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Adopting telemonitoring services during the pandemic for people affected by chronic disease is fundamental to ensure access to health care services avoiding the risk of COVID-19 infection. Among chronic diseases, Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease of adulthood, caused by the loss of spinal, bulbar and cortical motor neurons, which leads to paralysis of the voluntary muscles and, also, involves respiratory ones. Therefore, remote monitoring and teleconsulting are essential services for ALS patients with limited mobility, as the disease progresses, and for those living far from ALS centres and hospitals. In addition, the COVID 19 pandemic has increased the need to remotely provide the best care to patients, avoiding infection during ALS centre visits. The paper illustrates an innovative, secure medical monitoring and teleconsultation mobile cloud-based system for disabled people, such as those with ALS (Amyotrophic Lateral Sclerosis). The design aims to remotely monitor biosignals, such as ECG (electrocardiographic) and EMG (electromyographic) signals of ALS patients in order to prevent complications related to the pathology.

Dear Editor, Teleconsulting - defined as real-time consultation between doctors by exploiting video conferencing technology over the Internet network - is exponentially being implemented through the western world lastly triggered by COVID-19 pandemic...

Telemedicine is one of the rising and innovative tools in medicine that allows the remote delivery of health services over the internet. This technology enables people who do not have direct and urgent access to expert medical care to still get the services they need. Applications of telemedicine include telesurgeries, telementoring, teleproctoring and teleconsulting. Telesurgery is the case where an expert surgeon remotely performs a surgery on a patient while not physically in the operation room over a wired/wireless connection. Virtual reality (VR) and augmented reality (AR) are widely used to give the remote surgeon the required immersive experience and allow him/her to see exactly what the local surgeon is seeing. This paper focuses on surveying the current technologies used in telesurgeries. It starts off by exploring the tools used to create the immersive experience in telesurgery such as 3D cameras and 360 cameras, the headpieces and the robots used to give the remote surgeon the real feel and control of the surgery. It then continues to survey the techniques used to create that immersive experience including the different camera encodings, depth compression and estimation techniques and 3D modeling. Finally it briefly overviews some of the networking issues regarding the streaming of 3D videos in real-time. 2021 IEEE. Qatar National Research Fund Scopus

Background Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective Our objective was to gain a deeper understanding of ERCP practitioners’ attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons’ beliefs about teleguidance’s contribution to performance and factors that might interact with implementation. Results Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard “Ease of Use” items for “Compatibility and Implementation Climate.” In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P Conclusions Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes.

Background A cardiotocogram (CTG) is a device used to perceive the status of a fetus in utero in real time. There are a few reports of its use at home or during emergency transport. Objective The aim of this study was to test whether CTG and other perinatal information can be transmitted accurately using an experimental station with a 5G transmission system. Methods In the research institute, real-time fetal heart rate waveform data from the CTG device, high-definition video ultrasound images of the fetus, and high-definition video taken with a video camera on a single line were transmitted by 5G radio waves from the transmitting station to the receiving station. Results All data were proven to be transmitted with a minimum delay of less than 1 second. The CTG waveform image quality was not inferior, and there was no interruption in transmission. Images of the transmitted ultrasound examination and video movie were fine and smooth. Conclusions CTG and other information about the fetuses and pregnant women were successfully transmitted by a 5G system. This finding will lead to prompt and accurate medical treatment and improve the prognosis of newborns.

Telemedicine has only received limited attention by veterinary professional regulatory bodies, particularly in Europe. In Portugal, telemedicine is currently outside what is considered acceptable practice by the regulator, the Portuguese Veterinary Order (Ordem dos Medicos Veterinarios). As part of a wider research aimed at gathering evidence for developing a new veterinary Code of Professional Conduct, this study describes the use of the Policy Delphi technique to gather the views and perceptions of a purposeful sample of 41 Portuguese veterinarians regarding telemedicine. Four main issues were addressed using mixed research methods: teleconsultation, teleconsulting, teleadvice and the regulator’s role. Responses highlight participants’ perception of both the relevance of medical digital technologies in improving healthcare and their limitations. Overall opinion was that, although restrictions to remote veterinary practice should be reduced, improved guidance and regulation are warranted. Eighty percent of participants considered that limits to the use of veterinary telemedicine should be imposed and two thirds considered that a remote consultation must always be preceded by a face-to-face consultation. While most respondents thought that vet-to-vet teleconsulting using social media (namely Facebook) should not be banned, eighty-three percent recognised that it should be regulated by ethical standards. Participants’ concerns with telemedicine had mostly to do with reputational risk for the veterinary profession, while overlooking privacy or confidentiality issues. A consultative group should be established to ensure that telemedicine providers comply with professional requirements. It is expected that these results will support policy-making by the Portuguese Veterinary Order and by veterinary regulators at other jurisdictions.

Background Patient undergoing surgery may be afraid and concerned about the diagnosis, the treatment, the procedure, the postoperative care, and the surgical recovery. Good communication between staff and patients can minimize or prevent this situation. This study aimed to evaluate the effectiveness of a Telecare nursing intervention, “Telephone consultation”, in reducing the “Delayed surgical recovery” nursing diagnosis in patients undergoing laparoscopic cholecystectomy and hernia repair. Methods This study was performed in two different institutions located in Rio de Janeiro, Brazil. A total of 43 patients were enrolled. The experimental group consisted of 22 patients who had access to the telephone follow-up intervention, and the control group consisted of 21 patients who received conventional treatment without telephone follow-up. This was a randomized controlled study with patients who were 60 years or older and awaiting operative procedures of hernia repair and laparoscopic cholecystectomy who had a mobile or landline phone and were available for telephone contact. Results There was a reduction in “loss of appetite with nausea” (p = 0.013); “need help to complete self-care” (p = 0.041); “pain” (p = 0.041); and “postoperative sensation” (p = 0.023). The experimental group showed a significantly larger decrease in factors related to the “Delayed surgical recovery” diagnosis, suggesting a positive effect of the intervention compared to the effect in control group.\. Conclusion Telephone consultation identified factors that increased the risk of complications after surgery, recognized potential patients for delayed surgical recovery and helped perioperative nurses provide accurate interventions to prevent or mitigate delayed recovery. This study was registered in the platform Brazilian Registry of Clinical Trials (ReBEC) - link: http://www.ensaiosclinicos.gov.br under registration number RBR-4C249M, retrospectively registered on April 13, 2020.

Major adverse cardiac events, defined as death or myocardial infarction, are common causes of perioperative mortality and major morbidity in patients undergoing non-cardiac surgery. Reduction of perioperative cardiovascular risk in relation to non-cardiac surgery requires a stepwise patient evaluation that integrates clinical risk factors, functional status and the estimated stress of the planned surgical procedure. Major guidelines on preoperative cardiovascular risk assessment recommend to establish, firstly, the risk of surgery per se (low, moderate, high) and the related timing (elective vs. urgent/emergent), evaluate the presence of unstable cardiac conditions or a recent coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting), assess the functional capacity of the patient (usually expressed in metabolic equivalents), determine the value of non-invasive and/or invasive cardiovascular testing and then combine these data in estimating perioperative risk for major cardiac adverse events using validated scores (Revised Cardiac Risk Index (RCRI) or National Surgical Quality Improvement Program (NSQIP)). This stepwise approach has the potential to guide clinicians in determining which patients could benefit from cardiovascular therapy and/or coronary artery revascularization before non-cardiac surgery towards decreasing the incidence of perioperative morbidity and mortality. Finally, it should be highlighted that there is a need to implement specific strategies in the 2019 Coronavirus disease (COVID-19) pandemic to minimize the risk of transmission of COVID-19 infection during the preoperative risk assessment process.

Store and forward telemedicine is used routinely in health care, but there is little published information about how such telemedicine systems are used. For example, an important aspect of the system's usability is the length of time it takes to submit a referral. Referral-submission times were measured in networks based on the Collegium Telemedicus system. In a 25-week period in 2018/2019, eight Collegium networks received a total of 1,649 clinical or educational cases submitted via the web interface. The time to prepare a referral was measured in 669 of these cases, in two different ways. An indirect measurement of the referral-preparation time was calculated as the interval between the user logging in, and the referral being submitted. A direct measurement of the referral-preparation time was calculated as the interval between the user opening the referral page and the referral being submitted to the server. The difference between the two measurements represents time spent by the user on other activities after logging in, before beginning the referral. The median referral-preparation time, measured directly, was 888 s (IQR 512-1765). The median of the differences between the two preparation times was 27s (IQR 8-146). The referral-preparation times in the eight networks were broadly similar, despite the differences in the nature of their operation (clinical or educational), and the types of case handled (single specialty or multi-specialty). Quantitative information about aspects of the user interface, such as the referral-preparation time, is important not only in the initial system design, but also in its subsequent development.

Background We define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults. Methods We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based. Results Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers. Discussion E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.

Introduction Good metabolic control is important in type 2 diabetes mellitus to improve quality of life, work ability and life expectancy, and the use of telemedicine has proved efficient as an add-on to the usual treatment. However, few studies in type 2 diabetes patients have directly compared telemedicine with conventional outpatient treatment, and we wanted to evaluate whether telemedicine, compared with standard care, provides equivalent clinical outcomes. Methods Forty patients with type 2 diabetes mellitus allocated from October 2011–July 2012 were randomized to either treatment at home by video conferences only or standard outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-hour blood pressure, cholesterol levels and albuminuria. The video-telephone was a broadband solution installed and serviced by the Danish Telephone Company (TDC). Results The improvements in the two treatments, given as changes in percentage of telemedicine vs standard, showed significant differences in HbA1c (−15 vs −11%), mean blood glucose (−18 vs −13%) and in cholesterol (−7 vs −6%). No differences in LDL (−4 vs −6%), weight (−1 vs 2%), diastolic diurnal blood pressure (−1 vs −7%), and systolic diurnal blood pressure (0 vs −1%) were found. Nine consultations were missed in the standard outpatient group and none in the telemedicine group. Conclusions In the direct comparison of home video consultations vs standard outpatient treatment in type 2 diabetes mellitus, telemedicine was a safe and available option with favourable outcomes after six months treatment.

Introduction: This article aims to confirm the following core hypothesis: a Community of Practice¿s use of aWeb 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated. Methods: An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses. Results: It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more aWeb 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use. Conclusions: The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organizational and social determinants. © 2014, Ubiquity Press Ltd. All rights reserved.

INTRODUCTION: Modern strategies for the diagnosis and treatment of cardiac arhythmias include besides non-invasive methods an increasing variety of invasive and curative therapeutic strategies. In order to define proper rhythmologic diagnosis and to develop an optimal treatment strategy for individual patients, a high degree of rhythmologic expertise is necessary. Adequate platforms for information exchange, where physicians can meet rhythmologic experts to allow proper handling of individual rhythmologic problems are desirable. Thus, the Heart Center Leipzig develops the Web- and Fax-based consultancy and information service "EcgConsult". METHODS: The service utilizes the network capabilities of the Internet and of the common telecommunication network. This way information input can be achieved either by using a browser/email-client or by using a fax machine. All input from both networks is collected on a centralised mail-server (SSL-POP3 protocol). User interaction on the Web site is achieved with dynamic HTML and a moderated List-Server. The List-Server and an additional discussion area on the Web site are moderated by the Consultants at the Heart Center Leipzig, adequate processing of the site-content and technical management of the site have been outsourced to the university Internet workgroup Elchsoft/Medkonsult. RESULTS: A prototype of the site and the communication architecture for fax/email have been established and successfully beta-tested. Any consulting physician can easily send ECGs and additional material to the server with any fax-machine, where they are automatically TIFF-file converted. A password-protected site is already in use with selected clinicians (http://www.ecgconsult.de). For mobile site management, a web-based Control-Center has been designed. Outlines of contract models for members, guidelines for security purposes of the web-based communication, a business/cost plan and models for the logistic request management as well as for member/patient identification have been developed. DISCUSSION: The platform "EcgConsult" provides a network with fast and easy access to a specific target group and thus allows easy information exchange between the Heart Center Leipzig and rhythmologic experts and non-experts. This exchange may generate synergy effects by offering both groups a variety of data and information. Due to the use of web- and fax-based technology, the access to the service is easy and does not require PC-equipment or a scanner. The requests can be answered by the Heart Center consultants from any remote location world-wide. For the future open-ended architecture allows the participation of further consultants from clinics all over the world. The knowledge gathered from this project may help setting up guidelines for the development of other web-based medical competence centers / information services. []

Two teleradiology applications with the added-value of teleconsulting are described: CARE, a high level diagnostic oriented application with videoconference and image and cursor synchronization based on SUN stations, and RAIM, a lower level PC-based application oriented to the transmission of patients' results, reports and associated images. Their technical characteristics and solutions adopted are presented together with the context in which they have been developed and thought to fit in.