Video Teleconferencing Research Articles

Triangle of Healthy Caregiving for Veterans With Spinal Cord Injury: Proposal for a Mixed Methods Study

BackgroundSpinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning, and drastically altered quality of life (QOL). The Department of Veterans Affairs (VA) estimates that approximately 450 newly injured veterans and active-duty members receive rehabilitation at VA’s Spinal Cord Injury/Disorders Centers annually. VA virtual health services use technology and health informatics to provide veterans with better access and more effective care management. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention that incorporates SCI veterans’ caregivers into the VA SCI health care team and extends into the homes of veterans with SCI by using real-time clinical video teleconferencing (CVT). CVT facilitates video-clinic visits, which can include different types of clinical evaluations, therapy (physical/occupational), or psychosocial services. The “Triangle of Healthy Caregiving for SCI Veterans” builds on interactive, interdisciplinary health care relationships that exist between the veterans with SCI, their caregivers, and the VA SCI health care team. SCI veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life while living in their homes.ObjectiveThe goal of the proposed mixed methods project will assess SCI veterans’, their caregivers’, and the VA health care team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges, and outcomes for everyone involved in the intervention.MethodsData collection methods will be implemented over three sequential phases. First, in-depth interviews will be conducted with the telehealth coordinators to systematically document the administrative procedures involved in enrollment of veterans with SCI into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted to validate the content of the in-depth interviews and highlight any discrepancies observed. Semistructured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, their perceived utility, and effectiveness of the CVT system as well as the general impressions of the impact of the intervention on the SCI veterans’ health and function outcomes, caregiver burden, and daily caregiver burden. Finally, the research team will conduct a focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful for health care delivery to veterans with SCI and support services to SCI caregivers.ResultsThis proposal was funded in July 2017. It was reviewed and received institutional review board approval in March 2018, and the project was started immediately after, in the same month. As of September 2019, we have completed Phases I and III and have recruited 52 subjects for Phase II. We are beginning the data analysis. The study is projected to be completed in late summer of 2020, and the expected results are to be published in the fall of 2020.ConclusionsThe findings from this study will highlight the ways in which virtual health care technologies can be used to improve access to SCI specialized care for veterans and provide an estimation of the potential impact on clinical outcomes for veterans with SCI and their caregivers.International Registered Report Identifier (IRRID)DERR1-10.2196/14051

The Virtual Match: A New Approach to Celebrating Students During Social Distancing Due to COVID-19

To the Editor: Like many medical schools in the United States, the University of California, Irvine, School of Medicine canceled its traditional Match Day ceremony due to COVID-19. Acknowledging the disappointment associated with the cancellation of this seminal event for medical students, we sought to capture as many meaningful aspects of the in-person ceremony as possible through a virtual video conference event. We anticipated several challenges in planning this virtual event. Namely, we were concerned about technically managing a large number of participants and creating excitement during a virtual event. Coincidentally, the concept of “zoombombing” was first introduced during Match Week this year.1 To build excitement for the event, during Match Week, we distributed gift bags to students containing various celebratory items. On Match Day, the associate dean for students (M.B.O.) hosted the event on campus, with a small media team and videoconference monitor. Other school leadership joined the event remotely to adhere to social distancing protocols. A few technical decisions contributed positively to the event’s success. For example, we invited only graduating seniors and select faculty leadership to join the video teleconference, which allowed for better technical control and avoiding unwanted guests (“zoombombers”). We livestreamed our virtual Match Day event for family, friends, fellow students, and faculty on Panopto. For bandwidth considerations, we divided students into announcement groups of 10 or less. When each group was called, we invited them to turn on their audio and video. We called on each student individually, then students in the same group celebrated together after each announcement. Of our eligible graduating students, most (81%) chose to announce their results during the virtual Match Day event, which was slightly more than during past in-person events, although very few chose to “open” their results on camera. Most students had family, friends, or fellow students co-located with them as they presented. We encouraged students and viewers to use school-specific hashtags on social media, which we displayed on a sidebar during the livestream. One student wrote, “Virtual match day was so much fun!!! I’m so glad we were able to have a wonderful ceremony.” As medical schools plan future virtual events, we feel that several elements may improve their quality: limiting the number of participants to the videoconference, livestreaming, creating announcement groups, encouraging a social media presence, and distributing celebratory items before the event.

Examining Older Adult Cognitive Status in the Time of COVID‐19

Examining Older Adult Cognitive Status in the Time of <scp>COVID</scp>‐19

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report.

BackgroundThe risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.Materials and MethodsAn expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario.ResultsTwelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer.ConclusionThere was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.© 2020 RSNA; The American College of Chest Physicians, published by Elsevier Inc; and The American College of Radiology, published by Elsevier Inc.

Controlled trial of lovastatin combined with an open-label treatment of a parent-implemented language intervention in youth with fragile X syndrome

BackgroundThe purpose of this study was to conduct a 20-week controlled trial of lovastatin (10 to 40 mg/day) in youth with fragile X syndrome (FXS) ages 10 to 17 years, combined with an open-label treatment of a parent-implemented language intervention (PILI), delivered via distance video teleconferencing to both treatment groups, lovastatin and placebo.MethodA randomized, double-blind trial was conducted at one site in the Sacramento, California, metropolitan area. Fourteen participants were assigned to the lovastatin group; two participants terminated early from the study. Sixteen participants were assigned to the placebo group. Lovastatin or placebo was administered orally in a capsule form, starting at 10 mg and increasing weekly or as tolerated by 10 mg increments, up to a maximum dose of 40 mg daily. A PILI was delivered to both groups for 12 weeks, with 4 activities per week, through video teleconferencing by an American Speech-Language Association-certified Speech-Language Pathologist, in collaboration with a Board-Certified Behavior Analyst. Parents were taught to use a set of language facilitation strategies while interacting with their children during a shared storytelling activity. The main outcome measures included absolute change from baseline to final visit in the means for youth total number of story-related utterances, youth number of different word roots, and parent total number of story-related utterances.ResultsSignificant increases in all primary outcome measures were observed in both treatment groups. Significant improvements were also observed in parent reports of the severity of spoken language and social impairments in both treatment groups. In all cases, the amount of change observed did not differ across the two treatment groups. Although gains in parental use of the PILI-targeted intervention strategies were observed in both treatment groups, parental use of the PILI strategies was correlated with youth gains in the placebo group and not in the lovastatin group.ConclusionParticipants in both groups demonstrated significant changes in the primary outcome measures. The magnitude of change observed across the two groups was comparable, providing additional support for the efficacy of the use of PILI in youth with FXS.Trial registrationUS National Institutes of Health (ClinicalTrials.gov), NCT02642653. Registered 12/30/2015.

Telemedicine in Transgender Care: A Twenty-First-Century Beckoning.

The advent of telemedicine has undoubtedly revolutionized the practice of health care. With advances in photograph and live relay quality, and the ease of data transmission through the Internet, telemedicine has great potential in the field of plastic surgery. The majority of consultations in plastic surgery require visual diagnoses, thereby enabling telemedicine to help tackle issues of health care costs and accessibility.1,2 Telemedicine can help decrease patient travel and health care costs. Costa et al. described an average of 239 miles of travel avoided per visit for patients residing in the United States by using video teleconferencing for cleft lip/palate evaluations.3 At the same time, telemedicine-based approaches have been cited for having a high degree of accuracy.2,4 Engel et al. identified similar diagnostic accuracy between in-person examinations for free flap monitoring compared with remote smartphone photographic assessments.4 However, there is a paucity of literature focusing on the utility of telemedicine in the care of the transgender population. Despite the increasing social acceptance, gender-diverse people still face major challenges in access to appropriate health care.5–7 Thus, there is an urgent necessity to improve health care access for the transgender population.6,7 In 2017, Herman et al. found that approximately 1.4 million adults (0.6 percent of adults in the United States) and 150,000 youths (0.7 percent of the youths aged 13 to 17 in the United States) identify as transgender.8 Individuals who identify as transgender and seek medical or surgical transition require interdisciplinary health care involving multiple medical and ancillary services.6 Plastic surgeons play an invaluable role in gender-affirming operations in patients desiring these options.7,9 However, because of their complexity, these procedures are often limited to tertiary centers with specialized teams, which limits access to a large percentage of the transgender population.10 Many clinical assessments are amenable to telehealth, which can greatly facilitate health care access, decrease travel time, and reduce costs and wait times for these patients. Following gender-affirming surgery, there is a need for postoperative flap monitoring and assessment of wound healing.7,9 Scheduled postoperative telemedicine consultations would permit early identification of symptoms suggestive of complications. Furthermore, psychosocial issues continue after surgery and require periodic evaluation and support, which could be addressed through telehealth intervention. Recent literature has discussed the successful pilot implementation of telemedicine for providing transgender care in the Veteran’s Health Administration.6,11 These pilot studies reiterate the prospect of telemedicine in transgender care. However, the outcomes of telemedicine in the field of reconstructive surgery in this population are still lacking. In summary, both telemedicine and transgender care have been evolving over the past decade, particularly because of growing recognition and social awareness.7,12 Although telemedicine has been extensively adopted in plastic surgery2 and is starting to make steady inroads into transgender care,11 the cluster of these three fields has immense potential for revolutionizing the treatment of this population. Future studies should explore the effectiveness of telemedicine for improving outcomes and optimizing access to health care for this underserved population. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Therapeutic groups via video teleconferencing and the impact on group cohesion.

The use of synchronous telemental health for therapy group is a relatively new area of exploration. While telegroups have demonstrated they can be helpful in providing psychoeducation, there is less known about whether synchronous remote groups can develop group cohesion and whether patients can receive the benefit of a supportive group setting. A pilot study was conducted comparing group cohesion between patients who participated in a dialectical behavior therapy (DBT) group via video teleconferencing (VTC) and patients who participated in an in-person group. Findings indicate that while both groups felt equally connected to the facilitator, there were significant differences between the online and in-person groups on the group cohesion scale. Those in the online group did not feel as connected to other group members as those in the in-person group. Qualitative statements indicate that while an in-person group may have been preferable, the convenience of the online group outweighed any negative effects. Attendance was significantly better in the online group, suggesting that use of this technology may help to overcome barriers preventing treatment participation. The focus of this study was on group cohesion and changes in psychiatric symptoms were not evaluated. The use of telemental health for group therapy appears to be a viable alternative to traditional in-person groups, especially when no other treatment options are available. However, facilitators may need to take extra steps to build group cohesion when members are participating remotely.

A Tecnologia da Informação (TI) a serviço da gestão pública: vantagens da utilização da Videoconferência em audiências penais

This paper discusses the use of Video Hearing, Teleconference, or Videoconference equipment in the Brazilian criminal proceedings. It discusses its legality and identifies advantages of its application over the conventional model of criminal hearings. For this purpose, a bibliographic review was performed, where it was possible to verify its legal, constitutional and financial viability. Considering that its use complies with the constitutional principles of legal defense and contradictory, the benefits of its use for the legal system become undeniable, as it allows for the reduction of costs of the public entity and for the increase of the security standards of the judiciary's servers and for the public security. The advantages identified in the literature are in agreement with this finding (safety of those involved, speed and economy), demonstrating the gains from its application. Contrary to existing criticism, holding videoconference hearings preserves the individual rights and the guarantees declared by the Constitution of the Federative Republic of Brazil to convicts or defendants - since they are guaranteed the right to conduct an early and reserved interview with their advocate, thus ensuring confidentiality between lawyer and client.

Recruitment best practices of a cardiovascular risk reduction randomised control trial in rural Alaska Native communities

ABSTRACT Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and older, smoking daily, with hypertension and/or high cholesterol, residing in the Norton Sound region of Alaska. Study staff travelled to the remote communities to recruit, typically staying 5 days. Screening and enrolment success was examined by day, season, and staffing level. From June 2015 – December 2018, the study team made 122 trips, screening 1089 individuals and enrolling 314 participants. In the field, days 2–3 (51%) were best for screening, while days 3–4 (53%) had the greatest enrolment. Community size correlated with enrolment (r = 0.83, p <.001). Recruitment was optimised in spring and with multiple staff in the field. Despite challenges (e.g., harsh weather, poor internet connectivity), with active outreach (e.g. tabling in busy areas, attending community events, utilising mixed media, collaborating with clinic staff), the project reached its recruitment goal. Study findings can inform community-based tobacco treatment research trials in remote areas. Abbreviations CVD: Cardiovascular disease; VTC: Video teleconferencing; ANMC: Alaska Native Medical Centre; HEALTHH: Healing and Empowering Alaskan Lives Towards Healthy Hearts; NSHC: Norton Sound Health Corporation; RERB: Research Ethics Review Board

Telepsychiatry: Opportunities and Challenges

One of the major issues facing the patient population in the United States is the problem of effective and timely mental health care. The core of this issue is that patients are unable to see a mental health provider in a timely manner to be screened for psychiatric illness, be competently diagnosed and subsequently treated in an evidence-based manner. In a bid to mitigate this issue, the field of telepsychiatry has slowly evolved in the last couple of decades into a system which allows face-to-face quality psychiatric assessment, diagnosis and treatment modalities delivered through electronic mediums, primarily video teleconferencing. This electronic, cost effective mechanism allows access to a mental health provider in a timely manner, enhancing psychiatric care due to early intervention and follow-up, leading to positive outcomes. There is a dire need for mental health providers to be taught the skills required to evaluate patients who are not geographically present in their vicinity due to various circumstances and the optimal ways to assess their mental health conditions. There is a need for clinicians to learn this new and evolving technology and gain expertise to identify underlying emotional issues via technological means and help patients in achieving positive mental health outcomes.

A Systematic Review of the Use of Google Glass in Graduate Medical Education.

Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.

A Validation Study of the Remotely Administered Montreal Cognitive Assessment Tool in the Elderly Japanese Population.

Background: In an aging society, neuropsychological testing using video teleconferencing (VTC) is increasingly important. Despite the potential benefit of a VTC-administered Montreal Cognitive Assessment Tool (MoCA) to detect cognitive decline, only a limited number of studies have investigated this tool's reliability. Therefore, we aimed to evaluate the reliability of VTC-administered MoCA compared with face-to-face (FTF)-administered MoCA among elderly Japanese participants. Moreover, we examined participants' satisfaction with VTC-administered MoCA. Methods: Participants ≥60 years of age with and without cognitive impairment (i.e., those with mild cognitive impairment [MCI], those with dementia, and healthy controls [HC]) were assessed with VTC- and FTF-administered MoCA at an interval of >2 weeks and <3 months. The order effect (VTC first vs. FTF first) and time effect (first vs. second testing session), as well as several covariates such as age and years of education were controlled. Intraclass correlation coefficients (ICCs) were calculated using a mixed-effects model to assess the agreement between the two (VTC- vs. FTF-administered) groups. Participants' satisfaction with VTC-administered MoCA was examined using a Likert scale asking seven questions. Results: We included 73 participants in the study (36 men; age, 76.3 ± 7.5 years). The ICC for the MoCA total score was high in the entire sample (0.85), whereas ICCs were moderate to high for the subgroups (MCI: 0.82, dementia: 0.82, and HC: 0.53). Furthermore, we found good overall participant satisfaction with VTC-administered MoCA. Discussion: VTC-administered MoCA appears viable as an alternative to FTF-administered MoCA, although further replication studies with larger sample sizes are needed.

Practical and Regulatory Considerations of Teleprescribing via CVT.

Clinical video teleconferencing (CVT) represents a robust mechanism for more accessible medical care. Providers who practice medicine via CVT, including teleprescribing, should understand a number of core practical and regulatory factors. This paper aims to review these core factors, such that providers new to CVT may offer teleprescribing services in a manner consistent with current clinical standards and regulatory requirements. A number of practical factors relate to the setup and delivery of teleprescribing services that are contextually influenced by federal and state law. This review will elucidate the practical and regulatory factors relevant to teleprescribing and encourage the use of CVT for patient care. Through consideration of these factors, providers may better implement teleprescribing and prepare for future technology and policy changes relevant to practice.

A pilot study of a telehealth family-focused melanoma preventive intervention for children with a family history of melanoma.

Melanoma preventive interventions for children with familial risk are critically needed because ultraviolet radiation (UVR) exposure and sunburn occurrence early in life are the primary modifiable risk factors for melanoma. The current study examined the feasibility and acceptability of a new, family-focused telehealth intervention for children with familial risk for melanoma and their parents. The study also explored changes in child sun protection and risk behaviors, sunburn occurrence, and objectively measured UVR exposure. This was a prospective study with a single-group design (n = 21 parent-child dyads, children ages 8-17). Dyads were asked to participate in three in-person assessments and three live video teleconference intervention sessions. The intervention was feasibly delivered, and the intervention content was acceptable to parents and children. The intervention was associated with improvements in child use of certain sun protection strategies over time and declines in child UVR exposure. A telehealth-delivered,family-focused melanoma preventive intervention was feasibly delivered and was acceptable to parent-child dyads. Future melanoma preventive interventions for this at-risk population could incorporate eHealth technologies to facilitate improvements in use of sun protection and monitoring of UVR exposure. This trial was registered with Clinicaltrials.gov, number NCT02846714.

Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment.

Telepsychology holds promise as a treatment delivery method that may increase access to services as well as reduce barriers to treatment accessibility. The aim of this rapid evidence assessment was to assess the evidence for synchronous telepsychology interventions for 4 common mental health conditions (depression, anxiety, posttraumatic stress disorder, and adjustment disorder). Randomized controlled trials published between 2005 and 2016 that investigated synchronous telepsychology (i.e., telephone delivered, video teleconference delivered, or Internet delivered text based) were identified through literature searches. From an initial yield of 2,266 studies, 24 were included in the review. Ten studies investigated the effectiveness of telephone-delivered interventions, 11 investigated the effectiveness of video teleconference (VTC) interventions, 2 investigated Internet-delivered text-based interventions, and 2 were reviews of multiple telepsychology modalities. There was sufficient evidence to support VTC and telephone-delivered interventions for mental health conditions. The evidence for synchronous Internet-delivered text-based interventions was ranked as "unknown." Telephone-delivered and VTC-delivered psychological interventions provide a mode of treatment delivery that can potentially overcome barriers and increase access to psychological interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Amputees' Attitudes Toward Participation in Amputee Support Groups and the Role of Virtual Technology in Supporting Amputees: Survey Study.

BackgroundAcquiring information about and living with an amputation (or limb differential) is a lifelong endeavor. Although medical institutions address the immediate medical needs of amputees, information regarding how to live life as an amputee is provided from numerous sources, one of which is amputee support groups.ObjectiveThis study aimed at understanding why amputees join support groups, leave support groups, and possibly return to support groups as well as how technology, specifically virtual reality, might play a role in supporting patients’ needs. The results are intended to provide data for support groups, to increase their impact on amputee participants.MethodsA 38-item online survey was developed based on the findings of a previous randomized trial. The survey was administered between April and September 2018 and divided into four sections: Demographics, Limb Loss History, Amputee Support Group Participation, and Technology Usage. Items used multiple-choice, drop-down menu, check-box formats with explanation boxes for open-ended responses. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data.ResultsOf the 59 amputees enrolled, 54 completed the survey. All the respondents were aged 20-39 years, and nearly half of the older respondents thought audio and video teleconferencing or avatar-based technology would increase participation in support groups. The results suggest that an early goal for amputees who join support groups is to focus on regaining mobility and functionality in order to return to their normal life. Once achieved, the goal transitions to one of social connection with other amputees, although there is a caveat: Simply being an amputee may not provide sufficient connections for developing long-term social relationships. The strongest reason for joining a support group was to learn about living with an amputation, followed by networking and learning new skills.ConclusionsThe results suggest four key takeaways regarding amputee participation in support groups: (1) the needs of participants in amputee support groups change over time; (2) meeting content needs to be relevant to agendas primarily driven by participants; (3) support group participation is also driven by the desire to increase functionality by developing skills, become familiar with prosthetic technology, have more than amputation in common with other participants, and participate at the designated meeting time and location; and (4) the use of technology should support patients’ needs.

1286-P: U.S. Air Force Project ECHO Diabetes: Our Seven-Year Experience

The U.S. Air Force Medical Service (AFMS) provides medical care for active duty and retired service members and their families, which includes approximately 50,000 patients with diabetes at 76 clinics worldwide. With only 12 AFMS endocrinologists, the majority of diabetes care is provided by primary care providers (PCPs). In a strategic PCP knowledge expansion effort in 2012, the AFMS Diabetes Center of Excellence (DCOE) established a continuing telemedicine education program patterned after the Project Extension for Community Healthcare Outcomes (ECHO) model. Content of twice monthly video teleconference sessions included various diabetes standard of care topics and opportunities to discuss actual cases in real time. After seven years, this program has reached 560 unique individuals at 93 locations across the three military services and the Veterans’ Administration. Over time, groups of participants have expanded from providers only to a spectrum of diabetes care delivery disciplines: PCP, specialists, PharmD, NP, PA, RN, RD, and educators. From April through September 2018 alone, 11 presentations resulted in 499 potential CMEs at 33 locations. A total of 200 out of a potential 499 surveys were completed (40% response rate), which indicated an increase in moderate or strong agreement from 28 to 84% in knowledge sufficiency as a result of ECHO session participation. More importantly, those who felt moderate or strong confidence in the treatment of complex diabetes patients increased from 33 to 72%. Virtually all survey participants (96%) indicated a likelihood to make changes to their treatment practice based on content learned during ECHO sessions. In contrast to a traditional tertiary care referral model, models like Project ECHO Diabetes provide far greater reach, leveraging expert knowledge to increase the quality of diabetes care at the primary care level. In the context of the national diabetes epidemic and endocrinologist shortage, this model represents a realistic and responsible use of diabetes experts. Disclosure D. Beckman: None. M.W. True: None. C.C. Morrow: None. N. Watson: None. J.L. Wardian: None. J.M. Tate: None. T.J. Sauerwein: Speaker's Bureau; Self; AstraZeneca, Merck &amp; Co., Inc.

Remote neuropsychological assessment of elderly Japanese population using the Alzheimer’s Disease Assessment Scale: A validation study

Introduction Studies have demonstrated the high agreement of several remote neuropsychological tests using video teleconferencing (VTC) with face-to-face (FTF) tests. However, the reliability of the remotely administered Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog), one of the most commonly used neuropsychological tests to detect cognitive decline, has not been substantially elucidated, particularly in Japanese populations. Therefore, this study aimed to evaluate the reliability of the remotely administered ADAS-cog compared with FTF-administered ADAS-cog among elderly Japanese participants. Methods Participants aged ≥60 years with and without cognitive impairment, i.e. those with mild cognitive impairment (MCI), those with dementia and healthy controls (HCs), were assessed with the ADAS-cog using VTC and FTF testing at an interval of >2 weeks and <3 months. The assessment order (VTC or FTF) was randomized by participants. Participants’ scores were compared among the entire sample, as well as subgroups, using intra-class correlation coefficients (ICCs) in a mixed-effects model. Results A total of 73 participants were included in the study (36 men; age, 76.3 ± 7.6 years). The ICC for the ADAS-cog total score was high in the entire sample (0.86), whereas ICCs were moderate to high for the subgroups (MCI: 0.63, dementia: 0.80 and HC: 0.74). Discussion The results indicate that a VTC-administered ADAS-cog could be an alternative for an FTF-administered ADAS-cog, although further replication studies with larger sample sizes and a wider range of cognitive functionalities are warranted.

Commentary on: The Aesthetic Oculoplastic Surgery Video Teleconference Consult.

Commentary on: The Aesthetic Oculoplastic Surgery Video Teleconference Consult.

PortraitNet: Real-time portrait segmentation network for mobile device

Real-time portrait segmentation plays a significant role in many applications on mobile device, such as background replacement in video chat or teleconference. In this paper, we propose a real-time portrait segmentation model, called PortraitNet, that can run effectively and efficiently on mobile device. PortraitNet is based on a lightweight U-shape architecture with two auxiliary losses at the training stage, while no additional cost is required at the testing stage for portrait inference. The two auxiliary losses are boundary loss and consistency constraint loss. The former improves the accuracy of boundary pixels, and the latter enhances the robustness in complex lighting environment. We evaluate PortraitNet on portrait segmentation dataset EG1800 and Supervise-Portrait. Compared with the state-of-the-art methods, our approach achieves remarkable performance in terms of both accuracy and efficiency, especially for generating results with sharper boundaries and under severe illumination conditions. Meanwhile, PortraitNet is capable of processing 224 × 224 RGB images at 30 FPS on iPhone 7.