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Gaudine A, Parsons K, Smith-Young J. Older Adults' Experiences with Remote Care for Specialized Health Service During the COVID-19 Pandemic: A Descriptive Qualitative Study. Can J Aging 2024; 43:257-265. [PMID: 37869900 DOI: 10.1017/s0714980823000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic necessitated a rapid uptake of remote health care services. This qualitative descriptive study was designed to gain an understanding of older adults' experiences of remote care (telephone or online video conference appointments) for specialized health services during the COVID-19 pandemic. Twenty-one older adults (ages 65 years and older; 8 men and 13 women) living in eastern Canada participated in a semi-structured telephone interview. Data were analysed using qualitative content analysis. The vast majority of older adults were overall satisfied with their remote experiences of specialist care. Advantages to remote care for specialized services included convenience, safety during the pandemic, comfort, efficiency, and ease of visit. Disadvantages included communication not as effective, feeling depersonalized or disembodied, missing the human relationship, and wanting reassurance of physical assessment. It is important that health professionals understand the disadvantages for older adults of remote care visits in order to mitigate them.
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Affiliation(s)
- Alice Gaudine
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Karen Parsons
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne Smith-Young
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
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Subramanian S, Pamplin JC. Telemedicine for emergency patient rescue. Curr Opin Crit Care 2024; 30:217-223. [PMID: 38690953 DOI: 10.1097/mcc.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE OF REVIEW This article summarizes recent developments in the application of telemedicine, specifically tele-critical care (TCC), toward enhancing patient care during various types of emergencies and patient rescue scenarios when there are limited resources in terms of staff expertise (i.e., knowledge, skills, and abilities), staffing numbers, space, and supplies due to patient location (e.g., a non-ICU bed, the emergency department, a rural hospital) or patient volume as in pandemic surges. RECENT FINDINGS The COVID-19 pandemic demonstrated the need for rapidly scalable and agile healthcare delivery systems. During the pandemic, clinicians and hospital systems adopted telemedicine for various applications. Taking advantage of technological improvements in cellular networks and personal mobile devices, and despite the limited outcomes literature to support its use, telemedicine was rapidly adopted to address the fundamental challenge of exposure in outpatient settings, emergency departments, patient follow-up, and home-based monitoring. A critical recognition was that the modality of care (e.g., remote vs. in-person) was less important than access to care, regardless of the patient outcomes. This fundamental shift, facilitated by policies that followed emergency declarations, provided an opportunity to maintain and, in many cases, expand and improve clinical practices and hospital systems by bringing expertise to the patient rather than the patient to the expertise. In addition to using telemedicine to maintain patient access to healthcare, TCC was harnessed to provide local clinicians, forced to manage critically ill patients beyond their normal scope of practice or experience, access to remote expertise (physician, nursing, respiratory therapist, pharmacist). These practices supported decades of literature from the telemedicine community describing the effectiveness of telemedicine in improving patient care and the many challenges defining its value. SUMMARY In this review, we summarize numerous examples of innovative care delivery systems that have utilized telemedicine, focusing on 'mobile' TCC technology solutions to effectively deliver the best care to the patient regardless of patient location. We emphasize how a 'paradigm of better' can enhance the entirety of the healthcare system.
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Affiliation(s)
| | - Jeremy C Pamplin
- Medicine and Emergency and Operational Medicine, Uniformed Services University, Bethesda
- Telemedicine and Advanced Technology Research Center, Medical Research and Development Command, Ft. Detrick, Maryland, USA
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Stevens ER, Xu L, Kwon J, Tasneem S, Henning N, Feldthouse D, Kim EJ, Hess R, Dauber-Decker KL, Smith PD, Halm W, Gautam-Goyal P, Feldstein DA, Mann DM. Barriers to Implementing Registered Nurse-Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study. JMIR Form Res 2024; 8:e54996. [PMID: 38781006 DOI: 10.2196/54996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. OBJECTIVE As a delegation protocol, we adapted a validated electronic health record-integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. METHODS We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. RESULTS Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. CONCLUSIONS Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. TRIAL REGISTRATION ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lynn Xu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - JaeEun Kwon
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sumaiya Tasneem
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Natalie Henning
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Dawn Feldthouse
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Eun Ji Kim
- Northwell, New Hyde Park, NY, United States
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Wendy Halm
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- University of Wisconsin-Madison School of Nursing, Madison, WI, United States
| | | | - David A Feldstein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Devin M Mann
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Department of Medicine, New York University Langone, New York, NY, United States
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Fang J, Zhou W, Hayes DK, Wall HK, Wozniak G, Chung A, Loustalot F. Changes in Self-Measured Blood Pressure Monitoring Use in 14 States From 2019 to 2021: Impact of the COVID-19 Pandemic. Am J Hypertens 2024; 37:421-428. [PMID: 38483188 DOI: 10.1093/ajh/hpae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Self-measured blood pressure monitoring (SMBP) is an important out-of-office resource that is effective in improving hypertension control. Changes in SMBP use during the Coronavirus Disease 2019 (COVID-19) pandemic have not been described previously. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data were used to quantify changes in SMBP use between 2019 (prior COVID-19 pandemic) and 2021 (during the COVID-19 pandemic). Fourteen states administered the SMBP module in both years. All data were self-reported from adults who participated in the BRFSS survey. We assessed the receipt of SMBP recommendations from healthcare professionals and actual use of SMBP among those with hypertension (n = 68,820). Among those who used SMBP, we assessed SMBP use at home and sharing BP readings electronically with healthcare professionals. RESULTS Among adults with hypertension, there was no significant changes between 2019 and 2021 in those reporting SMBP use (57.0% vs. 55.7%) or receiving recommendations from healthcare professionals to use SMBP (66.4% vs. 66.8%). However, among those who used SMBP, there were significant increases in use at home (87.7% vs. 93.5%) and sharing BP readings electronically (8.6% vs. 13.1%) from 2019 to 2021. Differences were noted by demographic characteristics and residence state. CONCLUSIONS Receiving a recommendation from the healthcare provider to use SMBP and actual use did not differ before and during the COVID-19 pandemic. However, among those who used SMBP, home use and sharing BP readings electronically with healthcare professional increased significantly, although overall sharing remained low (13.1%). Maximizing advances in virtual connections between clinical and community settings should be leveraged for improved hypertension management.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wen Zhou
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Alina Chung
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Spaulding EM, Fang M, Commodore-Mensah Y, Himmelfarb CR, Martin SS, Coresh J. Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey. J Med Internet Res 2024; 26:e52124. [PMID: 38728070 PMCID: PMC11127137 DOI: 10.2196/52124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 02/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. OBJECTIVE This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. METHODS We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. RESULTS We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. CONCLUSIONS Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States
| | - Seth S Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, United States
- Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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Yang M, Evans JM, Singer SJ, Gutberg J, Porter TH, Grudniewicz A. Crisis leadership behaviors in healthcare: survey validation and influence on staff outcomes in primary care clinics during the COVID-19 pandemic. BMC Health Serv Res 2024; 24:590. [PMID: 38715045 PMCID: PMC11075262 DOI: 10.1186/s12913-024-11061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic triggered an unprecedented transition from in-person to virtual delivery of primary health care services. Leaders were at the helm of the rapid changes required to make this happen, yet outcomes of leaders' behaviours were largely unexplored. This study (1) develops and validates the Crisis Leadership and Staff Outcomes (CLSO) Survey and (2) investigates the leadership behaviours exhibited during the transition to virtual care and their influence on select staff outcomes in primary care. METHODS We tested the CLSO Survey amongst leaders and staff from four Community Health Centres in Ontario, Canada. The CLSO Survey measures a range of crisis leadership behaviors, such as showing empathy and promoting learning and psychological safety, as well as perceived staff outcomes in four areas: innovation, teamwork, feedback, and commitment to change. We conducted an exploratory factor analysis to investigate factor structure and construct validity. We report on the scale's internal consistency through Cronbach's alpha, and associations between leadership scales and staff outcomes through odds ratios. RESULTS There were 78 staff and 21 middle and senior leaders who completed the survey. A 4-factor model emerged, comprised of the leadership behaviors of (1) "task-oriented leadership" and (2) "person-oriented leadership", and select staff outcomes of (3) "commitment to sustaining change" and (4) "performance self-evaluation". Scales exhibited strong construct and internal validity. Task- and person-oriented leadership behaviours positively related to the two staff outcomes. CONCLUSION The CLSO Survey is a reliable measure of leadership behaviours and select staff outcomes. Our results suggest that crisis leadership is multifaceted and both person-oriented and task-oriented leadership behaviours are critical during a crisis to improve perceived staff performance and commitment to change.
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Affiliation(s)
- Michelle Yang
- École interdisciplinaire des sciences de la santé/Interdisciplinary School of Health Sciences, université d'Ottawa /University of Ottawa, 25 University Private, Ottawa, ON, K1N 7K4, Canada
| | - Jenna M Evans
- DeGroote School of Business, McMaster University, Hamilton, ON, L8S 4E8, Canada
| | - Sara J Singer
- Department of Health Policy, Stanford University, 615 Crothers Way, Stanford, CA, 94305, USA
| | - Jennifer Gutberg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Tracy H Porter
- Monte Ahuja College of Business, Cleveland State University, 1860 E. 18th St, Cleveland, OH, 44114, USA
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, 55 Laurier Ave. E, Ottawa, ON, K1N 6N5, Canada.
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Meparishvili K, Biliseishvili S, Tvildiani M, Goderdzishvili D, Kldiashvili E. Evaluating Health Care Professionals' Readiness for e-Health Adoption in the Context of the COVID-19 Pandemic: A Georgian Perspective. Telemed J E Health 2024; 30:1479-1483. [PMID: 38197851 DOI: 10.1089/tmj.2023.0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background: The COVID-19 pandemic has accelerated the adoption of Electronic health (e-Health), leveraging technologies such as telemedicine, electronic health records, artificial intelligence, and patient engagement platforms. This transformation underscores e-Health's role in providing efficient, patient-centered care. Our study explores health care professionals' readiness for these technologies, emphasizing the need for tailored education in this evolving landscape. Methods: In our study, conducted between February and March 2023, we administered a questionnaire-based survey to 500 staff members (82.4% female, 17.6% male) aged 25-70 from medical universities in Tbilisi, Georgia. The structured questionnaire covered topics such as computer literacy, telemedicine awareness, patient data security, and ethical considerations. We employed SPSS v21.0 for data analysis, encompassing descriptive statistics and thematic analysis of open-ended responses. Results: Our study included 500 participants categorized into five age groups. Notably, 31% considered themselves computer "experts," while 69% rated their skills as "intermediate" or "advanced." Furthermore, 85% used computers professionally, with 33% having practical computer training. Interestingly, 59% expressed interest in information technology training. Regarding e-Health, 15% believed it involves remote communication between health care professionals and patients, while 42% considered it "correct," and 37% "might be correct." Concerning its application in managing patients, opinions varied. In terms of e-Health's integration into Georgia's health care, responses ranged. Regarding patient data safety, participants exhibited diverse views. Finally, opinions on the necessity of informed consent for e-Health applications varied among participants. Conclusions: Our study explores health care professionals' readiness for e-Health adoption during the COVID-19 pandemic. It reveals varying computer literacy levels, a willingness to learn, differing views on e-Health applications, and mixed opinions on its integration into Georgian health care. These findings emphasize the need for clear e-Health terminology, education, tailored approaches, and a focus on data privacy and informed consent. Overall, e-Health's transformative role in modern health care is underscored.
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Montoya-Williams D, Gualy S, Mazur M, Huber M, Peña MM, DeMauro SB, Duncan AF. Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model. Am J Perinatol 2024; 41:e1075-e1083. [PMID: 36452972 PMCID: PMC10349908 DOI: 10.1055/a-1990-8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges. STUDY DESIGN To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020-July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses. RESULTS When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birth weight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity. CONCLUSION During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge. KEY POINTS · Telemedicine works well for high-risk neonatal populations.. · Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.. · NICUs should work to prevent food insecurity postdischarge..
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Affiliation(s)
- Diana Montoya-Williams
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | | | | | | | | | - Sara B. DeMauro
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - Andrea F. Duncan
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
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Antezana LA, Xie KZ, Yin LX, Bowen AJ, Yeakel S, Nassiri AM, Moore EJ. Performing parotidectomy postoperative follow-ups via telemedicine: Experience at a tertiary care, multiple-surgeon otolaryngology center. J Telemed Telecare 2024; 30:739-746. [PMID: 35549759 DOI: 10.1177/1357633x221095319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center. METHODS A retrospective case review was conducted of patients who underwent parotidectomy and postoperative video visits between November 2019 and December 2020. Success of video visit, plan if applicable, and post-visit outcomes were reviewed. Video visits were designated as successful if the physician could assess for complications in the postoperative course (e.g. first bite pain, Frey syndrome, ear numbness, unplanned visits to the emergency department, unplanned return to the operating room), perform examination of facial nerve function, and formulate care recommendations per clinical judgement without deferment of recommendations for a subsequent in-person visit. RESULTS There were 96 postoperative video visits with 91 unique parotidectomy patients. Demographics: 28/63 male/female; average age, 54y. All video visits were suitable for successful postoperative parotidectomy patient evaluation. Eight visits (8.3%) consisted of patients presenting with common postoperative complications (e.g. eye dryness, first bite pain) and warranted care recommendations. In only two cases did the patient require further in-person procedural (hematoma evacuation, seroma aspiration) follow-ups. For the other 91.7% of visits (n = 88), no additional recommendations were required as patients experienced uncomplicated postoperative courses. Of all the patients, 26.1% (n = 23) were instructed to follow-up for routine surveillance. All other patients, 73.9% (n = 65) were instructed to follow-up as needed. CONCLUSION Postoperative parotidectomy evaluation is highly amenable to being performed by video. A telemedicine option offers convenience for patients in the majority of cases without compromising clinical assessment and judgment for the physician.
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Affiliation(s)
- Luis A Antezana
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Katherine Z Xie
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley M Nassiri
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Hall K, Kafashzadeh D, Chen L, Dudovitz R, Ross MK. Trends in telemedicine visits among pediatric asthma patients during COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100239. [PMID: 38577483 PMCID: PMC10992722 DOI: 10.1016/j.jacig.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/24/2023] [Accepted: 01/07/2024] [Indexed: 04/06/2024]
Abstract
Background Environmental and social factors, including lack of access to asthma care, contribute to persistent inequities in asthma outcomes among children from historically marginalized ethnoracial groups. Telemedicine, which expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, may be an approach to augment access to pediatric asthma care. Objectives We sought to describe characteristics of pediatric (0-17 years) telemedicine users with asthma and characterize use trends throughout the COVID-19 pandemic. Methods We conducted a retrospective analysis using electronic health record data of pediatric patients with asthma seen at University of California, Los Angeles, Medical Center between March 2019 to March 2022 describing telemedicine user characteristics, trends of asthma-related telemedicine use, and associations between user characteristics and having a telemedicine visit. Results Among 6,777 patients with asthma, the percentage of asthma-related telemedicine visits peaked early in the pandemic, comprising 74.3% of visits, before decreasing to 13.6% in 2022. Compared to White patients, Black patients had lower odds of an asthma telemedicine visit (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26, 0.94). Those with public insurance (OR, 1.7; 95% CI, 1.19, 2.43), severe persistent asthma (OR, 3.03; 95% CI, 1.70, 5.42), or comorbidities (OR, 1.59; 95% CI, 1.08, 2.33) had higher odds. Time to first emergency department visit and hospitalization comparing those with at least one telemedicine visit to those with none were similar. Conclusions More pediatric asthma patients are using telemedicine since the COVID-19 pandemic, particularly those with medical complexity and comorbidities, and outcomes appear similar. However, Black patients at our institution have lower odds of using telemedicine.
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Affiliation(s)
- Kaitlin Hall
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Dariush Kafashzadeh
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Lucia Chen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Mindy K. Ross
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif
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11
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Fu R, Sutradhar R, Li Q, Eskander A. Virtual and in-person visits by Ontario physicians in the COVID-19 era. J Telemed Telecare 2024; 30:706-714. [PMID: 35296163 PMCID: PMC11027436 DOI: 10.1177/1357633x221086447] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We examined the coronavirus disease 2019 (COVID-19) pandemic impact on weekly trends in the billing of virtual and in-person physician visits in Ontario, Canada. METHODS In this retrospective cohort study, physician billing records from Ontario were aggregated on a weekly basis for in-person and virtual visits from 3 January 2016 to 27 March 2021. For each type of visit, a segmented negative binomial regression analysis was performed to estimate the weekly pre-pandemic trend in billing volume per thousand adults (3 January 2016 to 14 March 2020), the immediate change in mean volume at the start of the pandemic, and additional change in weekly volume in the pandemic era (15 March 2020 to 27 March 2021). RESULTS Before the start of the pandemic, the weekly volume of virtual visits per thousand adults was low with a 0.5% increase per week (rate ratio [RR]: 1.0053, 95% confidence interval [CI]: 1.0050-1.0056). A dramatic 65% reduction in in-person visits (RR: 0.35, 95% CI: 0.32-0.39) occurred at the start of the pandemic while virtual visits grew by 21-fold (RR: 21.3, 95% CI: 19.6-23.0). In the pandemic era, in-person visits rose by 1.4% per week (RR: 1.014, 95% CI: 1.011-1.017) but no change was observed for virtual visits (p-value = 0.31). Overall, we noted a 57.6% increase in total weekly physician visits volume after the start of the pandemic. DISCUSSION These results are meaningful for virtual care reimbursement models. Future study needs to assess the quality of care and whether the increase in virtual care volume is cost-effective to society.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology – Head and Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology – Head and Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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12
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Parsons JA, Romanis EC. "All hands on deck": a qualitative study of safeguarding and the transition to telemedical abortion care in England and Wales. Soc Sci Med 2024; 348:116835. [PMID: 38626482 DOI: 10.1016/j.socscimed.2024.116835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/18/2024]
Abstract
The COVID-19 pandemic raised significant challenges for in-person healthcare provision, leading healthcare providers to embrace digital health like never before. Whilst changes were made as part of a public health response, many have now become permanent fixtures of the healthcare landscape, significantly altering the way care is provided not only for patients, but also for the healthcare professionals that provide care. In abortion care in England and Wales, previously stringent regulations on in-person care provision were relaxed to permit the use of telemedicine and self-administration of medications at home. These changes have since been made permanent. However, there remains opposition to remote abortion care pathways on the basis of safeguarding. Opponents argue that it is not feasible to effectively safeguard patients accessing abortion care remotely. We conducted a qualitative study using semi-structured interviews with abortion care providers in England and Wales. Participants were asked about their views and experiences of the transition to remote care provision, with a particular focus on how they adapted their safeguarding practice. In this article, we present three themes that highlight the changing roles of healthcare professionals in abortion care: (1) a challenging backdrop and resulting apprehension, (2) adaptive practices, and (3) the continued importance of professional curiosity. Across all three themes, participants reflected significantly on how changes were made and what they experienced in the period of transition to telemedicine. In particular, they discussed the changing nature of their professional roles amidst digitalisation. Our findings provide a basis for reflection on the increasing introduction of digital approaches to healthcare provision, highlighting points for caution and emphasising the need to involve professionals in the transition process to ensure vital buy-in. Through this, we articulate two novel understandings of digitalisation: (1) the impact of speed-associated pressures on professional adaptation during digitalisation, and (2) off-proforma safeguarding through telemedicine as a form of invisible non-routine work.
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Affiliation(s)
- Jordan A Parsons
- Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK; Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
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13
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Hirani R, Noruzi K, Khuram H, Hussaini AS, Aifuwa EI, Ely KE, Lewis JM, Gabr AE, Smiley A, Tiwari RK, Etienne M. Artificial Intelligence and Healthcare: A Journey through History, Present Innovations, and Future Possibilities. Life (Basel) 2024; 14:557. [PMID: 38792579 PMCID: PMC11122160 DOI: 10.3390/life14050557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
Artificial intelligence (AI) has emerged as a powerful tool in healthcare significantly impacting practices from diagnostics to treatment delivery and patient management. This article examines the progress of AI in healthcare, starting from the field's inception in the 1960s to present-day innovative applications in areas such as precision medicine, robotic surgery, and drug development. In addition, the impact of the COVID-19 pandemic on the acceleration of the use of AI in technologies such as telemedicine and chatbots to enhance accessibility and improve medical education is also explored. Looking forward, the paper speculates on the promising future of AI in healthcare while critically addressing the ethical and societal considerations that accompany the integration of AI technologies. Furthermore, the potential to mitigate health disparities and the ethical implications surrounding data usage and patient privacy are discussed, emphasizing the need for evolving guidelines to govern AI's application in healthcare.
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Affiliation(s)
- Rahim Hirani
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
- Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA
| | - Kaleb Noruzi
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Hassan Khuram
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - Anum S. Hussaini
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Esewi Iyobosa Aifuwa
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Kencie E. Ely
- Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89106, USA
| | - Joshua M. Lewis
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Ahmed E. Gabr
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Abbas Smiley
- School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Raj K. Tiwari
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
- Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA
| | - Mill Etienne
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
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Bullo M, Kierszenowicz T, Acosta MC, Rolon MJ, Cecchini D, Rodriguez C, Scapellato P, Bottaro E, Losso MH. Telemedicine in HIV health care during the COVID-19 pandemic: An implementation research study in Buenos Aires, Argentina. HIV Med 2024. [PMID: 38657752 DOI: 10.1111/hiv.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV. METHODS AND SETTING We used the RE-AIM framework to evaluate the strategy. The study started during a COVID-19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy. RESULTS We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow-up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/μL. In total, 36.6% reported clinical events, and 20.4% presented with COVID-19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow-up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in-person appointments. CONCLUSION It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future.
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Affiliation(s)
- Manuela Bullo
- Hospital General de Agudos JM Ramos Mejia, Buenos Aires, Argentina
| | | | | | | | - Diego Cecchini
- Hospital General de Agudos C Argerich, Buenos Aires, Argentina
| | | | - Pablo Scapellato
- Hospital General de Agudos D Santojanni, Buenos Aires, Argentina
| | - Edgardo Bottaro
- Hospital General de Agudos D Santojanni, Buenos Aires, Argentina
| | - Marcelo H Losso
- Hospital General de Agudos JM Ramos Mejia, Buenos Aires, Argentina
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Shara N, Mirabal-Beltran R, Talmadge B, Falah N, Ahmad M, Dempers R, Crovatt S, Eisenberg S, Anderson K. Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data. JMIR Cardio 2024; 8:e53091. [PMID: 38648629 DOI: 10.2196/53091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. OBJECTIVE This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. METHODS Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm's learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. RESULTS In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. CONCLUSIONS This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities.
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Affiliation(s)
- Nawar Shara
- MedStar Health Research Institute, Hyattesville, MD, United States
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, DC, United States
| | | | | | - Noor Falah
- MedStar Health Research Institute, Hyattesville, MD, United States
| | - Maryam Ahmad
- MedStar Health Research Institute, Hyattesville, MD, United States
| | | | | | | | - Kelley Anderson
- School of Nursing, Georgetown University, Washington, DC, United States
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16
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Niemenoja O, Ämmälä AJ, Riihijärvi S, Lillrank P, Bono P, Taimela S. The impact of COVID-19 on healthcare booking and cancellation patterns: time series analysis of private healthcare service utilisation in Finland. BMC Health Serv Res 2024; 24:483. [PMID: 38637794 PMCID: PMC11027366 DOI: 10.1186/s12913-024-10987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND COVID-19 has had wide-reaching effects on healthcare services beyond the direct treatment of the pandemic. Most current studies have reported changes in realised service usage, but the dynamics of how patients engage with healthcare services are less well understood. We analysed the effects of COVID-19 on healthcare bookings and cancellations for various service channels between January 2020 and July 2021. METHODS Our data includes 7.3 million bookings, 11.0 million available appointments, and 405.1 thousand cancellations by 900.6 thousand individual patients between the ages of 18 and 65 years. The data were collected from electronic health record data, including laboratory and imaging services as well as inpatient stays, between January 2017 and July 2021. The patients were Finnish private and occupational healthcare customers in the capital region of Finland. We fitted an autoregressive moving average (ARIMA) model on data between 2017 and 2019 to predict the expected numbers of bookings, available appointments, and cancellations, which were compared to observed time series data between 2020 and 2021. RESULTS Utilisation of physical, in-person primary care physician appointments decreased by up to 50% during the first 18 months of the pandemic. At the same time, digital care channels experienced a rapid, multi-fold increase in service usage. Simultaneously, the number of bookings for laboratory and imaging services decreased by 50% below the pre-pandemic projections. The number of specialist and hospital service bookings remained at the predicted level during the study period. Cancellations for most health services increased sharply by up to three times the pre-COVID levels during the first weeks of the pandemic but returned to the pre-pandemic levels for the rest of the study period. CONCLUSIONS The reduction in in-person appointments and the increase in the utilisation of digital services was likely a contributing factor in the decrease of the utilisation of diagnostic and imaging services throughout the study period. Utilisation of specialist care and hospital services were not affected. Cancellations contributed to the changes in service utilisation only during the first weeks of the pandemic.
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Affiliation(s)
- Oskar Niemenoja
- Terveystalo Plc, Helsinki, Finland.
- Aalto University, Espoo, Finland.
| | | | | | | | - Petri Bono
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Simo Taimela
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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17
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Chen A, Chu WM, Peng N. Promoting new users' online health consultation services usage behavior strategically. Health Mark Q 2024:1-26. [PMID: 38634614 DOI: 10.1080/07359683.2024.2340196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Online consultation services have the potential to reduce the workload of healthcare staff, provide timely care to patients, and improve doctor-patient relationships. The COVID-19 pandemic has accelerated the development of these services and platforms, but it remains to be seen whether the general public will continue to use them after the pandemic is under control. This research proposes a framework to examine the factors contributing to UK adults' continued usage of online healthcare consultation services after COVID-19 restrictions have been lifted. A total of 430 new users completed surveys, and the results indicate that expectation confirmation, system quality, and information quality can positively impact users' self-efficacy toward using online consultation services. This, in turn, can influence their continued usage behavior. Furthermore, the results suggest that participants' perception of health risks can moderate the relationship between self-efficacy and continued usage behavior. The strategic implications of these findings are discussed.
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Affiliation(s)
- Annie Chen
- Roehampton Business School, Roehampton University, London, United Kingdom
| | - Wei-Min Chu
- Division Chief of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Norman Peng
- Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
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18
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Adebile TV, Adebile TM, Oloyede TF, Asifat OA, Biswas P, Sejoro S, Kersey JX. Telemedicine for obesity management among United States adults: A systematic and meta-analysis of intervention studies. J Telemed Telecare 2024:1357633X241247240. [PMID: 38632958 DOI: 10.1177/1357633x241247240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Obesity is projected to affect 86% of United States adults by 2030. Recent data show a surge to 41.9%, with the highest proportion in the 40-59 age group (44.3%). Obesity is linked to various health issues and preventable deaths. Telemedicine has emerged as a promising avenue for addressing obesity. This systematic review and meta-analysis examine the effectiveness of telemedicine interventions for managing obesity in US adults aged 40 and above. Through a thorough Preferred Reporting Items for Systematic Reviews and Meta-Analysis-guided search, 16 studies meeting inclusion criteria were identified. These studies employed diverse telemedicine technologies, including video-based and telephone sessions or a mixture of technologies. The analysis reveals a statistically significant mean difference of 0.93 in favor of telemedicine interventions for weight loss. Subgroup analysis suggests that intervention durations of 6-12 months and telephone-based sessions correlate with more substantial mean differences. This study provides valuable insights into the effectiveness of telemedicine in managing obesity, emphasizing the importance of intervention type and duration. Study limitations include variability and potential biases. Customized telemedicine strategies have the potential to combat the obesity epidemic among older adults in the United States, offering guidance to healthcare professionals aiming to reduce health risks and enhance overall well-being.
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Affiliation(s)
- Tolulope V Adebile
- Department of Biostatistics, Epidemiology and Environmental Sciences, Georgia Southern University, Statesboro, GA, USA
| | | | - Tobi F Oloyede
- Department of Health Policy & Community Health, Georgia Southern University, Statesboro, GA, USA
| | - Olamide A Asifat
- Department of Biostatistics, Epidemiology and Environmental Sciences, Georgia Southern University, Statesboro, GA, USA
| | - Purbasha Biswas
- Department of Biostatistics, Epidemiology and Environmental Sciences, Georgia Southern University, Statesboro, GA, USA
| | - Sarah Sejoro
- Department of Biostatistics, Epidemiology and Environmental Sciences, Georgia Southern University, Statesboro, GA, USA
| | - Jing X Kersey
- Department of Biostatistics, Epidemiology and Environmental Sciences, Georgia Southern University, Statesboro, GA, USA
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Remmits AJW, van Mastrigt GAPG, Evers SMAA, van Setten PA. Facilitators and barriers to the transition from outpatient clinic visits to home-based check-ups for children being treated with growth hormone: a mixed-methods study. Eur J Pediatr 2024; 183:1857-1870. [PMID: 38294515 PMCID: PMC11001668 DOI: 10.1007/s00431-023-05408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Abstract
Although the coronavirus disease 2019 (COVID-19) pandemic accelerated the adoption and expansion of telemedicine worldwide, little is known about the transition to home-based care for children. This study aims to investigate the facilitators and barriers to the transition from outpatient clinic visits to home-based check-ups (HBCU), for children being treated with growth hormone. A mixed-methods study was performed at Amalia Children's Hospital (Radboud University Medical Centre, Nijmegen), consisting of questionnaires and semi-structured and focus group interviews. For the quantitative part, the Measurement Instrument for Determinants of Innovation (MIDI) was utilised to investigate the facilitators and barriers for the 81 participants regarding the transition to HBCU. The MIDI questionnaire is comprised of four domains: the innovation-, user-, organisation-, and the socio-political scale. Descriptive statistics were performed for analysing the questionnaires. For the qualitative part, interviews with 10 participants derived from the questionnaire and the two focus group interviews were conducted, to gain more in-depth information about the research topic, until data saturation was reached. The interviews were analysed by using the reflective thematic approach, starting with deductive coding and followed by inductive coding. Several facilitators were recognised in our study: procedural clarity, self-efficacy, convenience, patient-centred care, increased accuracy in height measurements, social support, client/patient satisfaction/cooperation, patient-centred care, the flexibility and adaptivity of HBCU, physical start-up period of HBCU, and a potential decrease in healthcare costs. However, several barriers were also noted in our study: poor compatibility with current practice, lack of consultation within the team, feeling of being less controlled by physicians, unsettledness of the organisation, an increased workload for the staff, and insufficient information communication technology (ICT) facilities. CONCLUSION This study revealed that HBCU have considerable benefits for both patients and healthcare professionals, from the standpoint of innovation, user, and socio-political points of view. The identified facilitators and barriers to HBCU should be taken into account when further steps of implementing HBCU are considered. WHAT IS KNOWN • The Corona-Virus-Disease 2019 (COVID-19) pandemic has had an immense impact on health care worldwide. A substantial amount of the outpatient clinic visits for children treated with growth hormone was, as a result of the pandemic, transferred to online consultation. Transitioning paediatric growth hormone treatment to the home setting may be favorable for children and their parents/caregivers) as well for healthcare professionals. • Insights regarding facilitators and barriers is vital for the successful implementation and adoption of home-care technologies. WHAT IS NEW • To our knowledge, we are first to report on and explicit the facilitators and barriers of the transition to home-based check-ups, via online consultation for children being treated with growth hormone. • Both children and healthcare professionals reported major facilitators and some minor barriers to the transition to home-based check-ups, illustrating their potential value. These facilitators and barriers should be considered while working towards implementation of home-based check-ups.
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Affiliation(s)
- Anouk J W Remmits
- Amalia Children's Hospital, Department of Paediatric Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ghislaine A P G van Mastrigt
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Petra A van Setten
- Amalia Children's Hospital, Department of Paediatric Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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20
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Lai YK, Ye JF, Ao SH, Zhao X. Overcoming obstacles to mammography screening: Examining the role of offline healthcare barriers and online patient-provider communication. J Health Psychol 2024; 29:452-466. [PMID: 38411143 DOI: 10.1177/13591053241234260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient-provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening.
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Sikka V, King C, Klinker S, Mont T, Sommers-Olson B, Hunt BE, Davis S, Fonseca J. Telemedicine for veterans in the setting of the COVID-19 pandemic: Lessons learned from a virtual urgent care center. J Telemed Telecare 2024; 30:514-518. [PMID: 34970932 DOI: 10.1177/1357633x211069018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although telemedicine was predominantly adopted during the COVID-19 pandemic, its impact on healthcare outcomes in the veteran population in achieving first contact resolution, or the ability to safely manage patient care at home from an urgent care perspective, is yet to be determined. METHODS This study included 13,090 veteran patient episodes who presented to the Department of Veteran's Affairs Veterans Integrated Services Network 8's Clinical Contact Center, a virtual urgent care organization covering South Georgia, Florida, and U.S. Virgin Islands in providing episodic care, between March 2020 and February 2021. Multivariate logistic regression estimated the probability that veterans with COVID-19-related symptoms stayed at home compared to presenting to the emergency department (ED) or their primary care provider. RESULTS Patients with COVID-related symptoms were 33% less likely to present to the ED compared to patients who presented with non-COVID-related symptoms. DISCUSSION The virtual urgent care center enabled veterans to receive timely care and avoid public places that could potentially lead to a COVID-19 infection or infecting others.
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Affiliation(s)
- Veronica Sikka
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Christian King
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
- Orlando VA Healthcare System, Orlando, FL, USA
| | - Suzanne Klinker
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | - Theresa Mont
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | | | - Bruce E Hunt
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Stacey Davis
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | - Jennifer Fonseca
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
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22
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Khalil K, Tsapepas D, West-Thielke P. Transplant Pharmacists' Experience With Telehealth During the COVID-19 Pandemic. J Pharm Pract 2024; 37:307-310. [PMID: 36218440 PMCID: PMC9554573 DOI: 10.1177/08971900221132594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: The adoption of telehealth became a necessity for healthcare organizations during the COVID-19 pandemic. Transplant pharmacists are integral members of the multi-disciplinary care team who quickly adapted application of these technologies to ensure continuity of care. Objective: To assess transplant pharmacists' experience with telehealth during the COVID-19 pandemic. Methods: A 23-question online survey was developed to assess transplant pharmacists' experience with telehealth during the COVID-19 pandemic. Results: Forty-five pharmacists responded to the survey from a broad range of transplant centers. The majority of respondents indicated infrequent use of telehealth (98%) before the COVID-19 pandemic, but this was significantly changed during the pandemic with only 9% reporting infrequent use. Pharmacists anticipated a decrease in future use, but 91% of respondents stated they would like to continue utilization of telehealth in their practice post-pandemic. Conclusions: The adoption of telehealth during COVID-19 was widespread and has the potential to facilitate continuity of care. Though pharmacists anticipated a decrease in future use, a majority favored continued utilization of telehealth in their practice.
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Affiliation(s)
- Karen Khalil
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Demetra Tsapepas
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Transplantation, New York-Presbyterian Hospital, New York, NY, USA
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23
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Moretta P, Femiano C, Cavallo ND, Lanzillo A, Luciano F, Ferrante C, Maiorino A, Santangelo G, Marcuccio L. Family caregivers improve the diagnostic accuracy of disorders of consciousness: from remote to near-bed auditory stimulation. Eur J Phys Rehabil Med 2024; 60:198-206. [PMID: 38381451 PMCID: PMC11114155 DOI: 10.23736/s1973-9087.24.08179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Family caregivers (FC) contribute to reducing the misdiagnosis rate in patients with disorders of consciousness (DOC). Unfortunately, the recent pandemic of COVID-19 imposed drastic restrictions that limited the access of FC to the sensory/cognitive stimulation protocols. Telemedicine approaches have been implemented to avoid discontinuity in care pathways and to ensure caregivers involvement in rehabilitation programs. AIM The aim was to investigate whether the presence of FC remotely connected might help clinicians in eliciting higher cortically mediated behavioral responses in patients with DOC. DESIGN Cross-sectional study. SETTING Post-acute Unit of Neurorehabilitation. POPULATION DOC due to severe brain injury. METHODS Consecutive patients with DOC were assessed by means of the Coma Recovery Scale-Revised (CRS-R) by two expert examiners. Each patient underwent to five assessments in two weeks in three different conditions: 1) by the examiner only (standard); 2) with the verbal stimulation given by the FC remotely connected by PC tablet (caregiver in remote); and 3) with the verbal stimulation given by the FC physically present (caregiver in presence). RESULTS Thirty patients with DOC (VS/UWS=10; MCS=20; mean age: 51, range: 21-79; vascular: 16; anoxic: 6; TBI=8) and their FC were enrolled. Higher total scores of CRS-R were recorded both in "caregiver in remote" and in "caregiver in presence" than in standard condition (standard vs. remote, Z=2.942, P=0.003; standard vs. presence, Z=3.736, P<0.001). Furthermore, the administration of the CRS-R with a FC, elicited higher levels of behavioral responses in MCS patients, than CRS-R performed in standard condition. In particular, 2 patients out of 30 (6.66%) showed higher scores and better diagnosis when the CRS-R was administered with FC in remote. Similarly, 5 out of 30 patients (16.66%) showed better diagnoses when the CRS-R was administered with FC in presence. Five patients changed diagnosis between standard and presence conditions (3 MCS- were diagnosed as MCS+; 2 MCS+ were diagnosed as conscious). CONCLUSIONS Our findings add new evidence regarding the beneficial role of family members in the diagnosis of DOC, even mediated by telemedicine approach. CLINICAL REHABILITATION IMPACT In future guidelines, FC should have an active and supporting role in the diagnostic and rehabilitative process of DOC.
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Affiliation(s)
- Pasquale Moretta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy -
| | - Cinzia Femiano
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Nicola D Cavallo
- Department of Psychology, Luigi Vanvitelli University of Campania, Caserta, Italy
| | - Anna Lanzillo
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Fabrizio Luciano
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Cesario Ferrante
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Antonio Maiorino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Gabriella Santangelo
- Department of Psychology, Luigi Vanvitelli University of Campania, Caserta, Italy
| | - Laura Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
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Barajas JN, Hornung AL, Kuzel T, Mallow GM, Park GJ, Rudisill SS, Louie PK, Harada GK, McCarthy MH, Germscheid N, Cheung JP, Neva MH, El-Sharkawi M, Valacco M, Sciubba DM, Chutkan NB, An HS, Samartzis D. The Impact of COVID-19 Pandemic on Spine Surgeons Worldwide: A One Year Prospective Comparative Study. Global Spine J 2024; 14:956-969. [PMID: 36176014 PMCID: PMC9527127 DOI: 10.1177/21925682221131540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Survey. OBJECTIVE In March of 2020, an original study by Louie et al investigated the impact of COVID-19 on 902 spine surgeons internationally. Since then, due to varying government responses and public health initiatives to the pandemic, individual countries and regions of the world have been affected differently. Therefore, this follow-up study aimed to assess how the COVID-19 impact on spine surgeons has changed 1 year later. METHODS A repeat, multi-dimensional, 90-item survey written in English was distributed to spine surgeons worldwide via email to the AO Spine membership who agreed to receive surveys. Questions were categorized into the following domains: demographics, COVID-19 observations, preparedness, personal impact, patient care, and future perceptions. RESULTS Basic respondent demographics, such as gender, age, home demographics, medical comorbidities, practice type, and years since training completion, were similar to those of the original 2020 survey. Significant differences between groups included reasons for COVID testing, opinions of media coverage, hospital unemployment, likelihood to be performing elective surgery, percentage of cases cancelled, percentage of personal income, sick leave, personal time allocation, stress coping mechanisms, and the belief that future guidelines were needed (P<.05). CONCLUSION Compared to baseline results collected at the beginning of the COVID-19 pandemic in 2020, significant differences in various domains related to COVID-19 perceptions, hospital preparedness, practice impact, personal impact, and future perceptions have developed. Follow-up assessment of spine surgeons has further indicated that telemedicine and virtual education are mainstays. Such findings may help to inform and manage expectations and responses to any future outbreaks.
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Affiliation(s)
- Juan N Barajas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Timothy Kuzel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Gary M Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Grant J Park
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Samuel S Rudisill
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Philip K Louie
- Department of Neurosurgery, Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Garrett K Harada
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | | | | | - Jason Py Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong, SAR China
| | - Marko H Neva
- Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
| | - Marcelo Valacco
- Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina
| | - Daniel M Sciubba
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Norman B Chutkan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- International Spine Research & Innovation Initiative (ISRII), Chicago, IL, USA
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25
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van Schalkwijk D, Lodder P, Everaert J, Widdershoven J, Habibović M. Latent profiles of telehealth care satisfaction during the COVID-19 pandemic among patients with cardiac conditions in an outpatient setting. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:85-95. [PMID: 38765625 PMCID: PMC11096653 DOI: 10.1016/j.cvdhj.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background During the COVID-19 pandemic, telemedicine was advocated and rapidly scaled up worldwide. However, little is known about for whom this type of care is acceptable. Objective To examine which patient characteristics (demographic, medical, psychosocial) are associated with telehealth care satisfaction, attitude toward telehealth, and preference regarding telehealth over time in a cardiac patient population. Methods In total, 317 patients were recruited at the Elisabeth-TweeSteden Hospital in The Netherlands. All patients who had received telehealth care (telephone and video) in the previous 2 months were approached for participation. Baseline, 3-month, and 6-month questionnaires were administered online. A 3-step latent class analysis was conducted to identify trajectories of telehealth use over time and the possible association of the found trajectories with external variables. Results Five trajectories (classes) were identified for satisfaction with telehealth and 4 for attitude toward telehealth. Patients with higher distress, lower physical and mental health, higher scores on pessimism, and negative affectivity were more likely to be less satisfied. Patients with no partner, more comorbidities, higher distress, lower physical and mental health, and higher scores on pessimism were more likely to hold a negative attitude toward telehealth. For the future application of telehealth, marital status, comorbidities, digital health literacy, and pessimism were significantly related. Conclusion Results show that patients' profiles should be considered when offering telehealth care and that the "one size fits all" approach does not apply. Results can inform clinical practice on how to better implement remote health care in the future while considering a personalized approach.
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Affiliation(s)
- Dinah van Schalkwijk
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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26
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Saraux A, da Mota LMH, Dixit S, Gibofsky A, Matsubara T, Mulvey A, Koehn C, Mortezavi M, Segovia M, Kessouri M. Impact of the COVID-19 Pandemic on People Living with Rheumatoid Arthritis: Experiences and Preferences in Accessing Healthcare Across Five Countries. Rheumatol Ther 2024; 11:257-268. [PMID: 38217796 PMCID: PMC10920583 DOI: 10.1007/s40744-023-00629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION The global coronavirus 2019 (COVID-19) pandemic created many challenges in healthcare provision. This study aimed to evaluate the global impact of the COVID-19 pandemic on people living with rheumatoid arthritis (RA). METHODS The RA Narrative COVID-19 survey was conducted online among people with RA who resided in Brazil, Canada, France, Japan, and the US from August to September 2021. The survey examined disease management, healthcare access and experiences, and participant preferences for interactions with their doctor. RESULTS Overall, 500 participants completed the survey: 100 each resided in Brazil, Canada, France, Japan, and the US. Emotional well-being was the aspect of disease management most reported to be negatively impacted by the pandemic (55% of participants); 'having more anxiety and/or stress' during the pandemic was the top factor that made controlling RA symptoms more difficult (49% of participants). In comparison, the top factor that made controlling RA symptoms easier was 'having a less busy schedule' (35% of participants). More participants had virtual appointments during versus pre-pandemic (53% vs. 13%, respectively) and participants were equally satisfied with the overall quality of care received via virtual and in-person appointments (76% of participants were 'satisfied' or 'very satisfied' with both). However, participants generally preferred in-person over virtual appointments, except for prescription refills, for which preferences were similar (39% vs. 36%, respectively). CONCLUSIONS This survey suggests that the COVID-19 pandemic did negatively impact some aspects of disease management for people living with RA but had positive impacts on the utilization of virtual care. Although participants generally preferred in-person appointments, these results position virtual care as an appropriate means for routine follow-ups.
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Affiliation(s)
- Alain Saraux
- Rheumatology Unit, University Hospital, Hôpital de La Cavale Blanche, Brest, France
| | - Licia Maria Henrique da Mota
- Unidade de Reumatologia, Universidade de Brasília, Brasília, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Sanjay Dixit
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Allan Gibofsky
- Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA
| | - Tsukasa Matsubara
- Department of Orthopaedic Surgery, Matsubara Mayflower Hospital, Kato, Japan
| | | | - Cheryl Koehn
- Arthritis Consumer Experts, Vancouver, BC, Canada
| | | | | | - Meriem Kessouri
- Pfizer France, 23-25 Avenue du Dr Lannelongue, 75668, Paris, France.
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Heath L, Ordóñez-Mena JM, Aveyard P, Wherton J, Nicholson BD, Stevens R. How has the COVID-19 pandemic affected the delivery of preventive healthcare? An interrupted time series analysis of adults in English primary care from 2018 to 2022. Prev Med 2024; 181:107923. [PMID: 38432306 DOI: 10.1016/j.ypmed.2024.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Offering advice and support for smoking, obesity, excess alcohol, and physical inactivity is an evidence-based component of primary care. The objective was to quantify the impact of the pandemic on the rate of advice or referral for these four risk factors. METHODS A retrospective cohort study using primary care data from 1847 practices in England and 21,191,389 patients contributing to the Oxford Clinical Informatics Digital Hub. An interrupted time series analysis was undertaken with a single change point (March 2020). Monthly trends were modelled from 1st January 2018 - 30th June 2022 using segmented linear regression. RESULTS There was an initial step reduction in advice and referrals for smoking, obesity, excess alcohol, and physical inactivity in March 2020. By June 2022, advice on smoking (slope change -0.02 events per hundred patient years/month (EPH/month); 95% confidence interval (CI) -0.17, 0.21), obesity (0.06 EPH/month; 95% CI 0.01, 0.12), alcohol (0.02 EPH/month; 95% CI -0.01, 0.05) and physical inactivity (0.05 EPH/month; 95% CI 0.01, 0.09) had not returned to pre-pandemic levels. Similarly, smoking cessation referral remained lower (0.01 EPH/month; 95% CI -0.01, 0.09), excess alcohol referral returned to similar levels (0.0005 EPH/month; 95% CI 0.0002, 0.0008), while referral for obesity (0.14 EPH/month; 95% CI 0.10, 0.19) and physical inactivity (0.01 EPH/month; 95% CI 0.01, 0.02) increased relative to pre-pandemic rates. CONCLUSION Advice and support for smoking, and advice for weight, excess alcohol and physical inactivity have not returned to pre-pandemic levels. Clinicians and policy makers should prioritise preventive care in COVID-19 recovery plans.
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Affiliation(s)
- Laura Heath
- GP and Clinical Doctoral Fellow Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - José M Ordóñez-Mena
- Medical Statistician Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- GP and Professor of Behavioural Medicine Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph Wherton
- Senior Researcher Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- GP and Associate Professor Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Stevens
- Associate Professor of Medical Statistics Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Cinza-Sanjurjo S, Mazón-Ramos P, Rey-Aldana D, Garcia-Vega D, Portela-Romero M, Rodríguez-Mañero M, Sestayo-Fernández M, Lage-Fernández R, López-López R, González-Juanatey JR. Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients. Eur J Clin Invest 2024:e14197. [PMID: 38519859 DOI: 10.1111/eci.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The prevalence of cancer patients with concomitant cardiovascular (CV) disease is on the rise due to improved cancer prognoses. The aim of this study is to evaluate the long-term outcomes of cancer patients referred to a cardiology department (CD) via primary care using e-consultation. METHODS We analysed data from cancer patients with prior referrals to a CD between 2010 and 2021 (n = 6889) and compared two care models: traditional in-person consultations and e-consultations. In e-consultation model, cardiologists reviewed electronic health records (e-consultation) to determine whether the demand could be addressed remotely or necessitated an in-person consultation. We used an interrupted time series regression model to assess outcomes during the two periods: (1) time to cardiology consultation, (2) rates of all-cause and CV related hospital admissions and (3) rates of all-cause and CV-related mortality within the first year after the initial consultation or e-consultation at the CD. RESULTS Introduction of e-consultation for cancer patients referred to cardiology care led to a 51.8% reduction (95%CI: 51.7%-51.9%) in waiting times. Furthermore, we observed decreased 1-year incidence rates, with incidence rate ratios (iRRs) [IC95%] of .75 [.73-.77] for CV-related hospitalizations, .43 [.42-.44] for all-cause hospitalizations, and .87 [.86-.88] for all-cause mortality. CONCLUSIONS Compared to traditional in-person consultations, an outpatient care program incorporating e-consultation for cancer patients significantly reduced waiting times for cardiology care and demonstrated safety, associated with lower rates of hospital admissions.
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Affiliation(s)
- Sergio Cinza-Sanjurjo
- CS Milladoiro, Área Sanitaria Integrada Santiago de Compostela, A Coruña, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medicine Department, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Pilar Mazón-Ramos
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medicine Department, Santiago de Compostela University, Santiago de Compostela, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Daniel Rey-Aldana
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- CS A Estrada, Área Sanitaria Integrada Santiago de Compostela, Pontevedra, Spain
| | - David Garcia-Vega
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuel Portela-Romero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- CS Concepción Arenal, Área Sanitaria Integrada Santiago de Compostela, Rúa de Santiago León de Caracas, Santiago de Compostela, A Coruña, Spain
| | - Moisés Rodríguez-Mañero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuela Sestayo-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Ricardo Lage-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael López-López
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José R González-Juanatey
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medicine Department, Santiago de Compostela University, Santiago de Compostela, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Hassan A, Davies N. Expert Insight Into the Use of eHealth Interventions to Aid Medication Adherence During COVID-19. Patient Prefer Adherence 2024; 18:721-731. [PMID: 38529042 PMCID: PMC10962456 DOI: 10.2147/ppa.s437822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
Background and Aim The COVID-19 pandemic has transformed the way healthcare is delivered by the increased utilisation of eHealth tools to deliver remote patient consultations. These eHealth tools served various functions during COVID-19 including monitoring and surveillance of patients. Therefore, assessment of digital health interventions for monitoring medication adherence is crucial to maximise the potential benefits of eHealth. The aim of this study is to understand the perspectives of experts in medication adherence around eHealth interventions used to aid adherence during COVID-19. Methods The study was exploratory and utilized a mixed-method approach. Data was gathered from a survey distributed by the International society for Medication Adherence, and from arranging subsequent structured interviews. Purposive sampling was used to collect data from individuals who were rich in knowledge about the field of medication adherence. Template analysis was used to analyse the collected data. Results Twenty-one participants responded to the survey and 6 completed the interviews. Results showed that eHealth tools reduced barriers to medication adherence by improving health literacy of patients. The main strengths of eHealth technology used in COVID-19 highlighted by participants were convenience and user empowerment. Moreover, weaknesses and barriers included lack of cooperation between technology providers, lack of awareness of doctors about eHealth and patient's digital health literacy. Conclusion and Future Directions The increased utility of eHealth tools during COVID-19 highlighted their vital role in aiding medication adherence of patients. These technologies have both decreased and increased barriers to medication adherence through numerous ways. Future directions should focus on gaining the perspectives of patients on the use of eHealth interventions and its role in aiding medication adherence.
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Affiliation(s)
- Ahmed Hassan
- School of Medicine, Cardiff University, Cardiff, Wales
| | - Non Davies
- North Wales Medical School, Bangor University, Bangor, Wales
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Liu Y, Ju S, Wang J. Exploring the potential of ChatGPT in medical dialogue summarization: a study on consistency with human preferences. BMC Med Inform Decis Mak 2024; 24:75. [PMID: 38486198 PMCID: PMC10938713 DOI: 10.1186/s12911-024-02481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Telemedicine has experienced rapid growth in recent years, aiming to enhance medical efficiency and reduce the workload of healthcare professionals. During the COVID-19 pandemic in 2019, it became especially crucial, enabling remote screenings and access to healthcare services while maintaining social distancing. Online consultation platforms have emerged, but the demand has strained the availability of medical professionals, directly leading to research and development in automated medical consultation. Specifically, there is a need for efficient and accurate medical dialogue summarization algorithms to condense lengthy conversations into shorter versions focused on relevant medical facts. The success of large language models like generative pre-trained transformer (GPT)-3 has recently prompted a paradigm shift in natural language processing (NLP) research. In this paper, we will explore its impact on medical dialogue summarization. METHODS We present the performance and evaluation results of two approaches on a medical dialogue dataset. The first approach is based on fine-tuned pre-trained language models, such as bert-based summarization (BERTSUM) and bidirectional auto-regressive Transformers (BART). The second approach utilizes a large language models (LLMs) GPT-3.5 with inter-context learning (ICL). Evaluation is conducted using automated metrics such as ROUGE and BERTScore. RESULTS In comparison to the BART and ChatGPT models, the summaries generated by the BERTSUM model not only exhibit significantly lower ROUGE and BERTScore values but also fail to pass the testing for any of the metrics in manual evaluation. On the other hand, the BART model achieved the highest ROUGE and BERTScore values among all evaluated models, surpassing ChatGPT. Its ROUGE-1, ROUGE-2, ROUGE-L, and BERTScore values were 14.94%, 53.48%, 32.84%, and 6.73% higher respectively than ChatGPT's best results. However, in the manual evaluation by medical experts, the summaries generated by the BART model exhibit satisfactory performance only in the "Readability" metric, with less than 30% passing the manual evaluation in other metrics. When compared to the BERTSUM and BART models, the ChatGPT model was evidently more favored by human medical experts. CONCLUSION On one hand, the GPT-3.5 model can manipulate the style and outcomes of medical dialogue summaries through various prompts. The generated content is not only better received than results from certain human experts but also more comprehensible, making it a promising avenue for automated medical dialogue summarization. On the other hand, automated evaluation mechanisms like ROUGE and BERTScore fall short in fully assessing the outputs of large language models like GPT-3.5. Therefore, it is necessary to research more appropriate evaluation criteria.
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Affiliation(s)
- Yong Liu
- Department of Computer Science, Sichuan University, No. 24, South Section 1, 1st Ring Road, Chendu, 610065, Sichuan, China
| | - Shenggen Ju
- Department of Computer Science, Sichuan University, No. 24, South Section 1, 1st Ring Road, Chendu, 610065, Sichuan, China.
| | - Junfeng Wang
- Department of Computer Science, Sichuan University, No. 24, South Section 1, 1st Ring Road, Chendu, 610065, Sichuan, China
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Singhal M, Oyston C. Telehealth and Technology for Diabetes in Pregnancy Clinics: Staff Perspectives from South Auckland, New Zealand. Int J Telemed Appl 2024; 2024:6429519. [PMID: 38516417 PMCID: PMC10957257 DOI: 10.1155/2024/6429519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 09/19/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
Providing care for patients with diabetes in pregnancy (DiP) provides unique challenges beyond those faced in standard antenatal care or diabetes outside of pregnancy. Teleclinics (use of telephone, email, or other technologies) as an alternative to in-person clinic appointments have become more widely used for care since the start of the COVID-19 pandemic. To understand how teleclinics might be improved for ongoing use, it is important to understand the experiences and perceptions of the clinicians involved in DiP care. Aim. To understand staff experiences of DiP teleclinics and gain their perspectives on if and how teleclinics and other technologies might be best used in the future. Methods. A qualitative study using semistructured interviews of healthcare providers in a large DiP service. Twenty staff members (midwifery, obstetrics, physician, dietician, and administration) were approached to participate. Fifteen staff across 5 specialties consented to be interviewed. Template analysis of interview transcripts was performed, with a focus on 3 themes: collaboration and working together are important for providing care for DiP, a need for flexibility in scheduling and the ability to individualise the way care is provided, and challenges to adapting to new technology. Results. Potential benefits of teleclinics were acknowledged, but respondents also viewed teleclinics as not suitable for all DiP patients due to different needs and risks. Challenges to using teleclinics include establishing good rapport and the current limited infrastructure and patient resources. Conclusion. Healthcare providers viewed teleclinics as a way of supporting rather than replacing current care. Maintaining flexibility in clinic scheduling to allow incorporation of teleclinics into patient's current schedule of visits ad hoc and providing extra technical and administrative support are important considerations for developing a teleclinic service.
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Affiliation(s)
- Megan Singhal
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Middlemore Hospital, Te Whatu Ora Counties Manukau Health, South Auckland, New Zealand
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Kumar P, Puri O, Unnithan VB, Reddy AP, Aswath S, Pathania M. Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study. J Family Med Prim Care 2024; 13:1004-1011. [PMID: 38736819 PMCID: PMC11086785 DOI: 10.4103/jfmpc.jfmpc_1024_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/09/2023] [Indexed: 05/14/2024] Open
Abstract
Introduction This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country. Materials and Methods Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented. Results About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels. Conclusion While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.
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Affiliation(s)
- Pratyush Kumar
- Intern, Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India
| | - Oshin Puri
- Intern, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Vishnu B. Unnithan
- Department of Nuclear Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Asmitha P. Reddy
- Intern, Father Muller Medical College, Mangalore, Karnataka, India
| | - Shravya Aswath
- Intern, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Naik N, Talyshinskii A, Rassweiler J, Hameed BMZ, Somani BK. Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature. Curr Opin Urol 2024; 34:116-127. [PMID: 38038411 DOI: 10.1097/mou.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges. RECENT FINDINGS There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality. SUMMARY Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Jens Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Villavisanis DF, Blum JD, Plana NM, Taub PJ, Taylor JA. Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations. Cleft Palate Craniofac J 2024; 61:518-522. [PMID: 36168208 DOI: 10.1177/10556656221129967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cleft and craniofacial conditions often present with a variety of functional and esthetic sequelae optimally treated by a multidisciplinary approach. Diagnosis of such conditions pre- or postnatally may evoke parental uncertainty and anxiety, and an important primary consideration is the selection of a cleft and craniofacial team. Identifying an optimal team may be particularly important for developing long-term relationships with clinicians who will ideally work intimately with the family from diagnosis to adulthood. While families, parents, and providers should consider several factors, a dearth of evidence-based suggestions preclude critical appraisal of cleft and craniofacial teams. In this article, the authors summarize medical, surgical, and social considerations for selecting a cleft and craniofacial team to optimize patient outcomes and the family/caregiver experience.
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Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic & Reconstructive Surgery, Mount Sinai Health System, New York, NY, USA
| | - Jessica D Blum
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie M Plana
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter J Taub
- Division of Plastic & Reconstructive Surgery, Mount Sinai Health System, New York, NY, USA
| | - Jesse A Taylor
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Shmueli M, Lendner I, Ben-Shimol S. Effect of the COVID-19 pandemic on the pediatric infectious disease landscape. Eur J Pediatr 2024; 183:1001-1009. [PMID: 37726566 DOI: 10.1007/s00431-023-05210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
This narrative review aims to present an overview of the COVID-19 pandemic's effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children ("long COVID"), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription. Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of "long COVID" in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage. What is Known: • COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible. • The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse. What is New: • Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols. • The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).
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Affiliation(s)
- Moshe Shmueli
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Idan Lendner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatric Department B, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel.
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Jiang Z, Seyedi S, Griner E, Abbasi A, Rad AB, Kwon H, Cotes RO, Clifford GD. Multimodal Mental Health Digital Biomarker Analysis From Remote Interviews Using Facial, Vocal, Linguistic, and Cardiovascular Patterns. IEEE J Biomed Health Inform 2024; 28:1680-1691. [PMID: 38198249 PMCID: PMC10986761 DOI: 10.1109/jbhi.2024.3352075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Psychiatric evaluation suffers from subjectivity and bias, and is hard to scale due to intensive professional training requirements. In this work, we investigated whether behavioral and physiological signals, extracted from tele-video interviews, differ in individuals with psychiatric disorders. METHODS Temporal variations in facial expression, vocal expression, linguistic expression, and cardiovascular modulation were extracted from simultaneously recorded audio and video of remote interviews. Averages, standard deviations, and Markovian process-derived statistics of these features were computed from 73 subjects. Four binary classification tasks were defined: detecting 1) any clinically-diagnosed psychiatric disorder, 2) major depressive disorder, 3) self-rated depression, and 4) self-rated anxiety. Each modality was evaluated individually and in combination. RESULTS Statistically significant feature differences were found between psychiatric and control subjects. Correlations were found between features and self-rated depression and anxiety scores. Heart rate dynamics provided the best unimodal performance with areas under the receiver-operator curve (AUROCs) of 0.68-0.75 (depending on the classification task). Combining multiple modalities provided AUROCs of 0.72-0.82. CONCLUSION Multimodal features extracted from remote interviews revealed informative characteristics of clinically diagnosed and self-rated mental health status. SIGNIFICANCE The proposed multimodal approach has the potential to facilitate scalable, remote, and low-cost assessment for low-burden automated mental health services.
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Remmits AJW, van Mastrigt GAPG, Evers SMAA, der Grinten HLCV, van Setten PA. Parental measurement of height in growth hormone-treated children in the hospital setting proves valid: an observational study - potential for replacement of outpatient clinic visits to the home setting. Eur J Pediatr 2024; 183:1145-1152. [PMID: 37843612 PMCID: PMC10951002 DOI: 10.1007/s00431-023-05232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
Reliable height measurement plays a pivotal role in evaluating the efficacy of costly growth hormone (GH) therapy in children. Currently, regularly outpatient clinic visits are needed to accurately measure height. The outpatient clinic visits are time-consuming for parents as well for health care professionals. This observational study aimed to investigate the validity of parentally performed height measurements compared to height measurements in the outpatient setting. An observational study was performed at the outpatient clinic of Amalia's Children's Hospital Nijmegen. A portable stadiometer (PS) was developed for height measurements at home. Measurements with the PS were performed by the researcher (PSR) and parents/caregivers (PSP). Measurements performed with the electronic digital ruler (EDS) were considered as the gold standard. The parents were potentially unblinded for the gold standard measurement (EDS). Descriptive statistics, Wilcoxon signed-rank, and Pearson's correlation tests were performed. The Bland-Altman plots were made to illustrate the correlation of the PSR or PSP with the gold standard. The correlation between the height measurements with PSR or PSP compared to the EDS was substantial (PSR: r = 0.9998, R2 = 0.9996, P < 0.001; PSP: r = 0.9998, R2 = 0.9995, P < 0.001). However, a statistically significant underestimation of the PSR and PSP was observed (P < 0.001). The mean difference of the PSR and PSP was respectively - 0.21 cm ± 0.52 SD and - 0.30 cm ± 0.62 SD in comparison to the EDS. The Bland-Altman plots illustrated that 95% of the PSR measurements were between - 1.03 and 0.60 cm and 95% of the PSP measurements were between - 1.26 and 0.66 cm compared to the EDS. CONCLUSION We found a strong correlation between the PSR or PSP and the EDS, with only a minor underestimation of approximately 0.2-0.3 cm. In our opinion, this underestimation is clinically irrelevant as it does not result in an adjustment in GH dose. To conclude, parental height measurements could be a promising tool as it partially replaces outpatient clinic visits needed for measurements of height. Further studies are required to confirm this statement. WHAT IS KNOWN • The immense impact of the coronavirus disease 2019 (COVID-19) pandemic on health care has increased telemedicine worldwide. For adequate integration of telemedicine in paediatric growth hormone treatment, reliable height and weight measurements in the home setting are required. • Earlier studies have shown that parents are capable to reliable perform height measurements in healthy children. WHAT IS NEW • To our knowledge, this is the first study to show a strong correlation between the height measurements with a portable stadiometer by parents and those made with the electronic digital ruler (gold standard) in children treated with growth hormone. There was only a minor underestimation of approximately 0.2-0.3 cm, which we anticipated to be clinically irrelevant. • Therefore, home height measurements can at least partly replace costly outpatient visits for children being treated with growth hormone as part of an uncomplicated course. Moreover, these results may also be promising for implementation in other paediatric populations besides children treated with growth hormone.
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Affiliation(s)
- Anouk J W Remmits
- Department of Paediatric Endocrinology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ghislaine A P G van Mastrigt
- School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
| | - Hedi L Claahsen-van der Grinten
- Department of Paediatric Endocrinology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Petra A van Setten
- Department of Paediatric Endocrinology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Verma L, Turk T, Dennett L, Dytoc M. Teledermatology in Atopic Dermatitis: A Systematic Review. J Cutan Med Surg 2024; 28:153-157. [PMID: 38205736 PMCID: PMC11015705 DOI: 10.1177/12034754231223694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Telemedicine use has been increasing especially during the COVID-19 pandemic. Various studies have outlined benefits of telemedicine including improving health equity, reducing wait times, and cost-effectiveness. Skin diseases such as atopic dermatitis (AD) may potentially be managed via telemedicine. However, there are no evidence-based recommendations for best practices in telemedicine for assessing AD patients. The objective of this review is to assess and summarize current evidence on telemedicine modalities for AD. This review will assess patient outcomes from various telemedicine models for AD. A review protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Two reviewers independently screened potential studies and extracted data. Studies were included if they evaluated any telemedicine assessment for AD. Of 2719 identified records, 5 reports were included. Two reports used the direct-access online model, 1 used web-based consultation, 1 used e-health through a personal eczema portal, and 1 used an online platform and mobile application. All models were variations of the asynchronous, store and forward model. In all the included reports, teledermatology for the follow-up of patients with AD was effective and equivalent when compared to in-person appointments or standard treatment for their respective key outcome measures. However, it is unclear what the most effective teledermatology model is due to significant heterogeneity between studies. Teledermatology may serve as an important tool for triaging and follow-up of patients with AD. More studies are needed to determine which teledermatology models are most effective for virtual assessment of AD.
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Affiliation(s)
- Luvneet Verma
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tarek Turk
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - Liz Dennett
- Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Marlene Dytoc
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Naamanka E, Salakka I, Parkkila M, Hotti J, Poutiainen E. Effectiveness of teleneuropsychological rehabilitation: Systematic review of randomized controlled trials. J Int Neuropsychol Soc 2024; 30:295-312. [PMID: 37746802 DOI: 10.1017/s1355617723000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The effectiveness of neuropsychological rehabilitation is supported by the evidence found in previous reviews, but there is a lack of research regarding the effectiveness of remotely conducted neuropsychological rehabilitation. This review aimed to identify and evaluate the results of studies investigating the effectiveness of teleneuropsychological rehabilitation. METHODS Relevant articles were extracted from electronic databases and filtered to include studies published in 2016 or later to focus on recent practices. Data were synthesized narratively. RESULTS A total of 14 randomized controlled studies were included in the synthesis (9 for children/adolescents, 5 for adults). The most common type of intervention was computerized cognitive training with regular remote contact with the therapist (seven studies). Regarding children and adolescents, the evidence for the effectiveness was found only for these types of interventions with improvements in cognitive outcomes. The results regarding the family-centered interventions were mixed with improvements only found in psychosocial outcomes. No support was found for the effectiveness of interventions combining cognitive and motor training. Regarding adults, all included studies offered support for the effectiveness, at least to some extent. There were improvements particularly in trained cognitive functions. Long-term effects of the interventions with generalization to global functioning remained somewhat unclear. CONCLUSION Remote interventions focused on computerized cognitive training are promising methods within teleneuropsychological rehabilitation. However, their impact on long-term meaningful, everyday functioning remained unclear. More research is needed to reliably assess the effectiveness of teleneuropsychological interventions, especially with more comprehensive approaches.
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Affiliation(s)
| | - Ilja Salakka
- Rehabilitation Foundation, Helsinki, Finland
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Joona Hotti
- Rehabilitation Foundation, Helsinki, Finland
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Bayram F, Sonmez A, Kiyici S, Akbas F, Yetgin MK, Yazici D, Cingi A, Sargin M, Unal S, Iseri C, Mahmutoglu FS, Yumuk VD. Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm. Curr Obes Rep 2024; 13:167-182. [PMID: 38172478 DOI: 10.1007/s13679-023-00541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine. RECENT FINDINGS The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.
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Affiliation(s)
- Fahri Bayram
- Department of Endocrinology and Metabolism, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, Ankara Guven Hospital, Ankara, Turkey
| | - Sinem Kiyici
- Department of Endocrinology and Metabolism, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Feray Akbas
- Department of Internal Medicine, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Meral Kucuk Yetgin
- Department of Coaching Education, Sport Health Sciences, Marmara University Faculty of Sports Science, Istanbul, Turkey
| | - Dilek Yazici
- Department of Endocrinology and Metabolism, Koc University Faculty of Medicine, Istanbul, Turkey
| | - Asim Cingi
- Department of General Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sargin
- Department of Family Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Seniz Unal
- Private Clinical Psychology Office, Istanbul, Turkey
| | - Ceren Iseri
- Department of Internal Medicine, Nutrition Science, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fatih Selami Mahmutoglu
- Department of Criminal Law and Criminal Procedure Law, Turkish-German University Faculty of Law, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Department of Endocrinology and Metabolism, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
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Liu J, Cepeda M, Frangaj B, Shimbo D. The Burden of Cardiovascular Disease in the Post-COVID Era. Prim Care 2024; 51:1-11. [PMID: 38278564 DOI: 10.1016/j.pop.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
In 2019, before the COVID-19 pandemic, cardiovascular disease (CVD) was the leading cause of death. Since 2020, the pandemic has had far-reaching effects on the landscape of health care including CVD prevention and management. Recent decreases in life expectancy in the United States could potentially be explained by issues related to disruptions in CVD prevention and control of CVD risk factors from the COVID-19 pandemic. This article reviews the effects of the SARS-CoV-2 virus and the accompanying pandemic on CVD risk factor prevention and management in the United States. Potential solutions are also proposed for these patients.
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Affiliation(s)
- Justin Liu
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA
| | - Maria Cepeda
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA
| | - Brulinda Frangaj
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA
| | - Daichi Shimbo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA.
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Jensen RE, Rohde JA, Muro AH, Schweppe CA, Vanderpool RC. Analysis of Telehealth Discussion Trends on Reddit (2019-2022). Telemed J E Health 2024. [PMID: 38394136 DOI: 10.1089/tmj.2023.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Introduction: Use of telehealth increased during the COVID-19 pandemic and continues to be a popular health resource. This study analyzed the frequency and sentiment of telehealth discussions on Reddit. Methods: The data set included 13,071 publicly available Reddit submissions containing keywords related to telehealth over a 3-year period. We identified 173 unique subreddit communities, which were coded into mutually exclusive categories: (1) general telehealth, (2) individual care, (3) professional, (4) news, and (5) COVID-19. The Vader lexicon-based machine was used to assign sentiment scores. Results: Most subreddits were coded as individual care (n = 112), professional (n = 26), and news (n = 22). The frequency of submissions increased during the first 2 months of the pandemic and dropped in June 2020, but remained consistent through October 2022. Most Reddit submissions were positive in sentiment (56%). Conclusion: Findings show a mostly positive view of telehealth among Reddit users and an increase in telehealth-related discussions since the COVID-19 pandemic.
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Affiliation(s)
- Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences National Cancer Institute, Bethesda, Maryland, USA
| | - Jacob A Rohde
- Consumer Behavior Research Program, Center for Communication & Media Impact, RTI International, Durham, North Carolina, USA
| | - Abigail H Muro
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Catherine A Schweppe
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
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Wen T, Logue TC, Wright JD, D'Alton M, Booker WA, Friedman AM. Adverse delivery hospitalisation outcomes in 2020 during the COVID-19 pandemic. BJOG 2024. [PMID: 38375533 DOI: 10.1111/1471-0528.17783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate risk for adverse obstetric outcomes associated with the coronavirus disease 2019 (COVID-19) pandemic period and with COVID-19 diagnoses. DESIGN Serial cross-sectional study. SETTING A national sample of US delivery hospitalisations before (1/2016 to 2/2020) and during the first 10 months of (3/2020 to 12/2020) the COVID-19 pandemic. POPULATION All 2016-2020 US delivery hospitalisations in the National Inpatient Sample. METHODS Delivery hospitalisations were identified and stratified into pre-pandemic and pandemic periods and the likelihood of adverse obstetric outcomes was compared using logistic regression models with adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association. Risk for adverse outcomes was also analysed specifically for 2020 deliveries with a COVID-19 diagnosis. MAIN OUTCOME MEASURE Adverse maternal outcomes including respiratory complications and cardiac morbidity. RESULTS Of an estimated 18.2 million deliveries, 2.9 million occurred during the pandemic. The proportion of delivery hospitalisations with a COVID-19 diagnosis increased from 0.1% in March 2020 to 3.1% in December. Comparing the pandemic period to the pre-pandemic period, there were higher adjusted odds of transfusion (aOR 1.12, 95% CI 1.05-1.19), a respiratory complication composite (aOR 1.37, 95% CI 1.29-1.46), cardiac severe maternal morbidity (aOR 1.30, 95% 1.20-1.39), postpartum haemorrhage (aOR 1.19, 95% CI 1.15-1.24), placental abruption/antepartum haemorrhage (OR 1.04, 95% CI 1.00-1.08), and hypertensive disorders of pregnancy (OR 1.23, 95% CI 1.21-1.26). These associations were similar to unadjusted analysis. Risk for these outcomes during the pandemic period was significantly higher in the presence of a COVID-19 diagnosis. CONCLUSIONS In a national estimate of delivery hospitalisations, the odds of cardiac and respiratory outcomes were higher in 2020 compared with 2016-2019. COVID-19 diagnoses were specifically associated with a range of serious complications.
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Affiliation(s)
- Timothy Wen
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware, USA
| | - Jason D Wright
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Mary D'Alton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Whitney A Booker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Alexander M Friedman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California, USA
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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Ojinnaka CO, Johnstun L, Dunnigan A, Nordstrom L, Yuh S. Telemedicine Reduces Missed Appointments but Disparities Persist. Am J Prev Med 2024:S0749-3797(24)00066-7. [PMID: 38373529 DOI: 10.1016/j.amepre.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Missed appointments also known as no-shows adversely affect clinical outcomes, clinic efficiency, and quality of care and have been attributed to barriers such as work schedule conflicts and lack of transportation. The widespread telemedicine implementation and adoption that has occurred as a consequence of the COVID-19 pandemic has the potential to address these barriers and improve missed appointment rates. This study aims to analyze the relationship between telemedicine and missed appointments. METHODS This retrospective cohort study used electronic health records data from a safety-net academic health center with federally qualified clinics (March 2020-December 2022). Bivariate and multivariable generalized estimating equations were used to analyze the relationship between no-show and appointment type (in-person versus telemedicine appointment). Stratified adjusted regression analyses were used to calculate the average change in the marginal effect of telemedicine appointments on no-shows across covariates. The data were analyzed from September 2023 to October 2023. RESULTS Hispanic patients accounted for 60% of the 474,212 appointments, followed by non-Hispanic White (22.5%), non-Hispanic Black (13.3%), Asian (2.7%), Native American (1%), and other race/ethnicity patients (0.6%). The no-show rate for telemedicine appointments was 12% compared with 25% for in-person appointments. Multivariable analysis showed that telemedicine appointment was associated with a decreased likelihood of no-show compared with in-person appointments (OR=0.40, 95% CI=0.40, 0.41). The average change in the marginal effect of telemedicine appointments on the reduction of no-shows across race/ethnicity was greatest for Native American and non-Hispanic Black patients. CONCLUSIONS Telemedicine appointments were associated with a decreased likelihood of no-shows, and the protective effect of telemedicine appointments on missed appointments was greatest for underserved groups. Strategies to increase telemedicine uptake, especially for underserved groups, are critical.
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Mandal S, Wiesenfeld BM, Mann DM, Szerencsy AC, Iturrate E, Nov O. Quantifying the impact of telemedicine and patient medical advice request messages on physicians' work-outside-work. NPJ Digit Med 2024; 7:35. [PMID: 38355913 PMCID: PMC10867011 DOI: 10.1038/s41746-024-01001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
The COVID-19 pandemic has boosted digital health utilization, raising concerns about increased physicians' after-hours clinical work ("work-outside-work"). The surge in patients' digital messages and additional time spent on work-outside-work by telemedicine providers underscores the need to evaluate the connection between digital health utilization and physicians' after-hours commitments. We examined the impact on physicians' workload from two types of digital demands - patients' messages requesting medical advice (PMARs) sent to physicians' inbox (inbasket), and telemedicine. Our study included 1716 ambulatory-care physicians in New York City regularly practicing between November 2022 and March 2023. Regression analyses assessed primary and interaction effects of (PMARs) and telemedicine on work-outside-work. The study revealed a significant effect of PMARs on physicians' work-outside-work and that this relationship is moderated by physicians' specialties. Non-primary care physicians or specialists experienced a more pronounced effect than their primary care peers. Analysis of their telemedicine load revealed that primary care physicians received fewer PMARs and spent less time in work-outside-work with more telemedicine. Specialists faced increased PMARs and did more work-outside-work as telemedicine visits increased which could be due to the difference in patient panels. Reducing PMAR volumes and efficient inbasket management strategies needed to reduce physicians' work-outside-work. Policymakers need to be cognizant of potential disruptions in physicians carefully balanced workload caused by the digital health services.
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Affiliation(s)
- Soumik Mandal
- Dept of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
- Technology Management & Innovation, New York University Tandon School of Engineering, New York, NY, USA.
| | - Batia M Wiesenfeld
- New York University Leonard N Stern School of Business, New York, NY, USA
| | - Devin M Mann
- Dept of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- MCIT Department of Health Informatics, NYU Langone Health, New York, USA
| | - Adam C Szerencsy
- MCIT Department of Health Informatics, NYU Langone Health, New York, USA
| | - Eduardo Iturrate
- Dept of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Oded Nov
- Technology Management & Innovation, New York University Tandon School of Engineering, New York, NY, USA
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Chen J, Feng H, Sun J, Jiang Y. Omicron wave during December 2022 - January 2023: access to pharmaceuticals and healthcare resources and impacts on health outcomes in Shenzhen, China. J Pharm Policy Pract 2024; 17:2306867. [PMID: 38357548 PMCID: PMC10866053 DOI: 10.1080/20523211.2024.2306867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Purpose This study described pharmaceutical and medical resource accessibility of COVID-19 treatment in Shenzhen, China during the peak of COVID-19 infection from December 2022 to January 2023, and examined its influence on clinical outcomes. Methods We surveyed Shenzhen residents on COVID-19-related topics using electronic questionnaires. We conducted descriptive statistical analyses and multiple regressions including logistic and Tobit models to explore the impacts of resource constraints on patient outcomes. Resource utilisation and attempts to seek medical care were also described for severity-stratified subgroups. Results 76.8% of respondents reported experiencing COVID-19 symptoms between December 7, 2022 and January 29, 2023. Of those who attempted to purchase medication, 72.8% reported drug shortage. 49% of those seeking medical treatment experienced difficulties. Compared with those who did not experience drug shortages, those who did had an odds ratio of 1.959 (95% CI: 1.159 ∼3.313) of presenting with moderate to severe symptoms. Compared with those without difficulties in seeking medical treatment, those who did had an average of 0.39 (95% CI: 0.110 ∼0.670) more days absent from work. Conclusion Shenzhen residents with COVID-19 symptoms from December 2022 to January 2023 experienced a certain degree of pharmaceutical and medical resource constraints, which might have compromised their prognosis.
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Affiliation(s)
- Jiayue Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Haisu Feng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Jiatong Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
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48
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Kwon C, Essayei L, Spencer M, Etheridge T, Venkatesh R, Vengadesan N, Thiel CL. The Environmental Impacts of Electronic Medical Records Versus Paper Records at a Large Eye Hospital in India: Life Cycle Assessment Study. J Med Internet Res 2024; 26:e42140. [PMID: 38319701 PMCID: PMC10879968 DOI: 10.2196/42140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/22/2023] [Accepted: 04/19/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use. OBJECTIVE We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India. METHODS We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources. RESULTS This location's EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories. CONCLUSIONS The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system's GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care.
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Affiliation(s)
- Cordelia Kwon
- Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Lernik Essayei
- NYU Wagner School of Public Service, New York, NY, United States
| | - Michael Spencer
- Rausser College of Natural Resources, University of California, Berkeley, Berkeley, CA, United States
| | | | | | | | - Cassandra L Thiel
- Center for Healthcare Innovation and Delivery Science, Department of Population Health, NYU Langone Health, New York, NY, United States
- Department of Ophthalmology, NYU Langone Health, New York, NY, United States
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Scott SE, Jenkins G, Mickievicz E, Saladino J, Rick AM, Levenson R, Chang JC, Randell KA, Duplessis V, Miller E, Ragavan M. Creating Healing-Centered Spaces for Intimate Partner Violence Survivors in the Postpartum Unit: Examining Current Practices and Desired Resources Among Health Care Providers and Postpartum People. J Womens Health (Larchmt) 2024; 33:204-217. [PMID: 37971822 PMCID: PMC10880269 DOI: 10.1089/jwh.2023.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors.
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Affiliation(s)
- Sarah E Scott
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Genelle Jenkins
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erin Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jackie Saladino
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne-Marie Rick
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maya Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Khojasteh-Kaffash S, Parhizkar Roudsari P, Ghaffari Jolfayi A, Samieefar N, Rezaei N. Pediatric asthma exacerbation and COVID-19 pandemic: Impacts, challenges, and future considerations. J Asthma 2024; 61:81-91. [PMID: 37610180 DOI: 10.1080/02770903.2023.2251062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Asthma, a common disease among children and adolescents, poses a great health risk when ignored; therefore, a thorough follow-up to prevent exacerbations is emphasized. The aim of the present study is to investigate asthma exacerbation in children during the Coronavirus disease 2019 (COVID-19) era. DATA SOURCES This narrative review has been done by searching the PubMed and Embase databases using Asthma, COVID-19, Pandemic, and Symptom flare up as keywords. STUDY SELECTIONS Studies related to asthma exacerbation in COVID-19 pandemic were included. RESULTS Based on studies, controlled or mild to moderate asthma has not been considered a risk factor for COVID-19 severity and has not affected hospitalization, intensive care unit (ICU) admission, and mortality. Surprisingly, emergent and non-emergent visits and asthmatic attacks decreased during the pandemic. The three main reasons for decreased incidence and exacerbation of asthma episodes in the COVID-19 era included reduced exposure to environmental allergens, increasing the acceptance of treatment by pediatrics and caregivers, and decreased risk of other respiratory viral infections. Based on the available studies, COVID-19 vaccination had no serious side effects, except in cases of uncontrolled severe asthma, and can be injected in these children. Also, there was no conclusive evidence of asthma exacerbation after the injection of COVID-19 vaccines. CONCLUSION Further studies are recommended to follow the pattern of asthma in the post-pandemic situation and to become prepared for similar future conditions.
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Affiliation(s)
- Soroush Khojasteh-Kaffash
- Student Research Committee, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyvand Parhizkar Roudsari
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ghaffari Jolfayi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Cardiovascular Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Noosha Samieefar
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Science, Tehran, Iran
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