Artificial inteligence and its use in the process of providing health care

In the article, the author discusses the issue of electronic health care with a focus on telemedicine. The first part of the paper provides an overview and explanation of the basic related concepts, which are electronic healthcare and e-health, telemedicine and health care. In this part, the author also summarizes the relevant legislation. The author also presents the performance of telemedicine in the conditions of the Slovak Republic. Above all, the author asks which legal institutes are affected by another way of providing health care, which is distance medicine? The author gradually analyzes selected issues, namely instruction and informed consent, making audio or video-audio recording, recording telemedicine performance in medical documentation and payment for such performance. The conclusion of the article is devoted to summarizing and pointing out the threats and challenges of telemedicine, which the author considers the use of private communication platforms, the related violation of cyber security and the use of artificial intelligence. Key words: electronic healthcare, e-health, telemedicine, remote medicine, remote health care provision.

Perceptions of patients with wounds due to chronic limb-threatening ischemia

Patients with chronic limb-threatening ischemia (CLTI) face numerous barriers to caring for lower extremity wounds. We explored the perceptions of CLTI patients to their wound/management and sought to determine attitudes towards their vascular provider as well as willingness for management through telemedicine. Patients admitted to hospital for treatment of Rutherford Grade 5 and 6 CLTI were asked complete a wound evaluation survey and took part in a semi-structured interview. Semi-structured interviews were recorded, transcribed, and analyzed using an inductive coding strategy. Codes were grouped for thematic analysis and aggregated into assertions. Eleven patients with a mean age of 60 years (35–79 years) were interviewed. All patients had peripheral artery disease (PAD) and eight patients had diabetes as well. Three overarching themes were identified. First, patients appear to have limited coping mechanisms and are overwhelmed by the care of their wounds. Second, in this cohort of patients, many had become passive observers of their care as demonstrated by a limited understanding of their disease processes and detachment from wound management. The third theme was how strong the desire to do everything to prevent limb loss was, but patients acknowledged this is hard to translate into real life with limited resources. Patients with CLTI have concerns that vascular providers must recognize and address to build strong patient–provider relationships and increase activation for management of their wounds and other medical conditions. Patients who have access to technology and with guidance may be able to understand getting care through remote medicine.

The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients

Objectives: In the present report, we aimed to investigate the impact of the coronavirus disease (COVID-19) pandemic on vertigo/dizziness outpatient cancellations in Japan. Methods: We examined 265 vertigo/dizziness outpatients at the ear, nose, and throat department of the Nara Medical University between March 01, 2020, and May 31, 2020, during the COVID-19 pandemic in Japan. We also focused on 478 vertigo/dizziness outpatients between March 01, 2019, and May 31, 2019, before the COVID-19 pandemic, to compare the number of cancellations between these 2 periods. The reasons for cancellation and noncancellation were investigated using telephone multiple-choice questionnaires (telMCQs), particularly for patients with benign paroxysmal positional vertigo (BPPV) and Meniere’s disease (MD). Results: There were many cancellations for medical examinations during the 2020 study period. The total number of vertigo/dizziness outpatients decreased by 44.6% in the 2020 period compared to the same period in 2019. The percent reduction in clinic attendance from 2019 to 2020 (ie, [2019-2020]/2019) for patients with BPPV was higher than that for patients with MD. Compared to the other vertigo-associated conditions, patients with MD exhibited a lower percent reduction in clinic attendance. According to the results of the telMCQs, 75.0% of BPPV cases and 88.2% of MD cases cancelled their appointment and gave up visiting hospitals due to fear of COVID-19 infection, even if they had moderate to severe symptoms. On the contrary, 25.0% and 80.0% patients with BPPV and MD, respectively, did not cancel their appointment; they should not have visited the hospital but stayed at home because they had slight symptoms. Conclusions: These findings suggest that advanced forms should be prepared for medical care, such as remote medicine. These forms should not only be for the disease itself but also for the mental distress caused by persistent symptoms.

The evolution of telemedicine during COVID-19. From theory to practice?

It must be recognized that, in the lockdown period, in addition to the shortcomings of the telemedicine systems, diabetologists also highlighted the lack of knowledge of the telematic tools available on the market potentially usable immediately. For this reason our scientific societies (AMD-SID-SIE) have taken on the burden to collect from the companies that have responded to our request, the information on their remote medicine systems trying to classify them in a neutral but homogeneous way, in a matrix of technological characteristics able to describe the characteristics of each product. KEY WORDS telemedicine; diabetes mellitus; COVID-19.

Legal Aspects of Telemedicine

Although distance medicine has been actively developing worldwide over the past 20 years, no universal mechanism of legislation has been developed across foreign countries to achieve main goals of tele-health services: convenience, effectiveness, and accessibility.The need to improve states’ healthcare systems has increased after dealing with the challenges that the world faced in 2020. While organizing the fight against the spread of the coronavirus infection, a number of countries invoked telemedicine technologies. The experience of using e-health in difficult epidemiological situations should be perceived by states as positive and thus incorporated when preparing legislative changes aimed at improving the regulation of telemedicine.States should act jointly in relation to the development of remote medical care technologies. This will help to build up experience and knowledge that can be used in the future when transforming telemedical assistance into cross-border practice, including the adoption of international acts.Telemedicine should be regulated comprehensively, instigating legal regulations for such issues as medical care provision, digital technologies, medical insurance aspects, licensing, and the protection of personal data. As for theRussian Federation, the remote medicine care model implemented in the country is incomplete due to the inability to diagnose diseases remotely. Such a restriction entails the appearance of a number of questions in other areas: the responsibility of the doctor, the possibilities of cross-border medicine, or insurance compensation issues.The purpose of the article is to describe the legal regulation of telemedicine technologies in theRussian Federation, comparing Russian regulation with American experiences, and analyzing the main approaches taken by foreign researchers.

Design and Development of a Methodology Based on Expert Systems, Applied to the Treatment of Pressure Ulcers

The medical treatment of chronic wounds, pressure ulcers in particular, burdens healthcare systems nowadays with high expenses that result mainly from their monitoring and assessment stages. Decision support systems applied within the ‘remote medicine’ framework may be of help, not only to the process of monitoring the evolution of chronic wounds under treatment, but also to facilitate the prevention and early detection of potential risk conditions in the affected patients. In this paper, the design and definition of a new decision-support methodology to be applied to the monitoring and assessment stages of the medical treatment process for pressure ulcers is proposed. Built upon the use and development of expert systems, the methodology makes it possible to generate alerts derived from the evolution of a patient’s chronic wound, by means of the interpretation and combination of data coming from both an image of the wound, and the considerations of a healthcare professional with expertise in the subject matter. Some positive results are already shown regarding the determination of the ulcer’s status in the tests that have been carried out so far. Therefore, it is considered that the proposed methodology might lead to substantial improvements regarding both the treatment’s efficiency and cost savings.

Faculties to Support General Practitioners Working Rurally at Broader Scope: A National Cross-Sectional Study of Their Value

Strategies are urgently needed to foster rural general practitioners (GPs) with the skills and professional support required to adequately address healthcare needs in smaller, often isolated communities. Australia has uniquely developed two national-scale faculties that target rural practice: the Fellowship in Advanced Rural General Practice (FARGP) and the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM). This study evaluates the benefit of rural faculties for supporting GPs practicing rurally and at a broader scope. Data came from an annual national survey of Australian doctors from 2008 and 2017, providing a cross-sectional design. Work location (rurality) and scope of practice were compared between FACRRM and FARGP members, as well as standard non-members. FACRRMs mostly worked rurally (75–84%, odds ratio (OR) 8.7, 5.8–13.1), including in smaller rural communities (<15,000 population) (41–54%, OR 3.5, 2.3–5.3). FARGPs also mostly worked in rural communities (56–67%, OR 4.2, 2.2–7.8), but fewer in smaller communities (25–41%, OR 1.1, 0.5–2.5). Both FACRRMs and FARGPs were more likely to use advanced skills, especially procedural skills. GPs with fellowship of a rural faculty were associated with significantly improved geographic distribution and expanded scope, compared with standard GPs. Given their strong outcomes, expanding rural faculties is likely to be a critical strategy to building and sustaining a general practice workforce that meets the needs of rural communities.