Tele-echocardiography: enhancing quality at the point-of-care

A pediatric telecardiology system that facilitates integration between hospital-based services and community-based primary care

INTRODUCTION

Telecardiology has emerged as a vital field within telemedicine, fostering collaboration between hospital and community medicine. This pilot study introduces an innovative pediatric telecardiology system, comprising a telecardiology system seamlessly integrated with a hospital telemedicine platform. A smooth flow of ECG execution, transmission, and reporting between Primary Care Pediatrician clinics and the hospital was tested as the primary objective. User experience surveys were also considered.

METHODS

The study involved three Primary Care Pediatrician clinics, and the enrollment of children took place consecutively from January to July 2023. We integrated a digital electrocardiographic signal acquisition unit and online information transmission-capable tablets, that were provided to the pediatricians, with a telemedicine multitenant platform that facilitated the transmission of the patient's ECG data from the community to the Hospital Pediatric Cardiologist.

RESULTS

A total of 158 children (80 M/78F, 8.9 ± 2.8 yrs) underwent ECG recording (78.5 % medical certificates, 21.5 % presence of symptoms) The transmission and reporting of ECGs were successfully completed in all cases, without technical issues. Normal findings on the ECG were demonstrated in 94.9 % of children. 70.8 % of respondents completed all parts of the survey. Respondents had a high level of education (90 %) and demonstrated excellent or good competence in using digital technologies (89 %). 51 % of respondents were not familiar with the term "Telemedicine" and 81 % of the cases had no previous telemedicine experience. 90 % of users were very satisfied or satisfied with the service. Connection problems (2.8 %) and concerns about the service's reliability compared to standard care (3.7 %) were mentioned as possible limitations of the telecardiology.

CONCLUSIONS

Our pediatric telecardiology system offers a valuable diagnostic tool to enhance patient management in the community.

Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review

BACKGROUND

Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools.

OBJECTIVE

To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods.

DESIGN AND SETTING

Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education.

METHODS

A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators.

RESULTS

The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement.

CONCLUSION

We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography.

REGISTRATION NUMBER

DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Using remote consultation to enhance diagnostic accuracy of bedside transthoracic echocardiography during COVID-19 pandemic

Objective

The aim of this study was to evaluate the clinical significance of remote consultation over bedside transthoracic echocardiography (RC‐B‐TTE) for patients with coronavirus disease 2019 (COVID‐19).

Methods

Five frontline echocardiographers performed and interpreted B‐TTE for 30 patients with COVID‐19 in the isolation wards, and the on‐site B‐TTE reports (OSR) were generated. Then remote consultation over the 30 B‐TTE studies was conducted by two experienced echocardiographic consultants while blinded to the OSR, and the corresponding remote consultation reports (RCR) were generated. Subsequently, the five frontline echocardiographers were convened together to discuss the difference between the OSR and RCR, and to confirm the correct interpretation and the misdiagnosis using a “majority‐vote” consensus as the diagnostic “gold standard”. Afterwards the reasons for the misdiagnosis were given by the frontline echocardiographers themselves. The inter‐rater agreement between the OSR and the “gold standard” was assessed using Kappa coefficient and percent agreement.

Results

Complete correctness of the 30 copies of the RCR were determined by the 5 frontline echocardiographers. The reliability of the OSR in the findings of cardiac chamber dilation, left ventricular hypertrophy and pulmonary hypertension were weak (Kappa <0.6). The reliability of the OSR in the recognition of major cardiac abnormalities was very weak (Kappa =0.304, percent agreement =63.3%). Misdiagnosis of major abnormalities was found in 11 copies of OSR (11/30, 36.7%).

Conclusions

The protocol of RC‐B‐TTE has shown noticeable superiority in ameliorating diagnostic accuracy of echocardiography, which should be generalized to clinical practice during the COVID‐19 or similar pandemic.

Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology: A Prospective Multicenter Validation Study

OBJECTIVES

This study aimed to validate dermatologic ultrasound as a complementary teledermatologic imaging modality in primary and tertiary care centers.

METHODS

Six primary care centers and 1 tertiary care dermatology department collaborated in the program. Images were sent through the institutional teledermatologic platform to the tertiary care dermatology department. At the reference hospital, ultrasound images and clinical data were received and registered by a physician trained in dermatologic ultrasound. An in-person consultation was scheduled to confirm the teleultrasound diagnosis. The time of response by the tertiary center, quality and size of the teledermatologic image, and concordance with the in-person diagnosis were assessed for each dermatologic lesion.

RESULTS

A total of 147 teleultrasound consultations with 143 patients (93 women and 50 men; mean age ± SD, 47 ± 23 years) were evaluated between June 2018 and January 2019. Nine teleultrasound consultations (6.1%) were not valid. Discordance between teleultrasound and the in-person diagnosis was evident in 6 of 138 cases (4.3%). Most cases corresponded to benign skin tumors (66.7%), followed by inflammatory skin lesions (15.9%), nonmelanoma skin lesions (13%), and other skin lesions (4.3%). All malignant tumors were detected (sensitivity, 100%), although 2 cases of benign lesions were telediagnosed as malignant (specificity, 97.8%). The positive and negative predictive values of a teleultrasound diagnosis of cutaneous malignancy were 90% and 100%, respectively.

CONCLUSIONS

Asynchronous primary care teleultrasound combined with dermatologic ultrasound training at tertiary centers is an effective teledermatologic modality.