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Tele Otology in India: Last 10 Years-A Scopic Review. Indian J Otolaryngol Head Neck Surg 2022; 74:3776-3788. [PMID: 33968709 PMCID: PMC8088199 DOI: 10.1007/s12070-021-02546-4] [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: 02/20/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Hearing loss is the commonest sensory deficit among humans, affecting 466 million people worldwide. Early detection is the key to hearing rehabilitation, as speech and language develops early in the childhood. Scarcity of human resources and infrastructure in developing countries like India leads to difficulty in implementation of hearing screening programmes. Tele otology is very fruitful methodology in providing health care facility from distant site to the doorsteps of needy individuals. The action initiated in the field of tele otology in India was reviewed at electronic databases: Pubmed, Google scholar, Medline, Cochrane library, science direct and author mapper using the keywords 'tele otology' and 'tele audiometry' in January 2021. Eligible studies were those related to tele otology and tele audiometry in India. A total of 16 articles were shortlisted for the present study. Tele hearing testing was satisfactory for the parents in regard to accessibility, testing process and counselling. Tele audiometry surveillance shows better overall follow-up compliance rate then in-person audiological surveillance. During covid 19 pandemic virtual approach to the patient through video calling and telephone calls proved handy approach, ensuring safety profile of both health care professionals and patients. Even Tele ABR conducted in tele van shows similar results as in face-to-face mode ABR. Tele otology should be considered by the service providers and policy makers while planning for hearing screening programmes for both new-born and school going children in view of its reliability, low-cost, non-invasive and portability. The village health workers (VHWs) should be well trained in assisting tele practice and internet connectivity should be well established. Tele otology looks very promising in providing health services through the ever-expanding reach of global connectivity.
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Watila MM, Duncan C, Mackay G. Evaluation of telemedicine for new outpatient neurological consultations. BMJ Neurol Open 2022; 4:e000260. [PMID: 35571587 PMCID: PMC9082731 DOI: 10.1136/bmjno-2021-000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/27/2022] [Indexed: 11/11/2022] Open
Abstract
Objective The COVID-19 pandemic has broadened the use of teleneurology, how this compares with face-to-face (F2F) clinics is unclear. This study compared virtual with F2F new neurological consultations. Methods We retrospectively evaluated new outpatient consultations in neurology clinics in Aberdeen Royal Infirmary. We compared sociodemographic data, time to consultation, time to diagnosis, the need for reassessment and re-investigation between traditional F2F and virtual clinics using the web-based Attend Anywhere platform or telephone into patients’ own homes (or chosen location) without a trained assistant. We calculated the relative risk (RR) of the need for reassessment and re-investigation over 6-month periods by the suspected neurological diagnosis. Results 73% of consultations were virtual (Attend Anywhere or telephone) between June and October 2020, this was almost non-existent (<0.1%) in June–October 2019. We analysed 352 F2F (June–July 2019) and 225 virtual consultations (June–July 2020). Compared with F2F clinics, virtual clinics had a longer time to diagnosis (p=0.019), were more likely to be reassessed (RR: 2.2, 95% CI: 1.5 to 3.2; p<0.0001) and re-investigated (RR: 1.50, 95% CI: 0.88 to 2.54; p=0.133), this was likelier in those aged ≥60 years. Patients with headaches and suspected seizures were less likely to need reassessment or re-investigation following virtual clinics than multiple sclerosis and neuroinflammatory disorders, spinal cord disorders and functional neurological disorders. Conclusion This study demonstrates that virtual clinics have higher rates of reassessment and re-investigation than F2F clinics. As virtual clinics become a potential consultation alternative, this study should instruct the selection of patients for either consultation type.
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Affiliation(s)
- Musa Mamman Watila
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Callum Duncan
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Graham Mackay
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
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Ghosal S, Shah P. A deep-learning toolkit for visualization and interpretation of segmented medical images. CELL REPORTS METHODS 2021; 1:100107. [PMID: 35474999 PMCID: PMC9017181 DOI: 10.1016/j.crmeth.2021.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/23/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
Generalizability of deep-learning (DL) model performance is not well understood and uses anecdotal assumptions for increasing training data to improve segmentation of medical images. We report statistical methods for visual interpretation of DL models trained using ImageNet initialization with natural-world (T II) and supervised learning with medical images (L MI) for binary segmentation of skin cancer, prostate tumors, and kidneys. An algorithm for computation of Dice scores from union and intersections of individual output masks was developed for synergistic segmentation by T II and L MI models. Stress testing with non-Gaussian distributions of infrequent clinical labels and images showed that sparsity of natural-world and domain medical images can counterintuitively reduce type I and type II errors of DL models. A toolkit of 30 T II and L MI models, code, and visual outputs of 59,967 images is shared to identify the target and non-target medical image pixels and clinical labels to explain the performance of DL models.
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Affiliation(s)
- Sambuddha Ghosal
- Program in Media, Arts, and Sciences and Media Lab, Massachusetts Institute of Technology, 20 Ames Street, Cambridge, MA 02139, USA
| | - Pratik Shah
- Program in Media, Arts, and Sciences and Media Lab, Massachusetts Institute of Technology, 20 Ames Street, Cambridge, MA 02139, USA
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Ben-Omran MO, Livinski AA, Kopycka-Kedzierawski DT, Boroumand S, Williams D, Weatherspoon DJ, Iafolla TJ, Fontelo P, Dye BA. The use of teledentistry in facilitating oral health for older adults: A scoping review. J Am Dent Assoc 2021; 152:998-1011.e17. [PMID: 34521539 DOI: 10.1016/j.adaj.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services. TYPES OF STUDIES REVIEWED Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria. RESULTS Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up. CONCLUSIONS AND PRACTICAL IMPLICATIONS Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.
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Bhardwaj P, Yadav RK, Kurian S. Digitizing the Pharma Neurons - A Technological Operation in Progress! Rev Recent Clin Trials 2020; 15:178-187. [PMID: 32564760 DOI: 10.2174/1574887115666200621183459] [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: 02/27/2020] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Digitization and automation are the buzzwords in clinical research and pharma companies are investigating heavily here. Right from drug discovery to personalized medicine, digital patients and patient engagement, there is great consideration of technology at each step. METHODS The published data and online information available is reviewed to give an overview of digitization in pharma, across the drug development cycle, industry collaborations and innovations. The regulatory guidelines, innovative collaborations across industry, academics and thought leadership are presented. Also included are some ideas, suggestions, way forwards while digitizing the pharma neurons, the regulatory stand, benefits and challenges. RESULTS The innovations range from discovering personalized medicine to conducting virtual clinical trials, and maximizing data collection from the real-world experience. To address the increasing demand for the real-world data and the needs of tech-savvy patients, the innovations are shaping up accordingly. Pharma companies are collaborating with academics and they are co-innovating the technology for example Massachusetts Institute of Technology's program. This focuses on the modernization of clinical trials, strategic use of artificial intelligence and machine learning using real-world evidence, assess the risk-benefit ratio of deploying digital analytics in medicine, and proactively identifying the solutions. CONCLUSION With unfolding data on the impact of science and technology amalgamation, we need shared mindset between data scientists and medical professionals to maximize the utility of enormous health and medical data. To tackle this efficiently, there is a need of cross-collaboration and education, and align with ethical and regulatory requirements. A perfect blend of industry, regulatory, and academia will ensure successful digitization of pharma neurons.
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Affiliation(s)
| | - Raj Kumar Yadav
- Integral Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Sojan Kurian
- Tata Consultancy Services, New York, NY, United States
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Yauney G, Rana A, Wong LC, Javia P, Muftu A, Shah P. Automated Process Incorporating Machine Learning Segmentation and Correlation of Oral Diseases with Systemic Health. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3387-3393. [PMID: 31946607 DOI: 10.1109/embc.2019.8857965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Imaging fluorescent disease biomarkers in tissues and skin is a non-invasive method to screen for health conditions. We report an automated process that combines intraoral fluorescent porphyrin biomarker imaging, clinical examinations and machine learning for correlation of systemic health conditions with periodontal disease. 1215 intraoral fluorescent images, from 284 consenting adults aged 18-90, were analyzed using a machine learning classifier that can segment periodontal inflammation. The classifier achieved an AUC of 0.677 with precision and recall of 0.271 and 0.429, respectively, indicating a learned association between disease signatures in collected images. Periodontal diseases were more prevalent among males (p=0.0012) and older subjects (p=0.0224) in the screened population. Physicians independently examined the collected images, assigning localized modified gingival indices (MGIs). MGIs and periodontal disease were then cross-correlated with responses to a medical history questionnaire, blood pressure and body mass index measurements, and optic nerve, tympanic membrane, neurological, and cardiac rhythm imaging examinations. Gingivitis and early periodontal disease were associated with subjects diagnosed with optic nerve abnormalities (p<; 0.0001) in their retinal scans. We also report significant co-occurrences of periodontal disease in subjects reporting swollen joints (p=0.0422) and a family history of eye disease (p=0.0337). These results indicate cross-correlation of poor periodontal health with systemic health outcomes and stress the importance of oral health screenings at the primary care level. Our screening process and analysis method, using images and machine learning, can be generalized for automated diagnoses and systemic health screenings for other diseases.
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care. METHODS In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care. RESULTS Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable. CONCLUSIONS Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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Ganapathy K, Nukala L, Premanand S, Tamilmaran P, Aggarwal P, Saksena S, BrindhaDevi SP. Telemedicine in Camp Mode While Screening for Noncommunicable Diseases: A Preliminary Report from India. Telemed J E Health 2020; 26:42-50. [DOI: 10.1089/tmj.2018.0300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Singh Pardal M, Rajiva K, Orkeh G. Telemedicine in the era of COVID-19: The East and the West. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_86_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shah P, Kendall F, Khozin S, Goosen R, Hu J, Laramie J, Ringel M, Schork N. Artificial intelligence and machine learning in clinical development: a translational perspective. NPJ Digit Med 2019; 2:69. [PMID: 31372505 PMCID: PMC6659652 DOI: 10.1038/s41746-019-0148-3] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/08/2019] [Indexed: 12/26/2022] Open
Abstract
Future of clinical development is on the verge of a major transformation due to convergence of large new digital data sources, computing power to identify clinically meaningful patterns in the data using efficient artificial intelligence and machine-learning algorithms, and regulators embracing this change through new collaborations. This perspective summarizes insights, recent developments, and recommendations for infusing actionable computational evidence into clinical development and health care from academy, biotechnology industry, nonprofit foundations, regulators, and technology corporations. Analysis and learning from publically available biomedical and clinical trial data sets, real-world evidence from sensors, and health records by machine-learning architectures are discussed. Strategies for modernizing the clinical development process by integration of AI- and ML-based digital methods and secure computing technologies through recently announced regulatory pathways at the United States Food and Drug Administration are outlined. We conclude by discussing applications and impact of digital algorithmic evidence to improve medical care for patients.
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Affiliation(s)
- Pratik Shah
- 1Massachusetts Institute of Technology, Media Laboratory, Cambridge, MA USA
| | - Francis Kendall
- 1Massachusetts Institute of Technology, Media Laboratory, Cambridge, MA USA.,F. Hoffmann-La Roche AG, Strategic Innovation, San Francisco, CA USA
| | - Sean Khozin
- 3US Food and Drug Administration, Silver Spring, MD USA
| | | | - Jianying Hu
- 5IBM Research, Center for Computational Health, New York, NY USA
| | - Jason Laramie
- 6Novartis Institute of Biomedical Research, Cambridge, MA USA
| | | | - Nicholas Schork
- 7The Translational Genomics Research Institute, Quantitative Medicine and Systems Biology Phoenix, Phoenix, AZ USA
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Harrer S, Shah P, Antony B, Hu J. Artificial Intelligence for Clinical Trial Design. Trends Pharmacol Sci 2019; 40:577-591. [PMID: 31326235 DOI: 10.1016/j.tips.2019.05.005] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 12/23/2022]
Abstract
Clinical trials consume the latter half of the 10 to 15 year, 1.5-2.0 billion USD, development cycle for bringing a single new drug to market. Hence, a failed trial sinks not only the investment into the trial itself but also the preclinical development costs, rendering the loss per failed clinical trial at 800 million to 1.4 billion USD. Suboptimal patient cohort selection and recruiting techniques, paired with the inability to monitor patients effectively during trials, are two of the main causes for high trial failure rates: only one of 10 compounds entering a clinical trial reaches the market. We explain how recent advances in artificial intelligence (AI) can be used to reshape key steps of clinical trial design towards increasing trial success rates.
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Affiliation(s)
- Stefan Harrer
- IBM Research, IBM Research Australia Lab, 3006 Melbourne, VIC, Australia.
| | - Pratik Shah
- Massachusetts Institute of Technology, Media Lab, 02139 Cambridge, MA, USA
| | - Bhavna Antony
- IBM Research, IBM Research Australia Lab, 3006 Melbourne, VIC, Australia
| | - Jianying Hu
- IBM Research, IBM T.J. Watson Research Center, 10598 Yorktown Heights, NY, USA
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