Insights from telesurgery expert conference on recent clinical experience and current status of remote surgery.

Remote surgery provides opportunity for enhanced surgical capabilities, wider healthcare reach, and potentially improved patient outcomes. The network reliability is the foundation of successful implementation of telesurgery. It relies on a robust, high-speed communication network, with ultra-low latency. Significant lag has been shown to endanger precision and safety. Furthermore, the full-fledged adoption of telerobotics demands careful consideration of ethical challenges too. A deep insight into these issues has been investigated during the first Telesurgery Consensus Conference that took place in Orlando, Florida, USA, on the 3rd and 4th of February, 2024. During the Conference, the state of the art of remote surgery has been reported from robotic systems displaying telesurgery potential. The Hinotori, a robotic-assisted surgery platform developed by Medicaroid, experienced remote surgery as pre-clinical testing only; the Edge Medical Company, Shenzen, China, reported more than one hundred animal and 30 live human surgeries; the KanGuo reported human telesurgical cases performed with distances more than 3000 km; the Microport, China, collected more than 100 human operations at a distance up to 5000 km. Though, several issues-cybersecurity, data privacy, technical malfunctions - are yet to be addressed before a successful telesurgery implementation. Expanding the discussion to encompass ethical, financial, regulatory, and legal considerations is essential too. The Telesurgery collaborative community is working together to address and establish the best practices in the field.

Approaches to Medical Emergencies on Commercial Flights.

In-flight medical incidents are becoming increasingly critical as passengers with diverse health profiles increase in the skies. In this paper, we reviewed how airlines, aviation authorities, and healthcare professionals respond to such emergencies. The analysis was focused on the strategies developed by the top ten airlines in the world by examining training in basic first aid, collaboration with ground-based medical support, and use of onboard medical equipment. Appropriate training of crew members, availability of adequate medical resources on board airplanes, and improved capabilities of dialogue between a flying plane and medical doctors on the ground will contribute to a positive outcome of the majority of medical issues on board airlines. In this respect, the adoption of advanced telemedicine solutions and the improvement of real-time teleconsultations between aircraft and ground-based professionals can represent the future of aviation medicine, offering more safety and peace of mind to passengers in case of medical problems during a flight.

Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review.

Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.

[A look into the neighboring discipline: eHealth in oncology]. / Ein Blick in die Nachbardisziplin: eHealth in der Onkologie.

Digitalization is dramatically changing the entire healthcare system. Keywords such as artificial intelligence, electronic patient files (ePA), electronic prescriptions (eRp), telemedicine, wearables, augmented reality and digital health applications (DiGA) represent the digital transformation that is already taking place. Digital becomes real! This article outlines the state of research and development, current plans and ongoing uses of digital tools in oncology in the first half of 2024. The possibilities for using artificial intelligence and the use of DiGAs in oncology are presented in more detail in this overview according to their stage of development as they already show a noticeable benefit in oncology.

Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature.

BACKGROUND: Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. OBJECTIVE: The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. METHODS: Google Trends data were retrieved using the search topics "telemedicine" or "e-health" to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms "telemedicine" or "eHealth" (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. RESULTS: Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=-22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. CONCLUSIONS: Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives.

Emerging trends in management of long COVID with a focus on pulmonary rehabilitation: A review.

Long COVID, or post-acute sequelae of COVID-19 (PASC), represents a complex condition with persistent symptoms following SARS-Cov-2 infection. The symptoms include fatigue, dyspnoea, cognitive impairment, decreased quality of life in variable levels of severity. Potential mechanisms behind long COVID include vascular damage, immune dysregulation and viral persistence. Diagnosing long COVID involves medical evaluation by multidisciplinary team and assessment of persistent symptoms with scoring systems in development. Treatment strategies are symptom-focused, encompassing multidisciplinary care, rehabilitation and tailored exercise programmes. Pulmonary rehabilitation, an effective and critical component of long COVID management, has shown promise, particularly for patients with respiratory symptoms such as dyspnoea. These programmes, which combine exercise, breathing techniques, education and psychological support, improve symptoms, quality of life and overall recovery. Innovative technologies, such as telemedicine, wearable devices, telerehabilitation, are transforming long COVID management. Telemedicine facilitates consultations and interventions, eliminating healthcare access barriers. Wearable devices enable remote and continuous monitoring of patients during their rehabilitation activities. Telerehabilitation has proven to be safe and feasible and to have high potential for COVID-19 recovery. This review provides a concise overview of long COVID, encompassing its definition, prevalence, mechanisms, clinical manifestations, diagnosis and management approaches. It emphasizes the significance of multidisciplinary approach in diagnosis and treatment of long COVID, with focus on pulmonary rehabilitation and innovative technology advances to effectively address the management of long COVID.

Year in review 2023 - Back to the future.

This review synthesizes articles published in 2023, focusing on the impact of elexacaftor-tezacaftor-ivacaftor (ETI) in cystic fibrosis (CF) care. Real-world data highlights sustained benefits of ETI across age groups, while challenges like neuropsychological side effects persist. Beyond CFTR modulators, research explores telemedicine and novel therapies. Prioritizing equitable access and addressing unmet needs remain crucial for comprehensive CF management.

Aplicación de tecnologías móviles (m-Salud) y salud electrónica (e-Salud) en el manejo y en la prevención de la litiasis renal: revisión sistemática / Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review

Introducción La litiasis renal (LR) es una enfermedad urológica común, que a menudo requiere de cuidados a largo plazo. Las tecnologías de salud móvil (m-Salud) y salud electrónica (e-Salud) tienen el potencial de mejorar el manejo de las enfermedades crónicas e impactar sobre los patrones de la conducta. Para evaluar la aplicabilidad de estas herramientas en la mejora del tratamiento y la prevención de la LR, nos propusimos evaluar los datos actuales sobre el uso, los beneficios y las limitaciones de la m-Salud y la e-Salud en la LR. Métodos Se realizó una revisión sistemática de los estudios de investigación primaria sobre m-Salud y e-Salud en la evaluación y tratamiento de la LR. Dos investigadores independientes examinaron las citas por título y resumen para determinar su pertinencia y, a continuación, se realizó una revisión del texto completo para obtener un resumen descriptivo de los estudios. Resultados Se incluyeron 37 artículos para el análisis. Las principales áreas de interés fueron: 1) botellas de agua «inteligentes» y aplicaciones de dispositivos móviles para el seguimiento del consumo de líquidos, que mostraron un aumento de la ingesta en la mayoría de los estudios; 2) plataformas de seguimiento de stent ureterales, que mejoraron la tasa de stent retenidos a largo plazo; 3) clínicas virtuales para el tratamiento de la LR, las cuales han mejorado el acceso, han reducido costes y han mostrado resultados satisfactorios; 4) plataformas de endoscopia para teléfonos inteligentes, que ofrecieron una buena calidad de imagen respecto a sus costes en entornos de recursos limitados, y 5) información sobre la LR en línea para pacientes, la cual generalmente se caracterizó por ser de mala calidad y/o precisión, particularmente en YouTube®. La mayoría de los estudios eran pruebas de concepto o estudios de intervención de un solo brazo, con una evaluación limitada de la eficacia o de los resultados clínicos a largo plazo. Conclusiones ... (AU)

Introduction Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD. Methods We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies. Results A total of 37 articles were included for analysis. Primary domains of evidence included: 1) “smart” water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes. Conclusions Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines. (AU)

Assessing patient satisfaction with telephone-based consultations before, during and after the COVID-19 pandemic in Spain / Evaluación de la satisfacción de los pacientes con las consultas telefónicas antes, durante y después de la pandemia de COVID-19 en España

Objective: To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services. Design: A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted. Setting: PC. Participants: 405 users of PC services in Zaragoza (Spain). Main outcome measure: Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests. Results: The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine. Conclusion: This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions.(AU)

Objetivo: Validar un cuestionario para analizar la percepción de los usuarios de atención primaria (AP) con la consulta telefónica (CT) y estudiar la satisfacción de la CT por parte de estos. Diseño: Estudio en dos fases. Se validó un cuestionario sobre satisfacción con los servicios de telemedicina. Después, se realizó un estudio transversal sobre la satisfacción con la CT. Emplazamiento: AP. Participantes: Un total de 405 usuarios de servicios de AP en Zaragoza (España). Medición principal: Satisfacción con los servicios de telemedicina de AP. El análisis factorial se realizó a través del exploratorio con rotación Varimax. La fiabilidad de las dimensiones se analizó con el alfa de Cronbach. El inferencial se efectuó mediante pruebas paramétricas. Resultados: El cuestionario resultó válido y fiable (α>0,9) para evaluar la satisfacción de los usuarios con la telemedicina. Antes de la COVID-19, esta era adecuada (media=6,111/10) con la AP. Durante la pandemia la atención en AP pasó a ser mayoritariamente telefónica y la satisfacción disminuyó (media=3,555/10). Con respecto al futuro de la telemedicina, los usuarios lo consideraron insatisfactorio (media=2,977/10). Ser mujer, estar en paro y pertenecer a una zona de baja vulnerabilidad conllevó una peor percepción de la telemedicina. Conclusiones: Nuestro cuestionario fue un instrumento válido y fiable para evaluar la satisfacción de los usuarios de servicios de AP con la telemedicina, la cual disminuyó durante la COVID-19. La CT es una buena opción cuando los pacientes la consideran una herramienta complementaria y no sustitutiva para el seguimiento de sus dolencias.(AU)

SIG Tel@ rBLH 21 de Novembro de 2011: Perspectivas da Telessaúde no Estado do Amazonas

Palestra com o tema, Perspectivas da Telessaúde no Estado do Amazonas, proferida pelo Dr. Jefferson Guilherme em Congresso Brasileiro de Telessaúde e Telemedicina Manaus/AM.

Hospital de día psiquiátrico en tiempos de COVID: grupos y telemedicina / Psychiatric day hospital in times of covid: Groups and telemedicine

Tras decretarse el estado de alarma y el confinamiento por la amenaza del COVID-19, el acceso a los servicios de salud mental y recursos psicosociales se vio obstaculizado, incluso interrumpido.Un colectivo especialmente en riesgo es el de pacientes diag-nosticados de Trastorno Mental Grave. Estos presentan una serie de características que los hace más vulnerables a padecer un em-peoramiento en su salud mental.Desde el Hospital de Día para primeros brotes psicóticos de Pontones se intentó mantener la atención y el seguimiento estre-cho de los pacientes mediante la reestructuración del programa de tratamiento, optando por una intervención terapéutica alternativa mixto (con atención individual presencial y telefónica y terapias grupales por videoconferencia).El objetivo de este trabajo es dar a conocer la experiencia de la implementación de la telemedicina en nuestro HD como res-puesta a la emergencia sanitaria que ocasionó la pandemia, así como recoger el programa de actividades que se desarrollaron y el nivel de satisfacción con el tratamiento recibido de los pacientes que participaron.(AU)

Following the state of alarm and containment due to the CO-VID-19 threat, access to mental health services and psychosocial resources was hampered, even interrupted.A particularly at-risk group is that of patients diagnosed with Severe Mental Disorder. They present a series of characteristics that make them more vulnerable to a worsening of their mental health.From the Day Hospital for first psychotic outbreaks in Pontones we tried to maintain the attention and close monitoring of patients by restructuring the treatment programme, opting for a mixed al-ternative therapeutic intervention (with individual face-to-face and telephone attention and group therapies by videoconference).The aim of this paper is to report on the experience of implemen-ting telemedicine in our HD as a response to the health emergency caused by the pandemic, as well as to record the programme of activities that were developed and the level of satisfaction with the treatment received by the patients who participated.(AU)

Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022.

This cohort study assesses trends in monthly telehealth vs in-person utilization and spending rates for mental health services among commercially insured US adults before and during the COVID-19 pandemic.

A regulação jurídica brasileira do exercício da telemedicina no contexto da pandemia do COVID-19 / La regulació jurídica brasilera de l'exercici de la telemedicina en el context de la pandèmia de COVID-19 / La regulación jurídica brasileña del ejercicio de la telemedicina en el contexto de la pandemia de COVID-19 / The Brazilian legal regulation of the exercise of telemedicine in the context of the COVID-19 pandemic

O presente artigo tem como tema central a regulação jurídica do exercício da telemedicina, especialmente a partir do contexto criado na pandemia do COVID-19. Neste sentido, o estudo aborda os mecanismos legais e as orientações dadas pelo Conselho Federal de Medicina (CFM) para adoção da prática. Surgem, em virtude disso, diversos questionamentos referentes à situação trabalhista dos profissionais de saúde que utilizam a telemedicina como mecanismo de trabalho. O artigo, portanto, explanará a importância da adoção da telemedicina, como também as problemáticas oriundas de sua utilização.(AU)

L'article té com a tema central la regulaciójurídica de l'exercici de la telemedicina, especialment des del context creat en la pandèmia COVID-19. L'article aborda els mecanismes legals i les directrius donades pel Consell Federal de Medicina (CFM) per a l'adopció de la pràctica. Com a conseqüència, sorgeixen diverses preguntes sobre la situació laboral dels professionals sanitaris que utilitzen la telemedicina com a mecanisme de treball. L'article, per tant, explicarà la importància d'adoptar la telemedicina, així com els problemes derivats del seuús.(AU)

El artículo tiene como tema central la regulación jurídica del ejercicio de la telemedicina, especialmente desde el contexto creado en la pandemia COVID-19. El artículo aborda los mecanismos legales y las directrices dadas por el Consejo Federal de Medicina (CFM) para la adopción de la práctica. Como consecuencia, surgen varias preguntas sobre la situación laboral de los profesionales sanitarios que utilizan la telemedicina como mecanismo de trabajo. El artículo, por tanto, explicará la importancia de adoptar la telemedicina, así como los problemas derivados de su uso.(AU)

This article has as its central theme the legal regulation of the exercise of telemedicine, especially from the context created in the COVID-19 pandemic. In this sense, the study addresses the legal mechanisms and guidelines given by the Federal Council of Medicine (CFM) for the adoption of the practice. As a result, several questions arise regarding the work situation of health professionals who use telemedicine as a work mechanism. The article, therefore, will explain the importance of adopting telemedicine, as well as the problems that arise through it.(AU)

Disposition of patients utilising the virtual emergency department service in southeast region of Melbourne (SERVED-1).

OBJECTIVE: Supported by the state government, three health networks partnered to initiate a virtual ED (VED), as part of a broader roll-out of emergency telehealth services in Victoria. The aim of the present study (Southeast Region Virtual Emergency Department-1 [SERVED-1]) was to report the initial 5-month experience and included all patients assessed through the service over the first 5 months (1 February 2022 to 30 June 2022). METHODS: VED consults occurred after referral from paramedics in the pre-hospital setting. Electronic medical records were retrospectively reviewed for demographic, presenting complaint and outcome data. The primary outcome was the count of VED consultations. The secondary outcome was the proportion of patients where physical ED attendance was avoided within 72 h. The proportion of physical ED attendances avoided sub-grouped by primary presenting complaints were reported. RESULTS: There were 1748 patients who had a VED consultation, of which 1261 (72.1%; 95% confidence interval [CI] 70.0-74.2) patients had physical presentation to an ED avoided in the 72 h following the consult. There was a significant increase in consultations over the 5-month period (incidence rate ratio 1.27; 95% CI 1.23-1.31, P < 0.001) that was consistent in the three health services. The most common presenting complaints were COVID-19 and shortness of breath, and physical presentation was avoided most often among younger patients and those with COVID-19. CONCLUSIONS: Initial experience demonstrated a significant increase in adoption of the service and an overall avoidance of physical ED attendance by a majority of patients. These results support ongoing VED consultations, complemented by follow up and health economic evaluations.