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Maugeri A, Barchitta M, Basile G, Agodi A. Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature. J Med Internet Res 2024; 26:e50088. [PMID: 38753427 PMCID: PMC11140276 DOI: 10.2196/50088] [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: 06/19/2023] [Revised: 12/01/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. OBJECTIVE The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. METHODS Google Trends data were retrieved using the search topics "telemedicine" or "e-health" to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms "telemedicine" or "eHealth" (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. RESULTS Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=-22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. CONCLUSIONS Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives.
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Affiliation(s)
- Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
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Danys D, Marcinkeviciute K, Cereska V, Miknevicius P, Poskus T, Osorio J. Telementoring Experience for Complex Bariatric Operation-Laparoscopic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Obes Surg 2024; 34:1983-1986. [PMID: 38530550 DOI: 10.1007/s11695-024-07200-w] [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: 02/15/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
In a groundbreaking surgical collaboration, a team of surgeons in Lithuania successfully performed the first single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) operation under the remote telemonitoring guidance of a highly experienced surgeon from Spain.The Lithuanian surgical team, comprising skilled bariatric surgeons, meticulously prepared for the SADI-S operation under the remote guidance of their Spanish proctor. Utilizing video conferencing and real-time communication, the mentor provided step-by-step instructions, shared insights, and addressed any concerns during the procedure. The mentor's extensive experience and guidance ensured a safe and successful surgical outcome.This innovative approach not only demonstrates the potential of telemedicine in the field of complex bariatric surgeries but also highlights the power of international cooperation in advancing surgical techniques and patient care by using modern methods of telemedicine and proctorship.
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Affiliation(s)
- Donatas Danys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania.
| | | | - Vaidas Cereska
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Povilas Miknevicius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Kambakamba P, Naiem A, Betz E, Hotz AS, Richetti K, Stein M, Abry L, Meier A, Seeger N, Grochola F, Grieder F, Breitenstein S. Applying augmented reality in teaching of surgical residents-telementoring, a "stress-free" way to surgical autonomy? Langenbecks Arch Surg 2024; 409:100. [PMID: 38504065 DOI: 10.1007/s00423-024-03287-y] [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: 10/22/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Achieving surgical autonomy can be considered the ultimate goal of surgical training. Innovative head-mounted augmented reality (AR) devices enable visualization of the operating field and teaching from remote. Therefore, utilization of AR glasses may be a novel approach to achieve autonomy. The aim of this pilot study is to analyze the feasibility of AR application in surgical training and to assess its impact on intraoperative stress. METHODS A head-mounted RealWear Navigator® 500 glasses and the TeamViewer software were used. Initial "dry lab" testing of AR glasses was performed in combination with the Symbionix LAP Mentor™. Subsequently, residents performed various stage-adapted surgical procedures semi-autonomously (SA) (on-demand consultation of senior surgeon, who is in theatre but not scrubbed) versus permanent remote supervision (senior surgeon not present) via augmented reality (AR) glasses, worn by the resident in theatre. Stress was measured by intraoperative heart rate (Polar® pulse belt) and State-Trait Anxiety Inventory (STAI) questionnaire. RESULTS After "dry lab" testing, N = 5 senior residents performed equally N = 25 procedures SA and with AR glasses. For both, open and laparoscopic procedure AR remote assistance showed satisfactory applicability. Utilization of AR significantly reduced intraoperative peak pulse rate from 131 to 119 bpm (p = 0.004), as compared with the semi-autonomous group. Likewise, subjectively perceived stress according to STAI was significantly lower in the AR group (p = 0.011). CONCLUSION AR can be applied in surgical training and may help to reduce stress in theatre. In the future, AR has a huge potential to become a stepping stone to surgical autonomy.
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Affiliation(s)
- Patryk Kambakamba
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.
| | - Amir Naiem
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Elise Betz
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Anne-Sophie Hotz
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Katharina Richetti
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Moritz Stein
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Lisa Abry
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Aline Meier
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Nico Seeger
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Filip Grochola
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Felix Grieder
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Liang W, Zhou C, Bai J, Zhang H, Jiang B, Wang J, Fu L, Long H, Huang X, Zhao J, Zhu H. Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends. Front Bioeng Biotechnol 2024; 12:1328997. [PMID: 38405378 PMCID: PMC10884185 DOI: 10.3389/fbioe.2024.1328997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, China
| | - Juqin Bai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hongwei Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Bo Jiang
- Rehabilitation Department, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiangwei Wang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Lifeng Fu
- Department of Orthopedics, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Hengguo Long
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Xiaogang Huang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiayi Zhao
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Haibing Zhu
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
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Khalaf R, Meyers A, Sadeghi P, Reyes J, Fodor R, Jo D, Xia T, Papay F, Rampazzo A, Gharb BB. Efficacy of virtual plastic surgery encounters in establishment of care and surgical conversion. J Plast Reconstr Aesthet Surg 2023; 85:299-308. [PMID: 37541046 DOI: 10.1016/j.bjps.2023.07.011] [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: 02/26/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The efficacy of virtual visits in converting new patients into established patients undergoing surgical treatment has not been demonstrated. The aim of this study was to evaluate patient retention and surgical conversion rate after an initial virtual plastic surgery consultation. METHODS An IRB-approved retrospective review of all new plastic surgery patients seen between May and August 2020 at a single institution was conducted. The initial encounter type, chief complaint, demographics, treatment recommendation, insurance approval rate, number and modality of pre- and postoperative visits, time to procedure, follow up, and complications were recorded. Patient retention and surgery conversion rate were calculated. Statistical analysis was performed with Chi-squared test, Fisher's exact test, and unpaired t-test. RESULTS In total, the records of 1889 new patients were reviewed (1635 in-person, 254 virtual). Virtual patients were younger (44.5 ± 19.0 versus 49.5 ± 20.7 years, p < 0.001), and nearly half resided greater than 50 miles away (42% versus 16%, p < 0.001). Virtual patients more frequently presented for cosmetic surgery (14% versus 7%, p < 0.001), lymphedema (15% versus 3%, p < 0.001), and gender dysphoria (11% versus 2%, p < 0.001). In-person patients presented more often for trauma (18% versus 5%, p < 0.001), elective hand complaints (16% versus 3%, p < 0.001), and breast reconstruction (9% versus 4%, p < 0.01). There were no differences in patient retention (p = 0.45) and procedure conversion rate (p = 0.21) between the groups. CONCLUSION Telemedicine provides an opportunity to increase the practice catchment area and is as effective as in-person first encounters for establishing care and transition to surgery.
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Affiliation(s)
- Ryan Khalaf
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Abigail Meyers
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Payam Sadeghi
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jose Reyes
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - R'ay Fodor
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Diane Jo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Xia
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Francis Papay
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Antonio Rampazzo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Sutton TL, Beneville B, Johnson AJ, Mayo SC, Gilbert EW, Lopez CD, Grossberg AJ, Rocha FG, Sheppard BC. Socioeconomic and Geographic Disparities in the Referral and Treatment of Pancreatic Cancer at High-Volume Centers. JAMA Surg 2023; 158:284-291. [PMID: 36576819 PMCID: PMC9857629 DOI: 10.1001/jamasurg.2022.6709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/10/2022] [Indexed: 12/29/2022]
Abstract
Importance Treatment at high-volume centers (HVCs) has been associated with improved overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC); however, it is unclear how patterns of referral affect these findings. Objective To understand the relative contributions of treatment site and selection bias in driving differences in outcomes in patients with PDAC and to characterize socioeconomic factors associated with referral to HVCs. Design, Setting, Participants A population-based retrospective review of the Oregon State Cancer Registry was performed from 1997 to 2019 with a median 4.3 months of follow-up. Study participants were all patients diagnosed with PDAC in Oregon from 1997 to 2018 (n = 8026). Exposures The primary exposures studied were diagnosis and treatment at HVCs (20 or more pancreatectomies for PDAC per year), low-volume centers ([LVCs] less than 20 per year), or both. Main Outcomes and Measures OS and treatment patterns (eg, receipt of chemotherapy and primary site surgery) were evaluated with Kaplan-Meier analysis and logistic regression, respectively. Results Eight thousand twenty-six patients (male, 4142 [52%]; mean age, 71 years) were identified (n = 3419 locoregional, n = 4607 metastatic). Patients receiving first-course treatment at a combination of HVCs and LVCs demonstrated improved median OS for locoregional and metastatic disease (16.6 [95% CI, 15.3-17.9] and 6.1 [95% CI, 4.9-7.3] months, respectively) vs patients receiving HVC only (11.5 [95% CI, 10.7-12.3] and 3.9 [95% CI, 3.5-4.3] months, respectively) or LVC-only treatment (8.2 [95% CI, 7.7-8.7] and 2.1 [95% CI, 1.9-2.3] months, respectively; all P < .001). No differences existed in disease burden by volume status of diagnosing institution. When stratifying by site of diagnosis, HVC-associated improvements in median OS were smaller (locoregional: 10.4 [95% CI, 9.5-11.2] vs 9.9 [95% CI, 9.4-10.4] months; P = .03; metastatic: 3.6 vs 2.7 months, P < .001) than when stratifying by the volume status of treating centers, indicating selection bias during referral. A total of 94% (n = 1103) of patients diagnosed at an HVC received HVC treatment vs 18% (n = 985) of LVC diagnoses. Among patients diagnosed at LVCs, later year of diagnosis and higher estimated income were independently associated with higher odds of subsequent HVC treatment, while older age, metastatic disease, and farther distance from HVC were independently associated with lower odds. Conclusions and Relevance LVC-to-HVC referrals for PDAC experienced improved OS vs HVC- or LVC-only care. While disease-related features prompting referral may partially account for this finding, socioeconomic and geographic disparities in referral worsen OS for disadvantaged patients. Measures to improve access to HVCs are encouraged.
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Affiliation(s)
- Thomas L. Sutton
- Oregon Heath & Science University, Department of Surgery, Portland
| | - Blake Beneville
- Oregon Heath & Science University, School of Medicine, Portland
| | | | - Skye C. Mayo
- Oregon Heath & Science University, Division of Surgical Oncology, Department of Surgery, Knight Cancer Institute, Portland
| | - Erin W. Gilbert
- Oregon Heath & Science University, Department of Surgery, Portland
| | - Charles D. Lopez
- Oregon Heath & Science University, Division of Hematology and Oncology, Department of Medicine, Knight Cancer Institute, Portland
| | - Aaron J. Grossberg
- Oregon Heath & Science University, Department of Radiation Medicine, Portland
| | - Flavio G. Rocha
- Oregon Heath & Science University, Division of Surgical Oncology, Department of Surgery, Knight Cancer Institute, Portland
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Boike S, Mir M, Olson H, Cole D, Rauf I, Surani S, Khan SA. Perioperative management of emergency and elective surgeries during the pandemic. Hosp Pract (1995) 2023; 51:12-17. [PMID: 36629125 DOI: 10.1080/21548331.2023.2166746] [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: 01/12/2023]
Abstract
The effects of the 2019 novel coronavirus, SARS-CoV-2, and its associated pandemic are complex and widespread. It has permeated all aspects of daily life around the world. Unsurprisingly, it also had significant impacts on proceedings within hospitals around the world as well. Most notably, the multiple waves of the pandemic have each had untoward effects on surgical productivity within hospital systems. More specifically, the disruption of surgical procedures has impacted both emergent and elective cases. In the context of emergent procedures, hospital systems have had to reevaluate how they define 'emergent,' forcing them to determine which cases could not be rescheduled versus those that could. Elective procedures, on the other hand, were nearly halted altogether in the initial pandemic waves. If these were not completely stopped in some places, then they were greatly reduced. This paper will serve to describe the effect the pandemic has had on the proceedings of both elective and emergent surgeries. It will also describe how we have reevaluated and changed the way we define 'emergent' surgeries and describe the potential implications of this. We will also describe literature that speaks to the implications of the delay of elective procedures. Additionally, the cost implications of fewer surgical procedures performed will be discussed. Finally, we will describe literature that has established protocols for scheduling surgeries in waves of the pandemic, how these have evolved over time, and how they have created confusion for hospital systems navigating the pandemic.
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Affiliation(s)
- Sydney Boike
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mikael Mir
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Holly Olson
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Delaney Cole
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ibtisam Rauf
- St. George's School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Salim Surani
- College Station, Texas A&M University, TX, USA.,Research Collaborator, Mayo Clinic, Rochester, MN, USA
| | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
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Scheffer M, Cassenote A, de Britto E Alves MTSS, Russo G. The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil. Global Health 2022; 18:81. [PMID: 36123696 PMCID: PMC9483882 DOI: 10.1186/s12992-022-00875-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of telemedicine, or the provision of healthcare and communication services through distance-based technologies, has increased substantially since the 2019 novel coronavirus (COVID-19) pandemic. However, it is still unclear what are the innovative features of the widespread use of such modality, its forms of employment and the context in which it is used across pluralist health systems, particularly in low- and middle-income settings. We have sought to provide empirical evidence on the above issues by analysing the responses of medical doctors in a representative cross-sectional survey in two states in Brazil: São Paulo and Maranhão. METHODS We analysed the responses of 1,183 physicians to a survey on the impact of COVID-19 on their livelihood and working practice. Two independent samples per state were calculated based on a total of 152,511 active medical registries in São Paulo and Maranhão. Proportional stratified sampling was performed and the distributions for gender, age, state and location of address (capital or countryside) were preserved. The survey contained questions on the frequency of physicians' employment of telemedicine services; the specific activities where these were employed, and; the forms in which the pandemic had influenced the adoption or consolidation of this technology. We performed descriptive and univariate analysis based on the chi-square test or Fisher's exact test for the qualitative data, and the Mann-Whitney test in the quantitative cases. Data were shown as absolute frequency and proportion with a 95% confidence interval. RESULTS In our sample of physicians, telemedicine was employed as a form of clinical collaboration by most doctors (76.0%, 95 CI 73.6-78.5), but only less than a third of them (30.6%, 95 CI 28.0-33.3) used it as a modality to provide healthcare services. During the pandemic, telemedicine was used predominantly in COVID-19-related areas, particularly for hospital-based in-patient services, and in private clinics and ambulatory settings. Male, younger doctors used it the most. Doctors in São Paulo employed telemedicine more frequently than in Maranhão (p < 0.001), in urban settings more than in rural areas (p < 0.001). Approximately three-quarters of doctors in large hospitals reported using telemedicine services (78.3%, 95 CI 75.9-80.6), followed by doctors working for smaller private clinics (66.4%, 95 CI 63.7-69.1), and by a smaller proportion of primary care doctors (58.4%, 95 CI 55.6-61.2). CONCLUSIONS Our study suggests that telemedicine may have helped ensure and expand the range of communication and healthcare services in low- and middle-income settings during the COVID-19 pandemic. However, the modality appears to lend itself to be disproportionally used by doctors working in specific, priviledged sections of pluralistic health systems, and presumably by patients seeking care there. Regulation and incentives will be required to support the use of the technology across health systems in low- and middle-income countries in order to increase access to services for less disadvantaged populations.
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Affiliation(s)
- Mário Scheffer
- Department of Preventive Medicine, University of São, Paulo. Avenida Dr. Arnaldo, 455, 2º andar, sala 2166, São Paulo (, SP, CEP: 01246-903, Brazil
| | - Alex Cassenote
- Department of Preventive Medicine, University of São, Paulo. Avenida Dr. Arnaldo, 455, 2º andar, sala 2166, São Paulo (, SP, CEP: 01246-903, Brazil
| | | | - Giuliano Russo
- Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner street, London, E1 2AB, UK.
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Velnar T, Bosnjak R. Management of neurosurgical patients during coronavirus disease 2019 pandemics: The Ljubljana, Slovenia experience. World J Clin Cases 2022; 10:4726-4736. [PMID: 35801036 PMCID: PMC9198871 DOI: 10.12998/wjcc.v10.i15.4726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/12/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is an emerging disease, caused by severe acute respiratory syndrome coronavirus-2. It bears unique biological characteristics, clinical symptoms and imaging manifestations, therefore presenting an important and urgent threat to global health. As a result, a new public health crisis arose, threatening the world with the spread of the 2019 novel coronavirus. Despite the maximal worldwide public health responses aimed at containing the disease and delaying its spread, many countries have been confronted with a critical care crisis, and even more, countries will almost certainly follow. In Slovenia, the COVID-19 has struck the health system immensely and among all the specialities, neurosurgery has also been experiencing difficulties in the service, not only in regular, elective surgeries but especially during emergencies. The management of these neurosurgical patients has become more difficult than ever. We describe our protocol in the management of neurosurgical patients in the University Medical Centre Ljubljana, Slovenia and how neurosurgical pathology was tackled during the pandemics.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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