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Objective: To investigate the integration of and barriers to the utilization of telehealth technology and its components (telemedicine, e-Health, m-health) in daily otolaryngologic practice before the SARS CoV-2 (COVID-19) pandemic. Methods: This cross-sectional study was conducted at a tertiary academic center. A national survey of members of the American Academy of Otolaryngology-Head and Neck Surgery was administered. Descriptive analyses were performed to determine how telehealth was employed in otolaryngologists' practices. Results: A total of 184 surveys were completed. Telehealth technology was used by 50% of otolaryngologists surveyed. Regions with the largest percentage of physicians using telehealth were the Mid-Atlantic region (84%) and West Coast (67%). Most otolaryngologists indicated that they were familiar with telehealth or any of its components and how it is used in practice (52-83%), they had heard of telehealth or any of its components but were unsure what the terms specifically entailed (17-42%); 53% were satisfied with their current use of telehealth and electronic medical record (EMR); and 72% were comfortable utilizing smart devices for patient care. Most otolaryngologists (65%) indicated reimbursement as the biggest limitation to implementing telehealth, and 67% believed that typing was a hindrance to EMR utility. Conclusion: Half of the surveyed otolaryngologists used some form of telehealth at the time of the survey. The most commonly cited obstacle to physician adoption of telehealth was reimbursement. Although the adoption of telehealth technology was still limited in the field of otolaryngology based on this study, we are now seeing significant change due to the COVID-19 pandemic.

Background: As the burden of mental health disorders continues to increase worldwide, there is significant need to describe the cultural variations in presentation, diagnosis and treatment of these diseases. An understanding of these variations can lead to the development of more effective programs to manage these conditions. In Guatemala, depression is the second-leading cause of disability and yet mental health treatment resources are scarce, particularly for indigenous individuals. Aims: The primary research aim was to describe primary care nurses’ explanatory models of depression in their clinical work in indigenous communities in Guatemala. A secondary research aim was to describe training and resources which would support and empower these nurses, in order to lessen risk for burnout. Methods: A cross-sectional mixed methods survey was designed to elicit nurses’ perspectives on the presentation, cause and treatment of depression in the communities they serve, as well as their clinical and emotional comfort in working with depressed individuals. Two subsequent focus groups gathered qualitative commentary which informed training and resource recommendations. Theoretical thematic analysis was used to generate codes and themes from focus group transcripts and survey responses. Results: Guatemalan primary care nurses described symptoms of depression in their cultural context, identified socioeconomic factors which contribute to depression in their communities, and detailed treatment preferences. Limited referral options and concern for privacy made connecting patients to mental health care difficult. Nurses emphasized the need for community education on depression and for supplemental mental health resources which would increase their capacity to identify and treat depression. Conclusions: Primary care nurses in Guatemala identify and treat depression despite limited resources. Further investigations should focus on creating training modalities which include front-line nurses, given their critical role in the health system.

Background: The Telehealth Dissemination Forum brought together a cross section of telehealth providers and constituents to review the latest telehealth research funded by Patient-Centered Outcomes Research Institute (PCORI) and to ascertain whether there were known gaps in the research. Methods: A pre- and postsurvey was conducted before and after the general overview of the market and research presentations. Using elements of human-centered design, participants were exposed to alternative problem solving and program design methods with the goal of translating the research into practice. Participants were stratified into four groups each with a moderator. Designers instructed the group throughout the design session. Results: A debrief was conducted at the end of the day to determine the value of the session as written evaluations were often not completed or less constructive. Postmeeting surveys were analyzed. Conclusions: We determined that the dissemination was effective; knowledge, attitudes, practices, and beliefs changed based on how this information was presented. The forum had an impact on participants as they left with design tools to assist with complex problem solving.

Introduction: The Integrated Telemedicine and e-Health program (ITeHP) of Albania, built by the International Virtual e-Hospital Foundation (IVeH), has improved access to high-quality health care, particularly in high demanding specialty disciplines. We aimed to test the hypothesis that the majority of patients in remote and regional hospitals can be managed using telemedicine and will prevent unnecessary transfers. Methods: A retrospective analysis of prospectively collected data of patients seen between January 2014 and September 2018 was conducted. Patient demographics, type of teleconsultation modality used, and patient disposition were analyzed. The comparison of continuous data was performed with t-test or Mann-Whitney test. The categorical data were tested with chi-squared test and analysis of variance. Results: There were 2,842 patients seen in all the clinical disciplines during the study period. We excluded tele-autism and incomplete data. There were 2,724 records eligible for study. The most frequent consulting clinical programs (82.9%) were teleradiology (39.0%), teleneurotrauma (27.2%), and teletestroke (16.7%). The majority of patients (77.9%) were kept at regional centers and did not require transfer (p < 0.001) to a tertiary center. Of those transferred, 70.3% were male (p < 0.001), of which 81.6% were for transferred due to neurotrauma. Conclusion: The telemedicine program in Albania has improved access to specialized care in a number of specialty clinical disciplines, particularly in potentially life-threatening and time-sensitive conditions such as neurotrauma. Almost 80% of patients did not require transfer to tertiary centers and were kept for further treatment at the regional centers.

NASA has put people in unique and extreme environments for over six decades. Supporting these individuals with a comprehensive health-care system has evolved over this period. As the Apollo program ended and NASA began to contemplate a space shuttle and space station program, societal pressures in the late 1960s and early 1970s caused federal agencies such as NASA to reconsider how to link the needs of the space program with a growing pressure to address societal needs by forging interagency partnerships. The Space Technology Applied to the Rural Papago Health Care (STARPAHC) project provides an example of how NASA sought to balance these two imperatives in an age of diminishing federal support. This project can provide lessons for today’s uncertain budgetary future for agencies such as NASA, which are once again being asked to find creative and innovative ways to support their missions while demonstrating their larger value to society.

Introduction: Varying terms such as telemedicine, telehealth, and e-Health have increasingly been incorporated into medical education and clinical practice. While there is some variability...

INTRODUCTION: In the mid-1970s, NASA required a robust training program for physicians responsible for the medical needs of the Shuttle astronauts. Personnel at NASA worked closely with academicians and subject matter experts at Wright State University (WSU) to develop and establish a residency program in aerospace medicine. This academic training program was initiated in 1978 and closed in 2018. The objective of this historical piece is to catalog, for posterity, the impact this training program has had on national and international human spaceflight and aviation. METHODS: A thorough review of all available historical documents and oral histories provided by contemporaries were reviewed in detail, including a search of every available residents thesis and all available historical documents and reports at WSU and NASA Headquarters. RESULTS: Over the past 40 yr, WSU has graduated 172 individuals with an M.S. degree focused on aerospace medicine, of which 84 were residents. Nearly 50 of these residents have worked closely with NASA. Many others became integrated into academia, the aviation industry, or international space programs. DISCUSSION: With the growth in interest for government and commercial spaceflight, the field of aerospace medicine is poised to grow. Although it is not well known outside of the Aerospace Medicine community, the legacy of this pioneering, 40-yr civilian-based program is of significant value. If not recorded in an easily locatable and accessible manner, many of the challenges and outcomes from this residency could be lost until future generations have to spend the money, time, and effort to relearn them. Doarn CR, Shimada K, Shepanek M. The legacy of the Wright State University Aerospace Medicine Residency program. Aerosp Med Hum Perform. 2021; 92(9):744750.

The successful design, development, and operation of human-rated and human-operated systems require the combined effort of engineering, science, and human health disciplines. This is extre...

The purpose of this paper is to describe the curriculum and self-reported outcomes on measures of interdisciplinary leadership skills for work within the field of developmental disabilities from trainees in one interprofessional training program. The paper highlights one program’s curriculum and strategy for capturing self-report survey measures from trainees in cohorts from 2014–2018 (n = 86) on two surveys (Interdisciplinary Attitudes and Skills and Leadership Self-Evaluation Form) and three time points across the training year: before training (T1), mid-year (T2), and after training (T3). Data from 86 trainees are reported including demographics (nearly 80% white, 92% female), non-descriptive statistics due to non-normative samples, and tertiles demonstrating changes between time points. Significant differences between medians are reported between T1-T3 specifically related to utilizing interdisciplinary skills and gains in leadership competencies. Specific utilization of skills was reported to be ‘Greatly’ attributable to the LEND program related to sharing ideas and asking for help across disciplines. Trainees’ self-report from before training to after training indicates an increase in competence and utilization of interdisciplinary skills to be expected from participation in the curriculum. Self-report measures are

INTRODUCTION: In the 1990s, Canada, member states of the European Space Agency, Japan, the Russian Federation, and the United States entered into an international agreement Concerning Cooperation on the Civil International Space Station. Among the many unique infrastructure challenges, partners were to develop a comprehensive international medical system and related processes to enable crew medical certification and medical support for all phases of missions, in a framework to support a multilateral space program of unprecedented size, scope, and degree of integration. During the Shuttle/Mir Program, physicians and specialized experts from the United States and Russia studied prototype systems and developed and operated collaborative mechanisms. The 1998 NASA Memoranda of Understanding with each of the other four partners established the Multilateral Medial Policy Board, the Multilateral Space Medicine Board, and the Multilateral Medical Operations Panel as medical authority bodies to ensure International Space Station (ISS) crew health and performance. Since 1998, the medical system of the ISS Program has ensured health and excellent performance of the international crewsan essential prerequisite for the construction and operation of the ISSand prevented mission-impacting medical events and adverse health outcomes. As the ISS is completing its second decade of crewed operation, it is prudent to appraise its established medical framework for its utility moving forward in new space exploration initiatives. Not only the ISS Program participants, but other nations and space agencies as well, concomitant with commercial endeavors in human spaceflight, can benefit from this evidence for future human exploration programs.Doarn CR, Polk JD, Grigoriev A, Comtois J-M, Shimada K, Weerts G, Dervay JP, Taddeo TA, Sargsyan A. A framework for multinational medical support for the International Space Station: a model for exploration. Aerosp Med Hum Perform. 2021; 92(2):129134.

Austere conditions can be defined in many ways. They are places around the world and in space. Whenever individuals or groups travel to these places or live and work in them, they may find services austere or extremely limited. Healthcare services or access to healthcare knowledge can be impacted by a lack of resources or capable individuals who can provide them. Telemedicine and telehealth have been deployed in many of these austere environments effectively through significant research and evidence base. Examples of these are brought to you in a way that showcases the challenges and benefits of incorporating telemedicine. These examples include spaceflight, the battlefield, alpine environments, jungles, ships at sea, oil rigs, disasters, pandemics, and nursing homes. It is important to note that the integration of telemedicine and telehealth since the beginning of early 2020 concomitant with COVID-19 pandemic has skyrocketed. Many of us have been impacted physically, psychologically, and economically. Telemedicine and telehealth have been key to helping us all flatten the curve and help eradicate the disease.

Disasters present a worldwide problem that requires systematic, careful, and methodological preparation, but above all requires response by multiple teams, working in partnership. In other words, disaster management cycle includes mitigation, preparation, response, and recovery. To effectively respond to major disaster crises and engage in the management of disasters, often a multinational coordinated system must be implemented. Telemedicine should be part of this response and management in all phases.

Imagine a world without technology. What would we do? How would we survive? What would we do without our smartphones? Well, humanity did pretty good for thousands of years, even though there were some significant challenges put in front of our ancestors. Advances in telecommunications, computing power, data storage, and a variety of mechanical devices have helped healthcare, medicine, and public health reach new levels. The integration of these various tools has permitted telemedicine, telehealth, e-health, m-health, and telepresence to become common place and fully entrenched in commerce and all human activity. This chapter presents some of these technological advances at a very high level. A complete or exhaustive list would fill numerous volumes of several compendiums. The important points to remember are that these technological advances continue to amaze us. They become significant and I dare say vital to our way of life and our ability to enable better healthcare.

As we begin the second decade of the twenty-first century, there are those Americans who have limited access to medical care and health information. Advancements in technology—computers, sensors, information technology, and communications—provide a remarkable platform for change. Access via broadband communications can provide access to virtual care and educational services. Rural health policy is set by the Federal government but is influenced by many different contributing factors. Several states have been permitted to utilize telehealth, and it has been reimbursable, and as such, a lot of research has been conducted in rural areas. Sometimes events occur that alter the standard approach or the “old way.” Recently, the World Health Organization declared a pandemic due to COVID-19. This has caused the healthcare system to begin to finally embrace telemedicine and telehealth as an ideal tool across the entire landscape. There will always be challenges, and more often than not there are amazing solutions. This chapter provides a review of how telemedicine and telehealth are impacting healthcare in rural America.

The new world order caused by COVID-19 virus, associated with severe acute respiratory syndrome, multiple organ failure, and very high mortality, has brought about many changes to our world. Suddenly, the medical community, and those who finance the health care sector, realized that telemedicine and telepresence are applicable, desirable, acceptable, and much sought after by our patients and we can manage just about every disease and condition. Although, by and large, telemedicine has faced challenges and perhaps some resistance, despite its great potential, it has become evident that telemedicine can provide rapid, safe, and high-quality care remotely during this pandemic, the largest one since 1918. Perhaps one benefit of suffering through the COVID-19 pandemic will be the establishment of a new virtual medical world order, and that telemedicine has taken its deserving place in health care: prime time and a center stage.

This article reviews the current experience and the flaws encountered in the rush to deploy telemedicine as a substitute for in-person care in response to the raging coronavirus (COVID-19) pandemic; the preceding fault lines in the U.S. health care system that exacerbated the problem; and the importance of emerging from this calamity with a clear vision for necessary health care reforms. It starts with the premise that the precursors of catastrophes of this magnitude provide a valid basis for planning corrective measures, improved preparedness, and ultimately serious health reform. Such reform should include standardized protocols for proper deployment of telemedicine to triage patients to the appropriate level and source of care at the point of need, proper use of relevant technological innovations to deliver precision medicine, and the development of regional networks to coordinate and improve access to care while streamlining the care process. The other essential element is a universal payment system that puts the United States at par with the rest of the industrialized countries, regardless of variation among them. The ultimate goal is creating an efficient, effective, accessible, and equitable system of care. Although timing is uncertain, the pandemic will be brought under control. The path to a better future after the pandemic offers some consolation for the massive loss of life and treasure during this pandemic.