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Rudisill KE, Mathur N, Kalyanpur A. A teleradiology network for the improvement of healthcare and patient management in the developing countries of the African continent. Clin Imaging 2024; 111:110188. [PMID: 38759600 DOI: 10.1016/j.clinimag.2024.110188] [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: 08/21/2023] [Revised: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Africa is the second-largest continent on Earth in terms of both size and population. However, inaccessibility and shortfall of trained radiologists impede the delivery of adequate healthcare to such a large population. Teleradiology holds considerable potential in improving patient outcomes and healthcare delivery in African nations by furnishing timely interpretation of radiological examinations, particularly in those areas where there is a particular scarcity of radiologists. The aim of the present study was to assess the impact of teleradiology in the improvement of healthcare and patient management in the developing countries of the African continent. METHODS In this retrospective study, from January 2017 and December 2022, the scans of a cohort of patients from eight African countries were uploaded to the teleradiology cloud server and interpreted by board certified radiologists empanelled by a teleradiology service provider. RESULTS The telehealth model proposed in the study was seen to provide timely and quality reporting of 58,223 scans of 39,513 patients with a mean turn-around-time (TAT) of 2.46 h 95 % CI (2.44-2.48). DISCUSSION A dedicated teleradiology model designed in this study allowed the interpretation and analysis of the scans of the cohort of patients from hospitals in African countries by teleradiologists via high quality DICOM-image transfer over a cloud-based platform. The outcomes of our investigation reflect that teleradiology provides an effective solution for early diagnosis/interpretation of examinations performed in Africa. Further, the currently proposed teleradiology model may be used for other developing countries across the world to improve quality of care.
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Affiliation(s)
- Katelyn E Rudisill
- Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140, USA.
| | - Neetika Mathur
- Image Core Lab, Plot No. 7G, Opposite Graphite India, Whitefield, Bengaluru, Karnataka 560048, India.
| | - Arjun Kalyanpur
- Teleradiology Solutions, Plot No. 7G, Opposite Graphite India, Whitefield, Bengaluru, Karnataka 560048, India.
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Gamba IAD, Hartery A. The Virtual Reality Radiology Workstation: Current Technology and Future Applications. Can Assoc Radiol J 2024:8465371241230278. [PMID: 38362857 DOI: 10.1177/08465371241230278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Virtual reality (VR) and augmented reality (AR) technology hold potential across many disciplines in medicine to expand the delivery of education and healthcare. VR-AR applications in radiology, in particular, have gained prominence and have demonstrated advantages in many areas within the field. Recently, VR software has emerged to redesign the physical radiology workstation (ie, reading room) to expand the possibilities of diagnostic interpretation. Given the novelty of this technology, there is limited research investigating the potential applications of a simulated radiology workstation. In this review article, we explore VR-simulated reading room technology in its current form and illustrate the practical applications this technology will bring to future radiologists and learners. We also discuss the limitations and barriers to adopting this technology that must be overcome to truly understand its potential benefits. VR reading room technology offers great potential in radiology, but further research is needed to appreciate its benefits and identify areas for improvement. The findings and insights presented in this review contribute to the ongoing discourse on future technological advancements in radiology and healthcare, offering valuable recommendations for further research and practical implementation.
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Affiliation(s)
- Iain A D Gamba
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - Angus Hartery
- Memorial University of Newfoundland, St. John's, NL, Canada
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Xue Z, Wen B. Bioanalytical evaluation of wound depth and musculoskeletal injuries: Synergizing focused assessment with sonography for trauma with computed tomography/magnetic resonance imaging in orthopaedic trauma care. Int Wound J 2024; 21:e14647. [PMID: 38272795 PMCID: PMC10805531 DOI: 10.1111/iwj.14647] [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: 12/09/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Orthopaedic trauma care frequently necessitates prompt and precise assessment of musculoskeletal injuries and wound depth. The potential for improved diagnostic accuracy and patient outcomes exists with the integration of sophisticated imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) with focused assessment with sonography for trauma (FAST). The purpose of this research was to examine the benefits and drawbacks of this integrative method in the clinical environment. From June 2022 to September 2023, 250 patients who were admitted to Ningbo University Affiliated People's Hospital, participated in this cross-sectional observational study. Following the administration of FAST, CT and MRI were utilized to evaluate orthopaedic injuries and skin wounds in patients. Analyses of data centred on the precision of diagnoses, the influence of treatment decisions and patient outcomes. Aged and gendered differently, the study participants sustained the variety of injuries and superficial wounds that were predominantly the result of traffic accidents. The FAST assay exhibited sensitivity of 65%, specificity of 80% and 72% overall accuracy. MRI demonstrated the finest diagnostic performance (85% sensitivity, 95% specificity and 89% accuracy), whereas CT scans offered improved diagnostic efficacy (80% sensitivity, 90% specificity and 84% accuracy). Treatment decisions were substantially impacted by integration of these imaging modalities, resulting in modifications in 20%-35% of cases, depending on the specific modality employed. Specifically, MRI played a pivotal role in informing treatment approaches, influencing non-surgical as well as surgical procedures. This study substantiates the significant advantages of integrating FAST with CT and MRI in orthopaedic trauma care, particularly in the accurate assessment of wound depth. The synergistic use of these imaging techniques not only enhances diagnostic precision but also positively impacts treatment strategies and patient outcomes, emphasizing the need for a comprehensive diagnostic approach in trauma care settings.
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Affiliation(s)
- Zujun Xue
- OrthopedicsNingbo University Affiliated People's HospitalNingboChina
| | - Bi Wen
- Infection DepartmentNingbo University Affiliated People's HospitalNingboChina
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Kuo Y, Lee KL, Chen YL, Weng CY, Chang FC, Chen TJ, Wu HM, Wu CH. Working from home: Changes in radiologist reporting behavior in response to the COVID-19 pandemic. J Chin Med Assoc 2023; 86:859-864. [PMID: 37462444 DOI: 10.1097/jcma.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Remote reporting is an important preventive measure against coronavirus disease 2019 (COVID-19) for radiology departments; it reduces the chance of cross-infections between coworkers. The purpose of this study was to evaluate how the preferred locations that radiologists filed reports from changed in response to COVID-19 by measuring the use of internal teleradiology workstations. METHODS Data were obtained from the radiological information system (RIS) database at our institution, which recorded the reporting workstation for each radiological examination. The reporting activities in 2021 were divided into computed radiography (CR) and computed tomography (CT)/magnetic resonance imaging (MRI) groups. The Wilcoxon signed-rank test was used to measure differences in the use of off-site workstations in prepandemic, midpandemic, and postpandemic periods. RESULTS There were statistically significant increases in the number of reports filed from off-site workstations for each attending physician from the prepandemic period to the midpandemic period in both the CR (15.1%-25.4%, p = 0.041) and CT/MRI (18.9%-28.7%, p = 0.006) groups. There was no significant difference noted between the prepandemic and postpandemic periods for either the CR (15.1% vs 18.4%, p = 0.727) or CT/MRI group (18.9% vs 23.3%, p = 0.236). CONCLUSION In response to the COVID-19 outbreak, radiologists used internal teleradiology to report CR and CT/MRI examinations significantly more frequently. In contrast to the predictions of previous studies, the use of internal teleradiology returned to baseline levels after the pandemic was under control.
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Affiliation(s)
- Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Yi-Lun Chen
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Office of the Superintendent, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Silvestre Sombrio M, Mai W, Buch D, Costa Grotti G, Gabriela Luciani M, Rodrigues Froes T. Accuracy and reliability of tele-ultrasonography in detecting gastrointestinal obstruction in dogs and cats. J Small Anim Pract 2023; 64:367-374. [PMID: 36973863 DOI: 10.1111/jsap.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/19/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To assess the accuracy and interobserver agreement of tele-ultrasonography for the diagnosis of gastrointestinal obstruction in small animals by radiologists with different levels of experience. MATERIALS AND METHODS A retrospective cross-sectional study including dogs and cats admitted with gastrointestinal signs, between 2017 and 2019, that had abdominal ultrasonographic (US) examination performed and images saved for review. Patients were classified into two categories based on final diagnosis: animals with or without complete or partial gastrointestinal obstruction. Observers with four experience levels interpreted the archived ultrasound examinations, simulating a tele-ultrasonography consultation. Analyses of accuracy, sensitivity, specificity, positive and negative predictive values were obtained for each observer for detection of gastrointestinal obstruction. Agreement between observers for the gastrointestinal obstruction diagnosis was assessed using Fleiss's Kappa statistics. RESULTS Ninety patients with gastrointestinal signs were included. Of these, 23 of 90 had partial or complete gastrointestinal obstruction. Interpretation of the images by observers via tele-ultrasonography showed intervals of accuracy, sensitivity, specificity, positive and negative predictive values, respectively, of 78.9% to 87.8%, 73.9% to 100%, 77.6% to 89.6%, 55.9% to 70.8% and 90.9% to 100% for diagnosis of gastrointestinal obstruction. Agreement for the gastrointestinal obstruction diagnosis across all reviewers was moderate (Kappa 0.6). CLINICAL SIGNIFICANCE Tele-ultrasonography had good accuracy for detection of gastrointestinal obstruction, however had a rather low positive predictive value and only moderate interobserver agreement. Therefore, this technique should be used with caution in this clinical context, given the potential surgical decision at hand.
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Affiliation(s)
- M Silvestre Sombrio
- Veterinary Medicine Department, Paraná Federal University, Curitiba, Brazil
- UniRadio, São Paulo, Brazil
| | - W Mai
- Department of Clinical Sciences and Advanced Medicine, Section of Radiology, School of Veterinary Medicine of the University of Pennsylvania, Philadelphia, USA
| | - D Buch
- Veterinary Medicine Department, Paraná Federal University, Curitiba, Brazil
| | | | | | - T Rodrigues Froes
- Veterinary Medicine Department, Paraná Federal University, Curitiba, Brazil
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Lewis SJ, Borecky N, Li T, Barron ML, Brennan P, Trieu PDY. Radiologist Self-training: a Study of Cancer Detection when Reading Mammograms at Work Clinics or Workshops. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:571-577. [PMID: 35511333 PMCID: PMC9069117 DOI: 10.1007/s13187-022-02156-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 05/20/2023]
Abstract
Provision of online and remote specialist education and general continued professional education in medicine is a growing field. For radiology specifically, the ability to access web-based platforms that house high resolution medical images, and the high fidelity of simulated activities is increasingly growing due to positive changes in technology. This study investigates the differences in providing a self-directed specialist radiology education system in two modes: at clinics and in-person workshops. 335 Australian radiologists completed 562 readings of mammogram test sets through the web-based interactive BREAST platform with 325 at conference workshops and 237 at their workplaces. They engaged with test sets with each comprising of 60 mammogram cases (20 cancer and 40 normal). Radiologists marked the location of any cancers and had their performance measured via 5 metrics of diagnostic accuracy. Results show that the location of engagement with BREAST did not yield any significant difference in the performances of all radiologists and the same radiologists between two reading modes (P > 0.05). Radiologists who read screening mammograms for BreastScreen Australia performed better when they completed the test sets at designated workshops (P < 0.05), as was also the case for radiologists who read > 100 cases per week (P < 0.05). In contrast, radiologists who read less mammograms frequently recorded better performances in specificity and JAFROC at clinics (P < 0.05). Findings show that remotely accessed online education for specialised training and core skills building in radiology can provide a similar learning opportunity for breast radiologists when compared to on-site dedicated workshops at scientific meetings. For readers with high volumes of mammograms, a workshop setting may provide a superior experience while clinic setting is more helpful to less experienced readers.
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Affiliation(s)
- Sarah J Lewis
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, D18 - Level 7 Susan Wakil Health Building, New South Wales, 2006, Sydney, Australia
| | - Natacha Borecky
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, D18 - Level 7 Susan Wakil Health Building, New South Wales, 2006, Sydney, Australia
- BreastScreen New South Wales, Sydney, Australia
| | - Tong Li
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, D18 - Level 7 Susan Wakil Health Building, New South Wales, 2006, Sydney, Australia
| | - Melissa L Barron
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, D18 - Level 7 Susan Wakil Health Building, New South Wales, 2006, Sydney, Australia
| | - Patrick Brennan
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, D18 - Level 7 Susan Wakil Health Building, New South Wales, 2006, Sydney, Australia
| | - Phuong Dung Yun Trieu
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, D18 - Level 7 Susan Wakil Health Building, New South Wales, 2006, Sydney, Australia.
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Nabrawi E, Alanazi AT. Imaging in Healthcare: A Glance at the Present and a Glimpse Into the Future. Cureus 2023; 15:e36111. [PMID: 37065355 PMCID: PMC10098436 DOI: 10.7759/cureus.36111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
The utilization of artificial intelligence (AI) applications in medical imaging relies heavily on imaging informatics. That is a one-of-a-kind professional who works at the crossroads of clinical radiography, data science, and information technology. Imaging informaticians are becoming crucial players in expanding, assessing, and implementing AI in the medical setting. Teleradiology will continue to be a cost-effective healthcare facility that expands. Vendor neutral archive (VNA) isolates image presentation and storing systems, permitting platforms to develop quickly, and is a repository for organization-wide healthcare image data. Efforts are made to incorporate and integrate diagnostic facilities such as radiography and pathology to fulfill the needs and demands of targeted therapy. Developments in computer-aided medical object identification may alter the environment of patient services. Finally, interpreting and processing distinct complex healthcare data will create a data-rich context where evidence-based care and performance development may be driven.
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Morales Santos Á, Del Cura Rodríguez JL, Antúnez Larrañaga N. Teleradiology: good practice guide. RADIOLOGIA 2023; 65:133-148. [PMID: 37059579 DOI: 10.1016/j.rxeng.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/12/2022] [Indexed: 04/16/2023]
Abstract
Teleradiology is the electronic transmission of radiological images from one location to another with the main purpose of interpreting or consulting a diagnosis and must be subject to codes of conduct agreed upon by professional societies. The content of fourteen teleradiology best practice guidelines is analyzed. Their guiding principles are: the best interest and benefit of the patient, quality and safety standards homologous to the local radiology service, and use as a complement and support of the same. As legal obligations: guaranteeing rights by applying the principle of the patient's country of origin, establishing requirements in international teleradiology and civil liability insurance. Regarding the radiological process: integration with the local service process, guaranteeing the quality of images and reports, access to previous studies and reports and complying with the principles of radioprotection. Regarding professional requirements: compliance with the required registrations, licenses and qualifications, training and qualification of the radiologist and technician, prevention of fraudulent practices, respect for labor standards and remuneration of the radiologist. Subcontracting must be justified, managing the risk of commoditization. Compliance with the system's technical standards.
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Affiliation(s)
- Á Morales Santos
- Servicio de Radiología, Hospital Universitario Donostia, San Sebastián, Spain.
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Telerradiología: guía de buenas prácticas. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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Yeates EO, Grigorian A, Chinn J, Young H, Colin Escobar J, Glavis-Bloom J, Anavim A, Yaghmai V, Nguyen NT, Nahmias J. Night Radiology Coverage for Trauma: Residents, Teleradiology, or Both? J Am Coll Surg 2022; 235:500-509. [PMID: 35972171 DOI: 10.1097/xcs.0000000000000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients. STUDY DESIGN A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared. RESULTS A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001). CONCLUSIONS This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.
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Affiliation(s)
- Eric O Yeates
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Areg Grigorian
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
- Department of Surgery, University of Southern California (USC), Los Angeles, CA (Grigorian)
| | - Justine Chinn
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Hayley Young
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Jessica Colin Escobar
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Justin Glavis-Bloom
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Arash Anavim
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Vahid Yaghmai
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Ninh T Nguyen
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Jeffry Nahmias
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
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Siddiqi A, Smotherman C, Saremian J, Shiguang L, Alzubaidi Y, Masood S. Toward realization of remote controlled telecytopathology-a validation study from a large academic medical center from the southeast United States. J Am Soc Cytopathol 2022; 11:320-327. [PMID: 35589507 DOI: 10.1016/j.jasc.2022.04.003] [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: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION With increase in the number and types of biopsies requiring rapid on-site evaluation for adequacy, telecytopathology is one of the solutions. MATERIALS AND METHODS Using a microscope camera with MS Surface Pro, a live telecytopathology audio video feed for the adequacy of 55 study set validation cases was sent over Zoom from the satellite hospital over 10 miles away with cytopathologists at the main hospital. The study set cases included Diff-Quik-stained smears and core imprints. RESULTS The overall percent of positive agreement (accuracy) for adequacy during rapid on-site evaluation via telecytopathology was 96%. Core imprint percentage for positive agreement was slightly higher (96.2%), than fine-needle aspiration smears (95.8%). CONCLUSIONS Use of telecytopathology is the best solution for optimizing the cytopathologist's time for evaluating biopsy adequacy from distant sites.
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Affiliation(s)
- Anwer Siddiqi
- Department of Pathology, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida.
| | - Carmen Smotherman
- Department of Community Health and Family Medicine, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Jinous Saremian
- Department of Pathology, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Liu Shiguang
- Department of Pathology, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Yasir Alzubaidi
- Department of Pathology, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Shahla Masood
- Department of Pathology, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
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Nishath T, Wright K, Burke CR, Teng X, Cotter N, Yi JA, Drudi LM. Implementation of telemedicine in the care of patients with aortic dissection. Semin Vasc Surg 2022; 35:43-50. [PMID: 35501040 DOI: 10.1053/j.semvascsurg.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 01/18/2023]
Abstract
Telemedicine uses telephone-based or any form of digital communication for remote clinical services. It has been a field of interest for the last century, with broader implementation of telemedicine technologies during the last 25 years. The COVID-19 pandemic was an impetus for the adoption of these technologies globally across all health care services, including patient care, surgical practice, and workflow. As part of the patient engagement work in the Aortic Dissection Collaborative, this topic was identified as an important patient-centered research topic. Telemedicine has been adopted increasingly in vascular surgery; however, there is little evidence on appropriate use of these technologies pertaining to treating patients with aortic dissection or aortopathy in general. This landscape review summarizes the uses of telemedicine applications pre and post pandemic in medicine and vascular surgery, with a particular focus on uses in aortopathy. Using common resource databases, we identified articles related to the history of telemedicine, its current utilization, and application to vascular surgery and/or aortopathy. We briefly review the history of telemedicine and illustrate a range of applications in medicine before the pandemic, along with its rapid uptake globally during the COVID-19 pandemic. The enablers and barriers to using telemedicine are explored, although as a whole there is satisfaction with its integration among patients and providers. To address these, we offer recommendations to address future research as it pertains to telemedicine technologies in aortic dissection.
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Affiliation(s)
- Thamanna Nishath
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Katie Wright
- The VEDS Movement, Division of the Marfan Foundation, Port Washington, NY; Aortic Dissection Collaborative
| | - Christopher R Burke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Xiaoyi Teng
- Division of Vascular Surgery, Abbott Northwestern Hospital, Minneapolis, MN
| | | | - Jeniann A Yi
- Division of Vascular Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, Quebec, Canada; Carrefour de l'Innovation, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Tahir MY, Mars M, Scott RE. A review of teleradiology in Africa – Towards mobile teleradiology in Nigeria. SA J Radiol 2022; 26:2257. [PMID: 35169498 PMCID: PMC8832073 DOI: 10.4102/sajr.v26i1.2257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
eHealth is promoted as a means to strengthen health systems and facilitate universal health coverage. Sub-components (e.g. telehealth, telemedicine, mhealth) are seen as mitigators of healthcare provider shortages and poor rural and remote access. Teleradiology (including mobile teleradiology), widespread in developed nations, is uncommon in developing nations. Decision- and policy-makers require evidence to inform their decisions regarding implementation of mobile teleradiology in Nigeria and other sub-Saharan countries. To gather evidence, Scopus and PubMed were searched using defined search strings (September 2020). Duplicates were removed, and titles and abstracts reviewed using specified selection criteria. Full-text papers of selected resources were retrieved and reviewed against the criteria. Insight from included studies was charted for eight a priori categories of information: needs assessment, implementation, connectivity, evaluation, costing, image display, image capture and concordance. Fifty-seven articles were identified, duplicates removed and titles and abstracts of remaining articles reviewed against study criteria. Twenty-six papers remained. After review of full-texts, ten met the study criteria. These were summarised, and key insights for the eight categories were charted. Few papers have been published on teleradiology in sub-Saharan Africa. Teleradiology, including mobile teleradiology, is feasible in sub-Saharan Africa for routine X-ray support of patients and healthcare providers in rural and remote locations. Former technical issues (image quality, transmission speed, image compression) have been largely obviated through the high-speed, high-resolution digital imaging and network transmission capabilities of contemporary smartphones and mobile networks, where accessible. Comprehensive studies within the region are needed to guide the widespread introduction of mobile teleradiology.
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Affiliation(s)
- Mohammed Y Tahir
- Department of TeleHealth, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Medical Imaging Informatics ISID, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Maurice Mars
- Department of TeleHealth, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Richard E Scott
- Department of TeleHealth, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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15
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Karantanas AH, Efremidis S. The concept of the invisible radiologist in the era of artificial intelligence. Eur J Radiol 2022; 155:110147. [PMID: 35000823 DOI: 10.1016/j.ejrad.2021.110147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022]
Abstract
The radiologists were traditionally working in the background. What upgraded them as physicians during the second half of the past century was their clinical training and function precipitated by the evolution of Interventional Radiology and Medical Imaging, especially with ultrasonography. These allowed them to participate in patient's diagnosis and treatment by direct contact as well asvia multidisciplinary medical consultations. The wide application of teleradiology and PACS pushed radiologists back again which is no longer acceptable, especially in view of the amazing applications of artificial intelligence (AI) in Radiology. It is our belief that clinical radiologists have to be able to control the penetration of AI in Radiology, securing their work for the benefit of both clinicians and patients.
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Affiliation(s)
- Apostolos H Karantanas
- Department of Radiology, Medical School, University of Crete, 71110 Heraklion, Greece; Department of Medical Imaging, University Hospital, 71110 Heraklion, Greece; Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML) - Hybrid Imaging, 70013 Heraklion, Greece.
| | - Stavros Efremidis
- Prof. Emeritus, Department of Radiology, University of Ioannina, 45110 Ioannina, Greece
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16
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Lai YK, Kuo BJ, Lim KC, Lim CY, Low ASC, Png MA. Results of a study of remote reporting over virtual applications and using visually calibrated monitors. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211066135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives The purpose of this study is to examine differences in image quality, discrepancy rates, productivity and user experience between remote reporting over Virtual Application (VA) using visually calibrated monitors, and reporting using diagnostic grade workstations in hospital premises. Methods Three specialist accredited radiologists examined and provisionally reported outpatient CT and MR studies over PACS delivered as a VA, using visually calibrated monitors from their homes. They then proceeded to view the same studies within hospital premises and issue a final report. Surveys were filled out for each imaging study. Discrepancies were reviewed and assigned RADPEER scores. Results A total of 51 outpatient CT and MRIs were read. Relative to hospital premise reporting, on a Likert scale of 5 (the higher the better), average image quality was 3.9, speed of loading and image manipulation was 4.4 and productivity was 4.1. Remote reporting user experience did not differ significantly between CT versus MRI studies. Complete concordance rate was 80.4% (41/51) and only one of the studies had a significant discrepancy, which may have been due to extra time given to interpretation. All three radiologists reported factors influencing image display and quality as the top factor impacting remote reporting throughput. Conclusions Remote reporting over VA with visually calibrated monitors for CT and MR can be useful in periods of staffing difficulty to augment on-site radiologists, though attention must be paid to its limitations and policies defined by local leadership with reference to relevant national position
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Affiliation(s)
- Yusheng Keefe Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Kheng Choon Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Chee Yeong Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Meng Ai Png
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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17
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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18
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Berry LL, Letchuman S, Ramani N, Barach P. The High Stakes of Outsourcing in Health Care. Mayo Clin Proc 2021; 96:2879-2890. [PMID: 34412855 DOI: 10.1016/j.mayocp.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/13/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
Outsourcing in health care has become increasingly common as health system administrators seek to enhance profitability and efficiency while maintaining clinical excellence. When clinical services are outsourced, however, the outsourcing organization relinquishes control over its most important service value: high-quality patient care. Farming out work to an external service provider can have many unintended results, including inconsistencies in standards of care; harmful medical errors; declines in patient and employee satisfaction; and damage to clinicians' morale and income, and to the health organization's culture, reputation, and long-term financial performance. Research on outsourcing in the areas of emergency medicine, radiology, laboratory services, and environmental services provides concerning evidence of potentially large downsides when outsourcing is driven by short-term cost concerns or is planned without diligently considering all of the ramifications of not keeping key clinical and nonclinical services in-house. To better equip health system leaders for decision-making about outsourcing, we examine this body of literature, identify common pitfalls of outsourcing in specific clinical and nonclinical health services and scenarios, explore alternatives to outsourcing, and consider how outsourcing (when necessary) can be done in a strategic manner that does not compromise the values of the organization and its commitment to patients.
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Affiliation(s)
- Leonard L Berry
- Mays Business School, Texas A&M University, College Station, TX; Institute for Healthcare Improvement, Boston, MA.
| | | | - Nandini Ramani
- Mays Business School, Texas A&M University, College Station, TX
| | - Paul Barach
- Wayne State University School of Medicine, MI; Jefferson College of Population Health, Philadelphia, PA; Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
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19
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Home healthcare patient, caregiver and provider perspectives on use of unscheduled acute care and the usability and acceptability of on-demand telehealth solutions. Geriatr Nurs 2021; 42:1029-1034. [PMID: 34256152 DOI: 10.1016/j.gerinurse.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND/OBJECTIVES Home health care (HHC) agencies provide an important role in helping to transition patients from acute care to independent residential living. Telehealth has the potential to transform care delivery in HHC, however the majority of studies in HHC have focused on the use of telemonitoring for patients with specific chronic conditions. The objective of this study was to examine reasons HHC patients use acute care services and assess the acceptability of on-demand telehealth services among HHC patients, caregivers and personnel to help alleviate the need for seeking in-person acute care. Design/Setting/Participants/Measures: This study was a secondary analysis of qualitative data from in-depth interviews of 30 HHC personnel, patients and caregivers from a Medicare-certified HHC agency affiliated with a large healthcare system from January through May 2020. A conventional content analysis approach was used to identify themes. RESULTS Themes associated with reasons for seeking acute care included: sense of urgency, behavioral and psychosocial factors, and access to care. Participants described their perceptions of the benefits, usability and acceptability and barriers to using telehealth. Patients and HHC personnel agreed that on-demand telehealth should not replace in-person visits but all identified roles that on-demand telehealth services could play in improving communication and access to care. The biggest barriers to use of telehealth identified by HHC personnel were cost, access and ability to use technology by HHC patients. CONCLUSION This study identified reasons HHC patients seek unscheduled acute care and the usability and acceptability of on-demand telehealth services to increase access to care among HHC patients. These findings underscore the need to improve communication and coordination between patients, HHC personnel, and primary care providers and the role that on-demand telehealth services can have in transforming HHC.
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20
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Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol 2021; 13:171-191. [PMID: 34249238 PMCID: PMC8245752 DOI: 10.4329/wjr.v13.i6.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/15/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
The role of radiology and the radiologist have evolved throughout the coronavirus disease-2019 (COVID-19) pandemic. Early on, chest computed tomography was used for screening and diagnosis of COVID-19; however, it is now indicated for high-risk patients, those with severe disease, or in areas where polymerase chain reaction testing is sparsely available. Chest radiography is now utilized mainly for monitoring disease progression in hospitalized patients showing signs of worsening clinical status. Additionally, many challenges at the operational level have been overcome within the field of radiology throughout the COVID-19 pandemic. The use of teleradiology and virtual care clinics greatly enhanced our ability to socially distance and both are likely to remain important mediums for diagnostic imaging delivery and patient care. Opportunities to better utilize of imaging for detection of extrapulmonary manifestations and complications of COVID-19 disease will continue to arise as a more detailed understanding of the pathophysiology of the virus continues to be uncovered and identification of predisposing risk factors for complication development continue to be better understood. Furthermore, unidentified advancements in areas such as standardized imaging reporting, point-of-care ultrasound, and artificial intelligence offer exciting discovery pathways that will inevitably lead to improved care for patients with COVID-19.
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Affiliation(s)
- Dante L Pezzutti
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Vibhor Wadhwa
- Department of Radiology, Weill Cornell Medical Center, New York City, NY 10065, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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22
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Pacheco-Pereira C, Diogenes AR, Moore W, Katkar R, Noujeim ZEF, Flores-Mir C, Geha H. Trends in oral and maxillofacial radiology career: A survey. J Dent Educ 2021; 85:1565-1573. [PMID: 33999431 DOI: 10.1002/jdd.12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Accepted: 04/24/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE/OBJECTIVES To understand the professional aspirations of oral and maxillofacial radiologists (OMRs) by exploring their career choices and their association with educational background, engagement in professional activities, professional values, and overall level of career satisfaction. METHODS This prospective cross-sectional study surveyed board-certified OMRs in the United States and Canada from September to December 2019. A web-based questionnaire was created comprising 37 multiple-choice questions and an open-ended question focusing on their opinions regarding the profession's future. A thematic approach qualitatively explored open questions. RESULTS Of the 86 OMRs, 68, 10, and eight were board certified in the United States, Canada, and both countries, respectively. Activities considered "rewarding" included teaching and mentoring (65%) and radiologic reporting (55%). The majority spent approximately 20-30 h/week writing radiographic reports and less than 10 h in research. On an average, OMRs produced 21.9 (SD 12.8) reports per day. Activities considered less rewarding included administrative work (11%) and productivity pressure in institutions. OMRs working in academia reported higher incomes (p < 0.05). Finally, the majority of the OMRs were pleased with their career choices (79%). CONCLUSIONS There is an association between the contemporary OMRs' satisfaction feeling, teaching/mentoring, and the future challenges of participating in multidisciplinary teams. Overall, diverse career choices lead OMRs to be proud of their profession and significantly satisfied.
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Affiliation(s)
- Camila Pacheco-Pereira
- Department of Comprehensive Dentistry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anibal R Diogenes
- Department of Comprehensive Dentistry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Willian Moore
- Department of Comprehensive Dentistry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Rujuta Katkar
- Department of Comprehensive Dentistry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | | | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hassem Geha
- Department of Comprehensive Dentistry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
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23
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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24
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Yacoub JH, Swanson CE, Jay AK, Cooper C, Spies J, Krishnan P. The Radiology Virtual Reading Room: During and Beyond the COVID-19 Pandemic. J Digit Imaging 2021; 34:308-319. [PMID: 33620622 PMCID: PMC7901504 DOI: 10.1007/s10278-021-00427-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has disrupted the radiology reading room with a potentially lasting impact. This disruption could introduce the risk of obviating the need for the reading room, which would be detrimental to many of the roles of radiology that occur in and around the reading room. This disruption could also create the opportunity for accelerated evolution of the reading room to meet the strategic needs of radiology and health care through thoughtful re-design of the virtual reading room. In this article, we overview the impact of the COVID-19 pandemic on radiology in our institution and across the country, specifically on the dynamics of the radiology reading room. We introduce the concept of the virtual reading room, which is a redesigned alternative to the physical reading room that can serve the diverse needs of radiology and healthcare during and beyond the pandemic.
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Affiliation(s)
- Joseph H Yacoub
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA.
| | - Carl E Swanson
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Ann K Jay
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Cirrelda Cooper
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - James Spies
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Pranay Krishnan
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
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25
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Tian PGJ, Harris JR, Seikaly H, Chambers T, Alvarado S, Eurich D. Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan. JMIR Form Res 2021; 5:e17672. [PMID: 33620325 PMCID: PMC7943336 DOI: 10.2196/17672] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. OBJECTIVE As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. METHODS We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. RESULTS The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. CONCLUSIONS Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use. .
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Affiliation(s)
| | - Jeffrey Richard Harris
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Thane Chambers
- University of Alberta Libraries, University of Alberta, Edmonton, AB, Canada
| | - Sara Alvarado
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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26
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Ricci KB, Oslock WM, Ingraham AM, Rushing AP, Diaz A, Paredes AZ, Daniel VT, Collins CE, Heh VK, Baselice HE, Strassels SA, Caterino JM, Santry HP. Importance of Radiologists in Optimizing Outcomes for Older Americans with Acute Abdomen. J Surg Res 2021; 261:361-368. [PMID: 33493888 DOI: 10.1016/j.jss.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/06/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients presenting with acute abdominal pain often undergo a computed tomography (CT) scan as part of their diagnostic workup. We investigated the relationship between availability, timeliness, and interpretation of CT imaging and outcomes for life-threatening intra-abdominal diseases or "acute abdomen," in older Americans. METHODS Data from a 2015 national survey of 2811 hospitals regarding emergency general surgery structures and processes (60.1% overall response, n = 1690) were linked to 2015 Medicare inpatient claims data. We identified beneficiaries aged ≥65 admitted emergently with a confirmatory acute abdomen diagnosis code and operative intervention on the same calendar date. Multivariable regression models adjusted for significant covariates determined odds of complications and mortality based on CT resources. RESULTS We identified 9125 patients with acute abdomen treated at 1253 hospitals, of which 78% had ≥64-slice CT scanners and 85% had 24/7 CT technicians. Overnight CT reads were provided by in-house radiologists at 14% of hospitals and by teleradiologists at 66%. Patients were predominantly 65-74 y old (43%), white (88%), females (60%), and with ≥3 comorbidities (67%) and 8.6% died. STAT radiology reads by a board-certified radiologist rarely/never available in 2 h was associated with increased odds of systemic complication and mortality (adjusted odds ratio 2.6 [1.3-5.4] and 2.3 [1.1-4.8], respectively). CONCLUSIONS Delays obtaining results are associated with adverse outcomes in older patients with acute abdomen. This may be due to delays in surgical consultation and time to source control while waiting for imaging results. Processes to ensure timely interpretation of CT scans in patients with abdominal pain may improve outcomes in high-risk patients.
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Affiliation(s)
- Kevin B Ricci
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | | | | | - Amy P Rushing
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Adrian Diaz
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Anghela Z Paredes
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Vijaya T Daniel
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Courtney E Collins
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Victor K Heh
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Holly E Baselice
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Scott A Strassels
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio
| | - Jeffrey M Caterino
- Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Heena P Santry
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio.
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Petraglia AF, Olazagasti JM, Strong A, Dunn B, Anderson RT, Hanley M. Establishing Satellite Lung Cancer Screening Sites With Telehealth to Address Disparities Between High-risk Smokers and American College of Radiology-approved Centers of Designation. J Thorac Imaging 2021; 36:2-5. [PMID: 33044253 DOI: 10.1097/rti.0000000000000520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Aimee Strong
- School of Medicine; Departments of
- Radiology and Medical Imaging
| | - Brian Dunn
- Telemedicine Services, University of Virginia Health System, Charlottesville, VA
| | - Roger T Anderson
- School of Medicine; Departments of
- Public Health Sciences, University of Virginia
| | - Michael Hanley
- School of Medicine; Departments of
- Radiology and Medical Imaging
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Arias F, Safi DE, Miranda M, Carrión CI, Diaz Santos AL, Armendariz V, Jose IE, Vuong KD, Suarez P, Strutt AM. Teleneuropsychology for Monolingual and Bilingual Spanish-Speaking Adults in the Time of COVID-19: Rationale, Professional Considerations, and Resources. Arch Clin Neuropsychol 2020; 35:1249-1265. [PMID: 33150414 PMCID: PMC7665473 DOI: 10.1093/arclin/acaa100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Neuropsychological assessments with monolingual Spanish and bilingual Spanish/English-speaking adults present unique challenges. Barriers include, but are not limited to, the paucity of test norms, uncertainty about the equivalence of translated neuropsychological tests, and limited proficiency in the provision of culturally competent services. Similar issues generalize to telephone- and video-based administration of neuropsychological tests or teleneuropsychology (TeleNP) with Hispanics/Latinos (as), and few studies have examined its feasibility and validity in this group. The sudden onset of the COVID-19 pandemic prompted neuropsychologists to identify alternative ways to provide equitable care. Clinicians providing TeleNP to this population during (and after) the pandemic must consider safety, professional factors, and systemic barriers to accessing and benefitting from virtual modalities. METHOD This clinical process manuscript describes how cross-cultural neuropsychologists across five U.S. academic institutions serving Hispanics/Latinos (as) developed TeleNP models of care during the pandemic. RESULTS Workflows, test batteries, and resources for TeleNP assessment with monolingual and bilingual Spanish-speaking patients are included. Factors guiding model development and informing decisions to incorporate virtual administration of neuropsychological tests into their practice are also discussed. CONCLUSIONS Provision of TeleNP is a promising modality. Additional research in this area is warranted with focus on cultural and contextual factors that support or limit the use of TeleNP with this community.
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Affiliation(s)
- Franchesca Arias
- Hinda & Arthur Marcus Institute for Aging Research, The Aging Brain Center, Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Diomaris E Safi
- Department of Psychiatry and Behavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- UCLA Hispanic Neuropsychiatric Center of Excellence, Los Angeles, CA 90095, USA
| | - Michelle Miranda
- Department of Cognitive Neurology, University of Utah, Salt Lake City, UT 84112, USA
| | - Carmen I Carrión
- Department of Neurology, Yale School of Medicine, New Haven, CT 06519, USA
| | | | | | - Irene E Jose
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
| | - Kevin D Vuong
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Paola Suarez
- Department of Psychiatry and Behavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- UCLA Hispanic Neuropsychiatric Center of Excellence, Los Angeles, CA 90095, USA
| | - Adriana M Strutt
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
OBJECTIVE. In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic. CONCLUSION. Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.
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Joseph JW, Kennedy M, Nathanson LA, Wardlow L, Crowley C, Stuck A. Reducing Emergency Department Transfers from Skilled Nursing Facilities Through an Emergency Physician Telemedicine Service. West J Emerg Med 2020; 21:205-209. [PMID: 33207167 PMCID: PMC7673904 DOI: 10.5811/westjem.2020.7.46295] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/11/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Transfers of skilled nursing facility (SNF) residents to emergency departments (ED) are linked to morbidity, mortality and significant cost, especially when transfers result in hospital admissions. This study investigated an alternative approach for emergency care delivery comprised of SNF-based telemedicine services provided by emergency physicians (EP). We compared this on-site emergency care option to traditional ED-based care, evaluating hospital admission rates following care by an EP. Methods We conducted a retrospective, observational study of SNF residents who underwent emergency evaluation between January 1, 2017–January 1, 2018. The intervention group was comprised of residents at six urban SNFs in the Northeastern United States, who received an on-demand telemedicine service provided by an EP. The comparison group consisted of residents of SNFs that did not offer on-demand services and were transferred via ambulance to the ED. Using electronic health record data from both the telemedicine and ambulance transfers, our primary outcome was the odds ratio (OR) of a hospital admission. We also conducted a subanalysis examining the same OR for the three most common chronic disease-related presentations found among the telemedicine study population. Results A total of 4,606 patients were evaluated in both the SNF-based intervention and ED-based comparison groups (n=2,311 for SNF based group and 2,295 controls). Patients who received the SNF-based acute care were less likely to be admitted to the hospital compared to patients who were transferred to the ED in our primary and subgroup analyses. Overall, only 27% of the intervention group was transported to the ED for additional care and presumed admission, whereas 71% of the comparison group was admitted (OR for admission = 0.15 [9% confidence interval, 0.13–0.17]). Conclusion The use of an EP-staffed telemedicine service provided to SNF residents was associated with a significantly lower rate of hospital admissions compared to the usual ED-based care for a similarly aged population of SNF residents. Providing SNF-based care by EPs could decrease costs associated with hospital-based care and risks associated with hospitalization, including cognitive and functional decline, nosocomial infections, and falls.
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Affiliation(s)
- Joshua W Joseph
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Maura Kennedy
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Larry A Nathanson
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | | | | | - Amy Stuck
- West Health Institute, La Jolla, California
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Akalın Ç, Sasani H, Ekmen N. The Results of Abdominopelvic Computed Tomography Interpreted via Remote Access for the Diagnosis of Acute Appendicitis. Cureus 2020; 12:e9773. [PMID: 32953291 PMCID: PMC7491699 DOI: 10.7759/cureus.9773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Abdominal computed tomography (CT) is one of the imaging modalities for the diagnosis of acute appendicitis (AA). Today, CT scans can be interpreted via remote access called tele-radiology, besides conventional methods. The objective of this study was to evaluate the CT interpreted via tele-radiology for diagnosing AA. METHODS In this retrospective study, a total of 679 patients, who were interpreted via tele-radiology of CT due to suspicion of AA, were evaluated. Age, gender, CT findings, pathology results and intra-operative diagnosis of those with normal CT results were analysed. A sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of CT in the diagnosis of AA were calculated. RESULTS 520 patients who were operated with pre-diagnosed AA were found. Of those, 441 patients (84.8%) were diagnosed with AA according to CT reports, out of which 368 (83.4%) were positive (true-positive) and 73 (16.6%) were negative (false-positive) in terms of pathology results. In the remaining operated 79 patients with normal CT results, 58 (73.4%) were positive for AA and 21 (26.6%) (negative laparotomy) were negative for AA in terms of pathological examination. The sensitivity, specificity, accuracy, PPV and NPV of CT in the diagnosis of AA were determined as 81.2%, 67.7%, 76.7%, 83.4% and 64.2%, respectively. CONCLUSION The sensitivity and PPV rates were found similar in both conventional and tele-radiological methods. However, specificity, accuracy and NPV rates were determined lower than in literature. Additionally, the negative laparotomy rate was higher than the conventional method.
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Affiliation(s)
- Çağrı Akalın
- General Surgery, Ordu University Training and Research Hospital, Ordu, TUR
| | - Hadi Sasani
- Radiology, Tekirdağ Namık Kemal University Faculty of Mecine, Tekirdag, TUR
| | - Nergis Ekmen
- Gastroenterology, Gazi University Faculty of Medicine, Ankara, TUR
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Latifi R, Azevedo V, Boci A, Parsikia A, Latifi F, Merrell RC. Telemedicine Consultation as an Indicator of Local Telemedicine Champions' Contributions, Health Care System Needs or Both: Tales from Two Continents. Telemed J E Health 2020; 27:200-206. [PMID: 32706614 DOI: 10.1089/tmj.2019.0290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telemedicine systems increase access to care, particularly in remote and developing countries. Nationwide telemedicine programs in Cabo Verde and Albania have been built by the International Virtual e-Hospital Foundation (IVeH) and based on the effective Initiate-Build-Operate-Transfer (IBOT) strategy. The aim of this study was to compare the clinical results between the two programs and examine the relationship between the clinical teleconsultations as an indicator of health care system needs and the contribution of local telemedicine champions. Methods: Data were prospectively collected between 2014 and 2018 from Albania and Cabo Verde. Telemedicine champions were defined as programs, physicians, or hospitals who have contributed at least 100 telemedicine consultations during the study periods. Chi-squared test was utilized to analyze the data. Results: There were 2,442 teleconsultations in Cabo Verde and 2,724 teleconsultations in Albania during the study periods. Using the 100-consultation benchmark as the indicator of telemedicine champion, we identified radiology (n = 1,061), neurotrauma (n = 742), and general neurology or stroke (n = 489) as champion clinical disciplines in Albania. With the same method of 100 consultations, we identified eight champion clinical disciplines in Cabo Verde, including neurology (n = 720), cardiology (n = 313), orthopedics (n = 190), surgery (143), endocrinology (141), otolaryngology (n = 139), urology (n = 139), and dermatology (126). The patient transfer/nontransfer ratio was 0.5 in Cabo Verde and 0.3 in Albania (p < 0.001). Three hospitals in Albania and eight community hospitals/health care centers in Cabo Verde requested the majority of teleconsultations. Two main hospitals in Cabo Verde and Albania responded to the consultations. Conclusion: The successful implementation of a telemedicine program depends on many factors. However, physician champions, who eventually create clinical discipline champions, and represent the hospital champions, are the backbone of the sustainability and progress of any telemedicine program. The number of consultations reflects the lack of local specialty expertise to provide health care service and thus can be used for future planning and investment.
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Affiliation(s)
- Rifat Latifi
- Department of Surgery, School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.,International Virtual e-Hospital Foundation, Anchorage, Alaska, USA
| | - Vanda Azevedo
- National Telemedicine Service and Prevention and Control of Cerebro-Cardiovascular Diseases, Praia, Cabo Verde
| | - Arian Boci
- Integrated Telemedicine and e-Health Program of Albania, Tirana, Albania
| | - Afshin Parsikia
- International Virtual e-Hospital Foundation, Anchorage, Alaska, USA
| | - Fortesa Latifi
- International Virtual e-Hospital Foundation, Anchorage, Alaska, USA
| | - Ronald C Merrell
- International Virtual e-Hospital Foundation, Anchorage, Alaska, USA.,Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Dick EA, Raithatha A, Musker L, Redhead J, Mehta A, Amiras D. Remote reporting in the COVID-19 era: from pilot study to practice. Clin Radiol 2020; 75:710.e5-710.e8. [PMID: 32654757 PMCID: PMC7328588 DOI: 10.1016/j.crad.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
AIM To assess the benefits and challenges of remote reporting using an intra-departmental teleradiology system. MATERIALS AND METHODS A pilot of an in-hospital Trust radiologist reporting on in-hospital Trust patients via a remote login was undertaken. Reporting output, training impact, and quality improvement were measured. RESULTS Reporting output increased by 140%. Trainee satisfaction was high in a qualitative survey, particularly for out-of-hours support and teaching. Clinicians found the service to be similar to the same service provided by a locally based radiologist. CONCLUSION In the COVID-19 era, remote working has developed rapidly. This study shows that radiology departments can provide remote reporting that is equal in standard to reporting from within the hospital, and in addition, that there are advantages to output and training.
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Affiliation(s)
- E A Dick
- Department of Radiology, Imperial College NHS Trust, London, UK; University of Sydney, Sydney, NSW, Australia.
| | - A Raithatha
- Department of Radiology, Imperial College NHS Trust, London, UK
| | - L Musker
- Department of Radiology, Imperial College NHS Trust, London, UK
| | - J Redhead
- Medical Director's Office, Imperial College NHS Trust, UK
| | - A Mehta
- Department of Radiology, Imperial College NHS Trust, London, UK
| | - D Amiras
- Department of Radiology, Imperial College NHS Trust, London, UK
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Abstract
Patients with gynecologic cancers experience better outcomes when treated by specialists and institutions with experience in their diseases. Unfortunately, high-volume centers tend to be located in densely populated regions, leaving many women with geographic barriers to care. Remote management through telemedicine offers the possibility of decreasing these disparities by extending the reach of specialty expertise and minimizing travel burdens. Telemedicine can assist in diagnosis, treatment planning, preoperative and postoperative follow-up, administration of chemotherapy, provision of palliative care, and surveillance. Telemedical infrastructure requires careful consideration of the needs of relevant stakeholders including patients, caregivers, referring clinicians, specialists, and health system administrators.
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Rosenkrantz AB, Hanna TN, Steenburg SD, Tarrant MJ, Pyatt RS, Friedberg EB. The Current State of Teleradiology Across the United States: A National Survey of Radiologists' Habits, Attitudes, and Perceptions on Teleradiology Practice. J Am Coll Radiol 2019; 16:1677-1687. [PMID: 31271736 DOI: 10.1016/j.jacr.2019.05.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To explore the current state of teleradiology practice, defined as the interpretation of imaging examinations at a different facility from where the examination was performed. METHODS A national survey addressing radiologists' habits, attitudes, and perceptions regarding teleradiology was distributed by e-mail to a random sample of ACR members in early 2019. RESULTS Among 731 of 936 respondents who indicated a non-teleradiologist primary work setting, 85.6% reported performing teleradiology within the past 10 years and 25.4% reported that teleradiology represents a majority of their annual imaging volumes; 84.4% performed teleradiology for internal examinations and 45.7% for external examinations; 46.2% performed teleradiology for rural areas and 37.2% for critical access hospitals; 91.3% performed teleradiology during weekday normal business hours and 44.5% to 79.6% over evening, overnight, and weekend hours. In all, 76.9% to 86.2% perceived value from teleradiology for geographic, after-hours, and multispecialty coverage, as well as reduced interpretation turnaround times. The most common challenges for teleradiology were electronic health record access (62.8%), quality assurance (53.8%), and technologist proximity (48.4%). The strategy most commonly considered useful for improving teleradiology was technical interpretation standards (33.3%). Radiologists in smaller practices were less likely to perform teleradiology or performed teleradiology for lower fractions of work, were less likely to experience coverage advantages of teleradiology, and reported larger implementation challenges, particularly relating to electronic health records and prior examination access. CONCLUSION Despite historic concerns, teleradiology is widespread throughout modern radiology practice, helping practices achieve geographic, after-hours, and multispecialty coverage; reducing turnaround times; and expanding underserved access. Nonetheless, quality assurance of offsite examinations remains necessary. IT integration solutions could help smaller practices achieve teleradiology's benefits.
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Affiliation(s)
| | - Tarek N Hanna
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Robert S Pyatt
- Chambersburg Imaging Associates, Chambersburg, Pennsylvania
| | - Eric B Friedberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Chirra M, Marsili L, Wattley L, Sokol LL, Keeling E, Maule S, Sobrero G, Artusi CA, Romagnolo A, Zibetti M, Lopiano L, Espay AJ, Obeidat AZ, Merola A. Telemedicine in Neurological Disorders: Opportunities and Challenges. Telemed J E Health 2019; 25:541-550. [PMID: 30136898 PMCID: PMC6664824 DOI: 10.1089/tmj.2018.0101] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: Telemedicine represents an emerging model for the assessment and management of various neurological disorders. Methods: We sought to discuss opportunities and challenges for the integration of telemedicine in the management of common and uncommon neurological disorders by reviewing and appraising studies that evaluate telemedicine as a means to facilitate the access to care, deliver highly specialized visits, diagnostic consultations, rehabilitation, and remote monitoring of neurological disorders. Results: Opportunities for telemedicine in neurological disorders include the replacement of or complement to in-office evaluations, decreased time between follow-up visits, reduction in disparities in access to healthcare, and promotion of education and training through interactions between primary care physicians and tertiary referral centers. Critical challenges include the integration of the systems for data monitoring with an easy-to-use, secure, and cost-effective platform that is both widely adopted by patients and healthcare systems and embraced by international scientific societies. Conclusions: Multiple applications may spawn from a model based on digitalized healthcare services. Integrated efforts from multiple stakeholders will be required to develop an interoperable software platform capable of providing not only a holistic approach to care but also one that reduces disparities in the access to care.
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Affiliation(s)
- Martina Chirra
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Oncology, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Luca Marsili
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Linsdey Wattley
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Leonard L. Sokol
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth Keeling
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Simona Maule
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Gabriele Sobrero
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Ahmed Z. Obeidat
- Department of Neurology and Rehabilitation Medicine, The Waddell Center for Multiple Sclerosis, University of Cincinnati, Cincinnati, Ohio
| | - Aristide Merola
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
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Weinstein RS, Krupinski EA, Doarn CR. Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices. Med Clin North Am 2018; 102:533-544. [PMID: 29650074 DOI: 10.1016/j.mcna.2018.01.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry.
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Affiliation(s)
- Ronald S Weinstein
- Arizona Telemedicine Program, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast D107, Atlanta, GA 30322, USA
| | - Charles R Doarn
- Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
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39
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Telehealth in Physical Medicine and Rehabilitation: A Narrative Review. PM R 2018; 9:S51-S58. [PMID: 28527504 DOI: 10.1016/j.pmrj.2017.02.013] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022]
Abstract
Telehealth refers to health care interactions that leverage telecommunication devices to provide medical care outside the traditional face-to-face, in-person medical encounter. Technology advances and research have expanded use of telehealth in health care delivery. Physical medicine and rehabilitation providers may use telehealth to deliver care to populations with neurologic and musculoskeletal conditions, commonly treated in both acute care and outpatient settings. Patients with impaired mobility and those living in locations with reduced access to care may particularly benefit. Video-teleconferencing has been shown to be effective for management of burn patients during acute rehabilitation, including reduced health care use expenses and less disruptions to care. Telehealth can facilitate developing interprofessional care plans. Patients with neurologic conditions including stroke, spinal cord injury, traumatic brain injury, and amyotrophic lateral sclerosis may use telehealth to monitor symptoms and response to treatment. Telehealth also may facilitate occupational and physical therapy programs as well as improve weight management and skin care in patients with chronic conditions. Other applications include imaging review in sports medicine, symptom management and counseling in concussion, traumatic brain injury, and pain management programs. Limitations of telehealth include barriers in establishing relationship between medical provider and patient, ability to perform limited physical examination, and differences in payment models and liability coverage. The expansion of telehealth services is expected to grow and has potential to improve patient satisfaction by delivering high quality and value of care.
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40
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Kalid N, Zaidan AA, Zaidan BB, Salman OH, Hashim M, Muzammil H. Based Real Time Remote Health Monitoring Systems: A Review on Patients Prioritization and Related "Big Data" Using Body Sensors information and Communication Technology. J Med Syst 2017; 42:30. [PMID: 29288419 DOI: 10.1007/s10916-017-0883-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
The growing worldwide population has increased the need for technologies, computerised software algorithms and smart devices that can monitor and assist patients anytime and anywhere and thus enable them to lead independent lives. The real-time remote monitoring of patients is an important issue in telemedicine. In the provision of healthcare services, patient prioritisation poses a significant challenge because of the complex decision-making process it involves when patients are considered 'big data'. To our knowledge, no study has highlighted the link between 'big data' characteristics and real-time remote healthcare monitoring in the patient prioritisation process, as well as the inherent challenges involved. Thus, we present comprehensive insights into the elements of big data characteristics according to the six 'Vs': volume, velocity, variety, veracity, value and variability. Each of these elements is presented and connected to a related part in the study of the connection between patient prioritisation and real-time remote healthcare monitoring systems. Then, we determine the weak points and recommend solutions as potential future work. This study makes the following contributions. (1) The link between big data characteristics and real-time remote healthcare monitoring in the patient prioritisation process is described. (2) The open issues and challenges for big data used in the patient prioritisation process are emphasised. (3) As a recommended solution, decision making using multiple criteria, such as vital signs and chief complaints, is utilised to prioritise the big data of patients with chronic diseases on the basis of the most urgent cases.
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Affiliation(s)
- Naser Kalid
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.,Department of Computer Engineering Techniques, Al-Nisour University, Al Adhmia - Haiba Khaton, Baghdad, Iraq
| | - A A Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.
| | - B B Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - Omar H Salman
- Networking Department, Engineering College, Al Iraqia university, Baghdad, Iraq
| | - M Hashim
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - H Muzammil
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
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Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects. Telemed J E Health 2017; 23:155-191. [PMID: 28170313 DOI: 10.1089/tmj.2016.0278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Telepathology evolved from video microscopy (i.e., "television microscopy") research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of telepathology. METHODS A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.
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Affiliation(s)
- Rashid L Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Matthew R Dunn
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
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