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Teleconsultation is a type of medical practice similar to face-to-face consultations, and it allows a health professional to give a consultation remotely through information and communication technologies. In the context of the management of the coronavirus epidemic, the use of teleconsultation practices can facilitate healthcare access and limit the risk of avoidable propagation in medical cabinets. This paper presents the monitoring of international teleconsultation referrals in the era of Covid-19 to facilitate and prevent the suspension of access to care, the most common architecture for teleconsultation, communication technologies and protocols, vital body signals, video transmission, and the conduct of teleconsultation. The aim is to develop a teleconsultation platform to diagnose the patient in real time, transmit data from the remote location to the doctor, and provide a teleconsultation. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Introduction: One in five pregnant women in the UKis obese. Obesity is associated with increased risk of both maternal and foetal adverse outcomes. RCOG guidelines [1] recommend that all women with a booking BMI over 40 kg/m2 should be reviewed antenatally by a senior obstetric anaesthetist to guide risk assessment, medical optimisation and shared decision-making. The 2021 MBRRACE report [2] recommends that all women should be reweighed in the third trimester for accurate VTE risk scoring and prophylactic LMWH dosing. In our institution, reconfiguration of hospital areas as part of the COVID-19 response led to loss of designated clinic space for our obstetric anaesthetic clinic. As a result, our practice since has been to initially offer a telephone consultation followed by a face-to-face review if needed. Finding space for the latter has often been a significant logistical challenge. Our project sought to assess whether our practice continued to meet national standards in the wake of these changes. Method(s): Following audit approval, we retrospectively reviewed all women with a BMI >40 kg/m2 undergoing caesarean section (CS) over a six-month period (1/4/22 to 31/9/22). Result(s): 20 women met inclusion criteria (Category 1-3 CS - 12 women;Category 4 CS - 8 women). 100% of patients had booking height, weight and BMI recorded. 20% (4/20) of patients were reweighed in the 3rd trimester. Only 55% (11/20) of patients had been referred to and reviewed in the antenatal obstetric anaesthetic clinic (Figure). Of the 11 patients referred, 6 were referred later than 30 weeks. Of the 9 patients not referred, 8 had a BMI between 40 and 45 kg/m2. By contrast, 87% (6/7) of patients with BMI over 45 kg/m2 were referred and seen. Discussion(s): Our audit showed that we are not meeting national standards. Possible reasons identified were lack of awareness of the RCOG standards and referral criteria (especially for women with a BMI of 40 to 45 kg/m2) and logistical issues in undertaking face-to-face reviews without designated clinic space. Presentation of our results at the joint anaesthetic, obstetric and midwifery governance meeting has helped identify space in the antenatal clinic for face-to-face reviews, to start from March 2023 and to raise awareness of the national standards to ensure referral of all women with a BMI over 40 kg/m2. A reaudit is planned in 6 months. [Figure presented]Copyright © 2023 Elsevier Ltd
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During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies.Copyright © 2022 Elsevier Masson SAS
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Introduction: Universities represent important Centers for public health assistance. However, in the context of the COVID- 19 pandemic, most Brazilian universities have suspended their academic activities and outpatient care. Objective(s): Describe how the Teleconsultation Program in Oral Medicine of the School of Dentistry, Brazil, remotely contributes to counseling dentistry on diagnosing oral lesions and providing guidance on treating patients in the North Macro-region of Minas Gerais state. Material(s) and Method(s): Teleconsulting takes place remotely;the professional sends by smartphone, via WhatsApp, the case report, clinical images, and complementary exams, if appropriate. Concerning this, the specialist team analyzes the clinical case and returns it to the professional sender, providing information and suggestions on the oral lesions' diagnostic assessment and clinical management. Result(s): Since the beginning of the program, in 19 months, dentists from 40 municipalities were counseled, which resulted in 287 teleconsultations;from these cases, 103 cases were conducted face-to-face consultations in our Oral Diagnosis Service, and 38 cases were hypothesized as malignant lesions in the oral cavity and had their medical treatment conducted and followed by a multidisciplinary team, when appropriate. Conclusion(s): Teleconsultation Program represents an important tool to strengthen the communication between professionals of public health, improve health work processes, and promote better clinical guidance in Oral Medicine.
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Introduction: Coronavirus Disease-19 (COVID-19) Pandemic affected healthcare delivery worldwide from all quarters be it routine or essential care, including cancer care. All aspects like screening, diagnosis, and treatment were affected regardless of the developmental status of countries. Aim: To find out the extent and magnitude of cancer care affected during pandemic by comparing the data during pandemic for outpatient visits, new registrations, admissions, and day-care chemotherapy sessions with prepandemic data. Materials and Methods: This retrospective study was conducted in the Department of Medical Oncology of State Cancer Institute in Srinagar, India. The parameters assessed were the number of outpatient visits, new registrations, admissions, and day care chemotherapy sessions from the department of Medical Oncology. Anonymised cumulative data of all the patients who availed these services was included. Data were collected for eight months, during pandemic in 2020 and were compared with the data from previous year 2019. The effect of lockdown was assessed by comparing these parameters with the non lockdown period. Statistical analysis was done by independent t-test. Results: The number of outpatient visits dropped from 15425 from non lockdown period to 12670 in lockdown period (p-value=0.019), number of new admissions from 1613 to 1418 (p-value=0.001), and chemotherapy sessions from 9374 to 8081, (p-value=0.004). The number of patient registrations also declined but the drop was not significant (p-value=0.171). All the parameters except in-patient admission improved during the non lockdown period with the highest improvement in registration, but inpatient admission revealed a similar reduction as in the lockdown period. Conclusion: There was a significant effect of lock down due to COVID-19 pandemic on the number of outpatient visits, new admissions and chemotherapy sessions. This infers that, the treatment protocols and chemotherapeutic management of cancer care were badly affected by the advent of the pandemic. [ FROM AUTHOR] Copyright of Journal of Clinical & Diagnostic Research is the property of JCDR Research & Publications Private Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Access to quality healthcare service is a challenge for many patients, especially in situations which impose movement restrictions, such as the COVID-19 pandemic. Although it has the disadvantage of lacking a physical consultation, high accessibility makes telemedicine alongside teleconsultation preferred in numerous situations, contributing to high treatment adherence in patients. An important pathology addressed through telemedicine is diabetes mellitus, due to its possible commorbidities and negative impact. This study consisted of the analysis of the electronic files of 260 patients, between April and December 2020. A high adherence in prescription days covered was observed (89.91%). The increase of teleconsultations which was maintained even after the ease of lockdown measured suggested a good adherence to this method. Teleconsultation is an efficient method, with future prospects for providing healthcare. (English) [ FROM AUTHOR] Accesul la servicii de sănătate de calitate reprezintă o provocare pentru numeroși pacienți, în special în situații care impun limitarea deplasării, precum pandemia de COVID-19. Deși prezintă dezavantajul lipsei unui consult fizic, gradul ridicat de accesibilitate face ca telemedicina împreună cu teleconsultul să fie de preferat în numeroase situații, contribuind la aderența crescută la tratament a pacienților. Un loc important în rândul patologiilor abordate prin telemedicină îl deține diabetul zaharat, având în vedere posibilele comorbidități, precum și impactul negativ. Acest studiu a presupus analizarea fișelor electronice ale unui eșantion de 260 de pacienți, din perioada aprilie-decembrie 2020. S-a constatat o aderență bună la ridicarea rețetei (89,91%). Creșterea numărului de vizite prin teleconsult, care s-a menținut și după relaxarea măsurilor restrictive, a sugerat o aderență bună la această metodă. Teleconsultul este o metodă eficientă și cu perspective pentru furnizarea serviciilor de sănătate. (Romanian) [ FROM AUTHOR] Copyright of Farmacist.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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We have an established transition clinic for the patients with diabetes aged 16 to 19. Our Transition clinic covers a vast area including deprived areas such as Ellesmereport. We do have 3 monthly follow up in addition to the home visits by paedatric diabetes specialist nurses. The team involves paediatric consultants, pdsn and dietcician from adult and paedatrics departments. Virtual consultation were the main mode of consultations during covid. We used Accu Rx, Attendanywhere and telephone consultations. We compared the clinic attendance pre and post covid. We compared clinic attendance for 9 months from March 2019 to December 2019 which were pre Covid to March 2020 to December 2020 during Covid. We had 150 appointments in 2019 and 112 appointments in 2020. The DNAs were 21 during covid with virtual consultations and 28 pre Covid with face to face appointments. The DNA rates were 18.6% in 2019 as face to face review and 18.75% during covid as virtual consultations. Surprisingly, the DNA rates did not improve when the clinics were virtual as we expected. In Conclusion, the virtual consultations did not improve the attendance in this vulnerable age group. Due to vulnerability of this age group, we felt that the face to face consultations were more appropriate. All of our appointments for the diabetes transition clinics are face to face in person due to above findings.
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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.
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Aim: The aim of this study was to assess the knowledge, attitudes and practice of teledentistry during COVID-19 among dentists in Southern Saudi Arabia. Material(s) and Method(s): A questionnaire with 27 questions was constructed, validated and circulated electronically via social media channels like WhatsApp and by email to dentists from various fields in Southern Saudi Arabia. Data were collected and analyzed using the statistical software SPSS 23.0. Result(s): Most of the respondents showed a positive behavior towards all domains of the questionnaire, including knowledge, attitude and practice of teledentistry. Out of 839 participants, 532 participants were familiar with this term, most of them (64.4%) were practicing it during the pandemic of COVID-19. Discussion(s): It is an emerging technique that has the ability to improve the delivery of dental care diagnosis to communities with limited access or no access to specialists. As of today, there is a need for improvement in practicing it among the Saudi dental community.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Since the pandemic, remote medical consultations have become a routine part of healthcare provision. But the concept of remote consultations mediated via communication technology is not as new as we might expect, and was in fact predicted a century ago.Copyright © 2023 Wiley Interface Ltd.
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Background: Patients with cancer are at a higher risk of getting infected with the severe acute respiratory syndrome coronavirus 2 owing to their immunocompromised state. Providing care to these patients amidst the first wave of the coronavirus disease-2019 (COVID-19) pandemic was extremely challenging. Objective(s): This study was aimed at evaluating the clinical profile and disease-related outcomes of pediatric patients with hematological illnesses and cancer. Material(s) and Method(s): This retrospective study was conducted at a tertiary care center in North India during the first wave of the pandemic from March 2020 to December 2020. Children aged up to 18 years, who were treated for a hematological illness or malignancy or underwent hematopoietic stem cell transplantation (HSCT) and tested positive for COVID-19 regardless of symptoms were included in the study. Baseline demographic data related to the age, diagnosis, treatment status, and chemotherapy protocol used were collected. Outcomes including the cure rates, comorbidities, and sequelae were recorded. Result(s): A total of 650 tests for COVID-19 were performed for 181 children;22 patients were found to be COVID-19 positive. The most common diagnosis was acute leukemia (63.6%). None of the patients developed COVID-19 pneumonia. The majority of patients had asymptomatic infection and were managed at home. Among those with a symptomatic infection, the most common symptoms were fever and cough. A total of 3 (13.6%) patients needed oxygen therapy, one developed multisystem inflammatory syndrome of children leading to cardiogenic shock. Three patients required intensive care or respiratory support;all the patients had favorable clinical outcomes. The median time from the onset of COVID-19 to a negative result on the reverse transcription-polymerase chain reaction test was 21.3 days. Cancer treatment was modified in 15 patients (68.2%). Conclusion(s): Our results suggest that children with hemato-oncological illnesses rarely experience severe COVID-19 disease. The impact of the first wave of COVID-19 primarily manifested as disruptions in the logistic planning and administration of essential treatment to these children rather than COVID-19 sequelae.Copyright © 2021 Cancer Research, Statistics, and Treatment Published by Wolters Kluwer - Medknow.
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(1) Background: Hidradenitis suppurativa is a chronic, inflammatory skin disease. It is characterized by the transformation of normal skin into skin with abscesses, nodules, tunnels, and scars. The most commonly affected areas are the armpits, groins, buttocks, and subscapular area. Patients with HS require constant care under the supervision of the outpatient clinic. Due to the COVID-19 pandemic, consultations have been introduced in the form of telemedicine. The aim of this study was to evaluate the availability of HS treatment during the COVID-19 pandemic and to assess patient satisfaction, problems with access to medical care, and the impact of the pandemic on the course of the disease. (2) Methods: An internet survey with an anonymous questionnaire was used to assess the effectiveness of telemedicine consultations. The survey consisted of 25 closed questions, and responses were kept fully anonymous. (3) Results: Most respondents reported minor problems with accessing specialized HS medical care during the COVID-19 pandemic (n = 25, 35.71%). However, 35.71% (n = 25) of them reported major problems with appointments for specialized ambulatory treatment during the last few months of the pandemic, mainly due to delayed appointments. Almost half of the respondents had been diagnosed with COVID-19 (n = 34, 48.57%), and 58.57% (n = 41) of respondents did not see a correlation between COVID-19 infection and HS progression. (4) Conclusions: Our study showed that the pandemic significantly limited access to medical advice, and patients with hidradenitis suppurativa prefer standard consultations.
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Background: The COVID-19 pandemic led to a paradigm shift in routine care delivery with the widespread transition to virtual care without demanding preconditions. Caregivers' satisfaction is a critical parameter to ensuring the quality of clinical service in the pediatric population. Despite this fact, such patient-related factors are under-investigated and poorly documented in developing countries such as Ethiopia. The study was aimed to assess caregivers' satisfaction regarding teleconsultations and associated factors during COVID-19 pandemic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: Health institution-based cross-sectional survey was conducted in randomly selected caregivers who were served with phone-based medical consultations during the pandemic. Data were collected by means of a pretested, structured interviewer-administered questionnaire. Data were entered into Excel 2016 and analyzed using SPSS version 26. Logistic regression models were used to predict the association of study variables and adjusted for possible confounders. Results: Overall, 177 (61.5%) of participants reported satisfaction with the teleconsultation. Female caregivers (AOR=1.78; 95% CI 1.05, 3.01), having family support (AOR=2.6; 95% CI 1.45, 4.65), access to a nearby laboratory (AOR=2.18; 95% CI 1.24, 3.83), having access to nearby pharmacy (AOR=2.82; 95% CI 1.63, 4.86) were found to be predictors of caregivers' satisfaction with teleconsultation in the study area. Conclusion: A considerable number of caregivers were satisfied with the teleconsultation service during the COVID-19 pandemic. It is important for healthcare providers and policy makers to strengthen the provision of teleconsultation service options for caregivers including women and those with better access to diagnostic centers and pharmacies. They should try to make teleconsultation caregiver-friendly.
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Background/Aims Research has shown nurse-led gout clinics provide better outcomes compared to usual care. This District General Hospital set up a pilot nurse-led gout clinic in autumn 2019. This aimed to improve patients' understanding of their condition, achieve better control of serum uric acid levels (SUA), reduce flares and prevent Emergency Department attendances. Methods A modified clinic protocol, closely modelled on BSR guidance was agreed within the department. With consultant supervision, one nurse specialist provided a mix of in-person and telephone appointments. Targets were set aiming for SUA <360mumol/L for most patients and <300mumol/L for those with erosive change or tophi. All patients were offered prophylaxis. Patients required a rheumatologist's diagnosis of gout or crystal confirmation for enrolment. Exclusion criteria were significant renal or hepatic derangement. Within 3 months of the service starting SARS-CoV-2 impacted the operation of healthcare worldwide and led to the closure of routine outpatient clinics in Northern Ireland. A decision was made to switch the gout clinic to run entirely by telephone. Blood testing was facilitated through primary care and phlebotomy hubs. Results Over a 19-month period, 78 patients were treated and audited through this clinic: 69 men and 9 women. Average age was 57, mean SUA 509 mumol/L at referral and 322 mumol/L on discharge. 69 patients received allopurinol and 9 received febuxostat. No patients required uricosuric drugs. All patients were offered and agreed to take prophylaxis with a majority (85.8%) remaining on it for 3-6 months. Patients required a mean of 3.38 appointments prior to discharge from the clinic. The mean dose of urate lowering therapy on discharge was 315.9mg allopurinol and 93.3mg febuxostat. 95% experienced >=2 flares during their enrolment in the clinic with no patients requiring Emergency Department attendance due to gout flare. Conclusion The nurse-led gout clinic was well received by patients and was effective as a telephone service during the pandemic when so many services were stood down. The clinic was able to continue to provide education, deliver effective reductions in uric acid as well as reduce incidence of flares and Emergency Department attendances. Lower doses of urate lowering therapy than expected were needed to achieve target. A small number of patients were discharged prior to enrolment for initial non-engagement which may have been exacerbated by the lack of face-to-face appointments. Our COVID-19 model did struggle with those patients needing an interpreter. In-person initial appointments have since been restarted;however, a greater proportion of reviews will continue to be offered by telephone given the unexpected success of the model. This audit showed that a nurse-led gout clinic can run successfully, even during a pandemic with a significant reliance on telephone consultations.
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The coronavirus disease-2019 (COVID-19) pandemic has imposed a situation where all healthcare facilities except emergency services remain suspended. These times generated the necessity for the implementation of a healthcare delivery system that can be accessed digitally and, thus, benefit the majority of children as well as healthcare professionals. This review aims to propose a sound model of less technique sensitive, safe and handy strategies for dental traumatic injuries, endodontic and restorative concerns, and orthodontic urgencies until complete clinical help can be sought. Five hundred thirty articles were obtained from the PubMed, Google Scholar, Embase, Lilacs, and Cochrane databases published from 2011 to 2021. Nineteen articles that described teledentistry in the COVID-19 era were included. Teledentistry can serve as a vital patient management strategy that can aid in triaging urgent and elective patient treatment needs, ultimately easing the burden of clinics and at the same time providing a safer means of consultation. Copyright © 2021 Goswami, Nangia, Saxena, Chawla, Mushtaq, Singh and Jain.
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Current pandemic implies changes in patient care in rheumatology to reduce the risk of coronavirus transmission to patients visiting health-care facilities, by organizing less frequent blood tests, using teleconsultations, and switching from intravenous to subcutaneous drug administration. Patients under immunosuppressive treatment are considered at high risk of severe outcome and are protected accordingly by the Swiss authorities. However, current, scarce scientific evidence suggests that patients under immunosuppressive therapy do not necessarily develop severe COVID-19 presentations. Therefore, the current guidelines recommend pursuing the treatment throughout the pandemic. In case of SARS-CoV-2 infection, immunosuppressive drugs should be temporarily stopped, except for glucocorticoids, hydroxychloroquine and sulfasalazine.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.
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Background/Aims COVID-19 challenged traditional care models and necessitated introduction of remote consultations. We wanted to understand the experiences of people with rheumatoid arthritis (RA)/adult juvenile idiopathic arthritis (AJIA) on accessing healthcare remotely, and how well people understood their condition and treatment. Methods This collaborative work between the National Rheumatoid Arthritis Society (NRAS) and clinicians in Oxford led to the development of an electronic questionnaire that was disseminated in July 2021 for four weeks through e-newsletters and all NRAS social media platforms. Those living in the UK with RA and AJIA aged 18 and over were eligible. Analyses of data were performed in Microsoft Excel and IBM SPSSv28. Results We analysed 316 responses. There was a middle-aged (ages 46 to 54, 54.1%, n=171), Caucasian (97.5%, n=306), female (92.4%, n=292) preponderance. Most had RA (93%, n=294) followed by another inflammatory arthritis (4.1%, n=13) and AJIA (2.8%, n=9). The majority had their condition for >10 years (43.4%, n=137) but some were diagnosed <12 months ago (3.2%, n=10). Two thirds of participants (66.5%, n=210) did not know their DAS28 score. Of the remaining third, the most commonly reported measure was moderate disease activity (12%, n=38). Those with higher self-reported DAS28 scores were using analgesia more regularly (p<0.01) but we found no difference in NSAID, DMARD or steroid use. Age did not influence steroid usage (p=0.35), but those who had their condition for longer used more steroids and regular analgesia. Only 33.9% (n=107) of responders felt their condition had been managed adequately in the pandemic, with more reporting poor status (40.8%, n=129) rather than good (16.8%, n=53). Those living in the South of England reported statistically better disease control than those from the North, despite having more virtual assessments (p=0.02). Travelling and fear of Covid appeared more important than consultation skills. Just over a fifth (20.3%, n=64) felt greater focus should be given to patient concerns. Of the 9.1% of patients (n=29) with a new diagnosis made during the pandemic, 24.1% (n=7) unable to book a GP appointment easily. Patients experienced a median symptom time of 4-10 weeks before consulting GPs. Once assessed, 31% (n=9) were referred immediately while the median time was 4-8 weeks. We found 58.6% (n=17) of patients received their diagnosis within their initial rheumatology consultation and 76.5% (n=13) of these started a DMARD immediately. Conclusion Despite a greater emphasis on patient education and PROMs influencing clinical decision-making, it is staggering that two-thirds did not know their DAS28 score. Analgesia and steroid use were common in patients with well-established disease which remains a concern. Accessing appointments was a significant barrier to patients and delays in care were experienced at every step in the NHS management pathways. Remote consultations need greater emphasis on patient concerns.
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.