Patient-centered wound teleconsultation for cutaneous wounds: a feasibility study

Updated Scenario on Negative Pressure Wound Therapy

Negative pressure wound therapy (NPWT) is a widely used and effective treatment for managing complex wounds. This document discusses how NPWT can be used in wound care in an updated way. The updated scenario on NPWT provides a concise overview of the current state of NPWT and its implications in clinical practice. It highlights recent developments in NPWT, as well as the advancements in this field. As part of NPWT, vacuum-assisted closure is used and negative pressure is applied to the wound bed. It discusses the key components and mechanisms. In addition to improving wound healing, NPWT also reduces infection rates and improves patient comfort, among other benefits. In addition, this document discusses the specific indications and contraindications of NPWT, as well as the types of wounds that can be treated with NPWT, including diabetic foot ulcers, pressure ulcers, and traumatic wounds. The document emphasizes the importance of choosing patients appropriately and assessing wounds to ensure optimal outcomes. In addition, it provides evidence-based guidelines and clinical recommendations on NPWT. In addition to reviewing the latest research findings supporting NPWT in a variety of clinical settings, it also discusses randomized controlled trials and systematic reviews. In addition, it discusses the potential complications and challenges associated with NPWT, including pain, bleeding, and device malfunction. The purpose of this document is to shed light on the role of NPWT in wound care management by providing an updated scenario. NPWT can be incorporated into clinical practice by healthcare professionals if they understand its principles, benefits, indications, and limitations. Healthcare providers can optimize patient outcomes and improve wound healing in diverse patient populations by staying abreast of the latest advancements in NPWT.

Plastic Surgery in the Gulf Cooperation Council Countries: Role of Telemedicine

Internationally, telemedicine is finding its way into common day plastic surgery practice as a result of the COVID-19 pandemic. Nonetheless, no data about its practice in the Gulf region are available to date.

Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialty

Objective

The purpose of this paper is to review the literature and compile key clinically relevant applications of telemedicine for use in otolaryngology relevant to the post-COVID-19 era.

Study design

Systematic Literature Review.

Data sources

Pubmed and Google Scholar.

Review methods

Pubmed and Google Scholar were queried using combined key words such as “telemedicine,” “covid” and “otolaryngology.” The searches were completed in March–August 2020. Additional queries were made with particular subspecialty phrases such as “rhinology” or “otology” to maximize yield of relevant titles. Relevant articles were selected for abstract review. Applicable abstracts were then selected for review of the full text.

Results

Initial search identified 279 results. These were screened for relevance and 100 abstracts were selected for review. Abstracts were excluded if they were not in English, not related to otolaryngology, or if the full text was unavailable for access. Of these, 37 articles were selected for complete review of the full text.

Conclusion

The sudden healthcare closures during the COVID-19 pandemic resulted in a sharp increase in the use of telemedicine, particularly in subspecialty fields. Otolaryngologists are at a unique risk of infection resulting from the examination of the head and neck and aerosol-generating procedures due to the predilection of viral particles for the nasal cavities and pharynx. The COVID-19 pandemic may have served as a catalyst to implement telemedicine into clinical practice, however identifying ways to integrate telemedicine long term is key for a sustainable and viable practice in the post-COVID-19 era. Although many states are now finding themselves on the down-sloping side of their infection rate curve, many others remain at the apex. Additionally, the risk of future waves of this pandemic, or the onset of another pandemic, should not be overlooked. Practice modification guidelines that mitigate infection risk by utilizing telemedicine would be useful in these instances. Telemedicine can help to reduce infection spread by limiting unnecessary in-person interactions and help conserve personal protective equipment (PPE) by facilitating remote care with the added benefits of expanding care to broad geographic areas, limiting cost, time, and travel burden on patients and families, and enabling consistent follow up.

Telemedicine and the COVID-19 Pandemic: Are We Ready to Go Live?

Telemedicine use in the field of wound care had been increasing in popularity when the novel coronavirus 2019 paralyzed the globe in early 2020. To combat the constraints of healthcare delivery during this time, the use of telemedicine has been further expanded. Though many limitations of telemedicine are still being untangled, the benefits of virtual care are being realized in both inpatient and outpatient settings. In this article, the advantages and disadvantages of telemedicine are discussed through two case examples that highlight the promise of implementation during and beyond the pandemic.

Telesurgical Assessment: Using Smartphone Messaging to Efficiently Manage Postoperative Wounds

Background: Telemedicine is an evolving field of interactions between physicians and patients remotely. Health care delivery, patient satisfaction, adherence, earlier diagnosis, increased access, and cost reduction are all areas that telemedicine has potential influence. One focus involves the use of photos in wound assessment. Today, many patients' smartphones can capture high-quality digital photographs, which can easily be transmitted. Postoperative patients are an ideal population for this, as they have a certain level of uncertainty with regard to the healing course, which can often lead to patients seeking out care in unnecessarily costly settings. These visits can lead to inefficient use of health care resources, especially when a telesurgical assessment (TSA) could provide appropriate care more efficiently. Objective: We present data collected from a series of patients who received a TSA to demonstrate the potential benefits of incorporating TSA into postoperative wound care. Methods/Clinical Presentation: Patients who underwent a procedure and contacted their surgeon within 2 weeks with concerns received a TSA, which included a discussion as well as photographs through smartphone. Their surgeon then determined further treatment steps, if any. Results: We experienced that 85% of patients did not require emergent treatment for their concerns, 46% were prescribed medications, whereas 39% of patients did not require any intervention. Conclusion: Our results show that TSAs alleviated patient concerns and provide resolutions, while saving resources and increasing satisfaction. Incorporating aspects of telemedicine into outpatient practice could be valuable, especially with postoperative wound checks.

Patient-Directed Active Surgical Incisions Surveillance May Lead to Further Surgical Site Infection Reduction

Background: Surgical site infections have been a concern for many years, and decades-old articles demonstrate the benefit of surveillance and reporting of these infections with resulting decrease in incidence. Comprehensive surveillance is difficult and often incomplete and is hampered when patients must travel a distance for surgical care. In recent years there has been increasing interest in patient-generated health data (PGHD) that includes patients taking photographs of their surgical incisions. Methods: A selective review of articles on PGHD and photographic images was undertaken in combination with interviews of investigators in this field. Results: There is a possibility that a well-developed system to facilitate patient-provided images of the surgical incision to surgical care providers in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner could improve surgical surveillance and reduce unnecessary post-operative visits. Conclusions: Further study is required.

Recent Directions in Telemedicine: Review of Trends in Research and Practice

Objectives

Healthcare is now routinely delivered by telecommunications-based services in all developed countries and an increasing number of developing countries. Telemedicine is used in many clinical specialities and across numerous healthcare settings, which range from mobile patient-centric applications to complex interactions amongst clinicians in tertiary referral hospital settings. This paper discusses some recent areas of significant development and progress in the field with the purpose of identifying strong trends in both research and practice activities.

Methods

To establish the breadth of new ideas and directions in the field, a review of literature was made by searching PubMed for recent publications including terms (telemedicine OR telehealth) AND (challenge OR direction OR innovation OR new OR novel OR trend), for all searchable categories. 3,433 publications were identified that have appeared since January 1, 2005 (2,172 of these since January 1, 2010), based on a search conducted on June 1, 2015.

Results

The current interest areas in these papers span both synchronous telemedicine, including intensive care, emergency medicine, and mental health, and asynchronous telemedicine, including wound and burns care, dermatology and ophthalmology.

Conclusions

It is concluded that two major drivers of contemporary tele medicine development are a high volume demand for a particular clinical service, and/or a high criticality of need for clinical exper tise to deliver the service. These areas offer promise for further study and enhancement of applicable telemedicine methods and have the potential for large-scale deployments internationally, which would contribute significantly to the advancement of healthcare.

Postoperative Care Using a Secure Online Patient Portal: Changing the (Inter)Face of General Surgery

BACKGROUND

Many patients seek greater accessibility to health care. Meanwhile, surgeons face increasing time constraints due to workforce shortages and elevated performance demands. Online postoperative care may improve patient access while increasing surgeon efficiency. We aimed to evaluate patient and surgeon acceptance of online postoperative care after elective general surgical operations.

STUDY DESIGN

A prospective pilot study within an academic general surgery service compared online and in-person postoperative visits from May to December 2014. Included patients underwent elective laparoscopic cholecystectomy, laparoscopic ventral hernia repair, umbilical hernia repair, or inguinal hernia repair by 1 of 5 surgeons. Patients submitted symptom surveys and wound pictures, then corresponded with their surgeons using an online patient portal. The primary outcome was patient-reported acceptance of online visits in lieu of in-person visits. Secondary outcomes included detection of complications via online visits, surgeon-reported effectiveness, and visit times.

RESULTS

Fifty patients completed both online and in-person visits. Online visits were acceptable to most patients as their only follow-up (76%). For 68% of patients, surgeons reported that both visit types were equally effective, while clinic visits were more effective in 24% and online visits in 8%. No complications were missed via online visits, which took significantly less time for patients (15 vs 103 minutes, p < 0.01) and surgeons (5 vs 10 minutes, p < 0.01).

CONCLUSIONS

In this population, online postoperative visits were accepted by patients and surgeons, took less time, and effectively identified patients who required further care. Further evaluation is needed to establish the safety and potential benefit of online postoperative visits in specific populations.