Telemedicine and e-Health最新文献

{"title":"Short- and Long-Term Outcomes of e-Health and Internet-Based Psychological Interventions for Chronic Tinnitus: A Systematic Review and Meta-Analysis.","authors":"Heribert Sattel, Petra Brueggemann, Kurt Steinmetzger, Benjamin Boecking, Alexandra Martin, Christian Dobel, Birgit Mazurek","doi":"10.1089/tmj.2024.0050","DOIUrl":"10.1089/tmj.2024.0050","url":null,"abstract":"<p><p><b>Objective</b>: e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. <b>Methods</b>: Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. <b>Results</b>: We found a statistically significant large effect size for improvement in tinnitus distress (<i>d</i> = 0.83; [confidence interval 0.61-1.06] with total <i>n</i> = 450 for the experimental group and total <i>n</i> = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size <i>d</i> = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. <b>Conclusions</b>: Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":"151-166"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513034","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":"10.1089/tmj.2025.0014","url":null,"abstract":"","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":"127-128"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","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":"Lessons Learned from Offering Video Visits as an Alternative to Phone Visits: A Case Study from a Safety-Net Obstetrics Clinics.","authors":"Jennifer N Juarez Yoc, Elaine C Khoong, Misa Perron-Burdick, Ben Li, George Su, Courtney Lyles, Malini Nijagal","doi":"10.1089/tmj.2024.0017","DOIUrl":"10.1089/tmj.2024.0017","url":null,"abstract":"<p><p>Before the Covid-19 pandemic, human-centered design work in San Francisco found video visits promising for Medicaid-insured pregnant individuals. They were deemed likely better than phone at addressing concerns about remoteness. We describe our experience with introducing video visits within a safety net clinic that had rapidly adopted phone visits as the standard telemedicine option early in the pandemic. By utilizing Kotter's change framework, providing an equity-focused vision, and supporting the implementation with a skilled, on-the-ground project manager, temporary uptake of offering video visits was achieved. However, competing priorities, staffing structure, and institutional culture were barriers to creating sustained change once grant funding ended, even after improvement of digital infrastructure. Efforts to increase video visit uptake in systems where telephone visits are the norm-as is in many safety net systems-may have limited success without leadership-driven prioritization and culture change at all levels.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":"249-253"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513030","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":"Efficacy of Remote Psychological Interventions for Patients with Anxiety and Depression Symptoms: Systematic Review and Meta-Analysis.","authors":"Priscila Oliveira Machado Cecagno, Natália Donati Polesello, Tatiana Duque-Cartagena, Pedro Machado Luz, Eduardo Mundstock, Marcello Dala Bernardina Dalla, Douglas Kazutoshi Sato, Rita Mattiello","doi":"10.1089/tmj.2024.0297","DOIUrl":"10.1089/tmj.2024.0297","url":null,"abstract":"<p><p><b>Background:</b> Anxiety and depression are common mental disorders that are highly prevalent worldwide. Clinical trials have found that telehealth interventions result in increased accessibility and improved mental treatment effectiveness. However, a few comprehensive syntheses of evidence from randomized clinical trials that have been conducted to evaluate remote psychological vs face-to-face interventions for anxiety and depression are not conclusive. The objective of this work was to evaluate the efficacy of remote psychological interventions for patients with anxiety and depression symptoms. <b>Methods:</b> Randomized clinical trials with the following criteria were included: participants aged ≥5 years, of both sexes, and who underwent psychological therapy to treat anxiety and or depression symptoms. They were randomized to receive the same psychological treatment remotely or face-to-face. Review studies, animal studies, pilot studies, and studies with patients diagnosed with chronic diseases were excluded. Searches were performed on March 2024 in the following databases: MEDLINE, EMBASE, LILACS, CENTRAL, CINAHL, Web of Science, SciELO, APA PsycINFO, and Scopus. The meta-analysis was conducted using the random-effects model, and the standardized mean difference with the 95% confidence interval (CI) was used to estimate the effect. <b>Results:</b> Six studies were included in this systematic review. The meta-analysis showed no statistically significant difference when comparing remote or face-to-face treatment for depression (SMD of -0.10 [95% CI: -0.57 to 0.37; <i>I</i>²: 77%]) and anxiety (SMD of -0.06 [95% CI: -0.34 to 0.21; <i>I</i>²: 0%]) symptoms. <b>Conclusion:</b> Our meta-analysis indicates that remote psychotherapy demonstrates comparable efficacy to face-to-face care in mitigating symptoms of depression and anxiety. It allows patients to select the best modality for their daily routines, promoting greater engagement and adherence to treatment.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":"141-150"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301099","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":"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":"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}