Taking connected mobile-health diagnostics of infectious diseases to the field.

Mobile health, or 'mHealth', is the application of mobile devices, their components and related technologies to healthcare. It is already improving patients' access to treatment and advice. Now, in combination with internet-connected diagnostic devices, it offers novel ways to diagnose, track and control infectious diseases and to improve the efficiency of the health system. Here we examine the promise of these technologies and discuss the challenges in realizing their potential to increase patients' access to testing, aid in their treatment and improve the capability of public health authorities to monitor outbreaks, implement response strategies and assess the impact of interventions across the world.

Unveiling the Adoption and Barriers of Telemedicine in US Hospitals: A Comprehensive Analysis (2017-2022).

BACKGROUND: Telemedicine has emerged as a vital healthcare delivery model, especially pronounced during the COVID-19 pandemic. Our study uniquely focuses on an institutional lens, examining US hospitals to offer targeted policy implications. OBJECTIVE: To investigate the trend in telemedicine adoption across US hospitals from 2017 to 2022 and analyze the institutional challenges they encounter, particularly in the realm of electronic health information exchange. DESIGN: Cross-sectional study leveraging data from the American Hospital Association's (AHA) annual surveys for the years 2017 to 2021 and the 2022 AHA IT Supplement Survey. SETTING: The study includes a national sample of US hospitals, covering a diverse range of hospital types including large, nonprofit, teaching, and system-affiliated institutions. PARTICIPANTS: US hospitals form the study's participants, with a substantial response rate to the surveys. MAIN MEASURES: Key metrics include the number of telemedicine patient encounters, percentage of hospitals offering telemedicine services, and institutional challenges to electronic health information exchange. KEY RESULTS: Telemedicine encounters saw a 75% increase, growing from approximately 111.4 million in 2020 to nearly 194.4 million in 2021. The percentage of hospitals offering at least one form of telemedicine service went from 46% in 2017 to 72% in 2021. Larger, nonprofit, and teaching hospitals were more prone to telehealth adoption, without notable urban-rural disparities. While over 90% of hospitals allow patients to view and download medical records, only 41% permit online data submission. Importantly, 25% of hospitals identified Certified Health IT Developers such as EHR vendor as frequent culprits in information blocking, with cost being the primary obstacle. CONCLUSIONS: The findings underscore the rapid yet uneven adoption of telemedicine services in U.S. hospitals. The results point to the need for comprehensive policy interventions to address the challenges identified and realize telemedicine's full potential in healthcare delivery and resilience.

Trends in direct healthcare utilization observed for persons with MS among teleneurology users and diverse populations.

BACKGROUND: The impact of teleneurology on healthcare utilization (HCU) in MS is unknown. OBJECTIVE: Evaluate the association between teleneurology and HCU. METHODS: A retrospective longitudinal analysis of HCU among adult MS and clinically isolated syndrome (CIS) patients residing in the Cleveland/Akron area from July 2020 to July 2022. Negative binomial regression models evaluated the association between number of laboratory and MRI orders per visit and number of emergency visits per patient across patient groups with variable proportions of teleneurology visits. RESULTS: A total of 3208 patients completed 15,795 visits. Patients using teleneurology had more visits (rate ratio (RR) 1.707-1.719, p < 0.001). Teleneurology visits had fewer laboratory (RR 0.571) and MRI orders (RR 0.693, p < 0.001). There was no difference in emergency care utilization for teleneurology patients (p ⩾ 0.05). More emergency visits were observed in Black (RR 1.414) and Medicaid (RR 1.893) patients, regardless of visit type (p < 0.001). CONCLUSION: Teleneurology visits were associated with fewer orders, suggesting teleneurology may be incorporated into healthcare models without increasing utilization related to the visit. Teleneurology was also associated with increased visit volumes but no difference in emergency HCU. More studies are needed to clarify the ultimate impact of teleneurology on overall HCU. More emergency visits, regardless of visit type, were observed among at-risk populations, warranting further investigation.

Medical visits and mortality among dementia patients during the COVID-19 pandemic compared to rates predicted from 2019.

BACKGROUND: During the COVID-19 pandemic, patients with Alzheimer's disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes. METHODS: Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors' office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January-December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths - due to COVID and non-COVID causes - and changes in care use in the beneficiary's state of residence. RESULTS: Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p < .001). Emergency/inpatient visits declined (by 9 percent, p < .001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p < .001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49). CONCLUSIONS: Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits.

[Healthcare 4.0-Medicine in transition]. / Healthcare 4.0 ­ Medizin im Wandel.

Healthcare 4.0 describes the future transformation of the healthcare sector driven by the combination of digital technologies, such as artificial intelligence (AI), big data and the Internet of Medical Things, enabling the advancement of precision medicine. This overview article addresses various areas such as large language models (LLM), diagnostics and robotics, shedding light on the positive aspects of Healthcare 4.0 and showcasing exciting methods and application examples in cardiology. It delves into the broad knowledge base and enormous potential of LLMs, highlighting their immediate benefits as digital assistants or for administrative tasks. In diagnostics, the increasing usefulness of wearables is emphasized and an AI for predicting heart filling pressures based on cardiac magnetic resonance imaging (MRI) is introduced. Additionally, it discusses the revolutionary methodology of a digital simulation of the physical heart (digital twin). Finally, it addresses both regulatory frameworks and a brief vision of data-driven healthcare delivery, explaining the need for investments in technical personnel and infrastructure to achieve a more effective medicine.

[Telemedical care concepts for heart failure: status and future]. / Telemedizinische Versorgungskonzepte bei Herzinsuffizienz: Status und Zukunft.

Telemedical care concepts provide opportunities to improve the care of patients with chronic heart failure (CHF). The current state of telemedical technologies enables the effective monitoring of the disease. Germany is one of the first European countries with an entitlement to telemedical supporting care for CHF patients. The decision of the German Federal Joint Committee in 2020 to introduce telemedical supporting care for CHF patients marks a milestone. For the first time, a digital care procedure was included in the benefits catalogue of the statutory health insurance funds due to its proven benefits in terms of morbidity and mortality. Privately insured CHF patients have been entitled to these benefits since January 2024. Future developments, particularly with respect to artificial intelligence procedures in telemedicine, are promising but require more evidence. Further research, technological innovation and supportive policy frameworks are needed to realize the full potential of these approaches. Continued collaboration between healthcare professionals, technology developers and policy makers will be crucial in sustainably improving the care of heart failure patients with telemedicine.

[eHealth: digital bridges in the healthcare system]. / E-Health: digitale Brücken im Versorgungssystem.

Healthcare in Germany is divided into various service sectors, which differ in terms of outpatient and inpatient care as well as the legal and financial bases. The resulting breaks in consecutive patient care are to be overcome by integrating services into cross-sectoral processes (integrated care). Digitalization and the associated use of information and communication technology (ICT) play a decisive role in this. To derive implications and benefits it is necessary to classify the technical possibilities. For this purpose, eHealth is the basic generic term for all process support and direct patient applications that are based on the electronic exchange of data. A distinction can be made between technology for process support and technology for direct application on the patient. Applications in all categories are suitable for ensuring that interfaces in the flow of information between those involved in healthcare processes are adequately managed by eHealth. Furthermore, the allocation of specialized medicine through eHealth is independent of location and sector. New possibilities for generating and using structured data for evidence development and care research are realized through eHealth and the development of existing and new care models will be promoted.

The New Emerging Treatment Choice for Major Depressive Disorders: Digital Therapeutics.

The chapter provides an in-depth analysis of digital therapeutics (DTx) as a revolutionary approach to managing major depressive disorder (MDD). It discusses the evolution and definition of DTx, their application across various medical fields, regulatory considerations, and their benefits and limitations. This chapter extensively covers DTx for MDD, including smartphone applications, virtual reality interventions, cognitive-behavioral therapy (CBT) platforms, artificial intelligence (AI) and chatbot therapies, biofeedback, wearable technologies, and serious games. It evaluates the effectiveness of these digital interventions, comparing them with traditional treatments and examining patient perspectives, compliance, and engagement. The integration of DTx into clinical practice is also explored, along with the challenges and barriers to their adoption, such as technological limitations, data privacy concerns, ethical considerations, reimbursement issues, and the need for improved digital literacy. This chapter concludes by looking at the future direction of DTx in mental healthcare, emphasizing the need for personalized treatment plans, integration with emerging modalities, and the expansion of access to these innovative solutions globally.

Spina bifida transition care in India: strengths amidst challenges.

In India, adult neurosurgeons are required to care for children regularly because the concept of dedicated pediatric specialty care is not yet entirely established in the subcontinent. Likewise, pediatric neurosurgeons do not exclusively offer their services to the young, but they also provide care to adult patients with neurosurgical disorders. This creates a medical system where the transition between specialties is not often a formal and recognized aspect of neurosurgical care because most neurosurgeons provide care for patients of all ages. Additionally, there are very few teams geared toward caring for conditions in children that merit lifelong medical support, with spina bifida (SB) being one of them. Since there are no focused or structured pediatric programs on a large scale, developing a multidisciplinary clinic for adults becomes challenging. A pragmatic approach using technology-based education, supported by an organized system or a coordinator, may be a new strategy. A new system utilizing telemedicine and smartphones for established patients maybe an alternative option for SB children in India. During virtual video conferences, an established patient may benefit from multispecialty care and education toward a smooth transition that avoids significant issues with time, transportation, or financial constraints. Achieving a seamless transition among allied specialists from the pediatric to adult systems is a utopia. The current system in the subcontinent may be improved, with an opportunity to develop smooth transition care between coordinated specialists (who simultaneously treat children and adults). Learning from various global SB management styles, the Indian transition situation may offer another model in the near future.

Evolutionary Trends in the Adoption, Adaptation, and Abandonment of Mobile Health Technologies: Viewpoint Based on 25 Years of Research.

Over the past quarter-century, mobile health (mHealth) technologies have experienced significant changes in adoption rates, adaptation strategies, and instances of abandonment. Understanding the underlying factors driving these trends is essential for optimizing the design, implementation, and sustainability of interventions using these technologies. The evolution of mHealth adoption has followed a progressive trajectory, starting with cautious exploration and later accelerating due to technological advancements, increased smartphone penetration, and growing acceptance of digital health solutions by both health care providers and patients. However, alongside widespread adoption, challenges related to usability, interoperability, privacy concerns, and socioeconomic disparities have emerged, necessitating ongoing adaptation efforts. While many mHealth initiatives have successfully adapted to address these challenges, technology abandonment remains common, often due to unsustainable business models, inadequate user engagement, and insufficient evidence of effectiveness. This paper utilizes the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework to examine the interplay between the academic and industry sectors in patterns of adoption, adaptation, and abandonment, using 3 major mHealth innovations as examples: health-related SMS text messaging, mobile apps and wearables, and social media for health communication. Health SMS text messaging has demonstrated significant potential as a tool for health promotion, disease management, and patient engagement. The proliferation of mobile apps and devices has facilitated a shift from in-person and in-clinic practices to mobile- and wearable-centric solutions, encompassing everything from simple activity trackers to advanced health monitoring devices. Social media, initially characterized by basic text-based interactions in chat rooms and online forums, underwent a paradigm shift with the emergence of platforms such as MySpace and Facebook. This transition ushered in an era of mass communication through social media. The rise of microblogging and visually focused platforms such as Twitter(now X), Instagram, Snapchat, and TikTok, along with the integration of live streaming and augmented reality features, exemplifies the ongoing innovation within the social media landscape. Over the past 25 years, there have been remarkable strides in the adoption and adaptation of mHealth technologies, driven by technological innovation and a growing recognition of their potential to revolutionize health care delivery. Each mobile technology uniquely enhances public health and health care by catering to different user needs. SMS text messaging offers wide accessibility and proven effectiveness, while mobile apps and wearables provide comprehensive functionalities for more in-depth health management. Social media platforms amplify these efforts with their vast reach and community-building potential, making it essential to select the right tool for specific health interventions to maximize impact and engagement. Nevertheless, continued efforts are needed to address persistent challenges and mitigate instances of abandonment, ensuring that mHealth interventions reach their full potential in improving health outcomes and advancing equitable access to care.

Development Trends and Prospects of Technology-Based Solutions for Health Challenges in Aging Over the Past 25 Years: Bibliometric Analysis.

BACKGROUND: As the global population ages, we witness a broad scientific and technological revolution tailored to meet the health challenges of older adults. Over the past 25 years, technological innovations, ranging from advanced medical devices to user-friendly mobile apps, are transforming the way we address these challenges, offering new avenues to enhance the quality of life and well-being of the aging demographic. OBJECTIVE: This study aimed to systematically review the development trends in technology for managing and caring for the health of older adults over the past 25 years and to project future development prospects. METHODS: We conducted a comprehensive bibliometric analysis of literatures related to technology-based solutions for health challenges in aging, published up to March 18, 2024. The search was performed using the Web of Science Core Collection, covering a span from 1999 to 2024. Our search strategy was designed to capture a broad spectrum of terms associated with aging, health challenges specific to older adults, and technological interventions. RESULTS: A total of 1133 publications were found in the Web of Science Core Collection. The publication trend over these 25 years showed a gradual but fluctuating increase. The United States was the most productive country and participated in international collaboration most frequently. The predominant keywords identified through this analysis included "dementia," "telemedicine," "older-adults," "telehealth," and "care." The keywords with citation bursts included "telemedicine" and "digital health." CONCLUSIONS: The scientific and technological revolution has significantly improved older adult health management, particularly in chronic disease monitoring, mobility, and social connectivity. The momentum for innovation continues to build, with future research likely to focus on predictive analytics and personalized health care solutions, further enhancing older adults' independence and quality of life.

Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature.

BACKGROUND: Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. OBJECTIVE: The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. METHODS: Google Trends data were retrieved using the search topics "telemedicine" or "e-health" to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms "telemedicine" or "eHealth" (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. RESULTS: Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=-22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. CONCLUSIONS: Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives.

ChatGPT in surgery: a revolutionary innovation?

ChatGPT has brought about a new era of digital health, as this model has become prominent and been rapidly developing since its release. ChatGPT may be able to facilitate improvements in surgery as well; however, the influence of ChatGPT on surgery is largely unknown at present. Therefore, the present study reports on the current applications of ChatGPT in the field of surgery, evaluating its workflow, practical implementations, limitations, and future perspectives. A literature search was performed using the PubMed and Embase databases. The initial search was performed from its inception until July 2023. This study revealed that ChatGPT has promising capabilities in areas of surgical research, education, training, and practice. In daily practice, surgeons and surgical residents can be aided in performing logistics and administrative tasks, and patients can be more efficiently informed about the details of their condition. However, priority should be given to establishing proper policies and protocols to ensure the safe and reliable use of this model.

Advances in Portable and Wearable Acoustic Sensing Devices for Human Health Monitoring.

The practice of auscultation, interpreting body sounds to assess organ health, has greatly benefited from technological advancements in sensing and electronics. The advent of portable and wearable acoustic sensing devices marks a significant milestone in telemedicine, home health, and clinical diagnostics. This review summarises the contemporary advancements in acoustic sensing devices, categorized based on varied sensing principles, including capacitive, piezoelectric, and triboelectric mechanisms. Some representative acoustic sensing devices are introduced from the perspective of portability and wearability. Additionally, the characteristics of sound signals from different human organs and practical applications of acoustic sensing devices are exemplified. Challenges and prospective trends in portable and wearable acoustic sensors are also discussed, providing insights into future research directions.

Analysis of Telehealth Discussion Trends on Reddit (2019-2022).

Introduction: Use of telehealth increased during the COVID-19 pandemic and continues to be a popular health resource. This study analyzed the frequency and sentiment of telehealth discussions on Reddit. Methods: The data set included 13,071 publicly available Reddit submissions containing keywords related to telehealth over a 3-year period. We identified 173 unique subreddit communities, which were coded into mutually exclusive categories: (1) general telehealth, (2) individual care, (3) professional, (4) news, and (5) COVID-19. The Vader lexicon-based machine was used to assign sentiment scores. Results: Most subreddits were coded as individual care (n = 112), professional (n = 26), and news (n = 22). The frequency of submissions increased during the first 2 months of the pandemic and dropped in June 2020, but remained consistent through October 2022. Most Reddit submissions were positive in sentiment (56%). Conclusion: Findings show a mostly positive view of telehealth among Reddit users and an increase in telehealth-related discussions since the COVID-19 pandemic.

An Investigation of Teledermatology Trends in the State of Texas: A Multicenter, Retrospective Cohort Review of an eConsult Service Line.

Background: An eConsult is a growing teledermatology tool that has the potential to address health disparities. Trends in teledermatology usage are still being defined in the context of the pandemic, postpandemic recovery, and a growing nonphysician primary care provider population. Objective: The aim was to understand teledermatology utilization trends for asynchronous dermatology eConsults in the geographically expansive state of Texas. Methods: This multicenter retrospective study examined the eConsult tool within a large, nonprofit health system, comparing characteristics of 893 eConsult visits with 27,189 in-person dermatology encounters from January 2022 to March 2023. Results: When comparing the demographics of patients seen through eConsult versus traditional in-person visits, eConsults demonstrated a significantly higher prevalence of pediatric (22.5% vs. 7.6%, p < 0.001), Hispanic/Latino (20.5% vs. 10.4%, p < 0.001), African American (12.5% vs. 6.9%, p < 0.001), Asian (4.6% vs. 2.1%, p < 0.001), and American Indian (1.0% vs. 0.5%, p = 0.049) patients compared with in-person visits. eConsult users came from areas with a lower percentage of bachelor's degree holders, reduced average household income, and an increased proportion of Medicaid and Tricare users. Physicians (MD/DO) submitted more eConsult cases than nonphysician providers (NPPs), with comparable diagnostic agreement with teledermatologists and similar recommendation rates for in-person dermatology visits. Conclusions: While the limitation of this study was that it was a descriptive data analysis in a single health care system with limited generalizability, eConsults hold promise to broaden dermatologic access for underserved groups, especially children, individuals from underrepresented backgrounds, and Medicaid and Tricare members. While no significant diagnostic or referral differences were seen for eConsults initiated by primary care physician and NPPs, these changing trends should continue to be examined.

[Telemedicine for patients with facial palsy : Current developments and options in otorhinolaryngologic treatment]. / Telemedizin bei Fazialisparese : Aktuelle Entwicklungen und Möglichkeiten bei der Behandlung in der HNO-Heilkunde.

Digitalization is also becoming increasingly important in medicine. The COVID-19 pandemic has further accelerated this process and politicians are trying to create a framework for successful knowledge transfer and better digital medical care. This article describes the role of telemedicine in the treatment of patients suffering from facial nerve palsy. Facial nerve palsy has a wide range of effects, from limitations in facial mobility to psychological sequelae. While many of the acute, idiopathic facial nerve palsies improve after a few weeks, around a third of those affected develop synkinesis, involuntary movements that have lifelong functional and psychological consequences. Treatment includes various modalities, from medication and surgery to movement training. Telemedicine offers innovative solutions in cases of regional underuse, but also in the treatment of chronic facial nerve palsies. The article defines the term "telemedicine" in the current context and presents different types of application. A detailed analysis of the application scenarios of telemedicine in facial nerve palsy patients shows that despite a lack of evidence, many potentially useful concepts exist.

Approaches to Medical Emergencies on Commercial Flights.

In-flight medical incidents are becoming increasingly critical as passengers with diverse health profiles increase in the skies. In this paper, we reviewed how airlines, aviation authorities, and healthcare professionals respond to such emergencies. The analysis was focused on the strategies developed by the top ten airlines in the world by examining training in basic first aid, collaboration with ground-based medical support, and use of onboard medical equipment. Appropriate training of crew members, availability of adequate medical resources on board airplanes, and improved capabilities of dialogue between a flying plane and medical doctors on the ground will contribute to a positive outcome of the majority of medical issues on board airlines. In this respect, the adoption of advanced telemedicine solutions and the improvement of real-time teleconsultations between aircraft and ground-based professionals can represent the future of aviation medicine, offering more safety and peace of mind to passengers in case of medical problems during a flight.

Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review.

Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.

Neurological Examination via Telemedicine: An Updated Review Focusing on Movement Disorders.

Patients with movement disorders such as Parkinson's disease (PD) living in remote and underserved areas often have limited access to specialized healthcare, while the feasibility and reliability of the video-based examination remains unclear. The aim of this narrative review is to examine which parts of remote neurological assessment are feasible and reliable in movement disorders. Clinical studies have demonstrated that most parts of the video-based neurological examination are feasible, even in the absence of a third party, including stance and gait-if an assistive device is not required-bradykinesia, tremor, dystonia, some ocular mobility parts, coordination, and gross muscle power and sensation assessment. Technical issues (video quality, internet connection, camera placement) might affect bradykinesia and tremor evaluation, especially in mild cases, possibly due to their rhythmic nature. Rigidity, postural instability and deep tendon reflexes cannot be remotely performed unless a trained healthcare professional is present. A modified version of incomplete Unified Parkinson's Disease Rating Scale (UPDRS)-III and a related equation lacking rigidity and pull testing items can reliably predict total UPDRS-III. UPDRS-II, -IV, Timed "Up and Go", and non-motor and quality of life scales can be administered remotely, while the remote Movement Disorder Society (MDS)-UPDRS-III requires further investigation. In conclusion, most parts of neurological examination can be performed virtually in PD, except for rigidity and postural instability, while technical issues might affect the assessment of mild bradykinesia and tremor. The combined use of wearable devices may at least partially compensate for these challenges in the future.