Comparison of Endocrinologists' Physical Examination Documentation for In-person vs Video Telehealth Diabetes Visits

Translatability of physical examination to teleconsultation in primary care setting

BackgroundTelehealth has been widely accepted and investigated however little is known about virtual physical examination (VPE) in primary care settings. In order to understand and improve patient and clinician experience during VPE, we need to analyse the physical examination during in-person general practitioner (GP) consultations.ObjectiveWe aim to analyse the characteristics of physical examination (PE) during in-person GP consultations including topics of consultations, types of physical examinations, equipment used and body area examined. We then evaluate how translatable these PE are over telehealth.MethodsEligible consultations were extracted from a dataset archive named HaRI, which contains 281 in-person GP consultations in de-identified transcript and video format. Eligible consultations were processed with data extracted. Finally, an evidence-based scoring system was used on each PE, determining its likelihood of being translated to telehealth.ResultsWe analysed 169 in-person GP consultations, in which 79% (133 out of 169) required physical examination (PE). A total of 307 physical examinations, 224 counts of equipment and 331 counts of body parts were observed. Out of 52 physical examination components we have observed, 79% were translatable but only 8% of these were deemed easily translatable over telehealth. 21% of the physical examinations were considered 'untranslatable over telehealth'.ConclusionOver half (54%) of the physical examinations were at least moderately translatable, especially for vital signs, musculoskeletal, neurological and cardiovascular exams. However, more research is warranted to increase the accuracy, reliability and translatability of virtual physical examinations and when VPE is not feasible, safety netting should be applied.

Possibilities of using telemedical interventions in the framework of providing specialized endocrinological care to the population

Telemedicine is the use of telecommunication systems to provide medical care to the population at a distance. It has the potential to improve patient outcomes, access to care, and reduce health care costs. As telemedicine consultation applications continue to evolve, it is important to understand in which clinical situations and settings of care a telemedicine intervention is appropriate and can ensure that patients receive quality care. Objective: to assess the acceptability, effectiveness and safety of using TMC in the provision of specialized endocrinological care to patients. Search strategy: review of the most relevant studies published in the electronic databases Medscape, PubMed, PubMed Central, MEDLINE, Scopus, eLibrary, CyberLeninka. The selection criterion was scientific articles published up to March 2024 inclusive. Search keywords: telemedicine, virtual care, endocrinology, diabetes. Conclusions. The results of currently published studies have shown that telemedicine interventions can have a beneficial effect on the outpatient management of patients with chronic non-communicable diseases, in particular diabetes mellitus, and improve the self-management of glycemic parameters in patients. However, many questions remain unresolved regarding the choice of the optimal strategy for monitoring, treating and providing quality medical care to patients with endocrine pathology. Findings to date indicate significant promise for implementing telemedicine interventions within health care delivery. The advisability of their use in each specific case must be approached individually and solely as another, additional tool for improving the quality and accessibility of medical care.

Skin autofluorescence of advanced glycation end-products, glycemic memory, and diabetes complications

Since the pionneer work of Meerwaldt and the Groningen team, who related skin autofluorescence (SAF) to the dermal concentrations of advanced glycation end-products (AGEs), hundreds of articles have been devoted to its application in diabetes. Due to the slow turnover of the AGEs formed on collagen of the skin, the SAF can reflect the progressive accumulation of AGEs and hence be a marker of long-term glucose exposure. Accordingly, relations with HbA1c from the previous 3-10 years have been established in both type 1 and type 2 diabetes, and even in gestational diabetes mellitus. Other important determinants of SAF exist however, notably age, renal function, diet, and genetics. SAF is also related to current and future micro- and macrovascular complications of diabetes, as expected for a marker of glycemic memory. It is also related to some important emerging diabetes complications and comorbidities such as cancer, cognitive decline and liver disease. Quantitative information on glucose exposure during the previous years may be pertinent to personnalize care for patients with diabetes: priority for glucose control when SAF is low, and for screening for complications once SAF is high.

A Systematic Review of Telehealth Applications in Endocrinology

Introduction

The prevalence of telehealth has witnessed a significant increase in various medical domains, especially in endocrinology. Telehealth brings about considerable advantages for both patients and health care professionals. However, despite these positive aspects, the growing prominence of telehealth is accompanied by certain challenges. This systematic review aims to assess the role of telehealth in endocrinology, including its applications, effectiveness, challenges, and implications for patient care.

Methods

This study involved a thorough search using comprehensive techniques across databases such as PubMed/Medline, Embase, and Scopus. The studies were selected for a tailored adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to enhance the clarity of our systematic review's reporting.

Results

This systematic review explores global telemedicine applications in endocrinology. Addressing various endocrine conditions, interventions utilize technology tools such as smartphones and applications, offering multifaceted utility from education and data gathering to screening and treatment. Notably, these interventions demonstrate adaptability during the COVID-19 pandemic. Positive outcomes include enhanced patient education, disease self-management, reduced complications, and improved glycemic control. However, drawbacks include the need for technical proficiency, perceived lower care quality, and potential privacy risks. These nuanced findings contribute to the discourse on telemedicine efficacy and limitations.

Conclusion

In conclusion, telehealth holds significant potential in transforming endocrine care. While there are challenges to its implementation, the benefits it offers underscore its value as a health care delivery model.