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3.
Heart ; 107(5): 366-372, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33431425

RESUMO

The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic.


Assuntos
Insuficiência Cardíaca , Tecnologia de Sensoriamento Remoto , Telemedicina , /epidemiologia , Controle de Doenças Transmissíveis , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Telemedicina/instrumentação , Telemedicina/métodos , Telemedicina/tendências
6.
Clin Exp Dermatol ; 46(1): 145-146, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32754962

RESUMO

The UK healthcare system, including skin cancer departments, has been profoundly affected by the COVID-19 pandemic. Despite service capacity and a worldwide increase in incidence, anecdotal reports suggest a decline in skin cancer diagnoses following COVID-19. To determine if there has been a decrease in skin cancer diagnosis in the UK in the COVID-19 era, we analysed data from the Northern Cancer Network from 23 March 2020 to 23 June 2020 and compared it with the same period in 2019 (pre-COVID). In the COVID period, there was a decrease of 68.61% in skin cancer diagnoses, from 3619 to 1136 (P < 0.01). Surprisingly, skin cancer waiting times were also reduced in the COVID period compared to the pre-COVID period (median of 8 and 12 days, respectively; P < 0.001). Collectively, these data highlight a statistically significant reduction in both skin cancer diagnoses and waiting times during the COVID period.


Assuntos
/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , /virologia , Tomada de Decisão Clínica , Humanos , Incidência , Neoplasias Cutâneas/epidemiologia , Telemedicina/instrumentação , Reino Unido/epidemiologia
7.
Arch. Soc. Esp. Oftalmol ; 95(12): 586-590, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194908

RESUMO

OBJETIVO: Reportar una experiencia piloto de atención por telemedicina en la especialidad de oftalmología, en el periodo de confinamiento por la pandemia por COVID-19. MÉTODOS: Estudio descriptivo. Se describen características demográficas y clínicas de pacientes atendidos en periodo de confinamiento de 10 semanas. Se evalúa la satisfacción de los pacientes y médicos participantes mediante una encuesta en línea. RESULTADOS: En las primeras 10 semanas, se realizaron 291 atenciones de telemedicina oftalmológica. Los principales motivos de consulta fueron afecciones inflamatorias de la superficie ocular y párpados (79,4%), seguido de requerimientos administrativos (6,5%), afecciones no inflamatorias de la superficie ocular (5,2%), sospecha de estrabismo (3,4%) y síntomas vitreorretinales (3,1%); 22 pacientes (7,5%) fueron derivados a atención presencial inmediata. El nivel de satisfacción con la prestación fue alto, tanto en médicos (100%), como en pacientes (93,4%). CONCLUSIONES: La atención oftalmológica por telemedicina en periodo de pandemia es un instrumento de utilidad para realizar un filtro de potenciales consultas presenciales, ya sea electivas o de urgencia, y para reducir potencialmente el riesgo de contagio por COVID-1


BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Telemedicina/instrumentação , Projetos Piloto , Pandemias/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Teleoftalmologia , Betacoronavirus , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos
8.
ACS Nano ; 14(12): 16180-16193, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33314910

RESUMO

The management of the COVID-19 pandemic has relied on cautious contact tracing, quarantine, and sterilization protocols while we await a vaccine to be made widely available. Telemedicine or mobile health (mHealth) is well-positioned during this time to reduce potential disease spread and prevent overloading of the healthcare system through at-home COVID-19 screening, diagnosis, and monitoring. With the rise of mass-fabricated electronics for wearable and portable sensors, emerging telemedicine tools have been developed to address shortcomings in COVID-19 diagnostics, monitoring, and management. In this Perspective, we summarize current implementations of mHealth sensors for COVID-19, highlight recent technological advances, and provide an overview on how these tools may be utilized to better control the COVID-19 pandemic.


Assuntos
/métodos , /terapia , Gerenciamento Clínico , Telemedicina/métodos , Antígenos Virais/análise , Técnicas Biossensoriais/instrumentação , /virologia , Busca de Comunicante/instrumentação , Humanos , Aplicativos Móveis/provisão & distribução , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Nanotecnologia/instrumentação , Nanotecnologia/métodos , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Testes Imediatos/organização & administração , Quarentena/organização & administração , Telemedicina/instrumentação
9.
Nephrol Nurs J ; 47(6): 529-536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33377753

RESUMO

Despite the increasing number of consumer-based mobile health applications (mHealth apps) for self-care, there is little research exploring consumers' experiences with mHealth apps. Health apps using mobile technology have the potential to provide a platform for kidney transplant recipients to monitor their self-care in real time. This study explored kidney transplant recipients' perceptions of the usefulness of mHealth apps and identified features that Kidney transplant recipients believe are important for using mHealth apps. A qualitative design was used to explore a purposive sample of adult kidney transplant recipients from a Midwest Transplant Program who used an mHealth app. Qualitative content data analysis revealed three themes participants found useful: health tracking (medication, nutrition, fluid intake, lab values, and activity), feedback (short personalized messages, positive awards using symbols, and color-coded bar graphs indicating normal and abnormal ranges), and usability (large font, words that everyone can understand, and all information stored in one area).


Assuntos
Telefone Celular , Transplante de Rim , Aplicativos Móveis , Autocuidado , Telemedicina/métodos , Adulto , Humanos , Entrevistas como Assunto , Monitorização Fisiológica , Pesquisa Qualitativa , Telemedicina/instrumentação
11.
Sensors (Basel) ; 20(18)2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32932848

RESUMO

The emerging wearable medical devices open up new opportunities for the provision of health services and promise to accelerate the development of novel telemedical services. The main objective of this study was to investigate the desirable features and applications of telemedical services for the Polish older adults delivered by wearable medical devices. The questionnaire study was conducted among 146 adult volunteers in two cohorts (C.1: <65 years vs. C.2: ≥65 years). The analysis was based on qualitative research and descriptive statistics. Comparisons were performed by Pearson's chi-squared test. The questionnaire, which was divided into three parts (1-socio-demographic data, needs, and behaviors; 2-health status; 3-telemedicine service awareness and device concept study), consisted of 37 open, semi-open, or closed questions. Two cohorts were analyzed (C.1: n = 77; mean age = 32 vs. C.2: n = 69; mean age = 74). The performed survey showed that the majority of respondents were unaware of the telemedical services (56.8%). A total of 62.3% of C.1 and 34.8% of C.2 declared their understanding of telemedical services. The 10.3% of correct explanations regarding telemedical service were found among all study participants. The most desirable feature was the detection of life-threatening and health-threatening situations (65.2% vs. 66.2%). The findings suggest a lack of awareness of telemedical services and the opportunities offered by wearable telemedical devices.


Assuntos
Telemedicina/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Betacoronavirus , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Geriatria/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Polônia/epidemiologia , Tecnologia de Sensoriamento Remoto/instrumentação , Inquéritos e Questionários , Tecnologia sem Fio/instrumentação
12.
Biosens Bioelectron ; 169: 112617, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32998066

RESUMO

The outbreak of coronavirus disease (COVID-19) has caused a significant public health challenge worldwide. A lack of effective methods for screening potential patients, rapidly diagnosing suspected cases, and accurately monitoring of the epidemic in real time to prevent the rapid spread of COVID-19 raises significant difficulties in mitigating the epidemic in many countries. As effective point-of-care diagnosis tools, simple, low-cost and rapid sensors have the potential to greatly accelerate the screening and diagnosis of suspected patients to improve their treatment and care. In particular, there is evidence that multiple pathogens have been detected in sewage, including SARS-CoV-2, providing significant opportunities for the development of advanced sensors for wastewater-based epidemiology that provide an early warning of the pandemic within the population. Sensors could be used to screen potential carriers, provide real-time monitoring and control of the epidemic, and even support targeted drug screening and delivery within the integration of emerging mobile health (mHealth) technology. In this communication, we discuss the feasibility of an integrated point-of-care biosensor system with mobile health for wastewater-based epidemiology (iBMW) for early warning of COVID-19, screening and diagnosis of potential infectors, and improving health care and public health. The iBMW will provide an effective approach to prevent, evaluate and intervene in a fast, affordable and reliable way, thus enabling real-time guidance for the government in providing effective intervention and evaluating the effectiveness of intervention.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas Biossensoriais/instrumentação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina/instrumentação , Vigilância Epidemiológica Baseada em Águas Residuárias , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Pandemias , Sistemas Automatizados de Assistência Junto ao Leito , Esgotos/virologia
13.
Acta Diabetol ; 57(12): 1493-1499, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32748176

RESUMO

AIMS: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. METHODS: This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. RESULTS: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. CONCLUSIONS: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. Daily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision.


Assuntos
Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Fotografação/métodos , Retina/diagnóstico por imagem , Telemedicina/métodos , Adulto , Idoso , Brasil , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico por imagem , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Encaminhamento e Consulta , Smartphone , Telemedicina/instrumentação
14.
Diabetes Res Clin Pract ; 168: 108379, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32853692
15.
Diabetes Res Clin Pract ; 168: 108393, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32858098

RESUMO

BACKGROUND AND AIM: Jordan implemented abrupt and extreme lockdown measures to prevent the spread of COVID-19. This study aims to evaluate the effect of these measures on paediatric patients with type 1 diabetes in terms of acute metabolic complications and shortages in insulin and glucose measuring supplies. It also evaluates the caregivers' perceptions of the use of telemedicine during the lockdown. METHODS: This is a questionnaire-based cross-sectional study. It was completed using Google forms and patients/caregivers were asked to consent if they agreed to answer. RESULTS: 235 patients/families participated in the study. The mean age of the patients was 10.8 years ± 3.9 years (N = 229). Twenty-four children (10.2%) needed to visit the emergency department during the lockdown period which lasted for 10 weeks. Of these, eight (3.4%) were hospitalized due to acute metabolic complications. Families (58.3%) faced insulin shortages and 14% had to ration insulin, i.e., decrease the dose, during the lockdown. Glucose monitoring strips were rationed by 43.4% of families leading to more frequent low/high glucose readings in 75.5% of children of these families. Telemedicine using phones and social media applications was utilized for communication with healthcare professionals and continuing medical care. Most of the participants (85.5%) described it as a smooth and positive experience. CONCLUSIONS: The extreme lockdown due to COVID-19 pandemic caused insulin and glucose measuring equipment shortages in children with diabetes in Jordan. However, the use of telemedicine for providing guidance and support was perceived positively by the families.


Assuntos
Cuidado da Criança , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Diabetes Mellitus Tipo 1/terapia , Pneumonia Viral/epidemiologia , Quarentena , Telemedicina , Adolescente , Betacoronavirus , Glicemia/metabolismo , Automonitorização da Glicemia/instrumentação , Cuidadores/psicologia , Criança , Cuidado da Criança/métodos , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus Tipo 1/sangue , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Insulina/administração & dosagem , Jordânia/epidemiologia , Masculino , Pandemias , Pais/psicologia , Percepção , Quarentena/psicologia , Inquéritos e Questionários , Telemedicina/instrumentação , Telemedicina/organização & administração , Telemedicina/normas , Adulto Jovem
17.
Hautarzt ; 71(9): 691-698, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32720165

RESUMO

ADVANTAGES OF ARTIFICIAL INTELLIGENCE (AI): With responsible, safe and successful use of artificial intelligence (AI), possible advantages in the field of dermato-oncology include the following: (1) medical work can focus on skin cancer patients, (2) patients can be more quickly and effectively treated despite the increasing incidence of skin cancer and the decreasing number of actively working dermatologists and (3) users can learn from the AI results. POTENTIAL DISADVANTAGES AND RISKS OF AI USE: (1) Lack of mutual trust can develop due to the decreased patient-physician contact, (2) additional time effort will be necessary to promptly evaluate the AI-classified benign lesions, (3) lack of adequate medical experience to recognize misclassified AI decisions and (4) recontacting a patient in due time in the case of incorrect AI classifications. Still problematic in the use of AI are the medicolegal situation and remuneration. Apps using AI currently cannot provide sufficient assistance based on clinical images of skin cancer. REQUIREMENTS AND POSSIBLE USE OF SMARTPHONE PROGRAM APPLICATIONS: Smartphone program applications (apps) can be implemented responsibly when the image quality is good, the patient's history can be entered easily, transmission of the image and results are assured and medicolegal aspects as well as remuneration are clarified. Apps can be used for disease-specific information material and can optimize patient care by using teledermatology.


Assuntos
Inteligência Artificial , Dermatologia/métodos , Melanoma/diagnóstico por imagem , Aplicativos Móveis , Neoplasias Cutâneas/diagnóstico por imagem , Smartphone , Telemedicina/instrumentação , Humanos , Interpretação de Imagem Assistida por Computador , Oncologia , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico
18.
Pediatr Clin North Am ; 67(4): 675-682, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650866

RESUMO

Telehealth and telemedicine services can be a solution for improving accessibility and reducing the cost of health care. Challenges remain in designing, implementing, and sustainably scaling telehealth solutions. Research is lacking on the health impacts and cost-effectiveness of telehealth; more data are needed in the evaluation of telehealth programs, adjusting for potential participant bias and extending the time frame of evaluating impact. In addition, rethinking and addressing the economic incentives and payment for telehealth services, as well as the medical-legal framework for provider competition across geographic regions (and jurisdictions), are needed for greater adoption of telehealth services.


Assuntos
Desenvolvimento de Programas/métodos , Telemedicina/organização & administração , Segurança Computacional , Análise Custo-Benefício , Acesso aos Serviços de Saúde , Humanos , Registro Médico Coordenado , Telemedicina/economia , Telemedicina/instrumentação
19.
BMJ Sex Reprod Health ; 46(3): 172-176, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32665231

RESUMO

INTRODUCTION: This study aimed to explore patient experiences obtaining a medical abortion using an at-home telemedicine service operated by Marie Stopes Australia. METHODS: From July to October 2017, we conducted semistructured in-depth telephone interviews with a convenience sample of medical abortion patients from Marie Stopes Australia. We analysed interview data for themes relating to patient experiences prior to service initiation, during an at-home telemedicine medical abortion visit, and after completing the medical abortion. RESULTS: We interviewed 24 patients who obtained care via the at-home telemedicine medical abortion service. Patients selected at-home telemedicine due to convenience, ability to remain at home and manage personal responsibilities, and desires for privacy. A few telemedicine patients reported that a lack of general practitioner knowledge of abortion services impeded their access to care. Most telemedicine patients felt at-home telemedicine was of equal or superior privacy to in-person care and nearly all felt comfortable during the telemedicine visit. Most were satisfied with the home delivery of the abortion medications and would recommend the service. CONCLUSION: Patient reports suggest that an at-home telemedicine model for medical abortion is a convenient and acceptable mode of service delivery that may reduce patient travel and out-of-pocket costs. Additional provider education about this model may be necessary in order to improve continuity of patient care. Further study of the impacts of this model on patients is needed to inform patient care and determine whether such a model is appropriate for similar geographical and legal contexts.


Assuntos
Aborto Legal/psicologia , Misoprostol/uso terapêutico , Telemedicina/normas , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/uso terapêutico , Aborto Legal/métodos , Adulto , Austrália , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Misoprostol/administração & dosagem , Gravidez , Pesquisa Qualitativa , Telemedicina/instrumentação , Telemedicina/métodos
20.
J Biomed Inform ; 108: 103483, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32603793

RESUMO

Monitoring patients through robotics telehealth systems is an interesting scenario where patients' conditions, and their environment, are dynamic and unknown variables. We propose to improve telehealth systems' features to include the ability to serve patients with their needs, operating as human caregivers. The objective is to support the independent living of patients at home without losing the opportunity to monitor their health status. Application scenarios are several, and they spread from simple clinical assisting scenarios to an emergency one. For instance, in the case of a nursing home, the system would support in continuously monitoring the elderly patients. In contrast, in the case of an epidemic diffusion, such as COVID-19 pandemic, the system may help in all the early triage phases, significantly reducing the risk of contagion. However, the system has to let medical assistants perform actions remotely such as changing therapies or interacting with patients that need support. The paper proposes and describes a multi-agent architecture for intelligent medical care. We propose to use the beliefs-desires-intentions agent architecture, part of it is devised to be deployed in a robot. The result is an intelligent system that may allow robots the ability to select the most useful plan for unhandled situations and to communicate the choice to the physician for his validation and permission.


Assuntos
Monitorização Fisiológica/instrumentação , Robótica/tendências , Idoso , Inteligência Artificial , Sistemas Computacionais , Infecções por Coronavirus/terapia , Medicina de Emergência/instrumentação , Geriatria/instrumentação , Humanos , Infectologia/instrumentação , Informática Médica , Modelos Teóricos , Monitorização Fisiológica/métodos , Casas de Saúde , Pandemias , Pneumonia Viral/terapia , Risco , Telemedicina/instrumentação , Telemedicina/métodos
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