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Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Télémédecine (TLM) et télépsychothérapie (TLPT) se développent depuis plus d'une dizaine d'années à travers le monde mais les évaluations de cette nouvelle modalité de soin sont encore trop rares. Ce changement de cadre thérapeutique est-il satisfaisant ? Les résistances à cette évolution se situent-elles du côté du praticien ou du patient ? Le COVID-long, pathologie chronique apparue après la crise sanitaire de 2020, peut-il bénéficier de cette forme de thérapie ? C'est l'une des questions à laquelle cet article tente de répondre. Structuré en deux parties, cet article présente tout d'abord une revue détaillée des travaux passés et actuels en télépsychiatrie (TLP) et TLPT. Puis, les auteurs explorent des pistes de prise en charge de la symptomatologie psychopathologique du COVID-long, qui se caractérise essentiellement par des troubles anxiodépressifs ainsi qu'un état de stress post-traumatique (ESPT). La pluridisciplinarité s'impose dans la prise en charge du COVID-long. Thérapie cognitivo-comportementale (TCC) et psychothérapie interpersonnelle (IPT) se dégagent en tant que méthodes de traitement efficaces pour les troubles psychopathologiques. La réalité virtuelle ainsi que la réalité augmentée semblent également indiquées dans les TLPT des syndromes post-traumatiques. Quels que soient le modèle théorique sous-jacent aux actes et les modalités de la TLPT, ce dispositif exige l'acceptation du cadre sans réticence. Le changement de cadre est à prendre en considération, mais la qualité de l'alliance thérapeutique semble renforcée par l'aspect rassurant des consultations depuis le lieu de vie habituel du patient, et au-delà des thérapies en « visio », les thérapies épistolaires par échanges de courriers électroniques semblent particulièrement intéressantes. Telemedicine and virtual psychotherapy have been developing worldwide for over a decade, but evaluations of this new treatment modality are still too rare. Is this evolution in therapeutic treatment protocols satisfactory? Does resistance to this development come from the practitioner or the patient? Can long-term COVID, a chronic pathology that emerged after the pandemic of 2020, benefit from this approach to therapy? This article seeks to answer that question. Structured in two parts, this article first presents a detailed review of past and current work on telemedicine, and virtual psychotherapy. In the second part, the authors explore ways of treating the psychopathological symptomatology of long COVID, which is essentially characterized by anxiety-depressive disorders as well as post-traumatic stress disorder (PTSD). Multidisciplinarity is essential in the management of long COVID. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have proved to be effective treatment methods for the psychopathological disorders inherent in long COVID. Virtual reality, as well as augmented reality, also seems to be indicated as effective in virtual psychotherapy treatment of post-traumatic stress disorder (PTSD). Whatever the theoretical model underlying the actions and methods of virtual psychotherapy, it is important to accept without hesitation the framework. It would appear that the transferential and counter-transferential components of therapeutic relationships are not affected by the change of setting. The quality of the therapeutic alliance is strengthened by the reassuring aspect of consultations from the patient's usual place of residence. In addition to videoconference therapies, epistolary therapies using email exchanges seem also to be particularly interesting. [ABSTRACT FROM AUTHOR]

Recent technological advances in diagnostic and therapeutic endoscopy are the subject of recommendations by different National Society of Endoscopy, and require ongoing training to ensure quality care. To date, several resources are at our disposal to meet these training obligations. A mentoring phase is essential, given the high level of technical complexity involved. However, the lack of training sites and growing demand mean that this is still not widely available. Distance learning could be an alternative to improve access to training. This type of training offers: 1) remote companionship, known as "telementoring", and 2) expert review of procedural videos, known as "expert feedback". Dedicated platforms are already available on the web, offering a range of services covering these different aspects. Such a training approach seems not only feasible and effective, but also safe and cost-effective. It is important to consider its integration into our future training schemes. However, it remains to be seen where it fits in, how it can be implemented, and the scope and conditions of its application. Further trials and studies would certainly help to answer these questions and assess the added value this approach could bring. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Radiological imaging generates large data volumes for diagnosing. These data volumes still constitute an immense challenge for individual radiology practices, either when complying with the archive, hacker manipulation or swiftly distributing images among specialists as part of the diagnostic process. Analyzing images through illegal distortions may lead to inaccurate medical decisions. Watermarking techniques can be used to authenticate images, detect, and recover illegal changes made to teleradiology images as well. In this paper, a new blind medical image watermarking joint cryptocompression system is proposed to simultaneously achieve watermarking and compression. A discrete wavelet transform is applied to the medical image to locate different frequency sub-bands. The watermark is scrambled using one-dimensional chaotic map generator with uniform distribution modulo-one transformations for generating highly independent and uniformly distributed random chaotic sequences. A particle cryptocompression algorithm is applied for the insertion step: the scrambled watermark is inserted into the highest singular value derived from the compressed low-frequency sub-band, ensuring a delicate balance between imperceptibility and robustness. From the conducted tests and comparison of the obtained results with other techniques, we concluded that the robustness of the algorithm under various attacks was improved by the excellent value of the NC parameter, especially in the case of compression and geometric attacks. [ABSTRACT FROM AUTHOR]

A survey of patients teleconsulting GPs via pharmacy-based teleconsultation kiosks has shed light on their use of this telemedicine tool. The digitization of healthcare brings satisfaction to patient users, even if they are fragile with regard to the use of their health data. The virtual interface may discourage older patients. Users do not see teleconsultations as real consultations involving diagnosis and decision-making, but as a means of obtaining a prescription and validating their self-diagnosis. The tool is only used when the attending physician is unavailable. It is an integral part of unscheduled care. It appears to be a gateway to the delegation of certain unscheduled care to pharmacists. [ABSTRACT FROM AUTHOR]

This paper explores the implications of the digital advancements on patient empowerment and the role of healthcare professionals. It examines the challenges and opportunities presented by this digital shift, including data privacy concerns, the need for continuous technological adaptation, and the potential for increased healthcare accessibility. The paper underscores the critical importance of legal and ethical considerations in shaping a sustainable and equitable digital healthcare landscape. Through this exploration, the paper aims to provide a comprehensive overview of the ongoing digital revolution in French healthcare and its broader implications for the global healthcare sector. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Hospital Pharmacy / Journal Canadien de la Pharmacie Hospitalière is the property of Canadian Society of Hospital Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an ‘early hospital discharge’ program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff’s qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care.

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care. [ABSTRACT FROM AUTHOR]

Copyright of Gestion et Management Public is the property of Association Internationale de Recherche en Management Public (AIRMAP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This ethnographic study aimed to describe the experience of health professionals from a multiprofessional team with the transition to online care during the COVID-19 pandemic in an outpatient service of assistance in eating disorders of a university hospital in the interior of São Paulo. Ethnographic method was employed, with Geertz's Interpretive Theory of Culture as the theoretical framework. The research corpus was built based on participant observation and the researcher's diary entries, collected in a field notebook during the weekly meetings of the multiprofessional team that took place between July and December 2021. Exhaustive readings of the material were performed, based on an analysis procedure that made it possible to identify units of meaning that gave rise to the themes. The results were organized into two thematic axes: (1) Perceived changes in the relationship with service users, in which aspects related to the concern of professionals with the adherence of patients to the remote modality, the challenges of the new ways of producing care, and the quality of professionalpatient-family communication are highlighted; (2) Experiences of a multidisciplinary team that had to reinvent itself during the pandemic, a thematic axis that addresses the efforts to maintain motivation and group cohesion among the health staff in the transition to care mediated by digital technology and the challenges faced to preserve, as much as possible, the feeling of closeness and welcome during online care. It is concluded that the pandemic impacted in several ways the bond of health professionals with their work and with patients and families, which reinforces the importance of potentiating the exchanges provided by the virtual environment in times of uncertainty and mandatory withdrawal. It is necessary to consider both the favoring and limiting factors of the transition to care mediated by the use of technology, pondering its effects on the quality of the bond and the effectiveness of treatment. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La téléconsultation est un acte médical pris en charge par la sécurité sociale pour le suivi des patients depuis 2018 mais qui a connu un essor phénoménal avec la crise COVID de 2020. Le Conseil National Professionnel d'Allergologie a souhaité enquêter auprès de ses membres à ce propos. 82,1 % n'utilisait pas cet outil avant la crise mais pendant celle-ci 86,4 % des médecins l'ont fait et 66,8 % le font encore en 2021. La téléconsultation leur sert principalement pour le renouvellement d'une immunothérapie allergénique, de traitements symptomatiques et pour annoncer un bilan biologique. Un allergologue sur deux trouve "intéressant" le fait de pouvoir recevoir ainsi des nouveaux patients, notamment pour des patients dans un désert médical, une histoire d'allergie médicamenteuse ou une urticaire chronique. 57,3 % pensent gagner du temps grâce à la téléconsultation. On note ainsi que cet exercice de la médecine à distance est rentré dans les habitudes des allergologues qui ont su se l'approprier et l'adapter à leur pratique. Teleconsultation has been a reimbursed tool for monitoring patients since 2018 but which experienced a phenomenal boom with the COVID crisis of 2020. The National Professional Council of Allergology wanted to survey its members in this regard. 82.1% did not use this tool before the crisis but during it 86.4% of the doctors did it and 66.8% still do it in 2021. The teleconsultation is used mainly for the renewal of an allergen immunotherapy, symptomatic treatments and to announce a biological assessment. One in two allergists find it "interesting" to be able to receive new patients in this way, especially for patients in a medical desert, with a history of drug allergy or chronic urticaria. 57.3% think they save time thanks to teleconsultation. We note that this tool has become a habit of allergists who have known how to appropriate and adapt it to their practice. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Orthodontie Française is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use., Materials and Methods: Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial., Results: Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center., Discussion: The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: During the pandemic, teleconsultation, a sub-category of telemedicine, is becoming increasingly popular as an alternative mode of health care delivery. The integration of this type of virtual care in routine clinical care involves significant changes in traditional role and health care practices especially when considering communication skills for the patient-provider relationship. Although this type of delivery mode and long-term use of teleconsultation is dependent on the development of new skills, education and training provided by health profession programs remains sparse. Since the onset of COVID-19, the use of teleconsultation is in the spotlight to provide a safe and effective way to communicate with patients. Objective: Thus, the present article offers a critical view about the growing demand for teleconsultation from a clinical perspective and the need for the development of a formal curriculum for future health professionals. [ABSTRACT FROM AUTHOR]

Copyright of Gestion et Management Public is the property of Association Internationale de Recherche en Management Public (AIRMAP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La pandémie COVID a accéléré le développement de la téléconsultation à partir de mars 2020. La HAS avait élaboré, dès mai 2019, un guide des bonnes pratiques (Haute Autorité de santé – Téléconsultation et téléexpertise : guide de bonnes pratiques [has-sante.fr], 2019). Malgré le remboursement de cette pratique, le dispositif était peu employé par les professionnels. Au total, 60 000 téléconsultations sont facturées à l'assurance maladie en 2019, Plus de 17 millions de téléconsultations seront réalisés entre mi-mars et fin novembre 2020. De nombreux praticiens utilisent, de manière hebdomadaire, cette nouvelle procédure, plébiscités par les patients. Au travers de 2 exemples cliniques urologiques, nous allons vous présenter le cadre juridique qui encadre la téléconsultation. The COVID pandemic accelerated the development of teleconsultation from March 2020. The French National Authority for Health (HAS) had drawn up a guide to best practices in May 2019 (Haute Autorité de santé – Téléconsultation et téléexpertise : guide de bonnes pratiques [has-sante.fr], 2019). Despite the reimbursement of this practice, the device was little used by professionals. In total, 60,000 teleconsultations are billed to health insurance in 2019. More than 17 million teleconsultations will be carried out between mid-March and the end of November 2020. Many practitioners use this new procedure on a weekly basis, popular with patients. Through 2 urological clinical examples, we will present the legal framework that governs teleconsultation. [ABSTRACT FROM AUTHOR]

La télémédecine (TM) permet aux professionnels de la santé d'évaluer, diagnostiquer et traiter des patients à distance à l'aide des technologies de l'information et des communications (TIC), permettant l'accessibilité et l'équité des soins. Dans le but de planifier une voie d’accréditation pour les services de TM, la Direction régionale de la santé du Piémont a mené, en 2017, une enquête explorant plusieurs domaines, tels que définis par les directives nationales. Elle a révélé une riche expérience existante en Piémont. Cependant les niveaux de maturité des services sont très variés, ce qui suggère la nécessité d’une gouvernance centrale pour assurer des services appropriés et durables et ainsi les intégrer dans le système de santé régional. Deux études de cas sont présentées, où les obstacles et les facilitateurs de la TM sont discutés. La TM pendant la pandémie du Covid et la possibilité d'un cadre d'évaluation avec l'approche HTA (Health Technology Assessment) ont également été traité.

Introduction/background: Early identification of suspected stroke patients who might be eligible for a reperfusion strategy is a daily challenge in the management of patient referrals. The aim of this study was to evaluate the performance of a remote medical assessment in identifying patients eligible for endovascular therapy (EVT) while not eligible for intravenous thrombolysis (IVT), compared with a decision based on bedside clinico-radiological data., Methods: Patients admitted to the emergency department for acute neurological symptoms lasting for less than 24h were prospectively included. Assessment of the clinical severity and medical history was performed simultaneously by two vascular neurologists (VNs), one remotely using a mobile telemedicine solution (NOMADEEC), the other at the bedside. RACE score was calculated from the NIHSS score. At the end of the evaluation, both VNs quoted their treatment convictions (IVT/EVT). Final therapeutic decision following brain and vascular imaging was recorded and compared to remote and bedside predictions. The performances of three different conditions were evaluated: complete medical evaluation (NIHSS+medical history), NIHSS score alone, and RACE score alone. Remote and bedside performances were also compared. Diagnostic accuracy parameters (sensitivity, specificity, positive and negative predictive values) of each condition were estimated, along with their two-sided 95% binomial confidence intervals., Results: Out of 215 enrolled patients, 186 had a complete evaluation, 91 (54.3%) were diagnosed with an ischemic stroke or transient ischemic attack and 46 (24.7%) had an intracranial occlusion. Considering the three conditions evaluated remotely, RACE score-based decision provided the best sensitivity 54.6% [95% CI 23.4; 83.2]/specificity 80.6% [73.9; 86.2] combination. However, the complete medical evaluation had the best specificity (88.6% [82.9; 92.9] compared to RACE scores alone (P=0.038). Remote and bedside performances did not differ (κ=0.68 [0.59; 0.77])., Discussion/conclusion: This real-life study performed in the setting of emergency demonstrates that remote medical evaluations including recording of extensive medical information and NIHSS examination to address patient's eligibility to revascularization treatment is swiftly feasible and is as effective as bedside prediction to EVT and/or IVT. Remote standardized medical evaluation might improve the decision of patients' primary orientation and avoid overcrowding of comprehensive stroke centres., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Telemedicine has been recognized since 2010 as a constitutive element of care, however, it was not until 2016 that the first national experiments were able to be launched with the aim of validating a framework allowing a possible rapid passage in the common right. These experiments, which are due to end in December 2021, have succeeded in involving more than 100,000 patients, mainly suffering from cardiac pathologies. The arrival of COVID-19 has made it possible to measure the usefulness of practices at a distance both from teleconsultation and telemonitoring, with the appearance of organizational and technical innovations that must now be maintained and developed in order to integrate the telemedicine of tomorrow into our actual medicine. [ABSTRACT FROM AUTHOR]

Chronic heart failure in France is responsible for 160 000 hospitalizations per year. The treatment of chronic heart failure is multidisciplinary. Telemedicine (TLM) reinforces the therapeutic arsenal of this chronic pathology by the use of remote monitoring (TLS) on patients followed outside the care structure. This paradigm has proven its effectiveness with the help of digital networks and specific algorithms, which communicate through connected tools with the ICC patient. Clinical signs of worsening can trigger an alert that will be taken into account by the TLS. Early intervention on these warning signs avoids acute decompensation and a new hospitalization of the patient. The analysis of the results shows a rate of alerts that require the intervention of TLS teams, from 20 to 35% depending on the centers. The ETAPES program has set the regulatory framework for the TLS experiment for 4 years. It will end at the end of 2021. The feedback from the TLS centers is between 6 and 18 months. The satisfaction index of patients followed by TLS is 95%. The intermediate results (2018, 2019) and the evaluation of the ETAPES program, are in favor of TLS management of ICC patients. Therapeutic education and TLS improve patients' quality of life. The Ministry of Health plans a transition to the common law for TLS in 2022. [ABSTRACT FROM AUTHOR]

Home monitoring follow-up is part of the routine follow-up of the majority of implantable cardiac defibrillators, and is increasing regarding pacemakers follow-up. This article reviews history, guidelines and legislation for home monitoring follow-up of implantable cardiac devices, and discusses its evolution after ETAPES program. [ABSTRACT FROM AUTHOR]

Telemedicine in palliative care is established especially in countries with large geographical distances. Digital forms of communication (virtual consultations) are most frequently used and well-accepted by patients and caregivers. The main benefit lies in the reduction of the access barrier in the outpatient setting. Advantages are stress reduction for patients (travel, accessibility) and reduction in the care burden for relatives. Additional benefits compared to the physical visit for symptom-control, quality of life and costs are unclear. Risks are influenced by the lack of physical interaction and data security. To what extent telepalliative care makes sense in a high-density health system is difficult to predict. It is therefore important to use these new tools in a carefully adapted and scientifically verified way. [ABSTRACT FROM AUTHOR]

Introduction: Medication reconciliation (MedRec) reduces the risk of preventable medication-related adverse events (ADEs). A best possible medication discharge plan (BPMDP) is a revised list of medications a patient will take when discharged from hospital; a pharmacist review ensures accuracy. For many hospitals, on-site pharmacists are non-existent. Extension of a visual presence via a mobile robotic platform with real-time audiovisual communication by pharmacists to conduct MedRec remains unstudied. This study explored patient perceptions of a pharmacist-led BPMDP using a telepresence robot. Time requirements, unintentional discharge medication discrepancies (UMD), programme inefficiencies/ barriers and facilitators involved in pharmacist review of the discharge medication list and patient interviews were also described. Methods: This prospective cohort study enrolled adult patients admitted to a 12-bed community hospital at high risk of an ADE. Remote pharmacists reviewed the discharge prescription list, identified/resolved UMDs, and interviewed/counselled patients using a telepresence robot. Thereafter, patients completed an anonymous satisfaction questionnaire. Prescriber discharge UMDs were classified, and barriers/inefficiencies and facilitators were documented. Results: Nine patients completed an interview, with a 75% interview agreement rate. All patients were comfortable with the robot and 76% felt their care was better. With a median of 11 discharge medications/patient, the UMD rate was 78%; 71% had omitted medications, 43% involved a cardiovascular medication, 88% were due to a hospital system cause, and 43% were specifically due to an inaccurate best possible admission medication history. Median times for interview preparation, interview and UMD/drug therapy problem resolution were 45, 15 and 10 min, respectively. Conclusion: Using a telepresence robot to provide pharmacist-led BPMDPs is acceptable to patients and an innovative, effective solution to identify/resolve UMDs. [ABSTRACT FROM AUTHOR]

Since 2014, telemedicine and more broadly, digital health technologies (electronic medical record or EMR, Connected Paths, etc.) have benefited from substantial progress in France with the establishment of standards that define and promote its use in routine care (tele-expertise, teleconsultation, tele-care), supported by a government strategy to transform the health organization and the deployment of digital in health. The current pandemic has been an astonishing acceleration factor in the use of the latter in the field of routine care in order to limit disruptions in access to care and patient follow-up. In this update, we wish to carry out a summary review of the main works published in the literature in recent years (strongly driven by the pandemic) with regard to the management of chronic pain, but above all, to put into perspective that technology with these limits should not be the end but the tool at the service of a more fluid organization and better sharing of patient journeys by experimenting with new uses in a redesigned city-hospital cooperation. [ABSTRACT FROM AUTHOR]

La télémédecine se développe en France depuis 2018. L'objectif de cette enquête était d'évaluer les connaissances, attitudes, pratiques et formation des médecins internistes concernant la télémédecine. L'étude observationnelle descriptive nationale réalisée entre juillet et octobre 2019, via un auto-questionnaire en ligne auprès des membres de la Société Nationale Française de Médecine Interne et de l'Amicale des Jeunes Internistes, comportait une analyse descriptive et comparative par sous-groupes d'âge. L'analyse des 309 réponses des médecins qualifiés en médecine interne ou exerçant dans un service de médecine interne (61,8 %) et des internes de médecine interne (38,2 %) a montré que 34,6 % avaient des notions ou une bonne connaissance de la réglementation de la télémédecine. Pour respectivement 62,1 %, 72,5 % et 74,1 %, elle pouvait améliorer la prise en charge des patients, l'accès aux soins, et les échanges entre internistes et autres médecins. Les principaux freins à sa pratique étaient l'absence de face-à-face avec le patient (57,3 %) et les dysfonctionnements informatiques (55 %). Seuls 23,3 % la pratiquaient, dont 88,9 % de téléexpertise. Des actes de télémédecine étaient pratiqués de façon informelle (téléphone et email) dans 70,8 % des cas. Les médecins de plus de 50 ans connaissaient mieux la réglementation et pratiquaient plus la télémédecine officielle. Au total, 54 % souhaitaient pratiquer la télémédecine, et 72,8 % s'y former. Les attitudes envers la télémédecine étaient positives, mais peu d'internistes la connaissaient et la pratiquaient de façon formelle, justifiant une formation adaptée. Telemedicine has been developing in France since 2018. The objective of this survey was to assess the knowledge, attitudes, practices and training of internal physicians regarding telemedicine. A national descriptive observational study carried out between July and October 2019, via an online self-questionnaire with members of the National Society of Internal Medicine and the Association of Young Internists, included a descriptive and comparative analysis by subgroups of age. Analysis of 309 responses from physicians qualified in internal medicine or practicing in an internal medicine service (61,8%) and residents in internal medicine (38%) showed that 34.6% had notions or a good knowledge of regulation of telemedicine. For 62,1%, 72.5% and 74.1% respectively, it could improve patient care, access to care and exchanges between internists and other doctors. The main obstacles to this practice were the absence of face-to-face with the patient (57.3%) and computer dysfunctions (55%). Only 23.3% practiced it, including 88.9% tele-expertise. Telemedicine was performed informally (telephone and email) in 70.8% of the cases. Doctors over the age of 50 were better acquainted with the regulations and more practiced official telemedicine. In total, 54% wanted to practice telemedicine and 72.8% wanted to train there. Attitudes towards telemedicine were positive, but few internists knew about it and practiced it formally, warranting appropriate training. [ABSTRACT FROM AUTHOR]

Depuis 2009, le métier de pharmacien d'officine s'est enrichi de nombreuses nouvelles missions. Parallèlement, la télémédecine s'est déployée et représente aujourd'hui une étape importante pour la profession. La téléconsultation permet à l'officine d'être identifiée par la population comme une structure ressource de proximité de mise en relation avec un médecin. Avec le développement du télésoin, le pharmacien pourrait être sollicité pour une téléexpertise médicamenteuse et intégré dans une équipe de soins primaires dans le cadre de la télésurveillance des malades chroniques. Since 2009, the job of the dispensing pharmacist has been enriched with many new missions. At the same time, telemedicine has been deployed and now represents an important step for the profession. Teleconsultation allows the pharmacy to be identified by the population as a local resource structure that puts them in contact with a doctor. With the development of telecare, the pharmacist could be solicited for tele-expertise in medicine and integrated into a primary care team for the remote monitoring of chronic patients. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, telemedicine plays a critical role in providing safe, effective healthcare services, while reinforcing social distancing and optimizing the use of personal protective equipment. In this context, the Oklahoma Children's Hospital implemented virtual neonatology prenatal visits for pregnant women with a diagnosis of fetal anomalies. While tele-consultations have been broadly used with a high degree of acceptance in rural and remote areas, satisfaction has not been assessed in this particular scenario, where patients and physicians discussing sensitive healthcare information had to rapidly adjust to this new modality.Objectives: To evaluate patients' and neonatologists' satisfaction with virtual prenatal consultations in the context of the COVID-19 pandemic and to compare satisfaction levels of patients receiving virtual consultation with those receiving in-person consults.Methods: This cross-sectional study evaluated patients' and neonatologists' satisfaction with virtual consultations. Participants included pregnant women with diagnosis of fetal anomalies who received neonatology prenatal consultations at Oklahoma Children's Hospital, either in-person or through telemedicine, from May to mid-November 2020, and neonatologists providing virtual prenatal consultations in the same period. Virtual visits were delivered via Zoom Pro™. Patients and physicians who agreed to participate rated acceptability completing an anonymous 5-point Likert scale survey. Item frequencies and means for categories of items were computed by group (video-consult patients, in-person patients, physicians) and analyzed, using Welch's t for unequal sample size.Results: Overall consultation quality was rated good or excellent by 35 (100%) video-consult patients and 12 (100%) in-person patients. Patient group means computed on six 5-point Likert items about patient-physician communication did not differ significantly, video-consult: M = 28.71 (2.22); in-person consult: M = 28.92 (1.78) (p = 0.753263). All eight physicians (100%) agreed or strongly agreed that telemedicine was effective, using a 5-point Likert scale, and their combined consultation quality score computed on 10 survey questions was high: M = 46.4 (3.11).Conclusion: Despite patient inexperience with tele-consultations, the quick implementation of telemedicine, and the sensitive reason for the visit, patients and physicians were highly satisfied with virtual visits. Telemedicine is a safe, effective alternative for providing neonatology prenatal consultations for pregnant women with diagnosis of fetal anomalies during the pandemic.

La crise sanitaire de la COVID-19 a imposé une réorganisation majeure de l'offre de soins en France. Considérant la nécessité de maintenir des soins pour les adolescents souffrant de troubles physiques ou psychiques, les Maisons des Adolescents ont dû adapter en urgence leurs pratiques afin de maintenir au maximum la continuité des soins pour les adolescents et leurs familles. À travers le cas d'une adolescente qui a présenté une dégradation clinique de son anorexie mentale durant le confinement, nous présentons les réorganisations des soins au sein des différentes unités (consultations–hôpital de jour–unité d'hospitalisation temps plein) d'une Maison des Adolescents parisienne au cours de la pandémie de COVID-19. À partir de la littérature existante, nous discutons les avantages et limites de la télémédecine et les enjeux pratiques pour l'organisation future des soins pour les adolescents. Contrairement à la médecine pédiatrique ou pédopsychiatrique, il n'existe pas de protocole décrivant la mise en place de la télémédecine en médecine et psychiatrie de l'adolescent. Il est urgent d'approfondir les évaluations de l'utilisation de la télémédecine pour les adolescents. Ce type de recherche permettra d'améliorer les connaissances sur l'efficacité, l'acceptabilité et les limites de l'utilisation d'un dispositif de téléconsultation en psychiatrie de l'adolescent, en contexte de crise. Certaines modalités de soins à distance mises en place pendant la crise pourraient ainsi être maintenues dans le temps et s'inscrire en routine dans le domaine de la médecine et psychiatrie de l'adolescent. The COVID-19 sanitary crisis has imposed a major reorganization of the health care system in France. Lockdown could be a factor in the emergence or deterioration of psychological disorders; it can be even more fragilizing during the specific period of adolescence. The « Maisons des Adolescents » (Teenagers' Houses) had to urgently adjust their practices to provide continuity of care for adolescents suffering from physical or mental disorders. The « Maisons des Adolescents » are pluridisciplinary care centres for adolescents and their families that provide assessments and services for medical, psychological, socio-educational, educational and legal needs. How did care continue for adolescents during lockdown? What adjustments occurred in the « Maisons des Adolescents » during the health crisis? This article presents the case of an adolescent who suffered a significant deterioration of her anorexia nervosa during confinement. Through this case, we describe the reorganization of care within the different units (consultations - day hospital - hospitalization unit) of a Parisian « Maison des Adolescents » during the COVID-19 pandemic. In this service, the rapid implementation of the telemedicine system in the context of the COVID-19 pandemic made possible provision of continuity in care for vulnerable adolescents and families. Based on the existing literature, we discuss the advantages and limitations of telemedicine and the practical issues for the future organization of care for adolescents. In contrast to pediatric medicine or child psychiatry, there is no protocol describing the application of telemedicine in adolescent medicine and psychiatry. There is an urgent need for further evaluation of the use of telemedicine for this population. This kind of research will improve knowledge about the effectiveness, acceptability and limitations of using a teleconsultation device in adolescent psychiatry in a crisis context. Certain remote care modalities implemented during the sanitary crisis could thus be maintained over time and become routine in the field of adolescent medicine and psychiatry. [ABSTRACT FROM AUTHOR]

En Tunisie, comme ailleurs dans le monde, des formes graves de syndrome de détresse respiratoire aigu (SDRA) liées au SARS-Covid19 ont été observées. Quand les moyens habituels de réanimation n'étaient plus suffisants, la mise en place de l'"Extracorporeal membrane oxygenation" ou ECMO a été nécessaire pour certains. Toute la problématique de la prise en charge de ces malades en cette période de pandémie a été de gérer le fonctionnement de la machine d'ECMO habituellement réservée aux centres experts et spécialisés en la matière. Le service de chirurgie cardio-vasculaire du CHU La Rabta de Tunis a tenté l'expérience de gestion à distance des ECMO implantées dans les différentes réanimations de Grand Tunis en utilisant la télémédecine et les réseaux sociaux. Ainsi un groupe de discussion Facebook- Messenger a été créé et a permis la régie des malades sous ECMO via des vidéoconférences en temps réel et instantané faisant participer tous les intervenants. Un appel était lancé à chaque fois que le médecin en charge du patient en avait besoin. La vidéo a permis de discuter avec les chirurgiens et les perfusionnistes en temps réel des complications ou des problèmes posés par ces malades. Leur état clinique et leurs constantes vitales étaient partagés en permanence sur le groupe de discussion. Suite aux directives des chirurgiens experts et aux échanges faits sur le groupe, le médecin réanimateur pouvait alors intervenir sur tel ou tel paramètre. Les réseaux sociaux ont envahi le quotidien de tous et les professionnels de santé n'échappent pas à cette tendance. La pandémie de la Covid 19 n'a fait que renforcer cette alternative numérique dans un but d'efficacité et d'intérêt pour les patients. Si leur utilisation dans un cadre professionnel offre de nombreux avantages, elle doit toutefois se faire dans le respect des règles de déontologie et apporter une vraie plus-value à leur activité. In Tunisia, as elsewhere in the world, severe forms of acute respiratory distress syndrome (ARDS) related to SARS-Covid19 have been observed. When the usual means of resuscitation were no longer sufficient, the implementation of the Extracorporeal membrane oxygenation or ECMO was needed. The whole problem of the management of these patients in this pandemic period has been to manage the operation of the ECMO machine, usually reserved for expert and specialized centers in the field. The cardio-vascular surgery department of La Rabta teaching hospital of Tunis has tried the experience of management of ECMO implanted in the different reanimations of Tunis, remotely, using telemedicine and social networks. Thus, a Facebook-Messenger discussion group was created and enabled the management of patients under ECMO via video conferencing in real time involving all stakeholders. A call was made whenever the physician needed it. The video provided an opportunity to discuss with surgeons and perfusionists in real time the complications or problems of these patients. Their clinical status was continuously shared on the focus group. Following the instructions of the expert surgeons and the exchanges made on the group, the reanimator could then intervene on this or that parameter. Social media have invaded everyone's daily lives and health professionals are not exception to this trend. The Covid-19 pandemic has only strengthened this digital alternative with the goal of efficiency and patient interest. While their use in a professional setting offers many advantages, it must nevertheless be done in compliance with the rules of ethics and bring real added value. [ABSTRACT FROM AUTHOR]

Résumé: Objectif : L'objectif de la présente étude est de déterminer si la mise en place d'un suivi régulier et structuré des patients présentant une insuffisance cardiaque (IC) chronique, associé à une éducation thérapeutique, aboutissait à une meilleure prise en charge de ces patients. Patients et méthode : Il s'agissait d'une étude monocentrique, rétrospective, sur une cohorte de patients présentant une IC chronique avérée, suivis sur la région de Mulhouse (France), entre janvier 2016 et décembre 2017, par l'Unité de suivi des patients insuffisants cardiaques (USICAR). Ces patients bénéficiaient d'un suivi régulier protocolisé et d'un programme d'éducation thérapeutique pendant une période de 2 ans. Le critère principal de cette étude était : le nombre de jours d'hospitalisation pour IC par an et par patient. Les critères secondaires étaient : le nombre de jours d'hospitalisation pour autre cause cardiaque que l'IC et le nombre de séjours hospitaliers pour IC par patient. Ces critères étaient recueillis sur la période d'un an avant inclusion, après un an de suivi, puis à deux ans de suivi. Résultats : 159 patients, d'âge moyen de 72,9 ans, ont été inclus dans la présente étude. Ils présentaient tous une IC, essentiellement de stade I-II de la NYHA (88,7 %), d'origine préférentiellement ischémique (50,9 %), à fraction d'éjection ventriculaire gauche altérée dans 69,2 % des cas. En ce qui concerne le critère principal, celui-ci était en moyenne de 8,33 jours (6,84-10,13) durant l'année précédant l'inclusion, de 2,6 jours (1,51-4,47) durant la première année de suivi, et de 2,82 jours (1,30-6,11) (p < 0,01 pour les 2 comparaisons). Le nombre moyen de jours d'hospitalisation pour autre cause cardiaque que l'IC ramené au nombre de patients était : de 1,73 jours (1,16-2,6), de 1,81 jours (1,04-3,16) et de 1,32 jours (0,57-3,08) (p = ns). Le pourcentage d'hospitalisation pour IC pour chaque patient était : de 69,5 % (60,2-77,4) avant inclusion, de 16,2 % (10-25,2) durant la première année de suivi et de 19,3 % (11-31,8) durant la seconde (p < 0,001 pour les 2 comparaisons). Conclusion : La présente étude démontre l'intérêt d'un suivi protocolisé associée à un programme d'éducation thérapeutique pour améliorer la prise en charge des patients IC en ambulatoire, notamment pour les IC modérées. Objective: The objective of this study is to determine whether the implementation of regular and structured follow-up of patients with chronic heart failure (CHF), combined with therapeutic education, led to better management of these patients. Patients and Method: This was a monocentric, retrospective study on a cohort of patients with a proven CHF, followed in the Mulhouse region (France), between January 2016 and December 2017, by the Unit for Monitoring Heart Failure Patients (USICAR). These patients benefited from a regular protocolized follow-up and a therapeutic education program for a period of 2 years. The main criterion of this study was: the number of days of hospitalization for HF per year and per patient. The secondary endpoints were: the number of days of hospitalization for cardiac causes other than HF and the number of hospital stays for HF per patient. These criteria were collected over the one-year period before inclusion, at one-year-follow-up, and at two-years-follow-up. Results: 159 patients with a mean age of 72.9 years were included in this study. They all had a CHF, mainly stage I-II NYHA (88.7%), of predominantly ischemic origin (50.9%), with altered left ventricular ejection fraction in 69.2% of cases. The primary endpoint averaged 8.33 days (6.84-10.13) in the year prior to inclusion, 2.6 days (1.51-4.47) in the first year of follow-up, and 2.82 days (1.30-6.11) (p <0.01 for both comparisons). The mean number of days of hospitalization for other cardiac causes other than HF to patient numbers was: 1.73 days (1.16-2.6), 1.81 days (1.04-3.16), and 1.32 days (0.57-3.08) (p = ns). The percentage of hospitalization for HF for each patient was: 69.5% (60.2-77.4) before inclusion, 16.2% (10-25.2) during the first year of follow-up and 19.3% (11-31.8) during the second (p < 0.001 for both comparisons). Conclusion: This study demonstrates the value of a protocolized follow-up associated with a therapeutic education program to improve the management of ambulatory CHF patients, particularly for moderate CHF. [ABSTRACT FROM AUTHOR]

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Introduction: The Covid-19 epidemic has disrupted the management of chronic diseases and disrupted the majority of patient education programs in France. Adaptations via digital technology have been put in place. Objectives: Exploratory study evaluating feasibility and relevance of a web-based patient education program during the first lock-down related to Covid-19; reflections on the interest of web-workshops compared to face-to-face sessions. Method: Adaptation of a program on chronic polypathology led by a transverse patient education unit, for a weekly web-program with 5 web-workshops, self-training and organization of the team to the practice of web-workshops, collective reflections on the interest and limits of web-workshops. Results: From April 1st to the end of May 2020, 51 patients were included, and 32 completed an educational cycle (minimum 3 web-workshops). Out of an average of 6,1 educational objectives agreed at the beginning, 92,2% were totally or partially acquired. The average satisfaction at the end of each of the web-workshops was between 8.42 and 9.53 out of 10. Patients felt psychological support and a chance to break out of social isolation. Among the advantages and limitations of the web-workshops: better accessibility (geographical, availability), maintenance of remote group dynamics, technical limitations to be taken into account. Conclusion: The polypathology web-program with 5 web-workshops was deemed feasible, acceptable and relevant by patients and caregivers. The remote workshops appear to meet the needs of patients during a pandemic and beyond. [ABSTRACT FROM AUTHOR]

A group-based online psycho-education program for adults with attention deficit hyperactivity disorder (ADHD) and their families has been set up by a multi-professional psychiatric team. Feedback from users has mainly shown benefits in terms of improving self-esteem, destigmatization and accessibility to care. This suggests a real interest in developing this care offer in the pathway of ADHD adults., (Copyright © 2024. Published by Elsevier Masson SAS.)

Purpose: To meet the need for access to eye care in an area with a lack of physicians, a telemedicine workstation in ophthalmology was created. The main objective was to measure the improved access to eye care via telemedicine consultation., Methods: No criteria of age, sex or geographical location were defined. Depending on the cause for the consultation and the results of the examinations conducted by an ophthalmic technician physically present in the center, the patient might be given a telemedicine consultation with an ophthalmologist. Eleven indicators were defined to achieve the study objectives. Data were compared with a reference eye care center., Results: The quality, safety of care, and medical benefits of telemedicine consultation were not inferior to those of the reference center. The consultations screened 25 cases of age-related macular degeneration, 240 glaucoma, 229 cataracts and 27 diabetic retinopathy. 88.5% of patients were included in a cooperative ophthalmologist/technician protocol, compared with 27.3% in the reference center (P<0.0001)., Discussion: The telemedicine workstation must be linked to a main center located at most a one-hour drive away. The equipment must be adapted to the use of telemedicine and to allow the technician to perform the necessary assessments and examinations. The number of emergency department visits after telemedicine consultation at the telemedicine workstation was higher than the reference center, which may lead to a subsequent study., Conclusion: Telemedicine consultation improves access to eye care in a medically under-served area., (Copyright © 2023. Published by Elsevier Masson SAS.)

The COVID-19 pandemic urged us to reorganize many of our daily clinical processes. In this regard, the protection of vulnerable patient populations is of particular importance, since any visit to the outpatient clinic implies the risk of exposure to and infection with the SARS-CoV-2 virus. Nevertheless, patients with a pacemaker, an implantable cardioverter/defibrillator (ICD) or an implantable cardiac monitor need regular follow-up to assure proper functionality of these devices. Remote monitoring is the ideal solution to meet the requirements of patient protection and device safety during pandemics. Besides, remote monitoring has already proved its value in normal times. This article summarizes the functionality of remote monitoring, describes the patient benefit and associated challenges and opportunities. [ABSTRACT FROM AUTHOR]