific evidence, symptom-based referral algorithms demonstrated high sensitivity but poor correlation with physician decision-making.

TELEMONITORING IN PATIENTS WITH CHRONIC HEART FAILURE: EXPERIENCE FROM THE TELECUORE PROJECT IN PIACENZA

Abstract Background Starting from February 2023, the Piacenza’s Hospital has approved the use of a cardiological telemonitoring system called ‘TeleCuore’ project. This system, through the monitoring of various vital parameters which are frequently sent by patients via a dedicated platform, allows for remote assessment of the clinical status of 250 individuals with chronic heart failure (CHF). Objectives The objective of this study is to analyze the number and nature of alerts in the data sent by patients and the consequences on patient’s management derived from the alerts received through the telemedicine system. Materials and Methods 250 patients with CHF identified following recent episodes of clinical instability have been equipped with a home monitoring device (Adilife system). This involves collecting the following data: body weight, temperature, blood pressure, heart and respiratory rate, oxygen saturation, and single–lead EKG. These data are daily filtered by perfusionist technicians (TFCPC) and dedicated nurses, reviewed by the Case Manager and cardiologists. In case of recognition of altered parameters, the platform generates alerts according to pre–set clinical parameters, enabling proactive and personalized interventions on patients. In the 9 months of the TeleCuore project, 494 alerts were received, with 119 (24%) judged not clinically relevant, while 375 (76%) required operator intervention. Of these, 99 were due to weight gain (26%), 40 to low blood pressure (11%), 42 to high blood pressure (11%), 33 to tachycardia episodes (9%), 30 to bradycardia (8%), 49 for technic issues with the weight scale (13%), 78 for EKG artifacts (21%), and 4 for previously unknown atrial fibrillation (1%). 25 patients (8%) were invited for ambulatory clinical evaluation, 28 (7%) were managed through teleconsultation, and the remaining majority (85%) was handled via telephone contact for therapy adjustments (60.5%). 39.4% underwent re–training on the correct device use in the first month. Conclusions The TeleCuore Project is a pilot cardiological telemedicine initiative. Initial data confirm the utility of this system in optimizing the follow–up of patients with CHF, allowing for instant therapeutic adjustments based on the patient’s clinical progress. Teamwork of different healthcare professionals have emerged as crucial for the proper management of alerts. Further data will be needed to assess whether TeleCuore also helps reduce hospitalizations related to CHF.

999 telephone triage: a comparison of UK ambulance nurse and paramedic case mix, outcomes and audit compliance

PurposeMost UK ambulance services undertake remote assessments of 999 calls with nurses and paramedics to manage demand and reduce inappropriate hospital admissions. However, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they offer.Design/methodology/approachThe retrospective descriptive study analysed data collected at Welsh Ambulance Services University NHS Trust (WAST) from prioritisation, triage, and audit tools between the 17th May 2022 to 8th November 2022. A total of 21,076 cases and 728 audits were included for review.FindingsThere was little difference in the type and frequency of the presenting complaints assessed, and clinical outcomes reached in percentage terms. Whilst paramedics had more highly compliant call audits and fewer non-compliant call audits, there was, again, little difference in percentage terms between the two, indicating positive levels of safety across the two professional groups.Research limitations/implicationsThere continues to be a substantial difference between UK paramedics to those in the Middle East, the United States, and some African nations, which may limit the applicability of findings. This study also looked at a six-month window from only one UK service using one type of prioritisation and triage tool. Future research could explore longer periods from multiple services using various tools. It is important to note that this study did not link outcome data with primary, secondary or tertiary care settings. Thus, it is impossible to determine if the level of care aligned closely with the final diagnosis.Practical implicationsThe practical implications of this work include better workforce planning for agencies who have perhaps only employed one type of clinician or a reaffirmation to those who have employed both. The authors suggest that the training and education of both sets of clinicians could remain general in nature, with no overt requirement for specificity based on professional registration alone. Commissioners and stakeholders in the wider health economy should consider ensuring equitable access to alternative pathways for patients assessed by both nurses and paramedics.Social implicationsIt has been posited that UK nurses and paramedics are, by virtue of their consistency in education, skill set, licensure, and general experience, both able to achieve safe and effective remote outcomes in 999 settings. This study provides evidence to support that hypothesis. These results say more about the two professions' ability to work together rather than just the professions themselves. The multidisciplinary team approach is well-established in acute care settings, and is broadly considered to improve communication, coordination decision making, adherence to up-to-date treatment recommendations, and be positive for shared learning and development for younger colleagues.Originality/valueMost UK services use a mix of nurses and paramedics; however, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they each offer. The most recent studies of this nature were published in 2003 and 2004 and looked only at low-acuity 999 calls when remote assessment was not even an established role for UK paramedics. This study updates the literature, identifies areas for future research, and applies to the international setting for the most part.

Examining a Preclinical Alzheimer's Cognitive Composite for Telehealth Administration for Reliability Between In-Person and Remote Cognitive Testing with Neuroimaging Biomarkers.

The preclinical Alzheimer's cognitive composite (PACC) was developed for in-person administration to capture subtle cognitive decline. At the outset of the COVID-19 pandemic, cognitive testing was increasingly performed remotely by telephone or video administration. It is desirable to have a harmonized composite measurement derived from both in-person and remote assessments for identifying cognitive changes and to examine its relationship with common neuroimaging biomarkers. We defined a telehealth compatible PACC (tPACC) and examined its relationship with neuroimaging biomarkers related to neurodegeneration, brain function and perfusion, white matter integrity, and amyloid-β. We examined 648 participants' neuroimaging and in-person and remote cognitive testing data from the Wake Forest Alzheimer's Disease Research Center's Clinical Core cohort (observational study) to calculate a modified PACC (PACC5-RAVLT) score and tPACC scores (in-person and remote). We performed Spearman/intraclass correlation coefficient (ICC) analyses for reliability of tPACC scores and linear regression models to evaluate associations between tPACC and neuroimaging. Bland-Altman plots for agreement were constructed across cognitively normal and impaired (mild cognitive impairment and dementia) participants. There was a significant positive relationship between tPACCin-person and PACC5-RAVLT (Overall group: r2 = 0.94, N = 648), and tPACCin-person and tPACCremote (validation subgroup: ICC = 0.82, n = 53). Overall, tPACC showed significant associations with brain thickness/volume, gray matter perfusion, white matter free water, and amyloid-β deposition. There is a good agreement between tPACCand PACC5-RAVLTfor cognitively normal and impaired individuals. The tPACC is associated with common neuroimaging markers of Alzheimer's disease.

Quality and safety actions in primary care practices in COVID-19 pandemic: the PRICOV-19 study in Spain

BackgroundPrimary Health Care (PHC) has been key element in detection, monitoring and treatment of COVID-19 cases in Spain. We describe how PHC practices (PCPs) organized healthcare to guarantee quality and safety and, if there were differences among the 17 Spanish regions according to the COVID-19 prevalence.MethodsCross-sectional study through the PRICOV-19 European Online Survey in PCPs in Spain. The questionnaire included structure and process items per PCP. Data collection was due from January to May 2021. A descriptive and comparative analysis and a logistic regression model were performed to identify differences among regions by COVID-19 prevalence (low < 5% or high ≥5%).ResultsTwo hundred sixty-six PCPs answered. 83.8% of PCPs were in high prevalence regions. Over 70% PCPs were multi-professional teams. PCPs attended mainly elderly (60.9%) and chronic patients (53.0%). Regarding structure indicators, no differences by prevalence detected. In 77.1% of PCPs administrative staff were more involved in providing recommendations. Only 53% of PCPs had a phone protocol although 73% of administrative staff participated in phone triage. High prevalence regions offered remote assessment (20.4% vs 2.3%, p 0.004) and online platforms to download administrative documents more frequently than low prevalence (30% vs 4.7%, p < 0.001).More backup staff members were hired by health authorities in high prevalence regions, especially nurses (63.9% vs 37.8%, p < 0.001. OR:4.20 (1.01-8.71)). 63.5% of PCPs provided proactive care for chronic patients. 41.0% of PCPs recognized that patients with serious conditions did not know to get an appointment.Urgent conditions suffered delayed care in 79.1% of PCPs in low prevalence compared to 65.9% in high prevalence regions (p 0.240). A 68% of PCPs agreed on having inadequate support from the government to provide proper functioning. 61% of high prevalence PCPs and 69.5% of low ones (p: 0.036) perceived as positive the role of governmental guidelines for management of COVID-19.ConclusionsSpanish PCPs shared a basic standardized PCPs’ structure and common clinical procedures due to the centralization of public health authority in the pandemic. Therefore, no relevant differences in safety and quality of care between regions with high and low prevalence were detected. Nurses and administrative staff were hired efficiently in response to the pandemic. Delay in care happened in patients with serious conditions and little follow-up for mental health and intimate partner violence affected patients was identified. Nevertheless, proactive care was offered for chronic patients in most of the PCPs.

Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design.

The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.

Improving Outcomes for Vulnerable Children and Families: Applying what We Learned About the COVID-19 Pandemic and Child Maltreatment.

In this special issue, innovative research teams expanded work on the effects of the COVID-19 pandemic and lockdowns on child maltreatment by assessing these effects on treatment and service delivery following maltreatment, on the professionals responsible for identification and treatment, and on the systems responsible for oversight and instruction. One theme that emerged across these studies concerned challenges faced by professionals as they attempted to evaluate families and provide service and support. Organizational leadership was crucial in helping these professionals navigate challenges in a positive and productive manner. A second theme concerned remote service delivery. Findings suggested that remote maltreatment assessments, treatment, and court procedures all worked to some degree. Thus, despite the massive social disruption caused by the pandemic and lockdowns, parents, professionals, and systems were able to adapt and address core needs of children and families. In future work, it may be important to consider how these findings and their implications vary depending on the type of maltreatment children experienced. Doing so would allow for more nuanced understanding of the consequences of significant national and global crises on child maltreatment and would enable clearer recommendations regarding how best to protect children and support families during such events.

A Comparison of In-Person and Remote Administration Results of the SCAN–3 for Adolescents and Adults: Tests for Auditory Processing Disorders Screening Subtests

Purpose: Many standardized assessments in speech-language pathology can be administered via telepractice. However, the literature is limited on reporting the equivalency of assessment administration between in-person and remote testing. The SCAN–3 for Adolescents and Adults: Tests for Auditory Processing Disorders (SCAN-3:A) is widely used by speech-language pathologists and audiologists to screen for auditory processing disorder (APD). The purpose of this study was to compare in-person and remote administration results on the screening subtests of the SCAN-3:A to determine test–retest consistency across the two settings. Method: Eleven undergraduate and graduate students with normal hearing were administered the Gap Detection, Competing Words–Free Recall (CW-FR) and Auditory Figure Ground (AFG) screening subtests from the SCAN-3:A both in-person and via telepractice with the order counterbalanced across administrations. Specific modifications were made to accommodate remote assessment. Results: Screening pass/fail decisions were above 80% agreement for each of the three subtests. Significant correlations ( p &lt; .05) between in-person and remote scores were found for the CW-FR and AFG subtests. The mean score difference between administration type was not significant for the CW-FR subtest ( p = .921) but was significant for the AFG subtest ( p &lt; .05). Conclusions: These preliminary findings provide tentative, partial support for remote administration of the SCAN-3:A with adherence to specific recommendations. Some technical challenges were reported as well as other logistical limitations associated with remote administration. Recommendations to accommodate telepractice considerations for remote screening of APD are provided. Supplemental Material: https://doi.org/10.23641/asha.25632135

Artificial intelligence to automate assessment of ocular and periocular measurements.

To develop and validate a deep learning facial landmark detection network to automate the assessment of periocular anthropometric measurements. Patients presenting to the ophthalmology clinic were prospectively enrolled and had their images taken using a standardised protocol. Facial landmarks were segmented on the images to enable calculation of marginal reflex distance (MRD) 1 and 2, palpebral fissure height (PFH), inner intercanthal distance (IICD), outer intercanthal distance (OICD), interpupillary distance (IPD) and horizontal palpebral aperture (HPA). These manual segmentations were used to train a machine learning algorithm to automatically detect facial landmarks and calculate these measurements. The main outcomes were the mean absolute error and intraclass correlation coefficient. A total of 958 eyes from 479 participants were included. The testing set consisted of 290 eyes from 145 patients. The AI algorithm demonstrated close agreement with human measurements, with mean absolute errors ranging from 0.22 mm for IPD to 0.88 mm for IICD. The intraclass correlation coefficients indicated excellent reliability (ICC > 0.90) for MRD1, MRD2, PFH, OICD, IICD, and IPD, while HPA showed good reliability (ICC 0.84). The landmark detection model was highly accurate and achieved a mean error rate of 0.51% and failure rate at 0.1 of 0%. The automated facial landmark detection network provided accurate and reliable periocular measurements. This may help increase the objectivity of periocular measurements in the clinic and may facilitate remote assessment of patients with tele-health.

The value of a remote orthodontic assessment for children having permanent teeth extracted under general anaesthesia.

Introduction The number of children undergoing dental extractions under general anaesthetic (GA) remains high. The newly published Royal College of Surgeons guidelines in 2023 take a less prescriptive approach on balancing and compensating extractions for first permanent molars. In an effort to maintain an effective and efficient patient care pathway, an orthodontic remote assessment triage model was developed in West Dorset for the special care dentistry and community dental service.Aims The orthodontic triage form is now used across Dorset. This service evaluation assesses whether the form is still effective despite the upscaling. Furthermore, qualitative feedback was obtained from the clinicians involved in referring and triaging.Design The sample of 352 forms consisted of children aged 16 years or younger undergoing GA for dental extractions for whom orthodontic triage had been requested between March 2019 and March 2023. The clinician feedback was collected using a questionnaire.Results This service evaluation found that 53.1% of patients had their treatment plan modified following an orthodontic assessment. Positive feedback from all clinicians involved suggests there is potential to expand this model to other services.Discussion Involving the orthodontist can address orthodontic concerns which has the potential to simplify or obviate the need for future orthodontic treatment. Remote assessment reduces the need for face-to-face appointments. The clinician perspective influences willingness to further develop and expand the current pathway.Conclusion Remote triage has proved successful in Dorset. There is potential to build an initiative between primary and secondary care in the hopes of creating a universal national proforma to increase access to orthodontic opinions for children requiring dental extractions.

A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series.

Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y). A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure. The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low. The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.

The relationship between working memory and anxiety in individuals with early treated phenylketonuria (PKU).

Although early diagnosis and treatment prevent the severe impairments associated with untreated phenylketonuria (PKU), individuals with early treated PKU (ETPKU) nonetheless experience significant neurocognitive and psychological sequelae, including difficulties in working memory (WM) and increased risk of anxiety. The primary objective of the present study was to examine the extent to which anxiety may moderate the relationship between ETPKU and WM performance. A sample of 40 adults with ETPKU and a demographically comparable sample of 40 healthy adults without PKU completed a comprehensive assessment of WM performance and anxiety symptomatology. Data were collected using a variety of remote assessment methods (e.g., web-based neurocognitive tests, semistructured interview, report-based measures). The ETPKU group demonstrated significantly poorer WM performance as compared to the non-PKU group. The groups did not differ significantly in anxiety; however, high anxiety was more common in the ETPKU group (53% of sample) than the non-PKU group (33%). A significant interaction between anxiety, metabolic control (as reflected by Phe levels), and WM performance was observed for the ETPKU group. Individuals with high anxiety and/or high Phe levels (> 360 μmol/L) performed poorer than the non-PKU group. Individuals with low anxiety and relatively low Phe levels (< 360 μmol/L) performed comparably to the non-PKU group. Anxiety was found to moderate the relationship between Phe levels and WM performance in individuals with ETPKU. This finding underscores the importance of accounting for anxiety when evaluating neurocognitive performance in individuals with ETPKU whether for research or clinical purposes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Internet of Things-Enabled Patch With Built-in Microsensors and Wireless Chip: Real-Time Remote Monitoring of Patch Treatment.

We aimed to design, develop, and evaluate an internet of things-enabled patch (IoT patch) for real-time remote monitoring of adherence (or patch wear time) during patch treatment in child participants in clinical trials. This study provides healthcare providers with a tool for objective, real-time, and remote assessment of adherence and for making required adjustments to treatment plans. The IoT patch had two temperature microsensors and a wireless chip. One sensor was placed closer to the skin than the other, resulting in a temperature difference depending on whether the patch was worn. When the patch was worn, it measured temperatures every 30 seconds and transmitted temperature data to a cloud server via a mobile application every 15 seconds. The patch was evaluated via 2 experiments with 30 healthy adults and 40 children with amblyopia. Excellent monitoring accuracy was observed in both adults (mean delay of recorded time data, 0.4 minutes) and children (mean, 0.5 minutes). The difference between manually recorded and objectively recorded patch wear times showed good agreement in both groups. Experiment 1 showed accurate monitoring over a wide range of temperatures (from 0 to 30°C). Experiment 2 showed no significant differences in wearability (ease-of-use and comfort scores) between the IoT and conventional patches. The IoT patch offers an accurate, real-time, and remote system to monitor adherence to patch treatment. The patch is comfortable and easy to use. The utilization of an IoT patch may increase adherence to patch treatment based on accurate monitoring. Results show that the IoT patch can enable real-time adherence monitoring in clinical trials, improving treatment precision, and patient compliance to enhance outcomes.

Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease

IntroductionReliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. MethodsTwelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. ResultsThe results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. ConclusionFurthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.

Colorimetric Quick Response (QR) Tags and Other Time-Temperature Indicators (TTIs) for Remote Quality Assessment: Theoretical Kinetics Aspects

Colorimetric Quick Response (QR) Tags and Other Time-Temperature Indicators (TTIs) for Remote Quality Assessment: Theoretical Kinetics Aspects

Continual Monitoring of Respiratory Disorders to Enhance Therapy via Real-Time Lung Sound Imaging in Telemedicine

This work presents a configurable Internet of Things architecture for acoustical sensing and analysis for frequent remote respiratory assessments. The proposed system creates a foundation for enabling real-time therapy and patient feedback adjustment in a telemedicine setting. By allowing continuous remote respiratory monitoring, the system has the potential to give clinicians access to assessments from which they could make decisions about modifying therapy in real-time and communicate changes directly to patients. The system comprises a wearable wireless microphone array interfaced with a programmable microcontroller with embedded signal conditioning. Experiments on the phantom model were conducted to demonstrate the feasibility of reconstructing acoustic lung images for detecting obstructions in the airway and provided controlled validation of noise resilience and imaging capabilities. An optimized denoising technique and design innovations provided 7 dB more SNR and 7% more imaging accuracy for the proposed system, benchmarked against digital stethoscopes. While further clinical studies are warranted, initial results suggest potential benefits over single-point digital stethoscopes for internet-enabled remote lung monitoring needing noise immunity and regional specificity. The flexible architecture aims to bridge critical technical gaps in frequent and connected respiratory function at home or in busy clinical settings challenged by ambient noise interference.