Teleneurology clinics for polyneuropathy: a pilot study.

INTRODUCTION:Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. METHODS:For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. RESULTS:The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic's success, saving an average of 231 min per patient in round-trip travel. The medical team's caring and collaborative spirit received high praise. While the clinic's efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. CONCLUSION:In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter

Usability and Reliability of Autism Diagnostic Observation Schedule (ADOS) Module 4 Remote Administration

Autism Spectrum Disorder (ASD) is characterized by impairments in social interaction, impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities. The Autism Diagnostic Observation Schedule (ADOS) Module 4 is a semi-structured diagnostic assessment tool designed for verbally fluent adolescents and adults with possible ASD. Due to a lack of available clinical expertise, it can be difficult for adults to receive an accurate ASD diagnostic assessment, especially those residing in rural areas. An ADOS teleassessment system was developed using the Versatile and Integrated System for Telerehabilitation (VISYTER). VISYTER consists of computer stations at the client site and clinician site, and a web portal server for managing and coordinating all elements of the assessment process. Clinician usability and fidelity to standard, face-to-face administration, was assessed. After improvements to the system were made, a study was conducted to determine the reliability of the ADOS module 4 administrations delivered remotely. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote and face-to-face ADOS were administered. Weighted kappa was calculated for all 31 ADOS items. There was substantial agreement on 11 items and almost perfect or perfect agreement on 10 items. Intraclass correlations (ICCs) were calculated for algorithm subtotals. ICCs were greater than .75 for three out of four subtotals. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely, Po=83%; ĸ =.772, ICC=.92. Non-agreement may have been due to outside factors or practice effect despite a washout period. Finally, usability and satisfaction of the remote assessment system was evaluated from the participants’ perspectives. Participant satisfaction with the remote ADOS delivery system was high. The results of these studies demonstrate that an ASD assessment designed to be delivered face-to-face can be reliably administered remotely using an integrated web-based system

Telemedicine Scenario for Elderly People with Comorbidity

Progressive population aging is associated with negative social and economic impacts mainly due to its associated comorbidity rather than to aging per se. In this regard, information and communication technology resources may provide useful tools to assist the population with comorbidities through the use of telemedicine systems. However, despite their potential, such systems have not yet been effectively implemented due to a number of different reasons: absence of a clear business plan, poor acknowledgement of their clinical usefulness, and ethical and legal issues, among others. An analysis of current scenario from the point of view of the different actors (patients, health care providers, and health care systems) aimed at identifying the needs to be covered by telemedicine systems that could contribute to overcoming such problems. The present chapter is intended to offer such an analysisPostprint (author’s final draft

Determination of the informational content of symptoms in the dynamic processes of assessing the patient’s condition in e-health

The study is devoted to substantiating the tactics of choosing the signs of the patient's condition for diagnostic decision-making on corrective medical intervention in mobile medicine. The aim of the research: to study a creation of a methodology for determining the integral informativeness of the patient's symptoms during remote monitoring of his condition. Materials and methods: this article is based on search results in PubMed, Scopus, MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA articles published between January 1991 and January 2021 and containing the search terms “information technology”, “Mobile medicine”, “digital pathology” and “deep learning”, as well as the results of the authors' own research. The authors independently extracted data on concealment of distribution, consistency of distribution, blindness, completeness of follow-up, and interventions. Results: concluded that to determine the Informativeness of symptoms in mobile monitoring of patients, it is possible to use risk indicators of predicted conditions as a universal method. Given that the Informativeness of the patient's condition changes constantly, for online diagnosis of conditions during remote monitoring of the patient it is recommended to use the function of informative symptoms from time to time and use a set of approaches to assess the Informativeness of patient symptoms. It is proposed to use the strategy of diagnosis and treatment using probabilistic algorithms based on the values of the risk of complications of the pathological process, as well as the formulas of Kulbach and Shannon to determine individual trends in the pathological patient process. Conclusion: there was proposed to use risk indicators of predicted conditions as a universal method for determining the informational content of symptoms in mobile monitoring of patients

The role of telehealth technology in the remediation of pediatric feeding disorders

Teletherapy, the use of video conferencing technology to deliver therapy services, has the potential to provide ongoing services to children that might not otherwise be able to receive traditional intervention that it essential for them to thrive. Among children who are diagnosed with developmental disorders, as well as those who are typically developing, feeding related concerns are highly prevalent. The current report discusses the nature of feeding disorders in children across the continuum of development and diagnoses, synthesizes the current literature of feeding and non-feeding related intervention programs for children in various settings, and discusses their value for future clinical use and research.Communication Sciences and Disorder

Fog Computing in Medical Internet-of-Things: Architecture, Implementation, and Applications

In the era when the market segment of Internet of Things (IoT) tops the chart in various business reports, it is apparently envisioned that the field of medicine expects to gain a large benefit from the explosion of wearables and internet-connected sensors that surround us to acquire and communicate unprecedented data on symptoms, medication, food intake, and daily-life activities impacting one's health and wellness. However, IoT-driven healthcare would have to overcome many barriers, such as: 1) There is an increasing demand for data storage on cloud servers where the analysis of the medical big data becomes increasingly complex, 2) The data, when communicated, are vulnerable to security and privacy issues, 3) The communication of the continuously collected data is not only costly but also energy hungry, 4) Operating and maintaining the sensors directly from the cloud servers are non-trial tasks. This book chapter defined Fog Computing in the context of medical IoT. Conceptually, Fog Computing is a service-oriented intermediate layer in IoT, providing the interfaces between the sensors and cloud servers for facilitating connectivity, data transfer, and queryable local database. The centerpiece of Fog computing is a low-power, intelligent, wireless, embedded computing node that carries out signal conditioning and data analytics on raw data collected from wearables or other medical sensors and offers efficient means to serve telehealth interventions. We implemented and tested an fog computing system using the Intel Edison and Raspberry Pi that allows acquisition, computing, storage and communication of the various medical data such as pathological speech data of individuals with speech disorders, Phonocardiogram (PCG) signal for heart rate estimation, and Electrocardiogram (ECG)-based Q, R, S detection.Comment: 29 pages, 30 figures, 5 tables. Keywords: Big Data, Body Area Network, Body Sensor Network, Edge Computing, Fog Computing, Medical Cyberphysical Systems, Medical Internet-of-Things, Telecare, Tele-treatment, Wearable Devices, Chapter in Handbook of Large-Scale Distributed Computing in Smart Healthcare (2017), Springe

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution

Teleconsultation perspective for cardiovascular patients in Saudi Arabia

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This research of teleconsultation services aims to improve the quality of diagnosis and treatment for rural cardiovascular patients through utilizing distant medical expertise. Equitable access to expert healthcare as well as improved medical management for these patients can assist in modifying cardiovascular disease (CVD) risk and reduce morbidity and mortality in Saudi Arabia. The objectives were to design and develop a new care pathway for cardiovascular disease patients by utilizing teleconsultation technology, investigate factors and issues that might act as barriers to its adoption, and then evaluate the impact of this model on the stakeholders. A small scale pilot project was used to determine the issues of technology, processes and human resources required to deliver an effective service with the context of the research setting. Four primary healthcare centres, two regional hospitals, fifteen patients and sixty other participant stakeholders were included in this study. An approach using (PCP) patient care pathways was used to introduce the teleconsultation technology and integrate it within the healthcare delivery system. Compared to the traditional PCP, the modified PCP utilising teleconsultation technology improved the quality of healthcare through: Improved access to medical care and quality of diagnosis by obtaining the expertise of a distant specialist. More efficient medical evaluation and management. Enhanced role of primary healthcare centres and participating hospitals by providing all levels of health services for patients. Evidence-based referral (reduced waiting time, reduced burden on outpatient clinics). The telconsultation adoption barriers included: Inadequacy of finance Limited infrastructure Legal and regularity difficulties. Organization issues. Literacy on technology. This study recommends the following for telemedicine implementation in the country: Promote perception and readiness for ICT services with the healthcare community. Enhance structural readiness including appropriate infrastructure and adequate funding, human resources and equipment. Proactive policies to encourage growth of the telecommunication sector and to address concerns regarding privacy and security