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Chu G, Silva C, Adams K, Chacko B, Attia J, Nathan N, Wilson R. Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study. J Ren Care 2024; 50:128-137. [PMID: 37434485 DOI: 10.1111/jorc.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored. OBJECTIVES To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality. DESIGN A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth. PARTCIPANTS Home dialysis patients and their carers. MEASURUEMENTS Suveys and qualitative interviews. METHODS A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth. RESULTS Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants. CONCLUSION This study suggested that a blended model combining telehealth and face-to-face services would allow patient choice and is important to facilitate equity of care, particularly for those patients who were unwilling or had difficulty adopting technology.
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Affiliation(s)
- Ginger Chu
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Carla Silva
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Kelly Adams
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Bobby Chacko
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole Nathan
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rhonda Wilson
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Abstract
INTRODUCTION We examined the coronavirus disease 2019 (COVID-19) pandemic impact on weekly trends in the billing of virtual and in-person physician visits in Ontario, Canada. METHODS In this retrospective cohort study, physician billing records from Ontario were aggregated on a weekly basis for in-person and virtual visits from 3 January 2016 to 27 March 2021. For each type of visit, a segmented negative binomial regression analysis was performed to estimate the weekly pre-pandemic trend in billing volume per thousand adults (3 January 2016 to 14 March 2020), the immediate change in mean volume at the start of the pandemic, and additional change in weekly volume in the pandemic era (15 March 2020 to 27 March 2021). RESULTS Before the start of the pandemic, the weekly volume of virtual visits per thousand adults was low with a 0.5% increase per week (rate ratio [RR]: 1.0053, 95% confidence interval [CI]: 1.0050-1.0056). A dramatic 65% reduction in in-person visits (RR: 0.35, 95% CI: 0.32-0.39) occurred at the start of the pandemic while virtual visits grew by 21-fold (RR: 21.3, 95% CI: 19.6-23.0). In the pandemic era, in-person visits rose by 1.4% per week (RR: 1.014, 95% CI: 1.011-1.017) but no change was observed for virtual visits (p-value = 0.31). Overall, we noted a 57.6% increase in total weekly physician visits volume after the start of the pandemic. DISCUSSION These results are meaningful for virtual care reimbursement models. Future study needs to assess the quality of care and whether the increase in virtual care volume is cost-effective to society.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology – Head and Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology – Head and Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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De La Torre A, Diaz P, Perdomo R. Analysis of the virtual healthcare model in Latin America: a systematic review of current challenges and barriers. Mhealth 2024; 10:20. [PMID: 38689618 PMCID: PMC11058594 DOI: 10.21037/mhealth-23-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/03/2023] [Indexed: 05/02/2024] Open
Abstract
Background The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The objective of this study was to identify the current barriers to implementing and consolidating the virtual healthcare model, of "telemedicine", in Latin American countries. Methods A systematic review was conducted through four databases: PubMed, Scopus, Web of Science, and Virtual Health, including articles in Spanish, Portuguese, and English. A combination of Boolean operators was used with the terms "telemedicine", "telehealth", "telecare", "home care services", "remote care" and the name of each Latin American country. Articles published from January 2020 to January 2023 that reported on the barriers and challenges of using the virtual care model were included. Results Nineteen articles were included. Brazil (n=5) and Argentina (n=4) were the countries where there was the greatest interest to explore barriers to virtual care. The barriers identified were categorized into five main themes: (I) technological and technical issues; (II) absence of a physical examination; (III) patient's negative perceptions; (IV) negative perceptions among healthcare professionals; and (V) structural obstacles and those associated with the healthcare system. The main obstacles reported were connectivity problems, lack of a complete physical examination, issues of privacy, high risk of medical malpractice, and absence of local regulation. Conclusions The virtual care model is a safe and cost-effective alternative for the delivery of health services, with multiple benefits for patients and their families. The indication for the use of virtual care should be based on a risk model for patient prioritization. Likewise, the analysis of the main barriers and benefits is fundamental to consolidating this model of care and ensuring its expansion in the region.
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Puchades R, Said-Criado I. [Telemedicine in clinical practice: Barriers and risks]. Med Clin (Barc) 2024; 162:123-125. [PMID: 37985327 DOI: 10.1016/j.medcli.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Ramón Puchades
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España; Grupo de Trabajo de Medicina Digital de la Sociedad Española de Medicina Interna.
| | - Ismael Said-Criado
- Servicio de Urgencias, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España; Grupo de Trabajo de Medicina Digital de la Sociedad Española de Medicina Interna
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Restrepo JA, Henriquez R, Torre D, Graber ML. The physical exam and telehealth: between past and future. Diagnosis (Berl) 2024; 11:1-3. [PMID: 38033192 DOI: 10.1515/dx-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Jorge A Restrepo
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
| | - Richard Henriquez
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
| | - Dario Torre
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
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Hirosawa T, Sakamoto T, Harada Y, Tokumasu K, Shimizu T. Clinical decision support system using a machine learning model to assist simultaneous cardiopulmonary auscultation: Open-label randomized controlled trial. Digit Health 2024; 10:20552076241233689. [PMID: 38380082 PMCID: PMC10878214 DOI: 10.1177/20552076241233689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Background The utility of a clinical decision support system using a machine learning (ML) model for simultaneous cardiac and pulmonary auscultation is unknown. Objective This study aimed to develop and evaluate an ML system's utility for cardiopulmonary auscultation. Methods First, we developed an ML system for cardiopulmonary auscultation, using cardiopulmonary sound files from our previous study. The technique involved pre-processing, feature extraction, and classification through several neural network layers. After integration, the output class was categorized as "normal," "abnormal," or "undetermined." Second, we evaluated the ML system with 24 junior residents in an open-label randomized controlled trial at a university hospital. Participants were randomly assigned to the ML system group (intervention) or conventional auscultation group (control). During training, participants listened to four cardiac and four pulmonary sounds, all of which were correctly classified. Then, participants classified a series of 16 simultaneous cardiopulmonary sounds. The control group auscultated the sounds using noise-cancelling headphones, while the intervention group did so by watching recommendations from the ML system. Results The total scores for correctly identified normal or abnormal cardiopulmonary sounds in the intervention group were significantly higher than those in the control group (366/384 [95.3%] vs. 343/384 [89.3%], P = 0.003). The cardiac test score in the intervention group was better (111/192 [57.8%] vs. 90/192 [46.9%], P = 0.04); there was no significant difference in pulmonary auscultation. Conclusions The ML-based system improved the accuracy of cardiopulmonary auscultation for junior residents. This result suggests that the system can assist early-career physicians in accurate screening.
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Affiliation(s)
- Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Tetsu Sakamoto
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
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von Itzstein MS, Gwin ME, Gupta A, Gerber DE. Telemedicine and Cancer Clinical Research: Opportunities for Transformation. Cancer J 2024; 30:22-26. [PMID: 38265922 PMCID: PMC10827351 DOI: 10.1097/ppo.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Telemedicine represents an established mode of patient care delivery that has and will continue to transform cancer clinical research. Through telemedicine, opportunities exist to improve patient care, enhance access to novel therapies, streamline data collection and monitoring, support communication, and increase trial efficiency. Potential challenges include disparities in technology access and literacy, physical examination performance, biospecimen collection, privacy and security concerns, coverage of services by insurance, and regulatory considerations. Coupled with artificial intelligence, telemedicine may offer ways to reach geographically dispersed candidates for narrowly focused cancer clinical trials, such as those targeting rare genomic subsets. Collaboration among clinical trial staff, clinicians, regulators, professional societies, patients, and their advocates is critical to optimize the benefits of telemedicine for clinical cancer research.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary E. Gwin
- Department of Internal Medicine, University of Texas Southwestern Medical Center. Dallas, Texas, USA
| | - Arjun Gupta
- Department of Internal Medicine (Division of Hematology-Oncology), University of Minnesota, Minneapolis, Minnesota, USA
| | - David E. Gerber
- Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Al‐Rikaby A, Sulaiman A, Thompson JR, Saw RPM, Boyle F, Taylor N, Carlino MS, Morton RL, Nieweg OE, Thompson JF, Bartula I. Telehealth follow-up consultations for melanoma patients during the COVID-19 pandemic: Patient and clinician satisfaction. Cancer Med 2023; 12:21373-21388. [PMID: 37930181 PMCID: PMC10726917 DOI: 10.1002/cam4.6679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused rapid implementation of telehealth for melanoma follow-up care in Australia. This study explores Australian melanoma patients and clinicians' level of satisfaction with telehealth. METHODS A cross-sectional study was conducted across three specialist melanoma centres in Sydney, Australia. Melanoma patients (all stages) and clinicians completed mixed methods surveys seeking socio-demographic and clinical information and questionnaires to assess satisfaction with telehealth. Additionally, patients completed measures of quality of life, fear of cancer recurrence and trust in their oncologist. Patients and clinicians provided open-ended responses to qualitative questions about their perceptions of telehealth. RESULTS One hundred and fifteen patients and 13 clinicians responded to surveys. Telephone was used by 109 (95%) patients and 11 (85%) clinicians. Fifty-seven (50%) patients and nine (69%) clinicians preferred face-to-face consultations, 38 (33%) patients and 3 (23%) clinicians preferred a combination of face-to-face and telehealth consultations. Five (4%) patients and nil clinicians preferred telehealth consultations. Patients diagnosed with early-stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns were likely to report lower satisfaction with telehealth. Open-ended responses were consistent between patients and clinicians, who reported safety, convenience and improved access to care as major benefits, while identifying personal, interpersonal, clinical and system-related disadvantages. DISCUSSION While telehealth has been widely implemented during COVID-19, the benefits identified by patients and clinicians may extend past the pandemic. Telehealth may be considered for use in conjunction with face-to-face consultations to provide melanoma follow-up care.
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Affiliation(s)
- Ali Al‐Rikaby
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Ahmad Sulaiman
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
| | - Jake R. Thompson
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
| | - Robyn P. M. Saw
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Frances Boyle
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Patricia Ritchie Centre for Cancer Care and ResearchMater HospitalNorth SydneyNew South WalesAustralia
| | - Nicole Taylor
- Department of Medical OncologyWestmead and Blacktown HospitalsSydneyNew South WalesAustralia
| | - Matteo S. Carlino
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Medical OncologyWestmead and Blacktown HospitalsSydneyNew South WalesAustralia
| | - Rachael L. Morton
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- NHMRC Clinical Trials Centre, Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
| | - Omgo E. Nieweg
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - John F. Thompson
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Iris Bartula
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
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Almaghlouth I, Almalag HM, Alzuhair H, Alsaigh R, Bedaiwi A, Hassen LM, Alzomia S, Alanazi B, Alabdulkareem AM, Alahmari S, Asfina KN, Khalil N, Omair MA, Bedaiwi M. Impact of telemedicine on disease activity assessment: A case-crossover study nested within a cohort of patients with systemic lupus erythematosus. Lupus 2023; 32:1610-1618. [PMID: 37921574 DOI: 10.1177/09612033231211855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The utilisation of telemedicine has been rapidly growing among patients with rheumatic diseases, especially following the corona virus disease 2019 pandemic. Ease and convenience appear to dominate the reasons for this growth. However, the effects of this approach in patients with systemic lupus erythematosus (SLE) are yet to be revealed. In this study, we examined the effect of telemedicine on disease activity assessment and damage scores in patients with SLE. METHODS This case-crossover study was nested within a national prospective cohort of patients with SLE in Saudi Arabia. Patients with SLE were included if they fulfilled the Systemic Lupus International Collaborating Clinics classification criteria between March 2020 and March 2021 and were assessed at three time points with 3 months between assessments, according to the standardised protocol of this cohort. Telemedicine was conducted for the first evaluation, while in-person assessments were used at the second and third visits. The primary outcome was the difference in the SLE disease activity index 2000 (SLEDAI-2K) score. The primary analysis was conducted using the repeated measure model and adjusted for potential confounders, including demographics, medications, and changes in steroid doses. Several sensitivity analyses were conducted to mitigate selection and time-varying confounders. RESULTS A total of 92 participants were included in this study. Most patients were females (88%), with a mean (±standard deviation [SD]) age of 36 (±13) years. The mean (±SD) disease activity scores at baseline were as follows: SLEDAI-2K, 5 (±5); SLE responder index, 3.8 (±3.5); Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, 1 (±1). The mean difference in SLEDAI-2K score was -1.641 (95% confidence interval -2.773 to -0.510, p = 0.005*) between telemedicine and follow-up visits. The results were consistent in all sensitivity analyses. CONCLUSION We found that telemedicine assessment was associated with a much higher disease activity score than subsequent assessments, which may suggest an overestimation of disease activity and later assessment accuracy. Cautious adoption has been suggested for SLE patients with active disease.
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Affiliation(s)
- Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Haya M Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hajer Alzuhair
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rafif Alsaigh
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asma Bedaiwi
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lena M Hassen
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Zoology Department, College of Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman Alzomia
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Boshra Alanazi
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Saud Alahmari
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kazi Nur Asfina
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Najma Khalil
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Omair
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Bedaiwi
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Saati A, Au A, Joshi AU, Davis R, West FM, Lewiss RE. Can Untrained Patients Perform Their Own Skin and Soft Tissue Ultrasound Examination by Teleguidance? POCUS J 2023; 8:159-164. [PMID: 38099176 PMCID: PMC10721299 DOI: 10.24908/pocus.v8i2.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Objectives: This pilot study aims to determine if patients untrained in performing ultrasound can self-scan to obtain images under remote clinician teleguidance during a simulated telehealth encounter. This study also seeks to describe the patients' comfort level and barriers to performing an ultrasound examination on themselves using a handheld ultrasound device. Methods: This was a single center prospective observational cohort study conducted over a 4-month period in 2021. Patients were eligible if they had no prior training in the use of ultrasound and in the use of teleguidance. They voluntarily consented to participate at a single ambulatory internal medicine clinic. Results: 20 participants were enrolled and underwent teleguidance to ultrasound their own skin and soft tissues at the antecubital fossae. Six second video clips were evaluated by 2 subject matter experts using the Point of Care Ultrasound Image Quality scale. A score >7 was considered adequate for diagnostic interpretation. The average score was 10.15/14, with a minimum score of 5/14, and maximum score of 14/14 and a standard deviation (SD) of 2.39 using a two tailed Z-score. Setting alpha at 0.05 the 95% CI was (5.47-14.83). Conclusion: In a pilot study of 20 participants with no ultrasound experience, untrained healthy volunteers were able to perform technically acceptable and interpretable ultrasound scans using teleguidance by a trained clinician.
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Affiliation(s)
- Ammar Saati
- Department of Cardiovascular Medicine Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic FoundationCleveland, OHUSA
| | - Arthur Au
- Department of Emergency Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Aditi U Joshi
- Digital Health Intelligence, MDisrupt, Founder, Nagamed LLC
| | - Rebecca Davis
- Department of Internal Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Frances Mae West
- Department of Internal Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Resa E Lewiss
- Department of Emergency Medicine, University of Alabama at BirminghamBirmingham, ALUSA
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Guizado de Nathan G, Shaw LK, Doolen J. Social Determinants of Health: A Multilingual Standardized Patient Case to Practice Interpreter Use in a Telehealth Visit. MedEdPORTAL 2023; 19:11364. [PMID: 38028958 PMCID: PMC10643468 DOI: 10.15766/mep_2374-8265.11364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 09/14/2023] [Indexed: 12/01/2023]
Abstract
Introduction The growing diversity of the United States population and strong evidence of disparities in health care make it critically important to educate health care professionals to effectively address issues of culture. To that end, we developed a simulation for teaching interpreter use in a telehealth setting. Our contribution of non-English language preference (NELP) patient cases in Spanish, Tagalog, French, and Igbo advances existing literature by combining the skills of interpreter use and telehealth while widening the array of cultures represented. Methods Simulations were implemented for two cohorts of 60 first-year medical students. In the pilot, nine groups of six to seven students and one faculty met via Zoom with an NELP patient complaining of fatigue, weakness, and cough. When students determined the need for an interpreter, faculty admitted one to the meeting, and the telehealth visit continued. Postsession activities included debriefing and writing a progress note. Results Course evaluation comments from the first cohort and a postencounter survey of the second cohort were positive. They revealed that students learned to speak slower, in shorter phrases, and directly to the patient. Learners completed note documentation according to a rubric. Discussion This low-stakes activity provides faculty with a resource for introducing cultural competence into the curriculum. The original Spanish version of the case has been translated into three additional languages, providing a diverse representation of the NELP population. Important points for communicating through an interpreter are practiced in a telehealth setting with a fatigue case.
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Affiliation(s)
- Gigi Guizado de Nathan
- Former Standardized Patient Coordinator, Clinical Simulation Center of Las Vegas, University of Nevada, Las Vegas
| | - Laura K. Shaw
- Associate Professor, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas
| | - Jessica Doolen
- Associate Professor in Residence, School of Nursing, University of Nevada, Las Vegas
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Bajra R, Srinivasan M, Torres EC, Rydel T, Schillinger E. Training future clinicians in telehealth competencies: outcomes of a telehealth curriculum and teleOSCEs at an academic medical center. Front Med (Lausanne) 2023; 10:1222181. [PMID: 37849494 PMCID: PMC10577422 DOI: 10.3389/fmed.2023.1222181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023] Open
Abstract
Background This study describes the program and learning outcomes of a telehealth skills curriculum based on the Association of American Medical Colleges (AAMC) telehealth competencies for clerkship-level medical students. Methods A total of 133 third- and fourth-year medical students in a required family medicine clerkship at Stanford University School of Medicine participated in a telehealth curriculum, including a telehealth workshop, site-specific telehealth clinical encounters, and telemedicine objective structured clinical examinations (teleOSCEs) between July 2020 and August 2021. Their workshop communication and physical examination competencies were assessed in two teleOSCEs utilizing a novel telehealth assessment tool. Students' attitudes, skills, and self-efficacy were assessed through voluntary pre-clerkship, post-workshop, and post-OSCE surveys. Discussion Most learners reported low confidence in their telehealth physical examinations [n = 79, mean = 1.6 (scale 0-5, 5 = very confident, SD = 1.0)], which improved post-workshop [n = 69, 3.3 (0.9), p < 0.001]; almost all (97%, 70/72) felt the workshop prepared them to see patients in the clinic. In formative OSCEs, learners demonstrated appropriate "webside manner" (communication scores 94-99%, four items) but did not confirm confidentiality (21%) or review limitations of the visit (35%). In a low back pain OSCE, most learners assessed pain location (90%) and range of motion (87%); nearly half (48%) omitted strength testing. Conclusion Our telehealth curriculum demonstrated that telehealth competencies can be taught and assessed in medical student education. Improvement in self-efficacy scores suggests that an 80-min workshop can prepare students to see patients in the clinical setting. Assessment of OSCE data informs opportunities for growth for further development in the curriculum, including addressing visit limitations and confidentiality in telehealth visits.
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Affiliation(s)
- Rika Bajra
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Malathi Srinivasan
- One Health Teaching Scholars Program, Stanford CARE Internships Programs, Stanford Center for Asian Healthcare Research and Education, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Elise Cheng Torres
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Tracy Rydel
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Erika Schillinger
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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McConnell M, Kumar P, Mullur R. The Virtual Visit: A Telehealth Curriculum for Internal Medicine Residents Featuring a Virtual Physical Examination. J Grad Med Educ 2023; 15:582-586. [PMID: 37781440 PMCID: PMC10539141 DOI: 10.4300/jgme-d-22-00635.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 10/03/2023] Open
Abstract
Background During the COVID-19 pandemic, medical professionals were obligated to adapt to virtual care. Most resident physicians had no formal telehealth training. The virtual physical examination remained underutilized. Objective We describe a needs assessment leading to the creation of a telehealth curriculum for internal medicine (IM) and internal medicine pediatric (IM/P) residents, and report changes in residents' confidence level as well as feasibility data. We hypothesized that residents' confidence in delivering virtual care would significantly improve after implementing a telehealth curriculum. Methods A needs-based assessment for all University of California Los Angeles (UCLA) IM and IM/P residents was conducted in July 2020. Specific competencies were identified: (1) telehealth legal guidelines; (2) virtual physical examination; (3) health equity; and (4) telehealth chronic disease management. The curriculum was presented via 3 synchronous interactive online interventions between November 2020 and March 2021. Pre- and post-intervention learner assessments were conducted. Results Out of all 180 residents, 146 UCLA IM and IM/P residents completed pre- and post-Virtual Physical Examination curriculum surveys, which were not uniquely linked to individuals. Residents reported statistically significant increased confidence levels in performing a targeted virtual physical examination (P<.001; 95% CI 0.97-1.35), engaging patients or caregivers to assist in virtual examinations (P<.001; 95% CI 0.76-1.21), and using remote monitoring devices (P<.001; 95% CI 0.58-1.03). Conclusions Our results demonstrate that, within our IM and IM/P residency programs, a formalized telehealth curriculum significantly improved residents' confidence in delivering virtual care.
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Affiliation(s)
- Megan McConnell
- Megan McConnell, MD, is Clinical Instructor, Department of Medicine, Endocrinology, Diabetes, & Metabolism, University of California Los Angeles David Geffen School of Medicine
| | - Puneet Kumar
- Puneet Kumar, MD, is Assistant Clinical Professor, Department of Medicine, University of California Los Angeles David Geffen School of Medicine; and
| | - Rashmi Mullur
- Rashmi Mullur, MD, is Associate Professor, Department of Medicine, Endocrinology, Diabetes & Metabolism, University of California Los Angeles David Geffen School of Medicine, and Chief of Telehealth, Veterans Affairs Greater Los Angeles
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14
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Minuz P, Albini FL, Imbalzano E, Izzo R, Masi S, Pengo MF, Pucci G, Scalise F, Salvetti M, Tocci G, Cicero A, Iaccarino G, Savoia C, Sechi L, Parati G, Borghi C, Volpe M, Ferri C, Grassi G, Muiesan ML. Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-Related Cardiovascular Diseases: A Position Paper of the Italian Society of Arterial Hypertension (SIIA). High Blood Press Cardiovasc Prev 2023; 30:387-399. [PMID: 37594686 PMCID: PMC10600275 DOI: 10.1007/s40292-023-00595-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
High blood pressure is the leading cause of death and disability globally and an important treatable risk factor for cardiovascular, cerebrovascular and chronic kidney diseases. Digital technology, including mobile health solutions and digital therapy, is expanding rapidly in clinical medicine and has the potential to improve the quality of care and effectiveness of drug treatment by making medical interventions timely, tailored to hypertensive patients' needs and by improving treatment adherence. Thus, the systematic application of digital technologies could support diagnosis and awareness of hypertension and its complications, ultimately leading to improved BP control at the population level. The progressive implementation of digital medicine in the national health systems must be accompanied by the supervision and guidance of health authorities and scientific societies to ensure the correct use of these new technologies with consequent maximization of the potential benefits. The role of scientific societies in relation to the rapid adoption of digital technologies, therefore, should encompass the entire spectrum of activities pertaining to their institutional role: information, training, promotion of research, scientific collaboration and advice, evaluation and validation of technological tools, and collaboration with regulatory and health authorities.
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Affiliation(s)
- Pietro Minuz
- Department of Medicine, University of Verona, Medicina Generale C, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy.
| | | | - Egidio Imbalzano
- Hypertension Unit, Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, UK
| | - Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, "Santa Maria" Terni Hospital, Terni, Italy
| | - Filippo Scalise
- Center for the Study of Hypertension and Vascular Diseases-Clinical Institute Verano Brianza, Policlinico di Monza, Monza, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Arrigo Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Guido Iaccarino
- Center for Research on Hypertension and Related Conditions, Federico II University of Naples, Naples, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Leonardo Sechi
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
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Askanase AD, Aranow C, Kim MY, Kamen DL, Arriens C, Khalili L, Tang W, Barasch J, Dall'Era M, Mackay M. Protocol for virtual physical examination in an observational, longitudinal study evaluating virtual outcome measures in SLE. Lupus Sci Med 2023; 10:e000952. [PMID: 37429672 DOI: 10.1136/lupus-2023-000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/26/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE There is a lack of data on the use of telemedicine (TM) in SLE. SLE outcome measures remain complex, and clinicians and clinical trialists have raised concerns about the accuracy of virtual disease activity measures. This study evaluates the level of agreement between virtual SLE outcome measures and face-to-face (F2F) encounter. Here, we describe the study design, virtual physical examination protocol and demographics for the first 50 patients evaluated. METHODS AND ANALYSIS This is an observational, longitudinal study of 200 patients with SLE with varying levels of disease activity from 4 academic lupus centres serving diverse populations. Each study participant will be evaluated at a baseline and a follow-up visit. At each visit, participants are evaluated by the same physician first via a videoconference-based TM and then a F2F encounter. For this protocol, virtual physical examination guidelines relying on physician-directed patient self-examination were established. SLE disease activity measures will be completed immediately after the TM encounter and repeated after the F2F encounter for each visit. The degree of agreement between TM and F2F disease activity measures will be analysed using the Bland-Altman method. An interim analysis is planned after the enrolment of the first 50 participants. ETHICS AND DISSEMINATION This study has been reviewed by the Columbia University Medical Center Institutional Review Board (IRB Protocol #: AAAT6574). The full results of this study will be published after the final data analysis of 200 patients. The abrupt shift to TM visits due to the COVID-19 pandemic disrupted clinical practice and clinical trials. Establishing a high level of agreement between SLE disease activity measures obtained with videoconference TM and F2F at the same time point, will allow for improved assessment of disease activity when F2F data cannot be acquired. This information may guide both medical decision-making and provide reliable outcome measures for clinical research.
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Affiliation(s)
- Anca D Askanase
- Division of Rheumatology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Cynthia Aranow
- The Center for Autoimmune & Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Mimi Y Kim
- Department of Epidemiology & Population Health Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Diane L Kamen
- Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cristina Arriens
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Leila Khalili
- Division of Rheumatology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Wei Tang
- Division of Rheumatology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Julia Barasch
- Division of Rheumatology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Maria Dall'Era
- Division of Rheumatology, UCSF, San Francisco, California, USA
| | - Meggan Mackay
- The Center for Autoimmune & Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, New York, USA
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Arao KA, Fincke BG, Zupa MF, Vimalananda VG. Comparison of Endocrinologists' Physical Examination Documentation for In-person vs Video Telehealth Diabetes Visits. J Endocr Soc 2023; 7:bvad073. [PMID: 37384303 PMCID: PMC10299892 DOI: 10.1210/jendso/bvad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 06/30/2023] Open
Abstract
Objective Outpatient diabetes mellitus (DM) care over video telehealth (TH) requires modifications to how endocrinologists complete physical examinations (PEs). But there is little guidance on what PE components to include, which may incur wide variation in practice. We compared endocrinologists' documentation of DM PE components for in-person (IP) vs TH visits. Methods Retrospective chart review of 200 notes for new patients with DM from 10 endocrinologists (10 IP and 10 TH visits each) in the Veterans Health Administration between April 1, 2020, and April 1, 2022. Notes were scored from 0 to 10 based on documentation of 10 standard PE components. We compared mean PE scores for IP vs TH across all clinicians using mixed effects models. Independent samples t-tests were used to compare both mean PE scores within clinician and mean scores for each PE component across clinicians for IP vs TH. We described virtual care-specific and foot assessment techniques. Results The overall mean (SE) PE score was higher for IP vs TH (8.3 [0.5] vs 2.2 [0.5]; P < .001). Every endocrinologist had higher PE scores for IP vs TH. Every PE component was more commonly documented for IP vs TH. Virtual care-specific techniques and foot assessment were rare. Conclusions Our study quantifies the degree to which Pes for TH were attenuated among a sample of endocrinologists, raising a flag that process improvements and research are needed for virtual Pes. Organizational support and training could help increase PE completion via TH. Research should examine reliability and accuracy of virtual PE, its value to clinical decision-making, and its impact on clinical outcomes.
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Affiliation(s)
- Kevin A Arao
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA 01730, USA
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - Margaret F Zupa
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA 01730, USA
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
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Borrelli N, Grimaldi N, Papaccioli G, Fusco F, Palma M, Sarubbi B. Telemedicine in Adult Congenital Heart Disease: Usefulness of Digital Health Technology in the Assistance of Critical Patients. Int J Environ Res Public Health 2023; 20:5775. [PMID: 37239504 PMCID: PMC10218523 DOI: 10.3390/ijerph20105775] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
The number of adults with congenital heart disease (ACHD) has progressively increased in recent years to surpass that of children. This population growth has produced a new demand for health care. Moreover, the 2019 coronavirus pandemic has caused significant changes and has underlined the need for an overhaul of healthcare delivery. As a result, telemedicine has emerged as a new strategy to support a patient-based model of specialist care. In this review, we would like to highlight the background knowledge and offer an integrated care strategy for the longitudinal assistance of ACHD patients. In particular, the emphasis is on recognizing these patients as a special population with special requirements in order to deliver effective digital healthcare.
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Affiliation(s)
| | | | | | | | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
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18
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Nicole B. Katz. Addressing Rehabilitation Healthcare Disparities During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023. [ DOI: 10.1016/j.pmr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Maita KC, Palmieri-Serrano L, Avila FR, Torres-Guzman RA, Garcia JP, S. Eldaly A, Haider CR, Felton CL, Paulson MR, Maniaci MJ, Forte AJ. Imaging evaluated remotely through telemedicine as a reliable alternative for accurate diagnosis: a systematic review. Health Technol 2023. [DOI: 10.1007/s12553-023-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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20
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Restrepo JG, Alarcón J, Hernández A, Sangiovanni S, González S, Gallego K, Peña-Zárate EE, Libreros-Peña L, Escobar MF. Clinical outcomes in patients with solid tumors living in rural and urban areas followed via telemedicine: experience in a highly complex latin american hospital. BMC Cancer 2023; 23:253. [PMID: 36927771 PMCID: PMC10018944 DOI: 10.1186/s12885-023-10717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Difficulties in cancer services access increase the burden of disease and mortality in rural areas, and telehealth can be a useful tool to address these inequalities. OBJECTIVE We aimed to describe the outcomes of patients in rural and urban areas with solid tumors managed by oncologists through telemedicine. METHODS We conducted a retrospective cohort study of patients with solid tumors from March to December 2020. A total of 1270 subjects with solid tumors were included, 704 living in urban areas and 566 in rural areas. RESULTS The most frequent tumors were breast (51.8%) and prostate (12.4%). The trend of telemedicine care was similar for both populations; in-person care was more frequent in the urban population. There were no differences in referral to the emergency room, need for hospitalization, and mortality for both groups. CONCLUSION Telemedicine is a care modality that reduces barriers in the care of patients with solid tumors, evidencing similar outcomes regardless of living in rural or urban areas.
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Affiliation(s)
| | - Juliana Alarcón
- Centro de Investigaciones Clínicas, Fundación Valle Lili, Cali, Colombia.
| | - Andrés Hernández
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | - Sofía González
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Kelly Gallego
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | | | - María Fernanda Escobar
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia. .,Department of Gynecology and Obstetrics, Universidad Icesi, Cali, Colombia. .,Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 7600.2, Colombia.
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Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization and Implementation ResearchVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael E. Charness
- Chief of Staff of the VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation ResearchVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
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22
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Voss S, Adighibe A, Sanders E, Aaby D, Kravitt R, Clark G, Breen K, Barry A, Forrest GF, Kirshblum SC, Perez MA, Kalsi-Ryan S, Kocherginsky M, Rymer WZ, Sandhu MS. Development of a Remote Version of the Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP): Validity and Reliability. Neurorehabil Neural Repair 2023; 37:83-93. [PMID: 36987396 PMCID: PMC10939131 DOI: 10.1177/15459683231162830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND The Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP V1.0) was developed in 2010 as a 3-domain assessment for upper extremity function after tetraplegia (domains: Strength, Sensibility, and Prehension). A remote version (rGRASSP) was created in response to the growing needs of the field of Telemedicine. OBJECTIVE The purpose of this study was to assess the psychometric properties of rGRASSP, establishing concurrent validity and inter-rater reliability. METHODS Individuals with tetraplegia (n = 61) completed 2 visits: 1 in-person and 1 remote. The first visit was completed in-person to administer the GRASSP, and the second visit was conducted remotely to administer the rGRASSP. The rGRASSP was scored both by the administrator of the rGRASSP (Examiner 1), and a second assessor (Examiner 2) to establish inter-rater reliability. Agreement between the in-person and remote GRASSP evaluations was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman agreement plots. RESULTS The remote GRASSP demonstrated excellent concurrent validity with the GRASSP (left hand intraclass correlation coefficient (ICC) = .96, right ICC = .96). Concurrent validity for the domains was excellent for strength (left ICC = .96, right ICC = .95), prehension ability (left ICC = .94, right ICC = .95), and prehension performance (left ICC = .92, right ICC = .93), and moderate for sensibility (left ICC = .59, right ICC = .68). Inter-rater reliability for rGRASSP total score was high (ICC = .99), and remained high for all 4 domains. Bland-Altman plots and limits of agreements support these findings. CONCLUSIONS The rGRASSP shows strong concurrent validity and inter-rater reliability, providing a psychometrically sound remote assessment for the upper extremity in individuals with tetraplegia.
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Affiliation(s)
| | | | | | - David Aaby
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gina Clark
- Shirley Ryan Ability Lab, Chicago, IL, USA
| | | | | | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Steve C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Monica A. Perez
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Masha Kocherginsky
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Zev Rymer
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milap S. Sandhu
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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23
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Barwise A, Huschka T, Woo C, Egginton J, Huang L, Allen JS, Johnson M, Hamm K, Wolfersteig W, Phelan S, Allyse M. Perceptions and Use of Telehealth among diverse communities: A Multisite Community Engaged Mixed Methods Study. J Med Internet Res 2023; 25:e44242. [PMID: 36867682 PMCID: PMC10057900 DOI: 10.2196/44242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Telehealth has been increasingly adopted by healthcare systems since the start of the COVID-19 pandemic. Although telehealth may provide convenience for patients and clinicians, there are several barriers to accessing it and using it effectively to provide high quality patient care. OBJECTIVE This study, was part of a larger multisite community engaged study conducted to understand the impact of COVID-19 on diverse communities. The work described here explored the perceptions of and experience with telehealth use among diverse and underserved community members during COVID-19. METHODS We used mixed methods across three regions in the US (Midwest, Arizona, and Florida) from January 2021-November 2021. We promoted our study through social media and community partnerships, disseminating flyers in English and Spanish. We developed a moderator guide and conducted focus groups in English and Spanish mostly using a videoconferencing platform. Participants were placed in focus groups with others who shared similar demographic attributes and geographic location. Focus groups were audio-recorded and transcribed. We analyzed our qualitative data using the framework analytic approach. We developed our broader survey using validated scales and with input from community and scientific leaders and distributed it through social media in English and Spanish. We included a previously published questionnaire which had been used to assess perceptions about telehealth among patients with HIV. We analyzed our quantitative data using SAS software and standard statistical approaches. We examined the effect of region, age, ethnicity/race and education on use and perceptions of telehealth. RESULTS We included data from 47 focus groups. Due to our mode of dissemination, we cannot calculate a response rate for the survey. However, we received 3447 English language and 146 Spanish language responses. Over 90% of participants had internet access and 94% had used telehealth. About half of all participants agreed or strongly agreed that telehealth would be beneficial in the future because it better fit their schedules and they would not need to travel. However, about half also agreed or strongly agreed they would not be able to express themselves well and could not be examined when using telehealth. Indigenous participants were especially concerned about these issues when compared to other racial groups. CONCLUSIONS This work describes findings from a mixed methods community engaged research study about telehealth including perceived benefits and concerns. Although participants enjoyed the benefits of telehealth (not having to travel and easier scheduling) they also had concerns (not being able to express themselves well and not having a physical exam) about telehealth.. These sentiments were especially notable among the Indigenous population. Our work highlights the importance of fully understanding the impact of these novel health delivery modalities on the patient experience and actual or perceived quality of care received. CLINICALTRIAL
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Affiliation(s)
- Amelia Barwise
- Department of Family Medicine, Mayo Clinic, Rochester, US
| | - Todd Huschka
- Department of Family Medicine, Mayo Clinic, Rochester, US
| | | | - Jason Egginton
- Department of Family Medicine, Mayo Clinic, Rochester, US
| | - Lily Huang
- Quantitative Health Sciences, Mayo Clinic, Jacksonville, US
| | | | | | - Kathryn Hamm
- Office of Evaluation and Partner Contracts, Southwest Interdisciplinary Research Center,, Arizona State University, Phoenix, US
| | - Wendy Wolfersteig
- Office of Evaluation and Partner Contracts, Southwest Interdisciplinary Research Center,, Arizona State University, Phoenix, US
| | - Sean Phelan
- Department of Family Medicine, Mayo Clinic, Rochester, US
| | - Megan Allyse
- Quantitative Health Sciences, Mayo Clinic, Jacksonville, US
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24
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Hirosawa T, Ito T, Harada Y, Ikenoya K, Yokose M, Shimizu T. The utility of phonocardiograms in real-time remote cardiac auscultation using an internet-connected electronic stethoscope: Open-label randomized controlled pilot trial. Digit Health 2023; 9:20552076231161945. [PMID: 36896331 PMCID: PMC9989428 DOI: 10.1177/20552076231161945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background We have shown classical cardiac auscultation was superior to remote auscultation. We developed a phonocardiogram system to visualize sounds in remote auscultation. Objective This study aimed to evaluate the effect of phonocardiograms on the diagnostic accuracy in remote auscultation using a cardiology patient simulator. Methods In this open-label randomized controlled pilot trial, we randomly assigned physicians to the real-time remote auscultation group (control group) or the real-time remote auscultation with the phonocardiogram group (intervention group). Participants attended a training session in which they auscultated 15 sounds with the correct classification. After that, participants attended a test session where they had to classify 10 sounds. The control group auscultated the sounds remotely using an electronic stethoscope, an online medical program and a 4-K TV speaker without watching the TV screen. The intervention group performed auscultation like the control group but watched the phonocardiogram on the TV screen. The primary and secondary outcomes were the total test scores and each sound score, respectively. Results A total of 24 participants were included. The total test score in the intervention group (80/120, 66.7%) was higher than that in the control group (66/120, 55.0%), although the difference was statistically insignificant (P = .06). The correct answer rates of each sound were not different. Valvular/irregular rhythm sounds were not misclassified as normal sounds in the intervention group. Conclusions Using a phonocardiogram improved the total correct answer rate by more than 10% in remote auscultation, although statistically insignificant. The phonocardiogram could help physicians screen valvular/irregular rhythm sounds from normal sounds. Trial registration UMIN-CTR UMIN000045271; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051710.
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Affiliation(s)
- Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Takahiro Ito
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | | | - Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
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25
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Farr E, Goldring A, Vernacchia C, Woo L, Mhatre P, Rydberg L. Should virtual medical student clerkships in Physical Medicine & Rehabilitation continue? PM R 2022; 15:674-680. [PMID: 36580540 DOI: 10.1002/pmrj.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/03/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Ellen Farr
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne Goldring
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cara Vernacchia
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Woo
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Priya Mhatre
- Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leslie Rydberg
- Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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26
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Ramanathan A, Ramanathan P, Saha A. Survey on the use of general practice telehealth services for children during the COVID-19 pandemic. Aust J Prim Health 2022; 28:529-534. [PMID: 35701034 DOI: 10.1071/py21153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 05/03/2022] [Indexed: 12/13/2022]
Abstract
In 2020, the Australian Government introduced temporary Medicare Benefits Schedule item numbers for GP telehealth consultations to combat the spread of the COVID-19 pandemic. Patient satisfaction has been positive; however, the paediatric cohort has not been sufficiently investigated. We aimed to explore the rates of satisfaction of paediatric patients undergoing telehealth compared with standard consultations, as well as looking at any barriers faced. We developed and distributed an online survey to eligible patients (or their guardian) aged 0-17years who underwent a general practice telehealth consultation between March 2020 and May 2020 at 12 participating medical centres in Perth. We received 68 total responses with 35 deemed complete. The mean (s.d.) age of participants was 8.22 (5.34) years. A total of 88.2% of participants indicated that the level of care provided via telehealth was equal to or better than a standard consultation. A total of 70.6% of patients reported no barriers faced, with the most common barrier being lack of examination (20.6%). This study describes high public satisfaction with telehealth GP consultations for paediatric patients, with a good level of patient outcomes and minimal barriers. There may be benefit to widespread and ongoing use of telehealth consultations for the paediatric population and the extension of the temporary Medicare Benefits Schedule items.
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Affiliation(s)
- Ashwin Ramanathan
- Resident Medical Officer, Joondalup Health Campus, Perth, WA, Australia
| | | | - Amit Saha
- Consultant Paediatrician, St John of God Midland, Perth, WA, Australia
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27
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Cole E, Shaver J, Hiserote P, Friedman R. Increasing Resident Confidence With Telemedicine: Teaching the Virtual Examination. PRiMER 2022; 6:836953. [PMID: 36632493 PMCID: PMC9829006 DOI: 10.22454/primer.2022.836953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Julia Shaver
- Kaiser Permanente Santa Rosa Family Medicine Residency, Santa Rosa, CA
| | - Patricia Hiserote
- Kaiser Permanente Santa Rosa Family Medicine Residency, Santa Rosa, CA
| | - Rachel Friedman
- Kaiser Permanente Santa Rosa Family Medicine Residency, Santa Rosa, CA
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28
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Bobek H. Teaching Strategies for Online Nurse Practitioner Physical Assessment and Telehealth Education. Nurs Clin North Am 2022; 57:589-598. [DOI: 10.1016/j.cnur.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Kong-Wong C, Weiss MA, Shumway M, Schleyer A, Aas E, Rhodes M, Scott JD. Lessons Learned: Building a Comprehensive Telehealth Quality Program. Am J Med Qual 2022; 37:456-463. [PMID: 35799323 DOI: 10.1097/jmq.0000000000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The UW Medicine Telehealth Services team developed a comprehensive telehealth Quality Improvement (QI) program founded upon 5 QI pillars: incident reporting, patient experience surveys, patient complaints, peer review, and targeted QI projects. The authors outline the foundation of this QI program, early trends from peer review, patient experience surveys, and telehealth utilization by demographic group. Telehealth quality should be scrutinized with the same rigor applied to in-person care. All health systems should establish a telehealth QI program.
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Affiliation(s)
- Crystal Kong-Wong
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
- UW Medicine Digital Health, Seattle, WA
| | | | | | - Anneliese Schleyer
- Department of Medicine, University of Washington, School of Medicine, Seattle, WA
- UW Medicine, Office of the Chief Medical Officer, Seattle, WA
| | - Erin Aas
- Harborview Medical Center Quality Improvement, Seattle, WA
| | - Marcia Rhodes
- UW Medicine, Office of the Chief Medical Officer, Seattle, WA
| | - John D Scott
- UW Medicine Digital Health, Seattle, WA
- Department of Medicine, Division of Allergy, and Infectious Disease, University of Washington School of Medicine, Seattle, WA
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30
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Noronha C, Lo MC, Nikiforova T, Jones D, Nandiwada DR, Leung TI, Smith JE, Lee WW. Telehealth Competencies in Medical Education: New Frontiers in Faculty Development and Learner Assessments. J Gen Intern Med 2022; 37:3168-3173. [PMID: 35474505 PMCID: PMC9040701 DOI: 10.1007/s11606-022-07564-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery.
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Affiliation(s)
- Craig Noronha
- Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Danielle Jones
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepa Rani Nandiwada
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tiffany I Leung
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Janeen E Smith
- San Francisco VA Health Care System, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | - Wei Wei Lee
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, IL, USA.
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31
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Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of Telemedicine during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak 2022; 22:207. [PMID: 35922817 PMCID: PMC9351100 DOI: 10.1186/s12911-022-01952-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background The COVID-19 pandemic has prompted the decrease of in-person visits to reduce the risk of virus transmission. Telemedicine is an efficient communication tool employed between healthcare providers and patients that prevents the risk of exposure to infected persons. However, telemedicine use is not infallible; its users reported multiple issues that complicated the expansion of this technology. So, this systematic review aimed to explore the barriers and challenges of telemedicine use during the pandemic and to propose solutions for improving future use.
Methods A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. PubMed, Scopus, Web of Science, Academic Search Complete, CINAHL, Embase, and Science Direct were used to look for articles addressing barriers and challenges, in addition to articles proposing solutions. Studies were screened by title and abstract, followed by a full-text review. Risk of bias assessment was done using Critical Appraisal Skills Program for qualitative studies, Newcastle–Ottawa Scale for cross-sectional studies, and A MeaSurement Tool to Assess Systematic Reviews for systematic reviews. After the extraction of data, a narrative synthesis and analysis of the outcomes were performed. Results Among 1194 papers identified, only 27 studies were included. Barriers and challenges were assembled under 7 categories: technical aspects, privacy, data confidentiality and reimbursement, physical examination and diagnostics, special populations, training of healthcare providers and patients, doctor-patient relationship, and acceptability. Poor internet connection and lack of universal access to technology were among the technical barriers. Concerns about patient privacy and reimbursement hindered the use of telemedicine too. Physical examination and certain procedures were impossible to perform via telemedicine. Training both healthcare providers and patients was deficient. The doctor-patient relationship was troubled by telemedicine, and both healthcare providers and patients were reluctant to use telemedicine. Conclusion Widespread use of telemedicine is still hampered by various barriers and challenges. Healthcare providers should work with various stakeholders to implement the proposed solutions. More research and policy changes are essential to optimize telemedicine utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01952-0.
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Affiliation(s)
- Racha Ftouni
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.,Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Baraa AlJardali
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.,Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Hamdanieh
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Louna Ftouni
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.,Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nariman Salem
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
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32
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Chizmar L, Lewis S. A questionnaire for physical findings of malnutrition when physical exams are not possible. Nutr Clin Pract 2022; 37:1307-1315. [PMID: 35819371 DOI: 10.1002/ncp.10894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND When nutrition assessments must be performed virtually, such as during the coronavirus pandemic, it is difficult to fully assess patients for malnutrition without the ability to perform a nutrition-focused physical exam. Practitioners may ask patients about their physical appearance, but there is currently no validated set of questions whose answers correlate with nutrition-focused physical findings for the diagnosis of malnutrition in such situations. The aim of this study was to evaluate correlations between patients' responses to verbalized questions and physical signs of malnutrition. METHODS Questions related to the physical findings of malnutrition were developed and evaluated for content validity. Thirty patients receiving nutrition assessments at an acute care veterans' hospital were asked the questions prior to a nutrition-focused physical exam. Patients' responses were compared with a diagnosis of malnutrition and physical findings of muscle, fat, fluid accumulation, and handgrip strength. RESULTS Four questions significantly correlated with malnutrition: "Does the area around your eyes appear sunken in?" (P = 0.03), "Are you able to see your ribs?" (P = 0.05), "Do you feel you are unusually skinny for you?" (P = 0.001), and "Do you find yourself eating less due to swelling in your belly?" (P = 0.008). CONCLUSION There are relationships between patients' responses to certain verbalized questions and their physical status. Such questions can be used to identify physical signs of malnutrition when nutrition-focused physical exams cannot be performed. Further research is needed to validate these questions in other populations.
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Affiliation(s)
- Lora Chizmar
- Nutrition and Food Service, James A. Haley VA Hospital and Clinics, Tampa, Florida, USA
| | - Sherri Lewis
- Nutrition and Food Service, James A. Haley VA Hospital and Clinics, Tampa, Florida, USA
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33
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Savage DJ, Gutierrez O, Montané BE, Singh AD, Yudelevich E, Mahar J, Brateanu A, Khatri L, Fleisher C, Jolly SE. Implementing a telemedicine curriculum for internal medicine residents during a pandemic: the Cleveland Clinic experience. Postgrad Med J 2022; 98:487-491. [PMID: 33692154 PMCID: PMC7948159 DOI: 10.1136/postgradmedj-2020-139228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
Telemedicine training was not a substantial element of most residency programmes prior to the COVID-19 pandemic. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Programme (IMRP) is one of the largest programmes in the USA, which made the task of implementing a telemedicine curriculum more complex. Here we describe our experience implementing an effective, expedited telemedicine curriculum for our ambulatory resident clinics. This study was started in April 2020 when we implemented a resident-led curriculum and training programme for providing ambulatory telemedicine care. The curriculum was finalised in less than 5 weeks. It entailed introducing a formal training programme for residents, creating a resource guide for different video communication tools and training preceptors to safely supervise care in this new paradigm. Residents were surveyed before the curriculum to assess prior experience with telemedicine, and then afterward to assess the curriculum's effectiveness. We also created a mini-CEX assessment for residents to solicit feedback on their performance during virtual appointments. Over 2000 virtual visits were performed by residents in a span of 10 weeks. Of 148 residents, 38% responded to the pre-participation survey. A majority had no prior telemedicine experience and expressed only slight comfort with the modality. Through collaboration with experienced residents and faculty, we expeditiously deployed an enhancement to our ambulatory care curriculum to teach residents how to provide virtual care and help faculty with supervision. We share our insights on this experience for other residency programmes to use.
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Affiliation(s)
- David J Savage
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Omar Gutierrez
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Eric Yudelevich
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Jamal Mahar
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Andrei Brateanu
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Lakshmi Khatri
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Fleisher
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Stacey E Jolly
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
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Lam PW, Schwartz IS, Medford RJ. Use of virtual care by infectious disease specialists in Canada: A national survey. Antimicrob Steward Healthc Epidemiol 2022; 2:e106. [PMID: 36483399 PMCID: PMC9726522 DOI: 10.1017/ash.2022.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the type and extent of virtual care use among infectious disease specialists in Canada, with a focus on the clinical factors that influence the decision to provide virtual versus in-person care. METHODS Infectious disease physicians practicing in Canada were invited to complete a survey regarding their experiences with virtual care. The survey included 14 vignettes depicting new outpatient and post-hospital-discharge referrals. Participants were asked to select which (if any) virtual care modalities they would feel comfortable using and to specify a reason if they did not feel comfortable providing care virtually. Machine learning and natural language processing techniques were used to identify themes. RESULTS In total, 57 infectious disease physicians completed the survey. Respondents reported devoting 36.5% (SD, 18.4%) of their infectious disease practice to outpatient care, with 44.2% (SD, 23.2%) of it being delivered virtually. Respondents were more comfortable providing virtual care to post-hospital-discharge referrals who had been seen by an infectious disease physician compared to new outpatient referrals. When respondents were not comfortable with using any virtual care modality, the following common themes emerged: the need for physical examination, the importance of establishing a therapeutic relationship, the need for additional in-person tests or diagnostics, and patient counselling. CONCLUSION This study provides a glimpse into the current state of virtual care use in Canada and some of the major themes that affect decision making for virtual versus in-person care.
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Affiliation(s)
- Philip W. Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, TorontoOntario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard J. Medford
- Division of Infectious Diseases & Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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35
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Chen YH, Wu HW, Huang CC, Lee JK, Yang LT, Hsu TP, Hung CS, Ho YL. The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study. Interact J Med Res 2022; 11:e37880. [PMID: 35687404 PMCID: PMC9191329 DOI: 10.2196/37880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. Objective To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center. Methods We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. Results There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern. Conclusions Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks.
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Affiliation(s)
- Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Wen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Kuang Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Tan Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tse-Pin Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
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Kimura BJ, Resnikoff PM, Tran EM, Bonagiri PR, Spierling Bagsic SR. Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early COVID-19 Infection. J Am Soc Echocardiogr 2022; 35:1047-1054. [PMID: 35691456 PMCID: PMC9183238 DOI: 10.1016/j.echo.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In COVID-19, inpatient studies have demonstrated that lung ultrasound B-lines relate to disease severity and mortality and can occur in apical regions that can be imaged by the patients themselves. However, as illness begins in an ambulatory setting, we sought to determine the prevalence of B-lines in early outpatient infection and then test the accuracy of their detection using telehealth and automated methods. METHODS Consecutive adult patients (N=201) with positive testing for SARS-CoV-2, at least one clinical risk factor, and mild-moderate disease were prospectively enrolled at a monoclonal antibody infusion clinic. Physician imaging of the lung apices for 3 B-lines (ULC+) using 3MHz ultrasound was performed on all patients for prevalence data and served as the standard for a nested subset (n=50) to test the accuracy of telehealth methods, including patient self-imaging and automated B-line detection. Patient characteristics, vaccination data and hospitalizations were analyzed for associations with ULC+. RESULTS Mean patient age of 54 ±15 years, all lacking hypoxemia or fever, ULC+ was present in 55/201(27%) at a median of 7 symptomatic days (IQR:5-8) and in 4/5 patients who were later hospitalized (p=0.03). ULC+ was associated with unvaccinated status (OR=4.11[95% CI:1.85-9.33], p=0.001), diabetes (OR=2.56[95% CI:1.08-6.05], p=0.03), male sex (OR=2.14[95% CI:1.07-4.37], p=0.03), and hypertension/cardiovascular disease (OR=2.06[95% CI:1.02-4.23], p=0.04), while adjusting for BMI >25kg/m2. Telehealth and automated B-line detection had 84% and 82% accuracy, respectively. CONCLUSIONS In high-risk outpatients, B-lines in the upper lungs were common in early COVID-19 infection, related to subsequent hospitalization, and could be detected by telehealth and automated methods.
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Affiliation(s)
- Bruce J Kimura
- Dept of Medicine, Scripps Mercy Hospital, San Diego, California.
| | | | - Eric M Tran
- Dept of Medicine, Scripps Mercy Hospital, San Diego, California
| | | | - Samantha R Spierling Bagsic
- Dept of Medicine, Scripps Mercy Hospital, and the Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California
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Kumar N, Katiyar V, Praneeth K, Sharma R, Narwal P, Raheja A, Tandon V, Mishra S, Garg K, Suri A, Chandra PS, Kale SS. Challenges and prospects of neurosurgical teleconsultations in a developing country: a reality check. Neurosurg Focus 2022; 52:E5. [DOI: 10.3171/2022.3.focus2247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The adoption of telemedicine became a necessity during the COVID-19 pandemic because patients found commuting to be difficult owing to travel restrictions. Initially, audio-based teleconsultations were provided. Later, on the basis of the feedback of patients and caregivers, the authors started to provide video-based teleconsultations via WhatsApp. The authors subsequently surveyed the patients and caregivers to determine their satisfaction levels with telemedicine services.
METHODS
An anonymized telephone survey of patients who had participated in teleconsultation was conducted with a structured questionnaire. The responses were analyzed and their correlations with the perceived benefits and limitations of audio and video teleconsultation were determined.
RESULTS
Three hundred respondents were included in the first round of surveys, of whom 250 (83.3%) consented to video teleconsultation. Among the respondents who participated in both audio and video teleconsultations (n = 250), paired analysis showed that video teleconsultation was perceived as better in terms of providing easier access to healthcare services (p < 0.001), saving time (p < 0.001), and satisfaction with the way patient needs were conveyed to healthcare providers (p = 0.023), as well as in terms of adequacy of addressing healthcare needs (p < 0.001) and consequently providing a higher rate of overall satisfaction (p < 0.001). For both audio and video teleconsultation, overall patient satisfaction was significantly related to only previous exposure to WhatsApp. However, for video consultation, longer call duration (p = 0.023) was an important independent factor. Video teleconsultation was preferable to face-to-face consultation irrespective of educational status, but higher education was associated with preference for video teleconsultation.
CONCLUSIONS
Both audio and video teleconsultation are viable cost-effective surrogates for in-person physical neurosurgical consultation. Although audio teleconsultation is more user-friendly and is not restricted by educational status, video teleconsultation trumps the former owing to a more efficient and satisfactory doctor-to-patient interface.
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Affiliation(s)
- Narendra Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kokkula Praneeth
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Narwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P. Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S. Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Davis CB, Lorentzen AK, Patel H, Cheung D, Wright A, Lemery J, Penninga L. The Intersection of Telemedicine and Wilderness Care: Past, Present, and Future. Wilderness Environ Med 2022; 33:224-231. [PMID: 35459612 DOI: 10.1016/j.wem.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Wilderness medicine and telemedicine seemingly exist at opposite ends of the clinical continuum. However, these 2 specialties share a common history and the literature abounds with examples of successful deployment of telemedicine to resource limited settings. The recent widespread adoption of telemedicine has important ramifications for wilderness providers. Telemedicine is inherently reliant on some sort of technology. There is a wide spectrum of complexity involved, but in general these systems rely on a hardware component, a software component, and a network system to transmit information from place to place. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi, or communication satellites. However, bandwidth, defined as the amount of data which can be transmitted through a given connection over time, remains a limiting factor for many austere settings. Telemedicine services are typically organized into 4 categories: 1) live/interactive; 2) store and forward; 3) remote patient monitoring; and 4) mHealth. Each of these categories has an applicable wilderness medicine use case which will be reviewed in this paper. Though the regulatory environment remains complex, there is enormous potential for telemedicine to enhance the practice of wilderness medicine. Drones are likely to transform wilderness medicine supply chains by facilitating delivery of food, shelter, and medicines and are able to enhance search and rescue efforts. Remote consultations can be paired with remote patient monitoring technology to deliver highly specialized care to austere environments. Early feasibility studies are promising, but further prospective data will be required to define future best practices for wilderness telemedicine.
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Affiliation(s)
- Christopher B Davis
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | | | - Hemali Patel
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Dickson Cheung
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angela Wright
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jay Lemery
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luit Penninga
- Department of Surgery and Transplantation C2122, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Khan NA, Stergiou GS, Omboni S, Kario K, Renna N, Chapman N, McManus RJ, Williams B, Parati G, Konradi A, Islam SM, Itoh H, Mooi CS, Green BB, Cho MC, Tomaszewski M. Virtual management of hypertension: lessons from the COVID-19 pandemic-International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022. [PMID: 35579481 DOI: 10.1097/HJH.0000000000003205] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts' opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.
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Gray C, Wray C, Tisdale R, Chaudary C, Slightam C, Zulman D. Factors That Influence How Providers Assess the Appropriateness of Virtual Visits: A Qualitative Investigation (Preprint). J Med Internet Res 2022; 24:e38826. [PMID: 36001364 PMCID: PMC9453588 DOI: 10.2196/38826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background The rapid implementation of virtual care (ie, telephone or video-based clinic appointments) during the COVID-19 pandemic resulted in many providers offering virtual care with little or no formal training and without clinical guidelines and tools to assist with decision-making. As new guidelines for virtual care provision take shape, it is critical that they are informed by an in-depth understanding of how providers make decisions about virtual care in their clinical practices. Objective In this paper, we sought to identify the most salient factors that influence how providers decide when to offer patients video appointments instead of or in conjunction with in-person care. Methods We conducted semistructured interviews with 28 purposefully selected primary and specialty health care providers from the US Department of Veteran’s Affairs health care system. We used an inductive approach to identify factors that impact provider decision-making. Results Qualitative analysis revealed distinct clinical, patient, and provider factors that influence provider decisions to initiate or continue with virtual visits. Clinical factors include patient acuity, the need for additional tests or labs, changes in patients’ health status, and whether the patient is new or has no recent visit. Patient factors include patients’ ability to articulate symptoms or needs, availability and accessibility of technology, preferences for or against virtual visits, and access to caregiver assistance. Provider factors include provider comfort with and acceptance of virtual technology as well as virtual physical exam skills and training. Conclusions Providers within the US Department of Veterans Affairs health administration system consider a complex set of factors when deciding whether to offer or continue a video or telephone visit. These factors can inform the development and further refinement of decision tools, guides, and other policies to ensure that virtual care expands access to high-quality care.
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Affiliation(s)
- Caroline Gray
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Charlie Wray
- Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Rebecca Tisdale
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Camila Chaudary
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Cindie Slightam
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Donna Zulman
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
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Bae S, Borac S, Emre Y, Wang J, Wu J, Kashyap M, Kang S, Chen L, Moran M, Cannon J, Teasley ES, Chai A, Liu Y, Wadhwa N, Krainin M, Rubinstein M, Maciel A, Mcconnell MV, Patel S, Corrado GS, Taylor JA, Zhan J, Po MJ. Prospective validation of smartphone-based heart rate and respiratory rate measurement algorithms. Commun Med 2022; 2. [PMID: 35603304 PMCID: PMC9053269 DOI: 10.1038/s43856-022-00102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Measuring vital signs plays a key role in both patient care and wellness, but can be challenging outside of medical settings due to the lack of specialized equipment. Methods In this study, we prospectively evaluated smartphone camera-based techniques for measuring heart rate (HR) and respiratory rate (RR) for consumer wellness use. HR was measured by placing the finger over the rear-facing camera, while RR was measured via a video of the participants sitting still in front of the front-facing camera. Results In the HR study of 95 participants (with a protocol that included both measurements at rest and post exercise), the mean absolute percent error (MAPE) ± standard deviation of the measurement was 1.6% ± 4.3%, which was significantly lower than the pre-specified goal of 5%. No significant differences in the MAPE were present across colorimeter-measured skin-tone subgroups: 1.8% ± 4.5% for very light to intermediate, 1.3% ± 3.3% for tan and brown, and 1.8% ± 4.9% for dark. In the RR study of 50 participants, the mean absolute error (MAE) was 0.78 ± 0.61 breaths/min, which was significantly lower than the pre-specified goal of 3 breaths/min. The MAE was low in both healthy participants (0.70 ± 0.67 breaths/min), and participants with chronic respiratory conditions (0.80 ± 0.60 breaths/min). Conclusions These results validate the accuracy of our smartphone camera-based techniques to measure HR and RR across a range of pre-defined subgroups. Accurate measurement of the number of times a heart beats per minute (heart rate, HR) and the number of breaths taken per minute (respiratory rate, RR) is usually undertaken using specialized equipment or training. We evaluated whether smartphone cameras could be used to measure HR and RR. We tested the accuracy of two computational approaches that determined HR and RR from the videos obtained using a smartphone. Changes in blood flow through the finger were used to determine HR; similar results were seen for people with different skin tones. Chest movements were used to determine RR; similar results were seen between people with and without chronic lung conditions. This study demonstrates that smartphones can be used to measure HR and RR accurately. Bae et al. prospectively evaluated smartphone camera-based techniques for measuring heart rate and respiratory rate. They found measurements were accurate across a range of pre-defined subgroups.
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Venditti SA, Sazegar P, Fuchs LC, Snarskis CE. Family Medicine Resident and Faculty Perceptions About the Strengths and Limitations of Telemedicine Training. PRiMER 2022; 6:9. [PMID: 35481229 PMCID: PMC9037250 DOI: 10.22454/primer.2022.665996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Telemedicine has become a highly-utilized form of primary care, requiring medical schools and residency programs to develop standardized telemedicine training to meet learners' educational needs. This study highlights specific areas of clinical teaching and faculty development regarded as highly valuable in a family medicine (FM) residency program. METHODS We developed a needs assessment survey instrument based on Accreditation Council for Graduate Medical Education (ACGME) milestones and circulated it to faculty and residents at a suburban FM residency program in August 2020. We mapped each survey question to ACGME core competencies to identify common themes. We performed two-sample t tests to compare perceived self-confidence in faculty assessment and resident performance of key telemedicine clinical skills. RESULTS A total of 29 respondents (15 faculty, 14 residents) completed the survey. Both residents and faculty expressed comfort with obtaining a focused history, ruling out red flag symptoms, formulating a differential diagnosis, and planning follow-up care. Faculty reported confidence in their ability to provide feedback about medical knowledge and clinical decision making, but also identified a need for better feedback tools. Both faculty and residents identified a need for better teaching of physical exam skills during video visits. There were no statistically significant differences for perceived self-confidence in evaluating and performing key telemedicine skills between faculty and residents, respectively. CONCLUSION Development of effective telemedicine educational experiences should emphasize teaching virtual communication and physical exam skills, and developing new approaches to learner evaluation.
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Affiliation(s)
- Sarah A Venditti
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA
| | - Payam Sazegar
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA | Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Lance C Fuchs
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA | Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Carolyn E Snarskis
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA
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Booker R, Haase KR. Virtual Cancer Care Equity in Canada: Lessons From COVID-19. Clin J Oncol Nurs 2022; 26:224-227. [PMID: 35302552 DOI: 10.1188/22.cjon.224-227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic radically shifted healthcare delivery to patients with cancer. Virtual cancer care, or the remote delivery of health care, has become an important resource for patients in Canada to maintain access to cancer care during the pandemic. With an increased number of people regularly accessing the internet and smartphones being ubiquitous for nearly all ages, technology in health care has grown. Virtual cancer care has been referenced as the fourth pillar of cancer care and it appears it may be here to stay. This article explores the benefits and challenges associated with virtual cancer care and outlines the importance of ensuring it is safe and equitable. Oncology nurses can identify where virtual care can be used to mitigate inequities and call attention when these tools exacerbate inequities.
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Mclaughlin EJ, Ellett LC, Readman E, Mooney S. Telehealth for gynaecology outpatients during the COVID-19 pandemic: Patient and clinician experiences. Aust N Z J Obstet Gynaecol 2022; 62:553-559. [PMID: 35322405 PMCID: PMC9111195 DOI: 10.1111/ajo.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The COVID‐19 pandemic has necessitated alterations in provision of health care and how patients access it. Telehealth has replaced traditional face‐to‐face outpatient clinics in an unprecedented manner. This study aimed to assess overall patient and clinician satisfaction with telehealth consultations, to establish acceptability of telehealth during pandemic and non‐pandemic times, and document feedback. Materials and Methods A prospective observational study involving women presenting to a general gynaecology outpatient department was performed. Women who attended for consultation between 13 July and 4 September 2020 were invited to participate in a questionnaire following their telehealth appointment. Clinicians consulting in the outpatient department were invited to complete a questionnaire at the end of the eight‐week study period. Satisfaction, utility and acceptability data were obtained using visual analogue scales (VAS). Results Twenty‐six out of 56 (46.4%) clinicians and 124/870 (14.3%) patients completed the questionnaire. Patients who responded were older and more likely to have been born in Australia than women who did not (P = 0.0355 and P = 0.005, respectively). Overall patient satisfaction with telehealth was high (median VAS (interquartile range), 8.6 (5.6–9.8)). More women found telehealth to be acceptable during a pandemic than afterward (8.9 vs 6.6, P < 0.0001). Clinicians were less satisfied with telehealth than patients (7.1 vs 8.6, P = 0.02); however, most would be happy to continue using telehealth in non‐pandemic times (7.0 (6.2–9.8)). Conclusion Telehealth consultations allow provision of gynaecological care at a time when reducing risk of infection to patients and staff is paramount. Telehealth gynaecology consultations are efficient and convenient without significant detriment to patient or clinician satisfaction.
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Affiliation(s)
- Emma Jane Mclaughlin
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | | | - Emma Readman
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Mooney
- Department of Endosurgery, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Gawrys SP, Bradshaw JT, Parker LM. Standardization of osteopathic manipulative treatment in telehealth settings to maximize patient outcomes and minimize adverse effects. J Osteopath Med 2022; 122:377-378. [PMID: 35286787 DOI: 10.1515/jom-2021-0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Steven P Gawrys
- Rocky Vista University College of Osteopathic Medicine, Southern Utah Campus, Ivins, UT, USA
| | - Justin T Bradshaw
- Rocky Vista University College of Osteopathic Medicine, Southern Utah Campus, Ivins, UT, USA
| | - Lawsen M Parker
- Rocky Vista University College of Osteopathic Medicine, Southern Utah Campus, Ivins, UT, USA
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Lattner C, Badowski D, Otremba D, Gieger J, Klass J. Creating an Asynchronous Telehealth Simulation for Advance Nursing Practice Students. Clin Simul Nurs 2022; 63:5-9. [PMID: 35069937 PMCID: PMC8766629 DOI: 10.1016/j.ecns.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The ongoing use of telehealth services following the COVID-19 pandemic demonstrates its sustainability and how our health care system is transforming. To increase student learning, an asynchronous telehealth simulation as a learning strategy in an online advanced pharmacology course was developed. This innovative strategy allowed students to practice clinical decision-making and collaboration skills electronically to prepare them for the increased use of telehealth medicine. Integrating a prerecorded simulation-based experience using a web-based teleconference tool and embedding it within the Learning Management System is a simple, sustainable model for nursing faculty and students with various levels of technology proficiency.
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Affiliation(s)
| | - Donna Badowski
- DePaul University School of Nursing, Chicago, IL 60614-7282, USA
| | - Dorothy Otremba
- DePaul University School of Nursing, Chicago, IL 60614-7282, USA
| | - John Gieger
- DePaul University Center for Teaching and Learning, Chicago, IL 60604, USA
| | - Jes Klass
- DePaul University Center for Teaching and Learning, Chicago, IL 60604, USA
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Diaz-Miron J, Ogle S, Kaizer A, Acker SN, Rove KO, Inge TH. Surgeon, patient, and caregiver perspective of pediatric surgical telemedicine in the COVID-19 pandemic era. Pediatr Surg Int 2022; 38:241-248. [PMID: 34550442 PMCID: PMC8456071 DOI: 10.1007/s00383-021-05016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Adoption of telemedicine (TME) in surgical specialties, prior to the COVID-19 pandemic, has previously been slow. The purpose of this prospective, observational, single institution study is to evaluate surgeon and caregiver perspectives of TMEs during the pandemic. METHODS Surveys were distributed to surgical faculty regarding perceptions of TME early during the pandemic and 2 months later. Caregivers (or patients > 18 years old) were asked after each TME to complete a survey regarding perceptions of TMEs. RESULTS Surveys were distributed to 73 surgeons. Response rates were 71% initially and 63% at follow-up. Sixty-eight percent reported no prior TME experience. No significant differences were noted in the overall satisfaction. An inverse relationship between surgeon age and satisfaction at the follow-up survey was identified (p = 0.007). Additional surveys were distributed to 616 caregivers or patients (response rate 13%). Seventy-two percent reported no prior experience with TME and 79% described TME as similar to an in-person visit. Audiovisual satisfaction of the TME was higher in greater income households (p = 0.02). CONCLUSIONS Pre-pandemic experience with TME was low in both groups; however, experiences were perceived as satisfactory. Positive experiences with TME may encourage increased utilization in the future, although demographic variations may impact satisfaction with TME. TRIAL REGISTRATION Unique identifier NCT04376710 at Clinicaltrials.gov (5/6/2020).
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Affiliation(s)
- Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA.
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
| | - Alex Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
| | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Thomas H Inge
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
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Elliott T, Matsui EC, Cahill A, Smith L, Leibner L. Conducting a Professional Telemedicine Visit Using High-Quality Webside Manner. Curr Allergy Asthma Rep. [PMID: 35072928 PMCID: PMC8785697 DOI: 10.1007/s11882-022-01029-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
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Dempsey CM, Serino-Cipoletta JM, Marinaccio BD, O'Malley KA, Goldberg NE, Dolan CM, Parker-Hartigan L, Williams LS, Vessey JA. Determining factors that influence parents' perceptions of telehealth provided in a pediatric gastroenterological practice: A quality improvement project. J Pediatr Nurs 2022; 62:36-42. [PMID: 34894421 DOI: 10.1016/j.pedn.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, local and institutional guidelines restricted non-emergent, in-person visits in outpatient specialty clinics. Nurse practitioners (NPs) in pediatric gastroenterology clinics immediately shifted their practice to telehealth (TH). LOCAL PROBLEM The shift to TH necessitated a change in practice. This quality improvement project was designed to define factors influencing family's perceptions of TH and secure feedback on the TH experience. TH is remaining an option for accessing care even as restrictions are being lifted. Feedback is necessary to ensure that quality of care and high patient satisfaction are maintained in a virtual environment. METHODS The Unified Theory of Acceptance and Use of Technology was used to frame the project. Surveys were collected from NPs related to services provided and complexities of each encounter. Post-visit surveys were conducted with families to assess their perceptions of the visit. Findings were discussed to identify and address gaps in service. RESULTS Parent/family surveys were consistent with NP feedback. Results indicated that parents were satisfied with care provided via TH, but that these visits were limited by incomplete assessments, lacked the intimacy of in-person encounters and were often difficult to access due to technological issues. CONCLUSIONS It is anticipated that TH will be used in the post pandemic era to provide routine and non-emergent acute care. Institutions and providers need to consider factors influencing the patient experience learned during the pandemic and implement evidenced-based strategies that ensure quality care that meets patients' needs.
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Chu K, Sathanandan S. The virtual Clinical Assessment of Skills and Competence: the impact and challenges of a digitised final examination. BJPsych Bull 2021; 47:110-115. [PMID: 34937596 PMCID: PMC10063989 DOI: 10.1192/bjb.2021.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic has affected how clinical examinations are conducted, resulting in the Royal College of Psychiatrists delivering the Clinical Assessment of Skills and Competence virtually. Although this pragmatic step has allowed for progression of training, it has come at the cost of a significantly altered examination experience. This article aims to explore the fairness of such an examination, the difference in trainee experience, and the use of telemedicine to consider what might be lost as well as gained at a time when medical education and delivery of healthcare are moving toward the digitised frontier.
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Affiliation(s)
- Kenny Chu
- St Pancras Hospital, Camden and Islington NHS Foundation Trust, UK
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