Telemedicine and e-Health最新文献

{"title":"Smartphone-Based Applications for Atrial Fibrillation Detection: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy.","authors":"Isabella Oliveira Freitas Barbosa, Beatriz Costa de Oliveira, Charles Karel Martins Santos, Maria Clara Ramos Miranda, Gabriel Alves Barbosa, Antônio da Silva Menezes Júnior","doi":"10.1089/tmj.2024.0579","DOIUrl":"https://doi.org/10.1089/tmj.2024.0579","url":null,"abstract":"<p><p><b>Background:</b> Atrial fibrillation (AF) burden is strongly associated with an increased risk of stroke, which, in most cases, can be prevented through earlier detection of AF and the timely initiation of anticoagulation therapy. Smartphone devices can provide a simple, non-invasive, cost-effective early AF detection solution. <b>Methods:</b> PubMed, Embase, and Scopus databases were searched for studies comparing smartphone-based photoplethysmography (PPG) with standard electrocardiogram for AF detection. A bivariate random-effects model with a 95% confidence interval (CI) was applied to generate the summary receiver operating characteristic (SROC) curve. <b>Results:</b> Fourteen studies were included, comprising 5,090 patients with an AF prevalence of 31.6%. The pooled sensitivity and specificity were 0.96 (95% CI, 0.93-0.97) and 0.97 (95% CI, 0.95-0.98). The area under the SROC curve was 0.98 (95% CI, 0.94-0.99). The diagnostic odds ratio was 960 (95% CI, 439-2,104), with significant heterogeneity (<i>I</i>² = 51%). The projected positive and negative predictive values were 66.5% and 99.7%, respectively, in the elderly population aged >65 years and 39.2% and 99.9% in the general population. <b>Conclusion:</b> Smartphone-based PPG demonstrated relatively high sensitivity and specificity and appears capable of ruling out AF. Patients aged >65 are more likely to benefit from AF screening.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Statewide Telemedicine Referral System for Regional Monoclonal Antibody Infusion Centers.","authors":"Romeo R Fairley, Andrew Ta, Tatiana Emanuel, Traceee Rose, Justine Skyler, Ralph Riviello","doi":"10.1089/tmj.2023.0666","DOIUrl":"https://doi.org/10.1089/tmj.2023.0666","url":null,"abstract":"<p><p><b>Background:</b> Regional infusion centers (RICs) played an integral role in treating high-risk patients with COVID-19, with mild to moderate symptoms, who did not need acute hospitalization, with monoclonal antibodies. While any medical provider could place a RIC referral, it was recognized that many people face challenges with accessing care. A dedicated medical team was created to provide telemedical evaluation of patients and place appropriate referrals to RICs. The objective of this work was to assess patient populations who utilized a telemedicine referral system for COVID-19 antibody infusions. <b>Methods:</b> Providers used Pulsara, a Health Insurance Portability and Accountability Act-compliant video chat platform, to remotely screen patients and refer them to regional monoclonal antibody infusion centers if they met criteria. Basic demographic data were collected anonymously on all patients referred to the RICs, and medically underserved populations were determined using the uniform data system mapper. <b>Results:</b> A total of 6,031 patients were referred to RICs through Pulsara. Of these, 1,723 (29%) lived in medically underserved areas and 1,042 (17%) lived in mixed zones. In the second half of the program, 36 providers virtually screened 3,531 patients with 1,890 patients (53.5%) receiving an infusion. <b>Conclusions:</b> The successful implementation of a telehealth referral system facilitated the decentralization of monoclonal antibody infusion therapy from emergency departments to RICs. This system reached a significant number of people living within medically underserved areas.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Teledermatology in the General Teledermatology Practice: Population Variances in Contrasting Health Care Scenarios.","authors":"Héctor Fuenzalida, Hernán Herrera-Reyes, Diego Aragón-Caqueo, José Luis Gatica","doi":"10.1089/tmj.2024.0317","DOIUrl":"https://doi.org/10.1089/tmj.2024.0317","url":null,"abstract":"<p><p><b>Introduction:</b> Pediatric dermatology access is limited. Pediatric teledermatology (TD) opens the opportunity to explore diverse dermatological pathology promptly. Different TD modalities and providers may influence the consulting population. This study compares a synchronous TD from a private provider with the asynchronous TD of the public sector in Chile's health care system. <b>Methods:</b> A descriptive and inferential analysis of 168 synchronous and 239 asynchronous pediatric teleconsultations, responded from January 2023 to August 2023. <b>Results:</b> Pediatric teleconsultations accounted for nearly one-fifth of all consultations in both models. The synchronous group was significantly older (<i>p</i> = 0.0065; 10.18 years ± 5.43 [0-18 years]) than the asynchronous group (8.65 years ± 5.74 [0-18 years]). June marked the highest and lowest teleconsultation volumes in synchronous and asynchronous platforms, respectively. The most frequent diagnostic group in both modalities was the noninfectious inflammatory pathology. Significant differences were noted within this group (<i>p</i> < 0.0001), with acne and dermatitis being predominant in the synchronous model. Significant differences also emerged within the infectious inflammatory group (<i>p</i> = 0.002), with bacterial and fungal infections being more common in the synchronous modality, whereas chronic viral infections predominated in the asynchronous group. <b>Discussion:</b> Pediatric TD is an emerging tool that optimizes access, manages the demand, and reduces waiting times. Seasonal variations may influence caregiver preferences for a specific attention model. The consulting population using synchronous and asynchronous modalities differs significantly in age and diagnostic distributions. Understanding these differences is crucial for effectively addressing specific practice gaps in each attention model.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Are Single Reader Evaluations Insufficient in Teledermoscopic Assessments? Analyses of a Retrospective Cohort Study.","authors":"Carolina Nätterdahl, Hedvig Kristensson, Bertil Persson, Jan Lapins, Lina U Ivert, Niki Radros, Karina Schultz, Cecilia Sand, Sigrid Lundgren, Anja Pahlow Mose, Jonas Ingvar, Adis Dizdarevic, Kari Nielsen, Åsa Ingvar","doi":"10.1089/tmj.2024.0532","DOIUrl":"https://doi.org/10.1089/tmj.2024.0532","url":null,"abstract":"<p><p><b>Background:</b> Teledermoscopy (TDS) emerges as an efficient tool for diagnosing skin lesions. In Sweden, double reading is the standard of care, but risk factors for misdiagnosis or mismanagement using single reader evaluations (SRE) are not well-studied. This study aimed to assess the accuracy of SRE compared with the gold standard in TDS. <b>Methods:</b> This retrospective cohort study involved 1,997 TDS referrals sent from general practitioners to dermatologists in Stockholm, Sweden, selected based on dermoscopic diagnoses. All referrals underwent double reader evaluations (DRE). Each case was reassessed by a single external assessor, blinded to the DRE result. Based on predefined rules, a gold standard for the most correct diagnosis was established. Diagnostic accuracy and risk factors for misdiagnosis were evaluated. The trial was registered on ClinicalTrials.gov (ID NCT05033678). <b>Results:</b> Primary diagnosis by SRE agreed with the gold standard on benign-malignant classification in 84% of cases. Discordance was linked to lower diagnostic confidence and more frequent recommendations for further intervention. SRE achieved a benign-malignant sensitivity and specificity of 84% (95% confidence interval: 81-87% and 82-86%, respectively). The risk of overdiagnosis increased 96 times when assessors reported being \"very unconfident.\" Out of a total of 311 melanomas, melanoma <i>in situ</i>, lentigo maligna, and severely dysplastic nevi, 62 were not recognized in the SRE primary diagnosis. However, 50 of these misdiagnosed lesions were still recommended for accurate management. <b>Conclusions:</b> The confidence level of TDS assessors heavily influences diagnostic accuracy. Therefore, when diagnostic confidence is perceived as moderate or low, additional interventions should be considered.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Telemedicine Solutions to Provide Psychological Interventions for Women Receiving Fertility Treatments.","authors":"Verónica Martínez-Borba, Beatriz Lorente-Debón, Jorge Osma","doi":"10.1089/tmj.2024.0446","DOIUrl":"https://doi.org/10.1089/tmj.2024.0446","url":null,"abstract":"<p><p><b>Introduction:</b> Infertility and assisted reproduction treatment (ART) are frequently accompanied by the experience of emotional disorders. Psychological interventions are available for infertile populations, but the barriers of current face-to-face models of care difficult their dissemination. This systematic review (PROSPERO: CRD4202340179) aims to summarize how technologies are used in telemedicine psychological programs to manage emotional disorders in women undergoing fertility treatments. <b>Methods:</b> Searches were conducted in December 2023 in six different databases. Two independent researchers conducted the searches, extracted the information, and assessed the quality of the studies (NHLBI tool). <b>Results:</b> Nineteen studies including 2,520 participants met eligibility criteria. Interventions were provided mostly to women who were undergoing in vitro fertilization/intracytoplasmic sperm injection (<i>n</i> = 11). Emotional disorders most frequently addressed were anxiety and depression (<i>n</i> = 11). The majority of the psychological programs were based on cognitive-behavioral therapy (<i>n</i> = 6), emotional writing (<i>n</i> = 3), acceptance and commitment therapy (<i>n</i> = 3), or positive reappraisal (<i>n</i> = 3). Many interventions were based on the use of internet (<i>n</i> = 5), diaries (<i>n</i> = 3), self-administered manuals (<i>n</i> = 2), short message service (<i>n</i> = 1), or face-to-face sessions (<i>n</i> = 5) supported by the inclusion of phone calls, emails, or audios. There is a lack of preventive interventions (<i>n</i> = 1). <b>Conclusions:</b> To the best of our knowledge, this is the first systematic review that explores the use of all kinds of technologies to provide psychological interventions to manage emotional disorders during ART. Results derived from this work may guide the development of future telemedicine services to provide psychological interventions.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same as It Ever Was.","authors":"Charles R Doarn","doi":"10.1089/tmj.2025.0014","DOIUrl":"https://doi.org/10.1089/tmj.2025.0014","url":null,"abstract":"","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of The National Emergency Tele-Critical Care Network.","authors":"Jeremy C Pamplin, Matthew T Quinn, Jeanette R Little, Dina Passman, Benjamin K Scott","doi":"10.1089/tmj.2024.0585","DOIUrl":"https://doi.org/10.1089/tmj.2024.0585","url":null,"abstract":"<p><p><b>Background:</b> The COVID-19 pandemic exposed significant frailties of the U.S. healthcare system, especially inequities facing rural areas during surges when critical access and small community hospitals could not transfer patients to referral centers that were already overcapacity. Many clinicians suffered moral injury from managing these patients beyond their scope of practice or from the need to triage care. <b>Methods:</b> The National Emergency Tele-Critical Care Network (NETCCN) sought to provide a lifeline of free, ad hoc consultation to clinicians who needed help - a critical care \"911\" system - by using mobile devices and easy-to-use applications designed to help clinicians rapidly communicate with experts. <b>Results:</b> NETCCN provided 1,863 days of coverage to 60 hospitals in 17 states and U.S. territories at a fraction of the cost of boots-on-the ground emergency support. <b>Conclusions:</b> We review our experience delivering this support and provide recommendations to guide future development and integration of telemedicine programs into the National Disaster Medical System.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Telemedicine Acute Care for Undifferentiated High-Acuity Conditions: Is a Picture Worth a Thousand Words?","authors":"Mamata V Kene, Dana R Sax, Reena Bhargava, Madeline J Somers, E Margaret Warton, Jennifer Y Zhang, Adina S Rauchwerger, Mary E Reed","doi":"10.1089/tmj.2024.0425","DOIUrl":"https://doi.org/10.1089/tmj.2024.0425","url":null,"abstract":"<p><p><b>Objectives:</b> Telemedicine use increased substantially with the COVID-19 pandemic. Understanding of the impact of telemedicine modality (video vs. phone) on post-telemedicine acute care for higher risk conditions is limited. <b>Methods:</b> We conducted a retrospective study of telemedicine visits, comparing video with telephone, for selected diagnoses with potentially higher illness acuity, evaluating post-telemedicine emergency department (ED) and hospitalization rates. In a large, multicenter cohort of adult patient-initiated primary care telemedicine visits from March 1, 2020, to July 31, 2021, we evaluated 7-day ED and hospitalization rates for higher acuity diagnostic categories (cardiac, gastrointestinal, and respiratory) by telemedicine modality, provider familiarity, and patient sociodemographic and clinical characteristics. <b>Results:</b> Among 431,705 telemedicine encounters, 128,129 (29.7%) were video visits and 303,576 (70.3%) were telephone visits. Adjusting for patient and appointment factors, telephone encounters for cardiac conditions were associated with significantly higher 7-day ED visit rates than video encounters (5.5% vs. 4.9%, respectively) but similar hospitalization rates (0.7% vs. 0.8%, respectively); for gastrointestinal conditions, post-telemedicine adjusted ED and hospitalization rates were comparable between telemedicine modalities (4.0% for ED and 1.2% vs. 1.3% for hospitalization, respectively); among respiratory conditions, video encounters were associated with higher ED and hospitalization rates than telephone encounters (ED: 5.9% after video vs. 5.2% after phone; hospitalization: 1.9% after video vs. 1.5% after phone). Telemedicine encounters with patients' own primary care provider (PCP) were associated with lower adjusted rates of ED use across all conditions and modalities. <b>Conclusions:</b> Short-term ED and hospitalization rates following primary care video or telephone visits for selected acute, high-risk conditions varied by condition and PCP familiarity. Nuanced use of video visits may confer benefits triaging to downstream acute care.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Utilization Patterns Associated with eConsults for Headache: Insights from an Urban Academic Medical Center.","authors":"Soonmyung Hwang, Parul Agarwal, Mark Dakov, Margaret H Downes, Benjamin R Kummer","doi":"10.1089/tmj.2024.0483","DOIUrl":"https://doi.org/10.1089/tmj.2024.0483","url":null,"abstract":"<p><p><b>Introduction</b>: Interprofessional electronic consultations (eConsults) can reduce health care utilization and improve access to specialty care. However, health care utilization and access impacts of eConsults for headache disorders remain incompletely characterized. <b>Methods</b>: We conducted a retrospective, 1:3-matched cohort study comparing patients referred for in-person headache evaluations to patients who had a headache-related eConsult. The cohorts were propensity score-matched by age, sex, race, preferred language, provider specialty, insurance status, and medical comorbidities. Our primary outcome was the presence of one or more headache-related ambulatory encounters in the 12 months following the index referral date. We used univariable and conditional logistic regression models to ascertain the associations between referral type and outcome. <b>Results</b>: We identified 74 and 222 patients with eConsult and in-person referrals, respectively. Over the follow-up period, the proportion of patients with the primary outcome was significantly greater in the eConsult cohort than the in-person cohort (46.0% vs. 43.2%, <i>p</i> < 0.0001). A greater proportion of the in-person cohort had one or more ambulatory headache encounters in the 12 months preceding their referral than the eConsult cohort (10.8% vs. 5.4%, <i>p</i> < 0.0001). In the adjusted analysis, eConsult usage was not associated with significantly increased odds of the primary outcome (adjusted odds ratio [aOR] 1.1, 95% confidence interval [CI] 0.6-2.0, <i>p</i> = 0.71), although patients with one or more ambulatory neurology encounters in the preceding 12 months had significantly increased odds of the primary outcome (aOR 3.1, 95% CI 1.2-7.9, <i>p</i> = 0.015). <b>Conclusion</b>: Compared to in-person referrals, eConsult use for headache was not associated with significantly increased odds of having subsequent ambulatory headache-related encounters.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' Acceptability and Perspective on Utilizing Telemedicine in Breast Cancer Care and Management.","authors":"Jing-Hui Ng, Mee-Hoong See, Alias Haridah, Lee-Lee Lai, Li Ping Wong","doi":"10.1089/tmj.2024.0466","DOIUrl":"https://doi.org/10.1089/tmj.2024.0466","url":null,"abstract":"<p><p><b>Background:</b> Telemedicine has emerged as a promising solution to address the challenges of providing continuous care to breast cancer patients, particularly in remote areas. This study aims to assess the acceptability of using telemedicine for breast cancer follow-up. <b>Methods:</b> A cross-sectional study utilizing a self-administered survey was conducted from January to March 2024 among 450 breast cancer patients at the Universiti Malaya Medical Center, Malaysia. Partial least-squares structural equation modeling was used to identify factors such as demographics, patients' characteristics, experience with telemedicine, attitudes, and concern of telemedicine use influencing willingness to use telemedicine for breast cancer follow-up. <b>Results:</b> Of the total 450 complete responses received, nearly half (49.3%) reported being somewhat likely to seek telemedicine for breast cancer follow-up, while only 11.1% reported being very likely. Comfort with telemedicine emerged as the strongest predictor of willingness to use it (β = 0.757, <i>p</i> < 0.001). A higher level of concern significantly negatively impacted willingness (β = -0.138, <i>p</i> < 0.001). However, attitudes toward telemedicine (β = 0.059, <i>p</i> = 0.144) were not significantly associated with its use. Among demographic factors, only age (β = 0.074, <i>p</i> = 0.018) was significantly positively associated with the willingness to use telemedicine, while education levels were found to have a significant inverse association (β = -0.076, <i>p</i> = 0.034). <b>Conclusions:</b> Improving comfort with telemedicine and addressing various concerns about its use for breast cancer follow-up through educational programs and support services are essential. Tailoring communication and support for different age groups and education levels can also enhance acceptance and utilization.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}