Telemedicine Programs in Respiratory Diseases

Telemedicine programs are widely used in respiratory diseases, more often in patients with chronic obstructive pulmonary diseases (COPD). Telemedicine platforms use several devices to measure vital signs such as heart rate, respiratory rate, pulsioximetry or blood pressure between others. It is not unusual that patients could do questionnaires about clinical situation or communicate with their nurses via telephone, video-calling and/or Skype. The majority of results has been positive, with reduction in the number of emergency visits, hospitalizations and noninvasive ventilations. Despite their promising results, telemedicine programs/platforms are slow to implement. In this chapter, we reviewed some of the factors related to telemedicine implementation such as patients’ adherence, impact of telemedicine design and professionals\u27 resistance to change between others

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

Identification of audio evoked response potentials in ambulatory EEG data

Electroencephalography (EEG) is commonly used for observing brain function over a period of time. It employs a set of invasive electrodes on the scalp to measure the electrical activity of the brain. EEG is mainly used by researchers and clinicians to study the brain’s responses to a specific stimulus - the event-related potentials (ERPs). Different types of undesirable signals, which are known as artefacts, contaminate the EEG signal. EEG and ERP signals are very small (in the order of microvolts); they are often obscured by artefacts with much larger amplitudes in the order of millivolts. This greatly increases the difficulty of interpreting EEG and ERP signals.Typically, ERPs are observed by averaging EEG measurements made with many repetitions of the stimulus. The average may require many tens of repetitions before the ERP signal can be observed with any confidence. This greatly limits the study and useof ERPs. This project explores more sophisticated methods of ERP estimation from measured EEGs. An Optimal Weighted Mean (OWM) method is developed that forms a weighted average to maximise the signal to noise ratio in the mean. This is developedfurther into a Bayesian Optimal Combining (BOC) method where the information in repetitions of ERP measures is combined to provide a sequence of ERP estimations with monotonically decreasing uncertainty. A Principal Component Analysis (PCA) isperformed to identify the basis of signals that explains the greatest amount of ERP variation. Projecting measured EEG signals onto this basis greatly reduces the noise in measured ERPs. The PCA filtering can be followed by OWM or BOC. Finally, crosschannel information can be used. The ERP signal is measured on many electrodes simultaneously and an improved estimate can be formed by combining electrode measurements. A MAP estimate, phrased in terms of Kalman Filtering, is developed using all electrode measurements.The methods developed in this project have been evaluated using both synthetic and measured EEG data. A synthetic, multi-channel ERP simulator has been developed specifically for this project.Numerical experiments on synthetic ERP data showed that Bayesian Optimal Combining of trial data filtered using a combination of PCA projection and Kalman Filtering, yielded the best estimates of the underlying ERP signal. This method has been applied to subsets of real Ambulatory Electroencephalography (AEEG) data, recorded while participants performed a range of activities in different environments. From this analysis, the number of trials that need to be collected to observe the P300 amplitude and delay has been calculated for a range of scenarios

Reviewing people with Obstructive Sleep Apnoea Hypopnoea Syndrome: telehealth and templates

Introduction Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAHS) is estimated to affect one billion people globally, carrying a substantial risk of road traffic accidents due to daytime sleepiness with additional other adverse health impacts. Continuous positive airway pressure (CPAP) is an effective treatment but requires long-term adherence. Regular clinical review of CPAP therapy users is important to address any problems, assess symptom relief, and specifically to review implications for driving. Reviews can be face-to-face, by telephone, or via teleconsultation with remote telemonitoring of CPAP usage. My PhD addresses the mode of delivery and content of CPAP reviews for people with OSAHS in three distinct but interlinked projects. Aims and objectives: 1)Systematic review: To review the evidence for the effectiveness of teleconsultation combined with telemonitoring in the review of people with OSAHS receiving CPAP therapy compared to face-to-face care. 2)e-Delphi: i)To reach consensus amongst a panel of international sleep clinicians, academics, and CPAP users on the most important components to include in a CPAP review, and how often a review should take place. ii)To develop a structured sleep medicine review template that records the important components identified by the e-Delphi consensus panel. 3)Implementation study To introduce the template in three diverse sleep medicine Centres for use in face-to-face or remote consultations and observe implementation using mixed methods. Systematic review I followed Cochrane methodology and I searched ten electronic databases, trial registries, and reference lists for studies that included interventions that combined remote consultations with telemonitoring of CPAP usage. Outcome measures were: the proportion of CPAP users who had a review, adherence to CPAP, symptom control, satisfaction / acceptability, and cost-effectiveness. From 362 potentially relevant papers, I identified four randomised controlled trials and one controlled clinical trial (including 269 patients). The risk of bias was moderate in one, and moderate to high in four trials. Two trials reported the number and duration of reviews with inconsistent results. The teleconsultation / telemonitoring improved CPAP adherence in two trials; two reported no between-groups differences. Two trials, both at moderate to high risk of bias, showed no between-group differences in the Epworth Sleepiness Scale. Satisfaction was generally positive in all five trials; one trial reported that the teleconsultation / telemonitoring patients were ‘more likely to continue’ with CPAP therapy and one trial reported that CPAP teleconsultation / telemonitoring was cost-effective. e - Delphi and template development I recruited an international expert panel to identify the core components of a CPAP review derived from thirteen OSAHS guidelines and asked participants to score components (scale of one to five) over three rounds. Consensus was defined as ≥75% agreement for scores of ≥4. Free-text comments were analysed thematically. 40 participants completed all three scoring rounds. Of 36 potential components, 17 achieved consensus: treatment acceptability, sleep quality, symptom resolution (including reduction in apnoea-hypopnoea index), assessment of sleepiness (including when driving), technical issues (mask fit / humidification / cleaning / filters), CPAP adherence, and quality of life. Participants suggested reviews should be 12 to 18 monthly (more frequent when in early treatment) or “on demand / request.” Free text comments emphasised that reviews should be multidisciplinary, flexible (including telehealth), and focus on symptom control. Based on the consensus findings I devised a CPAP review template that included the core components suggested by the participants. Implementation study I recruited three Centres: City, Urban / Rural, and Rural to a mixed-methods implementation study. There were four stages: I.Development of a tailored implementation strategy II.Implementation III.Evaluation IV.Refining Effectiveness of the implementation strategy was assessed by template uptake, feasibility of use, and fields completed. Analysis of the quantitative data was descriptive. Nine clinicians participated in final semi-structured interviews which were analysed thematically. 219 anonymised templates were returned for analysis; all were completed voluntarily by nursing staff. The average completion time was 14 minutes; with six of the eight fields completed in over 90% of reviews. Six themes emerged from nine interviews. The template: 1) Facilitated a structured, standardised review, reducing variation in practice. 2) Was not perceived to affect clinical autonomy or person-centred care. 3) The decision to participate was made at organisational level and individuals in the departments were free to decide whether, or not, to use the template in any / all of their consultations. 4) Use of the template did not impact on how the review was conducted though template completion extended review time in one Centre where double data entry was required. 5) From a service perspective, the template was perceived as improving efficiency and promoting better patient outcomes whether in face-to-face reviews or teleconsultations. 6) The template was seen as potentially contributing to multidisciplinary team working. With the rapid deployment of Microsoft Teams and NHS Near Me during the COVID -19 pandemic, the template supported remote consultations and might be useful for education and training purposes. Adaptations (structure, content, and layout) were highlighted. An electronic template was suggested, integrated with the electronic health record, obviating the requirement to dictate letters and reducing administrative processes. Conclusions and context The three studies add to the evidence base on the regular review of CPAP users. Telemedicine is an option for CPAP reviews for people with OSAHS. The international consensus group identified important components that should be recorded in a CPAP review informing development of a structured review template. Implementation of the template was achieved in three Centres and was considered to provide structure to both face-to-face reviews and teleconsultations with a potentially important role in training staff and standardising care. Teleconsultation has come of age in the midst of a global pandemic for routine CPAP reviews, and electronic templates adapted to the local setting could support safe and effective care and promote efficient communication

Real-time attended home-polysomnography with telematic data transmission

Purpose: Home-polysomnography (HPSG) has been proposed as a cost-effective alternative for obstructive sleep apnea (OSA) diagnosis.We assessed, in a feasibility study, whether telematic transmission using the Dream® and Sleepbox® technologies was associated with low HPSG failure rate. Methods: Patients referred by chest physicians for clinical suspicion of OSA underwent one HPSG, using Dream® and Sleepbox® (Medatec, Belgium), which is a wireless system able to communicate with Dream®, and with Internet through a wi-fi/3G interface. It is equipped with a digital infrared camera, and with a speaker/microphone system for bidirectional audio/video communication via Skype®.The Sleep Lab nurse performed a remote discontinuous monitoring of the PSG. In case of sensor loss, she called the patient who had been previously educated to replace the sensors. Results: Twenty-one patients have been studied. 90% of the recordings were of excellent quality. We observed a 10% PSG failure rate: one failure of the Dream®, and one recording of poor quality. There were 2 successful Skype® interventions resulting in readjustment of the defective probes (nasal cannula and EEG). PSG signal visualization was possible in 90% of cases but Skype® connection was problematic in 19% of cases. However, patients could be reached by phone to solve the problem. Conclusions: Real-time attended HPSG through telematic data transmission is feasible and could be an interesting perspective to decrease the failure rate of home sleep studies, even if some technical aspects need to be improved. © 2013 Elsevier Ireland Ltd.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Reducing uncertainties in virtual consultation: the impact of media naturalness and mental model alignment on patient satisfaction in doctor-patient communication

Virtual consultation (VC) can be simply referred to as a telemedicine service that enables patients to access doctors remotely. It has been largely used by patients with many potential benefits. Nevertheless, many patients still have uncertainties regarding the consultation processes and results, which mostly concern communication with doctors. This thesis aims to answer the following two questions: 1) What uncertainties do patients have during VC, and how do these uncertainties affect patients’ satisfaction towards the consultation? 2) How does the medium affect patients’ perceived uncertainties and their satisfaction with VC? Two studies were conducted to examine the impact of media on perceived uncertainty and patients’ attitudes in doctor-patient computer-mediated communication (CMC), based on uncertainty reduction theory, media naturalness theory, and mental model theory.The first study is a content analysis to analyze why patients are willing to visit doctors virtually and what uncertainties patients have about VC. Patients’ online reviews on five famous virtual consultation systems were collected to do content analysis. The results show that the uncertainties patients have during patient-doctor communication in VC are mainly on doctors’ behaviour, describing symptoms, understanding doctors, doctors’ feelings and emotions, doctors’ attitudes, and VC process. This study helps to understand patients’ concerns about using healthcare systems to do VC and reconceptualizes uncertainty in the context of patient-doctor CMC. The second study is a field experiment to explore how media naturalness (selection of media) and mental model alignment (media content) influence the patients’ perceived uncertainties which then impact on the patients’ satisfaction with the VC experience. After three rounds of pre-tests, 327 valid questionnaires were obtained in the main test and used to do data analysis. The results support the following hypotheses: a) Higher levels of media naturalness reduce patients’ perceived uncertainty level. b) Higher levels of mental model alignment (i.e., the alignment of VC design with patients’ mental models) decrease patients’ perceived uncertainty level. c) Patients’ lower level of perceived uncertainty increases their level of satisfaction. This thesis contributes by revealing the meaning of uncertainties in VC and improving our understanding of how to reduce the patients’ perceived uncertainties by better designing VC system. It provides empirical evidence on how media naturalness and mental model alignment increase patients’ satisfaction on VC by reducing their uncertainties. The results can serve as a basis for further research on how to enhance the design of VC systems to fit patients’ psychological and cognitive processes when they use these systems to visit doctors online. The thesis contributes practically by facilitating healthcare providers to understand patients’ concerns and uncertainties while partaking in VC, and by guiding the design of VC systems to enhance communication between patients and doctors, and thus increase patient satisfaction