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The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic.
Wu, F, Rotimi, O, Laza-Cagigas, R, Rampal, T
Current oncology (Toronto, Ont.). 2021;(3):2248-2259
Abstract
Patients awaiting cancer treatment were classified as "vulnerable" and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.
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People living with type 1 diabetes point of view in COVID-19 times (COVIDT1 study): Disease impact, health system pitfalls and lessons for the future.
Tejera-Perez, C, Moreno-Pérez, Ó, Rios, J, Reyes-García, R
Diabetes research and clinical practice. 2021;:108547
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AIMS: To analyse the effects of confinement among people with type 1 diabetes (T1D) and their caregivers over the course of the COVID-19 crisis and to evaluate contemporary changes in medical assistance and patient preferences. METHODS An observational cross-sectional study designed as a self-reported web-based survey was conducted over the course of the COVID-19 pandemic. RESULTS A total of 769 subjects participated in the survey (603 people with T1D and 166 caregivers). Changes in glycaemic control were reported in 66% of cases, weight gain in 40.4% of cases and decreased exercise levels in 65.4% of cases. Of the cohort, 53% maintained contact with the healthcare team, and 23% received specific information related to COVID-19. Emotional support was requested by 17% of respondents. Regarding telemedicine, 97.9% agreed with its use with the following preferences regarding the future: telephone call (84.5%), video-call (60.6%) and platform devices (39.7%). CONCLUSIONS Over the course of the COVID-19 pandemic, at least two-thirds of people with T1D underwent changes in the management of their condition. Almost all participants agreed with the concept of telemedicine, favouring telephone and video calls as their preferred means of communication.
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Epidemiological characteristics and therapeutic management of patients with chronic heart failure who use smartphones: Potential impact of a dedicated smartphone application (report from the OFICSel study).
Pezel, T, Berthelot, E, Gauthier, J, Chong-Nguyen, C, Iliou, MC, Juillière, Y, Galinier, MC, De Groote, P, Beauvais, F, Bauer, F, et al
Archives of cardiovascular diseases. 2021;(1):51-58
Abstract
BACKGROUND The effectiveness of transitional care services for patients discharged from hospital after acute heart failure is challenging, especially in terms of reducing subsequent heart failure hospitalizations. The increased adoption of smartphone applications in society offers a new opportunity to interact with patients to avoid rehospitalization. Thus, electronic health (e-health) can enhance the impact of existing therapeutic education programmes. AIMS To determine the prevalence of smartphone use among patients with chronic heart failure, and to assess the epidemiological characteristics and therapeutic management of these patients, with a broader aim of developing smartphone-based therapeutic education programmes for patients. METHODS The French Observatoire français de l'insuffisance cardiaque et du sel (OFICSel) registry was conducted in 2017 by 300 cardiologists, and included both inpatients and outpatients who had been hospitalized for heart failure at least once in the previous 5 years. Data collection included demographic and heart failure-related variables, which were provided by the cardiologist and by the patient via a questionnaire. RESULTS Among the 2822 patients included, 2517 completed the questionnaire. Of this total, 907 patients (36%) were smartphone users. Compared with non-users, smartphone users were younger, were more frequently men, more frequently lived in cities, had a higher educational level and were more frequently professionally active. Smartphone users less frequently had diabetes, hypertension, atrial fibrillation or ischaemic cardiopathy. Only 22% of patients were actively participating in a therapeutic education programme. CONCLUSION Smartphones were used by more than one-third of patients with heart failure in France in 2017, underscoring the feasibility of developing a smartphone application to deliver therapeutic education to the population with chronic heart failure.
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Impact of teleophthalmology during COVID-19 lockdown in a tertiary care center in South India.
Ravindran, M, Segi, A, Mohideen, S, Allapitchai, F, Rengappa, R
Indian journal of ophthalmology. 2021;(3):714-718
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PURPOSE The aim of this study was to describe the experience of teleconsultations addressed at our hospital in India during the ongoing coronavirus (COVID-19) lockdown. METHODS This cross-sectional hospital-based study included 977 teleconsultations presenting between April 1st and May 31, 2020. A two-level protocol was implemented to triage the calls. RESULTS Overall, 977 teleconsultation were addressed. Of the 621 teleconsultation addressed the most common queries were related to redness/pain/ watering/blurred vision/itching/irritation (52.49%), followed by queries related to medications (28.01%), appointments (18.84%) & 0.64% cited an emergency need to visit the hospital due to sudden loss of vision. The majority of the queries were directed to the department of cornea (58.93%) followed by retina (16.26%), cataract (13.04%), glaucoma (10.14%) & pediatric ophthalmology (1.61%). The most common advice given to the patient was related to medications (47.66%) followed by appointment-related queries (31.72%) & fixing of surgical appointment (20.61%). Among the 356 preterm babies that were screened, 57 (16.01%) were diagnosed with retinopathy of prematurity (ROP). Of them 3 required laser and 3 were given injection. CONCLUSION Teleconsultation is here to stay beyond the pandemic. WhatsApp was the preferred modality of communication for us. Teleophthalmology has given us insights to use this evolving technology to reach out to the population at large to provide eye care services. We believe that this mode of teleophthalmology has helped us in providing feasible eye care to the patients.
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E-health. Patterns of use and perceived benefits and barriers among people living with HIV and their physicians. Part 1: Information retrieval on the Internet and social networks.
Jacomet, C, Bastiani, P, Prouteau, J, Lambert, C, Linard, F, Ologeanu-Taddei, R, Dellamonica, P
Medecine et maladies infectieuses. 2020;(7):575-581
Abstract
OBJECTIVES To identify patterns of use, perceived benefits, and barriers among people living with HIV (PLHIV) of online searches for health information and via social media. METHODS Online multicentre observational survey (October 15th-19th, 2018). RESULTS Study participation was accepted by 838/1377 PLHIV followed in 46 centres, of which 325 (39%) responded online: 181 (56%) had already used the Internet to search for health information; 88/181 (49%) on HIV infection and 78 (43%) on nutrition. These 56% were characterised by a higher educational level (OR=1.82±0.50; P=0.028) and more often consulted other specialists (OR=3.14±1.26; P=0.004). A subset of 87/180 (48%) PLHIV had changed the way they looked after their health based on their online research, and were more often in material/social deprivation (P=0.02) and diabetic (P=0.02). A small subset of 19/180 (11%) had already asked or answered a question on a forum; these people tended to be women (P=0.03) in material/social deprivation (P=0.009). 296/322 (92%) PLHIV trusted their physician whereas only 206 (64%) trusted information sourced on medical websites. 238/323 (74%) PLHIV expected their physicians to recommend websites if asked, whereas only 23/323 (7%) had actually been given this guidance. CONCLUSION More than half of PLHIV surveyed had already searched for health information on the Internet, and one in two had changed their behaviour based on the online search. PLHIV did not see the Internet as an alternative to physicians but they wanted their physicians to guide them on how to find quality health information to better self-manage their condition.
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Breaking barriers: Adjunctive use of the Ontario Telemedicine Network (OTN) to reach adolescents with obesity living in remote locations.
Coles, N, Patel, BP, Li, P, Cordeiro, K, Steinberg, A, Zdravkovic, A, Hamilton, JK
Journal of telemedicine and telecare. 2020;(5):271-277
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INTRODUCTION Implementation of telemedicine has been shown to improve health outcomes, such as body mass index (BMI). However, it is unclear whether telemedicine is useful alongside traditional weight-management programmes for adolescents with complex obesity. The objective was to evaluate implementation of the Ontario Telemedicine Network (OTN), a videoconferencing programme, as an adjunctive tool to face-to-face counselling within the setting of an established interdisciplinary obesity treatment programme. METHODS Our observational cohort included two groups of adolescents enrolled in a clinical obesity-management programme over a two year period. Adolescents (n = 50) in group 1 attended both in-person and virtual visits (OTN group), and adolescents (n = 50) in group 2 received only in-person visits (comparison group). Within the OTN group, satisfaction survey responses were compared between patients and healthcare professionals. Change in BMI per month, paediatric quality of life scores, session attendance and demographic variables were compared between groups. RESULTS OTN subjects averaged 4.9 telehealth visits per adolescent over the two year programme. Both OTN and comparison groups had similar changes in BMI (p = 0.757), with increases over time (p = 0.042). Paediatric quality of life scores in both groups improved over time compared to baseline (p < 0.001), with higher scores for children compared to parental-reported child scores (p = 0.008). Both adolescents and healthcare professionals using the OTN were similarly satisfied with their experience. CONCLUSION Adjunctive use of the OTN within the setting of a weight-management programme is feasible, well accepted by families and healthcare providers, and led to similar outcomes compared to usual care.
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Accuracy of Detection and Grading of Diabetic Retinopathy and Diabetic Macular Edema Using Teleretinal Screening.
Date, RC, Shen, KL, Shah, BM, Sigalos-Rivera, MA, Chu, YI, Weng, CY
Ophthalmology. Retina. 2019;(4):343-349
Abstract
PURPOSE To determine the accuracy of a county teleretinal screening program of detecting referable diabetic retinopathy (DR) and treatable diabetic macular edema (DME), as well as to evaluate patient compliance with clinic follow-up after referral from teleretinal screening. DESIGN Retrospective observational study. PARTICIPANTS Patients in the Harris Health System (HHS, Houston, TX) older than 18 years of age who underwent teleretinal screening between July 2014 and July 2016. METHODS Teleretinal imaging (TRI) consisting of single-field 45-degree nonmydriatic color fundus photography with referral thresholds of severe nonproliferative DR, proliferative DR, and significant DME. Teleretinal imaging results for all referred subjects were obtained and cross-referenced with dilated fundus examination findings with regard to DR severity and the presence of DME. Follow-up status was also noted. Subjects underwent OCT if deemed necessary by the examining specialist. Agreement between TRI and dilated fundus examination (DFE) findings was determined by calculating the Cohen κ coefficient. MAIN OUTCOME MEASURES The primary outcome measure is agreement between TRI results and DFE findings with regard to DR severity and the presence of DME. The secondary outcome measure is compliance with follow-up. RESULTS Of 1767 patients who were screened and referred for clinical examination, 935 (52.9%) attended their clinic appointment. Overall agreement between DFE and TRI was moderate (weighted κ 0.45) in terms of DR severity. There was agreement within one DR severity level in 86.2% of patients. The positive predictive value for detecting referable disease was 71.3%. Of patients referred for DME, 30.4% were deemed to have treatable DME. CONCLUSIONS The HHS teleretinal screening program demonstrates a high level of accuracy in the detection and classification of referable DR, but a lesser degree of accuracy in the detection of treatable DME. Only slightly more than half of participants were compliant with follow-up after a TRI referral. This large-scale study provides insight into the utility of teleretinal screening in a county health care system.
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Telemedicine for Diabetic Retinopathy Screening in an Urban, Insured Population Using Fundus Cameras in a Primary Care Office Setting.
Martinez, JA, Parikh, PD, Wong, RW, Harper, CA, Dooner, JW, Levitan, M, Nixon, PA, Young, RC, Ghafoori, SD
Ophthalmic surgery, lasers & imaging retina. 2019;(11):e274-e277
Abstract
BACKGROUND AND OBJECTIVE This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the "capture rate." RESULTS Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274-e277.].
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Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study.
Click, B, Anderson, AM, Ramos Rivers, C, Koutroubakis, IE, Hashash, JG, Dunn, MA, Schwartz, M, Swoger, J, Barrie, A, Szigethy, E, et al
Journal of clinical gastroenterology. 2018;(4):319-325
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BACKGROUND Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. STUDY We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. RESULTS Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates. CONCLUSIONS Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.
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Evaluation of a combination digital retinal camera with spectral-domain optical coherence tomography (SD-OCT) that might be used for the screening of diabetic retinopathy with telemedicine: A pilot study.
Sanborn, GE, Wroblewski, JJ
Journal of diabetes and its complications. 2018;(11):1046-1050
Abstract
AIMS: Pilot study to determine whether an instrument combining a non-mydriatic retinal camera and spectral domain optical coherence tomography (SD-OCT) is effective for screening patients with diabetic retinopathy (DR). METHODS Case series conducted between 2012 and 2013. DR imaged with a retinal camera/SD-OCT instrument viewed remotely was compared to a dilated examination by a retina specialist. RESULTS The combination instrument was better than the retina specialist in detecting more severe retinopathy, primarily because of the SD-OCT. For severe retinopathy (grade ≥ 3), the image grader had better sensitivity (87.3% [95% CI: 75.5%, 94.7%]) than the retina examiner (76.4% [95% CI: 63.0%, 86.8%]). Specificities were similar between the instrument grader (96.0% [95% CI: 86.3%, 99.5%]) and retina examiner (100.0% [95% CI: 92.9%, 100.0%]). When identifying diabetic macular edema (ME), the retina examiner only identified 47.6% (20/42) of eyes with ME detected by SD-OCT. The instrument was better than a dilated retinal examination in detecting ME and not as good at detecting mild or proliferative retinopathy. CONCLUSIONS As used in this study, the instrument was more effective in identifying DR than was the current recommendation of a dilated and comprehensive eye examination. SD-OCT is needed to accurately identify DR in a screening setting.