Publications by authors named "Sheila John"

10 Publications

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Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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April 2021

Validation of a Customized Algorithm for the Detection of Diabetic Retinopathy from Single-Field Fundus Photographs in a Tertiary Eye Care Hospital.

Stud Health Technol Inform 2019 Aug;264:1504-1505

Healthcare Technology Innovation Center, Indian Institute of Technology, Chennai, India.

The study was done to validate the real time efficacy of a customised algorithm in detecting diabetic retinopathy (DR) among diabetic patients being examined at the vitreo retinal outpatient department (VR OPD) of a tertiary care hospital, Diabetic Retinopathy algorithm showed sensitivity of 79% and specificity of 57% which is an acceptable methodology to diagnose diabetic retinopathy and avoid unnecessary referrals.
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August 2019

Developmental screening tool: Accuracy and feasibility of non-invasive anaemia estimation.

Technol Health Care 2018 ;26(4):723-727

Department of Teleophthalmology, Sankara Nethralaya, Chennai, India.

Anaemia is predicted as one of the serious communal health issue in the world. The deficiency exists most common among children and women. A substantial issue prevails in providing quality healthcare services to rural communities, which remains a challenge to health service providers throughout the world. Traditionally physician and health workers recognized anaemia from certain clinical findings, such as pallor of the conjunctivae, nail beds, lips, tongue, and oral mucosa. Confirmation of anaemic condition through physical examination of Dorsum of a tongue or lower bulbar conjunctiva is a subjective analysis. Invasive methods have a possibility to spread infection through the needle. The existing non-invasive techniques need costly equipment and qualified technicians. Growing developments in science and technologies play an important role in medicine. This proposal introduces a new non-invasive diagnostic tool correlating the hemoglobin with conjunctiva pallor colour scores and classification using neural networks. In this study, the eye images were obtained using a mobile camera were processed using the HSI model, which estimates different colour scores of the selected region. These scores were correlated with laboratory haemoglobin value. Feedforward neural network and Elman neural network were used for classifying anaemic and non-anaemic cases. This proposed tool will be useful for the health workers to identify the mass screening of anaemia in rural areas.
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January 2019

Customized nutrition intervention and personalized counseling helps achieve nutrition targets in perioperative liver transplant patients.

Clin Nutr ESPEN 2018 02 26;23:200-204. Epub 2017 Oct 26.

Department of Liver Transplantation, Apollo Hospitals, Chennai, India.

Background And Aim: Nutritional therapy is an integral part of care in all phases of liver transplantation (LTx). However, there are several factors that make it a challenge to manage malnutrition in these patients including, but not limited to, loss of appetite, dietary restrictions and dietary habits. Dietary habits are guided by personal choice, social, cultural and regional background with diversity ranging from veganism to vegetarianism with the latter predominant in Indian population. Therefore, it is difficult to improve nutritional intake of patients with standard dietary recommendations. We evaluated the effects of implementing personalized dietary counseling and a customized nutrition plan on its ability to enhance oral intake and, thereby improve nutritional status of patients with end stage liver disease (ESLD) being evaluated for LTx. We compared the outcomes with a matched group of patients who were prescribed standard dietary recommendations from a historic database. Primary outcome was measured by number of patients achieving ≥75% of recommended energy and protein requirements during hospitalization for LTx. Secondary outcomes included mean energy and protein intake, hours of ventilation, length of stay in Intensive Care Unit (ICU) and hospital, mortality and readmission rate in the acute phase (3months) after LTx.

Methods: This was a prospective observational study, performed at a single LTx centre. All patients >18years who enrolled for LTx and consented for the study were included. The study was conducted after obtaining institutional ethics committee approval. A protocol based nutrition planning was implemented from April'14. According to this protocol, all patients being evaluated for LTx underwent a detailed nutritional assessment by a qualified Clinical Dietitian (CD) and regularly followed up with until LTx. Nutritional intervention, including a customized nutrition care plan and personalized dietary counseling, was provided based on the severity of malnutrition. To evaluate the efficacy of this protocol, we compared the nutritional adequacy (calorie and protein intake) of 65 consecutive patients who underwent LTx between August'14-October'15 (group 1) with a historic database of 65 patients who underwent LTx between January'13 and April'14 (group 2). Patients' demographics, disease severity score, baseline markers of nutritional status (subjective global assessment (SGA), and body mass index (BMI)), were recorded. First, assessment of individual patient's oral energy and protein intake was determined by the daily calorie count during hospitalization. Then the nutritional intervention (oral nutrition supplement (ONS)/enteral nutrition (EN)/parenteral nutrition (PN)) plan was customized according to their spontaneous oral intake. As part of the protocol, health related quality of life was also assessed using short form 8 (SF-8) in group 1. Statistical analyses using Pearson's correlation, Chi-Square test were applied with SPSS version 20.0.

Results: The mean age of group 1 and 2 were 52.6 ± 9.8, 51.9 ± 10.5 (range 25-70years) with BMI of 26.8 ± 6.0, 26.5 ± 5.4 respectively. According to SGA, there was significant improvement in the nutritional status of group 1 patients compared to group 2 on admission for LTx. It was indicated that 88% of group 1 individuals in comparison to 98% in group 2 were malnourished. The calorie intake of group 1 (1740.2 ± 254.8) was significantly higher than group 2 (1568.5 ± 321.6) (p = 0.005). The marked improvement in protein intake in group 1 (63.1 ± 12.1) when compared with group 2 (53.1 ± 13.4) was statistically significant (p = 0.008). A subset analysis showed that non-vegetarians (consuming meat and dairy products) between the groups showed that group 1 had a significantly higher calorie (p = 0.004) and protein (p = 0.0001) intake compared to individuals in group 2. Following implementation of study's protocol, the goal of achieving ≥75% of the prescribed calories (p = 0.013) and protein (p = 0.0001) was significantly higher in group 1.

Conclusion: When compared to the standard prescription, an individualized protocol to diagnose, stratify the severity of malnutrition early, and follow up by customized nutrition planning for patients helped to achieve nutritional targets more effectively. Inspite of patients' diversity in nutritional habits and reluctance to accept change, it is clear that a qualified and dedicated transplant nutrition team can successfully implement perioperative nutrition protocol to achieve better nutritional targets.
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February 2018

Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review.

Nicotine Tob Res 2018 04;20(5):531-542

College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Asper Clinical Research Institute, Winnipeg, MB, Canada.

Introduction: The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine.

Aims And Methods: A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality.

Results: Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes.

Conclusions: This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed.

Implications: This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).
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April 2018

Assessment of Computer-Assisted Screening Technology for Diabetic Retinopathy Screening in India - Preliminary Results and Recommendations from a Pilot Study.

Stud Health Technol Inform 2016 ;231:74-81

Sankara Nethralaya, Chennai, India.

Background: Diabetic retinopathy (DR) is regarded as a major cause of preventable blindness, which can be detected and treated if the cases are identified by screening. Screening for DR is therefore being practiced in developed countries, and tele screening has been a prominent model of delivery of eye care for screening DR.

Aim: Our study has been designed to provide inputs on the suitability of a computer-assisted DR screening solution, for use in a larger prospective study.

Methods: Computer-assisted screening technology for grading diabetic retinopathy from fundus images by a set of machine learning algorithms.

Results: The preliminary recommendations from a pilot study of a system built using the public datasets and retrospective images, showed a good sensitivity and specificity.

Conclusion: The machine learning algorithms has to be validated on a larger dataset of a population level study.
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March 2018

A Pilot Study to Improve Access to Eye Care Services for Patients in Rural India by Implementing Community Ophthalmology through Innovative Telehealth Technology.

Stud Health Technol Inform 2015 ;214:139-45

The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.

Objective: To inform about a very unique and first of its kind telehealth pilot study in India that has provided virtual telehealth consultation to eye care patients in low resource at remote villages.

Background: Provision of Access to eye care services in remote population is always challenging due to pragmatic reasons. Advances in Telehealth technologies have provided an opportunity to improve access to remote population. However, current Telehealth technologies are limited to face-to-face video consultation only. We inform about a pilot study that illustrates real-time imaging access to ophthalmologists. Our innovative software led technology solution allowed screening of patients with varying ocular conditions.

Methods: Eye camps were conducted in 2 districts in South India over a 12-month period in 2014. Total of 196 eye camps were conducted. Total of 19,634 patients attended the eye camps. Innovative software was used to conduct consultation with the ophthalmologist located in the city hospital. The software enabled virtual visit and allowed instant sharing of fundus camera images for assessment and diagnosis.

Results: About 71% of the patients were found to have Refractive Error problems, 15% of them were found to have cataract, 7% of the patients were diagnosed to have Retina problems and 7% of the patients were found to have other ocular diseases. The patients requiring cataract surgery were immediately transferred to city hospital for treatment. Software led assessment of fundus camera images assisted in identifying retinal eye diseases.

Conclusion: Our real-time virtual visit software assisted in specialist care provision and illustrated a novel tele health solution for low resource population.
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December 2016

Governance and management of national telehealth programs in Asia.

Stud Health Technol Inform 2015 ;209:95-101

University of the Philippines Manila.

Unlabelled: Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency.

Objectives: enumerate the public funded national telehealth programs in Asia and determine the state of their governance and management.

Method: Review of literature, review of official program websites and request for information from key informants.

Conclusions: While there are national telehealth programs already in operation in Asia, most experience challenges with governance and subsequently, with management and sustainability of operations. It is important to learn from successful programs that have built and maintained their services over time. An IT governance framework may assist countries to achieve success in offering telehealth and telemedicine to their citizens.
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October 2016

Are smartphones comparable to laptops for image diagnosis in teleophthalmology?

Stud Health Technol Inform 2013 ;192:1065

Department of Teleophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India.

Objective: To assess the reliability and accuracy of smartphones in diagnosing transmitted fundus images in comparison with a laptop.

Materials And Methods: Fundus images captured with a Topcon NW 200 camera were transferred onto a conventional laptop and a smartphone and given to ophthalmologists for diagnosis. The smartphone and the laptop diagnosis were compared with the actual face to face diagnosis statistically to assess their diagnostic accuracy.

Results: Fundus images of 228 eyes of 114 patients (mean age 47 years,73.6% males) were included in the study. 92.5% eyes were correctly diagnosed by both smartphones and laptop. Smartphone analysis revealed 98% sensitivity,57% specificity and kappa value of 0.62 in comparison to laptop, suggessting substantial interrater agreement.

Conclusions: Smartphones are as effective as the laptop in diagnosing fundus pathologies and hold promise for teleophthalmology in future.
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April 2015

The Sankara Nethralaya mobile teleophthalmology model for comprehensive eye care delivery in rural India.

Telemed J E Health 2012 Jun 13;18(5):382-7. Epub 2012 Apr 13.

Department of Teleophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India.

Background: Teleophthalmology holds great potential to overcome barriers and improve quality, access, and affordability in eye care. We introduced mobile units for comprehensive eye care delivery and have successfully conducted eye camps over the past 1.5 years.

Methods: Here we describe the current process and review results of conducting comprehensive eye camps with the aid of teleophthalmology mobile units and determine major causes of avoidable blindness in central and south India. Retrospective chart reviews of all the camps were done as a part of the rural teleophthalmology project of Sankara Nethralaya during the period of April 2009-September 2010. Speciality consultation was achieved by means of teleophthalmology during which images were converted to Digital Imaging and Communications in Medicine standard and transferred to the base hospital by a satellite link using a very small aperture terminal at 256-384 kilobits per second with store-and-forward technology as well as real-time videoconferencing when possible. In addition to comprehensive examination, schoolteachers were trained to assess visual acuity, and various public awareness activities were undertaken.

Results: Over the 1.5-year study period, 54,751 patients underwent evaluation at 872 camps across four states in India. Among these, uncorrected refractive error was the commonest cause of avoidable blindness (59%), followed by cataract (30%). Retinal diseases, mainly diabetic retinopathy, contributed 3.3% of avoidable blindness, and corneal diseases accounted for another 1%.

Conclusions: Comprehensive eye camps utilizing a mobile teleophthalmology unit appears to be a very useful tool to improve eye care delivery in the developing world.
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June 2012