Role of telemedicine in anesthesia: Are we ready yet?

Telemedicine is a modality which utilizes technology to provide and support health care across large distances. It has redefined the practices of medicine in many specialties and continues to be a boon for clinicians on many frontiers. Its role in the branch of anesthesia remains largely unexplored but has shown to be beneficial in all the three phases: pre-operative, intra-operative, and post-operative. Now time has come that anesthesiologists across the globe reassess their strategies and utilize the telemedicine facilities in the field of anesthesia.Copyright © 2021 EDP Sciences. All rights reserved.

Antenatal anaesthetic assessment of parturients with BMI > 40 kg/m2

Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd

Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis.

BACKGROUND: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. OBJECTIVE: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. METHODS: A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. RESULTS: A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). CONCLUSIONS: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.

Cross glances on the videoconsultation

The covid-19 outbreak prompted many health care providers to use video consultation for the first time. While it is particularly useful in times of pandemic, a number of patients wish to continue using video consultation as it allows easy access to their physician. However, many physicians may be uncomfortable communicating with new technologies and without performing a traditional physical examination. Training in communication and virtual physical examination in telemedicine appears to be necessary, making it possible to make videoconsultation sustainable into daily practice while guaranteeing quality of care.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

A time for adaptation and reflection: the experience of Admiral Nurses during COVID-19

COVID-19 has meant that, globally, people, organisations and governments have had to make huge changes in life and work. The aim of this study is to explore the impact of working during the first wave of COVID-19 on Admiral Nurse practice (specialists in dementia care who support families affected by dementia). Semi-structured interviews were used to gather data from 19 Admiral Nurses. Themes drawn from the data show that Admiral Nurses experienced an immediate sense of impotence and helplessness, and, from there, moved through a process of adaptation to reach a new level of competence. This research provides insight into the experiences of Admiral Nurses and their adaptability in extraordinary circumstances.

Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points.

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.

Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review.

BACKGROUND: Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers. OBJECTIVE: This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings. METHODS: This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness. RESULTS: Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs. CONCLUSIONS: There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.

Medical Student and Consultant Surveys Assessing Educational Value of Telephone and Video Neurology Clinics

Introduction The COVID-19 pandemic affected medical students experience of clinical neurology. Outpatient clinics reverted to telephone or video consultations. We sought to assess the impact of this change via a survey of both students and consultant neurologists. Methods An online 14-part questionnaire using Likert scales and free text options was distributed to all Year 4 medical students and consultant neurologists via email. Results 366 students received the survey and 39 responded (an 11% response rate). 41 consultants received the survey and 9 responded (a 22% response rate). 83% of consultants felt the student's inter- action with the patient was affected by the telephone/video software. 29% of students strongly agreed and 36% agreed that technological barriers impacted their learning experience. The free text student feedback highlighted good practice. We developed best practice guidance which included use of video consultation software, student engagement and clinic debrief. This was distributed as digestible checklists for students and clinicians. The limitations of this survey are the small response rates of both consultant and student groups. Conclusion Remote consultations are likely to remain part of neurological practice. Ongoing evaluation of its effect on medical student education and specific guidance for educators is required.

Evaluation of an expert center video clinic for patients with chronic spontaneous urticaria

Background: The COVID-19 pandemic dramatically disrupts health care around the globe. The recent COVID-CU study performed at urticaria centers of reference and excellence (UCAREs) demonstrated that the rate of face-to- face consultations decreased from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. As of now, it is largely unclear how this affects patients with chronic urticaria. Method(s): We assessed a UCARE video clinic for chronic spontaneous urticaria (CSU) for applicability and satisfaction by patients. Result(s): From January of to October of 2021, 78 patients (mean age 39.7 yrs, 73.3% female) with CSU participated in this survey study. More than 90% patients perceived the image transmission and sound quality as smooth and without distortion. Virtually all patients (96.9%) found that the previously provided explanations and instructions on technical handling were easy to understand and accurate. Patients rated the scheduling and planning of the video consultation as good (98.5%) and stated that it was effortless and within reasonable time (93.8%). Overall, 90.8% felt safe and well informed when using the technology. Most patients reported that the specified time of 20 minutes was sufficient (75.4%), that they were able to address all relevant points (68.8%), and that they received sufficient information about their disease (70.8%) during the video consultation. Almost 80% reported that they felt they were being treated professionally and that they were satisfied with how the conversation with their treating physician unfolded. The majority of patients adjusted quickly and easily to the situation of a video consultation (84.6%) and felt well treated with regard to their medical needs (73.9%). In general, the concept of a video clinic and remote treatment were well perceived and easy to use for most patients (81.5%), and the majority could imagine being treated regularly in this setting in the future (75.4%). Conclusion(s): UCARE video clinic consultations are well received by patients with CSU, which suggests that this instrument may be useful during and beyond the COVID-19 pandemic in the management of patients with chronic urticaria by specialized centers.

COVID-19 measures as an opportunity to reduce the environmental footprint in orthopaedic and trauma surgery.

Background: Climate change and its consequences on our everyday life have also tremendous impacts on public health and the health of each individual. The healthcare sector currently accounts for 4.4% of global greenhouse gas emissions. The share of the emissions in the health care system caused by the transportation sector is 7%. The study analyses the effect of video consultation on the CO2 emissions during the Covid-19 pandemic in an outpatient clinic of the department of orthopaedics and traumatology surgery at a German university hospital. Methods: The study participants were patients who obtained a video consultation in the period from June to December 2020 and voluntarily completed a questionnaire after the consultation. The type of transport, travel time and waiting time as well as patient satisfaction were recorded by questionnaire. Results: The study comprised 51 consultations. About 70% of respondents would have travelled to the clinic by car. The reduction in greenhouse gas emissions of video consultations compared to a face-to-face presentation was 97% in our model investigation. Conclusion: The video consultation can be a very important part of the reduction of greenhouse gas emissions in the health care system. It also saves time for the doctor and patient and can form an essential part of individual patient care.

Teleconsultations in paediatric dermatology: a UK-wide clinician survey

The COVID-19 pandemic catapulted dermatology services into a digital era, with the rapid introduction of teleconsultations. Potential benefits include widening access to healthcare and environmental sustainability. Barriers to successful teleconsultations include reduced diagnostic accuracy and technical issues. National Health Service operational planning guidance recommends that >= 25% of consultations are delivered remotely (https://www.england.nhs.uk/wp-content/uploads/ 2021/03/B0468-implementation-guidance-21-22-prioritiesand- operational-planning-guidance.pdf). Yet there is a lack of data regarding the acceptability and effectiveness of paediatric dermatology teleconsultations. We conducted a survey to explore clinicians' experience of teleconsultations in paediatric dermatology, focusing on paediatric eczema, to inform a future clinical trial. The survey was created using an online platform (Microsoft Forms) and piloted by paediatric dermatologists. It was circulated via email to members of the British Society for Paediatric Dermatology, the British Association of Dermatologists and the UK Dermatology Clinical Trials Network (DCTN). It remained open for 7 weeks from July to September 2021. Descriptive analysis was undertaken using Microsoft Excel. There were 120 responses, the majority from consultant dermatologists (59%). Prior to COVID-19, the most commonly provided teleconsultation service was advice and guidance (A+G) to general practitioners (GPs;55% responses). The majority of responders (63%) conducted no teleconsultations. Teleconsultations accounted for < 25% of all consultations in 98% responses. Since the pandemic there has been a marked shift in practice. Forty-nine per cent of responders now conduct > 25% of consultations as teleconsultations. Only 8% provide no teleconsultations. Teleconsultations are now being offered for new consultations [n = 62 (80%)], followup consultations [n = 101 (84%)] and A+G for GPs [n = 96 (80%)]. The most common format is telephone consultations with photographs (72%). For follow-up of paediatric eczema, the most effective format was felt to be telephone consultations with photographs [n = 52 (43%)], followed by video consultations with photographs [n = 32 (27%)]. Over half of responders (54%) felt that teleconsultations were less effective than face-to-face appointments for follow-up of paediatric eczema. Seventeen (21%) responders felt they could accurately assess eczema severity using a video vs. 27 (34%) using photographs. Reported barriers to teleconsultations included poorquality images, technical problems, reduced diagnostic accuracy and impaired communication. Importantly, the issue of safeguarding children was a concern. The majority of clinicians felt that teleconsultations were beneficial for reducing footfall in hospitals and minimizing time missed from school. Our results demonstrate variation in clinician opinion on the effectiveness of teleconsultations and the optimal format for paediatric eczema follow-up appointments. As part of a UK DCTN-themed research call award, we plan to conduct a patient survey, qualitative patient interviews and a health economics analysis of teleconsultations for paediatric eczema. This feasibility work will help to inform a future clinical trial.

An investigation into the digitalisation of New Zealand general practice services during COVID-19

Aim: This study investigates the digital transition initiated by the onset of the COVID-19 pandemic and the factors that enabled the digitalisation of general practices (GPs) in New Zealand. method: Using a multiple case study design, we conducted 86 in-depth interviews with staff from 16 GP centres in New Zealand. Result(s): The critical enablers of digital transition in response to the pandemic were support from the community, agility and adaptability of GP medical centres and the ability to pragmatically create external operational processes to ensure business continuity and to meet patient expectations. Major barriers to digitalisation at the early stage of the COVID-19 pandemic (28 February to 30 August 2020) included lack of organisational leadership, financial support availability, systems management collaboration, and patient and staff knowledge and preferences. Digitalisation was characterised by the GP centre's ability to provide telehealth services using existing systems and technology, embracing e-prescription, e-referrals, e-lab and video-only consults. conclusion: The decision to adopt digitalisation had a significant impact on GP centres, disrupting the norm but also allowing continued access to health services to patients who were the most vulnerable during the pandemic. The pandemic forced GP medical centres to change to digitalisation and led to significant changes in GP medical centres' business models. However, it remains to be seen how the rapid change effected at this time correlates with patient satisfaction and how the digitalisation capabilities that have been built impact on future primary care services. This study suggests that changes brought about by COVID-19 may pave the way to an expansion of GP telehealth services, which has the potential to permanently change the primary care landscape.Copyright © 2023 New Zealand Medical Association. All rights reserved.

Are patients satisfied with video consultations? A survey in a dermatology outpatient setting

Video consultation (VC) use as a method of patient-healthcare interaction has expanded significantly across the National Health Service since the start of the COVID-19 pandemic. Emerging evidence suggests that VC used as an alternative to face-to-face (F2F) consultations offers several advantages such as safety of interaction and convenience (Johns G, Khalil S, Ogonovsky M et al. Taming the chaos: NHS professionals' perspective of using video consulting during COVID-19 in Wales. BMJ Open Qual 2021;10: e001318). A pilot programme of VC use in a dermatology department began in March 2021 using the Attend Anywhere electronic platform. The aim was to explore patient satisfaction of VC within the dermatology outpatient clinic setting for preselected inflammatory skin disorders in a teaching hospital. Data were collected prospectively for a period of 8 months. An automated questionnaire appeared at the end of the VC, prompting patients to provide feedback. The completed forms were collected and analysed by Technology Enabled Care (TEC) Cymru, a national service sponsored by the Welsh Government. Following communication with the research and evaluation lead, the data were shared with the authors. The questionnaire collected information on the type of appointment patients were attending, demographics, VC quality, whether patients had used VC before and/or would use it again in the future, if they had experienced any difficulties, and finally if they found the consultation beneficial. A total of 83 VCs were carried out and 48 patients completed the questionnaire (58% response rate). Participants were 72% female and ages ranged from 13-17 to > 80 years, with only 8.5% being > 65 years old. The majority of participants (72%) ranked the VC quality as excellent and in 69% of cases patients felt that it negated the need for a F2F consultation. All participants would use VC again, with only 8% preferring a F2F consultation. The vast majority of participants reported no technological issues, with audio being the highest ranked challenge of the VC (22%). Overall, the 'patient benefit' questions showed the majority of participants found VC advantageous vs. a F2F consultation and this included saving time overall (69%), in particular with travel and parking (84%), taking time off work (66%), improving access to care (69%), reducing the risk of infection (71%), reducing anxiety (60%) and improving family involvement during the consultation (55%). This study was limited by a small sample size and the questionnaire being designed for all healthcare settings and not specifically for dermatology. However, the results show a clear message of overall patient satisfaction when using VC with only limited technological challenges. VC is an innovative method of patient-healthcare interaction that if used in the correct setting can provide a preferable choice for communication between selected patients and dermatology staff.

Remote monitoring and virtual follow-up ventilation clinics in the age of Covid-19

Background: To review the efficacy of long-term non-invasive ventilation (LTV) with virtual follow-up, using assistive technologies and remote monitoring. Objective(s): Compliance greater than 4 hours, correction of hypercapnia and improvements in sleep and quality of life (QoL) were the objectives in improving patient outcome. Method(s): We conducted a retrospective cohort study including patients established on LTV over an 18 month period from the start of the pandemic. Initiation of LTV was established as an inpatient (n= 17;35%), outpatient (n= 28;57%) or from the patient's home (n= 4;8%) and follow-up was by telephone, video consultation or from the patient's own home. LTV was considered successful if compliance achieved was > 4 hours using remote monitoring, corrected hypercapnia (tCO2 < 6.5Kpa) and patient-reported improvements in sleep and QoL. Result(s): Forty-nine patients were included. LTV was initiated for: neuromuscular disease (n=19;39%), obesity hypoventilation or overlap (n=12;24%), chronic obstructive pulmonary disease (n=11;22%) and chest wall deformity (n=6;14%). Compliance > 4 hours was achieved in 69% with effective correction of hypercapnia (tCO2 < 6.5Kpa) in 67% and reported improved sleep and QoL at 63%. Overall success in all 3 objectives was 61%. Patient preference for future follow-up was 45% requesting face-to-face consultations and 33% to continue remotely. A proportion of the most vulnerable (14%) would prefer to be seen at home. Conclusion(s): Successful LTV can be achieved with remote compliance data and transcutaneous carbon dioxide monitoring to support virtual clinics. Patient preference for face-to-face consultations remains important in overall satisfaction.

Developing dermatology video consultations: a determination of quality

The COVID-19 pandemic precipitated a unique set of circumstances where the provision of care via telemedicine was rapidly adopted. Delivering high-quality care is a primary focus and the consideration of sustainability should be central to this process. Value in healthcare is often defined by outcomes for patients and populations in relation to economic costs;however, a more holistic approach using the 'triple bottom line' factors in environmental and societal impacts. The primary drivers in developing dermatology video consultations were the promotion of equitable and co-produced care, constructing sustainable healthcare and mitigating against environmental impacts, and demonstrating leadership in establishing new methods of outpatient care delivery. Patient video consultation demographics and outcomes were captured from 24 June 2020 to April 11 2020. Data were collected via the hospital software and dictation system with ethical approval. Patient experience was assessed via an online questionnaire. One hundred video consultation episodes were examined. The rate of nonattendance at scheduled video consultation was 10%. Successful video consultations were completed in 90% of patient episodes. Conversion to a telephone consultation was required in 12% and face-to-face presentation in 4%. Further information (e.g. photographs) was required to complete the consultation in 18%. In relation to outcomes, 25% of patients were discharged back to their general practitioner. Day case procedures were arranged in 12% of patients. Follow- up was conducted via telephone in 21% of patients (n = 12/56) and face to face in 79% (n = 44/56). The rate of change in diagnosis following face-to-face follow-up/investigation was 8%. Seventy patients completed an online questionnaire;the response rate was 70%. Mean age was 39 years (range 16-74). Eighty-five per cent were satisfied or very satisfied with their consultation, 83% felt their skin complaint was adequately addressed and 73% rated their overall user experience as very good or excellent. In relation to environmental impacts 12 760 km and 228.6 h of travel time were saved, and carbon emissions were reduced by 2.19 metric tonnes of CO2. In terms of accessibility, 84% of households in the area have fixed broadband and 42% have mobile broadband. When endeavouring to determine the quality of a new service many aspects require attention. Our service demonstrates equity in accessibility with a wide age range and good broadband coverage. The rate of change in diagnosis was low at 8% and patient satisfaction was high. Questionnaire responses provide an opportunity for co-production and positive environmental and societal impacts are also created.

Patient questionnaire-based triage improves outcomes for psoriasis referrals

COVID-19 has placed additional demands on a healthcare system that is already overstrained. While the National Health Service has coped extremely well in the face of new pressures, much of the pressure has transferred to a growing backlog of non-COVID outpatient care. Waiting lists have become unwieldy and new dermatology waiting times can be in excess of 18 months. We have developed a novel system to enable our tertiary referral dermatology department to triage rapidly and manage new patients with psoriasis, returning to target levels of activity, with minimum impact on patient care. Newly referred patients with psoriasis were sent a questionnaire, including the Dermatology Life Quality Index (DLQI), to direct their management appropriately. Patients were asked to estimate their affected body surface area using the palm measurements and affected body sites. Patients were also asked which treatment types they would be prepared to accept if offered (phototherapy, systemic therapy), as well as the type of clinic they would find acceptable. The latter included faceto- face only, telephone/video consultation or using a secure skin mobile phone app (MySkinSelfie), whereby photos are securely uploaded for viewing by the doctor but are still controlled by the patient. Of 265 patients, 222 responded (average response time 7 days). In total, 217 were offered an appointment. Thirty-one per cent were seen acutely (2 weeks) and the remainder in routine clinics. Two patients no longer wanted an appointment. An algorithm was used to place patients in appropriate clinics according to their responses. Patients who did not respond to the questionnaire within 4 weeks were sent a reminder letter and then discharged if there was still no reply (17%). Median DLQI was 15, with 63% of patients happy to have a telephone/video consultation, 72% were open to phototherapy, 80% were happy to use the MySkinSelfie App and 34% requested faceto- face appointments only. During the COVID-19 pandemic many dermatology units have had to limit the focus of their work on skin cancer, leaving little time for all but the most urgent patients with inflammatory disease. A previous systematic review and meta-analysis (Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 2017;77: 425-40) of 1.7 million patients with psoriasis confirmed an increased risk of suicidal ideation [odds ratio (OR) 2.05] and suicidal behaviour (OR 1.26;Singh et al.), highlighting the importance of managing these patients in a timely manner. General practitioner letters can lack sufficient information on disease severity/ urgency, but our simple model allows the department to streamline referrals quickly, ensures that the patient still wants to be seen and minimizes unnecessary hospital visits. We propose that this approach is considered by other dermatology departments to streamline outpatient waiting lists and accelerate a return to normal activity during the pandemic.

Training concepts with telemedicine in pediatric diabetology.

The high level of technologization in the treatment of type 1 diabetes mellitus made it possible to provide outpatient care during the coronavirus pandemic with the help of video consultations. The increasing experience of families' e-learning in school or professional life and the structures created in practices and clinics to provide telemedical consultations has allowed the continued development of different training concepts in pediatric diabetology. The use is diverse and individual, such as having additional caregivers participate in a face-to-face training sessions, to jointly perform timely processing in the case of acute questions from parents through data analysis, or to avoid long travel distances to attend a consultation. Important for implementation is a structured approach with all necessary tools, a quiet workplace, and the expectation of the possible occurrence of technical problems on both sides. Backup contact by telephone is helpful. Telemedicine training concepts in diabetes counselling is a new exciting experience and complements the care of the entire family with a child or adolescent with diabetes mellitus and should be used and expanded in the future.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Telemedicine in pediatric diabetology.

Since the coronavirus disease 2019 (COVID-19) pandemic, telemedicine in pediatric diabetology has become part of care of children and adolescents with type 1 diabetes (T1D) and their families, especially video consultations. An improvement in glycemic control as well as in therapy satisfaction could be achieved. Different requirements are necessary for implementation in the technical, organizational, and regulatory sense. For implementation, it is important to adapt the work-flow and to create an adequate workplace for video consultation with specific infrastructure. For the actual video consultation with the patient, all digital data should be used, e.g., from blood glucose meters and continuous glucose monitoring (CGM) devices as well as insulin pumps or digital pens, and the upload of these data by the patient beforehand is obligatory. The discussion of the data in a patient-centered manner with the use of graphs and figures derived from the ambulatory glucose profile (AGP) or similar methods should be done as in face-to-face consultations. Another possibility of telemedicine is video education. Here, it is not sufficient just to use known educational material, but this has to be adapted or, if necessary, some parts need to be newly developed. Reimbursement is still insufficient and needs to be improved to make telemedicine economically reasonable for the provider.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.