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Wick J, Le H, Wick K, Peddada K, Bacon A, Han G, Carroll T, Swinford S, Javidan Y, Roberto R, Martin A, Ebinu J, Kim K, Klineberg E. Patient Characteristics, Injury Types, and Costs Associated with Secondary Over-Triage of Isolated Cervical Spine Fractures. Spine (Phila Pa 1976) 2022; 47:414-422. [PMID: 34366413 DOI: 10.1097/brs.0000000000004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To aim of this study was to identify patient variables, injury characteristics, and costs associated with operative and non-operative treatment following inter-facility transfer of patients with isolated cervical spine fractures. SUMMARY OF BACKGROUND DATA Patients with isolated cervical spine fractures are subject to inter-facility transfer for surgical assessment, yet are often treated nonoperatively. The American College of Surgeons' benchmark rate of "secondary over-triage" is <50%. Identifying patient and injury characteristics as well as costs associated with treatment following transfer of patients with isolated cervical spine fractures may help reduce rates of secondary over-triage and healthcare expenditures. METHODS Patients transferred to a Level-1 trauma center with isolated cervical spine fractures between January 2015 and September 2020 were identified. Patient demographics, comorbidities, insurance data, injury characteristics, imaging workup, treatment, and financial data were collected for all patients. Multivariable logistic regression models were constructed to identify patient and injury characteristics associated with surgical treatment. RESULTS Nearly 75% of patients were treated non-operatively. Over 97% of transfers were accepted by the general surgery trauma service. Multivariable modeling found that higher BMI, presence of any neurologic deficit including spinal cord or isolated spinal nerve root injuries, present smoking status, or cervical spine magnetic resonance imaging obtained post-transfer, were associated with surgical treatment for isolated cervical spine fractures. Among patients with type II dens fractures, increased fracture displacement was associated with surgical treatment. Median charges to patients treated operatively and nonoperatively were $380,890 and $90,734, respectively. Median hospital expenditures for patients treated operatively and nonoperatively were $55,115 and $12,131, respectively. CONCLUSION A large proportion of patients with isolated cervical spine fractures are subject to over-triage. Injury characteristics are important for determining need for surgical treatment, and therefore interfacility transfer. Improving communication with spine surgeons when deciding to transfer patients may significantly reduce health care costs and resource use.Level of Evidence: 4.
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Affiliation(s)
- Joseph Wick
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Hai Le
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Katherine Wick
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Kranti Peddada
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Adam Bacon
- University of California Davis School of Medicine, Sacramento, CA
| | - Gloria Han
- University of California Davis School of Medicine, Sacramento, CA
| | - Trevor Carroll
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Steven Swinford
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Yashar Javidan
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Rolando Roberto
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Allan Martin
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Julius Ebinu
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Kee Kim
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
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Reliability and Effectiveness of Smartphone Technology for the Diagnosis and Treatment Planning of Pediatric Elbow Trauma. J Pediatr Orthop 2017; 36:483-7. [PMID: 25851688 DOI: 10.1097/bpo.0000000000000477] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mobile imaging, such as viewing radiographs as text messages, is increasingly prevalent in clinical settings. The purpose of this study was to determine whether remote diagnosis of pediatric elbow fractures using smartphone technology is reliable. In addition, this study aimed to determine whether the assessment regarding the decision for operative treatment is affected by evaluation of images on a mobile device as opposed to standard picture archiving and communication system (PACS). METHODS Standard anteroposterior and lateral radiographs of 50 pediatric elbow trauma cases were evaluated by 2 fellowship-trained pediatric orthopaedic surgeons and 2 senior orthopaedic residents. Raters were asked to classify the case as any of 6 diagnoses: supracondylar humerus, lateral condyle, medial epicondyle, radial neck fracture, positive posterior fat pad sign, or normal pediatric elbow. Raters were asked to choose operative or conservative treatment. After 1 week, photographs of the same images were taken from a standardized distance from a computer monitor with an iPhone 5 camera and transmitted by multimedia messaging to each rater. The same questions were again posed to raters. Interobserver and intraobserver reliabilities were calculated by Cohen κ-statistics with bootstrapped 95% confidence intervals. RESULTS Intraobserver reliability of classification of injuries on PACS compared with smartphone images was excellent, with an overall κ of 0.91. Treatment decision also demonstrated excellent intraobserver reliability (PACS vs. smartphones) with a κ of 0.86 for all raters. CONCLUSIONS Diagnosis of pediatric elbow injuries can be made equally reliably based on either PACS or transmitted multimedia messaging images taken with an iPhone camera from a computer screen and viewed on a smartphone. Treatment decisions can also be made reliably based on either image modality. CLINICAL RELEVANCE Using smartphones to transmit and display radiographs, which is common in current clinical practice, is effective and reliable for diagnosis and treatment planning of pediatric elbow injuries.
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Stahl I, Dreyfuss D, Ofir D, Merom L, Raichel M, Hous N, Norman D, Haddad E. Reliability of smartphone-based teleradiology for evaluating thoracolumbar spine fractures. Spine J 2017; 17:161-167. [PMID: 27542623 DOI: 10.1016/j.spinee.2016.08.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/20/2016] [Accepted: 08/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Timely interpretation of computed tomography (CT) scans is of paramount importance in diagnosing and managing spinal column fractures, which can be devastating. Out-of-hospital, on-call spine surgeons are often asked to evaluate CT scans of patients who have sustained trauma to the thoracolumbar spine to make diagnosis and to determine the appropriate course of urgent treatment. Capturing radiographic scans and video clips from computer screens and sending them as instant messages have become common means of communication between physicians, aiding in triaging and transfer decision-making in orthopedic and neurosurgical emergencies. PURPOSE The present study aimed to compare the reliability of interpreting CT scans viewed by orthopedic surgeons in two ways for diagnosing, classifying, and treatment planning for thoracolumbar spine fractures: (1) captured as video clips from standard workstation-based picture archiving and communication system (PACS) and sent via a smartphone-based instant messaging application for viewing on a smartphone; and (2) viewed directly on a PACS. STUDY DESIGN Reliability and agreement study. PATIENT SAMPLE Thirty adults with thoracolumbar spine fractures who had been consecutively admitted to the Division of Orthopedic Surgery of a Level I trauma center during 2014. OUTCOME MEASURE Intraobserver agreement. METHODS CT scans were captured by use of an iPhone 6 smartphone from a computer screen displaying PACS. Then by use of the WhatsApp instant messaging application, video clips of the scans were sent to the personal smartphones of five spine surgeons. These evaluators were asked to diagnose, classify, and determine the course of treatment for each case. Evaluation of the cases was repeated 4 weeks later, this time using the standard method of workstation-based PACS. Intraobserver agreement was interpreted based on the value of Cohen's kappa statistic. The study did not receive any outside funding. RESULTS Intraobserver agreement for determining fracture level was near perfect (κ=0.94). Intraobserver agreement for AO classification, proposed treatment, neural canal penetration, and Denis classification were substantial (κ values, 0.75, 0.73, 0.71, and 0.69, respectively). Intraobserver agreement for loss of vertebral height and kyphosis were moderate (κ values, 0.55 and 0.45, respectively) CONCLUSIONS: Video clips of CT scans can be readily captured by a smartphone from a workstation-based PACS and then transmitted by use of the WhatsApp instant messaging application. Diagnosing, classifying, and proposing treatment of fractures of the thoracic and lumbar spine can be made with equal reliability by evaluating video clips of CT scans transmitted to a smartphone or by the standard method of viewing the CT scan on a workstation-based PACS. Evaluating video clips of CT scans transmitted to a smartphone is a readily accessible, simple, and inexpensive method. We believe that it can be reliably used for consultations between the emergency physicians or orthopedic or neurosurgical residents with offsite, on-call specialists. It might also enable rural orcommunity emergency department physicians to communicate more efficiently and effectively with surgeons in tertiary referral centers.
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Affiliation(s)
- Ido Stahl
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel.
| | - Daniel Dreyfuss
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel
| | - Dror Ofir
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel
| | - Lior Merom
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel
| | - Michael Raichel
- Division of Orthopedics, Emek Medical Center, 21 Yitzhak Rabin Blvd, POB 1834111, Afula, Israel
| | - Nir Hous
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel
| | - Doron Norman
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel
| | - Elias Haddad
- Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel
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Kim C, Kang B, Choi HJ, Park JB. A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone. J Digit Imaging 2016; 28:399-406. [PMID: 25700617 DOI: 10.1007/s10278-015-9775-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro(st), Guri-si, Gyeonggi-do, 471-701, Republic of Korea
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Chen Y, James JJ, Turnbull AE, Gale AG. The use of lower resolution viewing devices for mammographic interpretation: implications for education and training. Eur Radiol 2015; 25:3003-8. [PMID: 26037712 DOI: 10.1007/s00330-015-3718-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Abstract
AIMS To establish whether lower resolution, lower cost viewing devices have the potential to deliver mammographic interpretation training. METHODS On three occasions over eight months, fourteen consultant radiologists and reporting radiographers read forty challenging digital mammography screening cases on three different displays: a digital mammography workstation, a standard LCD monitor, and a smartphone. Standard image manipulation software was available for use on all three devices. Receiver operating characteristic (ROC) analysis and ANOVA (Analysis of Variance) were used to determine the significance of differences in performance between the viewing devices with/without the application of image manipulation software. The effect of reader's experience was also assessed. RESULTS Performance was significantly higher (p < .05) on the mammography workstation compared to the other two viewing devices. When image manipulation software was applied to images viewed on the standard LCD monitor, performance improved to mirror levels seen on the mammography workstation with no significant difference between the two. Image interpretation on the smartphone was uniformly poor. Film reader experience had no significant effect on performance across all three viewing devices. CONCLUSION Lower resolution standard LCD monitors combined with appropriate image manipulation software are capable of displaying mammographic pathology, and are potentially suitable for delivering mammographic interpretation training. KEY POINTS • This study investigates potential devices for training in mammography interpretation. • Lower resolution standard LCD monitors are potentially suitable for mammographic interpretation training. • The effect of image manipulation tools on mammography workstation viewing is insignificant. • Reader experience had no significant effect on performance in all viewing devices. • Smart phones are not suitable for displaying mammograms.
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Affiliation(s)
- Yan Chen
- PERFORMS, Department of Computer Science, Loughborough University, Loughborough, UK,
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Krupinski EA. Telemedicine Workplace Environments: Designing for Success. Healthcare (Basel) 2014; 2:115-22. [PMID: 27429263 PMCID: PMC4934497 DOI: 10.3390/healthcare2010115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 11/16/2022] Open
Abstract
When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based practice and centered more in the home than it is now, it is still very important to consider ways to optimize the design of clinic-based telemedicine facilities. This is true on both ends of a consultation—where the patient is and where the consultant is. On the patient side, the first thing to realize is that most telemedicine clinics are not going to be newly designed and built. In all likelihood they will be existing rooms converted to telemedicine clinic rooms. Quite often the former room will not even have been used for clinical purposes, but may have simply been a storage area cleared out for telemedicine use. Therefore, design is often a challenge but there are a few basic principles that can be followed to create a workable clinical space. This paper will review some of the basic human factors principles to take into account when designing a working telemedicine environment.
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Affiliation(s)
- Elizabeth A Krupinski
- Department of Medical Imaging & Arizona Telemedicine Program, University of Arizona, 1609 N Warren Bldg 211, Tucson, AZ 85724, USA.
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Krupinski EA. Human Factors and Human-Computer Considerations in Teleradiology and Telepathology. Healthcare (Basel) 2014; 2:94-114. [PMID: 27429262 PMCID: PMC4934496 DOI: 10.3390/healthcare2010094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 11/24/2022] Open
Abstract
Radiology and pathology are unique among other clinical specialties that incorporate telemedicine technologies into clinical practice, as, for the most part in traditional practice, there are few or no direct patient encounters. The majority of teleradiology and telepathology involves viewing images, which is exactly what occurs without the "tele" component. The images used are generally quite large, require dedicated displays and software for viewing, and present challenges to the clinician who must navigate through the presented data to render a diagnostic decision or interpretation. This digital viewing environment is very different from the more traditional reading environment (i.e., film and microscopy), necessitating a new look at how to optimize reading environments and address human factors issues. This paper will review some of the key components that need to be optimized for effective and efficient practice of teleradiology and telepathology using traditional workstations as well as some of the newer mobile viewing applications.
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Affiliation(s)
- Elizabeth A Krupinski
- Department of Medical Imaging & Arizona Telemedicine Program, University of Arizona, 1609 N Warren Bldg 211, Tucson, AZ 85724, USA.
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Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform 2014; 5:229. [PMID: 24683442 PMCID: PMC3959919 DOI: 10.5210/ojphi.v5i3.4814] [Citation(s) in RCA: 232] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This paper examines the state of the art in mobile clinical and health-related apps. A 2012
estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals
and consumers continue to express concerns about the quality of many apps, calling for some form of
app regulatory control or certification to be put in place. We describe the range of apps on offer
as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps
that have been conducted to date, covering a range of clinical disciplines and topics. Our survey
includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps.
We discuss the concept of ‘apps as a medical device’ and the relevant regulatory
controls that apply in USA and Europe, offering examples of apps that have been formally approved
using these mechanisms. We describe the online Health Apps Library run by the National Health
Service in England and the calls for a vetted medical and health app store. We discuss the
ingredients for successful apps beyond the rather narrow definition of ‘apps as a medical
device’. These ingredients cover app content quality, usability, the need to match apps to
consumers’ general and health literacy levels, device connectivity standards (for apps that
connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy.
‘Happtique Health App Certification Program’ (HACP), a voluntary app certification
scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the
US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many
“similar” quality benchmarking tools and codes of conduct for information publishers
were proposed to appraise and rate online medical and health information. It is probably impossible
to rate and police every app on offer today, much like in those early days of the Web, when people
quickly realised the same regarding informational Web pages. The best first line of defence was, is,
and will always be to educate consumers regarding the potentially harmful content of (some)
apps.
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Shivapathasundram G, Heckelmann M, Sheridan M. Using smart phone video to supplement communication of radiology imaging in a neurosurgical unit: technical note. Neurol Res 2013; 34:318-20. [DOI: 10.1179/1743132812y.0000000006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
| | | | - Mark Sheridan
- Department of NeurosurgeryLiverpool Hospital, NSW, Australia
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The iPad tablet computer for mobile on-call radiology diagnosis? Auditing discrepancy in CT and MRI reporting. J Digit Imaging 2013; 25:628-34. [PMID: 22562174 DOI: 10.1007/s10278-012-9485-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Tablet computers such as the iPad, which have a large format, improved graphic display resolution and a touch screen interface, may have an advantage compared to existing mobile devices such as smartphones and laptops for viewing radiological images. We assessed their potential for emergency radiology teleconsultation by reviewing multi-image CT and MRI studies on iPad tablet computers compared to Picture Archival and Communication Systems (PACS) workstations. Annonymised DICOM images of 79 CT and nine MRI studies comprising a range of common on-call conditions, reported on full-featured diagnostic PACS workstation by one Reporting Radiologist, were transferred from PACS to three iPad tablet computers running OsiriX HD v 2.02 DICOM software and viewed independently by three reviewing radiologists. Structured documentation was made of major findings (primary diagnosis or other clinically important findings), minor findings (incidental findings), and user feedback. Two hundred and sixty four readings (88 studies read by three reviewing radiologists) were compared, with 3.4 % (nine of 264) major discrepancies and 5.6 % (15 of 264) minor discrepancies. All reviewing radiologists reported favorable user experience but noted issues with software stability and limitations of image manipulation tools. Our results suggest that emergency conditions commonly encountered on CT and MRI can be diagnosed using tablet computers with good agreement with dedicated PACS workstations. Shortcomings in software and application design should be addressed if the potential of tablet computers for mobile teleradiology is to be fully realized.
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Payne KFB, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC Med Inform Decis Mak 2012; 12:121. [PMID: 23110712 PMCID: PMC3504572 DOI: 10.1186/1472-6947-12-121] [Citation(s) in RCA: 317] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 10/26/2012] [Indexed: 11/27/2022] Open
Abstract
Background Smartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps) has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors. Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations. Methods An online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants’ views on apps that were desired or recommended and the characteristics of apps that were useful. Results 257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257) of medical students and 74.8% (n=98/131) of junior doctors owned a smartphone, with 56.6% (n=115/203) of students and 68.4% (n=67/98) of doctors owning an iPhone. The majority of students and doctors owned 1–5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p<0.001). Both populations showed similar trends of app usage of several times a day. Over 24hours apps were used for between 1–30 minutes for students and 1–20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps. Conclusions This study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice.
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Lamirel C, Bruce BB, Wright DW, Newman NJ, Biousse V. Nonmydriatic digital ocular fundus photography on the iPhone 3G: the FOTO-ED study. ACTA ACUST UNITED AC 2012; 130:939-40. [PMID: 22776940 DOI: 10.1001/archophthalmol.2011.2488] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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McNulty JP, Ryan JT, Evanoff MG, Rainford LA. Flexible image evaluation: iPad versus secondary-class monitors for review of MR spinal emergency cases, a comparative study. Acad Radiol 2012; 19:1023-8. [PMID: 22503894 DOI: 10.1016/j.acra.2012.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES Studies have highlighted the potential of handheld viewing devices for rapid diagnosis and increased smartphone usage among physicians and radiologists is known as is the clinical applicability of hand-held devices for computed tomography (CT) spinal injury cases. Magnetic resonance (MR), however, is the accepted gold standard for spinal imaging, providing visualization of both ligament and spinal cord pathology. This study investigated the diagnostic accuracy of the iPad, the most probable alternative display device outside the radiology environment and financially viable alternative, when reviewing emergency spinal MR images, in comparison with secondary-class LCD devices in the case of the interpretation of CT and MR imaging examinations. MATERIALS AND METHODS In total 31 MR cases including both positives (n = 13) containing one of four possible presentations: spinal cord compression, cauda equine syndrome, spinal cord hemorrhage, or spinal cord edema and controls (n = 18) were reviewed. Ziltron iPad software facilitated the display of cases and the receiver operating characteristic (ROC) analysis. Thirteen American Board of Radiology board-certified radiologists reviewed all cases on both displays. Standardized viewing conditions were maintained. RESULTS Dorfman-Berbaum-Metz multireader-multicase (DBM MRMC) analysis was performed including random readers/random cases, fixed readers/random cases and random readers/fixed cases. No differences of statistical significance (P ≤ .05) could be found in terms of area under the curve, sensitivity and specificity between the iPad and secondary-class display. CONCLUSION The iPad performed with equal diagnostic accuracy when compared with the secondary-class LCD device after DBM MRMC analysis, demonstrating the iPad as an option to aid initial review of MR spinal emergency cases.
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Affiliation(s)
- Jonathan P McNulty
- Diagnostic Imaging, School of Medicine and Medical Science, Health Science Centre, University College Dublin, Belfield, Ireland.
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Lewis ER, Thomas CA, Wilson ML, Mbarika VWA. Telemedicine in acute-phase injury management: a review of practice and advancements. Telemed J E Health 2012; 18:434-45. [PMID: 22694296 DOI: 10.1089/tmj.2011.0199] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To offer a systematic review of the body of literature in the emerging field of telemedicine in the management of acute-phase injuries. MATERIALS AND METHODS We conducted a literature review. RESULTS Telemedicine has only recently been applied to the specialties of trauma, emergency care, and surgery. The potential benefits of telemedicine include a decrease in travel expenses, enhanced continuity of care, and increased access to specialized consultants in medically underserved and rural areas. CONCLUSIONS There still exist barriers to the use of teletechnologies in medicine that limit their wider adoption. Poor infrastructure, limited equipment availability, and insufficient access to training and education for medical personnel have prevented wider use.
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Wallace D, Hussain A, Khan N, Wilson Y. A systematic review of the evidence for telemedicine in burn care: With a UK perspective. Burns 2012; 38:465-80. [DOI: 10.1016/j.burns.2011.09.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/18/2011] [Accepted: 09/21/2011] [Indexed: 01/18/2023]
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Abstract
PURPOSE The purpose of our study was to demonstrate the feasibility of sending uncompressed digital mammograms in a teleradiologic setting without loss of information by comparing image quality, lesion detection, and BI-RADS assessment. MATERIALS AND METHODS CDMAM phantoms were sent bidirectionally to two hospitals via the network. For the clinical aspect of the study, 200 patients were selected based on the BI-RAD system: 50% BI-RADS I and II; and 50% BI-RADS IV and V. Two hundred digital mammograms (800 views) were sent to two different institutions via a teleradiology network. Three readers evaluated those 200 mammography studies at institution 1 where the images originated, and in the two other institutions (institutions 2 and 3) where the images were sent. The readers assessed image quality, lesion detection, and BI-RADS classification. RESULTS Automatic readout showed that CDMAM image quality was identical before and after transmission. The image quality of the 200 studies (total 600 mammograms) was rated as very good or good in 90-97% before and after transmission. Depending on the institution and the reader, only 2.5-9.5% of all studies were rated as poor. The congruence of the readers with respect to the final BI-RADS assessment ranged from 90% and 91% at institution 1 vs. institution 2, and from 86% to 92% at institution 1 vs. institution 3. The agreement was even higher for conformity of content (BI-RADS I or II and BI-RADS IV or V). Reader agreement in the three different institutions with regard to the detection of masses and calcifications, as well as BI-RADS classification, was very good (κ: 0.775-0.884). Results for interreader agreement were similar. CONCLUSION Uncompressed digital mammograms can be transmitted to different institutions with different workstations, without loss of information. The transmission process does not significantly influence image quality, lesion detection, or BI-RADS rating.
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Choi HJ, Lee JH, Kang BS. Remote CT reading using an ultramobile PC and web-based remote viewing over a wireless network. J Telemed Telecare 2011; 18:26-31. [PMID: 22067287 DOI: 10.1258/jtt.2011.110412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We developed a new type of mobile teleradiology system using an ultramobile PC (UMPC) for web-based remote viewing over a wireless network. We assessed the diagnostic performance of this system for abdominal CT interpretation. Performance was compared with an emergency department clinical monitor using a DICOM viewer. A total of 100 abdominal CT examinations were presented to four observers. There were 56 examinations showing appendicitis and 44 which were normal. The observers viewed the images using a UMPC display and an LCD monitor and rated each examination on a five-point scale. Receiver operating characteristics (ROC) analysis was used to test for differences. The sensitivity and specificities of all observers were similarly high. The average area under the ROC curve for readings performed on the UMPC and the LCD monitor was 0.959 and 0.976, respectively. There were no significant differences between the two display systems for interpreting abdominal CTs. The web-based mobile teleradiology system appears to be feasible for reading abdominal CTs for diagnosing appendicitis and may be valuable in emergency teleconsultation.
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Affiliation(s)
- Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Gyunggi, Korea
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19
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Shergill I, Mohammed A. Teleradiology: 21st century communication in surgery. Br J Hosp Med (Lond) 2011; 72:271-4. [PMID: 21647042 DOI: 10.12968/hmed.2011.72.5.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Iqbal Shergill
- Department of Urology, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
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