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Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls

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... The clinical significance of this research will help shed light on what telemedicine and telehealth are and in which aspects they can be helpful for patients. Many articles attempt to explain the meaning and importance of telemedicine and telehealth [10,11], but most of them could not identify much difference between the two. We have reviewed all these articles. ...
... Many descriptions of telehealth and telemedicine are confusing. As these terms have become adopted in common use, they have lost their connection with the basic elements they set out to define [10]. Telehealth equipment is used as a tool for a specialist to investigate a patient with a disease condition and allows the patient to receive immediate expert advice [9]. ...
... Firstly, previous studies offered many definitions of telehealth and telemedicine [18,19]. However, the majority of articles stating that these two terms mean the same have limited the exact meaning of telehealth and telemedicine [9,10]. This study attempts to expand the current line of research, focusing first on all the given definitions of telehealth and telemedicine, and the comparison (Table 1) we have made shows the differences between them. ...
Article
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With the rapid progress in mobile healthcare and Internet medicine, the impact of telehealth and telemedicine on the satisfaction of patients and their willingness to travel has become a focus of the academic research community. This study analyses the differences between telehealth and telemedicine and their role in medical tourism. We examine how the information quality and communication quality of telehealth and telemedicine influence patient satisfaction, and their effects on patients’ willingness to undertake medical travel and on their medical travel behaviours. We conducted an empirical study on the use of telehealth and telemedicine and on medical travel behaviour in Azerbaijan using a survey for data collection. A total of 500 results were collected and analysed using SmartPLS 3.0. Results show that (1) the communication quality and information quality of telehealth and telemedicine and their effects on satisfaction have significantly positive influences on willingness to undertake medical travel; (2) the psychological expectations of value and cost (perceived value and perceived cost) have a positive influence on medical travel; and (3) willingness to participate in medical travel positively influences medical travel behaviour. Moreover, results of this study have implications for research on, and the practice of, using telehealth and telemedicine as they relate to medical tourism. This research may help improve knowledge about telehealth and telemedicine and understand the differences between them in detail. This empirical research model may also be useful for researchers from other countries who wish to measure medical travel behaviour.
... Esta herramienta es clave para la comunicación médica hasta la actualidad. El primer caso registrado, fue un "diagnóstico telefónico" que se le hizo a un niño que presentaba una infección en su laringe y tráquea (Darkins & Cary, 2000). En 1935, una organización italiana se constituyó para brindar asistencia médica sin costo a los barcos en el océano (Eren & Webster, 2016). ...
... Pero fue solo hasta 1973, cuando la telemedicina cobró especial auge, ya que se transmitió la primera conferencia y presentación de trabajos en la ciudad de Ann Arbor, en Michigan. Luego, se tuvo un impulso a estas prácticas, gracias a su adopción por la NASA y las fuerzas militares de ese país (Darkins & Cary, 2000). ...
... El Gobierno noruego financió la evaluación de la calidad de los diagnósticos basados en teleconsulta respecto a los realizados cara a cara, el acceso seguro y confiable de los pacientes desde su hogar a médicos expertos y la efectividad del servicio desde el punto de vista de costos. La experiencia mostró que cinco aspectos fueron claves para el funcionamiento de estos servicios (Darkins & Cary, 2000): ...
... In one of his first calls on the to-be-invented telephone, on March 10, 1876, Alexander Graham Bell, after pouring some battery acid on his hand, summoned his assistant, Thomas Watson, saying "Mr Watson, come here. I want you!" [68]. The use of remote communication for health purposes is often called tele-medicine. ...
... Since this first episode, all kind of technologies was exploited for tele-medicine. During the first decades of XXth century radio was used for putting in contact doctors to remote patients, e.g. on ships or people living in remote areas in Australia [68]. ...
... The term "telemedicine" refers to the use of electronic communications and information technology to deliver and support clinical care at a distance. [68] or, according to a more recent definition, tele-medicine is: ...
Thesis
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Background: Europe is living in an unsustainable situation. The economic crisis has been reducing governments’ economic resources since 2008 and threatening social and health systems, while the proportion of older people in the European population continues to increase so that it is foreseen that in 2050 there will be only two workers per retiree [54]. To this situation it should be added the rise, strongly related to age, of chronic diseases the burden of which has been estimated to be up to the 7% of a country’s gross domestic product [51]. There is a need for a paradigm shift, the need for a new way of caring for people’s health, shifting the focus from curing conditions that have arisen to a sustainable and effective approach with the emphasis on prevention. Some advocate the adoption of personalised health care (pHealth), a model where medical practices are tailored to the patient’s unique life, from the detec- tion of risk factors to the customization of treatments based on each individual’s response [81]. Personalised health is often associated to the use of Information and Communications Technology (ICT), that, with its exponential development, offers interesting opportunities for improving healthcare. The shift towards pHealth is slowly taking place, both in research and in industry, but the change is not significant yet. Many barriers still exist related to economy, politics and culture, while others are purely technological, like the lack of interoperable information systems [199]. Though interoperability aspects are evolving, there is still the need of a reference design, especially tackling implementation and large scale deployment of pHealth systems. This thesis contributes to organizing the subject of ICT systems for per- sonalised health into a reference model that allows for the creation of software development platforms to ease common development issues in the domain. Research questions: RQ1 Is it possible to define a model, based on software engineering techniques, for representing the personalised health domain in an abstract and representative way? RQ2 Is it possible to build a development platform based on this model? RQ3 Does the development platform help developers create complex integrated pHealth systems? Methods: As method for describing the model, the ISO/IEC/IEEE 42010 framework [25] is adopted for its generality and high level of abstraction. The model is specified in different parts: a conceptual model, which makes use of concept maps, for rep- resenting stakeholders, artefacts and shared information, and in scenarios and use cases for the representation of the functionalities of pHealth systems. The model was derived from literature analysis, including 7 industrial and scientific reports, 9 electronic standards, 10 conference proceedings papers, 37 journal papers, 25 websites and 5 books. Based on the reference model, requirements were drawn for building the development platform enriched with a set of requirements gathered in a survey run among 11 experienced engineers. For developing the platform, the continuous integration methodology [74] was adopted which allowed to perform automatic tests on a server and also to deploy packaged releases on a web site. As a validation methodology, a theory building framework for SW engineer- ing was adopted from [181]. The framework, chosen as a guide to find evidence for justifying the research questions, imposed the creation of theories based on models and propositions to be validated within a scope. The validation of the model was conducted as an on-line survey in three validation rounds, encompassing a growing number of participants. The survey was submitted to 134 experts of the field and on some public channels like relevant mailing lists and social networks. Its objective was to assess the model’s readability, its level of coverage of the domain and its potential usefulness in the design of actual, derived systems. The questionnaires included quantitative Likert scale questions and free text inputs for comments. The development platform was validated in two scopes. As a small-scale experiment, the platform was used in a 12 hours training session where 4 developers had to perform an exercise consisting in developing a set of typical pHealth use cases At the end of the session, a focus group was held to identify benefits and drawbacks of the platform. The second validation was held as a test-case study in a large scale research project called HeartCycle the aim of which was to develop a closed-loop disease management system for heart failure and coronary heart disease patients [160]. During this project three applications were developed by a team of programmers and designers. One of these applications was tested in a clinical trial with actual patients. At the end of the project, the team was interviewed in a focus group to assess the role the platform had within the project. Results: For what regards the model that describes the pHealth domain, its conceptual part includes a description of the main roles and concerns of pHealth stake- holders, a model of the ICT artefacts that are commonly adopted and a model representing the typical data that need to be formalized among pHealth systems. The functional model includes a set of 18 scenarios, divided into assisted person’s view, caregiver’s view, developer’s view, technology and services providers’ view and authority’s view, and a set of 52 Use Cases grouped in 6 categories: assisted person’s activities, system reactions, caregiver’s activities, user engagement, developer’s activities and deployer’s activities. For what concerns the validation of the model, a total of 65 people participated in the online survey providing their level of agreement in all the assessed dimensions and a total of 248 comments on how to improve and complete the model. Participants’ background spanned from engineering and software development (70%) to medical specialities (15%), with declared interest in the fields of eHealth (24%), mHealth (16%), Ambient Assisted Living (21%), Personalized Medicine (5%), Personal Health Systems (15%), Medical Informatics (10%) and Biomedical Engineering (8%) with an average of 7.25±4.99 years of experience in these fields. From the analysis of the answers it is possible to observe that the contacted experts considered the model easily readable (average of 1.89±0.79 being 1 the most favourable scoring and 5 the worst), sufficiently abstract (1.99±0.88) and formal (2.13±0.77) for its purpose, with a sufficient coverage of the domain (2.26±0.95), useful for describ- ing the domain (2.02±0.7) and for generating more specific systems (2±0.75) and they reported a partial interest in using the model in their job (2.48±0.91). Thanks to their comments, the model was improved and enriched with concepts that were missing at the beginning, nonetheless it was not possible to prove an improvement among the iterations, due to the diversity of the participants in the three rounds. From the model, a development platform for the pHealth domain was gen- erated called pHealth Patient Platform (pHPP). The platform includes a set of libraries, programming and deployment tools, a tutorial and a sample ap- plication. The main four modules of the architecture are: the Data Collection Engine, which allows abstracting sources of information like sensors or external services, mapping data to databases and ontologies, and allowing event-based interaction and filtering, the GUI Engine, which abstracts the user interface in a message-like interaction model, the Workflow Engine, which allows program- ming the application’s user interaction flows with graphical workflows, and the Rule Engine, which gives developers a simple means for programming the ap- plication’s logic in the form of “if-then” rules. After the 5 years experience of HeartCycle, partially programmed with pHPP, 5 developers were joined in a focus group to discuss the advantages and drawbacks of the platform. The view that emerged from the training course and the focus group was that the platform is well-suited to the needs of the engineers working in the field, it allowed the separation of concerns among the different specialities and it simplified some common development tasks like data management and asynchronous interaction. Nevertheless, some deficiencies were pointed out in terms of a lack of maturity of some technological choices, and for the absence of some domain-specific tools, e.g. for data processing or for health-related communication protocols. Within HeartCycle, the platform was used to develop part of the Guided Exercise system, a composition of ICT tools for the physical rehabilitation of patients who suffered from myocardial infarction. The system developed using the platform was tested in a randomized controlled clinical trial, in which 55 patients used the system for 21 weeks. The technical results of this trial showed that the system was stable and reliable. Some minor bugs were detected, but these were promptly corrected using the platform. This shows that the platform, as well as facilitating the development task, can be successfully used to produce reliable software. Conclusions: The research work carried out in developing this thesis provides responses to the three three research questions that were the motivation for the work. RQ1 A model was developed representing the domain of personalised health systems, and the assessment of experts in the field was that it represents the domain accurately, with an appropriate balance between abstraction and detail. RQ2 A development platform based on the model was successfully developed. RQ3 The platform has been shown to assist developers create complex pHealth software. This was demonstrated within the scope of one large-scale project, but the generic approach adopted provides indications that it would offer benefits more widely. The results of these evaluations provide indications that both the model and the platform are good candidates for being a reference for future pHealth developments.
... This precludes any telemedicine solutions, which are often used clinician to clinician to provide assistance with diagnostics or treatment. Using such a definition is in line with the WHO definition of telehealth which is "understood to mean the integration of ICT systems into the practice of protecting and promoting health, while telemedicine is the incorporation of these systems into curative medicine…" (Darkins & Cary, 2000;Kelly, 2021). ...
... There are concerns that certain patient groups do not benefit from virtual consultations. Certainly, in the literature, there is much evidence to suggest that whereas most patient groups can use telehealth well, there are outliers which need to be carefully considered and managed (Koonin, et al., 2020;Darkins & Cary, 2000;Fisk, et al., 2020;Aziz, et al., 2020), alongside ethical considerations (Kaplan & Litewka, 2008). ...
Article
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This paper seeks to understand the use of telehealth technologies post COVID-19. For many years, academics have sought to provide evidence that the use of telehealth can have positive effects on patient outcomes, increase access to healthcare for populations, and to ensure a better use of resources for all healthcare economies. Although a number of trials and implementations on local, regional and national scales have found positive outcomes, healthcare providers have resisted the drive to greater telehealth adoption. This paper does not examine the history of telehealth in any great detail, but examines the use of telehealth during the COVID-19 pandemic. The authors suggest that the increased use of telehealth is here to stay, and that health and care economies globally will need to adopt more telehealth solutions to continue to provide their services in a manner most appropriate for changing global populations. As part of the study, the authors identify that technology programmes alone cannot lead to better telehealth implementation. They suggest that telehealth needs to ensure and support safe healthcare; that it must be effective; that patient centricity is important; that timeliness is a major factor; that telehealth can increase efficiency; that it reduces health inequalities; and that big, bold, visionary change is required.
... 1 Telemedicine has been widely used since the 1990s, when healthcare providers used telephones whenever a patient felt sick, and later on, the development became accelerated in this modern era. 2 It is divided into three activities: teleconsultation involving telemonitoring, teleexpertise, and teleassistance. A further technological enhancement that also needs to be implemented in the health sector includes virtual and augmented reality, artificial intelligence, robotics, and gene writing. ...
... Based on these findings, it was concluded that this currative medicine is the part of telehealth which provided health services in various communities. 2 Primary physicians and nurses or midwives are the main people that mostly interact with patients. They either recommend patients to an expert or administer temporary medicine and observe the condition. ...
Article
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This article aimed to review the essence of telemedicine in current technology and innovation era especially in developing country and the regulation aspect as the main component for health care services. Global electronic health has two crucial components that are telehealth which is based on the e-commerce system and health informatics which is based on the e-learning system. There are five main categories to manage telemedicine, such as system management including revenue stream and technology literacy, health facilities, human resources, data authorization and security, and health protocol. A combination of telemedicine and wearable devices improves health care delivery opportunities by enhancing remote patient monitoring. World Health Organization (WHO) has been described telehealth services in developing country. Some issues related to telehealth are still must be well managed, such as patient’s data security of health services. Our community also should be encouraged to use telehealth. Regular training and evaluation for the people with poor educational background, low income, and stress are the main reasons why our community attend to healthcare service in spite of mild sickness.
... The use of applications based on remote medicine or 'telemedicine' [4][5][6][7][8][9][10][11][12][13][14][15] becomes useful in this context. Nowadays, these applications are already widely used to help healthcare services to follow up, assess, and diagnose patient conditions remotely. ...
... For this, a decision was made so that when the percentage variations between the Technical Risk and the Global Risk values exceed a certain threshold value, for example 20%, then the expert will be asked about her level of certainty on the assessment made, and so the Decision Factor value will be corrected. Equation (12) is used to implement the mentioned correction within the logarithmic zone. ...
Article
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The medical treatment of chronic wounds, pressure ulcers in particular, burdens healthcare systems nowadays with high expenses that result mainly from their monitoring and assessment stages. Decision support systems applied within the ‘remote medicine’ framework may be of help, not only to the process of monitoring the evolution of chronic wounds under treatment, but also to facilitate the prevention and early detection of potential risk conditions in the affected patients. In this paper, the design and definition of a new decision-support methodology to be applied to the monitoring and assessment stages of the medical treatment process for pressure ulcers is proposed. Built upon the use and development of expert systems, the methodology makes it possible to generate alerts derived from the evolution of a patient’s chronic wound, by means of the interpretation and combination of data coming from both an image of the wound, and the considerations of a healthcare professional with expertise in the subject matter. Some positive results are already shown regarding the determination of the ulcer’s status in the tests that have been carried out so far. Therefore, it is considered that the proposed methodology might lead to substantial improvements regarding both the treatment’s efficiency and cost savings.
... Moreover, a significant minority (up to 43.24%) of individuals are interested in Internet-mediated treatments, especially those who cite stigma as a barrier to care [13]. As such, these are obvious methods to study for helping individuals with anxiety disorders overcome barriers to treatment [14,15]. ...
... Videoconferencing, which uses audio and video transmission of communication over the Internet, offers patients access to mental health treatment without having to physically present in their clinician's office [14]. Videoconference-mediated interventions offer a format equivalent to face-to-face therapy, but they are deliv-ered remotely. ...
Chapter
Anxiety disorders are highly pervasive and debilitating. Despite the prevalence of these disorders, many people with anxiety disorders are unable to access care, and even fewer have access to evidence-based treatments. Online (or Internet-mediated) interventions may be effective in reducing barriers to care for people with anxiety. Internet-mediated mental health interventions have become increasingly utilized and studied in parallel with advancements in technology. With foundations in evidence-based therapy methods, such treatments have been adapted for a variety of disorders, including anxiety disorders. Results from a variety of studies suggest promising but mixed findings on feasibility, efficacy, and treatment engagement. There remain several important challenges to and considerations for the use of digital tools to treat anxiety disorders, including treatment dropout, negative attitudes toward Internet-mediated technologies, low technological literacy, and lack of access to technology.
... T elerehabilitation can be defined as providing rehabilitation health care services across a distance. 1 These services can be provided to remote locations through information and communication technologies 2 and can be accessed by patients in their homes or at a local health care facility. 3 Telerehabilitation is particularly appealing for stroke rehabilitation due to the limited availability and resources of outpatient services. ...
... The ability to provide health care services to individuals living in remote areas who are unable to attend traditional hospital-based outpatient programs is one of the primary overarching goals of telerehabilitation. 1 This goal is particularly salient to health care delivery in Canada, with a relatively small population spread across a large geographic area. Of the six studies included in the CPSR initiative, four reported that their intervention reached remote/rural sites. ...
Article
Introduction: Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy. However, the application of telerehabilitation interventions in stroke populations has proven to be more challenging than anticipated, with many studies showing mixed results in terms of its efficacy. Six different clinical trials examining stroke telerehabilitation were initiated across Canada as part of the Heart and Stroke Foundation's 2013 Tele-Rehabilitation for Stroke Initiative, with interventions ranging from lifestyle coaching to delivering memory, speech, or physical training. The purpose of this article was to summarize the over-arching findings from this initiative, particularly the facilitators and barriers to the implementation of telerehabilitation services within a research context. Methods: Details of the projects were obtained directly from the study investigators and from materials published by each group. Qualitative open-ended questions were posed to each group for the discussion of lessons learned. Results: Important lessons learned from this initiative included: (1) the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management; (2) patients are satisfied with telerehabilitation services when trained appropriately and some social interaction occurs; (3) clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible; and (4) technology should be selected based on ease of use and targeted to the skills and abilities of the users. Conclusions: Overall, results from these studies suggest that telerehabilitation services work best to augment face-to-face rehabilitation or when no other options are available.
... Telehealth is considered an umbrella term for all healthcare services [3,[7][8][9], defined by the World Health Organization as "the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities" [10,11]. Telemedicine restricts telehealth use to physicians [12] and, telerehabilitation refers to the services provided by any healthcare professionals for rehabilitation services [8]. ...
Article
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Background Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future. Main body Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users. Conclusions Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.
... Although face-to-face rehabilitation can improve postoperative complications in breast cancer patients, patients who have difficulty visiting a rehabilitation facility, including those in remote areas, may experience barriers to exercise. Therefore, interest in telehealth, which is defined as health care provided remotely via information and communication technology, 7 has been increasing. Telehealth can be provided via telephone, email, and videoconferencing, as well as relatively novel technologies such as virtual reality (VR) and augmented reality (AR). ...
Article
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Introduction: Limited range of motion (ROM) of the shoulder occurs commonly after breast cancer surgery, resulting in reduced quality of life and difficulty with activities of daily living. Physical exercise is effective in postoperative breast cancer patients, but no study has assessed the effects of augmented reality (AR)-based telerehabilitation. Therefore, this study aimed to investigate the effect of hospital-home linked rehabilitation therapy using an AR-based digital health care system (UINCARE Home+) in postoperative patients with breast cancer. Methods: This study was a prospective, multicenter, assessor-blinded, randomized controlled trial. Patients who underwent breast cancer surgery were assigned to either the UINCARE Home+ (intervention) group or the brochure-based home rehabilitation (control) group for an 8-week intervention. The study outcomes were the change in ROM of the affected shoulder, pain in the affected shoulder (Numerical Rating Scale [NRS]), functional outcomes (Disabilities of the Arm, Shoulder, and Hand questionnaire [QuickDASH] score), and quality of life (Functional Assessment of Cancer Therapy-Breast [FACT-B] and EuroQoL 5-Dimension 5-Level [EQ-5D-5L] scores), all of which were measured at enrollment and at 4, 8, and 12 weeks thereafter. Results: A total of 100 participants were enrolled in the study (n = 50 in each groups). In both groups, active and passive ROM, NRS, and the QuickDASH, FACT-B, and EQ-5D-5L scores showed significant improvements from baseline to 12 weeks (p < 0.001), but no group differences were detected. Discussion: A home-based exercise program with an AR system improved shoulder dysfunction in breast cancer patients and could be used in conjunction with a traditional hospital-based rehabilitation program. Trial Registration: ClinicalTrials.gov ID: NCT04316156.
... Telemedicine, the use electronic technologies to provide remote healthcare, has long been heralded as a solution to numerous healthcare barriers, including those regarding access and engagement. Despite technological advances, adoption of telemedicine lagged behind for a variety of reasons, including provider and patient skepticism, inability to integrate with traditional healthcare, ethical concerns, licensing issues, reimbursement, and policy [27,28]. Further, a 2019 report on telemedicine reviewing seven state Medicaid programs noted that technology barriers, such as unreliable internet services, prevent telemedicine from reaching the very populations considered to benefit the most from such services (e.g., rural individuals) [29]. ...
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Purpose of Review The purpose of this review is to summarize advances in behavioral treatments for pain and headache disorders, as well as recent innovations in telemedicine for behavioral treatments. Recent Findings Research for behavioral treatments continues to support their use as part of a multidisciplinary approach to comprehensive management for pain and headache conditions. Behavioral treatments incorporate both behavioral change and cognitive interventions and have been shown to improve outcomes beyond that of medical management alone. The onset of the COVID-19 public health emergency necessitated the rapid uptake of nontraditional modalities for behavioral treatments, particularly telemedicine. Telemedicine has long been considered the answer to several barriers to accessing behavioral treatments, and as a result of COVID-19 significant progress has been made evaluating a variety of telemedicine modalities including synchronous, asynchronous, and mobile health applications. Researchers are encouraged to continue investigating how best to leverage these modalities to improve access to behavioral treatments and to continue evaluating the efficacy of telemedicine compared to traditional in-person care. Summary Comprehensive pain and headache management should include behavioral treatments to address a variety of behavior change and cognitive targets. Policy changes and advances in telemedicine for behavioral treatments provide the opportunity to address historical barriers limiting access.
... As a consequence of the COVID-19 crisis, organizations had to rethink how to deliver healthcare services, and an alternative care model has thus emerged, leveraging information and communication technologies (ICT) to guarantee the continuance of such services. Health services delivered via digital means are referred to using terms such as "telehealth", "eHealth" or "mHealth" [3,4]; with specific regard to physiotherapy, the term "telerehabilitation" has been widely used in the literature to describe rehabilitation services delivered via ICT [5,6], and this is the term we will also use from this point on in the present review. Telerehabilitation can be Int. ...
Article
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COVID-19 has abruptly disrupted healthcare services; however, the continuity of rehabilitation could be guaranteed using mobile technologies. This review aims to analyze the feasibility and effectiveness of telehealth solutions proposed to guarantee the continuity of rehabilitation during the COVID-19 pandemic. The PubMed, Cochrane Library, Web of Science and PEDro databases were searched; the search was limited to randomized controlled trials, observational and explorative studies published up to 31 May 2022, assessing the feasibility and effectiveness of telerehabilitation during the COVID-19 pandemic. Twenty studies were included, for a total of 224,806 subjects: 93.1% with orthopedic complaints and 6.9% with non-orthopedic ones. The main strategies used were video and audio calls via commonly available technologies and free videoconferencing tools. Based on the current evidence, it is suggested that telerehabilitation is a feasible and effective solution, allowing the continuity of rehabilitation while reducing the risk of infection and the burden of travel. However, it is not widely used in clinical settings, and definitive conclusions cannot be currently drawn. Telerehabilitation seems a feasible and safe option to remotely deliver rehabilitation using commonly available mobile technologies, guaranteeing the continuity of care while respecting social distancing. Further research is, however, needed to strengthen and confirm these findings.
... Henceforth, telehealth interventions may serve as a commendable follow-up to personal healthcare delivery, and a decent solution to augment unequal access to healthcare in rural regions. Literature also suggests that developing countries are the potential benefactors of telehealth programs due to its cost efficient operating cost (Darkins & Cary, 2000;Hjelm, 2005;Sorrells, Tschirch & Liong, 2006;Miller, 2007;Maeder, 2010). ...
Article
Background/Objectives: Telehealth through videoconferencing has the potential to improve the lives of the elderly. Unfortunately, little is known on its health benefits in the physical and quality of life dimensions among seniors. The aim of this paper is to compare videoconferencing as a mode of telehealth with traditional healthcare delivery in the contexts of functional independence and Quality of Life (QoL) measures using a non-equivalent control group before-after quasi experimental design. Methods/Statistical analysis: One-hundred forty seniors from a rural area were purposively selected and distributed to the telehealth (n=82) and traditional (n=58) groups. SF-8 and Functional Independence Measure (FIM) were used to gather the needed data from the participants before and after exposure to the interventions. Findings: Results of t-tests indicate significant improvement in QoL of the two groups of subjects on both telehealth and traditional groups, while FIM measures exhibited no significant change among the telehealth group. Improvements/Applications: On the whole, study findings promote a more personal delivery of healthcare among the elderly, and challenges the health practitioners and policy makers to recognize the pragmatic worth of and improve telehealth as a complementary healthcare tool for traditional consultation in enhancing QoL among seniors. Impliedly, more researches with extended number of subjects and locale is needed to come up with a more generalizable result.
... Taking into account that using e-health may help tailor interventions to the caregivers' support needs [33], telemedicine approaches have been adapted to remotely manage ALS patients improving the efficiency of healthcare [34,35]. In particular, due to Coronavirus disease 2019 (COVID-19) pandemic, containment measures led to necessary restrictions in personal movement and reduced access to traditional healthcare resources. ...
Article
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Family caregivers of people with amyotrophic lateral sclerosis (ALS), a severely disabling neurodegenerative disease due to the degeneration of both upper and lower motor neurons, have a very demanding role in managing their relatives, thereby often experiencing heavy care burden. Previous literature has widely highlighted that this situation reduces caregivers’ quality of life and increases their psychological distress and risk of health problems, but there are relatively few studies that focus on psychological interventions for these situations. Family support is more—not less—important during crisis. However, during the COVID-19 pandemic, maintaining public safety has required restricting the physical presence of families for hospitalized patients. Caregivers of ALS patients felt increased sense of loneliness and experienced greater difficulties in the access to both hospital and home assistance. In response, health systems rapidly adapted family-centric procedures and tools to circumvent restrictions on physical presence. In this regard, internet-based and telehealth solutions have been adopted to facilitate the routine, predictable, and structured communication, crucial to family-centered care. This narrative review aims at addressing more current matters on support needs and interventions for improving wellbeing of caregivers of ALS patients. In particular, we aimed at highlighting several gaps related to the complex needs of caregivers of ALS patients, to the interventions carried out in order to respond to these needs, and to the changes that COVID-19 pandemic caused from 2020 to nowadays in clinical managing of ALS patients. Finally, we report ongoing experiences of psychological support for family caregivers of ALS patients through telehealth solutions, which have been reinforced in case of needing of physical distancing during the COVID-19 pandemic.
... However, telemedicine can be applied to health promotion, prevention, and public health and should not be limited to curative health care. The distinction could become unnecessary in the long term [35]. Especially, stemming from the rapid penetration of mobile phones, mobile health or m-health has emerged in the recent two decades. ...
Article
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Health services provided through the telecommunications system aim to improve the population’s health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries’ experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3–5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population’s health could be improved, which in turn would possibly increase productivity and social welfare.
... During the first lockdown due to the SARS CoV-2 pandemic in spring 2020 in CH, there was a moratorium on health professionals (HPs) carrying out non-urgent medical examinations, treatments, and interventions [9,10]. Consequently, the number of physiotherapy sessions per week in outpatient practices fell by 84% [11] and a high proportion of PTs submitted requests for an indemnity due to reduced working hours [12]. Swiss PTs, however, were still able to provide and invoice remote therapy to COVID-19 survivors or other patients with an urgent need of continuous therapy [13,14]. ...
Article
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Background The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs). Methods A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted. Results Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic. Conclusions During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed. Trial registration COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 ( https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry ).
... Tele-health, i.e., the provision of health care at a distance (HCD), might be suitable for continuing therapy under these circumstances [7]. The use of HCD has been described in a number of areas of work, including the outpatient area, the inpatient sector, the home environment, and school settings [8]. ...
Article
Full-text available
Background The COVID-19 pandemic impedes therapy and care activities. Tele-health, i.e., the provision of health care at a distance (HCD), is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD for occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1. Hypothesis: Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2. Hypothesis: Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD. Methods In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD, and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified. Results The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs ( n = 431) and midwives ( n = 501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age only had a significant influence on the use of videotelephony, SMS, and chat services. OTs experienced HCD significantly more positively than midwives (log odds = 1.3; p ≤ .01). Video-telephony (log odds = 1.1; p ≤ .01) and use of phone (log odds = 0.8; p = .01) were positive predictors for positive experience, while use of SMS (log odds = − 0.33; p = .02) was a negative predictor. Among OTs, 67.5% experienced HCD as positive or mostly positive, while 27.0% experienced it as negative or mostly negative. Among midwives, 39.5% experienced it as positive or mostly positive, while 57.5% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%). Conclusions HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.
... To provide mental healthcare to those who need it most, while simultaneously limiting exposure to COVID-19, many healthcare providers turned to telehealth as an effective way to abridge physical distance between patients and healthcare providers. Telehealth is defined as the use of technology via audio and video telecommunications in order to provide healthcare across geographical distances, to facilitate the exchange of information between healthcare providers, or provide healthcare when it is not possible to have face-to-face contact [3,4]. When applied to mental health, these methods are known as telepsychiatry, which includes teleconsultation, teletherapy, telepsychology, telepsychotherapy, or telemental health via videoconferencing, phone conversations, and real-time chat [5]. ...
Article
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Due to COVID-19, face-to-face mental health service delivery has been interrupted by social distancing and stay-at-home orders. To abridge physical distance between patients and healthcare providers, while limiting exposure to COVID-19, telepsychiatry has been widely adopted to provide services to patients with pre-existing mental health disorders. Though telepsychiatry has become more mainstream in delivering mental health services during COVID-19, evaluation studies of the rapid conversion of care delivery from face-to-face to telepsychiatry have been limited. The aim of this study was to review the literature on the transition of mental health service delivery to telepsychiatry during COVID-19. The findings of the current review showed that a majority of patients and healthcare providers were satisfied with telepsychiatry services, and suggest that telepsychiatry is feasible and appropriate for supporting patients and healthcare providers during COVID-19.
... The term telehealth is broad and includes many narrower terms like telemedicine, telepsychiatry, and telepsychology (Darkins & Cary, 2000). The prefix tele-is added to many terms to suggest distance (American Psychological Association, 2013). ...
Article
Due to the state of the COVID-19 in Florida, a community-based agency serving children and families had to transition abruptly to teletherapy. This agency adapted to pandemic-related challenges by transitioning from in-person to virtual therapy, which played a key role in safely serving community members. This article explores the unique benefits and difficulties of the transition to teletherapy under those circumstances. The agency clinical staff utilized their brief therapy skills and strengths-oriented perspective to aid in this abrupt transition, as illustrated by a case study. Ultimately, the agency's transition was a successful one as evidenced by a survey of both agency clinicians and clients, and by uninterrupted services at the same volume of cases and level of care. Suggestions are made for other providers seeking to cope with similar transitions.
... Telehealth care is according to WHO defined as the integration of tele communications systems into the practice of protecting and promoting health, and telemedicine is the incorporation of these systems into curative medicine (Darkin & Cary, 2000). ...
Chapter
This chapter describes a case study of the poor access to healthcare in the developing the countries with more focus on the rural areas and presents an adapted remote care delivery system approach for improving and increasing the access to healthcare services by overcoming certain cultural, social, financial, and linguistic barriers. The remote care delivery system integrates traditional practitioners because most people are more confident with the traditional medicine. The chapter presents the results of a practical on-site test of the proposed system. The test has shown the potentiality of the proposed system to improve the quality and effectiveness of healthcare and increase the accessibility of healthcare systems. The chapter also discusses the obstacles for applying standard telemedicine systems and e-health solutions in the developing world.
... The term "Telemedicine" was introduced to the world in the 1960s (12) . The term "Telemedicine" was introduced by Bird and his colleagues in 1969 to describe the delivery of medical care without the usual patient-physician confrontation (15) . Later, Bannet and associates introduced the word "Telehealth" in 1978 to broaden the scope of Telemedicine with the incorporation of patient/clinician education (16) . ...
... The concept of digital health is not a new or revolutionary one. For example, technologies, such as medical images and telemedicine date back over 100 years (1,2), while prototype wearable devices have been used to tackle obesity since the 1940s (3). Digital health, however, has had continually transforming effects in an industry that is notoriously resistant to change (4). ...
... Tele-health, i.e., the provision of health care at a distance (HCD), might be suitable for continuing therapy under these circumstances (8). The use of HCD has been described in a number of areas of work, including the outpatient area, the inpatient sector, the home environment and school settings (9). ...
Preprint
Full-text available
Background: The COVID-19 pandemic impedes therapy and care activities. Health care at a distance (HCD) is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD in occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1. Hypothesis: Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2. Hypothesis: Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD. Methods: In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified. Results: The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs (n=431) and midwives (n=501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age had only a significant influence on the use of videotelephony, SMS and chat services. OTs experienced HCD significantly more positively than midwives (log odds=1.3; p≤.01). Video-telephony (log odds=1.1; p≤.01) and use of phone (log odds=1.1; p=.01) were positive predictors for positive experience, while use of SMS (log odds=-0.33; p=.02) was a negative predictor. Among OTs, 75.7% experienced HCD as positive or mostly positive, while 13.9% experienced it as negative or mostly negative. Among midwives, 53.7% experienced it as positive or mostly positive, while 36.1% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%). Conclusions: HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.
... It is a convenient method as it can provide health-care services across geographic, time, social and cultural barriers. World Health Organization makes a distinction between telemedicine and telehealth, emphasizing that telehealth is performed generally for preventive medicine purposes and telemedicine is performed for treatment purposes (1). ...
Article
Objective:Telemedicine means to provide healthcare services to remote patients using modern information technology like audio/video communications, computer and telemetry. During global Coronavirus diseases-2019 (COVID-19) pandemic, home isolation was advised for general population, especially for individuals who were at higher risk for infection, like people living with obesity. Here, it was aimed to evaluate the data obtained with a telemedicine method performed for obesity center patients’ follow-ups during COVID-19 pandemic lockdown period and highlight the need for alternative follow-up methods for chronic diseases like obesity during crisis times.Method:All registered obesity center patients were included in the study. Phone calls were made by the directing doctor and patients were asked about their diet compliance, exercise level, the way they felt, present weight, any problems about their accompanying diseases or obtaining their medications. Recommendations were made (healthy nutrition, hydration, home exercises, coping with distress, the necessity of home isolation, precautions needed to be taken when they have to go out). The answers were categorized and number of patients for each category were determined.Results:The number of patients that were called was 101, 86 for those who answered and 15 for those who did not respond. When their last registered weight in kg was compared with the present weight declared by the patient, 40.7% had weight gain (n=35), 50% had weight loss (n=43) and 9.3% (n=8) patients had same weight. When they were asked about their food consumption, 27.9% (n=24) of patients were following the recommended diet, 29% (n=29) were not following any recommendations about their diet and 33% (n=33) were partially following their dietary recommendations. The most common mistake was snacking throughout the day and at nighttime. When they were asked about their physical activity level, 30.2 % (n=26) of patients were doing home exercises regularly, 50% (n=43) were not exercising at all and 19.8 % (n=17) were partially doing home exercises. The most common home exercise was home-walking programmes. When they were asked how they felt, 53.5% (n=46) of patients declared to be generally good, 24.4% (n=21) were generally bad and 22.1 (n=19) were partially good. The most common complaint was sleep disturbances and anxiety.Conclusion:Telemedicine is an easy, safe and effective follow-up method for chronic diseases like obesity at extraordinary times like the pandemic period we are going through. Its application can be broader after medical and legal regulations become clear to let both the patients and the healthcare professionals who use this method be safe in all aspects.
... Some African villages used smoke signals to warn outsiders not to approach the village during an epidemic. Similarly, ships used flags to warn that they were in quarantine (Darkins & Cary, 2000). Nevertheless, modern IT has given new meaning to the practice of telemedicine (Bladwin, Clarke, & Jones, 2002). ...
Chapter
Telemedicine requires a new type of worker: the health care teleworker. Nevertheless, physicians remain wary of adopting telemedicine. This work examines the sources of the resistance to incorporating telemedicine. We adopt a focus centering on the difficulties that human factors have in accepting the practice of telemedicine. Employees’ resistance to change comes mainly from the inertia that perpetuates traditional routines and methods of working. The success of telemedicine projects will be determined by these human factors as well as by an adequate use of information technology and an appropriate organizational management. This work also offers some practical implications in human resource management for managers of telemedicine projects to consider.
... The breadth of coverage that this technology spans is virtually limitless, and its use in the scope of clinical health care delivery is encompassed by the term telemedicine, which enables health care to be carried out at a distance. 1 Telemedicine is playing an even more important role in response to the COVID-19 pandemic. ...
... The term 'telehealth' can be thought of as an umbrella term to describe the provision of healthcare at a distance using information and communication technology (ICT) sources and is inclusive of all healthcare professions (Darkins and Cary, 2000). Over more recent years, there has been an explosion of new terminology that aims to describe the healthcare profession involved (e.g. ...
Article
Introduction Musculoskeletal conditions are a leading cause of global morbidity. Access to traditional in-person healthcare can be difficult for some under usual conditions and has become a ubiquitous barrier throughout the COVID-19 pandemic. Telehealth, defined as the ‘delivery of healthcare at a distance using information and communication technology’ is a solution to many access barriers and has been rapidly adopted by many healthcare professions throughout the crisis. While significant advancements in technology has made the widespread adoption of telehealth feasible, there are many factors to be considered when implementing a telehealth service. Purpose The aims of this masterclass are to (i) introduce telehealth and outline the current research within the context of musculoskeletal physiotherapy; (ii) provide insights into some of the broader challenges in the wide-scale adoption of telehealth; and (iii) to describe a systematic approach to implementing telehealth into existing healthcare settings, along with some practical considerations. Implications Telehealth is a broad concept and should be implemented to meet the specific needs of a healthcare service. This masterclass offers a structured approach to the implementation of a musculoskeletal physiotherapy telehealth service, and highlights practical considerations required by both clinicians and healthcare organisations throughout all stages of the implementation process.
... Patient education can be challenging and relies on multiple factors including but not limited to provider training, patient and/or caregiver level of technological knowledge and education, as well as a diverse number of cultural factors and expectations. [55][56][57][58][59][60][61] The safety and quality of home-based care and self-monitoring depend on patient and/or caregiver understanding of the disease and the ability to practically and efficiently use the tele-presence tools at their disposal. In this context, good patient education requires a supportive learning environment, and the ability to individualize instructions to the patient's needs, level of understanding, general comfort with applicable technology, among other factors and expectations. ...
Article
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In many acutely affected hot spots of COronaVIrus Disease (COVID-19) the capacity of the healthcare system, and in particular emergency department and hospital beds, can be insufficient to manage the volume of patient encounters and hospital admissions due to exaggerated imbalances in critical resource availability. Further, given our increasing knowledge of the somewhat unpredictable COVID-19 clinical progression, it is prudent to institute an active observation regimen to detect early signs of deterioration in a non-trivial proportion of patients who do not require hospital admission. As the current inpatient management of COVID-19 relies heavily on managing oxygenation, selected patients could be discharged home if oxygen administration could be addressed in a safe manner, under well designed and appropriately implemented regimens. The need for diligent and close monitoring of COVID-19 patients who are discharged home arises due to the occurrence of clinically silent and unpredictable hypoxia and consequently, an increased mortality risk. Consequently and understandably, there is some degree of controversy surrounding this topic, mandating a properly structured and highly regimented approach.
... The focus in case studies 2 and 3 was to explore how a TeleConsultation Classroom (TCC) approach could support a community of learning for educators who were supporting learners on the autism spectrum in inclusive settings. TCC approaches use electronic communications and technology to provide support when distance separates the participants (Darkins and Cary 2000). The use of TCC to overcome professional isolation and implement support and services to rural regions is a growing area of research. ...
Article
Full-text available
Implementing inclusive education requires on-going commitment to teachers’ professional learning. One way of implementing professional learning is to develop learning communities based on Lave and Wenger’s ideas of situated learning and learning as social practice. Learning communities, drawing on models of Professional Learning Communities and communities of practice, were designed to build capacity for inclusive teaching in two rural schools in Australia and a peri-urban school in South Africa. This paper reports on a multi-case study that involves a cross-case analysis of these three learning communities. We demonstrate that across the three cases, responsiveness to contextual exigencies matters, expertise matters and supportive networks matter. These findings are further illuminated by complexity theory which draws attention to learning communities operating at the confluence of a number of interacting systems, as well as the possibility of change where teacher learning occurs through the recontextualisation of knowledge and learning across boundaries. Our findings support situated learning that values collaboration to develop social and inclusive cultures and practice in schools. The findings also have the potential to inform planning for professional learning for inclusive education.
... The provision of health care remotely through technological modalities, known as telehealth services, has been at the forefront of reducing barriers to care for rural communities. 18,19 To date, telemental health is considered one of the most active telehealth applications in the United States. 20 The continued growth of telemental health offers an important avenue for providing evidence-based treatment for underserved populations to whom mental health care may otherwise not be available. ...
Article
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
... Telehealth really took off in the 1990s when technology improvements made teledelivery of health care feasible (Emery, 1998;Darkins and Cary, 2000). Over 50% of hospitals systems provided some types of telehealth services in 2013 (Marcoux and Vogenberg 2016 Telehealth has applications in all areas of medicine: from home care, to psychiatry, dermatology, oncology, pediatrics, sports medicine, cardiology, etc (Krupinky et al (2002), and affect healthcare utilization and outcomes through many channels. ...
Article
This paper uses panel data techniques to investigate the impact of state mandates to cover telehealth services on private insurance premiums and enrollment, health-care utilization, and health outcomes. There is evidence that telehealth insurance mandates are associated with an increase in primary care, but no significant changes in overall health outcomes. However, there is evidence of a reduction of secondary care and improvement in health outcomes in non-metropolitan areas. The results provide useful information regarding the potential of telehealth to reduce health-care costs as well as to reduce disparities in access to health care and in health outcomes.
... Telecare was being practiced with telephone support even before the arrival of digital technologies; for example, Darkins and Cary (2000) identified a journal report from 1897 of remote diagnosisin that case, of a child being diagnosed with a croup cough. However, digital tools have made new forms of telecare possible. ...
Article
In terms of Human–Computer Interaction, healthcare presents paradoxes: on the one hand, there is substantial investment in innovative health technologies, particularly around “big data” analytics and personal health technologies; on the other hand, most interactive health technologies that are currently deployed at scale are difficult to use and few innovative technologies have achieved significant market penetration. We live in a time of change, with a shift from care being delivered by professionals towards people being expected to be actively engaged and involved in shared decision making. Technically, this shift is supported by novel health technologies and information resources; culturally, the pace of change varies across contexts. In this paper, I present a “space” of interactive health technologies, users and uses, and interdependencies between them. Based on a review of the past and present, I highlight opportunities for and challenges to the application of HCI methods in the design and deployment of digital health technologies. These include threats to privacy, patient trust and experience, and opportunities to deliver healthcare and empower people to manage their health and wellbeing in ways that better fit their lives and values.
... A continuación se detallan tres definiciones para poder tener una clara referencia respecto a lo que comprende la telemedicina. Una definición menciona a la telemedicina como "El uso de tecnologías avanzadas de telecomunicaciones para el intercambio de información sobre la salud y la prestación de servicios sanitarios a través de distancia, tiempo y barreras socio-culturales" (Darkins & Cary, 2000, p. 2). En el libro Telemedicine ...
Thesis
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The problems of hospital care or health services in general have represented great challenges to the current governments in Ecuador, because much of the demand of Ecuadorian society has been to have health service to ensure timely and quality care. The inclusion of telecommunications to provide telehealth services is called telemedicine. This study provides a complement to the provision of health services through a community model using telemedicine. This project reveals the reality of Cerecita about healthservices and propose a solution that is expected to reduce the number of patients that move in search of health services. With this proposal is expected to raise awareness about the reasons for the application of telemedicine, and also, promote penetration of it in rural areas, based on an orderly and actual study. The information was obtained through patient surveys of health center and population of the enclosure Cerecita and also an interview to the staff in charge of the medical center. This project will be developed through a descriptive research quantitative type. Keywords:Cerecita, telemedicine, telemedicine room, eHealth, telehealth, rural areas
... COPD was chosen to be one sample application for our system due to the high and rising amount of patients and their implications on the health system. A remote supervision of these patients promises a reduction of hospitalization and therefore a reduction of costs [42,43]. The physicians expect to find parameters that, when monitored over larger periods, can predict exacerbations and allow to take preventive Chapter 2 Fundamentals actions. ...
Thesis
Full-text available
Telemedicine uses telecommunication and information technology to provide health care services over spatial distances. In the upcoming demographic changes towards an older average population age, especially rural areas suffer from a decreasing doctor to patient ratio as well as a limited amount of available medical specialists in acceptable distance. These areas could benefit the most from telemedicine applications as they are known to improve access to medical services, medical expertise and can also help to mitigate critical or emergency situations. Although the possibilities of telemedicine applications exist in the entire range of healthcare, current systems focus on one specific disease while using dedicated hardware to connect the patient with the supervising telemedicine center. This thesis describes the development of a telemedical system which follows a new generic design approach. This bridges the gap of existing approaches that only tackle one specific application. The proposed system on the contrary aims at supporting as many diseases and use cases as possible by taking all the stakeholders into account at the same time. To address the usability and acceptance of the system it is designed to use standardized hardware like commercial medical sensors and smartphones for collecting medical data of the patients and transmitting them to the telemedical center. The smartphone can also act as interface to the patient for health questionnaires or feedback. The system can handle the collection and transport of medical data, analysis and visualization of the data as well as providing a real time communication with video and audio between the users. On top of the generic telemedical framework the issue of scalability is addressed by integrating a rule-based analysis tool for the medical data. Rules can be easily created by medical personnel via a visual editor and can be personalized for each patient. The rule-based analysis tool is extended by multiple options for visualization of the data, mechanisms to handle complex rules and options for performing actions like raising alarms or sending automated messages. It is sometimes hard for the medical experts to formulate their knowledge into rules and there may be information in the medical data that is not yet known. This is why a machine learning module was integrated into the system. It uses the incoming medical data of the patients to learn new rules that are then presented to the medical personnel for inspection. This is in line with European legislation where the human still needs to be in charge of such decisions. Overall, we were able to show the benefit of the generic approach by evaluating it in three completely different medical use cases derived from specific application needs: monitoring of COPD (chronic obstructive pulmonary disease) patients, support of patients performing dialysis at home and councils of intensive-care experts. In addition the system was used for a non-medical use case: monitoring and optimization of industrial machines and robots. In all of the mentioned cases, we were able to prove the robustness of the generic approach with real users of the corresponding domain. This is why we can propose this approach for future development of telemedical systems.
... Słowa kluczowe: telemedycyna, należyta staranność, systemy łączności Folia Cardiologica 2018; 13, 5: 489-493 Wstęp Jak definiuje ją Światowa Organizacja Zdrowia (WHO, World Health Organization), telemedycyna to świadczenie usług opieki zdrowotnej, w której kluczową rolę odgrywa rozłączność miejsca, przez wszystkie osoby wykonujące za- wody medyczne, z wykorzystaniem instrumentów służących wymianie istotnych informacji w celach diagnostycznych, leczniczych oraz zapobiegania chorobom i urazom, pro- wadzenia badań i ich oceny, zapewnienia, kontynuacji kształcenia pracowników służby zdrowia, czyli w celu poprawy zdrowia poszczególnych osób oraz tworzonych przez nie społeczności [1][2][3]. Wykorzystanie rozwiązań telemedycznych może stanowić istotne remedium na nie- które, spośród licznych, problemy systemowe w ochronie zdrowia. Tego rodzaju instrumenty mogą służyć rozwią- zaniu problemów niedoboru kadr medycznych, prowa- dzą do ograniczenia zbędnych kosztów hospitalizacji i przyspieszają proces diagnostyczny. ...
... Such a situation makes it necessary to travel, and becomes a barrier when frequent and continuous care is needed [52]: ICT can bridge the separation between patient and doctor [53]. Then there is the socioeconomic divide to consider: IBI can contribute to face disparities and inequalities in access to healthcare services [54][55][56]. However, more studies are needed to compare different settings (e.g., rural vs. urban), and within urban scenarios patients should be differentiated by their ability to access the healthcare system [15]. ...
Article
Full-text available
Introduction Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. Methods Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. Results None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0–4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. Conclusions Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.
... For more than a decade, research has been predominantly focusing on assessing telemedicine with regard to its technological attributes (8)(9)(10)(11), cost, quality, and access (12)(13)(14) as well as patient and physician satisfaction (15)(16)(17)(18). However, little is known about the experiences and skills that participants employ in telemedicine encounters and further research is needed to analyze social interaction within an environment that is characterized by organizational, spatial, and technological novelties (19)(20)(21)(22). ...
Article
Full-text available
This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decision-making. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients.
... A potential solution to overcome many of the environmental barriers associated with poor healthcare access may be the implementation of telehealth, as an additional method of service delivery. Telehealth is defined as the provision of health care at a distance using telecommunication technology and is considered to be a medium through which equitable access to healthcare services may be achieved (Darkins and Cary, 2000). A recent systematic review (Mani et al., 2016) concluded that whilst performing a musculoskeletal physiotherapy assessment via telehealth (specifically videoconferencing) is technically feasible with overall excellent reliability, several aspects of the physical examination had low to moderate concurrent validity. ...
Article
Objective: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. Design: Repeated-measures study design. Participants: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. Intervention: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. Main outcome measures: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. Results: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1 = 0.58–0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1 = 0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. Conclusion: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person.
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When implemented in practice, digital technologies have shown improvements in morbidity and mortality outcomes in patients with cardiovascular disease (CVD). For scholars, research into digital technologies in cardiovascular care has been relatively recent, thus it is important to understand the history of digital health technology in cardiovascular research—its emergence, rate of growth, hot topics, and its temporal evolution. The aim of this study was to analyse more than 16,000 articles in this domain based on their scientometric indicators. Web of Science (WoS) Core Collection was accessed and searched at several levels, including titles, abstracts, keywords, authors, sources and individual articles. Analysis examined the temporal shifts in research and scholarly focus based on keywords, networks of collaboration, topical divisions in relation to digital technologies, and influential publications. Findings showed this research area is growing exponentially. Co-citation analysis revealed twenty prominent research streams and identified variation in the magnitude of activities in each stream. A recent emergence of research activities in digital technology in cardiovascular rehabilitation (CR), out-of-hospital cardiac arrest (OHCA), and arrythmia research was also demonstrated. Conversely, wearable technologies, activity tracking and electronic medical records research are now past their peak of reported research activity. With increasing amounts of novel technologies becoming available and more patients taking part in remote health care monitoring, further evaluation and research into digital technologies, including their long-term effectiveness, is needed. Furthermore, emerging technologies, which are evaluated and/or validated should be considered for implementation into clinical practice as treatment and prevention modalities for CVD.
Chapter
The telemedicine industry has evolved as an alternative method of patient contact in the presence of barriers to face-to-face contact such as the current COVID-19 pandemic or other geographic and temporal barriers that prevent patients from accessing healthcare. According to the World Health Organization (WHO), half of the world’s population cannot access basic health services. One of the promises of telemedicine is to reduce some of these barriers and improve access to healthcare and global health equity (Darkins and Cary, Telemedicine and telehealth: principles, policies, performance, and pitfalls, Springer, New York, 2000; Norris, Essentials of telemedicine and telecare, Wiley, London, 2002). Although telemedicine holds great promise, its implementation can be complicated by regulatory factors that can vary by country and region. Especially in developed nations, there may be complex laws and policies around aspects of telemedicine such as privacy and billing which can make its implementation difficult (Norris, Essentials of telemedicine and telecare, Wiley, London, 2002; Ackerman et al., Telemed J E Health 8(1):75, 2002).In this chapter, we provide an overview of purposes and mechanisms of telemedicine delivery, and the infrastructural and process requirements for a successful orthopedic telemedicine assessment. We discuss technical infrastructure required for a successful assessment including hardware, software, network, other tools, and physical space set-up. We then discuss the process involved in conducting smooth and effective encounter, both from the healthcare provider’s point of view as well as the patient’s point of view.KeywordsTelemedicine purposesInfrastructureProcess of telemedicine conductPatient checklist
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Covid-19 is an infectious disease that will become a global pandemic in 2020. To reduce the transmission rate, WHO has issued various recommendations for the community, such as the use of masks, regular hand washing, coughing and sneezing etiquette, keeping a distance between people, avoiding crowded places, and others. The existence of public restrictions creates new problems for patients because of difficulties in seeking treatment. Telemedicine is a form of telehealth, which is a health service that is carried out remotely. This technology makes it easier for patients to interact with doctors without having to meet face to face. The purpose of this study was to determine the level of satisfaction of users of telemedicine services at RSIA Stella Maris Medan. The type of research used is non-experimental quantitative with a quantitative analytical study design. The population and samples used were 186 users of telemedicine services at RSIA Stella Maris. The results showed that users considered the features of the availability of options to be able to choose the treating doctor, the confidentiality of medical records, the stability of the internet network, the friendly and ready to help the attitude of the nurses, and the long waiting time for the drug delivery process as the most important features of each service dimension. To improve the quality of RSIA Stella Maris telemedicine services, many features are a priority to be improved, as well as features are maintained.
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Introduction: Due to COVID-19 the ability to see all patients face-to-face (FTF) was removed. Services implemented telehealth to cater for patients requiring musculoskeletal care. A service evaluation was undertaken to assess the effectiveness of a mixed telehealth/FTF approach and identify if stratifying patients could help tailor intervention. Methods: Retrospective analysis of data collected from patients who were assessed by Musculoskeletal Physiotherapists in one Scottish health board was undertaken. Patients were divided into low, medium and high risk sub-groups through the Keele STarT MSK tool. Outcome measures for pain and musculoskeletal health were taken at baseline/discharge along with satisfaction/preference. Descriptive and Inferential statistical analysis was conducted to establish whether changes in the outcome measures within and between risk sub-groups were statistically significant. Results: Pain level difference from baseline to discharge demonstrated clinically and statistically significant improvements across all risk groups (N = 89). Musculoskeletal health demonstrated clinically significant improvements across all risk groups and statistically significant improvements in the medium/high risk groups but not the low risk. Patients with knee osteoarthritis and low back pain in the medium risk group had fewest appointments while patients with chronic shoulder pain had the most. The majority of patients were satisfied with all mediums but preferred FTF or an option between telehealth/FTF in the future. Conclusion: Telehealth is a promising model of care when utilised in combination with FTF for patients with musculoskeletal conditions. Through stratification, identifying specific conditions and shared decision making it may be possible to treat certain patient groups via telehealth.
Article
Objective: The authors' objective was to compare the actual cost of a regional pediatric neurosurgery telemedicine clinic (PNTMC) with the estimated cost of a traditional physician-staffed outreach clinic. Methods: The authors' PNTMC was a partnership between the University of Florida College of Medicine-Jacksonville and Georgia Children's Medical Services to service the population of Georgia's Southeast Health District. Neurosurgeons based in Jacksonville conducted telemedicine visits with patients located at a remote site in Georgia with the assistance of nursing personnel from Children's Medical Services. The authors determined the actual annual per-patient costs at the Jacksonville and Georgia sites for fiscal years 2018 (FY18) and 2019 (FY19) and estimated the cost of providing traditional physician-staffed outreach clinics. Results: During FY18 and FY19, the neurosurgery team conducted an average of 24.5 telemedicine patient encounters per year at a cost of $369 per patient visit. The per-patient cost was 32.5% less than the estimated per-patient cost of $547 at a traditional outreach clinic. Conclusions: The authors provided neurosurgical telehealth visits to appropriate patients, with a substantial cost savings per patient visit compared with traditional physician-staffed outreach clinics.
Article
Background context: Musculoskeletal (MSK) pain presents a global challenge. Individual and group pain management programmes (PMPs) are recommended approaches for patients with chronic MSK disorders. With advances in remote healthcare capability, telehealth, and the recent COVID‐19 pandemic, the importance of telehealth PMPs has become even more evident. Nevertheless, it is not known how patients perceive PMPs for their MSK complaint when delivered via telehealth. Objective: To synthesise the evidence of patients' experiences of group and individual telehealth PMPs for chronic MSK pain. Design: A scoping review informed by the PRISMA extension for scoping reviews. Data sources: Based on a planned search strategy, modified following initial searches, an electronic search was conducted of key databases: Cochrane Library, Medline, CINAHL, EMBASE, AMED, SportDiscus and APA PsychInfo from 2010 until 11 May 2021. Study selection: Any qualitative or mixed methods study reporting patient experiences of telehealth PMPs for patients with MSK disorders. Data extraction and data synthesis: Data were extracted and synthesised using thematic analysis. Results: From 446 identified studies, 10 were included. Just two studies investigated group telehealth PMPs for patients with MSK disorders, with eight delivered individually. Four main themes emerged: (1) Usability of the technology, (2) Tailored care, (3) Therapeutic alliance and (4) Managing behaviour. The findings highlight patient acceptability of telehealth to support self‐management for chronic MSK disorders, with appropriate clinical and technical support. Group telehealth has the potential to empower patients with peer support. Remote delivery of PMPs also impacts on how patients and providers interact, communicate and develop a therapeutic relationship. Conclusions and implications: Barriers and enablers to engagement in telehealth PMPs for patients with chronic MSK disorders have been identified. Peer support and group cohesiveness can be achieved remotely to enhance the patient experience. There is a critical need for further research in this area.
Chapter
Tunisia experienced huge changes in demographic, social, economic and political fields over the last six decades since independence. Until now, it is still a country of huge contrasts. Important progress on political transition led to an open democratic system of governance, whereas, economic field has not known the same fate [1]. Tunisian population accounts 11,839,475 people on August 30, 2020, according to the last update of the United Nations data, which corresponds to 0.15% of the worldwide population. Median population’s age is about 32.8 years. Population distribution by age was detailed in Figure 1 and showed a stationary type pyramid with declining birth rate and relatively low death rate. According to last previsions, Tunisia’s population will continue to grow until 2058 reaching a plateau of 13.96 million people [2]. Life expectancy is continuously increasing since 1955 in both sex (Figure 2). Population density in Tunisia is about 76 per Km2, with a total land area of 155,360 Km2. Almost 70.1% of Tunisians live in urban areas distributed in many sizable cities (Figure 3) [2, 3]. The largest one corresponds to the capital of Tunisia, Tunis in the North east, including a population of about one million. Sfax, located in the South East, is the next largest and populated city following the capital with a population of 330,000. Other cities are distributed in different areas of the Tunisian territory with populations over 100,000 including mainly Sousse in the Center East, Kairouan in the Center, Gabes in the South East, Bizerte in the extreme North, Aryanah in the North East and Gafsa in the South West [4, 5]. Thus, it’s obvious that major cities are scattered randomly on the Tunisian territory with unequal access to healthcare. Although better sanitary conditions, these urban areas could not totally ensure support to the healthcare needs of the neighboring regions whether urban or rural.
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The rapid spread of Coronavirus disease (COVID-19) has led to global pandemic affecting mental and physical well-being of people around the world. Given the highly contagious nature of COVID-19, public authorities in order to restrict the escalation of the virus ordered social lockdown and asked people to self-quarantine at homes if they develop any symptoms. As a result, these new social regulations have changed how individuals live and carry out everyday tasks in the general society. Reduced physical activity during lockdown has enhanced vulnerability to develop infections and non-communicable diseases. While on the other side, due to absence of routine medical surveillance, the condition of people with existing chronic conditions has deteriorated. Re-allocation of health care resources to treat COVID-19 patients put forward unprecedented challenge for the healthcare system in terms of providing medical support to non-infected out-patients. Extended social lockdowns are also causing adverse repercussions for physiotherapy and rehabilitation out-patient services. COVID-19 restrictions have hampered the in-person interaction of therapists and patients for in-person consultations and therapy sessions. Thus, leading to overall delay in the management and recovery of patients, especially those who are at a critical stage of treatment. During these unprecedented times of COVID19 pandemic, provision of telehealth appeared to be the guiding light to tackle these evolving challenges of public health. Focusing on the out-patients who need close supervision for therapies and counselling, in this piece, “I” am arguing that methods of telemedicine and tele-rehabilitation should be actively adopted in the healthcare services to bridge the gap caused due to COVID-19.
Conference Paper
Diabetes is a chronical illness, commonly considered as the disease of the 21st Century. Diabetic foot is one of the several conditions associated to this disease, which in the most severe cases might be the cause of amputations on the lower limbs. Such condition involves a high social impact for patients and families, and puts an important burden on the health and care systems. It is essential to aim at an early detection of the pathology and at its continuous monitoring in order to perform a convenient follow-up of those patients’ condition, from both the preventive and the therapeutic viewpoints. Following this line, different decision support methodologies are nowadays under development within the remote medicine framework, that in this specific case might help to improve the process for monitoring and treating patients that are likely to develop wounds associated with diabetic foot condition. This communication, framed in the previously introduced context, aims to carry out the conceptual adaptation of the decision support methodology presented by the authors in a previous work, which addressed the prevention and monitoring of patients likely to develop wounds associated to diabetic foot condition. The revised methodology, complemented by the use of expert systems, will allow to generate alerts associated to the evolution of foot wounds in at-risk diabetic patients, by means of the interpretation and combined use of: a set of data coming from a test, a picture, and the opinions and considerations provided by an expert in the topic. Said information is fed into two concurrent inference systems, which produce a number of risk indicators that, after being appropriately combined, determine a final alert associated to a measurement of diabetic foot condition risk. Even if this system is at the moment at an active development stage, it is expected that its usage will make possible to improve the process for an early detection of the potential issues associated with diabetic foot condition, as well as the monitoring of its associated pathologies.
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