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Shomorony A, Weitzman R, Chen YH, Liao D, Sclafani AP. Augmented Virtual Examination for Cosmetic and Functional Rhinoplasty. Facial Plast Surg Aesthet Med 2024; 26:65-70. [PMID: 37358622 DOI: 10.1089/fpsam.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Background: Few studies have critically evaluated the quality of data obtained during telemedical evaluations of patients with nasal complaints. Objective: To compare the quality of data provided by remote endoscopic and external nasal examination with those by in-person evaluations for rhinoplasty and functional nasal surgery, measured by detectability of anatomic features, and to assess associated patient experience measured by reported ease, discomfort, and likelihood of peer recommendation. Materials and Methods: Twenty healthy subjects performed a nasal self-examination using an endoscope and webcam under remote videoconferencing service (VCS) guidance. They subsequently underwent in-person examination and were surveyed about their experience. Inter-rater reliability was calculated using kappa coefficients. Detectability of anatomic features by in-person versus virtual examination was compared using Wilcoxon and chi-square tests. Results: Median subject age was 27.5 years (range 23-77). Kappa coefficients were 0.78 for in-person and 0.66 for virtual evaluations. Only the internal nasal valve and inferior turbinate were better visualized in person. There were no differences between detectability of external features on in-person versus virtual examinations. Subjects' average likelihood of recommending this technology (1-10) was 8.65 (SD 1.4). Conclusions: Intranasal examination by physician-guided remote endoscopy and webcam-based facial analysis demonstrate nasal anatomy comparable with in-person evaluation and anterior rhinoscopy.
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Affiliation(s)
- Andre Shomorony
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rachel Weitzman
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Yu Han Chen
- Weill Cornell Medical College, New York, New York, USA
| | - David Liao
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Anthony P Sclafani
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
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Shomorony A, Weitzman R, Chen H, Sclafani AP. Augmented otorhinologic evaluation in telemedical visits. Am J Otolaryngol 2024; 45:104088. [PMID: 37832329 DOI: 10.1016/j.amjoto.2023.104088] [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: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To determine if an endoscopic otologic and rhinologic examination performed by a patient and interpreted remotely by an otolaryngologist is non-inferior to in-person examination, and to assess the feasibility of this system for telemedical visits. MATERIALS AND METHODS Twenty healthy subjects performed a self-examination of their ears and nose using a commercially available endoscope under remote guidance by an otolaryngology provider over Zoom. This same provider and another otolaryngologist also performed separate, in-person examinations of each subject and rated their findings. Finally, both providers blindly reviewed a video recording of each virtual exam four weeks later and rated their findings. Subjects were surveyed about their experience. Interrater reliability was calculated using Cohen's kappa coefficients and the ability to detect different anatomic structures and features by in-person vs. virtual examination was compared using Wilcoxon tests and Chi-squared proportion tests. RESULTS The subjects' average age was 30 (SD 11.5) years. Interrater reliability was excellent; kappa coefficients were 0.72 and 0.81 (p < 0.001) for virtual and in-person exams, respectively. Of the 3 anatomic structures within the ear exam, none showed a difference in detectability between virtual and in-person exams. Of the 12 structures in the nasal exam, 3 were better visualized in-person and 9 showed no difference. Subject satisfaction was excellent; the average likelihood of recommending this virtual technology to peers (1-10) was 8.65 (SD 1.4). CONCLUSIONS Patient self-examination of the ears and nose using a portable endoscope may be an effective strategy for obtaining valuable data during telemedical otolaryngology visits.
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Affiliation(s)
- Andre Shomorony
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA.
| | - Rachel Weitzman
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Hannah Chen
- Weill Cornell Medical College, New York, NY, USA
| | - Anthony P Sclafani
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
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Xie KZ, Antezana LA, Bowen AJ, Yin LX, Yeakel S, Nassiri A, Moore EJ. Telemedicine evaluation of new head and neck patients at a tertiary academic clinic during the coronavirus disease 2019 pandemic. J Telemed Telecare 2022:1357633X221100054. [PMID: 35668638 PMCID: PMC9177817 DOI: 10.1177/1357633x221100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. METHODS A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. RESULTS A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time (n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients (n = 67), followed by biopsy report 30.6% (n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made (p = 0.024). For new patients with parotid masses (n = 42), definitive treatment plans could be made 97.6% of the time (n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072-0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. DISCUSSION In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns.
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Affiliation(s)
- Katherine Z Xie
- Mayo Clinic Alix School of
Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luis A Antezana
- Mayo Clinic Alix School of
Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Bowen
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Sarah Yeakel
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Ashley Nassiri
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology (ENT)/Head
and Neck Surgery, Mayo
Clinic, Rochester, MN, USA
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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Vincent P, Haw G, Buiret G. [Patient satisfaction after mandibular orthosis fitting by teleconsultation]. Rev Mal Respir 2021; 39:8-12. [PMID: 34801330 DOI: 10.1016/j.rmr.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Since the COVID-19 crisis, we have all had to apply telemedicine. As an example, we offered patients teleconsultations for titration of their mandibular advancement device for sleep apnea. The main objective of this study was to determine patient satisfaction with this new method of consultation. METHODS A cross-sectional survey using a satisfaction questionnaire was carried out in patients having been given an appliance adjustment teleconsultation by our establishment between March 2020 and February 2021. RESULTS Adjustment of their orthosis by telemedicine was systematically proposed to seventy-five patients, of whom seventeen accepted (22.7%), with a mean age of 52.3 years. The consultations were short (mean duration: 5min), and more than a third were carried out at the patient's workplace; by and large, they were considered highly satisfactory (mean score 4.3/5). CONCLUSION Although appliance adjustment by teleconsultation was not overwhelmingly accepted when offered, it gave great satisfaction after performance. This type of consultation is both technologically and administratively easy to organize, and it can be proposed as a supplementary service, suitable for all ages.
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Affiliation(s)
- P Vincent
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier de Valence, 159, boulevard du Maréchal-Juin, 26953 Valence, France
| | - G Haw
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier de Valence, 159, boulevard du Maréchal-Juin, 26953 Valence, France
| | - G Buiret
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier de Valence, 159, boulevard du Maréchal-Juin, 26953 Valence, France.
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Sclafani AP. Commentary on the manuscript "Telemedicine for otolaryngological assessments". Am J Otolaryngol 2021; 42:103174. [PMID: 34400009 DOI: 10.1016/j.amjoto.2021.103174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
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Sclafani AP, Shomorony A, Stewart MG, Grunstein E, Overdevest JB. Telemedicine lessons learned during the COVID-19 pandemic: The augmented outpatient otolaryngology teleconsultation. Am J Otolaryngol 2021; 42:102960. [PMID: 33610921 PMCID: PMC7883738 DOI: 10.1016/j.amjoto.2021.102960] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 12/20/2022]
Abstract
Purpose Telemedicine use in otolaryngology waxed and waned during the COVID-19 pandemic outbreak in the U.S. Assessing the patterns of telemedicine use and its perceived limitations during the COVID-19 outbreak in 2020 allows identification and correction of impediments to consistent telemedicine use by otolaryngologists. Materials and methods Full-time faculty of 2 academic otolaryngology departments in New York City were surveyed regarding their telemedicine use from March through August 2020 during the “first wave” of the COVID-19 pandemic. Based on these findings, a method of “augmented outpatient otolaryngology teleconsultation” designed to enhance the quality of the physical examination was developed and employed from August to December 2020. Patients receiving this augmented teleconsult were anonymously surveyed about their telemedical experience. Results Telemedicine use by faculty was minimal prior to the pandemic, but as total outpatient volume decreased 65–84% across subspecialties, it was used by all otolaryngologists during COVID-19. Physicians were less confident in making a telemedical diagnosis at all phases of the study in all subspecialties. Patients who had an augmented otolaryngology teleconsultation were satisfied with it, believed it facilitated earlier care, limited the time and cost of travel to the physician's office and felt their physician was able to perform a sufficient physical examination. Conclusions During the COVID-19 crisis, physicians utilized teleotolaryngology to provide care but were less satisfied with their ability to make an accurate diagnosis. Inexpensive direct-to-consumer digital otoscopes can improve the quality of the physical examination provided and can address both patient and physician needs.
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Dai Z, Wang Y, Hang C, Zhu K, Meng X. Telemedicine for ear diseases with the smartphone otoscopes via WeChat in the COVID-19 era. Am J Otolaryngol 2021; 42:102997. [PMID: 33770717 DOI: 10.1016/j.amjoto.2021.102997] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to evaluate the outcomes and satisfaction of ear patients who participated in the smartphone otoscopes telemedicine via WeChat. METHODS Patients in this study included newly diagnosed outpatients and online patients who did not undergo an outpatient diagnosis. Patients performed regular ear self-examinations, took pictures at home using their smartphone endoscopes, and submitted images to a WeChat community. Otolaryngologist gave timely online feedback. All of the following data were recorded: patients age and gender, disease duration, outpatient diagnosis, side, telemedicine duration, number of telemedicine visits, outcomes, satisfaction. RESULTS A total of 74 patients were included in the study, including 39 males and 35 females, with an average age of 31.1 ± 13.7 years (range 4-55 years). Of these patients, 68 were outpatients, and 6 directly participated in telemedicine online. The patient's disease duration ranged from 1 day to 15 days, with an average of 4.0 ± 3.0 days. The mean duration was 8.1 days (range: 3-21 days) for telemedicine. The mean number of visits was 2.7 times (range: 2-6 times) for telemedicine. 68 (91.9%) of the 74 patients were cured, 6 (8.1%) were improved, and 0 (0%) were ineffective. Almost all patients were pleased with the telemedicine service, 71.9 0% were very satisfied (n = 62), 28.10% were very satisfied (n = 11), and 0% were dissatisfied (n = 0). CONCLUSIONS Smartphone otoscopes telemedicine can decrease outpatient follow-up, reduce the risk of cross-infection, increase telemedicine accuracy, and improve patient satisfaction. It is worthy of clinical application in the COVID-19 era.
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Mallen JR, Shah MU, Drake R, Kreicher K, Falcone T, Karter N, Schoem S, Grindle C, Wolfe S, Kuo CL, Mu J, Lotterman S, Bonaiuto G. Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage. JAMA Otolaryngol Head Neck Surg 2021; 146:909-913. [PMID: 32816011 DOI: 10.1001/jamaoto.2020.1972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Telemedicine is rapidly gaining traction as a way to reduce costs and connect patients with medical experts outside their local communities. Peritonsillar abscess (PTA) is a logical pathologic condition to evaluate for effectiveness of remote diagnosis given its prevalence and the paucity of on-site otolaryngologists at many institutions. Objective To explore the potential of otolaryngology telemedical consultation in triaging and diagnosing patients with suspected PTA. Design, Setting, and Participants A comparative effectiveness research study was conducted from January 1 to June 30, 2018, at 3 tertiary care hospitals among 31 consecutive patients aged 18 to 85 years for whom the otolaryngology department was consulted to assess for PTA. Statistical analysis was conducted from July 1 to September 30, 2018. Interventions Telemedical evaluation of suspected PTA by 5 attending otolaryngologists blinded to patients' history aside from the chief report of odynophagia. Otolaryngologists rated each patient video on whether they believed the patient had a PTA and whether the case warranted prompt evaluation by an otolaryngologist. Predictions were compared with the criterion standard of drainage or negative needle aspiration. Otolaryngologists additionally assessed video quality. Main Outcomes and Measures Rates of accurate diagnosis and triage of PTA based on otolaryngologists' review of oropharyngeal examinations recorded using standard smartphone cameras, as well as percentage of videos of oropharyngeal examinations using standard smartphone cameras deemed of sufficiently high quality for clinical decision-making. Results A total of 31 patients (16 women [51.6%]; mean age, 31.9 years [range, 18-62 years]) were recruited, and 16 patients (51.6%) had a PTA. Comparing otolaryngologists' predictions with PTA status by the criterion standard, the prediction was consistent with that of the criterion standard 81% of the time averaged across otolaryngologists (mean diagnostic accuracy, 0.81). Similarly, the mean diagnostic accuracy was 0.83 when comparing the otolaryngologist's suggestion for a prompt in-person evaluation with actual PTA status by the criterion standard. Comparing patients who were deemed to require prompt otolaryngology evaluation and those with PTA by the criterion standard, mean sensitivity was 90%. Videos were rated as of sufficiently high quality to make a diagnosis in 154 of 155 videos (99.4%). Conclusions and Relevance This study suggests that telemedical consultation is a viable, cost-conscious, efficient, and safe approach to PTA management. Despite having some difficulty diagnosing PTAs based on "history concerning for PTA" and oropharyngeal video alone, otolaryngologists are able to determine, with high sensitivity, which patients require prompt otolaryngology evaluation. The recording of consistently high-quality video using a standard smartphone camera is achievable without formal training.
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Affiliation(s)
- Jonathan R Mallen
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Manan Udayan Shah
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Ryan Drake
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Kathryn Kreicher
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Todd Falcone
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Nicholas Karter
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Scott Schoem
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington.,Division of Otolaryngology, Department of Surgery, Connecticut Children's Medical Center, Hartford
| | - Christopher Grindle
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington.,Division of Otolaryngology, Department of Surgery, Connecticut Children's Medical Center, Hartford
| | - Stephen Wolfe
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
| | - Chia-Ling Kuo
- Connecticut Institute for Clinical and Translational Science, University of Connecticut Health, Farmington
| | - Jinjian Mu
- Connecticut Institute for Clinical and Translational Science, University of Connecticut Health, Farmington
| | - Seth Lotterman
- Department of Emergency Medicine, University of Connecticut Health, Farmington.,Department of Emergency Medicine, Hartford Hospital, Hartford, Connecticut
| | - Gregory Bonaiuto
- Division of Otolaryngology, Department of Surgery, University of Connecticut Health, Farmington
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Riley PE, Fischer JL, Nagy RE, Watson NL, McCoul ED, Tolisano AM, Riley CA. Patient and Provider Satisfaction With Telemedicine in Otolaryngology. OTO Open 2021; 5:2473974X20981838. [PMID: 33474522 PMCID: PMC7797587 DOI: 10.1177/2473974x20981838] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The objective of this study is to evaluate patient and provider satisfaction with telemedicine encounters across 3 otolaryngology practices. Study Design Cross-sectional survey. Setting A military community hospital, an academic military hospital, and a nonmilitary academic center. Methods A telephone-based survey of patients undergoing telemedicine encounters for routine otolaryngology appointments was performed between April and July 2020. Patients were asked about their satisfaction, the factors affecting care, and demographic information. A provider survey was emailed to staff otolaryngologists. The survey asked about satisfaction, concerns for reimbursement or liability, encounters best suited for telemedicine, and demographic information. The results were analyzed with descriptive statistics and a multivariable logistic linear regression model to determine odds ratios. Results A total of 325 patients were surveyed, demonstrating high satisfaction with telemedicine (average score, 4.49 of 5 [best possible answer]). Patients perceived “no negative impact” or “minor negative impact” on the encounter due to the lack of a physical examination or face-to-face interaction (1.86 and 1.95 of 5, respectively). High satisfaction was consistent across groups for distance to travel, age, and reason for referral. A total of 25 providers were surveyed, with an average satisfaction score of 3.44 of 5. Providers reported “slight” to “somewhat” concern about reimbursement (40%) and liability (32%). Conclusion Given patients’ and providers’ levels of satisfaction, there is likely a role for telemedicine in otolaryngology practice that may benefit patient care independent of the COVID-19 pandemic.
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Affiliation(s)
- Phoebe Elizabeth Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ryan E Nagy
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Nora L Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Charles A Riley
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Otolaryngology-Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
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Coco L, Davidson A, Marrone N. The Role of Patient-Site Facilitators in Teleaudiology: A Scoping Review. Am J Audiol 2020; 29:661-675. [PMID: 32692575 DOI: 10.1044/2020_aja-19-00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Teleaudiology helps improve access to hearing health care by overcoming the geographic gap between providers and patients. In many teleaudiology encounters, a facilitator is needed at the patient site to help with hands-on aspects of procedures. The aim of this study was to review the scope and nature of research around patient-site facilitators in teleaudiology. We focused on identifying the facilitators' background, training, and responsibilities. Method To conduct this scoping review, we searched PubMed, CINAHL, and Embase. To be included, studies needed to address teleaudiology; be experimental/quasi-experimental, correlational/predictive, or descriptive; be published in English; and include the use of a facilitator at the patient location. Results A total of 82 studies met the inclusion criteria. The available literature described a number of different individuals in the role of the patient-site facilitator, including audiologists, students, and local aides. Fifty-seven unique tasks were identified, including orienting the client to the space, assisting with technology, and assisting with audiology procedures. The largest number of studies (n = 42) did not describe the facilitators' training. When reported, the facilitators' training was heterogenous in terms of who delivered the training, the length of the training, and the training content. Conclusions Across studies, the range of duties performed by patient-site facilitators indicates they may have an important role in teleaudiology. However, details are still needed surrounding their background, responsibilities, and training. Future research is warranted exploring the role of the patient-site facilitator, including their impact on teleaudiology service delivery. Supplemental Material https://doi.org/10.23641/asha.12475796.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
| | - Alyssa Davidson
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
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Fieux M, Duret S, Bawazeer N, Denoix L, Zaouche S, Tringali S. Téléconsultation en ORL : enquête de satisfaction en période pandémique COVID-19. ANNALES FRANÇAISES D'OTO-RHINO-LARYNGOLOGIE ET DE PATHOLOGIE CERVICO-FACIALE 2020. [PMCID: PMC7298459 DOI: 10.1016/j.aforl.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
But Étudier l’intérêt de la téléconsultation en période de pandémie liée au COVID-19. Matériel et méthodes Étude prospective comportant une enquête de satisfaction réalisée au sein d’un service d’ORL d’un centre hospitalo-universitaire où la téléconsultation a été mise en place pour remplacer les consultations programmées. Les patients étaient répartis en deux groupes selon leur niveau de satisfaction pour en identifier les facteurs prédictifs. Une valeur de p < 0,005 était considérée statistiquement significative. L’objectif principal était d’évaluer le taux de satisfaction des patients à la suite d’une téléconsultation en ORL pendant le confinement mondial. L’objectif secondaire était d’identifier des facteurs prédictifs de la satisfaction globale des patients. Résultats 125 patients ont été vu en téléconsultation sur une période de 7 jours d’inclusion et 100 patients ont complété le questionnaire. Le taux de satisfaction globale était de 87 %. Aucun facteur prédictif cliniquement pertinent n’était associé de façon statistiquement significative avec la satisfaction. Respectivement 76 et 61 % des patients avaient jugé satisfaisante la qualité du son et de la vidéo sans impact significatif sur leur satisfaction globale (respectivement OR = 3,40 ; valeur de p = 0,049 et OR = 3,79 ; valeur de p = 0,049). L’absence d’examen physique n’était pas significativement corrélée à une diminution de la satisfaction globale (OR = 0,30 ; valeur de p = 0,027). Conclusion La téléconsultation ne permettait pas une prise en charge médicale complète mais en situation de pandémie, elle a été bien accueillie par les patients. Elle représentait un moyen simple de maintenir la continuité des soins médicaux tout en réduisant le risque de contamination par contact direct entre les patients et le personnel soignant.
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Ning AY, Cabrera CI, D'Anza B. Telemedicine in Otolaryngology: A Systematic Review of Image Quality, Diagnostic Concordance, and Patient and Provider Satisfaction. Ann Otol Rhinol Laryngol 2020; 130:195-204. [PMID: 32659100 DOI: 10.1177/0003489420939590] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Telemedicine allows for the remote delivery of patient care and has been found to have a wide range of uses in otolaryngology. In order to achieve best practices in telemedicine, a platform must be effective and both patients and providers must be satisfied with the use of technology. As telemedicine becomes more widely used in otolaryngology clinics, particularly in the face of the current COVID-19 pandemic, it is important to assess its applicability in this field. The goal of this study was to evaluate existing literature on telemedicine and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies. METHODS A systematic review was conducted on PubMed and MEDLINE according to the PRISMA 2009 guidelines for articles from 1982 to 2019 relating to telemedicine in otolaryngology. English language studies with primary or secondary endpoints pertaining to image quality, diagnostic concordance, or patient or provider satisfaction were included. Descriptive studies, editorials, and literature reviews were excluded. RESULTS A total of 32 studies were included in our review. Studies assessing imaging quality and diagnostic concordance reported adequate results but with some heterogeneity. Patient and provider satisfaction were consistently high. CONCLUSIONS The literature supports telemedicine delivery of otorhinolaryngologic care as having achieved high rates of patient and provider satisfaction with adequate image quality and heterogeneity in diagnostic concordance. Variability in diagnostic accuracy was reported, but appears improved given proper clinical context. More standardized studies are needed specific to telemedicine in the field of otolaryngology.
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Affiliation(s)
- Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian D'Anza
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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14
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Fieux M, Duret S, Bawazeer N, Denoix L, Zaouche S, Tringali S. Telemedicine for ENT: Effect on quality of care during Covid-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:257-261. [PMID: 32624390 PMCID: PMC7306717 DOI: 10.1016/j.anorl.2020.06.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS To assess the benefit of telemedicine consultation during the Covid-19 pandemic. MATERIAL AND METHODS A prospective study of patient satisfaction with telemedicine consultation was carried out in the ENT department of a university hospital center where telemedicine consultations were set up to replace scheduled out-patient consultations. Patients were divided into two groups according to overall satisfaction, in order to identify predictive factors. The significance threshold was set at P<0.005. The main endpoint was patient satisfaction after an ENT telemedicine consultation during global lockdown. The secondary endpoint comprised predictive factors for overall satisfaction. RESULTS One hundred of the 125 patients with telemedicine consultation over a 7-day inclusion period completed the questionnaire. Overall satisfaction was 87%. There were no clinically relevant predictive factors significantly associated with satisfaction. Sound and video quality was satisfactory for 76% and 61% of patients respectively, without significant impact on overall satisfaction (respectively: OR=3.40, P-value=0.049; and OR=3.79, P-value=0.049). Lack of physical examination did not significantly correlate with reduced overall satisfaction (OR=0.30, P-value=0.027). CONCLUSION Telemedicine consultation did not allow complete medical care but, in a difficult time like the global pandemic, was well accepted by patients. It is a simple way to maintain continuity of care while reducing contamination risk by avoiding direct contact between patients and healthcare professionals.
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Affiliation(s)
- M Fieux
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
| | - S Duret
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - N Bawazeer
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Umm Al Qura University, Mecca, Saudi Arabia
| | - L Denoix
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - S Zaouche
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - S Tringali
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
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15
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Hagge D, Knopf A, Hofauer B. [Telemedicine in the fight against SARS-COV-2-opportunities and possible applications in otorhinolaryngology : Narrative review]. HNO 2020; 68:433-439. [PMID: 32300823 PMCID: PMC7160613 DOI: 10.1007/s00106-020-00864-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hintergrund Die COVID-19-Pandemie bringt Gesundheitssysteme weltweit bisweilen an die Belastungsgrenze. Ein Grund dafür ist die rasant steigende Anzahl von Neuinfizierten. Zum anderen verschärfen die hohen Ausfallquoten bei Ärzten und Pflegern insbesondere in der HNO-Heilkunde zusätzlich die Situation. Telemedizin kann dabei ein sinnvolles Mittel sein, um die Anzahl von Arzt-Patienten-Kontakten zu reduzieren. Dadurch könnten Infektionsketten unterbrochen werden und das Infektionsrisiko für Ärzte minimiert werden. Methoden Zur Erstellung des Reviews wurde eine selektive Literaturrecherche unter www.pubmed.com mit den einschlägig verwendeten englischen Fachtermini für Telemedizin und HNO durchgeführt. Zudem wurde eine Recherche unter www.news.google.com zu aktuellen Entwicklungen der COVID-19-Pandemie mit den Suchbegriffen Telemedizin und COVID-19 betrieben. Ergebnisse Telemedizin kann sowohl im direkten Patientenkontakt als auch bei der konsiliarischen Unterstützung von Allgemeinmedizinern hilfreich sein. Die vorliegenden Studien zeigen, dass im Durchschnitt mehr als 50 % der Arztbesuche telemedizinisch durchführbar wären. Sowohl Ärzte als auch Patienten bewerten den Einsatz von Telemedizin als positiv. Weder die Bildqualität noch die Handhabung der Technik stellen relevante Hindernisse bei der sicheren Diagnosestellung dar. Patienten gaben an, dass der telemedizinische Arztbesuch nicht länger dauerte als ein traditioneller Arztbesuch. Zudem wurde von den Patienten die schnellere und bessere Verfügbarkeit von medizinischer Versorgung durch Telemedizin hervorgehoben. Schlussfolgerung Telemedizin kann einen entscheidenden Beitrag zur Bewältigung der aktuellen COVID-19-Pandemie leisten. Zudem kann die Etablierung von Telemedizin dabei helfen, auf zukünftige Pandemien besser vorbereitet zu sein.
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Affiliation(s)
- Daniel Hagge
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - Andreas Knopf
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - Benedikt Hofauer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
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16
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Philips R, Seim N, Matrka L, Locklear B, Moberly AC, Inman M, Essig G. Cost savings associated with an outpatient otolaryngology telemedicine clinic. Laryngoscope Investig Otolaryngol 2019; 4:234-240. [PMID: 31024993 PMCID: PMC6476262 DOI: 10.1002/lio2.244] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 11/04/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To test the null hypothesis that there is no difference in patient cost savings between the telemedicine and traditional face‐to‐face approach. The second objective was to assess the financial impact on the peripheral healthcare system, as compared with staffing a conventional clinic with “on‐site” otolaryngologist. Methods Twenty‐one patients were enrolled. To assess “patient‐benefit” cost savings, a model was formulated that would utilize a certified nurse practitioner (CNP) to conduct a general otolaryngology clinic at the peripheral site, as compared with having to travel to the tertiary referral center. A “peripheral site‐benefit” cost analysis was performed to assess costs of initiating and operating a telemedicine clinic at the peripheral site, compared with having an on‐site otolaryngologist. Results The total patient‐benefit cost savings would be $182.09 per patient per encounter and $333.22 per patient annually. The fixed cost to the peripheral site to initiate the telemedicine system was $9,895. Two hundred sixty telemedicine encounters would be needed to offset the initial cost, and 537 encounters would be needed to surpass revenue of the conventional clinic. Conclusion A real‐time telemedicine otolaryngology clinic provides significant cost savings for both patients and the peripheral healthcare system. This pilot study supports telemedicine as a cost‐effective approach to providing general otolaryngology care to rural patients. Level of Evidence 4
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Affiliation(s)
- Ramez Philips
- Ohio State University College of Medicine Columbus Ohio U.S.A
| | - Nolan Seim
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Brittany Locklear
- Division of Regional Outreach Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Mark Inman
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Garth Essig
- Department of Otolaryngology-Head and Neck Surgery Ohio State University Wexner Medical Center Columbus Ohio U.S.A
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17
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Goedeke J, Ertl A, Zöller D, Rohleder S, Muensterer OJ. Telemedicine for pediatric surgical outpatient follow-up: A prospective, randomized single-center trial. J Pediatr Surg 2019; 54:200-207. [PMID: 30343977 DOI: 10.1016/j.jpedsurg.2018.10.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Telemedicine is gaining popularity for a variety of indications. We performed a randomized controlled trial comparing telemedical versus conventional clinic follow-up in terms of feasibility and quality. METHODS Patients discharged from pediatric surgery were randomized to telemedical or onsite follow-up. In the telemedical group, video telephony was used to obtain interim history and physical findings. Onsite patients were personally seen in the outpatient clinic. Caregivers completed a postvisit survey on satisfaction and efficiency. Providers scored data transmission quality and clinical interpretability. RESULTS From March 2015 until January 2017, 224 patients were randomized equally to the study groups. Telemedicine was highly accepted by caregivers, and data transmission quality was sufficient for comprehensive follow-up. No important clinical findings were missed. Quality of interaction scored higher in the telemedical versus the onsite group (77.8% vs. 48%, p < 0.001) as did caregiver satisfaction (5.4 vs. 5.1, p < 0.03). Travel investment, time required, loss of earnings, and days off from work/school were all significantly lower in the telemedical group (p < 0.001). CONCLUSIONS Telemedical posthospitalization follow-up in pediatric surgery provides a cost-effective, time-saving alternative for patients and caregivers that is well received and accepted. The quality of clinical data transmission is sufficient to provide safe care and uncompromised clinical judgment. TYPE OF STUDY Prospective and randomized controlled study. LEVEL OF EVIDENCE Level 1b.
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Affiliation(s)
- Jan Goedeke
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Alexandra Ertl
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniela Zöller
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Institute for Medical Biometry and Statistics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stephan Rohleder
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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18
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Saadi R, Goldenberg D, Goldenberg D. Using Technology in Global Otolaryngology. Otolaryngol Clin North Am 2018; 51:555-561. [PMID: 29472013 DOI: 10.1016/j.otc.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Technology is integral to the diverse diagnostics and interventions of Otolaryngology. Historically, major advances in this field derive from advances of associated technologies. Challenges of visualization and surgical access are increasingly overcome by integrating endoscopic, electronic, and robotic instruments. Otolaryngology is often limited to urban areas and large academic centers, making it difficult to allocate care and resources to many underserved populations. The widespread use of technology has important implications in regards to global access to this field as telemedicine is most effectively applied to specialties that are heavily reliant on data and visuals that may be electronically disseminated.
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Affiliation(s)
- Robert Saadi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850 H091, Hershey, PA 17033, USA
| | - Dana Goldenberg
- Tulane University, 6823 Street, Charles Avenue, New Orleans, LA 70118, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850 H091, Hershey, PA 17033, USA.
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19
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Rimmer RA, Christopher V, Falck A, de Azevedo Pribitkin E, Curry JM, Luginbuhl AJ, Cognetti DM. Telemedicine in otolaryngology outpatient setting-single Center Head and Neck Surgery experience. Laryngoscope 2018; 128:2072-2075. [DOI: 10.1002/lary.27123] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Ryan A. Rimmer
- Department of Otolaryngology; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Vanessa Christopher
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Ailsa Falck
- Department of Telemedicine ; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | | | - Joseph M. Curry
- Department of Otolaryngology; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Adam J. Luginbuhl
- Department of Otolaryngology; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - David M. Cognetti
- Department of Otolaryngology; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
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20
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Pozza ED, D'Souza GF, DeLeonibus A, Fabiani B, Gharb BB, Zins JE. Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up. Aesthet Surg J 2017; 38:101-109. [PMID: 29117293 DOI: 10.1093/asj/sjx079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. OBJECTIVES The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? METHODS From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. RESULTS A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. CONCLUSIONS The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Gehaan F D'Souza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Anthony DeLeonibus
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Brianna Fabiani
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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21
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Yulzari R, Bretler S, Avraham Y, Sharabi-Nov A, Even-Tov E, Gilbey P. Mobile Technology-Based Real-Time Teleotolaryngology Care Facilitated by a Nonotolaryngologist Physician in an Adult Population. Ann Otol Rhinol Laryngol 2017; 127:46-50. [PMID: 29182011 DOI: 10.1177/0003489417745089] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Telehealth can improve access to specialist care. Very few reports of the use of smartphones for teleotolaryngology exist. The objective of this study is to evaluate the use of mobile teleotolaryngology facilitated by a nonotolaryngologist physician. METHODS A prospective study in adult patients attending a general otolaryngology outpatient clinic. The telehealth encounter with a remote otolaryngologist was facilitated by a final-year medical student simulating a general physician prior to the scheduled visit. The patient and the remote otolaryngologist rated their satisfaction with the encounter. The remote otolaryngologist formulated a diagnosis and rated the level of certainty of this diagnosis. Diagnoses from the telehealth encounter and the face-to-face encounter were compared. RESULTS Forty-eight patients with an average age of 42.5 years participated in this study. In 79.2% of the consultations, there was concordance between the diagnoses. The average patient and remote otolaryngologist satisfaction with the encounter was 9.5 ± 0.9 and 8.7 ± 1.3, respectively. Twenty-four of the 48 visits (50%) were defined as unnecessary. In the otology group, concordance rates and rates of preventable visits were highest. CONCLUSIONS Synchronous telehealth consultations, facilitated by a general physician, can be an alternative to visiting a general otolaryngology clinic, especially for otologic patients.
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Affiliation(s)
- Raphael Yulzari
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shlomi Bretler
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Yaniv Avraham
- 2 Otolaryngology, Head & Neck Surgery Unit, Ziv Medical Center, Safed, Israel
| | - Adi Sharabi-Nov
- 3 Research Wing, Ziv Medical Center, Safed, Israel and Tel-Hai Academic College, Tel-Hai, Israel
| | - Ella Even-Tov
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,2 Otolaryngology, Head & Neck Surgery Unit, Ziv Medical Center, Safed, Israel
| | - Peter Gilbey
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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22
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Lozada KN, Morton K, Stepan K, Capo J, Chai RL. The clinical impact of bedside fiberoptic laryngoscopic recording on a tertiary consult service. Laryngoscope 2017; 128:818-822. [DOI: 10.1002/lary.26821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/18/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Kirkland N. Lozada
- Department of Otolaryngology; New York Eye and Ear Infirmary of Mount Sinai; New York New York
| | - Kathryn Morton
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York U.S.A
| | - Katelyn Stepan
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York U.S.A
| | - Joseph Capo
- Department of Otolaryngology; New York Eye and Ear Infirmary of Mount Sinai; New York New York
| | - Raymond L. Chai
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York U.S.A
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23
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Son E, Halbert A, Abreu S, Hester R, Jefferson G, Jennings K, Pine H, Watts T. Role of Google Glass in improving patient satisfaction for otolaryngology residents: a pilot study. Clin Otolaryngol 2017; 42:433-438. [PMID: 27992944 DOI: 10.1111/coa.12810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient-physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication-related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. STUDY DESIGN Prospective randomised trial. SETTING Tertiary care hospital. SUBJECT AND METHODS To evaluate the effect on patient satisfaction, five residents were recorded using the Google Glass in an outpatient clinic setting by 50 randomised patients. Modified surveys based on the CG-CAHPS survey were completed by patients at the conclusion of each clinic encounter. The recorded videos were evaluated by two independent faculties. Summarised data and video were distributed to each resident for review as the intervention. The residents were recorded again by 45 additional patients with evaluation by patients and faculties. RESULTS After intervention, the scores from faculty surveys regarding patient satisfaction including the subject of better explanations (P > 0.001), listening carefully (P > 0.001), addressing patient questions (P > 0.001), displaying respect (P > 0.001) and spending adequate time (P = 0.0005) all significantly improved, as well as overall performance (P = 0.014). The scores from patient surveys did significantly improve. CONCLUSION This study demonstrates the improvements in patient satisfaction and patient-physician communication can be achieved with the use of Google Glass as a first-person recording device in the outpatient otolaryngology clinic setting.
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Affiliation(s)
- E Son
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - A Halbert
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - S Abreu
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - R Hester
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - G Jefferson
- Department of Otolaryngology, Head and Neck Surgery, University of Illinois in Chicago, Chicago, IL, USA
| | - K Jennings
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - H Pine
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - T Watts
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
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24
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Beswick DM, Vashi A, Song Y, Pham R, Holsinger FC, Rayl JD, Walker B, Chardos J, Yuan A, Benadam-Lenrow E, Davis D, Sung CK, Divi V, Sirjani DB. Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population. Head Neck 2016; 38:925-9. [PMID: 26899939 DOI: 10.1002/hed.24386] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/26/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit. METHODS Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference. RESULTS Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17-36 days) and 72 (range, 31-108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs. CONCLUSION A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. © 2016 Wiley Periodicals, Inc. Head Neck 38: 925-929, 2016.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Anita Vashi
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Yohan Song
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Rosemary Pham
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - F Chris Holsinger
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - James D Rayl
- Department of Otolaryngology - Head and Neck Surgery, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico
| | - Beth Walker
- Ambulatory Care Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - John Chardos
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Annie Yuan
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Ella Benadam-Lenrow
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Dolores Davis
- Department of Surgery, Central California Veterans Affairs Health Care System, Fresno, California
| | - C Kwang Sung
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Davud B Sirjani
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Telemedicine in Cleft Care: Reliability and Predictability in Regional and International Practice Settings. J Craniofac Surg 2016; 26:1116-20. [PMID: 26010103 DOI: 10.1097/scs.0000000000001560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Regional and international cleft care providers are challenged in their ability to deliver reliable, comprehensive care. Our institution utilizes video teleconferencing to facilitate initial evaluation and postoperative cleft care. This study describes our experience using telemedicine, generates a perioperative treatment algorithm using this technology, and compares cost-utility of telemedicine to in-person ambulatory visits when regional practices are involved. METHODS A 5-year retrospective review of all cleft patients evaluated in an ambulatory setting was conducted. Patient demographics and location, number, and type of telemedicine visits were recorded. Specific treatment algorithms utilizing telemedicine for perioperative care for primary and secondary cleft lip and nasal repair, palatoplasty, and operation for velopharyngeal insufficiency are described. A cost-utility analysis was performed comparing distances between patient homes and primary hub versus telemedicine clinic sites. RESULTS Five hundred nineteen patients were identified; 18.1% attended at least 1 teleconferencing visit. Postoperative follow-up was 100%. The majority of screening, preoperative, and postoperative care was provided using telemedicine. In-person evaluations were performed when intraoral assessments were necessary. Telemedicine visits were associated with an average savings of 239 miles per visit in the United States and 578 miles per visit in Mexico. CONCLUSIONS Video teleconferencing can be used to provide comprehensive regional and international cleft care to facilitate initial evaluations and consistent follow-up. This technology can alleviate the travel burden on families and cleft care providers practicing over a large geographic radius.
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Garritano FG, Goldenberg D. Successful Telemedicine Programs in Otolaryngology. Otolaryngol Clin North Am 2011; 44:1259-74, vii. [DOI: 10.1016/j.otc.2011.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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van der Pol M, McKenzie L. Costs and benefits of tele-endoscopy clinics in a remote location. J Telemed Telecare 2010; 16:89-94. [PMID: 20139140 DOI: 10.1258/jtt.2009.090609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the cost and benefits of tele-endoscopy clinics in a remote location in Scotland. Before the introduction of a tele-endoscopy service, patients whose symptoms suggested possible cancer of the airways had to travel to the mainland (to Aberdeen) to receive an endoscopy. The costs of staff, capital, disposables and travel were estimated for the tele-endoscopy clinic and for the conventional, mainland clinic. The benefits of the two types of clinic were estimated from a sample of the general public using a survey method called the discrete choice experiment. The average cost per patient was lower for the tele-endoscopy clinic (pounds sterling 353) than for the mainland clinic (pounds sterling 381). This was true if more than 27 patients were seen per year. Assuming equal waiting times, individuals preferred the tele-endoscopy clinic to the mainland clinic. The net benefits were larger for tele-endoscopy clinics as long as the additional waiting time was not longer than four weeks. Tele-endoscopy clinics in Shetland are an efficient alternative to conventional practice. The results are sensitive to both economies of scale and scope. The model can readily be applied to mainland communities outside the main population centres in Scotland.
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Dorrian C, Ferguson J, Ah-See K, Barr C, Lalla K, van der Pol M, McKenzie L, Wootton R. Head and neck cancer assessment by flexible endoscopy and telemedicine. J Telemed Telecare 2009; 15:118-21. [PMID: 19364891 DOI: 10.1258/jtt.2009.003004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have conducted a feasibility study to establish whether ENT tele-endoscopy would be a suitable method of service delivery for patients who live in the Shetland Islands. Ten clinics were conducted over a period of 17 months using ISDN-based videoconferencing at a bandwidth of 384 kbit/s. A total of 42 patients were seen in Aberdeen via videoconferencing for a head and neck cancer assessment. Feasibility was confirmed after the first 20 patients, following positive feedback from all concerned and the absence of any significant clinical or technical problems. A total of 42 journeys was avoided, each journey saving 123 kg CO(2) per person. A preliminary cost analysis showed that the threshold at which tele-ENT became cheaper than travel was a workload of 35 patients/year. The actual workload during the pilot study was 29 patients/year. A national telemedicine service for the initial assessment of potential malignancy has the potential to reduce unnecessary transfers to specialist centres, with accompanying reductions in carbon emissions.
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Affiliation(s)
- Cathy Dorrian
- Scottish Centre for Telehealth, Foresterhill Lea, Aberdeen, UK.
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Xu CQ, Smith AC, Scuffham PA, Wootton R. A cost minimisation analysis of a telepaediatric otolaryngology service. BMC Health Serv Res 2008; 8:30. [PMID: 18241356 PMCID: PMC2270267 DOI: 10.1186/1472-6963-8-30] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 02/04/2008] [Indexed: 01/18/2023] Open
Abstract
Background Paediatric ENT services in regional areas can be provided through telemedicine (tele-ENT) using videoconferencing or with a conventional outpatient department ENT service (OPD-ENT) in which patients travel to see the specialist. The objective of this study was to identify the least-cost approach to providing ENT services for paediatric outpatients. Methods A cost-minimisation analysis was conducted comparing the annual costs of the two modes of service provided by the Royal Children's Hospital (RCH) in Brisbane. Activity records were reviewed to analyse volume of activity during a 12 month period in 2005, i.e. number of clinics, duration of clinics, number of consultations via telemedicine and in outpatient clinics, diagnoses, and travel related information. A sensitivity analysis was conducted using factors where there was some uncertainty or potential future variation. Results During the study period, 88 ENT consultations were conducted via videoconference for 70 patients at Bundaberg Base Hospital. 177 ENT consultations were conducted at the RCH for 117 patients who had travelled from the Bundaberg region to Brisbane. The variable cost of providing the tele-ENT service was A$108 per consultation, compared with A$155 per consultation for the conventional outpatient service. Telemedicine was cheaper when the workload exceeded 100 consultations per year. If all 265 consultations were conducted as tele-ENT consultations, the cost-savings would be $7,621. Conclusion The cost-minimisation analysis demonstrated that under the circumstances described in this paper, the tele-ENT service was a more economical method for the health department of providing specialist ENT services.
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Affiliation(s)
- Cathy Q Xu
- Centre for Online Health, University of Queensland, Level 3 Foundation Building, Royal Children's Hospital, Herston, Queensland 4029, Australia.
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Eikelboom RH, Mbao MN, Coates HL, Atlas MD, Gallop MA. Validation of tele-otology to diagnose ear disease in children. Int J Pediatr Otorhinolaryngol 2005; 69:739-44. [PMID: 15885325 DOI: 10.1016/j.ijporl.2004.12.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 12/20/2004] [Accepted: 12/24/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if digitised still eardrum images, with a clinical history, and audiometry and tympanometry data provide sufficient information to an ear specialist to make an assessment of a patient. METHODS 66 children (9 months to 16 years) from remote communities were assessed by an ear specialist by standard otoscopy, using a clinical history, audiometry and tympanometry. Up to five images of each ear were digitised. At a later date, the ear specialist made observations, diagnoses and recommendations for management from the images and clinical data. RESULTS There was a significant correlation (p<0.01) between image quality and age of the subject. There were significant agreements for the clinically important observations of otorrhea, perforation, retracted tympanic membrane and atrophy of the tympanic membrane (p<0.05). There were significant agreements for the diagnoses of acute otitis media, chronic suppurative otitis media, otitis media with effusion and Eustachian tube dysfunction. The rate of recommendations for review or referral after a tele-otology assessment were between 4 and 16% higher than those in made in the field. The agreements between the various forms of advice or recommendations made in the field to those made by tele-otology were statistically significant (p<0.01). CONCLUSIONS A tele-otology system that incorporates good quality digitised images of the tympanic membrane, audiological and tympanometric data, and a comprehensive clinical history provides the ear specialist with sufficient information to make a confident diagnose of existing middle ear disease, and provide management advice to the patients' primary care provider.
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Affiliation(s)
- Robert H Eikelboom
- Lions Ear and Hearing Institute, Grd Flr E-Block, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
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Patricoski C, Kokesh J, Ferguson AS, Koller K, Zwack G, Provost E, Holck P. A comparison of in-person examination and video otoscope imaging for tympanostomy tube follow-up. Telemed J E Health 2004; 9:331-44. [PMID: 14980090 DOI: 10.1089/153056203772744653] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective of this study was to determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination. Forty patients having undergone tympanostomy tube placement in both ears were independently examined in-person by two otolaryngologists and imaged using a video otoscope and telemedicine software package. The two physicians later reviewed images at 6 and 12 weeks. Physical examination findings and diagnosis were documented and compared for their concordance using kappa statistics. For both physicians, the intraprovider concordance between the in-person examination and the corresponding image review was high for each of the physical examination findings: Tube In 93-94% (K 0.85-0.87), Tube Patent 86-93% (K 0.74-0.85), Drainage 94-98% (K 0.42-0.66), Perforation 85-98% (K 0.40-0.84), Granulation 95-99% (K -0.01 to 0.00), Middle Ear Fluid 89-91% (K -0.03 to 0.50), and Retracted 89-94% (K 0.13-0.43). These agreement rates are similar to the normal interprovider concordance observed when two physicians independently examined the same patient in-person for physical exam findings: Tube In 96% (K 0.93), Tube Patent 94% (K 0.88), Drainage 96% (K 0.56), Perforation 90% (K 0.60), Granulation 96% (K 0.39), Middle Ear Fluid 88% (K 0.14), and Retracted 91% (K 0.43). For both physicians, the intraprovider diagnostic concordance between the in-person examination and the corresponding image review was high 79-85% (K 0.67-0.76). The interprovider diagnostic concordance for the in-person exam was 88% (K 0.81). The interprovider diagnostic concordance when two physicians independently reviewed all images was 84% (K 0.74), and 89% (K 0.80) when poor images were excluded. This study demonstrates that physician review of video otoscope images is comparable to an in-person microscopic examination. Store-and-forward video otoscopy may be an acceptable method of following patients post-tympanostomy tube placement.
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Affiliation(s)
- Chris Patricoski
- Alaska Federal Health Care Access Network, Anchorage, Alaska, USA.
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Sclafani AP. Telemedicine in plastic surgery. Plast Reconstr Surg 2003; 112:936. [PMID: 12960903 DOI: 10.1097/01.prs.0000074503.05570.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Melcer T, Hunsaker D, Crann B, Caola L, Deniston W. A prospective evaluation of ENT telemedicine in remote military populations seeking specialty care. Telemed J E Health 2003; 8:301-11. [PMID: 12419024 DOI: 10.1089/15305620260353199] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study evaluated telemedicine use in remote military treatment facilities (MTFs) ashore over a 4-month period to help guide telemedicine applications for shipboard medical departments. A prospective study design was used to evaluate specialty care provided by an ear/nose/throat (ENT) physician via videoconferencing (VC) for patients at remote MTFs in TRICARE Region 9. The study provided a complete and continuous sample of ENT consultations during a planned 4-month period. Data sources included a telemedicine database and telephone interviews to assess attitudes of physician and nonphysician medical personnel. A total of 193 VC consultations (hereafter referred to as teleconsultations) were conducted following referrals from primary providers. Patients were mostly young, male, active-duty personnel. Forty-five percent of the 193 teleconsultations resulted in changed diagnosis by the ENT specialist relative to initial diagnosis by the referring provider. This rate of clinical impact was substantial, and it generalized across various ENT conditions, demographics, and MTFs. Medical personnel reported generally positive attitudes about telemedicine technologies and the telemedicine process in TRICARE Region 9. Nonphysician providers reported slightly more favorable attitudes compared to physicians. These results suggest that ENT telemedicine has substantial clinical impact in the military populations treated at MTFs. A high rate of changed diagnoses (45%) was observed across age, gender, military status, ENT conditions, and treatment facilities. Medical personnel reported positive attitudes about using the telemedicine system. These results support the use of telemedicine in shipboard medical departments.
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Affiliation(s)
- Ted Melcer
- Naval Health Research Center, Field Medical Technologies, San Diego, California 92186-5122, USA.
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Eikelboom RH, Atlas MD, Mbao MN, Gallop M. Tele-otology: planning, design, development and implementation. J Telemed Telecare 2002; 8 Suppl 3:14-17. [PMID: 12537892 DOI: 10.1258/13576330260440718] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The view of the tympanic membrane of the ear provides the specialist with important information for the assessment of ear disease and for treatment planning. In rural and remote areas, the incidence of ear disease is high but access to ear specialists is limited. As part of a project to deliver tele-otoscopy services to remote Western Australia, we have investigated various aspects of a tele-otoscopy system. We found that the MedRX video-otoscope is relatively safe to use and produces images of very good quality. A confident diagnosis could be made from still images compressed to 20 kByte. Video sequences could be compressed to a ratio of 1:300. Furthermore, a software package has been developed, and we are developing a training course for health-care workers in remote areas.
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Affiliation(s)
- Robert H Eikelboom
- Lions Ear and Hearing Institute, and Otolaryngology Department, University of Western Australia, Australia
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Abstract
More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious. Examples in otolaryngology might include images of the larynx manipulated to better demonstrate the inflamed tissue of reflux, or images of the tympanic membrane manipulated to better demonstrate early retraction. Despite dramatic and likely continued decreases, equipment cost is still an issue. Current research points to good consumer acceptance, and certainly with each new generation the technology is more readily accepted. As Nesbitt [4] points out, it is certainly not difficult to look to the future and see ubiquitous broadband with video as common as telephone, or even extreme broadband enabling robotics and virtual reality TV with three-dimensional touch. Robotics and genomics will eventually play a greater role in telemedicine and our lives in general. Applications for remote diagnosis in biologic warfare defense and homeland security are currently raising interest in telemedicine. Telemedicine will be combined with new technological advances such as virtual "fly-through" computerized axial tomography examinations. Instead of performing an exploratory tympanotomy, surgeons will use computer programs to "fly through" and examine all aspects of a patient's middle or even inner ear. Spectral imaging of the eardrum, larynx, or oropharynx will immediately identify bacteria without cultures, or gram stain, and potential malignancy without biopsy. By measuring fluorescence emitted from an oropharynx illuminated with a specific visible or nonvisible light spectrum, spectral imaging will be able to provide instant identification of bacteria or evidence of malignant changes. The underlying principles of a successful business model must continue to be applied, with the most critical ingredient for telemedicine's success being the filling of specific health care needs. As long as the need is there, telemedicine in otolaryngology will advance.
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Affiliation(s)
- Michael R Holtel
- USN Otolaryngology-Head and Neck Surgery, 1 Jarrett-White Road, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA.
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Cross SS, Dennis T, Start RD. Telepathology: current status and future prospects in diagnostic histopathology. Histopathology 2002; 41:91-109. [PMID: 12147086 DOI: 10.1046/j.1365-2559.2002.01423.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Telepathology is the process of diagnostic histopathology performed on digital images viewed on a display screen rather than by conventional glass slide light microscopy. The technology of telepathology has radically improved over the past 5 years so that it is no longer the limiting factor in the diagnostic process. This review looks at the resources needed for dynamic and static telepathology, including image quality, computers and software interfaces, means of transmission and human resources. It critically analyses 32 published trials of telepathology, including some large prospective studies, in all areas of diagnostic histopathology including intraoperative frozen sections, routine and referral cases. New developments, including internet solutions and virtual microscopy, are described and there is analysis of the economics of telepathology within health care systems. The review concludes that all the necessary technology for telepathology is available, there is strong published evidence for a diagnostic accuracy comparable with glass slide diagnosis, in many contexts there is a clear-cut economic argument in favour of telepathology, and that the technique should now be integrated into mainstream diagnostic histopathology.
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Affiliation(s)
- S S Cross
- Digital Pathology Research Group, Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, School of Medicine and Bioscience, University of Sheffield, South Yorkshire, UK.
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Krupinski E, Nypaver M, Poropatich R, Ellis D, Safwat R, Sapci H. Telemedicine/telehealth: an international perspective. Clinical applications in telemedicine/telehealth. Telemed J E Health 2002; 8:13-34. [PMID: 12020403 DOI: 10.1089/15305620252933374] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Abstract
In this study, telemedicine and the use of advanced telemedicine technologies are explained. Telemedicine is the use of modern telecommunications and information technologies for the provision of clinical care to individuals at a distance, and transmission of information to provide that care. Telemedicine can be used for decision making, remote sensing, and collaborative arrangements for the real-time management of patients at a distance. The use of telecommunications and information technologies in providing health services is determined. Telemedicine is described as combination of topics from the fields of telecommunication, medicine, and informatics. The medical systems infrastructure consisting of the equipment and processes used to acquire and present clinical information and to store and retrieve data are explained in details. The challenges existing in telemedicine development in different countries are given. Technological, political, and professional barriers in applications of telemedicine are defined. An investigation of telemedicine applications in various fields is presented, and enormous impact of telemedicine systems on the future of medicine is determined.
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Affiliation(s)
- Nihal Fatma Güler
- Department of Electronics and Computer Education, Faculty of Technical Education, Gazi University, Ankara, Turkey.
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Abstract
BACKGROUND Telemedicine (TM) is the use of advanced information and communication technology to provide health care services. TM in general, and specifically in the field of otolaryngology, has become a reality. Because of the improvements in telecommunications and computer technology, TM applications are becoming more common in both hospitals and private practice. These applications are altering the manner in which otolaryngology is practiced both at the primary care and the specialist level. This study reviews and summarizes the use of TM specifically in otolaryngology, and discusses some of its advantages, barriers, and future. MATERIAL AND METHODS A review of the current literature pertaining to the use of TM applications in otolaryngology-head and neck surgery was performed. RESULTS TM applications are being developed and used worldwide in the many fields of otolaryngology. As telecommunication and audio-visual technologies advance, these applications become more exacting and cost effective. CONCLUSION We encourage the otolaryngologist to understand the technical, legal, ethical, and financial impact of TM on managed care in otolaryngology and to make use of the potential opportunities of TM in otolaryngology-head and neck surgery.
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Affiliation(s)
- David Goldenberg
- Galil Center for Telemedicine and Medical Informatics, Technion Institute of Technology Faculty of Medicine, 32 Freud St., Haifa, 34753 Israel
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