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  • NLM标题： Telemed J E Health
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  • 1.

    【2hr】A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure

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    机译 比较服务不足的黑人和西班牙裔心衰患者的远程医疗自我管理与标准门诊管理的随机对照试验
    摘要：>Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days.>Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate.>Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83–2.27), hospitalization (RR = 0.92, CI = 0.57–1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50–28%; COM = 57–13%; p = 0.05).>Conclusions: These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.
  • 2.

    【2hr】Quality Assurance in Telehealth: Adherence to Evidence-Based Indicators

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    机译 远程医疗的质量保证：遵守循证指标
    摘要：>Background: Value enhancing telehealth (TH) lacks a robust body of formal clinically focused quality assessment studies. Innovations such as telehealth must always demonstrate that it preserves or hopefully advances quality.>Introduction: We sought to determine whether adherence to the evidence-based Choosing Wisely (CW) recommendations (antibiotic stewardship) for acute sinusitis differs for encounters through direct-to-consumer (DTC) telemedicine verses “in-person” care in an emergency department (ED) or an urgent care (UC) center.>Materials and Methods: Study design was a retrospective review. Patients with a symptom complex consistent with acute sinusitis treated through DTC were matched with ED and UC patients, based upon time of visit. Charts were reviewed to determine patient characteristics, chief complaint, final diagnosis, presence or absence of criteria within the CW guidelines, and whether or not antibiotics were prescribed. The main outcome was adherence to the CW campaign recommendations.>Results: A total of 570 visits were studied: 190 DTC, 190 ED, and 190 UC visits. The predominant chief complaints were upper respiratory infection (36%), sore throat (25%), and sinusitis (18%). Overall, there was a 67% (95% CI 62.3–71.7) adherence rate with the CW guidelines for sinusitis: DTC visits (71%), ED visits (68%), and UC visits (61%). There was a nonsignificant difference (p = 0.29) in adherence to CW guidelines based upon type of visit (DTC, UC, and ED).>Discussion: The challenge is to demonstrate whether or not DTC TH compromises quality.>Conclusion: In this study, DTC visits were associated with at least as good an adherence to the CW campaign recommendations as emergency medicine (EM) and UC in-person visits.
  • 3.

    【2hr】Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

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    机译 在城市远眼科计划中眼科护理人员之间的糖尿病性视网膜病变评估差异
    摘要：>Background: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability.>Introduction: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program.>Methods: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (Ppos) or negative agreement (Pneg) were used to assess variability.>Results: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% ± 4.6%, Pneg = 0.91–0.95), presence of moderate nonproliferative or worse retinopathy (87% ± 3.9%, Ppos = 0.67–1.00), and presence of macular edema (99% ± 0.9%, Ppos = 0.67–1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% ± 11%, Ppos = 0.21–0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% ± 8.1%, Ppos = 0.19–0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% ± 5.0%, Ppos = 0.50–0.90).>Discussion: Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times.>Conclusions: Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.
  • 4.

    【2hr】The Third National Telemedicine Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships

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    机译 第三届全国远程医疗与远程医疗服务提供商展示会议：推进远程医疗合作伙伴关系
    摘要：>Introduction: As telemedicine and telehealth services are experiencing increasing rates of adoption, industry leaders and healthcare service providers are becoming increasingly focused on human resource issues encountered in the delivery of a broad range of telehealth services. To create a forum for the discussion of many interrelated elements of telehealth service industry, a national conference entitled “Telemedicine & Telehealth Service Provider Showcase” (SPS) Conference was established in 2014, and repeated in 2016 and 2017, in Arizona. These SPS Conferences include thought leaders, telehealth service providers, government administrators, and academicians from leading programs addressing service provider workforce issues.>Methods: This report summarizes the content of SPS 2017 conference, held in Phoenix, AZ, October 2–3, 2017. The topics covered at SPS 2017 include using telehealth services as a strategic asset; development of appropriate effective partnerships; direct-to-consumer initiatives; important reimbursement, legislative, and regulatory issues (i.e., Centers for Medicare & Medicaid Services [CMS] approaches, financial models, and return on investment [ROI]); marketing; evaluation and applied metrics; remote monitoring and sensors; integration with electronic health records; and overall lessons learned.>Results: The content of SPS 2017 is summarized in the body of this report. The SPS 2017 program evaluators included attendees, speakers, and exhibitors. The knowledge attendees gained at SPS 2017 was characterized, by all three groups, as forward-looking and practical.>Conclusion: SPS 2017 succeeded in identifying, and focusing on, solutions for issues, challenges, and barriers impacting the rapidly expanding telehealth service segment of the healthcare industry. The growing interest in this annual SPS Conference series apparently reflects, in part, the program committee's successes in identifying practical issues and their potential solutions.
  • 5.

    【2hr】Factors Influencing Rural End-Users Acceptance of e-Health in Developing Countries: A Study on Portable Health Clinic in Bangladesh

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    机译 影响发展中国家农村最终用户接受电子医疗的因素：孟加拉国便携式医疗诊所的研究
    摘要：>Background: Existing studies regarding e-health are mostly focused on information technology design and implementation, system architecture and infrastructure, and its importance in public health with ancillaries and barriers to mass adoption. However, not enough studies have been conducted to assess the end-users' reaction and acceptance behavior toward e-health, especially from the perspective of rural communities in developing countries.>Objective: The objective of this study is to explore the factors that influence rural end users' acceptance of e-health in Bangladesh.>Methods: Data were collected between June and July 2016 through a field survey with structured questionnaire form 292 randomly selected rural respondents from Bheramara subdistrict, Bangladesh. Technology Acceptance Model was adopted as the research framework. Logistic regression analysis was performed to test the theoretical model.>Results: The study found social reference as the most significantly influential variable (Coef. = 2.28, odds ratio [OR] = 9.73, p < 0.01) followed by advertisement (Coef. = 1.94, OR = 6.94, p < 0.01); attitude toward the system (Coef. = 1.52, OR = 4.56, p < 0.01); access to cellphone (Coef. = 1.37, OR = 3.92, p < 0.05), and perceived system effectiveness (Coef. = 0.74, OR = 2.10, p < 0.01). Among demographic variables, age, gender, and education were found significant while we did not find any significant impact of respondents' monthly family expenditure on their e-health acceptance behavior. The model explains 54.70% deviance (R2 = 0.5470) in the response variable with its constructs. The “Hosmer-Lemeshow” goodness-of-fit score (0.539) is also above the standard threshold (0.05), which indicates that the data fit well with the model.>Conclusion: The study provides guidelines for the successful adoption of e-health among rural communities in developing countries. This also creates an opportunity for e-health technology developers and service providers to have a better understanding of their end users.
  • 6.

    【2hr】A Clinical Decision Support System for Diabetic Retinopathy Screening: Creating a Clinical Support Application

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    机译 糖尿病视网膜病变筛查的临床决策支持系统：创建临床支持应用程序
    摘要：>Background: The aim of this study was to build a clinical decision support system (CDSS) in diabetic retinopathy (DR), based on type 2 diabetes mellitus (DM) patients.>Method: We built a CDSS from a sample of 2,323 patients, divided into a training set of 1,212 patients, and a testing set of 1,111 patients. The CDSS is based on a fuzzy random forest, which is a set of fuzzy decision trees. A fuzzy decision tree is a hierarchical data structure that classifies a patient into several classes to some level, depending on the values that the patient presents in the attributes related to the DR risk factors. Each node of the tree is an attribute, and each branch of the node is related to a possible value of the attribute. The leaves of the tree link the patient to a particular class (DR, no DR).>Results: A CDSS was built with 200 trees in the forest and three variables at each node. Accuracy of the CDSS was 80.76%, sensitivity was 80.67%, and specificity was 85.96%. Applied variables were current age, gender, DM duration and treatment, arterial hypertension, body mass index, HbA1c, estimated glomerular filtration rate, and microalbuminuria.>Discussion: Some studies concluded that screening every 3 years was cost effective, but did not personalize risk factors. In this study, the random forest test using fuzzy rules permit us to build a personalized CDSS.>Conclusions: We have developed a CDSS that can help in screening diabetic retinopathy programs, despite our results more testing is essential.
  • 7.

    【2hr】m-Health Policy Readiness and Enabling Factors: Comparisons of Sub-Saharan Africa and Organization for Economic Cooperation and Development Countries

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    机译 移动医疗政策的就绪状态和促成因素：撒哈拉以南非洲与经济合作与发展组织的比较
    摘要：>Background: As an innovative solution to poor access to care in low- and middle-income countries (LMICs), m-health has gained wide attention in the past decade.>Introduction: Despite enthusiasm from the global health community, LMICs have not demonstrated high uptake of m-health promoting policies or public investment.>Materials and Methods: To benchmark the current status, this study compared m-health policy readiness scores between sub-Saharan Africa and high-income Organization for Economic Cooperation and Development (OECD) countries using an independent two-sample t test. In addition, the enabling factors associated with m-health policy readiness were investigated using an ordinal logistic regression model. The study was based on the m-health policy readiness scores of 112 countries obtained from the World Health Organization Third Global Survey on e-Health.>Results: The mean m-health policy readiness score for sub-Saharan Africa was statistically significantly lower than that for OECD countries (p = 0.02). The enabling factors significantly associated with m-health policy readiness included information and communication technology development index (odds ratio [OR] 1.57; 95% confidence interval [CI] 1.12–2.2), e-health education for health professionals (OR 4.43; 95% CI 1.60–12.27), and the location in sub-Saharan Africa (OR 3.47; 95% CI 1.06–11.34).>Discussion: The findings of our study suggest dual policy goals for m-health in sub-Saharan Africa. First, enhance technological and educational support for m-health. Second, pursue global collaboration for building m-health capacity led by sub-Saharan African countries with hands-on experience and knowledge.>Conclusion: Globally, countries should take a systematic and collaborative approach in pursuing m-health policy with the focus on technological and educational support.
  • 8.

    【2hr】Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study

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    机译 使用消费类设备进行的远程医疗体检表明喉咙痛急诊患者的体格检查与亲自体检的一致性差：一项前瞻性盲研究
    摘要：>Background: Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat.>Materials and Methods: This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine.>Results: Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation.>Conclusion: Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of the physical examination in treatment decisions for patients with sore throat and the use of telemedicine in avoiding in-person healthcare visits.
  • 9.

    【2hr】Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network

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    机译 频繁的轮辐联系与改进的医院绩效相关：马萨诸塞州综合医院远程卒中网络的结果
    摘要：>Background: For acute ischemic stroke patients, shorter time to thrombolytic (tissue plasminogen activator [tPA]) is associated with improved outcomes.>Introduction: Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times for tPA administration is unknown. We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact.>Materials and Methods: We identified 375 patients treated with tPA by conventional or telestroke methods in an academic hub-and-spoke telestroke network for whom date and time data were available. Strength of the spoke–hub connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient's presentation. Patient-level regression analyses examined the relationship between DTN time and spoke–hub connection during the year of the patient's presentation, controlling for temporal trends and clustering within hospitals.>Results: Sixteen spoke hospitals contributed data on 375 tPA-treated patients from 2006–2015. Hospitals treated a median of 13.5 patients with tPA per year; median hospital-level DTN was 78.8 min (interquartile range [IQR] 71.3–85). Median number of telestroke consults per year was 34 (range 3–137). Among all 375 patients, median DTN was 76 min (IQR 60–97). Strength of spoke–hub connection was significantly associated with faster DTN time for patients (1.3 min gain per 10 additional consults, p = 0.048).>Conclusions: More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for secular trends in DTN improvements.
  • 10.

    【2hr】Asynchronous Telepsychiatry: A Component of Stepped Integrated Care

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    机译 异步远程精神病学：逐步综合护理的组成部分
    摘要：>Objective: Integrated behavioral healthcare models typically involve a range of consultation options for mental healthcare. Asynchronous telepsychiatry (ATP) consults may be an additional potential choice, so we are conducting a 5-year clinical trial comparing ATP with synchronous telepsychiatry (STP) consultations.>Methods: Patients referred by primary care providers are randomly assigned to one of the two treatment groups, ATP or STP. Clinical outcome, satisfaction, and economic data are being collected from patients for 2 years at 6-month intervals.>Results: Baseline characteristics for the first 158 patients and case examples of ATP are presented.>Conclusion: Implementing ATP in existing integrated behavioral healthcare models could make mental healthcare more efficient.
  • 11.

    【2hr】Accuracy and Reliability of a Handheld Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema

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    机译 手持非散瞳眼底照相机的远程视盘水肿检测的准确性和可靠性
    摘要：>Background: Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty.>Introduction: The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema.>Materials and Methods: Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics.>Results: The sensitivity and specificity for detection of optic disc edema were 71.8–92.2% and 81.6–95.2%, respectively. Photos were found to be ungradable in 0–8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52–0.67] to 0.72 (95% CI: 0.66–0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63–0.92) to 0.82 (95% CI: 0.69–0.95).>Discussion: Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate–strong and strong within individual providers.>Conclusions: Portable photography holds promise for use in remote screening of optic disc edema.
  • 12.

    【2hr】Predicting Pulmonary Function from Phone Sensors

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    机译 通过电话传感器预测肺功能
    摘要：>Introduction: Smartphones are ubiquitous, but it is unknown what physiological functions can be monitored at clinical quality. Pulmonary function is a standard measure of health status for cardiopulmonary patients. We have shown phone sensors can accurately measure walking patterns. Here we show that improved classification models can accurately predict pulmonary function, with sole inputs being motion sensors from carried phones.>Subjects and Methods: Twenty-five cardiopulmonary patients performed 6-minute walk tests in pulmonary rehabilitation at a regional hospital. They carried smartphones running custom software recording phone motion. Each patient's pulmonary function was measured by spirometry. A universal model, based on support vector machine, then computed the category of function with input from signal processing features and patient demographic features.>Results: All but a few of every 10-second interval for every patient was correctly predicted. The trained model perfectly computed the GOLD (Global Initiative for Chronic Obstructive Lung Disease) level 1/2/3, which is a standard classification of pulmonary function. Each level was determined to have a characteristic motion, which could be recognized from the sensor features. In addition, longitudinal changes were detected for 10 patients with multiple walk tests, except for cases with clinical instability.>Conclusions: These results are encouraging toward clinical validation of passive monitors running continuously in the background, for patients in homes during daily activities. Initial testing indicates the same high accuracy as with active monitors, for patients in hospitals during walk tests. We expect patients can simply carry their phones during everyday living, while models support automatic prediction of pulmonary function for health monitoring.
  • 13.

    【2hr】The Impact of Prospective Telemedicine Implementation in the Management of Childhood Acute Lymphoblastic Leukemia in Recife Brazil

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    机译 前瞻性远程医疗实施对巴西累西腓儿童急性淋巴细胞白血病的管理的影响
    摘要：>Background: A gap in childhood cancer outcomes remains between developed and developing countries. Persistence of this gap may be caused by financial, social, or educational disparities. Twinning and distance learning initiatives may improve such disparities. Integrating telemedicine into pediatric oncology twinning programs enhances education and facilitates patient-centered capacity building.>Materials and Methods: We performed an analysis of Web-based meetings held from August 2005 through July 2009 between the International Outreach Program at St. Jude Children's Research Hospital and the Instituto Materno Infantil de Pernambuco (IMIP) in Recife, Brazil. We determined the effect of these online conferences on the development and implementation of an innovative protocol for children with acute lymphoblastic leukemia (ALL) at IMIP.>Results: Meetings occurred in 45 months of the 48-month study period with an average of two meetings per month. A total of 163 new patients were discussed during the study period; we retrieved documentation of patient-related discussions for 147 of them, constituting 286 discussions. On average, each patient was discussed 1.9 times (range, 1–15 discussions/patient). Compared with that of the era predating the online meetings (1993–2005), overall mortality, early death, and relapse of patients with ALL decreased after the telemedicine program was instituted at IMIP.>Discussion: Personal dedication and institutional support are essential for successful telemedicine initiatives. Documentation and archival of meetings are important for accurately measuring outcomes and developing methods for improved care.>Conclusions: Integration of telemedicine into twinning programs facilitates communication about interventions, leading to improved outcomes of pediatric patients with cancer.
  • 14.

    【2hr】Patient and Provider Satisfaction with Teledermatology

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    机译 病人和医疗服务提供者对皮肤科的满意度
    摘要：>Background: There is little research comparing dermatologist and patient satisfaction with in-person, store-and-forward, and live interactive examinations.>Objective: To compare satisfaction with in-person examinations to store-and-forward and live interactive consultations having two types of video.>Methods: A controlled study was conducted where patients referred for dermatology consultations were examined in-person, by video, and by store-and-forward methods. Video changed between compressed and uncompressed on alternate clinics. Patients and dermatologists rated encounters after each examination. Dermatologists doing store-and-forward evaluations rated the quality of information provided. After experiencing all methods patients ranked their preferences. Dermatologists ranked their preferences at the end of the study.>Results: In-person examinations were preferred by both patients and dermatologists. Overall, satisfaction with teledermatology was still high. Patients were evenly divided in preferring store-and-forward workups or live interactive video. Dermatologists were also divided on store-and-forward and uncompressed video, but tended toward the latter. Compressed video was the least preferred method among dermatologists.>Limitations: Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice.>Conclusions: Patients and dermatologists prefer in-person examinations and diverge on preferring store-and-forward and live interactive when video is not compressed. The amount of video compression that can be applied without noticeable image degradation is a question for future research.
  • 15.

    【2hr】Rural and Urban/Suburban Families Use of a Web-Based Mental Health Intervention

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    机译 农村和城市/郊区家庭对基于网络的心理健康干预措施的使用
    摘要：>Background/Introduction: Access to mental healthcare among rural residents is a national concern because unique barriers (e.g., fewer providers, distance to services) create significant challenges for the 60 million Americans who live in these settings. There is now a large body of literature demonstrating the efficacy of a wide range of Internet-based interventions. However, little is known about the extent to which individuals in rural settings will use these approaches and find them acceptable. Research with youths and their caregivers within this scope is particularly limited and, therefore, of great importance. >Methods: We examined access and completion of a Web-based disaster mental health intervention in a population-based sample of 1,997 rural (n = 676) and urban/suburban (n = 1,321) adolescents and their caregivers who were affected by the Spring 2011 tornadoes that touched down in parts of Missouri and Alabama. >Results: Results indicated no differences in the rate of access or completion of Web-based modules based on geographical location. Furthermore, for those who did not access the Web-based resource, no differences were observed with respect to reasons for not accessing modules based on geographical location. >Discussion: These data have promising implications for the reach of Web-based resources to both rural and urban/suburban communities, as well as the willingness of adolescents and their caregivers to access and complete such resources, regardless of geographical location.
  • 16.

    【2hr】Eye Disease in Patients with Diabetes Screened with Telemedicine

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    机译 远程医疗筛查的糖尿病患者的眼病
    摘要：>Background: Telemedicine with nonmydriatic cameras can detect not only diabetic retinopathy but also other eye disease. >Objective: To determine the prevalence of eye diseases detected by telemedicine in a population with a high prevalence of minority and American Indian/Alaskan Native (AI/AN) ethnicities. >Subjects and Methods: We recruited diabetic patients 18 years and older and used telemedicine with nonmydriatic cameras to detect eye disease. Two trained readers graded the images for diabetic retinopathy, age-related macular degeneration (ARMD), glaucomatous features, macular edema, and other eye disease using a standard protocol. We included both eyes for analysis and excluded images that were too poor to grade. >Results: We included 820 eyes from 424 patients with 72.3% nonwhite ethnicity and 50.3% AI/AN heritage. While 283/424 (66.7%) patients had normal eye images, 120/424 (28.3%) had one disease identified; 15/424 (3.5%) had two diseases; and 6/424 (1.4%) had three diseases in one or both eyes. After diabetic retinopathy (104/424, 24.5%), the most common eye diseases were glaucomatous features (44/424, 10.4%) and dry ARMD (24/424, 5.7%). Seventeen percent (72/424, 17.0%) showed eye disease other than diabetic retinopathy. >Conclusions: Telemedicine with nonmydriatic cameras detected diabetic retinopathy, as well as other visually significant eye disease. This suggests that a diabetic retinopathy screening program needs to detect and report other eye disease, including glaucoma and macular disease.
  • 17.

    【2hr】Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review

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    机译 通过非侵入性数字技术进行的远程患者监护：系统评价
    摘要：>Background: We conducted a systematic literature review to identify key trends associated with remote patient monitoring (RPM) via noninvasive digital technologies over the last decade. >Materials and Methods: A search was conducted in EMBASE and Ovid MEDLINE. Citations were screened for relevance against predefined selection criteria based on the PICOTS (Population, Intervention, Comparator, Outcomes, Timeframe, and Study Design) format. We included studies published between January 1, 2005 and September 15, 2015 that used RPM via noninvasive digital technology (smartphones/personal digital assistants [PDAs], wearables, biosensors, computerized systems, or multiple components of the formerly mentioned) in evaluating health outcomes compared to standard of care or another technology. Studies were quality appraised according to Critical Appraisal Skills Programme. >Results: Of 347 articles identified, 62 met the selection criteria. Most studies were randomized control trials with older adult populations, small sample sizes, and limited follow-up. There was a trend toward multicomponent interventions (n = 26), followed by smartphones/PDAs (n = 12), wearables (n = 11), biosensor devices (n = 7), and computerized systems (n = 6). Another key trend was the monitoring of chronic conditions, including respiratory (23%), weight management (17%), metabolic (18%), and cardiovascular diseases (16%). Although substantial diversity in health-related outcomes was noted, studies predominantly reported positive findings. >Conclusions: This review will help decision makers develop a better understanding of the current landscape of peer-reviewed literature, demonstrating the utility of noninvasive RPM in various patient populations. Future research is needed to determine the effectiveness of RPM via noninvasive digital technologies in delivering patient healthcare benefits and the feasibility of large-scale implementation.
  • 18.

    【2hr】The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

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    机译 远程放射学和相关应用的经验基础：证据综述
    摘要：>Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. >Methods: A selective review of the credible literature during the past decade (2005–2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. >Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
  • 19.

    【2hr】Current State and Model for Development of Technology-Based Care for Attention Deficit Hyperactivity Disorder

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    机译 基于技术的注意力缺陷多动障碍护理的现状和发展模型
    摘要：>Introduction: Care (i.e., evaluation and intervention) delivered through technology is used in many areas of mental health services, including for persons with attention deficit hyperactivity disorder (ADHD). Technology can facilitate care for individuals with ADHD, their parents, and their care providers. The adoption of technological tools for ADHD care requires evidence-based studies to support the transition from development to integration into use in the home, school, or work for persons with the disorder. The initial phase, which is development of technological tools, has begun in earnest; however, the evidence base for many of these tools is lacking. In some instances, the uptake of a piece of technology into home use or clinical practice may be further along than the research to support its use. >Methods: In this study, we review the current evidence regarding technology for ADHD and also propose a model to evaluate the support for other tools that have yet to be tested. >Results: We propose using the Research Domain Criteria as a framework for evaluating the tools' relationships to dimensions related to ADHD. >Conclusion: This article concludes with recommendations for testing new tools that may have promise in improving the evaluation or treatment of persons with ADHD.
  • 20.

    【2hr】Telehealth Measures Screening for Developmental Language Disorders in Spanish-Speaking Toddlers

    包量

    机译 远程医疗措施筛查西班牙语幼儿的发展性语言障碍
    • 作者：Mark Guiberson
    • 刊名：Telemedicine Journal and e-Health
    • -1年第9期
    摘要：>Background: This is the second of two studies that described the use of telehealth language screening measures for use with young Spanish-speaking children. >Introduction: The purpose of this study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking toddler-age children from rural and underserved areas of the country. >Materials and Methods: This study applied an asynchronous hybrid telehealth approach that implemented parent-structured play activities with a standard set of stimuli, and interaction with a My First Words e-book. These interactions were recorded with a mini camcorder. In addition, a traditional pen and paper parent questionnaire measure was collected. Sixty-two mostly Spanish-speaking preschool-age children and their parents participated. Twenty-two children had developmental language disorders (DLDs) and 40 had typical language development. >Results: Although several of the individual measures were significantly and strongly associated with standardized language scores, only reported vocabulary had classification accuracy values that were desirable for screening for DLDs. An improvement was observed when reported vocabulary was combined with a number of different words children produced during interactions with parents. >Conclusions: This research provides additional evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. More specifically, reported vocabulary combined with number of different words produced by a child can provide informative and accurate diagnostic information when screening Spanish-speaking toddler-age children for DLDs. These findings replicate the first study in showing that hybrid telehealth approaches that combine the use of video technology and traditional pen and paper surveys yield strong results, and may be a viable screening alternative when face-to-face access to a bilingual provider is not possible.
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