Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. AIM: The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. RESULTS: eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. CONCLUSION: teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms-eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.

COVID-19 Pandemic and Telephone Triage before Attending Medical Office: Problem or Opportunity?

During the COVID-19 emergency, the medical operating protocols have been largely modified for reducing any type of contamination risk, for working in a safe way and for making the patient feel in a safe environment. Telemedicine, smart phones and apps could represent important devices for the community, in order to prevent virus trasmission and to perform quick diagnosis and management at medical offices. This manuscript could be useful for clinicians with regard to the current state of the effectiveness of the telephone triage in this COVID-19 epidemic period. Therefore, it could be an important starting point for future perspectives about telemedicine and virtual patient management.

Standard Health Level Seven for Odontological Digital Imaging.

BACKGROUND: A guide for the implementation of dental digital imaging reports was developed and validated through the International Standard of Health Informatics-Health Level Seven (HL7), achieving interoperability with an electronic system that keeps dental records. INTRODUCTION: Digital imaging benefits patients, who can view previous close-ups of dental examinations; providers, because of greater efficiency in managing information; and insurers, because of improved accessibility, patient monitoring, and more efficient cost management. Finally, imaging is beneficial for the dentist who can be more agile in the diagnosis and treatment of patients using this tool. MATERIALS AND METHODS: The guide was developed under the parameters of an HL7 standard. It was necessary to create a group of dentists and three experts in information and communication technologies from different institutions. DISCUSSION: Diagnostic images scanned with conventional radiology or from a radiovisiograph can be converted to Digital Imaging and Communications in Medicine (DICOM) format, while also retaining patient information. The guide shows how the information of the health record of the patient and the information of the dental image could be standardized in a Clinical Dental Record document using international informatics standard like HL7-V3-CDA document (dental document Level 2). Since it is an informatics standardized document, it could be sent, stored, or displayed using different devices-personal computers or mobile devices-independent of the platform used. CONCLUSIONS: Interoperability using dental images and dental record systems reduces adverse events, increases security for the patient, and makes more efficient use of resources. This article makes a contribution to the field of telemedicine in dental informatics. In addition to that, the results could be a reference for projects of electronic medical records when the dental documents are part of them.

Readiness for Teledentistry: Validation of a Tool for Oral Health Professionals.

We validated a survey tool to test the readiness of oral health professionals for teledentistry (TD). The survey tool, the University of Calgary Health Telematics Unit's Practitioner Readiness Assessment Tool (PRAT) gathered information about the participants' beliefs, attitudes and readiness for TD before and after a teledentistry training program developed for a rural state in the Mid-Western United States. Ninety-three dental students, oral health and other health professionals participated in the TD training program and responded to the survey. Wilcoxon signed rank test was used to assess statistical differences in the change in the readiness rating before and after the training. Principal Components Analysis identified a three factor structure for the PRAT tool: Attitudes/ Attributes of Personnel; Motivation to Change and Institutional Resources. Overall, the evaluation demonstrated a positive change in all trainees' attitudes following the training sessions, with the majority of trainees acknowledging a positive impact of the training on their readiness for teledentistry.

Mobile primary healthcare services and health outcomes of children in rural Namibia.

INTRODUCTION: In rural areas of Namibia where health facilities are far apart, health outcomes are poor among high utilization groups such as pregnant women and children. Among children, orphans and vulnerable children (OVC) are generally more affected than non-OVC. This study assessed the health changes of orphans and other vulnerable and non-vulnerable children visiting a mobile clinic in rural Namibia. METHODS: Over a 6 month period, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders and referrals was collected from the records of a mobile clinic serving farms and surrounding areas in parts of rural Namibia. Data were compared for all children with visits in months 1 or 2 (baseline) and a visit in months 5 or 6 (follow up). Data for a cohort of children seen at both time points (the longitudinal group) were also analyzed. RESULTS: For all children, there was significant reduction in outstanding immunizations (5% to 1% p<0.0001), skin and intestinal parasites (15.5% to 0.2% p<0.0001), and stunting (26.9% to 14.2% p<0.0001) between baseline and follow up. Within the longitudinal group, reductions were observed in the prevalence of anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001) between the two time points. At baseline, orphans were more likely to have incomplete immunizations and parasitic infections. Among orphans, incomplete immunizations declined from 25% to 0 (p<0.001) while parasitic infections decreased from 22.7% to 0 (p<0.001). Among other vulnerable children incomplete immunizations declined from 5% to 1% (p=0.002), as did skin and parasitic infestations (17.2% to 0.3% p<0.001). CONCLUSION: Regular mobile clinic visits improved the health indices of child attendees. The greatest change was among OVC whose disease burden was greater at baseline. Mobile clinics may be an effective intervention in hard-to-reach, resource-limited settings.

The virtual dental home: bringing oral health to vulnerable and underserved populations.

Large and increasing oral health disparities in the U.S. population led the Institute of Medicine to call for expanded research and demonstration of delivery systems that test new methods and technologies. These new methods include delivering oral health services in nontraditional settings, using nondental professionals, expanded roles for existing dental professionals and new types of dental professionals, and incorporating telehealth technologies. The virtual dental home is a system that demonstrates the characteristics called for by the IOM.

Using telehealth technologies to improve oral health for vulnerable and underserved populations.

Telehealth refers to the use of technology to provide health care at a distance. The important and increasing role of telehealth in the delivery of health care has been recognized for several decades. Although there are fewer reports on the use of telehealth to deliver oral health services, evidence is emerging that these technologies can enhance the ability of the oral health delivery system to reach vulnerable and underserved populations.

Implementation of a Teledentistry Platform for Dental Emergencies for the Elderly in the Context of the COVID-19 Pandemic in Chile.

Objectives: To develop and implement a "semi-presential" technology platform to support urgent and priority dental care for the elderly in the context of the COVID-19 pandemic among the Chilean population. Methods: A dental mobile clinic was implemented along with the development of a technological platform designed to support emergency and priority dental procedures, including teleconsultation with specialists. Under strict biosafety protocols, dental care was provided in five Chilean regions between February and May 2021. Sociodemographic, medical, and dental data were recorded. Results: A total of 135 patients over sixty years old, with a mean age of 72 years, were treated, 48 males and 87 females were attended between February and May 2021 in five different regions of Chile. 53.3% required immediate or urgent treatment, and 24.4% were derived to specialists from whom 60.6% needed immediate or urgent treatment. 74.3% of teleconsultations were derived to an oral pathology specialist. Conclusion: It was shown that a "semi-presential" technology platform implemented in a mobile dental clinic can help elderly people who are impeded to look for traditional dental assistance during a pandemic.

Patients' E-Readiness to use E-Health technologies for oral health.

INTRODUCTION: Scientific evidence highlights the importance of E-Readiness in the adoption and implementation of E-Oral Health technologies. However, to our knowledge, there is no study investigating the perspective of patients in this regard. Therefore, the objective of this study was to explore patients' E-Readiness in the field of dentistry. MATERIALS AND METHODS: A qualitative study was conducted using interpretive descriptive methodology. Purposeful sampling with maximum variation and snowball techniques were used to recruit the study participants via McGill University dental clinics and affiliated hospitals, as well as private or public dental care organizations. A total of 15 face-to-face, semi-structured and 60 to 90-minute audio recorded interviews were conducted. Data collection and analyses were performed concurrently, and interviews were continued until saturation was reached. Activity theory was used as the conceptual framework, and thematic analysis was used to analyze data. Data analysis was conducted both manually and with the use of "ATLAS-ti" software. RESULTS: Four major themes emerged from the study; unlocking barriers, E-Oral Health awareness, inquisitiveness for E-Oral Health technology and enduring oral health benefits. These themes correspond with all three types of readiness (core, engagement and structural). CONCLUSION: The study results suggest that dental patients consider E-Oral Health as a facilitator to access to care, and they are ready to learn and use E-Oral Health technology. There is a need to implement and support E-Oral Health technologies to improve patient care.

Exploring the impact of the COVID-19 pandemic on pediatric surgical services.

Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to manifest mild to moderate symptoms and mortality was primarily observed in patients aged <1 year and having underlying comorbidities. Most of the cases were asymptomatic in children, hence, posing a challenge for pediatric surgery centers to take drastic measures to reduce the virus transmission. Telemedicine was introduced and out-patient consultations were conducted online as out-patient clinics were closed. Elective surgeries were postponed with delayed appointments while the healthcare sector was diverted towards tackling COVID-19. Case urgency was classified and triaged, leading to limited surgeries being performed only in COVID-19 negative patients following an extensive screening process. The screening process consisted of online history taking and RT-PCR tests. Newer practices such as mouth rinse, video laryngoscopy, and anesthesia were introduced to restrict patients from crying, coughing, and sneezing, as an attempt to avoid aerosolization of viral particles and safely conduct pediatric surgeries during the pandemic. Surgical trainees were also affected as the smaller number of surgeries conducted reduced the clinical experience available to medical enthusiasts. There is still room for advanced practices to be introduced in pediatric surgery and restore all kinds of surgeries to improve the quality of life of the patient.

The Impact of COVID-19 Related Lockdown on Dental Practice in Central Italy-Outcomes of A Survey.

The COVID-19 pandemic has affected lives and professions worldwide. We aimed to determine the behavior of dentists during the lockdown in Central Italy through an online survey. We demonstrated that the most frequent of urgencies, not otherwise manageable through telemedicine, was dental pulp inflammation. Although a statistically significant increase in the use of some of the personal protective equipment (PPE) from pre to during lockdown was shown, dentists were afraid of being infected during the dental procedures. Moreover, we showed that digital dentistry, telemedicine, use of the rubber dam, distancing of the appointments and further structural changes at the dental office are necessary to reduce the contagion among dentists and patients. No significant differences were shown between gender.

Detecting Common Eye Diseases Using the First Teleophthalmology GlobeChek Kiosk in the United States: A Pilot Study.

PURPOSE: The aim of this study was to assess the benefit and feasibility of the teleophthalmology GlobeChek kiosk in a community-based program. DESIGN: Single-site, nonrandomized, cross-sectional, teleophthalmologic study. METHODS: Participants underwent comprehensive evaluation that consists of a questionnaire form, brief systemic evaluation, screening visual field (VF), and GlobeChek kiosk screening, which included but not limited to intraocular pressure, pachymetry, anterior segment optical coherence tomography, posterior segment optical coherence tomography, and nonmydriatic fundus photography. The results were evaluated by a store-and-forward mechanism and follow-up questionnaires were obtained through phone calls. RESULTS: A total of 326 participatents were screened over 4 months. One hundred thirty-three (40.79%) participants had 1 condition in either eye, and 47 (14.41%) had >1 disease. Seventy (21.47%) had glaucoma, 37 (11.34%) narrow-angles, 6 (1.84%) diabetic retinopathy, 4 (1.22%) macular degeneration, and 43 (13.10%) had other eye disease findings. Age >65, history of high blood pressure, diabetes mellitus, not having a dental examination >5 years, hemoglobn A1c measurement of ≥5.6, predibates risk score of ≥9, stage 2 hypertension, and low blood pressure were found to be significant risk factors. As for the ocular parameters, all but central corneal thickness, including an intraocular pressure >21 mm Hg, vertical cup to disc ratio >0.7, visual field abnormalities, and retinal nerve fiber layer thinning were found to be significant. CONCLUSIONS: GlobeChek kiosk is both workable and effective in increasing access to care and identifying the most common causes of blindness and their risk factors.

Dental Health Services Response to COVID-19 in Norway.

We aimed to investigate the management of urgent dental care, the perception of risk and workplace preparedness among dental staff in Norway during the COVID-19 pandemic. An electronic questionnaire regarding the strictest confinement period in Norway (13 March-17 April 2020) was distributed to dental staff. Among the 1237 respondents, 727 (59%) treated patients, of whom 170 (14%) worked in clinics designated to treat patients suspected or confirmed to have COVID-19. Out of them 88% (143) received training and 64% (103) simulation in additional infection prevention procedures, while 27 (24%) respondents reported deviation. In total, 1051 (85%) respondents perceived that dental staff had a high risk of being infected, 1039 (84%) that their workplace handled the current situation well, 767 (62%) that their workplace had adequate infection control equipment and 507 (41%) agreed that their workplace is well equipped to handle an escalation. Before an appointment, 1182 (96%) respondents always/often inquired per phone information if a patient experienced symptoms of COVID-19, and 1104 (89%) asked about a history of travel to affected areas. Twice as many patients on average per week were treated by phone than in a clinic. A lower proportion of dental staff in high incidence counties applied additional infection prevention measures compared to low and medium incidence counties. To conclude, urgent dental health care was managed relatively well in Norway. Additional training of the dental staff in adequate infection prevention and step-by-step procedures may be needed. These results may be used to improve the dental health service's response to future outbreaks.

Patient and clinician experiences with telehealth for patient follow-up care.

OBJECTIVES: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology. STUDY DESIGN: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system. METHODS: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys. RESULTS: When comparing VVVs and office visits, 62.6% of patients and 59.0% of clinicians reported no difference in "the overall quality of the visit." VVVs were vastly preferred to office visits by patients for convenience and travel time. A majority (52.5%) of clinicians reported higher efficiency of a VVV appointment. CONCLUSIONS: For established patients, VVVs may provide effective follow-up and enhanced convenience when compared with traditional office visits.

A Medical Support in Offshore Racing - Workshop on Medical Support for Offshore Yacht Races, Telemedical Advice Service (TMAS), 1-2 December 2018, London, United Kingdom.

The safety and health of sailors offshore is of major concern. World Sailing (WS) and International Maritime Health Association (IMHA) are taking seriously the potential dangers to the safety and health at sea. By the nature of their sport, the sailors racing in offshore racing environment can be exposed to injuries and other health problems that can endanger their lives. Being aware of the potential dangers caused by the distance from onshore health facilities and lack of professional help on board, IMHA and WS decided to support the activities that are leading to the enhancement of safety and health protection on board. With common initiative, joint Workgroup on Medical Support in Offshore Racing has been formed and the series of workshop organised. The WS/IMHA Workgroup on Medical Support for Offshore Yacht Races previously reached consensus on the common competences and learning outcomes for medical training for offshore racing. In addition, the Workgroup has also set standards for required medical kit inventory for yachts par- ticipating in the various categories of offshore yacht races. Documents were both approved by WS Medical Commission and the IMHA Board. Fourth workshop on Medical Support for Offshore Yacht Races was held in London, United Kingdom, 1-2 December 2018 and workgroup reached consensus on the standards for availability of Telemedical Advice Services (TMAS) for the various categories of offshore yacht races held under the authority of WS. This position paper sets out how the TMAS should be integrated with the practical usage of medicines and medical equipment on board offshore racing yachts. In addition, this position paper also sets out how the level of medical training integrates with appropriate use of the TMAS. Overall, the three WS/IMHA position papers on the triad of medical inventories, medical training and TMAS, are aimed at providing the best possible medical care on offshore racing yachts, by fully integrating each part of the triad of medical support.

A systematic review of the research evidence for the benefits of teledentistry.

Objective This review is designed to inform future decisions about the benefits of integrating teledentistry into routine health services, by presenting an overview of the evidence for the effectiveness and economic impact of teledentistry. Methods Two reviewers searched PubMed, EMBASE and CINAHL databases through November 2016 to identify published peer-reviewed studies in English. Teledentistry studies were included if they were; (a) controlled (randomised or non-randomised) assessment studies; and (b) compared outcomes of a teledentistry intervention in terms of clinical or economic evaluation with the outcomes of traditional clinical alternatives. The quality of the studies was evaluated using a quality appraisal tool that considered study performance and design. Results This review identified 385 publications, of which 217 full-text articles were retrieved for further inspection. Of these, only 11 articles met the inclusion criteria. Nine of the included articles showed some clinical outcomes; the other two were primarily economic analyses. The balance of these studies assesed the efficacy of teledentistry interventions rather than their effectiveness. Four studies (36%) achieved higher quality scores and have greater potential to influence health-care decision-making. To date, the most convincing published evidence regarding the efficacy of teledentistry was provided by studies on paediatric dentistry, orthodontics and oral medicine. The economic analysis referred only to cost-minimisation, suggesting that the use of teleconsultation in dentistry can be cost-saving when compared to a conventional consultation. However, high-quality economic studies on teledentistry are rare. Conclusion There is emerging evidence supporting the efficacy of teledentistry. However, there is not yet enough conclusive evidence, particularly for its effectiveness, cost-effectiveness and long-term use, to make evidence-based policy decisions on teledentistry.

Accuracy of teledentistry examinations at predicting actual treatment modality in a pediatric dentistry clinic.

Objectives The purpose of this study was to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. Methods A retrospective dental record review was completed of 251 rural pediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a board-certified pediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. Proportions of children who were referred for specific treatment modalities and who completed treatment and proportions of children for whom the treatment recommendation was changed were calculated. Fisher's exact test was used to assess statistical significance. Results The initial treatment modality was not changed for 221/251 (88%) children initially seen for a teledentistry consultation. Thirty (12%) children had the initial treatment modality changed, most frequently children who were initially suggested treatment with nitrous oxide. Based on the initial treatment modality, changes to a different treatment modality were statistically significant (Fisher's exact test, p < 0.0001). Conclusions Our data suggest that the use of a live-video teledentistry consultation can be an effective way of predicting the best treatment modality for rural children with significant dental disease. A live-video teledentistry consultation can be an effective intervention to facilitate completion of complex treatment plans for children from a rural area that have extensive dental needs.

A nursing home telehealth system: keeping residents connected.

Live video and detailed images of nursing home residents can be transmitted in real time via the Internet. This telehealth system allows residents and long-term care health professionals to connect with experts not available on-site. Electronic stethoscope, otoscope, dermascope, dentalscope, and electrocardiogram are available for use via the Internet. Impediments to implementing telehealth systems in long-term care include costs and the lack of reimbursement for telehealth services. Reimbursement for telemedicine in nursing homes is limited by originating site, current procedural terminology codes, and facility location.