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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [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: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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2
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Accuracy of telemedicine for the diagnosis and treatment of patients with shoulder complaints. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Malik MH, Brinjikji W. Feasibility of telesurgery in the modern era. Neuroradiol J 2022; 35:423-426. [PMID: 35341371 PMCID: PMC9437503 DOI: 10.1177/19714009221083141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Telesurgery is not a foreign concept and dates to as early as the 1920s. The use of robots in medicine has had a very positive effect and improved outcomes with little to no adverse effects. Having global access to telemedicine and telesurgery during the COVID-19 pandemic and being able to provide top medical care to gravely ill and contagious patients without compromising the safety of the medical team would be a very big achievement. We explore the hurdles needed to make it a realistic goal and give recommendations to achieve it utilizing the major advancements that have occurred over the past few years in the fields of engineering, communication etc. The biggest issues needed to be addressed are of financial investment, legal concerns, and availability of high-speed uninterrupted data connections.
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Affiliation(s)
- Muhammad Hammad Malik
- Department of Radiology, RinggoldID:6915Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Waleed Brinjikji
- Department of Radiology, RinggoldID:6915Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Rabin A, Dolkart O, Kazum E, Wengier R, Goldstein Y, Maman E, Chechik O. Shoulder assessment by smartphone: a valid alternative for times of social distancing. Arch Orthop Trauma Surg 2022; 142:979-985. [PMID: 33439302 PMCID: PMC7803879 DOI: 10.1007/s00402-021-03762-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The delivery of orthopaedic care via telemedicine services has the potential to promote accessibility and decrease medical care expenses, while facilitating the control of infectious disease spreading. The purpose of this study was to assess agreement regarding diagnosis, recommended course of management and the perceived need for additional diagnostic testing between a video examination (VE) and a face to face (FTF) assessment of patients with shoulder disorders. METHODS Forty-seven (18 females) patients presenting to a shoulder surgery clinic were assessed consecutively by VE and a FTF examination. All assessments were conducted by a shoulder specialist. Agreement regarding the established diagnosis, the recommended course of management and the need for additional diagnostic tests was assessed using percent agreement and kappa (95% CI) coefficient. Differences in the content, duration and satisfaction between the two examination modes were also assessed. RESULTS Percent agreement and kappa (95% CI) coefficient for agreement regarding diagnosis were 85.1% and 0.82 (0.69-0.94), respectively. Percent agreement and kappa (95% CI) coefficient regarding the recommended course of management and the need for additional diagnostic testing were 61.7% and 0.43 (0.22-0.63), and 74.5% and 0.49 (0.25-0.74), respectively. The VE resulted in collection of less physical examination information, took longer to complete and was associated with less satisfaction by both patient and examiner. CONCLUSIONS Video examination of patients with shoulder disorders may present a valid alternative to FTF examination. Nevertheless, the content of the video-based physical examination may need to be modified to facilitate a clearer detection of indications for specific interventions or diagnostic tests.
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Affiliation(s)
- Alon Rabin
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Oleg Dolkart
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Reut Wengier
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | | | - Eran Maman
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
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Ajrawat P, Young Shin D, Dryan D, Khan M, Ravi B, Veillette C, Leroux T. The Use of Telehealth for Orthopedic Consultations and Assessments: A Systematic Review. Orthopedics 2021; 44:198-206. [PMID: 34292815 DOI: 10.3928/01477447-20210621-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, tele-health for orthopedic care is expanding rapidly. The authors sought to identify the evidence describing the effectiveness, barriers, and clinical applications of telehealth for orthopedic assessments and consultations. MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched from inception to March 2020. Forty-seven studies were included, with the most common conditions evaluated being trauma related and the primary modality being videoconferencing. Available literature supports the use of telehealth for orthopedic consultations and assessments because it yields moderate-to-high patient and provider satisfaction, accurate examinations, cost-effectiveness, and reduced wait times. Most commonly reported concerns were professional liability, network security, and technical issues. Given the COVID-19 pandemic, rapid implementation and uptake of virtual assessment for patient care has occurred. The current evidence suggests that telehealth is capable of providing prompt access to quality, cost-efficient orthopedic consultations and assessments. [Orthopedics. 2021;44(4):198--206.].
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Hobson S, Aleem IS, Bice MJ, Butt BB, Bydon M, Elder BD, Fredericks DR, Helgeson MD, Patel RD, Sebastian A, Wagner SC, Williams SK, Xiong AE, Anderson PA, Freedman B. A Multicenter Evaluation of the Feasibility, Patient/Provider Satisfaction, and Value of Virtual Spine Consultation During the COVID-19 Pandemic. World Neurosurg 2021; 154:e781-e789. [PMID: 34389525 PMCID: PMC8490082 DOI: 10.1016/j.wneu.2021.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
Objective To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic. Methods Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected. Results A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation. Conclusions This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.
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Affiliation(s)
- Sandra Hobson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ilyas S Aleem
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Miranda J Bice
- Department of Orthopedic Surgery, UW Health University Hospital, Madison, Wisconsin, USA
| | - Bilal B Butt
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mohamad Bydon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald R Fredericks
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Melvin D Helgeson
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rakesh D Patel
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Arjun Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Wagner
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Seth K Williams
- Department of Orthopedic Surgery, UW Health University Hospital, Madison, Wisconsin, USA
| | - Ashley E Xiong
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Anderson
- Department of Orthopedic Surgery, UW Health University Hospital, Madison, Wisconsin, USA
| | - Brett Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Telephone consultation service in orthopedics during COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 65:167-171. [PMID: 34040680 PMCID: PMC8045449 DOI: 10.1016/j.recote.2020.07.007] [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] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
Background and aim The current COVID-19 pandemic scenario has driven surgical departments to a transformation. The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation. They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved. 53% of all telematic visits were successful. Conclusions Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.
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Miguela Álvarez SM, Bartra Ylla A, Salvador Carreño J, Castillón P, García Cardona C, Anglès Crespo F. Telephone consultation service in orthopedics during COVID-19 pandemic. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:167-171. [PMID: 33422454 PMCID: PMC7832733 DOI: 10.1016/j.recot.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
Antecedentes y objetivo Durante la pandemia COVID-19, la actividad de los servicios quirúrgicos se ha visto obligada a adaptarse y transformarse. La telemedicina se está implantando como nunca antes en esta nueva situación, en la que los pacientes están confinados y los profesionales sanitarios presentan riesgo de infectarse. El objetivo es mostrar que una reestructuración combinada telemática y presencial de las visitas, permite asegurar la asistencia médica, garantizando la protección del personal sanitario y de los pacientes. Material y método Estudio descriptivo observacional sobre el seguimiento de pacientes durante la pandemia por COVID-19, combinando la consulta telefónica con la presencial. Resultados Se realizaron un total de 5.031 llamadas telefónicas, diferenciando entre derivaciones, visitas de atención primaria especializada y consulta externa hospitalaria. Se registraron como: efectivas, tributarias de visita presencial y no se logra contacto telefónico. Y las dividimos en dos grupos: resueltas y no resueltas. Del total de visitas no presenciales telefónicas fueron efectivas un 53%. Conclusiones La medicina telemática es una opción factible en un servicio de traumatología, y de manera adecuada será una opción interesante de mantener tras la pandemia. Futuras líneas de investigación deberían ser abiertas para mejorar la capacidad de resolución de este sistema, analizar su relación coste-efectividad y subsanar los conflictos legales que pudieran existir.
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Affiliation(s)
- S M Miguela Álvarez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España.
| | - A Bartra Ylla
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España
| | - J Salvador Carreño
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - P Castillón
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - C García Cardona
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España
| | - F Anglès Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Mútua Terrassa, Barcelona, España; Departamento de Cirugía, Universitat de Barcelona (UB), Barcelona, España
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Ting L, Wilkes M. Telemedicine for Patient Management on Expeditions in Remote and Austere Environments: A Systematic Review. Wilderness Environ Med 2021; 32:102-111. [PMID: 33423896 DOI: 10.1016/j.wem.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022]
Abstract
Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice. Where no healthcare professionals are present, telemedicine may be the sole source of expert care. This systematic review appraises and summarizes the current literature regarding telemedicine in patient management on expeditions to remote locations and identifies areas for future research. MEDLINE and EMBASE were systematically searched for relevant articles from 1980 through February 2018. Data were handled according to the PRISMA process and analyzed using type-specific critical appraisal checklists where possible. Two hundred twenty-five articles were identified, 33 of which were included in this systematic review. They encompassed a variety of remote environments, including maritime (13), polar (9), mountainous (5), jungle (1), and multiple austere environments (6). Although some environments were better reported than others, many overarching concepts were generalizable. Through channels of communication that included telephone, radio, videoconferencing, and email, telemedicine has been used effectively in a range of environments to initiate treatment, follow up with patients, and determine the appropriateness of evacuation. Telementoring, in which a remote expert guides a local care provider in performing a procedure or task, is a promising aspect of telemedicine that is currently being developed. As technology advances, the scope of telemedicine will continue to expand. However, each new telemedical development must be shown to do more than simply function in a remote environment. Instead, new technologies should be tested for improved patient, practitioner, or expedition outcomes, within a telemedical system.
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Affiliation(s)
- Louise Ting
- Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom.
| | - Matt Wilkes
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, United Kingdom
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Abstract
PURPOSE Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in orthopedics in these procedures has increased significantly. The aim of this systematic review was to find out to what extent there is scientific evidence for the use of telemedicine in the orthopedic field. METHODS A systematic literature search was carried out in various databases on randomized controlled trials (RCTs) on telemedical applications in orthopedics. RESULTS Altogether, 14 articles were identified that reported about a total of eight RCTs of telemedical applications in orthopedics. Two RCTs were about a patient-to-doctor video consultation and six RCTs were about telerehabilitation after knee and hip arthroplasty (4 × knee arthroplasty, one hip and knee arthroplasty, one hip arthroplasty). For the majority of outcome parameters evaluated, there were no significant differences between the study groups. The cost effectiveness of videoconsultations depended on the workload (number of patient consultations) as well as the effectiveness of telerehabilitation on the distance of the patient's home to the health care center (30 km round-trip). CONCLUSION There is sufficient evidence to recommend the use of telemedical methods in orthopedics. However, more research is necessary to further expand the possibilities of telemedical methods with regard to physical examination.
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Gensheimer WG, Miller KE, Stowe J, Little J, Legault GL. Military Teleophthalmology in Afghanistan Using Mobile Phone Application. JAMA Ophthalmol 2020; 138:1053-1060. [PMID: 32852513 DOI: 10.1001/jamaophthalmol.2020.3090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The coronavirus disease 2019 pandemic has highlighted the need to expand telemedicine solutions. Objective To beta test a secure teleophthalmology mobile app at military treatment facilities in Afghanistan. Design, Setting, and Participants This prospective case series included 16 military treatment facilities at diverse roles of care including forward operating bases in Afghanistan and 1 location outside of Afghanistan. Thirty point-of-care medics and medical professionals were included from September to November 2019. Interventions Users placed teleophthalmology consults on their mobile phone using the mobile eye care app, and an expeditionary ophthalmologist stationed at a military hospital in Afghanistan responded. Users graded the mobile app using a rating scale from 1 to 5, with 1 being very dissatisfied and 5 being very satisfied. Main Outcomes and Measures Mean initial response time, agreement between the teleophthalmology diagnosis and final diagnosis, treatment and management following recommendations outlined in the Joint Trauma System clinical practice guidelines, prevention of the need for aeromedical evacuation, user satisfaction, and security and the Health Insurance Portability and Accountability Act compliance of consult. Results There were 28 consults placed over 6 weeks by 18 different users that were received by the expeditionary ophthalmologist. The mean (SD) patient age was 30.3 (9.8) years. Most patients were male (26 [93%]) and active duty US military (22 [78%]). The mean initial response time was 3 minutes 58 seconds (95% CI, 2 minutes 30 seconds to 5 minutes 26 seconds). There was agreement between the teleophthalmology diagnosis and final diagnosis in 24 consults (86%; 95% CI, 72%-100%). The treatment and management followed recommendations outlined in the Joint Trauma System Clinical Practice Guidelines for Eye Trauma: Initial Care in 28 consults (100%). Teleophthalmology consultation prevented the need for aeromedical evacuation in 4 consults (14%; 95% CI, 0.7%-28%). The patient returned to duty in 15 consults (54%; 95% CI, 34%-73%). Median overall satisfaction was 5 (minimum, 3; maximum, 5). All 28 consults (100%) were secure and compliant with the Health Insurance Portability and Accountability Act. Conclusions and Relevance While only a limited number of consults were evaluated, this study suggests that teleophthalmology mobile phone apps may improve and extend ophthalmic care in combat zones.
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Affiliation(s)
- William G Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland.,Department of Surgery, Division of Ophthalmology, Uniformed Services University, Bethesda, Maryland
| | - Kyle E Miller
- Department of Surgery, Division of Ophthalmology, Uniformed Services University, Bethesda, Maryland.,Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia
| | - Jennifer Stowe
- US Army Aeromedical Research Laboratory, United States Army Medical Research and Development Command, Fort Rucker, Alabama
| | - Jeanette Little
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland
| | - Gary L Legault
- Department of Surgery, Division of Ophthalmology, Uniformed Services University, Bethesda, Maryland.,Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas
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Backhaus L, Bierke S, Karpinski K, Häner M, Petersen W. SARS-CoV-2-Pandemie und ihre Auswirkungen auf Orthopädie und Unfallchirurgie: „Booster“ für die Telemedizin. ACTA ACUST UNITED AC 2020. [PMCID: PMC7221338 DOI: 10.1007/s43205-020-00062-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mit dem Ausbruch der COVID-19-Pandemie ist das Interesse an telemedizinischen Versorgungsmöglichkeiten gewachsen. Diese betreffen einerseits den Bereich der Diagnostik, aber auch die Überwachung von Therapieverläufen und Rehabilitationsmaßnahmen. Aufgrund der derzeitigen Ressourcenbeschränkungen sahen sich viele Orthopäden und Unfallchirurgen gezwungen, Videosprechstunden einzurichten, obwohl Standards für orthopädische Konsultationen bisher nur unzureichend entwickelt sind. Um die Effizienz der virtuellen Orthopädie zu maximieren, sollten die Patienten auf den virtuellen Besuch vorbereitet werden (Checkliste mit spezifischen Anweisungen zur Kamerapositionierung, Körperpositionierung, Einstellung und Kleidung, Prüfung der audiovisuellen Fähigkeiten). Klassische diagnostische Maßnahmen wie Anamnese, Inspektion und Beurteilung radiologischer Befunde sind in der Videosprechstunde möglich. Es entfällt jedoch die Möglichkeit der funktionellen Untersuchung (Stabilität des Kniegelenkes, Schultertests). Auch wenn erste wissenschaftliche Studien gezeigt haben, dass die telemedizinische Diagnostik der konventionellen Diagnostik nicht unterlegen ist, so fehlen doch validierte Untersuchungsprotokolle und Methoden. Die postoperative Überwachung von Rehabilitationsmaßnahmen kann z. B. durch den Einsatz von Sensoren erleichtert werden. Mit moderner Sensorik ist mittlerweile eine kostengünstige Erfassung der Gelenkbeweglichkeit und Gelenkstellung möglich und wird bereits im Bereich der Rehabilitation nach Rekonstruktion des vorderen Kreuzbandes eingesetzt. Auch hier ist sicher weitere Forschung notwendig, um diese Methoden zu validieren. Wir glauben, dass die derzeitige Pandemie Chancen bietet, die Möglichkeiten der Telemedizin für die Orthopädie und Unfallchirurgie auszubauen, um sie auch in der Zukunft weiter zu nutzen (z. B. bei der Versorgung von Patienten aus dem Ausland oder in dünn besiedelten Gebieten sowie der Betreuung von Hochleistungs- und Profisportlern).
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Affiliation(s)
- Luisa Backhaus
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar-Theyß-Straße 27–31, 14193 Berlin, Deutschland
| | - Sebastian Bierke
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar-Theyß-Straße 27–31, 14193 Berlin, Deutschland
| | - Katrin Karpinski
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar-Theyß-Straße 27–31, 14193 Berlin, Deutschland
| | - Martin Häner
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar-Theyß-Straße 27–31, 14193 Berlin, Deutschland
| | - Wolf Petersen
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar-Theyß-Straße 27–31, 14193 Berlin, Deutschland
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Abstract
Context: Considering the pivotal role of telemedicine in providing healthcare services for remote areas, some of the military medical centers, especially in developed countries, use different types of telemedicine programs. Objectives: The present study aimed at identifying the implemented telemedicine projects in military medicine worldwide and introducing their features. Evidence Acquisition: The current systematic review was performed in 2018. PubMed, Scopus, Embase, and Web of Science databases were searched for articles published from 2014 to 2018 by a combination of related keywords, and the related original articles were then selected based on the inclusion and exclusion criteria. Data were collected by a data extraction form, and then the data were summarized and reported based on the study objectives. Results: Of the 173 articles retrieved from the first round of search, 12 were included in the study; five (41.66%) studies had used the synchronous (real-time telemedicine) method. The United States, with nine studies, had the highest number of projects in military telemedicine. Most studies (n = 7) were performed on tele-psychology and the application of telemedicine in psychology. All selected studies reported the positive effects of telemedicine on providing healthcare for military forces. Conclusions: The proper utilization of telemedicine equipment is effective in saving time for both patients and healthcare providers, reducing costs, supporting in natural disasters, and satisfying patients with military medicine. To achieve telemedicine program objectives, they should be set precisely. Considering the importance of timely healthcare services, it is suggested to utilize synchronous methods and tools such as video conferencing.
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Huang EY, Knight S, Guetter CR, Davis CH, Moller M, Slama E, Crandall M. Telemedicine and telementoring in the surgical specialties: A narrative review. Am J Surg 2019; 218:760-766. [PMID: 31350010 DOI: 10.1016/j.amjsurg.2019.07.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The field of telemedicine has grown tremendously over the last decade. We present a systematic review of publications on telemedicine as it pertains to surgery, addressing six facets: 1) telerobotics, 2) telementoring, 3) teleconsulting, 4) telemedicine in post-operative follow-up, 5) tele-education, and 6) current technology. DATA SOURCES A search of relevant literature querying PubMed, Web of Science, and Science Direct was performed using the following keywords: telecommunication, telemedicine, telehealth, virtual health, virtual medicine, general surgery, surgery, surgical or surgical patients. CONCLUSIONS Telemedicine is being used to care for patients in remote areas, to help expert surgeons assist other specialists in the office or novice surgeons in the operating room, as well as to help teach the next generation of surgeons. There are many opportunities for surgeons to utilize this technology to optimize their practice.
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Affiliation(s)
- Eunice Y Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N. Dunlap St., Second Floor, Memphis, TN, 38105, USA.
| | - Samantha Knight
- Southern Illinois School of Medicine, 701 N. First Street, PO Box 19638, Springfield, IL, 62702, USA.
| | - Camila Roginski Guetter
- Federal University of Parana, Medical School. Rua Padre Camargo, 285. Alto da Glória, Curitiba, PR, 80060-240, Brazil.
| | | | - Mecker Moller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, Fl, 33131, USA.
| | - Eliza Slama
- Department of Surgery, St. Agnes Hospital, 900 S. Caton Avenue, Baltimore, MD, 21229, USA.
| | - Marie Crandall
- University of Florida College of Medicine, Jacksonville 655 W. 8th Street Jacksonville, FL, 32209, USA.
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15
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Haverkamp FJC, Veen H, Hoencamp R, Muhrbeck M, von Schreeb J, Wladis A, Tan ECTH. Prepared for Mission? A Survey of Medical Personnel Training Needs Within the International Committee of the Red Cross. World J Surg 2018; 42:3493-3500. [PMID: 29721638 PMCID: PMC6182760 DOI: 10.1007/s00268-018-4651-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Humanitarian organizations such as the International Committee of the Red Cross (ICRC) provide worldwide protection and medical assistance for victims of disaster and conflict. It is important to gain insight into the training needs of the medical professionals who are deployed to these resource scarce areas to optimally prepare them. This is the first study of its kind to assess the self-perceived preparedness, deployment experiences, and learning needs concerning medical readiness for deployment of ICRC medical personnel. METHODS All enlisted ICRC medical employees were invited to participate in a digital questionnaire conducted during March 2017. The survey contained questions about respondents' personal background, pre-deployment training, deployment experiences, self-perceived preparedness, and the personal impact of deployment. RESULTS The response rate (consisting of nurses, surgeons, and anesthesiologists) was 54% (153/284). Respondents rated their self-perceived preparedness for adult trauma with a median score of 4.0 on a scale of 1 (very unprepared) to 5 (more than sufficient); and for pediatric trauma with a median score of 3.0. Higher rates of self-perceived preparedness were found in respondents who had previously been deployed with other organizations, or who had attended at least one master class, e.g., the ICRC War Surgery Seminar (p < 0.05). Additional training was requested most frequently for pediatrics (65/150), fracture surgery (46/150), and burns treatment (45/150). CONCLUSION ICRC medical personnel felt sufficiently prepared for deployment. Key points for future ICRC pre-deployment training are to focus on pediatrics, fracture surgery, and burns treatment, and to ensure greater participation in master classes.
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Affiliation(s)
- Frederike J. C. Haverkamp
- Department of Surgery (internal postal code 618), Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harald Veen
- World Health Organization, Geneva, Switzerland
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiderdorp, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Ministry of Defence, Utrecht, The Netherlands
| | - Måns Muhrbeck
- Department of Surgery, Linköping University, Gamla Övägen 25, 603 79 Norrköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Gamla Övägen 25, 603 79 Norrköping, Sweden
| | - Johan von Schreeb
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Andreas Wladis
- International Committee of the Red Cross, 19 Avenue de la paix, 1202 Geneva, Switzerland
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Edward C. T. H. Tan
- Department of Surgery (internal postal code 618), Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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16
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Neville CW. Telehealth: A Balanced Look at Incorporating This Technology Into Practice. SAGE Open Nurs 2018; 4:2377960818786504. [PMID: 33415198 PMCID: PMC7774340 DOI: 10.1177/2377960818786504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 11/16/2022] Open
Abstract
This article explores the use of telehealth and the ability to provide health care to patients through interactive technology and telecommunication tools. The use of telehealth continues to grow, reaching multiple medical specialties and providing care to a greater population of patients. The purpose of this article is to increase the knowledge of telehealth, identify positive outcomes associated with telehealth as well as potential barriers, and evaluate the benefits against the downfalls to determine whether the positive outcomes outweigh the barriers.
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17
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Caffery LJ, Taylor M, North JB, Smith AC. Tele-orthopaedics: A snapshot of services in Australia. J Telemed Telecare 2017; 23:835-841. [DOI: 10.1177/1357633x17732800] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health services in the United States and Europe have reported that tele-orthopaedics saves significant patient travel time, reduces time off work, increases satisfaction with care and in some scenarios reduces the cost of care. Less is known about the role of tele-orthopaedics in Australia. The aim of this study was to explore Australian-based tele-orthopaedic services, and to identify the barriers and enablers associated with these services. We used a qualitative case study methodology where specific services were identified from multiple sources and invited to participate in a structured interview. Nine tele-orthopaedic services contributed to the study. Telehealth activity in each service ranged from one to 75 patients per week, and service maturity ranged from three months to 10 years. Services were used predominantly for fracture clinics and peri-operative consultations. The majority (78%) of services used videoconferencing. Two services used asynchronous methods to review radiographs without direct patient involvement. Tele-orthopaedics was found to be disruptive as it required the redesign of many care processes. However, all services found the redesign feasible. Staff resistance was a commonly cited barrier. Further, imaging repositories from multiple imaging providers complicated access to information. Key enablers included clinical champions, picture archiving and communication systems, and the perceived benefit to patients who would avoid the need for travel. Whilst it appears that tele-orthopaedics is not widely utilised in Australia, recognition of the barriers and enablers is important for the development of similar services.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Australia
| | - John B North
- Department of Orthopaedics, Princess Alexandra Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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18
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Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and Clinical Decision Making: a Systematic Review. Acta Inform Med 2016; 24:286-292. [PMID: 27708494 PMCID: PMC5037984 DOI: 10.5455/aim.2016.24.286-292] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/15/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations. METHOD The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library. RESULTS 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles. CONCLUSION The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired.
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Affiliation(s)
- Kolsoum Deldar
- Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Seyed Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Musculoskeletal Injuries in Iraq and Afghanistan: Epidemiology and Outcomes Following a Decade of War. J Am Acad Orthop Surg 2016; 24:341-8. [PMID: 27115793 DOI: 10.5435/jaaos-d-15-00123] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The combined wars in Afghanistan and Iraq represent the longest ongoing conflicts in American military history, with a combined casualty estimate of >59,000 service members. The nature of combat over the last decade has led to precipitous increases in severe orthopaedic injuries, including traumatic amputations and injuries to the spine. Nearly 75% of all injuries sustained in combat now are caused by explosive mechanisms, and fractures comprise 40% of all musculoskeletal injuries. Injuries to the axial skeleton are more frequent among personnel exposed to combat, and spinal trauma is identified in nearly 40% of those killed. Musculoskeletal injuries are expensive and generate some of the highest rates of long-term disability. Noncombat musculoskeletal injuries are endemic within deployed military service members and occur at a greater than threefold rate compared with combat musculoskeletal injuries. Service members with musculoskeletal injuries or behavioral health conditions, such as posttraumatic stress disorder, depression, and psychosis, and those occupying a low socioeconomic status, have an increased risk of inferior outcomes.
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Raison N, Khan MS, Challacombe B. Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential? Curr Urol Rep 2016; 16:43. [PMID: 26025497 DOI: 10.1007/s11934-015-0522-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing many areas of medical practice and education. Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, telementoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and telementoring. However, barriers to the further implementation of telemedicine remain. In this review, the developments and recent advances of telemedicine across the three domains are discussed together with the challenges and limitations that need to be overcome.
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Affiliation(s)
- Nicholas Raison
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK,
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