The E-Nurture Project: A Hybrid Virtual Neonatal Follow Up Model for 2021.

Neonatal follow-up has long focused on a model of surveillance and identification of short-term outcomes. This model has long become outdated, with evidence documenting the need for longer follow-up with known school-based challenges and significant gaps in knowledge by educators. This article reviews the history of neonatal follow-up and demonstrates a novel approach to neonatal follow-up, built largely with a hybrid virtual platform, which then became essential with the declaration of the pandemic in 2020.

Telehealth Systems for Midwifery Care Management during the COVID-19 Pandemic: A Systematic Review

Background: Intrinsic features of COVID-19 disease, including the severity of the virus transmission and mortality rates, make it difficult to provide obstetric care to pregnant women. In this regard, telemedicine can provide comprehensive midwifery care relying on new technologies, such as virtual clinic, telehealth, tele-monitoring, m-Health, wearable sensors, and the internet of medical things. The objective of this study is to identify the application and requirements of a telehealth system for midwifery care. Methods: We conducted a literature search from 2019/12/1 to 2022/10/1 using the following electronic scientific databases: Web of Science, Scopus, PubMed, Science Direct, and Google Scholar. We carried out hand searches from the reference lists of retrieved studies of journals. Results: We showed that, during COVID-19 pandemic, prenatal care via telehealth increased and telehealth is a good strategy for prenatal and post-partum disease managements. Mental health services are also feasible via telehealth. These new technologies also reduce the risks associated with interpersonal contacts in COVID-19 pandemic. Conclusion: With the COVID-19 pandemic, telehealth became the norm. The future of medical services will be built around this technology and that is a great opportunity to move toward a great evolution. Copyright © 2023, Journal of Iranian Medical Council. All rights reserved. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Experience and perception of utilizing virtual clinic in neurological assessment in Saudi Arabia.

Introduction: The World Health Organization defined electronic health as "the unified usage of information technology and electronic communications in the health sector." In the Kingdom of Saudi Arabia, outpatient encounters were largely shifted to virtual clinics due to the crisis caused by COVID-19. This study aimed to evaluate the neurology consultants', specialists', and residents' experience and perception of utilizing virtual services for neurological assessment in Saudi Arabia. Methods: This cross-sectional study was conducted by sending an anonymous online survey to neurologists and neurology residents in Saudi Arabia. The survey was developed by the authors and contained three main sections: demographics, subspecialty and years of experience after residency, and virtual clinics during the coronavirus disease 2019 (COVID-19) pandemic. Result: A total of 108 neurology-practicing physicians in Saudi Arabia responded to the survey. Overall, 75% experienced virtual clinics, and 61% of them used phones for consultation. In neurology clinical practice, there was a significant difference (P < 0.001) regarding the teleconsultations for follow-up patients compared to the newly referred patients, being more suitable for the follow-up cases. Additionally, most neurology practicing physicians showed more confidence in performing history-taking tasks virtually (82.4%) than in physical examination. However, it was found that consultants were significantly (P < 0.03) more confident to virtually perform the cranial nerve, motor, coordination, and extrapyramidal assessments than the neurology residents. Physicians deemed it more suitable to conduct teleconsultations for patients with headaches and epilepsy than for those with neuromuscular and demyelinating diseases/multiple sclerosis. Furthermore, they agreed that patients' experiences (55.6%) and physicians' acceptance (55.6%) were the two main limitations to implementing virtual clinics. Discussion: This study revealed that neurologists were more confident in performing history-taking in virtual clinics than in physical exams. On the contrary, consultants were more confident in handling the physical examination virtually than the neurology residents. Moreover, the most accepted clinics to be handled electronically were the headache and epilepsy clinics in comparison to the other subspecialties, being mainly diagnosed using history. Further studies with larger sample sizes are warranted to observe the level of confidence in performing different duties in neurology virtual clinics.

Virtual keratoconus monitoring clinic in a tertiary university hospital in the United Kingdom.

Purpose: To describe a new pathway for virtual keratoconus (KC) monitoring in the corneal department of a tertiary referral center in the UK during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A virtual outpatient clinic to monitor KC patients (KC PHOTO clinic) was created. All patients from the KC database in our department were included. At each hospital visit, patients' visual acuity and tomography (Pentacam; Oculus, Wetzlar, Germany) were collected by a health-care assistant and an ophthalmic technician, respectively. The results were virtually reviewed by a corneal optometrist to identify stability or progression of KC and discussed with a consultant if needed. Those with progression were contacted by telephone and listed for corneal crosslinking (CXL). Results: From July 2020 until May 2021, 802 patients were invited to attend the virtual KC outpatient clinic. Of them, 536 patients (66.8%) attended and 266 (33.2%) did not attend. After corneal tomography analysis, 351 (65.5%) were stable, 121 (22.6%) showed no definite evidence of progression, and 64 (11.9%) showed progression. Forty-one (64%) patients with progressive KC were listed for CXL and the remaining 23 patients deferred treatment after the pandemic. By converting a face-to-face clinic to a virtual clinic, we were able to increase our capacity by nearly 500 appointments per year. Conclusion: In pandemic times, hospitals have developed novel methods of delivering safe patient care. KC PHOTO is a safe, effective, and innovative method of monitoring KC patients and diagnosing progression. In addition, virtual clinics can increase the clinic capacity tremendously and reduce the need of face-to-face appointments, which is beneficial in pandemic conditions.

A permanent legacy of the pandemic? Outcomes of and staff views on the introduction of virtual clinics to an Irish oncology service.

BACKGROUND: Virtual clinics were introduced to our practice in March 2020. We aimed to assess outcomes from virtual clinics and to assess staff views on them and their barriers to implementation nationally. METHODS: We prospectively assessed outcomes from 53 planned virtual consultations in a cancer centre oncology outpatient department (April-July 2020). Thirty-two oncologists completed an online survey. RESULTS: Visit durations ranged from < 5 min (n = 2, 4%) to 30 + min/patient (n = 9, 20%) (median: 18 min (range 4-141, IQR 10-30 min)). Median time spent preparing for patients who did not attend (n = 6, 11%) was 15 min (range 9-15 min). Most patients were scheduled for routine follow-up (n = 41, 87%), with some planned for an early in-person visit (n = 3) or investigation (n = 3). Where bloods had been requested (n = 25), samples had often not been taken (n = 20, 80%) or results were unavailable (n = 3, 12%). Different plans may have been agreed with two patients (4%) had they attended in-person. Virtual visits were perceived as faster by most doctors in the online survey (n = 26, 84%), with some (n = 5, 16%) reporting a difference of 10 min per patient. Many (n = 13, 42%) arranged earlier follow-up appointments. Low satisfaction was associated with difficulty with patient assessment (81%) or communication (63%), resource limitation (48%), or poor access to results of investigations (40%). The majority (n = 21, 67%) do not feel their virtual clinic quality is as good as in-person. CONCLUSIONS: If virtual clinics are to play a long-term role in oncology, it is essential to monitor clinic quality and plan visits proactively.

Virtual clinic in pregnancy and postpartum healthcare: A systematic review.

Background and Aims: To monitor the health status of pregnant women moment by moment, new technologies in the field of telemedicine can be used, such as virtual visits and virtual clinics. During the COVID-19 pandemic, by using these technologies, useful and satisfactory services have been provided to pregnant mothers. The aim of this study is to specify the applications, features, and infrastructure of a comprehensive virtual clinic in the field of gynecological and pregnancy care. Methods: A systematic review search was conducted through the scientific databases from February 2013 to February 2022 using Scopus, Web of Science, and PubMed. Furthermore, manual searches in Google Scholar and the reference lists of included studies were carried out. Results: In this systematic review we included 16 articles that reported experiences in virtual clinics in pregnancy and postpartum healthcare. The involved studies were experimental, cohort, and cross-sectional studies. The target group users were pregnant or women who gave birth and families of neonatal. The application of virtual clinics was for the visit, consultation, monitoring, follow-up, and home care virtually. Highly satisfaction scores of caregivers after virtual visits and consultation were reported. There were some challenges during virtual visits and consultation; the most important challenge was a poor internet connection. Conclusion: The reviewed studies show promising outcomes according to patient and provider satisfaction. We predict that telehealth will become a growingly significant part of gynecological care in the future.

A Prospective Audit Comparing Optos Widefield Imaging to Fundus Examination for Von Hippel-Lindau Retinal Screening.

Background Von Hippel-Lindau (VHL) disease is an autosomal dominant multisystem disorder caused by germline mutations at chromosome 3p25-26 in the VHLtumour suppressor gene. Retinal manifestations include capillary haemangiomas that develop in up to 80% of gene carriers. Lifelong retinal surveillance involves yearly assessment usually by fundoscopy and often as part of a VHL multidisciplinary clinic. Optos ultra-widefield retinal imaging is now becoming more widely used in virtual retinal screening clinics. We aimed to assess discrepancies in the pickup rate of angioma and angiomatous-associated disease between slit-lamp fundoscopy and Optos ultra-widefield imaging. Methodology A total of 49 patients had both Optos ultra-widefield retinal imaging and slit-lamp fundoscopy over 16 months in VHL retinal surveillance clinics at the John Radcliffe Hospital, Oxford, UK. Optos images were analysed for image quality and presence of angioma(s) by a Consultant Ophthalmologist who was masked to the fundoscopy findings. The pickup rate was compared between slit-lamp fundoscopy and Optos imaging. Results In total, data on 94 eyes were collected. Of the total Optos retinal images, 12.8% were positive for angiomas compared to 11.7% from the slit-lamp examination. There was a discrepancy of 1.1% (one value) where the Optos image analysis suggested a possible angioma, which was not identified on slit-lamp examination. Optos imaging identified all angiomas in this cohort. Conclusions Optos imaging was non-inferior to slit-lamp examination in this sample of 94 eyes. In the current COVID-19 climate, reducing clinician-patient interaction is important. This research supports providing retinal imaging as an acceptable alternative to the yearly slit-lamp fundus examination.

Perception of primary caregiver toward virtual pediatric clinics for type 1 diabetes mellitus during COVID-19 pandemic in Jeddah, Saudi Arabia: A cross-sectional study.

Background: Virtual phone clinics were adopted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, as an alternative to in-person routine outpatient visits amid the COVID-19 pandemic. This study aimed to assess primary caregiver perceptions of the virtual phone clinics towards routine care of pediatric patients with type 1 diabetes mellitus (T1DM). Methods: A cross-sectional research design was employed through a web-based research tool where the primary caregivers of pediatric patients with T1DM participated. Data were analyzed descriptively and statistically using independent t-tests and one-way analysis of variance. Results: In total, 214 participants were included in this study. The average primary caregiver perception value towards virtual phone clinics was 66.71 ± 23.1%, which suggested a satisfactory perception of their experience. Statistically significant differences (p > 0.05) were not found between the mean perception values and demographic characteristics. Higher mean primary caregiver perception values were associated with those who: (1) agreed or strongly agreed to be contented with their current state of health, (2) did not ask their physicians to be physically seen during a virtual visit, (3) preferred having four virtual visits or more, and (4) preferred having single to no in-person visits at all. Conclusion: This study revealed a generally acceptable primary caregiver perception regarding virtual clinics. Telemedicine is recommended for routine treatment alongside regular in-clinic appointments to improve the quality of care for pediatric patients with T1DM.

Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis.

BACKGROUND: Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. OBJECTIVE: This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. METHODS: We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features, and specialties/departments were collected, and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. RESULTS: Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician's positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient's age, the physician's age, and the physician's sex were not associated with the utilization of virtual clinics in our study. CONCLUSIONS: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient's sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician's attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.

Virtual arthroplasty clinic: a single centre experience: commentary on progress, cost savings and patient retention.

BACKGROUND: The COVID pandemic highlights utility of remote patient follow-up. We observe a Virtual Clinic (VC) follow-up model for arthroplasty used at a metropolitan hospital. Patients aged <70 that exhibit no issues in face-to-face review (F2F) progress to VC. We aimed to review VC's cost-effectiveness, and identify potential improvements to patient allocation and retention. METHOD: A retrospective database was collated of all hip and knee joint arthroplasties performed at Frankston Hospital over a 12-month period in 2017-2018. Patient encounters were followed from operation to discharge from F2F and, if appropriate, VC (involving imaging and a paper-based qualitative questionnaire). VC attendance was compared to that of the year in which it was introduced (2014). The Clinical Costings Department provided average hospital spending for each of these modes of follow-up. RESULTS: Of 516 joint arthroplasties performed, 500 attended outpatient clinic (OPC). There were 884 F2F appointments (average 1.7 per person, range 0-12). One-hundred-and-fifty-four arthroplasties were correctly assigned to subsequent VC as per protocol (30%). Completed VC responses were received for 86 arthroplasties (56% response rate). In the period studied, VC attendance increased significantly compared to the year following introduction (36-56%, p < 0.05), with the questionnaire revealing a high-level of patient satisfaction for this method of follow-up. Over the period studied, we estimate VC has saved $250 000 and 300 review hours from OPC. CONCLUSION: Implementing VC for follow-up of arthroplasty may demonstrate a method of saving hospital resources. Appropriate early enrolment of patients to reduce F2F burden, and VC retention, should be encouraged.

Assessing the Availability of Teleconsultation and the Extent of Its Use in Malaysian Public Primary Care Clinics: Cross-sectional Study

Background: The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries. Objective: The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics. Methods: A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic. Results: In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states;other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45;telephone consultation, 36/97). Conclusions: Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.

Physician Satisfaction With Virtual Ophthalmology Clinics During the COVID-19 Pandemic: A Tertiary Eye Care Center Experience.

Background In this study, we aimed to assess ophthalmologists' experience with teleophthalmology during the coronavirus disease 2019 (COVID-19) pandemic in the central region of Saudi Arabia. In addition, we evaluated their satisfaction level and explored their satisfaction determinants. Methodology We conducted an online survey for ophthalmologists who participated in the virtual ophthalmology clinic during COVID-19 between November 2020 and September 2021. The survey was used to evaluate ophthalmologists' experience with teleophthalmology during the pandemic. Ophthalmologists were asked to measure their satisfaction with equipment and technical issues, communication, and clinical assessment, and to provide an overall program evaluation. Data were analyzed via frequency measures (e.g., numbers, percentages, mean, and standard deviation). Results Out of the 113 ophthalmologists who were invited to participate in our study, 71 completed the survey. In total, 23 (32.4%) participants were general ophthalmologists, 15 (21.1%) were subspecialists in the cornea, 16 (22.5%) were subspecialists in glaucoma, one (1.4%) was a subspecialist in neuro-ophthalmology, seven (9.9%) were subspecialists in pediatric ophthalmology, eight (11.3%) were subspecialists in the retina, and one (1.4%) participant was a subspecialist in oculoplastic. Overall, 56.3% of the respondents were satisfied with teleophthalmology. Ophthalmologists who subspecialized in the retina demonstrated higher levels of satisfaction than other subspecialties. The most common challenge reported by ophthalmologists in the virtual consultation was the lack of adequate equipment to evaluate the patients (53.5%), followed by technical issues (43.7%) and the patients' lack of experience in using virtual consultation services (38%). Overall satisfaction score was the highest among ophthalmologists who reported providing at least five video consultations before the survey. Conclusions The findings from our study suggest that the subspeciality of ophthalmologists and the number of video consultations conducted by ophthalmologists are important determinants in their level of satisfaction with teleophthalmology. The majority of the respondents were satisfied with the virtual clinic during the COVID-19 pandemic. The current pandemic could pave the way for the future use of telemedicine in ophthalmology if virtual eye examinations become standardized.

Patient and professional experiences with virtual antenatal clinics during the COVID-19 pandemic in a UK tertiary obstetric hospital: Questionnaire study

Background: The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective: We evaluated patients'and professionals' experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods: A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results: We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P = .23), ethnicity (P = .95), number of previous births (P = .65), or pregnancy losses (P = .94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions: Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Virtual Clinic: Best Practices for Patients and Doctors Under CoVid-19 Pandemic

Virtual Clinic is a web based software application, where patients can consult with physicians, psychologists, therapists, and other health professionals. No physical presence of the patient is required in the virtual clinic. It is much better during the examination if the disease does not require it as the obligatory diagnostic prerequisite. The web-based VC has been designed for functional and nonfunctional purposes and specifications. These criteria have been met through interviews that have semi structured and open-ended questions on disease evaluation by medical practitioners. Finished questions concerning the evaluation by the experience of the disease. And if s a very open source application that any user can link a shared issue to a conference. This virtual clinic was used during lockdown due to Covid-19. There have been many lock-downs in countries all over the world. This was the only option during the pandemic. In developing the application, we were particularly concerned about the provision of services and the reliable, secure, and efficient storage of data. Here, the non-functional and functional requirements are proposed along with such clinic's design. Such requirements were collected depending on the input that medical practitioners have specified via interviews that had open ended and semi structured questions related to assessment of disease according to their experience. © 2021, Indian Journal of Forensic Medicine and Pathology. All rights reserved.

Patients' Attendance to The Virtual Compared to The In-person Complimentary Outpatient Clinics at a Tertiary Care Hospital in Western Saudi Arabia: A Comparative Cross-sectional Study

Background: During the COVID-19 pandemic, outpatient clinics in National Guard-Health Affairs Hospitals, Saudi Arabia, have shifted their healthcare services towards virtual clinics to keep up with patient appointments while maintaining infection control precautions. This study aimed to determine if patient attendance compliance has changed by implementing virtual "phone call" appointments compared to the conventional physical appointments in outpatient clinics. Methods: This comparative cross-sectional study was conducted by comparing patients' demographic information, and compliance to virtual calls and physician recommendations during 2020 with the regular physical attendance clinics in 2019. Patient data was collected from the electronic medical records after randomly selecting the sample for each year from 6 main outpatient clinics. Results: During the 4-month period of 2020 (March-June), in which virtual clinics were implemented, there was a significant decrease in the attendance compliance when compared to the same period in 2019 conventional clinics. Data were analyzed for 404 and 407 patients' medical records from each year, respectively. The drop in the clinic attendance compliance was the highest in the pediatric oncology clinic. Moreover, physician orders of investigations and medications were significantly reduced. Conclusion: COVID-19 pandemic had a significant negative impact on patient care. Although that impact was seen greatest among those with chronic conditions and oncology patients, it was an essential step towards infection control during this difficult period. However, the pandemic is an opportunity to establish a comprehensive virtual care system that will ensure easy access and continuity of patient care. [ FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd 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.)

Teleprogramming Service Provides Safe and Remote Stimulation Options for Patients with DRG-S and SCS Implants.

BACKGROUND: Chronic pain patients implanted with a neurostimulation device typically require follow-up and device programming visits to address changes in symptoms or treatment. Follow-up visits require access to specialty care and necessitate patients to take time off work, commute long distances, arrange for travel, and/or work with a caregiver's schedule. Telemedicine was adopted for some patient management as a result of the Sars-Cov-2 pandemic; however, remote optimization for neuromodulation still required an in-person visit to adjust device parameters. An FDA-approved digital platform enables remote programming of an implanted neuromodulation device using a real-time audio-video link from the clinical programmer to the patient controller. The Remote Optimization, Adjustment, and Measurement for Chronic Pain Therapy (ROAM-CPT) is a multi-center, prospective study that is currently underway to access the effectiveness of the teleprogramming system in fulfilling patients' clinical demands. METHODS: This pilot study surveyed 16 patients to determine the ability of the teleprogramming platform to provide a rapid solution safely and effectively for patient's chronic pain. Data were collected using a questionnaire that asked 6 clinician-centric questions and 5 patient-centric questions. RESULTS: 4/4 surveyed physicians were able to address patients' needs. 16/16 surveyed patients reported a quick resolution to pain and 15/16 did not require additional follow-up. Data curated from this pilot study show that the teleprogramming application greatly improves patient care, is preferred by both clinicians and patients with minimal disruptions to patients' everyday lives. CONCLUSION: Teleprogramming provides real-time virtual programming capabilities and optimizes patients' therapy. PERSPECTIVE: This article describes remote device programming and analysis as an alternative to in-person programming/treatment sessions for neuromodulation patients. This remote option gives patients access to timely and clinically appropriate device management when in-person care may not be available.

Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes.

Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics. Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (bleeding and/or bruises). The patients were asked to complete the pharmacist satisfaction survey (PSS) after their consultation to assess patient satisfaction with the new virtual consultation system. Linguistic and cultural validation was conducted for the questionnaire. Results: A total of 270 patients were included in the study. The mean percentage of overall INR values in the range was 59.39% ± 32.84, and the mean time with the overall INR was within the therapeutic range 57.81% ± 32.08. Thirty-one percent of the sample had good anticoagulation control (time in therapeutic range >70%). The median satisfaction score was 32 (IQR 28-36) with a maximum score of 40. Conclusion: This is the first study to assess the tele-pharmacy anticoagulation clinic's efficiency and patient satisfaction in Saudi Arabia during the COVID-19 pandemic. This type of consultation was as effective as face-to-face consultations. The study also highlighted that though the reduction in the cost of care was not substantial, there was a significant increase in resource (clinical pharmacist) utilization as a result of this model. The adoption of tele-pharmacy resulted in time savings for the clinical pharmacists who can be utilized in many other improvement projects in adult ambulatory clinics to ensure the delivery of better quality and safe patient care.

Providing post-lung transplant care during the time of COVID-19.

The COVID-19 pandemic is a public health emergency of international concern. Solid organ transplant recipients have been identified as being at high risk of acquiring the virus SARS-CoV-2 and having a more severe COVID-19 disease. This article describes the experience of the National Lung Transplant Centre in Ireland in changing established care pathways for lung transplant recipients during the pandemic. The innovations which were put in place to protect this clinically vulnerable group are discussed. With the advancement of technology and remote monitoring systems available, patient-focused strategies and community-based interventions were implemented. Additional strategies have been implemented so that the new model of care can be safely maintained.

Virtual clinics in foot and ankle surgery: patient and clinician perceptions.

BACKGROUND: The worldwide COVID-19 pandemic has led to the popularisation of 'virtual' clinics. In orthopaedics, little is known about the use of virtual clinics within foot and ankle surgery, specifically. METHODS: A cross-sectional observation study of patients and clinicians in response to virtual clinics in foot and ankle surgery. Patients seen in a virtual clinic were contacted by telephone from two weeks after their consultation and asked to complete a 12-point questionnaire. Demographic information was also collected. Clinicians in foot and ankle completed a 10-point questionnaire. RESULTS: One hundred patient responses were collected. Patient satisfaction with virtual clinics was positive, with 65% of respondents reporting they were very happy (Likert scale rating 5). More than 90% of patients felt they received enough information, felt involved, felt the virtual clinic was helpful and knew who to contact if there was a problem. However, 79% would still prefer a face-to-face consultation, and 22% would have preferred a video consultation. Clinician responses were more cautious, with 60% stating they were neither happy nor unhappy (Likert scale rating 3). Virtual clinics may be faster for the clinician. CONCLUSIONS: Virtual clinics may be more convenient for patients, with high satisfaction levels reported, but represent significant clinical challenges for foot and ankle surgeons. Elements of virtual clinics may persist post pandemic, particularly in routine follow-up. Virtual clinics are not appropriate for new patient referrals.

Outcomes of a virtual craniofacial clinic for assessing plagiocephaly during the COVID-19 pandemic.

OBJECTIVE: The aim of this study was to carry out a quantitative analysis of a virtual craniofacial clinic during the COVID-19 pandemic. METHODS: The charts of 90 patients from a single institution were reviewed. Of these patients, 45 visited the virtual clinic during the COVID-19 pandemic. The other 45 patients visited the clinic in the 3 months prior to COVID-19. Demographics including the mean age at the visit, chief complaint, visit diagnosis, appointment duration, helmet usage, accuracy of the diagnosis, need for a CT scan, and the need for a follow-up appointment were assessed. Diagnostic accuracy, the frequency of follow-up appointments, and patient satisfaction (via survey), as well as additional associated factors, were analyzed to determine the efficacy and satisfaction associated with the virtual clinic approach. RESULTS: The mean patient age at time of the visit was 5.6 and 7.3 months (p = 0.244), and the mean time from referral to appointment was 19.2 and 19 days (p = 0.934), in the in-person and virtual cohorts, respectively. There was no significant difference in the variety of chief complaints between the in-person and virtual visits, with 97.8% and 93.3% of patients' parents reporting abnormal head shape, respectively, and the remainder reporting more infrequent complaints (p = 0.435). The visit diagnosis was plagiocephaly in 93.3% of the in-person cohort and 80.0% of the virtual cohort (p = 0.118). The final diagnosis exhibited a similar pattern, with 95.6% of the in-person cohort and 88.9% of the virtual cohort observed as positional plagiocephaly; the remaining diagnoses were more infrequent (p = 0.434). The most common alternative diagnosis in the virtual visit cohort was a metopic ridge (8.4%). In the in-person visit cohort, the most common alternative diagnosis was equally a benign enlargement of the subarachnoid space in infancy, scalp mass, and skull lesion (2.2% each). None of the patients in either cohort were diagnosed with synostosis. Eighty percent of the in-person visits were 15 to 30 minutes in duration, with the remaining 20% being 31 minutes or longer; virtual visits were all 30 minutes or less, with 95.6% being 15 to 30 minutes (p = 0.002). Helmets were prescribed for 2 patients in the in-person cohort and no patients in the virtual cohort (p = 0.494). Alterations in diagnosis were made in 2.2% of in-person visits and 6.7% of virtual visits (p = 0.616). Follow-up was required in 15.6% of the in-person visits and 31.1% of the virtual visits (p = 0.134). CT was only utilized twice, once in the in-person visit cohort and once in the virtual visit cohort. CONCLUSIONS: Virtual clinic encounters resulted in comparable diagnostic accuracy. The trend toward frequent follow-up assessments and changes in the final diagnosis in the virtual clinic cohort has indicated a level of diagnostic uncertainty via the virtual interface, which required in-person assessment for confirmation. This finding did not contribute toward diagnostic inaccuracy with respect to missed synostosis. The study results have indicated that telemedicine can be an effective modality in assessing craniofacial pathology.