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Lee S, Hitt WC. Clinical Applications of Telemedicine in Gynecology and Women's Health. Obstet Gynecol Clin North Am 2021; 47:259-270. [PMID: 32451017 DOI: 10.1016/j.ogc.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telemedicine and telehealth (TM/TH) are the 2 terms used interchangeably focusing on the delivery of health care services at a long distance using telecommunication technology. TM/TH has several gynecologic applications, including the well-woman visits, preventive care, preconception counseling, family planning including contraception and medical abortion, infertility workup, teleradiology, cervical cancer screening and colposcopy, mental health, and telesurgery. The goals of TM/TH are not only improving quality of health care in patients and building a virtual community of physicians but also increasing convenience, efficacy, and decreasing medical cost. In gynecology, TM/TH plays an important role, especially in well-woman care.
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Affiliation(s)
- Siwon Lee
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA
| | - Wilbur C Hitt
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA.
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Quercia K, Tran PL, Jinoro J, Herniainasolo JL, Viviano M, Vassilakos P, Benski C, Petignat P. A Mobile Health Data Collection System for Remote Areas to Monitor Women Participating in a Cervical Cancer Screening Campaign. Telemed J E Health 2017; 24:277-282. [PMID: 28846504 DOI: 10.1089/tmj.2017.0146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Barriers to efficient cervical cancer screening in low- and medium-income countries include the lack of systematic monitoring of the participants' data. The aim of this study was to assess the feasibility of a mobile health (m-Health) data collection system to facilitate monitoring of women participating to cervical cancer screening campaign. METHODS Women aged 30-65 years, participating in a cervical cancer screening campaign in Ambanja, Madagascar, were invited to participate in the study. Cervical Cancer Prevention System, an m-Health application, allows the registration of clinical data, while women are undergoing cervical cancer screening. All data registered in the smartphone were transmitted onto a secure, Web-based platform through the use of an Internet connection. Healthcare providers had access to the central database and could use it for the follow-up visits. Quality of data was assessed by computing the percentage of key data missing. RESULTS A total of 151 women were recruited in the study. Mean age of participants was 41.8 years. The percentage of missing data for the key variables was less than 0.02%, corresponding to one woman's medical history data, which was not sent to the central database. Technical problems, including transmission of photos, human papillomavirus test results, and pelvic examination data, have subsequently been solved through a system update. CONCLUSION The quality of the data was satisfactory and allowed monitoring of cervical cancer screening data of participants. Larger studies evaluating the efficacy of the system for the women's follow-up are needed in order to confirm its efficiency on a long-term scale.
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Affiliation(s)
- Kelly Quercia
- 1 Faculty of Medicine, University of Geneva , Geneva, Switzerland
| | - Phuong Lien Tran
- 2 Gynecology Division, Geneva University Hospitals , Geneva, Switzerland
| | | | | | - Manuela Viviano
- 2 Gynecology Division, Geneva University Hospitals , Geneva, Switzerland
| | - Pierre Vassilakos
- 4 Geneva Foundation for Medical Education and Research , Geneva, Switzerland
| | - Caroline Benski
- 2 Gynecology Division, Geneva University Hospitals , Geneva, Switzerland .,3 St-Damien Health Center , Ambanja, Madagascar
| | - Patrick Petignat
- 2 Gynecology Division, Geneva University Hospitals , Geneva, Switzerland
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Use of Smartphones as Adjuvant Tools for Cervical Cancer Screening in Low-Resource Settings. J Low Genit Tract Dis 2016; 19:295-300. [PMID: 26247260 DOI: 10.1097/lgt.0000000000000136] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Our aim was to evaluate the feasibility and performance of smartphone digital images for the detection of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) as an adjunct to a conventional visual inspection approach with acetic acid (VIA) and Lugol's iodine (VILI), in comparison with detection by histopathologic examination. METHODS Three hundred women were primarily screened for human papillomavirus (HPV) using self-collected vaginal specimens. Human papillomavirus-positive women were then invited for VIA and VILI, which were interpreted as (i) nonpathological, (ii) pathological or, (iii) inconclusive. Cervical smearing, endocervical brushing, and cervical biopsies were performed. Digital images of the cervix were taken with a smartphone and evaluated offsite by experienced health care providers. Sensitivity and specificity for CIN2+ were compared between on-site and off-site observers, using histopathological diagnosis as the criterion standard. RESULTS Eighty-eight HPV-positive women were screened for cervical cancer. Overall, 7 cases of CIN2+ (8.0%) were diagnosed using biopsy specimens. The on-site physician obtained a sensitivity of 28.6% (95% confidence interval [95% CI], 3.7-71) and a specificity of 87.2% (95% CI, 77.7- 93.7). The off-site physicians obtained a sensitivity ranging between 42.9% (95% CI, 9.9-81.6; p = 1) and 85.7% (95% CI, 42.1-99.6; p = .13) and a specificity between 48.1% (95% CI, 36.5- 59.7; p < .001) and 79.2% (95% CI, 68.5-87.6; p = .10). Comparison between observers did not reach significance. Observers assessed 95.6% of all images as very good or acceptable for interpretation purpose. CONCLUSION Smartphone images may be a useful adjunct to conventional VIA and VILI for the detection of CIN2+ and improve cervical cancer screening in low-resource settings.
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Bucchi L, Cristiani P, Costa S, Schincaglia P, Garutti P, Sassoli de Bianchi P, Naldoni C, Olea O, Sideri M. Rationale and development of an on-line quality assurance programme for colposcopy in a population-based cervical screening setting in Italy. BMC Health Serv Res 2013; 13:237. [PMID: 23809615 PMCID: PMC3701540 DOI: 10.1186/1472-6963-13-237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/18/2013] [Indexed: 11/29/2022] Open
Abstract
Background Colposcopy, the key step in the management of women with abnormal Pap smear results, is a visual technique prone to observer variation, which implies the need for prolonged apprenticeship, continuous training, and quality assurance (QA) measures. Colposcopy QA programmes vary in level of responsibility of organizing subjects, geographic coverage, scope, model, and type of actions. The programmes addressing the clinical standards of colposcopy (quality of examination and appropriateness of clinical decisions) are more limited in space and less sustainable over time than those focused on the provision of the service (resources, accessibility, etc.). This article reports on the protocol of a QA programme targeting the clinical quality of colposcopy in a population-based cervical screening service in an administrative region of northern Italy. Methods/design After a situation analysis of local colposcopy audit practices and previous QA initiatives, a permanent web-based QA programme was developed. The design places more emphasis on providing education and feedback to participants than on testing them. The technical core is a log-in web application accessible on the website of the regional Administration. The primary objectives are to provide (1) a practical opportunity for retraining of screening colposcopists, and (2) a platform for them to interact with colposcopists from other settings and regions through exchange and discussion of digital colposcopic images. The retraining function is based on repeated QA sessions in which the registered colposcopists log-in, classify a posted set of colpophotographs, and receive on line a set of personal feedback data. Each session ends with a plenary seminar featuring the presentation of overall results and an interactive review of the test set of colpophotographs. This is meant to be a forum for an open exchange of views that may lead to more knowledge and more diagnostic homogeneity. The protocol includes the criteria for selection of colpophotographs and the rationale for colposcopic gold standards. Discussion This programme is an ongoing initiative open to further developments, in particular in the area of basic training. It uses the infrastructure of the internet to give a novel solution to technical problems affecting colposcopy QA in population-based screening services.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRST, 47014 Meldola, Forlì, Italy.
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New technologies and advances in colposcopic assessment. Best Pract Res Clin Obstet Gynaecol 2011; 25:667-77. [PMID: 21664876 DOI: 10.1016/j.bpobgyn.2011.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 11/22/2022]
Abstract
To have a good grasp of clinical colposcopy, it is necessary to understand the histopathologic structure of the normal and dysplastic cervical epithelium. Previous meta-analyses had indicated high overall sensitivity of colposcopy in detecting dysplastic lesions, but recent studies have suggested that the technique has much lower sensitivity in detecting high-grade intraepithelial neoplasia. The best practice in colposcopy relies on accurately taking a biopsy from the correct (i.e. most morphological abnormal) site, and by taking more than one biopsy, the sensitivity for detection of high-grade cervical intraepithelial neoplasia can be increased. Cytological screening programmes of proven and maintained high quality will enhance the predictive colposcopic accuracy for high-grade cervical intraepithelial neoplasia after referral. With the advent of computerised colposcopy and the Internet, digital imaging can be transmitted in real-time for instant viewing, facilitating distant consultation and education. This form of 'telemedicine' will allow family practice and remote areas to have access to colposcopy expertise. Of all the currently available technological adjuncts to colposcopy, spectroscopy devices have demonstrated relatively high sensitivities, and seem to have the best potential to become the technique of choice in future routine clinical practice in developed countries following the human papillomavirus vaccination. Other alternatives may need to be used in parts of the globe with high disease incidence and without organised screening or vaccination programmes. Opportunities remain for global collaboration in research, education and training to promote more effective and affordable cervical screening, and to enhance the skills of colposcopists worldwide.
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Bergmo TS. Can economic evaluation in telemedicine be trusted? A systematic review of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2009; 7:18. [PMID: 19852828 PMCID: PMC2770451 DOI: 10.1186/1478-7547-7-18] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 10/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine. METHODS A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured. RESULTS This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis. CONCLUSION As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results.
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Affiliation(s)
- Trine S Bergmo
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, N-9038 Tromsø, Norway.
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Louwers JA, Kocken M, ter Harmsel WA, Verheijen RHM. Digital colposcopy: ready for use? An overview of literature. BJOG 2009; 116:220-9. [PMID: 19076954 DOI: 10.1111/j.1471-0528.2008.02047.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aims of this review were to summarise the various methods of digital colposcopy and to provide an overview of their efficacy. We conducted a literature search and focused on papers that described a technique for colposcopy, other than conventional colposcopy, and compared this with conventional colposcopy and/or histology and included digitalisation of the process. All papers have been classified in one of the following categories: digital imaging and telecolposcopy, spectroscopy, computerised colposcopy, optical coherence tomography and confocal microcolposcopy. Among the most promising developments is spectroscopy, allowing a more or less automated analysis and interpretation of the colposcopic image.
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Affiliation(s)
- J A Louwers
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
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Ferris DG, Mitra S, Nutter B. Digitized cervical images: problems, solutions, and potential medical impact. J Low Genit Tract Dis 2005; 10:10-5. [PMID: 16378027 DOI: 10.1097/01.lgt.0000194056.20485.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate compression, illumination enhancement, registration, segmentation, automated classification and steganography using digitized cervical images. MATERIALS AND METHODS The Hybrid Multi-Scale Vector Quantization algorithm developed at Texas Technological University and other automated systems were used to improve digitized cervical images. RESULTS We demonstrated high levels of image compression, illumination enhancement, registration, automated segmentation and classification and steganography of digitized cervical images. CONCLUSIONS Digitized cervical images can be altered to facilitate research of cervical neoplasia.
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Affiliation(s)
- Daron G Ferris
- Gynecologic Cancer Prevention Center, Department of Family Medicine, Medical College of Georgia, Augusta, 30912, USA.
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Ferris DG, Litaker M. Interobserver Agreement for Colposcopy Quality Control Using Digitized Colposcopic Images During the ALTS Trial. J Low Genit Tract Dis 2005; 9:29-35. [PMID: 15870519 DOI: 10.1097/00128360-200501000-00007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate interobserver agreement among colposcopy quality control reviewers viewing digitized cervical images during the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS). MATERIALS AND METHODS Three colposcopy quality control reviewers independently examined modem-transferred digitized colposcopic images from subjects examined at four clinical centers. Reviewers indicated colposcopic impression, Reid colposcopic index scores, lesion size, and the technical quality of the image. Rates of agreement were evaluated using the kappa statistic and McNemar and Bowker tests of symmetry. RESULTS Regarding colposcopic impressions, the average weighted kappa for pairs of initial reviewers was 0.36 (95% confidence interval, 0.33-0.39). kappa scores with respect to Reid colposcopic index, cervical image quality, and lesion size ranged from 0.23 to 0.28, 0.18 to 0.27, and 0.33 to 0.42, respectively. CONCLUSIONS Fair rates of agreement and poor to fair kappa scores among ALTS colposcopy quality control reviewers were noted for colposcopic impression, Reid colposcopic index scores, image quality, and lesion size. Great latitude exists in the interpretation of digitized cervical images. Poor image quality partially may explain these suboptimal results.
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Affiliation(s)
- Daron G Ferris
- Gynecologic Cancer Prevention Center, Department of Family Medicine, The Medical College of Georgia, Augusta, GA 30912, USA.
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Ferris DG, Litaker MS. Colposcopy quality control by remote review of digitized colposcopic images. Am J Obstet Gynecol 2004; 191:1934-41. [PMID: 15592275 DOI: 10.1016/j.ajog.2004.06.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to estimate the accuracy of colposcopy quality control review of subjects' digitized colposcopic images during the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion triage study (ALTS). STUDY DESIGN After colposcopic examination and the acquisition of 2 digitized cervical images, colposcopists recorded colposcopic diagnoses in a standardized computer database. The images were transferred by modem to colposcopy quality control reviewers for a blinded interpretation, including assessment of image quality. Reviewers' and colposcopists' diagnoses were compared with histologic diagnoses using standard contingency table methods. RESULTS Colposcopists and reviewers underdiagnosed 16.1% and 25.3% of subjects, and overdiagnosed 44.7% and 19.8% of subjects compared with histology, respectively. The sensitivity and specificity for detecting cervical intraepithelial neoplasia 2 or greater were 35.4% versus 23.2%, P < .0001, and 89.9% versus 95.0%, P < .0001, respectively, for colposcopists and reviewers. CONCLUSION Colposcopy quality control by review of digitized colposcopic images in clinical trials warrants further evaluation if the accuracy can be improved.
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Affiliation(s)
- Daron G Ferris
- Departments of Family Medicine and Obstetrics and Gynecology, 1423 Harper St, HH-100, Medical College of Georgia, Augusta, GA 30912, USA.
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