Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings: A Systematic Review.

Background: Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at health care facilities. However, its adoption in health care is not entirely realized due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian health care system, observed at the infrastructural, sociocultural, regulatory, and financial levels, from the perspectives of health care providers, patients, patient caregivers, society, health organizations, and the government. Methods: This review complies with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015. A total of 2,706 peer-reviewed studies published from December 2016 to September 2023 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE, and PsycInfo databases were considered for the title and abstract screening, after which 334 articles were chosen for the full-text review. In the end, 46 studies were selected for data synthesis. Results: Analysis of the literature revealed key barriers such as data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), infrastructure issues, and ICT training gaps. Facilitators included reduced health care delivery costs, enhanced patient access to health care in remote areas, and shorter patient wait times. The real-world experiences of Indian telemedicine practitioners and pioneers are also explored to complement literature-based perspectives on telemedicine implementation. Both stress the need for reliable internet connectivity, technological adoption, comprehensive ICT training, positive sociocultural attitudes, stringent data privacy measures, and viable business models as crucial for effective telemedicine adoption, with experts emphasizing practical adaptability alongside the literature-recognized facilitators.

Stable G-quadruplex enabling sequences are selected against by the context-dependent codon bias.

The distributions of secondary structural elements appear to differ between coding regions (CDS) of mRNAs compared to the untranslated regions (UTRs), presumably as a mechanism to fine-tune gene expression, including efficiency of translation. However, a systematic and comprehensive analysis of secondary structure avoidance because of potential bias in codon usage is difficult as some of the common secondary structures, such as, hairpins can be formed by numerous sequence combinations. Using G-quadruplex (GQ) as the model secondary structure we studied the impact of codon bias on GQs within the CDS. Because GQs can be predicted using specific consensus sequence motifs, they provide an excellent platform for investigation of the selectivity of such putative structures at the codon level. Using a bioinformatics approach, we calculated the frequencies of putative GQs within the CDS of a variety of species. Our results suggest that the most stable GQs appear to be significantly underrepresented within the CDS, through the use of specific synonymous codon combinations. Furthermore, we identified many peptide sequence motifs in which silent mutations can potentially alter translation via stable GQ formation. This work not only provides a comprehensive analysis on how stable secondary structures appear to be avoided within the CDS of mRNA, but also broadens the current understanding of synonymous codon usage as they relate to the structure-function relationship of RNA.