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Alhussein M. Use of Real-Time Remote Tele-mentored Ultrasound Echocardiography for Cardiovascular Disease Diagnosis in Adults: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:779-787. [PMID: 38448316 DOI: 10.1016/j.ultrasmedbio.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Cardiovascular diseases remain a major health challenge, leading to high rates of death and hospitalization globally. In the battle against these ailments, echocardiography stands as the frontline tool for diagnosis. Pioneering the charge in innovation, real-time remote tele-mentored ultrasound echocardiography (RTMUS echo) has emerged. This cutting-edge technique facilitates the instant transmission of cardiac imaging from the patient's side to experts in far-off locations, enabling prompt diagnosis and expert consultation. To bridge this gap, a systematic review was conducted to understand RTMUS echo's current applications in diagnosing heart diseases. Searches across six databases, guided by strict inclusion and exclusion criteria, yielded nine relevant articles. These studies assessed the feasibility of RTMUS echo and the technology behind it, confirming its potential for high-quality cardiac imaging. The findings reveal that RTMUS echo could notably improve care for cardiac patients, especially those in resource-constrained settings or in isolation because of infection risks. This technology enables quick access to diagnostic expertise, which is otherwise unavailable in such areas. Future research should aim to optimize the cost-effectiveness and application of RTMUS echo to enhance its benefits for global healthcare.
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Affiliation(s)
- Manal Alhussein
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, USA.
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Hjorth-Hansen AK, Andersen GN, Graven T, Gundersen GH, Kleinau JO, Mjølstad OC, Skjetne K, Stølen S, Torp H, Dalen H. Feasibility and Accuracy of Tele-Echocardiography, With Examinations by Nurses and Interpretation by an Expert via Telemedicine, in an Outpatient Heart Failure Clinic. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2313-2323. [PMID: 32436616 DOI: 10.1002/jum.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To study the feasibility and accuracy of focused echocardiography by nurses supported by near-real-time interpretation via telemedicine by an experienced cardiologist. METHODS Fifty consecutive patients were included from an outpatient heart failure (HF) clinic. Limited echocardiography was performed by 1 of 3 specialized nurses. The echocardiograms were transferred by a secure transfer model for near-real-time interpretation to 1 out-of-hospital cardiologist, assessing, among others, the left ventricular (LV) internal diameter, end-diastolic volume, ejection fraction, left atrial (LA) indexed end-systolic volume, mitral early inflow velocity (E), the ratio of E to mitral late inflow, and the ratio of E to the mitral annular early diastolic velocity. The reference method was echocardiography by 1 of 4 experienced cardiologists. RESULTS The median age of the population (46% women) was 79 (range, 33-95) years. The assessment and quantification of LA and LV dimensions, volumes, and functional indices were feasible in 94% or more via the telemedical approach. The agreement with reference measurements was very high by the telemedical approach. The mean duration ± SD of the complete telemedical approach from the start of echocardiography until the cardiologist's report was received by the caregiving nurse was 1.32 ± 0.36 (range, 1.58) hours. The correlations with reference to the above-specified indices were r = 0.75 to 0.94. CONCLUSIONS Limited echocardiography by nurses in an outpatient heart failure clinic, supported by interpretation by an out-of-hospital cardiologist, was feasible and reliable. This may reduce geographic disparities and allow more patients to benefit from the advantages of implementing focused echocardiography by noncardiologists in diagnostics and follow-up.
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Affiliation(s)
- Anna Katarina Hjorth-Hansen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Garrett Newton Andersen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Graven
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Guri Holmen Gundersen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens Olaf Kleinau
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
| | - Kyrre Skjetne
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Stian Stølen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
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Yano K, Kanda H, Iida T, Hayashi K, Toyama Y, Kunisawa T. Internet-Based Intraoperative Real-Time Transesophageal Echocardiography in Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 34:1117-1120. [PMID: 31859032 DOI: 10.1053/j.jvca.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Kiichi Yano
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takafumi Iida
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Kentaro Hayashi
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuki Toyama
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Rouse CA, Woods BT, Mahnke CB. A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport. J Telemed Telecare 2017; 24:224-229. [PMID: 28094679 DOI: 10.1177/1357633x16689500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii. Results During the study period 100 infants received 192 tele-echocardiograms: 46% of infants had tele-echocardiograms completed for suspected patent ductus arteriosus, 28% for suspected congenital heart disease, 12% for possible congenital heart disease in the setting of likely pulmonary hypertension, and 10% for possible congenital heart disease in the setting of other congenital anomalies. Of these, 17 patients were aeromedically evacuated for cardiac reasons; 12 patients were transported to Hawaii, while five patients with complex heart disease were transported directly to the United States mainland for interventional cardiac capabilities not available in Hawaii. Discussion This study demonstrates the use of tele-echocardiography to guide treatment, reduce long and potentially risky trans-Pacific transports, and triage transports to destination centers with the most appropriate cardiac capabilities.
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Affiliation(s)
- Christopher A Rouse
- 1 Walter Reed National Military Medical Center, Department of Pediatrics, Division of Neonatology, Bethesda, USA.,2 Uniformed Services University of Health Sciences, Department of Pediatrics, Bethesda, USA.,3 779th Medical Operations Squadron, Maryland, USA
| | - Brandon T Woods
- 4 University of Washington, School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle, USA
| | - C Becket Mahnke
- 5 Tripler Army Medical Center, Department of Pediatrics, Hawaii, USA
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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Wang TT, Li JM, Zhu CR, Hong Z, An DM, Yang HY, Ren JC, Zou XM, Huang C, Chi XS, Chen JN, Hong Z, Wang WZ, Xu CG, He L, Li WM, Zhou D. Assessment of Utilization and Cost-Effectiveness of Telemedicine Program in Western Regions of China: A 12-Year Study of 249 Hospitals Across 112 Cities. Telemed J E Health 2016; 22:909-920. [PMID: 27314300 DOI: 10.1089/tmj.2015.0213] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China. MATERIALS AND METHODS In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis. RESULTS Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals). CONCLUSIONS The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and cost-effectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries.
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Affiliation(s)
- Ting-Ting Wang
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Jin-Mei Li
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Cai-Rong Zhu
- 2 Department of Health Statistics, West China School of Public Health, Sichuan University , Chengdu, Sichuan, China
| | - Zhen Hong
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Dong-Mei An
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Hong-Yu Yang
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Jie-Chuan Ren
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Xue-Mei Zou
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Cheng Huang
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Xiao-Sa Chi
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Jia-Ni Chen
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Zhen Hong
- 3 Department of Neurology, Huashan Hospital, Fudan University , Shanghai, China
| | - Wen-Zhi Wang
- 4 Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Cai-Gang Xu
- 5 Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .,6 Department of Public Affairs Development, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Li He
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Wei-Min Li
- 7 Department of Respiratory Medicine, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Dong Zhou
- 1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
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Webb CL, Waugh CL, Grigsby J, Busenbark D, Berdusis K, Sahn DJ, Sable CA. Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study. J Am Soc Echocardiogr 2013; 26:1090-8. [PMID: 23860093 DOI: 10.1016/j.echo.2013.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous single-center studies have shown that telemedicine improves care in newborns with suspected heart disease. The aim of this study was to test the hypothesis that telemedicine would shorten time to diagnosis, prevent unnecessary transports, reduce length of stay, and decrease exposure to invasive treatments. METHODS Nine pediatric cardiology centers entered data prospectively on patients aged <6 weeks, matched by gestational age, weight, and diagnosis. Subjects born at hospitals with and without access to telemedicine constituted the study group and control groups, respectively. Data from patients with mild or no heart disease were analyzed. RESULTS Data were obtained for 337 matched pairs with mild or no heart disease. Transport to a tertiary care center (4% [n = 15] vs 10% [n = 32], P = .01), mean time to diagnosis (100 vs 147 min, P < .001), mean length of stay (1.0 vs 26 days, P = .005) and length of intensive care unit stay (0.96 vs 2.5 days, P = .024) were significantly less in the telemedicine group. Telemedicine patients were significantly farther from tertiary care hospitals than control subjects. The use of inotropic support and indomethacin was significantly less in the telemedicine group. By multivariate analysis, telemedicine patients were less likely to be transported (odds ratio, 0.44; 95% confidence interval, 0.23-0.83) and less likely to be placed on inotropic support (odds ratio, 0.16; 95% confidence interval, 0.10-0.28). CONCLUSIONS Telemedicine shortened the time to diagnosis and significantly decreased the need for transport of infants with mild or no heart disease. The length of hospitalization and intensive care stay and use of indomethacin and inotropic support were less in telemedicine patients.
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Affiliation(s)
- Catherine L Webb
- University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA.
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Singh S, Bansal M, Maheshwari P, Adams D, Sengupta SP, Price R, Dantin L, Smith M, Kasliwal RR, Pellikka PA, Thomas JD, Narula J, Sengupta PP. American Society of Echocardiography: Remote Echocardiography with Web-Based Assessments for Referrals at a Distance (ASE-REWARD) Study. J Am Soc Echocardiogr 2013; 26:221-33. [DOI: 10.1016/j.echo.2012.12.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Indexed: 11/28/2022]
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