Efficacy of Telemedicine Utilization for Cardiac Outpatients’ Care during the Pandemic of COVID-19: A Large Center Experience in the Wave of the PandemicRead the full article
International Journal of Telemedicine and Applications focuses on the applications of medical practice and care at a distance and their supporting technologies such as, computing, communications, and networking technologies.
International Journal of Telemedicine and Applications maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.
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A Smart Chatbot for Interactive Management in Beta Thalassemia Patients
Background. β-thalassemia is an inherited blood disorder that affects the production of hemoglobin molecules owing to the reduction or absence of beta chains. Transfusion therapy has had a key role in extending the lifespan of β-thalassemia patients. This life-saving therapy is linked to numerous assessments and complications that now comprise most thalassemia management considerations. Consequently, many patients do not receive adequate information about the required assessments, as indicated by evidence-based medical guidelines. Patients with β-thalassemia may benefit from chatbots that follow up on their condition and that provide the required assessment information. Self-management will hopefully have a positive impact on health outcomes. Objectives. This study aims to develop a chatbot that can assist in the management of β-thalassemia by providing the assessment information required to monitor patients’ statuses. Methods. The chatbot operated as a messaging system. A question/answer system was created based on knowledge pertaining to β-thalassemia assembled from experts, medical guidelines, and articles. Recommendations regarding the patient’s follow-up assessment are made based on the answers. Results. A prototype was implemented to demonstrate how the chatbots could dynamically and flexibly provide the assessment information required to follow up on and monitor patients. A small sample of adults with β-thalassemia used the chatbot to examine the system’s usability and perceived utility. A system usability scale and utility scale were implemented to complete a post-test survey. The chatbots were considered by 34 patients, of whom the majority (72%) found them easy to use, while more than 90% of patients considered their use beneficial. Most of the participants agreed that the chatbots could improve their knowledge about their β-thalassemia assessments. Conclusion. Our findings suggest that chatbots can be beneficial to the development of recommended tests and management related to the assessment of β-thalassemia.
Malaria Diagnosis Using a Lightweight Deep Convolutional Neural Network
The applications of AI in the healthcare sector are increasing day by day. The application of convolutional neural network (CNN) and mask-region-based CNN (Mask-RCCN) to the medical domain has really revolutionized medical image analysis. CNNs have been prominently used for identification, classification, and feature extraction tasks, and they have delivered a great performance at these tasks. In our study, we propose a lightweight CNN, which requires less time to train, for identifying malaria parasitic red blood cells and distinguishing them from healthy red blood cells. To compare the accuracy of our model, we used transfer learning on two models, namely, the VGG-19 and the Inception v3. We train our model in three different configurations depending on the proportion of data being fed to the model for training. For all three configurations, our proposed model is able to achieve an accuracy of around 96%, which is higher than both the other models that we trained for the same three configurations. It shows that our model is able to perform better along with low computational requirements. Therefore, it can be used more efficiently and can be easily deployed for detecting malaria cells.
Telepresence Robots at the Urology and Emergency Department: A Pilot Study Assessing Patients’ and Healthcare Workers’ Satisfaction
COVID-19 intensified interest in telemedicine, yet no study has evaluated the use of a telepresence robot on unselected urological patients. Therefore, we performed a survey study of patients, bedside caregivers and urologists, investigating the satisfaction and applicability of a telepresence robot (Beam Pro, Suitable Technologies, USA) at the urology ward and emergency department. The primary outcome was the number of patient encounters solved without the urologist’s physical presence. Between March 2021 and May 2021, patients, caregivers, and urologists filled in 42, 35, and 54 questionnaires, respectively. Most patients were male (79%), with a mean age of 64 (). Two of the department’s ten urologists participated. The urologists responded that physical examination was required in 7 (13%) encounters. The caregivers would have preferred the urologist physically present in 11 (31%) cases. Most patients (71%) “agreed” or “strongly agreed” that they were willing to be attended by a telepresence robot at future evaluations and generally, patients gave high satisfaction scores. Though implementation among the department’s urologists was a major challenge, participating urologists reported that physical presence could be avoided in 87% of the patient encounters. Studies of patient-reported outcome measures comparing telemedical and physical patient encounters are needed.
Healthcare Providers’ Perspective about the Use of Telemedicine in Egypt: A National Survey
Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients’ data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption.
Remote ECG Monitoring by ECG247 Smart Heart Sensor
Background. Heart rhythm disorders are common and may be associated with serious complications. The quality of the ECG signal is crucial to detect and classify arrhythmias. Most available devices for assessment arrhythmias do not allow for remote monitoring. The Norwegian ECG247 Smart Heart Sensor is a new remote patch monitor developed to simplify the assessment of arrhythmias. This study was aimed at evaluating the quality of the ECG signal from the ECG247 Smart Heart Sensor compared to standard 12-lead ECG. Methods. ECG recordings with ECG247 Smart Heart Sensor and a standard 12-lead ECG recorder were performed in 97 volunteers at Sorlandet Hospital, Arendal, Norway, in 2019. All ECGs were analysed by two independent cardiologists. Results. A total of 97 participants (53% men, age 48 (±14) years) were included in the study. The ability for both systems to use recorded ECG data for arrhythmia detection was good (100%). The quality of the P-wave (mean score 1.1 vs. 1.5) and the QRS complex (mean score 1.0 vs. 1.0) from the ECG247 Smart Heart Sensor and that from the 12-lead ECG were comparable (scale: 1: extremely good, 9: not accepted). Noise artefacts were a minor issue in all recordings. Conclusions. The ECG quality from the ECG247 Smart Heart Sensor was comparable to the ECG quality from the standard 12-lead ECG. The ECG247 Smart Heart Sensor may enable easy and remote diagnostics of heart rhythm disorders. This trial is registered with NCT04700865.
Impact of Implementing Teleophthalmology Referral Guidelines Using the eyeSmart EMR App in 63,703 Patients from India
Objective. To describe the clinical indications and the impact of implementation of specific teleophthalmology referral guidelines in a large rural village vision centre network in India. Methods. This cross-sectional vision centre-based study included 1,016,284 patients presenting between January 2017 and March 2020. Patients who were referred for a teleophthalmology opinion were included as cases. The data were collected using the eyeSmart EMR app on a smart tablet. A training intervention was done to reinforce the implementation of targeted teleophthalmology referral guidelines. Results. Overall, 63,703 (6.3%) patients were referred for a teleophthalmology opinion and were included for analysis. The median age was 41 (IQR: 26-59) years, and adults (88.4%) were commonly referred for a consult. The two most common age groups were between 31-40 years (17.4%) and 21-30 years (16.3%), and the majority of patients were male (59.1%). The most common clinical indication was cornea and anterior segment disorders (71.05%). The most common queries for teleophthalmology referral before versus after the reinforcement of implementation of guidelines were red eye (33.4% vs. 45.6%) followed by cataract (21.2% vs. 8.1%). There was an increase in the red eye (<0.001) and a decrease in cataract (<0.001) which was statistically significant. The proportion of patients for whom a teleophthalmology consult could have been requested but not sent was minimal (2.3%). Conclusion. Implementation of targeted teleophthalmology referral guidelines enables an effective triage to seek opinion for more pertinent ocular diseases that require care. Adult male patients with cornea and anterior segment disorders are most commonly referred for a teleophthalmology opinion.