Telemedicine Activities Research Articles

Remote Medical Education in Indonesia: Analysis of 10 Years of Activities

Introduction: With ongoing development of technology, and especially amid the current COVID-19 pandemic, there is rapidly increasing need for remote communications, including in the field of medical education. This study aimed to evaluate our telemedicine activities between Japan and Indonesia. Methods: We retrospectively analysed the data acquired for the period 2010–2019 inclusive, looking at number of programmes, content, participating sites, and videoconferencing systems. We also digitally sent questionnaires to attendees to request their evaluation of image quality and programmes. Results: There were a total 135 programmes, with 29 participating institutions in Indonesia. The number of programmes increased rapidly in 2017, following a rapid increase of participating sites in 2016. Programmes included endoscopy (50 programmes, 37%), neurology (25, 19%), and dentistry (12, 9%). Between 5 and 10 sites connected with 81 programmes (60% of all), and more than 10 sites with 33 (24%). The most commonly used videoconferencing system was Vidyo (108, 80%), followed by Zoom (15, 11%). Participating institutions were located among 19 cities on the five major islands. Image quality received a favourable evaluation from 98% (504/516) of questionnaire respondents, with 100% (400/400) holding a favourable view of the programmes. Conclusion: Remote medical education expanded in Indonesia in the 10 years under review. This expansion is expected to continue to foster more specialists and it is anticipated to improve medical care nationwide.

Adapting to post-COVID19 research in Parkinson's disease: Lessons from a multinational experience

• COVID-19 has significant impact on PD research and education activities. • Country-specific restrictions may pose challenges to PD research and require careful adaptations. • Neurological Symptoms of COVID-19 may overlap with PD.

Mental health interventions in healthcare workers in infectious disease outbreak-A systematic review

BackgroundExtended evidence has established that healthcare workers face several mental health problems during a disease outbreak, which could have a long-term impact. To address these issues, elaboration and implementation of psychological/psychiatric interventions or strategies is of utmost importance. In this context, this systematic review aimed at identifying strategies to manage mental health issues in healthcare workers during infectious disease outbreaks.MethodsPubMed, Cochrane, Scopus and Web of Science were searched to retrieve pertinent articles published in English until May 2020. Articles reporting measures, interventions, strategies, or recommendations to manage mental health problems in healthcare workers during an infectious disease outbreak, of any study design were included. The quality assessment was performed according to the study design of the included articles.ResultsOur search strategy produced a total of 2358 articles. After the screening process 33 articles met the inclusion criteria, addressing COVID-19 (40%), followed by SARS (21%) and Ebola Virus (15%). The findings emphasized that organisations should follow an evidence-based approach and establish comprehensive programs to assist hospital staff during disease outbreaks. The preliminary results show that the creation of a psychological response team, training, e-learning, courses, psychosocial counselling, screening instruments and telemedicine activities could improve the capacity of response and coping, and reduce mental health issues in healthcare workers.ConclusionsTo minimize the psychological impact of future infectious disease outbreaks, evidence-based intervention strategies should be implemented to retain mental health among healthcare workers. Our results may provide the necessary insights that could be applied during the COVID-19 pandemic.Key messages During infectious disease outbreaks healthcare workers are faced with mental health issues, that need to be addressed through tailored interventions offering coping strategies and increase resilience.Mental health related interventions or strategies include the implementation of professional training, psychosocial counselling, courses, and the creation of a psychological response team.

Health care for chronic neurological patients after COVID-19.

Health care for chronic neurological patients after COVID-19.

Mental Health Services in Lombardy during COVID-19 outbreak

Lombardy is the Region in Italy the most heavily affected by coronavirus disease (COVID-19) contagion. The Regional Health Authority mandates that mental health services should be guaranteed, identifying mental health as a priority for their citizens. Recommendations for occupational and health safety have been provided to patients and hospital staff, including support for telemedicine activities and remote psychosocial interventions. Services of the Mental Health Departments of Milano “Niguarda” and Brescia “Spedali Civili” Hospitals are providing continued care at a community, residential and hospital level, and to positive COVID-19 psychiatric patients in need of hospitalization.

2019 Italian Society of Cardiology Census on telemedicine in cardiovascular disease: a report from the working group on telecardiology and informatics

BackgroundThe aim of this study was to assess by a census supported by the Italian Society of Cardiology (Società Italiana di Cardiologia, SIC) the present implementation of telemedicine in the...

Decision support system for in-flight emergency events

Medical problems during flight have become an important issue as the number of passengers and miles flown continues to increase. The case of an incident in the plane falls within the scope of the healthcare management in the context of scarce resources associated with isolation of medical actors working in very complex conditions, both in terms of human and material resources. Telemedicine uses information and communication technologies to provide remote and flexible medical services, especially for geographically isolated people. Therefore, telemedicine can generate interesting solutions to the medical problems during flight. Our aim is to build a knowledge-based system able to help health professionals or staff members addressing an urgent situation by given them relevant information, some knowledge, and some judicious advice. In this context, knowledge representation and reasoning can be correctly realized using an ontology that is a representation of concepts, their attributes, and the relationships between them in a particular domain. Particularly, a medical ontology is a formal representation of a vocabulary related to a specific health domain. We propose a new approach to explain the arrangement of different ontological models (task ontology, inference ontology, and domain ontology), which are useful for monitoring remote medical activities and generating required information. These layers of ontologies facilitate the semantic modeling and structuring of health information. The incorporation of existing ontologies [for instance, Systematic Nomenclature Medical Clinical Terms (SNOMED CT)] guarantees improved health concept coverage with experienced knowledge. The proposal comprises conceptual means to generate substantial reasoning and relevant knowledge supporting telemedicine activities during the management of a medical incident and its characterization in the context of air travel. The considered modeling framework is sufficiently generic to cover complex medical situations for isolated and vulnerable populations needing some care and support services.

Telemedicine in France: A review of registered clinical trials from 2000 to 2015

Summary Introduction Telemedicine activity is increasing in France. The assessment of telemedicine research, however, including registered clinical trials, has yet to be published. Using an international open access database (ClinicalTrials.gov), a study was conducted to identify registered telemedicine clinical trials in France from 2000 to 2015. Materials and methods The data extracted on 6th August 2015 led to the retrieval of a total of 41 studies, of which 39 were included. Results The first registered telemedicine clinical trial was received in 2006 and the latest in 2015. The studies were primarily conducted by public hospitals (66.7%), followed by private companies (20.5%). The objectives of the studies were primarily treatment based with all having efficacy and/or safety endpoints. Sixteen trials were in the recruiting phase, 12 were completed and four were terminated before the date of completion. The main telemedicine activities in the studies involved telemonitoring (n = 28), teleconsultation (n = 7) and tele-expertise (n = 3). Ten medical specialties were represented in the trials with a key focus on cardiology, endocrinology and pulmonology. Discussion and conclusions Telemedicine clinical trials have increased in France most evidently since 2011. The use of an open clinical trials database enabled characteristics to be described. A telemedicine registry may be necessary to improve future research as well as to enhance evidence-informed health policies regarding telemedicine activities in France.

Telemental health in Brazil: past, present and integration into primary care

Background Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research.

Design and implementation of a contracting method for telemedicine activities in the Rhône-Alpes region, France

Summary Background On July 21st 2009, France became the first European country to adopt telemedicine legislation. A Decree, No. 2010-1229 published in 2010, specified the need for telemedicine activities to be legally contracted with the Agence regionale de sante (ARS), the regional level of French Ministry of Health. In this paper, the contract management in ARS Rhone-Alpes for telemedicine activities is stated, along with the characteristics of telemedicine contracts received by the ARS Rhone-Alpes. Methods Health information system (HIS) unit of the ARS Rhone-Alpes had the responsibility to design and implement the contracting method. The design consisted of writing a standard telemedicine legal contract, defining a contract assessment process and creating decision support tools for contract assessment. Implementation of the method began with the first telemedicine contract receipt on May 30th, 2014. Results A five steps contract assessment process was designed relying on ARS Rhone-Alpes internal organization. On October 31st 2014, twelve telemedicine contracts were received, and 3 were validated and signed. Among the 12 received contracts, 4 concerned dialysis activities, and 2 concerned radiology activities. Implementation of contracting method was successfully managed with the administrative process being satisfactory from both parties; the agency staff and the telemedicine project leaders. Conclusion Although 12 contracts were received compared to the estimated total of 60 telemedicine known activities and projects in the region, contracting telemedicine activities was an essential tool to support quality improvement of telemedicine activities and to ensure their integration into both national and regional health policies. The main identified weakness was the length of the administrative process. Further accomplishment is needed in the future to ensure all concerned telemedicine activities are contracted.

Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector.

BackgroundThe healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers.ObjectivesTo evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector.MethodsA life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases.ResultsReplacing physical visits with telemedicine appointments resulted in a significant 40–70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car.ConclusionsTelemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.

Effect of a teleretinal screening program on eye care use and resources.

Telemedicine is a useful clinical method to extend health care to patients with limited access. Minimal information exists on the subsequent effect of telemedicine activities on eye care resources. To evaluate the effect of a community-based diabetic teleretinal screening program on eye care use and resources. The current study was a retrospective medical record review of patients who underwent diabetic teleretinal screening in the community-based clinics of the Atlanta Veterans Affairs Medical Center from October 1, 2008, through March 31, 2009, and who were referred for an ophthalmic examination in the eye clinic. Clinical medical records were reviewed for a 2-year period after patients were referred from teleretinal screening. The following information was collected for analysis: patient demographics, referral and confirmatory diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications, and spectacle prescriptions. The accuracy between referring and final diagnoses and the eye care resources that were used in the care of referred patients. The most common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage of agreement among these 5 visually significant diagnoses was 90.4%, with a total sensitivity of 73.6%. Diabetic macular edema required the greatest number of ophthalmology clinic visits, diagnostic tests, and surgical procedures. Using Medicare cost data estimates, the mean cost incurred during a 2-year period per patient seen in the eye clinic was approximately $1000. Although a teleretinal screening program can be accurate and sensitive for multiple visually significant diagnoses, measurable resource burdens should be anticipated to adequately prepare for the associated increase in clinical care.

Role of telemedicine technology in endocrine surgery knowledge sharing.

This retrospective study was designed to assess the outcome of telemedicine technology supportive of educational collaboration among endocrine surgery peers and its impact on knowledge and skill development. The study was carried out in the Department of Endocrine Surgery in collaboration with School of Telemedicine and Biomedical Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, during October 1999-December 2012. Telemedicine activities were divided into various modules (e.g., case/problem-based learning, clinical grand rounds, postgraduate course/continuing medical education/conference). Endocrine surgeons participating in such sessions were divided into two groups (faculty and residents). A multimodule questionnaire was constructed based on a Likert scale (2-7 points) to test various aspects (e.g., technical performance, role in knowledge exchange, skill development, level of satisfaction, and future recommendations). Responses were expressed in proportions, and the chi-squared test was used to find the differences in opinions of the study groups. The questionnaire was sent to 38 surgeons, of whom 36 replied (response rate, 94.74%); of these respondents, 14 were faculty and 22 were residents. More than 80% of participants felt that the technology helped in learning new things and strengthening relations with peers, whereas >90% were of the view that it helped in knowledge exchange and development of skills as well as was helpful in supporting clinical decisions. More than 90% of participants were satisfied and enjoyed using this technology and also were of the opinion that the technology should be integrated into other specialties. Satisfaction with the technology was excellent to good for 94.44% of participants. Both faculty and residents were of the same opinion, and there was no significant difference in their replies. Knowledge sharing in a collaborative environment using telemedicine technology has been found successful in a low-resource setting and is now adopted in the departmental educational program.

Survey of paediatricians’ opinions on a regional paediatric telecardiology service

The aim of this study is to evaluate consultant general paediatricians' opinions of a UK paediatric telecardiology service. A structured questionnaire was developed and sent to all consultant paediatricians working in a district general hospital in Northern Ireland. Paediatricians (n = 35) regarded the regional paediatric telecardiology service as very useful and of good value for money. Paediatricans in hospitals without access to telecardiology expressed a desire to join the network (86%, 12/14). More frequent use of the paediatric telecardiology service was associated with increased confidence in performing echocardiography and using the telemedicine equipment and a special interest in neonatology. The vast majority of paediatricians (32/35, 91%) believed that there should be a shared clinical responsibility for the patient following a teleconsultation. A total of 33/35 (94%) stated that the telephone costs of the consultation should be paid by the paediatrician but that the professional time of the cardiologist should be paid by the tertiary centre (29/35, 83%). Paediatricians have consistently positive experiences of a regional paediatric telecardiology service. They believe that clinical responsibility is shared, and there should not be any professional fee for telemedicine activities.

Telemedicine and Advances in Urban and Rural Healthcare Delivery in Africa

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine.

Telemedicine in India: Current Scenario and the Future

India, with its diverse landmass and huge population, is an ideal setting for telemedicine. Telemedicine activities were started in 1999. The Indian Space Research Organization has been deploying a SATCOM-based telemedicine network across the country since that year. Various government agencies-Department of Information Technology and Ministry of Health & Family Welfare, state governments, premier medical and technical institutions of India-have taken initiatives with the aim to provide quality healthcare facilities to the rural and remote parts of the country. The Government of India has planned and implemented various national-level projects and also extended telemedicine services to South Asian and African countries. Efforts are taking place in the field of medical e-learning by establishing digital medical libraries. Some institutions that are actively involved in telemedicine activities have started curriculum and noncurriculum telemedicine training programs. To support telemedicine activities within the country, the Department of Information Technology has defined the Standards for Telemedicine Systems and the Ministry of Health & Family Welfare has constituted the National Telemedicine Task Force. There are various government and private telemedicine solution providers and a few societies and associations actively engaged to create awareness about telemedicine within the country. With its large medical and IT manpower and expertise in these areas, India holds great promise and has emerged as a leader in the field of telemedicine.

Clinical Nurse Coordinators: A New Generation of Highly Specialized Oncology Nursing in Jordan

Despite the important role of nurses in a pediatric oncology team, the marginalization of nursing is common, especially in developing countries. At the King Hussein Cancer Center (KHCC) in Jordan, the position of the clinical nurse coordinator (CNC) was created in the pediatric neuro-oncology and ocular oncology services to empower the role of nursing. Our advanced nursing practice is based on the domains of the Strong Model of Advanced Practice, which are direct patient care, support of systems, education, research and publications, and professional leadership. There is strong involvement of the CNC in clinical care, patient education, follow-up, and interdisciplinary collaboration, which has resulted in improved survival, reduced morbidity, and increased compliance of patients and also their successful reintegration into society. The coordination of twinning initiatives and telemedicine activities has helped ensure the quality of treatment and supported research initiatives in the services. Such a positive impact has led to a significant increase in the recruitment of CNCs at KHCC. We propose that the role of nursing be strengthened in developing countries to improve the level of care provided to patients and their families.

A review of telemedicine in China

Telemedicine in China began in the mid-1980s and the early Chinese telemedicine activities were mostly based on store-and-forward techniques as the telecommunication infrastructure required for realtime work was not available. In recent years, telemedicine in China has developed quickly with the rapid growth of telecommunication networks. China now has three major telemedicine networks: the Golden Health Network (GHN), the International MedioNet of China (IMNC) network and the People's Liberation Army (PLA) telemedicine network. Nonetheless, research and application of telemedicine is at a relatively early stage in China. We suggest that the Chinese government needs to make a policy in favour of rural people and invest more in telemedicine, so that they can enjoy low-cost telemedicine services and foster a large telemedicine market.

Wireless-accessible sensor populations for monitoring biological variables

The current health-care infrastructure is generally considered to be inadequate to meet the needs of an increasingly older population. We have investigated the feasibility of a passive in-home monitoring system based on wireless accessible sensor populations (WASP). In an EU-funded project we have identified the system architecture and the sensors required to gather data from elderly patients by continuous monitoring. Data from biological variables (heart rate, accelerometers, body temperature and galvanic skin response) and everyday habits (body position, movements) will be transmitted to a central monitoring centre. A Body Sensor Network (worn by the patient and able to communicate with a personal mobile hub) and an Ambient Sensor Network (a number of wireless sensors incorporated into the patient's home) are envisaged. The system will be tested by using it in the telemedicine activities of the Health Telematic Network, which manages home help projects for elderly patients.

Realizing Telemedicine Advantages at the National Level: Cases from the United Arab Emirates

This research was initiated to explore telemedicine adoption and diffusion in healthcare organizations in the United Arab Emirates (UAE). Research on telemedicine applications in the UAE focused on two main areas. First, it was revealed that the telemedicine application was not extensively employed in the UAE. There are no self-initiated telemedicine networks or specialty telemedicine centers in the UAE. A study was conducted on the perceptions of UAE healthcare professional concerning their attitudes and behavior toward adopting the telemedicine technology in their organizations, using a theoretical construct extended from the technological innovation literature. Second, existing telemedicine activities were initiated in cooperation with the Mayo Clinic. These consist of multimedia telemedicine systems for second opinion tele-consultations. The effectiveness of this approach has also been examined. The research discusses the findings in the light of the overall literature, highlighting further implications and suggesting ways where telemedicine could be applied in the UAE. There is still much growth and opportunity for self-governed specialty telemedicine systems and networks in the UAE.