The digital transformation of surgery.

Rapid advances in digital technology and artificial intelligence in recent years have already begun to transform many industries, and are beginning to make headway into healthcare. There is tremendous potential for new digital technologies to improve the care of surgical patients. In this piece, we highlight work being done to advance surgical care using machine learning, computer vision, wearable devices, remote patient monitoring, and virtual and augmented reality. We describe ways these technologies can be used to improve the practice of surgery, and discuss opportunities and challenges to their widespread adoption and use in operating rooms and at the bedside.

Defining digital surgery for the future.

Innovations in robotics, virtual and augmented reality, and artificial intelligence are being rapidly adopted as tools of "digital surgery". Despite its quickly emerging role, digital surgery is not well understood. A recent study defines the term itself, and then specifies ethical issues specific to the field. These include privacy and public trust, consent, and litigation.

Report of National Brain Tumor Society roundtable workshop on innovating brain tumor clinical trials: building on lessons learned from COVID-19 experience.

On July 24, 2020, a workshop sponsored by the National Brain Tumor Society was held on innovating brain tumor clinical trials based on lessons learned from the COVID-19 experience. Various stakeholders from the brain tumor community participated including the US Food and Drug Administration (FDA), academic and community clinicians, researchers, industry, clinical research organizations, patients and patient advocates, and representatives from the Society for Neuro-Oncology and the National Cancer Institute. This report summarizes the workshop and proposes ways to incorporate lessons learned from COVID-19 to brain tumor clinical trials including the increased use of telemedicine and decentralized trial models as opportunities for practical innovation with potential long-term impact on clinical trial design and implementation.

The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials.

BACKGROUND: The burden of cancer is increasing; projections over the next 2 decades suggest that the annual cases of cancer will rise from 14 million in 2012 to 22 million. However, cancer patients in the 21st century are living longer due to the availability of novel therapeutic regimens, which has prompted a growing focus on maintaining patients' health-related quality of life. Telehealth is increasingly being used to connect with patients outside of traditional clinical settings, and early work has shown its importance in improving quality of life and other clinical outcomes in cancer care. OBJECTIVE: The aim of this study was to systematically assess the literature for the effect of supportive telehealth interventions on pain, depression, and quality of life in cancer patients via a systematic review of clinical trials. METHODS: We searched PubMed, EMBASE, Google Scholar, CINAHL, and PsycINFO in July 2013 and updated the literature search again in January 2015 for prospective randomized trials evaluating the effect of telehealth interventions in cancer care with pain, depression, and quality of life as main outcomes. Two of the authors independently reviewed and extracted data from eligible randomized controlled trials, based on pre-determined selection criteria. Methodological quality of studies was assessed by the Cochrane Collaboration risk of bias tool. RESULTS: Of the 4929 articles retrieved from databases and relevant bibliographies, a total of 20 RCTs were included in the final review. The studies were largely heterogeneous in the type and duration of the intervention as well as in outcome assessments. A majority of the studies were telephone-based interventions that remotely connected patients with their health care provider or health coach. The intervention times ranged from 1 week to 12 months. In general, most of the studies had low risk of bias across the domains of the Cochrane Collaboration risk of bias tool, but most of the studies had insufficient information about the allocation concealment domain. Two of the three studies focused on pain control reported significant effects of the intervention; four of the nine studies focus on depression reported significant effects, while only the studies that were focused on quality of life reported significant effects. CONCLUSIONS: This systematic review demonstrates the potential of telehealth interventions in improving outcomes in cancer care. However, more high-quality large-sized trials are needed to demonstrate cogent evidence of its effectiveness.

The future of Connected Health in preventive medicine.

Over the last decade, Connected Health (CH) has shown great value in the management of chronic disease (CD), but has limited application in preventing these diseases that remain a huge burden to the society. Technological advances have made determination of genetic predisposition to disease possible and have gained wide use in oncology to develop more effective and individualized treatment strategies-Personalized Medicine. There is growing interest in the application of these genetic tests in predicting risk for complex genetic diseases; even, direct-to-consumer tests are increasingly becoming available and affordable. CH has shown great potential in collecting phenotypic data, which can be overlaid on genomic data to deliver a more precise and personalized preventive care that better engages patients. The goal of a CH program that uses genetic data would be to monitor individuals' risk factors and predict the onset of CD. This prediction would be coupled with coaching to delay or prevent the onset of disease. However, the challenge remains that many CDs are due to complex interaction between genes and modifiable environmental risk factors that are still under-studied.

Text-message reminders to improve sunscreen use: a randomized, controlled trial using electronic monitoring.

OBJECTIVE: To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application. DESIGN: We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device. SETTING: Participants were recruited from the general community. PARTICIPANTS: Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages. Intervention Half of the participants received daily text-message reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The text-message reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen. Main Outcome Measure The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period. RESULTS: All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily text-message reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (P < .001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence. CONCLUSIONS: Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Short-term data demonstrate that using existing cellular telephone text-message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives. Trial Registration clinicaltrials.gov Identifier: NCT00535769.

Evaluation of digital skin images submitted by patients who received practical training or an online tutorial.

We evaluated the ability of subjects to capture and submit teledermatology images with a digital camera. We also examined whether participants who received individual training sessions would capture better-quality images than participants who were provided only with self-training. Fifty participants were randomized between in-person training and self-training via an online tutorial. The majority of participants were young, well educated women. Two dermatologists reading the images for quality indicators had high agreement that digital images acquired were of high quality: images were well framed, appropriately bright, in focus and did not have a shadow. There was moderate agreement on diagnosis-related indicators, such as the presence or absence of pustules or papules and acne versus rosacea. There was no difference in the image-quality attributes between participants personally trained and those trained with the online tutorial. Subjects participating in this study were able to acquire images of good quality, irrespective of whether they received practical training or used an online tutorial.

Willingness-to-pay stated preferences for telemedicine versus in-person visits in patients with a history of psoriasis or melanoma.

The objective of this study was to evaluate willingness-to-pay stated preferences for telemedicine versus in-person clinic visits in patients with a history of psoriasis or melanoma. Face-to-face interviews were conducted with 92 (n = 92) adult participants with a history of psoriasis or melanoma recruited primarily from hospital-based dermatology practices. Data were collected on patient demographics and willingness-to-pay responses. In a combined analysis for patients with melanoma and psoriasis, 73% of participants preferred telemedicine over in-person visits if access to the physician was quicker. The majority of those choosing telemedicine (95%) were also willing to pay a median of 25 dollars(5 dollars-500 dollars) out-of-pocket. When time to see a physician was held constant for telemedicine and in-person visits, 19% of participants preferred telemedicine and about 58% of these participants were willing to pay a median of 25 dollars(10 dollars-125 dollars) out-of-pocket. This preliminary work suggests that dermatology patients prefer telemedicine if this modality provides quicker access to their physician.

Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review.

OBJECTIVE: To assess whether transferring knowledge from specialists at centres of excellence to referring doctors through online consultations can improve the management of patients requiring specialised care. DESIGN: Retrospective case review of the first year of internet based patient initiated consultations between referring doctors and consulting specialists. SETTING: US teaching hospitals affiliated with an organisation providing internet based consultations. PARTICIPANTS: Doctors in various settings around the world engaging in internet based consultations with specialists. MAIN OUTCOME MEASURES: New recommendations for treatment, change in diagnosis, and turnaround time for consultation compared with time to see a specialist. RESULTS: 79 consultations took place. 90% (n=71) of consultations were for services related to oncology. 90% of consultations involved new recommendations for treatment. The most common recommendation was a new chemotherapeutic regimen (68%, n=54). Diagnosis changed in 5% (n=4) of cases. The average turnaround time was 6.8 working days compared with an average of 19 working days to see a comparable specialist. CONCLUSIONS: Internet based consultations between specialists at centres of excellence and referring doctors contribute to patient care through recommendations for new treatment and timely access to specialist knowledge. Although change in diagnosis occurred in only a few cases, the prognostic and therapeutic implications for these patients may be profound.