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Brekelmans W, van der Burg BLSB, Brouwer RJ, Belo JN, Hoencamp R. Teleconsulting in wound care: Connecting the primary care to the wound specialist reduces unnecessary referrals. Wound Repair Regen 2024; 32:445-450. [PMID: 38656746 DOI: 10.1111/wrr.13185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/27/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
In the Netherlands the primary care (General Practitioner or homecare nurse) encounter a variety of wounds ranging from traumatic to diabetic foot ulcers. According to a recent study 82.4% of the patients with a wound can be treated in a primary setting with the GP as medical supervisor. The remaining 17.6% of patients need more extensive care including advice by a specialised doctor, diagnosis and treatment. Prompt analyses and treatment of underlying causes by specialised doctors in a multidisciplinary setting is necessary for treating patients with complicated wound. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care. And describes the effect on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital. All data was collected prospectively from June 2020 until October 2021. The study involved a process where primary care could seek advice from a Wound Physician at the Alrijne Wound Centre through a specialised Electronic Health Consultation. A total of 118 patients were analysed. 41/118 (34.7%) patients required a physical consultation with analysis and treatment in the hospital, after teleconsultation. The remaining 77/118 (65.3%) could be treated in primary care after Electronic Health Consultation. The mean duration of wound existence until Electronic Health Consultation was 39.3 days (range 5-271, SD: 38.5). 3/41 (7.3%) of the referrals were unnecessary. Electronic Health Consultation serves as a valuable and efficient tool for enhancing wound care, ultimately contributing to improved patient management and resource allocation within the healthcare system. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care and the influence on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital.
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Affiliation(s)
- W Brekelmans
- Alrijne Wound Centre, Alrijne Hospital, Leiderdorp, The Netherlands
- Department of Surgery, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - B L S Borger van der Burg
- Alrijne Wound Centre, Alrijne Hospital, Leiderdorp, The Netherlands
- Department of Surgery, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
| | - R J Brouwer
- Alrijne Wound Centre, Alrijne Hospital, Leiderdorp, The Netherlands
- Department of Surgery, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
| | - J N Belo
- General practice Valkenburg, Valkenburg, The Netherlands
| | - R Hoencamp
- Alrijne Wound Centre, Alrijne Hospital, Leiderdorp, The Netherlands
- Department of Surgery, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
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Rosenburg M, Tuvesson H, Lindqvist G, Brudin L, Fagerström C. Associations between self-care advice and healing time in patients with venous leg ulcer- a Swedish registry-based study. BMC Geriatr 2024; 24:124. [PMID: 38302867 PMCID: PMC10835865 DOI: 10.1186/s12877-024-04660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient's nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff's advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors. METHODS The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time. RESULTS No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32-2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12-2.15, p = 0.009) showed an association with longer healing time. CONCLUSIONS Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.
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Affiliation(s)
- Marcus Rosenburg
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
- School of Health and Welfare, Department of Health and Nursing, Halmstad University, Halmstad, Sweden.
| | - Hanna Tuvesson
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Gunilla Lindqvist
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Fagerström
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
- Department of Research Region Kalmar County, Kalmar, Sweden
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Campbell K, Greenfield G, Li E, O'Brien N, Hayhoe B, Beaney T, Majeed A, Neves AL. The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review. J Med Internet Res 2023; 25:e48920. [PMID: 37647117 PMCID: PMC10500356 DOI: 10.2196/48920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. OBJECTIVE This study aims to evaluate the impact of virtual consultations on the quality of primary care. METHODS A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. RESULTS In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. CONCLUSIONS Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.
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Affiliation(s)
- Kate Campbell
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Niki O'Brien
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ana Luísa Neves
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Barakat‐Johnson M, Kita B, Jones A, Burger M, Airey D, Stephenson J, Leong T, Pinkova J, Frank G, Ko N, Kirk A, Frotjold A, White K, Coyer F. The viability and acceptability of a Virtual Wound Care Command Centre in Australia. Int Wound J 2022; 19:1769-1785. [PMID: 35607997 PMCID: PMC9615290 DOI: 10.1111/iwj.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digitally enabled application for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic wounds from 9 centres, encompassing hospital services, outpatient clinics, and community nurses in one metropolitan and rural state in Australia, were enrolled and a total of 61 wounds were analysed over 7 months. Patients received, on average, an occasion of service every 4.4 days, with direct queries responded to in a median time of 1.5 hours. During the study period, 26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the digital wound application as easy to use. Potential mean travel savings of $99.65 for rural patients per visit were recognised. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.
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Affiliation(s)
- Michelle Barakat‐Johnson
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Badia Kita
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Aaron Jones
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Health Informatics UnitSydney Local Health DistrictSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital Health, University of SydneySydneyNew South WalesAustralia
| | - Mitchell Burger
- Health Informatics UnitSydney Local Health DistrictSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital Health, University of SydneySydneyNew South WalesAustralia
- Information Communication Technology, Strategy Architecture and Innovation, Sydney Local Health DistrictSydneyNew South WalesAustralia
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - David Airey
- Riverina EndovascularWagga WaggaNew South WalesAustralia
| | - John Stephenson
- Biomedical StatisticsSchool of Human and Health Services, University of HuddersfieldHuddersfieldUnited Kingdom
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUnited Kingdom
| | - Thomas Leong
- Nursing and Midwifery ServicesRoyal Prince Alfred Hospital, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Jana Pinkova
- Nursing and Midwifery ServicesRoyal Prince Alfred Hospital, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Georgina Frank
- Podiatry DepartmentSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Natalie Ko
- Department of Nursing and MidwiferyConcord HospitalSydneyNew South WalesAustralia
| | - Andrea Kirk
- Nursing and Midwifery ServicesWestern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Astrid Frotjold
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Kate White
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSWSydneyNew South WalesAustralia
| | - Fiona Coyer
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUnited Kingdom
- Intensive Care ServicesRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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Wickström HL, Fagerström C, Öien RF, Anderberg P, Midlöv P. Antibiotic prescription using a digital decision support system: a register-based study of patients with hard-to-heal ulcers in Sweden. BMJ Open 2022; 12:e060683. [PMID: 36302578 PMCID: PMC9621189 DOI: 10.1136/bmjopen-2021-060683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate differences in antibiotic prescription for patients with hard-to-heal ulcers assessed using a digital decision support system (DDSS) compared with those assessed without using a DDSS. A further aim was to examine predictors for antibiotic prescription. DESIGN Register-based study. SETTING In 2018-2019, healthcare staff in primary, community and specialist care in Sweden tested a DDSS that offers a mobile application for data and photograph transfer to a platform for multidisciplinary consultation and automatic transmission of data to the Registry of Ulcer Treatment (RUT). Register-based data from patients assessed and diagnosed using the DDSS combined with the RUT was compared with register-based data from patients whose assessments were merely registered in the RUT. PARTICIPANTS A total of 117 patients assessed using the DDSS combined with the RUT (the study group) were compared with 1784 patients whose assessments were registered in the RUT without using the DDSS (the control group). PRIMARY AND SECONDARY OUTCOME MEASURES The differences in antibiotic prescription were analysed using the Pearson's χ2 test. A logistic regression analysis was used to check for influencing factors on antibiotic prescription. RESULTS Patients assessed using a DDSS in combination with the RUT had significantly lower antibiotic prescription than patients entered in the RUT without using the DDSS (8% vs 26%) (p=0.002) (only healed ulcers included). Predictors for antibiotic prescription were diabetes; long healing time; having an arterial, neuropathic or malignant ulcer. CONCLUSIONS A DDSS with data and photograph transfer that enables multidisciplinary communication appears to be a suitable tool to reduce antibiotic prescription for patients with hard-to-heal ulcers.
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Affiliation(s)
- Hanna Linnea Wickström
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Blekinge Wound Healing Centre, Region Blekinge, Karlshamn, Sweden
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar län, Kalmar, Sweden
| | - Rut Frank Öien
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Kostovich CT, Etingen B, Wirth M, Patrianakos J, Kartje R, Baharestani M, Weaver FM. Outcomes of Telehealth for Wound Care: A Scoping Review. Adv Skin Wound Care 2022; 35:394-403. [PMID: 35170501 DOI: 10.1097/01.asw.0000821916.26355.fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care. DATA SOURCES An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer. STUDY SELECTION Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria. DATA EXTRACTION Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others. DATA SYNTHESIS Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs. CONCLUSIONS Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.
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Affiliation(s)
- Carol T Kostovich
- Carol T. Kostovich, PhD, RN, CHSE, is Research Health Scientist, Edward Hines, Jr. VA Hospital, Hines, IL; and Associate Professor, Assistant Dean of Innovative Educational Strategies, Marcella Niehoff School of Nursing, Loyola University, Chicago, IL. At the Hines VA Hospital, Bella Etingen, PhD, is Research Health Scientist, Center of Innovation for Complex Chronic Healthcare; Marissa Wirth, MPH, is Research Health Science Specialist; Jamie Patrianakos, MA, is Research Health Science Specialist; and Rebecca Kartje, MD, MS, is Analyst. Mona Baharestani, PhD, APN, CWON, FACCWS, is Associate Chief, Wound Care & Research, James H. Quillen VAMC, Johnson City (Mountain Home), Johnson City, TN. Frances M. Weaver, PhD, is Research Health Scientist, Hines VA Hospital, and Professor, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL. Acknowledgment: This work was supported by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views, position, or policy of the Department of Veterans Affairs or the US Government. The authors have disclosed no other financial relationships related to this article. Submitted June 8, 2021; accepted in revised form July 23, 2021; published online ahead of print February 14, 2022
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The Infection Control Route in the Operating Room Effectively Reduces the Wound Infection of Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9270045. [PMID: 35707472 PMCID: PMC9192282 DOI: 10.1155/2022/9270045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 12/07/2022]
Abstract
Surgical care is one of the significant aspects of global healthcare, with approximately 234 million operations being conducted annually. Surgical treatment has a substantial risk of complications and death. This study was conducted to explore the application effect of the infection control route in the operating room on the wound infection prevention care of patients. The clinical data of 136 patients receiving surgical treatment from October 2018 to October 2019 were retrospectively analyzed. The participants were assigned via random draw at a ratio of 1 : 1 to receive either routine care management (control group) or the infection control route (research group). The surgical wound infections of patients in the two groups were compared. The research group had higher scores in surgical materials management and disinfectant management than the control group (P < 0.01). In the research group, the total number of colonies within 5 minutes before surgery, 25 minutes after the start of surgery, and after surgery were all smaller than those in the control group (P < 0.01). There were no significant differences in the grade B healing rate between the two groups (P > 0.05), and the research group had a significantly higher healing rate in grade A than the control group, but its grade C healing rate and wound infection rate were significantly lower than those in the control group (P < 0.05). In the research group, the length of hospital stay, the time to get out of bed, the antibiotic use duration, and the stitch removal time was significantly shorter than those in the control group (P < 0.0001). The research group received a higher clinical nursing satisfaction than the control group (P < 0.05). The infection control route in the operating room for infection prevention care effectively reduces the wound infection rate of patients and accelerates their postoperative recovery.
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Yammine K, Estephan M. Telemedicine and diabetic foot ulcer outcomes. A meta-analysis of controlled trials. Foot (Edinb) 2022; 50:101872. [PMID: 35219129 DOI: 10.1016/j.foot.2021.101872] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
Telemedicine (TM) has been advanced as an effective approach to wound care management. In this era of COVID-19 pandemic, it is paramount to assess the evidence behind the use of TM in treating diabetic foot ulcers (DFU). This meta-analysis aims at evaluating the efficacy of TM versus face-to-face attendance in managing DFU. In total, four controlled studies were included in the meta-analysis comprising 3 randomized trials. The total pooled sample comprised 816 patients (816 ulcers): 337 in TM group and 479 in the control group. The results were as follows: (a) healing rate OR was 1.35, in favor of TM (p = 0.4), (b) time to heal with means of 73 ± 24.1 days and 83.5 ± 28.4 days, for the TM and control group, respectively (p = 0.35), c) the amputation rate OR was 0.48 (p = 0.007) in favor of the TM group, d) the mortality rate OR was 1.66 (p = 0.2), and e) a trend for lesser cost than face-to-face group (p = 0.4). While future research using large-sampled controlled studies is warranted, the present meta-analysis demonstrated that treating DFU via TM could be at least as effective as to face-to-face attendance. In times where clinic visits are reduced or not possible such as during this COVID-19 pandemic and the likely-to-happen future outbreaks, TM could be a valuable alternative.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
| | - Michel Estephan
- Department of Emergency Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
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Fagerström C, Wickström H, Tuvesson H. Still engaged – healthcare staff’s engagement when introducing a new eHealth solution for wound management: a qualitative study. BMC Health Serv Res 2022; 22:103. [PMID: 35078483 PMCID: PMC8788143 DOI: 10.1186/s12913-022-07515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management. Methods A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis. Results Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others. Conclusions The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.
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Gamus A, Keren E, Kaufman H, Brandin G, Peles D, Chodick G. Telemedicine versus face-to-face care for treatment of patients with lower extremity ulcers. J Wound Care 2021; 30:916-921. [PMID: 34747216 DOI: 10.12968/jowc.2021.30.11.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Lower extremity ulcers (LEUs) are associated with a decline in patients' quality of life (QoL). Better healthcare availability in remote regions, facilitated by telemedicine (TM), may improve patient wellbeing. The aim of this study was to compare the QoL of patients treated via synchronous video TM with that of patients treated with standard face-to-face (FTF) care. METHOD The study was performed in a large health services provider in Israel (Maccabi Healthcare Services). TM was used in four remote locations; the FTF method was applied in two regional clinics. The treatment protocol was performed by a nurse and supervised by the regional physician in both treatment modes. A validated Wound-QoL questionnaire in Hebrew was used to assess patient outcomes. RESULTS A total of 83 patients were treated via TM and 94 patients were treated FTF. The mean QoL for patients treated via TM was 0.546±0.249 compared with 0.507±0.238 for the FTF group. A similarity relating to outcomes in both treatment methods was demonstrated by a difference of 0.039 (95% confidence interval -0.33-0.111) and p=0.291. The probability of the difference being within the limits of the interval in a replicated study was 83.4%. The equivalence/non-inferiority was established within the accepted Δ=0.12 range. CONCLUSION The results indicated no reduced QoL for patients with LEUs treated with telemedicine versus with standard FTF care. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
- Alexander Gamus
- Maccabi Health Services, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Epidemiology and Database Research Unit, Israel
| | - Elad Keren
- Maccabi Health Services, Israel.,Soroka Medical Center, Beer-Sheba, Israel
| | | | | | | | - Gabriel Chodick
- Maccabi Health Services, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Epidemiology and Database Research Unit, Israel
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11
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Telemedicine for the treatment of foot ulcers in people with diabetes. Hippokratia 2021. [DOI: 10.1002/14651858.cd014652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wickström H, Öien RF, Midlöv P, Anderberg P, Fagerström C. Pain and analgesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations. J Wound Care 2021; 30:S23-S32. [PMID: 34120467 DOI: 10.12968/jowc.2021.30.sup6.s23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. METHOD This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. RESULTS The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. CONCLUSION To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.
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Affiliation(s)
- Hanna Wickström
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.,Blekinge Wound Healing Centre, Karlshamn, Sweden
| | - Rut F Öien
- Blekinge Wound Healing Centre, Karlshamn, Sweden.,Blekinge Centre of Competence, Karlskrona, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Karlskrona, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Sweden
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13
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Huang Z, Wu S, Yu T, Hu A. Efficacy of Telemedicine for Patients with Chronic Wounds: A Meta-Analysis of Randomized Controlled Trials. Adv Wound Care (New Rochelle) 2021; 10:103-112. [PMID: 32320355 DOI: 10.1089/wound.2020.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: The meta-analysis was performed to summarize the available evidence and assess the efficacy of telemedicine for patients with chronic wounds. Approach: PubMed, Embase, Web of Science, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were electronically searched to identify eligible studies updated to February 2020 to collect randomized controlled trials regarding the efficacy of telemedicine for patients with chronic wounds. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies with the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed using RevMan 5.3 and StataSE. Results: Fourteen studies involving 1,926 patients were included in the meta-analysis. Compared with usual care, telemedicine intervention significantly improved wound healing rate (risk ratio [RR] = 1.44, confidence interval [95% CI] = 1.16-1.80, p = 0.001) and reduced adverse events (RR = 0.52, 95% CI = 0.34-0.80, p = 0.003). No significant differences were found between patients allocated to the telemedicine group or usual care group, in terms of the outcomes of healing time, change in wound size, or mortality. Innovations: Telemedicine is an effective approach to promote chronic wound healing and reduce adverse events. Conclusion: The meta-analysis demonstrates that telemedicine may improve the healing rate and reduce adverse events for patients with chronic wounds. Because of the limited quality and quantity of the included studies, rigorous studies with adequate sample sizes are required to conclude with more confidence.
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Affiliation(s)
- Zehao Huang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Siyu Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Yu
- Nursing Department, Lingnan Branch of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ailing Hu
- Nursing Department, Lingnan Branch of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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14
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Wickström H, Tuvesson H, Öien R, Midlöv P, Fagerström C. Health Care Staff's Experiences of Engagement When Introducing a Digital Decision Support System for Wound Management: Qualitative Study. JMIR Hum Factors 2020; 7:e23188. [PMID: 33295295 PMCID: PMC7758170 DOI: 10.2196/23188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/29/2020] [Accepted: 11/14/2020] [Indexed: 01/12/2023] Open
Abstract
Background eHealth solutions such as digital decision support systems (DDSSs) have the potential to assist collaboration between health care staff to improve matters for specific patient groups. Patients with hard-to-heal ulcers have long healing times because of a lack of guidelines for structured diagnosis, treatment, and follow-up. Multidisciplinary collaboration in wound management teams is essential. A DDSS could offer a way of aiding improvement within wound management. The introduction of eHealth solutions into health care is complicated, and the engagement of the staff seems crucial. Factors influencing and affecting engagement need to be understood and considered for the introduction of a DDSS to succeed. Objective This study aims to describe health care staff’s experiences of engagement and barriers to and influencers of engagement when introducing a DDSS for wound management. Methods This study uses a qualitative approach. Interviews were conducted with 11 health care staff within primary (n=4), community (n=6), and specialist (n=1) care during the start-up of the introduction of a DDSS for wound management. The interviews focused on the staff’s experiences of engagement. Content analysis by Burnard was used in the data analysis process. Results A total of 4 categories emerged describing the participants’ experiences of engagement: a personal liaison, a professional commitment, an extended togetherness, and an awareness and understanding of the circumstances. Conclusions This study identifies barriers to and influencers of engagement, reinforcing that staff experience engagement through feeling a personal liaison and a professional commitment to make things better for their patients. In addition, engagement is nourished by sharing with coworkers and by active support and understanding from leadership.
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Affiliation(s)
- Hanna Wickström
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Blekinge Wound Healing Centre, Karlshamn, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Rut Öien
- Blekinge Centre of Competence, Karlskrona, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
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Abstract
The increasing use of smartphones is accompanied by a significant increase in the use of mobile applications (apps). Chronically ill patients could permanently profit from this development.This development is fuelled by the Digital Healthcare Act (DVG), whereby patients have a legal claim to certain apps, so-called digital health applications (DiGAs), which are reimbursed by the statutory health insurance companies. Especially in the field of rheumatology, there are various opportunities to implement apps in the management of chronic diseases and their comorbidities. Furthermore, rheumatic patients and rheumatologists are becoming interested in apps and are willing to use them in the daily routine. This article tries to shed light on the chances and risks of apps and gives a first insight into the digital landscape of rheumatology apps in Germany.
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16
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Wickström H, Öien RF, Midlöv P, Anderberg P, Fagerström C. Pain and analgaesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations. J Wound Care 2020; 29:S18-S27. [PMID: 32804019 DOI: 10.12968/jowc.2020.29.sup8.s18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. METHOD This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. RESULTS The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. CONCLUSION To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.
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Affiliation(s)
- Hanna Wickström
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.,Blekinge Wound Healing Centre, Karlshamn, Sweden
| | - Rut F Öien
- Blekinge Wound Healing Centre, Karlshamn, Sweden.,Blekinge Centre of Competence, Karlskrona, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Karlskrona, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Sweden
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Dijkstra HP, Ergen E, Holtzhausen L, Beasley I, Alonso JM, Geertsema L, Geertsema C, Nelis S, Ngai ASH, Stankovic I, Targett S, Andersen TE. Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic. Br J Sports Med 2020; 54:1162-1167. [PMID: 32605933 PMCID: PMC7513251 DOI: 10.1136/bjsports-2020-102650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
Background The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. Aim The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. Results eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. Conclusion teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.
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Affiliation(s)
- H Paul Dijkstra
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar .,Department for Continuing Education, University of Oxford, Oxford, UK
| | - Emin Ergen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Louis Holtzhausen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Ian Beasley
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,The Royal Ballet, London, UK
| | - Juan Manuel Alonso
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Liesel Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Celeste Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Sofie Nelis
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Aston Seng Huey Ngai
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Ivan Stankovic
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Stephen Targett
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Thor Einar Andersen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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18
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Chen L, Cheng L, Gao W, Chen D, Wang C, Ran X. Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e15574. [PMID: 32584259 PMCID: PMC7381084 DOI: 10.2196/15574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 05/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.
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Affiliation(s)
- Lihong Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Cheng
- Department of Clinical Laboratory, Nuclear Industry 416 Hospital, the 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China.,School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Wei Gao
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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19
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Hrynyschyn R, Dockweiler C, Iltner J, Hornberg C. [Teleconsultation for vascular- and diabetes-associated chronic wounds : A systematic review of health-related and economic implications]. Hautarzt 2019; 71:114-123. [PMID: 31659390 DOI: 10.1007/s00105-019-04498-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In addition to lowering the quality of life of those affected, long periods of treatment and high recurrence rates of chronic wounds cause major economic costs for health care systems. Furthermore, inadequate health care and undersupply of care can be observed in Germany. Thus, new forms of care such as teleconsultation are being discussed increasingly. Recent changes in the remuneration system and macerations in the ban of remote treatment support those trends. METHODS A systematic review was conducted in July 2018 using PubMed and CENTRAL databases for randomized controlled trials between 2008 and 2018. Only randomized clinical trials in which patients with chronic wound who received treatment and follow-up by teleconsultation using information and communication technology to share data were included. In total, 6 international clinical trials were identified. RESULTS Regarding the current state of research, there is no definite evidence that teleconsultation can improve the care of chronic wound patients. Most likely, wound healing time was positively influenced. No correlation was found between mortality and hospitalizations when teleconsultation was used. CONCLUSION On the basis of the included studies, the evidence for the care of chronic wounds by teleconsultation is unclear. Further research is needed to examine the health-related and economic benefits of teleconsultation to support integration into health care systems.
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Affiliation(s)
- Robert Hrynyschyn
- Centre for ePublic Health Research, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
| | - Christoph Dockweiler
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Jessica Iltner
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Claudia Hornberg
- Medizinische Fakultät, Universität Bielefeld, Bielefeld, Deutschland
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