BACKGROUND

text-align: justify;" data-mce-style="text-align: justify;">The Philippines has the highest number of new leprosy cases in the Western Pacific Region, with 1,000 to 2,000+ cases detected annually over the past decade. Out of 46 filariasis-endemic provinces in the country, 43 have eliminated lymphatic filariasis. However, many grade 2 disabilities acquired from these neglected tropical diseases (NTDs) remain undetected due to inadequate monitoring during and after treatment. This was further exacerbated by the detrimental impact of COVID-19 on healthcare access. The pandemic prompted initial adoption of teletraining, making a feasibility study necessary.

text-align: justify;" data-mce-style="text-align: justify;">This study aimed to determine the feasibility of using telehealth and distance learning to train healthcare workers and patients in the integrated rehabilitation and prevention of impairments and disabilities from leprosy, lymphatic filariasis, mycetoma, diabetes, pressure ulcers, and other chronic wounds.

text-align: justify;" data-mce-style="text-align: justify;">Selected rural health units, patients with disabilities, and their caregivers in a leprosy- and lymphatic filariasis-endemic region were recruited. Municipal health officers and leprosy coordinators helped in the conceptualization, planning, implementation, and evaluation of the teletraining program to ensure its acceptability and utilization. Asynchronous and synchronous methods were used. The main reference was the "Ten Steps" guide. Training materials were shared via Google Drive and flash drives sent to each study site. One-day didactics and skills trainings were conducted through live-interactive sessions using online platforms (Zoom or Google Meet). Topics focused on nerve function assessment (for leprosy and diabetes), problems of mobility, lymphedema, wound care, and self-care. Participants practiced and demonstrated their skills on local patients, with mentoring through Messenger chats. Knowledge and performance assessments were conducted.

text-align: justify;" data-mce-style="text-align: justify;">The study was conducted from 2021 to 2022 and the actual training implemented within four months of 2022. Two municipalities of Sultan Kudarat province, Mindanao Island group with one rural health unit (RHU) each had participated. All participants (N=16; eight RHU personnel and eight village health workers) attended the synchronous skills training, 12 (75%) submitted return demo videos, and 13 (81.25%) had practicum patients. All participants rated the training as successfully attaining objectives and activities. All were generally satisfied with the teletraining because of improved knowledge and skills gained and were willing to continue it. Efficiency, speed, quality of training, and trainers had high ratings. Teletraining was considered effective in improving the wound care of their patients. Patients were also satisfied with the home care. However, the unreliable internet service in the study sites created difficulties during synchronous sessions and negatively affected appropriateness of teletraining. Finding patients for practicum was challenging. Some supplies were not available in local drugstores and had to be shipped from Manila, raising costs. Overall, the rating of the teletraining was good.

text-align: justify;" data-mce-style="text-align: justify;">Teletraining of health workers from distant health units on integrated disability prevention and care is feasible in terms of implementation, acceptability, and practicality if stable internet connectivity is available. Larger studies are recommended.

BACKGROUND AND OBJECTIVES

text-align: justify;" data-mce-style="text-align: justify;">Depression and anxiety are common among patients with cardiovascular disease. With increased stress from the ongoing pandemic, it is important to evaluate these conditions. Hence, this study aimed to identify the prevalence of depression and anxiety among outpatient consults via telemedicine through the HADS-P questionnaire and to compare the clinical and socioeconomic profile of patients with HADS-P score of >/=11.

text-align: justify;" data-mce-style="text-align: justify;">This is a cross-sectional descriptive study including participants, outpatients in the cardiology clinic through an online survey regarding their socioeconomic demographic profile and the HADS-P questionnaire. Patients with scores of >/=11 for anxiety or depression were identified and the two groups were compared using a chi-square test analysis.

text-align: justify;" data-mce-style="text-align: justify;">One hundred and twelve patients were recruited. Majority were females, with a partner, unemployed and living below the poverty line. The most common cardiovascular condition was ischemic heart disease and most patients were at least functional class II. The measured prevalence of probable anxiety and depression were 22% and 8%, respectively. A significant difference between the presence of both anxiety and depression was seen in participants with no partners; and for depression alone, in employed participants.

text-align: justify;" data-mce-style="text-align: justify;">Anxiety and depression are common in this sample population. HADS-P is a simple way of screening patients for these conditions so that holistic care may be instituted and appropriate referrals for psychological intervention may be done.

BACKGROUND

text-align: justify;" data-mce-style="text-align: justify;">Telemedicine as a response to the need for consultation amidst limited face to face interaction during the pandemic became part of the services of most tertiary hospitals in Davao City. In order to ensure the client’s needs are addressed by existing telemedicine services, it is important to look at the level of client satisfaction and identify factors that influence it.

text-align: justify;" data-mce-style="text-align: justify;">The main objective of the study was to determine the level of satisfaction and the factors influencing it among the patients of the Family Medicine Department of a tertiary hospital in Davao City on the telemedicine services they received.

text-align: justify;" data-mce-style="text-align: justify;">The study employed a descriptive cross-sectional design utilizing a self-administered telemedicine satisfaction questionnaire developed from the Clinician and Group Adult Visit Survey 4.0 (beta) and Telehealth Usability Questionnaire (TUQ). Participants were 18 years old and above and sought teleconsultation in the institution during the pandemic. Excluded were those who did not give consent. The data gathered were analyzed using an Epi-Info software to determine what factors were associated with level of satisfaction, a chi-square test was done for nominal and ordinal data while a t-test or ANOVA as applicable was used for continuous data.

text-align: justify;" data-mce-style="text-align: justify;">A total of 278 patients were surveyed. More than ninety-five percent of the respondents perceived high satisfaction rating on the telemedicine service while less than five percent were dissatisfied. Eight factors were identified that seem to affect level of satisfaction. These include employment status, network connection and frequency of telemedicine.

text-align: justify;" data-mce-style="text-align: justify;">The study identified that the telemedicine in SPMC DFCM provides high level of satisfaction among patients availing the service. It was also identified that factors such as employment status, network connectivity and frequency of using the service affects the level of satisfaction.

INTRODUCTION: The COVID-19 pandemic has changed care provision models, with a rapid increase in the adoption of telemedicine to reduce in-person visits. Although there are many benefits to teledermatology, there are also factors that hinder its widespread adoption. We aimed to examine patients' perceptions of teledermatology to identify the barriers to its adoption. METHODS: A prospective study was conducted from 15 June to 14 August 2020. Patients were invited to complete a questionnaire in an outpatient dermatology clinic via direct approach by clinical staff or posters posted at the door of consultation rooms. RESULTS: Out of 2,276 clinic attendances, 997 survey responses (43.8%) were collected over a 3-month period. When asked if they would change their subsequent visit to teledermatology, 294 (29.5%) patients were keen, 166 (16.6%) were unsure and 537 (53.9%) declined. Significant factors for declining teledermatology were lack of prior exposure to videoconferencing ( P < 0.01) and lower educational level ( P = 0.019). Patients also raised concerns regarding the ability of teledermatology to address medical concerns (32.1%) and indicated a preference for face-to-face consultation (29.7%). CONCLUSION Factors that influence patients' decision to adopt teledermatology, such as concerns about its ability to address medical issues, lack of IT literacy or experience in teleconferencing, are modifiable. Targeted strategies such as careful patient selection, a dedicated teleconsultation workflow, and the use of a novel 'teledermatology patient journey' (including a clinic walkthrough at the first visit) and an intuitive audio-enabled user interface, may improve patient perceptions and adoption of teleconsultation service.
Humans ; COVID-19/epidemiology* ; Dermatology/methods* ; Telemedicine ; Male ; Female ; Prospective Studies ; Middle Aged ; Adult ; Surveys and Questionnaires ; SARS-CoV-2 ; Aged ; Perception ; Young Adult ; Pandemics ; Skin Diseases/diagnosis* ; Videoconferencing

INTRODUCTION: We aimed to understand the awareness and attitudes of elderly Southeast Asians towards telehealth services during the coronavirus disease 2019 (COVID-19) pandemic in this study. METHODS: In this qualitative study, 78 individuals from Singapore (51.3% female, mean age 73.0 ± 7.6 years) were interviewed via telephone between 13 May 2020 and 9 June 2020 during Singapore's first COVID-19 'circuit breaker'. Participants were asked to describe their understanding of telehealth, their experience of and willingness to utilise these services, and the barriers and facilitators underlying their decision. Transcripts were analysed using thematic analysis, guided by the United Theory of Acceptance Use of Technology framework. RESULTS: Of the 78 participants, 24 (30.8%) were able to describe the range of telehealth services available and 15 (19.2%) had previously utilised these services. Conversely, 14 (17.9%) participants thought that telehealth comprised solely home medication delivery and 50 (51.3%) participants did not know about telehealth. Despite the advantages offered by telehealth services, participants preferred in-person consultations due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy and a lack of access to telehealth-capable devices. CONCLUSION Our results showed poor overall awareness of the range of telehealth services available among elderly Asian individuals, with many harbouring erroneous views regarding their use. These data suggest that public health education campaigns are needed to improve awareness of and correct negative perceptions towards telehealth services in elderly Asians.
Humans ; COVID-19/epidemiology* ; Female ; Telemedicine ; Aged ; Male ; Singapore/epidemiology* ; Qualitative Research ; Health Knowledge, Attitudes, Practice ; SARS-CoV-2 ; Aged, 80 and over ; Middle Aged ; Pandemics ; Awareness ; Asian People ; Southeast Asian People

This review examines strategies for the prevention and management of obesity, hypertension, type 2 diabetes mellitus and dyslipidaemia, conditions that are increasing in Singapore, as components of individualised health plans in 'Healthier SG' and beyond. We describe cardiometabolic disease prevention and management initiatives in Changi General Hospital (CGH), including collaborations with SingHealth Polyclinics, Active SG, Exercise is Medicine Singapore and community partners in the Eastern Community Health Outreach programme, and highlight advances in curable hypertension (e.g., primary hyperaldosteronism) and novel cardiovascular risk markers such as lipoprotein(a). We also outline technology-based interventions, notably the CGH Health Management Unit, which demonstrate the utility and convenience of telemedicine, and digital therapeutics in the form of apps that have been shown to improve treatment adherence and clinical outcomes. Individual empowerment, in partnership with community and healthcare providers and supported by research and innovation of care delivery, is key to building a healthier and stronger nation.
Humans ; Singapore ; Diabetes Mellitus, Type 2/therapy* ; Hypertension/therapy* ; Obesity/therapy* ; Dyslipidemias/therapy* ; Telemedicine ; Cardiovascular Diseases/prevention & control* ; Exercise ; Metabolic Diseases/prevention & control*

INTRODUCTION: Although pre-exposure prophylaxis (PrEP) has been available in Singapore since 2016, its uptake among gay, bisexual and other men-who-have-sex-with-men (GBMSM) is low. The iPARTY study was established to evaluate the acceptability and feasibility of PrEP and a PrEP teleconsultation service for young GBMSM aged 18 to 29 years. METHOD: A total of 53 young GBMSM were enrolled in the iPARTY study. They had a total of 5 in-person consultations and teleconsultations, at 12-week intervals. Laboratory tests and quarterly baseline surveys were performed to assess PrEP adherence, sexual behaviour, and incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). RESULTS: Thirty-five participants completed the entire 12-month follow-up. Most participants had positive experiences with PrEP teleconsultations. There was a statistically significant fall in participants' aggregate Patient Health Questionnaire-9 scores throughout the study. Self-reported PrEP adherence decreased over the course of the study, denoting improved mental health. Although self-reported condom use for anal intercourse and participants' risk perception of HIV decreased after PrEP adoption, there was no statisti-cally significant increase in STI incidence. CONCLUSION This pilot project has shown that PrEP services provide an opportunity for YMSM to access sexual health testing, treatment and counselling, and may even have tangible benefits on the mental health of this population. Teleconsultation is shown to be a suitable platform for the delivery of such services. Collaborative initiatives are crucial to further enhance the affordability and accessibility of PrEP in Singapore, and to improve patient adherence.
Adolescent ; Adult ; Humans ; Male ; Young Adult ; Anti-HIV Agents/administration & dosage* ; Feasibility Studies ; Health Risk Behaviors ; HIV Infections/psychology* ; Incidence ; Medication Adherence ; Mental Health/statistics & numerical data* ; Pilot Projects ; Pre-Exposure Prophylaxis/statistics & numerical data* ; Sexual and Gender Minorities/statistics & numerical data* ; Sexually Transmitted Diseases/prevention & control* ; Singapore/epidemiology* ; Telemedicine/statistics & numerical data* ; Homosexuality, Male/statistics & numerical data*

The emergence of new-generation artificial intelligence technology has brought numerous innovations to the healthcare field, including telemedicine and intelligent care. However, the artificial intelligent medical device sector still faces significant challenges, such as data privacy protection and algorithm reliability. This study, based on invention patent analysis, revealed the technological innovation trends in the field of artificial intelligent medical devices from aspects such as patent application time trends, hot topics, regional distribution, and innovation players. The results showed that global invention patent applications had remained active, with technological innovations primarily focused on medical image processing, physiological signal processing, surgical robots, brain-computer interfaces, and intelligent physiological parameter monitoring technologies. The United States and China led the world in the number of invention patent applications. Major international medical device giants, such as Philips, Siemens, General Electric, and Medtronic, were at the forefront of global technological innovation, with significant advantages in patent application volumes and international market presence. Chinese universities and research institutes, such as Zhejiang University, Tianjin University, and the Shenzhen Institute of Advanced Technology, had demonstrated notable technological innovation, with a relatively high number of patent applications. However, their overseas market expansion remained limited. This study provides a comprehensive overview of the technological innovation trends in the artificial intelligent medical device field and offers valuable information support for industry development from an informatics perspective.
Artificial Intelligence ; Patents as Topic ; Humans ; Inventions ; China ; Brain-Computer Interfaces ; Telemedicine ; Equipment and Supplies ; Robotics ; Algorithms

Medical visual question answering (MVQA) plays a crucial role in the fields of computer-aided diagnosis and telemedicine. Due to the limited size and uneven annotation quality of the MVQA datasets, most existing methods rely on additional datasets for pre-training and use discriminant formulas to predict answers from a predefined set of labels. This approach makes the model prone to overfitting in low resource domains. To cope with the above problems, we propose an image-aware generative MVQA method based on image caption prompts. Firstly, we combine a dual visual feature extractor with a progressive bilinear attention interaction module to extract multi-level image features. Secondly, we propose an image caption prompt method to guide the model to better understand the image information. Finally, the image-aware generative model is used to generate answers. Experimental results show that our proposed method outperforms existing models on the MVQA task, realizing efficient visual feature extraction, as well as flexible and accurate answer outputs with small computational costs in low-resource domains. It is of great significance for achieving personalized precision medicine, reducing medical burden, and improving medical diagnosis efficiency.
Humans ; Image Processing, Computer-Assisted/methods* ; Diagnosis, Computer-Assisted/methods* ; Algorithms ; Telemedicine

Heart failure (HF) is the end-stage of all cardiac diseases, characterized by high prevalence, high mortality, and heavy social and economic burden. Early warning of HF exacerbation is of great value for outpatient management and reducing readmission rates. Currently, remote dynamic monitoring technology, which captures changes in hemodynamic and physiological parameters of HF patients, has become the primary method for early warning and is a hot research topic in clinical studies. This paper systematically reviews the progress in this field, which was categorized into invasive monitoring based on implanted devices, non-invasive monitoring based on wearable devices, and other monitoring technologies based on audio and video. Invasive monitoring primarily involves direct hemodynamic parameters such as left atrial pressure and pulmonary artery pressure, while non-invasive monitoring covers parameters such as thoracic impedance, electrocardiogram, respiration, and activity levels. These parameters exhibit characteristic changes in the early stages of HF exacerbation. Given the clinical heterogeneity of HF patients, multi-source information fusion analysis can significantly improve the prediction accuracy of early warning models. The results of this study suggest that, compared with invasive monitoring, non-invasive monitoring technology, with its advantages of good patient compliance, ease of operation, and cost-effectiveness, combined with AI-driven multimodal data analysis methods, shows significant clinical application potential in establishing an outpatient management system for HF.
Humans ; Heart Failure/physiopathology* ; Monitoring, Physiologic/methods* ; Wearable Electronic Devices ; Remote Sensing Technology ; Early Diagnosis ; Electrocardiography ; Hemodynamics