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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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Vassallo DJ, Buxton PJ, Kilbey JH, Trasler M. The First Telemedicine Link for the Defence Medical Services. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1742271x9800600204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- DJ Vassallo
- Hospital Squadron 24 Armoured Field Ambulance, Sipovo
| | | | | | - M Trasler
- MOSS Project, Saighton Camp, Chester
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3
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Bauer AS, Blazar PE, Earp BE, Louie DL, Pallin DJ. Characteristics of emergency department transfers for hand surgery consultation. Hand (N Y) 2013; 8:12-6. [PMID: 24426887 PMCID: PMC3574481 DOI: 10.1007/s11552-012-9466-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The purpose of this study was to establish the characteristics of patients who are transferred from referring emergency departments (EDs) to two receiving institutions for hand-related emergencies. Our primary hypothesis was that many transferred patients would not require emergent specialty intervention. Our secondary hypotheses were that treatment would differ by day of presentation and type of insurance coverage. METHODS We searched ED records for all hand-related cases over 1 year. We reviewed charts for demographics and treatment details. The main outcome measures were whether patients were seen by a hand surgeon or underwent surgery within 24 h of transfer. RESULTS The study group comprised 296 patients. Ninety-two percent saw a specialty resident, and 48 % saw a hand surgeon. Thirty-nine percent of patients were taken to the operating room within 24 h of presentation. Of patients transferred on the weekends, 48 % saw a hand surgeon versus 61 % of those transferred on weekdays. Similarly, 51 % of patients transferred on a weekday were taken to the OR within 24 h, while 38 % of patients transferred on a weekend were taken to the OR in the same time frame. CONCLUSIONS More than half of transfers for hand emergencies did not result in examination by a hand surgeon, and nearly two thirds did not require a visit to the OR within 24 h. Patients transferred on the weekend were less likely to see a hand surgeon than those transferred on weekdays. Alternative methods of consultation might allow avoidance of transfer.
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Affiliation(s)
- Andrea S. Bauer
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- />Shriners Hospital for Children Northern California, 2425 Stockton Blvd., Sacramento, CA 95817 USA
| | - Philip E. Blazar
- />Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Brandon E. Earp
- />Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Dexter L. Louie
- />Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Daniel J. Pallin
- />Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
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Leclère FM, Mathys L, Juon B, Franz T, Unglaub F, Vögelin E. Macroreplantations of the upper extremity: a series of 11 patients. Arch Orthop Trauma Surg 2012; 132:1797-805. [PMID: 22886169 DOI: 10.1007/s00402-012-1590-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Micro- or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. MATERIALS AND METHODS Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). RESULTS All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. CONCLUSION Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Franck Marie Leclère
- Department of Plastic and Hand Surgery, University of Bern, Inselspital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
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5
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The utility of multimedia in the diagnosis and management of acute and subacute problems in hand surgery. Ann Plast Surg 2012; 68:389-90. [PMID: 22421485 DOI: 10.1097/sap.0b013e318242e114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A typical consultation is based on a phone conversation between the consulting service and the surgeon. If the description given to the surgeon misrepresents the severity of the condition, unnecessary transfer of the patient could follow. In an attempt to reduce the occurrence of unnecessary transfers, we started supplementing our consultation with video captured with a cell phone camera demonstrating specific points in clinical examination of the hand. These videos were sent to the surgeon to clarify the clinical picture. We found this method useful in some cases in ruling out the need for urgent transfer.
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6
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Chen H, Kuo H, Chung K, Chen S, Tang Y, Su S. Quality improvement of microsurgery through telecommunication—the postoperative care after microvascular transfer of intestine. Microsurgery 2012; 32:96-102. [PMID: 22267277 DOI: 10.1002/micr.20965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Hung‐Chi Chen
- Plastic Surgery, China Medical Hospital, China Medical University, Taiwan
| | - Hsin‐Chih Kuo
- Health Management, I‐Shou University, Kaohsiung County, Taiwan
| | - Kuo‐Piao Chung
- Health Policy and Management, National Taiwan University, Taiwan
| | - Shih‐Heng Chen
- Plastic Surgery, National Taiwan University Hospital, Taiwan
| | - Yueh‐Bih Tang
- Plastic Surgery, National Taiwan University Hospital, Taiwan
| | - Syi Su
- Health Policy and Management, National Taiwan University, Taiwan
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7
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Zwingenberger AL, Bouma JL, Saunders HM, Nodine CF. Expert interpretation compensates for reduced image quality of camera-digitized images referred to radiologists. Vet Radiol Ultrasound 2011; 52:591-5. [PMID: 21831251 DOI: 10.1111/j.1740-8261.2011.01836.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We compared the accuracy of five veterinary radiologists when reading 20 radiographic cases on both analog film and in camera-digitized format. In addition, we compared the ability of five veterinary radiologists vs. 10 private practice veterinarians to interpret the analog images. Interpretation accuracy was compared using receiver operating characteristic curve analysis. Veterinary radiologists' accuracy did not significantly differ between analog vs. camera-digitized images (P = 0.13) although sensitivity was higher for analog images. Radiologists' interpretation of both digital and analog images was significantly better compared with the private veterinarians (P < 0.05).
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Affiliation(s)
- Allison L Zwingenberger
- Matthew J. Ryan Department of Clinical Studies, Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104, USA.
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8
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Cell-phone based multimedia messaging service (MMS) and burn injuries. Burns 2009; 35:1191-3. [DOI: 10.1016/j.burns.2009.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 03/29/2009] [Indexed: 11/18/2022]
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Jones SM, Balk EJ, Hill TJ, Reynolds S. Setting up a store‐and‐forward telemedicine service for acute trauma in a hospital trust. ACTA ACUST UNITED AC 2009; 27:107-14. [PMID: 15799587 DOI: 10.1080/01405110400007866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Telemedicine is a valuable, but as yet underused, resource for the delivery of health-care to patients. This paper describes the development of a new store-and-forward telemedicine service at the Queen Victoria Hospital, which is a tertiary referral centre for plastic surgery in the United Kingdom. The practical requirements of such a system, and the technical and legal difficulties experienced during the initial stages, are also discussed.
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Affiliation(s)
- S M Jones
- Plastic Surgery Department, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK.
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10
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[Telemedicine and hand injuries: a feasibility study]. ANN CHIR PLAST ESTH 2009; 55:8-13. [PMID: 19195760 DOI: 10.1016/j.anplas.2008.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 10/02/2008] [Indexed: 11/20/2022]
Abstract
In France, we count 1,400,000 hand injuries per year. Only 20% are taken care by hand surgeons. In these 20% many of injuries can be healed by non specific centres. Among the 80% remaining injuries, many of complex injuries should be taken care by specialised centres. It is advisable to get a specialised point of view despite the distance. The purpose of this work is to study the feasibility of telediagnosis in hand emergencies. The material contained a computer, a camera and a website which access needed a password. The physician in emergency room built up the e-medical file which can be referred by the expert to give his mind. The agreement of the patients was sought and all the data were unnamed. One hundred and twenty-nine e-medical files were created from a local general hospital. Sixty-six patients had wound injuries and 63 osteo-articular injuries. Sex-ratio was 3.8 and age average was 33 years old. Four hundred and sixty pictures and four movies were stored. The average of duration of tele-expert response was 7 h. Our results underline the great part which can be played by telemedicine in hand emergencies orientations.
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11
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Reddy MS, Bhati C, Neil D, Mirza DF, Manas DM. National Organ Retrieval Imaging System: results of the pilot study. Transpl Int 2008; 21:1036-44. [PMID: 18764835 DOI: 10.1111/j.1432-2277.2008.00720.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Efficient utilization of marginal liver grafts is dependant on the accurate assessment and relay of graft-related information to recipient units in an organ-sharing network. Currently, information is conveyed by the recovery team over the telephone and can sometimes be inconclusive or incomplete. We have developed a web-based instrument called the National Organ Retrieval Imaging System (NORIS) to improve this assessment process. The aim of this pilot study was to assess the feasibility of real-time data upload and the reliability of web-based remote assessment in identifying donor livers with significant macro-steatosis. Data from 153 donor livers uploaded to the website were analysed. Completeness of graft data uploads, accuracy of on-site and two separate remote assessments using a semi-objective graft score in identifying grafts with moderate or severe macro-vesicular steatosis were analysed. Uploads were complete in all recoveries. Liver grafts with moderate or severe macro-vesicular steatosis had a higher incidence of initial poor function (7/10 vs. 26/86, P = 0.029). Organ scores for steatotic grafts were significantly higher than nonsteatotic grafts in all three assessments (P < 0.001). Accuracy of the two remote assessors was similar to the actual on-site assessment. There was a substantial degree of inter-observer agreement between the assessments (kappa statistics = 0.658, 0.597, 0.698). Feasibility of real-time data upload and reliability of remote graft assessment have been confirmed.
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Affiliation(s)
- Mettu S Reddy
- Hepatobiliary & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
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12
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Morgan BW, Read JR, Solan MC. Photographic wound documentation of open fractures: an update for the digital generation. Emerg Med J 2008; 24:841-2. [PMID: 18029517 DOI: 10.1136/emj.2007.049726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the availability of working cameras in UK emergency departments and to discuss the merits of digital imaging over Polaroid. DESIGN This study was conducted by means of a telephone questionnaire to 50 UK emergency departments. RESULTS It was found that 80% were able to produce either a working Polaroid or digital camera, and that 63% of emergency departments had a digital camera available. CONCLUSIONS We report a pronounced increase in the ability of emergency departments to photograph open fractures, due in part to the availability of digital cameras. We recommend the appropriate use of these tools in the management of open fractures.
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Affiliation(s)
- B W Morgan
- Macclesfield District General Hospital, Macclesfield, Cheshire, UK.
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13
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Telemedicine for acute plastic surgical trauma and burns. J Plast Reconstr Aesthet Surg 2008; 61:31-6. [DOI: 10.1016/j.bjps.2006.03.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/10/2006] [Accepted: 03/17/2006] [Indexed: 11/20/2022]
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Stutchfield BM, Jagilly R, Tulloh BR. SECOND OPINIONS IN REMOTE SURGICAL PRACTICE USING EMAIL AND DIGITAL PHOTOGRAPHY. ANZ J Surg 2007; 77:1009-12. [DOI: 10.1111/j.1445-2197.2007.04299.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tangtrakulwanich B, Kwunpiroj W, Chongsuvivatwong V, Geater AF, Kiatsiriroj N. Teleconsultation with digital camera images is useful for fracture care. Clin Orthop Relat Res 2006; 449:308-12. [PMID: 16691138 DOI: 10.1097/01.blo.0000218737.31129.6c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Teleconsultation using digital camera images has not yet been proven useful in orthopaedic practice. We ascertained the validity and reliability of teleconsultation using digital camera images of 100 patients with nondisplaced or minimally displaced fractures and 50 healthy age-matched subjects. We used three sets of images from each patient: a digitized radiograph, digital clinical photographs of the injured site, and conventional analog radiographs. Assessments were made independently by three groups of assessors: four orthopaedic staff members, four senior residents, and four junior residents all of whom evaluated the digitized information via E-mail. Digitized radiographs, digitized radiographs supplemented with a clinical photograph, and conventional radiographs were assessed consecutively at 1-week intervals. We used clinical and radiographic followup data as a gold standard. The overall reliability (kappa), sensitivity, and specificity of digitized radiographs were 0.57, 83.2%, and 80.7%, respectively. Reliability, sensitivity, and specificity of the digitized radiographs were not decreased after transmitting via E-mail. The level of experience in radiographic interpretation was associated independently with fracture misdiagnosis. Teleconsultation using digital camera images was valid and reliable. We recommend sending clinical photographs with the digitized radiograph. LEVEL OF EVIDENCE Diagnostic study, level II. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Boonsin Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Songkhla, Thailand.
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16
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Abstract
Better care for patients and improved health care depends on the availability of good information which is accessible when and where it is needed. The development of technology, more specifically the Internet, has expanded the means whereby information can be acquired and transmitted over large distances enabling the concept of telemedicine to become a reality. Telemedicine, defined as the practise of medicine at a distance, encompasses diagnosis, education and treatment. It is a technology that many thought would expand rapidly and change the face of medicine. However, this has not happened and during the last decade although certain telemedicine applications, such as video-consulting and teleradiology, have matured to become essential health care services in some countries, others, such as telepathology, remain the subject of intensive research effort. Telemedicine can be used in almost any medical specialty although the specialties best suited are those with a high visual component. Wound healing and wound management is thus a prime candidate for telemedicine. Development of a suitable telemedical system in this field could have a significant effect on wound care in the community, tertiary referral patterns and hospital admission rates.
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Affiliation(s)
- Sophie M Jones
- Odstock Burns, Wound Healing & Reconstructive Surgery Charitable Trust, Laing Laboratory, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK
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Abboud JA, Bozentka DJ, Beredjiklian PK. Telemedicine consultation for patients with upper extremity disorders is reliable. Clin Orthop Relat Res 2005:250-7. [PMID: 15930947 DOI: 10.1097/01.blo.0000155009.77961.5c] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Telemedicine is a valuable resource for the delivery of health care to patients in underserved areas. The purpose of this study was to assess the reliability of asynchronous teleconsultation in the diagnosis and establishment of treatment plans for patients with disorders of the upper extremity. One hundred patients with disorders of the upper extremity were prospectively evaluated. Initial patient evaluations, done by an independent evaluator, involved a medical history, physical examination, digital images of the patient, and digitized radiographic studies. This patient information was presented electronically to two hand surgeons 6 months after one surgeon independently evaluated the patients in the outpatient clinic. The physicians formulated diagnosis and treatment plans for the patients based on the blinded electronic information. These findings then were compared with the treatment plans made by the physicians at the time of the patients' visits. Telemedicine consultation resulted in excellent agreement within observers (kappa = .92) and between observers (kappa = .86). Telemedicine consultation seems to be a reliable method for diagnosis and establishment of treatment plans in the management of upper extremity disorders. LEVEL OF EVIDENCE Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph A Abboud
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 39th and Market Streets, Philadelphia, PA 19104, USA.
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18
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Abstract
The benefits of digital photography are certainly numerous and include rapid image production, easy and quick deletion of poor images, no need for film or its associated expenses, decreased costs for enlargements, ease of editing and image storage, effortless placement in presentations or publications. Many physicians believe that the benefits of digital images clearly outweigh any limitations that future technologic advances will minimize. Digital imaging allows for the seamless integration of all patient images (e.g., clinical, radiographic, pathologic) into the medical record. Additionally, manipulating these images with lighting, filters, of other processing techniques may encourage diagnostic advances (e.g., distinguishing between benign and malignant surface lesions). Some drawbacks, however, continue to exist, including cost of the hardware and software, continuously evolving technology, power consumption and battery usage, lower image resolution compared with 35-mm photography, and the need to have backup image files. With decreasing costs, improving resolutions, and enhanced capabilities, digital cameras will overcome these limitations rapidly.
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Affiliation(s)
- Richard V Smith
- Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Road, Bronx, NY 10467, USA.
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Koch H, Hubmer M, Haas F, Schwarzl F, Scharnagl E. Hand surgery and the internet: results of a worldwide survey. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2002; 7:167-70. [PMID: 12596273 DOI: 10.1142/s0218810402001072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2002] [Accepted: 04/12/2002] [Indexed: 11/18/2022]
Abstract
The opportunities offered by the Internet are employed increasingly in medicine. To obtain data on the extent to which the Internet is used by hand surgeons, survey forms were sent to 1043 participants of the Congress of the IFSSH in Vancouver in 1998. Ninety-four per cent of the respondents use the Internet. Most of the participants use the World Wide Web for literature searches, information on events and to read scientific articles. E-mail is used for general and scientific communication with colleagues and also for transmission of patient-related data. Perceived apprehensions include secure transmission of sensitive data, slow data transmission, and the lack of structure and of an authority to control the contents of the Internet. Virtual congresses and a newsgroup on hand surgery seem to be worthwhile future goals. Some problems pointed out in this survey have already been solved, at least partially, and possible solutions for the rest are discussed.
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Affiliation(s)
- H Koch
- Division of Plastic Surgery, Department of Surgery, Graz University School of Medicine, Auenbruggerplatz 29, A-8036 Graz Austria.
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Koch H, Dabernig J, Allert S, Puchinger M, Scharnagl E. Plastic surgeons and the Internet: results of a worldwide survey. Ann Plast Surg 2002; 49:466-9; discussion 470-1. [PMID: 12439012 DOI: 10.1097/00000637-200211000-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To obtain information on the use of the Internet, 3,139 survey forms were sent out to plastic surgeons throughout the world. More than 90% of the 565 respondents have access to the Internet and 85.5% use electronic mail for professional matters. They use the World Wide Web to search the literature, to read scientific articles, and to obtain information on congresses. A substantial proportion of the contributors have a positive attitude toward virtual congresses on the Internet and most would welcome a newsgroup dedicated to plastic surgery. Perceived apprehensions include secure transmission of sensitive data, slow data transmission, and the lack of structure and of an authority to control the contents of the Internet. Virtual congresses and a newsgroup on plastic surgery seem to be worthwhile future goals. Some problems pointed out in this survey have already been solved, at least partially, and possible solutions for the rest are discussed.
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Affiliation(s)
- Horst Koch
- Division of Plastic Surgery, Department of Surgery, Karl-Franzens University, Graz, Austria
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21
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Baldwin AJ, Langton SG. Postoperative monitoring of flaps by digital camera and Internet link. Br J Oral Maxillofac Surg 2001; 39:120-1. [PMID: 11286445 DOI: 10.1054/bjom.2000.0610] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A J Baldwin
- Blackburn Royal Infirmary, Blackburn, Lancashire, UK.
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Boulanger B, Kearney P, Ochoa J, Tsuei B, Sands F. Telemedicine: a solution to the followup of rural trauma patients? J Am Coll Surg 2001; 192:447-52. [PMID: 11294400 DOI: 10.1016/s1072-7515(01)00796-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Outpatient followup of rural trauma patients is problematic for physicians and patients. Our hypothesis was that telemedicine-based followup of trauma patients discharged to remote areas is feasible and is associated with high patient and physician satisfaction. STUDY DESIGN We chose 11 counties in Kentucky surrounding a remote telemedicine site as our region of interest. Any adult trauma patient who was discharged from our Level I trauma center to this geographic region was eligible to have routine followup appointment(s) at the TeleTrauma Clinic. Patients were examined and interviewed with the assistance of a nurse, an electronic stethoscope, and a close-up imaging instrument. Radiographs performed at the telemedicine site were viewed. Patients and physicians completed a survey after the appointment. RESULTS To date, we have conducted 22 telemedicine-based followup assessments of trauma patients. The average age and Injury Severity Score were 42 years and 18, respectively. Plain radiographs were reviewed in 13 cases. Our patient surveys indicated a high degree of satisfaction with the teleappointment. In 15 of 22 patients, no further clinical followup was arranged. The differences in travel distances and times for an appointment at the TeleTrauma Clinic versus an appointment at our Level I trauma center were significant. The average and median duration of the appointments was 14 minutes. All telemedicine encounters were done by two physicians, who recorded a high level of satisfaction. CONCLUSIONS Our early experience with the outpatient followup of remote trauma victims by telemedicine is encouraging. Patient surveys indicate a high degree of satisfaction. As a result of our favorable experience, telemedicine-based followup may be expanded to other regions of Kentucky.
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Affiliation(s)
- B Boulanger
- Department of Surgery and Kentucky TeleCare, University of Kentucky Medical Center, Lexington 40536-0084, USA
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Use of Telehealth for Chronic Wound Care. J Wound Ostomy Continence Nurs 2001. [DOI: 10.1097/00152192-200103000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Internet-based imaging is changing the way urology services are delivered by allowing rapid communication between remote locations. This review focuses on Internet-based imaging modalities, the hardware needed to transmit and view these images, and current applications. With the continuing expansion of Internet-based resources, all physicians must become accustomed to integrating the Internet and Internet-based imaging into their practices.
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Affiliation(s)
- N McFarlane
- Department of Urology, Univeristy of Western Ontario, London, Canada
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Kuo RL, Delvecchio FC, Babayan RK, Preminger GM. Telemedicine: recent developments and future applications. J Endourol 2001; 15:63-6. [PMID: 11248922 DOI: 10.1089/08927790150500971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telemedicine, or the delivery of health care from a distance, is an exciting field that has undergone rapid advancements over the past three decades. Previous studies have demonstrated that telemedicine can effectively assist in patient care. However, cost issues and the lack of resources to sustain telemedicine systems have previously limited the use of this technology. Herein, we explore the development, current applications, and future of telemedicine.
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Affiliation(s)
- R L Kuo
- The Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
Digital photography has become a practical alternative to film photography for documentation, communication, and education about orthopaedic problems and treatment. Digital cameras may be used to document preoperative and postoperative condition, intraoperative findings, and imaging studies. Digital photographs are captured on the charged coupler device (CCD) of the camera, and processed as digital data. Images may be immediately viewed on the liquid crystal display (LCD) screen of the camera and reshot if necessary. Photographic image files may be stored in the camera in a floppy diskette, CompactFlash card, or SmartMedia card, and transferred to a computer. The images may be manipulated using photo-editing software programs, stored on media such as Zip disks or CD-R discs, printed, and incorporated into digital presentations. The digital photographs may be transmitted to others using electronic mail (e-mail) and Internet web sites. Transparency film slides may be converted to digital format and used in digital presentations. Despite the initial expense to obtain the required hardware, major cost savings in film and processing charges may be realized over time compared with film photography.
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Affiliation(s)
- B Elbeshbeshy
- Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, NY, USA
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Abstract
More than 3000 open fractures occur in UK each year. They require early assessment and meticulous treatment in order to avoid devastating complications. The British Orthopaedic Association and British Association of Plastic Surgeons Working Party recommend that an instant photograph be taken of an open wound prior to the application of a dressing. The dressing can then remain undisturbed until the definitive surgical debridement is performed in theatre. Such practice reduces nosocomial infection. Fifty-one accident and emergency departments were surveyed by the means of a telephone questionnaire. Forty-one percent were unable to photograph an open fracture wound. A further 20% had no access to a camera outside of office hours. The cheap, simple and effective recommendations of the Working party are not being followed.
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Affiliation(s)
- M C Solan
- Princess Royal Hospital, Lewes Road, Haywards Heath, RH16 4EX, West Sussex, UK
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28
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Abstract
In the not too distant future, the minimally invasive renal surgeon will be able to practice an operation on a difficult case on a three-dimensional virtual reality simulator, providing all attributes of the real procedure. The patient's imaging studies will be imported into the simulator to better mimic particular anatomy. When confident enough of his or her skills, the surgeon will start operating on the patient using the same virtual reality simulator/telepresence surgery console system, which will permit the live surgery to be conducted by robots hundreds of miles away. The robots will manipulate miniature endoscopes or control minimally or noninvasive ablative technologies. Endoscopic/laparoscopic footage of the surgical procedure will be stored digitally in optical disks to be used later in telementoring of a surgery resident. All this and more will be possible in the not so distant third millennium.
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Affiliation(s)
- F C Delvecchio
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Senior MA, Southern SJ, Nishikawa H, Chumas PD. The digital op note. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:633. [PMID: 11000089 DOI: 10.1054/bjps.2000.3424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fraser HS, McGrath SJ. Information technology and telemedicine in sub-saharan Africa. BMJ (CLINICAL RESEARCH ED.) 2000; 321:465-6. [PMID: 10948012 PMCID: PMC1118376 DOI: 10.1136/bmj.321.7259.465] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bruno D, Delvecchio FC, Preminger GM. Digital still image recording during video endoscopy. J Endourol 1999; 13:353-6; discussion 356-7. [PMID: 10446795 DOI: 10.1089/end.1999.13.353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the advances in telemedicine and virtual consultation services comes the need for state-of-the-art endoscopic imaging techniques and equipment. Concomitant with current day concerns of cost containment, the ability to utilize the aforementioned tools in a cost-effective fashion that lowers operating expenses, accurately depicts procedures, and expedites chart documentation is paramount. We report on a fast and efficient way to obtain and store images during endoscopic procedures, which can be stored on standard 3.5-inch floppy disks using an innovative digital image recorder. These images are stored as high-resolution (640x480x24) JPEG files, which can be placed in electronic medical records, imported into Internet Web pages, incorporated into slide presentations, and, most importantly, stored in easily accessed archives.
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Affiliation(s)
- D Bruno
- The Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Kirkpatrick AW, Brenneman FD, McCallum A, Breeck K, Boulanger BR. Prospective evaluation of the potential role of teleradiology in acute interhospital trauma referrals. THE JOURNAL OF TRAUMA 1999; 46:1017-23. [PMID: 10372617 DOI: 10.1097/00005373-199906000-00006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Teleradiology is one form of telemedicine that would allow the transmission of radiographs before the transfer of acutely traumatized patients between referring and receiving hospitals. The purpose of this study was to evaluate the potential impact of a prehospital teleradiology system on trauma patient management and transfer. METHODS Forty-four injured adults referred to a trauma center were included. The history, physical examination, and radiographic findings reported by the referring physician to the receiving physician were documented. The plain radiographs of the chest, pelvis, and cervical spine taken at the referring hospital were obtained after patient transfer. For each case, two reviewers blinded to the case (surgeon [S] and emergency department physician [E]) and one reviewer not blinded to the case were individually presented with the referring physician's report and the radiographs. The reviewers were surveyed as to the implications of viewing the plain radiographs taken at the referring hospital before patient transfer. RESULTS Overall, the blinded reviewers felt that viewing the radiographs before transfer would have influenced care in 40% and 38% of cases as judged by (S) and (E), respectively, with a crude agreement of 67.5% (kappa level, 0.32). The blinded reviewers (S and E) commonly noted the following four changes in management as a result of viewing the referred radiographs: requested further clinical history (S, 18%; E, 23%), suggested further pretransfer interventions (S, 38%; E, 30%), suggested further pretransfer diagnostic tests (S, 25%; E, 13%), and emphasized precautions during transfer (S, 28%; E, 30%). The nonblinded reviewer suggested potential influence in the management of at least 65% of the cases. CONCLUSION This study suggests that viewing the radiographs of acutely injured trauma patients has the potential to influence many aspects of the management of interhospital transfer.
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Affiliation(s)
- A W Kirkpatrick
- Vancouver Hospital & Health Sciences Centre, British Columbia, Canada.
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Kuo RL, Aslan P, Dinlenc CZ, Lee BR, Screnci D, Babayan RK, Kavoussi LR, Preminger GM. Secure transmission of urologic images and records over the Internet. J Endourol 1999; 13:141-6. [PMID: 10360490 DOI: 10.1089/end.1999.13.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Telemedicine has become a common method for the transmission of images and patient data across long distances. Our goal was to assess the efficiency and accuracy of Photomailer MD software, a store-and-forward telemedicine system, in the urologic setting. METHODS Photomailer MD software was loaded on two computers in the host institution, one with a T1 connection to the Internet and the other with a dial-up modem connection (24,000 bits/second), and computers at three remote sites. A total of 14 clinical cases, comprised of digitized histories and radiographic images, were sent to the remote institutions four separate times using the four transmission modes available: nonencrypted, 56-bit encryption, 128-bit encryption, and 128-bit encryption with password. The following data points were recorded: file size before and after encryption, file transmission times, and diagnostic accuracy of the remote urologists. One-way ANOVA was used to compare mean values statistically, while the z-test was used to compare diagnostic accuracies. RESULTS Encryption increased the file size by a mean of 37.8%, with the three encryption modes increasing file sizes by the same number of kilobytes. When a dial-up modem was used, encrypted files required a significantly longer transmission time (P < 0.05) than the unencrypted files. The same trend was seen with the T1 connection, although the differences often were not significant. When T1 transmission times were compared with modem times with other variables held constant, modem times were significantly longer (P < 0.05). Diagnostic accuracies for each of the three remote centers ranged from 85.7% to 100%. Differences in accuracy rates between attending physicians and residents were not significant. CONCLUSIONS Photomailer MD provides a secure, convenient, and affordable method of transmitting patient images and records via the Internet. Transmission speed was significantly greater when using a T1 line and also tended to be faster when files were not encrypted. There was no significant difference in transmission time among the three encryption modes; therefore, 128-bit encryption with a password should be used to maximize security. Diagnostic accuracies were comparable to those in the literature. In general, 640 x 480-pixel resolution was adequate for urologic diagnoses, although higher-resolution images may improve accuracy.
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Affiliation(s)
- R L Kuo
- Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Affiliation(s)
- R W Whitehouse
- Department of Clinical Radiology, Manchester Royal Infirmary, UK.
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