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Bui C, Parange N, Bezak E, Bidner A. The Role of Telehealth in Ultrasound Training for Remote Learners: A Systematic Review. Telemed J E Health 2024; 30:963-975. [PMID: 38052050 DOI: 10.1089/tmj.2023.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Introduction: Remote learners and educators face geographic, professional, and personal barriers that affect their access to quality ultrasound education. The integration of telehealth in ultrasound education enables learners performing ultrasound to receive real-time instruction from an educator at a distant or remote site. However, to date, there has been poor understanding of the efficacy, benefits, shortcomings, and economic impact of telehealth education in comparison to in-person ultrasound training. The aim of this research was to assess current literature on telehealth in ultrasound education and hands-on training, its outcomes and impact, and requirements for future development. Methods: This review examined international literature on telehealth in ultrasound training. The primary author and second investigator were involved in the research and reached consensus on the eligibility criteria, search strategy, included articles, data extraction, and quality assessment. Results: A total of 23 studies were obtained from Medline, Emcare and Scopus. Key themes identified: Most studies saw an equivalent improvement in knowledge and skills through pre and postassessments in both in-person and telehealth sessions. Generally, learners felt comfortable performing ultrasound guided by a remote educator and felt their skills had been advanced across all studies. Educators reported positive feedback, however compared with learners, educators expressed less satisfaction with the telehealth session. Conclusions: This study demonstrated the feasibility of telehealth in ultrasound training for remote learners with little to no experience. Quality studies with comparable outcomes are needed to ascertain the safe and effective application of telehealth in ultrasound training.
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Affiliation(s)
- Catthy Bui
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Nayana Parange
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Eva Bezak
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
- Department of Physics, The University of Adelaide, Adelaide, South Australia
| | - Amber Bidner
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
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Huerta R, Kaduk SI, Fatai L, Rusch H, Weber T, Sammito S. A Built-In Guidance System to Monitor Vital Signs in Space and on Earth. Aerosp Med Hum Perform 2024; 95:139-146. [PMID: 38356124 DOI: 10.3357/amhp.6273.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
INTRODUCTION: Different types of remote expeditions often require an expedition crew to conduct medical emergency assessments without prior medical training. Modern technology offers new devices that support diagnosis with a simple guided user instructions interface. It is not yet clear how quickly medically untrained individuals can acquire the required skills with such a device. This study investigated the time and quality of obtained outcomes, as well as the mental workload when using a vital signs monitor and its guided procedure interface during a simulation of a medical emergency event.METHODS: There were 50 individuals (25 medically inexperienced, 25 medically trained) who participated in this study. In a randomized order subjects measured electrocardiography, noninvasive blood pressure, pulse oximetry, and body temperature. The procedure was repeated after a 20-min break. Completion time, data validity, and mental workload were analyzed.RESULTS: Average times to obtain stable and reliable signals of all recorded vital signs were significantly shorter for both groups during the second attempt and for medically experienced individuals in comparison to medically inexperienced individuals. The number of errors did not change between attempts for both groups. The mental workload was higher during the first attempt in both groups for most vital sign acquisitions.DISCUSSION: Automated devices could be easily and quickly used by members of a given expedition, even if the crew lacks advanced medical training. With relatively little training provided by a built-in guidance system, medically untrained individuals can achieve a basic level of proficiency in reliably obtaining valid vital signs.Huerta R, Kaduk SI, Fatai L, Rusch H, Weber T, Sammito S. A built-in guidance system to monitor vital signs in space and on Earth. Aerosp Med Hum Perform. 2024; 95(3):139-146.
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Engelsen PC, Heyerdahl F, Maddali DD, Akhavi MS, Undseth RM, Elle OJ, Brun H. Ascending with ultrasound: telementored eFAST in flight-a feasibility study. Emerg Radiol 2024; 31:25-31. [PMID: 38066242 PMCID: PMC10830595 DOI: 10.1007/s10140-023-02186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Teleultrasound uses telecommunication technologies to transmit ultrasound images from a remote location to an expert who guides the acquisition of images and interprets them in real time. Multiple studies have demonstrated the feasibility of teleultrasound. However, its application during helicopter flight using long-term evolution (LTE) for streaming has not been studied. Therefore, we conducted a study to examine the feasibility of teleultrasound in an Airbus H145 helicopter. METHODS Four anesthesiologists and one military physician were recruited to perform telementored extended Focused Assessment with Sonography in Trauma (eFAST) during nine helicopter flights, each with a unique healthy volunteer. A radiologist was recruited as a remote expert, guiding the physicians in their examinations. The examining physicians reported the user experience of telementored eFAST on a questionnaire, while the remote expert rated the diagnostic quality of the images on a 1-5 Likert scale. In addition, we measured the duration of the examinations and key LTE network parameters including signal strength, quality, and continuity. RESULTS The images were rated to an average of 4.9 by the remote expert, corresponding to good diagnostic quality. The average duration of telementored eFAST was 05:54 min. LTE coverage was negatively affected by proximity to urban areas and ceased above 2000 ft altitude. Occasional audio problems were addressed by using the Voice over LTE network for communication. The examining physicians unanimously reported on the questionnaire that they would use telementored eFAST on patients. CONCLUSION Telementored eFAST is feasible in ambulance helicopters and can produce images of good diagnostic quality. However, it relies on stable LTE coverage, which is influenced by many factors, including the helicopter's altitude and flight path. Furthermore, its benefit on patient outcomes remains to be proven.
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Affiliation(s)
| | - Fridtjof Heyerdahl
- The Air Ambulance Department, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Henrik Brun
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
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Shi R, Rosario J. Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review. Prehosp Disaster Med 2023; 38:645-653. [PMID: 37622570 PMCID: PMC10548023 DOI: 10.1017/s1049023x23006234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
Ultrasound with remote assistance (tele-ultrasound) may have potential to improve accessibility of ultrasound for prehospital patients. A review of recent literature on this topic has not been done before, and the feasibility of prehospital tele-ultrasound performed by non-physician personnel is unclear. In an effort to address this, the literature was qualitatively analyzed from January 1, 2010 - December 31, 2021 in the MEDLINE, EMBASE, and Cochrane online databases on prehospital, paramedic-acquired tele-ultrasound, and ten articles were found. There was considerable heterogeneity in the study design, technologies used, and the amount of ultrasound training for the paramedics, preventing cross-comparisons of different studies. Tele-ultrasound has potential to improve ultrasound accessibility by leveraging skills of a remote ultrasound expert, but there are still technological barriers to overcome before determinations on feasibility can be made.
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Affiliation(s)
- Rachel Shi
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Javier Rosario
- University of Central Florida College of Medicine, Orlando, Florida, USA
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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Kirkpatrick AW, McKee JL, Conly JM, Flemons K, Hawkins W. Smarter faster just-in-time hemorrhage control: A pilot evaluation of remotely piloted aircraft system delivered STOP-THE-BLEED equipment with just-in-time remote telementored deployment. Heliyon 2023; 9:e12985. [PMID: 36820166 PMCID: PMC9938468 DOI: 10.1016/j.heliyon.2023.e12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction Remotely Piloted Aircraft Systems (RPAS) can access patients inaccessible to traditional rescue. Just-in-time remote telementoring (RTM) of naïve users to self-care could potentially address challenges in salvaging exsanguination in remote environments. Methods An exsanguination self-application task was established in a wilderness location. Three volunteers-initiated distress calls to prompt RPAS precision delivered STOP-THE-BLEED kits, after which a remote mentor directed the volunteers how to self-care. Results Limited connectivity prevented video, however each volunteer delivered images and initiated conversation with the mentor pre-RPAS arrival. Thereafter, all subjects were able to unpack and deploy hemorrhage control adjuncts under verbal direction, and to simulate self-application. All subjects were able to successfully apply wound-clamps, tourniquets, and pack wounds although one had insufficient pressure. Discussion RPASs can deliver supplies long before human rescuers, and communication connectivity might allow remote mentoring in device application. Further development of technology and self-care paradigms for exsanguination are encouraged.
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Affiliation(s)
- Andrew W. Kirkpatrick
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada,Department of Critical Care Medicine, Canada,Department of Surgery, Canada,Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada,University of Calgary, Canada,Corresponding author. Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada.
| | - Jessica L. McKee
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada
| | - John M. Conly
- University of Calgary, Canada,Department of Medicine, University of Calgary, Calgary, Alberta, Canada,W21C, O’ Brien Institute for Public Health University of Calgary, Calgary, Alberta, Canada
| | - Kristin Flemons
- University of Calgary, Canada,W21C, O’ Brien Institute for Public Health University of Calgary, Calgary, Alberta, Canada
| | - Wade Hawkins
- Centre for Innovation and Research in Unmanned Systems (CIRUS), Southern Alberta Institute of Technology (SAIT), Calgary, Alberta, Canada
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Kirkpatrick AW, McKee JL, Couperus K, Colombo CJ. Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care. Diagnostics (Basel) 2022; 12:2884. [PMID: 36428945 PMCID: PMC9689087 DOI: 10.3390/diagnostics12112884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.
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Affiliation(s)
- Andrew W. Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
- Departments of Critical Care Medicine and Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jessica L. McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
| | - Kyle Couperus
- Ready Medic One (RMO) Research Group, Tacoma, WA 98431, USA
| | - Christopher J. Colombo
- Department of Medicine, Uniformed Services University of Health Sciences Bethesda Maryland, Bethesda, MD 20814, USA
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8
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A randomized controlled pilot trial of video-modelling versus telementoring for improved hemorrhage control wound packing. Am J Surg 2022; 224:769-774. [DOI: 10.1016/j.amjsurg.2022.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
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To Watch Before or Listen While Doing? A Randomized Pilot of Video-Modelling versus Telementored Tube Thoracostomy. Prehosp Disaster Med 2022; 37:71-77. [PMID: 35177133 DOI: 10.1017/s1049023x22000097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND New care paradigms are required to enable remote life-saving interventions (RLSIs) in extreme environments such as disaster settings. Informatics may assist through just-in-time expert remote-telementoring (RTM) or video-modelling (VM). Currently, RTM relies on real-time communication that may not be reliable in some locations, especially if communications fail. Neither technique has been extensively developed however, and both may be required to be performed by inexperienced providers to save lives. A pilot comparison was thus conducted. METHODS Procedure-naïve Search-and-Rescue Technicians (SAR-Techs) performed a tube-thoracostomy (TT) on a surgical simulator, randomly allocated to RTM or VM. The VM group watched a pre-prepared video illustrating TT immediately prior, while the RTM group were remotely guided by an expert in real-time. Standard outcomes included success, safety, and tube-security for the TT procedure. RESULTS There were no differences in experience between the groups. Of the 13 SAR-Techs randomized to VM, 12/13 (92%) placed the TT successfully, safely, and secured it properly, while 100% (11/11) of the TT placed by the RTM group were successful, safe, and secure. Statistically, there was no difference (P = 1.000) between RTM or VM in safety, success, or tube security. However, with VM, one subject cut himself, one did not puncture the pleura, and one had barely adequate placement. There were no such issues in the mentored group. Total time was significantly faster using RTM (P = .02). However, if time-to-watch was discounted, VM was quicker (P = .000). CONCLUSIONS Random evaluation revealed both paradigms have attributes. If VM can be utilized during "travel-time," it is quicker but without facilitating "trouble shooting." On the other hand, RTM had no errors in TT placement and facilitated guidance and remediation by the mentor, presumably avoiding failure, increasing safety, and potentially providing psychological support. Ultimately, both techniques appear to have merit and may be complementary, justifying continued research into the human-factors of performing RLSIs in extreme environments that are likely needed in natural and man-made disasters.
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Ball CG. Getting going: Incorporating ultrasound into an HPB practice. Surg Open Sci 2022; 8:47-49. [PMID: 35308135 PMCID: PMC8927842 DOI: 10.1016/j.sopen.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
The incorporation of ultrasound into a hepatopancreatobiliary surgical practice is both exciting and potentially intimidating. Although it is relatively straightforward to obtain detailed intraoperative ultrasound training from a small variety of formal programs, didactic curriculum, and mentorship experiences, seamless integration of this new knowledge into a hepatopancreatobiliary practice can be more challenging than expected. Although this is particularly true when a graduate begins a new practice, it is also relevant when incorporating hepatopancreatobiliary ultrasound into a mature group practice environment. This review outlines knowing your environment, certification and competency, credentialing and privileging, transition to independent practice, and maintaining competence.
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Affiliation(s)
- Chad G. Ball
- Corresponding author: Tel.: + 1 403 944 3417; fax: + 1 403 944 8799.
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Sun YK, Li XL, Wang Q, Zhou BY, Zhu AQ, Qin C, Guo LH, Xu HX. Improving the quality of breast ultrasound examination performed by inexperienced ultrasound doctors with synchronous tele-ultrasound: a prospective, parallel controlled trial. Ultrasonography 2021; 41:307-316. [PMID: 34794212 PMCID: PMC8942725 DOI: 10.14366/usg.21081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This prospective study explored the value of synchronous tele-ultrasound (US) to aid doctors inexperienced in US with breast US examinations. METHODS In total, 99 patients were enrolled. Two trainee doctors who were inexperienced in US (trainee A [TA] and trainee B [TB]) and one doctor who was an expert in US completed the US examinations sequentially. TA completed the US examinations independently, while TB was instructed by the expert using synchronous tele-US. Subsequently, the expert performed on-site US examinations in person. Separately, they selected the most clinically significant nodule as the target nodule. Consistency with the expert and image quality were compared between TA and TB to evaluate tele-US. Furthermore, TB and the patients evaluated tele-US through questionnaires. RESULTS TB demonstrated higher consistency with the expert in terms of target nodule selection than TA (93.3% vs. 63.3%, P<0.001). TB achieved good inter-observer agreement (>0.75) with the expert on five US features (5/9, 55.6%), while TA only did so for one (1/9, 11.1%) (P=0.046). TB's image quality was higher than TA's in gray value, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (P=0.018, P<0.001, P<0.001, P=0.033, and P=0.006, respectively). The comprehensive assessment score was higher for TB than for TA (3.96±0.82 vs. 3.09±0.87, P<0.001). Tele-US was helpful in 69.7% of US examinations and had a training effect in 68.0%. Furthermore, 63.6% of patients accepted tele-US and 60.6% were willing to pay. CONCLUSION Tele-US can help doctors inexperienced in US to perform breast US examinations.
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Affiliation(s)
- Yi-Kang Sun
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao-Long Li
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qiao Wang
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Bo-Yang Zhou
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - An-Qi Zhu
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chuan Qin
- Department of Ultrasound, Karamay Center Hospital, Karamay, China
| | - Le-Hang Guo
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Xiong Xu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Hampton L, Brindley P, Kirkpatrick A, McKee J, Regehr J, Martin D, LaPorta A, Park J, Vergis A, Gillman L. Strategies to improve communication in telementoring in acute care coordination: a scoping review. Can J Surg 2020; 63:E569-E577. [PMID: 33253511 DOI: 10.1503/cjs.015519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring. Methods Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers. Search results were gathered in June 2017 and updated in January 2018. Identified articles were categorized by theme. Results We identified 144 articles, of which 56 met our inclusion criteria. Forty-one articles focused on improving dispatcher-directed cardiopulmonary resuscitation (CPR). Major themes included the importance of language in identifying out-of-hospital cardiac arrest and how to provide instructions to enable administration of effective CPR. A standardized approach with scripted questions was associated with improved detection of out-of-hospital cardiac arrest, and a concise script was associated with improved CPR quality compared to no mentoring, unscripted mentoring or more complex instructions. Six articles focused on physician-physician consultation. Use of a handover tool that highlighted critical information outperformed an unstructured approach regarding transmission of vital information. Nine articles examined telementoring in trauma resuscitation. A common theme was the need to establish an understanding between mentor and provider regarding the limitations of the provider and his or her environment. Conclusion The available data suggest that standardization coupled with short, concise validated scripts could improve efficacy, safety and engagement. Improvements will require multidisciplinary input, practice and deliberate efforts to address barriers.
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Affiliation(s)
- Lauren Hampton
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Peter Brindley
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Andrew Kirkpatrick
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jessica McKee
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Julian Regehr
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Douglas Martin
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Anthony LaPorta
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jason Park
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Ashley Vergis
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Lawrence Gillman
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
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Kirkpatrick AW, Mckee JL, Netzer I, Mckee IA, McBeth P, Wachs JP, Ball CG, Glassberg E. A Randomized Trial of Mentored vs Nonmentored Military Medics Compared in the Application of a Wound Clamp Without Prior Training: When to Shut Up and Just Watch! Mil Med 2020; 185:67-72. [PMID: 32074324 DOI: 10.1093/milmed/usz251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Hemorrhage control is a basic task required of first responders and typically requires technical interventions during stressful circumstances. Remote telementoring (RTM) utilizes information technology to guide inexperienced providers, but when this is useful remains undefined. METHODS Military medics were randomized to mentoring or not from an experienced subject matter expert during the application of a wound clamp (WC) to a simulated bleed. Inexperienced, nonmentored medics were given a 30-second safety briefing; mentored medics were not. Objective outcomes were time to task completion and success in arresting simulated bleeding. RESULTS Thirty-three medics participated (16 mentored and 17 nonmentored). All (100%) successfully applies the WC to arrest the simulated hemorrhage. RTM significantly slowed hemorrhage control (P = 0.000) between the mentored (40.4 ± 12.0 seconds) and nonmentored (15.2 ± 10.3 seconds) groups. On posttask questionnaire, all medics subjectively rated the difficulty of the wound clamping as 1.7/10 (10 being extremely hard). Discussion: WC application appeared to be an easily acquired technique that was effective in controlling simulated extremity exsanguination, such that RTM while feasible did not improve outcomes. Limitations were the lack of true stress and using simulation for the task. Future research should focus on determining when RTM is useful and when it is not required.
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Affiliation(s)
- Andrew W Kirkpatrick
- Regional Trauma Services, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Department of Critical Care Medicine, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Alberta Health Services, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9.,Canadian Forces Health Services, 713 Montreal Road, Ottawa, ON K1G 0G6
| | - Jessica L Mckee
- Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9
| | - Itamar Netzer
- Israeli Defense Force Medical Corp, 9 Yitzhak Rabin Blvd., Kiryat Ben-Gurion, Jerusalem 9103001, Israel
| | - Ian A Mckee
- City of Edmonton, 10351 96 St, Edmonton, AB T5H 2H5
| | - Paul McBeth
- Regional Trauma Services, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Department of Critical Care Medicine, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Alberta Health Services, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9
| | - Juan P Wachs
- Regenstrief Center for Healthcare Engineering, Gerald D. and Edna E. Mann Hall, Suite 225, 203 S. Martin Jischke Drive, West Lafayette, IN 47907-1971.,School of Industrial Engineering, Purdue University, 610 Purdue Mall, West Lafayette, IN 47907
| | - Chad G Ball
- Regional Trauma Services, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9.,Alberta Health Services, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9
| | - Elon Glassberg
- Faculty of Medicine, Bar-Ilan University, Ramat Gan 5290002, Israel
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Remote Real-Time Ultrasound Supervision via Commercially Available and Low-Cost Tele-Ultrasound: a Mixed Methods Study of the Practical Feasibility and Users' Acceptability in an Emergency Department. J Digit Imaging 2020; 32:841-848. [PMID: 30478478 DOI: 10.1007/s10278-018-0157-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Minor emergency departments (ED) struggle to access sufficient expertise to supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using tele-ultrasound (tele-US) for remote supervision may remedy this situation. We aimed to evaluate the feasibility of real-time supervision via tele-US when applied to an everyday ED clinic. We conducted a mixed methods study that assessed practical feasibility, determined performance, and explored users' acceptability of supervision via tele-US. Technical performance was assessed quantitatively by the ratio in mean gray value between images on site and as received by the supervisor, and by after-compression frame rate. Qualitatively, 12 exploratory semi-structured interviews were conducted with exposed junior doctors and supervisors. Remote supervision via tele-US was performed with 10 junior doctors scanning 45 included patients. During performance assessment, neither alternating internet connection nor software significantly changed the mean gray value ratio. The lowest median frame rate of 4.6 (interquartile range [IQR]: 3.1-5.0) was found by using a 4G internet connection; the highest of 28.5 (IQR: 28.5-29.0) was found with alternative computer and local area network internet connection. In interviews, supervisors stressed the importance of preserving frame rate, and junior doctors emphasized a need for shared ultrasound terminology. In the qualitative analysis, setup mobility, accessibility, and time consumption were emphasized as being of key importance for future clinical implementations. Remote supervision via a commercially available and low-cost tele-US setup is operational for both junior doctors and supervisors when applied to lung and cardiac POCUS scans of hospitalized patients.
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15
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Panebianco NL, Liu RB, Alerhand S, Au AK, Bailitz J, Chiem AT, Damewood SC, Friedman L, Gottlieb M, Lema PC, Lewiss RE, Lin J, Lin M, Liang Liu E, Magee MA, Nelson MJ, Sajed D, Situ‐LaCasse EH, Stolz L. Joint Recommendations and Resources for Clinical Ultrasound Education Amidst the COVID-19 Era. AEM EDUCATION AND TRAINING 2020; 4:438-442. [PMID: 33150291 PMCID: PMC7592817 DOI: 10.1002/aet2.10506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 05/28/2023]
Affiliation(s)
- Nova L. Panebianco
- From theDepartment of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Rachel B. Liu
- theDepartment of Emergency MedicineYale School of MedicineNew HavenCTUSA
| | - Stephen Alerhand
- theDepartment of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNJUSA
| | - Arthur K. Au
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - John Bailitz
- theDepartment of Emergency MedicineNorthwestern UniversityChicagoILUSA
| | - Alan T. Chiem
- theDepartment of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Sara C. Damewood
- theDepartment of Emergency MedicineUniversity of WisconsinMadisonWIUSA
| | - Lucas Friedman
- theDepartment of Emergency MedicineUniversity of California at Riverside School of MedicineRiversideCAUSA
| | - Michael Gottlieb
- theDepartment of Emergency MedicineRush University Medical CenterChicagoILUSA
| | - Penelope C. Lema
- theDepartment of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
| | - Resa E. Lewiss
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Judy Lin
- theDepartment of Emergency MedicineMaimonides Medical CenterBrooklynNYUSA
| | - Maya Lin
- theDepartment of Emergency MedicineNew York Presbyterian–Brooklyn Methodist HospitalBrooklynNYUSA
| | - E. Liang Liu
- theDepartment of Emergency MedicineEmory UniversityAtlantaGAUSA
| | - Mark A. Magee
- theDepartment of Emergency MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaPAUSA
| | - Mathew J. Nelson
- theDepartment of Emergency MedicineNorth Shore University HospitalManhassetNYUSA
| | - Dana Sajed
- theDepartment of Emergency MedicineLA County + USC Medical CenterLos AngelesCAUSA
| | - Elaine H. Situ‐LaCasse
- theDepartment of Emergency MedicineUniversity of Arizona/Banner University Medical Center–TucsonTucsonAZUSA
| | - Lori Stolz
- and theDepartment of Emergency MedicineUniversity of CincinnatiCincinnatiOHUSA
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16
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Kirkpatrick AW, McKee JL, Volpicelli G, Ma IWY. The Potential for Remotely Mentored Patient-Performed Home Self-Monitoring for New Onset Alveolar-Interstitial Lung Disease. Telemed J E Health 2020; 26:1304-1307. [PMID: 32654656 DOI: 10.1089/tmj.2020.0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is an acute respiratory illness. Although most infected persons are asymptomatic or have only mild symptoms, some patients progress to devastating disease; such progression is difficult to predict or identify in a timely manner. COVID-19 patients who do not require hospitalization can self-isolate at home. Calls from one disease epicenter identify the need for homebased isolation with telemedicine surveillance to monitor for impending deterioration. Methodology: Although the dominant approach for these asymptomatic/paucisymptomatic patients is to monitor oxygen saturation, we suggest additionally considering the potential merits and utility of home-based imaging. Chest computed tomography is clearly impractical, but ultrasound has shown comparable sensitivity for lung involvement, with major advantages of short and simple procedures, low cost, and excellent repeatability. Thoracic ultrasound may thus allow remotely identifying the development of pneumonitis at an early stage of illness and potentially averting the risk of insidious deterioration to severe pneumonia and critical illness while in home isolation. Conclusions: Lung sonography can be easily performed by motivated nonmedical caregivers when directed and supervised in real time by experts. Remote mentors could thus efficiently monitor, counsel, and triage multiple home-based patients from their "control center." Authors believe that this approach deserves further attention and study to reduce delays and failures in timely hospitalization of home-isolated patients.
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Affiliation(s)
- Andrew W Kirkpatrick
- Department of Critical Care Medicine and University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Surgery, and the University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Trauma Program, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jessica L McKee
- Department of Surgery, and the University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Irene W Y Ma
- John A. Buchanan Chair, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Vatsvåg V, Todnem K, Næsheim T, Cathcart J, Kerr D, Oveland NP. Offshore telementored ultrasound: a quality assessment study. Ultrasound J 2020; 12:33. [PMID: 32613261 PMCID: PMC7329972 DOI: 10.1186/s13089-020-00180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Telementored ultrasound (US) connects experts to novices through various types of communication and network technologies with the overall aim to bridge the medical imaging gap between patients’ diagnostic needs and on-site user experience. The recurrent theme in previous research on remote telementored US is the limited access to US machines and experienced users. This study was conducted to determine whether telementored US was feasible in a remote offshore setting. The aim was to assess if an onshore US expert can guide an offshore nurse through focused US scanning protocols by connecting an US machine to existing videoconference units at the offshore hospitals and to evaluate the diagnostic quality of the images and cineloops procured. Results The diagnostic quality of cineloops was scored on a five-point scale. The percentage of cineloops suitable for interpretation (score 3 ≥) for the FATE and e-FAST protocols was 96.4 and 79.1. Lung sliding and seashore sign could be identified in all volunteers. The scan time for the FAST protocol (n = four scanning positions), FATE protocol (n = six scanning positions) and both lungs (n = two scanning positions) was 1 min 20 s, 4 min 15 s and 32 s, respectively. Conclusion A novice US user can be guided by a remote expert through focused US protocols within an acceptable time frame and with good diagnostic quality using existing communication and network systems found onboard offshore oil rigs.
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Affiliation(s)
- Victoria Vatsvåg
- School Health Sciences, Ulster University, Co., Antrim, UK. .,Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
| | - Kjetil Todnem
- Department of Health and Working Environment, Global Business Support, Equinor ASA, Stavanger, Norway
| | - Torvind Næsheim
- Cardiovascular Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Anaesthesiology, University Hospital North Norway, Tromsø, Norway
| | - John Cathcart
- School Health Sciences, Ulster University, Co., Antrim, UK
| | - Daniel Kerr
- School Health Sciences, Ulster University, Co., Antrim, UK
| | - Nils Petter Oveland
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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Telemedicine in the Era of Coronavirus Disease 2019 (COVID-19): A Neurosurgical Perspective. World Neurosurg 2020; 139:549-557. [PMID: 32426065 PMCID: PMC7229725 DOI: 10.1016/j.wneu.2020.05.066] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022]
Abstract
Despite the substantial growth of telemedicine and the evidence of its advantages, the use of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the coronavirus disease 2019 (COVID-19) pandemic has limited typical evaluation of patients with neurologic issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuroexamination. However, we argue that an accurate and comprehensive neurologic examination can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. In addition, certain neurosurgical visits such as postoperative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.
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19
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Kirkpatrick AW, McKee JL. Lung ultrasonography in a woman with COVID-19: This examination could be remote. CMAJ 2020; 192:E435. [PMID: 32312827 DOI: 10.1503/cmaj.75302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Andrew W Kirkpatrick
- Acute Care, Trauma, and General Surgery and Critical Care Medicine, TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, Alta
| | - Jessica L McKee
- Project manager, TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Group, University of Calgary, Calgary, Alta
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20
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Salerno A, Tupchong K, Verceles AC, McCurdy MT. Point-of-Care Teleultrasound: A Systematic Review. Telemed J E Health 2020; 26:1314-1321. [PMID: 32302520 DOI: 10.1089/tmj.2019.0177] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Telemedicine and point-of-care ultrasound have merged to create a field known as teleultrasound (TUS). Real-time TUS involves the transmission of bedside ultrasound (US) images with direct feedback from an US expert. In this review, we summarize the current uses of real-time TUS and discuss its potential future uses. Methods: We performed a literature search (PubMed and EMBase) to assess articles related to real-time TUS. Data were extracted using a standardized collection form, and relevant articles were separated into feasibility or clinical studies. Results: Our search yielded 45 articles, with most of the reports taking place in resource-constrained settings. A large portion of the studies discussed the use of the focused assessment with sonography in trauma exam. Others included musculoskeletal, vascular, and echocardiography. Conclusion: Real-time TUS allows for rapid access to diagnostic imaging in various clinical settings. This technology is poised to expand with many uses on the horizon.
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Affiliation(s)
- Alexis Salerno
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Keegan Tupchong
- Division of Critical Care Medicine, Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Avelino C Verceles
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael T McCurdy
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Point-of-care resuscitation research: From extreme to mainstream: Trauma Association of Canada Fraser Gurd Lecture 2019. J Trauma Acute Care Surg 2020; 87:571-581. [PMID: 31136525 DOI: 10.1097/ta.0000000000002375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Gurd Family surgical legacy was deeply intertwined with National service in both World Wars. My own personal research mission has attempted to emulate such service, by enhancing the tools and techniques available to facilitate point-of-care diagnosis and resuscitation in extreme and adverse environments. Our efforts involving point-of-care diagnosis/resuscitation and the telementored guidance of those remotely responding to catastrophic injury have included collaborations with National Aeronautics and Space Administration (NASA) the Canadian Space Agency, the Canadian Forces, its democratic allies, and non-governmental surgical organizations. Research has been conducted in resuscitative suites and operating theaters, research laboratories, parabolic flight aircraft, on humanitarian surgical missions, and from ski-hills and firehalls. The initial phases of these efforts involved inaugural studies in resuscitative sonography including defining the Extended Focused Assessment with Sonography for Trauma (EFAST) examination. Although the original work was commissioned for Space Medicine, generalization to mainstream practice further justifies space medicine research. Iterative steps in advancing telementored resuscitation have subsequently involved the maturation of space-mandated telementored ultrasound support (TMUS), exploration of TMUS in terrestrial clinical practice, and the creation of increasingly mobile (hand-held) TMUS solutions. Subsequently it was recognized that teleultrasound is simply one informatic dimension of remote telemedicine, and current efforts are focused in a Program known as TeleMentored Ultrasound Supported Medical Interactions (TMUSMI) of remote responders required to intervene with catastrophic trauma. While this research program has yielded many techniques and findings that have benefited mainstream terrestrial practice, these investigations are currently ongoing, and we hope to demonstrate that TMUSMI may benefit all Canadians especially those in remote areas, as well as potentially every global inhabitant without immediate access to care. Further, we propose that to fully utilize these techniques, a new specialty, that of the remote medical mentor will be required, a new specialty that will require the creation and scientific validation of its principles and techniques.
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22
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Landgraf P, Spies C, Lawatscheck R, Luz M, Wernecke KD, Schröder T. Does Telemedical Support of First Responders Improve Guideline Adherence in an Offshore Emergency Scenario? A Simulator-Based Prospective Study. BMJ Open 2019; 9:e027563. [PMID: 31462465 PMCID: PMC6720317 DOI: 10.1136/bmjopen-2018-027563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate, in a simulator-based prospective study, whether telemedical support improves quality of emergency first response (performance) by medical non-professionals to being non-inferior to medical professionals. SETTING In a simulated offshore wind power plant, duos (teams) of offshore engineers and teams of paramedics conducted the primary survey of a simulated patient. PARTICIPANTS 38 offshore engineers and 34 paramedics were recruited by the general email invitation. INTERVENTION Teams (randomised by lot) were supported by transmission technology and a remote emergency physician in Berlin. OUTCOME MEASURES From video recordings, performance (17 item checklist) and required time (up to 15 min) were quantified by expert rating for analysis. Differences were analysed using two-sided exact Mann-Whitney U tests for independent measures, non-inferiority was analysed using Schuirmann one-sided test. The significance level of 5 % was Holm-Bonferroni adjusted in each family of pairwise comparisons. RESULTS Nine teams of engineers with, nine without, nine teams of paramedics with and eight without support completed the task. Two experts quantified endpoints, insights into rater dependence were gained. Supported engineers outperformed unsupported engineers (p<0.01), insufficient evidence was found for paramedics (p=0.11). Without support, paramedics outperformed engineers (p<0.01). Supported engineers' performance was non-inferior (at one item margin) to that by unsupported paramedics (p=0.03). Supported groups were slower than unsupported groups (p<0.01). CONCLUSIONS First response to medical emergencies in offshore wind farms with substantially delayed professional care may be improved by telemedical support. Future work should test our result during additional scenarios and explore interdisciplinary and ecosystem aspects of this support. TRIAL REGISTRATION NUMBER DRKS00014372.
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Affiliation(s)
- Philipp Landgraf
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Lawatscheck
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Global Medical Affairs, Therapy Area Cardiovascular, Bayer Pharma AG, Berlin, Germany
| | - Maria Luz
- Faculty of Computer Science, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Torsten Schröder
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Netzer I, Kirkpatrick AW, Nissan M, McKee JL, McBeth P, Dobron A, Glassberg E. Rubrum Coelis: The Contribution of Real-Time Telementoring in Acute Trauma Scenarios-A Randomized Controlled Trial. Telemed J E Health 2019; 25:1108-1114. [PMID: 30707651 DOI: 10.1089/tmj.2018.0173] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most deaths in military trauma occur soon after wounding, and demand immediate on scene interventions. Although hemorrhage predominates as the cause of potentially preventable death, airway obstruction and tension pneumothorax are also frequent. First responders caring for casualties in operational settings often have limited clinical experience. Introduction: We hypothesized that communications technologies allowing for real-time communications with a senior medically experienced provider might assist in the efficacy of first responding to catastrophic trauma. Methods: Thirty-three basic life saving (BLS) medics were randomized into two groups: either receiving telementoring support (TMS, n = 17) or no telementoring support (NTMS, n = 16) during the diagnosis and resuscitation of a simulated critical battlefield casualty. In addition to basic life support, all medics were required to perform a procedure needle thoracentesis (not performed by BLS medics in Israel) for the first time. TMS was performed by physicians through an internet link. Performance was assessed during the simulation and later on review of videos. Results: The TMS group was significantly more successful in diagnosing (82.35% vs. 56.25%, p = 0.003) and treating pneumothorax (52.94% vs. 37.5%, p = 0.035). However, needle thoracentesis time was slightly longer for the TMS group versus the NTMS group (1:24 ± 1:00 vs. 0:49 ± 0:21 minu, respectively (p = 0.016). Complete treatment time was 12:56 ± 2:58 min for the TMS group, versus 9:33 ± 3:17 min for the NTMS group (p = 0.003). Conclusions: Remote telementoring of basic life support performed by military medics significantly improved the medics' ability to perform an unfamiliar lifesaving procedure at the cost of prolonging time needed to provide care. Future studies must refine the indications and contraindications for using telemedical support.
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Affiliation(s)
- Itamar Netzer
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada.,Canadian Forces Medical Services, Ottawa, Canada
| | - Mor Nissan
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Jessica L McKee
- Canadian Forces Medical Services, Ottawa, Canada.,Innovative Trauma Care, Edmonton, Canada
| | - Paul McBeth
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada.,Canadian Forces Medical Services, Ottawa, Canada
| | - Alex Dobron
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Elon Glassberg
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel.,Bar-Ilan University Faculty of Medicine, Safed, Israel
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24
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Brief training increases nurses' comfort using tele-ultrasound: A feasibility study. Intensive Crit Care Nurs 2018; 51:45-49. [PMID: 30514602 DOI: 10.1016/j.iccn.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nurses and other non-physician providers have demonstrated proficiency at obtaining images in the tele-ultrasound system. However, use of this skill requires comfort with the procedure and willingness to incorporate it into practice. OBJECTIVES To assess 1) level of comfort of non-physician providers performing tele-ultrasound before and after brief training and 2) feasibility of implementing an educational programme that improves level of comfort. METHODS Feasibility study including a brief training session followed by hands-on tele-ultrasound. The pilot cohort performed tele-ultrasound on a healthy volunteer. The clinical cohort performed tele-ultrasound on criticalli ill patients with shock or respiratory failure. Remote intensivists provided real-time guidance via tele-medicine technology. Each participant completed a survey assessing training experience and level of comfort before and after training. RESULTS Sixteen non-physician providers participated. All participants agreed that the training session prepared them for image acquisition and that the training experience was positive. The number of participants comfortable with ultrasound improved significantly (before vs. after training: 5/16 [31%] vs. 16/16 [100%], mean Likert score 2.7 vs. 4.8, p = 0.001). CONCLUSIONS After brief training, participants could comfortably perform tele-ultrasound and were more willing to incorporate it into tele-ICU-directed care. Results support conducting a larger-scale trial of tele-US to assess clinical utility.
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Smith A, Addison R, Rogers P, Stone-McLean J, Boyd S, Hoover K, Pollard M, Dubrowski A, Parsons M. Remote Mentoring of Point-of-Care Ultrasound Skills to Inexperienced Operators Using Multiple Telemedicine Platforms: Is a Cell Phone Good Enough? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2517-2525. [PMID: 29577381 DOI: 10.1002/jum.14609] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/05/2017] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Telemedicine technology contributes to the teaching of point-of-care ultrasound (US); however, expensive equipment can limit its deployment in resource-challenged settings. We assessed 3 low-cost telemedicine solutions capable of supporting remote US training to determine feasibility, acceptability, and effectiveness. We also explored the value of instructional videos immediately before telementoring. METHODS Thirty-six participants were randomly assigned to receive US mentoring in 1 of 3 telemedicine conditions: multiple fixed cameras, a smartphone, and traditional audio with a live US stream. Participants were then asked to perform a standardized US examination of the right upper quadrant under remote guidance. We measured observer's global ratings of performance along with the mentor's and student's rating of effort and satisfaction to determine which of the 3 approaches was most feasible, acceptable, and effective. During the second phase, students were randomized to watch an instructional video or not before receiving remote coaching on how to complete a subxiphoid cardiac examination. Effort, satisfaction, and performance from the independent observer's and student's perspective were surveyed. RESULTS There was no significant difference between the different telemedicine setups from the observer's perspective; however, the mentor rated the smartphone significantly worse (P = .028-.04) than other technologies. Platforms were rated equivalent from the student's perspective. No benefit was detected for watching an instructional video before the mentored task. CONCLUSIONS Remote US skills can be taught equally effectively by using a variety of telemedicine technologies. Smartphones represent a viable option for US training in resource-challenged settings.
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Affiliation(s)
- Andrew Smith
- Primary Healthcare Research Unit, Health Sciences Center, St John's, Newfoundland, Canada
| | - Reuben Addison
- School of Human Kinetics and Recreation, Health Sciences Center, St John's, Newfoundland, Canada
| | - Peter Rogers
- Discipline of Emergency Medicine, Health Sciences Center, St John's, Newfoundland, Canada
| | - Jordan Stone-McLean
- Discipline of Emergency Medicine, Health Sciences Center, St John's, Newfoundland, Canada
| | - Sarah Boyd
- Primary Healthcare Research Unit, Health Sciences Center, St John's, Newfoundland, Canada
| | - Kristopher Hoover
- Faculty of Engineering and Applied Sciences, Health Sciences Center, St John's, Newfoundland, Canada
| | - Megan Pollard
- Discipline of Emergency Medicine, Health Sciences Center, St John's, Newfoundland, Canada
| | - Adam Dubrowski
- Discipline of Emergency Medicine, Health Sciences Center, St John's, Newfoundland, Canada
| | - Mike Parsons
- Discipline of Emergency Medicine, Health Sciences Center, St John's, Newfoundland, Canada
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26
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Kirkpatrick AW, McKee JL, Netzer I, McBeth PB, D'Amours S, Kock V, Dobron A, Ball CG, Glassberg E. Transoceanic Telementoring of Tube Thoracostomy Insertion: A Randomized Controlled Trial of Telementored Versus Unmentored Insertion of Tube Thoracostomy by Military Medical Technicians. Telemed J E Health 2018; 25:730-739. [PMID: 30222511 DOI: 10.1089/tmj.2018.0138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Tension pneumothorax is a frequent cause of potentially preventable death. Tube thoracostomy (TT) can obviate death but is invasive and fraught with complications even in experienced hands. We assessed the utility of a remote international virtual network (RIVN) of specialized mentors to remotely guide military medical technicians (medics) using wireless informatics. Methods: Medics were randomized to insert TT in training mannequins (TraumaMan; Abacus ALS, Meadowbrook, Australia) supervised by RIVN or not. The RIVN consisted of trauma surgeons in Canada and Australia and a senior medic in Ohio. Medics wore a helmet-mounted wireless camera with laser pointer to confirm anatomy and two-way voice communication using commercial software (Skype®). Performance was measured through objective task completion (pass/fail) regarding safety during the procedure, proper location, and secure anchoring of the tube, in addition to remote mentor opinion and subjective debrief. Results: Fourteen medics attempted TT, seven mentored and seven not. The RIVN was functional and surgeons on either side of the globe had real-time communication with the mentees. TT placement was considered safe, successful, and secure in 100% of mentored (n = 7) procedures, although two (29%) received corrective remote guidance. All (100%) of the unmentored attempted and adequately secured the TT and were safe. However, only 71% (n = 5) completed the task successfully (p = 0.46). Participating medics subjectively felt remote telementoring (RTM) increased self-confidence (strong agreement mean 5/5 ± 0); confidence to perform field TT (agreement (4/5 ± 1); and decreased anxiety (strong agreement 5/5 ± 1). Subjectively, the remote mentors felt in 100% of the mentored procedures that "yes" they were able to assist the medics (1.86 ± 0.38), and in 71% (n = 5) felt "yes" they made TT safer (2.29 ± 0.49). Conclusions: RTM descriptively increased the success of TT placement and allowed for real-time troubleshooting from thousands of kilometers with a redundant capability. RTM was subjectively associated with high levels of satisfaction and self-reported self-confidence. Continued controlled and critical evaluation and refinement of telemedical techniques should continue. Trial Registration: ID ISRCTN/77929274.
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Affiliation(s)
- Andrew W Kirkpatrick
- 1Regional Trauma Services, University of Calgary, Calgary, Canada.,2Canadian Forces Medical Services, Ottawa, Canada
| | - Jessica L McKee
- 1Regional Trauma Services, University of Calgary, Calgary, Canada.,2Canadian Forces Medical Services, Ottawa, Canada
| | | | - Paul B McBeth
- 1Regional Trauma Services, University of Calgary, Calgary, Canada
| | | | - Volker Kock
- 2Canadian Forces Medical Services, Ottawa, Canada
| | - Alex Dobron
- 3Israeli Defence Force Medical Corp, Haifa, Israel
| | - Chad G Ball
- 1Regional Trauma Services, University of Calgary, Calgary, Canada
| | - Elon Glassberg
- 3Israeli Defence Force Medical Corp, Haifa, Israel.,5Faculty of Medicine, Bar-Ilan University, Safed, Israel.,6The Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Au AK, Adhikari S, Slovis BH, Sachs PB, Lewiss RE. Hospital Information Technology is critical to the success of a point-of-care ultrasound program. Am J Emerg Med 2018; 37:558-559. [PMID: 30100332 DOI: 10.1016/j.ajem.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, United States of America
| | - Benjamin H Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Peter B Sachs
- Department of Radiology, University of Colorado, Aurora, CO, United States of America
| | - Resa E Lewiss
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
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Kim C, Hur J, Kang BS, Choi HJ, Shin JH, Kim TH, Chung JH. Can an Offsite Expert Remotely Evaluate the Visual Estimation of Ejection Fraction via a Social Network Video Call? J Digit Imaging 2018; 30:718-725. [PMID: 28484920 DOI: 10.1007/s10278-017-9974-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to investigate whether an offsite expert could effectively evaluate visually estimated ejection fraction (EF) while watching and guiding the echocardiographic procedure of an onsite novice practitioner using a social network video call. Sixty patients presenting to the intensive care unit and requiring echocardiography between October and November 2016 were included. Sixty novice sonographers without any previous experience of echocardiography participated. Prior to the procedure, the onsite cardiologist completed the echocardiography and determined the EF using the modified Simpson's method (reference value). Then, the novice practitioner performed the echocardiography again with the offsite expert's guidance via a social network video call. The EF was visually estimated by the offsite expert while watching the ultrasound video on the smartphone display. Spearman's rank correlation and Bland-Altman plot analysis were conducted to assess the agreement between the two methods. There was excellent agreement between the two methods, with a correlation coefficient of 0.94 (p < 0.001). The Bland-Altman plot showed that the average bias was -3.05, and the limit of agreement (-10.3 to 4.2) was narrow. The offsite expert was able to perform an accurate visual estimation of ejection fraction remotely via a social network video call by mentoring the onsite novice sonographer. ClinicalTrials.gov Identifier: NCT02960685.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jin Hur
- Department of Emergency Medicine, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jeong-Hun Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jae Ho Chung
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
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Abstract
Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.
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Affiliation(s)
| | - Leila Eadie
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
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30
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A Feasibility Study of Telementoring for Identifying the Appendix Using Smartphone-Based Telesonography. J Digit Imaging 2018; 30:148-155. [PMID: 27826671 DOI: 10.1007/s10278-016-9921-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We investigated the feasibility of the clinical application of novice-practitioner-performed/offsite-mentor-guided ultrasonography for identifying the appendix. A randomized crossover study was conducted using a telesonography system that can transmit the ultrasound images displayed on the ultrasound monitor (ultrasound sequence video) and images showing the practitioner's operations (background video) to a smartphone without any interruption in motion over a Long-Term Evolution (LTE) network. Thirty novice practitioners were randomly assigned to two groups. The subjects in group A (n = 15) performed ultrasonography for the identification of the appendix under mentoring by an onsite expert, whereas those in group B (n = 15) performed the same procedure under mentoring by an offsite expert. Each subject performed the procedure on three simulated patients. After a 4-week interval, they performed the procedure again under the other type of mentoring. A total of 90 ultrasound examinations were performed in each scenario. The primary outcomes were the success rate for identifying the appendix and the time required to identify the appendix. The success rates for identifying the appendix were 91.1 % (82/90) in onsite-mentored ultrasonography and 87.8 % (79/90) in offsite-mentored ultrasonography; both rates were high, and there was no significant difference (p = 0.468) between them. The time required in the case of offsite mentoring (median, 242.9 s; interquartile range (IQR), 238.2) was longer than that for onsite mentoring (median, 291.4 s; IQR, 200.9); however, the difference was not significant (p = 0.051). It appears that offsite mentoring can allow novice onsite practitioners to perform ultrasonography as effectively as they can under onsite mentoring, even for examinations that require proficiency in rather complex practices, such as identifying the appendix.
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31
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Kim C, Cha H, Kang BS, Choi HJ, Lim TH, Oh J. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos. J Digit Imaging 2018; 29:347-56. [PMID: 26620200 DOI: 10.1007/s10278-015-9849-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %-and 100 cases of suspected pediatric appendicitis (static organ)-50 with signs of acute appendicitis and 50 with no findings of appendicitis-were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunmin Cha
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro(st), Guri-si, GyeongGi-do, 471-701, Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
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32
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Loh BCS, Then PHH. Deep learning for cardiac computer-aided diagnosis: benefits, issues & solutions. Mhealth 2017; 3:45. [PMID: 29184897 PMCID: PMC5682365 DOI: 10.21037/mhealth.2017.09.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/28/2017] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular diseases are one of the top causes of deaths worldwide. In developing nations and rural areas, difficulties with diagnosis and treatment are made worse due to the deficiency of healthcare facilities. A viable solution to this issue is telemedicine, which involves delivering health care and sharing medical knowledge at a distance. Additionally, mHealth, the utilization of mobile devices for medical care, has also proven to be a feasible choice. The integration of telemedicine, mHealth and computer-aided diagnosis systems with the fields of machine and deep learning has enabled the creation of effective services that are adaptable to a multitude of scenarios. The objective of this review is to provide an overview of heart disease diagnosis and management, especially within the context of rural healthcare, as well as discuss the benefits, issues and solutions of implementing deep learning algorithms to improve the efficacy of relevant medical applications.
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Affiliation(s)
- Brian C S Loh
- Swinburne University of Technology Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Patrick H H Then
- Swinburne University of Technology Sarawak Campus, Kuching, Sarawak, Malaysia
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33
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The Damage Control Surgery in Austere Environments Research Group (DCSAERG): A dynamic program to facilitate real-time telementoring/telediagnosis to address exsanguination in extreme and austere environments. J Trauma Acute Care Surg 2017. [PMID: 28628601 DOI: 10.1097/ta.0000000000001483] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hemorrhage is the most preventable cause of posttraumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or resuscitative surgery in austere environments. Revolutions in technology for remote mentoring of ultrasound and surgery may enhance capabilities to utilize the skill sets of non-physicians. Thus, our research collaborative explored remote mentoring to empower non-physicians to address junctional and torso hemorrhage control in austere environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative surgery for torso hemorrhage control, understanding and mitigating physiological stress during such tasks, and the technical practicalities of conducting damage control surgery (DCS) in austere environments. Iterative projects involved randomized guiding of firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS, randomized remote mentoring of MedTechs conducting resuscitative surgery for torso exsanguination in an anatomically realistic surgical trainer ("Cut Suit") including physiological monitoring, and trained surgeons conducting a comparative randomized study for torso hemorrhage control in normal (1g) versus weightlessness (0g). This work demonstrated that firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive firefighter in Memphis could also be remotely mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, both mentored and unmentored MedTechs and trained surgeons completed resuscitative surgery for hemorrhage control on the Cut-Suit, demonstrating practicality for all involved. While remote mentoring did not decrease blood loss among MedTechs, it increased procedural confidence and decreased physiologic stress. Therefore, remote mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that remote mentoring supports diagnosis, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.
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34
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Kirkpatrick AW, McKee JL, Tien CH, LaPorta AJ, Lavell K, Leslie T, McBeth PB, Roberts DJ, Ball CG. Abbreviated closure for remote damage control laparotomy in extreme environments: A randomized trial of sutures versus wound clamps comparing terrestrial and weightless conditions. Am J Surg 2017; 213:862-869. [PMID: 28390649 DOI: 10.1016/j.amjsurg.2017.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/14/2017] [Accepted: 03/21/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Far-Forward Damage Control Laparotomies (DCLs) might provide direct-compression of visceral hemorrhage, however, suturing is a limiting factor, especially for non-physicians. We thus compared abbreviated skin closures comparing skin-suture (SS) versus wound-clamp (WC), on-board a research aircraft in weightlessness (0g) and normal gravity (1g). METHODS Surgeons conducted DCLs on a surgical-simulator; onboard the hangered-aircraft (1g), or during parabolic flight (0g), randomized to either WC or SS. RESULTS Ten surgeons participated. Two (40%) surgeons randomized to suture in 0g were incapacitated with motion-sickness, and none were able to close in either 1 or 0g. With WC, two completely closed in 1g as did three in 0g, despite having longer incisions (p = 0.016). Overall skin-closure with WC was significantly greater in both 1g (p = 0.016) and 0g (p = 0.008). CONCLUSIONS WC was more effective in 1g and particularly 0g. Future studies should address the utility of abbreviated WC abdominal closure to facilitate potential Far-Forward DCL. TRIAL REGISTRATION ID ISRCTN/77929274.
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Affiliation(s)
- Andrew W Kirkpatrick
- Canadian Forces Health Services, Nationwide, Canada; Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
| | | | - Colonel Homer Tien
- Canadian Forces Health Services, Nationwide, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Kit Lavell
- Strategic Operations, San Diego, CA, USA
| | - Tim Leslie
- Flight Research Laboratory, National Research Council of Canada, Ottawa, ON, Canada
| | - Paul B McBeth
- Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | - Derek J Roberts
- Department of Surgery, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | - Chad G Ball
- Department of Surgery, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
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35
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Arbeille P, Zuj K, Saccomandi A, Ruiz J, Andre E, de la Porte C, Carles G, Blouin J, Georgescu M. Teleoperated Echograph and Probe Transducer for Remote Ultrasound Investigation on Isolated Patients (Study of 100 Cases). Telemed J E Health 2016; 22:599-607. [DOI: 10.1089/tmj.2015.0186] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philippe Arbeille
- UMPS-CERCOM (Unit of Medicine and Space Physiology), Faculty of Medicine, University of Tours, Tours, France
| | - Kathryn Zuj
- UMPS-CERCOM (Unit of Medicine and Space Physiology), Faculty of Medicine, University of Tours, Tours, France
| | | | - Jose Ruiz
- Department of Obstetrics and Gynecology, University Hospital, Ceuta, Spain
| | - Elise Andre
- Multidisciplinary Health House, Richelieu, France
| | | | - Gabriel Carles
- Hospital of North East Guyana, St. Laurent du Maroni, Guyana, France
| | - Joel Blouin
- UMPS-CERCOM (Unit of Medicine and Space Physiology), Faculty of Medicine, University of Tours, Tours, France
| | - Monica Georgescu
- UMPS-CERCOM (Unit of Medicine and Space Physiology), Faculty of Medicine, University of Tours, Tours, France
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Kirkpatrick AW, McKee I, McKee JL, Ma I, McBeth PB, Roberts DJ, Wurster CL, Parfitt R, Ball CG, Oberg S, Sevcik W, Hamilton DR. Remote just-in-time telementored trauma ultrasound: a double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display. Am J Surg 2016; 211:894-902.e1. [PMID: 27020901 DOI: 10.1016/j.amjsurg.2016.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Remote-telementored ultrasound involves novice examiners being remotely guided by experts using informatic-technologies. However, requiring a novice to perform ultrasound is a cognitively demanding task exacerbated by unfamiliarity with ultrasound-machine controls. We incorporated a randomized evaluation of using remote control of the ultrasound functionality (knobology) within a study in which the images generated by distant naive examiners were viewed on an ultrasound graphic user interface (GUI) display viewed on laptop computers by mentors in different cities. METHODS Fire-fighters in Edmonton (101) were remotely mentored from Calgary (n = 65), Nanaimo (n = 19), and Memphis (n = 17) to examine an ultrasound phantom randomized to contain free fluid or not. Remote mentors (2 surgeons, 1 internist, and 1 ED physician) were randomly assigned to use GUI knobology control during mentoring (GUIK+/GUIK-). RESULTS Remote-telementored ultrasound was feasible in all cases. Overall accuracy for fluid detection was 97% (confidence interval = 91 to 99%) with 3 false negatives (FNs). Positive/negative likelihood ratios were infinity/0.0625. One FN occurred with the GUIK+ and 2 without (GUIK-). There were no statistical test performance differences in either group (GUIK+ and GUIK-). CONCLUSIONS Ultrasound-naive 1st responders can be remotely mentored with high accuracy, although providing basic remote control of the knobology did not affect outcomes.
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Affiliation(s)
- Andrew W Kirkpatrick
- Regional Trauma Services, University of Calgary, 1403 29 St NW Calgary, Alberta, T2N 2T9, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Canadian Forces Medical Services, Canada.
| | - Ian McKee
- Edmonton Fire Department, Edmonton, Alberta, Canada
| | | | - Irene Ma
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul B McBeth
- Regional Trauma Services, University of Calgary, 1403 29 St NW Calgary, Alberta, T2N 2T9, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek J Roberts
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles L Wurster
- Department of Emergency Medicine, Nanaimo Regional General Hospital, Nanaimo, British Columbia
| | | | - Chad G Ball
- Regional Trauma Services, University of Calgary, 1403 29 St NW Calgary, Alberta, T2N 2T9, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Douglas R Hamilton
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
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Levine AR, Buchner JA, Verceles AC, Zubrow MT, Mallemat HA, Papali A, McCurdy MT. Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine. J Crit Care 2016; 33:51-5. [PMID: 27006267 DOI: 10.1016/j.jcrc.2016.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/20/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Remote telementored ultrasound (RTMUS) systems can deliver ultrasound (US) expertise to regions lacking highly trained bedside ultrasonographers and US interpreters. To date, no studies have evaluated the quality and clinical utility of US images transmitted using commercially available RTMUS systems. METHODS This prospective pilot evaluated the quality of US images (right internal jugular vein, lung apices and bases, cardiac subxiphoid view, bladder) obtained using a commercially available iPad operating FaceTime software. A bedside non-physician obtained images and a tele-intensivist interpreted them. All US screen images were simultaneously saved on the US machine and captured via a FaceTime screen shot. The tele-intensivist and an independent US expert rated image quality and utility in guiding clinical decisions. RESULTS The tele-intensivist rated FaceTime images as high quality (90% [69/77]) and could comfortably make clinical decisions using these images (96% [74/77]). Image quality did not differ between FaceTime and US images (97% (75/77). Strong inter-rater reliability existed between tele-intensivist and US expert evaluations (Spearman's rho 0.43; P<.001). CONCLUSION An RTMUS system using commercially available two-way audiovisual technology can transmit US images without quality degradation. For most anatomic sites assessed, US images acquired using FaceTime are not inferior to those obtained directly with the US machine.
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Affiliation(s)
- Andrea R Levine
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA, 15213, United States.
| | - Jessica A Buchner
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Marc T Zubrow
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., Suite 5-N-162, Baltimore, MD, 21201, United States.
| | - Haney A Mallemat
- University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
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Kirkpatrick AW, Tien H, LaPorta AT, Lavell K, Keillor J, Wright Beatty HE, McKee JL, Brien S, Roberts DJ, Wong J, Ball CG, Beckett A. The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study. J Trauma Acute Care Surg 2015; 79:741-7. [PMID: 26422331 PMCID: PMC4623848 DOI: 10.1097/ta.0000000000000829] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. METHODS An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the "Cut Suit") was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon. RESULTS There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004). CONCLUSION Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Canadian Forces Health Services (A.W.K., H.T., J.W., A.B.); Departments of Surgery (A.W.K., D.J.R., C.G.B.), Critical Care Medicine (A.W.K.), and Community Health Sciences (D.J.R.), and Regional Trauma Services (A.W.K., C.G.B.), Foothills Medical Centre; and Innovative Trauma Care (J.L.M.), Edmonton, Calgary, Alberta; Sunnybrook Health Sciences Centre (H.T.), Toronto; and Royal College of Physicians and Surgeons (S.B.); and Flight Research Laboratory (J.K., H.E.W.B.), National Research Council of Canada, Ottawa, Ontario, Canada; Rocky Vista University, Parker, Colorado (A.T.L.); and Strategic Operations (K.L.), San Diego, California
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Kirkpatrick AW, LaPorta A, Brien S, Leslie T, Glassberg E, McKee J, Ball CG, Wright Beatty HE, Keillor J, Roberts DJ, Tien H. Technical innovations that may facilitate real-time telementoring of damage control surgery in austere environments: a proof of concept comparative evaluation of the importance of surgical experience, telepresence, gravity and mentoring in the conduct of damage control laparotomies. Can J Surg 2015; 58:S88-90. [PMID: 26100783 DOI: 10.1503/cjs.014214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Bleeding to death is the most preventable cause of posttraumatic death worldwide. Despite the fact that many of these deaths are anatomically salvageable with relatively basic surgical interventions, they remain lethal in actuality in prehospital environments when no facilities and skills exist to contemplate undertaking basic damage control surgery (DCS). With better attention to prehospital control of extremity hemorrhage, intracavitary bleeding (especially intraperitoneal) remains beyond the scope of prehospital providers. However, recent revolutions in the informatics and techniques of telementoring (TMT), DCS and highly realistic accelerated training of motivated first responders suggests that basic lifesaving DCS may have applicability to save bleeding patients in austere environments previously considered unsalvageable. Especially with informatic advances, any provider with Internet connectivity can potentially be supported by highly proficient specialists with content expertise in the index problem. This unprecedented TMT support may allow highly motivated but inexperienced personnel to provide advanced surgical interventions in extreme environments in many austere locations both on and above the planet.
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Affiliation(s)
- Andrew W Kirkpatrick
- The Regional Trauma Services, the Department of Surgery, University of Calgary, Calgary, Alta. and the Canadian Forces Health Services
| | - Anthony LaPorta
- The Rocky Vista School of Osteopathic Medicine, Parker, Colo
| | - Susan Brien
- The Royal College of Physicians and Surgeons of Canada, Ottawa, Ont
| | - Tim Leslie
- NRC Aerospace Flight Research Laboratory, Ottawa, Ont
| | - Elon Glassberg
- The Trauma & Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Ramat Gan, Israel
| | | | - Chad G Ball
- The Regional Trauma Services, and the Department of Surgery, University of Calgary, Calgary, Alta
| | | | | | - Derek J Roberts
- The Regional Trauma Services and the Department of Surgery, University of Calgary, Calgary, Alta
| | - Homer Tien
- The Canadian Forces Health Services, the 1 Canadian Field Hospital, Petawawa, Ont., the Trauma Services and the Department of Surgery, Sunnybrook Medical Centre, Toronto, Ont
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Kim C, Kang BS, Choi HJ, Lim TH, Oh J, Chee Y. Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED. Am J Emerg Med 2015; 33:1354-9. [PMID: 26306436 DOI: 10.1016/j.ajem.2015.07.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis. METHODS This prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis. The diagnostic confidence of each examiner (resident, remote expert, and onsite expert) was rated on a 5-point Likert scale. The appendix identification rate and the diagnostic values; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each type of examination were calculated. RESULTS A total of 115 pediatric cases with suspected acute appendicitis, including 36 with pathology-confirmed acute appendicitis, between June 2014 and February 2015 were enrolled in this study. In 9 of the 115 (7.8%) cases, a non-appendicitis diagnosis was determined in the absence of the successful identification of a normal appendix upon resident examination. Of these, seven appendices were identified upon expert tele-ultrasonography. The diagnostic values for expert tele-ultrasonography were higher (sensitivity: 1.000, specificity: 0.975, PPV: 0.947, NPV: 1.000) than those for resident-performed ultrasonography (sensitivity: 0.917, specificity: 0.899, PPV: 0.805, NPV: 0.959) and similar to those for onsite expert-performed ultrasonography (sensitivity: 1.000, specificity: 0.987, PPV: 0.973, NPV: 1.000). CONCLUSION Tele-ultrasonography with tele-mentoring between EM residents and experienced mentors was effectively applied in diagnosing pediatric acute appendicitis in an emergency clinical setting.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Youngjoon Chee
- School of Electrical Engineering, Ulsan University, Republic of Korea
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Levine AR, McCurdy MT, Zubrow MT, Papali A, Mallemat HA, Verceles AC. Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images. J Crit Care 2015; 30:871-5. [PMID: 26122274 DOI: 10.1016/j.jcrc.2015.05.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/25/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Intensive care unit telemedicine (tele-ICU) uses audiovisual systems to remotely monitor and manage patients. Intensive care unit ultrasound can augment an otherwise limited bedside evaluation. To date, no studies have utilized tele-ICU technology to assess the quality and clinical use of real-time ultrasound images. We assessed whether tele-intensivists can instruct nonphysicians to obtain high-quality, clinically useful ultrasound images. METHODS This prospective pilot evaluated the effectiveness of a brief educational session of nonphysician "ultrasonographers" on their ability to obtain ultrasound images (right internal jugular vein, bilateral lung apices and bases, cardiac subxiphoid view, bladder) with real-time tele-intensivist guidance. All ultrasound screen images were simultaneously photographed with a 2-way camera and saved on the ultrasound machine. The tele-intensivist assessed image quality, and an independent ultrasound expert rated their use in guiding clinical decisions. RESULTS The intensivist rated the tele-ICU camera images as high quality (70/77, 91%) and suitable for guiding clinical decisions (74/77, 96%). Only bilateral lung apices demonstrated differences in quality and clinical use. All other images were rated noninferior and clinically useful. CONCLUSION Tele-intensivists can guide minimally trained nonphysicians to obtain high-quality, clinically useful ultrasound images. For most anatomic sites, tele-ICU images are of similar quality to those acquired directly by ultrasound.
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Affiliation(s)
- Andrea R Levine
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, United States.
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Marc T Zubrow
- Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., Suite 5-N-162, Baltimore, MD, 21201, United States.
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Haney A Mallemat
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
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Doarn CR, Merrell RC. Telemedicine in Space Medicine and Extreme Terrestrial Analogs. Telemed J E Health 2014; 20:405-7. [DOI: 10.1089/tmj.2014.9989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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