Prediction of dysphagia aspiration through machine learning-based analysis of patients' postprandial voices.

BACKGROUND: Conventional diagnostic methods for dysphagia have limitations such as long wait times, radiation risks, and restricted evaluation. Therefore, voice-based diagnostic and monitoring technologies are required to overcome these limitations. Based on our hypothesis regarding the impact of weakened muscle strength and the presence of aspiration on vocal characteristics, this single-center, prospective study aimed to develop a machine-learning algorithm for predicting dysphagia status (normal, and aspiration) by analyzing postprandial voice limiting intake to 3 cc. METHODS: Conducted from September 2021 to February 2023 at Seoul National University Bundang Hospital, this single center, prospective cohort study included 198 participants aged 40 or older, with 128 without suspected dysphagia and 70 with dysphagia-aspiration. Voice data from participants were collected and used to develop dysphagia prediction models using the Multi-Layer Perceptron (MLP) with MobileNet V3. Male-only, female-only, and combined models were constructed using 10-fold cross-validation. Through the inference process, we established a model capable of probabilistically categorizing a new patient's voice as either normal or indicating the possibility of aspiration. RESULTS: The pre-trained models (mn40_as and mn30_as) exhibited superior performance compared to the non-pre-trained models (mn4.0 and mn3.0). Overall, the best-performing model, mn30_as, which is a pre-trained model, demonstrated an average AUC across 10 folds as follows: combined model 0.8361 (95% CI 0.7667-0.9056; max 0.9541), male model 0.8010 (95% CI 0.6589-0.9432; max 1.000), and female model 0.7572 (95% CI 0.6578-0.8567; max 0.9779). However, for the female model, a slightly higher result was observed with the mn4.0, which scored 0.7679 (95% CI 0.6426-0.8931; max 0.9722). Additionally, the other models (pre-trained; mn40_as, non-pre-trained; mn4.0 and mn3.0) also achieved performance above 0.7 in most cases, and the highest fold-level performance for most models was approximately around 0.9. The 'mn' in model names refers to MobileNet and the following number indicates the 'width_mult' parameter. CONCLUSIONS: In this study, we used mel-spectrogram analysis and a MobileNetV3 model for predicting dysphagia aspiration. Our research highlights voice analysis potential in dysphagia screening, diagnosis, and monitoring, aiming for non-invasive safer, and more effective interventions. TRIAL REGISTRATION: This study was approved by the IRB (No. B-2109-707-303) and registered on clinicaltrials.gov (ID: NCT05149976).

Assessing the usability and reliability of a web-based teledentistry tool for remote diagnosis of oral lesions: a cross-sectional study.

BACKGROUND: Oral mucosa lesions are the third most prevalent oral pathology, following caries and periodontal diseases. Teledentistry offers an effective way to manage patients with these lesions. The accuracy of remote diagnoses and consultations relies heavily on the quality of the information and photos sent to remote specialists. This study aims to evaluate the usability and reliability of a teledentistry tool for the remote diagnosis of oral lesions. METHODS: The cross-sectional study included both usability evaluation and reliability assessment. The teledentistry platform, "OralMedTeledent", facilitated synchronous and asynchronous interactions, allowing for patient consultations, remote follow-ups, and doctor-to-doctor consultations. Usability was evaluated by 5 experts using the Nielsen heuristic checklist. Reliability was assessed from August 2022 to September 2023 with 109 patients, using Cohen's kappa coefficient to measure agreement between examiners and the gold standard in diagnosing oral lesions. RESULTS: The findings revealed 66 usability issues, most of which were related to helping users recognize, diagnose, and recover from errors, as well as issues with help and documentation. Among these, 11 issues were of minor severity. The reliability test, conducted with 109 participants (57.8% female, 42.2% male) showed that the web-based teleconsultation system performed significantly well. The system demonstrated significant substantial performance (0.81 ≤ κ < 1; P > 0.05). CONCLUSION: Overall, the web-based teleconsultation system has proven to be reliable for the remote diagnosis of oral lesions, making it a valuable alternative during emergencies such as the COVID-19 pandemic. However, several usability issues have been identified and need to be addressed.

The unforeseen future: Impacts of the COVID-19 pandemic on home video-EEG telemetry.

The coronavirus disease 2019 (COVID-19) pandemic had widespread impact on health care systems globally-particularly services arranged around elective admission and attendance such as epilepsy monitoring units and home video-EEG telemetry (HVET). Here, we review the ongoing impacts of the pandemic on HVET services among several different providers who used different initial models of HVET. We discuss the features of HVET that led to success in providing continued diagnostic services to patients with epilepsy and related disorders and through retrospective audit of our services demonstrate the high diagnostic yield of HVET. We reflect on this unforeseen future and its implications for other diagnostic techniques and approaches.

Pilot Feasibility Study of a Multi-View Vision Based Scoring Method for Cervical Dystonia.

Abnormal movement of the head and neck is a typical symptom of Cervical Dystonia (CD). Accurate scoring on the severity scale is of great significance for treatment planning. The traditional scoring method is to use a protractor or contact sensors to calculate the angle of the movement, but this method is time-consuming, and it will interfere with the movement of the patient. In the recent outbreak of the coronavirus disease, the need for remote diagnosis and treatment of CD has become extremely urgent for clinical practice. To solve these problems, we propose a multi-view vision based CD severity scale scoring method, which detects the keypoint positions of the patient from the frontal and lateral images, and finally scores the severity scale by calculating head and neck motion angles. We compared the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) subscale scores calculated by our vision based method with the scores calculated by a neurologist trained in dyskinesia. An analysis of the correlation coefficient was then conducted. Intra-class correlation (ICC)(3,1) was used to measure absolute accuracy. Our multi-view vision based CD severity scale scoring method demonstrated sufficient validity and reliability. This low-cost and contactless method provides a new potential tool for remote diagnosis and treatment of CD.

Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry.

BACKGROUND: Intraoral scans (IOS) provide three-dimensional images with approximate true colors representing a possible tool in teledentistry for remote examination. The aim of the present cross-sectional validation study was, therefore, to evaluate the levels of agreement between remote diagnoses derived from IOS and diagnoses based on clinical examinations for assessing dental and periodontal conditions. METHODS: The test sample comprised 10 patients representing different clinical conditions. Following the acquisition of IOS (Trios, 3Shape), a full-mouth dental and periodontal examination was done and periapical radiographs were taken. Ten dentists were asked to perform dental and periodontal scorings for each of the ten patients on a tablet computer presenting the IOS. Scores included diagnosis of gingivitis/periodontitis, and evaluated presence as well as amount of plaque and calculus, and presence of teeth exhibiting gingival recession, furcation involvement, erosion, tooth wear, stain, and non-carious cervical lesion, as well as presence of decayed, filled, and crowned teeth and implants. In a second round of assessments, the periapical radiographs were provided and the dentists were able to change the scores. The time for the remote assessment was recorded. The agreement between remote and clinical scorings (reference) was then analyzed descriptively. RESULTS: The mean time for the tele assessment was 3.17 min and the additional consultation of the radiographs accounted for another 1.48 min. The sensitivity and specificity values were 0.61 and 0.39 for gingivitis and 0.67 and 0.33 for periodontitis, with no relevant changes when radiographs were provided for the diagnosis of periodontitis (0.72 and 0.28). The agreement for dichotomized dental and periodontal indices ranged between 78 and 95%. With the provision of radiographs, the remote examiners were able to detect existing filled teeth, crowned teeth, and implants, whereas the detection of decayed teeth (70%) was not improved. CONCLUSIONS: The remote examination using IOS was effective in detecting dental findings, whereas periodontal conditions could not be assessed with the same accuracy. Still, remote assessment of IOS would allow a time-efficient screening and triage of patients. Improvement of the image quality of IOS may further allow to increase the accuracy of remote assessments in dentistry. According to the Swiss Regulation this investigation is not a clinical trial and therefore no registration in a WHO-registry is needed.

A Dynamic MooM Dataset Processing Under TelMED Protocol Design for QoS Improvisation of Telemedicine Environment.

Telemedicine research improves the connectivity of remote patients and doctors. Researchers are focused on data optimization and processing over a predefined channel of communication under a depictive low QoS. In this paper a consolidated representation of telemedicine infrastructure of modern topological arrangement is represented and validated. The infrastructure is aided with Multiple Objective Optimized Medical dataset (MooM) processing and a channel optimizing TelMED protocol designed exclusively for remote medicine dataset transmission and processing. The proposed infrastructure provides an application oriented approach towards Electronics health records (EHR) creation and updating over edge computation. The focus of this article is to achieve higher order of Quality of Service (QoS) and Quality of Data (QoD) compared to typical communication channels algorithms for processing of medical data sample. Typically the proposed technique results are achieved to discuss in MooM dataset processing and TelMED channel optimization sessions and a resulting improvement is discussed with a comparison of each MooM dataset in reverse processing towards server end of diagnosis and a consolidated QoS is retrieved for proposed infrastructure.

Plasmodium species differentiation by non-expert on-line volunteers for remote malaria field diagnosis.

BACKGROUND: Routine field diagnosis of malaria is a considerable challenge in rural and low resources endemic areas mainly due to lack of personnel, training and sample processing capacity. In addition, differential diagnosis of Plasmodium species has a high level of misdiagnosis. Real time remote microscopical diagnosis through on-line crowdsourcing platforms could be converted into an agile network to support diagnosis-based treatment and malaria control in low resources areas. This study explores whether accurate Plasmodium species identification-a critical step during the diagnosis protocol in order to choose the appropriate medication-is possible through the information provided by non-trained on-line volunteers. METHODS: 88 volunteers have performed a series of questionnaires over 110 images to differentiate species (Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, Plasmodium knowlesi) and parasite staging from thin blood smear images digitalized with a smartphone camera adapted to the ocular of a conventional light microscope. Visual cues evaluated in the surveys include texture and colour, parasite shape and red blood size. RESULTS: On-line volunteers are able to discriminate Plasmodium species (P. falciparum, P. malariae, P. vivax, P. ovale, P. knowlesi) and stages in thin-blood smears according to visual cues observed on digitalized images of parasitized red blood cells. Friendly textual descriptions of the visual cues and specialized malaria terminology is key for volunteers learning and efficiency. CONCLUSIONS: On-line volunteers with short-training are able to differentiate malaria parasite species and parasite stages from digitalized thin smears based on simple visual cues (shape, size, texture and colour). While the accuracy of a single on-line expert is far from perfect, a single parasite classification obtained by combining the opinions of multiple on-line volunteers over the same smear, could improve accuracy and reliability of Plasmodium species identification in remote malaria diagnosis.

A Novel Mobile Health Approach to Early Diagnosis of Oral Cancer.

AIM: The incidence of oral cancer is high in India, which can be reduced by early detection. We aimed to empower frontline health care providers (FHP) for early detection and connect specialist to rural population through mHealth. MATERIALS AND METHODS: We provided training to FHPs in examination of oral cavity, use of mobile phone for image capture, and risk factor analysis. The FHPs were selected from different cohorts in resource-constrained settings. The workflow involved screening of high-risk individuals in door-to-door and workplace settings, and capture of images of suspected lesions. Uploaded data were interpreted and recommendation was sent by specialist from a remote location. Their recommendation was intimated to FHPs who arranged for further action. Two more initiatives, one for multiple dental schools and another for private practitioners, were undertaken. RESULTS: During the period from 2010 to 2018, 42,754 subjects have been screened, and 5,406 subjects with potentially malignant disorders have been identified. The prevalence of potentially malignant disorders varied from 0.8 to 62% at different cohorts; 516 biopsies have been performed at remote locations. CONCLUSION: Connecting specialists to rural population was made possible through the use of mobile health. Trained FHP were able to reach out to the population. Electronic data capture facilitated efficient follow-up. The program was very cost-effective with screening completed under $1 per person. CLINICAL SIGNIFICANCE: In view of the high incidence of oral cancer in India, and the resource-constrained settings, mobile health paves the way for better access to specialist care for the rural population.

Accuracy of acute burns diagnosis made using smartphones and tablets: a questionnaire-based study among medical experts.

BACKGROUND: Remote assistance for burns by medical experts can support nurses and general physicians in emergency care with diagnostic and management advice. Previous studies indicate a high diagnostic accuracy based on images viewed on a computer screen, but whether image-based analysis by experts using handheld devices is accurate remains to be determined. METHOD: A review of patient data from eight emergency centres in the Western Cape, South Africa, revealed 10 typical cases of burns commonly seen in children and adults. A web-based questionnaire was created with 51 images of burns representing those cases. Burns specialists from two countries (South Africa and Sweden (n = 8 and 7 respectively)) and emergency medicine specialists from South Africa (n = 11) were contacted by email and asked to assess each burn's total body surface area (TBSA) and depth using a smartphone or tablet. The accuracy and inter-rater reliability of the assessments were measured using intraclass correlation coefficients (ICC), both for all cases aggregated and for paediatric and adult burn cases separately. Eight participants repeated the questionnaire on a computer and intra-rater reliability was calculated. RESULTS: The assessments of TBSA are of high accuracy all specialists aggregated (ICC = 0.82 overall and 0.81 for both child and adult cases separately) and remain high for all three participant groups separately. The burn depth assessments have low accuracy all specialists aggregated, with ICCs of 0.53 overall, 0.61 for child and 0.46 for adult cases. The most accurate assessments of depth are among South African burns specialists (reaching acceptable for child cases); the other two groups' ICCs are low in all instances. Computer-based assessments were similar to those made on handheld devices. CONCLUSION: As was the case for computer-based studies, burns images viewed on handheld devices may be a suitable means of seeking expert advice even with limited additional information when it comes to burn size but less so in the case of burn depth. Familiarity with the type of cases presented could facilitate image-based diagnosis of depth.

Remote diagnosis of traumatic dental injuries using digital photographs captured via a mobile phone.

BACKGROUND: Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries. AIM: To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely. MATERIAL AND METHODS: The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses. RESULTS: The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available. CONCLUSION: The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.

Malaria diagnosis and mapping with m-Health and geographic information systems (GIS): evidence from Uganda.

BACKGROUND: Rural populations experience several barriers to accessing clinical facilities for malaria diagnosis. Increasing penetration of ICT and mobile-phones and subsequent m-Health applications can contribute overcoming such obstacles. METHODS: GIS is used to evaluate the feasibility of m-Health technologies as part of anti-malaria strategies. This study investigates where in Uganda: (1) malaria affects the largest number of people; (2) the application of m-Health protocol based on the mobile network has the highest potential impact. RESULTS: About 75% of the population affected by Plasmodium falciparum malaria have scarce access to healthcare facilities. The introduction of m-Health technologies should be based on the 2G protocol, as 3G mobile network coverage is still limited. The western border and the central-Southeast are the regions where m-Health could reach the largest percentage of the remote population. Six districts (Arua, Apac, Lira, Kamuli, Iganga, and Mubende) could have the largest benefit because they account for about 28% of the remote population affected by falciparum malaria with access to the 2G mobile network. CONCLUSIONS: The application of m-Health technologies could improve access to medical services for distant populations. Affordable remote malaria diagnosis could help to decongest health facilities, reducing costs and contagion. The combination of m-Health and GIS could provide real-time and geo-localized data transmission, improving anti-malarial strategies in Uganda. Scalability to other countries and diseases looks promising.

A Stand-Alone EEG Monitoring System for Remote Diagnosis.

BACKGROUND: In low-income countries with limited infrastructure, remote diagnoses are a sustainable solution to healthcare issues. Current electroencephalography (EEG) monitoring devices are very expensive and may not be feasible in rural areas. Because a seizure is nonstationary, composed of multiple frequencies, and difficult to acquire, visual and conventional frequency-based methods have limited application. MATERIALS AND METHODS: One hundred healthy individuals at their best possible conscious state and 25 patients with an epileptic seizure a few hours prior to the time of recording were chosen. The recordings were carried at Shri Preethi Hospital and Nanda Engineering College, Tamilnadu, India, during the period of June 2014-December 2014. The primary objective was to differentiate the diseased from normal individuals, as well as quantifying the EEG signal and diagnosing remotely. RESULTS: Using wavelet coefficients, the separation between seizure and nonseizure states was measured and compared with that of healthy individuals of different age groups. The systems performance was measured by parameters such as sensitivity, specificity, region of convergence, and precision rate. CONCLUSIONS: The novelty of this article lies in the design, development, and clinical analysis of a low-cost EEG device for remote diagnosis.

Remote Diagnosis on Upper Respiratory Tract Infections Based on a Neural Network with Few Symptom Words-A Feasibility Study.

This study aims explore the feasibility of using neural network (NNs) and deep learning to diagnose three common respiratory diseases with few symptom words. These three diseases are nasopharyngitis, upper respiratory infection, and bronchitis/bronchiolitis. Through natural language processing, the symptom word vectors are encoded by GPT-2 and classified by the last linear layer of the NN. The experimental results are promising, showing that this model achieves a high performance in predicting all three diseases. They revealed 90% accuracy, which suggests the implications of the developed model, highlighting its potential use in assisting patients' understanding of their conditions via a remote diagnosis. Unlike previous studies that have focused on extracting various categories of information from medical records, this study directly extracts sequential features from unstructured text data, reducing the effort required for data pre-processing.

Mandibular movement monitor provides faster, yet accurate diagnosis for obstructive sleep apnoea: A randomised controlled study.

Many patients with obstructive sleep apnoea (OSA) remain undiagnosed and thus untreated, and in part this relates to delay in diagnosis. Novel diagnostic strategies may improve access to diagnosis. In a multicentre, randomised study, we evaluated time to treatment decision in patients referred for suspected OSA, comparing a mandibular movement (MM) monitor to respiratory polygraphy, the most commonly used OSA detection method in the UK. Adults with high pre-test probability OSA were recruited from both northern Scotland and London. 40 participants (70 % male, mean±SD age 46.8 ± 12.9 years, BMI 36.9 ± 7.5 kg/m2, ESS 14.9 ± 4.1) wore a MM monitor and respiratory polygraphy simultaneously overnight and were randomised (1:1) to receive their treatment decision based on results from either device. Compared to respiratory polygraphy, MM monitor reduced time to treatment decision by 6 days (median(IQR): 13.5 (7.0-21.5) vs. 19.5 (13.7-35.5) days, P = 0.017) and saved an estimated 29 min of staff time per patient.

The rise of Telecardiology in developing countries.

Telecardiology, the remote diagnosis and treatment of cardiac conditions, is experiencing a significant increase in developing nations. This article explores the driving forces behind this trend and its implications. Limited access to healthcare facilities, especially in rural, isolated, and underdeveloped regions, has propelled the adoption of telecardiology as a cost-effective solution to bridge the gap in cardiac care provision. Technological advancements, such as portable diagnostic devices and improvements in telecommunication infrastructure, have facilitated the expansion of telecardiology services. Moreover, the COVID-19 pandemic has accelerated the acceptance and deployment of telehealth solutions worldwide. Nevertheless, challenges persist, including regulatory hurdles, data privacy concerns, and disparities in digital literacy. Despite these obstacles, the rise of telecardiology in developing countries presents a promising opportunity to enhance access to cardiac care and improve health outcomes among underserved populations.

Challenges in Early Diagnosis of Melanoma Using Tele-Dermatology.

Numerous classification systems have been developed over the years, systems which not only provide assistance to dermatologists, but also enable individuals, especially those living in areas with low medical access, to get a diagnosis. In this paper, a Machine Learning model, which performs a binary classification, and, which for the remainder of this paper will be abbreviated as ML model, is trained and tested, so as to evaluate its effectiveness in giving the right diagnosis, as well as to point out the limitations of the given method, which include, but are not limited to, the quality of smartphone images, and the lack of FAIR image datasets for model training. The results indicate that there are many measures to be taken and improvements to be made, if such a system were to become a reliable tool in real-life circumstances.

Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review.

BACKGROUND: Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases. OBJECTIVE: The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients. METHODS: A scoping review was conducted with the methodological framework of Arksey and O'Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data. RESULTS: This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation. CONCLUSIONS: With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients.

The Nomadic Digital Pathologist. Validation of a simple, dual slide scanner with remote reporting for a regional upper gastrointestinal specialist multidisciplinary meeting.

Background: This article describes how a simple slide scanner with remote viewing software enabled a remote "nomadic" pathologist to continue his role as specialist lead for a regional gastrointestinal multidisciplinary team meeting (MDTM) after relocating to another site in the 5 hospital Southwest UK Peninsula cancer network just prior to the COVID-19 pandemic. Materials and methods: The author used digital pathology (DP) to supplement a conventional workflow as a way of minimising delay in reporting and reviewing slides for a regional specialist Oesophagogastric MDTM (the OGSMDT). The specialist centre at University Hospital Plymouth (UHP) is 58 miles from the author's new workplace at Royal Cornwall Hospital (RCHT). Slides from the 44 cases (10% of this specialist annual workload) in this validation study were reported or reviewed digitally using the slide scanner. All were listed for the OGSMDT due to being clinically suspicious for upper gastrointestinal malignancy, having been processed at UHP, or one of the other hospitals in the cancer network. Results: The scanner allowed the author who was only on site at UHP 1 day per week to prevent delays in reporting/reviewing glass slides, using remote DP. Confidence in digital diagnosis was assessed using the Royal College of Pathologists recommendations. The author was the primary pathologist signing out 31, and second opinion for the remaining 13 cases. These comprised a mixture of biopsies as well as endoscopic and surgical excision specimens. The DP system enabled the author to report the cases digitally with an equivalent degree of confidence to glass slides and no significant discrepancies were identified between the author's digital and final glass slide diagnosis. Conclusions: The scanner was found to be safe and effective for remote reporting and review for OGSMDT cases. It was recognised that DP was advantageous to enable this role to continue remotely but that a fully integrated digital reporting system capable of high-capacity scanning would be preferable to the simple system used.

Feasibility and acceptability of telepathology system among the rural communities of Bangladesh: A pilot study.

Context: Telepathology is a promising tool for remote communities to receive pathology services where professional diagnosis services are inadequate. Aims: We aimed to clarify how effective telepathology was when compared with conventional pathology service among rural communities of Bangladesh. Methods and Materials: We conducted a cross-sectional study in suburban and rural areas of Bangladesh between June and August 2020. We enrolled 117 participants who received both telepathology services from Thakurgaon Eye Hospital and conventional pathology service experience. The participant's satisfaction with the accessibility and perceptions were statistically compared. In addition, we summarized descriptive statistics using the frequencies and percentages of participants' responses. Statistical Analysis Used: Wilcoxon's Signed-rank test using SPSS statistic software version 25.00. Results: Among the study participants, service cost, travel cost, travel time, waiting time, and travel distance were significantly higher for conventional pathology than telepathology (P < 0.001). The majority of participants (94%) were satisfied with the telepathology experience; however, one out of 117 participants was dissatisfied with this service when their travel distance was far away (≥50 km). Among the participants, 91.5% thought that telepathology service was effective for their treatment, and 98.3% wanted to continue this service in their community. On an average, participants saved 58% (95% CI, 53.4-61.5) of cost using telepathology rather than conventional pathology service. Conclusions: Remote under-resourced communities received professional pathology services with less time-consuming and significantly lower costs using the telepathology approach. Where pathology services are absent/insufficient, telepathology is efficacious for primary diagnosis, screening, and referral through professional pathologists for the satisfactory treatment of unreached communities.