Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users' Perspectives: Multicenter, Cross-Sectional Study in Dermatology.

BACKGROUND: Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. OBJECTIVE: The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. METHODS: This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. RESULTS: Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). CONCLUSIONS: This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. TRIAL REGISTRATION: ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036.

Evaluation of the reliability and validity of computerized tests of attention.

Different aspects of attention can be assessed through psychological tests to identify stable individual or group differences as well as alterations after interventions. Aiming for a wide applicability of attentional assessments, Psychology Experiment Building Language (PEBL) is an open-source software system for designing and running computerized tasks that tax various attentional functions. Here, we evaluated the reliability and validity of computerized attention tasks as provided with the PEBL package: Continuous Performance Task (CPT), Switcher task, Psychomotor Vigilance Task (PVT), Mental Rotation task, and Attentional Network Test. For all tasks, we evaluated test-retest reliability using the intraclass correlation coefficient (ICC), as well as internal consistency through within-test correlations and split-half ICC. Across tasks, response time scores showed adequate reliability, whereas scores of performance accuracy, variability, and deterioration over time did not. Stability across application sites was observed for the CPT and Switcher task, but practice effects were observed for all tasks except the PVT. We substantiate convergent and discriminant validity for several task scores using between-task correlations and provide further evidence for construct validity via associations of task scores with attentional and motivational assessments. Taken together, our results provide necessary information to help design and interpret studies involving attention assessments.

Vision- and touch-dependent brain correlates of body-related mental processing.

In humans, the nature of sensory input influences body-related mental processing. For instance, behavioral differences (e.g., response time) can be found between mental spatial transformations (e.g., mental rotation) of viewed and touched body parts. It can thus be hypothesized that distinct brain activation patterns are associated with such sensory-dependent body-related mental processing. However, direct evidence that the neural correlates of body-related mental processing can be modulated by the nature of the sensory stimuli is still missing. We thus analyzed event-related functional magnetic resonance imaging (fMRI) data from thirty-one healthy participants performing mental rotation of visually- (images) and haptically-presented (plastic) hands. We also dissociated the neural activity related to rotation or task-related performance using models that either regressed out or included the variance associated with response time. Haptically-mediated mental rotation recruited mostly the sensorimotor brain network. Visually-mediated mental rotation led to parieto-occipital activations. In addition, faster mental rotation was associated with sensorimotor activity, while slower mental rotation was associated with parieto-occipital activations. The fMRI results indicated that changing the type of sensory inputs modulates the neural correlates of body-related mental processing. These findings suggest that distinct sensorimotor brain dynamics can be exploited to execute similar tasks depending on the available sensory input. The present study can contribute to a better evaluation of body-related mental processing in experimental and clinical settings.

Illusory Body Ownership Affects the Cortical Response to Vicarious Somatosensation.

Fundamental human feelings such as body ownership ("this" body is "my" body) and vicariousness (first-person-like experience of events occurring to others) are based on multisensory integration. Behavioral links between body ownership and vicariousness have been shown, but the neural underpinnings remain largely unexplored. To fill this gap, we investigated the neural effects of altered body ownership on vicarious somatosensation. While recording functional brain imaging data, first, we altered participants' body ownership by robotically delivering tactile stimulations ("tactile" stroking) in synchrony or not with videos of a virtual hand being brushed ("visual" stroking). Then, we manipulated vicarious somatosensation by showing videos of the virtual hand being touched by a syringe's plunger (touch) or needle (pain). Only after the alteration of body ownership (synchronous visuo-tactile stroking) and specifically during late epochs of vicarious somatosensation, vicarious pain was associated with lower activation in premotor and anterior cingulate cortices with respect to vicarious touch. At the methodological level, the present study highlights the importance of the neural response's temporal evolution. At the theoretical level, it shows that the higher-level (cognitive) impact of a lower-level (sensory) body-related processing (visuo-tactile) is not limited to body ownership but also extends to other psychological body-related domains, such as vicarious somatosensation.

Network-based fMRI-neurofeedback training of sustained attention.

The brain regions supporting sustained attention (sustained attention network; SAN) and mind-wandering (default-mode network; DMN) have been extensively studied. Nevertheless, this knowledge has not yet been translated into advanced brain-based attention training protocols. Here, we used network-based real-time functional magnetic resonance imaging (fMRI) to provide healthy individuals with information about current activity levels in SAN and DMN. Specifically, 15 participants trained to control the difference between SAN and DMN hemodynamic activity and completed behavioral attention tests before and after neurofeedback training. Through training, participants improved controlling the differential SAN-DMN feedback signal, which was accomplished mainly through deactivating DMN. After training, participants were able to apply learned self-regulation of the differential feedback signal even when feedback was no longer available (i.e., during transfer runs). The neurofeedback group improved in sustained attention after training, although this improvement was temporally limited and rarely exceeded mere practice effects that were controlled by a test-retest behavioral control group. The learned self-regulation and the behavioral outcomes suggest that neurofeedback training of differential SAN and DMN activity has the potential to become a non-invasive and non-pharmacological tool to enhance attention and mitigate specific attention deficits.

Personode: A Toolbox for ICA Map Classification and Individualized ROI Definition.

Canonical resting state networks (RSNs) can be obtained through independent component analysis (ICA). RSNs are reproducible across subjects but also present inter-individual differences, which can be used to individualize regions-of-interest (ROI) definition, thus making fMRI analyses more accurate. Unfortunately, no automatic tool for defining subject-specific ROIs exists, making the classification of ICAs as representatives of RSN time-consuming and largely dependent on visual inspection. Here, we present Personode, a user-friendly and open source MATLAB-based toolbox that semi-automatically performs the classification of RSN and allows for defining subject- and group-specific ROIs. To validate the applicability of our new approach and to assess potential improvements compared to previous approaches, we applied Personode to both task-related activation and resting-state data. Our analyses show that for task-related activation analyses, subject-specific spherical ROIs defined with Personode produced higher activity contrasts compared to ROIs derived from single-study and meta-analytic coordinates. We also show that subject-specific irregular ROIs defined with Personode improved ROI-to-ROI functional connectivity analyses.Hence, Personode might be a useful toolbox for ICA map classification into RSNs and group- as well as subject-specific ROI definitions, leading to improved analyses of task-related activation and functional connectivity.

Analyzing the association between functional connectivity of the brain and intellectual performance.

Measurements of functional connectivity support the hypothesis that the brain is composed of distinct networks with anatomically separated nodes but common functionality. A few studies have suggested that intellectual performance may be associated with greater functional connectivity in the fronto-parietal network and enhanced global efficiency. In this fMRI study, we performed an exploratory analysis of the relationship between the brain's functional connectivity and intelligence scores derived from the Portuguese language version of the Wechsler Adult Intelligence Scale (WAIS-III) in a sample of 29 people, born and raised in Brazil. We examined functional connectivity between 82 regions, including graph theoretic properties of the overall network. Some previous findings were extended to the Portuguese-speaking population, specifically the presence of small-world organization of the brain and relationships of intelligence with connectivity of frontal, pre-central, parietal, occipital, fusiform and supramarginal gyrus, and caudate nucleus. Verbal comprehension was associated with global network efficiency, a new finding.