Application of non-mydriatic fundus photography-assisted telemedicine in diabetic retinopathy screening

BACKGROUND Early screening and accurate staging of diabetic retinopathy(DR)can reduce blindness risk in type 2 diabetes patients.DR’s complex pathogenesis involves many factors,making ophthalmologist screening alone insufficient for prevention and treatment.Often,endocrinologists are the first to see diabetic patients and thus should screen for retinopathy for early intervention.AIM To explore the efficacy of non-mydriatic fundus photography(NMFP)-enhanced telemedicine in assessing DR and its various stages.METHODS This retrospective study incorporated findings from an analysis of 93 diabetic patients,examining both NMFP-assisted telemedicine and fundus fluorescein angiography(FFA).It focused on assessing the concordance in DR detection between these two methodologies.Additionally,receiver operating characteristic(ROC)curves were generated to determine the optimal sensitivity and specificity of NMFP-assisted telemedicine,using FFA outcomes as the standard benchmark.RESULTS In the context of DR diagnosis and staging,the kappa coefficients for NMFPassisted telemedicine and FFA were recorded at 0.775 and 0.689 respectively,indicating substantial intermethod agreement.Moreover,the NMFP-assisted telemedicine’s predictive accuracy for positive FFA outcomes,as denoted by the area under the ROC curve,was remarkably high at 0.955,within a confidence interval of 0.914 to 0.995 and a statistically significant P-value of less than 0.001.This predictive model exhibited a specificity of 100%,a sensitivity of 90.9%,and a Youden index of 0.909.CONCLUSION NMFP-assisted telemedicine represents a pragmatic,objective,and precise modality for fundus examination,particularly applicable in the context of endocrinology inpatient care and primary healthcare settings for diabetic patients.Its implementation in these scenarios is of paramount significance,enhancing the clinical accuracy in the diagnosis and therapeutic management of DR.This methodology not only streamlines patient evaluation but also contributes substantially to the optimization of clinical outcomes in DR management.

Intervention effect of telemedicine on ischemic stroke:a systematic review and meta-analysis

Background:Telemedicine refers to the use of information technology by medical institutions to directly provide diagnostic and therapeutic services to patients outside the healthcare facility.It encompasses various aspects such as remote diagnosis,remote monitoring,remote consultation,and remote outpatient services.Numerous articles have evaluated its role in controlling diseases like hypertension,diabetes,atrial fibrillation,and ischemic stroke.However,the existing literature exhibits varying quality and sample sizes,lacking robust convincing power and systematic effectiveness evaluation.Methods:Following The Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines,we identified articles on remote medical intervention in ischemic stroke through databases including Web of Science,PubMed,EMBASE,Cochrane Library,CNKI,Weipu,and Wanfang.The search spanned from the inception of the databases to June 30,2022.Two researchers independently assessed literature quality,extracted data,and conducted meta-analysis using RevMan 5.3 software.Results:Ten articles,involving 5092 patients,were included.Meta-analysis results indicate that telemedicine can effectively enhance compliance with doctors’advice in ischemic stroke patients.Telemedicine is also associated with reduced stroke recurrence,moderate to severe disability,systolic and diastolic blood pressure,National Institutes of Health Stroke Scale scores,and Modified Rankin Scale scores.Additionally,telemedicine demonstrates effectiveness in improving Fugl-Meyer motor function assessment and the Barthel Index of activity of daily living in ischemic stroke patients.However,telemedicine does not significantly reduce stroke hospitalization in the past year and the death rate.Conclusion:In comparison to traditional healthcare,telemedicine exhibits advantages in improving compliance and enhancing functionality in ischemic stroke patients.It is worth promoting telemedicine for better management of ischemic stroke patients.However,this study does not explain how telemedicine improves the functionality of ischemic stroke patients,indicating a need for further research.

Knowledge and Attitude of Salesmen in Nigeria towards Telemedicine

Need for prompt access to healthcare led to this cross-sectional study aimed to determine the knowledge and attitude of Sales men in Nigeria. It involved 362 Salesmen from some selected big companies in three states (Taraba, Benue and Adamawa) and Abuja. An electronic survey prepared using Google Form was used to collect information through social media such as WhatsApp. The research tool was validated by three experts in public health and the reliability test was done using Cronbach Alpha and a 0.7 co-efficient was obtained. The findings from the study revealed that 98.1% respondents have heard about telemedicine while 98.1% agreed that mobile health can help especially during emergency. However, 97.2% knew telemedicine involves Live consultation and interactive sessions from a distance. Nevertheless, 95.9% knew telemedicine makes it possible for one to access clinical services from a distance while 93.4% were aware that telemedicine has provision for storage and forwarding, 82.9% knew telemedicine makes it possible for one to easily reach medical specialists. On their attitudes towards telemedicine, 49.7% and 49.4% of the respondents strongly agreed and agreed respectively that telemedicine makes it easier for one to reach his doctor while 42% and 49.4% agreed and strongly agreed that telemedicine helps to curb the spread of infection. However, 47% and 49.7% respectively agreed and strongly agreed that telemedicine enables one to receive medical attention even at odd hours or while in remote villages. Meanwhile, 42% and 49.4% respectively agreed and strongly agreed that telemedicine reduces cost. Also, 44.2% and 51.9% of the respondents respectively agreed and strongly agreed that telemedicine offers appropriate medical follow-up. Nevertheless, 43.6% of the respondents agreed while 52.8% strongly agreed that telemedicine offers medical attention while one is in the comfort of his home. Finally, 45% and 47% of the participants respectively agreed and strongly agreed that with telemedicine one does not need to waste a whole day of work just to receive medical attention. In conclusion, the knowledge of telemedicine was high (82.9%) among the Salesmen while the attitude reflected high (93.6%) acceptance. Therefore, there is a need to introduce the use of telemedicine Apps to the Salesmen and also subsidize the applications.

Telemedicine in inflammatory bowel diseases:A new brick in the medicine of the future?

Inflammatory bowel disease(IBD)is a chronic digestive disease that requires continuous monitoring by healthcare professionals to determine the appropriate therapy and monitor short-term and long-term complications.The progressive development of information technology has enabled healthcare personnel to deliver care services to patients remotely.Therefore,various applications of telemedicine in IBD management have evolved,including telemonitoring,teleconsulting,teleducation,telenursing,telenutrition,and telepathology.While evidence has been provided for some telemedicine applications,targeted studies are still required.This review summarises the major studies that have evaluated telemedicine and its application in the management of IBD.

Telemedicine and Smart Healthcare—The Role of Artificial Intelligence, 5G, Cloud Services, and Other Enabling Technologies

This paper discusses telemedicine and the employment of advanced mobile technologies in smart healthcare delivery. It covers the technological advances in connected smart healthcare, including the roles of artificial intelligence, machine learning, 5G and IoT platforms, and other enabling technologies. It also presents the challenges and potential risks that could arise from delivering connected smart healthcare services. Healthcare delivery is witnessing revolutions engineered by the developments in mobile connectivity and the plethora of platforms, applications, sensors, devices, and equipment that go along with it. Human society is evolving fast in response to these technological developments, which are also pushing the connectivity-providing sector to create and adopt new waves of network technologies. Consequently, new communications technologies have been introduced into the healthcare system and many novel applications have been developed to make it easier for sharing data in various forms and volumes within health-related services. These applications have also made it possible for telemedicine to be effectively adopted. This paper provides an overview of some of the recent developments within the space of mobile connectivity and telemedicine.

The Development Opportunities and Dilemmas of Telemedicine - Base on the Perspective of Medical Resource Distribution

Objective To discuss issues related to telemedicine in the context of the“Internet plus”and the prevention of novel coronavirus in early 2020,so as to provide some reference for the rapid development of Internet plus telemedicine.Methods Literature analysis method was used to summarize the current status of telemedicine at home and abroad.Descriptive statistical analysis and comparative analysis were also conducted to analyze the data of population and health in the“China Health Statistical Yearbook”and“China Statistical Yearbook”from 2009 to 2018.Results and Conclusion The distribution of medical demand and medical resources is uneven in 31 provinces,municipalities and autonomous regions,such problems are more serious between urban and rural areas in different regions.The population’s demand for medical care and the allocation of medical resources have the characteristics of positive correlation,large urban-rural differences and regional imbalance.Confronted with the situation that the uneven distribution of medical resources provides potential development opportunities for telemedicine and the difficulties in the further development of telemedicine,the government should formulate policies to improve the publicity of telemedicine,setting up a full coverage of telemedicine service system.Besides,hospitals should ensure the information security monitoring.

Robust Reversible Audio Watermarking Scheme for Telemedicine and Privacy Protection

The leakage of medical audio data in telemedicine seriously violates the privacy of patients.In order to avoid the leakage of patient information in telemedicine,a two-stage reversible robust audio watermarking algorithm is proposed to protect medical audio data.The scheme decomposes the medical audio into two independent embedding domains,embeds the robust watermark and the reversible watermark into the two domains respectively.In order to ensure the audio quality,the Hurst exponent is used to find a suitable position for watermark embedding.Due to the independence of the two embedding domains,the embedding of the second-stage reversible watermark will not affect the first-stage watermark,so the robustness of the first-stage watermark can be well maintained.In the second stage,the correlation between the sampling points in the medical audio is used to modify the hidden bits of the histogram to reduce the modification of the medical audio and reduce the distortion caused by reversible embedding.Simulation experiments show that this scheme has strong robustness against signal processing operations such as MP3 compression of 48 db,additive white Gaussian noise(AWGN)of 20 db,low-pass filtering,resampling,re-quantization and other attacks,and has good imperceptibility.

Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes:A meta-analysis

BACKGROUND Telemedicine is defined as the delivery of health services via remote communication and technology.It is a convenient and cost-effective method of intervention,which has shown to be successful in improving glyceamic control for type 2 diabetes patients.The utility of a successful diabetes intervention is vital to reduce disease complications,hospital admissions and associated economic costs.AIM To evaluate the effects of telemedicine interventions on hemoglobin A1c(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),post-prandial glucose(PPG),fasting plasma glucose(FPG),weight,cholesterol,mental and physical quality of life(QoL)in patients with type 2 diabetes.The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention;telemedicine characteristics,patient characteristics and self-care outcomes.METHODS PubMed Central,Cochrane Library,Embase and Scopus databases were searched from inception until 18th of June 2020.The quality of the 43 included studies were assessed using the PEDro scale,and the random effects model was used to estimate outcomes and I2 for heterogeneity testing.The mean difference and standard deviation data were extracted for analysis.RESULTS We found a significant reduction in HbA1c[-0.486%;95%confidence interval(CI)-0.561 to-0.410,P<0.001],DBP(-0.875 mmHg;95%CI-1.429 to-0.321,P<0.01),PPG(-1.458 mmol/L;95%CI-2.648 to-0.268,P<0.01),FPG(-0.577 mmol/L;95%CI-0.710 to-0.443,P<0.001),weight(-0.243 kg;95%CI-0.442 to-0.045,P<0.05),BMI(-0.304;95%CI-0.563 to-0.045,P<0.05),mental QoL(2.210;95%CI 0.053 to 4.367,P<0.05)and physical QoL(-1.312;95%CI 0.545 to 2.080,P<0.001)for patients following telemedicine interventions in comparison to control groups.The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups.The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention,as well as those involving telemonitoring,and those provided via modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction.In addition,interventions delivered at a less than weekly frequency,as well as those given for a duration of 6 mo,and those lead by allied health resulted in better HbA1c outcomes.Furthermore,interventions with a focus on biomedical parameters,as well as those with an engagement level>70%and those with a drop-out rate of 10%-19.9%showed greatest HbA1c reduction.The patient characteristics investigation reported that Hispanic patients with T2DM had a greater HbA1c reduction post telemedicine intervention.For self-care outcomes,telemedicine interventions that resulted in higher postintervention glucose monitoring and self-efficacy were shown to have better HbA1c reduction.CONCLUSION The findings indicate that telemedicine is effective for improving HbA1c and thus,glycemic control in patients with type 2 diabetes.In addition,telemedicine interventions were also found to significantly improved other health outcomes as well as QoL scores.The results of the subgroup analysis emphasized that interventions in the form of telemonitoring,via a clinical treatment model and with a focus on biomedical parameters,delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction.This is in addition to being led by allied health,through modes such as video conference and interactive telephone,with an intervention engagement level>70%and a drop-out rate between 10%-19.9%.Due to the high heterogeneity of included studies and limitations,further studies with a larger sample size is needed to confirm our findings.

Improving cirrhosis care: The potential for telemedicine and mobile health technologies

Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failurefrom successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.

Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists

Diabetic retinopathy(DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus(DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters(glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR(6.96%) and diabetic macular edema(6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs.

COVID-19 pandemic:usefulness of telemedicine in management of arrhythmias in elderly people

In March 2020,the WHO defined the diffusion of novel coronavirus,Severe Acute Respiratory Syndrome-Coronavirus-2(SARS-CoV-2)as pandemic.[1-3]As a consequence,the Italian Government among others has enforced quarantine on the population to contain the diffusion of the infection.Quarantine refers to the separation of communities who have been exposed to an infectious disease.[1-3]Elderly people's lives have been drastically affected by the lockdown and the fear related to the disease’s potential effects and transmission.Fear of contracting COVID-19 is on the rise due to the death toll and alarming news reports in the media.[2,3].

Steganography-Based Transmission of Medical Images Over Unsecure Network for Telemedicine Applications

Steganography is one of the best techniques to hide secret data.Several steganography methods are available that use an image as a cover object,which is called image steganography.In image steganography,the major features are the cover object quality and hiding data capacity.Due to poor image quality,attackers could easily hack the secret data.Therefore,the hidden data quantity should be improved,while keeping stego-image quality high.The main aim of this study is combining several steganography techniques,for secure transmission of data without leakage and unauthorized access.In this paper,a technique,which combines various steganographybased techniques,is proposed for secure transmission of secret data.In the pre-processing step,resizing of cover image is performed with Pixel Repetition Method(PRM).Then DES(Data Encryption Standard)algorithm is used to encrypt secret data before embedding it into cover image.The encrypted data is then converted to hexadecimal representation.This is followed by embedding using Least Signification Bit(LSB)in order to hide secret data inside the cover image.Further,image de-noising using Convolutional Neural Network(CNN)is used to enhance the cover image with hidden encrypted data.Embedded Zerotrees of Wavelet Transform is used to compress the image in order to reduce its size.Experiments are conducted to evaluate the performance of proposed combined steganography technique and results indicate that the proposed technique outperforms all existing techniques.It achieves better PSNR,and encryption/decryption times,than existing methods for medical and other types of images.

Telemedicine in the COVID-19 era:Taking care of children with obesity and diabetes mellitus

Severe acute respiratory syndrome coronavirus 2 infection was declared a pandemic in January 2020.Since then,several measures to limit virus transmission have been imposed;among them,home confinement has been the most severe,with drastic changes in the daily routines of the general population.The“stay at home”rule has impaired healthcare service access,and patients with chronic conditions were the most exposed to the negative effects of this limitation.There is strong evidence of the worsening of obesity and diabetes mellitus in children during this period.To overcome these issues,healthcare providers have changed their clinical practice to ensure follow-up visits and medical consultation though the use of telemedicine.Telemedicine,including telephone calls,videocalls,data platforms of shared telemedicine data platforms mitigated the negative effect of pandemic restrictions.Published evidence has documented good metabolic control and weight management outcomes in centers that performed extensive telemedicine services last year during the pandemic.This review discusses studies that investigated the use of telemedicine tools for the management of pediatric obesity and diabetes.

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.

Tele-COVID: A Telemedicine SOA-Based Architectural Design for COVID-19 Patients

In Wuhan,China,a novel Corona Virus(COVID-19)was detected in December 2019;it has changed the entire world and to date,the number of diagnosed cases is 38,756,2891 and 1,095,2161 people have died.This happened because a large number of people got affected and there is a lack of hospitals for COVID-19 patients.One of the precautionary measures for COVID-19 patients is isolation.To support this,there is an urgent need for a platform that makes treatment possible from a distance.Telemedicine systems have been drastically increasing in number and size over recent years.This increasing number intensies the extensive need for telemedicine for the national healthcare system.In this paper,we present Tele-COVID which is a telemedicine application to treat COVID-19 patients from a distance.Tele-COVID is uniquely designed and implemented in Service-Oriented Architecture(SOA)to avoid the problem of interoperability,vendor lock-in,and data interchange.With the help of Tele-COVID,the treatment of patients at a distance is possible without the need for them to visit hospitals;in case of emergency,necessary services can also be provided.

Advances in telemedicine for the management of the elderly cardiac patient

Telemedicine is the use of information and communication technology to deliver healthcare at a distance.It has been resorted to during the COVID-19 pandemic to lessen the need for in-person patient care decreasing the risk of transmission,and it can be of benefit afterward in the management of cardiac disease.The elderly population has unique challenges concerning the use of telehealth technologies.We thus review the advances in telemedicine technologies in treating elderly cardiac patients including in our discussion only studies with a mean age of participants above 60.Remote monitoring of blood pressure,weight,and symptoms,along with home ECG recording has been found to be superior to usual in-clinic follow up.Combining remote monitoring with video conferencing with physicians,patient education websites,and applications is also of benefit.Remote monitoring of Implantable Cardioverter Defibrillators(ICD)and Cardiac Resynchronization Therapy Defibrillators(CRT-D)is also beneficial but can be at the cost of an increase in both appropriate and inappropriate interventions.Implantable sensing devices compatible with remote monitoring have been developed and have been shown to improve care and cost-effectiveness.New smartphone software can detect arrhythmias using home ECG recordings and can detect atrial fibrillation using smartphone cameras.Remote monitoring of implanted pacemakers has shown non-inferiority to in clinic follow up.On the other hand,small-scale questionnaire-based studies demonstrated the willingness of the elderly cardiac patients to use such technologies,and their satisfaction with their use and ease of use.Large-scale studies should further investigate useability in samples more representative of the general elderly population with more diverse socioeconomic and educational backgrounds.Accordingly,it seems that studying integrating multiple technologies into telehealth programs is of great value.Further efforts should also be put in validating the technologies for specific diseases along with the legal and reimbursement aspects of the use of telehealth.

Expanding telemedicine to reduce the burden on the healthcare systems and poverty in Africa for a post-coronavirus disease 2019 (COVID-19) pandemic reformation

The coronavirus disease 2019(COVID-19)global public health emergency,has exposed the fragility of health systems.Access to healthcare became a scarce commodity as healthcare providers and resource-poor popula­tions became victims of the novel corona virus.Therefore,this study focuses on Africa’s readiness to integrate telemedicine into the weak health systems and its adoption may help alleviate poor healthcare and poverty after COVID-19.We conducted a narrative review through different search strategies in Scopus on January 20,2021,to identify available literature reporting implementation of various telemedicine modes in Africa from January 1,2011 to December 31,2020.We summarized 54 studies according to geographies,field,and implementation methods.The results show a willingness to adopt telemedicine in the resource-poor settings and hard-to-reach populations,which will bring relief to the inadequate healthcare systems and alleviate poverty of those who feel the burden of healthcare cost the most.With adequate government financing,telemedicine promises to enhance the treating of communicable and non-communicable diseases as well as support health infrastructure.It can also alleviate poverty among vulnerable groups and hard-to-reach communities in Africa with adequate government financing.However,given the lack of funding in Africa,the challenges in implementing telemedicine require global and national strategies before it can yield promising results.This is especially true in regards to alleviating the multidimensionality of poverty in post-COVID-19 Africa.

The Use of Telemedicine in Bangladesh during COVID-19 Pandemic

This paper presents the impact of telemedicine use among patients and healthcare professionals during the epidemic due to COVID-19 outbreak in Bangladesh. According to our findings, as the coronavirus outbreak quickly surges worldwide, many countries are adapting non-therapeutic preventative measures. Telemedicine is the exchange of medical information from one location to another using electronic communication. Telemedicine refers to the use of information and communication technology to provide healthcare support. During the pandemic, it is safer not to visit a hospital physically for consultation until and unless it is of utmost emergency. In this scenario, Telemedicine plays a vast role in developing both the quality and access to healthcare services during a pandemic. The current (COVID-19) scenario has shown us the significance of using Telehealth to deliver healthcare, especially as a means of decreasing the risk of cross-contamination caused by close contact. Bangladesh, like every other nation, has started using telemedicine as a means of providing digital healthcare services. As the outbreak continues, this paper finds that several telemedicine service providers in Bangladesh have increased their operation for serving the general mass. This paper finds the role of telemedicine during the COVID-19 pandemic as a bridge between providing safe healthcare consultation while keeping social distance as advised. The current situation of COVID-19 in Bangladesh has also been discussed in this paper. Despite some challenges of a telemedicine application in Bangladesh, the role of telemedicine is quite impactful during the pandemic.

E-Health and Telemedicine: Current State and Future Steps

The article reviews the questions related to building the e-health systems. The key element of the system is electronic healthcare record to be formed according to the modular approach in the form of primary and satellite electronic medical records. Person-centred healthcare is proposed as a foundation for e-health. Such an approach provides a potential opportunity for all the medical doctors to obtain necessary information about their patients at any time via the teleconsultations in particular. Transition to e-health is associated with the creation of new opportunities for making diagnostic and therapeutic decisions based on the use of build-in decision support modules. The computer-assisted software design or hybrid systems are considered as the fourth generation medical information systems. It is reasonable to implement the entire information space of e-health, including the information systems of medical institutions and regional data repositories, based on cloud-optimized storage and computing solutions. This approach is expected to be implemented in Russia as a part of the unified state health information system. The authorized access to integrated databases for medical doctors of various specialties is required. In the framework of e-health, telemedicine is considered as an important component. Main elements comprise the real-time access of medical consultants to personified medical databases and remote follow-up of patients by the means of personal or home-based telemedicine. The use of personal portable devices for the control of vital signs of the organism is especially promising. Electronic stethoscopes and specialized video cameras for acquiring objective information should be increasingly used by remote consultants. Unfortunately, this trend is still underdeveloped in Russia. In perspective, e-health as unified medical space will provide a transition to the integrated analysis of population health by medical doctors of various specialties from different countries and will open new prospects for studying health based on the intelligent analysis of integrated data of patients.

Utilizing Anesthesiologists, Emergency and Critical Care Physicians with Telemedicine Monitoring to Develop Intubation and Ventilation Services in an Intensive Care Unit in the Austere Medical Environment: A Case Series. Expansion of the EP/CC GAS Project

Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.