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Nnake CO, Concepcion-Gonzalez A, Malka MS, Berube E, Ferris A, Bainton N, Vitale MG, Roye BD. Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors. J Pediatr Orthop 2024; 44:443-447. [PMID: 38584340 DOI: 10.1097/bpo.0000000000002692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood. This study aims to find the incidence of cardiac findings in patients with severe scoliosis ≥90° without cardiac history. METHODS A single-institution retrospective chart review was performed. Inclusion criteria were scoliosis patients with curves ≥90 degrees and a screening echocardiogram performed within 6 months of spine surgery. Patients with a previous cardiac history, diagnosis associated with cardiac comorbidities (eg, connective tissue disease), or major coronal curves <90 degrees were excluded. Echocardiogram reports and perioperative clinical notes from involved services (including orthopaedics, cardiology, and anesthesia) were reviewed. Any postoperative use of vasopressors and reasons for their use were recorded. RESULTS Overall, 50 patients met the inclusion criteria. The mean age at surgery was 14.0 ± 4.9 years old (range: 2 to 33). The mean major curve was 108 ± 19 degrees (range: 90 to 160 degrees). A normal echocardiogram was seen in 38 (76%), whereas 6 patients (12%) had mild dilation of the aortic sinus or root, 4 (8%) had mild valvular regurgitation, 1 patient had a small atrial septal defect, and 1 had a trace pericardial effusion. No patient had any changes made to their perioperative plan and one patient was advised to see a cardiologist postoperatively. Postoperatively, 8 patients (16%) received vasopressors to raise blood pressure to meet preset goal MAP, but only one of these 8 had a positive echocardiogram (mild valvular insufficiency), which was not seen as a contributing factor to the use of pressors. CONCLUSIONS This study suggests that screening echocardiograms for patients without a cardiac history or related symptoms does not contribute to the evaluation of perioperative risk or anesthetic management. Creating clear, evidence-based guidelines for the utilization of perioperative testing, like echocardiograms, can reduce the social, time, and financial burdens on families. Such guidelines are vital for appropriate risk assessment and proper utilization of health care resources. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | - Anne Ferris
- Department of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
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Kaushik R. Telehealth and Children with Medical Complexity. Pediatr Ann 2024; 53:e74-e81. [PMID: 38466329 DOI: 10.3928/19382359-20240109-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Although use of telehealth may have begun centuries ago and has grown considerably through the 20th century, the coronavirus disease 2019 pandemic skyrocketed telemedicine's reach, including its use in pediatrics. The American Academy of Pediatrics endorses telehealth as a "critical infrastructure to efficiently implement the medical home model of care." Particularly for children with medical complexity (CMC), telehealth offers great promise to improve access to continuous, coordinated primary care, reduce time to pediatric subspecialty care, and support distance education for both pediatric providers and patients and their families. This article details the numerous benefits of telehealth to CMC with an emphasis on its use as an extender of the medical home, describes the venues in which telehealth augments access to safe, high-quality care, presents best practices in engaging in telehealth encounters, and enumerates barriers that may exacerbate current health inequities. We review current published telehealth patient-/caregiver-level, clinician-level, and payor-level outcomes while revealing research gaps and opportunities. [Pediatr Ann. 2024;53(3):e74-e81.].
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Al Senaidi KS, Sulaiman W. A Pediatric Cardiology Outreach Clinic in a Local Hospital: An Experience Review from South A'Sharqiyah, Oman. Oman Med J 2024; 39:e611. [PMID: 38988802 PMCID: PMC11233933 DOI: 10.5001/omj.2024.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/09/2023] [Indexed: 07/12/2024] Open
Abstract
Objectives Specialized pediatric cardiology clinics conducted in local hospitals are an important part of delivering specialized care to patients close to their homes. This study aimed to review our experience with a specialized pediatric cardiology outreach clinic at Jaalan Bani Bu Ali Hospital, South A'Sharqiyah, Oman. Methods Patient records for each individual, seen in the outreach clinic between March 2018 and June 2022, were reviewed to determine demographic information, reason for referral, underlying diagnosis, and clinic visit outcomes. Results Over the study period, 29 clinics were conducted, with 360 patients seen. Of these, 200 (55.6%) were male with a median age of 13 months. The majority of patients (n = 271; 75.3%) were referred due to a cardiac murmur. Most patients had a normal cardiac evaluation (n = 177; 49.2%). The most common congenital heart diseases detected were mild pulmonary valve stenosis (14.8%) and moderate to large secundum atrial septal defects (13.7%). Significant cardiac lesions detected included severe pulmonary hypertension (2.2%), tetralogy of Fallot (1.6%), and cor triatriatum sinistrum (0.5%). Overall, 70 (19.4%) patients were referred to tertiary care hospitals, and 179 (49.7%) were reassured and discharged. Conclusions Conducting specialized pediatric cardiology outreach clinics in overpopulated areas is effective and well-received by families. It reassures many families and reduces the need for unnecessary travel to specialized centers. These clinics also play a crucial role in detecting patients with significant cardiac defects requiring urgent care. Implementing specialized clinics in primary and secondary health centers could be beneficial for other subspecialties in reducing long waiting lists.
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Affiliation(s)
- Khalfan Salim Al Senaidi
- Unit of Pediatric Cardiology, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Wael Sulaiman
- Department of Child Health, Jaalan Bani Bu Ali Hospital, South A’Sharqiyah, Oman
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Warren PW, Beck AF, Zang H, Anderson J, Statile C. Inequitable access: factors associated with incomplete referrals to paediatric cardiology. Cardiol Young 2024; 34:428-435. [PMID: 35848164 DOI: 10.1017/s1047951122002037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps. STUDY DESIGN We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient's geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression. RESULTS There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22-1.63), public insurance (OR 1.29; 95% CI 1.14-1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08-1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52-0.74). CONCLUSION Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.
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Affiliation(s)
- Paul W Warren
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, USA
| | - Andrew F Beck
- General and Community Pediatrics and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jeffrey Anderson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Christopher Statile
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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5
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Theis RP, Dorbu JI, Mavrodieva ME, Guerrero RA, Wright SE, Donahoo WT, Modave F, Carrasquillo O, Shenkman EA. Telehealth Implementation Response to COVID-19 in the OneFlorida+ Clinical Research Network: Perspectives of Clinicians and Health Systems Leaders. Telemed J E Health 2024; 30:268-277. [PMID: 37358611 PMCID: PMC10794842 DOI: 10.1089/tmj.2023.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction: The COVID-19 pandemic forced health systems worldwide to make rapid adjustments to patient care. Nationwide stay-at-home mandates and public health concerns increased demand for telehealth to maintain patients' continuity of care. These circumstances permitted observation of telehealth implementation in real-world settings at a large scale. This study aimed to understand clinician and health system leader (HSL) experiences in expanding, implementing, and sustaining telehealth during COVID-19 in the OneFlorida+ clinical research network. Methods: We conducted semistructured videoconference interviews with 5 primary care providers, 7 specialist providers, and 12 HSLs across 7 OneFlorida+ health systems and settings. Interviews were audiorecorded, transcribed, and summarized using deductive team-based template coding. We then used matrix analysis to organize the qualitative data and identify inductive themes. Results: Rapid telehealth implementation occurred even among sites with low readiness, facilitated by responsive planning, shifts in resource allocation, and training. Common hurdles in routine telehealth use, including technical and reimbursement issues, were also barriers to telehealth implementation. Acceptability of telehealth was influenced by benefits such as the providers' ability to view a patient's home environment and the availability of tools to enhance patient education. Lower acceptability stemmed from the inability to conduct physical examinations during the shutdown. Conclusions: This study identified a broad range of barriers, facilitators, and strategies for implementing telehealth within large clinical research networks. The findings can contribute to optimizing the effectiveness of telehealth implementation in similar settings, and point toward promising directions for telehealth provider training to improve acceptability and promote sustainability.
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Affiliation(s)
- Ryan P. Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Joshua I. Dorbu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Maria E. Mavrodieva
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Richard A. Guerrero
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Stacy E. Wright
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - William T. Donahoo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - François Modave
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Olveen Carrasquillo
- Miller School of Medicine, Division of General Internal Medicine, University of Miami, Miami, Florida, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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Nurtsch A, Teufel M, Jahre LM, Esber A, Rausch R, Tewes M, Schöbel C, Palm S, Schuler M, Schadendorf D, Skoda EM, Bäuerle A. Drivers and barriers of patients' acceptance of video consultation in cancer care. Digit Health 2024; 10:20552076231222108. [PMID: 38188860 PMCID: PMC10768612 DOI: 10.1177/20552076231222108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background Due to digitization in the medical sector, many healthcare interactions are switched to online services. This study assessed the acceptance of video consultations (VCs) in cancer care, and determined drivers and barriers of acceptance. Methods A cross-sectional online-based survey study was conducted in Germany from February 2022 to February 2023. Recruitment took place at oncology outpatient clinics, general practitioners, oncology practices and via cancer-related social media channels. Inclusion criteria were a cancer diagnosis, cancer treatment and internet access. Sociodemographic, medical data, eHealth-related data were acquired via an online assessment. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used to determine the acceptance of VC and its predictors. Results Of N = 350 cancer patients, 56.0% (n = 196) reported high acceptance of VC, 28.0% (n = 98) stated moderate acceptance and 16.0% (n = 56) indicated low acceptance. Factors influencing acceptance were younger age (β = -.28, p < .001), female gender (β = .35, p = .005), stage of disease (β = .11, p = .032), high digital confidence (β = .14, p = .010), low internet anxiety (β = -.21, p = .001), high digital overload (β = -.12, p = .022), high eHealth literacy (β = .14, p = .028), personal trust (β = -.25, p < .001), internet use (β = .17, p = .002), and the UTAUT predictors: performance expectancy (β = .24, p < .001), effort expectancy (β = .26, p < .001), and social influence (β = .34, p < .001). Conclusions Patients' acceptance of VC in cancer care is high. Drivers and barriers to acceptance identified should be considered for personalized applications. Considering the growing demand for cancer care establishing digital healthcare solutions is justified.
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Affiliation(s)
- Angelina Nurtsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Maria Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - André Esber
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Raya Rausch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Mitra Tewes
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Palliative Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christoph Schöbel
- Faculty of Sleep Medicine and Telemedicine, West German Lung Center, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Medical Oncology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Eljack MMF, Elhadi YAM, Mahgoub EAA, Ahmed KAHM, Mohamed MTAA, Elnaiem W, Mohamedsharif A, Nour AB, Muhammed AEM, Gebril MSM, Asghar MS, El-Osta A. Physician experiences with teleconsultations amidst conflict in Sudan. Sci Rep 2023; 13:22688. [PMID: 38114741 PMCID: PMC10730898 DOI: 10.1038/s41598-023-49967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study.
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Affiliation(s)
| | | | | | | | | | - Walaa Elnaiem
- Community Department, Faculty of Medicine, University of Alneelain, Khartoum, Sudan
| | - Asma Mohamedsharif
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Alshareef B Nour
- Wad Medani College of Medical Sciences and Technology, Wad Medani, Sudan
| | | | | | | | - Austen El-Osta
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Chatterjee A, Prinz A, Riegler MA, Das J. A systematic review and knowledge mapping on ICT-based remote and automatic COVID-19 patient monitoring and care. BMC Health Serv Res 2023; 23:1047. [PMID: 37777722 PMCID: PMC10543863 DOI: 10.1186/s12913-023-10047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND e-Health has played a crucial role during the COVID-19 pandemic in primary health care. e-Health is the cost-effective and secure use of Information and Communication Technologies (ICTs) to support health and health-related fields. Various stakeholders worldwide use ICTs, including individuals, non-profit organizations, health practitioners, and governments. As a result of the COVID-19 pandemic, ICT has improved the quality of healthcare, the exchange of information, training of healthcare professionals and patients, and facilitated the relationship between patients and healthcare providers. This study systematically reviews the literature on ICT-based automatic and remote monitoring methods, as well as different ICT techniques used in the care of COVID-19-infected patients. OBJECTIVE The purpose of this systematic literature review is to identify the e-Health methods, associated ICTs, method implementation strategies, information collection techniques, advantages, and disadvantages of remote and automatic patient monitoring and care in COVID-19 pandemic. METHODS The search included primary studies that were published between January 2020 and June 2022 in scientific and electronic databases, such as EBSCOhost, Scopus, ACM, Nature, SpringerLink, IEEE Xplore, MEDLINE, Google Scholar, JMIR, Web of Science, Science Direct, and PubMed. In this review, the findings from the included publications are presented and elaborated according to the identified research questions. Evidence-based systematic reviews and meta-analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Additionally, we improved the review process using the Rayyan tool and the Scale for the Assessment of Narrative Review Articles (SANRA). Among the eligibility criteria were methodological rigor, conceptual clarity, and useful implementation of ICTs in e-Health for remote and automatic monitoring of COVID-19 patients. RESULTS Our initial search identified 664 potential studies; 102 were assessed for eligibility in the pre-final stage and 65 articles were used in the final review with the inclusion and exclusion criteria. The review identified the following eHealth methods-Telemedicine, Mobile Health (mHealth), and Telehealth. The associated ICTs are Wearable Body Sensors, Artificial Intelligence (AI) algorithms, Internet-of-Things, or Internet-of-Medical-Things (IoT or IoMT), Biometric Monitoring Technologies (BioMeTs), and Bluetooth-enabled (BLE) home health monitoring devices. Spatial or positional data, personal and individual health, and wellness data, including vital signs, symptoms, biomedical images and signals, and lifestyle data are examples of information that is managed by ICTs. Different AI and IoT methods have opened new possibilities for automatic and remote patient monitoring with associated advantages and weaknesses. Our findings were represented in a structured manner using a semantic knowledge graph (e.g., ontology model). CONCLUSIONS Various e-Health methods, related remote monitoring technologies, different approaches, information categories, the adoption of ICT tools for an automatic remote patient monitoring (RPM), advantages and limitations of RMTs in the COVID-19 case are discussed in this review. The use of e-Health during the COVID-19 pandemic illustrates the constraints and possibilities of using ICTs. ICTs are not merely an external tool to achieve definite remote and automatic health monitoring goals; instead, they are embedded in contexts. Therefore, the importance of the mutual design process between ICT and society during the global health crisis has been observed from a social informatics perspective. A global health crisis can be observed as an information crisis (e.g., insufficient information, unreliable information, and inaccessible information); however, this review shows the influence of ICTs on COVID-19 patients' health monitoring and related information collection techniques.
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Affiliation(s)
- Ayan Chatterjee
- Department of Information and Communication Technology, Centre for e-Health, University of Agder, Grimstad, Norway.
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway.
| | - Andreas Prinz
- Department of Information and Communication Technology, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Michael A Riegler
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway
| | - Jishnu Das
- Department of Information Systems, Centre for e-Health, University of Agder, Kristiansand, Norway
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Montazeri Ghahjaverstan N, Balmer-Minnes D, Taghibeyglou B, Moineau B, Chaves G, Alizadeh-Meghrazi M, Cifra B, Jeewa A, Yadollahi A. Textile-based Wearable to Monitor Heart Activity in Paediatric Population: A Pilot Study. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:187-195. [PMID: 37969855 PMCID: PMC10642137 DOI: 10.1016/j.cjcpc.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/25/2023] [Indexed: 11/17/2023]
Abstract
Background Cardiac monitoring for children with heart disease still employs common clinical techniques that require visits to hospital either in an ambulatory or inpatient setting. Frequent cardiac monitoring, such as heart rate monitoring, can limit children's physical activity and quality of life. The main objective of this study is to evaluate the performance of a textile-based device (SKIIN) in measuring heart rate (HR) in different tasks: lying down, sitting, standing, exercising, and cooling down. Methods Twenty participants including healthy children and children with heart disease were included in this study. The difference between the HRs recorded by the SKIIN was compared with a reference electrocardiogram collection by normalized root mean squared error. Participants completed a questionnaire on their experience wearing the textile device with additional parental feedback on the textile device collected. Results Participants had the median age of 14 years (range: 10-17 years), with body mass index 23.1 ± 3.8 kg/m2 and body surface area 1.70 ± 0.25 m2. The HR recorded by SKIIN and reference system significantly changes between tasks (P < 0.001), while not significantly different from each other (P > 0.05). The normalized root mean squared error was 3.8% ± 3.0% and 3.6% ± 3.7% for healthy and the heart disease groups, respectively. All participants found the textile device non-irritating and easy to wear. Conclusions This study provides proof of concept that HR can be robustly and conveniently monitored by smart textiles, with similar accuracy to standard-of-care devices.
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Affiliation(s)
- Nasim Montazeri Ghahjaverstan
- Sleep Research Laboratory, KITE—Toronto Rehabilitation Institute, University Health Network Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Diana Balmer-Minnes
- Division of Cardiology, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Behrad Taghibeyglou
- Sleep Research Laboratory, KITE—Toronto Rehabilitation Institute, University Health Network Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Bastien Moineau
- Research and Development, Myant Inc, Toronto, Ontario, Canada
| | - Gabriela Chaves
- Research and Development, Myant Inc, Toronto, Ontario, Canada
| | | | - Barbara Cifra
- Division of Cardiology, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Division of Cardiology, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Azadeh Yadollahi
- Sleep Research Laboratory, KITE—Toronto Rehabilitation Institute, University Health Network Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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10
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Guss CE, Pitts S. Advocacy: caring for teens beyond the bedside. Curr Opin Pediatr 2023; 35:399-400. [PMID: 37405722 DOI: 10.1097/mop.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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11
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Dodeja AK, Schreier M, Granger M, Mitchell D, Chumita R, Sisk T, Daniels CJ, Rajpal S. Patient Experience with Telemedicine in Adults with Congenital Heart Disease. Telemed J E Health 2023; 29:1261-1265. [PMID: 36656168 DOI: 10.1089/tmj.2022.0279] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction: The COVID-19 pandemic has resulted in increased use of telemedicine. There are limited data on patient experience with telemedicine in adults with congenital heart disease (ACHD). We hypothesized that due to their complex medical history, ACHD would prefer in-person clinic visits over telemedicine. Methods: We conducted a nurse-administered telephone survey based on Agency for Healthcare Research and Quality recommendations to assess patient experience after ACHD telemedicine visits in the early part of the pandemic from March 2020 to June 2020. Results: Of 216 ACHD who had telemedicine visits, 136 (63%) agreed to participate in the survey. Mean age was 45 ± 18 years, majority (65%) being video encounters. Most (98%) patients expressed that the telemedicine visit was successful in addressing their health care needs. Only 21 (15%) patients reported technical issues. Most patients (76%) preferred telemedicine given testing was provided separately, 25 (18%) preferred in-person clinic visits, and 8 (6%) had no preference. Of the 25 patients over 65 years, 19 (76%) would choose telemedicine over the in-person clinic, and only 1 patient reported technical difficulties. Conclusion: ACHD reported a positive experience with telemedicine. Technical limitations were infrequent even among the elderly. The majority of patients felt that their health care needs were addressed and would consider telemedicine over clinic visits. These data are important as payors move away from supporting telemedicine and hospitals restructure, with and without ongoing COVID-19 concerns.
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Affiliation(s)
- Anudeep K Dodeja
- Division of Pediatric Cardiology, Connecticut Children's, Hartford, Connecticut, USA
| | - Matthew Schreier
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Cardiovascular Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Matthew Granger
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Deborah Mitchell
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rosemary Chumita
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tracey Sisk
- Division of Cardiovascular Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Curt J Daniels
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Cardiovascular Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Saurabh Rajpal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Cardiovascular Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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12
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Hartman D, Ebenroth E, Farrell A. Utilizing technology to expand home monitoring to high-risk infants with CHD. Cardiol Young 2023; 33:1124-1128. [PMID: 35836381 DOI: 10.1017/s1047951122002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infants born with single ventricle physiology that require an aorto-pulmonary shunt are at high risk for sudden cardiac death, particularly during the interstage period between the first-stage palliation and the second-stage palliation. Home monitoring programs have decreased interstage mortality in the hypoplastic left heart syndrome population prompting programs to expand the home monitoring program to other high-risk populations. At our mid-sized program, we implemented the Locus Health home monitoring platform first in the hypoplastic left heart syndrome population, then expanding to the single ventricle shunt population. Interstage mortality for the hypoplastic left heart syndrome population after initiation of the home monitoring program went from 18% prior to 2009 to 7% as of the end of 2020 (n = 99), with 2.8% mortality from 2013 to 2020 and 0% mortality since initiation of the Locus program in 2017. Caregiver surveys done prior to discharge and then 3 weeks later were used to document caregiver experience using the digital home monitoring program. Caregivers reported overall positive experience with the digital application, with 91.8% stating that they felt confident taking care of their baby at home. Transitioning the home monitoring program from a traditional binder to an iPad with the Locus Health application allowed us to expand the program, utilize the electronic medical record, bill for the service, and demonstrate positive experiences for caregivers. Overall engagement and adherence with the program by caregivers were 50.94 and 45.45%, with a total of 112 patient episodes. Reimbursement from private insurance providers was 22% of the billed amount for 2020.
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Affiliation(s)
- Dana Hartman
- Riley Hospital for Children at Indiana University Health, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, USA
| | - Eric Ebenroth
- Indiana University School of Medicine, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, Indiana, USA
| | - Anne Farrell
- Riley Hospital for Children at Indiana University Health, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, USA
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13
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Nguyen J, Takesh T, Parsangi N, Song B, Liang R, Wilder-Smith P. Compliance with Specialist Referral for Increased Cancer Risk in Low-Resource Settings: In-Person vs. Telehealth Options. Cancers (Basel) 2023; 15:2775. [PMID: 37345112 DOI: 10.3390/cancers15102775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 06/23/2023] Open
Abstract
Efforts are underway to improve the accuracy of non-specialist screening for oral cancer (OC) risk, yet better screening will only translate into improved outcomes if at-risk individuals comply with specialist referral. Most individuals from low-resource, minority, and underserved (LRMU) populations fail to complete a specialist referral for OC risk. The goal was to evaluate the impact of a novel approach on specialist referral compliance in individuals with a positive OC risk screening outcome. A total of 60 LRMU subjects who had screened positive for increased OC risk were recruited and given the choice of referral for an in-person (20 subjects) or a telehealth (40 subjects) specialist visit. Referral compliance was tracked weekly over 6 months. Compliance was 30% in the in-person group, and 83% in the telehealth group. Approximately 83-85% of subjects from both groups who had complied with the first specialist referral complied with a second follow-up in-person specialist visit. Overall, 72.5% of subjects who had chosen a remote first specialist visit had entered into the continuum of care by the study end, vs. 25% of individuals in the in-person specialist group. A two-step approach that uses telehealth to overcome barriers may improve specialist referral compliance in LRMU individuals with increased OC risk.
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Affiliation(s)
- James Nguyen
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Thair Takesh
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Negah Parsangi
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Bofan Song
- College of Optical Sciences, University of Arizona, Tucson, AZ 85721, USA
| | - Rongguang Liang
- College of Optical Sciences, University of Arizona, Tucson, AZ 85721, USA
| | - Petra Wilder-Smith
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
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Klais M, Doll U, Purbojo A, Dittrich S, Rottermann K. The Congenital Cardiology Cloud: Proof of feasibility of Germany's first tele-medical network for pediatric cardiology. J Telemed Telecare 2023:1357633X231158838. [PMID: 36938629 DOI: 10.1177/1357633x231158838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND For an optimal interplay based on the data-secure exchange of diagnostic data between patients, ambulatory care, and hospital care, we implemented the first tele-medical network for pediatric cardiology in Germany, the Congenital Cardiology Cloud. This study focuses on its feasibility, technical characteristics, and implementation in routine clinical work. METHODS Tele-medical traffic comprised numbers of incoming/outgoing data, related file types, treatment options for tele-medically processed patients, and patient classification with respect to the severity of disease. Proof of feasibility was related to the number of successful tele-medical transmissions of discharge documents at the end of the observation period (02/2020-10/2020). RESULTS Analysis of Congenital Cardiology Cloud's data communication showed a number of 1178 files for a total of 349 patients, favoring transmissions towards the clinic. Incoming traffic was predominantly characterized by diagnostic data regarding tele-consultations (76.6%), consisting of a multitude of file types, whereas 93.4% of the dispatched data corresponded to discharge letters. The number of tele-consultations counted up to 61, with a necessary subsequent treatment or diagnostic procedure in 90.2% of the presented cases. Tele-medically processed patients generally showed to be more complex (severe chronic heart disease 42.4% vs. 23.7%). At the end of the observation period, 97.6% of the discharge documents were transmitted via telemedicine. DISCUSSION The implementation of the first tele-medical network for pediatric cardiology in Germany proves recent technological developments to successfully enable innovative patient care, connecting the ambulatory and hospital sector for a joint patient advice, predominantly in more complex cases. Possible governmentally guided refinancing concepts will show its long-term feasibility.
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Affiliation(s)
- Marko Klais
- Department of Pediatric Cardiology, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Ulrike Doll
- Department of Pediatric Cardiology, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiology, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Kathrin Rottermann
- Department of Pediatric Cardiology, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
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Tandon A, Nguyen HH, Avula S, Seshadri DR, Patel A, Fares M, Baloglu O, Amdani S, Jafari R, Inan OT, Drummond CK. Wearable Biosensors in Congenital Heart Disease: Needs to Advance the Field. JACC. ADVANCES 2023; 2:100267. [PMID: 37152621 PMCID: PMC10162770 DOI: 10.1016/j.jacadv.2023.100267] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 05/09/2023]
Abstract
Traditional measures of clinical status and physiology have generally been based in health care settings, episodic, short in duration, and performed at rest. Wearable biosensors provide an opportunity to obtain continuous non-invasive physiologic data from patients with congenital heart disease (CHD) in the real-world setting, over longer durations, and across varying levels of activity. However, there are significant technical limitations to the use of wearable biosensors in CHD. Here, we review current applications of wearable biosensors in CHD; how clinical and research uses of wearable biosensors must consider various CHD physiologies; the technical challenges in developing wearable biosensors for CHD; and special considerations for digital biomarkers in CHD.
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Affiliation(s)
- Animesh Tandon
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Cleveland Clinic Children's Center for Artificial Intelligence (C4AI), Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case School of Engineering at Case Western Reserve University, Cleveland, Ohio, USA
| | - Hoang H. Nguyen
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sravani Avula
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dhruv R. Seshadri
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Akash Patel
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Munes Fares
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Orkun Baloglu
- Cleveland Clinic Children's Center for Artificial Intelligence (C4AI), Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Department of Critical Care, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- Cleveland Clinic Children's Center for Artificial Intelligence (C4AI), Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Roozbeh Jafari
- Departments of Biomedical Engineering, Computer Science and Electrical Engineering, Texas A&M University, College Station, Texas, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Colin K. Drummond
- Department of Biomedical Engineering, Case School of Engineering at Case Western Reserve University, Cleveland, Ohio, USA
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16
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Li B, Gillmeyer KR, Molloy-Paolillo B, Vimalananda VG, Elwy AR, Wiener RS, Rinne ST. Scoping Review of Pulmonary Telemedicine Consults: Current Knowledge and Research Gaps. Ann Am Thorac Soc 2023; 20:456-465. [PMID: 36490386 PMCID: PMC9993154 DOI: 10.1513/annalsats.202205-404oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/09/2022] [Indexed: 12/13/2022] Open
Abstract
Rationale: Telemedicine consults, including video consults, telephone consults, electronic consults, and virtual conferences, may be particularly valuable in the management of chronic pulmonary diseases, but there is limited guidance on best practices for pulmonary telemedicine consults. Objectives: This scoping review aims to identify, characterize, and analyze gaps in the published literature on telemedicine consults health providers use to manage patients with chronic pulmonary diseases. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library from database origin through July 10, 2021. We included manuscripts describing applications of telemedicine consults for patients with chronic pulmonary diseases (asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease). We restricted our review to full-length articles published in English about provider-led (as opposed to nurse-led) telemedicine consults. Results: Our search yielded 3,118 unique articles; 27 articles met the inclusion criteria. All telemedicine consult modalities and chronic pulmonary conditions were well represented in the review except for pulmonary hypertension and interstitial lung disease, which were represented by one and no articles, respectively. Most articles described a small, single-center, observational study that focused on the acceptability, feasibility, use, and/or clinical effectiveness of the telemedicine consult. Few studies had objectively measured clinical outcomes or included a comparator group, and none compared telemedicine consult modalities against one another. Conclusions: Our scoping review identified limited literature describing pulmonary telemedicine consults and highlighted several gaps in the literature that warrant increased attention. Providers treating chronic pulmonary diseases are left with limited guidance on best practices for telemedicine consults.
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Affiliation(s)
| | | | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - Varsha G. Vimalananda
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island; and
| | - Renda Soylemez Wiener
- The Pulmonary Center, and
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Seppo T. Rinne
- The Pulmonary Center, and
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
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17
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Calò P, Leblond P, Girodet M, Gauchet A, Anota A, Christophe V, Bertrand A. Health Workers' Perception and Emotions Surrounding Teleconsultation in Pediatric Cancer Care During the COVID-19 Pandemic. J Pediatr Hematol Oncol 2023; 45:e222-e227. [PMID: 35129149 DOI: 10.1097/mph.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS During the first lockdown of the coronavirus disease 2019 (COVID-19) pandemic, we developed a teleconsultation model and conducted a survey-based study with the aim to evaluate satisfaction and emotions of health workers (HWs), to assess the feasibility of teleconsultations, and to evaluate technical issues. MATERIALS AND METHODS This is a prospective monocentric exploratory study based on synchronous, video consultations between HWs and pediatric patients treated for blood or solid malignancies or blood benign diseases. Every HW completed an online survey which covered technical aspects, data concerning satisfaction, quality of the interaction with the patient, and emotions felt after the teleconsultation. A score was calculated for each aspect. RESULTS Eleven specialists participated in the study, and we selected 84 questionnaires. With a satisfaction rate of 74%, HWs felt mostly calm (80%), relaxed (70%), stress-free (69%), and relieved (65%). We calculated the following median scores: an overall satisfaction score of 6.67 (0 to 10), a global feeling score of 8.79 (3.33 to 10.00), and a quality score of 7.34 (2.50 to 10.00). A strong correlation between the quality of teleconsultation and the satisfaction of the HWs has been highlighted ( r =0.588). CONCLUSION Our series is an encouragingly positive experience from the perspective of the HWs, their feelings, and perceptions.
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Affiliation(s)
| | | | | | | | - Amélie Anota
- Departments of Human and Social Sciences
- Clinical Research and Innovation, Leon Berard Center
- French National Platform Quality of Life and Cancer
| | - Veronique Christophe
- Departments of Human and Social Sciences
- University of Lille, UMR CNRS 9193-SCALab-Affective and Cognitive Sciences, Lille, France
| | - Amandine Bertrand
- Pediatric Hematology and Oncology Institute (IHOPe)
- Departments of Human and Social Sciences
- Research on Healthcare Performance (RESHAPE), Lyon
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18
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020235. [PMID: 36836469 PMCID: PMC9965862 DOI: 10.3390/jpm13020235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | | | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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Ivaniuk AV. CONCEPTUAL, FUNCTIONAL-ORGANISATIONAL MODEL OF THE REGIONAL CENTRE FOR CARDIOLOGY AND CARDIAC SURGERY BASED ON PUBLIC-PRIVATE PARTNERSHIP. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2161-2168. [PMID: 37948709 DOI: 10.36740/wlek202310105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim: To substantiate the model of the Regional Center for Cardiology and Cardiac Surgery (RCCCS) based on the principles of public-private partnership (PPP). PATIENTS AND METHODS Materials and methods: A systematic approach and analysis, medical-statistical and sociological method, expert assessment and method of conceptual modelling. RESULTS Results: A comprehensive medical and social study of the morbidity rate of the population of the Kyiv region (Ukraine) with circulatory system diseases (CSD), as well as an analysis of the activities of the cardiological service of the Kyiv region in 2010-2019, have been made. Deficiencies in the organisation of medical care were identified, and strategic directions for its improvement were substantiated. The results of a sociological survey of CSD patients, cardiologists and experts - health care organisers have been analysed. According to the results of the expert assessment, health care institutions (HCI) providing cardiac care to the population in the Kyiv region are not ready to work under the conditions of the market economy; there is no appropriate regulatory framework, economic and legal independence of HCI, there is no market strategy for the development of HCI. CONCLUSION Conclusions: The model of RCCCS, based on the principles of PPP being a medical institution of a new organisational and legal form, is capable of providing high-quality and affordable highly specialised medical care of the third level to the population with diseases of the circulatory system at the regional level.
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Affiliation(s)
- Anatolii V Ivaniuk
- KYIV CITY CLINICAL HOSPITAL NO 1, KYIV, UKRAINE; BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
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Anvari S, Neumark S, Jangra R, Sandre A, Pasumarthi K, Xenodemetropoulos T. Best Practices for the Provision of Virtual Care: A Systematic Review of Current Guidelines. Telemed J E Health 2023; 29:3-22. [PMID: 35532969 DOI: 10.1089/tmj.2022.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care. The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters. Methods: A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data were synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) tool was used to evaluate the quality of evidence. Results: A total of 60 guidelines for virtual care encounters were included; 52% of these were published in the context of the COVID-19 pandemic. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included guidelines, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. Thirty-one guidelines also provided guidance to patients or caregivers. Overall guideline quality was poor. Discussion: General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation before a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices and guidelines on patient attitudes and outcomes to further optimize the provision of virtual care for specific patient populations.
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Affiliation(s)
- Sama Anvari
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Samuel Neumark
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rhea Jangra
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anthony Sandre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Keerthana Pasumarthi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ted Xenodemetropoulos
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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21
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Pöyry H, Aarnivala H, Huhtamäki H, Pokka T, Renko M, Valmari P, Tapiainen T. Parental Ability to Assess Pediatric Vital Signs. J Pediatr 2023; 252:177-182.e2. [PMID: 35973446 DOI: 10.1016/j.jpeds.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate parents' ability to accurately assess their child's heart and respiratory rates (RRs) in the context of potential utility for telehealth visits. STUDY DESIGN In this controlled study of 203 child-parent pairs, parents measured their child's heart rate (HR) using 4 methods: palpation, auscultation, and 2 photoplethysmographic smartphone applications. Parents measured RR by inspecting the child and tapping the smartphone application. The gold standards were electrocardiogram for the HR and the child's breaths measured by a health care professional for 60 seconds for the RR. We plotted the measurements using a Bland-Altman plot with 95% limits of agreement. RESULTS Parents underestimated HR by palpation with a calculated bias of -18 beats per minute (bpm) (SD, 19), with limits of agreement ranging from -56 to 19 bpm. Parents overestimated and underestimated HR by auscultation with limits of agreement ranging from -53 to 46 bpm. Smartphone applications did not improve the accuracy of measurements. The accuracy of parental RR measurements was low. For young children, bias was -0.8 breaths per minute (brpm) (SD, 9.8) with limits of agreement from -20 to 19 brpm, and for older children, bias was 0.9 brpm (SD 7.4) with limits of agreement from 6 to 15 brpm. The sensitivity of parental subjective opinion to recognize accelerated RR was 37% (95% CI, 25%-51%). CONCLUSION Parents were not able to assess their child's RR or HR accurately. Digital remote assessment of children should not rely on parental measurements of vital signs.
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Affiliation(s)
- Hilla Pöyry
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland.
| | - Henri Aarnivala
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
| | - Heikki Huhtamäki
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
| | - Marjo Renko
- Department of Pediatrics, The University of Eastern Finland and Kuopio University Hospital, Finland
| | - Pekka Valmari
- Department of Pediatrics, Lapland Central Hospital, Rovaniemi, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland; Biocenter Oulu, University of Oulu, Finland.
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22
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Dechert BE, Kaczor SM, LaPage MJ, Hale BW, Bradley DJ. Nurse Practitioner Delivered Virtual Care in a Pediatric Specialty Clinic. J Pediatr Health Care 2022; 37:287-290. [PMID: 36464520 DOI: 10.1016/j.pedhc.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Virtual care in pediatric specialty practice has become widely used to increase access to care, one in which nurse practitioners (NPs) can play a vital role. We sought to evaluate the outcomes of virtual care provided by pediatric cardiology and electrophysiology (EP) NPs for pediatric and congenital heart disease patients. METHOD Retrospective review of all virtual care visits performed by pediatric EP NPs between October 2019 and October 2021 at a single tertiary care center. RESULTS NPs delivered virtual care for 287 pediatric EP evaluations for 276 patients; 132 (45%) independently, with the remaining 155 collaborating with an electrophysiologist as a shared visit. The mean age was 15.2 ± 8.9 years. DISCUSSION NPs performed a significant subset of these visits independently and were a vital part of all visits in this study. The role of the NP in specialty pediatric virtual care should continue to be supported and advanced.
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Affiliation(s)
- Brynn E Dechert
- Brynn E. Dechert, Pediatric Nurse Practitioner, Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Staci M. Kaczor, Family Nurse Practitioner. Martin J. LaPage, Associate Professor. Benjamin W. Hale, Associate Professor. David J. Bradley, Professor..
| | - Staci M Kaczor
- Brynn E. Dechert, Pediatric Nurse Practitioner, Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Staci M. Kaczor, Family Nurse Practitioner. Martin J. LaPage, Associate Professor. Benjamin W. Hale, Associate Professor. David J. Bradley, Professor
| | - Martin J LaPage
- Brynn E. Dechert, Pediatric Nurse Practitioner, Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Staci M. Kaczor, Family Nurse Practitioner. Martin J. LaPage, Associate Professor. Benjamin W. Hale, Associate Professor. David J. Bradley, Professor
| | - Benjamin W Hale
- Brynn E. Dechert, Pediatric Nurse Practitioner, Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Staci M. Kaczor, Family Nurse Practitioner. Martin J. LaPage, Associate Professor. Benjamin W. Hale, Associate Professor. David J. Bradley, Professor
| | - David J Bradley
- Brynn E. Dechert, Pediatric Nurse Practitioner, Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Staci M. Kaczor, Family Nurse Practitioner. Martin J. LaPage, Associate Professor. Benjamin W. Hale, Associate Professor. David J. Bradley, Professor
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23
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Preminger TJ. Telemedicine in pediatric cardiology: pros and cons. Curr Opin Pediatr 2022; 34:484-490. [PMID: 35983842 DOI: 10.1097/mop.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review recent uses of telemedicine in pediatric cardiology, highlighting merits, challenges, and future directions. RECENT FINDINGS The COVID-19 pandemic accelerated telemedicine use, which has had a positive impact with respect to providers, patients, and their caregivers. Recent data have demonstrated the feasibility and effectiveness of telemedicine through expediting needed care and reducing healthcare utilization, including unnecessary emergency department visits, transports, and hospitalizations. With increasing complexity of cardiac care, telecardiology allows for establishing a medical home, improving access, and continuity of care. Great potential also exists for telecardiology to permit more consistent preventive care, possibly resulting in improved health equity, reduced morbidity and mortality, and associated costs. Challenges to optimal implementation of telecardiology, which are all surmountable, include the currently unaccounted additional workload and administrative burden, licensing restrictions, disparities in access to care, insurance reimbursement, and potential fraud and abuse. SUMMARY Telecardiology allows for efficient, quality, effective, collaborative care and is foundational to creating innovative, high-value care models. Through integration with accelerating technology and in-person visits, a sustainable hybrid model of optimal care can be achieved. Addressing barriers to progress in telecardiology is critical.
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Affiliation(s)
- Tamar J Preminger
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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24
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Camoni N, Cirio S, Salerno C, Balian A, Bruni G, D’Avola V, Cagetti MG. COVID-19 Pandemic and Remote Consultations in Children: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9787. [PMID: 36011421 PMCID: PMC9407809 DOI: 10.3390/ijerph19169787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Telemedicine is becoming a standard method of consultation, and the COVID-19 pandemic has increased its need. Telemedicine is suitable for non-communicable diseases (NCDs) in the pediatric population, as these are chronic conditions that affect many children worldwide. The aim of this study was to analyze the bibliometric parameters of publications on the use of telemedicine for the most common NCDs in children before and after the COVID-19 pandemic. Following the electronic search, 585 records were selected. "Metabolic diseases" was the most frequent topic before and after the pandemic, accounting for 34.76% in 2017-2019 and 33.97% in 2020-2022. The average IF of the journals from which records were retrieved was 5.46 ± 4.62 before and 4.58 ± 2.82 after the pandemic, with no significant variation. The number of citations per reference averaged 14.71 ± 17.16 in 2017-2019 (95% CI: 12.07; 17.36) and 5.54 ± 13.71 in 2020-2022 (95% CI: 4.23; 6.86). Asthma, metabolic diseases, and neurodevelopmental disorders were the most explored topics. A relevant finding concerns the increasing number of observational studies after the pandemic, with a reduction of the interventional studies. The latter type of study should be recommended as it can increase the evaluation of new strategies for the management of NCDs.
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Affiliation(s)
- Nicole Camoni
- Department of Restorative, Preventive and Paediatric Dentistry, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Claudia Salerno
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Araxi Balian
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Dental and Stomatology Unit, Cittadella Hospital, AULSS 6 Euganea, 35013 Cittadella, Italy
| | - Giulia Bruni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Valeria D’Avola
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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25
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Fitzgerald M, Bhatt A, Thompson LA, Schwartz A, Thomas AO, Schinasi DA, Otero J, Carpenter P, Thomas JS, Black NP. Telemedicine in Pediatric Training: A National Needs Assessment of the Current State of Telemedicine Education in Pediatric Training. Acad Pediatr 2022; 22:713-717. [PMID: 34732381 DOI: 10.1016/j.acap.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe the current state of telemedicine within pediatric training programs to inform development of a national telemedicine training curriculum for pediatric trainees. METHODS We conducted an anonymous cross-sectional survey of pediatric residency (Fall 2020) and fellowship program directors (Spring 2021) on their current telemedicine practices in pediatric post-graduate training. RESULTS Forty-eight US pediatric residency programs (n = 48/198, 24%) and 422 fellowship programs completed the survey (n = 422/872, 48%); combined response rate 44% (n = 470/1070). Pre-COVID-19, 12% (n = 57/470) of programs surveyed reported using telemedicine in their training program, but during the pandemic 71% (n = 334/470) reported telemedicine use with trainees. Over 71% (n = 334/470) agreed that a formalized curriculum is important, yet 69% (n = 262/380) of programs reporting telemedicine use either did not have a curriculum or were unsure if one existed at their program. Respondents who were unsure/not likely to add a telemedicine curriculum and/or indicated that a telemedicine curriculum would not be important (52% n = 243/470), cited "time" (55%, n = 136/243) most frequently as a barrier. CONCLUSIONS Our needs assessment indicates marked increase in use of telemedicine with trainees by respondent pediatric training programs, with fewer than 50% reporting a formalized training curriculum and most agreeing that a curriculum is important.
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Affiliation(s)
- Melissa Fitzgerald
- University of Florida, Department of Pediatrics (M Fitzgerald, LA Thompson, J Otero, NP Black), Gainesville, Fla.
| | - Avni Bhatt
- University of California, Davis, School of Medicine (A Bhatt), Sacramento, Calif
| | - Lindsay A Thompson
- University of Florida, Department of Pediatrics (M Fitzgerald, LA Thompson, J Otero, NP Black), Gainesville, Fla
| | - Alan Schwartz
- University of Illinois Chicago, Department of Pediatrics (A Schwartz), Chicago, Ill
| | - Aaron O Thomas
- University of Florida, Information Technology (AO Thomas), Gainesville, Fla
| | - Dana A Schinasi
- Northwestern University Feinberg School of Medicine (DA Schinasi), Chicago, Ill
| | - Jaclyn Otero
- University of Florida, Department of Pediatrics (M Fitzgerald, LA Thompson, J Otero, NP Black), Gainesville, Fla
| | - Pamela Carpenter
- University of Utah/Primary Children's Hospital (P Carpenter), Salt Lake City, Utah
| | - Julie S Thomas
- University of Florida, UF Health Cancer Center, Clinical Research Office (JS Thomas), Gainesville, Fla
| | - Nicole Paradise Black
- University of Florida, Department of Pediatrics (M Fitzgerald, LA Thompson, J Otero, NP Black), Gainesville, Fla
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26
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Roelle L, Ocasio J, Littell L, Fredman E, Miller N, Conner T, Van Hare G, Avari Silva JN. Expanding telehealth through technology: Use of digital health technologies during pediatric electrophysiology telehealth visits. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:256-261. [PMID: 35965632 PMCID: PMC9363236 DOI: 10.1016/j.cvdhj.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lisa Roelle
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Juliana Ocasio
- School of Arts and Sciences, Washington University in St. Louis, St. Louis, Missouri
| | | | - Eli Fredman
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tracy Conner
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - George Van Hare
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer N. Avari Silva
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Address reprint requests and correspondence: Dr Jennifer N. Avari Silva, Division of Pediatric Cardiology, 1 Children’s Place, CB 8116 NWT, Saint Louis, MO 63110.
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27
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Jone PN, John A, Oster ME, Allen K, Tremoulet AH, Saarel EV, Lambert LM, Miyamoto SD, de Ferranti SD. SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e1037-e1052. [PMID: 35400169 DOI: 10.1161/cir.0000000000001064] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.
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28
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Uscher-Pines L, McCullough C, Dworsky MS, Sousa J, Predmore Z, Ray K, Magit A, Rivanis C, Lerner C, Iwakoshi J, Barkley S, Marcin JP, McGuire T, Browne MA, Swanson C, Cleary JP, Kelly E, Layton K, Schulson L. Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e224759. [PMID: 35357455 PMCID: PMC8972035 DOI: 10.1001/jamanetworkopen.2022.4759] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE The identification of variation in health care is important for quality improvement. Little is known about how different pediatric subspecialties are using telehealth and what is driving variation. OBJECTIVE To characterize trends in telehealth use before and during the COVID-19 pandemic across pediatric subspecialties and the association of delivery change with no-show rates and access disparities. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 8 large pediatric medical groups in California collaborated to share aggregate data on telehealth use for 11 pediatric subspecialties from January 1, 2019, to December 31, 2021. MAIN OUTCOMES AND MEASURES Monthly in-person and telehealth visits for 11 subspecialties, characteristics of patients participating in in-person and telehealth visits, and no-show rates. Monthly use rates per 1000 unique patients were calculated. To assess changes in no-show rates, a series of linear regression models that included fixed effects for medical groups and calendar month were used. The demographic characteristics of patients served in person during the prepandemic period were compared with those of patients who received in-person and telehealth care during the pandemic period. RESULTS In 2019, participating medical groups conducted 1.8 million visits with 549 306 unique patients younger than 18 years (228 120 [41.5%] White and 277 167 [50.5%] not Hispanic). A total of 72 928 patients (13.3%) preferred a language other than English, and 250 329 (45.6%) had Medicaid. In specialties with lower telehealth use (cardiology, orthopedics, urology, nephrology, and dermatology), telehealth visits ranged from 6% to 29% of total visits from May 1, 2020, to April 30, 2021. In specialties with higher telehealth use (genetics, behavioral health, pulmonology, endocrinology, gastroenterology, and neurology), telehealth constituted 38.8% to 73.0% of total visits. From the prepandemic to the pandemic periods, no-show rates slightly increased for lower-telehealth-use subspecialties (9.2% to 9.4%) and higher-telehealth-use subspecialties (13.0% to 15.3%), but adjusted differences (comparing lower-use and higher-use subspecialties) in changes were not statistically significant (difference, 2.5 percentage points; 95% CI, -1.2 to 6.3 percentage points; P = .15). Patients who preferred a language other than English constituted 6140 in-person visits (22.2%) vs 2707 telehealth visits (11.4%) in neurology (P < .001). CONCLUSIONS AND RELEVANCE There was high variability in adoption of telehealth across subspecialties and in patterns of use over time. The documentation of variation in telehealth adoption can inform evolving telehealth policy for pediatric patients, including the appropriateness of telehealth for different patient needs and areas where additional tools are needed to promote appropriate use.
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Affiliation(s)
| | | | | | | | | | - Kristin Ray
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony Magit
- Rady Children’s Hospital San Diego, San Diego, California
| | - Chris Rivanis
- Children’s Hospital Orange County, Orange, California
| | - Carlos Lerner
- UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Joy Iwakoshi
- Loma Linda University Health, Loma Linda, California
| | - Steven Barkley
- Cottage Children's Medical Center, Santa Barbara, California
| | | | - Troy McGuire
- Children’s Hospital Los Angeles, Los Angeles, California
| | | | - Craig Swanson
- Sutter Children’s Medical Center, Sacramento, California
| | | | - Erin Kelly
- Sutter Children’s Medical Center, Sacramento, California
- Children’s Specialty Care Coalition, Sacramento, California
| | - Katie Layton
- Children’s Specialty Care Coalition, Sacramento, California
| | - Lucy Schulson
- RAND Corporation, Arlington, Virginia
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:309-324. [PMID: 36479525 PMCID: PMC9510217 DOI: 10.1007/s40746-022-00258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
Purpose of Review Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice. Recent Findings In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence. Summary TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.
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30
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Dey J, Bhowmik A, Sarkar A, Karforma S, Chowdhury B. Cryptographic Engineering on COVID-19 Telemedicine: An Intelligent Transmission Through Recurrent Relation Based Session Key. WIRELESS PERSONAL COMMUNICATIONS 2022; 122:3167-3204. [PMID: 34518743 PMCID: PMC8426590 DOI: 10.1007/s11277-021-09045-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 05/14/2023]
Abstract
Constraints imposed due to the cameo of the novel corona virus has abruptly changed the operative mode of medical sciences. Most of the hospitals have migrated towards the telemedicine mode of services for the non-invasive and non-emergency patients during the COVID-19 time. The advent of telemedicine services has remotely rendered health services to different types of patients from their isolates. Here, the patients' medical data has to be transmitted to different physicians/doctors in a safe manner. Such data are to be secured with a view to restore its privacy clause. Cardio vascular diseases (CVDs) are a kind of cardiac disease related to blockage of arteries and veins. Cardiac patients are more susceptible to the COVID-19 attacks. They are advised to be treated though cardiac telemedicine services. This paper presents an intelligent and secured transmission of clinical cardiac reports of the patients through recurrence relation based session key. Such reports were made through the following confusion matrix operations. The beauty of this technique is that confusion matrices are transferred to specified number of cardiologists with additional secret shares encapsulation. The case of robustness checking, transparency and cryptographic engineering has been tested under different set of inputs. The total cryptographic time observed here was noted as 469.92 ms, 3 ms 74.45 , 502.88 ms, 361.38 ms, 493.12 ms, and 660.16 ms, which is acceptable when compared with other classical techniques. The estimation of correlation coefficient in proposed variables has been recorded as - 0.362 . Different types of result and its analysis proves the efficiency of the proposed technique. It will provide more security in medical data transmission, especially in the needy hours of COVID-19 pandemic.
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Affiliation(s)
- Joydeep Dey
- Department of Computer Science, M.U.C Women’s College, Burdwan, India
| | - Anirban Bhowmik
- Department of Computer Science, M.U.C Women’s College, Burdwan, India
| | - Arindam Sarkar
- Department of Computer Science & Electronics, R.K.M. Vidyamandira, Belur, India
| | - Sunil Karforma
- Department of Computer Science, The University of Burdwan, Burdwan, India
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Adapting Interstage Home Monitoring with the use of Telemedicine During the COVID-19 Pandemic. Pediatr Cardiol 2022; 43:1136-1140. [PMID: 35192020 PMCID: PMC8861595 DOI: 10.1007/s00246-022-02835-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/24/2022] [Indexed: 11/05/2022]
Abstract
Pediatric single ventricle patients have seen dramatic improvements in overall outcomes over the past several decades. This is attributed to the development of home monitoring programs for interstage patients. In today's current COVID-19 pandemic, the use of telemedicine has allowed providers to care for these patients and support their families effectively while minimizing the risk of COVID-19 exposure. Our single-center study reviewed the charts of nine patients followed by our single ventricle team through the COVID-19 pandemic. Patients discharged from the hospital and enrolled in our digital home monitoring program were included. Records were retrospectively reviewed for total number of outpatient visits, adverse events, unplanned hospital readmissions, and unplanned procedures. These results were then compared to outcomes from 2018 to 2019. In-person visits averaged every 6 weeks compared to every 2-3-week pre-pandemic. Zero adverse events reported with the use of telemedicine compared to one adverse event pre-pandemic. There was a 50% decrease in unplanned readmissions and 60% decrease in unplanned procedures during our study period. One patient was diagnosed with acute COVID-19 infection and managed conservatively via telemedicine with full recovery. To our knowledge, this is the only case-control study reporting the use of telemedicine during the COVID-19 pandemic in the interstage population. Although not statistically significant, we report a decrease in total adverse events, unplanned procedures, and unplanned admissions. Telemedicine visits allowed for identification of issues requiring hospital readmission as well as conservative management of one patient with COVID-19.
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Bittmann S, Luchter E, Moschuring-Alieva E, Bittmann L, Villalon G. Telemedicine in Pediatrics: Introduction of an Innovative New Tool to Diagnose and Treat Children in an Ambulatory Setting. J Clin Med Res 2021; 13:515-516. [PMID: 34925663 PMCID: PMC8670770 DOI: 10.14740/jocmr4614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/04/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Stefan Bittmann
- Ped Mind Institute (PMI), Medical and Finance Center Epe, Gronau, Germany
| | - Elisabeth Luchter
- Ped Mind Institute (PMI), Medical and Finance Center Epe, Gronau, Germany
| | | | - Lara Bittmann
- Ped Mind Institute (PMI), Medical and Finance Center Epe, Gronau, Germany
| | - Gloria Villalon
- Ped Mind Institute (PMI), Medical and Finance Center Epe, Gronau, Germany
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Choo ZY, Lenti G, Castaneda J, Hart C, Young S, Alcocer Alkureishi L. Effects of Telemedicine on Pediatric Clinical Care During COVID-19. Pediatr Ann 2021; 50:e503-e508. [PMID: 34889136 DOI: 10.3928/19382359-20211110-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has provided unprecedented opportunity for the growth of telemedicine in pediatrics. Clinics rapidly expanded their telemedicine capabilities and converted in-person visits to virtual visits to offer patients continued care while limiting infection risks. Although the transition to video visits has several benefits-patient convenience, versatility of care, ease of follow up, and management of chronic conditions-these gains are only available to those who have the requisite technology access and literacy needed to conduct a video visit. The need for technology-dependent care stands to further widen preexisting disparities in access to care for those who cannot use or afford the necessary technology. Our article explores some of these benefits and challenges and reminds us that although telemedicine has proven to have high utility for many patients, there are improvements that must still be made to ensure equitable accessibility and durability of virtual visits. [Pediatr Ann. 2021;50(12):e503-e508.].
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Fremed MA, Niaz T, Hope KD, Altman CA, Levy VY, Glickstein JS, Johnson JN. Adaptations of paediatric cardiology practice during the COVID-19 pandemic. Cardiol Young 2021; 32:1-5. [PMID: 34657645 PMCID: PMC8545844 DOI: 10.1017/s1047951121004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/10/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.
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Affiliation(s)
- Michael A. Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle D. Hope
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carolyn A. Altman
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Victor Y. Levy
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Julie S. Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Baker-Smith CM, Sood E, Prospero C, Zadokar V, Srivastava S. Impact of Social Determinants and Digital Literacy on Telehealth Acceptance for Pediatric Cardiology Care Delivery during the Early Phase of the COVID-19 Pandemic. J Pediatr 2021; 237:115-124.e2. [PMID: 34174247 PMCID: PMC8564722 DOI: 10.1016/j.jpeds.2021.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine whether telehealth acceptance by parents of children with heart disease is predicted by sociodemographic and/or by parental digital literacy, and to assess parental perceptions of telehealth usability and reliability. STUDY DESIGN We conducted a single center study comparing telehealth acceptance versus visit cancellation/rescheduling for pediatric cardiology visits during the early phase of the COVID-19 pandemic. All parent/guardians who consented to survey completion received a validated survey assessing their digital literacy. Consenting parents who accepted telehealth received an additional validated survey assessing their perceptions of telehealth usability and reliability. RESULTS A total of 849 patients originally were scheduled for in-person visits between March 30 and May 8, 2020. Telehealth acceptance was highest among younger, publicly insured, Hispanic patients with primary diagnoses of arrhythmia/palpitations, chest pain, dysautonomia, dyslipidemia and acquired heart disease. Among parents who completed surveys, a determinant of telehealth acceptance was digital literacy. Telehealth was determined to be a usable and reliable means for health care delivery. CONCLUSION Although the potential for inequitable selection of telehealth due to sociodemographic factors exists, we found that such factors were not a major determinant for pediatric cardiology care within a large, diverse, free-standing pediatric hospital.
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Affiliation(s)
- Carissa M. Baker-Smith
- Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington (DE),Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia (PA)
| | - Erica Sood
- Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington (DE),Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia (PA)
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington (DE)
| | - Varsha Zadokar
- Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington (DE)
| | - Shubhika Srivastava
- Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington (DE),Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia (PA)
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Shapiro H, Reza N. Cardiovascular Medical Education During the Coronavirus Disease 2019 Pandemic: Challenges, Adaptations, and Considerations for the Future. US CARDIOLOGY REVIEW 2021; 15. [PMID: 34413903 PMCID: PMC8372241 DOI: 10.15420/usc.2020.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted
graduate medical education for cardiovascular fellows in training. During the
initial case surge in the US in early 2020, most training programs reformatted
didactic curricula, redeployed fellows in training to non-cardiac services or
furloughed fellows in training on non-essential services, reimagined procedural
training in light of decreased case volumes, and balanced issues regarding
trainee wellbeing and safety with occupational COVID-19 exposure risk. In this
article, the authors review the educational challenges posed by the COVID-19
pandemic, and discuss opportunities to incorporate technological and curricular
innovations spurred by the pandemic into cardiovascular fellowship training in
the future.
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Affiliation(s)
- Hilary Shapiro
- Division of Cardiovascular Medicine, Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, CA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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Reeves JJ, Ayers JW, Longhurst CA. Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm. J Med Internet Res 2021; 23:e24785. [PMID: 33477104 PMCID: PMC7857524 DOI: 10.2196/24785] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/20/2020] [Accepted: 01/16/2021] [Indexed: 12/15/2022] Open
Abstract
The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.
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Affiliation(s)
- J Jeffery Reeves
- Department of Surgery, University of California San Diego, La Jolla, CA, United States
| | - John W Ayers
- Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
| | - Christopher A Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
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Schwartz BN, Klein JH, Barbosa MB, Hamersley SL, Hickey KW, Ahmadzia HK, Broth RE, Pinckert TL, Sable CA, Donofrio MT, Krishnan A. Expanding Access to Fetal Telecardiology During the COVID-19 Pandemic. Telemed J E Health 2021; 27:1235-1240. [PMID: 33513044 DOI: 10.1089/tmj.2020.0508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: This study aims to describe one center's experience in expanding a fetal telecardiology program through collaborative work with maternal fetal medicine (MFM) clinics with the goal of safely reaching mothers during the COVID-19 pandemic. We sought to define the extent of fetal telehealth conversion at a large fetal cardiac care center and evaluate the diagnostic accuracy for studies performed. Methods: At our center, fetal telemedicine expanded from one MFM site before the pandemic to four additional sites by May 2020. A retrospective review of fetal telecardiology visits between March 15 and July 15, 2020, was performed. The chart was reviewed for confirmation of diagnosis postnatally. Results: With pandemic onset, there was a large increase in the number of telemedicine visits with a total of 122 mothers seen between five MFM clinics. Fourteen mothers (11.5%) had abnormal fetal echocardiograms requiring additional follow-up, and seven mothers (5.8%) had a fetal echocardiogram suspicious for a critical congenital heart disease (CCHD). All the fetal echocardiograms suspicious for CCHD were confirmed on postnatal echocardiogram. To our knowledge, none of the normal fetal echocardiograms were found to have congenital heart disease postnatally. Conclusions: In response to the COVID-19 pandemic, we rapidly transitioned to fetal telecardiology using a variety of formats. This has reduced potential infectious exposure for pregnant mothers and minimized contact between physicians without compromising diagnostic accuracy. In our experience, the expansion of a telemedicine program requires strong initial infrastructure, prior relationships with MFM providers, and appropriate training among obstetric sonographers.
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Affiliation(s)
- Bryanna N Schwartz
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Jennifer H Klein
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Megan B Barbosa
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Sheri L Hamersley
- Maternal-Fetal Medicine Associates of Maryland, Rockville, Maryland, USA.,Department of Obstetrics and Gynecology, The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kimberly W Hickey
- Maternal-Fetal Medicine Associates of Maryland, Rockville, Maryland, USA.,The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University, Washington, District of Columbia, USA
| | - Richard E Broth
- TLC Perinatal PA, Silver Spring, Germantown and Hagerstown, Maryland, USA
| | - Thomas L Pinckert
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine, Washington, District of Columbia, USA.,Greater Washington Maternal Fetal Medicine and Genetics, Washington, District of Columbia, USA
| | - Craig A Sable
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Mary T Donofrio
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Anita Krishnan
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
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Rapid Telehealth Implementation during the COVID-19 Global Pandemic: A Rapid Review. Healthcare (Basel) 2020; 8:healthcare8040517. [PMID: 33260457 PMCID: PMC7712147 DOI: 10.3390/healthcare8040517] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
The implementation and continued expansion of telehealth services assists a variety of health care organizations in the delivery of care during the current COVID-19 global pandemic. However, limited research has been conducted on recent, rapid telehealth implementation and expansion initiatives regarding facilitators and barriers surrounding the provision of quality patient care. Our rapid review evaluated the literature specific to rapid telehealth implementation during the current COVID-19 pandemic from three research databases between January 2020 and May 2020 and reported using preferred reporting items for systematic reviews and meta-analyses (PRISMA). The results indicate the rapid implementation and enhanced use of telehealth during the COVID-19 pandemic in the United States surrounding the facilitators and barriers to the provision of patient care, which are categorized into three identified themes: (1) descriptive process-oriented implementations, (2) the interpretation and infusion of the CARES Act of 2020 telehealth exemptions related to the relaxation of patient privacy and security (HIPAA) protocols, and (3) the standard of care protocols and experiences addressing organizational liability and the standard of care. While the study limitation of sample size exists (n = 21), an identification of rapid telehealth implementation advancements and challenges during the current pandemic may assist health care organizations in the delivery of ongoing quality care during the COVID-19 pandemic.
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Arshad Ali S, Bin Arif T, Maab H, Baloch M, Manazir S, Jawed F, Ochani RK. Global Interest in Telehealth During COVID-19 Pandemic: An Analysis of Google Trends™. Cureus 2020; 12:e10487. [PMID: 33083187 PMCID: PMC7567313 DOI: 10.7759/cureus.10487] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Since the outbreak, healthcare systems across the globe are overcrowded with coronavirus disease (COVID-19) patients. To sustain the response towards the pandemic, many hospitals have adapted to virtual healthcare and telemedicine. Google™ has become the most widely used search engine over the years. Google Trends™ can be used to depict the public interest over a certain topic. The output of the Google Trends™ is displayed as relative search volume (RSV) which is the proportionate search volume regarding a specific topic comparative to the total search volume in a specific time and region. The primary aim of this study was to evaluate the relationship between the daily reported number of new COVID-19 cases and deaths and the corresponding changes in Google Trends™ RSV of telehealth over six months. Methods A retrospective study was conducted from January 21, 2020 to July 21, 2020. About 17 countries that reported the total number of cases greater than 200,000 in the situation report of July 21, 2020 were selected to be a part of this study. The daily reported new cases and deaths globally and of the selected countries were extracted from the World Health Organization (WHO) situation reports. The combination of keywords used for obtaining the RSV data through Google Trends™ was “telehealth”, “telemedicine”, “mHealth”, and “eHealth”. These words were used with the “+” feature of Google Trends™ with “1/21/2020 to 7/21/2020” as time range, “all categories” for the category, and “web search” for the type of search. The worldwide RSV as well as the RSVs of the selected countries were obtained from the Google Trends™ website. Spearman’s correlation coefficient (ρ) was used to determine the strength of the relationship between new cases or deaths and RSVs related to telehealth. Results A positive fair correlation was established between the global interest in telehealth and the new cases (ρ=0.307, p-value<0.001) and deaths (ρ=0.469, p-value<0.001) reported worldwide. The United States of America (USA), India, and Bangladesh were found to have a positive fair correlation between the public interest regarding telehealth and the emerging new COVID-19 cases and deaths. The United Kingdom (UK) and Italy demonstrated a positive poor correlation between the rising new cases or deaths and RSV. Similar statistics were noted for the daily new cases of Chile. For Turkey, a positive fair correlation between new deaths and RSV while a positive poor correlation between new cases and RSV was observed. No significant correlation was observed for the rest of the selected countries. Conclusion This study highlights the steadily rising public interest in telehealth during the COVID-19 pandemic. Telemedicine can provide the necessary remote consultation and healthcare for patients in the current situation. However, previous studies have shown that the majority of the countries are inadequately equipped for the digitization of the healthcare system. Therefore, it has become necessary to incorporate telemedicine into the healthcare system to combat any possible pandemic in the future.
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Affiliation(s)
| | - Taha Bin Arif
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hira Maab
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mariam Baloch
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sana Manazir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Fatima Jawed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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