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Antezana LA, Xie KZ, Yin LX, Bowen AJ, Yeakel S, Nassiri AM, Moore EJ. Performing parotidectomy postoperative follow-ups via telemedicine: Experience at a tertiary care, multiple-surgeon otolaryngology center. J Telemed Telecare 2024; 30:739-746. [PMID: 35549759 DOI: 10.1177/1357633x221095319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center. METHODS A retrospective case review was conducted of patients who underwent parotidectomy and postoperative video visits between November 2019 and December 2020. Success of video visit, plan if applicable, and post-visit outcomes were reviewed. Video visits were designated as successful if the physician could assess for complications in the postoperative course (e.g. first bite pain, Frey syndrome, ear numbness, unplanned visits to the emergency department, unplanned return to the operating room), perform examination of facial nerve function, and formulate care recommendations per clinical judgement without deferment of recommendations for a subsequent in-person visit. RESULTS There were 96 postoperative video visits with 91 unique parotidectomy patients. Demographics: 28/63 male/female; average age, 54y. All video visits were suitable for successful postoperative parotidectomy patient evaluation. Eight visits (8.3%) consisted of patients presenting with common postoperative complications (e.g. eye dryness, first bite pain) and warranted care recommendations. In only two cases did the patient require further in-person procedural (hematoma evacuation, seroma aspiration) follow-ups. For the other 91.7% of visits (n = 88), no additional recommendations were required as patients experienced uncomplicated postoperative courses. Of all the patients, 26.1% (n = 23) were instructed to follow-up for routine surveillance. All other patients, 73.9% (n = 65) were instructed to follow-up as needed. CONCLUSION Postoperative parotidectomy evaluation is highly amenable to being performed by video. A telemedicine option offers convenience for patients in the majority of cases without compromising clinical assessment and judgment for the physician.
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Affiliation(s)
- Luis A Antezana
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Katherine Z Xie
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley M Nassiri
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Schults A, Tham RL, Nelson CP, Finkelstein JB. Factors contributing to telemedicine efficacy in pediatric urology. J Pediatr Urol 2024:S1477-5131(24)00200-6. [PMID: 38679525 DOI: 10.1016/j.jpurol.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Despite swift implementation of telemedicine with the coronavirus disease 2019 pandemic, there is a paucity of research on its use for management of pediatric urology patients. Specifically, there is limited knowledge and inconsistent data on the effectiveness of telemedicine for various pediatric urologic conditions. Our aim was to evaluate the efficacy of pediatric urological care provided via video visits (VVs) at a large tertiary care children's hospital. MATERIAL AND METHODS We performed a prospective assessment of pediatric urology patients younger than 21 years who had a VV between 5/18/2022 and 5/17/2023. New patients with a testicular diagnosis were not eligible for VVs. After entering the diagnosis and submitting billing using a modifier for telemedicine, clinicians were mandated to select whether the VV allowed for: complete case management (CCM), suboptimal case management (SCM), or incomplete case management (ICM) requiring an in-person visit. Case management categorizations were analyzed according to patient pathology, visit type (i.e., new or established), and patient-centered variables including age, sex, race, insurance type, need for an interpreter, and distress score [a proxy for socioeconomic status]. RESULTS During the one-year period, there were 3267 telemedicine patients with a median age of 9 years (IQR 3-13) and 57.0% were male. Most VVs (89.3%) were established encounters. Almost 12% of telemedicine patients had external organ pathology (EOP, e.g., phimosis), 43.0% had internal organ pathology (IOP, e.g., hydronephrosis), and 45.1% had functional urological pathology (FUP, e.g., dysfunctional voiding). Clinicians deemed 96.9%, 2.7%, and 0.5% of VVs as having CCM, SCM or ICM, respectively. Telemedicine patients with IOP or FUP were more likely to have CCM, than those with EOP (98.5% and 97.8% vs 87.1%, p < 0.0001). On multivariable analysis, patient age, pathology, and visit type were predictive of VV efficacy. DISCUSSION Now that telemedicine use has slowed, it is necessary to evaluate and establish its optimal role in pediatric urology. Factors associated with VV efficacy included older patient age, internal organ or functional urological pathology, and established encounters. The long-term success of telemedicine requires suitable patient selection. CONCLUSIONS Telemedicine is quite effective for the management of a wide variety of pediatric urology patients. Continued evaluation of telemedicine, including multi-institutional investigation and corroboration, is necessary for the development of evidence-based best practice guidelines regarding appropriate, safe, and effective integration of telemedicine that drives pediatric urological care forward to meet the demands of the future.
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Affiliation(s)
- Austin Schults
- Department of Urology Massachusetts General Hospital, Boston, MA, USA.
| | - Regina L Tham
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
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Kassa AM, Nyström N, Waldenvik K, Engstrand Lilja H. Experiences and satisfaction of video follow up of children with paediatric gastrointestinal conditions linking tertiary centre with guardians and clinicians at the local hospital: a cross-sectional study. BMC Pediatr 2024; 24:6. [PMID: 38172717 PMCID: PMC10763293 DOI: 10.1186/s12887-023-04475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Children with complicated gastrointestinal conditions are dependent on follow up by tertiary care specialists throughout childhood to prevent and treat complications. In Sweden, paediatric surgical- and intestinal rehabilitation centres are centralised which means that many patients and guardians have to travel long distances to access tertiary referral centres. Our tertiary referral centre has developed a model of shared care with video conferences for follow up with our centre and the patient and guardians attending together with the responsible professionals at the local hospital. This study aimed to investigate the experiences and satisfaction with video follow-up visits (VFV) between a tertiary referral centre and guardians and clinicians at their local hospital. METHODS Eligible participants were families with children with oesophageal atresia, intestinal failure and intestinal motility disorders and their local clinicians attending VFV with our tertiary referral centre from 2015 to 2020. Questionnaires included fixed-response alternatives, a 6-point Likert scale and open questions. RESULTS Fifty-seven out of 102 families (56%) and 19 out of 27 local clinicians (70%) responded the questionnaires. In 68% of the VFV, two guardians attended compared to 35% in the physical visits. Of the guardians attending VFV, 82% lost ≤ half a working day and 91% attending physical visits lost ≥ one full working day. Median distance to the tertiary referral centre was 267 km and attending VFV avoided emissions of 7.2 metric tonnes of CO2. Of the guardians, 90% and of the clinicians 95% were satisfied with VFV. Advantages were avoidance of travelling and the participants shared the same information. CONCLUSIONS VFV is an appropriate alternative to physical visits with a high grade of satisfaction among the guardians and clinicians. VFV was time-saving for the families and reduced CO2 emissions.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Paediatric Surgery unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden.
| | - Niklas Nyström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Paediatric gastroenterology unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden
| | - Kajsa Waldenvik
- Paediatric gastroenterology unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden
| | - Helene Engstrand Lilja
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Paediatric Surgery unit, Uppsala University Children's Hospital, Uppsala, SE-751 85, Sweden
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Cai PY, Balthazar A, Logvinenko T, Nelson CP, Finkelstein JB. Accuracy of telemedicine for diagnosis and pre-operative assessment of pediatric penile conditions. J Pediatr Urol 2023; 19:521.e1-521.e7. [PMID: 37055341 DOI: 10.1016/j.jpurol.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Patients with penile conditions comprise a significant proportion of any pediatric urology practice, and physical examination is the mainstay of diagnosis for such conditions. While the rapid adoption of telemedicine (TM) facilitated access to pediatric urology care during the pandemic, the accuracy of TM-based diagnosis for pediatric penile anatomy and pathology has not been studied. Our aim was to characterize the diagnostic accuracy of TM-based evaluation of pediatric penile conditions by comparing diagnosis during the initial virtual visit (VV) with a subsequent in-person visit (IPV). We also sought to assess the agreement between scheduled and actual surgical procedure performed. METHODS A single-institution prospective database of male patients less than 21 years of age who presented for evaluation of penile conditions between August 2020 and December 2021 was analyzed. Patients were included if they had an IPV with the same pediatric urologist within 12 months of the initial VV. Diagnostic concordance was based on a surgeon-reported survey of specific penile diagnoses, completed at both initial VV and follow-up IPV. Surgical concordance was assessed based on the proposed versus billed CPT code(s). RESULTS Median age among 158 patients was 10.6 months. The most frequent VV diagnoses were penile adhesions (n = 37), phimosis (n = 26), "other" (n = 24), post-circumcision redundancy (n = 18), and buried penis (n = 14). Initial VV and subsequent IPV diagnoses were concordant in 40.5% (64/158); 40/158 (25%) had partial concordance (at least one diagnosis matched). There was no difference in age, race, ethnicity, median time between visits, or device type between patients with concordant vs. discordant diagnoses. Of 102 patients who underwent surgery, 44 had VV only while 58 had IPV prior to surgery. Concordance of scheduled versus actual penile surgery was 90.9% in those patients who only had a VV prior to surgery. Overall, surgery concordance was lower among those with hypospadias repairs vs. non-hypospadias surgery (79.4% vs. 92.6%, p = 0.05). CONCLUSION Among pediatric patients being evaluated by TM for penile conditions, there was poor agreement between VV-based and IPV-based diagnoses. However, besides hypospadias repairs, agreement between planned and actual surgical procedures performed was high, suggesting that TM-based assessment is generally adequate for surgical planning in this population. These findings leave open the possibility that, among patients not scheduled for surgery or IPV, certain conditions might be misdiagnosed or missed entirely.
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Affiliation(s)
- Peter Y Cai
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Andrea Balthazar
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Julia B Finkelstein
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
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Choi L, Riedinger C, Gardner K, Ziegler C, Brinson R, Sutton E. Gauging the Acceptance of Telemedicine in Postoperative Evaluation of Uncomplicated Laparoscopic Appendectomy and Cholecystectomy. TELEMEDICINE REPORTS 2023; 4:259-265. [PMID: 37637377 PMCID: PMC10457610 DOI: 10.1089/tmr.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/29/2023]
Abstract
Background Telemedicine is a rising field, with continuous expansion into different realms of health care delivery. However, minimal research has been done to analyze the utilization in surgical specialties. This study aims to assess satisfaction and acceptance of postoperative telehealth care after uncomplicated general surgery cases. Methods Patients who had undergone uncomplicated laparoscopic cholecystectomy or uncomplicated laparoscopic appendectomy were eligible to be enrolled in this study. Patients with gangrenous gallbladder, malignancy, operative complications, or appendix perforation were excluded. The experimental group underwent postoperative follow-up within a web-based platform (http://bluejeans.com), whereas the control group had an in-person clinic visit. Survey results containing satisfaction, comfort, and time usage were obtained. Likert scale 1-5 was utilized to quantify responses. Results Thirty patients were enrolled into this prospective single intervention trial (20 experimental, 10 control). Ninety percent (n = 18) of the experimental group stated satisfaction with their visit, and 75% (n = 15) would suggest telemedicine usage to other physicians. Postoperative visit satisfaction was not statistically different between the experimental and control groups (4.2 vs. 4.5, p = 0.124). A higher percentage of the control group took >3 h for the visit than the telemedicine group (30% vs. 15%), with two individuals in the control group dedicating their full day to the visit, compared with zero individuals in the experimental group. Comfort with technology used during the visit was not statistically different between the telemedicine and in-person groups (4.35 vs. 4.5, p = 0.641). Conclusions Telemedicine for postoperative evaluation on selective general surgery cases is feasible and provides adequate patient satisfaction and improved time utilization.
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Affiliation(s)
- Lily Choi
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA
| | - Courtney Riedinger
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kent Gardner
- Office of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Craig Ziegler
- Office of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Reginald Brinson
- Office of Information Technology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erica Sutton
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
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Jungbauer WN, Gudipudi R, Brennan E, Melvin CL, Pecha PP. The Cost Impact of Telehealth Interventions in Pediatric Surgical Specialties: A Systematic Review. J Pediatr Surg 2023; 58:1527-1533. [PMID: 36379748 PMCID: PMC10121966 DOI: 10.1016/j.jpedsurg.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Telehealth is a rapidly expanding care modality in the United States. Pediatric surgical patients often require complex care which can incur significant expenses, some of which may be alleviated by telehealth. We performed a systematic review comparing telehealth and in-person visits, and telehealth's impacts on the cost of healthcare across pediatric surgical specialties. METHODS A systematic review was performed using the following databases: PubMed (MEDLINE), Scopus (Elsevier), and CINAHL (EBSCOHost), searched from inception to July 10th, 2022. Studies were included per the following criteria: (1) investigated a telehealth intervention for pediatric surgical care and (2) provided some metric of telehealth cost compared to an in-person visit. Non-English or studies conducted outside of the U.S. were excluded. RESULTS Fourteen manuscripts met inclusion criteria and presented data on 7992 visits, including patients with a weighted average age of 7.5 ± 3.5 years. Most (11/14) studies used telehealth in a synchronous, or "real-time" context. Of the studies which calculated dollar cost savings for telehealth visits compared to in-person appointments we found a substantial range of savings per visit, from $48.50 to $344.64. Cost savings were frequently realized in terms of reduced travel expenditures, lower opportunity costs (e.g. lost wages), and decreased hospital labor requirements. CONCLUSIONS This review suggests that telehealth provides cost incentives to pediatric surgical care in many scenarios, including post-operative visits and some routine clinic visits. Future work should focus on standardizing the metrics by which cost impacts are analyzed and detailing which visits are most appropriately facilitated by telehealth. LEVEL OF EVIDENCE V.
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Affiliation(s)
- W Nicholas Jungbauer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Rachana Gudipudi
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina, Charleston, SC, United States
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States.
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Shirriff A, Gragas A, Tabak B, Abella M, Ahn HJ, Woo R. Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations. J Surg Res 2023; 288:240-245. [PMID: 37030181 PMCID: PMC10076909 DOI: 10.1016/j.jss.2023.03.009] [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: 12/02/2022] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION The Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations. METHODS We conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05. RESULTS A total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899). CONCLUSIONS Our results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.
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Affiliation(s)
- Ashley Shirriff
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii.
| | - Anna Gragas
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Benjamin Tabak
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Maveric Abella
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Russell Woo
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
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In-Person Versus Video Preoperative Visit: A Randomized Clinical Trial. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:58-66. [PMID: 36548105 DOI: 10.1097/spv.0000000000001259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE This study further supports virtual visits for gynecologic preoperative care. OBJECTIVES The objective of this study was to determine if preoperative video visits are noninferior to in-person visits in pelvic reconstructive surgery. Secondary objectives are as follows: patient satisfaction, convenience, visit duration, total perioperative visits, and patient travel time/distance. STUDY DESIGN Noninferiority randomized-controlled trial of patients undergoing pelvic reconstructive surgery randomized to in-person or video counseling. The primary outcome was a composite score on the Preoperative Preparedness Questionnaire. RESULTS Demographics were similar except for higher body mass index (BMI) in the video group (29.5 vs 26.3; P = 0.01), and fewer patients in the video group used text messaging for health care delivery (40.7% vs 59.3%, P = 0.04). Video visits were noninferior to in-person visits in Preoperative Preparedness Questionnaire scores (62.5 ± 4.6 vs 63.0 ± 3.6; difference = 0.5; 95% confidence interval, -0.8, □). There was no difference in "strongly agree" response to question 11, "Overall, I feel prepared for my upcoming surgery" (79.6% vs 88.9%, P = 0.19). Satisfaction was higher for video visits based on composite Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey scores (31.3 ± 1.5 vs 30.5 ± 2, P = 0.02). Video visits were more convenient (100% vs 85.2%, P < 0.01), of shorter duration for patients (39.3 ± 14.0 minutes vs 55.9 ± 18.9 minutes; P < 0.01), and similar length for health care providers (28.8 ± 9.6 minutes vs 28.2 ± 9.8 minutes; P = 0.77). The video visit group had fewer office visits (2.0 vs 3.0, P < 0.01) and traveled 66 minutes ( P < 0.01) and 28 miles ( P < 0.01) less. CONCLUSION Preoperative video visits are noninferior to in-person visits for preparing patients for pelvic reconstructive surgery.
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Cockrell HC, Maine RG, Hansen EE, Mehta K, Salazar DR, Stewart BT, Greenberg SLM. Environmental impact of telehealth use for pediatric surgery. J Pediatr Surg 2022; 57:865-869. [PMID: 35918239 DOI: 10.1016/j.jpedsurg.2022.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The healthcare sector is responsible for 10% of US greenhouse gas emissions. Telehealth use may decrease healthcare's carbon footprint. Our institution introduced telehealth to support SARS-CoV-2 social distancing. We aimed to evaluate the environmental impact of telehealth rollout. METHODS We conducted a retrospective cohort study of pediatric patients seen by a surgical or pre anesthesia provider between March 1, 2020 and March 1, 2021. We measured patient-miles saved and CO2 emissions prevented to quantify the environmental impact of telehealth. Miles saved were calculated by geodesic distance between patient home address and our institution. Emissions prevented were calculated assuming 25 miles per gallon fuel efficiency and 19.4 pounds of CO2 produced per gallon of gasoline consumed. Unadjusted Poisson regression was used to assess relationships between patient demographics, geography, and telehealth use. RESULTS 60,773 in-person and 10,626 telehealth encounters were included. This represented an 8,755% increase in telehealth use compared to the year prior. Telehealth resulted in 887,006 patient-miles saved and 688,317 fewer pounds of CO2 emitted. Demographics significantly associated with decreased telehealth use included Asian and Black/African American racial identity, Hispanic ethnic identity, and primary language other than English. Further distance from the hospital and higher area deprivation index were associated with increased telehealth use (IRR 1.0006 and 1.0077, respectively). CONCLUSION Incorporating telehealth into pediatric surgical and pre anesthesia clinics resulted in significant CO2 emission reductions. Expanded telehealth use could mitigate surgical and anesthesia service contributions to climate change. Racial and linguistic minority status were associated with significantly lower rates of telehealth utilization, necessitating additional inquiry into equitable telemedicine use for minoritized populations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Rebecca G Maine
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Elizabeth E Hansen
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way, NE, Seattle WA 98105, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 Pacific Street, BB-1469, Seattle, WA 98195, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Daniela Rebollo Salazar
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sarah L M Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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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12
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Xie KZ, Antezana LA, Bowen AJ, Yin LX, Yeakel S, Nassiri A, Moore EJ. Telemedicine evaluation of new head and neck patients at a tertiary academic clinic during the coronavirus disease 2019 pandemic. J Telemed Telecare 2022:1357633X221100054. [PMID: 35668638 PMCID: PMC9177817 DOI: 10.1177/1357633x221100054] [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] [Received: 01/31/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. METHODS A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. RESULTS A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time (n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients (n = 67), followed by biopsy report 30.6% (n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made (p = 0.024). For new patients with parotid masses (n = 42), definitive treatment plans could be made 97.6% of the time (n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072-0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. DISCUSSION In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns.
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Affiliation(s)
- Katherine Z Xie
- Mayo Clinic Alix School of
Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luis A Antezana
- Mayo Clinic Alix School of
Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Ashley Nassiri
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
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13
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Liu Z, Guan Z, Lan H, Zhao Y, Ye Z, Lv D, Yu Q, Wang M, Peng K, Fu N, Mazzon G, Gu D. Evaluating the Lower Urinary Tract Syndrome with a Telemedicine Application: An Exploration of the Electronic Audiovisual Prostate Symptom Score. Front Surg 2022; 9:848923. [PMID: 36003282 PMCID: PMC9394459 DOI: 10.3389/fsurg.2022.848923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background The Visual Prostate Symptom Score (VPSS) is used for the assessment of lower urinary tract symptoms (LUTS). It is usually administered by general practitioners (GPs), but in these cases, outcomes do not seem to be reflecting the real conditions of a patient well, with consequent risks of misestimations and misinterpretations. We developed an electronic audiovisual version of VPSS (EPSS), a new symptom scale based on a telemedicine mobile light-based app. The aim of this study is to test and evaluate its reliability. Methods We enrolled male patients aged between 50 and 80 years across 24 community-based healthcare facilities in Guangzhou, China. Patients were asked to complete the Chinese version of VPSS and EPSS before consultation with the urology specialists. Patients were divided into two groups based on age. First, we analyzed the rate of full understanding of EPSS using a chi-square test. Then, we analyzed the difference between each score of EPSS, VPSS, and outcomes measured by specialists, used as the reference score (RS). Finally, the outcomes were analyzed with the Spearman test and Bartlett test separately. Results Seventy-nine male patients were included (mean age 70.42 years). Patients were divided into two groups: group 1 (>70 years, n = 40) and group 2 (<70 years, n = 39). The full-understanding rates in groups 1 and 2 were 50% and 64.1%, respectively. No significant differences were noted between groups (p = 0.206). A t-test was presented between each question of VPSS, EPSS, and RS. All questions did not display significant differences (p > 0.05); total scores from the three scales had no significant differences in the evaluation of LUTS. We further explored the variations of choices made by patients in different scales. Spearman’s test among VPSS, EPSS, and RS showed positive correlations, and coefficients of the total score were 0.92, 0.91, and 0.93 (p < 0.05). Conclusion EPSS can be easily used in a significant number of patients and showed correlation with the VPSS and RS. Moreover, certain items resulted in better performance than VPSS. The results showed that EPSS could be a valuable option for both patients and GPs monitoring LUTS and particularly helpful when teleconsultations are considered, especially during the COVID-19 pandemic.
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Affiliation(s)
- Ziyu Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan College, Guangzhou Medical University, Guangzhou, China
| | - Zhiyuan Guan
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan College, Guangzhou Medical University, Guangzhou, China
| | - Hongyu Lan
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan College, Guangzhou Medical University, Guangzhou, China
| | - Yan Zhao
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiming Ye
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan College, Guangzhou Medical University, Guangzhou, China
| | - Daojun Lv
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qingfeng Yu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming Wang
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kaoqing Peng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanfei Fu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Urology Department, San Bassano Hospital, Bassano del Grappa, Italy
| | - Di Gu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Correspondence: Di Gu
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14
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Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review. World J Surg 2022; 46:1855-1869. [PMID: 35428920 PMCID: PMC9012517 DOI: 10.1007/s00268-022-06549-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking. Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes. Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06549-2.
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15
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Shim JY, Kaur R, Laufer MR, Grimstad FW. The Use of Telemedicine in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2022; 35:133-137. [PMID: 34619357 DOI: 10.1016/j.jpag.2021.09.010] [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: 02/03/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To study the feasibility of virtual visits for ambulatory encounters in pediatric and adolescent gynecology DESIGN: A retrospective review SETTING: Boston Children's Hospital PARTICIPANTS: Patients who were seen virtually through the Division of Gynecology between January 1, 2020 and June 1, 2020 MAIN OUTCOME MEASURE(S): Patient demographics, visit diagnoses, and operational characteristics of the completed visits RESULTS: There were a total of 654 virtual visits for 614 patients. Ninety-one percent (n=558) of patients were in-state, and the median age of patients was 17 years (range 0 - 37 years). The majority were return visits (n=502, 76.8%), 115 (17.6%) were new patient visits, and 32 (4.89%) were post-operative visits. The median virtual visit duration was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (n=485, 74.2%), abnormal uterine bleeding (n=225, 34.4%), and pelvic pain (n=82, 12.5%). The percentage of virtual visits which required an in-person follow-up visit within 90 days was low (n=14, 2.1%). Five of these were within 30 days from the initial virtual visit, 6 were within 60 days, and 3 were within 90 days. CONCLUSION Telemedicine is a feasible method for expanding access to, and healthcare delivery for, pediatric and adolescent gynecology, with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Ravneet Kaur
- Innovative and Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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16
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Mahmoud MA, Daboos M, Gouda S, Othman A, Abdelmaboud M, Hussein ME, Akl M. Telemedicine (virtual clinic) effectively delivers the required healthcare service for pediatric ambulatory surgical patients during the current era of COVID-19 pandemic: A mixed descriptive study. J Pediatr Surg 2022; 57:630-636. [PMID: 34953564 PMCID: PMC8626150 DOI: 10.1016/j.jpedsurg.2021.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Children often suffer from congenital or acquired diseases. Ambulatory cases represent the vast majority of pediatric surgical cases. COVID-19 pandemic-associated regulatory precautions had made the process of seeking medical advice at a suitable appointment such a big problem. We utilized telemedicine (online encounter) to deliver the required healthcare service for sorting and guiding pediatric ambulatory surgical patients. In this article, we aimed to: (1) present our experience, (2) evaluate the effectiveness, and (3) document the results of this technology to solve the problem of difficult healthcare accessibility. MATERIALS AND METHODS In this study, we compared the utilization of telemedicine (virtual clinic via video consultation) prospectively in the current era of the COVID-19 pandemic in the period from June 2020 to July 2021 to the in-person clinic encounter at the outpatient department (OPD) retrospectively in the previous year (from June 2019 until the end of May 2020) for perioperative management of pediatric ambulatory surgical patients. The study was conducted at 3 tertiary care pediatric surgery centers. The information recorded for analysis included: demographic data, surgical condition distribution, time interval from the appointment request till the actual encounter with the surgeon, conversation duration, distance traveled, and ultimate fate of the consultations. For both groups, service was evaluated after the first follow-up visit by a patient survey questionnaire (Patient Experience Assessment form) including questions relevant to each encounter. RESULTS A total of 1124 pediatric patients with various ambulatory surgical conditions had been scheduled for virtual clinic video encounters. Of them, 1056 cases were evaluated by video consultation, supervised by their parents or caregivers, thus, achieving an attendance rate of 94%. Of the remaining cases, 2% (n = 23) were canceled and 4% (n = 45) did not attend the virtual clinic. Two-thirds of the cases live in rural /remote areas. Patients' overall satisfaction was 92%. This was in comparison to 872 pediatric ambulatory surgical patients scheduled for in-person clinic visits before the implementation of the virtual clinic. Of them, only 340 cases had attended the clinic, thus, achieving an attendance rate of 39%. Of the remaining cases, 450 cases (51.6%) were canceled and 82 cases (9.4%) did not attend the clinic (no show). About 48% of the cases live in rural areas. For this group, patients' overall satisfaction was 63%. The mean encounter duration was similar for both groups (∼ 5 min). Surgical condition distribution was also similar (p-value: 0.694). For new cases, the time interval from appointment request till the actual encounter was very short for the virtual clinic group (range: 6-15 days) as compared to the in-person clinic group (range: 30-180 days). Patients were followed up for a median period of 14 ± 3.25 months (range: 6-22 months) with no patient loss to follow-up. CONCLUSION Telemedicine can effectively bridge the patient-physician communication gap caused by the regulatory precautions mandated by the current COVID-19 pandemic. It achieved an attendance rate of 94% and parents' / patients' overall satisfaction of 92%.
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Affiliation(s)
- Muhammad Abdelhafez Mahmoud
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo 11651, Egypt; Pediatric Surgery Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh 14213, Saudi Arabia; Pediatric Surgery Department, Alyamamah Maternity and Children's Hospital, Riyadh, Saudi Arabia.
| | - Mohammad Daboos
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo 11651, Egypt
| | - Samir Gouda
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo 11651, Egypt
| | - Alsayed Othman
- Pediatric Surgery Unit – Department of Surgery, Al-Azhar University Hospital, Assuit Branch, Egypt
| | - Mohamed Abdelmaboud
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo 11651, Egypt
| | | | - Mabrouk Akl
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo 11651, Egypt
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17
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ElAgami H, Woodward B, Awolaran G, Kalidasan V. Virtual consultation in paediatric urology during the COVID-19 pandemic: The effect of pathology on the outcome. J Telemed Telecare 2022; 28:539-546. [PMID: 35253528 PMCID: PMC8902319 DOI: 10.1177/1357633x221076967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Virtual consultation (VC) has exponentially increased during the COVID-19
pandemic. Lessons from using this modality during the pandemic will need to
be appraised carefully before integrating it into the routine practice. Some
paediatric urology patients can potentially be excellent candidates for
routine VC. Objectives Investigate the ability of clinicians to make management plans using VCs and
identify accordingly the group of patients that can benefit from routine VC.
Evaluate the routine use of VC without travel restrictions. Methods Designed in two phases. Phase 1, during the lockdown, prospective collection
of data after the consultation assessing the clinician satisfaction in
making a decision by VC. The results were then divided according to the
patient pathology; internal organ pathology (IOP), functional urological
pathology (FUP) or external organ pathology (EOP). Data was then analysed to
demonstrate if different outcomes can be related to the pathology. Phase 2
after the ease of the lockdown to judge the lessons learnt looking at the
same parameters in patients who are selected to receive VC and evaluate
journey saved by the patients, measured in miles. Results One hundred and forty-four consultations were assessed. One hundred and
fourteen in phase 1 and 30 from phase 2. Mean age 7.2 years. In phase 1, 57%
of patients were reviewed by consultants and 72% were followed up.
Thirty-seven per cent had IOP, 24.5% FUP and 38.5% EOP. Clinicians were more
likely to reach a decision with patients with IOP and FUP
P < 0.0001 and 0.0024, respectively. Phase 2
demonstrated the change of practice where 93% of the patients were either
IOP or FUP. An average of 27 miles per patient was saved on journeys. Discussion VC for paediatric urology patients was employed effectively to avoid hospital
contact during the lockdown. From the lessons learnt that patients with IOP
and FUP can continue to benefit from VC after the ease of lockdown without
compromising the decision making. VC is a viable way to structure services
in the future for selected paediatric urology conditions.
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Affiliation(s)
- Hesham ElAgami
- University Hospital Sussex, Royal Alexandra Children Hospital, Brighton, UK
| | - Benjamin Woodward
- University Hospital Sussex, Royal Alexandra Children Hospital, Brighton, UK
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18
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Curfman A, Hackell JM, Herendeen NE, Alexander J, Marcin JP, Moskowitz WB, Bodnar CEF, Simon HK, McSwain SD. Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care. Pediatrics 2022; 149:184902. [PMID: 35224638 DOI: 10.1542/peds.2021-056035] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.
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Affiliation(s)
- Alison Curfman
- Department of Pediatrics, Mercy Clinic, St Louis, Missouri.,Rubicon Founders
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College and Boston Children's Health Physicians, Pomona, New York
| | - Neil E Herendeen
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Joshua Alexander
- Departments of Physical Medicine and Rehabilitation and Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James P Marcin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California Davis and University of California Davis Children's Hospital, Sacramento, California
| | - William B Moskowitz
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Mississippi and University of Mississippi Medical Center, Jackson, Mississippi
| | - Chelsea E F Bodnar
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Montana, Missoula, Montana
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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19
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Pettit S, Young E, Jung I. Systematic review of telemedicine in pediatric urology. J Pediatr Urol 2022; 18:17-22. [PMID: 34642111 DOI: 10.1016/j.jpurol.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Telemedicine has bridged the distance gap between patients and pediatric urologists for over a decade, yet many pediatric urologists have not embraced it as a major part of their practice. The purpose of this systematic review is to evaluate and clarify the optimal role of telemedicine in pediatric urology, as well as the benefits, barriers, risks, and other important considerations that must be accounted for in its optimal adoption. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review utilized Medical Subject Headings (MeSH) to search PubMed through April 29, 2021 as follows: (Humans [MeSH]) AND ((Child [MeSH]) OR (Infant [MeSH])) AND ((Remote Consultation [MAJR]) OR (Telemedicine [MAJR]) OR (Videoconferencing [MAJR]) OR (Health Services Accessibility [MAJR])) AND ((Urology [MAJR]) OR (Postoperative Care [MAJR]) OR (Urologic Surgical Procedures [MAJR])). 73 resulting articles, plus 21 from manual searches (e.g. papers too recent to have MeSH terms), were screened. 17 met inclusion criteria by discussing telemedicine in context of pediatric urology in a full manuscript. Non-complete manuscripts and papers not specifically considering pediatric urology, or in which telemedicine was not a major focus, were excluded. RESULTS 17 papers met inclusion criteria. Varied approaches to the topic included surveys, controlled studies, retrospective studies, and descriptive opinion pieces. Quality of evidence varied, representing at least 1851 virtual encounters, 409 in-person encounters, and 68 clinician opinions. Four papers included a comparison or control group, and none utilized randomization. All 17 papers support expanded application of telemedicine in pediatric urology with varied evidence that telemedicine improves patient access to pediatric urologic care, satisfies both patient families and clinicians, is safe, provides equivalent outcomes, and is practicable. CONCLUSIONS Implementation of telemedicine in pediatric urology should be expanded as it can practicably and safely improve patient access to pediatric urologic care, satisfy both patient families and clinicians, and maintain outcomes.
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Affiliation(s)
- Samuel Pettit
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME, 04005, USA.
| | - Ezekiel Young
- Department of Urology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, 100 High Street Buffalo, NY, 14203, USA.
| | - Ichabod Jung
- Department of Urology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, 100 High Street Buffalo, NY, 14203, USA.
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Baldor D, Lewis PR, Tadlock MD. Routine in-person post-operative follow-up for uncomplicated laparoscopic appendectomy does not change management. Surg Endosc 2022; 36:3775-3780. [PMID: 34468847 PMCID: PMC8409267 DOI: 10.1007/s00464-021-08693-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Eliminating points in the continuum of care that do not change management is a safe strategy for cost containment and workflow efficiency in health systems. As a process improvement initiative, we sought to identify whether routine, outpatient follow-up changes management in laparoscopic appendectomy in a military hospital. METHODS We performed a retrospective chart review of adult patients undergoing laparoscopic appendectomy during a one-year period. The primary outcome was identification of a change in management during routine in person follow-up. Secondary outcomes included location of patient presentation with a post-operative event (clinic, emergency department, primary care provider), and if those visits changed management. Events were defined as any deviation from the typical post-operative course within 6 weeks of surgery, including abnormal specimen pathology. RESULTS One-hundred and seventy-six appendectomies were performed over one year, and 148 patients met inclusion criteria (median age = 27, 66.9% male). Perforation was identified in 10.1% of patients. Seventeen-point-five percent of patients had a post-operative event, of which persistent pain was the most common. Only 2.0% of all patients saw a change in management at their routine in person follow-up appointment. Eighty percent of patients with any post-operative events sought care outside of their routine in person follow up appointments. No variable was independently associated with a change in management. CONCLUSION Routine in-person clinical follow-up for laparoscopic appendectomy almost never changes management. Perforated appendicitis may be an indication for in-person follow-up. Considering a telemedicine model for post-operative follow-up of laparoscopic appendectomy patients will provide a safe and effective alternative to in-person clinic visits, while saving patients time and allowing providers the clinic freedom to prioritize more urgent and new patients.
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Affiliation(s)
- Daniel Baldor
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA
| | - Paul R Lewis
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA.
- Department of Surgery, Naval Medical Center San Diego, FPO AP 96362, 34800 Bob Wilson Dr., PSC 482 Box 2629, San Diego, CA, 92134, USA.
| | - Matthew D Tadlock
- Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA, 92134, USA
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21
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Kuo AC, Geleris B, Arnhym A. TeleBBD: Telehealth management of bladder bowel dysfunction - A provider survey of benefits and limitations. J Pediatr Urol 2021; 17:792.e1-792.e7. [PMID: 34656434 DOI: 10.1016/j.jpurol.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bladder bowel dysfunction (BBD), defined by the International Children's Continence Society (ICCS) as a spectrum of lower urinary tract and bowel symptoms, represents to up to 40% of pediatric urology consults. Management of BBD involves strict behavioral management with frequent follow ups by urology advanced practice providers (APPs). If left untreated, patients may develop secondary comorbidities that impact their renal and/or bladder function, bowel function, and psychosocial well-being. Previous studies have reported feasibility for virtual post-operative visits and prenatal consultations, however, telehealth management of BBD, or TeleBBD, has not yet been studied. The goal of this study is to survey APPs in pediatric urology to understand how TeleBBD compares to in-person visits, and identify benefits and limitations of TeleBBD. STUDY DESIGN An online survey via Qualtrics was designed based on current practice guidelines for BBD management and telehealth considerations. Survey was distributed in September 2020 via the Pediatric Urology Nurses & Specialists listserv. Group qualitative coding was completed by the authors to generate themes that emerged from the results. RESULTS/DISCUSSION A total of 53 APPs from across 21 states in the US completed the online survey, with 49 (92%) APPs reporting currently providing TeleBBD. Those who did not provide TeleBBD typically do not manage BBD patients. Summary Table shows the comparison of TeleBBD with in-person visits, with many elements of TeleBBD better or the same as in-person visits. APPs reported that TeleBBD has been most beneficial in increasing access and overall improvement in follow up which is significant for management of this chronic condition. Barriers include access to technology/internet and inability to perform full physical exams via televisit. Limitations of the study include lack of validated survey and small sample size. Overall increased access and improved patient adherence and resolution from BBD is significant for this patient population for prevention of secondary comorbidities. CONCLUSION This is the first study to survey APPs across the US specifically exploring indication of TeleBBD as well as comparison of TeleBBD with in-person visits. The perception of improved access to care and less no-show rates is significant especially during the pandemic in providing continuity of care and prevent secondary comorbidities. Additionally, TeleBBD was felt to be just as effective as in-person visits for patient adherence to treatment, and other components of care, with the exception of ability to provide physical exams. Providers leveraged the benefits of TeleBBD and shared strategies for best practices.
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Affiliation(s)
- Angel Chen Kuo
- University of California San Francisco School of Nursing, Dept of Family Health Care Nursing, 2 Koret Way, Room N411Y, San Francisco, CA, 94143, USA.
| | - Bethany Geleris
- University of California, San Francisco, Department of Pediatric Urology, 744 52nd Street, 4th Floor, Oakland, CA, 94609, USA.
| | - Anne Arnhym
- University of California, San Francisco, Department of Pediatric Urology, 1825 4th Street, 5th Floor, San Francisco, CA, 94143, USA.
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Radtke S, Umeh R, Chavez M, Curiel Z, Mendez K. Utilizing Telemedicine for Delivery of Postoperative Care Following Minimally Invasive Gynecologic Surgery: A Randomized Controlled Trial. Gynecol Minim Invasive Ther 2021; 10:148-153. [PMID: 34485058 PMCID: PMC8384027 DOI: 10.4103/gmit.gmit_66_20] [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] [Received: 05/31/2020] [Revised: 10/22/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity (P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group (P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.
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Affiliation(s)
- Steven Radtke
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Randle Umeh
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Martha Chavez
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Zuleika Curiel
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Karla Mendez
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
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Nourian A, Smith N, Kleinman L, Boxer R, Shelton JB. A 5-Year Single-Institution Experience Integrating Telehealth Into Urologic Care Delivery. Telemed J E Health 2021; 27:997-1002. [DOI: 10.1089/tmj.2020.0267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alex Nourian
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicholas Smith
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
| | - Leonard Kleinman
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jeremy B. Shelton
- Department of Urology, University of California, Los Angeles, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Mohammadi S, Miller WC, Wu J, Pawliuk C, Robillard JM. Effectiveness of eHealth Tools for Hip and Knee Arthroplasty: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:696019. [PMID: 36188859 PMCID: PMC9397702 DOI: 10.3389/fresc.2021.696019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Abstract
Objective: This study aimed to compare the effectiveness and costs of eHealth tools with usual care in delivering health-related education to patients' undergoing total hip or knee arthroplasty due to osteoarthritis.Data Sources: Six electronic databases were searched to identify randomized controlled trials and experimental designs (randomized or not) examining the effect of eHealth tools on pre- or post-operative care. Only manuscripts written in English were included. In the current study, no specific primary or secondary outcomes were selected. Any study that investigated the impacts of eHealth tools on hip or knee arthroplasty outcomes were included.Review Methods: Two researchers reviewed all titles and abstracts independently and in duplicate. Two researchers also conducted full-text screening and data extraction from the 26 selected articles.Results: The data were descriptively reported, and themes could emerge from each outcome. Two researchers separately assessed the Risk of Bias for each paper using the Cochrane risk of bias assessment tool. The majority of studies evaluated the impact of eHealth tools on physical (n = 23) and psychosocial outcomes (n = 19). Cost-related outcomes were measured in 7 studies. eHealth tools were found to be equivocal to usual care, with few studies reporting statistically significant differences in physical or psychosocial outcome measures. However, cost-related outcomes showed that using eHealth tools is more cost-effective than usual care.Conclusions: This review demonstrated that eHealth tools might be as effective as usual care, and possibly more cost-effective, a crucial implication for many overly burdened health care systems.
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Affiliation(s)
- Somayyeh Mohammadi
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William C. Miller
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Wu
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Colleen Pawliuk
- BC Children Hospital Research Institute, Vancouver, BC, Canada
| | - Julie M. Robillard
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Julie M. Robillard
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Lo Bianco G, Papa A, Schatman ME, Tinnirello A, Terranova G, Leoni MLG, Shapiro H, Mercadante S. Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques. J Clin Med 2021; 10:2303. [PMID: 34070601 PMCID: PMC8198659 DOI: 10.3390/jcm10112303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. METHODS Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. RESULTS Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy;
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
| | - Alfonso Papa
- Pain Department, AO “Ospedali dei Colli”, Monaldi Hospital, 80131 Naples, Italy;
| | - Michael E. Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA;
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Andrea Tinnirello
- Anesthesiology and Pain Management Unit, Azienda Socio Sanitaria Territoriale della Franciacorta, 25032 Chiari, Italy
| | - Gaetano Terranova
- Anaesthesia and Intensive Care Department, Asst Gaetano Pini, 20122 Milano, Italy;
| | | | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Sebastiano Mercadante
- Pain Relief and Supportive Care, Private Hospital La Maddalena, 90100 Palermo, Italy;
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Lombardo AM, Andolfi C, Deshpande AP, Aizen JM, Dangle PP, Gundeti MS. Pediatric urology amidst SARS-CoV-2 pandemic: Building the future with current knowledge. J Pediatr Surg 2021; 56:923-928. [PMID: 33483106 PMCID: PMC7816876 DOI: 10.1016/j.jpedsurg.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has ripped around the globe, stolen family members and forced healthcare systems to operate under an unprecedented strain. As of December 2020, 74.7 million people have contracted COVID-19 worldwide and although vaccine distribution has commenced, a recent rise in cases suggest that the pandemic is far from over. METHODS This piece explores how COVID-19 has explicitly impacted the field of pediatric urology and its patients with a focus on vulnerable subpopulations. RESULTS Various medical and surgical associations have published guidelines in reaction to the initial onset of the pandemic in early 2020. DISCUSSION AND CONCLUSION As the number of patients with COVID-19 increases, long-term recovery and future preparedness are imperative and should be cognizant of patient subpopulations that have been subject to disproportionate morbidity and mortality burden. Development of a dedicated response team would aid in achieving preparedness by drafting and implementing plans for resource allocation during scarcity, including logistic and ethical considerations of vaccine distribution. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alyssa M. Lombardo
- University of Chicago Pritzker, School of Medicine, 924 E 57th St. Ste. 104, Chicago, IL 60637, United States,Corresponding author
| | - Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States,The MacLean Center for Clinical Medical Ethics, The University of Chicago, 5841 S Maryland Ave. MC 6098, Chicago, IL 60637, United States
| | - Abhishek P. Deshpande
- University of Illinois, College of Medicine, 1853W Polk St. MC 785, Chicago, IL 60612, United States
| | - Joshua M. Aizen
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States
| | - Pankaj P. Dangle
- Section of Pediatric Urology, Department of Urology, University of Alabama at Birmingham, Children's of Alabama, 1530 3rd Ave. S, Birmingham, AL 35233, United States
| | - Mohan S. Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Division of the Biological Sciences and Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 7122, Chicago, IL 60637, United States
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Almannie R, Almuhaideb M, Alzahrani M, Binsaleh S, Alyami F. "Tele-urology": Is the COVID-19 pandemic a wake-up call? Urol Ann 2021; 13:89-94. [PMID: 34194131 PMCID: PMC8210714 DOI: 10.4103/ua.ua_133_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this research is to measure the current use of telemedicine technologies among urologists, their readiness to adopt the same, and to assess the barriers preventing such usage. METHODS Two hundred and twenty eight board-certified urologists completed our self-designed survey. An analysis was done to assess the increase in the use of telemedicine and the urologists' telemedicine experience responses. Data analysis was done using SPSS software. RESULTS There has been a tremendous increase in the use of telemedicine among urologists during the coronavirus disease (COVID-19) pandemic. Most of the respondents of this study performed general urology as part of their daily practice (59.6%). Prior to the pandemic, 53.9% of the participants had never used any means of telemedicine. However, during the pandemic, 72.4% of urologists who had never used telemedicine began using the same. Almost all of the respondents agreed that physical examination is difficult when using telemedicine, which resulted in the highest mean value among the questionnaire items. Urologists below 35-year-old agreed, to a larger extent, that telemedicine saves them more time and is simple to use than urologists from other age groups. CONCLUSION During the COVID-19 pandemic, most urologists adopted telemedicine technology rapidly. Adopting telemedicine in the future could have multiple advantages. However, the limitations of telemedicine should be respected in order to avoid compromising patient safety.
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Affiliation(s)
- Raed Almannie
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mana Almuhaideb
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Meshari Alzahrani
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Saleh Binsaleh
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alyami
- Department of Surgery, Division of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Brimley S, Natale C, Dick B, Pastuszak A, Khera M, Baum N, Raheem OA. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021; 9:289-295. [PMID: 33752994 PMCID: PMC9585225 DOI: 10.1016/j.sxmr.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 01/23/2023]
Abstract
Introduction Although telemedicine (TM) has been available for several decades, the recent increase in its acceptance due to the COVID-19 pandemic has emerged as a valuable solution for the delivery of health care that provides easy, affordable, and convenient communication with urologic patients. Objectives The objective of this study was to highlight limiting factors and provide successful practical solutions to assist urologists in incorporating and maintaining TM in their practices. Methods A thorough literature review was conducted utilizing PubMed, Cochrane library, clinicaltrials.gov, Google Scholar, and Web of Science. Search terms and keywords included “telemedicine” and “urology.” Only articles written or translated into the English language were included. Results A total of 12 peer-reviewed articles were identified that discussed barriers for incorporation of TM in urology. Articles exclusive to the use of TM during the COVID-19 pandemic were also included, as well as American Urological Association and European Urological Association guidelines and Centers for Medicare & Medicaid Services statements and policies regarding TM pertinent to urological practice. Conclusion TM is currently a viable option and fills an unmet need for most practicing urologists, especially during the COVID-19 pandemic, offering insight to the relative ease of transition to online clinical practice. OA Raheem, S Brimley, C Natale, et al. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021;9:289–295.
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Affiliation(s)
- Scott Brimley
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Brian Dick
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Neil Baum
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
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Kirshenbaum E, Rhee EY, Gettman M, Spitz A. Telemedicine in Urology: The Socioeconomic Impact. Urol Clin North Am 2021; 48:215-222. [PMID: 33795055 DOI: 10.1016/j.ucl.2021.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The emergence of the COVID-19 pandemic and subsequent public health emergency (PHE) have propelled telemedicine several years into the future. With the rapid adoption of this technology came socioeconomic inequities as minority communities disproportionately have yet to adopt telemedicine. Telemedicine offers solutions to patient access issues that have plagued urology, helping address physician shortages in rural areas and expanding the reach of urologists. The Centers for Medicare & Medicaid Services have adopted changes to expand coverage for telemedicine services. The expectation is that telemedicine will continue to be a mainstay in the health care system with gradual expansion in utilization.
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Affiliation(s)
- Eric Kirshenbaum
- Uropartners, Suite 312, 1475 E Belvidere Rd, Grayslakle, IL 60030, USA.
| | - Eugene Y Rhee
- Kaiser Permanente Urology, 4405 Vandever Ave, San Diego, CA 92120, USA; Urology, Permanente Federation
| | - Matthew Gettman
- Mayo Clinic Department of Urology, 200 First Street SW, Rochester, MN 55905, USA
| | - Aaron Spitz
- Orange County Urology, 23961 Calle De La Magdalena, Laguna Hills, CA 92653, USA
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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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Yadav SK, Yadav N. Continuity of cancer care in the era of COVID-19 pandemic: Role of social media in low- and middle-income countries. World J Clin Cases 2021; 9:291-295. [PMID: 33521097 PMCID: PMC7812886 DOI: 10.12998/wjcc.v9.i2.291] [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: 04/10/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
A novel coronavirus (severe acute respiratory syndrome coronavirus 2) first detected in Wuhan, China, has spread rapidly since December 2019, causing more than 1.4 million confirmed infections and 15000 fatalities (as of April 9, 2020). The outbreak was declared a pandemic by the World Health Organization on March 11, 2020. Isolation, quarantine, social distancing, and community containment measures were rapidly implemented in China, which helped in containing the disease. However, other low- and middle-income countries lack such extensive infrastructural capacities and resources. Cancer patients are particularly at high risk of infection and mortality due to immunosuppression. Hence self-quarantine is recommended for them. Additionally, it is becoming impossible to maintain the continuity of care when cancer patients have to avoid physical visits. Social media applications, e.g., Facebook and WhatsApp, can provide educational group program and psychosocial support to these patients while maintain social distancing. We have analyzed their use in this review article and how it could change the follow-up of cancer patients during this pandemic.
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Affiliation(s)
- Sanjay Kumar Yadav
- Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur 482003, Madhya Pradesh, India
| | - Nishtha Yadav
- Department of Radiology, Super-specialty Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur 482003, Madhya Pradesh, India
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Mohanty A, Srinivasan VM, Burkhardt JK, Johnson J, Patel AJ, Sheth SA, Viswanathan A, Yoshor D, Kan P. Ambulatory neurosurgery in the COVID-19 era: patient and provider satisfaction with telemedicine. Neurosurg Focus 2020; 49:E13. [PMID: 33260126 DOI: 10.3171/2020.9.focus20596] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.
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Affiliation(s)
- Alina Mohanty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | | | - Jeremiah Johnson
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | - Daniel Yoshor
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Peter Kan
- 2Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
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Winkelman AJ, Beller HL, Morgan KE, Corbett ST, Leroy SV, Noona SW, Berry KL, Kern NG. Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic. J Pediatr Urol 2020; 16:840.e1-840.e6. [PMID: 33077389 PMCID: PMC7543732 DOI: 10.1016/j.jpurol.2020.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Telemedicine video visits are an under-utilized form of delivering health care. However due to the COVID-19 pandemic, practices are rapidly adapting telemedicine for patient care. We describe our experience in rapidly introducing video visits in a tertiary academic pediatric urology practice, serving primarily rural patients during the COVID-19 pandemic. OBJECTIVE The primary aim of this study was to assess visit success rate and identify barriers to completing video visits. The secondary aim identified types of pathologies feasible for video visits and travel time saved. We hypothesize socioeconomic status is a predictor of a successful visit. MATERIALS AND METHODS Data was prospectively collected and analyzed on video visits focusing on visit success, defined by satisfactory completion of the visit as assessed by the provider. Other variables collected included duration, video platform and technical problems. Retrospective data was collected via chart review and analyzed including demographics, insurance, and distance to care. Socioeconomic status was estimated using the Distressed Communities Index generated for patient zip code. RESULTS/DISCUSSION Out of 116 attempted visits, 81% were successful. The top two reasons for failure were "no-show" (64%) and inability to connect (14%). Success versus failure of visit was similar for patient age (p = 0.23), sex (p = 0.42), type of visit (initial vs. established) (p = 0.51), and socioeconomic status (p = 0.39). After adjusting for race, socioeconomic status, and type of provider, having public insurance remained a significant predictor of failure (p = 0.017). Successful visits were conducted on multiple common pediatric urologic problems (excluding visits requiring palpation on exam), and video was sufficient for physical exams in most cases (Summary Table). A median of 2.25 h of travel time was saved. CONCLUSIONS While socioeconomic status, estimated using the Distressed Communities Index, did not predict success of video visits, patients with public insurance were more likely to have a failed video visit. There is compelling evidence that effective video visits for certain pathologies can be rapidly achieved in a pediatric urology practice with minimal preparation time.
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Affiliation(s)
| | - Haerin L Beller
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Kathryn E Morgan
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Sean T Corbett
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Susan V Leroy
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Sean W Noona
- School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Kaitlin L Berry
- School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Nora G Kern
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
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Irarrázaval MJ, Inzunza M, Muñoz R, Quezada N, Brañes A, Gabrielli M, Soto P, Dib M, Urrejola G, Varas J, Valderrama S, Crovari F, Achurra P. Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic. Surg Endosc 2020; 35:6300-6306. [PMID: 33140151 PMCID: PMC7605475 DOI: 10.1007/s00464-020-08130-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
Summary and background data Recent coronavirus outbreak and “stay at home” policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak. Methods Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed. Results Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, (P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department. Conclusions In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.
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Affiliation(s)
- María J Irarrázaval
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martin Inzunza
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Rodrigo Muñoz
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Nicolás Quezada
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Alejandro Brañes
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Mauricio Gabrielli
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pedro Soto
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martín Dib
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Gonzalo Urrejola
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Julian Varas
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Sebastián Valderrama
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Fernando Crovari
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pablo Achurra
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile.
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Liao CH, Wu YT, Cheng CT, Ooyang CH, Kang SC, Fu CY, Hsu YP, Hsieh CH, Chen CC. An Image-Based Mobile Health App for Postdrainage Monitoring: Usability Study. J Med Internet Res 2020; 22:e17686. [PMID: 32857060 PMCID: PMC7486677 DOI: 10.2196/17686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background The application of mobile health (mHealth) platforms to monitor recovery in the postdischarge period has increased in recent years. Despite widespread enthusiasm for mHealth, few studies have evaluated the usability and user experience of mHealth in patients with surgical drainage. Objective Our objectives were to (1) develop an image-based smartphone app, SurgCare, for postdrainage monitoring and (2) determine the feasibility and clinical value of the use of SurgCare by patients with drainage. Methods We enrolled 80 patients with biliary or peritoneal drainage in this study. A total of 50 patients were assigned to the SurgCare group, who recorded drainage monitoring data with the smartphone app; and 30 patients who manually recorded the data were assigned to the conventional group. The patients continued to record data until drain removal. The primary aim was to validate feasibility for the user, which was defined as the proportion of patients using each element of the system. Moreover, the secondary aim was to evaluate the association of compliance with SurgCare and the occurrence of unexpected events. Results The average submission duration was 14.98 days, and the overall daily submission rate was 84.2%. The average system usability scale was 83.7 (SD 3.5). This system met the definition of “definitely feasible” in 34 patients, “possibly feasible” in 10 patients, and “not feasible” in 3 patients. We found that the occurrence rates of complications in the SurgCare group and the conventional group were 6% and 26%, respectively, with statistically significant differences P=.03. The rate of unexpected hospital return was lower in the SurgCare group (6%) than in the conventional groups (26%) (P=.03). Conclusions Patients can learn to use a smartphone app for postdischarge drainage monitoring with high levels of user satisfaction. We also identified a high degree of compliance with app-based drainage-recording design features, which is an aspect of mHealth that can improve surgical care.
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Affiliation(s)
- Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Yu-Tung Wu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chun-Hsiang Ooyang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Yu-Pao Hsu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
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The Promise of Smartphone Applications in the Remote Monitoring of Postsurgical Wounds: A Literature Review. Adv Skin Wound Care 2020; 33:489-496. [PMID: 32810062 DOI: 10.1097/01.asw.0000694136.29135.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review the clinical and scientific literature on remote monitoring and management of postsurgical wounds using smartphone applications (apps). DATA SOURCES MEDLINE, PubMed, EMBASE, and Cochrane libraries were searched for relevant articles on patients who received surgery and were monitored postdischarge via an app. STUDY SELECTION Articles were selected with the terms "mobile phones," "smartphones," "wounds," "monitor," and "patient preference." DATA EXTRACTION The authors found 276 review articles related to telemedicine in wound care. Investigators reviewed the titles and abstracts of the search results and selected 83 articles that were relevant to the remote monitoring of wounds using smartphone apps. DATA SYNTHESIS The topics explored in selected literature included smartphone app importance to telemedicine, benefits (medical and financial), app examples, and challenges in the context of wound monitoring and management. The authors identified several challenges and limitations that future studies in the field need to address. CONCLUSIONS Remote monitoring and management of wounds using smartphone apps is a valuable technique to enhance the quality of and access to healthcare. However, although some patients may prefer this technology, some lack technological competence, limiting telemedicine's applicability. In addition, issues remain with the reliable interpretation of data collected through apps.
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Deer TR, Sayed D, Pope JE, Chakravarthy KV, Petersen E, Moeschler SM, Abd-Elsayed A, Amirdelfan K, Mekhail N. Emergence From the COVID-19 Pandemic and the Care of Chronic Pain: Guidance for the Interventionalist. Anesth Analg 2020; 131:387-394. [PMID: 32452905 PMCID: PMC7258839 DOI: 10.1213/ane.0000000000005000] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND: The current Coronavirus Disease (COVID-19) pandemic led to a significant disruption in the care of pain from chronic and subacute conditions. The impact of this cessation of pain treatment may have unintended consequences of increased pain, reduced function, increased reliance on opioid medications, and potential increased morbidity, due to the systemic impact of untreated disease burden. This may include decreased mobility, reduction in overall health status, and increase of opioid use with the associated risks. METHODS: The article is the study of the American Society of Pain and Neuroscience (ASPN) COVID-19 task force to evaluate the policies set forth by federal, state, and local agencies to reduce or eliminate elective procedures for those patients with pain from spine, nerve, and joint disease. The impact of these decisions, which were needed to reduce the spread of the pandemic, led to a delay in care for many patients. We hence review an emergence plan to reinitiate this pain-related care. The goal is to outline a path to work with federal, state, and local authorities to combat the spread of the pandemic and minimize the deleterious impact of pain and suffering on our chronic pain patients. RESULTS: The article sets forth a strategy for the interventional pain centers to reemerge from the current pandemic and to set a course for future events. CONCLUSIONS: xxx.
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Affiliation(s)
- Timothy R Deer
- From the Department of Pain Medicine, The Spine and Nerve Center of The Virginias, Charleston, West Virginia.,Department of Anesthesiology and Pain Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jason E Pope
- Evolve Restorative Center, Santa Rosa, California
| | - Krishnan V Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, California.,Division of Pain Medicine, Department of Anesthesiology, Veterans Affairs (VA) San Diego Healthcare, San Diego, California
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Nagy Mekhail
- Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
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"Ramping up telemedicine in pediatric urology- Tips for using a new modality". J Pediatr Urol 2020; 16:288-289. [PMID: 32327290 DOI: 10.1016/j.jpurol.2020.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
Abstract
The COVID pandemic has incited the rapid implementation of telehealth services. Through telemedicine, pediatric urologists can counsel children and their families about genitourinary tract conditions, while adhering to social distancing requirements and keeping families safe at home. With the accelerated use of telemedicine, it is crucial to maintain standards of providing high-quality and secure urologic care. Clinicians must practice effective virtual communication or 'webside' manner. While research may not be a priority, collecting data on telemedicine efforts will be critical in bringing about both payer-based and legislative reforms to encourage and enable wider telemedicine use in the post-COVID world.
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Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic. J Am Acad Orthop Surg 2020; 28:451-463. [PMID: 32282441 PMCID: PMC7197335 DOI: 10.5435/jaaos-d-20-00227] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, emergency department consultation room, induction room, operating room, and recovery room) are reviewed.
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Current use of telehealth in urology: a review. World J Urol 2019; 38:2377-2384. [PMID: 31352565 DOI: 10.1007/s00345-019-02882-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Applications of telehealth have been growing in popularity. However, there is little information on how telehealth is being used in Urology. In this review, we examine current applications of telehealth in urological practices as well as barriers to implementation. METHODS A review was conducted of original research within the past 10 years describing telehealth applications in urology. Articles on telehealth as applied to other specialties were reviewed for discussion on real or perceived barriers to implementation. RESULTS Twenty-four articles met the inclusion criteria. The most common application of telehealth was using a video visit to assess or follow-up with patients. The second most commonly described applications of telehealth were telementorship, or the use of telehealth technology to help train providers, and telemedicine used in diagnostics. Studies consistently stated the effectiveness of the telehealth applications and the high level of patient and provider satisfaction. CONCLUSIONS Telehealth is sparingly used in urology. Barriers to implementation include technological literacy, reimbursement uncertainties, and resistance to change in workflow. When used, telehealth technologies are shown to be safe, effective, and satisfactory for patients and providers. Further investigation is necessary to determine the efficacy of telehealth applications.
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DeAntonio JH, Kang HS, Cockrell HC, Rothstein W, Oiticica C, Lanning DA. Utilization of a handheld telemedicine device in postoperative pediatric surgical care. J Pediatr Surg 2019; 54:1005-1008. [PMID: 30782441 DOI: 10.1016/j.jpedsurg.2019.01.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to assess the utilization of a handheld telemedicine (TM) device in the postoperative care of pediatric surgical patients. METHODS We performed postoperative TM evaluations using an advanced medical tablet immediately prior to seeing the patients in clinic as well as at two different time points from their home. The caregivers and physicians were surveyed about their overall satisfaction. RESULTS Twenty-four postoperative patients who underwent a variety of general surgical operations were included. There were no changes to the TM plan of care following "in person" evaluations (n = 12) and no complications, missed diagnoses, emergency department visits, or additional clinic visits in those who only had TM postoperative evaluations (n = 12). Caregiver satisfaction ratings were 3.92 ± 0.28 out of 4 (4 = very satisfied). Ninety-two percent of caregivers responded that they would be comfortable with a TM-only postoperative evaluation in the future. The physician was able to formulate an accurate assessment and plan using the device. The average travel distance saved was 44.7 ± 45.5 miles (range = 10-150 miles). CONCLUSIONS These preliminary data suggest safe and effective care with high caregiver and physician satisfaction can be provided by utilizing TM in the postoperative care of pediatric surgical patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jonathan H DeAntonio
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Hae Sung Kang
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Hannah C Cockrell
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - William Rothstein
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Claudio Oiticica
- Children's Hospital of Richmond at Virginia Commonwealth University, Children's Pavilion, Richmond, VA
| | - David A Lanning
- Children's Hospital of Richmond at Virginia Commonwealth University, Children's Pavilion, Richmond, VA.
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Small AC, Thorogood SL, Shah O, Healy KA. Emerging Mobile Platforms to Aid in Stone Management. Urol Clin North Am 2019; 46:287-301. [PMID: 30961861 DOI: 10.1016/j.ucl.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nephrolithiasis is an increasingly common condition worldwide and mobile technology is revolutionizing how patients with kidney stone are being diagnosed and managed. Emerging platforms include software applications to increase adherence to stone prevention, mobile compatible hardware, online social media communities, and telemedicine. Applications and hardware specifically relevant to increasing hydration, diet modification, medication adherence, and rapid diagnosis (ie, mobile ultrasound and endoscopy) have the greatest potential to reduce stone recurrence and expedite treatment. Social media and online communities have also been rapidly adopted by patients and providers to promote education and support.
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Affiliation(s)
- Alexander C Small
- Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
| | - Samantha L Thorogood
- Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
| | - Ojas Shah
- Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
| | - Kelly A Healy
- Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA.
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Financial implications of telemedicine visits in an academic endocrine surgery program. Surgery 2019; 165:617-621. [DOI: 10.1016/j.surg.2018.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 11/18/2022]
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Goedeke J, Ertl A, Zöller D, Rohleder S, Muensterer OJ. Telemedicine for pediatric surgical outpatient follow-up: A prospective, randomized single-center trial. J Pediatr Surg 2019; 54:200-207. [PMID: 30343977 DOI: 10.1016/j.jpedsurg.2018.10.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Telemedicine is gaining popularity for a variety of indications. We performed a randomized controlled trial comparing telemedical versus conventional clinic follow-up in terms of feasibility and quality. METHODS Patients discharged from pediatric surgery were randomized to telemedical or onsite follow-up. In the telemedical group, video telephony was used to obtain interim history and physical findings. Onsite patients were personally seen in the outpatient clinic. Caregivers completed a postvisit survey on satisfaction and efficiency. Providers scored data transmission quality and clinical interpretability. RESULTS From March 2015 until January 2017, 224 patients were randomized equally to the study groups. Telemedicine was highly accepted by caregivers, and data transmission quality was sufficient for comprehensive follow-up. No important clinical findings were missed. Quality of interaction scored higher in the telemedical versus the onsite group (77.8% vs. 48%, p < 0.001) as did caregiver satisfaction (5.4 vs. 5.1, p < 0.03). Travel investment, time required, loss of earnings, and days off from work/school were all significantly lower in the telemedical group (p < 0.001). CONCLUSIONS Telemedical posthospitalization follow-up in pediatric surgery provides a cost-effective, time-saving alternative for patients and caregivers that is well received and accepted. The quality of clinical data transmission is sufficient to provide safe care and uncompromised clinical judgment. TYPE OF STUDY Prospective and randomized controlled study. LEVEL OF EVIDENCE Level 1b.
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Affiliation(s)
- Jan Goedeke
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Alexandra Ertl
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniela Zöller
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Institute for Medical Biometry and Statistics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stephan Rohleder
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Young K, Gupta A, Palacios R. Impact of Telemedicine in Pediatric Postoperative Care. Telemed J E Health 2018; 25:1083-1089. [PMID: 30517056 DOI: 10.1089/tmj.2018.0246] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: A shortage of pediatricians and long wait times in the hospitals render more efficient follow-up visits increasingly important. Virtual visits between physician and patient offer a solution to this problem. Increased awareness, improved technology, and efficient scheduling methods will contribute to the quality and adoption of telemedicine programs. Introduction: The aim of this study was to analyze the impact of pediatric telemedicine on wait times and visit durations, as compared with in-person visits. A secondary goal was to assess the efficiency of different scheduling methods for virtual visits. Materials and Methods: The study included >800 postoperative virtual visits from urology, cardiovascular surgery, and ophthalmology, comprising data on wait times, visit duration, and postvisit satisfaction collected through SBR Health and Redcap. In-person visit data were collected on 14 patients in urology, and satisfaction scores were obtained through Press Ganey for urology and ophthalmology. Results: Patients reported very high satisfaction with virtual visits and benefitted from reduced wait times, while receiving care of comparable duration and quality. Longer blocks of time scheduled exclusively for virtual visits correlated with shorter wait times. Discussion: Supplementing health care with telemedicine is a viable way to provide patient-centered care. Implemented effectively, a telemedicine program can contribute greatly to the value a hospital provides to its patients. Conclusions: Virtual visits provide an efficient way to conduct postoperative visits, reducing wait times and increasing physician efficiency while retaining high satisfaction and quality of care.
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Affiliation(s)
- Katherine Young
- Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Amar Gupta
- Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, Massachusetts.,Institute for Medical Engineering and Science (IMES), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Rafael Palacios
- Institute for Medical Engineering and Science (IMES), Massachusetts Institute of Technology, Cambridge, Massachusetts.,Institute for Research in Technology, Universidad Pontificia Comillas, Madrid, Spain
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Vallasciani S, Abdo B, Rauf Z, Anjum A, Ghulman S, Alghammas H, AlTaweel W. Telehealth for the Assessment of Patients Referred for Pediatric Urological Care: A Preliminary Cost Savings Analysis and Satisfaction Survey. Telemed J E Health 2018; 25:756-761. [PMID: 30359550 DOI: 10.1089/tmj.2018.0159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Almost one-fifth of the population of Saudi Arabia lives in rural areas and may still lack access to specialty healthcare. Because of the growing demand for telehealth services, we initiated the virtual clinic (VC) concept for new referrals to the pediatric urology clinic (PUC), the primary tertiary care unit in Riyadh. Methods: We conducted a retrospective analysis of costs and timing involved with the VC practice for a 1-year period. The cost analysis is based on savings realized by patients as a result of the VC evaluation. A 15-question nonvalidated satisfaction survey was also conducted by an independent observer. Results: Of 105 patients assessed through the VC program, 44 were accepted for surgery and further investigation. The number of trips to the center saved by the virtual encounter were 203, resulting in a savings of 740,950 Saudi Arabian Riyals (SAR) minus the cost of the VC. The cost of conducting most of the investigations at the referring hospital instead of the PUC represented a savings of 639,970 SAR. Thus, the overall cost savings to patient and family and to the PUC was 1,311,570 SAR. An additional benefit was the reduction in the time for treatment from 6.6 to 3.9 months. The overall satisfaction rate was 89%. Conclusions: Although preliminary, our study indicates that telemedicine can achieve a cost savings without compromising the safety or adversely affecting patient management. Further studies should more clearly define the benefits and any limitations, and reveal how the technology could be used most effectively.
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Affiliation(s)
- Santiago Vallasciani
- 1Pediatric Urology Division, Urology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Badawiya Abdo
- 3Department of Health Outreach and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zainab Rauf
- 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abeeda Anjum
- 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sanaa Ghulman
- 4Department of Nursing Affairs, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hanan Alghammas
- 5Quality Management Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed AlTaweel
- 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,6Urology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Pilot Study to Evaluate the Safety, Feasibility, and Financial Implications of a Postoperative Telemedicine Program. Ann Surg 2018; 268:700-707. [DOI: 10.1097/sla.0000000000002931] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Glassman DT, Puri AK, Weingarten S, Hollander JE, Stepchin A, Trabulsi E, Gomella LG. Initial Experience with Telemedicine at a Single Institution. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Deborah T. Glassman
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ajay K. Puri
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah Weingarten
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Judd E. Hollander
- Department of Emergency Medicine and JeffConnect, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anna Stepchin
- JeffConnect, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edouard Trabulsi
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leonard G. Gomella
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
Telemedicine use in urology is an evolving practice. In this article, the authors review the early experience of telemedicine specifically as it relates to urologic practice and discuss the future implications and the utility of telemedicine as it applies to other fields.
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Affiliation(s)
- Adam Miller
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Eugene Rhee
- Department of Urology, Kaiser Permanente San Diego, Administration, 2nd Floor Finance, 4511 Orcutt Avenue, San Diego, CA 92120, USA
| | - Matthew Gettman
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Aaron Spitz
- Department of Urology, University of California-Irvine, Orange County Urology Associates, 25200 La Paz Road Suite 200, Laguna Hills, CA 92653, USA.
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