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Bui C, Parange N, Bezak E, Bidner A. The Role of Telehealth in Ultrasound Training for Remote Learners: A Systematic Review. Telemed J E Health 2024; 30:963-975. [PMID: 38052050 DOI: 10.1089/tmj.2023.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Introduction: Remote learners and educators face geographic, professional, and personal barriers that affect their access to quality ultrasound education. The integration of telehealth in ultrasound education enables learners performing ultrasound to receive real-time instruction from an educator at a distant or remote site. However, to date, there has been poor understanding of the efficacy, benefits, shortcomings, and economic impact of telehealth education in comparison to in-person ultrasound training. The aim of this research was to assess current literature on telehealth in ultrasound education and hands-on training, its outcomes and impact, and requirements for future development. Methods: This review examined international literature on telehealth in ultrasound training. The primary author and second investigator were involved in the research and reached consensus on the eligibility criteria, search strategy, included articles, data extraction, and quality assessment. Results: A total of 23 studies were obtained from Medline, Emcare and Scopus. Key themes identified: Most studies saw an equivalent improvement in knowledge and skills through pre and postassessments in both in-person and telehealth sessions. Generally, learners felt comfortable performing ultrasound guided by a remote educator and felt their skills had been advanced across all studies. Educators reported positive feedback, however compared with learners, educators expressed less satisfaction with the telehealth session. Conclusions: This study demonstrated the feasibility of telehealth in ultrasound training for remote learners with little to no experience. Quality studies with comparable outcomes are needed to ascertain the safe and effective application of telehealth in ultrasound training.
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Affiliation(s)
- Catthy Bui
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Nayana Parange
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Eva Bezak
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
- Department of Physics, The University of Adelaide, Adelaide, South Australia
| | - Amber Bidner
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
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Solvin H, Lippert M, Holmstrøm H, Elle OJ, Brun H. Real-time Remote Expert-guided Echocardiography by Medical Students. Ultrasound J 2023; 15:28. [PMID: 37266713 DOI: 10.1186/s13089-023-00328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Echocardiography is a highly specialised examination performed by experienced healthcare professionals. These experienced healthcare professionals may not be available to patients during all hours in rural healthcare facilities. Remote-guided echocardiography could improve the availability of specialised care for patients living in rural areas. This study examined the feasibility of real-time remote guidance for medical students to perform an echocardiographic assessment of the left side of the heart. Thirteen healthy volunteers were recruited for remote-guided echocardiography, which was performed by 13 medical students. Student examinations/images were compared to reference echocardiography. Measurements of left ventricular fractional shortening and mitral valve blood flow velocity were also compared. Furthermore, guidance through a smartphone videoconference was compared to designated remote guidance software. RESULTS Two-thirds of the images acquired by students were rated as medium or good quality and usable to evaluate two thirds of the cardiac structures. No significant bias was found for left ventricular fractional shortening. The measurements from the students' exams had a variation coefficient of 14.8% compared to the reference. The calculated deviation of the insonation angle was above 25° for both E and A-wave mitral valve blood flow velocity measurements. Images acquired by guidance through smartphone videoconference were of lower quality than those obtained using the designated remote guidance software. CONCLUSION Real-time remote-guided echocardiography performed by medical students has limited value for clinical screening but could be useful for educational purposes.
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Affiliation(s)
- Håvard Solvin
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Oslo, Norway.
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo , Oslo, Norway.
- Department of Paediatrics, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Oslo, Norway.
| | - Matthias Lippert
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Oslo, Norway
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo , Oslo, Norway
| | - Henrik Holmstrøm
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Oslo, Norway
- Department of Paediatric Cardiology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo , Oslo, Norway
- Department of Informatics, University of Oslo, Gaustadalleen 23 b, 0373, Oslo, Oslo, Norway
| | - Henrik Brun
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo , Oslo, Norway
- Department of Paediatric Cardiology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Oslo, Norway
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Real-Time Remote Tele-Mentored Echocardiography: A Systematic Review. ACTA ACUST UNITED AC 2020; 56:medicina56120668. [PMID: 33276628 PMCID: PMC7761589 DOI: 10.3390/medicina56120668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Real-time remote tele-mentored echocardiography (RTMUS echo) involves the transmission of clinical ultrasound (CU) cardiac images with direct feedback from a CU expert at a different location. In this review, we summarize the current uses of RTMUS to diagnose and manage cardiovascular dysfunction and discuss expanded and future uses. Materials and Methods: We performed a literature search (PubMed and EMBase) to access articles related to RTMUS echo. We reviewed articles for selection using Covidence, a web-based tool for managing systematic reviews and data were extracted using a separate standardized collection form. Results: Our search yielded 15 articles. Twelve of these articles demonstrated the feasibility of having a novice sonographer mentored by a tele-expert in obtaining a variety of cardiac ultrasound views. The articles discussed different technological specifications for the RTMUS system, but all showed that adequate images were able to be obtained. Overall, RTMUS echo was found to be a positive intervention that contributed to patient care. Conclusion: RTMUS echo allows for rapid access to diagnostic imaging in various clinical settings. RTMUS echo can help in assessing patients that may require a higher level of isolation precautions or in other resource-constrained environments. In the future, identifying the least expensive way to utilize RTMUS echo will be important.
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Luwen LMS, Shaobo DMD, Yaqiong LP, Ruiqing LMD, Yuejin WMS, Lianzhong ZMD. Development Status and Prospect of Remote Diagnosis and Treatment of Echocardiography Worldwide. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Cohen GI. A practical guide to graphic communication for quality assurance, education, and patient care in echocardiography. Echocardiography 2019; 36:1747-1754. [PMID: 31541574 PMCID: PMC6856834 DOI: 10.1111/echo.14464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022] Open
Abstract
Graphic communication (GC) is useful for continuous quality improvement (CQI), education, and patient care when in‐person discussion is not possible because of geographic and schedule constraints. In echocardiography, these constraints can be mitigated by (a) capturing screenshots and device photos or videos and sharing them by email or text message, (b) simultaneous viewing of images on digital displays, and (c) broadcasting the study real time during acquisition to other mobile or stationary devices. Screenshots are useful for CQI and education and can be acquired, annotated, and shared with minimal impact on the flow of clinical echo interpretation. Providers at different locations can employ GC for shared clinical decision making by viewing echo studies from the same server, video conferencing or accessing real‐time broadcast from a device. Which GC tool is selected is determined by its ease of use, the provider's goals and whether immediate image review is needed.
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Affiliation(s)
- Gerald I Cohen
- Department of Cardiology, Ascension St. John Hospital, Detroit, MI, USA
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Liu L, Duan S, Zhang Y, Wu Y, Zhang L. Initial Experience of the Synchronized, Real-Time, Interactive, Remote Transthoracic Echocardiogram Consultation System in Rural China: Longitudinal Observational Study. JMIR Med Inform 2019; 7:e14248. [PMID: 31287062 PMCID: PMC6643765 DOI: 10.2196/14248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/19/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. Objective This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. Methods By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People’s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. Results This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. Conclusions The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability.
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Affiliation(s)
- Luwen Liu
- People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaobo Duan
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Ye Zhang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuejin Wu
- People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lianzhong Zhang
- People's Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial People's Hospital, Zhengzhou, China
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Lee Y, Shin H, Kim C, Lee I, Choi HJ. Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners: A STROBE-compliant article. Medicine (Baltimore) 2019; 98:e15191. [PMID: 30946386 PMCID: PMC6456141 DOI: 10.1097/md.0000000000015191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to determine the value of cumulative summation (CUSUM) analysis in assessing the proficiency of novice practitioners in estimating the left ventricular ejection fraction (EF).Seven novice practitioners with no echocardiography experience were recruited in this observational study. Each practitioner assessed EF from echocardiographic video files of 100 cases, one by one, and received feedback and teaching. We obtained a CUSUM score through comparison of the gold standard values of EF and the EF values determined by the practitioners. Then, the practitioners underwent the same test 4 weeks later, except without feedback and teaching, using echocardiographic video files from 100 other cases.The mean number of visual estimation cases required to pass the learning curve (LC)-CUSUM test was 56.3 ± 9.1 (95% CI 47.8-64.7). The LC-CUSUM average of the 7 novice practitioners showed improvement in visual estimation skill, with an average acceptable level achieved after a mean experience of 55 cases. In the test performed after 4 weeks, 5 of the 7 novice practitioners showed significantly good overall agreement. All novice practitioners had a kappa coefficient greater than .8, and significant and almost perfect agreement was observed. All the participants exhibited a percentage of correct answers greater than 81%.We found that the novice practitioners could acquire an acceptable level of skill for estimating EF with short-term, self-learning-focused echocardiographic training.
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Affiliation(s)
- Yoonje Lee
- Department of Emergency Medicine, College of Medicine, Korea University Anam Hospital, Seoul
| | - Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Inhye Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
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Kim C, Kim H. Emergency medical technician-performed point-of-care blood analysis using the capillary blood obtained from skin puncture. Am J Emerg Med 2017. [PMID: 29519760 DOI: 10.1016/j.ajem.2017.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Comparing a point-of-care (POC) test using the capillary blood obtained from skin puncture with conventional laboratory tests. METHODS In this study, which was conducted at the emergency department of a tertiary care hospital in April-July 2017, 232 patients were enrolled, and three types of blood samples (capillary blood from skin puncture, arterial and venous blood from blood vessel puncture) were simultaneously collected. Each blood sample was analyzed using a POC analyzer (epoc® system, USA), an arterial blood gas analyzer (pHOx®Ultra, Nova biomedical, USA) and venous blood analyzers (AU5800, DxH2401, Beckman Coulter, USA). Twelve parameters were compared between the epoc and reference analyzers, with an equivalence test, Bland-Altman plot analysis and linear regression employed to show the agreement or correlation between the two methods. RESULTS The pH, HCO3, Ca2+, Na+, K+, Cl-, glucose, Hb and Hct measured by the epoc were equivalent to the reference values (95% confidence interval of mean difference within the range of the agreement target) with clinically inconsequential mean differences and narrow limits of agreement. All of them, except pH, had clinically acceptable agreements between the two methods (results within target value ≥80%). Of the remaining three parameters (pCO2, pO2 and lactate), the epoc pCO2 and lactate values were highly correlated with the reference device values, whereas pO2 was not. (pCO2: R2=0.824, y=-1.411+0.877·x; lactate: R2=0.902, y=-0.544+0.966·x; pO2: R2=0.037, y=61.6+0.431·x). CONCLUSION Most parameters, except only pO2, measured by the epoc were equivalent to or correlated with those from the reference method.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Hansol Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Loh BCS, Then PHH. Deep learning for cardiac computer-aided diagnosis: benefits, issues & solutions. Mhealth 2017; 3:45. [PMID: 29184897 PMCID: PMC5682365 DOI: 10.21037/mhealth.2017.09.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/28/2017] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular diseases are one of the top causes of deaths worldwide. In developing nations and rural areas, difficulties with diagnosis and treatment are made worse due to the deficiency of healthcare facilities. A viable solution to this issue is telemedicine, which involves delivering health care and sharing medical knowledge at a distance. Additionally, mHealth, the utilization of mobile devices for medical care, has also proven to be a feasible choice. The integration of telemedicine, mHealth and computer-aided diagnosis systems with the fields of machine and deep learning has enabled the creation of effective services that are adaptable to a multitude of scenarios. The objective of this review is to provide an overview of heart disease diagnosis and management, especially within the context of rural healthcare, as well as discuss the benefits, issues and solutions of implementing deep learning algorithms to improve the efficacy of relevant medical applications.
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Affiliation(s)
- Brian C S Loh
- Swinburne University of Technology Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Patrick H H Then
- Swinburne University of Technology Sarawak Campus, Kuching, Sarawak, Malaysia
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