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Borna S, Gomez-Cabello CA, Pressman SM, Haider SA, Sehgal A, Leibovich BC, Cole D, Forte AJ. Comparative Analysis of Artificial Intelligence Virtual Assistant and Large Language Models in Post-Operative Care. Eur J Investig Health Psychol Educ 2024; 14:1413-1424. [PMID: 38785591 PMCID: PMC11119735 DOI: 10.3390/ejihpe14050093] [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: 04/12/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
In postoperative care, patient education and follow-up are pivotal for enhancing the quality of care and satisfaction. Artificial intelligence virtual assistants (AIVA) and large language models (LLMs) like Google BARD and ChatGPT-4 offer avenues for addressing patient queries using natural language processing (NLP) techniques. However, the accuracy and appropriateness of the information vary across these platforms, necessitating a comparative study to evaluate their efficacy in this domain. We conducted a study comparing AIVA (using Google Dialogflow) with ChatGPT-4 and Google BARD, assessing the accuracy, knowledge gap, and response appropriateness. AIVA demonstrated superior performance, with significantly higher accuracy (mean: 0.9) and lower knowledge gap (mean: 0.1) compared to BARD and ChatGPT-4. Additionally, AIVA's responses received higher Likert scores for appropriateness. Our findings suggest that specialized AI tools like AIVA are more effective in delivering precise and contextually relevant information for postoperative care compared to general-purpose LLMs. While ChatGPT-4 shows promise, its performance varies, particularly in verbal interactions. This underscores the importance of tailored AI solutions in healthcare, where accuracy and clarity are paramount. Our study highlights the necessity for further research and the development of customized AI solutions to address specific medical contexts and improve patient outcomes.
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Affiliation(s)
- Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Syed Ali Haider
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ajai Sehgal
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
| | - Bradley C. Leibovich
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Dave Cole
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
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2
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McLean KA, Sgrò A, Brown LR, Buijs LF, Daines L, Potter MA, Bouamrane MM, Harrison EM. Evaluation of remote digital postoperative wound monitoring in routine surgical practice. NPJ Digit Med 2023; 6:85. [PMID: 37147462 PMCID: PMC10161985 DOI: 10.1038/s41746-023-00824-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
Remote digital postoperative wound monitoring provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot a remote digital postoperative wound monitoring service and evaluate the readiness for implementation in routine clinical practice. This was a single-arm pilot implementational study of remote digital postoperative wound monitoring across two tertiary care hospitals in the UK (IDEAL stage 2b, clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery were recruited and received a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients received 30-day postoperative follow-up, including the Telehealth Usability Questionnaire (TUQ). A thematic mixed-methods approach was used, according to the WHO framework for monitoring and evaluating digital health interventions. 200 patients were enroled, of whom 115 (57.5%) underwent emergency surgical procedures. Overall, the 30-day SSI rate was 16.5% (n = 33/200), with 72.7% (n = 24) diagnosed post-discharge. Usage of the intervention was 83.0% (n = 166/200), with subsequently 74.1% (n = 123/166) TUQ completion. There were no issues reported with feasibility of the technology, with the reliability (3.87, 95% CI: 3.73-4.00) and quality of the interface rated highly (4.18, 95%: 4.06-4.30). Patient acceptance was similarly high with regards to ease of use (4.51, 95% CI: 4.41-4.62), satisfaction (4.27, 95% CI: 4.13-4.41), and usefulness (4.07, 95% CI: 3.92-4.23). Despite the desire for more frequent and personalised interactions, the majority viewed the intervention as providing meaningful benefit over routine postoperative care. Remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.
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Affiliation(s)
- Kenneth A McLean
- Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK
| | - Alessandro Sgrò
- Colorectal Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Leo R Brown
- Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Louis F Buijs
- Colorectal Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Luke Daines
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK
| | - Ewen M Harrison
- Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK.
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3
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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4
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Jarvis NR, Jarvis T, Morris BE, Verhey EM, Rebecca AM, Howard MA, Teven CM. A Scoping Review of Mobile Apps in Plastic Surgery: Patient Care, Trainee Education, and Professional Development. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4943. [PMID: 37063506 PMCID: PMC10101243 DOI: 10.1097/gox.0000000000004943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/16/2023] [Indexed: 04/18/2023]
Abstract
Over the past 10 years, smartphones have become ubiquitous, and mobile apps serve a seemingly endless number of functions in our everyday lives. These functions have entered the realm of plastic surgery, impacting patient care, education, and delivery of services. This article reviews the current uses of plastic surgery mobile apps, app awareness within the plastic surgery community, and the ethical issues surrounding their use in patient care. Methods A scoping review of electronically available literature within PubMed, Embase, and Scopus databases was conducted in two waves in November and May 2022. Publications discussing mobile application use in plastic surgery were screened for inclusion. Results Of the 80 nonduplicate publications retrieved, 20 satisfied the inclusion criteria. Articles acquired from the references of these publications were reviewed and summarized when relevant. The average American Society of Plastic Surgeons evidence rating of the publications was 4.2. Applications could be categorized broadly into three categories: patient care and surgical applications, professional development and education, and marketing and practice development. Conclusions Mobile apps related to plastic surgery have become an abundant resource for patients, attending surgeons, and trainees. Many help bridge gaps in patient care and surgeon-patient communication, and facilitate marketing and practice development. Others make educational content more accessible to trainees and performance assessment more efficient and equitable. The extent of their impact on patient decision-making and expectations has not been completely elucidated.
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Affiliation(s)
| | - Tyler Jarvis
- Division of Plastic Surgery, Penn State Health Medical Center, Hershey, Penn
| | - Bryn E. Morris
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz
| | - Erik M. Verhey
- From the Mayo Clinic Alix School of Medicine, Scottsdale, Ariz
| | - Alanna M. Rebecca
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz
| | - Michael A. Howard
- Division of Plastic and Reconstructive Surgery, Northwestern Medicine, Chicago, Ill
| | - Chad M. Teven
- Division of Plastic and Reconstructive Surgery, Northwestern Medicine, Chicago, Ill
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Du EY, Moody RA, Simpson MC, Nellore A, Sinnwell JG, Heiland LD, Grace SA, Chen CL. Factors Shifting Preference Toward Telemedicine in the Delivery of Skin Cancer Reconstruction Care. Laryngoscope 2023; 133:294-301. [PMID: 35567379 DOI: 10.1002/lary.30215] [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: 01/11/2022] [Revised: 03/24/2022] [Accepted: 05/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Identify which delivery modality for skin reconstruction care, face-to-face (FTF) in-person versus two telemedicine modalities, store-and-forward (S&F) and live video chat (LVC), is patient preferred and how cost, access, wait time, and demographics influence this preference. STUDY DESIGN Cross-sectional survey. METHODS A 16-question survey querying demographics and five scenario-specific preferences questions for the delivery of skin cancer reconstruction care was created and distributed via Amazon Mechanical Turk (MTurk), a crowdsourcing online marketplace, and in-person to Mohs micrographic surgery patients. RESULTS 1394 MTurk and 55 in-person responses were included. While 82.1% of online respondents prefer FTF clinic visits, this decreases to 58.3% with an in-person visit cost (p < 0.01) and furthermore to a minority 43.5% with both an in-person visit cost and wait time (p < 0.01) despite 77.8% believing that usefulness to the surgeon would improve FTF. Both the MTurk and in-person cohorts demonstrated similar response patterns despite considerable demographic differences. Multivariable analyses revealed that telemedicine was preferred by MTurk respondents with Medicaid (adjusted OR [95% CI]: 1.97 [1.18-3.31]) or Medicare (1.69 [1.10-2.59]) versus private insurance, and prior skin cancer (2.01 [1.18-3.42]) and less preferred by those earning $140,000+ per year (0.49 [0.29-0.82]) compared to those earning <$20,000 per year. CONCLUSIONS FTF visits are preferred for skin cancer reconstruction care; this shifts toward virtual care with a cost and wait time in spite of the perceived quality of care. Individuals with socioeconomic barriers to access prefer telemedicine. MTurk can be a valuable tool for behavioral research in FPRS. LEVEL OF EVIDENCE NA Laryngoscope, 133:294-301, 2023.
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Affiliation(s)
- Eric Y Du
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Rylee A Moody
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
| | - Aditya Nellore
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Joseph G Sinnwell
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
| | - Luke D Heiland
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Shane A Grace
- Department of Dermatology, Saint Louis University, St. Louis, Missouri, U.S.A
| | - Collin L Chen
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
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6
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Chatham DR. Reducing Risks for a Dissatisfied Patient in Facial Cosmetic Surgery. Facial Plast Surg Clin North Am 2023; 31:183-193. [PMID: 37001922 DOI: 10.1016/j.fsc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Patient selection in aesthetic surgery is the ultimate inexact science, a mixture of surgical judgment, expertise, ego, gut feelings, personality interactions, and a spin of the roulette wheel. Using our procedural skills as well as our interpersonal skills will enhance our professional satisfaction and improve the quality of life for others as we try to reduce the likelihood of dissatisfaction, both for our patients and ourselves.
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Affiliation(s)
- Donn R Chatham
- Department Otolaryngology, University of Louisville Medical School.
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7
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Tzeng YH, Yin WH, Lin KC, Wei J, Liou HR, Sung HJ, Lang HC. Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis. J Med Internet Res 2022; 24:e40288. [PMID: 35917486 PMCID: PMC9377537 DOI: 10.2196/40288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. Objective This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. Methods We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients’ demographic characteristics, disease type, physicians’ features, and specialties/departments were collected, and physicians’ opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. Results Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician’s positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient’s age, the physician’s age, and the physician’s sex were not associated with the utilization of virtual clinics in our study. Conclusions Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient’s sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician’s attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.
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Affiliation(s)
- Yun-Hsuan Tzeng
- Health Management Center, Cheng Hsin General Hospital, Taipei, TW.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TW
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, TW.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TW
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei, TW.,Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, TW
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, TW
| | - Hao-Ren Liou
- Health Management Center, Cheng Hsin General Hospital, Taipei, TW
| | - Hung-Ju Sung
- Health Management Center, Cheng Hsin General Hospital, Taipei, TW
| | - Hui-Chu Lang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei, TW
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8
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Del Balso C, Taylor MA, Ching M, Lawendy AR, Sanders DW. Preoperative photography improves patient satisfaction following hallux valgus surgery. Foot Ankle Surg 2022; 28:492-496. [PMID: 34980572 DOI: 10.1016/j.fas.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient satisfaction is variable following hallux valgus (HV) surgery. This prospective, blinded, randomized trial endeavored to determine whether showing patients a preoperative photograph would improve satisfaction following HV corrective surgery. METHODS Adult patients undergoing HV surgery were randomized to a picture group (P) or a no picture group (NP). P-group patients were shown their preoperative photograph for 5 min at each postoperative visit. Outcome measures included the Foot Function Index (FFI), the Foot Ankle Outcome Score (FAOS), and a patient satisfaction questionnaire. RESULTS Twenty-nine patients were enrolled in the study (15P, 14 NP). At 3, and 6 months postoperatively, patients in the P-group were more likely to be completely satisfied with the appearance of their foot. There were no differences between groups with respect to postoperative HVA, IMA, or FFI, and FAOS scores. CONCLUSION Patient satisfaction is increased following hallux valgus corrective surgery by reminding patients of the preoperative appearance of their foot through the use of photographs. LEVEL OF EVIDENCE Level I, randomized control trial.
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Affiliation(s)
- Christopher Del Balso
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada.
| | - Michel A Taylor
- Hughston Clinic Tennessee, Nashville, Tennessee, United States
| | - Michael Ching
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Abdel Rahman Lawendy
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - David W Sanders
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada
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9
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Knight SR, Ng N, Tsanas A, Mclean K, Pagliari C, Harrison EM. Mobile devices and wearable technology for measuring patient outcomes after surgery: a systematic review. NPJ Digit Med 2021; 4:157. [PMID: 34773071 PMCID: PMC8590052 DOI: 10.1038/s41746-021-00525-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.
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Affiliation(s)
- Stephen R Knight
- Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Nathan Ng
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Kenneth Mclean
- Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Claudia Pagliari
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ewen M Harrison
- Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
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10
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Mancini R, Bartolo M, Pattaro G, Ioni L, Picconi T, Pernazza G. The role of telemedicine in the postoperative home monitoring after robotic colo-rectal cancer surgery: a preliminary single center experience. Updates Surg 2021; 74:171-178. [PMID: 34313956 DOI: 10.1007/s13304-021-01132-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
The telemedicine studies, takes care and prevents diseases at distance basing on the interaction among physicians and patients remotely. Few data are available on its application to early postoperative after surgery. The endpoints of our preliminary experience were the detection, as primary, of feasibility and safety of home telemonitoring after robotic colo-rectal resection and, as secondary, perception and satisfaction of the patients. From December 2019 to March 2020, at the Division of Robotic Surgery of San Giovanni Hospital of Rome, 20 of 29 colorectal cancer patients, submitted to Robotic resection, were prospectively included in a program of postoperative home telemonitoring. Telemonitoring was considered feasible if at least 75% of data were available and safe if morbidity ≤ II by Clavien-Dindo classification. Perception and patients' satisfaction were evaluated through a dedicated questionnaire. Out of 20 patients, the median age was 68 years, overall postoperative morbidity was 30%, all events classified Clavien-Dindo Grade I or II. Only 2 patients were corresponded to surgical consult without readmission during home telemonitoring. Compliance of patients was > 80%, overall grade of satisfaction was very high: 4.2 as median (range 0-5). In this preliminary study, the procedures of postoperative home telemonitoring were feasible and safe and high rate of patients' satisfaction was observed. The telemedicine could enhance the role of robotic technique in decrease the hospital stay and improving postoperative recovery after surgery. Further structured prospective trial are needed to validate the routine application of telemedicine in healthcare.
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Affiliation(s)
- Raffaello Mancini
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy.
| | - Michelangelo Bartolo
- Service of Telemedicine of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Giada Pattaro
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Luigi Ioni
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Tullio Picconi
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Graziano Pernazza
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
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11
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Artificial Intelligent Virtual Assistant for Plastic Surgery Patient's Frequently Asked Questions: A Pilot Study. Ann Plast Surg 2021; 84:e16-e21. [PMID: 32032120 DOI: 10.1097/sap.0000000000002252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Artificial Intelligent Virtual Assistants (AIVA) is a segment of artificial intelligence that is rapidly developing. However, its utilization to address patients' frequently asked questions remains unexplored. METHODS We developed an AIVA to answer questions related to 10 frequent topics asked by plastic surgery patients in our institution. Between July 27, 2018, and August 10 of 2018, we recruited subjects with administrative positions at our health care institution to chat with the virtual assistant. They asked, with their own words, 1 question for each topic and filled out a satisfaction questionnaire. Postsurvey analysis of questions and answers allowed assessment of the virtual assistant's accuracy. RESULTS Thirty participants completed the survey. The majority was female (70%), and the mean age was 27.76 years (SD, 8.68 [19-51] years). The overall accuracy of the plastic surgery AIVA was 92.3% (277/294 questions), and participants considered the answer correct in 83.3% of the time (250/294 answers). Most of the participants considered the AIVA easy to use, answered adequately, and could be helpful for patients. However, when asked if this technology could replace a human assistant, they stayed neutral.
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12
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Brown-Johnson CG, Spargo T, Kling SMR, Saliba-Gustafsson EA, Lestoquoy AS, Garvert DW, Vilendrer S, Winget M, Asch SM, Maggio P, Nazerali RS. Patient and surgeon experiences with video visits in plastic surgery-toward a data-informed scheduling triage tool. Surgery 2021; 170:587-595. [PMID: 33941389 DOI: 10.1016/j.surg.2021.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronavirus disease 2019 provided the impetus for unprecedented adoption of telemedicine. This study aimed to understand video visit adoption by plastic surgery providers; and patient and surgeon perceptions about its efficacy, value, accessibility, and long-term viability. A secondary aim was to develop the proposed 'Triage Tool for Video Visits in Plastic Surgery' to help determine visit video eligibility. METHODS This mixed-methods evaluation assessed provider-level scheduling data from the Division of Plastic and Reconstructive Surgery at Stanford Health Care to quantify telemedicine adoption and semi-structured phone interviews with patients (n = 20) and surgeons (n = 10) to explore stakeholder perspectives on video visits. RESULTS During the 13-week period after the local stay-at-home orders due to coronavirus disease 2019, 21.4% of preoperative visits and 45.5% of postoperative visits were performed via video. Video visits were considered acceptable by patients and surgeons in plastic surgery in terms of quality of care but were limited by the inability to perform a physical examination. Interviewed clinicians reported that long-term viability needs to be centered around technology (eg, connection, video quality, etc) and physical examinations. Our findings informed a proposed triage tool to determine the appropriateness of video visits for individual patients that incorporates visit type, anesthesia, case, surgeon's role, and patient characteristics. CONCLUSION Video technology has the potential to facilitate and improve preoperative and postoperative patient care in plastic surgery but the following components are needed: patient education on taking high-quality photos; standardized clinical guidelines for conducting video visits; and an algorithm-assisted triage tool to support scheduling.
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Affiliation(s)
- Cati G Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA.
| | - Tavish Spargo
- Division of Plastic and Reconstructive Surgery, Stanford Health Care, Stanford, CA
| | - Samantha M R Kling
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Anna Sophia Lestoquoy
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Donn W Garvert
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Marcy Winget
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Paul Maggio
- Department of Surgery, Stanford Health Care, Stanford, CA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford Health Care, Stanford, CA
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COVID-19 Reducing the Risks: Telemedicine is the New Norm for Surgical Consultations and Communications. Aesthetic Plast Surg 2021; 45:343-348. [PMID: 32885319 PMCID: PMC7471549 DOI: 10.1007/s00266-020-01907-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION COVID-19, a worldwide pandemic, has enforced a national lockdown in the UK which produced a paradigm shift about the way medical practitioners would perform consultations and communication with their patients. Senior authors realised that in lockdown there was only one option to see a patient: virtual consultation via telecommunication technologies. This paper will discuss the current benefits and considerations of Telemedicine, particularly in plastic surgery, to decipher the next route of action to further validate its use for future implementation. METHOD A detailed literature review was carried out comparing papers from 1992 to 2020. A survey of 122 consultant plastic surgeons found an encouraging result as 70% positively embraced the suggestion of Telemedicine in their current practice. DISCUSSION Telemedicine produced equal or improved patient satisfaction. Its utilisation reduced cost for patient, clinic and consultant. With accessibility to a large percentage of the population, Telemedicine enables infection control and adherence to social distancing during COVID-19. Considerations include dependability on internet access, legal aspects, cyber security and General Data Protection Regulation (GDPR), the inability to perform palpation or physical inspection and psychological impacts on the patient. CONCLUSION In modern times, Telemedicine has become more accessible and COVID-19 has made it more applicable than ever before. More in-depth research is needed for validation of this technique within plastic surgery. While maintaining quality of care and a vital role in social distancing, there is a strong need for standardisation of Telemedicine processes, platforms, encryption and data storage. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abstract
BACKGROUND Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery. OBJECTIVE To provide a review of the applications of telemedicine within dermatologic surgery. MATERIALS AND METHODS A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology. RESULTS The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care. CONCLUSION For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice.
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15
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Singh AK, Kasle DA, Jiang R, Sukys J, Savoca EL, Z Lerner M, Kohli N. A Review of Telemedicine Applications in Otorhinolaryngology: Considerations During the Coronavirus Disease of 2019 Pandemic. Laryngoscope 2020; 131:744-759. [PMID: 32942340 PMCID: PMC7537247 DOI: 10.1002/lary.29131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/HYPOTHESIS Review the published literature of telemedicine's use within otorhinolaryngology (ORL), highlight its successful implementation, and document areas with need of future research. STUDY DESIGN State of the Art Review. METHODS Three independent, comprehensive searches for articles published on the subject of telemedicine in ORL were conducted of literature available from January 2000 to April 2020. Search terms were designed to identify studies which examined telemedicine use within ORL. Consensus among authors was used to include all relevant articles. RESULTS While several, small reports document clinical outcomes, patient satisfaction, and the cost of telemedicine, much of the literature on telemedicine in ORL is comprised of preliminary, proof-of-concept reports. Further research will be necessary to establish its strengths and limitations. CONCLUSIONS Particularly during the coronavirus disease of 2019 pandemic, telemedicine can, and should, be used within ORL practice. This review can assist in guiding providers in implementing telemedicine that has been demonstrated to be successful, and direct future research. Laryngoscope, 131:744-759, 2021.
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Affiliation(s)
- Amrita K Singh
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - David A Kasle
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Roy Jiang
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Jordan Sukys
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Emily L Savoca
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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16
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Cremades M, Ferret G, Parés D, Navinés J, Espin F, Pardo F, Caballero A, Viciano M, Julian JF. Telemedicine to follow patients in a general surgery department. A randomized controlled trial. Am J Surg 2020; 219:882-887. [PMID: 32252983 DOI: 10.1016/j.amjsurg.2020.03.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Telemedicine is becoming more popular in many medical specialties but few studies have been conducted in General Surgery. This study aims to evaluate the feasibility of its introduction in this specialty. METHODS A prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction. RESULTS Patients were enrolled between March 2017 and April 2018 and there were no statistically significant differences between the groups' characteristics. The primary outcome was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). No differences were found in clinical outcomes (P = 0.832) or patient satisfaction (P = 0.099). CONCLUSION Telemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.
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Affiliation(s)
- Manel Cremades
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain.
| | - Georgina Ferret
- General Surgery, Hospital Universitari Doctor Josep Trueta, Spain
| | - David Parés
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Jordi Navinés
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Franc Espin
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Fernando Pardo
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Albert Caballero
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Marta Viciano
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
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Lavallee DC, Lee JR, Semple JL, Lober WB, Evans HL. Engaging Patients in Co-Design of Mobile Health Tools for Surgical Site Infection Surveillance: Implications for Research and Implementation. Surg Infect (Larchmt) 2019; 20:535-540. [PMID: 31429644 PMCID: PMC6823881 DOI: 10.1089/sur.2019.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: As the use of patient-owned devices, including smartphones and tablets, to manage day-to-day activities grows, so does healthcare industry's interest to better leverage technology to engage patients. For surgical care, a unique opportunity exists to capture patient-generated health data (PGHD) including photographs. As part of a broader initiative to evaluate PGHD for surgical site infection (SSI) surveillance, we sought evidence regarding patient involvement and experience with PGHD for SSI monitoring and surveillance. Methods: Through a scoping review of the literature and semi-structured stakeholder interviews we gathered evidence on what is currently known about patient perspectives of and experiences with mobile health (mHealth) interventions for post-operative recovery. We presented findings to and discussed with the ASSIST PGHD Stakeholder Advisory Group (PSAG) to generate priorities for further examination. Results: Our scoping review yielded 34 studies that addressed post-discharge use of PGHD for monitoring and surveillance of SSI. Of these, 16 studies addressed at least one outcome regarding patient experience; the most commonly measured outcome was patient satisfaction. Only three studies reported on patient involvement in the development of PGHD tools and interventions. We conducted interviews (n = 24) representing a range of stakeholder perspectives. Interviewees stressed the importance of patient involvement in tool and program design, noting patient involvement ensures the "work" that patients do in their daily lives to manage their health and healthcare is recognized. Discussion of evidence with the ASSIST PSAG resulted in formal recommendations for direct involvement of patients and caregivers for future work. Conclusions: While mHealth initiatives to advance post-operative management offer the ability to improve patient engagement, work is needed to ensure the patient voice is reflected. Active engagement with patients and caregivers in the development of new technology, the design of new workflows, and the conduct of research and evaluation ensures that the patient experiences and values are incorporated.
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Affiliation(s)
- Danielle C Lavallee
- Department of Surgery, University of Washington, Seattle, Washington. Seattle, Washington
| | - Jenney R Lee
- Department of Surgery, University of Washington, Seattle, Washington. Seattle, Washington
| | - John L Semple
- University of Toronto, Women's College Hospital, Toronto, Ontario, Canada
| | - William B Lober
- Departments of Health Informatics and Global Health, University of Washington, Seattle, Washington. Seattle, Washington
| | - Heather L Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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18
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De La Cruz Monroy MFI, Mosahebi A. The Use of Smartphone Applications (Apps) for Enhancing Communication With Surgical Patients: A Systematic Review of the Literature. Surg Innov 2019; 26:244-259. [DOI: 10.1177/1553350618819517] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background. The widespread use and development of smartphones and mHealth apps has the potential to overcome communication deficiencies in health care. Objective. To carry out a literature review of studies that evaluate patients’ experience on the use of perioperative mHealth apps. Methods. An up-to-date systematic review on studies assessing patients’ use of mHealth apps for communicating with the health care team in the perioperative period was performed following the PRISMA statement. Results. Ten studies (in 11 articles) were identified: 8 feasibility studies and 2 randomized controlled trials. Nine studies included apps used for postoperative monitoring while 1 study also provided preoperative guidance. Discussion. An analysis of barriers and motivations of patients and health care professionals to the use of perioperative mHealth apps was performed. Barriers included patients’ lack of confidence when using apps and potential lack of time from health care professionals to monitor information submitted by patients. Motivations included patients’ sense of being looked after and potential cost-effectiveness and increased efficiency of health care services. This analysis led to the concept of the “ideal app” that would need to be developed following adequate protocols and security standards. Features of the ideal app include preoperative advice on medications and investigations, information on surgery, and a remote follow-up tool to improve safety and to minimize unnecessary clinic appointments and associated costs. Conclusion. There is an overall positive impression of the use of perioperative mHealth apps. However, further studies are required to assess the impact that they have on patients’ care and healthcare professional services.
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Affiliation(s)
| | - Afshin Mosahebi
- University College London, London, UK
- Leicester Royal Infirmary, Leicester, UK
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19
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Williams AM, Bhatti UF, Alam HB, Nikolian VC. The role of telemedicine in postoperative care. Mhealth 2018; 4:11. [PMID: 29963556 PMCID: PMC5994447 DOI: 10.21037/mhealth.2018.04.03] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
Telemedicine has become one of the most rapidly-expanding components of the health care system. Its adoption has afforded improved access to care, greater resource efficiency, and decreased costs associated with traditional office visits and has been well established in a wide array of fields. Telemedicine has been adopted in several domains of surgical care. In recent years, the role of telemedicine in postoperative care has caught attention as it has demonstrated excellent clinical outcomes, enhanced patient satisfaction, increased accessibility along with reduced wait times, and cost savings for patients and health care systems. In this narrative review, we describe the history of telemedicine, its adoption in the field of surgery and its various modalities, its use in the postoperative setting, and the potential benefits to both patients and healthcare systems. As telemedicine continues to emerge as a powerful tool for health care delivery, we also discuss several barriers to its widespread adoption as well as the future utility of telemedicine in postoperative care.
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Affiliation(s)
- Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Umar F Bhatti
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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20
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Austin RE. Commentary on: Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up. Aesthet Surg J 2017; 38:110-113. [PMID: 28605405 DOI: 10.1093/asj/sjx107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ryan E Austin
- Private practice, Mississauga, ON, Canada and Aesthetic Surgery Journal
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