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Antezana LA, Xie KZ, Yin LX, Bowen AJ, Yeakel S, Nassiri AM, Moore EJ. Performing parotidectomy postoperative follow-ups via telemedicine: Experience at a tertiary care, multiple-surgeon otolaryngology center. J Telemed Telecare 2024; 30:739-746. [PMID: 35549759 DOI: 10.1177/1357633x221095319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center. METHODS A retrospective case review was conducted of patients who underwent parotidectomy and postoperative video visits between November 2019 and December 2020. Success of video visit, plan if applicable, and post-visit outcomes were reviewed. Video visits were designated as successful if the physician could assess for complications in the postoperative course (e.g. first bite pain, Frey syndrome, ear numbness, unplanned visits to the emergency department, unplanned return to the operating room), perform examination of facial nerve function, and formulate care recommendations per clinical judgement without deferment of recommendations for a subsequent in-person visit. RESULTS There were 96 postoperative video visits with 91 unique parotidectomy patients. Demographics: 28/63 male/female; average age, 54y. All video visits were suitable for successful postoperative parotidectomy patient evaluation. Eight visits (8.3%) consisted of patients presenting with common postoperative complications (e.g. eye dryness, first bite pain) and warranted care recommendations. In only two cases did the patient require further in-person procedural (hematoma evacuation, seroma aspiration) follow-ups. For the other 91.7% of visits (n = 88), no additional recommendations were required as patients experienced uncomplicated postoperative courses. Of all the patients, 26.1% (n = 23) were instructed to follow-up for routine surveillance. All other patients, 73.9% (n = 65) were instructed to follow-up as needed. CONCLUSION Postoperative parotidectomy evaluation is highly amenable to being performed by video. A telemedicine option offers convenience for patients in the majority of cases without compromising clinical assessment and judgment for the physician.
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Affiliation(s)
- Luis A Antezana
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Katherine Z Xie
- *Luis Antezana and Katherine Xie are equally contributed to this paper
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley M Nassiri
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Garcia JP, Avila FR, Torres-Guzman RA, Maita KC, Lunde JJ, Coffey JD, Demaerschalk BM, Forte AJ. A narrative review of telemedicine and its adoption across specialties. Mhealth 2024; 10:19. [PMID: 38689613 PMCID: PMC11058596 DOI: 10.21037/mhealth-23-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/17/2023] [Indexed: 05/02/2024] Open
Abstract
Background and Objective Telemedicine and video consultation are crucial advancements in healthcare, allowing remote delivery of care. Telemedicine, encompassing various technologies like wearable devices, mobile health, and telemedicine, plays a significant role in managing illnesses and promoting wellness. The corona virus disease 2019 (COVID-19) pandemic accelerated the adoption of telemedicine, ensuring convenient access to medical services while maintaining physical distance. Legislation has supported its integration into clinical practice and addressed compensation issues. However, ensuring clinical appropriateness and sustainability of telemedicine post-expansion has gained attention. We south to identify the most friendly and resistant specialties to telemedicine and to understand areas of interest within those specialties to grasp potential barriers to its use. Methods We aimed to identify articles that incorporated telemedicine in any medical or surgical specialty and determine the adoption rate and intent of this new form of care. Additionally, a secondary search within these databases was conducted to analyze the advantages, disadvantages, and implementation of telemedicine in the healthcare system. Non-English articles and those without full text were excluded. The study selection and data collection process involved using search terms such as "medicine", "surgery", "specialties", "telemedicine", and "telemedicine". Key Content and Findings Telemedicine adoption varies among specialties. The pandemic led to increased usage, with telemedicine consultations comprising 30.1% of all visits, but specialties like mental health, gastroenterology, and endocrinology showed higher rates of adoption compared to optometry, physical therapy, and orthopedic surgery. Conclusions The data shows that telemedicine uptake varies by specialty and condition due to the need for physical exams. In-person visits still dominate new patient visits despite increased telemedicine use. Telemedicine cannot fully replace in-person care but has increased visit volume and is secure. The adoption of telemedicine is higher in medical practices than in surgical practices, with neurosurgery and urology leading. Further research is needed to assess telemedicine's suitability and effectiveness in different specialties and conditions.
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Affiliation(s)
- John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Bart M. Demaerschalk
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
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Grygorian A, Montano D, Shojaa M, Ferencak M, Schmitz N. Digital Health Interventions and Patient Safety in Abdominal Surgery: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e248555. [PMID: 38669018 PMCID: PMC11053376 DOI: 10.1001/jamanetworkopen.2024.8555] [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: 08/29/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Over the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these telemedicine interventions are associated with improved patient safety outcomes has not been assessed in systematic and meta-analytic reviews. Objective To estimate the implications of telemedicine interventions for complication and readmission rates in a population of patients with abdominal surgery. Data Sources PubMed, Cochrane Library, and Web of Science databases were queried to identify relevant randomized clinical trials (RCTs) and nonrandomized studies published from inception through February 2023 that compared perioperative telemedicine interventions with conventional care and reported at least 1 patient safety outcome. Study Selection Two reviewers independently screened the titles and abstracts to exclude irrelevant studies as well as assessed the full-text articles for eligibility. After exclusions, 11 RCTs and 8 cohort studies were included in the systematic review and meta-analysis and 7 were included in the narrative review. Data Extraction and Synthesis Data were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline and assessed for risk of bias by 2 reviewers. Meta-analytic estimates were obtained in random-effects models. Main Outcomes and Measures Number of complications, emergency department (ED) visits, and readmissions. Results A total of 19 studies (11 RCTs and 8 cohort studies) with 10 536 patients were included. The pooled risk ratio (RR) estimates associated with ED visits (RR, 0.78; 95% CI, 0.65-0.94) and readmissions (RR, 0.67; 95% CI, 0.58-0.78) favored the telemedicine group. There was no significant difference in the risk of complications between patients in the telemedicine and conventional care groups (RR, 1.05; 95% CI, 0.77-1.43). Conclusions and Relevance Findings of this systematic review and meta-analysis suggest that perioperative telehealth interventions are associated with reduced risk of readmissions and ED visits after abdominal surgery. However, the mechanisms of action for specific types of abdominal surgery are still largely unknown and warrant further research.
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Affiliation(s)
- Artem Grygorian
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Diego Montano
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Mahdieh Shojaa
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Maximilian Ferencak
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Norbert Schmitz
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
- Faculty of Medicine, Department of Psychiatry, McGill University, Montreal, Québec, Canada
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Lathan R, Hitchman L, Walshaw J, Ravindhran B, Carradice D, Smith G, Chetter I, Yiasemidou M. Telemedicine for sustainable postoperative follow-up: a prospective pilot study evaluating the hybrid life-cycle assessment approach to carbon footprint analysis. Front Surg 2024; 11:1300625. [PMID: 38562585 PMCID: PMC10982357 DOI: 10.3389/fsurg.2024.1300625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Surgical site infections (SSI) are the most common healthcare-associated infections; however, access to healthcare services, lack of patient awareness of signs, and inadequate wound surveillance can limit timely diagnosis. Telemedicine as a method for remote postoperative follow-up has been shown to improve healthcare efficiency without compromising clinical outcomes. Furthermore, telemedicine would reduce the carbon footprint of the National Health Service (NHS) through minimising patient travel, a significant contributor of carbon dioxide equivalent (CO2e) emissions. Adopting innovative approaches, such as telemedicine, could aid in the NHS Net-Zero target by 2045. This study aimed to provide a comprehensive analysis of the feasibility and sustainability of telemedicine postoperative follow-up for remote diagnosis of SSI. Methods Patients who underwent a lower limb vascular procedure were reviewed remotely at 30 days following the surgery, with a combined outcome measure (photographs and Bluebelle Wound Healing Questionnaire). A hybrid life-cycle assessment approach to carbon footprint analysis was used. The kilograms of carbon dioxide equivalent (kgCO2e) associated with remote methods were mapped prospectively. A simple outpatient clinic review, i.e., no further investigations or management required, was modelled for comparison. The Department of Environment, Food, and Rural Affairs (DEFRA) conversion factors plus healthcare specific sources were used to ascertain kgCO2e. Patient postcodes were applied to conversion factors based upon mode of travel to calculate kgCO2e for patient travel. Total and median (interquartile range) carbon emissions saved were presented for both patients with and without SSI. Results Altogether 31 patients (M:F 2.4, ±11.7 years) were included. The median return distance for patient travel was 42.5 (7.2-58.7) km. Median reduction in emissions using remote follow-up was 41.2 (24.5-80.3) kgCO2e per patient (P < 0.001). The carbon offsetting value of remote follow-up is planting one tree for every 6.9 patients. Total carbon footprint of face-to-face follow-up was 2,895.3 kgCO2e, compared with 1,301.3 kgCO2e when using a remote-first approach (P < 0.001). Carbon emissions due to participants without SSI were 700.2 kgCO2e by the clinical method and 28.8 kgCO2e from the remote follow-up. Discussion This model shows that the hybrid life-cycle assessment approach is achievable and reproducible. Implementation of an asynchronous digital follow-up model is effective in substantially reducing the carbon footprint of a tertiary vascular surgical centre. Further work is needed to corroborate these findings on a larger scale, quantify the impact of telemedicine on patient's quality of life, and incorporate kgCO2e into the cost analysis of potential SSI monitoring strategies.
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Affiliation(s)
- Ross Lathan
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - Louise Hitchman
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Bharadhwaj Ravindhran
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - George Smith
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
| | - Marina Yiasemidou
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
- The Royal London, Barts Health NHS Trust, London, United Kingdom
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O'Connor AL, Shmelev A, Shettig A, Santucci NM, Bray J, Bazarian A, Orenstein SB, Nikolian VC. Assessing Patient-Reported Experiences for In-Person and Telemedicine-Based Preoperative Evaluations. Telemed J E Health 2024; 30:472-479. [PMID: 37624627 DOI: 10.1089/tmj.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background: The COVID-19 pandemic has transformed health care delivery through the rise of telehealth solutions. Though telemedicine-based care has been identified as safe and feasible in postoperative care, data on initial surgical consultations in the preoperative setting are lacking. We sought to compare patient characteristics, anticipated downstream care utilization, and patient-reported experiences (PREs) for in-person versus telemedicine-based care conducted for initial consultation encounters at a hernia and abdominal wall center. Methods: Patients evaluated at an abdominal wall reconstruction center from August 2021 to August 2022 were prospectively surveyed. Patient characteristics, anticipated downstream care utilization, and PREs were compared. Results: Of the 176 respondents, 50.6% (n = 89) utilized telemedicine-based care and had similar demographic and disease characteristics to those receiving in-person care. Telemedicine-based care saved a median of 47 min [interquartile range 20-112.5 min] of round-trip travel time per patient, with 10.1% of encounters resulting in supplemental in-person evaluation. A large proportion of telemedicine-based and in-person encounters resulted in recommendations for operative intervention, 38.2% versus 55.2%, respectively. Indirect costs of care were significantly lower for patients utilizing telemedicine-based services. Patient satisfaction related to encounters was non-inferior to in-person care. Overall, the majority of patients responded that they preferred future care to be delivered via telemedicine-based services, if offered. Conclusions: Preoperative telemedicine-based care was associated with significant cost-savings over in-person care related with comparable patient satisfaction. Health systems should continue to dedicate resources to optimizing and expanding perioperative telemedicine capabilities.
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Affiliation(s)
- Amber L O'Connor
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Artem Shmelev
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Abigale Shettig
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicole M Santucci
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Jordan Bray
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Alina Bazarian
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Sean B Orenstein
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Vahagn C Nikolian
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Haveman ME, Jonker LT, Hermens HJ, Tabak M, de Vries JPP. Effectiveness of current perioperative telemonitoring on postoperative outcome in patients undergoing major abdominal surgery: A systematic review of controlled trials. J Telemed Telecare 2024; 30:215-229. [PMID: 34723689 DOI: 10.1177/1357633x211047710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perioperative telemonitoring of patients undergoing major surgery might lead to improved postoperative outcomes. The aim of this systematic review is to evaluate the effectiveness of current perioperative telemonitoring interventions on postoperative clinical, patient-reported, and financial outcome measures in patients undergoing major surgery. METHODS For this systematic review, PubMed, CINAHL, and Embase databases were searched for eligible articles published between January 1, 2009 and March 15, 2021. Studies were eligible as they described: (P) patients aged 18 years or older who underwent major abdominal surgery, (I) perioperative telemonitoring as intervention, (C) a control group receiving usual care, (O) any type of postoperative clinical, patient-reported, or financial outcome measures, and (S) an interventional study design. RESULTS The search identified 2958 articles of which 10 were eligible for analysis, describing nine controlled trials of 2438 patients. Perioperative telemonitoring comprised wearable biosensors (n = 3), websites (n = 3), e-mail (n = 1), and mobile applications (n = 2). Outcome measures were clinical (n = 8), patient-reported (n = 5), and financial (n = 2). Results show significant improvement of recovery time, stoma self-efficacy and pain in the early postoperative phase in patients receiving telemonitoring. Other outcome measures were not significantly different between the groups. CONCLUSION Evidence for the effectiveness of perioperative telemonitoring in major surgery is scarce. There is a need for good quality studies with sufficient patients while ensuring that the quality and usability of the technology and the adoption in care processes are optimal.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Leonie T Jonker
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Jean-Paul Pm de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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Wong C, Bent MA, Omar H, Abousamra O. Launching telemedicine in a tertiary ambulatory pediatric orthopedic clinic during the coronavirus disease-19 pandemic: a retrospective study. J Pediatr Orthop B 2024; 33:97-102. [PMID: 36723520 DOI: 10.1097/bpb.0000000000001056] [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] [Indexed: 02/02/2023]
Abstract
Telemedicine services increased dramaticallyduring the coronavirus disease (COVID-19) pandemic, with limited studies on its implementation within pediatric orthopedics. The goal of this study was to examine patient satisfaction and the efficacy of pediatric orthopedic telemedicine visits. Two hundred and sixty-nine qualifying telehealth visits took place at a metropolitan area pediatric institute between 1 March and 30 May 2020. Patients were invited to complete an anonymous satisfaction survey on their telemedicine experience. Sixty-seven patients responded to the survey. A chart review was completed for all 269 telemedicine visits. Ninety-two percent (249/269) of telemedicine visits were with established patients, and 95% (256/269) of visits were satisfactorily completed without further evaluation, with one visit requiring urgent in-person evaluation. Overall, patients were satisfied with initiating the telemedicine visit (mean score of 4.56/5), as they felt comfortable discussing needs with the provider (4.68/5), and the visit saved time (4.61/5). However, patients were less enthused when deciding if telemedicine was of comparable quality to an in-person visit (3.68/5). Our analysis showed that telemedicine is a viable alternative to in-person visits for various pediatric orthopedic visits, with minimal urgent complications. Patients benefited primarily from the time savings when using a telemedicine visit. However, our study also demonstrates certain limitations of telemedicine, likely due to patients' perceived value of an in-person evaluation. Our study's findings should encourage the continued implementation of pediatric orthopedic telemedicine as an adjunct to in-person clinical practice.
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Affiliation(s)
- Cynthis Wong
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas
| | - Melissa A Bent
- Children's Hospital of Los Angeles, Children's Orthopedic Center
- University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Hanna Omar
- Children's Hospital of Los Angeles, Children's Orthopedic Center
| | - Oussama Abousamra
- Children's Hospital of Los Angeles, Children's Orthopedic Center
- University of Southern California, Keck School of Medicine, Los Angeles, California, USA
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Lim B, Seth I, Dooreemeah D, Lee CHA. Delving into New Frontiers: assessing ChatGPT's proficiency in revealing uncharted dimensions of general surgery and pinpointing innovations for future advancements. Langenbecks Arch Surg 2023; 408:446. [PMID: 37999815 DOI: 10.1007/s00423-023-03173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The advent of artificial intelligence (AI) has significantly influenced various medical domains, including general surgery. This research aims to assess ChatGPT, an AI language model, in its ability to shed light on the historical facets of general surgery and pinpoint opportunities for innovation. METHODS A series of 7 pertinent questions on field of general surgery was posed to ChatGPT. The AI-generated responses were meticulously examined for their relevance, accuracy, and novelty. Additionally, the study explored the AI's ability to recognize knowledge gaps and propose inventive solutions. Expert general surgeons and general surgical residents possessing comprehensive research experience assessed ChatGPT's answers by comparing them to established guidelines and existing literature. RESULTS ChatGPT presented information that was relevant and accurate, albeit superficial. However, it exhibited convergent thinking and was unable to produce truly groundbreaking ideas to transform general surgery. Instead, it pointed to current popular trends with significant potential for further development. It failed to provide references when prompted and even created references that could not be verified in exhibiting databases. CONCLUSION While ChatGPT demonstrated a comprehensive understanding of existing general surgical knowledge and the capacity to generate relevant, evidence-based material, it displayed limitations in producing truly groundbreaking concepts or discoveries beyond current knowledge. These results highlight the necessity of enhancing AI-driven models to facilitate the emergence of new insights and promote synergistic, human-AI partnerships for expediting advancements within the general surgery domain.
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Affiliation(s)
- Bryan Lim
- Department of Surgery, Peninsula Health, Melbourne, VIC, 3199, Australia.
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Ishith Seth
- Department of Surgery, Peninsula Health, Melbourne, VIC, 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Surgery, Bendigo Hospital, Victoria, 3550, Australia
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Wang X, Su A, Liu F, Gong Y, Wei T, Gong R, Zhu J, Li Z, Lei J. Trends, Influence Factors, and Doctor-Patient Perspectives of Web-Based Visits for Thyroid Surgery Clinical Care: Cross-Sectional Study. J Med Internet Res 2023; 25:e47912. [PMID: 37796623 PMCID: PMC10664019 DOI: 10.2196/47912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/16/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In recent years, the new generation of telecommunication technologies has profoundly changed the traditional medical industry. To alleviate the medical difficulties faced by patients with thyroid diseases, hospitals have opened web-based visits and actively combined online-to-offline outpatient services. OBJECTIVE This study aims to explore differences between office and web-based outpatient services from doctors' and patients' perspectives, illustrate the effect of the COVID-19 pandemic on outpatient services, and provide clues for improving the online-to-offline mode of care for patients with thyroid diseases. METHODS We collected the complete web-based and office outpatient records of the Thyroid Surgery Center of West China Hospital. A total of 300,884 completed patient encounters occurred (201,840 office visits and 99,044 web-based visits) from January 1, 2019, to May 31, 2022. We performed logistic regression to evaluate the association between the chosen visit type and patients' sociodemographic characteristics. RESULTS The number of web-based visits rapidly increased since March 2020 and reached 45.1% (4752/10,531) of all encounters in December 2021. The COVID-19 pandemic dramatically accelerated the development of web-based visits. Web-based visits were preferred by patients 18-45 years old (odds ratio [OR] 2.043, 95% CI 1.635-2.552, P<.001), patients with relatively high-paying jobs (technical staff: OR 1.278, 95% CI 1.088-1.479, P=.003; office clerk: OR 1.25, 95% CI 1.07-1.461, P=.005; national public servant: OR:1.248, 95% CI 1.042-1.494, P=.02), and patients living in Sichuan Province (excluding Chengdu; OR 1.167, 95% CI 1.107-1.23, P<.001). The medicine cost (P<.001) and examination cost (P<.001) of office visits were significantly higher than those of web-based visits. CONCLUSIONS Web-based outpatient visits have increased rapidly in recent years, and the COVID-19 pandemic has boosted their development. The preference for web-based visits was influenced by the socioeconomic and demographic characteristics of both patients and doctors.
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Affiliation(s)
- Xinyi Wang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anping Su
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Liu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Gong
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rixiang Gong
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqiang Zhu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianyong Lei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Mazandarani M, Lashkarbolouk N, Hashemi M. Evaluation of Awareness and Attitude of Telemedicine among Primary Healthcare Workers in Deprived Area Health Centers. Int J Telemed Appl 2023; 2023:5572286. [PMID: 37794852 PMCID: PMC10547571 DOI: 10.1155/2023/5572286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
Background Telemedicine has the potential to make healthcare more efficient, organized, and available and is a more beneficial technology that can ease preventive treatment and improve long-term health management. This is especially essential for those who face financial or regional reasons to get quality treatment. Telemedicine in Iran is a new medical field and a noble way to access medical facilities for populations living in deprived areas, and the primary healthcare workers in these deprived medical centers are the implementers of telemedicine in those areas; we aimed to investigate the awareness and attitude towards telemedicine among all the healthcare workers in these centers. Method This is a descriptive cross-sectional study at the Health Centers of Raz County in North Khorasan Province, Iran, and 149 healthcare workers were included. For collecting information, we used a questionnaire that consisted of two parts. The first part contains the demographic data of health care workers, and the second part includes the 5-point Likert scale questionnaire (questions on telemedicine awareness, attitude, and self-report readiness). Result Most participants (51%) were male, and 69.8% were married. The most frequent sources of information about telemedicine are colleagues (40.3%), continuing education (24.7%), and social media and the internet (10.1%). Awareness did not significantly relate to gender, age, marital status, or work experience, but awareness of physicians and midwives is higher than other groups (p < 0.05). The awareness of healthcare workers using continuing education, articles, workshops, or conferences was significantly higher (p < 0.05). The attitude scores for most questions are above 3.4 and reflect a positive attitude about telemedicine. Attitudes did not show a significant relation to gender, age, marital status, or work experience. Conclusion Using telemedicine in developing countries, rural or urban areas have a high potential to improve epidemiological investigations, disease control, and clinical case management. Providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help get a more realistic picture of their perceptions.
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Affiliation(s)
- Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Narges Lashkarbolouk
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Mitra Hashemi
- Deputy of Research and Technology, North Khorasan University Of Medical Sciences, Bojnurd, Iran
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Urbonas T, Lakha AS, King E, Pepes S, Ceresa C, Udupa V, Soonawalla Z, Silva MA, Gordon-Weeks A, Reddy S. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg 2023; 17:23. [PMID: 37644474 PMCID: PMC10466851 DOI: 10.1186/s13037-023-00368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. RESULTS We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. CONCLUSIONS Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
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Affiliation(s)
- Tomas Urbonas
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adil Siraj Lakha
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Emily King
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Sophia Pepes
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Carlo Ceresa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Venkatesha Udupa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Zahir Soonawalla
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Michael A Silva
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Alex Gordon-Weeks
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Srikanth Reddy
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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Shaikh CF, Woldesenbet S, Munir MM, Moazzam Z, Endo Y, Alaimo L, Azap L, Yang J, Katayama E, Lima HA, Dawood Z, Pawlik TM. Utilization of Telemedicine among Medicare beneficiaries undergoing Hepatopancreatic Surgery during the COVID-19 Pandemic. J Gastrointest Surg 2023; 27:1611-1620. [PMID: 37254021 PMCID: PMC10228881 DOI: 10.1007/s11605-023-05711-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Telemedicine may serve as an important avenue to address disparities in access to cancer care. We sought to define factors associated with telemedicine use among Medicare beneficiaries who underwent hepatopancreatic (HP) surgery, as well as characterize trends in telemedicine usage relative to community vulnerability based on the enactment of the Medicare telemedicine coverage waiver. METHODS Patients who underwent HP surgery between 2013-2020 were identified from the Medicare Standard Analytic Files (SAF). Telemedicine utilization was assessed pre- versus post- implementation of the Medicare telemedicine coverage waiver; the county-level social vulnerability index (SVI) was obtained from the Center for Disease Control. Interrupted time series analysis with negative binomial and multivariable logistic regression methods were used to assess changes in telemedicine utilization after the implementation of the Medicare telemedicine coverage waiver relative to SVI. RESULTS Pre-waiver telemedicine visits were scarce among 16,690 patients (0.2%, n = 28), while post-waiver telemedicine adoption was substantial among 3,301 patients (45.8%, n = 1,388). Post-waiver, the median patient age was 70 years (IQR, 66-74) with the majority of patients being age 65-69 (n = 994, 32.8%); 1,599 (52.8%) were female. Most patients self-identified as White (n = 2641, 87.1%), while a minority of patients self-identified as Black (n = 190, 6.3%), Asian (n = 18, 0.6%), Hispanic (n = 35, 1.2%), or Other/unknown (n = 147, 4.9%). On multivariable regression analysis, patients who lived in highly vulnerable counties (referent Low SVI; moderate SVI: OR 1.09, 95% CI 0.86-1.39, p = 0.449; high SVI: OR 0.72, 95% CI 0.55-0.94, p = 0.001) and individuals with advancing age (referent 18-64; 65-69, OR 0.68, 95%CI 0.54-0.86; 70-74, OR 0.56, 95%CI 0.44-0.71; 75-79, OR 0.57, 95%CI 0.44-0.75; 80-84, OR 0.43, 95%CI 0.30-0.61; 85 + , OR 0.25, 95%CI 0.13-0.49) had lower odds of utilizing telemedicine. In contrast, Black patients (referent White; OR 2.26, 95% CI 1.65-3.10) and patients with a higher CCI score > 2 (referent ≤ 2; OR 1.49, 95% CI 1.28-1.71) were more likely to use telemedicine (all p < 0.001). CONCLUSIONS Medicare beneficiaries residing in counties with extreme vulnerability, as well as elderly individuals, were markedly less likely to use telemedicine services related to HP surgical episodes of care. The lower utilization of telemedicine in areas of high social vulnerability was attributable to concomitant lower rates of internet access in these areas.
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Affiliation(s)
- Chanza Fahim Shaikh
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Jason Yang
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Zaiba Dawood
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Tsagkaris C, Trygonis N, Spyrou V, Koulouris A. Telemedicine in Care of Sarcoma Patients beyond the COVID-19 Pandemic: Challenges and Opportunities. Cancers (Basel) 2023; 15:3700. [PMID: 37509361 PMCID: PMC10378403 DOI: 10.3390/cancers15143700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created a challenging environment for sarcoma patients. Most oncology societies published guidelines or recommendations prioritizing sarcoma patients and established telehealth as an efficient method of approaching them. The aim of this review is the assessment of current evidence regarding the utilization of telemedicine in diagnosis, treatment modalities, telerehabilitation and satisfaction among sarcoma patients and healthcare providers (HP). METHODS This systematic review was carried out using the databases PubMed and Ovid MEDLINE according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS The application of telemedicine to the management of sarcoma has yielded improved clinical and psychological outcomes. Specifically, significant progress has been demonstrated in the areas of tele-oncology and telerehabilitation during the last decade, and the COVID-19 outbreak has accelerated this transition toward them. Telehealth has been proven efficient in a wide spectrum of applications from consultations on physical therapy and psychological support to virtual care symptom management. Both HP and patients reported satisfaction with telehealth services at levels comparable to in-person visits. CONCLUSIONS Telehealth has already unveiled many opportunities in tailoring individualized care, and its role in the management of sarcoma patients has been established in the post-COVID-19 era, as well.
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Affiliation(s)
- Christos Tsagkaris
- European Student Think Tank, Public Health and Policy Working Group, 1058 DE Amsterdam, The Netherlands
| | - Nikolaos Trygonis
- Department of Orthopaedics, University Hospital of Heraklion, 70013 Heraklion, Greece
| | - Vasiliki Spyrou
- Post Covid Department, Theme Female Health, Karolinska University Hospital, 14157 Stockholm, Sweden
| | - Andreas Koulouris
- Department of Oncology-Pathology, Karolinska Institute, 17176 Stockholm, Sweden
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, 17177 Stockholm, Sweden
- Faculty of Medicine, University of Crete, 70013 Heraklion, Greece
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Levy BE, Wilt WS, Johnson J, Wallace H, Ballert E, Newcomb M, Cavatassi W, Harris A. Procedure-Based Telehealth Utilization in General Surgery. Am J Med Qual 2023; 38:154-159. [PMID: 37125671 DOI: 10.1097/jmq.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors hypothesize that standardized telehealth (TH) scheduling processes will improve TH utilization without increasing adverse events. Fifty visits preimplementation and 67 visits postimplementation were audited from June 2021 to January 2022. Both leadership and frontline stakeholders were engaged to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes related to TH completion, cost, and TH scheduling were collected after implementation. Preimplementation TH scheduling rate was 32%. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. Following implementation, 95% of patients undergoing eligible procedures had TH follow-up. This provided improved access to surgical follow-up care, by reducing travel needs to the Veterans Affairs facility. Secondarily, this intervention increased clinic appointment availability and resulted in possible increased revenue for billable visits. Standardizing TH scheduling based on the procedure improves the utilization of TH resulting in improved clinic efficiency and increased revenue, without increasing adverse events.
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Affiliation(s)
- Brittany E Levy
- Department of General Surgery, University of Kentucky, Lexington, KY
| | - Wesley S Wilt
- Department of General Surgery, University of Kentucky, Lexington, KY
| | | | | | - Erik Ballert
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Melissa Newcomb
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - William Cavatassi
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Andrew Harris
- Lexington Veteran's Affairs Medical Center, Lexington, KY
- Department of Urology, University of Kentucky, Lexington, KY
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15
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Shirriff A, Gragas A, Tabak B, Abella M, Ahn HJ, Woo R. Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations. J Surg Res 2023; 288:240-245. [PMID: 37030181 PMCID: PMC10076909 DOI: 10.1016/j.jss.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION The Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations. METHODS We conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05. RESULTS A total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899). CONCLUSIONS Our results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.
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Affiliation(s)
- Ashley Shirriff
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii.
| | - Anna Gragas
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Benjamin Tabak
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Maveric Abella
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Russell Woo
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
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Poly TN, Islam MM, Walther BA, Lin MC, Jack Li YC. Artificial intelligence in diabetic retinopathy: Bibliometric analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107358. [PMID: 36731310 DOI: 10.1016/j.cmpb.2023.107358] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The use of artificial intelligence in diabetic retinopathy has become a popular research focus in the past decade. However, no scientometric report has provided a systematic overview of this scientific area. AIMS We utilized a bibliometric approach to identify and analyse the academic literature on artificial intelligence in diabetic retinopathy and explore emerging research trends, key authors, co-authorship networks, institutions, countries, and journals. We further captured the diabetic retinopathy conditions and technology commonly used within this area. METHODS Web of Science was used to collect relevant articles on artificial intelligence use in diabetic retinopathy published between January 1, 2012, and December 31, 2022 . All the retrieved titles were screened for eligibility, with one criterion that they must be in English. All the bibliographic information was extracted and used to perform a descriptive analysis. Bibliometrix (R tool) and VOSviewer (Leiden University) were used to construct and visualize the annual numbers of publications, journals, authors, countries, institutions, collaboration networks, keywords, and references. RESULTS In total, 931 articles that met the criteria were collected. The number of annual publications showed an increasing trend over the last ten years. Investigative Ophthalmology & Visual Science (58/931), IEEE Access (54/931), and Computers in Biology and Medicine (23/931) were the most journals with most publications. China (211/931), India (143/931, USA (133/931), and South Korea (44/931) were the most productive countries of origin. The National University of Singapore (40/931), Singapore Eye Research Institute (35/931), and Johns Hopkins University (34/931) were the most productive institutions. Ting D. (34/931), Wong T. (28/931), and Tan G. (17/931) were the most productive researchers. CONCLUSION This study summarizes the recent advances in artificial intelligence technology on diabetic retinopathy research and sheds light on the emerging trends, sources, leading institutions, and hot topics through bibliometric analysis and network visualization. Although this field has already shown great potential in health care, our findings will provide valuable clues relevant to future research directions and clinical practice.
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Affiliation(s)
- Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei 110, Taiwan; Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Md Mohaimenul Islam
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei 110, Taiwan; AESOP Technology, Songshan District, Taipei 105, Taiwan
| | - Bruno Andreas Walther
- Alfred-Wegener-Institut Helmholtz-Zentrum für Polar- und Meeresforschung, Am Handelshafen 12, Bremerhaven D-27570, Germany
| | - Ming Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei 110, Taiwan; Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; AESOP Technology, Songshan District, Taipei 105, Taiwan.
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Discordance between Subjective and Objective Assessments of Activity after Pediatric Appendectomy. J Surg Res 2023; 283:751-757. [PMID: 36463814 DOI: 10.1016/j.jss.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/03/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Physical activity recovery after pediatric surgery can be assessed using objective measures such as step counts, but practice currently relies on subjective assessment by proxy. It is unclear how subjective and objective assessments of activity relate. We compared caregiver assessment of return to normal physical activity after pediatric appendectomy to step count recovery measured by a Fitbit. METHODS Pediatric patients who underwent appendectomy were recruited between 2020 and 2022 to be monitored for 21 d with a Fitbit. Patients were grouped by the postoperative day (POD) (7, 14, or 21) their caregiver first reported their activity was "back to normal." Objective return to normal step count was estimated for each group by modeling the inflection point from increasing steps to a plateau. These measures were determined discordant if the subjective report remained outside the modeled 95% confidence interval (CI) for the day the group plateaued. RESULTS Thirty-nine simple appendicitis and 40 complicated appendicitis patients were recruited. Among simple appendicitis patients, daily steps plateaued on POD 10.8 (95% CI 7.4-14.3), POD 14.0 (95% CI 11.0-17.1), and POD 11.1 (95% CI 6.9-15.3) for the day 7, day 14, and day 21 groups, respectively. Complicated appendicitis groups plateaued on POD 12.8 (95% CI 8.7-16.9), POD 15.2 (95% CI 11.1-19.3), and POD 16.7 (95% CI 12.3-21.0), respectively. Significant discordance was observed between subjective and objective assessments for the day 7 and day 14 simple groups and for the day 7 complicated group. CONCLUSIONS There was significant discordance between caregiver and accelerometer-assessed activity recovery after pediatric surgery. Development of objective measures of recovery could help standardize assessment of children's recovery after surgery.
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O'Connor AL, Shettig A, Santucci NM, Sutton TL, Bray JO, Borzy C, Orenstein SB, Nikolian VC. Bedside vs webside: Assessing patient-reported experiences for in-person and telemedicine-based perioperative evaluations. Am J Surg 2023; 225:847-851. [PMID: 36870791 DOI: 10.1016/j.amjsurg.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/24/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Though telemedicine has been identified as safe and feasible, data on patient reported experiences (PREs) are lacking. We sought to compare PREs between in-person and telemedicine-based perioperative care. METHODS Patients evaluated from August-November 2021 were prospectively surveyed to assess experiences and satisfaction with care rendered during in-person and telemedicine-based encounters. Patient and hernia characteristics, encounter related plans, and PREs were compared between in-person and telemedicine-based care. RESULTS Of 109 respondents (86% response rate), 55% (n = 60) utilized telemedicine-based perioperative care. Indirect costs were lower for patients using telemedicine-based services, including work absence (3% vs. 33%, P < 0.001), lost wages (0% vs. 14%, P = 0.003), and requirements for hotel accommodations (0% vs. 12%, P = 0.007). PREs related to telemedicine-based care were non-inferior to in-person care across all measured domains (P > 0.4). CONCLUSIONS Telemedicine-based care yields significant cost-savings over in-person care with similar patient satisfaction. These findings suggest that systems should focus on optimization of perioperative telemedicine services.
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Affiliation(s)
| | | | | | | | - Jordan O Bray
- Oregon Health & Science University, Portland, OR, USA
| | - Charlie Borzy
- Oregon Health & Science University, Portland, OR, USA
| | | | - Vahagn C Nikolian
- Oregon Health & Science University, Portland, OR, USA. https://twitter.com/VNikolian
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Dickey AM, Wasko MM. Digital Disparities in Patient Adoption of Telemedicine. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2023. [DOI: 10.4018/ijhisi.318043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Telemedicine's growth during the COVID-19 pandemic exposed digital and health disparities in U.S. communities. Public health advocates suggest disparities in healthcare access may be mitigated through free or low-cost broadband. However, prior research shows that many factors influence patient adoption of information technologies; therefore, increasing access to broadband alone is insufficient. This paper advances a patient-centered model of telemedicine (TM) adoption supported by qualitative interview data. The model illustrates that patient adoption of TM is driven by a complex sociotechnical system comprised of technology factors, structural factors underlying the provider's provision of TM, and individual patient factors. Findings highlight the importance of the physical place of the TM visit, the need for experienced TM healthcare workers and technology support for patients, the impact of provider-mandated technology on task-technology fit (TTF), and the strength of the patient-provider relationship. These factors affect patient perceptions of TTF and ultimately TM adoption.
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Bray JO, O'Connor S, Sutton TL, Santucci NM, Elsheikh M, Bazarian AN, Orenstein SB, Nikolian VC. Patient-performed at-home surgical drain removal is safe and feasible following hernia repair and abdominal wall reconstruction. Am J Surg 2023; 225:388-393. [PMID: 36167625 DOI: 10.1016/j.amjsurg.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traditionally, surgical drains are considered a relative contraindication to telemedicine-based postoperative care. We sought to assess the safety, feasibility, and outcomes of an at-home patient-performed surgical drain removal pilot program. METHODS A prospective cohort study among patients who were discharged with surgical drains was performed. Patients discharged with drains were given the option for in-clinic, provider-performed removal, or at-home, patient-performed drain removal. Patient demographics, health characteristics, perioperative metrics, and operative outcomes were compared and analyzed. RESULTS A total of 68 encounters with drain removal were included (at-home: 28%, n = 19; in-clinic: 72%, n = 49), with both groups having similar demographics, except for age (median age of telemedicine-based at-home: 50 vs in-clinic: 62 years, p = 0.03). Patients who opted into at-home, patient-performed drain removal were more likely to have drain removal occur earlier (9 vs 13 days for in-clinic, p < 0.001). In-clinic removal resulted in increased encounters with surgical nursing staff and increased travel time, with no significant difference in complication burden. CONCLUSIONS Patient-performed at-home drain removal is safe and allows for more timely drain removal.
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Affiliation(s)
- Jordan O Bray
- Oregon Health & Science University, Portland, OR, USA
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21
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Wilson HA, Mocanu V, McLean C, Birch DW, Karmali S, Switzer NJ. Characterization of Pre- and Postpandemic 30-Day Follow-Up After Elective Bariatric Surgery: a Retrospective MBSAQIP Analysis of 834,646 Patients. Obes Surg 2023; 33:443-452. [PMID: 36539591 PMCID: PMC9767801 DOI: 10.1007/s11695-022-06423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015-2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up. METHODS Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2020. Cohorts were divided into pre-pandemic and pandemic years and patients with and without 30-day follow-up. Multivariable logistic regression analysis was used to identify general factors independently predictive of 30-day follow-up. The primary aim was to evaluate the impact of the COVID-19 pandemic on short-term 30-day follow-up adherence. A secondary outcome was to characterize general short-term postoperative 30-day follow-up associated with elective bariatric surgery and identify independent predictors of 30-day follow-up among bariatric surgery patients using multivariable logistic regression analysis. RESULTS A total of 834,646 patients were identified. Follow-up rates significantly increased in the COVID era in 2020 (p < 0.0001). Patients who achieved 30-day follow-up were older and had an increased burden of medical comorbidities, including non-insulin and insulin-dependent diabetes mellitus, hypertension, dyslipidemia, as well as increased BMI compared to patients lacking follow-up. The cohort with successful 30-day follow-up was more likely to receive gastric bypass and had increased rates of metabolic comorbidities. After adjusting for comorbidities, the greatest independent predictors of follow-up were the 2020 COVID-19 era year, Asian race, black race, and gastroesophageal reflux disease. CONCLUSIONS After adjusting for comorbidities, the 2020 COVID-19 era year was one of the greatest predictors of follow-up after bariatric surgery. Postoperative follow-up rates after elective bariatric surgery are excellent at > 95% and increased during the 2020 COVID-19 era year. Several independent predictors of follow-up were identified which may help in development of strategies aimed to mitigate lack of postoperative follow-up.
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Affiliation(s)
- Hillary A. Wilson
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB T6G 2R7 Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Cheynne McLean
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Daniel W. Birch
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Noah J. Switzer
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
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22
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McMaster T, Mori K, Lee S, Manasa S, Stelmach W, To H. Innovations and Implementation of Telemedicine in Surgical Clinics Beyond COVID-19: A Narrative Review. Telemed J E Health 2023; 29:50-59. [PMID: 35736794 DOI: 10.1089/tmj.2021.0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Telemedicine has emerged as a powerful tool in the delivery of health care to surgical patients and innovations are developing to address challenges in the technology, enhancing consumer-provider encounters while located remotely. Our study aims at collating and commenting on the published evidence for how current challenges in telemedicine for surgical clinics are met by innovations currently in development. We also comment on the implementation and monitoring strategies for telemedicine. Methods: Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science, and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient"; and "surgical clinic." For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting, and if they had a focus during the COVID-19 pandemic. Results: Three hundred forty-five articles were identified and screened, so that 73 articles were included in the review. Almost all articles were from Western countries (n = 69), mostly in surgical journals (n = 39) and from a range of sub-specialties, but pre-dominantly orthopedics (n = 12) and general surgery (n = 9). The majority were original comparative studies, with 31 studies directly comparing telemedicine with in-person appointments and 22 articles focused on implementation during COVID-19. Discussion/Conclusion: Advanced telecommunication technology has enabled telemedicine to become an effective and safe form of health care delivery, with high consumer and provider satisfaction. Innovative protocol and technology developments have addressed the limitations of telemedicine. Sophisticated and familiar medical software integrates with electronic medical records to automate and streamline documentation, consent, and billing processes. Surgical clinics are investing in telehealth workflow co-ordination and information technology support to troubleshoot any technical difficulties as well as education for providers and consumers to address technology illiteracy. As health care services continue to transition their systems to an online network, further research is required to understand the ability and assess the feasibility of telemedicine to fully integrate.
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Affiliation(s)
- Thomas McMaster
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Krinal Mori
- Department of Surgery, Northern Health, Epping, Australia
| | - Sharon Lee
- Department of Surgery, Northern Health, Epping, Australia
| | - Siri Manasa
- Department of Surgery, Northern Health, Epping, Australia
| | - Wanda Stelmach
- Department of Surgery, Northern Health, Epping, Australia
| | - Henry To
- Department of Surgery, Northern Health, Epping, Australia.,Department of Surgery, Werribee Mercy Hospital, Werribee, Australia
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23
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Consultation Management during the COVID-19 Pandemic: The Experience of Lithuanian Physicians. Healthcare (Basel) 2022; 10:healthcare10122472. [PMID: 36553996 PMCID: PMC9778364 DOI: 10.3390/healthcare10122472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Crises in the medicine sector such as the COVID-19 pandemic encourage the search for effective solutions for the provision of health care services, when conventional face-to-face consultations may be difficult to deliver effectively due to contact restrictions. The main objective of this study was to investigate consultation management provided by physicians during the COVID-19 pandemic in Lithuania. The dependence of diagnostic testing and vaccination of patients on the socio-demographic characteristics of physicians was also assessed. An anonymous survey was carried out during the COVID-19 pandemic, between 21 June 2021 and 17 September 2021, involving 191 physicians (9% of the total population) working in family physician teams in Lithuania. Thirty-nine Lithuanian Primary Health Care Institutions (PHCIs) were selected for this study, of which 11 were public and 28 were private. Private and public PHCIs employed 31% and 63% of the respondents, respectively, and 6% of respondents worked at both types of institutions. Concerning telemedicine, the physician-respondents frequently provided consultations over the telephone (79.6%) and in-person (63.9%), but less so via the Internet, with the latter option never being used at all by 57.1% of the respondents. Whilst telephone consultations were frequently provided by Lithuanian physicians, only half of the respondents chose to provide services over the Internet. Private, smaller, and rural-based PHCIs should more actively offer viral diagnostics and vaccination services.
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24
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Yang Z, Zhang T, Garg H, Venkatachalam K. A multi-criteria framework for addressing digitalization solutions of medical system under interval-valued T-spherical fuzzy information. Appl Soft Comput 2022. [DOI: 10.1016/j.asoc.2022.109635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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25
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Alzubaidi SJ, Khurana A, Sill A, Knuttinen JMG, Kriegshauser S, Naidu S, Patel I, Oklu R. Establishing a telemedicine program for interventional radiology: a study of patient opinion and experience. Diagn Interv Radiol 2022; 28:603-608. [PMID: 36550761 PMCID: PMC9885727 DOI: 10.5152/dir.2022.21837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The COVID-19 pandemic forced healthcare officials to implement new policies, such as the use of virtual consultations over office-based medical appointments, to reduce the transmission of the virus. The purpose of this study is to quantitatively compare patients' experiences with virtual outpatient telemedicine encounters at a single academic institution in Interventional Radiology (IR) and in-person visits during the course of the COVID-19 pandemic. METHODS The TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were used to survey patients' satisfaction with both in-person and virtual office visits. RESULTS Ninety respondents (38 in-person, 52 virtual) acknowledged numerous benefits of virtual visits versus in-person office visits including reductions in time, cost, and potential viral transmission risk during the COVID-19 pandemic. No statistically significant difference was noted, based on a Likert scale from 1 to 7, between in-person and virtual visits (all p > 0.05) for scheduling related factors. No statistically significant difference was noted in any of the MCCS subscales between the two cohorts in regards to medical information communication (all p > 0.05). A majority of patients with virtual encounters (82.7%) stated that it was easy to obtain an electronic device for use during the telemedicine visit, and 73.1% of patients felt that setting up the telemedicine encounter was easy. CONCLUSION This study demonstrates that telemedicine is an acceptable alternative to in-office appointments and could increase access to IR care outside of the traditional physician-patient interaction. With telemedicine visits, patients can communicate their concerns and obtain information from the doctor with noninferior communication compared to in-person visits.
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Affiliation(s)
- Sadeer J Alzubaidi
- Division of Vascular and Interventional Radiology, Mayo Clinic, Arizona, US
| | | | - Andrew Sill
- Department of Radiology, Mayo Clinic, Arizona, US
| | | | - Scott Kriegshauser
- Division of Vascular and Interventional Radiology, Mayo Clinic, Arizona, US
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Mayo Clinic, Arizona, US
| | - Indravadan Patel
- Division of Vascular and Interventional Radiology, Mayo Clinic, Arizona, US
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Mayo Clinic, Arizona, US
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26
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Iqbal E, Bray JO, Sutton T, Akhter M, Orenstein SB, Nikolian VC. Perioperative Telemedicine Utilization Among Geriatric Patients Being Evaluated for Abdominal Wall Reconstruction and Hernia Repair. Telemed J E Health 2022. [PMID: 36255440 DOI: 10.1089/tmj.2022.0223] [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: 11/13/2022] Open
Abstract
Introduction: Perioperative telemedicine services have increasingly been utilized for ambulatory care, although concerns exist regarding the feasibility of virtual consultations for older patients. We sought to review telemedicine encounters for geriatric patients evaluated at a hernia repair and abdominal wall reconstruction center. Methods: A retrospective review of telemedicine encounters between May 2020 and May 2021 was performed. Patient characteristics and encounter-specific outcomes were compared among geriatric (older than65 years old) and nongeriatric patients. Clinical care plans for encounters were reviewed to determine potential downstream care utilization. Patient-derived benefits related to time saved in travel time was calculated using geo-mapping. Outcomes for postoperative encounters were assessed to determine if complication rates differed between geriatric and nongeriatric populations. Results: A total of 313 telemedicine encounters (geriatric: 41.9%) were conducted among 251 patients. Reviewing preoperative factors for hernia care, geriatric patients presented with higher rates of recurrent or incisional hernias (87.9% vs. 70.7%, p < 0.01). Potential travel time was longer for geriatric patients (104 min vs. 42 min, p = 0.03) in the preoperative setting. No differences in clinical care plans were found. Only 8.6% of preoperative encounters resulted in recommendations for supplemental in-person evaluation. Operative plans were coordinated for 42.5% of all preoperative telemedicine encounters. There was no difference in complication rate between geriatric and nongeriatric patients (p > 0.05) in the postoperative setting, with no complications directly attributable to telemedicine-based care. Conclusions: Telemedicine-based evaluations appear to function well among geriatric patients seeking hernia repair and abdominal wall reconstruction. Clinical care plans rendered following telemedicine-based encounters are appropriate with a low rate of supplemental in-person evaluations. Telemedicine use resulted in significantly more time saved in commuting to and from clinic for geriatric patients.
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Affiliation(s)
- Emaad Iqbal
- Columbia University Irving Medical Center, New York, New York, USA
| | - Jordan O Bray
- Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Sutton
- Oregon Health and Science University, Portland, Oregon, USA
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27
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Gross K, Georgeades C, Farazi M, Calaway L, Gourlay D, Van Arendonk KJ. Utilization and Adequacy of Telemedicine for Outpatient Pediatric Surgical Care. J Surg Res 2022; 278:179-189. [PMID: 35605570 PMCID: PMC9121887 DOI: 10.1016/j.jss.2022.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Telemedicine (TM) use accelerated out of necessity during the COVID-19 pandemic, but the utility of TM within the pediatric surgery population is unclear. This study measured utilization, adequacy, and disparities in uptake of TM in pediatric surgery during the COVID-19 pandemic. METHODS Scheduled outpatient pediatric surgery clinic encounters at a large academic children's hospital from January 2020 through March 2021 were reviewed. Sub-group analysis examined post-operative (PO) visits after appendectomy and umbilical, epigastric, and inguinal hernia repairs. RESULTS Of 9149 scheduled visits, 87.9% were in-person and 12.1% were TM. TM visits were scheduled for PO care (76.9%), new consultations (7.1%), and established patients (16.0%). Although TM visits were more frequently canceled or no shows (P < 0.001), most canceled TM visits were PO visits, of which 41.7% were canceled via electronic communication reporting the absence of any PO concerns. TM visits were adequate for accomplishing visit goals in 98.2%, 95.5%, and 96.2% of PO, new, and established patient visits, respectively. Patients utilizing TM visits were more frequently of white race, privately-insured, from less disadvantaged neighborhoods, and living a greater distance from clinic (P < 0.001 for all comparisons). CONCLUSIONS TM was adequate for the majority of visits in which it was utilized, including the basic PO visits that occurred via TM. TM was used more by patients with greater travel and less by those of minority race, with public insurance, and from more disadvantaged neighborhoods. Future work is necessary to ensure broad access to this useful tool for all children requiring surgical care.
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Affiliation(s)
- Kendall Gross
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manzur Farazi
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lynn Calaway
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Gourlay
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin.
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28
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Fink T, Chen Q, Chong L, Hii MW, Knowles B. Telemedicine versus face-to-face follow up in general surgery: a randomized controlled trial. ANZ J Surg 2022; 92:2544-2550. [PMID: 36069322 PMCID: PMC9826044 DOI: 10.1111/ans.18028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Telemedicine provides healthcare to patients at a distance from their treating clinician. There is a lack of high-quality evidence to support the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial-conducted before the COVID-19 pandemic-aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) by telephone compared to face-to-face follow-up after uncomplicated general surgical procedures. METHODS Patients following laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic. Patient demographics, perioperative details and postoperative outcomes were compared. Patient satisfaction was assessed via a standardized Likert-style scale. RESULTS One hundred and twenty-three patients were randomized over 12 months. Mean consultation times were significantly shorter for telemedicine than face-to-face clinics (telemedicine 10.52 ± 7.2 min, face-to-face 15.95 ± 9.96 min, P = 0.0021). There was no difference between groups in the attendance rates, nor the incidence or detection of postoperative complications. Of the 58 patients randomized to the telemedicine arm, 40% reported high, and 60% reported very high satisfaction with the method of clinic follow-up. CONCLUSION Telemedicine postoperative follow-up is safe and acceptable to patients and could be considered in patients undergoing uncomplicated benign general surgery.
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Affiliation(s)
- Teagan Fink
- Department of Hepatobiliary and Upper Gastrointestinal SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia,The Department of Surgery, St Vincent's HospitalThe University of MelbourneMelbourneVictoriaAustralia
| | - Qianyu Chen
- Department of Hepatobiliary and Upper Gastrointestinal SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Lynn Chong
- Department of Hepatobiliary and Upper Gastrointestinal SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia,The Department of Surgery, St Vincent's HospitalThe University of MelbourneMelbourneVictoriaAustralia
| | - Michael W. Hii
- Department of Hepatobiliary and Upper Gastrointestinal SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia,The Department of Surgery, St Vincent's HospitalThe University of MelbourneMelbourneVictoriaAustralia
| | - Brett Knowles
- Department of Hepatobiliary and Upper Gastrointestinal SurgerySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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29
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Irvine K, Alarcon M, Dyck H, Martin B, Carr T, Groot G. Virtual surgical consultation during the COVID-19 pandemic: a patient-oriented, cross-sectional study using telephone interviews. CMAJ Open 2022; 10:E1008-E1016. [PMID: 36446425 PMCID: PMC9718540 DOI: 10.9778/cmajo.20210159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health care delivery shifted rapidly during the COVID-19 pandemic, whereby virtual consultations replaced many face-to-face interactions. We sought to gather patient perspectives on their experiences with virtual surgical consultation, the advantages and disadvantages of this delivery method and their overall satisfaction with virtual appointments. METHODS We conducted a patient-oriented, cross-sectional study. Adult patients (age > 18 yr) who had a virtual consultation with a participating general surgeon in Saskatoon, Saskatchewan, from April to May 2020 were eligible. We conducted telephone interviews using open- and close-ended questions. We used thematic analysis to determine themes from the qualitative data. As research team members, 2 patient partners were involved in identifying priorities, developing the research question, designing research methods, analyzing data and disseminating findings. We analyzed and presented quantitative data descriptively. RESULTS We interviewed 45 participants from 7 general surgery practices; the average age was 62 years. Most participants lived outside Saskatoon and had virtual follow-up appointments. The 3 themes related to advantages of virtual consultations were convenience, cost savings and decreased exposure to pathogens. The 4 themes related to their disadvantages were that they were not as personal, the surgeon was not able to perform a physical examination, and there were issues with scheduling and issues with technology. Most participants were satisfied with the care they received (n = 41) and would be willing to use virtual consultation in the future (n = 31). INTERPRETATION We found that virtual consultations are an effective and efficient way to deliver surgical care but are not appropriate for every situation and cannot completely replace face-to-face interactions. Our study identified the advantages and disadvantages of virtual surgical consultation to help better guide the delivery of virtual care in the future.
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Affiliation(s)
- Kyle Irvine
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask.
| | - Marissa Alarcon
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Heather Dyck
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Barbara Martin
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Tracey Carr
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Gary Groot
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
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30
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López A, Escobar MF, Urbano A, Alarcón J, Libreros-Peña L, Martinez-Ruiz DM, Casas LÁ. Experience with Obese Patients Followed via Telemedicine in a Latin American Tertiary Care Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912406. [PMID: 36231703 PMCID: PMC9564633 DOI: 10.3390/ijerph191912406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Obesity is a major public health concern worldwide. Latin America has experienced rapid growth in obesity incidence during the last few decades. Driven by confinement measures, a telemedicine program was implemented in March 2020 to give continuity to obese patients' care through a weight loss program led by the endocrinology department in a tertiary care medical center in Latin America. OBJECTIVE This study aimed to describe the clinical experience of using digital health for monitoring and attention of obese patients and description of weight change outcomes of these patients followed via telemedicine during March 2020-December 2020. METHODS A retrospective cohort study was conducted including 202 patients. A Skillings-Mack test was performed to conduct a subgroup analysis of the medians of the weight over the follow-up period, and a mixed multiple linear regression model was performed to estimate the expected average change in weight over time Results: We observed good adherence to the program, represented by a weight loss of -4.1 kg at three months of follow-up, which was maintained even during the sixth month of follow-up. CONCLUSIONS Digital Health strategies such as telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care and showing satisfactory results in the management of obese patients.
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Affiliation(s)
- Alejandro López
- Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
| | - Maria Fernanda Escobar
- Department of Telemedicine, Fundación Valle del Lili, Cali 760032, Colombia
- Department of Gynecology and Obstetrics, Universidad Icesi, Cali 760031, Colombia
- Correspondence:
| | - Alejandra Urbano
- Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juliana Alarcón
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | | | - Luz Ángela Casas
- Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
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31
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Paro A, Rice DR, Hyer JM, Palmer E, Ejaz A, Shaikh CF, Pawlik TM. Telehealth Utilization Among Surgical Oncology Patients at a Large Academic Cancer Center. Ann Surg Oncol 2022; 29:7267-7276. [PMID: 35896926 PMCID: PMC9331038 DOI: 10.1245/s10434-022-12259-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/05/2022] [Indexed: 01/24/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic increased the use of telehealth within medicine. Data on sociodemographic and clinical characteristics associated with telehealth utilization among cancer surgical patients have not been well-defined. Methods Cancer patients who had a surgical oncology visit at the James Cancer Hospital in March 2020–May 2021 were included. Patient demographic and clinical characteristics were recorded; access to modern information technology was measured using the Digital Divide Index (DDI). A logistic regression model was used to assess odds of receiving a telehealth. Results Among 2942 patients, median DDI was 18.2 (interquartile range 17.4–22.1). Patients were most often insured through managed care (n = 1459, 49.6%), followed by Medicare (n = 1109, 37.7%) and Medicaid (n = 267, 9.1%). Overall, 722 patients (24.5%) received at least one telehealth visit over the study period. On multivariable analysis, age (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80–0.98 per 10-year increase), sex (male vs. female: OR 1.83, 95% CI 1.45–2.32), cancer type (pancreatic vs. breast: OR 9.19, 95% CI 6.38–13.23; colorectal vs. breast: OR 5.31, 95% CI 3.71–7.58), insurance type (Medicare vs. Medicaid: OR 1.58, 95% CI 1.04–2.41) and county of residence (distant vs. neighboring: OR 1.33, 95% CI 1.06–1.66) were associated with increased odds of receiving a telehealth visit. Patients from high DDI counties were not less likely to receive telehealth visits versus patients from low DDI counties (OR 1.15, 95% CI 0.85–1.57). Conclusions Several patient sociodemographic and clinical characteristics had an impact on the likelihood of receiving a telehealth visit versus an in-person visit, suggesting that telehealth may not be equally accessible to all surgical oncology patients. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-12259-9.
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Affiliation(s)
- Alessandro Paro
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Daniel R Rice
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Elizabeth Palmer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Chanza Fahim Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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Muschol J, Heinrich M, Heiss C, Knapp G, Repp H, Schneider H, Thormann U, Uhlar J, Unzeitig K, Gissel C. Assessing Telemedicine Efficiency in Follow-up Care With Video Consultations for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36996. [PMID: 35896015 PMCID: PMC9377439 DOI: 10.2196/36996] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 02/06/2023] Open
Abstract
Background Telemedicine can help mitigate important health care challenges, such as demographic changes and the current COVID-19 pandemic, in high-income countries such as Germany. It gives physicians and patients the opportunity to interact via video consultations, regardless of their location, thus offering cost and time savings for both sides. Objective We aimed to investigate whether telemedicine can be implemented efficiently in the follow-up care for patients in orthopedic and trauma surgery, with respect to patient satisfaction, physician satisfaction, and quality of care. Methods We conducted a prospective randomized controlled trial in a German university hospital and enrolled 60 patients with different knee and shoulder conditions. For follow-up appointments, patients received either an in-person consultation in the clinic (control group) or a video consultation with their physician (telemedicine group). Patients’ and physicians’ subsequent evaluations of these follow-up appointments were collected and assessed using separate questionnaires. Results On the basis of data from 52 consultations after 8 withdrawals, it was found that patients were slightly more satisfied with video consultations (mean 1.58, SD 0.643) than with in-clinic consultations (mean 1.64, SD 0.569), although the difference was not statistically significant (P=.69). After excluding video consultations marred by technical problems, no significant difference was found in physician satisfaction between the groups (mean 1.47, SD 0.516 vs mean 1.32, SD 0.557; P=.31). Further analysis indicated that telemedicine can be applied to broader groups of patients and that patients who have prior experience with telemedicine are more willing to use telemedicine for follow-up care. Conclusions Telemedicine can be an alternative and efficient form of follow-up care for patients in orthopedic and trauma surgery in Germany, and it has no significant disadvantages compared with in-person consultations in the clinic. Trial Registration German Clinical Trials Register DRKS00023445; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023445
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Affiliation(s)
- Jennifer Muschol
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Holger Repp
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Henning Schneider
- Institute of Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Johanna Uhlar
- Institute of Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - Kai Unzeitig
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Gissel
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
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Bray JO, Sutton TL, Akhter MS, Iqbal E, Orenstein SB, Nikolian VC. Outcomes of Telemedicine-Based Consultation among Rural Patients Referred for Abdominal Wall Reconstruction and Hernia Repair. J Am Coll Surg 2022; 235:128-137. [PMID: 35703970 DOI: 10.1097/xcs.0000000000000213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perioperative telemedicine use has increased as a result of the COVID-19 pandemic and may improve access to surgical care. However, studies assessing outcomes in populations at risk for digital-health disparities are lacking. We sought to characterize the pre- and postoperative outcomes for rural patient populations being assessed for hernia repair and abdominal wall reconstruction with telehealth. METHODS Patients undergoing telehealth evaluation from March 2020 through May 2021 were identified. Rurality was identified by zip code of residence. Rural and urban patients were compared based on demographics, diagnosis, treatment plan, and visit characteristics and outcomes. Downstream care use related to supplementary in-person referral, and diagnostic testing was assessed. RESULTS Three hundred-seventy-three (196 preoperative, 177 postoperative) telehealth encounters occurred during the study period (rural: 28% of all encounters). Rural patients were more likely to present with recurrent or incisional hernias (90.0 vs 72.7%, p = 0.02) and advanced comorbidities (American Society of Anesthesiologists status score > 2: 73.1 vs 52.1%, p = 0.009). Rural patients derived significant benefits related to time saved commuting, with median distances of 299 and 293 km for pre- and postoperative encounters, respectively. Downstream care use was 6.1% (N = 23) for additional in-person evaluations and 3.4% (N = 13) for further diagnostic testing, with no difference by rurality. CONCLUSIONS Perioperative telehealth can safely be implemented for rural populations seeking hernia repair and may be an effective method for reducing disparities. Downstream care use related to additional in-person referral or diagnostic testing was minimally impacted in both the preoperative and postoperative settings. These findings suggest that rurality should not deter surgeons from providing telemedicine-based surgical consultation for hernia repair.
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Affiliation(s)
- Jordan O Bray
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Thomas L Sutton
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Mudassir S Akhter
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Emaad Iqbal
- Department of Surgery, Columbia University Medical Center, New York, NY (Iqbal)
| | - Sean B Orenstein
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Vahagn C Nikolian
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
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Kuehner G, Wu W, Choe G, Douaiher J, Reed M. Telemedicine Implementation Trends in Surgical Specialties Before and After COVID-19 Shelter in Place: Adjusting to a Changing Landscape. Surgery 2022; 172:1471-1477. [PMID: 35999062 PMCID: PMC9189120 DOI: 10.1016/j.surg.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/17/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
Background The COVID-19 pandemic caused a shift from in-person care to telemedicine, providing a unique opportunity to evaluate trends and efficiency of telemedicine usage within surgical subspecialties in a large, integrated health care system before and after shelter in place mandates. Methods This retrospective cohort study included all of the Kaiser Permanente Northern California members referred to surgical services from January 1, 2019 to June 13, 2020 and receiving a surgical procedure. We compared the patient referrals (categorized as benign, urgent, or cancer) before and after shelter in place mandates, and we examined rates of telemedicine (video or telephone) usage for preoperative consultations, postoperative visits, time from referral to first surgical encounter, and to surgery or procedure. In multivariate analyses, we assessed the patient and provider characteristics associated with telemedicine usage. Results There was a total of 34,875 surgical referrals resulting in a procedure, with a significant decline in referral after shelter in place mandates. Preoperative encounter types shifted from 89.8% in-person before shelter in place mandates to 70.2% telemedicine after shelter in place mandates (P < .0001). The median time from referral to first encounter decreased after shelter in place mandates, as did median time to procedure. After shelter in place mandates, postoperative encounters were mainly telemedicine (65.8%) compared with before shelter in place mandates (41.7%) (P < .0001). Overall, there was a comparable uptake of telemedicine usage in almost all evaluated categories of patient characteristics after shelter in place mandates. Conclusion Within a health care system with prior telemedicine capability, surgical specialties were able to shift to telemedicine rapidly, equitably, and efficiently in the preoperative and postoperative encounters of benign, urgent, and cancer diagnosis during mandated COVID-19 restrictions.
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Affiliation(s)
| | - Weilu Wu
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Giye Choe
- The Permanente Medical Group, Oakland, CA
| | | | - Mary Reed
- Kaiser Permanente Northern California Division of Research, Oakland, CA
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Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review. World J Surg 2022; 46:1855-1869. [PMID: 35428920 PMCID: PMC9012517 DOI: 10.1007/s00268-022-06549-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking. Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes. Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06549-2.
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Abstract
OBJECTIVES The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality. DESIGN A prospective cohort study. SETTING European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period. PATIENTS Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia. MAIN OUTCOME MEASURES The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan-Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect. RESULTS Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days. CONCLUSIONS The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov.
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Bellini V, Valente M, Gaddi AV, Pelosi P, Bignami E. Artificial intelligence and telemedicine in anesthesia: potential and problems. Minerva Anestesiol 2022; 88:729-734. [PMID: 35164492 DOI: 10.23736/s0375-9393.21.16241-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The application of novel technologies like Artificial Intelligence (AI), Machine Learning (ML) and telemedicine in anesthesiology could play a role in transforming the future of health care. In the present review we discuss the current applications of AI and telemedicine in anesthesiology and perioperative care, exploring their potential influence and the possible hurdles. EVIDENCE ACQUISITION AI technologies have the potential to deeply impact all phases of perioperative care from accurate risk prediction to operating room organization, leading to increased cost-effective care quality and better outcomes. Telemedicine is reported as a successful mean within the anaesthetic pathway, including preoperative evaluation, remote patient monitoring, and postoperative care. EVIDENCE SYNTHESIS The utilization of AI and telemedicine is promising encouraging results in perioperative management, nevertheless several hurdles remain to be overcome before these tools could be integrated in our daily practice. CONCLUSIONS AI models and telemedicine can significantly influence all phases of perioperative care, helping physicians in the development of precision medicine.
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Affiliation(s)
- Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marina Valente
- General Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio V Gaddi
- Center for Metabolic diseases and Atherosclerosis, University of Bologna, Bologna, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy -
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Simko AP, Hudak ML, Han SH, Huo J, Hayward K, Aldana PR. Economic analysis of a pediatric neurosurgery telemedicine clinic. J Neurosurg Pediatr 2022; 29:590-595. [PMID: 35120321 DOI: 10.3171/2021.12.peds21403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to compare the actual cost of a regional pediatric neurosurgery telemedicine clinic (PNTMC) with the estimated cost of a traditional physician-staffed outreach clinic. METHODS The authors' PNTMC was a partnership between the University of Florida College of Medicine-Jacksonville and Georgia Children's Medical Services to service the population of Georgia's Southeast Health District. Neurosurgeons based in Jacksonville conducted telemedicine visits with patients located at a remote site in Georgia with the assistance of nursing personnel from Children's Medical Services. The authors determined the actual annual per-patient costs at the Jacksonville and Georgia sites for fiscal years 2018 (FY18) and 2019 (FY19) and estimated the cost of providing traditional physician-staffed outreach clinics. RESULTS During FY18 and FY19, the neurosurgery team conducted an average of 24.5 telemedicine patient encounters per year at a cost of $369 per patient visit. The per-patient cost was 32.5% less than the estimated per-patient cost of $547 at a traditional outreach clinic. CONCLUSIONS The authors provided neurosurgical telehealth visits to appropriate patients, with a substantial cost savings per patient visit compared with traditional physician-staffed outreach clinics.
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Affiliation(s)
| | - Mark L Hudak
- 2Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Sabrina H Han
- 3Department of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; and
| | - Jinhai Huo
- 4University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Kelsey Hayward
- 3Department of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; and
| | - Philipp R Aldana
- 3Department of Pediatric Neurosurgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; and
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Outcomes for audio-only and video-based preoperative encounters for abdominal wall reconstruction and hernia consultations. Am J Surg 2022; 224:698-702. [DOI: 10.1016/j.amjsurg.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/11/2021] [Accepted: 01/19/2022] [Indexed: 12/28/2022]
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Gopal A, Bonanno V, Block VJ, Bove RM. Accessibility to Telerehabilitation Services for People With Multiple Sclerosis: Analysis of Barriers and Limitations. Int J MS Care 2022; 24:260-265. [PMID: 36545648 PMCID: PMC9749830 DOI: 10.7224/1537-2073.2022-002] [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: 12/24/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), telemedicine improves access to specialized medical care; however, barriers remain, including universal access and effective implementation. Focusing on telerehabilitation, ie, remotely delivered physical therapy, our goal was to identify barriers to telerehabilitation implementation and factors associated with patients completing telerehabilitation physical therapy treatment. METHODS Quantitative data included a review of electronic health records of patients with MS treated at the University of California San Francisco Physical Therapy Faculty Practice. We extracted demographic, clinical, and transit-related factors. For patients who scheduled an initial evaluation, we recorded the number of follow-ups, cancellations, completed physical therapy goals, and discharges. Qualitative data included interviews with 3 board-certified neurologic physical therapists and patients' perspectives recorded in the subjective portion of physical therapy notes. RESULTS We identified 111 patients with at least 1 visit (in-person or telerehabilitation) to physical therapy (82 women; mean ± SD age, 54.2 ± 12.7 years). Patients with no disability (Expanded Disability Status Scale [EDSS] score, 0) were 73% less likely to schedule a follow-up appointment (in-person or telerehabilitation) than those with some disability (EDSS score, >0) (odds ratio, 0.27; 95% CI, 0.09-0.75; P = .012). Neurologic physical therapists identified reduced travel burden and scheduling flexibility as benefits of telerehabilitation vs in-person visits. Barriers to telerehabilitation included low technological literacy, cognitive impairment, and fall risk. Patients described scheduling conflicts and pain/illness as barriers to telerehabilitation. CONCLUSIONS Patients with no disability were least likely to complete physical therapy treatment via telerehabilitation. Although both benefits and barriers to completing physical therapy via telerehabilitation are present, the neurologic physical therapists were supportive of a hybrid model for physical therapy.
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Affiliation(s)
- Arpita Gopal
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA
| | - Valeria Bonanno
- The Multiple Sclerosis Center Sant’Andrea Hospital, University La Sapienza, Rome, Italy (VB)
| | - Valerie J. Block
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA,The Department of Physical Therapy and Rehabilitation Science (VJB), University of California San Francisco, San Francisco, CA, USA
| | - Riley M. Bove
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA
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Donnally CJ, Vaccaro AR, Schroeder GD, Divi SN. Is Evaluation With Telemedicine Sufficient Before Spine Surgery? Clin Spine Surg 2021; 34:359-362. [PMID: 32496310 DOI: 10.1097/bsd.0000000000001027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Smith SM, Jacobsen JHW, Atlas AP, Khoja A, Kovoor JG, Tivey DR, Babidge WJ, Clancy B, Jacobson E, O'Neill C, North JB, Wu R, Maddern GJ, Frydenberg M. Telehealth in surgery: an umbrella review. ANZ J Surg 2021; 91:2360-2375. [PMID: 34766688 DOI: 10.1111/ans.17217] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Telehealth use has increased worldwide during the COVID-19 pandemic. However, hands-on requirements of surgical care may have resulted in slower implementation. This umbrella review (review of systematic reviews) evaluated the perceptions, safety and implementation of telehealth services in surgery, and telehealth usage in Australia between 2020 and 2021. METHODS PubMed was searched from 2015 to 2021 for systematic reviews evaluating real-time telehealth modalities in surgery. Outcomes of interest were patient and provider satisfaction, safety, and barriers and facilitators associated with its use. Study quality was appraised using the AMSTAR 2 tool. A working group of surgeons provided insights into the clinical relevance to telehealth in surgical practice of the evidence collated. RESULTS From 2025 identified studies, 17 were included, which were of low to moderate risk of bias. Patient and provider satisfaction with telehealth was high. Time savings, decreased healthcare resource use and lower costs were reported as key advantages of the service. Inability to perform comprehensive examinations was noted as the primary barrier. In Australia, peak telehealth usage coincided with the introduction of temporary telehealth services and increased lockdown measures. CONCLUSIONS Patients and providers are broadly satisfied with telehealth and its benefits. Barriers may be overcome via multidisciplinary collaboration. Telehealth may benefit surgical care long-term if implemented correctly both during and after the COVID-19 pandemic.
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Affiliation(s)
- Sarah M Smith
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Jonathan Henry W Jacobsen
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Alvin P Atlas
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Adeel Khoja
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - David R Tivey
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Bridget Clancy
- Department of Surgery, St. John of God Warrnambool Hospital, Warrnambool, Victoria, Australia
| | - Erica Jacobson
- Department of Paediatric Neurosurgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Christine O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Cancer and Public Health Research, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John B North
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - Roxanne Wu
- Department of Surgery, Cairns Private Hospital, Cairns, Queensland, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Nikolian VC, Akhter M, Iqbal EJ, Sutton T, Samhan A, Orenstein SB, Rosen MJ, Poulose BK. A National Evaluation of Surgeon Experiences in Telemedicine for the Care of Hernia and Abdominal Core Health Patients. World J Surg 2021; 46:76-83. [PMID: 34604922 PMCID: PMC8487675 DOI: 10.1007/s00268-021-06332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 12/11/2022]
Abstract
Background Surgeons are increasingly utilizing telemedicine to provide perioperative services to patients. Safety, satisfaction, and feasibility of these programs in general populations have been established, but it is unclear how telemedicine can be integrated into subspecialty care. We report results of a national survey related to telehealth practices among members of the Abdominal Core Health Quality Collaborative (ACHQC).
Methods Survey responses were analyzed to determine current strategies in telemedicine utilization. Surgeon preferences, perceptions of validity, and identified barriers to implementation of telemedicine were assessed. Results Forty surgeons within the ACHQC responded, with 90% of respondents reporting use of telemedicine to deliver perioperative care to patients with hernias and abdominal core health concerns. Surgeons appeared to be more comfortable managing preoperative patients with image-confirmed diagnoses of hernias. Surgeons were universally more comfortable delivering postoperative care via telemedicine. Connectivity, patient engagement, and reimbursement were identified as potential barriers to expansion of telemedicine. Seventy-eight percent of respondents reported that they would increase telemedicine utilization if current regulations were maintained in the future. Conclusions This study found that hernia specialists are utilizing telemedicine at a higher rate than before the COVID-19 pandemic, with surgeons reporting interest in continued use of this modality beyond the pandemic. These findings suggest that future work in telemedicine optimization may improve the quality of care that can be delivered to patients with abdominal core health concerns. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06332-9.
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Affiliation(s)
- Vahagn C Nikolian
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Mudassir Akhter
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Emaad J Iqbal
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Thomas Sutton
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ashraf Samhan
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sean B Orenstein
- Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health & Science University, Mail Code L 233A, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Michael J Rosen
- Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Ohio State University, Columbus, OH, USA
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Health-related quality of life in adults with tetralogy of Fallot repair: a systematic review and meta-analysis. Qual Life Res 2021; 30:2715-2725. [PMID: 34021473 DOI: 10.1007/s11136-021-02875-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the advancement in diagnostics and clinical management, patients with Tetralogy of Fallot (ToF) are surviving till adulthood. Hence, assessing the impact of ToF repair on health-related quality of life (HRQOL) of these patients is becoming increasingly important. The objective of this paper is to conduct a systematic review and meta-analysis of the HRQOL in patients who have undergone ToF repair. METHODS A systematic search was conducted using PubMed, CINAHL, Medline and Web of Science databases. Studies that compared the HRQOL of adult patients (mean age ≥ 18 years) who had previously undergone ToF repair with healthy controls were included. Analysis was done via Revman V5.3 using a random effects model. RESULTS The 16 studies (15 using SF-36) included in the meta-analysis, comprised 1818 patients and 50,265 healthy controls. There was a higher proportion of males (59%). The mean ages at surgery and at HRQOL assessment were 5.37 years and 30.3 years, respectively. We found that repaired ToF patients had a statistically significantly lower score in the physical component summary (SMD = - 0.92 CI = - 1.54, - 0.30) and physical functioning (SMD = - 0.27 CI = - 0.50, - 0.03) compared to healthy controls. However, these patients had statistically significantly higher scores in the bodily pain domain (SMD = 0.35 CI = 0.12, 0.58) and social functioning (SMD = 0.23 CI = 0.01, 0.46), while there was no significant difference in other domains. CONCLUSION Overall, physical domain of HRQOL was statistically significantly lower in repaired ToF patients compared to healthy controls. However, repaired ToF patients scored significantly higher on bodily pain and Social Functioning. There was additionally no difference in the HRQOL between the two groups in other domains of HRQOL.
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Affiliation(s)
- Karen Ruby Lionel
- Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
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de Brouwer IJ, Elaut E, Becker-Hebly I, Heylens G, Nieder TO, van de Grift TC, Kreukels BPC. Aftercare Needs Following Gender-Affirming Surgeries: Findings From the ENIGI Multicenter European Follow-Up Study. J Sex Med 2021; 18:1921-1932. [PMID: 37057483 DOI: 10.1016/j.jsxm.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/31/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While much emphasis has been put on the evaluation of gender-affirming surgery (GAS) approaches and their effectiveness, little is known about the health care needs after completion of these interventions. AIM To assess post-GAS aftercare needs using a mixed-method approach and relate these to participant characteristics. METHODS As part of the ENIGI follow-up study, data was collected 5 years after first contact for gender-affirming treatments in 3 large European clinics. For the current analyses, only participants that had received GAS were included. Data on sociodemographic and clinical characteristics was collected. Standard aftercare protocols were followed. The study focused on participants' aftercare experiences. Participants rated whether they (had) experienced (predefined) aftercare needs and further elaborated in 2 open-ended questions. Frequencies of aftercare needs were analyzed and associated with participant characteristics via binary logistic regression. Answers to the open-ended questions were categorized through thematic analysis. OUTCOMES Aftercare needs transgender individuals (had) experienced after receiving GAS and the relation to sociodemographic and clinical characteristics. RESULTS Of the 543 individuals that were invited for the ENIGI follow-up study, a total of 260 individuals were included (122 (trans) masculine, 119 (trans) feminine, 16 other, 3 missing). The most frequently mentioned aftercare need was (additional) assistance in surgical recovery (47%), followed by consultations with a mental health professional (36%) and physiotherapy for the pelvic floor (20%). The need for assistance in surgical recovery was associated with more psychological symptoms (OR=1.65), having undergone genital surgery (OR=2.55) and lower surgical satisfaction (OR=0.61). The need for consultation with a mental health professional was associated with more psychological symptoms and lower surgical satisfaction. The need for pelvic floor therapy was associated with more psychological symptoms as well as with having undergone genital surgery. Thematic analysis revealed 4 domains regarding aftercare optimization: provision of care, additional mental health care, improvement of organization of care and surgical technical care. CLINICAL IMPLICATIONS Deeper understanding of post-GAS aftercare needs and associated individual characteristics informs health care providers which gaps are experienced and therefore should be addressed in aftercare. STRENGTHS & LIMITATIONS We provided first evidence on aftercare needs of transgender individuals after receiving GAS and associated these with participant characteristics in a large multicenter clinical cohort. No standardized data on aftercare received was collected, therefore the expressed aftercare needs cannot be compared with received aftercare. CONCLUSION These results underline a widely experienced desire for aftercare and specify the personalized needs it should entail. IJ de Brouwer, E Elaut, I Becker-Hebly et al. Aftercare Needs Following Gender-Affirming Surgeries: Findings From the ENIGI Multicenter European Follow-Up Study. J Sex Med 2021;18:1921-1932.
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Affiliation(s)
- Iris J de Brouwer
- Amsterdam University Medical Center (location VUmc), Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam University Medical Center (location VUmc), Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | - Els Elaut
- University Hospital Ghent, Center of Sexology and Gender, Ghent, Belgium; Ghent University, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium
| | - Inga Becker-Hebly
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Gunter Heylens
- University Hospital Ghent, Center of Sexology and Gender, Ghent, Belgium
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim C van de Grift
- Amsterdam University Medical Center (location VUmc), Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam University Medical Center (location VUmc), Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands.
| | - Baudewijntje P C Kreukels
- Amsterdam University Medical Center (location VUmc), Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands
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Harkey K, Connor CD, Wang H, Kaiser N, Matthews BD, Kelz R, Reinke CE. View from the Patient Perspective: Mixed-Methods Analysis of Post-Discharge Virtual Visits in a Randomized Controlled Trial. J Am Coll Surg 2021; 233:593-605.e4. [PMID: 34509613 DOI: 10.1016/j.jamcollsurg.2021.07.688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Virtual visits (VVs) are being used increasingly to provide patient-centered care and have undergone rapid uptake during the COVID-19 pandemic. Our aim was to compare satisfaction and convenience of virtual post-discharge follow-up for surgical patients and qualitatively analyze free-text survey responses in a randomized controlled noninferiority trial. Patient satisfaction with VVs has not been evaluated previously in a randomized controlled trial and few mixed-methods analyses have been done to understand barriers and facilitators to post-discharge visits. STUDY DESIGN Patients undergoing laparoscopic appendectomy or cholecystectomy were randomized to VV or in-person visit (2:1). Surveys with 11 multiple-choice and 2 open-ended questions evaluated patient satisfaction and convenience. Univariate analysis compared responses to the multiple-choice questions and qualitative content analysis evaluated open-ended responses. RESULTS Of 442 enrolled patients, 289 completed their postoperative visit and were sent surveys (55% response rate). Patients were categorized as VV (n = 135), crossover (randomized to virtual but completed in-person; n = 53), and in-person visits (n = 101). Patient-reported satisfaction was similar, but convenience was higher for VV patients. Open-ended responses (72 VVs, 14 crossovers, and 41 in-person visits) were qualitatively analyzed. In all groups, patient experience was influenced by quality of care, efficiency, and convenience. Barriers were different for virtual and in-person appointments. CONCLUSIONS We found that quality of, and access to, care-whether in person or virtual-remained critical components of patient satisfaction. VVs address many barriers associated with in-person visits and were more convenient, but can present additional technological barriers.
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Affiliation(s)
| | - C Danielle Connor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC
| | | | | | | | - Rachel Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
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Mohammadi S, Miller WC, Wu J, Pawliuk C, Robillard JM. Effectiveness of eHealth Tools for Hip and Knee Arthroplasty: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:696019. [PMID: 36188859 PMCID: PMC9397702 DOI: 10.3389/fresc.2021.696019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Abstract
Objective: This study aimed to compare the effectiveness and costs of eHealth tools with usual care in delivering health-related education to patients' undergoing total hip or knee arthroplasty due to osteoarthritis.Data Sources: Six electronic databases were searched to identify randomized controlled trials and experimental designs (randomized or not) examining the effect of eHealth tools on pre- or post-operative care. Only manuscripts written in English were included. In the current study, no specific primary or secondary outcomes were selected. Any study that investigated the impacts of eHealth tools on hip or knee arthroplasty outcomes were included.Review Methods: Two researchers reviewed all titles and abstracts independently and in duplicate. Two researchers also conducted full-text screening and data extraction from the 26 selected articles.Results: The data were descriptively reported, and themes could emerge from each outcome. Two researchers separately assessed the Risk of Bias for each paper using the Cochrane risk of bias assessment tool. The majority of studies evaluated the impact of eHealth tools on physical (n = 23) and psychosocial outcomes (n = 19). Cost-related outcomes were measured in 7 studies. eHealth tools were found to be equivocal to usual care, with few studies reporting statistically significant differences in physical or psychosocial outcome measures. However, cost-related outcomes showed that using eHealth tools is more cost-effective than usual care.Conclusions: This review demonstrated that eHealth tools might be as effective as usual care, and possibly more cost-effective, a crucial implication for many overly burdened health care systems.
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Affiliation(s)
- Somayyeh Mohammadi
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William C. Miller
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Wu
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Colleen Pawliuk
- BC Children Hospital Research Institute, Vancouver, BC, Canada
| | - Julie M. Robillard
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Julie M. Robillard
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Nadella S, Wang TT, Bear A, Panchal N. Do Medical Insurance Companies Reimburse Telemedicine Office Visits the Same as In-Person Office Visits in an Academic Oral and Maxillofacial Surgeon Setting? J Oral Maxillofac Surg 2021; 79:2398-2403. [PMID: 34547264 DOI: 10.1016/j.joms.2021.08.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The use of telemedicine has grown exponentially over the last decade, but its widespread adoption has been hindered, at least in part, by uncertainty over reimbursement rate for services. The aim of this study is to compare reimbursement rates of telemedicine and in-person visits in an academic oral and maxillofacial surgery practice. METHODS The investigators implemented a retrospective cohort study. The sample was composed of patients who were treated by the oral-maxillofacial surgery service at the University of Pennsylvania Health System from March 17, 2020 to February 27, 2021. The primary predictor variable was the type of patient visit, either telemedicine or in-person. Patient status, either established or new, was a covariate. The outcome variable was the mean reimbursement-to-charge (RC) ratio. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS This study included 6,082 submitted claims for 4,045 patients for in-person and telemedicine oral-maxillofacial surgery office visits. The mean reimbursement per insurance payor was $98.07 for a telemedicine visit (mean RC ratio = 0.48 with a standard deviation of ± 0.20) and $109.5 for an in-person visit (mean RC ratio = 0.50 with a standard deviation of ± 0.19). While there was a significant difference between the RC ratio for total telemedicine versus in-person visits (P = .001), the magnitude of the difference was only 2%. When stratifying the comparison by new (P = .73) and established patients (P = .20) for both telemedicine and in-person office visits, there was no significant difference in RC ratios. CONCLUSIONS The results suggest that there are no major discrepancies in financial reimbursement rate between telemedicine and in-person office visits. Both methods of treatment may be financially effective for oral-maxillofacial surgery providers. Future studies can compare reimbursement rates among different insurance providers and among different institutions in the United States.
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Affiliation(s)
- Srighana Nadella
- DMD Candidate, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA; BA Candidate, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA
| | - Tim T Wang
- Associate Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Adam Bear
- Supervisor of Billing, University of Pennsylvania Health System, Philadelphia, PA
| | - Neeraj Panchal
- Assistant Professor and Section Chief of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, Penn Presbyterian Medical Center, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.
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Cruz MJ, Nieblas-Bedolla E, Young CC, Feroze AH, Williams JR, Ellenbogen RG, Levitt MR. United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons. Neurosurgery 2021; 89:364-371. [PMID: 34133724 PMCID: PMC8344865 DOI: 10.1093/neuros/nyab185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/03/2021] [Indexed: 01/14/2023] Open
Abstract
Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons' familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.
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Affiliation(s)
- Michael J Cruz
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher C Young
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John R Williams
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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