Telehealth Devices Research Articles

0603 Transforming Obstructive Sleep Apnea Treatment: Telehealth and Mandibular Advancement Devices

0603 Transforming Obstructive Sleep Apnea Treatment: Telehealth and Mandibular Advancement Devices

INTEGRATIVE HEALTHCARE APPROACHES FOR CHILDREN WITH SPECIAL NEEDS: A HOLISTIC STUDY ON CHALLENGES AND SOLUTIONS

This study delves into the intricate healthcare landscape for children with special needs, shedding light on the multifarious challenges these individuals face and evaluating the effectiveness of integrative healthcare models tailored to their unique requirements. Conducted at Sekolah Kebangsaan Pendidikan Khas Kuantan, this cross-sectional qualitative analysis involved detailed surveys with 20 teachers and engaging discussions with 24 students, aiming to unravel the complexities of providing holistic care to this vulnerable population. The investigation meticulously identifies pivotal concerns such as the prevalence of behavioral issues, particularly in autistic children, who often exhibit aggressive and self-injurious behaviors, and the struggles encountered by hearing-impaired students in communication and learning. It further explores the susceptibility of these children to frequent infections due to immune system dysfunction, exacerbated by dietary imbalances and physical inactivity. The research emphasizes the indispensable role of early detection and intervention in mitigating health risks and outlines the significance of specialized supplements, medications, and rigorous oral hygiene practices in maintaining the overall well-being of these children. Additionally, the study brings to the forefront the critical impact of socioeconomic factors on healthcare access, advocating for equitable healthcare solutions. It also highlights the transformative potential of technology, including telehealth and assistive devices, in overcoming barriers to healthcare and education. Through this analysis, the study advocates for a comprehensive, integrative care approach that encompasses medical, educational, social, and psychological services, underscoring the necessity of collaborative efforts among healthcare providers, educators, and families to significantly enhance the quality of life and well-being of children with special needs.

Handwriting intervention effectiveness via telehealth delivery

ABSTRACT Background Handwriting improvements have been found to improve foundational academic literacy skills. As telehealth usage has increased, the effectiveness of delivering handwriting interventions using telehealth has not been researched. The additional literacy benefits of handwriting interventions delivered via telehealth have also not been examined. Purpose This repeated baseline case series sought to determine the effectiveness and feasibility of the Handwriting Without Tears® (HWT) program via telehealth delivery for handwriting and spelling outcomes for children who present with handwriting and/or spelling delays. Methods A repeated pretest and posttest design was used. The Test of Handwriting Skills-Revised was used to assess handwriting quality and speed. The Test of Written Spelling-5 was used to evaluate spelling. Participants completed 7 synchronous HWT telehealth visits with 14 asynchronous visits offered. Findings Significant gains in handwriting speed were observed. Participants had insignificant changes in handwriting quality and spelling. Satisfaction, consistent attendance, and minimal accommodations required to translate the HWT program to telehealth were noted. However, technological issues and the impact of telehealth devices were also observed. Conclusion Results indicate that handwriting interventions delivered via telehealth can improve handwriting speed; however, further research is warranted to determine if this modality improves handwriting quality and spelling delivered.

Nurse-led telehealth intervention effectiveness on reducing hypertension: a systematic review

BackgroundHypertension is a public health concern for many countries. The World Health Organization has established a global objective to reduce the prevalence of non-communicable diseases, including hypertension, which is associated with cardiovascular disease. Remote nursing interventions can potentially lessen the burden on the healthcare system and promote a healthier population. This systematic review aims to synthesize available evidence on the effectiveness of nursing-led telehealth interventions in reducing blood pressure in hypertensive patients.MethodsA systematic review was conducted. The search was performed from May to June 2021, in the databases: PubMed, Scopus, Cochrane Library, Web of Science, CINAHL, and ProQuest within 2010–2021 in English, Spanish and Portuguese. Randomized controlled trials and Quasi-experimental studies were considered. This systematic review followed the criteria of the Cochrane Handbook for Systematic Reviews of Interventions, with the support of the PRISMA guidelines and registered in PROSPERO. For critical analysis, the tools of the Joanna Briggs Institute were used.ResultsOf the 942 articles found, six controlled clinical trials and one quasi-experimental study were selected. Different nurse-led interventions (telehealth devices, remote video consultation, calls and email alerts) have demonstrated a significant decrease in blood pressure (especially systolic blood pressure) in the intervention groups. Nurse-led interventions also effect hypertension awareness, self-efficacy, and self-control. Positive effects on lowering cholesterol, consumption of fruits and vegetables, physical activity and adherence to medication were also described.ConclusionNurse-led interventions delivered remotely have a positive effect in lowering the blood pressure of patients with hypertension. Further research is required to support strategies that will deliver the best continuous, quality, and cost-effective nursing care.

ASSESSING TELEHEALTH USE AMONG OLDER ADULTS WITH LIMITED RESOURCES DURING THE COVID-19 PANDEMIC

Abstract The COVID-19 pandemic created new barriers to accessing primary care services, particularly among older adults who has faced barriers related to access to care, transportation, health literacy, and social isolation. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics and a local community partner to conduct wellness calls to older adult patients identified through clinic EHR. This project aimed to provide educational and telehealth support to vulnerable adults with limited resources in the Tri-County region of Florida. Wellness calls were made to determine educational and technical support needs of the older adults designated as underprivileged. We identified 44 participants to receive telehealth devices. Samsung tablets were mailed with educational resources, developed by NSU SFGWEP related to COVID-19 pandemic. The information included health, vaccine education, and instructions to access telehealth services. They had the tablets for six months. We conducted bi-weekly calls to offer peer training to access the educational materials. The participants were asked a series of questions to assess the effectiveness of the peer training support. Among participants, 36% (n=16) found the education materials impactful. Most participants, 89% (n=39), used the tablet, and 23% (n=10) reported using it daily. 11% (n=5) used it for telehealth, 7% (n=3) to connect with friends and family, and 7% (n=3) to connect with faith. This pilot project suggests that tablets were beneficial in assisting the participants in accessing education materials and resources encouraging the use of telehealth appointments and eliminating some of the social isolation.

Building and implementing a contactless clinical trial protocol for patients with COVID-19: A Korean perspective.

IntroductionTo effectively manage patients with coronavirus disease 2019 (COVID-19) while minimizing contact between medical staff, clinical trial protocol that facilitates contactless patient management was designed to predict deterioration of disease condition and monitor mental health status.MethodsThrough consultation with infectious disease specialists and psychiatrists, this study identified main clinical indicators related to respiratory and non-respiratory outcomes, and mental health. Telehealth devices that could collect relevant data indicators were explored. The following three modes were identified: wearable devices, video calls, and online questionnaires. Clinical trial protocol was implemented to patients confirmed with COVID-19 infection and admitted to Seongnam residential treatment centers between September 1, 2021 and December 30, 2021. Data were collected from wearable devices, video calls, online questionnaires, and from electronic health records. Participant satisfaction was assessed through an online survey at the time of discharge.ResultsIn total, 120 asymptomatic and mildly symptomatic COVID-19 patients participated in this trial. Seven types of physiological and life log data were collected from 87 patients using wearable devices, video and audio recordings, and online mental health-related questionnaire. Most participants were satisfied with the overall trial process, but perceived difficulties in using telehealth devices.ConclusionThis trial collected simultaneously generated multimodal patient data using various telehealth devices in a contactless setting for COVID-19 patients. Data collected in this study will be used to build a remote patient management system based on the prediction algorithms.

The future of telemedicine and wearable technology in IBD.

Telemedicine has quickly become an essential part of modern healthcare, particularly in the management of chronic conditions like inflammatory bowel disease. The purpose of this review is to describe the current use of telehealth, mobile applications and wearable devices in inflammatory bowel disease and potential future applications. Telemedicine was increasingly used during the Coronavirus Disease 2019 pandemic. Virtual consultations allowed clinical care to continue despite pandemic-related restrictions without compromising the quality of care for patients with inflammatory bowel disease (IBD). It also benefits patients who would not have access to care due to financial or geographical barriers. Mobile applications allow patients with IBD to record disease activity among other metrics, allowing for earlier healthcare provider intervention. Wearable devices are increasingly being explored to monitor physiological indicators of disease activity and flare. Telehealth and remote patient monitoring has been successfully integrated into the care of IBD patients. The advantages of these modalities include better access to specialist care and remote noninvasive disease monitoring. Careful consideration must be given to patient privacy, data protection and equitable access. These modalities have enormous potential to improve patient care through accurate consistent data collection and even the prediction of disease activity.

Telehealth experiences of vulnerable clients living in Tasmania.

ObjectiveTo understand the experiences of vulnerable clients who used telehealth during the Coronavirus pandemic.DesignThe study employed a qualitative enquiry, utilising semi‐structured interviews lasting 30‐60 minutes with a thematic analysis approach to explore factors influencing client experience with telehealth.SettingA wide range of locations across Tasmania, Australia.ParticipantsTwelve participants who were considered to be vulnerable on a number of domains, including: health and human wellbeing factors, social risk factors, functional limitations, and individual behavioural factors.InterventionsThe provision of telehealth consultations to vulnerable clients.Main outcome measuresFour global themes were discovered: i) Telehealth saves time, money and energy; ii) User friendly technology facilitates care; iii) Rapport and confidentiality helps clients to feel safe; and iv) Fit for purpose telehealth provides a quality service.ResultsThe discovered themes entailed the major finding that most participants were satisfied with the overall quality of the telehealth service they received and the convenience of this service. Concerns were raised regarding the limitations around social interaction, physical examination, and access to fit‐for‐purpose telehealth devices.ConclusionThis research with vulnerable clients, from Tasmania, supports the evidence that the utilisation of telehealth allows more convenient access to care. To optimise the service, however, concerns regarding the desire for social interaction, appropriate physical examination, and access to fit‐for‐purpose telehealth devices will need to be addressed.

Stakeholder Power Analysis of the Facilitators and Barriers for Telehealth Solution Implementation in China: A Qualitative Study of Individual Users in Beijing and Interviews With Institutional Stakeholders.

BackgroundFacing COVID 19, the use of telehealth solutions grows exponentially. However, despite the large investments made into telehealth solutions, the implementation process remains slow and sluggish. Moreover, during COVID-19, older people experienced difficulties and had the highest mortality rates, and those lucky enough to survive faced tremendous pressure to use QR code-based health monitoring systems.ObjectiveThis paper aims to determine the barriers and incentives for the implementation of telehealth solutions via a case study about telehealth implementation in China.MethodsWe conducted 8 semi-structured interviews following the design of the interactive learning framework (research question defining, participant recruitment, exploratory stage, consultation stage, integration stage, and follow-up interview). One interview with a government official from the National Health Commission and another interview with a government official from the China Center for Disease Control and Prevention was conducted in the exploratory stage. The consultation stage comprised one interview with a business manager from the Huawei Wearable Unit, one interview with a business manager from Alibaba Health Brain Unit, and one interview with a business manager from Xiaomi. Two interviews with doctors from Fudan University-affiliated Huashan Hospital and Fudan University-affiliated Zhongshan hospital were conducted in the integration stage. In addition, 8 focus group studies with 64 participants from rural and urban Beijing were conducted. Finally, another telephone interview with a business manager of the Xiaomi Wearable Unit was conducted in the follow-up stage.ResultsTelehealth solutions are designed to assist health care providers in realizing the quadruple aim of better health outcomes, lowering health care costs, improved health care quality, and improved doctor and patient experiences. Governments have high incentives to improve health care efficiency via telehealth solutions. However, they have limited resources to make the necessary infrastructure transformation.ConclusionsTo fully realize the potential of telehealth devices, heavy infrastructure investment in the telecommunication network is required beforehand to resolve the interoperability issue occurring during the data collection process for telehealth solutions. The industry also demands a mature business model incorporating collaboration between various stakeholders and industrial partners to invest in infrastructure. Governments have high interest and significant influence on building the necessary infrastructure for telehealth solution implementation in China. Industrial actors have a high interest and a medium level of power for telehealth solution implementation. Users have high interest but a lower level of power for the usage of telehealth solutions, and doctors have low interest and a medium level of power for telehealth solutions implementation.

Telehealth and digital developments in society that persons 75 years and older in European countries have been part of: a scoping review

BackgroundDemographic changes are leading to an ageing population in Europe. People are becoming more dependent on digital technologies and health ministries invest increasingly in digitalisation. Societal digital demands impact older people and learning to use new telehealth systems and digital devices are seen as a means of securing their needs.MethodsThe present study undertakes a scoping review in order to map relevant evidence about telehealth and digital developments in society involving citizens aged 75 and over in European countries. It focuses on their experiences and the main barriers to, and facilitators of, societal digital demands. A framework proposed by Arksey and O`Malley was used to guide the scoping review process. The studies included in the review covered telehealth, digital technology and digital devices, and the context covered participants` own home or surroundings. A comprehensive search on PubMed/MEDLINE, CINAHL, Scopus, Embase and Open Grey was undertaken.ResultsOut of 727 identified citations, 13 sources which met the inclusion criteria (9 original study articles, 2 theses, 1 letter about a product and 1 project report). Few of the studies identified have investigated European citizens 75 years and older separately. The studies included varied in their design, location and focus. Older people have experienced both telehealth and digital devices making life easier and the opposite. The outstanding facilitator found was that technology should be easy to use, and difficulty in remembering the instructions was seen as an important barrier. Interestingly, both social support and lack of social support were found as facilitators of using new devices.ConclusionsTelehealth may give a sense of security but learning to use a new device often takes extra effort. Older people were more open to new devices if the possible advantages of the new technology outweighed the effort that would be involved in adopting a new strategy. As technology develops rapidly, and life expectancy in Europe is anticipated to rise continually, there is a need for new and additional research among older European citizens. Future research should cover the technical solutions most relevant to older people today, social support and participants` access to the devices.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses.

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients' satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.

Leveraging digital tools to support recovery from substance use disorder during the COVID-19 pandemic response

Treatment for substance use disorder (SUD) during the COVID-19 pandemic poses unique challenges, both due to direct effects from the illness, and indirect effects from the physical measures needed to “flatten the curve.” Stress, isolation, lack of structure, limited access to physical and mental health care, and changes in treatment paradigms all increase risk of return to drug use events and pose barriers to recovery for people with SUDs. The pandemic has forced treatment providers and facilities to rapidly adapt to address these threats while redesigning their structure to accommodate physical distancing regulations. Digital health interventions can function without the need for physical proximity. Clinicians can use digital health intervention, such as telehealth, wearables, mobile applications, and other remote monitoring devices, to convert in-person care to remote-based care, and they can leverage these tools to address some of the pandemic-specific challenges to treatment. The current pandemic provides the opportunity to rapidly explore the advantages and limitations of these technologies in the care of individuals with SUD.

Rapid creation of an emergency department telehealth program during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) has spread to nearly every continent, with over 2.6 m cases confirmed worldwide. Emergency departments care for a significant number of patients who are under investigation for COVID-19 or are COVID-19-positive. When patients present in the emergency department, there is an increased risk of spreading the virus to other patients and staff. We designed an emergency department telehealth program for patients physically in the emergency department, to reduce exposure and conserve personal protective equipment. While traditional telehealth is designed to be patient-specific and device-independent, our emergency department telehealth program was device-specific and patient-independent. In this article, we describe how we rapidly implemented our emergency department telehealth program, used for 880 min of contact time and 523 patient encounters in a 30-day period, which decreased exposure to COVID-19 and conserved personal protective equipment. We share our challenges, successes and recommendations for designing an emergency department telehealth program, building the technological aspects, and deploying telehealth devices in the emergency department environment. Our recommendations can be adopted by other emergency departments to create and run their own emergency department telehealth initiatives.

PRIVACY AND SECURITY FOR TELEHEALTH DEVICES

In this research, we study the privacy and security capabilities provided by telehealth devices. Our aim is to evaluate how vulnerable these popular devices are in the presence of malicious cyber attackers. As older adults increasingly rely on telehealth devices, it is crucial that cybersecurity aspects of these devices are clearly communicated to them. Moreover, older adults frequently lack the technical expertise to evaluate the security and privacy capabilities of the devices. The lack of control over telehealth devices is a major concern for older adults. Older adults view certain limitations within these devices as decreasing their privacy and security. These limitations include the lack of control over accepting calls, taking screenshots, and assigning access privileges. For large scale adaptation of telehealth devices by older adults, it is crucial that these devices not only satisfy their intended purpose but also exhibit user friendly features and strong security and privacy capabilities. Modeling cyber threats against telehealth devices is not studied sufficiently . Malicious actors may compromise telehealth devices and create further threats to security and privacy of the users. In this research, we studied the cyber threats against telehealth devices. We built a threat model that ranks cyber threats based on their impact. We investigated how the operating system of popular devices supports access control. We found that none of the current technologies support location-based access control. We claim that this represents a major limitation and that supporting location-based access control is necessary to ensure users’ privacy in their own home.

PERCEPTIONS, ACCEPTABILITY, EXPECTATIONS, AND CONCERNS OF SMART HOME TECHNOLOGIES AMONG OLDER ADULTS

Optimal aging in place has become a common preference among older adults to maintain identity and independence, thus smart home technologies are increasingly utilized to achieve these goals. However, disconnect may exist between potential technological benefit and perceptions of acceptability and usability (Lee & Coughlin, 2015). We assessed perceptions of adults aged 50+ (range 50-90 years) to analyze their priorities and ultimate acceptability of smart home technology. Data were collected through surveys, focus groups, and case study interviews. Three major themes emerged regarding smart home utilization: benefits, concerns, and expectations. Participants endorsed smart home technologies (e.g., sensors, telehealth devices) and identified benefits, such as the promotion of optimal aging (e.g., maintaining independence, staying active, safety). However, responses also reflected concerns about privacy, ease of use, and amount of control. Expectations regarding smart homes included more mobility, efficiency, and safety within the home. One participant described technology as having “options [that] are exhausting, but also exciting.” Survey responses (n=30) were analyzed to understand participants’ familiarity with smart home technologies, including: nanotechnology (10.7%), smart showers (42.9%), home sensors (70.4%), telehealth (74.1%), smart appliances (71.4%), personal sensors (81.5%), and voice-activated devices (96.4%). Additionally, respondents indicated their willingness to implement these technologies to maintain and/or improve their daily functioning: nanotechnology (53.8%), smart showers (28.6%), home sensors (66.6%), telehealth (81.5%), smart appliances (40.0%), personal sensors (55.5%), voice-activated devices (64.3%). Discussion focuses on the priorities and needs older adults express regarding technology utilization and the implications for person-centered design and implementation of future smart home technologies.

Comparative Effectiveness of Telehealth Devices in Pediatric Clinic Setting

Health services research has shown that telemedicine is effective in a number of settings, but little has been published in the peer reviewed literature regarding the evaluation of digital health tools to validate the quality of the data acquired from such devices to accurately inform clinical decision making. The primary aim of the study was to evaluate a novel multifunctional remote examination device in comparison to other FDA approved stand-alone digital examination devices currently available to clinicians. The secondary aim was to evaluate which device produced images or sounds that …

Comparative Effectiveness of Telehealth Devices in Pediatric Clinic Setting

Comparative Effectiveness of Telehealth Devices in Pediatric Clinic Setting

Patient-reported outcomes: A 5-year long study reveals previously unreported therapeutic, demographic, socio-economic, and other correlations in vitiligo

Vitiligo is a non-lethal, non-communicable, immune-mediated, and generally progressive skin disease, with poorly understood etiopathogenesis and weak evidence base. The aim of the study is to contribute to the scant research on the patient-reported outcomes in vitiligo, and to examine the presence of associations between various inputs for possible use in clinical practice. The study was designed as a web-based questionnaire with 40 inputs across seven dimensions. The questions include demographics, skin type, eye and natural hair color, age of respondent and age of onset, possible triggers, disease extent, localization, progression and activity, the efficacy of most common treatment modalities, medication side-effects, heredity and diseases among parents, and out-of-pocket expenses for treatments to date. The analysis presented with this work contributes to the discussion about the relation between therapies, socio-economic factors, and treatment outcomes in vitiligo. All physicians should adequately manage patient expectations in terms of overall treatment duration and expected out-of-pocket expenses, and actively evaluate patients at shorter intervals. A more aggressive therapeutic approach using telehealth devices should be considered to supplement therapy, monitor treatment progress, and protocol compliance.

Telehealth, Mobile Applications, and Wearable Devices are Expanding Cancer Care Beyond Walls.

To review telehealth solutions, mobile applications, and wearable devices that are currently impacting patients, caregivers, and providers who work in the oncology setting. A literature search was conducted using the terms (Telehealth, Mobile Health, mHealth, Wearable Devices) + (Oncology, Cancer Care). There are many current applications of telehealth and mobile health in the oncology setting. Nurses who care for patients with cancer should be aware of the pervasiveness and impact of telehealth and mobile health to this unique population.

Exploring distinct trajectories of use of telehealth devices among adults with hypertension: a latent class growth analysis approach

Background : Telehealth devices are considered with potential to foster improved health outcome for patients with hypertension. However, the longitudinal use trajectories of telehealth devices have not been identified yet, nor has the connection between developmental trajectories of telehealth devices use and health outcome over time. Objective : To identify the longitudinal trajectories of use of telehealth devices among patients with hypertension, characterize features for each trajectory, and to unravel the correlation between longitudinal trajectories of telehealth devices use patterns and BP control outcome. Methods : A total of 122 patients with hypertension were enrolled, portable telehealth device were given to them to monitor blood pressure. Socio-demographics (e.g. name, age, sex, marital status) were collected at baseline. The real-time measured data, including time and both systolic and diastolic blood pressure data, were sent up to cloud platform through the portable device. The latent class growth analysis modeling approach was used to determine the latent trajectory of telehealth use. And the joint trajectory method was used to identify the correlation between the longitudinal trajectories of telehealth use and BP control status. Results : 5 distinct trajectories were finally identified: Persistently low (47.1%), Moderate with decreasing (23.9%), Sharply decreasing (11.2%), High with decreasing (11.3%), Persistently high with increasing (6.6%). However, no statistical significant differences in age, marital status, BP (both SBP and DBP) and BP control status in the first period between the 5 trajectories were found. It provided evidence that strong correlation existed between the longitudinal telehealth devices use patterns and individuals’ longitudinal BP control status. Conclusions : The latent trajectories of telehealth use were identified; yet, no predictors of trajectory membership have been found. Although more prove of the causal relationship needs to be revealed in further studies, this study demonstrated that regular monitor has some positive correlation with improved BP control.