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Leyendecker J, Prasse T, Bieler E, Yap N, Eysel P, Bredow J, Hofstetter CP. Smartphone applications for remote patient monitoring reduces clinic utilization after full-endoscopic spine surgery. J Telemed Telecare 2024:1357633X241229466. [PMID: 38321874 DOI: 10.1177/1357633x241229466] [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: 02/08/2024]
Abstract
INTRODUCTION The rising number of outpatient spine surgeries creates challenges in postoperative management and care. Telemedicine offers a unique opportunity to reduce in-person clinic visits and improve resource allocation. We aimed to investigate the impact of a validated smartphone application on clinic utilization following full-endoscopic spine surgery (FESS). METHODS We evaluated patients undergoing FESS from 2020 to 2022 and a pre-COVID control group (CG) from 2018 to 2019. Subsequently, we divided the patients into three groups: one using the application (intervention group, IG), and two CGs (2020-2022, CG and 2018-2019, historical control group (HG)). We analyzed the post-surgical hospitalization rate, all follow-ups, and virtually transmitted patient-reported outcomes. RESULTS A total of 115 patients were included in the IG. The CG consisted of 137 and the HG of 202 patients (CG and HG in the following). Group homogeneity was satisfactory regarding patient age (p = 0.9), sex (p = 0.88), and body mass index (p = 0.99). IG patients were treated as outpatients significantly more often [14.78% vs. 29.2% vs. 37.62% (p < 0.001)]. Additionally, IG patients showed significantly higher follow-up compliance [74.78% vs. 40.14% vs. 37.13% (p < 0.001)] 3-month post-surgery and fewer in-patient follow-up visits [(0.5 ± 0.85 vs. 1.32 ± 0.8 vs. 1.33 ± 0.7 (p < 0.001)]. CONCLUSION Our results underline the feasibility, efficacy, and safety of remote patient monitoring following FESS. Furthermore, they highlight the opportunity to implement a virtual wound checkup, and to substantially improve postoperative follow-up compliance via telemedicine.
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Affiliation(s)
- Jannik Leyendecker
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eliana Bieler
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Natalie Yap
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
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Mahdavi A, Atlasi R, Ebrahimi M, Azimian E, Naemi R. Human resource management (HRM) strategies of medical staff during the COVID-19 pandemic. Heliyon 2023; 9:e20355. [PMID: 37771528 PMCID: PMC10522956 DOI: 10.1016/j.heliyon.2023.e20355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Healthcare workers are at the forefront of fight against COVID-19 and the managers of medical centers should develop coping strategies for the challenges caused by COVID-19, especially for health human resources in order to improve the performance of healthcare organizations. Hence, the purpose of this study is to investigate the human resource management strategies of medical staff during the COVID-19 to help them cope with the new strains of COVID-19 or epidemics of viral diseases that may occur in the future. In this study, a search was performed in the international Web of Science electronic database, using keywords such as human resource management and COVID-19. As a result, a total of 1884 articles published between January 1st, 2020 and October 22nd, 2021 were extracted. After screening the articles based on inclusion and exclusion criteria, 24 articles were selected to enter the study. Then, a scientometric analysis was performed on the content of selected articles and the results were presented in the form of tables and conceptual models. In total, 9 strategies were extracted from the selected articles including development of organizational culture, staff screening, policy-making, infection control training and monitoring the implementation of learned materials, patient management, human resource management, psychological and motivational support, communication and coordination, and digital health services. Employing comprehensive strategies to maintain the health of healthcare workers during the COVID-19 can play an effective role in reducing burnout, improving productivity and employee satisfaction, and in increasing the resilience of healthcare workers. It also has a positive effect on the patient's safety. Revision and reengineering of human resource management strategies in health and treatment organizations according to different cultures and contexts require research and investment in creative and innovative strategies.
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Affiliation(s)
- Abdullah Mahdavi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
| | - Rasha Atlasi
- Information and Scientometrics Center at Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Iran
| | - Maryam Ebrahimi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ehsanollah Azimian
- Department of Linguistics and Foreign Languages, Payame Noor University, Tehran, Iran
| | - Roya Naemi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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Riew GJ, Lovecchio F, Samartzis D, Louie PK, Germscheid N, An H, Cheung JPY, Chutkan N, Mallow GM, Neva MH, Phillips FM, Sciubba D, El-Sharkawi M, Valacco M, McCarthy MH, Makhni MC, Iyer S. Telemedicine in Spine Surgery: Global Perspectives and Practices. Global Spine J 2023; 13:1200-1211. [PMID: 34121482 PMCID: PMC10416595 DOI: 10.1177/21925682211022311] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional, anonymous, international survey. OBJECTIVES The COVID-19 pandemic has resulted in the rapid adoption of telemedicine in spine surgery. This study sought to determine the extent of adoption and global perspectives on telemedicine in spine surgery. METHODS All members of AO Spine International were emailed an anonymous survey covering the participant's experiences with and perceptions of telemedicine. Descriptive statistics were used to depict responses. Responses were compared among regions. RESULTS 485 spine surgeons participated in the survey. Telemedicine usage rose from <10.0% to >39.0% of all visits. A majority of providers (60.5%) performed at least one telemedicine visit. The format of "telemedicine" varied widely by region: European (50.0%) and African (45.2%) surgeons were more likely to use phone calls, whereas North (66.7%) and South American (77.0%) surgeons more commonly used video (P < 0.001). North American providers used telemedicine the most during COVID-19 (>60.0% of all visits). 81.9% of all providers "agreed/strongly agreed" telemedicine was easy to use. Respondents tended to "agree" that imaging review, the initial appointment, and postoperative care could be performed using telemedicine. Almost all (95.4%) surgeons preferred at least one in-person visit prior to the day of surgery. CONCLUSION Our study noted significant geographical differences in the rate of telemedicine adoption and the platform of telemedicine utilized. The results suggest a significant increase in telemedicine utilization, particularly in North America. Spine surgeons found telemedicine feasible for imaging review, initial visits, and follow-up visits although the vast majority still preferred at least one in-person preoperative visit.
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Affiliation(s)
- Grant J. Riew
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Francis Lovecchio
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Philip K. Louie
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Howard An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Jason Pui Yin Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Norman Chutkan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Gary Michael Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Marko H. Neva
- Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Frank M. Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Daniel Sciubba
- Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
| | - Marcelo Valacco
- Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina
| | - Michael H. McCarthy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Melvin C. Makhni
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Mudd A, Feo R, Pinero de Plaza MA, Tieu M, Paia SY, Cleland J, Windle A, George S, Thompson MQ, Ambagtsheer RC, Muller A, Hall A, Lange B. The Use of Digital Technologies in the Inpatient Setting to Promote Communication During the Early Stage of an Infectious Disease Outbreak: A Scoping Review. Telemed J E Health 2023; 29:172-197. [PMID: 35758765 DOI: 10.1089/tmj.2021.0615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.
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Affiliation(s)
- Alexandra Mudd
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rebecca Feo
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Maria A Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Shila Y Paia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jenny Cleland
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alice Windle
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Northern Adelaide Local Health Network, Allied Health Division, Lyell McEwin Hospital, Adelaide, Australia
| | - Mark Q Thompson
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,Adelaide Geriatrics Training & Research with Aged Care Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,Health Vertical, Torrens University Australia, Adelaide, Australia
| | - Amanda Muller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anna Hall
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Rispoli R, Cappelletto B. Telemedicine in practice: Patient selection and strategies adopted in spinal care during the COVID-19 era and beyond. Surg Neurol Int 2022; 13:383. [PMID: 36128140 PMCID: PMC9479600 DOI: 10.25259/sni_638_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
The SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on health-care systems around the world. To deal with this challenge, we developed a prospectus design and test a teleconsultation procedure suitable for both diagnostic and therapeutic needs of outpatients in our Spine and Spinal Cord Surgery Units.
Methods:
(1) The first 15 patients received in-person and telemedicine visits: Our pilot began with screening protocol that involved 15 patients who received an in-person assessment and a telemedicine consult. The 15 patients who were selected were already known to our unit after having had at least one previous in-person visit. Further, they had to be neurologically intact or have a stable neurological examination. The secondary teleconsultation took place as a synchronous face-to-face communication between the doctor and the patient through a video interface (Lifesize Video Conferencing, Austin, Texas). If the patient demonstrated worsening of symptoms or of their condition, they were rescheduled for an immediate/timely in-person revisit with a spinal physician. (2) Fifty patients were offered telemedicine visits alone: 35 accepted: Next, from 2020 to 2021, we provided a questionnaire to 50 patients, we deemed eligible for teleconsultations: 35 agreed to the teleconsultations, while 15 refused (i.e., selecting direct in-person assessments).
Results:
We found a comparable quality for the clinical consultations/assessments provided in-person versus through telemedicine. Further, the additional 35 patients who were positively impressed with the quality of the medical care provided utilizing the telemedicine/remote visits alone.
Conclusion:
When pandemic conditions worsen, telemedicine appears to be a viable and important tool/ alternative for spinal surgeons to screen potential patients for treatment/surgery. This preliminary study suggests that a remote examination may be effective, particularly in patients who have previously undergone prior in-person evaluations.
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Helgeson MD, Pisano AJ, Wagner SC. What's New in Spine Surgery. J Bone Joint Surg Am 2022; 104:1039-1045. [PMID: 36149239 DOI: 10.2106/jbjs.22.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alfred J Pisano
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Baart N, Hoving JL, Donker-Cools BHPM. Physicians' perspectives and future vision on disability assessments by phone during the COVID-19 pandemic: a cross-sectional survey. BMC Health Serv Res 2022; 22:687. [PMID: 35606761 PMCID: PMC9125537 DOI: 10.1186/s12913-022-08068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/26/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Physicians, who perform disability assessments for the Dutch Social Security Institute, were urged to conduct phone consultations from their homes to prevent the spread of COVID-19. The purpose of the study was to evaluate the perspectives of physicians regarding phone consultations during the COVID-19 pandemic. Additionally, to explore physicians' views on a more widespread future use of phone consultations in the context of work disability assessments. METHODS An electronic survey conducted from June to August 2020 included 41 statements categorized into themes previously identified in both the literature on physicians' phone consultations and emerging from daily practice. All 1081 physicians working at the Dutch Social Security Institute were invited by e-mail to participate in the survey. Participants indicated on a 5-point Likert scale whether they strongly disagreed, disagreed, neither agreed nor disagreed, agreed or strongly agreed with the statements. The collected data were analysed using descriptive statistics. RESULTS In general, physicians had become accustomed to perform phone consultations. Negative experiences included difficulties in getting an impression of patients and assessing patients' functional limitations. About half of physicians found that phone consultations took more effort, 61% asked more questions due to no direct patient observations. According to 67%, it is mostly necessary to perform an in-person consultation to adequately assess functional limitations of a patient with persistent medically unexplained physical symptoms. A great majority did not prefer telephone consultations to in-person consultations. However, more than half of physicians perceive a greater preference for phone consultations in the future than previously. 56% thought that replacement of in-person consultations with phone consultations in the future might lead to more complaints. CONCLUSIONS Perspectives and future views varied among physicians performing disability assessments by phone. A majority of physicians experienced difficulties with different aspects of the assessment. Despite these difficulties, most physicians support to continue the wider use of phone consultations. To improve remote disability assessments it is required to gain more insights into conditions under which a phone assessment can be as diligent as an in-person assessment.
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Affiliation(s)
- Nadia Baart
- Social Security Institute, Social Medical Affairs division, PO Box 58285, 1040 HG Amsterdam, the Netherlands
| | - Jan Lucas Hoving
- Coronel Institute of Occupational Health, Department of Public and Occupational Health, Amsterdam UMC and Research Center for Insurance Medicine, PO Box 22700, 1100 DE Amsterdam, the Netherlands
| | - Birgit Helena Petra Maria Donker-Cools
- Social Security Institute, Social Medical Affairs division, PO Box 58285, 1040 HG Amsterdam, the Netherlands
- Coronel Institute of Occupational Health, Department of Public and Occupational Health, Amsterdam UMC and Research Center for Insurance Medicine, PO Box 22700, 1100 DE Amsterdam, the Netherlands
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9
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Ye IB, Thomson AE, Donahue J, Oster B, Miseo VS, Jauregui JJ, Cavanaugh D, Koh E, Gelb D, Ludwig S. Similar Accuracy of Surgical Plans after Initial In-Person and Telemedicine Evaluation of Spine Patients. World Neurosurg 2022; 164:e1043-e1048. [DOI: 10.1016/j.wneu.2022.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
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Franco D, Gonzalez G, Hines K, Mouchtouris N, Sharan A, Harrop J. Commentary: Developing a Prediction Model for Identification of Distinct Perioperative Clinical Stages in Spine Surgery With Smartphone-Based Mobility Data. Neurosurgery 2022; 90:e163-e164. [PMID: 35377346 DOI: 10.1227/neu.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Daniel Franco
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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Lightsey HM, Yeung CM, Bernstein DN, Sumathipala MG, Chen AF, Schoenfeld AJ, Makhni MC. Patient Experiences of Telemedicine in Spine Care: A Mixed Methods Study. Spine (Phila Pa 1976) 2022; 47:27-33. [PMID: 34352842 DOI: 10.1097/brs.0000000000004188] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Survey-based study. OBJECTIVE We performed a mixed methods study involving patients using telemedicine for spine care. We sought to understand factors influencing the utilization and evaluation of this modality. SUMMARY OF BACKGROUND DATA Telemedicine has been integrated into routine spine care; its long-term viability will depend not only on optimizing its safety, efficiency, and cost-effectiveness, but also on understanding patient valuation of its benefits and limitations. METHODS We used a clinical registry to identify spine patients seen virtually by providers at our tertiary academic medical center between March and September of 2020. We distributed an online survey that queried patients' experiences with telemedicine. We performed statistical analyses of Likert-scale questions and a thematic analysis of free-form responses. Sociodemographic data were abstracted and analyzed. RESULTS Overall, we evaluated 139 patient surveys. High levels of patient-rated care and patient-rated experience were observed for both in-person and telemedicine visits; however, in-person visits were rated significantly higher in both respects (9.3/10 vs. 8.7/10 for patient-rated care, P < 0.001; 9.0/10 vs. 8.4/10 for patient-rated experience, P = 0.006). A preference for in-person first-time visits was observed which was not maintained for follow up appointments. Both patient and clinical factors influenced perceptions of telemedicine. Thematic analysis of free-form responses provided by 113 patients (81%) generated favorable, unfavorable, and reflective themes, each further contextualized by subthemes. Responders were not significantly different from nonresponders across sociodemographic characteristics. CONCLUSION Our quantitative and qualitative findings yield insight into the patient experience of telemedicine in spine care. A preference for in-person visits was notable, particularly for new patient evaluations. This preference was not maintained for follow-up care. Patients acknowledged the benefits of telemedicine and reflected on its effective integration with in-person care. These results may guide best practices to improve access and patient satisfaction in the future.Level of Evidence: 4.
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Affiliation(s)
- Harry M Lightsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Caleb M Yeung
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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12
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Mazarakis NK, Koutsarnakis C, Komaitis S, Drosos E, Demetriades AK. Reflections on the future of telemedicine and virtual spinal clinics in the post COVID-19 era. BRAIN AND SPINE 2022; 2:100930. [PMID: 36248094 PMCID: PMC9375852 DOI: 10.1016/j.bas.2022.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
Both patients and surgeons seem to show significant satisfaction with virtual spinal clinics. Virtual spinal clinics may be an important adjunct to traditional face-to-face clinics. Limitations in physical examination constitute main concern. Patient selection is an important factor in deciding who is a suitable candidate for a virtual spinal clinic. Medicolegal concerns need to be adequately addressed if spinal virtual clinics are to be routinely used.
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Abraham J, Meng A, Holzer KJ, Brawer L, Casarella A, Avidan M, Politi MC. Exploring patient perspectives on telemedicine monitoring within the operating room. Int J Med Inform 2021; 156:104595. [PMID: 34627112 PMCID: PMC10627166 DOI: 10.1016/j.ijmedinf.2021.104595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical decision support systems and telemedicine for remote monitoring can together support clinicians' intraoperative decision-making and management of surgical patients' care. However, there has been limited investigation on patient perspectives about advanced health information technology use in intraoperative settings, especially an electronic OR (eOR) for remote monitoring and management of surgical patients. PURPOSE Our study objectives were: (1) to identify participant-rated items contributing to patient attitudes, beliefs, and level of comfort with eOR monitoring; and (2) to highlight barriers and facilitators to eOR use. METHODS We surveyed 324 individuals representing surgical patients across the United States using Amazon Mechanical Turk, an online platform supporting internet-based work. The structured survey questions examined the level of agreement and comfort with eOR for remote patient monitoring. We calculated descriptive statistics for demographic variables and performed a Wilcoxon matched-pairs signed-rank test to assess whether participants were more comfortable with familiar clinicians from local hospitals or health systems monitoring their health and safety status during surgery than clinicians from hospitals or health systems in other regions or countries. We also analyzed open-ended survey responses using a thematic approach informed by an eight-dimensional socio-technical model. RESULTS Participants' average age was 34.07 (SD = 10.11). Most were white (80.9%), male (57.1%), and had a high school degree or more (88.3%). Participants reported a higher level of comfort with clinicians they knew monitoring their health and safety than clinicians they did not know, even within the same healthcare system (z = -4.012, p < .001). They reported significantly higher comfort levels with clinicians within the same hospital or health system in the United States than those in a different country (z = -10.230, p < .001). Facilitators and barriers to eOR remote monitoring were prevalent across four socio-technical dimensions: 1) organizational policies, procedures, environment, and culture; 2) people; 3) workflow and communication; and 4) hardware and software. Facilitators to eOR use included perceptions of improved patient safety through a safeguard system and perceptions of streamlined care. Barriers included fears of incorrect eOR patient assessments, decision-making conflicts between care teams, and technological malfunctions. CONCLUSIONS Participants expressed significant support for intraoperative telemedicine use and greater comfort with local telemedicine systems instead of long-distance telemedicine systems. Reservations centered on organizational policies, procedures, environment, culture; people; workflow and communication; and hardware and software. To improve the buy-in and acceptability of remote monitoring by an eOR team, we offer a few evidence-based guidelines applicable to telemedicine use within the context of OR workflow. Guidelines include backup plans for technical challenges, rigid care, and privacy standards, and patient education to increase understanding of telemedicine's potential to improve patient care.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States; Institute for Informatics, Washington University School of Medicine, St Louis, MO, United States.
| | - Alicia Meng
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Luke Brawer
- Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Aparna Casarella
- Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Michael Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, United States
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Garfan S, Alamoodi AH, Zaidan BB, Al-Zobbi M, Hamid RA, Alwan JK, Ahmaro IYY, Khalid ET, Jumaah FM, Albahri OS, Zaidan AA, Albahri AS, Al-Qaysi ZT, Ahmed MA, Shuwandy ML, Salih MM, Zughoul O, Mohammed KI, Momani F. Telehealth utilization during the Covid-19 pandemic: A systematic review. Comput Biol Med 2021; 138:104878. [PMID: 34592585 PMCID: PMC8450049 DOI: 10.1016/j.compbiomed.2021.104878] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/27/2022]
Abstract
During the coronavirus disease (COVID-19) pandemic, different technologies, including telehealth, are maximised to mitigate the risks and consequences of the disease. Telehealth has been widely utilised because of its usability and safety in providing healthcare services during the COVID-19 pandemic. However, a systematic literature review which provides extensive evidence on the impact of COVID-19 through telehealth and which covers multiple directions in a large-scale research remains lacking. This study aims to review telehealth literature comprehensively since the pandemic started. It also aims to map the research landscape into a coherent taxonomy and characterise this emerging field in terms of motivations, open challenges and recommendations. Articles related to telehealth during the COVID-19 pandemic were systematically searched in the WOS, IEEE, Science Direct, Springer and Scopus databases. The final set included (n = 86) articles discussing telehealth applications with respect to (i) control (n = 25), (ii) technology (n = 14) and (iii) medical procedure (n = 47). Since the beginning of the pandemic, telehealth has been presented in diverse cases. However, it still warrants further attention. Regardless of category, the articles focused on the challenges which hinder the maximisation of telehealth in such times and how to address them. With the rapid increase in the utilization of telehealth in different specialised hospitals and clinics, a potential framework which reflects the authors' implications of the future application and opportunities of telehealth has been established. This article improves our understanding and reveals the full potential of telehealth during these difficult times and beyond.
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Affiliation(s)
- Salem Garfan
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia
| | - A H Alamoodi
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia.
| | - B B Zaidan
- Future Technology Research Centre, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliou, Yunlin, 64002, Taiwan, ROC
| | | | - Rula A Hamid
- College of Business Informatics, University of Information Technology and Communications (UOITC), Baghdad, Iraq
| | - Jwan K Alwan
- Biomedical Informatics College, University of Information Technology and Communications (UOITC), Baghdad, Iraq; Faculty of Computer Science and Information Technology, University of Malaya (UM), Malaysia
| | - Ibraheem Y Y Ahmaro
- Computer Science Department, College of Information Technology, Hebron University, Hebron, Palestine
| | - Eman Thabet Khalid
- Department of Computer Sciences, College of Education for Pure Sciences, University of Basrah, Basrah, Iraq
| | - F M Jumaah
- Department of Computer and Software Engineering, Polytechnique Montréal, Canada
| | - O S Albahri
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia
| | - A A Zaidan
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia
| | - A S Albahri
- Informatics Institute for Postgraduate Studies (IIPS), Iraqi Commission for Computers and Informatics (ICCI), Baghdad, Iraq
| | - Z T Al-Qaysi
- Department of Computer Science, Computer Science and Mathematics College, Tikrit University, Iraq
| | - M A Ahmed
- Department of Computer Science, Computer Science and Mathematics College, Tikrit University, Iraq
| | - Moceheb Lazam Shuwandy
- Department of Computer Science, Computer Science and Mathematics College, Tikrit University, Iraq
| | - Mahmood M Salih
- Department of Computer Science, Computer Science and Mathematics College, Tikrit University, Iraq
| | - Omar Zughoul
- Computer Information System, Ahmed Bin Mohammed Military College, Al Shahaniya, Qatar
| | - K I Mohammed
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia
| | - Fayiz Momani
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia
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15
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R Niakan Kalhori S, Bahaadinbeigy K, Deldar K, Gholamzadeh M, Hajesmaeel-Gohari S, Ayyoubzadeh SM. Digital Health Solutions to Control the COVID-19 Pandemic in Countries With High Disease Prevalence: Literature Review. J Med Internet Res 2021; 23:e19473. [PMID: 33600344 PMCID: PMC7951053 DOI: 10.2196/19473] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/27/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. OBJECTIVE Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. METHODS For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. RESULTS We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. CONCLUSIONS Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises.
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Affiliation(s)
| | - Kambiz Bahaadinbeigy
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kolsoum Deldar
- School of Paramedicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Marsa Gholamzadeh
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Spine surgeon perceptions of the challenges and benefits of telemedicine: an international study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2124-2132. [PMID: 33452924 PMCID: PMC7811153 DOI: 10.1007/s00586-020-06707-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
Introduction While telemedicine usage has increased due to the COVID-19 pandemic, there remains little consensus about how spine surgeons perceive virtual care. The purpose of this study was to explore international perspectives of spine providers on the challenges and benefits of telemedicine. Methods Responses from 485 members of AO Spine were analyzed, covering provider perceptions of the challenges and benefits of telemedicine. All questions were optional, and blank responses were excluded from analysis. Results The leading challenges reported by surgeons were decreased ability to perform physical examinations (38.6%), possible increased medicolegal exposure (19.3%), and lack of reimbursement parity compared to traditional visits (15.5%). Fewer than 9.0% of respondents experienced technological issues. On average, respondents agreed that telemedicine increases access to care for rural/long-distance patients, provides societal cost savings, and increases patient convenience. Responses were mixed about whether telemedicine leads to greater patient satisfaction. North Americans experienced the most challenges, but also thought telemedicine carried the most benefits, whereas Africans reported the fewest challenges and benefits. Age did not affect responses. Conclusion Spine surgeons are supportive of the benefits of telemedicine, and only a small minority experienced technical issues. The decreased ability to perform the physical examination was the top challenge and remains a major obstacle to virtual care for spine surgeons around the world, although interestingly, 61.4% of providers did not acknowledge this to be a major challenge. Significant groundwork in optimizing remote physical examination maneuvers and achieving legal and reimbursement clarity is necessary for widespread implementation.
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Lovecchio F, Riew GJ, Samartzis D, Louie PK, Germscheid N, An HS, Cheung JPY, Chutkan N, Mallow GM, Neva MH, Phillips FM, Sciubba DM, El-Sharkawi M, Valacco M, McCarthy MH, Makhni MC, Iyer S. Provider confidence in the telemedicine spine evaluation: results from a global study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:2109-2123. [PMID: 33222003 PMCID: PMC7680633 DOI: 10.1007/s00586-020-06653-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
Purpose To utilize data from a global spine surgeon survey to elucidate (1) overall confidence in the telemedicine evaluation and (2) determinants of provider confidence. Methods Members of AO Spine International were sent a survey encompassing participant’s experience with, perception of, and comparison of telemedicine to in-person visits. The survey was designed through a Delphi approach, with four rounds of question review by the multi-disciplinary authors. Data were stratified by provider age, experience, telemedicine platform, trust in telemedicine, and specialty. Results Four hundred and eighty-five surgeons participated in the survey. The global effort included respondents from Africa (19.9%), Asia Pacific (19.7%), Europe (24.3%), North America (9.4%), and South America (26.6%). Providers felt that physical exam-based tasks (e.g., provocative testing, assessing neurologic deficits/myelopathy, etc.) were inferior to in-person exams, while communication-based aspects (e.g., history taking, imaging review, etc.) were equivalent. Participants who performed greater than 50 visits were more likely to believe telemedicine was at least equivalent to in-person visits in the ability to make an accurate diagnosis (OR 2.37, 95% C.I. 1.03–5.43). Compared to in-person encounters, video (versus phone only) visits were associated with increased confidence in the ability of telemedicine to formulate and communicate a treatment plan (OR 3.88, 95% C.I. 1.71–8.84). Conclusion Spine surgeons are confident in the ability of telemedicine to communicate with patients, but are concerned about its capacity to accurately make physical exam-based diagnoses. Future research should concentrate on standardizing the remote examination and the development of appropriate use criteria in order to increase provider confidence in telemedicine technology.
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Affiliation(s)
- Francis Lovecchio
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Grant J Riew
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Philip K Louie
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Jason Pui Yin Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Norman Chutkan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Gary Michael Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Marko H Neva
- Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Baltimore, MD, USA, John Hopkins University, Baltimore, MD, USA
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
| | - Marcelo Valacco
- Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina
| | | | - Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
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