Telehealth utilization among Egyptian population and health institutional readiness:An exploratory study

Objective:This study aimed to assess the public’s perspectives and the health institutions’readiness for telehealth utilization in Egypt.Methods:A cross-sectional study design was employed,and data were collected from a convenient sample of 800 Egyptian citizens and 26 nursing administrators and information technology personnel from 16 governmental hospitals and 10 private hospitals between January and March 2022.The Egyptian community utilization of telehealth questionnaire and the telemedicine hospital readiness assessment were used to collect the data.Results:The results revealed that 35.1%of the general Egyptian population used telehealth services and 43%expressed willingness to use them in future.As perceived by the general Egyptian population,the most prevalent barriers to telehealth utilization were communication barriers(97.6%),lack of confidence in health professionals(77.6%),technological limitations(72.5%),the need for physical examination(25%),and privacy concerns(10%).Regarding hospital readiness,42%of governmental hospitals were not taking any initiative to implement telehealth services,and 15.4%were at the beginner level,meaning that some steps had been taken.However,the hospital was still far from being able to implement telehealth services.In contrast,private hospitals were either at the beginner or advanced level.Conclusion:Although the use of telehealth services in Egypt has increased,there is a need to address the barriers to public utilization and improve hospitals’readiness to implement telehealth services to enhance public usage.

eHealth,telehealth,and telemedicine in the management of the COVID-19 pandemic and beyond:Lessons learned and future perspectives

In this article,we discuss evidence supporting the effective implementation of e Health,telehealth,and telemedicine during the coronavirus disease 2019 pandemic,with a view towards its permanent future integration in healthcare.We performed a literature search for articles describing the use of telehealth/telemedicine in the pandemic context using five databases.The articles selected describe the use of telemedicine as its advantages in terms of practicality and costeffectiveness.This synthesis of articles is applicable to high-,middle-and lowincome countries.Some of the notable benefits include breaking down geographical and time barriers,reducing waiting lists and crowding in healthcare facilities,and saving on national healthcare expenditure.However,there are a number of difficulties with the widespread implementation of telemedicine services that mainly relate to bureaucratic and regulatory concerns.Moreover,it is also important to make healthcare professionals and providers aware of the limits of this tool to avoid potential cases of negligence.Patients in turn will have to be made aware of and be educated on the use of this new healthcare modality before it is accepted by them.In the current socio-economic climate,it is therefore essential to implement a telehealth model aimed at efficiency and continuity of healthcare,as well as leading to an improvement in the quality of life of patients,whilst optimising existing resources and reducing costs.In that regard,the adoption of e Health,telehealth,and telemedicine services should be considered highly timely,despite current existing limitations.

Telehealth interventions to reduce management complications in type 1 diabetes:A review

Type 1 diabetes is a chronic illness with a high burden of care.While effective interventions and recommendations for diabetes care exist,the intensive nature of diabetes management makes compliance difficult.This isespecially true in children and adolescents as they have unique psychosocial and diabetes needs.Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions,namely time,cost,and access.Telehealth interventions allow for the dissemination of these interventions to a broader audience.Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use.While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over inperson interventions,many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered.These and other challenges are discussed with recommendations for researchers and telehealth providers provided.

Development of a telehealth monitoring service after colorectal surgery:A feasibility study

AIM To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery,within an enhanced recovery protocol.METHODS Florence(FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions,such as hypertension,using text-messaging.Newalgorithms were designed to monitor the well-being,basic physiological observations and any patient-reported symptoms,and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge.All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback.RESULTS Over a four-week period,16 out of 17 patients used the FLO telehealth service at home.These patients did not receive telephone follow-up at three days,as per our standard protocol,unless they reported being unwell or did not make use of the technology.Three patients were readmitted within 30 d,and two of these were identified as being unwell by FLO prior to readmission.No adverse events attributable to the use of the technology were encountered.CONCLUSION The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible.The use of this technology may assist in the early recognition and management of complications after discharge.

Utilization of HEVC ChaCha20-Based Selective Encryption for Secure Telehealth Video Conferencing

Coronavirus(COVID-19)is a contagious disease that causes exceptional effect on healthcare organizationsworldwide with dangerous impact on medical services within the hospitals.Because of the fast spread of COVID-19,the healthcare facilities could be a big source of disease infection.So,healthcare video consultations should be used to decrease face-to-face communication between clinician and patients.Healthcare video consultations may be beneficial for some COVID-19 conditions and reduce the need for faceto-face contact with a potentially positive patient without symptoms.These conditions are like top clinicians who provide remote consultations to develop treatment methodology and follow-up remotely,patients who consult about COVID-19,and those who have mild symptoms suggestive of the COVID-19 virus.Video consultations are a supplement to,and not a substitute for,telephone consultations.It may also form part of a broader COVID-19 distance care strategy that contains computerized screening,separation of possibly infectious patients within medical services,and computerized video-intensive observing of their intensive care that helps reduce mixing.Nowadays,the spread of the COVID-19 virus helps to expand the use of video healthcare consultations because it helps to exchange experiences and remote medical consultations,save costs and health procedures used to cope with the pandemic of the COVID-19 virus,and monitor the progress of treatment plans,moment by moment from a distance with precision,clarity and ease.From this perspective,this paper introduces a high-efficiency video coding(HEVC)ChaCha20-based selective encryption(SE)scheme for secure healthcare video Consultations.The proposed HEVC ChaCha20-based SE scheme uses the ChaCha20 for encrypting the sign bits of the Discrete Cosine Transform(DCT)and Motion Vector Difference(MVD)in the HEVC entropy phase.The main achievement of HEVC ChaCha20-based SE scheme is encrypting the most sensitive video bits with keeping low delay time,fixed bit rate of the HEVC,and format compliance.Experimental tests guarantee that the proposed HEVC ChaCha20-based SE scheme can ensure the confidentiality of the healthcare video consultations which has become easy to transmit through the internet.

Building an Architectural Component Model for a Telehealth Service

Models of services, processes and technology are useful tools for conceptualizing complex systems such as healthcare. The application of a component architecture helps illustrate the processes and technologies that are important to the operation of a health service and conceptualize the relationships between each component. Telehealth services are relatively recent and have characteristics that do not fit neatly into established models of health services. This paper analyzes the components used to build a telehealth in the home service in South Australia and the design choices that were taken. The service used commodity-based devices and systems to deliver simple to use, low-cost in the home care. Building on this analysis, the components required in an architectural component model of a telehealth service are identified enabling a provisional architecture for telehealth services to be derived from an existing internationally recognized architectural model for eHealth systems. Situated within the broad family of eHealth architectures, a Telehealth Architectural Model of telehealth processes, software, devices, common systems and ICT infrastructure is proposed that represents the components required to support telehealth and allows for customization of services according to clinical models of care.

Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition

Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%;n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81;p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care;and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00;n = 122;91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.

Dose of Telehealth to Improve Community-Based Care for Adults Living with Multiple Chronic Conditions: A Systematic Review

The purpose of this systematic review is to identify evidence of the appropriate dose of telehealth intervention services provided to community dwelling adults experiencing chronic illness or disability related to effectiveness, quality, safety, and cost. Academic Search Complete, CINAHL, MEDLINE, Cochrane, and JBI were searched using combinations of “telehealth or telemedicine or telemonitoring or telepractice or telenursing or telecare AND chronic illness or chronic disease”. Of the identified 449 articles, 47 articles met the inclusion criteria. Most study designs were quasi-experimental one group pre-test post-test (N = 16) with few Randomized Controlled Trials (N = 12). Twenty-three published articles studied the effect of telehealth for one chronic condition (49.9%) while 24 (51.1%) examined the effectiveness of telehealth for multiple chronic conditions. Measurement of telehealth outcomes varied and included efficacy, healthcare utilization, quality, adherence, cost, and safety. No standard measure of dose could be extrapolated. Length of intervention was measured and reported differently in each study. The dose of telehealth services that improve care effectiveness, quality, safety, and cost is still unknown for community dwelling adults experiencing chronic illness. The findings from this systematic review do indicate that longer duration of telehealth services (51 weeks), regardless of modality, produced positive outcomes as opposed to those with shorter durations (37 - 38 weeks) that produced neutral or mixed results. Collecting and reporting data related to clinical workflow such as dose of intervention specific to disease and type of modality is recommended. Rigorous study design including standard measurement at the RCT and Comparative Effectiveness level is still needed.

Telehealth Combined with Differentiated ART Delivery Improves ART Pick Up during COVID 19 at a Large HIV Treatment Facility in Trinidad and Tobago

Objective: To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large treatment facility in Trinidad and Tobago during COVID-19. Design and Methods: Beginning in April 2020, a list of patients was generated daily prior to their scheduled ART appointments. Nurses, doctors and social workers conducted telephone consultations to first screen patients for COVID-19 symptoms, conducted brief medical and behavioural health screenings, and helped patients to identify barriers to ART retention. Patients were recommended for 1) fast track ART refill collection at facility, 2) community ART refills, and 3) ART pick-up through patient peers. The uptake and outcomes of telehealth and ART pick up were compared with the corresponding period in 2019. Data was analyzed using SPSS 21.0. Results: During the period April-June 2020, 1361 patients were identified for telephone consultations, 1084 (80%) were successfully contacted and 984 patients (88%) participated in phone session. The independent t test showed a significant increase in ART pick-up when compared to the corresponding period in 2019. 59% of patients collected via fast-track ART refill, 30% had community refills, and 11% pick-up medications through patient peers. Conclusion: Telehealth is an integral component of DSD as part of the COVID-19 response at the MRF. Understanding the medium and longer-term outcomes of Telehealth can provide additional insights on the scale up of telehealth as a component of DSD to improve ART outcomes for patients in the context of the developing countries of the Caribbean.

Telehealth for Substance Use Disorders Treatment in Nigeria: Implementation Strategies Post-COVID-19

The COVID-19 pandemic has changed the way healthcare services are delivered. These changes will likely persist as countries recover from the economic crises following lockdowns. In developing countries, services for substance use disorders (SUDs) are inadequate and as countries prioritize infectious diseases, individuals with SUDs may suffer further neglect. This paper is a narrative review of peer-reviewed and grey literature on the current challenges with SUD treatment in Nigeria assesses how telehealth may positively affect access to evidence-based treatments and suggests strategies for implementation considering the unique challenges and opportunities in the country. If prioritized in her policy, telehealth has the potential to improve treatment outcomes for SUDs in Nigeria.

Evaluation of the Usability of a Telehealth System for COVID-19 According to the Perception of the User Professional

With the advent of the pandemic, the Brazilian Ministry of Health structured in record time the Telehealth Service of the Unified Health System called TeleSUS, an ecosystem based on the intensive use of information technology involving automated mechanisms and a personalized health care center at distance. In addition to constant evaluations carried out in the service as a public health strategy, at clinical and epidemiological levels, the team involved in the project was also concerned with evaluating the system developed to enable the operation of remote care, from the conception of the organization of health actions to the technological development of the digital health tool. The objective of this study was to carry out an evaluation of a telehealth system, measuring the degree of satisfaction of users of health professionals regarding its usability and identifying factors that positively and/or negatively influence the evaluation.

Telehealth has comparable outcomes to in-person diabetic foot care during the COVID-19 pandemic

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed obstacles to the delivery of diabetic foot care.In response to this remote healthcare services have been deployed offering monitoring,follow-up,and referral services to patients with diabetic foot ulcers and related conditions.Although,remote diabetic foot care has been studied before the COVID-19 pandemic as an alternative to inperson care,the peculiar situation of the pandemic,which dictates that remote care would be the sole available option for healthcare practitioners and patients,necessitates an evaluation of the relevant knowledge obtained since the beginning of the severe acute respiratory syndrome coronavirus 2 outbreak.AIM To perform a thorough search in PubMed/Medline and Cochrane to identify original records on the topic.METHODS To identify relevant peer-reviewed publications and gray literature,the authors searched PubMed-MEDLINE and Cochrane Library-Cochrane Central Register of Controlled Trials starting September 27 till October 31,2021.The reference lists of the selected sources and relevant systematic reviews were also hand–searched to identify potentially relevant resources.Otherwise,the authors searched Reference Citation Analysis(https://www.referencecitationanalysis.com/).RESULTS A number of randomized prospective studies,case series,and case reports have shown that the effectiveness of remote care is comparable to in-person care in terms of hospitalizations,amputations,and mortality.The level of satisfaction of patients’receiving this type of care was high.The cost of remote healthcare was not significantly lower than in-person care though.CONCLUSION It is noteworthy that remote care during the COVID-19 pandemic appeared to be more effective and well-received than remote care in the past.Nevertheless,larger studies spanning over longer time intervals are necessary in order to validate these results and provide additional insights.

Characterization and cross-comparison of digital stethoscopes for telehealthremote patient auscultation

Stethoscopes are commonly used to diagnose cardiac and respiratory diseases.The advent of digital stethoscopes added the capability to remotely monitor the cardiorespiratory well-being of patients and facilitate digital remote auscultations for physicians to examine their patients outside of the clinic.To increase the adoption of a hybrid diagnosis between in-person and remote auscultations,it is important to characterize the frequency response of different configurations of digital stethoscopes.A standard testing platform was adopted from the literature and re-validated by seven physicians.Two wearable and two non-wearable digital stethoscopes were investigated.A similarity factor score was used to analyze select time-synchronized acoustic events that achieved high fidelity between stethoscopes.The frequency responses between devices were compared using the correlation coefficient.Two devices reported the highest correlation coefficient of 0.72 and 0.75 in the wearable and non-wearable categories,respectively.The correlation coefficient of the frequency responses between the same pair of devices on the human chest was 0.91.With such a high agreement in the frequency response between the wearable and non-wearable digital stethoscope,it can be concluded that the configuration of digital stethoscope is not a limiting factor of performance,and both are acceptable and desirable for physicians to adopt either configuration in remote delivery of healthcare.

远程医疗管理在老年中重度慢性阻塞性肺疾病患者稳定期呼吸康复中的效果:一项随机对照研究

背景我国慢性阻塞性肺疾病(COPD)患者数量巨大,呼吸康复训练作为COPD患者稳定期管理的重要部分,可有效提高患者肺功能及生活质量,减少家庭及社会负担,国外有研究数据显示远程医疗管理下实施呼吸康复可提高患者的肺功能和生活质量(QOL)评分,但是国内,尤其是西部尚缺乏相关实践。目的评估通过远程医疗管理进行呼吸康复训练与传统治疗相结合对老年中重度COPD患者通气能力及肺功能的影响。方法本研究为前瞻性随机对照研究,连续性纳入2021年6月—2022年6月就诊于四川省第四人民医院及5个联合社区的COPD患者,采用随机数字表进行简单随机分组,将患者分为试验组和对照组。对照组接受传统的长期规律吸入支气管扩张剂及口服药物治疗,试验组在对照组治疗方案的基础上采用远程医疗管理。对两组患者进行为期6个月的研究,分别在基线时及干预1、3、6个月后记录患者的肺功能、博格评分(Borg评分)、6 min步行试验(6MWT)、QOL评分。结果研究对象分为对照组(72例)和试验组(73例),两组患者的性别、年龄及基线时肺功能[第1秒用力呼气末容积占预计值百分比(FEV_(1)%pred)及第1秒用力呼气末容积与用力肺活量(FVC)的比值(FEV_(1)/FVC)]比较,差异均无统计学意义(P>0.05)。时间和组间对FEV_(1)%pred、FEV_(1)/FVC、6MWT水平、QOL评分中呼吸困难、情绪存在交互作用(P<0.05)。干预1、3、6个月后,试验组FEV_(1)%pred、FEV_(1)/FVC、Borg评分、6MWT、QOL评分优于对照组(P<0.05);干预3、6个月后,试验组FEV_(1)%pred、FEV_(1)/FVC、Borg评分、6MWT、QOL评分优于干预后1个月时(P<0.05)。结论采用远程医疗管理对老年中重度COPD稳定期患者进行呼吸康复,干预3、6个月后能有效改善该类患者肺功能,提高生活质量及生存质量。

远程失眠认知行为治疗慢性失眠障碍的疗效研究

目的比较远程失眠认知行为治疗(CBT-I)与面对面CBT-I对失眠患者睡眠影响的差异,研究远程CBT-I的有效性。方法招募2019年3月至2023年5月重庆市中医院睡眠门诊收治的108例慢性失眠障碍患者,经剔除后最终纳入74例进行分析,其中远程组38例,面对面组36例。使用失眠严重指数(ISI)、匹兹堡睡眠质量指数(PSQI)评估失眠症状以及睡眠质量,使用广泛性焦虑障碍问卷(GAD-7)和患者健康问卷(PHQ-9)评估患者焦虑和抑郁情绪,使用睡眠信念和态度量表(DBAS-16)评估患者的不合理睡眠认知,使用格拉斯哥睡眠努力量表(GSES)量化患者的睡眠努力。比较两组患者的治疗效果。结果在干预前和干预后,两组ISI、PSQI、GAD-7、PHQ-9、DBAS-16、GSES评分比较差异均无统计学意义(P>0.05)。干预后,面对面组的各问卷得分均显著低于干预前(P<0.05),远程组除GAD-7外的各问卷得分亦显著低于干预前(P<0.05)。结论远程CBT-I可有效改善中国失眠患者的夜间及日间症状、睡眠不良信念和行为,是可扩大CBT-I获得性的方法。

远程医疗在慢性肾衰竭病人居家自我管理中的应用研究进展

对国内外远程医疗在慢性肾衰竭病人居家自我管理中的应用研究进行综述,包括远程医疗的概念及发展、远程医疗在慢性肾衰竭病人自我管理中的应用方式及应用效果等,以期为加快肾科远程医疗提供参考,完善慢性肾衰竭病人的自我管理方案。

Telehealth interventions for alcohol use disorder:A systematic review

Alcohol use disorder(AUD)is a worldwide problem for individuals of varying ages and backgrounds and is associated with the underlying cause of alcoholic liver disease,liver cirrhosis,liver cancer,or many other common diseases and health conditions.Existing treatments such as cognitive behavioral therapy(CBT)have been demonstrated as an evidence-based treatment to aid individuals struggling with AUD.However,these treatments have excessive costs and time demand with trained experts.In this paper,we examine the efficacy and long-term impacts of digitally delivered CBT and other online telehealth tools and apps for AUD patients.Results show the effectiveness in the ability of digitally delivered CBT to decrease alcohol use in AUD patients.The additional use of online technologies and smartphone apps for post-CBT care demonstrates that such computer-aided apps could have long-term effects when it is continually employed,which opens the door for AUD patients who were not seeking treatment elsewhere.Further longitudinal examination research is needed to evaluate the lasting effects in liver health and other chronic diseases associated with digitally delivered alcohol reduction for AUD patients.

Telehealth in the times of SARS-CoV-2 infection for the otolaryngologist

Objective:In response to the American Academy of Otolaryngology e Head and Neck Surgery’s recommendations to limit patient care activities in the times of SARS-CoV-2,many elective surgeries have been canceled without patient clinics transitioning to virtual visits.With regulations for telemedicine loosened,new possibilities for the practice of otolaryngology have opened.To address the uncertain duration of this pandemic,a review was conducted of current literature on use of telemedicine services in the current SARS-CoV-2 pandemic and in previous national emergencies to reveal the role telemedicine can play for otolaryngology practices.Data sources:Pubmed articles with an independent search query were utilized.Methods:Literature review performed by one author searched for all published Englishlanguage literature on telehealth in the SARS-CoV-2 era.Articles were considered for discussion if they provided relevant developments for telemedicine in the context of the SARSCoV-2 pandemic.Results:Telemedicine can be up-scaled in the current SARS-CoV-2 pandemic where exposure containment is of the utmost priority.With patient interaction possible through virtual communication,telemedicine allows continued patient care while minimizing the risk of viral spread.In the realm of otolaryngology,telemedicine has been used in the past during disasters with other studies demonstrating high diagnostic concordance with inpatient visits.Many institutions have recognized the potential for such care as they begin utilize both virtual visits and in-person care during this pandemic.Conclusion:To limit the spread of SARS-CoV-2,we support the AAO-HNS recommendation for the adoption of novel ways to employ telemedicine in this era.Many emergency departments and health care systems have the infrastructure necessary for synchronous video telemedicine visits that can be leveraged to provide quality care with patients.With the continued need to socially distance,telemedicine can protect both physicians and patients from unnecessary exposure to the virus.