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Leong M, Obaid M, Fernandez Ramos MC, Eichenberger R, John A, Krumholtz-Belkin P, Roeder T, Parvez B. Skilled lactation support using telemedicine in the neonatal intensive care unit. J Perinatol 2024; 44:687-693. [PMID: 38341485 DOI: 10.1038/s41372-024-01894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of NICU breastfeeding outcomes before and after implementing telelactation. METHODS Pre-Telemedicine mothers received in-person support by NICU lactation consultants, while Telemedicine mothers received solely telemedicine consults after maternal discharge. RESULTS Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably, babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge. CONCLUSIONS This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.
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Affiliation(s)
- Melanie Leong
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA.
- Westchester Medical Center, Valhalla, New York, USA.
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA.
| | - Maria Obaid
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA
- Westchester Medical Center, Valhalla, New York, USA
| | - Maria Cristina Fernandez Ramos
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA
- Westchester Medical Center, Valhalla, New York, USA
| | | | - Annamma John
- Westchester Medical Center, Valhalla, New York, USA
| | | | - Tina Roeder
- Westchester Medical Center, Valhalla, New York, USA
| | - Boriana Parvez
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA
- Westchester Medical Center, Valhalla, New York, USA
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
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2
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Erno J, Gomes T, Baltimore C, Lineberger JP, Smith DH, Baker GH. Automated Identification of Patent Ductus Arteriosus Using a Computer Vision Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2707-2713. [PMID: 37449663 DOI: 10.1002/jum.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Patent ductus arteriosus (PDA) is a vascular defect common in preterm infants and often requires treatment to avoid associated long-term morbidities. Echocardiography is the primary tool used to diagnose and monitor PDA. We trained a deep learning model to identify PDA presence in relevant echocardiographic images. METHODS Echocardiography video clips (n = 2527) in preterm infants were reviewed by a pediatric cardiologist and those relevant to PDA diagnosis were selected and labeled (PDA present/absent/indeterminate). We trained a convolutional neural network to classify each echocardiography frame of a clip as belonging to clips with or without PDA. A novel attention mechanism that aggregated predictions for all frames in each clip to obtain a clip-level prediction by weighting relevant frames. RESULTS In early model iterations, we discovered training with color Doppler echocardiography clips produced the best performing classifier. For model training and validation, 1145 such clips from 66 patients (661 PDA+ clips, 484 PDA- clips) were used. Our best classifier for clip level performance obtained sensitivity of 0.80 (0.83-0.90), specificity of 0.77 (0.62-0.92) and AUC of 0.86 (0.83-0.90). Study level performance obtained sensitivity of 0.83 (0.72-0.94), specificity of 0.89 (0.79-1.0) and AUC of 0.93 (0.89-0.98). CONCLUSIONS Our novel deep learning model demonstrated strong performance in classifying echocardiography clips with and without PDA. Further model development and external validation are warranted. Ultimately, integration of such a classifier into auto detection software could streamline PDA imaging workflow. This work is the first step toward semi-automated, bedside detection of PDA in preterm infants.
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Affiliation(s)
- Jason Erno
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas Gomes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher Baltimore
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John P Lineberger
- Department of Electrical and Computer Engineering, Clemson University, Clemson, South Carolina, USA
| | - D Hudson Smith
- Department of Electrical and Computer Engineering, Clemson University, Clemson, South Carolina, USA
| | - G Hamilton Baker
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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Saidinejad M, Barata I, Foster A, Ruttan TK, Waseem M, Holtzman DK, Benjamin LS, Shahid S, Berg K, Wallin D, Atabaki SM, Joseph MM. The role of telehealth in pediatric emergency care. J Am Coll Emerg Physicians Open 2023; 4:e12952. [PMID: 37124475 PMCID: PMC10131292 DOI: 10.1002/emp2.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
In 2006, the Institute of Medicine published a report titled "Emergency Care for Children: Growing Pains," in which it described pediatric emergency care as uneven at best. Since then, telehealth has emerged as one of the great equalizers in care of children, particularly for those in rural and underresourced communities. Clinicians in these settings may lack pediatric-specific specialization or experience in caring for critically ill or injured children. Telehealth consultation can provide timely and safe management for many medical problems in children and can prevent many unnecessary and often long transport to a pediatric center while avoiding delays in care, especially for time-sensitive and acute interventions. Telehealth is an important component of pediatric readiness of hospitals and is a valuable tool in facilitating health care access in low resourced and critical access areas. This paper provides an overview of meaningful applications of telehealth programs in pediatric emergency medicine, discusses the impact of the COVID-19 pandemic on these services, and highlights challenges in setting up, adopting, and maintaining telehealth services.
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Affiliation(s)
- Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Isabel Barata
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthManhassetNew YorkUSA
| | - Ashley Foster
- Harvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Muhammad Waseem
- Lincoln Medical CenterBronxNew YorkUSA
- Weill Cornell MedicineNew YorkUSA
| | | | - Lee S. Benjamin
- Trinity Health St. Joseph Medical CenterAnn ArborMichiganUSA
| | - Sam Shahid
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Kathleen Berg
- Dell Medical School at the University of TexasAustinTexasUSA
| | - Dina Wallin
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Shireen M. Atabaki
- The George Washington University, School of MedicineChildren's National HospitalWashingtonDistrict of ColumbiaUSA
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Mahalwar G, Kumar A, Kalra A. Virtual Cardiology: Past, Present, Future Directions, and Considerations. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:117-122. [PMID: 37305213 PMCID: PMC10225773 DOI: 10.1007/s12170-023-00719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/13/2023]
Abstract
Purpose of Review Through this review, we attempt to explore the role of telemedicine and virtual visits in the field of cardiology pre-COVID-19 and during COVID-19 pandemic, their limitations and their future scope for delivery of care. Recent Findings Telemedicine, which rose to prominence during COVID-19 pandemic, helped not only in reducing the burden on the healthcare system during a time of crisis but also in improving patient outcomes. Patients and physicians also favored virtual visits when feasible. Virtual visits were found to have the potential to be continued beyond the pandemic and play a significant role in patient care alongside conventional face-to-face visits. Summary Although tele-cardiology has proven beneficial in terms of patient care, convenience, and access, it comes with its fair share of limitations-both logistical and medical. Whilst there remains a great scope for improvement in the quality of patient care provided through telemedicine, it has shown the potential to become an integral part of medical practice in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s12170-023-00719-0.
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Affiliation(s)
- Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ankur Kalra
- Franciscan Physician Network Cardiology, Franciscan Health, 3900 St. Francis Way, Suite 200 Lafayette, IN 47905 Lafayette, USA
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Kernizan D, Srivastava S, Nigam P, Geary EM, Baker-Smith C. Telehealth and Application of Appropriate Use Criteria for Pediatric Transthoracic Echocardiography. Pediatr Cardiol 2023; 44:640-646. [PMID: 35962201 PMCID: PMC9374290 DOI: 10.1007/s00246-022-02985-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Abstract
Appropriate use criteria (AUC) for the performance of outpatient transthoracic echocardiography are based on history, physical examination and electrocardiograms. Telehealth provides access to clinical care in the absence of a physical examination. We assessed application of AUC for performance of echocardiography following a telehealth visit. In this single center study, we retrospectively reviewed the charts of pediatric patients whose originally scheduled in person visits were converted to telehealth visits between March and May 2020. Patients were referred for echocardiogram by the telehealth cardiologist. Echocardiograms requested during the telehealth visit were retrospectively classified as appropriate [A], may be appropriate [M], or rarely appropriate [R] by two independent reviewers. Findings from the echocardiogram were classified as normal, abnormal, or abnormal and motivating treatment by the same two independent reviewers based upon results from the echocardiogram report and physician office visit note. Of the 441 patients seen by telehealth, interquartile range of 1.9-15.3 years, 114 (26%) patients were referred for an echocardiogram. Of the patients for whom echocardiograms were requested, 56/114 (49%) were new to cardiology. Echocardiograms were rated: A-85 (75%), M-5 (4%), and R-24 (21%). Of the 108 completed studies, 61 (56%) were normal, 44 (41%) were abnormal, and three (3%) were abnormal motivating treatment. Abnormal TTE findings were not detected in the R encounters compared with abnormal findings in 46/82 (56%) of the A completed studies. Seventy-one percent (15/21) of the R-rated studies were performed for murmur evaluation.
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Affiliation(s)
- Daphney Kernizan
- Nemours Cardiac Centre, Nemours Children’s Hospital, 1600 Rockland Rd, Wilmington, DE 19803 USA
| | - Shubhika Srivastava
- Nemours Cardiac Centre, Nemours Children’s Hospital, 1600 Rockland Rd, Wilmington, DE 19803 USA ,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA
| | - Priya Nigam
- Nemours Cardiac Centre, Nemours Children’s Hospital, 1600 Rockland Rd, Wilmington, DE 19803 USA
| | - Elaine M. Geary
- Nemours Cardiac Centre, Nemours Children’s Hospital, 1600 Rockland Rd, Wilmington, DE 19803 USA
| | - Carissa Baker-Smith
- Nemours Cardiac Centre, Nemours Children's Hospital, 1600 Rockland Rd, Wilmington, DE, 19803, USA. .,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Chuo J, Makkar A, Machut K, Zenge J, Jagarapu J, Azzuqa A, Savani RC. Telemedicine across the continuum of neonatal-perinatal care. Semin Fetal Neonatal Med 2022; 27:101398. [PMID: 36333212 PMCID: PMC9623499 DOI: 10.1016/j.siny.2022.101398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- John Chuo
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center; Oklahoma City, Oklahoma, USA
| | - Kerri Machut
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeanne Zenge
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Rashmin C. Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sandhu T, DeShea L, Jagarapu J, Savani RC, Chuo J, Azzuqa A, Beasley WH, Hallford G, Makkar A. Multicenter study assessing physicians' and transport teams' attitudes and expectations about utilizing telemedicine to manage critical neonatal transports. J Telemed Telecare 2022:1357633X221104563. [PMID: 35765233 DOI: 10.1177/1357633x221104563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Managing critically ill neonates has unique challenges, and the transport team plays an important role in stabilizing and facilitating the transfer of these neonates from lower-level nurseries to tertiary centers, and the use of telemedicine in transport (tele-transport) can potentially benefit patient care. We conducted a multicenter study to assess the readiness for utilizing telemedicine as an adjunct to guide the care of critically ill neonates among physicians and transport team members (TTMs). This is the first multicenter study that explored physicians' and TTMs' perceptions of telemedicine usage and its value in neonatal transport. METHODS A confidential, voluntary survey on pre-implementation attitudes toward telemedicine usage during neonatal transport was conducted as part of a quality improvement initiative. This survey involved physicians and TTMs from four academic institutions whose responses were entered into an online survey using REDCap®. The survey inquired about satisfaction with the current practice of phone consultation and the perception of using telemedicine to optimize the management of neonates during transport. RESULTS The overall response rate for the survey was 60.1%; 82 of 127 (64.6%) physicians and 64 of 116 (55.2%) TTMs responded to the surveys. Half of the physicians and less than one-fourth of the TTMs had prior experience with telemedicine other than that used on neonatal transport. TTMs expressed greater concern about the inconvenience of video (55% vs. physicians 35% agree or strongly agree) and its time consumption (84% vs. physicians 50%). More than 70% of physicians and less than half of TTMs endorsed the potential for added value and quality improvement with video capability. Almost half of TTMs reported concern about video calls reducing their autonomy in patient care. Physicians expressed confidence in management decisions they would make after video calls (72% confident or very confident) and less confidence (49%) about both the phone assessment by TTMs and their decisions based on phone assessment. In contrast, TTMs were confident or very confident (94%) in both sharing their assessment over the phone and executing patient management after a phone call, compared with 70% for decisions made after video calls. CONCLUSIONS Physicians and TTMs had distinct opinions on the use of telemedicine during neonatal transport. Physicians were more likely than TTMs to agree with statements about the potential for improving quality of care, while TTMs were more likely than physicians to say video calls would be time-consuming and inconvenient. We speculate some differences may stem from the TTMs' concern about losing their autonomy. Therefore, during implementation, it is critical for physicians and TTMs to agree on a shared mental model of indications for telemedicine during transport and its value to the patient care.
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Affiliation(s)
- Tavleen Sandhu
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lise DeShea
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Medical Center, Dallas, TX, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Medical Center, Dallas, TX, USA
| | - John Chuo
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, 12317University of Pittsburgh School of Medicine/UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - William H Beasley
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gene Hallford
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abhishek Makkar
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:309-324. [PMID: 36479525 PMCID: PMC9510217 DOI: 10.1007/s40746-022-00258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
Purpose of Review Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice. Recent Findings In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence. Summary TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.
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Mohammadzadeh N, Rezayi S, Tanhapour M, Saeedi S. Telecardiology interventions for patients with cardiovascular Disease: A systematic review on characteristics and effects. Int J Med Inform 2021; 158:104663. [PMID: 34922178 DOI: 10.1016/j.ijmedinf.2021.104663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The prevalence and mortality of cardiovascular diseases are high worldwide. Telecardiology can be used to diagnose and treat these diseases. This paper aimed to review the effectiveness (positive and negative) of implemented telecardiology services in terms of clinical, economic, and patient-reported aspects. METHODS A comprehensive search was conducted in Medline (through PubMed), Scopus, ISI web of science, and IEEE Xplore databases from inception to April 7, 2021. the studies that examined the effectiveness of telecardiology interventions were included. RESULTS Fifty studies were included in this systematic review. Most investigations (22%) were conducted in the US. In 22% of studies, telecardiology intervention was used for patients with heart failure. Telecardiology has been used in most studies for tele-monitoring (n = 21, 42%) and tele-consultation (n = 17, 34%) and in 29 studies (58%), was applied for ECG transmission. The highest rate of effects reported by studies was clinical. Thirty-five studies (70%) reported the clinical effects; twenty-one studies reported the positive effects for the economic category, and fifteen studies reported the positive effect for patient-reported class. The most positive clinical effects of telecardiology were early diagnosis, early treatment, and mortality reduction. The most positive effect of the economic class was the reduction of health care costs. The most effects of the patient-reported category were improving the patient's quality of life and patient satisfaction. CONCLUSION Telecardiology can help early diagnosis and treatment of cardiovascular diseases. It also has great potential in reducing health care costs and increasing quality of life and patient satisfaction.
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Affiliation(s)
- Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorayya Rezayi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Tanhapour
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Saeedi
- Clinical Research Development Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran; Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Casani A, Tozzi N, Cocca F. The impact of neonatologist performed echocardiography in an Italian neonatal unit. J Neonatal Perinatal Med 2021; 15:237-242. [PMID: 34864692 DOI: 10.3233/npm-210811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The main goal of neonatologist performed echocardiography is to timely assess hemodynamic changes in order to properly manage unsteady neonates. Detailed structural heart assessment remains the domain of pediatric cardiologists. Nonetheless, many neonatologists take on an additional role in diagnosis of congenital heart defects, mostly compelled by the lack of in-house pediatric cardiology services. The experience of neonatologist performed echocardiography in an Italian neonatal unit was reported and the risk benefit profile of this practice was discussed. MATERIAL AND METHODS We retrospectively reviewed the echocardiograms undertaken by the neonatologist on infants admitted to the neonatal unit and postnatal ward of the Hospital San Pio in Benevento, over a 2-year period. Details of scans and concordance between neonatologist and cardiologist were analyzed. RESULTS A total of 160 echocardiographic studies were done by the neonatologist on 136 infants. The ECG was requested in a minority of infants. The most common reason for performing the echocardiogram was admission to the neonatal care unit. Around half of the echocardiograms were normal. The remaining scans resulted in functional and structural abnormalities, transitional changes, and doubtful findings. Cardiac anomalies were significantly more likely found in cases of echocardiograms performed for fetal indications. Only 28 patients were eventually referred to the cardiology services. The inter-rater agreement was satisfactory. CONCLUSIONS The hemodynamic assessment of sick infants, as well as triaging and referral of neonates with structural heart diseases are valuable advantages of the echocardiography run by neonatologists.Collaboration with pediatric cardiologists and robust training and accreditation programs are essential to ensure safety and quality service.
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Affiliation(s)
- A Casani
- Neonatal Intensive Care Unit, Maternal and Child Health Department, AO San Pio, Benevento, Italy
| | - N Tozzi
- Division of Cardiology, Interventional Cardiology, and Coronary Care Unit, Thoracic and Cardiovascular Department, AO San Pio, Benevento, Italy
| | - F Cocca
- Neonatal Intensive Care Unit, Maternal and Child Health Department, AO San Pio, Benevento, Italy
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Cardiac point of care ultrasound in resource limited settings to manage children with congenital and acquired heart disease. Cardiol Young 2021; 31:1651-1657. [PMID: 33682650 DOI: 10.1017/s1047951121000834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In resource limited settings, children with cardiac disease present late, have poor outcomes and access to paediatric cardiology programmes is limited. Cardiac point of care ultrasound was introduced at several Médecins Sans Frontières sites to facilitate cardiopulmonary assessment. We describe the spectrum of disease, case management and outcomes of cases reviewed over the Telemedicine platform. METHODS Previously ultrasound naïve, remotely placed clinical teams received ultrasound training on focussed image acquisition. The Médecins Sans Frontières Telemedicine platform was utilised for remote case and imaging review to diagnose congenital and acquired heart disease and guide management supported by a remotely situated paediatric cardiologist. RESULTS Two-hundred thirty-three cases were reviewed between 2016 and 2018. Of 191 who underwent focussed cardiac ultrasound, diagnoses included atrial and ventricular septal defects 11%, atrioventricular septal defects 7%, Tetralogy of Fallot 9%, cardiomyopathy/myocarditis 8%, rheumatic heart disease 8%, isolated pericardiac effusion 6%, complex congenital heart disease 4% and multiple other diagnoses in 15%. In 17%, there was no identifiable abnormality while 15% had inadequate imaging to make a diagnosis. Cardiologist involvement led to management changes in 75% of cases with a diagnosis. Mortality in the entire group was disproportionately higher among neonates (38%, 11/29) and infants (20%, 16/81). There was good agreement on independent review of selected cases between two independent paediatric cardiologists. CONCLUSION Cardiac point of care ultrasound performed by remote clinical teams facilitated diagnosis and influenced management in cases reviewed over a Telemedicine platform. This is a feasible method to support clinical care in resource limited settings.
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Perdue A, Mullett C, Umer A, Rosen P. Utility of telemedicine in pediatric rheumatology during the COVID-19 pandemic. Pediatr Rheumatol Online J 2021; 19:148. [PMID: 34593000 PMCID: PMC8481105 DOI: 10.1186/s12969-021-00624-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telemedicine has provided an alternative to in-person visits for patients practicing social distancing and undergoing quarantine. During this time, there has been a rapid expansion of telemedicine and its implementation in various clinical specialties and settings. In this observational study we aim to examine the utility of telemedicine in a pediatric rheumatology clinic, for 3 months during the COVID-19 pandemic. METHODS A review of outpatient pediatric rheumatology telemedicine encounters were conducted from April-June 2020. Telemedicine visits (n = 75) were compared to patients seen in practice over the prior year in office-based visits (March 2019-March 2020) (n = 415). Patient characteristics, information on no-show visits, completed visits, new patient or follow-up status, and if new patients had received a visit within 2 weeks of calling to schedule an appointment were analyzed by chart review. An independent sample t-test and Chi Square statistic was used to determine statical significance between the two groups. A two-proportion z-test was used to compare visit metrics. RESULTS The percentage of new patients utilizing telemedicine (60%) was lower and statistically significant compared to the percentage of new patient office visits (84%) the previous year (p < 0.0001). There was no change in no-show rate between groups and patient characteristics were similar. CONCLUSIONS This study demonstrates a statistically significant decrease in new patient visits during the pandemic with telemedicine-only appointments compared to in-office visits over the previous year. This suggests a possible hesitation to seek care during this time. However, there was no significant difference among patient characteristics between telemedicine visits during the pandemic and during in-office visits in the previous year. In our experience, patient visits were able to be conducted via telemedicine with a limited physical exam using caregiver's help during the pandemic. However, further studies will need to ascertain patient satisfaction and preference for telemedicine in the future.
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Affiliation(s)
- Ashley Perdue
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA.
| | - Charles Mullett
- grid.268154.c0000 0001 2156 6140West Virginia University School of Medicine, Morgantown, WV USA
| | - Amna Umer
- grid.268154.c0000 0001 2156 6140Department of Pediatrics/Research, West Virginia University, Morgantown, WV USA
| | - Paul Rosen
- grid.268154.c0000 0001 2156 6140West Virginia University School of Medicine, Morgantown, WV USA
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Duncan-Park S, Dunphy C, Becker J, D’Urso C, Annunziato R, Blatter J, Conrad C, Goldfarb SB, Hayes D, Melicoff E, Schecter M, Visner G, Armstrong B, Chin H, Kesler K, Williams NM, Odim JN, Sweet SC, Danziger-Isakov L, Shemesh E. Remote intervention engagement and outcomes in the Clinical Trials in Organ Transplantation in Children consortium multisite trial. Am J Transplant 2021; 21:3112-3122. [PMID: 33752251 PMCID: PMC8856090 DOI: 10.1111/ajt.16567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 01/25/2023]
Abstract
Remote interventions are increasingly used in transplant medicine but have rarely been rigorously evaluated. We investigated a remote intervention targeting immunosuppressant management in pediatric lung transplant recipients. Patients were recruited from a larger multisite trial if they had a Medication Level Variability Index (MLVI) ≥2.0, indicating worrisome tacrolimus level fluctuation. The manualized intervention included three weekly phone calls and regular follow-up calls. A comparison group included patients who met enrollment criteria after the subprotocol ended. Outcomes were defined before the intent-to-treat analysis. Feasibility was defined as ≥50% of participants completing the weekly calls. MLVI was compared pre- and 180 days postenrollment and between intervention and comparison groups. Of 18 eligible patients, 15 enrolled. Seven additional patients served as the comparison. Seventy-five percent of participants completed ≥3 weekly calls; average time on protocol was 257.7 days. Average intervention group MLVI was significantly lower (indicating improved blood level stability) at 180 days postenrollment (2.9 ± 1.29) compared with pre-enrollment (4.6 ± 2.10), p = .02. At 180 days, MLVI decreased by 1.6 points in the intervention group but increased by 0.6 in the comparison group (p = .054). Participants successfully engaged in a long-term remote intervention, and their medication blood levels stabilized. NCT02266888.
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Affiliation(s)
- Sarah Duncan-Park
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children’s Hospital, New York, New York,Fordham University, Department of Psychology, Bronx, New York
| | - Claire Dunphy
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children’s Hospital, New York, New York,Fordham University, Department of Psychology, Bronx, New York
| | - Jacqueline Becker
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children’s Hospital, New York, New York
| | - Christine D’Urso
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children’s Hospital, New York, New York
| | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children’s Hospital, New York, New York,Fordham University, Department of Psychology, Bronx, New York
| | | | - Carol Conrad
- Lucille Packard Children’s Hospital, Palo Alto, California
| | | | - Don Hayes
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Marc Schecter
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Gary Visner
- Boston Children’s Hospital, Boston, Massachusetts
| | | | | | | | | | - Jonah N Odim
- National Institutes of Health, NIAID, Bethesda, Maryland
| | | | | | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children’s Hospital, New York, New York
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Establishment of a cardiac telehealth program to support cardiovascular diagnosis and care in a remote, resource-poor setting in Uganda. PLoS One 2021; 16:e0255918. [PMID: 34358281 PMCID: PMC8345851 DOI: 10.1371/journal.pone.0255918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. Methods All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by cardiologists in Kampala; and 5) communication of results to patients/families in Gulu. Clinical care and technical aspects were tracked. Diagnoses and recommendations were analyzed by age groups (0–5 years, 6–21 years, 22–50 years and > 50 years). A mixed methods approach involving interviews and surveys was used to assess patient satisfaction. Healthcare sector costs of telemedicine-based cardiovascular care were estimated using time-driven activity-based costing. Results Normal studies made up 47%, 55%, 76% and 45% of 1,324 patients in the four age groups from youngest to oldest. Valvular heart disease (predominantly rheumatic heart disease) was the most common diagnosis in the older three age groups. Medications were prescribed to 31%, 31%, 24%, and 48% of patients in the four age groups. The median time for consultation was 7 days. A thematic analysis of focus group transcripts displayed an overall acceptance and appreciation for telemedicine, citing cost- and time-saving benefits. The cost of telemedicine was $29.48/visit. Conclusions Our data show that transmission and interpretation of echocardiograms from a remote clinic in northern Uganda is feasible, serves a population with a high burden of heart disease, has a significant impact on patient care, is favorably received by patients, and can be delivered at low cost. Further study is needed to better assess the impact relative to existing standards of care and cost effectiveness.
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Abstract
Over a century of innovations in technology and medical care have led to the current day capabilities in telemedicine. In this chapter, we discuss the evolution of telemedicine over the last century and highlight various applications in neonatal care. We hope this chapter demonstrates the exponential adoption of telemedicine, particularly in neonatology, and the breadth and depth of the technology being used.
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16
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Bunnell BE, Kazantzis N, Paige SR, Barrera J, Thakkar RN, Turner D, Welch BM. Provision of Care by "Real World" Telemental Health Providers. Front Psychol 2021; 12:653652. [PMID: 34025519 PMCID: PMC8138039 DOI: 10.3389/fpsyg.2021.653652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Despite its effectiveness, limited research has examined the provision of telemental health (TMH) and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy (CBT) in their remote practice. The most commonly used in-session and between-session (i.e., homework) exercises included coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Institute for Social Neuroscience Psychology, Melbourne, VIC, Australia
| | | | - Janelle Barrera
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Rajvi N. Thakkar
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Dylan Turner
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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Abstract
PURPOSE OF REVIEW Telehealth in neonatology is a rapidly expanding modality for providing care to neonatal patient populations. In this review, we describe the most recent published innovations in neonatal telehealth, spanning the neonatal ICU (NICU), community/rural hospitals and the patient's home. RECENT FINDINGS Telemedicine for neonatal subspecialty care has continued to expand, from well established uses in retinopathy of prematurity screening and tele-echocardiography, to applications in genetics and neurology. Within the NICU itself, neonatologist-led remote rounding has been shown to be a feasible method of increasing access to expert care for neonates in rural hospitals. Telehealth has improved parental and caregiver education, eased the NICU-to-home transition experience and expanded access to lactation services for rural mothers. Telemedicine-assisted neonatal resuscitation has improved the quality of resuscitation and reduced unnecessary neonatal transports to higher levels of care. Finally, the global COVID-19 pandemic has accelerated the expansion of neonatal telehealth. SUMMARY Telehealth provides increased access to expert neonatal care and improves patient outcomes, while reducing the cost of care for neonates in diverse settings. Continued high-quality investigation of the impacts of telehealth on patient outcomes and healthcare systems is critical to the continued development of neonatal telemedicine best practices.
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Affiliation(s)
| | - Kelli Lund
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Trang Huynh
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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18
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Phillips AA, Sable CA, Atabaki SM, Waggaman C, Bost JE, Harahsheh AS. Ambulatory cardiology telemedicine: a large academic pediatric center experience. J Investig Med 2021; 69:1372-1376. [DOI: 10.1136/jim-2021-001800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/31/2022]
Abstract
We performed a retrospective study of cardiology telemedicine visits at a large academic pediatric center between 2016 and 2019 (pre COVID-19). Telemedicine patient visits were matched to data from their previous in-person visits, to evaluate any significant differences in total charge, insurance compensation, patient payment, percent reimbursement and zero reimbursement. Miles were measured between patient’s home and the address of previous visit. We found statistically significant differences in mean charges of telemedicine versus in-person visits (2019US$) (172.95 vs 218.27, p=0.0046), patient payment for telemedicine visits versus in-person visits (2019US$) (11.13 vs 62.83, p≤0.001), insurance reimbursement (2019US$) (65.18 vs 110.85, p≤0.001) and insurance reimbursement rate (43% vs 61%, p=0.0029). Rate of zero reimbursement was not different. Mean distance from cardiology clinic was 35 miles. No adverse outcomes were detected. This small retrospective study showed cost reduction and a decrease in travel time for families participating in telemedicine visits. Future work is needed to enhance compensation for telemedicine visits.
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19
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Makkar A, Milsten J, McCoy M, Szyld EG, Lapadula MC, Ganguly A, DeShea LA, Ponniah U. Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System. Telemed J E Health 2021; 27:1136-1142. [PMID: 33449839 DOI: 10.1089/tmj.2020.0440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: The nationwide shortage of pediatric cardiologists in medically underserved areas poses a challenge to congenital heart disease (CHD) screening requiring echocardiography, resulting in transfer of neonates to regional Level III/IV Neonatal Intensive Care Units (NICUs). This study aimed to evaluate the accuracy, safety, and cost-effectiveness of tele-echocardiography for advanced CHD screening at a Level II NICU managed by a hybrid telemedicine system. Methods: Retrospective chart review of infants requiring tele-echocardiography at a Level II NICU. Patient demographics, echocardiography indications, and findings were analyzed. Agreement between tele-echocardiography and conventional echocardiography findings was assessed. Transport cost savings were calculated based on preventable transfers to Level IV NICU. Descriptive statistics were computed for demographic and clinical variables. Results: Over 5 years, 52 infants were screened for CHD. Thirty-two infants (62%) had findings consistent with minor CHD or normal neonatal transitional physiology. Twenty infants (38%) had abnormal findings requiring follow-up with either a conventional echocardiography as inpatient at the regional Level IV NICU or as outpatient after discharge. Only 5 infants (10%) required transfer to a Level IV NICU for CHD management, whereas 15 infants (29%) were scheduled for outpatient follow-up. Strong agreement was noted between tele-echocardiography and conventional echocardiography findings. No case of critical congenital heart disease (CCHD) was missed. Tele-echocardiography saved $260,000 in transport costs. Conclusions: Tele-echocardiography can be accurate, safe, and effective in CHD screening, preventing unnecessary transfer of most infants to regional Level III/IV NICUs, saving transfer costs.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer Milsten
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Edgardo G Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria C Lapadula
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Abhrajit Ganguly
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lise A DeShea
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Umakumaran Ponniah
- Division of Cardiology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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20
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Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228525. [PMID: 33212979 PMCID: PMC7698537 DOI: 10.3390/ijerph17228525] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
Understanding what motivates mental health providers to use telemedicine (i.e., telemental health) is critical for optimizing its uptake, especially during unprecedented times (e.g., the COVID-19 pandemic). Drawing from the Technology Acceptance Model (TAM), this report examined the characteristics of telemental health providers and how the acceptability of telemedicine features contributes to their intention to use the technology more often in practice. Telemental health providers (N = 177) completed an online survey between March and May 2019. Most providers (75%) spent less than 25% of their work-week using telemedicine, but 70% reported an intention to use telemedicine more in the future. The belief that telemedicine affords greater access to patients, work-life balance, flexibility in providing care, and the opportunity to be at the forefront of innovative care were significant predictors of intentions to use the technology more in the future. Other significant predictors included needing assistance to coordinate insurance reimbursements, manage a successful telemedicine practice, and integrate the telemedicine program with other health IT software. Findings have important implications for increasing the frequency of telemedicine use among telemental health providers. Future research and practice should leverage providers' positive beliefs about telemedicine acceptability and consider their needs to enhance its uptake.
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21
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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22
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Data S, Mukama M, McMillan D, Singhal N, Bajunirwe F. First-step validation of a text message-based application for newborn clinical management among pediatricians. BMC Pediatr 2020; 20:406. [PMID: 32854664 PMCID: PMC7450570 DOI: 10.1186/s12887-020-02307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/20/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neonatal mortality is high in developing countries. Lack of adequate training and insufficient management skills for sick newborn care contribute to these deaths. We developed a phone application dubbed Protecting Infants Remotely by Short Message Service (PRISMS). The PRISMS application uses routine clinical assessments with algorithms to provide newborn clinical management suggestions. We measured the feasibility, acceptability and efficacy of PRISMS by comparing its clinical case management suggestions with those of experienced pediatricians as the gold standard. METHODS Twelve different newborn case scenarios developed by pediatrics residents, based on real cases they had seen, were managed by pediatricians and PRISMS®. Each pediatrician was randomly assigned six of twelve cases. Pediatricians developed clinical case management plans for all assigned cases and then obtained PRISMS suggested clinical case managements. We calculated percent agreement and kappa (k) statistics to test the null hypothesis that pediatrician and PRISMS management plans were independent. RESULTS We found high level of agreement between pediatricians and PRISMS for components of newborn care including: 10% dextrose (Agreement = 73.8%), normal saline (Agreement = 73.8%), anticonvulsants (Agreement = 100%), blood transfusion (Agreement =81%), phototherapy (Agreement = 90.5%), and supplemental oxygen (agreement = 69.1%). However, we found poor agreement with potential investigations such as complete blood count, blood culture and lumbar puncture. PRISMS had a user satisfaction score of 3.8 out of 5 (range 1 = strongly disagree, 5 = strongly agree) and an average PRISMS user experience score of 4.1 out of 5 (range 1 = very bad, 5 = very good). CONCLUSION Management plans for newborn care from PRISMS showed good agreement with management plans from experienced Pediatricians. We acknowledge that the level of agreement was low in some aspects of newborn care.
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Affiliation(s)
- Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.
- Consortium for Affordable Medical Technologies in Uganda, Mbarara, Uganda.
| | - Martin Mukama
- Consortium for Affordable Medical Technologies in Uganda, Mbarara, Uganda
| | - Douglas McMillan
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Uwaezuoke SN, Ndu IK, Eneh CI, Anusiem CA, Ayuk AC. A short course of oral ranitidine as a novel treatment for toddler's diarrhea: a parallel-group randomized controlled trial. BMC Pediatr 2020; 20:380. [PMID: 32781992 PMCID: PMC7422520 DOI: 10.1186/s12887-020-02267-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The current paradigm for treating toddler's diarrhea comprises dietary modification and fluid restriction. Previous studies show that probiotics and proton-pump inhibitors (PPIs) or H2 blockers could control diarrhea associated with functional gastrointestinal disorders (FGIDs). This study aims to determine and compare the efficacy of a short course of oral ranitidine and a probiotic in the treatment of toddler's diarrhea. METHODS This study was a parallel-group randomized controlled trial (RCT). We sequentially enrolled 40 patients who met the eligibility criteria. We randomly assigned 20 patients to the oral ranitidine group, ten patients to the probiotic group, and ten patients to the placebo group. In the oral ranitidine group, patients received oral ranitidine (3 mg/kg/day) once daily for 10 days; in the probiotic and placebo groups, they were administered 5 to 10 billion colony-forming units (CFUs) per day of lyophilized Lactobacillus rhamnosus and 50 mg of once-daily oral vitamin C tablet respectively for 10 days. Stool frequency and consistency on the 10th day of the interventions were recorded as the primary outcomes. We used the Student's t-test to determine if there were significant differences in the mean daily stool frequencies in the three intervention groups. A p-value < 0.05 was adopted as the level of statistical significance. RESULTS In the ranitidine group, stool frequency decreased significantly from an average of five per day on the first day to an average of approximately one per day on the 10th day of intervention (t = 10.462, p < 0.001). Additionally, stool consistency normalized on the 10th day of intervention. In the probiotic group, there was a significant reduction in stool frequency from an average of five per day on the first day to four per day on the 10th day (t = 2.586, p = 0.041), although stool consistency remained loose. However, stool consistency and frequency were not significantly affected in the placebo group (t = 1.964, p = 0.072). CONCLUSION Oral ranitidine is more effective than probiotics in reducing stool frequency and normalizing stool consistency in toddler's diarrhea. We recommend multi-center trials with appropriate study designs to confirm and validate this finding. TRIAL REGISTRATION ISRCTN, ISRCTN10783996 . Registered 8 April 2016-Registered retrospectively.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Pediatrics, University of Nigeria of Nigeria Teaching Hospital Ituku-Ozalla Enugu/College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
| | - Ikenna K Ndu
- Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chizoma I Eneh
- Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chikere A Anusiem
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
- Harvard University, Cambridge, USA
| | - Adaeze C Ayuk
- Department of Pediatrics, University of Nigeria of Nigeria Teaching Hospital Ituku-Ozalla Enugu/College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
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Scope of telemedicine in neonatology. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020. [PMID: 32434631 PMCID: PMC7389396 DOI: 10.7499/j.issn.1008-8830.2001135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is a widespread shortage of physicians worldwide, especially in rural areas. This shortage is more prevalent when it comes to subspecialty care, even in developed countries. One way to provide access to specialty care is using technology via telemedicine. Telemedicine has evolved over the last two decades, and its use is becoming widespread in developed countries. However, its use in the neonatal population is still limited and practiced only in some centers. It is now apparent that telemedicine can be successfully used in the neonatal population for screening premature infants for retinopathy of prematurity, congenital heart disease, bedside clinical rounds, neonatal resuscitation with the support of a tertiary care hospital, and family support. This avoids unnecessary transfer and appears to provide the same quality of care that the baby would have received at the tertiary care facility. This approach also improves family satisfaction, as the baby and the mother are kept together, and reduces the cost of care. This review focuses on the use of telemedicine in neonatal care, concentrating on the main areas where telemedicine has been shown to be successful and effective, including the status of telemedicine in China.
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Enhancing the Sustainable Goal of Access to Healthcare: Findings from a Literature Review on Telemedicine Employment in Rural Areas. SUSTAINABILITY 2020. [DOI: 10.3390/su12083318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fighting health inequalities is a challenge addressed by the United Nations Strategic Development Goals (UN-SDGs). Particularly, people living in rural areas suffer from a lack of health infrastructure, which would jeopardize their inclusion in universal coverage for specialist care. Delivering valuable healthcare in underserved areas can be achieved through the employment of new technical innovations, such as telemedicine, which improves service delivery processes. Accordingly, this paper discusses how telemedicine strategies have enhanced the sustainability of right of “access to healthcare” in rural areas. Once we derived the sustainability pillars for healthcare from the UN-SDGs 3 and 10 according to the WHO innovation assessment metrics, a PRISMA-based literature review was conducted using the Scopus database. English, peer-reviewed articles/reviews from 1973 to 2019 were considered. The enquiry covers two analyses: (i) quantitative-bibliometric on 2267 papers; and (ii) qualitative-narrative on the 30 most significant papers. Interest about the topic has increased in the last decade following digitalization diffusion. The most productive and collaborative countries are those with huge dimensions and under financial restrictions. From a sustainability-oriented standpoint, telemedicine enhances both emergency and diagnostic healthcare in rural areas by decreasing the cost of services, expanding coverage of specialist cares, and increasing the quality of the outcomes. For health policies, telemedicine can be considered a suitable solution for providing cost-effective and sustainable healthcare.
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Telehealth for Pediatric Cardiology Practitioners in the Time of COVID-19. Pediatr Cardiol 2020; 41:1081-1091. [PMID: 32656626 PMCID: PMC7354365 DOI: 10.1007/s00246-020-02411-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 01/18/2023]
Abstract
Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.
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Leary JC, Walsh KE, Morin RA, Schainker EG, Leyenaar JK. Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review. J Hosp Med 2019; 14:694-703. [PMID: 31532739 PMCID: PMC6827538 DOI: 10.12788/jhm.3268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the majority of children are hospitalized in nonchildren's hospitals, little is known about the quality and safety of pediatric care in community hospitals. OBJECTIVE The aim of this study was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in United States community hospitals. METHODS We performed a systematic literature search in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set in general, nonuniversity, or nonchildren's hospitals. We extracted data on study design, patient descriptors, and quality outcomes and assessed the risk of bias using modified Newcastle-Ottawa Scales. RESULTS A total of 44 articles met the inclusion criteria. Study designs, patient populations, and quality outcome measures were heterogeneous; only three clinical domains, (1) perinatal regionalization, (2) telemedicine, and (3) imaging radiation, were explored in multiple studies with consistent directionality of results. A total of 30 studies were observational, and 22 studies compared community hospital quality outcomes with other hospital types. The remaining 14 studies reported testing of interventions; 12 showed improved quality of care postintervention. All studies reported an outcome addressing safety, effectiveness, or efficiency, whereas timeliness, patient-centeredness, and equity were infrequently addressed. Risk of bias was moderate or high for 72% of studies. CONCLUSIONS Literature on the inpatient care of children in community hospitals is limited, making it difficult to evaluate healthcare quality. Measures of timeliness, patient-centeredness, and equity are underrepresented. The field would benefit from more multicenter collaborations to facilitate the application of robust study designs and to enable a systematic assessment of individual interventions and community hospital quality outcomes.
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Affiliation(s)
- Jana C Leary
- The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
- Corresponding Author: Jana C. Leary, MD, MS; E-mail: ; Telephone: 617-636-4624
| | - Kathleen E Walsh
- James M Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Rebecca A Morin
- Tufts University, Hirsh Health Sciences Library, Boston, Massachusetts
| | | | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Telehealth in Plastic Surgery: A Veterans Affairs Hospital Perspective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1840. [PMID: 30534478 PMCID: PMC6250470 DOI: 10.1097/gox.0000000000001840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Telemedicine is a rapidly growing tool since its invention in the 1950s. Recently, it has expanded to the field of plastic surgery. In the Connecticut VA System, there is 1 plastic surgeon at a central location for the state of Connecticut and southern Massachusetts. Our aim was to pilot a telehealth program for plastic surgery consultation within the VA to improve access to subspecialty care. We intend to discuss the value of telehealth as part of consultation services, and assess patient attitudes toward telemedicine. Methods: Patients in the Connecticut VA System referred for plastic surgery consultation for evaluation of nonurgent diagnoses, such as skin lesions, carpal tunnel syndrome, and chronic wounds, were invited to participate. After being appropriately consented according to Connecticut state law, patients completed a postvisit questionnaire rating their overall satisfaction, quality of interaction, and ability to communicate using a modified 10-point Likert scale. Means were calculated for numerical responses. Preference for future telehealth visits was reported as a percentage. Results: Forty-one of 44 eligible patients elected to participate. Of those patients, 83% (n = 34) stated they prefer telemedicine services for future visits. Patients rated overall satisfaction 9.2/10, overall quality of interaction 9.2/10, ability to communicate 9.3/10, and sound and video quality 8.6/10 and 9.0/10, respectively. Conclusion: Remote video telemedicine is a feasible method of plastic surgery consultation and results in high patient satisfaction. Further studies should focus on cost-effectiveness and ways to broaden the use of telehealth services in plastic surgery.
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Kim C, Cha H, Kang BS, Choi HJ, Lim TH, Oh J. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos. J Digit Imaging 2018; 29:347-56. [PMID: 26620200 DOI: 10.1007/s10278-015-9849-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %-and 100 cases of suspected pediatric appendicitis (static organ)-50 with signs of acute appendicitis and 50 with no findings of appendicitis-were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunmin Cha
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro(st), Guri-si, GyeongGi-do, 471-701, Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
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Abstract
OBJECTIVES The aims of this study were to identify locations of births in Arizona with critical CHD, as well as to assess the current use of pulse-oximetry screening and capacities of birth centres to manage a positive screen. Study design Infants (n=487) with a potentially critical CHD were identified from the Arizona Department of Health Services from 2012 and 2013; charts were retrospectively reviewed. Diagnosis was confirmed using echocardiographies. ArcGIS was used to generate maps to visualise the location of treating facility and mother's residence. Birth centres were surveyed to assess screening practices and capacities to manage critical CHD in 2015. RESULTS Of the 272 patients identified with critical CHD, 52% had been diagnosed prenatally. Patients travelled an average distance of 55.1 miles to their treating facility. Mortality was not related to prenatal diagnosis (p=0.30), living at a high elevation (p=0.82), or to distance travelled to the treating facility (p=0.68). Of 50 birth centres, 33 responded to the survey and all centres practiced critical CHD screening. A total of 25 centres could perform paediatric echocardiographies; 64% of these centres could digitally transmit echocardiograms. In all, 24 birth centres maintained access to prostaglandins. CONCLUSIONS Pulse-oximetry screening in newborns is currently implemented in the majority of Arizona hospitals. Although most centres could perform initial management steps following a positive screen, access to paediatric cardiology services was limited. Patients with critical CHD sometimes travelled a great distance to treating facilities. Digital transmission of echocardiograms or tele-echocardiography would reduce the distance travelled for the management of a positive screen, decrease the financial burden of transportation, and expedite care for critically ill neonates.
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Wilk AS, Chen LM. Interdependence in decision-making by medical consultants: implications for improving the efficiency of inpatient physician services. Hosp Pract (1995) 2017; 45:222-229. [PMID: 29125409 DOI: 10.1080/21548331.2017.1400369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Hospital administrators are seeking to improve efficiency in medical consultation services, yet whether consultants make decisions to provide more or less care is unknown. We examined how medical consultants account for prior consultants' care when determining whether to provide intensive consulting care or sign off in the treatment of complex surgical inpatients. We applied three distinct theoretical frameworks in the interpretation of our results. METHODS We performed a retrospective cohort study of consultants' care intensity, measured alternately using a dummy variable for providing two or more days consulting (versus one) and a continuous measure of total days consulting, with 100% Medicare claims data from 2007-2010. Our analytic samples included consults for beneficiaries undergoing coronary artery bypass grafting (n = 61,785) or colectomy (n = 33,460) in general acute care hospitals. We compared the care intensity of consultants who observed different patterns of consulting care before their initial consults using ordinary least squares regression models at the patient-physician dyad level, controlling for patient comorbidity and many other patient- and physician-level factors as well as hospital region and year fixed effects. RESULTS Consultants were less likely to provide intensive consulting care with each additional prior consultant on the case (1.2-1.7 percent) or if a prior consultant rendered intensive consulting care (20.6-21.5 percent) but more likely when prior consults were more concentrated across consultants (2.9-3.1 percent). Effects on consultants' total days consulting were similar. CONCLUSION On average, consultants appeared to calibrate their care intensity for individual patients to maximize their value to all patients. Interventions for improving consulting care efficiency should seek to facilitate (not constrain) consultants' decision-making processes.
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Affiliation(s)
- Adam S Wilk
- a Department of Health Policy and Management, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Lena M Chen
- b Center for Health Outcomes and Policy , University of Michigan , Ann Arbor , MI , USA.,c Institute for Healthcare Policy and Innovation , University of Michigan , Ann Arbor , MI , USA.,d Division of General Medicine, Department of Internal Medicine , University of Michigan Health System , Ann Arbor , MI , USA
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Satou GM, Rheuban K, Alverson D, Lewin M, Mahnke C, Marcin J, Martin GR, Mazur LS, Sahn DJ, Shah S, Tuckson R, Webb CL, Sable CA. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e648-e678. [PMID: 28193604 DOI: 10.1161/cir.0000000000000478] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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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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Molinari G, Molinari M, Di Biase M, Brunetti ND. Telecardiology and its settings of application: An update. J Telemed Telecare 2017; 24:373-381. [PMID: 28084886 DOI: 10.1177/1357633x16689432] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Among the wide range of medical specialties in which telemedicine has been successfully applied, cardiology can be considered as one of the most important fields of application. Through the transmission of clinical data and the electrocardiogram, telecardiology allows access to a real-time assessment (teleconsultation) without any need to travel for both patient and cardiologist. This review discusses the impact of telecardiology in different clinical settings of application. Pre-hospital telecardiology has proved to be useful either in the clinical management of remote patients with acute coronary syndrome or in supporting the decision-making process of general practitioners. In the setting of in-hospital telecardiology, most of the applications refer to real-time echocardiography transmissions between rural small hospitals and tertiary care centres, particularly for the diagnosis or exclusion of congenital heart disease in newborns. Finally, many trials show that post-hospital telecardiology improves outcomes and reduces re-admissions or outpatient contacts in patients with heart failure, arrhythmias or implantable devices.
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Affiliation(s)
| | | | - Matteo Di Biase
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Natale D Brunetti
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
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Lopes EL, Beaton AZ, Nascimento BR, Tompsett A, Dos Santos JP, Perlman L, Diamantino AC, Oliveira KK, Oliveira CM, Nunes MDCP, Bonisson L, Ribeiro AL, Sable C. Telehealth solutions to enable global collaboration in rheumatic heart disease screening. J Telemed Telecare 2016; 24:101-109. [PMID: 27815494 DOI: 10.1177/1357633x16677902] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle income countries can improve access to echocardiography for rheumatic heart disease.
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Affiliation(s)
- Eduardo Lv Lopes
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | | | | | | | | | | | | | - Cassio M Oliveira
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | - Leonardo Bonisson
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
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Kornowski R, Zlochiver S, Botzer L, Tirosh R, Abboud S, Misan S. Validation of vital signs recorded via a new telecare system. J Telemed Telecare 2016; 9:328-33. [PMID: 14680516 DOI: 10.1258/135763303771005225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A telecare system (Medic4All) has been developed that relies on a wireless wristwatch-like sensor to measure the pulse wave from the radial artery. From this, the heart rate and respiration rate are derived. The system's performance was examined by comparing the results obtained from the pulse wave signal with those obtained from conventional electrocardiographic and spirometer devices. A total of 144 patients participated in the study; their mean (SD) age was 43 (18) years. There were 44 cardiac patients in group 1 and 100 healthy patients, who were studied in their homes, in group 2. There was a significant correlation between the heart rates measured by the two monitoring methods. A ‘difference versus average’ analysis showed that the error distribution had a mean (SD) value of – 0.1 (3.3) beats/min. Similarly, the respiration rates measured by the two techniques were significantly correlated. The error distribution had a mean (SD) value of 0.1 (1.9) respirations/min. The present study suggests that the wrist-worn sensor represents a promising tool for online detection and monitoring of vital signs in the home.
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Affiliation(s)
- Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
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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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Abstract
This article examines the current role of telehealth as a tool in the delivery of pediatric health care. It defines telemedicine and telehealth and provides an overview of different types of telehealth services. The article then explores the potential of telehealth to improve pediatric health care quality and safety through increased access to care, enhanced communication, expanded educational opportunities, and better resource utilization. It also discusses current challenges to the implementation of telehealth, including technological, financial, and licensing barriers, as well as provider, patient, and legal concerns.
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Affiliation(s)
- Levon Utidjian
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1024, Room 1080, Philadelphia, PA 19104, USA.
| | - Erika Abramson
- Department of Pediatrics, Weill Cornell Medicine, 525 E 68th Street, Rm M610A, New York, NY 10065, USA; Healthcare Policy and Research, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA
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Abstract
Cardiovascular disease is one of the main fields of application for telemedicine, with benefits in almost all areas in the continuum of cardiovascular disease. The greatest impact has been shown in the early diagnosis of cardiovascular disease, in second consultation, between non-cardiologist and cardiologist and between cardiologists, and in follow-up and secondary prevention of cardiovascular disease. At present, the main area of implementation for telemedicine in cardiovascular disease is represented by pre-hospital triage, with telemedicine electrocardiogram in acute myocardial infarction. Significant results have also been achieved in the second opinion consultation of pediatric subjects with congenital cardiovascular disease, home-monitoring and the management of patients affected by chronic heart failure or with an implanted device. However, there is significant room for further improvement in delivering telemedicine assistance even in 'very-remote' populations, such as detainees, patients in developing countries or in underdeveloped areas of developed countries.
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Affiliation(s)
| | - Simonetta Scalvini
- b U.O. Cardiologia Riabilitativa , IRCCS Fondazione Salvatore Maugeri , Brescia , Italy
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Jury SC, Kornberg AJ. Data review of an ongoing telehealth programme in a tertiary paediatric hospital. J Telemed Telecare 2015; 20:384-90. [PMID: 25399999 DOI: 10.1177/1357633x14552375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Royal Children's Hospital (RCH) in Melbourne has been providing teleconsultations since 2011 using web-based videoconferencing. We reviewed telehealth activity over the first 30 months of the programme. The average consultation rate was 14 per month in 2012, 39 in 2013 and 49 per month in the first half of 2014. One-third of all activity (265 out of 852 consultations) was provided by only two departments: neurology and respiratory medicine. By June 2014, 92% of departments (n = 34) had provided one or more video-consultations. Most telehealth activity was provided by just a few clinicians. A review of actual and billed activity between July 2013 and April 2014 showed that 36% of booked telehealth appointments (n = 144 of 395) were not billed to Medicare; financial and other processes have since been streamlined. A snapshot of telehealth activity over a two-month period was used to estimate the revenue from telehealth. Approximately 65 billed telehealth appointments per month would be required to fund a 0.6 FTE coordinator's post. Overall, the findings have been valuable in planning the future expansion of telehealth at the RCH.
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Affiliation(s)
- Susan C Jury
- Telehealth Department, Royal Children's Hospital, Melbourne, Australia
| | - Andrew J Kornberg
- Neurology Department, Royal Children's Hospital, Melbourne, Australia
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Kim C, Kang BS, Choi HJ, Lim TH, Oh J, Chee Y. Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED. Am J Emerg Med 2015; 33:1354-9. [PMID: 26306436 DOI: 10.1016/j.ajem.2015.07.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis. METHODS This prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis. The diagnostic confidence of each examiner (resident, remote expert, and onsite expert) was rated on a 5-point Likert scale. The appendix identification rate and the diagnostic values; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each type of examination were calculated. RESULTS A total of 115 pediatric cases with suspected acute appendicitis, including 36 with pathology-confirmed acute appendicitis, between June 2014 and February 2015 were enrolled in this study. In 9 of the 115 (7.8%) cases, a non-appendicitis diagnosis was determined in the absence of the successful identification of a normal appendix upon resident examination. Of these, seven appendices were identified upon expert tele-ultrasonography. The diagnostic values for expert tele-ultrasonography were higher (sensitivity: 1.000, specificity: 0.975, PPV: 0.947, NPV: 1.000) than those for resident-performed ultrasonography (sensitivity: 0.917, specificity: 0.899, PPV: 0.805, NPV: 0.959) and similar to those for onsite expert-performed ultrasonography (sensitivity: 1.000, specificity: 0.987, PPV: 0.973, NPV: 1.000). CONCLUSION Tele-ultrasonography with tele-mentoring between EM residents and experienced mentors was effectively applied in diagnosing pediatric acute appendicitis in an emergency clinical setting.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Youngjoon Chee
- School of Electrical Engineering, Ulsan University, Republic of Korea
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Garingo A, Friedlich P, Chavez T, Tesoriero L, Patil S, Jackson P, Seri I. "Tele-rounding" with a remotely controlled mobile robot in the neonatal intensive care unit. J Telemed Telecare 2015; 22:132-8. [PMID: 26116855 DOI: 10.1177/1357633x15589478] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/24/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the feasibility of 'tele-rounding' in the neonatal intensive care. METHODS In this prospective study utilizing telemedicine technology in the NICU for daily patient bedside rounds ('tele-rounds'), twenty pairs of neonates were matched according to gestational age, diagnoses, and disease severity. One patient was cared for by the on-site NICU team lead by an on-site neonatologist. The other patient was cared for by the on-site team but led by an off-site neonatologist using a remote-controlled robot. Patient rounding data, clinical outcomes, length of stay, and hospital costs were compared between the two groups. Parents and staff were also surveyed about their satisfaction with telemedicine. RESULTS Except for one parameter, no significant differences in care or outcomes were found between patients cared for by either neonatologist. The exception was the time the off-site neonatologist spent on the patient encounter compared to the on-site neonatologist (median [interquartile range]), (5 minutes [5, 6] vs. 8 minutes [7, 10.5], p = 0.002). This difference was due primarily to time needed to operate and maneuver the robot or occasionally to slower or dropped connection to the Internet. There were positive perceptions of telemedicine among both parents and NICU staff. CONCLUSION As long as direct bedside care providers are available, remote-controlled, robotic telemedicine technology can be utilized by neonatologists to perform daily patient rounds in the neonatal intensive care unit.
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Affiliation(s)
- Arlene Garingo
- Department of Pediatrics, Children's Hospital Los Angeles, USA
| | | | - Thomas Chavez
- Department of Pediatrics, Children's Hospital Los Angeles, USA
| | - Linda Tesoriero
- Department of Pediatrics, Children's Hospital Los Angeles, USA
| | - Shilpa Patil
- Department of Pediatrics, Children's Hospital Los Angeles, USA
| | - Paige Jackson
- Department of Pediatrics, Children's Hospital Los Angeles, USA
| | - Istvan Seri
- Department of Pediatrics, Children's Hospital Los Angeles, USA
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Value of interactive scanning for improving the outcome of new-learners in transcontinental tele-echocardiography (VISION-in-Tele-Echo) study. J Am Soc Echocardiogr 2014; 28:75-87. [PMID: 25306222 DOI: 10.1016/j.echo.2014.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Point-of-care (POC) echocardiography may be helpful for mass triage, but such a strategy requires adequately trained sonographers at the remote site. The aim of this study was to test the feasibility of using a novel POC echocardiography training program for improving physicians' imaging skills during preanesthetic cardiac evaluations performed in a community camp organized for treating cataract blindness. METHODS Seventeen physicians were provided 6 hours of training in the use of POC echocardiography; nine were taught on site and eight were taught online through a transcontinental tele-echocardiography system. The trained physicians subsequently scanned elderly patients undergoing cataract surgery. The quality of images was graded, and agreement between local physicians' interpretations and Web-based interpretations by worldwide experts was compared. RESULTS A total of 968 studies were performed, with 660 used for validating physicians' competence. Major cardiac abnormalities were seen in 136 patients (14.2%), with 32 (3.3%) deemed prohibitive to surgery in unmonitored settings. Although good-quality images were obtained more frequently by physicians trained on site rather than online (P = .03), there were no differences between the two groups in agreement with expert interpretations. The majority of physicians (70.6%) expressed satisfaction with the training (average Likert-type scale score, 4.24 of 5), with no difference seen between the two groups. The training resulted in significant improvements in self-perceived competence in all components of POC echocardiography (P < .001 for all). CONCLUSIONS This study establishes the feasibility of using short-duration, one-on-one, personalized transcontinental tele-echocardiography education for wider dissemination of echocardiographic skills to local physicians in remote communities, essential for optimizing global cardiovascular health.
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Krishnan A, Fuska M, Dixon R, Sable CA. The Evolution of Pediatric Tele-echocardiography: 15-Year Experience of Over 10,000 Transmissions. Telemed J E Health 2014; 20:681-6. [DOI: 10.1089/tmj.2013.0279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anita Krishnan
- Children's National Heart Institute, Children's National Medical Center, Washington, D.C
| | - Mary Fuska
- Children's National Heart Institute, Children's National Medical Center, Washington, D.C
| | - Ron Dixon
- Children's National Heart Institute, Children's National Medical Center, Washington, D.C
| | - Craig A. Sable
- Children's National Heart Institute, Children's National Medical Center, Washington, D.C
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Siefkes HM, Hogan WJ, Flood SM, Ramsey KL, Reller MD, Starmer AJ, Phillipi CA. Impact of educational video on critical congenital heart disease screening. Clin Pediatr (Phila) 2014; 53:733-41. [PMID: 24607664 DOI: 10.1177/0009922814525992] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the status of pulse oximetry screening and barriers to implementing screening programs. METHODS This was a prospective pre-post intervention survey of nurse managers and medical directors of hospital-based birthing centers in Oregon, Idaho, and Southern Washington. The intervention was a 7-minute video demonstrating and discussing pulse oximetry screening for critical congenital heart disease. RESULTS Analysis of matched pairs showed a significant increase in the use of pulse oximetry screening during the study period from 52% to 73% (P < .0001). Following implementation of the video, the perception of all queried potential barriers decreased significantly among individuals from hospitals self-identified as nonscreening at baseline. Viewing the educational video was associated with an increase in the percentage of individuals from nonscreening hospitals that rated screening as "very beneficial" (45% vs 90%, P = .0001). CONCLUSIONS An educational video was associated with improved opinions of pulse oximetry screening among hospitals not currently screening.
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Affiliation(s)
- Heather M Siefkes
- Oregon Health & Science University, Portland, OR, USA University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Mark D Reller
- Oregon Health & Science University, Portland, OR, USA
| | - Amy J Starmer
- Oregon Health & Science University, Portland, OR, USA Harvard Medical School, Boston, MA, USA
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Otero AV, Lopez-Magallon AJ, Jaimes D, Motoa MV, Ruz M, Erdmenger J, Muñoz RA. International telemedicine in pediatric cardiac critical care: a multicenter experience. Telemed J E Health 2014; 20:619-25. [PMID: 24901442 DOI: 10.1089/tmj.2013.0307] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe our multicenter experience in telemedicine-assisted pediatric cardiac critical care (PCCC) with four hospitals in Latin America from July 2011 to June 2013. MATERIALS AND METHODS This was a descriptive study based on telemedicine encounters related to quality of communication, assessed information, activities, and recommendations. Comparison among centers was performed. A postimplementation survey was conducted through a 5-point Likert scale questionnaire investigating acceptance among professionals involved with the telemedicine service through the assessment of general satisfaction, perception about the work system, usefulness, and impact on medical practice. RESULTS One thousand forty consultations were conducted for 476 patients. Postoperatively, patients were distributed into Risk Adjustment Classification for Congenital Heart Surgery (RACHS-1) categories as follows: 2%, 26%, 36%, 26%, and 10% in categories 1, 2, 3, 4, and 6, respectively. A real-time intervention took place in 23% of encounters. Of the 2,173 recommendations given, 70 were related to extracorporeal membrane oxygenation management. There was a different RACHS-1 distribution and encounter characteristics among centers. From a total of 51 surveys sent, 27 responses were received, and among responders, overall satisfaction was very high (4.27 ± 0.18), as well as work system quality (4.4 ± 0.37). Telemedicine was considered useful in the cardiac intensive care unit (3.86 ± 0.60), for patient outcomes (3.8 ± 0.51), and for education (3.7 ± 0.71). There was a difference in overall satisfaction, perception about telemedicine usefulness in education, and impact on medical practice among centers. CONCLUSIONS An international, multicenter telemedicine program in PCCC is technologically and logistically feasible. Prospective interventions in our international multicenter telemedicine program should consider differences in staff composition, perception of needs, and patient population among centers.
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Affiliation(s)
- Andrea Victoria Otero
- 1 Division of Pediatric Cardiac Critical Care, Children's Hospital of the University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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Hishitani T, Fujimoto Y, Saito Y, Sugamoto K, Hoshino K, Ogawa K. A medical link between local maternity hospitals and a tertiary center using telediagnosis with fetal cardiac ultrasound image transmission. Pediatr Cardiol 2014; 35:652-7. [PMID: 24259010 DOI: 10.1007/s00246-013-0834-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
Information and communication technology has been widely applied to various fields, including clinical medicine. We report here a telediagnosis system using ultrasound image transmission. The effect of telediagnosis, using a medical link between local maternity hospitals and our children's medical center, was verified. The number of fetal telediagnosis for cardiac disease, and cases referred to a perinatal care center and emergent transportation of neonates with congenital heart disease from maternity hospitals, were calculated based on the hospital records. The percentage of patients found to have heart disease was compared between out-patient clinic and telediagnosis cases. Telediagnosis increased, allowing maternity hospital staff to obtain support easily from a specialist when making a diagnosis. Many severe cases were transferred to tertiary centers with the correct diagnosis; consequently, the number of emergent transportations of neonates with severe cardiac anomalies continued to below. Telediagnosis was also useful as an educational tool for maternity hospital staff, who improved their skills during conversations with a specialist. Unlike in the outpatient clinic, consultation by telediagnosis was requested even for cases of mild abnormalities, and the number of false-positives increased, while many cardiac anomalies were found in the early stage. Furthermore, telediagnosis was helpful for pregnant women requiring bed rest, and also had the advantage of allowing a doctor to be able to talk with parents. Establishing a fetal telediagnosis system is a useful strategy to improve neonatal care through a medical link between local maternity hospitals and a tertiary center.
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Affiliation(s)
- Takashi Hishitani
- Department of Cardiology, Saitama Children's Medical Center, Magome 2100, Iwatsuki-ku, Saitama-shi, Saitama, 339-8551, Japan,
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Abstract
Hospitals have, for centuries, maintained a central position in the health care system, providing care for critically ill patients. Despite being a cornerstone of health care delivery, we are witnessing the beginning of a major transformation in their function. There are several forces driving this transformation, including health care costs, shortage of health care professionals, volume of people with chronic diseases, consumerism, health care reform, and hospital errors. The neonatal intensive care unit (NICU) at Utah Valley Regional Medical Center in Provo, Utah, began an aggressive redesign/quality improvement effort in 1990. It became obvious that our care processes were designed for health care deliverers and not for the families. An ongoing revamp of our care delivery processes was undertaken using significant input from a parent focus meeting, parental interviews, and development of a parent-to-parent support group. As a result of this work, it became obvious we needed a new model to truly empower parents. The idea of "NICU is Home" was born. We elected to make a mind shift, not to focus on what families think, but rather on how they think. Web cams and other video apparatus have been used in a number of NICUs across the country. We decided our equipment requirements would need to include high-resolution cameras, full high-definition video recording, autofocus, audio microphones, automatic noise reduction, and automatic low-light correction. Our conferencing software needed to accommodate multiple users and have multiple-picture capabilities, low band width, and inexpensive technology. It was recognized that a single video camera feed was insufficient to adequately capture the desired amount of information. Verbal communication between parents and their babies' principal care providers is critical. Parents loved the idea of expanding the remote NICU web cam of their baby to a two-way physician-parent communication bedside monitor. Doctors at Utah Valley Regional Medical Center now have a mobile desk using a WiFi computer/camera/audio to communicate with the family in real-time or leave a recording.
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Hsieh JC, Li AH, Yang CC. Mobile, cloud, and big data computing: contributions, challenges, and new directions in telecardiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6131-53. [PMID: 24232290 PMCID: PMC3863891 DOI: 10.3390/ijerph10116131] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 12/26/2022]
Abstract
Many studies have indicated that computing technology can enable off-site cardiologists to read patients’ electrocardiograph (ECG), echocardiography (ECHO), and relevant images via smart phones during pre-hospital, in-hospital, and post-hospital teleconsultation, which not only identifies emergency cases in need of immediate treatment, but also prevents the unnecessary re-hospitalizations. Meanwhile, several studies have combined cloud computing and mobile computing to facilitate better storage, delivery, retrieval, and management of medical files for telecardiology. In the future, the aggregated ECG and images from hospitals worldwide will become big data, which should be used to develop an e-consultation program helping on-site practitioners deliver appropriate treatment. With information technology, real-time tele-consultation and tele-diagnosis of ECG and images can be practiced via an e-platform for clinical, research, and educational purposes. While being devoted to promote the application of information technology onto telecardiology, we need to resolve several issues: (1) data confidentiality in the cloud, (2) data interoperability among hospitals, and (3) network latency and accessibility. If these challenges are overcome, tele-consultation will be ubiquitous, easy to perform, inexpensive, and beneficial. Most importantly, these services will increase global collaboration and advance clinical practice, education, and scientific research in cardiology.
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Affiliation(s)
- Jui-Chien Hsieh
- Department of Information Management, Yuan Ze University, 135 Yuan-Tung Road, Chungli 32003, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-3-4638800 (ext. 2798); Fax: +886-3-4352077
| | - Ai-Hsien Li
- Cardiovascular Center, Far Eastern Memorial Hospital, Banchao, Taipei 220, Taiwan; E-Mail:
| | - Chung-Chi Yang
- Division of Cardiology, Department of Medicine, Taoyuan Armed Forces General Hospital, Longtan 325, Taiwan; E-Mail:
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Impact of Critical Care Telemedicine Consultations on Children in Rural Emergency Departments*. Crit Care Med 2013; 41:2388-95. [DOI: 10.1097/ccm.0b013e31828e9824] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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