Search Results (24)

Background/Objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine. Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end. Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical–legal aspects (e.g., data security, privacy, informed consent); clinician–patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up. Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas. Full article

Background: Cognitive decline does not always occur; therefore, it is important to recognise the predictors in people over 60. The COVID-19 pandemic led to isolation to limit the spread of the virus, with older people being the most affected. Objectives: To analyse the cognitive variables of older adults in confinement during COVID-19 using tele-neuropsychology for cognitive assessment, comparing online with in-person screening. Methods: In total, 148 subjects took part in the study. Participants were assigned to the in-person or online intervention based on their preferences. A person close to the patient also participated in the study as an informant. Results: The results support the suitability of the protocol used in both modalities (face-to-face/online). Conclusions: Both assessments (face-to-face and online) are equally effective. The findings are consistent with the importance of cognitive measures and the key informant corroboration in identifying indicators of cognitive decline and implementing early intervention strategies. Full article

Background: This study innovatively combines Artificial Intelligence (AI) algorithms with smartphone technology, automatically detecting the Near Point of Convergence (NPC) and diagnosing Convergence Insufficiency (CI) without the need for extra diagnostic tools and, notably, without having to rely on the subject’s vocal response, marking an unprecedented approach in the field to the best of our knowledge. Methods: This was a prospective study that enrolled 86 participants. The real-time tracking of eye structures and movements was conducted using AI technologies integrated with a mobile application (MobileS). Participants brought the smartphone closer, focusing on a target displayed on the screen. The system calculated pupillary distance (PD) and phone-to-face distance, incorporating a unique feature called the exodeviation episode’s counter (ExoCounter) to determine the NPC. Additionally, participants underwent testing using the RAF Ruler test (RulerT), considering the ground truth. Results: MobileS demonstrated significant correlation with the RulerT, as evidenced by a Pearson correlation coefficient of 0.74 (p < 0.001) and an Intraclass Correlation Coefficient (ICC) of 0.73 (p < 0.001), highlighting its reliability and consistency with conventional ophthalmic testing. Additionally, the system exhibited notable sensitivity and specificity in diagnosing CI. Notably, user feedback indicated a preference for the MobileS, with 71% of participants favouring it for its ease of use and comfort. Conclusions: MobileS is a precise, user-friendly tool for independent NPC measurement, applicable in tele-ophthalmology and home-based care. Its versatility extends beyond CI diagnosis, marking a significant advancement in ophthalmic diagnostics for accessible and efficient eye care. Full article

Background: About 15 million people suffer a stroke each year, of which 10–15% occur in people under 50 years of age. The clinical management of neurological disorders depends on reliable diagnostic tools to identify impairments and aid in the early and accurate detection of disease. The objective of this study is to present a systematic review protocol for identifying the scientific evidence on the use of tele-assessment compared with in-person assessment delivery by physiotherapists for stroke patients. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024613552). Methods: Original studies of any design in which physiotherapy tele-assessment using videoconferencing compared with face-to-face assessment for patients with stroke conditions will be included. The research will be carried out in PubMed/Medline, Cochrane Library, PEDro (Physiotherapy Evidence Database), and NICE. The risk of bias will be assessed using the Quality Appraisal Tool for studies of diagnostic Reliability (QAREL) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Results: The screening, selection, and analysis process will be conducted by two independent researchers and reviewed by a third evaluator to resolve any potential disagreements. The feasibility of conducting a meta-analysis for quantitative data will be evaluated based on the homogeneity analysis of the selected studies. Conclusions: We hope that this systematic review protocol will provide scientific evidence for tele-assessment as a physiotherapeutic assessment strategy for stroke patients and that it will be available as a complementary tool to face-to-face physiotherapeutic assessments for specific situations. Full article

Artificial intelligence (AI) is rapidly gaining attention in radiology and cardiology for accurately diagnosing structural heart disease. In this review paper, we first outline the technical background of AI and echocardiography and then present an array of clinical applications, including image quality control, cardiac function measurements, defect detection, and classifications. Collectively, we answer how integrating AI technologies and echocardiography can help improve the detection of congenital heart defects. Particularly, the superior sensitivity of AI-based congenital heart defect (CHD) detection in the fetus (>90%) allows it to be potentially translated into the clinical workflow as an effective screening tool in an obstetric setting. However, the current AI technologies still have many limitations, and more technological developments are required to enable these AI technologies to reach their full potential. Also, integrating diagnostic AI technologies into the clinical workflow should resolve ethical concerns. Otherwise, deploying diagnostic AI may not address low-resource populations’ healthcare access disadvantages. Instead, it will further exacerbate the access disparities. We envision that, through the combination of tele-echocardiography and AI, low-resource medical facilities may gain access to the effective detection of CHD at the prenatal stage. Full article

Background: The reported data on African universal neonatal hearing screening (UNHS) practices tend to be quite scarce, despite the developments in hearing screening the last two decades. The objective of this systematic review was (a) to identify the most recent (in a 20-year span) literature information about NHS/UNHS programs in Africa and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with an emphasis on bilateral hearing loss cases. Methods: Queries were conducted via the PubMed, Scopus, and Google Scholar databases for the time window of 2004–2024. The mesh terms used were “OAE”, “universal neonatal hearing screening”, “congenital hearing loss”, “well babies”, and “Africa”. Only research articles and review papers were considered as good candidates. The standard English language filter was not used, to identify information from non-English-speaking scientific communities and groups. Results: Data from 15 papers were considered, reflecting the neonatal hearing practices of nine African states. No country-wide NHS programs were reported. The various screening realities are implemented within big urban centers, leaving the residents of rural areas unassisted. For the latter, proposals based on tele-medicine protocols have been suggested. The data on HL prevalence are also incomplete, but the available data refer to rates from 3 to 360 subjects per 1000. These data cannot be taken at face value but within the small sample size context in which they were acquired. Regarding the causes of HL, very few data have been reported; consanguinity is the most attributed factor, at least in the Sub-Saharan African states. For the majority of the programs, no data were reported on hearing loss prevalence/incidence or on any strategies to restore hearing. Conclusions: The information on the African neonatal hearing screening are quite scarce, and it is an urgent need to convince audiologists from the African localized programs to publish their hearing screening data. Full article

Introduction: People with special care needs often face significant barriers in accessing dental care due to physical and cognitive limitations, leading to high rates of dental issues like caries. Despite the growing recognition of these challenges, unmet dental care needs remain prevalent. This review aims to explore the global landscape of special care dentistry to identify gaps and opportunities for improving dental services for this population. Methodology: A systematic search was conducted across three online databases—PubMed, Embase, and Scopus—to identify relevant articles from their inception through May 2024. Reference lists of the selected studies were also screened for additional sources. A thematic synthesis approach was applied to derive both descriptive and analytical themes. The scoping review was guided by the Arksey and O’Malley framework to examine the scope and nature of studies and documents related to dental care for individuals with special care needs. Furthermore, a Google search was performed to include accessible theses and official government documents from various countries. Results: A total of 49 studies from 11 countries were reviewed, all centered on providing dental care for people with special needs. The analysis revealed three main themes: Human resources, care delivery model, and management. Within these, nine subthemes emerged: Mid-level oral care providers, dentists, special care dentistry as a specialty, tele-dentistry, mobile dentistry, hospital care, levels of healthcare provision, financial support, and education. These themes and subthemes highlight essential areas for enhancing services for those people. Conclusions: A holistic approach is essential to enhance dental care for people with special needs. Critical strategies, including the involvement of mid-level oral care providers, the adoption of tele-dentistry and mobile units, and the availability of hospital-based services for complex cases, are crucial. To truly transform care for those people, each country must adapt these strategies to its specific context, aligning resources and policies to create an inclusive, accessible, and effective system. Full article

Natural wound healing products are in increased demand. The potential for unexplored Sedum species in wound healing was discovered based on benefits of the genus reported in traditional medicine. The objectives were to screen ten Sedum species for wound healing, to ascertain the optimal harvest period using the five best, and finally to investigate effects of extraction protocols on wound healing using the most promising species. Different protocols were used to extract leaf polyphenol and mucilage content. Wound healing was assessed from L929 fibroblast migration. April was the optimal harvest month for wound healing efficacy, whereas the highest polyphenol content and antioxidant activity were evident in September and November. S. album Murales (ALBU), the best candidate, was then compared with S. telephium (TELE), which is well recognized in skin care. The mucilage-containing aqueous extract of ALBU was shown for the first time to induce the highest fibroblast migration after 24 h, not evident in TELE. Moreover, functional constituents contained within the absolute acetone- and isopropanol-containing polyphenol pools from ALBU induced significantly higher migration compared to TELE. A prototype cream, containing the water- and solvent-extracted bioactive compounds was effective at inducing fibroblast migration at 24 h in ALBU. The potential of ALBU in wound healing was evidenced and warrants further investigation. Full article

Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare. Full article

Background: Colorectal cancer diagnosis and treatment negatively impact sexual health. However, there is still a lack of interventions targeting the sexual healthcare needs of colorectal cancer patients and survivors. This systematic review aimed to identify and summarize the efficacy of available psychological interventions aimed at improving colorectal cancer patients’ and survivors’ sexual health. Methods: This review followed PRISMA guidelines for systematic reviews. A database search was conducted for studies published until July 2023 on EBSCO Host, Web of Science, PubMed, and the Cochrane Library. Manuscripts were screened according to inclusion and exclusion criteria. The risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies. Results: From the 1499 records screened, four studies describing psychological interventions to improve the sexual health of the target population were identified. All studies reported on e-health programs and showed evidence of their efficacy in the improvement of participants’ sexual function. The studies presented low scores on the Quality Assessment Tool for Quantitative Studies. Conclusions: Despite the evidence that tele/e-health psychological interventions have the potential to effectively promote sexual health in colorectal cancer patients and survivors, more robust research is needed to allow for generalization. Future research should further assess the efficacy of e-health interventions (eMental Health) in promoting sexual health in patients with colorectal cancer. Full article

Background and Objectives: The health-related mobile applications (app) might assist in promoting inclusive health and tele-treatment, especially for the less severe diseases. In this paper, a study had been done to determine the app’s reliability in terms of raters and the app’s agreement with the Snellen chart. Materials and Methods: A cross-sectional sectional study was conducted between November 2019 and September 2020. Participants were selected via purposive sampling from selected communities in Terengganu state. All participants underwent vision testing with the Vis-Screen app and Snellen chart for validity and reliability accordingly. Results: A total of 408 participants were involved, with a mean age of 29.3. The sensitivity of the presenting vision of the right eye (PVR) ranged from 55.6% to 88.4%, with specificity between 94.7% to 99.3%, while the positive and negative predictive values were between 57.9% and 81.7% and 96.8% and 99.0%, respectively. The positive likelihood ratios ranged between 16.73 and 73.89, whereas the negative likelihood ratios ranged from 0.12 to 0.45. The area under the receiver operating characteristic curve (AUC) for all cut-off points ranged between 0.93 and 0.97, and the optimum cut-off point was at 6/12. The kappa values for intra-rater and inter-rater were 0.85 and 0.75, respectively, while the app’s reliability with the Snellen chart was 0.61. Conclusions: Vis-Screen was concluded to be valid and reliable for use as a screening tool for detecting individuals with visual impairment and blindness in the community. A valid and reliable portable vision screener like Vis-Screen will help expand the eye care feasibility while providing similar accuracy as the conventional charts in clinical practices. Full article

Considering the increasing need for oral and dental care in the elderly, teledentistry has been proposed to improve the education of elderly patients in oral health maintenance and risk factor control, identify patients’ concerns in advance, facilitate monitoring, and save time and money. The present cross-sectional analysis of Google search data through real-time surveillance with Google Trends aimed to determine Google users’ interest in oral and dental needs and teledentistry applications in the elderly, and to compare search volumes before and after the COVID-19 outbreak. Extracted CVS data were qualitatively analyzed. Pearson and Spearman correlation analyses were performed between searches for “elderly” and “teledentistry”, and all the oral and dental needs and teledentistry applications. The Mann–Whitney U test compared search volumes in the 36 months before and after the beginning of the COVID-19 pandemic. Google users’ interest in the elderly and related oral and dental needs was diffusely medium–high, while teledentistry and its applications were of lower interest. Interest in teledentistry and its applications was strongly related to interest in the older population, which is consistent with the assumption that older adults represent the population segment that could benefit most from these tools. A positive correlation was also found between searches for “Elderly” and searches for almost all oral and dental needs typical of the geriatric population. Search volumes increased significantly after the outbreak of the COVID-19 pandemic. More information about teledentistry should be disseminated to increase knowledge and awareness, especially among older patients, about its indications, applications, and advantages. Full article

Objective: Ultrasound (US) plays an important role in the diagnosis and management of breast diseases; however, effective breast US screening is lacking in rural and remote areas. To alleviate this issue, we prospectively evaluated the clinical availability of 5G-based telerobotic US technology for breast examinations in rural and remote areas. Methods: Between September 2020 and March 2021, 63 patients underwent conventional and telerobotic US examinations in a rural island (Scenario A), while 20 patients underwent telerobotic US examination in a mobile car located in a remote county (Scenario B) in May 2021. The safety, duration, US image quality, consistency, and acceptability of the 5G-based telerobotic US were assessed. Results: In Scenario A, the average duration of the telerobotic US procedure was longer than that of conventional US (10.3 ± 3.3 min vs. 7.6 ± 3.0 min, p = 0.017), but their average imaging scores were similar (4.86 vs. 4.90, p = 0.159). Two cases of gynecomastia, one of lactation mastitis, and one of postoperative breast effusion were diagnosed and 32 nodules were detected using the two US methods. There was good interobserver agreement between the US features and BI-RADS categories of the identical nodules (ICC = 0.795–1.000). In Scenario B, breast nodules were detected in 65% of the patients using telerobotic US. Its average duration was 10.1 ± 2.3 min, and the average imaging score was 4.85. Overall, 90.4% of the patients were willing to choose telerobotic US in the future, and tele-sonologists were satisfied with 85.5% of the examinations. Conclusion: The 5G-based telerobotic US system is feasible for providing effective breast examinations in rural and remote areas. Full article

Cognitive impairment (CI) represents a common symptom in patients suffering from multiple sclerosis (MS), which can affect every stage of the disease course. Recent studies seem to support cognitive rehabilitation (CR) for minimizing the CI consequences. We reviewed the currently available evidence on the non-pharmacological approaches to CI, with the aim of giving an overview of the treatments used worldwide, from the traditional methods to the most recent techniques. A search of the literature was conducted on PubMed (articles in English performed in the last five years on humans). A total of 37 articles met our eligibility criteria after screening titles, abstracts and full-text and were divided into three main groups: in-presence interventions; studies performed via tele-rehabilitation and miscellaneous. Despite the great heterogeneity of the intervention and assessment methods, the evidence suggests that a non-pharmacological approach can improve MS-related CI. Cognitive rehabilitation seems effective and well established, as well as the use of computerized CR having the benefit of being even more appealing. Limited conclusions can be drawn on group CR due to the small number of studies focused on this kind of intervention. Some of the innovative approaches (virtual reality, EEG-based neurofeedback, brain stimulation, exercise, diet modification) may play a role in future studies and should be deeply explored. Full article

Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment. Full article