L'acte médical à l'épreuve de la télémédecine bucco-dentaire

The medical act is still a very vague notion in spite of the numerous developed attempts of definition. The treaty of medical law stays the reference but the devolpment of information and communication technologies and in particularly the telemedicine open the debate. This remote medical practice gives a new dimension to the medical act which deserves to be discussed. The odontology often stood back in the development of the telemedicine. Nevertheless there is a real public health issu on the oral state of the frail populations in France and in all countries. The development of a project of oral remote consultation in region Languedoc-Roussillon opens the discussion about the place of this profession in the landscape of the telemedicine.L'acte médical reste une notion encore très floue malgré les nombreuses tentatives de définition développées. Le traité de droit médical reste la référence mais l'apparition des technologies de l'information et de la communication et particulièrement la télémédecine relance le débat. Cette pratique médicale à distance donne une nouvelle dimension à l'acte médical qui mérite d'être discuté. L'odontologie est souvent restée en retrait dans le développement de la télémédecine. Il y a pourtant un réel besoin de santé public sur l'état bucco-dentaire des populations fragiles en France et dans la totalité des pays. Le développement d'un projet de téléconsultation bucco-dentaire en région Languedoc-Roussillon ouvre la discussion sur la place de cette profession dans le paysage de la télémédecine

Telemedicine in Dentistry, Lessons to be Learned: A Case Study

Most of the telemedicine projects do not pass the pilot stage. A comprehensive evaluation of telemedicine pilot projects is needed in order to improve their success rate and to create a knowledge base for future projects. In this paper we address this issue through the study case on a pilot teledentistry project with 5 different implementation sites. A literature review of teledentistry and telemedicine in general, points towards a rather one sided approach when evaluating these projects. The organizational aspect does not seem to be a priority in these evaluations while we consider its crucial impact on project’s continuity and adoption. To support this assumption we use a healthcare information systems implementation perspective which allowed us to assess the adoption barriers for the teledentistry pilot. We make assumptions on how it could be used for telemedicine pilots and for telemedicine projects in general. We have collected data using qualitative methods such as semi-structured interviews and non participant observation of teledentistry activities and meetings related to the project. After drawing the dental teleconsultation process and observing that most of it turns around electronic medical records(EMR) we focused to identify all potential adoption barriers and linking them with the list of EMR adoption barriers by Paré et al. (2014). We have identified 23 adoption barriers for teledentristry: 4 in 5/5 implementation sites, 1 in 4/5 sites, 6 in 3/5 sites, 2 in 2/5 sites and 10 in 1/5 sites. Out of the 23 teledentistry adoption barriers, 17 have been linked with EMR adoption barriers. By adding the remaining 6 items to the EMR adoption barriers list and adapting the items to the telemedicine context we propose a telemedicine pilot project adoption barriers list

2019: The Year of Teledentistry in France?

In France, access to a dentist for elderly people, disabled people or inmates is limited. A person’s access to a dentist decreases by 25% when joining a nursing home. A national report mentioned that 85% of residents in nursing homes didn’t have access to a dentist in the past year and 42% in the last 5 years. There are fewer data on disabled people, but 48% of people with disabilities have, at least, one important issue related to oral health. Two examples of teledentistry, the e-DENT project from University Hospital of Montpellier and the TEL-E-DENT project from the public Hospital of Guéret, are presented to describe how teledentistry works in France, the current legal framework, remuneration of teledentistry and the pros and cons of teledentistry in France. 2019 will be crucial for the development of teledentistry as a number official decisions will be made that will influence the implementation of this kind of activity

Patient satisfaction with E-Oral Health care in rural and remote settings: a systematic review protocol

BACKGROUND: Individuals living in rural and remote settings face oral health problems and access-to-care barriers due to the shortage of oral health care providers in these areas, geographic remoteness, lack of appropriate infrastructure and lower socio-economic status. E-Oral Health technology could mitigate these barriers by providing the delivery of some aspects of health care and exchange of information across geographic distances. This review will systematically evaluate the literature on patient satisfaction with received E-Oral Health care in rural and remote communities. METHODS: This systematic review will include interventional and observational studies in which E-Oral Health technology is used as an intervention in rural and remote communities of any country worldwide. Conventional oral health care will be used as a comparator when provided. Patient satisfaction with received E-Oral Health care will be considered as a primary outcome for this review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Global Health will be searched using a comprehensive search strategy. Two review authors will independently screen results to identify potentially eligible studies and independently extract the data from the included studies. A third author will resolve any discrepancies between reviewers. Two independent researchers will assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation. DISCUSSION: The potential implications and benefits of E-Oral Health care can inform policymakers and health care professionals to take advantage of this technology to address health care challenges in these areas

Accident Damage Analysis Module (ADAM) – Technical Guidance, Software tool for Consequence Analysis calculations

This report provides a technical description of the modelling and assumptions of the Accident Damage Analysis Module (ADAM) software application, which has been recently developed by the Joint Research Centre (JRC) of the European Commission (EC) to assess physical effects of an industrial accident resulting from an unintended release of a dangerous substanceJRC.E.2-Technology Innovation in Securit

High-resolution sea surface reconstructions off Cape Hatteras over the last 10 ka

International audienceThis study presents high-resolution foraminiferal-based sea surface temperature, sea surface salinity and upper water column stratification reconstructions off Cape Hatteras, a region sensitive to atmospheric and thermohaline circulation changes associated with the Gulf Stream. We focus on the last 10,000 years (10 ka) to study the surface hydrology changes under our current climate conditions and discuss the centennial to millennial time scale variability. We observed opposite evolutions between the conditions off Cape Hatteras and those south of Iceland, known today for the North Atlantic Oscillation pattern. We interpret the temperature and salinity changes in both regions as co-variation of activities of the subtropical and subpolar gyres. Around 8.3 ka and 5.2-3.5 ka, positive salinity anomalies are reconstructed off Cape Hatteras. We demonstrate, for the 5.2-3.5 ka period, that the salinity increase was caused by the cessation of the low salinity surface flow coming from the north. A northward displacement of the Gulf Stream, blocking the southbound low-salinity flow, concomitant to a reduced Meridional Overturning Circulation is the most likely scenario. Finally, wavelet transform analysis revealed a 1000-year period pacing the δ18O signal over the early Holocene. This 1000-year frequency band is significantly coherent with the 1000-year frequency band of Total Solar Irradiance (TSI) between 9.5 ka and 7 ka and both signals are in phase over the rest of the studied period

Teledentistry from research to practice: a tale of nineteen countries

AimThe COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries.MethodsData were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe.ResultsTen (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries.ConclusionDespite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry

The medical act in the test of teledentistry

L'acte médical reste une notion encore très floue malgré les nombreuses tentatives de définition développées. Le traité de droit médical reste la référence mais l'apparition des technologies de l'information et de la communication et particulièrement la télémédecine relance le débat. Cette pratique médicale à distance donne une nouvelle dimension à l'acte médical qui mérite d'être discuté. L'odontologie est souvent restée en retrait dans le développement de la télémédecine. Il y a pourtant un réel besoin de santé public sur l'état bucco-dentaire des populations fragiles en France et dans la totalité des pays. Le développement d'un projet de téléconsultation bucco-dentaire en région Languedoc-Roussillon ouvre la discussion sur la place de cette profession dans le paysage de la télémédecine.The medical act is still a very vague notion in spite of the numerous developed attempts of definition. The treaty of medical law stays the reference but the devolpment of information and communication technologies and in particularly the telemedicine open the debate. This remote medical practice gives a new dimension to the medical act which deserves to be discussed. The odontology often stood back in the development of the telemedicine. Nevertheless there is a real public health issu on the oral state of the frail populations in France and in all countries. The development of a project of oral remote consultation in region Languedoc-Roussillon opens the discussion about the place of this profession in the landscape of the telemedicine

Advocacy for a Digital Oral Health That Leaves No One Behind

International audienceDuring the first wave of the coronavirus disease 2019 (COVID-19) pandemic, the lockdown enforced led to considerable disruption to the activities of dental services, even leading to closures. To mitigate the impact of the lockdowns, systems were quickly put in place in most countries to respond to dental emergencies, giving priority to distance screening, advice to patients by remote means, and treatment of urgent cases while ensuring continuous care. Digital health was widely adopted as a central component of this new approach, leading to new practices and tools, which in turn demonstrated its potential, limitations, and possible excesses. Political leaders must become aware of the universal availability of digital technology and make use of it as an additional, safe means of providing services to the public. In view of the multiple uses of digital technologies in health—health literacy, teaching, prevention, early detection, therapeutics, and public health policies—deployment of a comprehensive program of digital oral health will require the adoption of a multifaceted approach. Digital tools should be designed to reduce, not increase, inequalities in access to health care. It offers an opportunity to improve healthy behavior, lower risk factors common to oral diseases and others noncommunicable diseases, and contribute to reducing oral health inequalities. It can accelerate the implementation of universal health coverage and help achieve the 2030 Sustainable Development Agenda, leaving no one behind. Digital oral health should be one of the pillars of oral health care after COVID-19. Universal access to digital oral health should be promoted globally. The World Health Organization’s mOralHealth program aims to do that. Knowledge Transfer Statement: This position paper could be used by oral health stakeholders to convince their government to implement digital oral health program