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Goodman ZS, Gardner SM, Rustad JK, Finn CT, Landsman HS, Ho PA. Using Academic Consultation-Liaison Telepsychiatry to Meet the Mental Health Needs of Complex, Medically Ill Patients in Underserved Areas: A Case Report. Telemed J E Health 2024; 30:895-898. [PMID: 37917927 DOI: 10.1089/tmj.2023.0352] [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] [Indexed: 11/04/2023] Open
Abstract
Background: The nationwide shortage of mental health resources often disproportionately affects rural areas. As innovative strategies are required to address mental health resource shortages in rural areas, telepsychiatry consultation (TPC) may represent a population health-oriented approach to bridge this gap. In this case report, we examine the use of TPC from an academic consultation-liaison psychiatry service to a rural community hospital. Case Report: We describe the case of a woman with Wernicke encephalopathy seeking to leave the hospital against medical advice and the role that the TPC service played in the patient's evaluation and management, including assessing decision-making capacity. Discussion: We then examine benefits and limitations of the service, including a narrative review of the relevant, but limited, available literature as well as suggestions for how the service may be improved and incorporated into psychiatry residency and fellowship training in the future.
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Affiliation(s)
- Zachary S Goodman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Spencer M Gardner
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James K Rustad
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Mental Health and Behavioral Sciences, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Christine T Finn
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - H Samuel Landsman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Patrick A Ho
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Pandya A, Parashar S, Waller M, Portnoy J. Telemedicine beyond the pandemic: challenges in the pediatric immunology clinic. Expert Rev Clin Immunol 2023; 19:1063-1073. [PMID: 37354030 DOI: 10.1080/1744666x.2023.2229956] [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: 02/19/2023] [Accepted: 06/22/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Telemedicine and electronic medical records (EMRs) have revolutionized healthcare in recent years, offering numerous benefits that improve the delivery of care and the overall patient outcomes. AREAS COVERED Telemedicine allows providers to diagnose and treat patients remotely, often eliminating the need for face-to-face visits. Its benefits include improved access to care, convenience for patients, and reduced costs both for patients and providers. When used with remote patient monitoring and remote therapeutic monitoring, continuous care becomes possible. EMRs allow providers to store, access, and share patient information more efficiently than paper charts. The benefits of EMRs include improved patient safety, increased efficiency, and reduced costs. EXPERT OPINION The combination of telemedicine with EMRs makes it possible to envision the advent of computer-assisted diagnosis (CAD). This technology uses artificial intelligence and machine learning algorithms to analyze medical information including images, clinical and physiologic data, test results and remotely obtained information to support healthcare providers in making accurate diagnoses. By providing providers with what is essentially a second opinion, CAD systems can help prevent misdiagnoses and improve the quality of care. Such systems are not meant to replace healthcare providers, but rather to support them in making more informed and accurate diagnoses.
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Affiliation(s)
- Aarti Pandya
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Sonya Parashar
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Morgan Waller
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jay Portnoy
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
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Kameda-Smith MM, Pond GR, Seow H. Rurality index score and pediatric neuro-oncological outcome in Ontario. J Neurosurg Pediatr 2023; 31:275-281. [PMID: 36640100 DOI: 10.3171/2022.12.peds22446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Rapid access to neurosurgical decisions and definitive management are vital for the outcome of neurocritical patients. There are unique challenges associated with the provision of services required to maintain critical infrastructure for rural citizens. Given that a relationship between rurality, marginalization, and health outcomes has been identified as associated with higher mortality rates and higher rates of many diseases, the authors studied whether worse clinical outcomes were associated with rurality in pediatric neuro-oncological disease. METHODS Using linked administrative databases, the authors retrospectively analyzed a population-based cohort of patients diagnosed with a pediatric brain tumor between 1996 and 2017 in Ontario, Canada. The main variable of interest was the Rurality Index for Ontario (RIO; larger value denotes more rural); the main outcome was survival, while controlling for surgery and tumor type. RESULTS Of the 1428 patients included, 53.9% were male. Overall survival of all the children (controlling for surgery and tumor type) at 1, 5, and 10 years was 84.7%, 65.1%, and 58.4%, respectively. A total of 11.5% were classified as living in a rural area of Ontario. The distance to the nearest pediatric neurosurgical hospital ranged from 25.6 to 167.4 km. The RIO score was 0 in 38.7% of children, and the majority of patients had a RIO score < 40. A higher RIO score was not a significant factor (continuous p = 0.12/ordinal p = 0.18) associated with length of follow-up, indicating that rurality was not significantly linked to compliance with clinical follow-up. CONCLUSIONS Rurality of the region in which pediatric neuro-oncological patients reside was not associated with patient outcome (HR 0.83, p = 0.39).
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Affiliation(s)
| | | | - Hsien Seow
- 3Oncology, McMaster University, Hamilton, Ontario, Canada
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Severini RDSG, Marcovici M, Farhat SCL, Bivanco-Lima D, Couto TB, Amarante AC, Rodrigues KR, Ghosn DSNB, Schvartsman C. How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency. Clinics (Sao Paulo) 2023; 78:100162. [PMID: 36805149 PMCID: PMC9933318 DOI: 10.1016/j.clinsp.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program. OBJECTIVE To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results. METHODS Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training. RESULTS There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject. CONCLUSION This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.
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Affiliation(s)
- Rafael da Silva Giannasi Severini
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Michelle Marcovici
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Sylvia Costa Lima Farhat
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Danielle Bivanco-Lima
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSP), São Paulo, SP, Brazil
| | - Thomaz Bittencourt Couto
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Carolina Amarante
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Katharina Reichmann Rodrigues
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Danielle Saad Nemer Bou Ghosn
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cláudio Schvartsman
- Departamento Emergência, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Buchi AB, Langlois DM, Northway R. Use of Telehealth in Pediatrics. Prim Care 2022; 49:585-596. [DOI: 10.1016/j.pop.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rahman Jabin MS, Hammar T. Issues with the Swedish e-prescribing system - An analysis of health information technology-related incident reports using an existing classification system. Digit Health 2022; 8:20552076221131139. [PMID: 36249479 PMCID: PMC9554230 DOI: 10.1177/20552076221131139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges. Methods A number of health information technology-related incidents were collected retrospectively from various sources using purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents (n = 24) were subjected to an existing framework, i.e., the Health Information Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis. Results Several types of software-related issues (n = 22) were identified: system configuration, interface with other software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges. Conclusions This study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.
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Affiliation(s)
- Md Shafiqur Rahman Jabin
- Md Shafiqur Rahman Jabin, Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Hus Vita (level 3), Kalmar 392 31, Sweden.
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Knaus ME, Kersey K, Ahmad H, Weaver L, Thomas JL, Metzger GA, Wood RJ, Gasior AC. Both sides of the screen: Provider and patient perspective on telemedicine in pediatric surgery. J Pediatr Surg 2022; 57:1614-1621. [PMID: 35430030 PMCID: PMC8949635 DOI: 10.1016/j.jpedsurg.2022.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND There has been increased telemedicine use secondary to the COVID-19 pandemic. The objective of this study was to assess patient/parent satisfaction with their telemedicine experience, gauge provider perspective on telemedicine for the management of pediatric colorectal disease and evaluate the quality of telemedicine care being provided. METHODS A cross sectional study was performed at a single institution from March 2020-February 2021. Patients who completed a patient/parent telemedicine survey after a telemedicine appointment and nurse practitioners/surgeons who completed a provider telemedicine survey were included. Patient and provider characteristics and responses were analyzed using descriptive statistics. Differences between the levels of provider confidence to provide telemedicine care were analyzed using Pearson's chi-square test. RESULTS 118 patients/parents completed the survey. The median age of patients was 7 years. Most patients were male (59%) and White (73%). The most common diagnosis was anorectal malformation (49%). 71% of parents felt the telemedicine visit was as effective or better than an in-person visit and over 70% said they prefer a telemedicine visit to an in-person visit. Ten surgeons and 8 nurse practitioners completed the provider survey. 28% had previous telemedicine experience and 94% planned to continue offering telemedicine appointments. Providers felt significantly more confident performing clinical duties via video telemedicine compared to telephone telemedicine. CONCLUSIONS Telemedicine is a useful adjunct or alternative in pediatric surgery for complex patients who require multidisciplinary care. Providers show confidence with the use of video telemedicine and parents show high satisfaction, with the majority preferring telemedicine visits over in-person visits. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maria E. Knaus
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States,Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Kelly Kersey
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hira Ahmad
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Laura Weaver
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Jessica L. Thomas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Gregory A. Metzger
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Richard J. Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Alessandra C. Gasior
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States,Department of Colon and Rectal Surgery, The Ohio State University, Columbus, OH, United States,Corresponding author at: Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
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Severini RDSG, Oliveira PCD, Couto TB, Simon Junior H, Andrade APMD, Nanbu DY, Farhat SCL, Schvartsman C. Fast, cheap and feasible: Implementation of pediatric telemedicine in a public hospital during the Covid-19 pandemic. J Pediatr (Rio J) 2022; 98:183-189. [PMID: 34181889 PMCID: PMC8196314 DOI: 10.1016/j.jped.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In Brazil, telemedicine was allowed as an exception during the coronavirus disease (COVID-19) pandemic. Despite its recognized value and availability, telemedicine is not universally used, suggesting that some barriers prevent its adoption and acceptance within the community. This study aims to describe the implementation of a low-cost telemedicine service in a pediatric hospital in Brazil. METHOD Retrospective descriptive study reporting the first three months (April to June 2020) of the experience of implementing a low-cost telemedicine emergency care program in a public tertiary hospital. The service was available to patients up to 18 years of age enrolled in this hospital. A tool for assessing the severity of the patient was developed, the aim of standardizing the procedure, while maintaining quality and safety. Guardian's satisfaction was assessed with a questionnaire sent after teleconsultations. RESULTS 255 teleconsultations were carried out with 140 different patients. Of the total consultations, 182 were from 99 patients that had performed the Real-Time Polymerase Chain Reaction (RT-PCR) test for the new coronavirus (SARS-Cov-2) or had direct contact with a person known to be positive for COVID-19. Only 26 (14%) were referred to an in-person consultation. No deaths, adverse events or delayed diagnosis were recorded. 86% of the patients who answered the satisfaction questionnaire were satisfied and 92% would use telemedicine again. CONCLUSION This study presents an innovative implementation of a telemedicine program in a public and exclusively pediatric tertiary service, serving as a reference for future implementation in other public services in Brazil and developing countries.
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Affiliation(s)
- Rafael da Silva Giannasi Severini
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Carpini de Oliveira
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thomaz Bittencourt Couto
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Hany Simon Junior
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anarella Penha Meirelles de Andrade
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Danilo Yamamoto Nanbu
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Sylvia C L Farhat
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cláudio Schvartsman
- Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento de Emergência, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, SP, Brazil
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Knaus ME, Ahmad H, Metzger GA, Beyene TJ, Thomas JL, Weaver LJ, Gasior AC, Wood RJ, Halaweish I. Outcomes of a telemedicine bowel management program during COVID-19. J Pediatr Surg 2022; 57:80-85. [PMID: 34686377 PMCID: PMC8452355 DOI: 10.1016/j.jpedsurg.2021.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Due to the COVID-19 pandemic, we transitioned from an in-person bowel management program (BMP) to a telemedicine BMP. The telemedicine BMP consisted of video and/or phone call visits (remote) or a single initial in-person visit followed by remote visits (hybrid). We hypothesized that patient/family satisfaction of a telemedicine BMP would be comparable to an in-person BMP and that there would be improvement in quality of life and functional outcomes after the telemedicine BMP. METHODS After IRB approval, demographic and outcomes data were obtained for patients who underwent the telemedicine BMP from May-October 2020. Outcomes included a parent/patient satisfaction survey, Pediatric Quality of Life Inventory (PedsQL), and parent/patient-reported outcome measures (Vancouver, Baylor, and Cleveland scores) at baseline, 1 and 3 month follow-up. Variables were compared using Chi-square or Wilcoxon-Mann-Whitney tests and a generalized mixed model was used to evaluate outcomes scores at follow-up compared to baseline. RESULTS Sixty-seven patients were included in our analysis with an average age of 8.6 years (SD: 3.9). Patients had the following diagnoses anorectal malformation (52.2%), Hirschsprung's disease (20.9%), functional constipation (19.4%), myelomeningocele (6.0%), and spinal injury (1.5%). Forty-eight patients (72%) underwent the remote BMP and 19 (28%) underwent the hybrid BMP. Sixty-two percent of parents completed the satisfaction survey, with a median score of 5 (very satisfied) for all questions. Over 75% of parents said they would prefer a telemedicine program over an in-person program. There was significant improvement in the Baylor and Vancouver scores after the BMP (p < 0.01), but no difference in the PedsQL or Cleveland scores (p > 0.05). There was a significant improvement in stool continence after the BMP (p < 0.01). CONCLUSION A telemedicine BMP can be an acceptable alternative to a traditional in-person program. There was high parental/patient satisfaction and significant improvement in outcomes. Further research is needed to assess long-term outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maria E. Knaus
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States,Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hira Ahmad
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Gregory A. Metzger
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, United States
| | - Tariku J. Beyene
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jessica L. Thomas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Laura J. Weaver
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Alessandra C. Gasior
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States,Division of Colon and Rectal Surgery, Department of Surgery, The Ohio State University, Columbus, OH, United States
| | - Richard J. Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Ihab Halaweish
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States.
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Determining factors that influence parents' perceptions of telehealth provided in a pediatric gastroenterological practice: A quality improvement project. J Pediatr Nurs 2022; 62:36-42. [PMID: 34894421 DOI: 10.1016/j.pedn.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, local and institutional guidelines restricted non-emergent, in-person visits in outpatient specialty clinics. Nurse practitioners (NPs) in pediatric gastroenterology clinics immediately shifted their practice to telehealth (TH). LOCAL PROBLEM The shift to TH necessitated a change in practice. This quality improvement project was designed to define factors influencing family's perceptions of TH and secure feedback on the TH experience. TH is remaining an option for accessing care even as restrictions are being lifted. Feedback is necessary to ensure that quality of care and high patient satisfaction are maintained in a virtual environment. METHODS The Unified Theory of Acceptance and Use of Technology was used to frame the project. Surveys were collected from NPs related to services provided and complexities of each encounter. Post-visit surveys were conducted with families to assess their perceptions of the visit. Findings were discussed to identify and address gaps in service. RESULTS Parent/family surveys were consistent with NP feedback. Results indicated that parents were satisfied with care provided via TH, but that these visits were limited by incomplete assessments, lacked the intimacy of in-person encounters and were often difficult to access due to technological issues. CONCLUSIONS It is anticipated that TH will be used in the post pandemic era to provide routine and non-emergent acute care. Institutions and providers need to consider factors influencing the patient experience learned during the pandemic and implement evidenced-based strategies that ensure quality care that meets patients' needs.
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Pecina JL, Nigon LM, Penza KS, Murray MA, Kronebusch BJ, Miller NE, Jensen TB. Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study. J Med Internet Res 2021; 23:e25899. [PMID: 34932016 PMCID: PMC8726036 DOI: 10.2196/25899] [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] [Received: 11/23/2020] [Revised: 03/04/2021] [Accepted: 10/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.
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Affiliation(s)
- Jennifer L Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Leah M Nigon
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Kristine S Penza
- Mayo Clinic Express Care, Mayo Clinic, Rochester, MN, United States
| | - Martha A Murray
- Mayo Clinic Express Care, Mayo Clinic, Rochester, MN, United States
| | | | - Nathaniel E Miller
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Teresa B Jensen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
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Marx T, Reuter PG, Adnet F. Effectiveness of formal telephone advice for children younger than six years of age with fever or gastroenteritis. Am J Emerg Med 2021; 57:176-177. [PMID: 34949476 DOI: 10.1016/j.ajem.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Tania Marx
- Service d'accueil des urgences / SAMU 25, Centre Hospitalier Universitaire de Besançon, 3 boulevard Fleming, 25030 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France.
| | - Paul-Georges Reuter
- AP-HP, SAMU 92, Hôpital Raymond Poincaré, 104, boulevard Raymond Poincaré, 92380 Garches, France; Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe Soins Primaires et Prévention, CESP, 94807 Villejuif, France
| | - Frédéric Adnet
- AP-HP, Service des Urgences et SAMU, Centre Hospitalier Universitaire Avicenne, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France
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13
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Osmanlliu E, Gagnon I, Weber S, Bach CQ, Turnbull J, Seguin J. The Waiting Room Assessment to Virtual Emergency Department pathway: Initiating video-based telemedicine in the pediatric emergency department. J Telemed Telecare 2021; 28:452-457. [PMID: 34636683 DOI: 10.1177/1357633x211044038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has presented pediatric emergency departments with unique challenges, resulting in a heightened demand for adapted clinical pathways. In response to this need, the Montreal Children's Hospital pediatric emergency department introduced the WAVE (Waiting Room Assessment to Virtual Emergency Department) pathway, a video-based telemedicine pathway for selected non-critical patients, aiming to reduce safety issues related to emergency department overcrowding, while providing timely care to all children presenting and registering at our emergency department. The objective of the WAVE pilot phase was to evaluate the feasibility and acceptability of telemedicine in our pediatric emergency department, which was previously unfamiliar with this mode of care delivery. During the six-week, three-evening per week deployment, we conducted 18 five-hour telemedicine shifts. In total, 27 patients participated in the WAVE pathway. Results from this pilot phase met four of five a priori feasibility and acceptability criteria. Overall, participating families were satisfied with this novel care pathway and reported no disruptive technological barriers.
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Affiliation(s)
- Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada.,507266Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Isabelle Gagnon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada.,507266Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Saskia Weber
- Quality and Continuous Improvement Office, 10040Montreal Children's Hospital, Canada
| | - Chi Quan Bach
- Partnership Office, 54473McGill University Health Centre, Canada
| | - Jennifer Turnbull
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada
| | - Jade Seguin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada.,507266Research Institute of the McGill University Health Centre (RI-MUHC)
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14
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Kenney LB, Vrooman LM, Lind ED, Brace‐O'Neill J, Mulder JE, Nekhlyudov L, Recklitis CJ. Virtual visits as long-term follow-up care for childhood cancer survivors: Patient and provider satisfaction during the COVID-19 pandemic. Pediatr Blood Cancer 2021; 68:e28927. [PMID: 33559385 PMCID: PMC7995169 DOI: 10.1002/pbc.28927] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022]
Abstract
Telemedicine can potentially meet objectives of long-term follow-up care (LTFU) for childhood cancer survivors (CCS) while reducing barriers. We surveyed providers at our institution about their satisfaction with video-conference virtual visits (VV) with 81 CCS during COVID-19 restrictions. The same 81 CCS (or parent proxies) were surveyed about their experience, of which 47% responded. Providers and CCS were highly satisfied with VV (86% and 95% "completely/very satisfied," respectively). CCS rated VV "as/nearly as" helpful as in-person visits (66%) and 82% prefer VV remain an option postpandemic. High levels of survivor and provider satisfaction with VV support ongoing investigation into implementation for LTFU.
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Affiliation(s)
- Lisa B. Kenney
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Lynda M. Vrooman
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Eileen Duffey Lind
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | - Jill Brace‐O'Neill
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | - Jean E. Mulder
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Larissa Nekhlyudov
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA,Department of Medicine Brigham and Women's HospitalBostonMassachusettsUSA
| | - Christopher J. Recklitis
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
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Manglani M, Gabhale Y, Lala MM, Balakrishnan S, Bhuyan K, Rewari BB, Setia MS. Assessing the Effectiveness of a Telemedicine Initiative in Clinical Management of Children Living with HIV/AIDS in Maharashtra, India. Curr HIV Res 2021; 19:201-215. [PMID: 33397239 DOI: 10.2174/1573399817666210104102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the effectiveness of telemedicine in the clinical management of children living with HIV/AIDS in resource-limited settings ; Background: Telemedicine is an important mechanism for service delivery in health care settings, both in resource-rich and resource-poor settings. Such service delivery mechanisms have shown to be associated with virologic suppression and higher CD4 counts. These services are also associated with improved access, shorter visiting times, and higher patient satisfaction. ; Objective: We designed the present two-group comparison study to compare the clinical evaluation and management of children in the anti-retroviral therapy (ART) centres linked to telemedicine facility with those who are not linked to this facility in Maharashtra, India. ; Methods: We analysed clinical records from six ART centres in Maharashtra; of these, 250 children were in the linked ART centres and 301 were in the non-linked ART centres. The outcomes were classified according to investigations, management, and monitoring. For management, we evaluated: 1) Initiation of cotrimoxazole prophylaxis; 2) Children not initiated on ART when required; 3) ART regime after appropriate investigations; and 4) Change of regime (if immunologically indicated). For monitoring, we assessed the haematological monitoring of children on ART. ; Results: The mean (SD) ages of children in linked and non-linked ART centres were 10.8 (4.6) and 10.9 (4.6) years, respectively (p=0.80). After adjusting for individual and structural level variables, physical examination (OR: 2.0, 95% CI; 1.2, 3.2), screening for tuberculosis (OR: 12.9, 95% CI: 2.0, 82.9) and cotrimoxazole prophylaxis were significantly more likely in the linked centres compared with non-linked centres (OR: 1.8, 95% CI: 1.4, 2.2). A higher proportion of children eligible for ART were not initiated on treatment in the non-linked centres compared with linked centres (26% vs. 8%, p=0.06). Children were less likely to be initiated on zidovudine-based regimens without baseline haemoglobin or with baseline haemoglobin of less than 9 gm% in linked centres (OR: 0.7, 95% CI: 0.6, 0.8). Similarly, children in the linked centres were less likely to have been started on nevirapine-based regimens without baseline liver enzymes (OR: 0.8, 95% CI: 0.7, 0.9). ; Conclusion: Thus, the overall clinical management of Children Living with HIV/ AIDS (CLHA) was better in ART centres linked with the telemedicine initiative compared with those who were not linked. Children in the linked ART centres were more likely to have a complete baseline assessment (physical, hematological, radiological, and screening for TB); the presence of a pediatrician in the centres was helpful.
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Affiliation(s)
- Mamta Manglani
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | - Yashwant Gabhale
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | - Mamatha Murad Lala
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | | | - Khanindra Bhuyan
- UNICEF, Near 73, Lodhi Gardens, Lodhi Estate, New Delhi, 110003, India
| | - Bharat Bhushan Rewari
- WHO Regional Office of South East Asea, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India
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16
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Chen A, Punn R, Collins RT, Chen JH, Stauffer KJ, Wang R, Alexander S, MacMillen Lechich K, Murphy DJ, Chung S, Selamet Tierney ES. Tele-Clinic Visits in Pediatric Patients with Marfan Syndrome Using Parentally Acquired Echocardiography. J Pediatr 2021; 232:140-146. [PMID: 33453199 DOI: 10.1016/j.jpeds.2021.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To test feasibility of tele-clinic visits using parentally acquired vital signs and focused echocardiographic images in patients with Marfan syndrome. STUDY DESIGN We included patients with Marfan syndrome aged 5-19 years followed in our clinic. We excluded patients with Marfan syndrome and history of previous aortic root (AoR) surgery, cardiomyopathy, arrhythmia, or AoR ≥4.5 cm. We trained parents in-person to acquire focused echocardiographic images on their children using a hand-held device as well as how to use a stadiometer, scale, blood pressure (BP) machine, and a digital stethoscope. Before tele-clinic visits, parents obtained the echocardiographic images and vital signs. We compared tele-clinic and on-site clinic visit data. Parental and clinic echocardiograms were independently analyzed. RESULTS Fifteen patient/parent pairs completed tele-clinic visits, conducted at a median of 7.0 (IQR 3.0-9.9) months from the in-person training session. Parents took a median of 70 (IQR 60-150) minutes to obtain the height, weight, heart rate, BP, cardiac sounds, and echocardiographic images before tele-clinic visits. Systolic BP was greater on-site than at home (median +13 mm Hg, P = .014). Height, weight, diastolic BP, heart rate, and AoR measurements were similar. CONCLUSIONS This study provides information for implementing tele-clinic visits using parentally acquired vital signs and echocardiographic images in patients with Marfan syndrome. The results show that tele-clinic visits are feasible and that parents were able to obtain focused echocardiographic images on their children. TRIAL REGISTRATION ClinicalTrials.gov: NCT03581682.
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Affiliation(s)
- Angela Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Rajesh Punn
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - R Thomas Collins
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Jonathan H Chen
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA
| | - Katie Jo Stauffer
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Rena Wang
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Samantha Alexander
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Kirstie MacMillen Lechich
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Daniel Jerome Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA
| | - Sukyung Chung
- Palo Alto Medical Foundation's Research Institute, Palo Alto, CA
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA.
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Peck CJ, Parsaei Y, Lattanzi J, Gowda AU, Yang J, Lopez J, Steinbacher DM. The Geographic Availability of Certified Cleft Care in the United States: A National Geospatial Analysis of 1-Hour Access to Care. J Oral Maxillofac Surg 2021; 79:1733-1742. [PMID: 33812798 DOI: 10.1016/j.joms.2021.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Children with cleft lip and/or palate (CLP) require longitudinal multidisciplinary care. Travel distance to comprehensive cleft centers may be a barrier for some families. This study evaluated the geospatial availability of certified cleft teams across the United States. MATERIALS AND METHODS A geographic catchment area within a 1-hour travel radius of each American Cleft Palate-Craniofacial Association-certified cleft center was mapped using TravelTime distance matrix programming. The proportion of children located within each catchment area was calculated using county-level data from the National Kids Count Data Center, with aggregate estimates of patients with CLP based on state-level data from the Centers for Disease Control and Prevention. One-hour access was compared across regions and based on urbanization data collected from the US Census. RESULTS There were 182 American Cleft Palate-Craniofacial Association-certified centers identified. As per study estimates, 28,331 (27.3%) children with CLP did not live within 1-hour travel distance to any center. One-hour access was highest in the Northeast (84.2% of children, P < .001) and lowest in the South (65.7%) and higher in states with the greatest urbanization in comparison with more rural states (85.1 vs 37.4%, P < .001). Similar patterns were seen for access to 2 or more cleft centers. The number of CLP children-per-center was highest in the West (775) and lowest in the Northeast (452). CONCLUSIONS Travel distances of more than 1 hour may affect more than 25,000 (1 of 4) CLP children in the US, with significant variation across geographic regions. Future studies should seek to understand the impact of and provide strategies for overcoming geographic barriers.
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Affiliation(s)
- Connor J Peck
- Medical Student, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Yassmin Parsaei
- Medical Student, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT; and Orthodontic Resident, Division of Orthodontics, University of Connecticut, Farmington, CT
| | - Jakob Lattanzi
- Undergraduate Research Assistant, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Arvind U Gowda
- Surgical Resident, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Jenny Yang
- Surgical Resident, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Joseph Lopez
- Craniofacial Fellow, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | - Derek M Steinbacher
- Chief of Oral and Maxillofacial Surgery, Professor of Plastic Surgery, Yale School of Medicine, New Haven, CT.
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Souverein EA, Kim JW, Loudin NN, Johnston J, Stewart C, Reid MW, Lee TC, Nallasamy S. Feasibility of asynchronous video-based telemedicine in the diagnosis and management of paediatric blepharoptosis. J Telemed Telecare 2021:1357633X20985394. [PMID: 33470165 DOI: 10.1177/1357633x20985394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the validity of using video glasses as part of an asynchronous telemedicine screening protocol for paediatric blepharoptosis. METHODS A physician assistant wearing Pivothead SMART Series glasses recorded videos of paediatric patients referred for blepharoptosis in primary, down and upgaze while holding a ruler next to the eyes. An oculoplastic surgeon viewed the stored videos and recorded margin-reflex distance 1 and levator function. Using these measurements, the surgeon determined whether surgical intervention was recommended and, if so, which procedure was recommended. The surgeon recorded the same parameters for each patient based on an in-person examination performed later that day. Videos were reviewed eight months later and the same parameters were recorded. RESULTS Twenty-nine children (n = 58 eyes) were enrolled. Margin-reflex distance 1 and levator function measurements based on same-day video review agreed with in-person examination 94.8% (intraclass correlation coefficient = 0.82) and 98.3% (intraclass correlation coefficient = 0.96) of the time, respectively. Margin-reflex distance 1 and levator function measurements based on later video review agreed with in-person examination 93.1% (intraclass correlation coefficient = 0.85) and 94.8% (intraclass correlation coefficient = 0.93) of the time, respectively. Agreement in identifying surgical candidates was almost perfect (= = 0.93) for same-day video review and substantial (= = 0.73) for later video review. Sensitivity of identifying surgical patients was 100% for both same-day video review and later video review; though specificity was lower at 94.1% for same-day video review and 76.5% for later video review. DISCUSSION Asynchronous telemedicine encounters employing video glasses are a useful screening modality for identifying surgical paediatric blepharoptosis patients.
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Affiliation(s)
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | | | - Julia Johnston
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Carly Stewart
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, USA
| | - Thomas C Lee
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
| | - Sudha Nallasamy
- The Vision Center at Children's Hospital Los Angeles, USA.,USC Roski Eye Institute, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
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Hendra K, Neemuchwala F, Chan M, Ly NP, Gibb ER. Patient and Provider Experience With Cystic Fibrosis Telemedicine Clinic. Front Pediatr 2021; 9:784692. [PMID: 34900879 PMCID: PMC8653948 DOI: 10.3389/fped.2021.784692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
In response to the novel coronavirus (COVID-19) pandemic, all in-person cystic fibrosis (CF) appointments were converted to telemedicine visits at UCSF Benioff Children's Hospital. The purpose of our study was to learn about the experiences that patients, families, and providers had with telemedicine visits and to assess their interest in using telemedicine in the future. Our hypothesis was that most patients, families, and providers want to continue telemedicine visits in the future. An anonymous 11-question survey was distributed to patients, families, and providers in November and December 2020. The survey was completed by 46 of 72 families (64% response rate) and 24 of 25 providers (96% response rate). Thirty-seven families (80%) and 21 providers (88%) were satisfied with their telemedicine experience. Thirty-three families (72%) want to have telemedicine visits in the future. Thirty-five families (76%) and 22 providers (92%) were satisfied with their experience using Zoom. Forty families (87%) and 19 providers (90%) want 2 or more visits each year to be via telemedicine. Our study showed that most families and providers were satisfied with telemedicine, would like to continue using telemedicine, and prefer to have at least 2 of the 4 recommended annual CF visits via telemedicine. Our survey identified the following benefits to telemedicine: decreased travel time, decreased cost, and avoiding exposure to COVID. However, we need to ensure that we do not exacerbate existing health disparities for families that do not speak English and/or do not have the internet capabilities to support telemedicine technology.
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Affiliation(s)
- Kalen Hendra
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States
| | - Fatima Neemuchwala
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States.,Division of Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Marilynn Chan
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States.,Division of Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Ngoc P Ly
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States.,Division of Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth R Gibb
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States.,Division of Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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