BIOSOFT HELP FILES

Respiratory rate > 60/min in < 2/12 olds, > 50/min in 2-12/12 olds, > 40/min above 1 yrs olds.  Absence of Tachypnea excludes significant LRTI or pneumonia in infants

1)      Oral infections – gingivitis, sialadenitis, dry mouth,

2)      Perioral infections

3)      Dental devices

4)      Drug-induced – ACEI, any drug which causes dryness of mouth also can cause taste disturbances

5)      Bell’s palsy 

1)      Head injury –

2)      Nasal obstruction unilateral, persistent - Intranasal mass lesions

3)      Leukoplakia – candidiasis, HIV infection, immunodeficiency states

4)      Mass lesions intracranial -

(Bromley 2000)

1)      Poor oral hygiene

2)      Smoking, food and drink stains

3)      Drugs

4)      Trauma

5)      Caries

6)      Fluorosis

7)      Amelogenesis imperfecta

8)      Dentinogenesis

9)      Porphyria

Telehealth is an emerging mode of care delivery that can improve access to care, reduce cost, and enhance patient and health professional experience while providing effective care.1 One central component of telehealth is the video visit, in which audiovisual technology is used to connect patients and health professionals in lieu of an in-person encounter.2 The video visit allows physicians to evaluate patients and provide treatment recommendations regardless of geographical distance. While physicians’ ability to perform a physical examination during the video visit is somewhat limited, many examination techniques are still feasible, and telehealth encounters and traditional in-person visits have similar performance characteristics.3-5

Telehealth has promise for patients with cancer, where concerns regarding access, cost, and experience are common.6-9 A randomized controlled trial of video vs in-person visits for follow-up after radical prostatectomy demonstrated equivalent efficiency, similar satisfaction, and significantly lower cost for the video visits.10 In addition, multiple studies have demonstrated that telehealth can improve access to cancer care for patients in rural settings while achieving equal or better patient satisfaction and generating cost savings when compared with in-person visits.11-13

Despite its many advantages, the use of telehealth in oncology is highly variable, and its uptake (until a recent surge due to the coronavirus disease 2019 [COVID-19] pandemic) has been limited nationally.14 Various factors likely contribute to slow adoption, including liability concerns, licensure challenges, reimbursement inconsistencies, and workflow ambiguity.15 We hypothesize that the perceptions health professionals have of this care delivery model are also a critical component of adoption, as the presence of perceived barriers to a service is associated with low utilization.16 However, to date, the perceptions of health professionals about the utility of telehealth for cancer care are not well understood.

The goal of this study is to report the results of a qualitative interview study focused on eliciting medical oncology health professional perceptions regarding the use of telehealth for patient care prior to the COVID-19 pandemic.

Abstract
Importance Telehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals’ perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts.

Objective To identify medical oncology health professionals’ perceptions of the barriers to and benefits of telehealth video visits.

Design, Setting, and Participants This qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, an urban academic health system in the US with a cancer center. All medical oncology physicians, physicians assistants, and nurse practitioners at the hospital were eligible to participate. A combination of volunteer and convenience sampling was used, resulting in the participation of 29 medical oncology health professionals, including 20 physicians and 9 advanced practice professionals, in semistructured interviews.

Main Outcomes and Measures Medical oncology health professionals’ perceptions of barriers to and benefits of telehealth video visits as experienced by patients receiving cancer treatment.

Results Of the 29 participants, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years. Respondents’ perceptions were organized using the 4 domains of the National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact. Respondents disagreed on the clinical effectiveness and potential limitations of the virtual physical examination, as well as on the financial impact on patients. Respondents also largely recognized the convenience and improved access to care enabled by telehealth for patients. However, many reported concern regarding the health professional–patient relationship and their limited ability to comfort patients in a virtual setting.

Conclusions and Relevance Medical oncology health professionals shared conflicting opinions regarding the barriers to and benefits of telehealth in regard to clinical effectiveness, patient experience, access to care, and financial impact. Understanding oncologists’ perceptions of telehealth elucidates potential barriers that need to be further investigated or improved for telehealth expansion and continued utilization; further research is ongoing to assess current perceptions of health professionals and patients given the rapid expansion of telehealth during the COVID-19 pandemic.

Heyer A, Granberg RE, Rising KL, Binder AF, Gentsch AT, Handley NR. Medical Oncology Professionals’ Perceptions of Telehealth Video Visits. JAMA Netw Open. 2021;4(1):e2033967. doi:10.1001/jamanetworkopen.2020.33967

WHO has expanded the definition of telemedicine recently to include many healthcare delivery services.

Within the WHO/ITU National eHealth strategy toolkit, telemedicine is defined as supporting
“the provision of health care services at a distance” (18). Although other definitions elaborate on
telemedicine as the use of ICT for medical diagnostic, monitoring, and therapeutic purposes at
a distance (72–75), the driving principle is centered on the provision of remote clinical support
as a means of overcoming geographical barriers (72). Telemedicine can function between clients
and health workers who are separated by distance, as well as among health workers based in
different locations. The type of exchange between these actors varies and may include remote
consultations, remote monitoring of vital signs or diagnostic data, and the transmission of medical
files such as images for review, commonly referred to as “store and forward” (72–75).

THUS ACCORDING TO WHO THE AIMS OF TM ARE :
1. Getting rid of inequity of healthcare resource maldistribution
2. Getting rid of inaccessibility to healthcare resources

WHO VERY CLEARLY SAYS TM INCLUDES :
1. Remote consultations
2. Remote monitoring of vital signs
3. Remote monitoring of diagnostic data
4. Transmission of medical files such as images etc (your data sharing comes here)

8. National eHealth strategy toolkit. Geneva: World Health Organization and International Telecommunication Union; 2012 (https://apps.who.int/iris/handle/10665/75211,accessed 2 September 2015)
72. Telemedicine opportunities and developments in Member States: report on the second global survey on eHealth. Geneva: World Health Organization; 2010 (Global Observatory for eHealth series, volume 2; http://apps.who.int/iris/bitstream/handle/10665/44497/9789241564144_eng.pdf, accessed 26 November 2018).
73. Wootton R. Telemedicine support for the developing world. J Telemed Telecare. 2008;14(3):109-14.
74. Hersh WR, Hickam DH, Severance SM, Dana TL, Krages KP, Helfand M. Telemedicine for the Medicare population: update. Evidence Report/Technology Assessment. 2006;131:1-41.
75. Gonçalves BDC, Buckley BS, Fønhus MS, Glenton C, Henschke N, Lewin S, et al. Mobile-based technologies to support client-to-healthcare provider communication and management of care (Protocol). Cochrane Database of Systematic Reviews 2018; 1. Art. No. CD012928. doi: 10.1002/14651858.CD012928.

see under hair cycle.

Telomeres are DNA structures at the end of chromosomes that protect them from damage and instability.1 In most cells, telomeres shorten with each cell cycle; thus, telomere shortening indicates the proliferative history of the cell.2 When telomeres become critically short, cells enter senescence cell cycle arrest or undergo apoptosis.2 Telomere attrition is largely associated with age and genetic determinants but is modulated by host-related genetics (such as male sex) as well as lifestyle factors (eg, smoking, physical activity, and stress).3 Leukocyte telomere length (LTL) serves as a biomarker for the telomere length of the individual organism, and shortening of LTL has been associated with a broad range of pathologies, including lung, liver, hematologic, and cardiovascular diseases, as well as multiple cancer entities.4-6 Despite that, to our knowledge, the prognostic value of LTL remains to be comprehensively characterized,7 as most studies have either relatively small sample sizes, short follow-up duration, or insufficient power to detect clinically meaningful associations.

1)      Normal  part of development

2)      Common among the sick, hungry or overstimulated child