General practitioners’ perceptions of asynchronous telemedicine in a randomized controlled trial of teledermatology.

Background: Telemedicine is viewed as having a key role to play in the Government’s plans to modernise the NHS.1 However, to date there are few studies which have explored the views and acceptability of GPs towards telemedicine in primary care. Aim: To elicit the perceptions of GPs towards teledermatology (TD) before and after it’s introduction into their Practices and to observe whether GP views of TD had changed over the course of the study. Design of study: A postal questionnaire administered as part of a wider randomised controlled trial of telemedicine in dermatology. Setting: A locality group of eight General Practices in Sheffield and a single teaching hospital in Sheffield that provided the local dermatology referral service. Method: A postal questionnaire circulated to all GPs from the eight participating Practices. Results: A 85.7% (36/42) response rate was achieved. Only 21% (n=7; 95% CI: 10-37%) of respondents felt satisfied/very satisfied with TD in their Practice, 47% (n=16) said that they were dissatisfied or very dissatisfied. Thirty one per cent (n=10; 95% CI: 18-49%) said that they felt confident about diagnosis and management of care through TD, with 28% (n=9) reporting that they were unconfident. Only 23% (n=8; 95% CI: 12-39%) of respondents said that they would consider using a telemedicine system in the future, 34% (n=12) said they would probably or definitely not and 43% (n=15) were unsure. There was some evidence that GPs views about TD became more negative over the course of the study. Conclusions: The study reports less favourable GP responses to telemedicine than observed in previous studies, and suggests that the model of telemedicine described in this study paper would not be widely acceptable to GPs

Telemedicine in neurosurgery during SARS-CoV2 Pandemic

Introduction and purposeFirst large scale introduction and research of telecommunication in medicine was conducted in year 1977. However, until current SARS-CoV-2 Pandemic, telemedicine has been used only in emergency interventions or in cases in which only remote healthcare provision services were available. Healthcare was forced to implement telemedical changes in a scale broader beyond imagination, in order to limit the risk of COVID transmission and preserve the scarce healthcare resources. Especially in surgical fields, such as neurosurgery, which strongly depend on on-site procedures, this time has been extremely demanding. The aim of the study is to present the current views and effectiveness of implementation of telemedicine in neurosurgery during SARS-CoV2 pandemic. Substantial articles on implementation and challenges of telemedicine in neurosurgery from period 02.2020-09.2020 were analyzed.  Current state of knowledgeWithin 581 articles of PubMED database, 15 substantial articles on advancements of telemedicine in neurosurgery during SARS-CoV2 Pandemic were included in the review. 60% of the articles discussed telemedicine implementation and improvements made, 40% of the articles discussed the legislative changes, telemedicine recommendations and good pratices. Most of the articles noted the significant increase in provision of services using telemedicine and high satisfaction of patients and professionals from the remote visits. However, many challenges of the technology has been encountered including difficulties in conducting proper remote examination, lack of standarized protocols, concerns of the ethical and social matters, such as patient’s confidentiality and privacy concerns, digital illiteracy in patients, and the need for more advanced hardware and more secure software for the provision of high quality services. Conclusions Reviewed research presents significant improvements in introduction of telemedicine in neurosurgical field in times of COVID Pandemic, however due to many multidisciplinary concerns regarding telemedicine implementation, face-to-face examination and communication still should take priority over the telemedicine interventions in the non-emergency future.  

The Veterans Affairs Neuropathy Scale: A Reliable, Remote Polyneuropathy Exam.

Introduction: Polyneuropathy (PN) complaints are common, prompting many referrals for neurologic evaluation. To improve access of PN care in distant community clinics, we developed a telemedicine service (patient-clinician interactions using real-time videoconference technology) for PN. The primary goal of this study was to construct a remote exam for PN that is feasible, reliable, and concordant with in-person assessments for use in our tele-PN clinics. Methods: To construct the VA Neuropathy Scale (VANS), we searched the literature for existing, validated PN assessments. From these assessments, we selected a parsimonious set of exam elements based on literature-reported sensitivity and specificity of PN detection, with modifications as necessary for our teleneurology setting (i.e., a technician examination under the direction of a neurologist). We recruited 28 participants with varying degrees of PN to undergo VANS testing under 5 scenarios. The 5 scenarios differed by mode of VANS grading (in-person vs. telemedicine) and by the in-person examiner type (neurologist vs. technician) in telemedicine scenarios. We analyzed concordance between the VANS and a person's medical chart-derived PN status by modeling the receiver operating characteristic (ROC) curve. We analyzed reliability of the VANS by mixed effects regression and computing the intraclass correlation coefficient (ICC) of scores across the 5 scenarios. Results: The VA Neuropathy Scale (VANS) tests balance, gait, reflexes, foot inspection, vibration, and pinprick. Possible scores range from 0 to 50 (worst). From the ROC curve, a cutoff of >2 points on the VANS sets the sensitivity and specificity of detecting PN at 98 and 91%, respectively. There is a small (1.3 points) but statistically significant difference in VANS scoring between in-person and telemedicine grading scenarios. For telemedicine grading scenarios, there is no difference in VANS scores between neurologist and technician examinations. The ICC is 0.89 across all scenarios. Discussion: The VANS, informed by existing PN instruments, is a promising clinical assessment tool for diagnosing and monitoring the severity of PN in telemedicine settings. This pilot study indicates acceptable concordance and reliability of the VANS with in-person examinations

A telemedicina előnyei és hátrányai

Telemedicine is used more and more frequently worldwide. It is increasingly popular in North America, Australia, South Africa, as well as the Scandinavian countries. However, it is not commonly used in Hungary despite various attempts, which is presumably due to earlier dismissive governmental attitude. In this paper the authors analyze ethical, legal and financial aspects of telemedicine from the viewpoints of physicians and patients, too. The results indicate that it cannot be clearly decided whether telemedicine is worth to apply at present. Further, introduction of telemedicine should be based on experience gained in local application

Home Care Nurses\u27 Perceptions of Telemedicine

Introduction: Congestive heart failure (CHF) is a progressive and disabling illness with high healthcare utilization costs. Due to its complexity and the large number of patients diagnosed with CHF, telemedicine has been increasingly incorporated as part of CHF management. Many studies support its benefits in improving patient outcomes and its practicality to be used in the home care setting. However, more research is needed to investigate home care nurses’ perceptions of telemedicine and how those perceptions affect its implementation. Objectives: To explore home care nurses’ perceptions of telemedicine and how these perceptions could affect how telemedicine is implemented in home-care. Methods: The current study used a quantitative descriptive design, 40 home care nurses from a home healthcare agency in Western New York participated. Data was collected using a five-point Likert-scale questionnaire and later analyzed using Statistical Package for the Social Science (SPSS 24) Results: Home care nurses have an average to high level of knowledge of telemedicine (77%) but most of them reported lack of telemedicine education (87%). Significant differences were found between the nurses’ level of education and familiarity with telemedicine (F = 7.510; p = .002) and familiarity with telemedicine guidelines (F=5.03; p=.012). Conclusion: Most participants reported positive perceptions of telemedicine. Home care nurses’ familiarity of telemedicine is affected by their level of education. Findings indicate that further implementation of telemedicine training is important to increase home care nurses’ awareness of telemedicine. Further, home care agencies should consider encouraging their staff to further their nursing education as this may lead to stronger support for the use of telemedicine

Telemedicine in cardiology

Introduction Telemedicine is becoming regularly used in rural part of some of developed countries. Moreover, it could be applied to improve diagnosis and emergency care in adults as well as in neonatal care. Material and methods Articles in the EBSCO database have been analyzed using keywords: telemedicine, cardiology. The available literature is subjectively selected. Then, the newest version of every paper was searched for. Results Results of researches with applications of telemedicine in cardiology in emergency, chronic conditions. Moreover, potential costs and benefits were described. Conclusions Telemedicine could be useful for patients, their families, clinicians and regional healthcare systems. The rapidly changing healthcare climate includes an increasing focus on cost reduction, quality improvement and results, patient-centered care and technology solutions, all of which are well served by the optimal use of telemedicine

Digital health, telemedicine and COVID-19

Introduction Artificial intelligence, digital health, telemedicine, portable sensors, virtual reality - these new technologies will completely change the way patients and doctors perceive healthcare. The coronavirus pandemic has caused an explosive increase in the need for digital services, including those related to health and medicine.Objective: This review is to examine the interaction between telemedicine, digital health and the possibility of introducing new technologies to respond to and address the epidemic of COVID-19Source of information: Searched in the databases of Google, Google Scholar, Medscape, Medline, Linkedin, Twitter by keywords: telemedicine, digital health, artificial intelligence, COVID-19Conclusion: The new epidemic situation caused by COVID-19 is already further catalyzing the faster application of telemedicine, digital health in most medical specialties and activities. We reviewed and systematized the new trends in telemedicine caused by the COVID-19 epidemic

The introduction of a fetal ultrasound telemedicine service: quality outcomes and family costs

Introduction: The complexity of fetal medicine (FM) referrals that can be managed in a district general hospital (DGH) is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing. We report the successful introduction of a fetal ultrasound telemedicine service. Methods: All women referred for FM consultation from the linked DGH were seen via a weekly telemedicine service, excluding cases where invasive testing was anticipated. Image and audio quality were rated (using a 5 point scale) following each consultation. Women referred for their first appointment were asked to complete a questionnaire following the consultation. Figures presented are median [range]. Results: 80 women had a telemedicine consultation between October 2015 and September 2016. 37 cases were new referrals because of fetal anomaly (n = 17), exclusion of abnormal placental invasion (n = 11), small-for-gestational-age (n = 7) and prior history of fetal anomaly (n = 2) and 43 cases were follow-up consultations. Median gestation was 29 [13–36] weeks. Image quality was of sufficient quality to achieve the aims of the consultation in 79 cases with an image score of 4 [3–5] and audio score of 5 [3–5]. Journey to the telemedicine consultation was 20 [4–150] minutes in comparison to an estimated journey time of 238 [120–450] minutes to the FM centre. Estimated family costs for attendance at the FM centre were £95 [20–555]. Conclusion: We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced and used to provide high quality consultations

Telemedicine devices in internal medicine and neurology

Introduction Monitoring of patients systems remotely with feedback send to physician and patient could be applied in many fields of medicine. Telemedicine could presumably lead to improvement of patients care and treatment both in chronic conditions and in emergency, lowering demands on costs and time resources. Material and methods Articles in the EBSCO database have been analyzed using keywords: Telemedicine devices, telemedicine devices, neurology, cardiology. The available literature is subjectively selected. Then, the newest version of every paper was searched for. Results The most important and popular types of devices used in telemedicine in internal medicine and neurology were presented. Conclusions The development of devices in telemedicine results in an increase in effectiveness in the diagnosis and treatment of patients. In addition, remote access to the results of measurements made by these devices affects the quality of treatment

The Implementation of Telemedicine in the Covid-19 Era

Introduction: During the COVID-19 global pandemic in 2020, social distancing policies called for health care providers to turn to telemedicine platforms for most of their patient encounters. We aimed to better understand the experiences and perspectives of patients and providers who used telemedicine in the primary care setting. Methods: This study included semi-structured interviews with patients and providers who participated in telemedicine visits during the beginning of the COVID-19 pandemic. Patients (n = 14) were from a rural Maine practice and providers (n = 10) were from practices within 100 miles of a tertiary care center. The interviews were analyzed through inductive coding and applying the constant comparative method. Results: Both patients and providers expressed general satisfaction with their telemedicine experiences. Patients (64%) and providers (90%) felt “comfortable” with telemedicine. They praised telemedicine for its convenience and recognized the benefit of having a telemedicine option in the future. However, there was a mixed response regarding perceived efficacy of telemedicine and the ability to emotionally connect over virtual platforms. Finally, the participants in this study discussed dissatisfaction with the loss of the “ritual of medicine.” Discussion: The COVID-19 pandemic posed barriers to health care that parallel existing barriers in rural states. For much of this rural population, the rapid implementation of telemedicine enabled easier access to care. However, the implementation also saw many technological and infrastructural roadblocks. Conclusions: Understanding the benefits and challenges of telemedicine for patients and providers will be critical in assuring that telemedicine continues to improve access to health care