Telemedicine Approach Research Articles

A frugal and innovative telemedicine approach for rural India – automated doctor machine

A frugal and innovative telemedicine approach for rural India – automated doctor machine

Telehealth and telemedicine applications for the diabetic foot: A systematic review.

SummaryThe aim of this systematic review is to assess the peer‐reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease. MEDLINE/PubMed was searched for peer‐reviewed studies on telehealth and telemedicine approaches for assessing, monitoring, preventing, or treating diabetic foot disease. Four modalities were formulated: dermal thermography, hyperspectral imaging, digital photographic imaging, and audio/video/online communication. Outcome measures were: validity, reliability, feasibility, effectiveness, and costs. Sixty‐one studies were eligible for analysis. Three randomized controlled trials showed that handheld infrared dermal thermography as home‐monitoring tool is effective in reducing ulcer recurrence risk, while one small trial showed no effect. Hyperspectral imaging has been tested in clinical settings to assess and monitor foot disease and conflicting results on its diagnostic use show that this method is still in an experimental stage. Digital photography is used to assess and monitor foot ulcers and pre‐ulcerative lesions and was found to be a valid, reliable, and feasible method for telehealth purposes. Audio/video/online communication is mainly used for foot ulcer monitoring. Two randomized controlled trials show similar healing efficacy compared with regular outpatient clinic visits, but no benefit in costs. In conclusion, several technologies with good psychometric properties are available that may be of benefit in helping to assess, monitor, prevent, or treat diabetic foot disease, but in most cases, feasibility, effectiveness, and cost savings still need to be demonstrated to become accepted and used modalities in diabetic foot care.

Innovative Telemedicine Approaches in Different Countries: Opportunity for Adoption, Leveraging, and Scaling-Up

In the age of digitization, a growing percentage of services are becoming available online, and this trend is affecting healthcare too. As evolving technology creates more avenues for physicians to deliver affordable and instant care to their patients, there has been a sharp increase in the number of telemedicine implementations across the world.1 As in other disciplines, guidelines and regulations on telemedicine lag behind the use of the technology and are still being crafted and modified. For example, the new nationwide policy on telemedicine of the Department of Veterans Affairs (VA) of the US Government became effective in mid-2018 and incorporates the opinion and recommendations made 7 years earlier. In recent years, the VA spent over $1 billion a year on transportation of veterans to and from hospitals; now with telemedicine, this amount can be used increasingly for other purposes. This cost-saving experience at the national scale should alert industry actors, national governments, and consumers of the growing urgency to address the policy and regulatory aspects of telemedicine to provide healthcare services with greater speed, quality, and safety to rapidly increasing percentages of citizens of their respective countries.

Managing Epilepsy by Telemedicine in Resource-Poor Settings.

Epilepsy is a common and treatable disease; in rich countries the expectation is that two-thirds of people will have their seizure episodes controlled on medication. In low- and middle-income countries (LMICs) however most people are not on treatment either because no doctors live near them or the logistics of affordable drug supply is absent. People with epilepsy then are prone to the bad effects of this disease—death, disfigurement from accidents and burns, and social problems due to the stigma with which the disease is associated. So this represents a failure of conventional face-to-face medicine. Might a telemedicine approach do better? The World Health Organization has suggested that non-physician health workers are empowered to diagnose and manage epilepsy; to do this they will need considerable medical support, which might be provided by telemedicine through the telephone, smartphone applications or a combination. This paper sets out what telemedicine does at present for people with epilepsy in LMICs and suggests how it might be developed in the future.

Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme.

SummaryBackgroundThe public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two‐way video‐conferencing is a modality that can potentially surmount geographic barriers and staffing shortages.MethodsPatients from the Dartmouth‐Hitchcock Weight and Wellness Center were recruited into a pragmatic, single‐arm, nonrandomized study of a remotely delivered 16‐week evidence‐based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures.ResultsOf 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16‐week programme sessions (27% attrition). Mean age was 46.9 ± 11.6 years (88.9% female), with a mean body mass index of 41.3 ± 7.1 kg/m2 and mean waist circumference of 120.7 ± 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 ± 0.58 on 1‐5 Likert scale—low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 ± 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30‐second sit‐to‐stand test, a mean improvement of 2.46 stands (P = .005) was observed.ConclusionA telemedicine‐delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.

Assessment of Psychological Dimensions in Telemedicine Care for Gestational Diabetes Mellitus: A Systematic Review of Qualitative and Quantitative Studies.

Background and Objective: Gestational Diabetes Mellitus (GDM) is a complex and wide spread problem and is considered one of the most frequent chronic metabolic conditions during pregnancy. According to a recent consensus conference held in Italy, new technologies can play a role in the so-called process of fertilization of the individual's ecosystem engagement, representing support for systemic collaboration among the main actors. The current systematic review aimed at providing an update of the literature about telemedicine for GDM, considering the role of psychological dimensions such as empowerment/self-efficacy, engagement and satisfaction.Methods: The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The data sources were PubMed, ScienceDirect, Cochrane, and Scopus databases.Results: Thirteen articles were identified as eligible and relevant for the final qualitative synthesis, but none was specific for the topic of engagement. The quality or research bias of the studies presents methodological limits. Most studies had clinical outcomes as a primary object. Concerning empowerment and self-efficacy, there were only preliminary findings reporting any improvements derived from using telemedicine approaches. Conversely, there were more consistent and positive results concerning the satisfaction of patients and clinicians.Conclusions: These results are not sufficient to state a conclusive evaluation of positive effects of telemedicine use for GDM care. A more in-depth investigation of engagement and empowerment dimensions is necessary, as some benefits for the management of chronic conditions were already detected. Further investigations will also be necessary concerning the acceptability and feasibility of telemedicine systems by clinicians.

Plus Disease in Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) Study: Characteristics, Predictors, and Accuracy of Image Grading

To describe characteristics and predictors of plus disease, and the accuracy of image grading for plus disease in the e-ROP Study. Secondary analyses of data from 13 North American centers. Premature infants with birth weight (BW) <1251 g. Infants underwent regularly scheduled diagnostic examinations by ophthalmologists and digital imaging by trained imagers using a wide-field digital camera. Two masked nonphysician trained readers independently evaluated images for posterior pole abnormality (normal, preplus, plus), with discrepancies adjudicated by a reading supervisor. Logistic regression models were used to determine predictors for plus disease. The sensitivity and specificity of image grading for plus disease were calculated using the clinical examination finding as reference standard. Odds ratios (OR), sensitivity, and specificity. Among 1239 infants (mean BW 864 g, mean gestational age [GA] 27 weeks), 129 infants (10%) (226 eyes, 75% bilateral) had plus disease from clinical examination. When plus disease was first diagnosed in clinical examination at median postmenstrual age (PMA) of 36 weeks (range: 32-43 weeks), 94% to 96% of plus occurred in the superior or inferior temporal quadrant. Significant predictors for plus disease from multivariate analysis were as follows: GA (OR= 3.2 for ≤24 vs. ≥28 weeks, P= 0.004), race (OR= 2.4 for white vs. black, P=0.01), respiratory support (OR= 7.1, P= 0.006), weight gain (OR= 1.5 for weight gain ≤12 vs. >18 g/day, P= 0.03), and image findings at the first image session, including presence of preplus/plus disease (OR= 2.7, P= 0.003), ROP stage (OR= 4.2 for stage 3 ROP vs. no ROP, P= 0.006), and blot hemorrhage (OR= 3.1, P=0.003). These features predicted plus disease with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.85-0.92). The image grading using preplus as the cut point had sensitivity of 94% (95% CI: 90%-97%) and specificity of 81% (95% CI: 79%-82%) for detecting plus disease in an eye. Among e-ROP infants, plus disease developed in 10% of infants at a median PMA of 37 weeks, with the majority being bilateral and mostly in the superior or inferior temporal quadrant. GA, race, respiratory support, postnatal weight gain, image findings of the posterior pole, and ROP predict development of plus disease. Nonphysician image grading can detect almost all plus disease with good specificity.

Picture and spoken word presentation in repetition training for anomia: does stimulus order matter? Evidence obtained from 12 individuals with chronic aphasia using a computer-based telemedicine approach

ABSTRACT Background: Presenting pictures accompanied by the corresponding spoken words to be repeated is a commonly used method for treating naming impairments in aphasic people. Aims: In this study, we investigated whether the presentation order of pictures and words in repetition training affects treatment outcome. Methods & Procedures: We administered a computer-based word repetition protocol at a distance to 12 individuals with chronic pure anomia. The words to be repeated were presented with the corresponding pictures. We manipulated the timing of word and picture presentation. In one condition Picture-Word condition (Pic-Wd), the picture onset preceded that of the corresponding spoken word; in the other condition Word-Picture (Wd-Pic), the presentation order was reversed. Data were analyzed at the group and the single subject level to determine the relative efficacy of the two experimental conditions and the cognitive features predicting therapy success. Outcomes & Results: The study demonstrates the substantial equivalence of the two presentation orders at the group level. At the single subject level in a minority of cases, there are hints of an asymmetrical response favoring either the Pic-Wd or the Wd-Pic treatment. Non-word repetition skills were the only feature in the participants’ cognitive profile that was reliably linked to therapy outcome. Conclusions: When pictures are presented alongside the corresponding word in repetition training, stimuli presentation order seems to have only a minor effect on therapy outcome. Potential advantages of both treatments are discussed with reference to the cognitive profile of treated patients.

Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR)

BackgroundIn an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital.MethodsVillage health workers (VHWs) underwent a five day training program on conducting Distortion Product Oto Acoustic Emissions (DPOAE) screening and assisting in tele-ABR. VHWs conducted DPOAE screening in 91 villages and hamlets in two administrative units (blocks) of a district in South India. A two-step DPOAE screening was carried out by VHWs in the homes of infants and children under five years of age in the selected villages. Those with ‘refer’ results in 2nd screening were recommended for a follow-up diagnostic ABR testing in person (Group A) at the tertiary care hospital or via tele-medicine (Group B). The overall outcome of the community-based hearing screening program was analyzed with respect to coverage, refer rate, follow-up rate for 2nd screenings and diagnostic testing. A comparison of the outcomes of tele-versus in-person diagnostic ABR follow-up was carried out.ResultsSix VHWs who fulfilled the post training evaluation criteria were recruited for the screening program. VHWs screened 1335 children in Group A and 1480 children in Group B. The refer rate for 2nd screening was very low (0.8%); the follow-up rate for 2nd screening was between 80 and 97% across the different age groups. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital.ConclusionsNon-availability of audiologists and limited infrastructure in rural areas has prevented the establishment of large scale hearing screening programs. In existing programs, considerable challenges with respect to follow-up for diagnostic testing was reported, due to patients being submitted to traveling long distance to access services and potential wage losses during that time. In this program model, integration of a tele-ABR diagnostic follow-up improved follow-up in comparison to in-person follow-up. VHWs were successfully trained to conduct accurate screenings in rural communities. The very low refer rate, and improved follow-up rate reflect the success of this community-based hearing screening program.

C.13.02 Impact of antipsychotic side effects on patient functioning: The patient's perspective

In order to contain the coronavirus disease 2019 (COVID-19) pandemic, Germany has implemented drastic restrictions on public or social life, while health institutions are invoked to postpone elective procedures. Although urologists are less involved in the direct treatment of COVID-19 patients, the current situation strongly affects the urological work routine.To analyze the impact of the COVID-19 pandemic on various aspects of work and personal life among urologists in Germany.A total of 589 urologists in Germany participated in an online survey between March 27 and April 11, 2020.Participants were stratified into subgroups according to professional characteristics.Most urologists rated Germany as “well prepared” and the increasing restrictions of social life as “very positive.” Routine operation was more restricted in hospitals than in the outpatient sector (p = 0.046). Moreover, urologists from the outpatient sector felt significantly less prepared for the COVID-19 pandemic (p = 0.001), reported a higher shortage of protective medical equipment (p < 0.001), and described a tendency toward a higher level of threat (p = 0.054). Although restrictions regarding telemedicine approaches were reported by 60% of participants, the outpatient sector used telehealth more frequently than hospitals (25.5% vs 17.0%, p < 0.001). Limitations include the national design and the restricted survey period.This survey systematically evaluates the impact of the COVID-19 pandemic on personal and professional aspects of German urologists. We identified several issues, such as a higher shortage of medical protective equipment in the outpatient sector that could trigger specific measures to further improve the quality of urological care in Germany.We evaluated a potential impact of the coronavirus disease 2019 (COVID-19) pandemic on professional and personal aspects of the urologists in Germany. Our results suggest that the outpatient sector should receive specific attention as, for example, shortage of protective equipment was more common.

A telemedicine approach to carpal tunnel syndrome: is it useful? A 2 year retrospective analysis in the province of Venice

In 2016 we started to perform electrodiagnostic studies (EDX) for suspected carpal tunnel syndrome (CTS) in our district, conducted independently by the technical staff (complete median e ulnar sensorimotor conduction study of median e ulnar nerves, with proximal stimulation and F waves), according to general practitioner request: EDX reports are performed within 7 days by neurologists through the central station in the main hospital, indicating to repeat EDX when negative. The study analyzes if CTS telemedicine approach is useful. We retrospectively collected data from 314 EDX studies carried out from March 2016, enumerate CTS positive patients, side, grading and time of onset. Data were collected from 314 patients, 81 males and 233 females, mean age 60 ± 16 years, 289 with CTS confirmed, 198 monolateral and 91 bilateral (92% positive exams). 122 patients had mild, 142 medium and 25 severe CTS. 25 patients had negative EDX: 6 had ulnar mononeuropathy, 4 had suspected radiculopathy, 1 had motor median mononeuropathy and 14 no other suspected diseases. 21 patients had coherent symptoms but negative EDX, while only 12 on 314 requests are incongruous Telemedicine provide a good alternative for diagnosing CTS. Few and contradictory data are available regarding intraoperative seizures (IOS) during surgery for Low Grade Gliomas (LGGs). Aim of this study was to evaluate the occurrence of IOS in regard to pre-operative clinical data, tumor molecular characteristics and electrocorticographic patterns. We performed a retrospective analysis of 155 patients affected by LGGs and tumor-related epilepsy, who underwent surgery in our Department, between 2007 and 2017. Pre-operative seizures frequency was as follows: 59% monthly, 34% weekly and 11% daily. 73% of patients were operated on through awake surgery. IOS occurred in 39 patients: in 9 patients only electrographic seizures occurred while in 13 patients seizures were cognitive, sensory, autonomic or emotional, thus recognizable only by means of electrocorticography (ECoG). Nineteen seizures were induced by brain mapping. Patients with ECoG epileptiform inter-critical patterns and IDH1/2 mutated tumors or oligodendrogliomas were more likely to develop IOS (p

Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review.

BackgroundTelemedicine and telehealth solutions are emerging rapidly in health care and have the potential to decrease costs for insurers, providers, and patients in various settings. Pediatric populations that require specialty care are disadvantaged socially or economically or have chronic health conditions that will greatly benefit from results of studies utilizing telemedicine technologies. This paper examines the emerging trends in pediatric populations as part of a systematic literature review and provides a scoping review of the type, extent, and quantity of research available.ObjectiveThis paper aims to examine the role of remote patient monitoring (RPM) and telemedicine in neonatal and pediatric settings. Findings can be used to identify strengths, weaknesses, and gaps in the field. The identification of gaps will allow for interventions or research to improve health care quality and costs.MethodsA systematic literature review is being conducted to gather an adequate amount of relevant research for telehealth in pediatric populations. The fields of RPM and telemedicine are not yet very well established by the health care services sector, and definitions vary across health care systems; thus, the terms are not always defined similarly throughout the literature. Three databases were scoped for information for this specific review, and 56 papers were included for review.ResultsThree major telemedicine trends emerged from the review of 45 relevant papers—RPM, teleconsultation, and monitoring patients within the hospital, but without contact—thus, decreasing the likelihood of infection or other adverse health effects.ConclusionsWhile the current telemedicine approaches show promise, limited studied conditions and small sample sizes affect generalizability, therefore, warranting further research. The information presented can inform health care providers of the most widely implemented, studied, and effective forms of telemedicine for patients and their families and the telemedicine initiatives that are most cost efficient for health systems. While the focus of this review is to summarize some telehealth applications in pediatrics, we have also presented research studies that can inform providers about the importance of data sharing of remote monitoring data between hospitals. Further reports will be developed to inform health systems as the systematic literature review continues.

Identification and Management of Middle Ear Disorders in a Rural Cleft Care Program: A Telemedicine Approach.

The aim of this study was to devise a grassroots-level strategy for identification and management of middle ear disorders in a community-based program for individuals with cleft lip and palate in 2 rural districts in the state of Tamil Nadu in South India. Community workers underwent training to conduct video otoscopy using the ENTraview device. Community workers conducted video otoscopy on 160 individuals with cleft lip and palate between 3 and 35 years old in the community. Middle ear conditions were identified using store-and-forward telepractice. Diagnostic telehearing evaluation was conducted using synchronous pure tone audiometry and tympanometry for those who were identified with tympanic membrane (TM) and/or middle ear diseases (MEDs). A review of data collected over a 13-month period was carried out to assess coverage and follow-up intervention rates. The program was successful in achieving 80% coverage for identification of TM and MEDs within 13 months of program implementation. TM and/or MEDs were identified in 26% (82/320 ears) of those who underwent video otoscopy. Telehearing evaluations were completed on 42 ears of individuals with TM and/or MEDs; 52% (22/42 ears) of these individuals had a minimal, mild, or moderate degree of hearing loss. Regarding follow-up for intervention, 78% qualified for surgical intervention, and 31% qualified for medication. This grassroots-level telemedicine approach was successful in achieving better coverage, and store-and-forward telepractice helped in providing remote diagnosis and recommendation by otolaryngologists to all individuals with TM/MEDs in the rural community. The follow-up for otological intervention significantly improved from that achieved in the previous years.

Factors in Premature Infants Associated With Low Risk of Developing Retinopathy of Prematurity

Most premature infants will not develop retinopathy of prematurity (ROP) of clinical relevance, yet screening evaluations often continue beyond hospital discharge, even for those infants without ROP. To identify the characteristics of infants at low risk for ROP, for whom further postdischarge screening may be of limited value. This study took place in North American neonatal intensive care units where clinicians had expertise in ROP. Infants with birth weight less than 1251 g who were born at or transferred into an Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) study center were enrolled. The study included post hoc analysis of prospectively collected in-hospital ROP examination results among infants enrolled in the e-ROP study. We characterized infants without ROP and performed logistic regression on the subset of infants who were 27 to 33 weeks' gestational age to determine characteristics associated with the absence of ROP during all in-hospital examinations. The main measure was the absence of ROP prior to hospital discharge; the main outcome was treatment for ROP. A total of 1257 infants born at 22 to 35 weeks' gestation (median [interquartile range (IQR)], 26 [25-28] weeks) with birth weights less than 1251 g (median [IQR], 860 [690-1040] g) underwent 4113 ROP examinations between 31 and 47 weeks' postmenstrual age. Overall, 1153 examinations (38%) showed no ROP, and 456 infants (36%) did not have ROP prior to study center discharge or study end point. Among infants without ROP during examinations at 32 and 33 weeks' postmenstrual age, 16 (9.4%) and 14 (5.3%) subsequently underwent ROP treatment, respectively. At hospital discharge, there was no ROP in 59% of infants of 27 to 33 weeks' gestational age, compared with 15% of those who were less than 27 weeks' gestational age (difference, 44% [95% CI, 38.5%-48.1%]; P ≤ .001). With more than 85% follow-up among infants without ROP by 37 weeks' postmenstrual age, none (95% CI, 0%-0.98%) were treated for ROP. In multivariate analysis of infants born at 27 to 33 weeks' gestation, larger birth weight (OR, 4.1 [95% CI, 1.6-10.3]) and higher gestational age (OR, 4.0 [95% CI, 1.5-10.8]) were significantly associated with absence of ROP. These findings suggest that, for infants of 27 weeks' gestational age or greater and birth weights larger than 750 g, if no ROP has been detected by discharge at near-term postmenstrual age, then further ROP surveillance has limited value. Studies of all infants at risk are needed to develop more specific, objective criteria for termination of ROP surveillance and focus resources on infants at higher risk of ROP. ClinicalTrials.gov Identifier: NCT01264276.

Informed consent in refractive surgery: in-person vs telemedicine approach.

PurposeThe aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion.MethodsPatients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality.ResultsPrior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient’s satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon’s approach. The type of consent (remote or in-clinic) had no impact on patient’s perception of consent quality in the regression model.ConclusionThe majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient’s perception of consent quality, regardless of the method of their consent.

Asymmetry of Retinopathy of Prematurity Border in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

To measure the location of the retinopathy of prematurity (ROP) border in a sample of premature infants developed ROP and to determine the location for predicting subsequent development of referral-warranted ROP (defined as stage 3 ROP, zone I ROP, or plus disease) or treated ROP. Secondary analysis of data from an observational cohort study, the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study. Infants with birth weight (BW) of less than 1251 g with at least 1 examination and imaging session at 34 weeks postmenstrual age (PMA) or younger with ROP not meeting referral-warranted ROP and at least 1 subsequent examination at 36 weeks PMA or older. The 5-image set from the first imaging session for each eligible eye was mosaicked, and measurements of the ROP border were made using Image J. Measurements were compared among 3 groups of eyes with ROP: (1) those that never developed referral-warranted ROP or received treatment, (2) those that developed referral-warranted ROP but did not receive treatment, and (3) those that received treatment. Referral-warranted ROP and treated ROP. Three hundred seventeen eyes from 217 infants with mean BW of 755 g, mean gestational age (GA) of 25 weeks, and mean PMA of 33 weeks at first examination met study criteria. Of 211 eyes (66.6%) with sufficient-quality images for grading, 147 (69.7%) did not develop referral-warranted ROP or receive treatment, 36 (17.1%) developed referral-warranted ROP not requiring treatment, and 28 (13.3%) received treatment for ROP. Among all eyes, the disc-to-ROP border distance followed a consistent pattern, with nasal less than inferior less than superior less than temporal. In multivariate analysis adjusted by BW and GA, nasal ROP border distance was a significant predictor of the subsequent development of ROP that was treated (odds ratio, 0.86 for every 10-pixel increase in distance; P = 0.002). Retinopathy of prematurity is located asymmetrically around the optic disc and is closest to the optic disc nasally. Location of ROP nasally at first imaging is a significant predictor for subsequent development of ROP that was treated.

Age-related macular degeneration in China: a population-based and clinical study

BackgroundAge-related macular degeneration (AMD) is one of the most common causes of irreversible blindness worldwide. We assessed its epidemiology and related factors in China. MethodsThrough population-based studies and clinical investigations, we assessed prevalence, incidence, and associated factors of AMD. The population-based investigations included several epidemiological surveys of ophthalmological and systemic diseases in China. The clinical studies consisted of biochemical examinations of aqueous humour samples obtained from patients undergoing intraocular surgery. FindingsIn the Beijing Eye Public Health Care Study, by use of a telemedicine approach, macular degeneration was identified to have caused visual impairment in 2700 (0·48%) of 562 788 elderly study participants (aged 55–85 years). In the Beijing Eye Study study, including 4439 participants and surveys done three times in 5-year intervals over a total period of 10 years, the prevalence of early AMD was 1·4%, late AMD was 0·20%, and exudative AMD was 0·10% per individual. Factors linearly association with AMD prevalence were older age (OR 1·06, 95% CI 1·04–1·08; p<0·0001), hyperopic refractive error (OR 1·16, 1·04–1·28; p=0·008), residence in a rural region (OR 0·33, 0·17–0·49; p<0·0001), and a lower level of education (OR 1·36, 1·07–1·65; p=0·01). The 5-year incidence of early AMD was 4·2% (SD 0·4, 95% CI 3·5–5·0), late AMD was 0·1% (SD 0·1, 0·0–0·2), and neovascular AMD was 0·1% (SD 0·1, 0·0–0·2). 5-year incidence was correlated with older age (odds ratio [OR] 1·03, 95% CI 1·01–1·06; p=0·01) and hyperopic refractive error (OR 1·15, 1·03–1·33; p=0·03). In participants with exudative AMD, as compared with control participants, intraocular concentrations of intercellular adhesion molecule-1 (844 pg/mL [SD 2073] vs 246 pg/mL [SD 206]; p=0·001) and soluble vascular cell adhesion molecule-1 (7978 pg/mL [SD 7120] vs 2999 pg/mL [SD 1426]; p=0·001) were significantly elevated. The concentration of MCP-1 decreased (p=0·009) with the type of subfoveal neovascular membrane (classic membrane type, occult membrane, retinal pigment epithelium detachment; p=0·009). In control participants, as compared with patients with neovascular AMD, the concentration of vascular endothelial growth factor (VEGF) was correlated with significantly shorter axial length (r −0·58; p=0·008). InterpretationBesides older age, hyperopic refractive error was the most important risk factor for prevalence and incidence of AMD in Chinese adults. The intraocular concentration of VEGF as a major AMD-associated growth factor decreased with increased axial length. The marked increase in myopia in the generation now aged younger than 30 years in China might be assumed to have a protective effect against AMD in the future. FundingNational Natural Science Foundation of China.

Telemedicine and prostate cancer survivorship: a narrative review.

Prostate cancer survivors have unique needs that encompass diagnosis and treatment-related side effects. The provision of services for prostate cancer survivors is often limited by resources, time constraints in traditional clinic visits, payment, and patient and provider comfort with discussion of sensitive topics including sexual and urinary health, both of which are largely impacted by treatment. Telemedicine, the remote delivery of health care services using telephone, mobile, web, and video platforms, allows for potential cost savings, in addition to ease and comfort as patients can engage in telemedicine-based resources in the comfort of their homes. Furthermore, survivors prefer to seek information online making telemedicine approaches for prostate cancer survivorship care an ideal combination. A majority of the telemedicine-based interventions used the web, followed by telephone, mobile, and video platforms. In limited studies, telemedicine delivery of survivorship care has equal efficacy to traditional care delivery. In addition, although older patients did not use the Internet regularly, they were willing to adapt to Internet usage if it had the potential to increase their quality of life. Telemedicine delivery of prostate cancer survivorship care is acceptable, feasible, cost-effective, and potentially preferred by prostate cancer survivors. Additionally, it emphasizes knowledge, self-management and self-monitoring serving to increase self-efficacy. This specialized care allows for greater access and reaches a wider catchment area compared to traditional clinic visits. This is especially important as the number of prostate cancer survivors increases and healthcare systems incorporate alternatives to traditional in-person care.

Acceptance of a new non-invasive fetal monitoring system and attitude for telemedicine approaches in obstetrics: a case-control study.

Reduction of maternal morbidity and mortality is a major worldwide objective anchored in the millennium goals of the United Nations. To improve fetal and maternal care, a constant attempt to discover groundbreaking technologies is ongoing. One approach is the enhancement of non-invasive fetal ECG devices. Most importantly, acceptance of new technologies by pregnant women is a prerequisite for successful implementation. This questionnaire-based study conducted at the University Hospital Heidelberg, Germany between May and June 2017 evaluates pregnant women's attitudes towards a new device for fetal ECG monitoring and its potential home usage. The study population was questioned after exposure to the Parides/Atlantis prototype (Nemo Healthcare, Veldhoven, The Netherlands), whereas the maternal and gestational age-matched control group was left to envision telemedical topics. The prototype and its potential usage in a clinical and telemedical setting was highly accepted, and its comfort and appearance satisfied participants. Its use caused significantly improved telemedical understanding as envision increased (p = 0.0015). Implementation and integration of telemedical devices into antenatal care was significantly preferred by the study group (p = 0.0011), though participants desire more specific features for their personal use. Optional home-based self-monitoring to reduce scheduled doctoral visits (p = 0.0004) as well as self-assessment prior to self-initiated, unscheduled consultation (p < 0.0001) could be affected positively by such a device. Furthermore, it could reduce face-to-face interaction with the care provider (p = 0.0163). The positive feedback on remote self-monitoring might open options for a more "patient as partners" oriented prenatal care in the future. Safety and reliability remain a major issue. More comprehensive studies with new technologies are needed to diligently ensure quality of care. Finally, results for new technologies must be communicated to pregnant women for their acceptance and usage of new devices.

Telemedicine in long-term care of glaucoma patients

Introduction This manuscript describes data from an original study, simulating a tele-glaucoma programme in an established clinic practice with an interdisciplinary team. This is a ‘real life’ trial of a telemedicine approach to see a follow-up patient. The goal is to evaluate the accuracy of such a programme to detect worsening and/or unstable disease. Such a programme is attractive since in-clinic time could be reduced for both the patient and provider. This study evaluates agreement between in-person and remote assessment of glaucoma progression. Methods A total of 200 adult glaucoma patients were enrolled at a single institution. The in-person assessment by an optometrist or glaucoma specialist at time of enrolment was used as the gold standard for defining progression. Collated clinical data were then reviewed by four masked providers who classified glaucoma as progression or non-progression in each eye by comparing data from enrolment visit to data from the visit immediately prior to enrolment. Agreement of glaucoma progression between the masked observer and the in-person assessment was determined using Kappa statistics. Intra-observer agreement was calculated using Kappa to compare in-person to remote assessment when both assessments were performed by the same provider (n = 279 eyes). Results A total of 399 eyes in 200 subjects were analysed. Agreement between in-person versus remote assessment for the determination of glaucoma progression was 63%, 62%, 69% and 68% for each reader 1–4 (kappa values = 0.19, 0.20, 0.35 and 0.33, respectively). For intra-observer agreement, reader 1 agreed with their own in-person assessment for 65% of visits (kappa = 0.18). Discussion Intra-observer agreement was similar to the agreement for each provider who did not see the patient in person. This similarity suggests that telemedicine may be equally effective at identifying glaucomatous disease progression, regardless of whether the same provider performed both in-clinic and remote assessments. However, fair agreement levels highlight a limitation of using only telemedicine data to determine progression compared with clinical detail available during in-patient assessment.