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Fallahian M, Mohammad K, Aghaie E, Ghandi A. Mortality rate of preterm neonates in two teaching hospitals in Teheran, Islamic Republic of Iran. East Mediterr Health J 2021. [DOI: 10.26719/1995.1.2.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In a retrospective study conducted in two teaching hospitals in Teheran, records of 573 preterm infants were reviewed. The birth weights ranged between 500 and 2500 grams, and the gestational ages between 24 and 36 weeks. This study indicated that the expected survival rate of neonates was greatly influenced by a gestational age of more than 32 weeks and a birth weight exceeding 1250 grams. The youngest surviving neonate was a female whose gestational age was 26-27 weeks and birth weight 1500 grams. The smallest surviving [in weight] was a female infant of 750 grams and a gestational age of 28-29 weeks. This study revealed that an increase in the age and weight of preterm neonates leads to a rapid decline in mortality rate
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Van De Voort E, Klem T, Struik G, Birnie E, Sinke R, Ghandi A. Good cosmetic outcome after vacuum assisted excision of benign breast lesions. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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van de Voort EMF, Klem TMAL, Struik GM, Birnie E, Sinke RHJA, Ghandi A. Patient reported cosmetic outcome after vacuum assisted excision of benign breast lesions: a cross-sectional study. Br J Radiol 2020; 93:20190994. [PMID: 32649240 DOI: 10.1259/bjr.20190994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Better cosmetic outcome after vacuum assisted excision (VAE) compared to surgical excision of benign breast lesions is suggested in previous studies but has never been evaluated with validated outcome measures. In this study, patient reported cosmetic outcome after VAE was evaluated. METHODS Patients who underwent VAE between July 2017 and December 2018 were invited to complete the cosmetic subscale of the Dutch Breast Cancer Treatment Outcome Scale, comparing the treated with the untreated breast. Response mode ranged from 1 (no difference) to 4 (large difference) and cosmetic outcome was calculated as the unweighted mean. Clinical outcomes included: tumor size, number of cores, complications, residual lesions and recurrences. RESULTS Response rate was 73.4% (47 of 64 patients). Median tumor size was 15 mm (range 5-51 mm) and median number of cores 6.5 (range 1-85), complete excision was confirmed in all but two patients. Mean cosmetic outcome was good (mean score ≤1.75) in 74% of patients and no patients reported a poor cosmetic outcome (mean score >3.25). A hematoma occurred in five patients (one needed aspiration) and a skin rash in one patient, no patients developed an infection or seroma. CONCLUSION In this study VAE is safe and effective for tumors up to 5 cm and patient reported cosmetic outcome was good. Patients with benign lesions could benefit from VAE as an alternative for surgical excision. ADVANCES IN KNOWLEDGE A formal quantitative measurement of cosmetic outcome after vacuum assisted excision for benign breast lesions was still lacking. This study shows that this cosmetic outcome is overall good in benign lesions up to 5 cm.
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Affiliation(s)
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.,Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.,Department of Genetics, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Renata H J A Sinke
- Department of Pathology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Ali Ghandi
- Department of Radiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Van De Voort E, Klem T, Struik G, Ghandi A, Sinke R. 123P Cosmetic outcome after vacuum-assisted excision is good and independent of the amount of resected tissue. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Struik GM, Hoekstra N, Klem TM, Ghandi A, Verduijn GM, Swaak-Kragten AT, Schoonbeek A, de Vries KC, Sattler MA, Verhoef K, Birnie E, Pignol JP. Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy. Radiother Oncol 2018; 131:8-13. [PMID: 30773191 DOI: 10.1016/j.radonc.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/14/2018] [Accepted: 11/04/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE During oncoplastic breast-conserving surgery (BCS), the surgical cavity is closed to reduce seroma formation. This makes the radiotherapy target definition using clips challenging, leading to poor inter-observer agreement and potentially geographical misses. We hypothesize that injecting a radiopaque hydrogel in the lumpectomy cavity before closure improves radiotherapy target definition and agreement between observers. MATERIALS AND METHODS Women undergoing BCS in a single university hospital were prospectively accrued in the study. Three to 9 ml of iodined PolyEthylene Glycol (PEG) hydrogel and clips were inserted in the lumpectomy cavity. A CT-scan was performed at 4 to 6 weeks. CT images of BCS patients with standard clips only were used as control group, matched on age, specimen weight, and distance between clips. Six radiation oncologists delineated the tumor bed volumes and rated the cavity visualization scores (CVS). The primary endpoint was the agreement between observers measured using a Conformity Index (Cx). RESULTS Forty-two patients were included, 21 hydrogel procedures and 21 controls, resulting in 315 observer pairs. The feasibility of the intervention was 100%. The median Cx was higher in the intervention group (Cx = 0.70, IQR [0.54-0.79]) than in the control group (Cx = 0.54, IQR [0.42-0.66]), p < 0.00, as were the CVS (3.5 [2.5-4.5] versus 2.5 [2-3.5], p < 0.001). The rate of surgical site infections was similar to literature. CONCLUSIONS The use of radiopaque PEG enables to identify the lumpectomy cavity, resulting in a high inter-observer agreement for radiotherapy target definition. This intervention is easy to perform and blend well into current practice.
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Affiliation(s)
- Gerson M Struik
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands; Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Nienke Hoekstra
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Taco M Klem
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands
| | - Ali Ghandi
- Franciscus Gasthuis and Vlietland, Department of Radiology, Rotterdam, the Netherlands
| | - Gerda M Verduijn
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | | | - Alja Schoonbeek
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kim C de Vries
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Margriet A Sattler
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kees Verhoef
- Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Erwin Birnie
- Franciscus Gasthuis and Vlietland, Department of Statistics and Education, Rotterdam, the Netherlands
| | - Jean-Philippe Pignol
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands; Dalhousie University, Department of Radiation Oncology, Halifax, Canada.
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Struik GM, Godart J, Verduijn GM, Kolkman-Deurloo IK, de Vries KC, de Boer R, Koppert LB, Birnie E, Ghandi A, Klem TM, Pignol JP. A randomized controlled trial testing a hyaluronic acid spacer injection for skin toxicity reduction of brachytherapy accelerated partial breast irradiation (APBI): a study protocol. Trials 2018; 19:689. [PMID: 30558672 PMCID: PMC6298013 DOI: 10.1186/s13063-018-3035-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) is a treatment option for selected early stage breast cancer patients. Some APBI techniques lead to skin toxicity with the skin dose as main risk factor. We hypothesize that a spacer injected between the skin and target volume reduces the skin dose and subsequent toxicity in permanent breast seed implant (PBSI) patients. METHODS In this parallel-group, single-center, randomized controlled trial, the effect of a subcutaneous spacer injection on skin toxicity among patients treated with PBSI is tested. Eligibility for participation is derived from international guidelines for suitable patients for partial breast radiotherapy, e.g. women aged ≥ 50 years with a histologically proven non-lobular breast carcinoma and/or ductal carcinoma in situ (DCIS), tumor size ≤ 3 cm, node-negative, and PBSI technically feasible. Among exclusion criteria are neoadjuvant chemotherapy, lymphovascular invasion, and allergy for hyaluronic acid. For the patients allocated to receive spacer, after the PBSI procedure, 4-10 cc of biodegradable hyaluronic acid (Barrigel™, Palette Life Sciences, Santa Barbara, CA, USA or Restylane SubQ®, Galderma Benelux, Breda, the Netherlands) is injected directly under the skin using ultrasound guidance to create an extra 0.5-1 cm space between the treatment volume and the skin. The primary outcome is the rate of telangiectasia at two years, blindly assessed using Bentzen's 4-point scale. Secondary outcomes include: local recurrence; disease-free and overall survival rates; adverse events (pain, redness, skin/subcutaneous induration, radiation dermatitis, pigmentation, surgical site infection); skin dose; cosmetic and functional results; and health-related quality of life. A Fisher's exact test will be used to test differences between groups on the primary outcome. Previous studies found 22.4% telangiectasia at two years. We expect the use of a spacer could reduce the occurrence of telangiectasia to 7.7%. A sample size of 230 patients will allow for a 10% lost to follow-up rate. DISCUSSION In this study, the effect of a subcutaneous spacer injection on the skin dose, late skin toxicity, and cosmetic outcome is tested in patients treated with PBSI in the setting of breast-conserving therapy. Our results will be relevant for most forms of breast brachytherapy as well as robotic radiosurgery, as skin spacers could protect the skin with these other techniques. TRIAL REGISTRATION Netherlands Trial Register, NTR6549 . Registered on 27 June 2017.
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MESH Headings
- Brachytherapy/adverse effects
- Brachytherapy/methods
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Dermal Fillers/administration & dosage
- Dermal Fillers/adverse effects
- Female
- Humans
- Hyaluronic Acid/administration & dosage
- Hyaluronic Acid/adverse effects
- Hyaluronic Acid/analogs & derivatives
- Injections, Subcutaneous
- Mastectomy, Segmental
- Middle Aged
- Netherlands
- Radiation Dosage
- Radiodermatitis/diagnosis
- Radiodermatitis/etiology
- Radiodermatitis/prevention & control
- Radiotherapy, Adjuvant
- Randomized Controlled Trials as Topic
- Telangiectasis/diagnosis
- Telangiectasis/etiology
- Telangiectasis/prevention & control
- Time Factors
- Treatment Outcome
- Tumor Burden
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Affiliation(s)
- Gerson M. Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Jeremy Godart
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Gerda M. Verduijn
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | | | - Kim C. de Vries
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Raymond de Boer
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Linetta B. Koppert
- Department of Surgery, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, the Netherlands
- Department of Genetics, UMC Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
| | - Ali Ghandi
- Department of Radiology, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, the Netherlands
| | - Taco M. Klem
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
- Department of Radiation Oncology, Dalhousie University, 5820 University Avenue, Halifax, NS B3H1V7 Canada
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Struik GM, Pignol JP, Kolkman-Deurloo IK, Godart J, Verduijn GM, Koppert LB, Birnie E, Ghandi A, Klem TM. Subcutaneous spacer injection to reduce skin toxicity in breast brachytherapy: A pilot study on mastectomy specimens. Brachytherapy 2018; 18:204-210. [PMID: 30528494 DOI: 10.1016/j.brachy.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Accelerated partial breast irradiation is a treatment option for selected patients with early-stage breast cancer. Some accelerated partial breast irradiation techniques lead to skin toxicity with the skin dose as a main risk factor. Biodegradable spacers are effective and safe in prostate brachytherapy to protect the rectum. We hypothesize that a subcutaneous spacer injection reduces the skin dose in breast brachytherapy. METHODS AND MATERIALS Ultrasound-guided spacer injections, either hyaluronic acid (HA) or iodined polyethylene glycol (PEG), were performed on fresh mastectomy specimens. Success was defined as a spacer thickness of ≥5 mm in the high-dose skin area. Usability was scored using the system usability scale. Pre and postinjection CT scans were used to generate low-dose-rate seed brachytherapy treatment plans after defining a clinical target volume. Maximum dose to small skin volumes (D0.2cc) and existence of hotspots (isodose ≥90% on 1 cm2 of skin) were calculated as skin toxicity indicators. RESULTS We collected 22 mastectomy specimens; half had HA and half had PEG injection. Intervention success was 100% for HA and 90.9% for PEG (p = NS). Hydrodissection was feasible in 81.8% with HA and 63.6% with PEG. Median system usability scale score was 97.5 for HA and 82.5 for PEG (p < 0.001). Mean D0.2cc was 80.8 Gy without spacer and 53.7 Gy with spacer (p < 0.001). Skin hotspots were present in 40.9% without spacer but none with spacer (p < 0.001). CONCLUSIONS A spacer injection in mastectomy specimens is feasible. An extra 5 mm space is always achieved, thereby potentially reducing the skin dose dramatically in low-dose-rate seed breast brachytherapy.
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Affiliation(s)
- Gerson M Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jeremy Godart
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gerda M Verduijn
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands; Division of Woman and Baby, Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ali Ghandi
- Department of Radiology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Taco M Klem
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
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Struik GM, Pignol JP, Kolkman-Deurloo IK, Godart J, Verduijn GM, Koppert LB, Birnie E, Ghandi A, Klem TM. Subcutaneous Spacer Injection to Reduce Skin Toxicity in Breast Brachytherapy - A Pilot Study on Mastectomy Specimen. Brachytherapy 2018. [DOI: 10.1016/j.brachy.2018.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Struik G, Pignol J, Ghandi A, Schiphof-Godart J, Kolkman-Deurloo I, Koppert L, Verduijn G, Birnie E, Klem T. Use of a subcutaneous spacer for skin protection during breast brachytherapy – a pilot study on mastectomy specimen. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Struik G, Pignol J, Ghandi A, Kolkman-Deurloo I, Birnie E, Klem T. EP-2213: A subcutaneous spacer injection for skin protection during breast brachytherapy – a pilot study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Struik G, Ghandi A, Kolkman-Deurloo IK, Birnie E, Pignol J, Klem T. Pilot study on the use of a subcutaneous spacer injection in the breast for skin protection during brachytherapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx144.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Elford R, White H, Bowering R, Ghandi A, Maddiggan B, St John K, House M, Harnett J, West R, Battcock A. A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing. J Telemed Telecare 2000; 6:73-82. [PMID: 10824374 DOI: 10.1258/1357633001935086] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We used a PC-based videoconferencing system to conduct child psychiatry assessments. The telecommunications link was six digital lines, giving a total bandwidth of 336 kbit/s. Twenty-three patients (aged 4-16 years), accompanied by their parents, completed two psychiatric assessments, one via videoconferencing and another face to face (FTF). The order of assessments was randomized. Questionnaires were used to record the diagnosis, treatment recommendations and the psychiatrists', patients' and their parents' satisfaction with each assessment. An independent evaluator concluded that in 22 cases (96%) the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF. The psychiatrists stated that videoconferencing assessments were an adequate alternative to FTF assessments and did not interfere with diagnosis. However, the responses from the psychiatrist satisfaction questionnaire showed that they preferred FTF assessments. No significant difference was found in the patients' or parents' satisfaction responses after the two types of assessment. The majority of children (82%) 'liked' using the telepsychiatry system and six (26%) preferred it to a FTF assessment. Most parents (91%) indicated that they would prefer to use the videoconferencing system than to travel a long distance to see a psychiatrist in person.
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Affiliation(s)
- R Elford
- Telemedicine Centre, Memorial University of Newfoundland, St John's, Canada.
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