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Padovani P, Singh Y, Pass RH, Vasile CM, Nield LE, Baruteau AE. E-Health: A Game Changer in Fetal and Neonatal Cardiology? J Clin Med 2023; 12:6865. [PMID: 37959330 PMCID: PMC10650296 DOI: 10.3390/jcm12216865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements have greatly impacted the healthcare industry, including the integration of e-health in pediatric cardiology. The use of telemedicine, mobile health applications, and electronic health records have demonstrated a significant potential to improve patient outcomes, reduce healthcare costs, and enhance the quality of care. Telemedicine provides a useful tool for remote clinics, follow-up visits, and monitoring for infants with congenital heart disease, while mobile health applications enhance patient and parents' education, medication compliance, and in some instances, remote monitoring of vital signs. Despite the benefits of e-health, there are potential limitations and challenges, such as issues related to availability, cost-effectiveness, data privacy and security, and the potential ethical, legal, and social implications of e-health interventions. In this review, we aim to highlight the current application and perspectives of e-health in the field of fetal and neonatal cardiology, including expert parents' opinions.
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Affiliation(s)
- Paul Padovani
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert H. Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children’s Hospital, New York, NY 10029, USA;
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France;
| | - Lynne E. Nield
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A1, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alban-Elouen Baruteau
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
- CHU Nantes, CNRS, INSERM, L’Institut du Thorax, Nantes Université, 44000 Nantes, France
- INRAE, UMR 1280, PhAN, Nantes Université, 44000 Nantes, France
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Meiman J, Zhang C, Holland B. Use of fetal tele-echo at small regional hospitals increases the rate of prenatal diagnosis of congenital heart disease. Prenat Diagn 2022; 42:1120-1132. [PMID: 35702985 DOI: 10.1002/pd.6196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/27/2022] [Accepted: 05/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND To improve the rate of prenatal diagnosis of Congenital heart disease (CHD) in Kentucky, four fetal tele-echocardiography sites were established at regional hospitals in Kentucky: Ashland in 2011, Paducah in 2014, Lexington in 2014, and Owensboro in 2016. METHODS A 13-year retrospective review of medical records at Norton Children's Hospital was performed to identify patients with CHD who had cardiac surgery or intervention prior to one year of age. The rate of prenatal diagnosis prior to establishing any fetal tele-echocardiography sites was compared to the rate of prenatal diagnosis after the sites were established. Independent t-tests were used to determine if there was a statistically significant increase in the rate of prenatal diagnosis. RESULTS 1287 patients had cardiac surgery or cath lab intervention prior to one year of age at our institution from June 2005 to December 2018 and were included in the analysis. Seventeen patients were excluded due to incomplete medical records. The rate of prenatal diagnosis prior to the implementation of the first fetal tele-echocardiography site was 13.8% and after the sites were established, the prenatal diagnosis rate was 39.7% (p < 0.01). CONCLUSION Increasing the number of fetal tele-echocardiography sites at small regional hospitals in Kentucky was associated with a statistically significant increase in the rate of prenatal diagnosis for patients less than 1 year of age who had cardiac surgery or cath lab intervention at Norton Children's Hospital in Louisville. Fetal tele-echocardiography is an effective method to improve the rate of prenatal diagnosis in regions served by small regional hospitals with limited access to fetal echocardiography.
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Affiliation(s)
- Jenna Meiman
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Charlie Zhang
- Department of Geography and Geosciences, University of Louisville, Louisville, Kentucky, USA
| | - Brian Holland
- Department of Pediatrics, Division of Pediatric Cardiology, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Abstract
Over a century of innovations in technology and medical care have led to the current day capabilities in telemedicine. In this chapter, we discuss the evolution of telemedicine over the last century and highlight various applications in neonatal care. We hope this chapter demonstrates the exponential adoption of telemedicine, particularly in neonatology, and the breadth and depth of the technology being used.
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Implementation of a statewide, multisite fetal tele-echocardiography program: evaluation of more than 1100 fetuses over 9 years. J Perinatol 2020; 40:1524-1530. [PMID: 32382116 DOI: 10.1038/s41372-020-0677-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/20/2020] [Accepted: 04/24/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We sought to describe the implementation and effectiveness of a statewide fetal tele-echocardiography program serving a resource-limited population. STUDY DESIGN In 2009, our heart center established six satellite clinics for fetal tele-echocardiography around the state. We retrospectively reviewed all fetal tele-echocardiograms performed through 2018. Yearly statewide prenatal detection rates of operable congenital heart disease were queried from the Society of Thoracic Surgeons database. RESULT In 1164 fetuses, fetal tele-echocardiography identified all types of congenital heart disease, with a sensitivity of 74% and specificity of 97%. For the detection of ductal-dependent congenital heart disease, fetal tele-echocardiography was 100% sensitive and specific. Between 2009 and 2018, annual statewide prenatal detection rates of congenital heart disease requiring heart surgery in the first 6 months of life rose by 159% (17-44%; R2 = 0.88, p < 0.01). CONCLUSIONS The present study provides a framework for an effective, large-scale fetal tele-echocardiography program.
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Bidmead E, Lie M, Marshall A, Robson S, Smith VJ. Service user and staff acceptance of fetal ultrasound telemedicine. Digit Health 2020; 6:2055207620925929. [PMID: 32477585 PMCID: PMC7232054 DOI: 10.1177/2055207620925929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 04/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective We present qualitative findings from interviews with frontline clinicians and
service users of a fetal telemedicine service. Methods Semi-structured interviews with clinical stakeholders and service users were
conducted, undertaken as part of a service evaluation. Data collection was
undertaken by different teams, using interview schedules aligned to
independent evaluation aims. Data were subjected to thematic analysis. Results Sonographers reported four main challenges: delivering a shared consultation;
the requirement to resist scanning intuitively; communications during the
scan; and restricted room space. Notwithstanding, all clinicians reported
that participating women were accepting of the technology. Service users
reported few concerns. The main benefits of fetal telemedicine were
identified as upskilled staff, increased access to specialist support and
improved management of complex pregnancies. Convenience was identified as
the main benefit by service users, including savings in time and money from
not having to travel, take time off work, and arrange childcare. Conclusions Service users and clinical stakeholders were accepting of the service.
Service users reported satisfaction with communications during the
consultation and awareness that telemedicine had facilitated local access to
clinical expertise. Whilst clinical stakeholders reported challenges, the
iterative nature of the evaluation meant that concerns were discussed,
responded to, and overcome as the pilot developed. Clinical stakeholders’
perception of benefits for service users encouraged their acceptance.
Moreover, the evaluation established that fetal ultrasound telemedicine is a
viable method to access expertise safely and remotely. It provided
demonstrable evidence of a potential solution to some of the healthcare
challenges facing rural hospitals.
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Affiliation(s)
| | - Mabel Lie
- Population and Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | | | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, UK
| | - Vikki J Smith
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, University of Northumbria, UK
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Mabuchi A, Waratani M, Tanaka Y, Mori T, Kitawaki J. Telediagnosis system for congenital heart disease in a Japanese prefecture. J Med Ultrason (2001) 2020; 47:463-468. [PMID: 32328807 DOI: 10.1007/s10396-020-01020-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to evaluate the accuracy of prenatal diagnosis using a spatio-temporal image correlation-based telediagnosis system at a tertiary referral unit in a Japanese prefecture over a 9-year period, and to investigate the validity of delivery hospital selection. METHODS This study retrospectively analyzed telediagnosis cases from 2009 to 2018 in six geographically remote hospitals. We built a telediagnosis system called the Kyoto Fetal Ultrasonographic Telediagnosis System (K-FUTS). Three-dimensional ultrasonographic images from these referral hospitals were forwarded to the Kyoto Prefectural University of Medicine (KPUM) Hospital through an optical fiber network system for analysis. The primary endpoint was accuracy of prenatal diagnosis. Cases with severe congenital heart disease (CHD) that required immediate postnatal treatment were identified using the K-FUTS. These cases were then examined to determine whether they were delivered at appropriate hospitals. RESULTS During the study period, datasets from 182 cases were transferred to KPUM Hospital. Twenty-one datasets were excluded because of data unavailability or poor image quality. CHD was detected in 14.9% of cases (24/161); the accuracy of prenatal diagnosis was 95.0% (153/161). The K-FUTS identified seven severe cases with CHD requiring immediate postnatal surgical or medical treatment. These cases were delivered at KPUM Hospital with a pediatrician present. The remaining 17 cases considered suitable for delivery at the referral hospitals were delivered there, and they did not require intervention immediately after birth. CONCLUSION Our telediagnosis system contributed to the prenatal diagnosis of CHD and management of pregnancies in patients who were geographically remote from a tertiary hospital.
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Affiliation(s)
- Aki Mabuchi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Miyoko Waratani
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yukiko Tanaka
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Cuneo BF, Olson CA, Haxel C, Howley L, Gagnon A, Benson DW, Kaizer AM, Thomas JF. Risk Stratification of Fetal Cardiac Anomalies in an Underserved Population Using Telecardiology. Obstet Gynecol 2020; 134:1096-1103. [PMID: 31599844 DOI: 10.1097/aog.0000000000003502] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate a fetal telecardiology program in a medically underserved area. METHODS We conducted a prospective case series of pregnant women at 18-38 weeks of gestation with risk factors for fetal congenital heart disease. Obstetric ultrasonographers performed fetal echocardiograms (local site) that were read in real time. The results were given to the mother by a fetal cardiologist at a children's hospital 243 miles and two mountain passes away (distant site). We evaluated the fetal telecardiology program in five domains: 1) education of obstetric ultrasonographers before initiation of telecardiology services, 2) process and efficiency, 3) patient satisfaction, 4) economic effects, and 5) accuracy of cardiac diagnosis and success of risk stratification. RESULTS The program was initiated on November 12, 2015, and here we describe its first 37 months. Over the initial training period of 3 months and about 70 examinations, obstetric ultrasonographers improved their identification of fetal congenital heart disease. Telecardiology was performed once a week and also for suspected fetal congenital heart disease or arrhythmia outside clinic hours, for a total of 455 examinations. All mothers preferred having their fetal cardiac evaluations performed locally as opposed to traveling to the distant center. The estimated cost to parents for fetal cardiac evaluation at the distant center was nine times greater than that of telecardiology ($581 vs $61). Congenital heart disease or arrhythmia was diagnosed in 28 and 15 fetuses, respectively; there was one false-negative result. All fetuses were correctly risk-stratified with respect to delivery location. CONCLUSIONS Neither diagnostic quality nor patient satisfaction were sacrificed with telecardiology. The program was feasible, empowered the local health care providers and ultrasonographers, offered strong economic advantages to families, and offered the benefit of timely standard-of-care, face-to-face consultation without travel. Based on the success of this program, further studies are warranted to assess its replicability.
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Affiliation(s)
- Bettina F Cuneo
- Colorado Fetal Care Center, the Heart Institute, the Department of Pediatrics, and the TeleHealth Department, Children's Hospital Colorado, and the University of Colorado School of Medicine, Aurora, and St. Mary's Medical Center, Grand Junction, Colorado; the Department of Pediatrics, Children's Hospital of Wisconsin; Milwaukee Wisconsin; and the Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care. METHODS In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care. RESULTS Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable. CONCLUSIONS Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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Telehealth for Pediatric Cardiology Practitioners in the Time of COVID-19. Pediatr Cardiol 2020; 41:1081-1091. [PMID: 32656626 PMCID: PMC7354365 DOI: 10.1007/s00246-020-02411-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 01/18/2023]
Abstract
Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.
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Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
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Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
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11
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Vavolizza RD, Dar P, Suskin B, Moore RM, Stern KWD. Clinical yield of fetal echocardiography for suboptimal cardiac visualization on obstetric ultrasound. CONGENIT HEART DIS 2018; 13:407-412. [PMID: 29372591 DOI: 10.1111/chd.12584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/17/2017] [Accepted: 12/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Suboptimal cardiac imaging on obstetric ultrasound is a frequent referral indication for fetal echocardiography, even in the absence of typical risk factors for fetal cardiac disease. The clinical profile of patients and findings of examinations performed for such an indication are not well defined. Given the increased cost, time and resource utilization of fetal echocardiography, we sought to determine the clinical findings of such referrals. STUDY DESIGN We performed a single-center review of such referrals from January 2010 to June 2016. Patients with commonly accepted indications for fetal echocardiography were excluded. Demographic variables and echocardiogram findings were collected. Findings were classified as (1) "normal," (2) "probably normal," if minor pathology could not confidently be excluded, or if minor findings were noted that were expected to resolve, or (3) "abnormal." Rates of pathology were determined with comparison of nonobese and obese populations. RESULTS A total of 583 gestations in 562 women were included (median gestational age 23.3 weeks, range 19.0-38.4). The median body mass index (BMI) was 34.6 kg/m2 (range 17.2-66.3 kg/m2 ). The majority of women were obese (BMI ≥ 30 kg/m2 in 74.6%). Overall, 574 of 583 examinations (98.5%) were normal or "probably normal." Pathology was noted in 9 fetuses (1.5%), 3 of whom required intervention (0.5%). No ductal dependent lesions were diagnosed. There was no significant difference in pathology rates between nonobese and obese mothers. CONCLUSIONS We found a low fetal cardiac anomaly rate in studies performed for suboptimal views on obstetric ultrasound. The majority of women referred for this indication were obese. The practice of routine referral for this indication deserves further evaluation.
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Affiliation(s)
- Rick D Vavolizza
- Department of Pediatrics, Division of Cardiology, Children's Hospital at Montefiore, New York, New York, USA.,University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Pe'er Dar
- Department of Obstetrics and Gynecology, Division of Fetal Medicine and Ultrasound, Montefiore Medical Center, New York, New York, USA.,Albert Einstein College of Medicine, New York, New York, USA
| | - Barrie Suskin
- Department of Obstetrics and Gynecology, Division of Fetal Medicine and Ultrasound, Montefiore Medical Center, New York, New York, USA.,Albert Einstein College of Medicine, New York, New York, USA
| | - Robert M Moore
- Albert Einstein College of Medicine, New York, New York, USA.,Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine, Jacobi Medical Center, New York, New York, USA
| | - Kenan W D Stern
- Department of Pediatrics, Division of Cardiology, Children's Hospital at Montefiore, New York, New York, USA.,Albert Einstein College of Medicine, New York, New York, USA
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13
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Brown J, Holland B. Successful Fetal Tele-Echo at a Small Regional Hospital. Telemed J E Health 2017; 23:485-492. [DOI: 10.1089/tmj.2016.0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Julianna Brown
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Brian Holland
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
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Satou GM, Rheuban K, Alverson D, Lewin M, Mahnke C, Marcin J, Martin GR, Mazur LS, Sahn DJ, Shah S, Tuckson R, Webb CL, Sable CA. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e648-e678. [PMID: 28193604 DOI: 10.1161/cir.0000000000000478] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Further Reading. J Telemed Telecare 2016. [DOI: 10.1258/135763307782213598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
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Hishitani T, Fujimoto Y, Saito Y, Sugamoto K, Hoshino K, Ogawa K. A medical link between local maternity hospitals and a tertiary center using telediagnosis with fetal cardiac ultrasound image transmission. Pediatr Cardiol 2014; 35:652-7. [PMID: 24259010 DOI: 10.1007/s00246-013-0834-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
Information and communication technology has been widely applied to various fields, including clinical medicine. We report here a telediagnosis system using ultrasound image transmission. The effect of telediagnosis, using a medical link between local maternity hospitals and our children's medical center, was verified. The number of fetal telediagnosis for cardiac disease, and cases referred to a perinatal care center and emergent transportation of neonates with congenital heart disease from maternity hospitals, were calculated based on the hospital records. The percentage of patients found to have heart disease was compared between out-patient clinic and telediagnosis cases. Telediagnosis increased, allowing maternity hospital staff to obtain support easily from a specialist when making a diagnosis. Many severe cases were transferred to tertiary centers with the correct diagnosis; consequently, the number of emergent transportations of neonates with severe cardiac anomalies continued to below. Telediagnosis was also useful as an educational tool for maternity hospital staff, who improved their skills during conversations with a specialist. Unlike in the outpatient clinic, consultation by telediagnosis was requested even for cases of mild abnormalities, and the number of false-positives increased, while many cardiac anomalies were found in the early stage. Furthermore, telediagnosis was helpful for pregnant women requiring bed rest, and also had the advantage of allowing a doctor to be able to talk with parents. Establishing a fetal telediagnosis system is a useful strategy to improve neonatal care through a medical link between local maternity hospitals and a tertiary center.
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Affiliation(s)
- Takashi Hishitani
- Department of Cardiology, Saitama Children's Medical Center, Magome 2100, Iwatsuki-ku, Saitama-shi, Saitama, 339-8551, Japan,
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Hishitani T, Fujimoto Y, Saito Y, Sugamoto K, Hoshino K, Ogawa K. Accuracy of telediagnosis of fetal heart disease using ultrasound images transmitted via the internet. Pediatr Int 2014; 56:289-91. [PMID: 24730637 DOI: 10.1111/ped.12318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/31/2014] [Accepted: 02/12/2014] [Indexed: 11/29/2022]
Abstract
We verified the feasibility of telediagnosis of fetal disease by (i) grading telediagnosis by a pediatric cardiologist into five confidence levels; and (ii) comparison of fetal telediagnosis with hands-on fetal diagnosis or postnatal diagnosis. In 114 patients suspected of having heart disease (real time, n = 15; recorded image transmission, n = 99), 79 patients were in level 5 (excellent), 17 in level 4 (good), eight in level 3 (fair), 10 in level 2 (poor), and no patients in level 1 (bad). The average was 4.5, and in 96 patients (84% of all) telediagnosis was accurate (above 4), whereas in 18 patients it was inaccurate (level 2 or 3). In re-examination of 25 patients, telediagnosis was confirmed in patients in level 4 and 5, whereas heart disease was missed in patients in levels 2 or 3. The correct diagnosis matched the high confidence level of a specialist based on recognizable transmitted images.
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Affiliation(s)
- Takashi Hishitani
- Department of Cardiology, Saitama Children's Medical Center, Saitama, Japan
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Webb CL, Waugh CL, Grigsby J, Busenbark D, Berdusis K, Sahn DJ, Sable CA. Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study. J Am Soc Echocardiogr 2013; 26:1090-8. [PMID: 23860093 DOI: 10.1016/j.echo.2013.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous single-center studies have shown that telemedicine improves care in newborns with suspected heart disease. The aim of this study was to test the hypothesis that telemedicine would shorten time to diagnosis, prevent unnecessary transports, reduce length of stay, and decrease exposure to invasive treatments. METHODS Nine pediatric cardiology centers entered data prospectively on patients aged <6 weeks, matched by gestational age, weight, and diagnosis. Subjects born at hospitals with and without access to telemedicine constituted the study group and control groups, respectively. Data from patients with mild or no heart disease were analyzed. RESULTS Data were obtained for 337 matched pairs with mild or no heart disease. Transport to a tertiary care center (4% [n = 15] vs 10% [n = 32], P = .01), mean time to diagnosis (100 vs 147 min, P < .001), mean length of stay (1.0 vs 26 days, P = .005) and length of intensive care unit stay (0.96 vs 2.5 days, P = .024) were significantly less in the telemedicine group. Telemedicine patients were significantly farther from tertiary care hospitals than control subjects. The use of inotropic support and indomethacin was significantly less in the telemedicine group. By multivariate analysis, telemedicine patients were less likely to be transported (odds ratio, 0.44; 95% confidence interval, 0.23-0.83) and less likely to be placed on inotropic support (odds ratio, 0.16; 95% confidence interval, 0.10-0.28). CONCLUSIONS Telemedicine shortened the time to diagnosis and significantly decreased the need for transport of infants with mild or no heart disease. The length of hospitalization and intensive care stay and use of indomethacin and inotropic support were less in telemedicine patients.
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Affiliation(s)
- Catherine L Webb
- University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA.
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Mistry H, Gardiner HM. The Cost-Effectiveness of Prenatal Detection for Congenital Heart Disease Using Telemedicine Screening. J Telemed Telecare 2013; 19:190-6. [DOI: 10.1258/jtt.2012.120418] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We estimated the longer-term cost-effectiveness of using telemedicine screening for prenatal detection of congenital heart disease (CHD). One hospital in south-east England with a telemedicine service was connected to a fetal cardiology unit in London. A UK health service perspective was adopted. Evidence on costs and outcomes for standard-risk pregnant women during the antenatal period was based on patient-level data. Extrapolation beyond the end of the study (just after delivery) was carried out for the lifetime of children born with and without CHD. Expert opinion and data from published sources was used to populate a decision model. Future costs and benefits were discounted. The main outcome was quality-adjusted life years (QALYs) and results were expressed as cost per QALY gained. Various one-way sensitivity analyses were conducted. The model showed that offering telemedicine screening by specialists to all standard-risk pregnant women was the dominant strategy (i.e. cheaper and more effective). The sensitivity analyses found that the model was robust, and that telemedicine remained the most cost-effective strategy. The study showed that it would be cost-effective to provide telemedicine examinations as part of an antenatal screening programme for all standard-risk women.
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Affiliation(s)
- Hema Mistry
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Helena M Gardiner
- Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Hammersmith Campus, London, UK
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The impact of medical informatics on patient satisfaction: A USA-based literature review. Int J Med Inform 2013; 82:141-58. [DOI: 10.1016/j.ijmedinf.2012.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 10/09/2012] [Accepted: 12/26/2012] [Indexed: 11/23/2022]
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Singh S, Bansal M, Maheshwari P, Adams D, Sengupta SP, Price R, Dantin L, Smith M, Kasliwal RR, Pellikka PA, Thomas JD, Narula J, Sengupta PP. American Society of Echocardiography: Remote Echocardiography with Web-Based Assessments for Referrals at a Distance (ASE-REWARD) Study. J Am Soc Echocardiogr 2013; 26:221-33. [DOI: 10.1016/j.echo.2012.12.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Indexed: 11/28/2022]
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McCrossan BA, Sands AJ, Kileen T, Doherty NN, Casey FA. A fetal telecardiology service: patient preference and socio-economic factors. Prenat Diagn 2012; 32:883-7. [PMID: 22718083 DOI: 10.1002/pd.3926] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 05/26/2012] [Accepted: 05/27/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate patients' opinions on a fetal cardiology telemedicine service compared with usual outpatient care, the effect of the telemedicine consultation on maternal anxiety and its impact on travel times and time absent from work. METHODS Prospective study over 20 months. Eligible patients attended for routine anomaly scan followed by fetal echocardiogram transmitted to the regional centre with live guidance by a fetal cardiologist, followed by parental counselling. All patients were offered a fetal cardiology appointment at the regional centre. Structured questionnaires assessing maternal satisfaction, travel times/days off and anxiety scores completed at time of both fetal echocardiograms. RESULTS Sixty-seven patients were recruited and 66 completed the study. Participants expressed very high satisfaction rates with fetal telecardiology, equivalent to face-to-face consultation. The telecardiology appointments were associated with significantly reduced travel times and days off work (p < 0.01). Expectant mothers expressed a clear inclination for a fetal cardiology appointment at the local hospital facilitated by telemedicine (p < 0.01). CONCLUSIONS Fetal telecardiology is highly acceptable to patients and is even preferred compared with travelling to a regional centre. There are additional socio-economic benefits that should encourage the development of remote fetal cardiology services.
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Affiliation(s)
- Brian A McCrossan
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.
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Sheehan FH, Ricci MA, Murtagh C, Clark H, Bolson EL. Expert visual guidance of ultrasound for telemedicine. J Telemed Telecare 2010; 16:77-82. [PMID: 20139139 DOI: 10.1258/jtt.2009.090313] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Expert visual guidance (EVG) is computer assistance that displays to the examiner how the image plane moves towards (or away from) a desired anatomical location as the ultrasound probe is manipulated over the patient's body. We tested whether EVG by a remote expert could assist inexperienced examiners in acquiring abdominal ultrasound images. The inexperienced examiners were 20 medical students, who were randomly assigned to verbal instruction alone (Group 1) or to EVG (Group 2). The examiners were tested on their ability to visualize the abdominal aorta and the right kidney. Group 2 was more successful in identifying specified anatomy in longitudinal and cross-sectional views of the aorta (95 vs. 75%, P = 0.032) and kidney (98 vs. 88%, P = 0.09). The groups succeeded equally well in obtaining a true cross-sectional view of the aorta. Kidney length was also similar when measured by the two groups. The results demonstrate that an inexperienced ultrasonographer can be significantly assisted by EVG compared to verbal instruction alone. This could be useful for tele-mentoring in rural hospitals as well as for teaching, both in person and at a remote site.
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Affiliation(s)
- Karen S Rheuban
- Office of Telemedicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Dowie R, Mistry H, Young TA, Franklin RCG, Gardiner HM. Cost implications of introducing a telecardiology service to support fetal ultrasound screening. J Telemed Telecare 2008; 14:421-6. [DOI: 10.1258/jtt.2008.080401] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A district hospital in south-east England used a telecardiology service for fetal cardiac diagnosis alongside an existing arrangement for referring pregnant women directly to perinatal cardiologists in London for detailed fetal echocardiography. Women were identified for referral according to local protocols when having a second trimester anomaly scan. For the telemedicine referrals, the sonographers video-recorded images from the anomaly scans for transmission during monthly videoconferences. The cost of the women's antenatal care was calculated from the specialist assessment until delivery, while family costs were collected in a postal survey. Over 15 months, telemedicine was used in 52 cases, while 24 women were seen in London. The London women were more likely to have had an ultrasound abnormality (29% v 10%, P = 0.047). A telemedicine assessment of 5 min duration was more costly than an examination in London (mean cost per referral of £206 v £74, P < 0.001). However, the telecardiology service was cost neutral after 14 days and for the extended period until delivery. Travel costs for London women averaged £37 compared with £5.50 for the telemedicine referrals. Telemedicine may be useful to support perinatal cardiologists in the UK whose workloads are expanding in response to improved standards in antenatal ultrasound screening.
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Affiliation(s)
- Robin Dowie
- Health Economics Research Group, Brunel University, Uxbridge
| | - Hema Mistry
- Health Economics Research Group, Brunel University, Uxbridge
| | - Tracey A Young
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield
| | - Rodney CG Franklin
- Brompton Fetal Cardiology, Royal Brompton and Harefield NHS Trust, London
| | - Helena M Gardiner
- Brompton Fetal Cardiology, Royal Brompton and Harefield NHS Trust, London
- Institute of Reproductive and Developmental Biology, Imperial College, London, UK
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High-grade video compression of echocardiographic studies: a multicenter validation study of selected motion pictures expert groups (MPEG)-4 algorithms. J Am Soc Echocardiogr 2007; 20:527-36. [PMID: 17484994 DOI: 10.1016/j.echo.2006.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Large files produced by standard compression algorithms slow down spread of digital and tele-echocardiography. We validated echocardiographic video high-grade compression with the new Motion Pictures Expert Groups (MPEG)-4 algorithms with a multicenter study. METHODS Seven expert cardiologists blindly scored (5-point scale) 165 uncompressed and compressed 2-dimensional and color Doppler video clips, based on combined diagnostic content and image quality (uncompressed files as references). One digital video and 3 MPEG-4 algorithms (WM9, MV2, and DivX) were used, the latter at 3 compression levels (0%, 35%, and 60%). RESULTS Compressed file sizes decreased from 12 to 83 MB to 0.03 to 2.3 MB (1:1051-1:26 reduction ratios). Mean SD of differences was 0.81 for intraobserver variability (uncompressed and digital video files). Compared with uncompressed files, only the DivX mean score at 35% (P = .04) and 60% (P = .001) compression was significantly reduced. At subcategory analysis, these differences were still significant for gray-scale and fundamental imaging but not for color or second harmonic tissue imaging. Original image quality, session sequence, compression grade, and bitrate were all independent determinants of mean score. CONCLUSIONS Our study supports use of MPEG-4 algorithms to greatly reduce echocardiographic file sizes, thus facilitating archiving and transmission. Quality evaluation studies should account for the many independent variables that affect image quality grading.
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Thomas JD, Adams DB, Devries S, Ehler D, Greenberg N, Garcia M, Ginzton L, Gorcsan J, Katz AS, Keller A, Khandheria B, Powers KB, Roszel C, Rubenson DS, Soble J. Guidelines and recommendations for digital echocardiography. J Am Soc Echocardiogr 2005; 18:287-97. [PMID: 15746725 DOI: 10.1016/j.echo.2005.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- James D Thomas
- American Society of Echocardiography, 1500 Sunday Drive, Suite 102, Raleigh, NC 27607, USA
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Woodson KE, Sable CA, Cross RR, Pearson GD, Martin GR. Forward and store telemedicine using Motion Pictures Expert Group: a novel approach to pediatric tele-echocardiography. J Am Soc Echocardiogr 2005; 17:1197-200. [PMID: 15502797 DOI: 10.1016/j.echo.2004.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Live transmission of echocardiograms over integrated services digital network lines is accurate and has led to improvements in the delivery of pediatric cardiology care. Permanent archiving of the live studies has not previously been reported. Specific obstacles to permanent storage of telemedicine files have included the ability to produce accurate images without a significant increase in storage requirements. OBJECTIVE We evaluated the accuracy of Motion Pictures Expert Group (MPEG) digitization of incoming video streams and assessed the storage requirements of these files for infants in a real-time pediatric tele-echocardiography program. RESULTS All major cardiac diagnoses were correctly diagnosed by review of MPEG images. MPEG file size ranged from 11.1 to 182 MB (56.5 +/- 29.9 MB). CONCLUSIONS MPEG digitization during live neonatal telemedicine is accurate and provides an efficient method for storage. This modality has acceptable storage requirements; file sizes are comparable to other digital modalities.
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Affiliation(s)
- Kristina E Woodson
- Division of Cardiology, Los Angeles Children's Hospital, Los Angeles, CA, USA
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Burke D, Menachemi N, Brooks RG. Diffusion of Information Technology Supporting the Institute of Medicineʼs Quality Chasm Care Aims. J Healthc Qual 2005; 27:24-32, 39. [PMID: 16416889 DOI: 10.1111/j.1945-1474.2005.tb00542.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article examines the degree to which healthcare information technology (HIT) supporting the Institute of Medicine's (IOM) six care aims is utilized in the hospital setting and explores organizational factors associated with HIT use. Guided by the IOM's Crossing the quality chasm report and associated literature, 27 applications and/or capabilities are classified according to one or more of the six care aims. A structured survey of Florida hospitals identified the use of HIT. Results suggest that, on average, hospitals have not yet embraced HIT to support the IOM's care aims and that associated organizational factors vary according to care aim.
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Affiliation(s)
- Darrell Burke
- College of Information, Florida State University, USA.
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Abstract
PURPOSE OF REVIEW Fetal diagnosis and the supporting specialties of perinatology, neonatology, and surgery have made rapid strides in the last decade. Numerous centers are focusing on this multifaceted niche area as the medical field realizes its vast promise and potential. The authors review some of the major advancements in thought and practice in the field of fetal echocardiography while attempting to give a less detailed overview for the less involved perinatologist. RECENT FINDINGS First trimester fetal echocardiography has been an area of recent interest as transducer technology improves. As a result, optimum timing of first and subsequent scans and the population profile they are to be applied to have become an issue that begs consensus. Three-dimensional and four-dimensional fetal echocardiography have also received a boost for the same reasons, and both are being studied for feasibility and accuracy. Fetal tissue Doppler and spectral Doppler imaging are potential areas for exploration; the early steps have been taken. Awareness of associated ultrasound markers, such as exaggerated nuchal translucency, as clues to the presence of congenital heart disease is important, even if controversial. SUMMARY The issue of missed prenatal diagnosis is disturbing, especially when it arises against a background of tremendous skill and technologic support. Strategies to minimize mistakes in this critical aspect need to be agreed on by the involved teams and put in place in a multidisciplinary manner if they are to have an important impact.
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Affiliation(s)
- Aarti Hejmadi Bhat
- Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, Oregon 97239-3098, USA
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Nguyen LT, Massman NJ, Franzen BJ, Ahrenholz DH, Sorensen NW, Mohr WJ, Solem LD. Telemedicine Follow-up of Burns: Lessons Learned from the First Thousand Visits. ACTA ACUST UNITED AC 2004; 25:485-90. [PMID: 15534456 DOI: 10.1097/01.bcr.0000144538.82184.19] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Telemedicine is an evolving technology that is used for health education, health care administration, and health care distribution. The potential benefits of telemedicine include a decrease in travel expenses, improved continuity of care, and increased access to specialized consultants, thus meeting the needs of patients, practitioners, and communities. Telemedicine has many evolving applications, including improved access to health care in medically underserved and rural areas. Regions Burn Center assessed the efficacy and efficiency of burn visits via telemedicine and identified the barriers and benefits specific to burn care. Information regarding travel costs and financial data were evaluated from a total of 1000 burn follow-up visits with 294 patients via telemedicine during a 5-year interval. Our results indicate that telemedicine burn visits are a cost-effective clinical alternative for the patient. However, telemedicine can be a financial burden to health care systems and inefficient for health care providers.
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Affiliation(s)
- Lan T Nguyen
- Burn Center, Regions Hospital, 640 Jackson Street, St. Paul, MN 55101, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe several of the most relevant and exciting recent advances in the field of fetal cardiology. RECENT FINDINGS First, the prenatal detection of congenital heart disease has improved, and continues to improve, with the increasingly widespread incorporation of the four-chamber view and outflow tracts into the routine screening fetal ultrasound evaluation. Second, increasingly sophisticated computer processing systems and improvements in imaging technology have enabled the development of automated three-dimensional ultrasound imaging systems that promise to revolutionize both the prenatal detection and diagnosis of congenital heart disease. Conventional two-dimensional imaging approaches may soon become obsolete. Third, there has been an increasing ability to intervene successfully prenatally not only for fetal arrhythmias and heart failure, but also for some forms of structural heart disease. In some cases of left or right ventricular outflow tract obstruction, early intervention during the second trimester may prevent the development of ventricular hypoplasia. Finally, several recent studies suggest that prenatal diagnosis may improve neonatal outcome for fetuses with congenital heart disease. The growing ability to intervene prenatally has the potential to improve neonatal outcome still further. SUMMARY These critical and exciting developments in fetal cardiology promise to increase fetal echocardiography's clinical impact dramatically during the years to come.
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Affiliation(s)
- Mark Sklansky
- Pediatric Cardiology, Childrens Hospital Los Angeles, California 90027, USA.
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:611-7. [PMID: 12905995 DOI: 10.1002/pd.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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