The potential of computerised analysis of bowel sounds for diagnosis of gastrointestinal conditions: a systematic review.

BACKGROUND: Gastrointestinal (GI) conditions are highly prevalent, and their standard diagnostic tests are costly and carry risks. There is a need for new, cost-effective, non-invasive tests. Our main objective was to assess the potential for use of bowel sounds computerised analysis in the diagnosis of GI conditions. METHODS: The systematic review followed the PRISMA requirements. Searches were made of four databases (PubMed, MEDLINE, Embase, and IEEE Xplore) and the references of included papers. Studies of all types were included. The titles and abstracts were screened by one author. Full articles were reviewed and data collected by two authors independently. A third reviewer decided on inclusion in the event of disagreement. Bias and applicability were assessed via a QUADAS tool adapted to accommodate studies of multiple types. RESULTS: Two thousand eight hundred eighty-four studies were retrieved; however, only 14 studies were included. Most of these simply assessed associations between a bowel sound feature and a condition. Four studies also included assessments of diagnostic accuracy. We found many significant associations between a bowel sound feature and a GI condition. Receiver operating characteristic curve analyses revealed high sensitivity and specificity for an irritable bowel syndrome test, and a high negative predictive value for a test for post-operative ileus. Assessment of methodological quality identified weaknesses in all studies. We particularly noted a high risk of bias in patient selection. Because of the limited number of trials included and the variety in conditions, technology, and statistics, we were unable to conduct pooled analyses. CONCLUSIONS: Due to concerns over quality and small sample sizes, we cannot yet recommend an existing BSCA diagnostic test without additional studies. However, the preliminary results found in the included studies and the technological advances described in excluded studies indicate excellent future potential. Research combining sophistical clinical and engineering skills is likely to be fruitful. SYSTEMATIC REVIEW REGISTRATION: The review protocol (review ID number 42016054028) was developed by three authors (AI, KMW, and JM) and was published in the PROSPERO International prospective register of systematic reviews. It can be accessed from https://www.crd.york.ac.uk/PROSPERO/ .

Real-time teleophthalmology video consultation: an analysis of patient satisfaction in rural Western Australia.

BACKGROUND: Teleophthalmology, particularly real-time video consultation, holds great potential in Australia and similar countries worldwide, where geography, population and medical workforce distribution make it difficult to provide specialist eye services outside of major cities. Assessment and referrals from rural optometrists are vital to the success of teleophthalmology. While there is good evidence for the efficacy of such services, there is limited evidence for patient satisfaction with video consultation. METHODS: To evaluate patient satisfaction with teleophthalmology, the current study recruited patients who underwent a video consultation with Lions Outback Vision, for a follow-up telephone-based questionnaire assessing satisfaction. Regression analysis was performed assessing which demographic features and which features of the video consultation itself were associated with highest overall satisfaction. RESULTS: One hundred and nine of the 137 eligible patients completed the questionnaire (79.6 per cent; 55 per cent male; mean age 64.61 years). The majority of the participants were either 'Very satisfied' (69.1 per cent) or 'Satisfied' (24.5 per cent) with the service. No one reported being either 'Dissatisfied' or 'Very dissatisfied'. Linear regression did not reveal any demographic or follow-up variables as predictive of greater total satisfaction; however, participants who were older, felt they could easily explain their medical problems to the doctor in the video consultation and believed that telemedicine enabled them to save money and time, and were more likely to report higher overall satisfaction. CONCLUSION: Teleophthalmology is a promising new way to overcome barriers to the delivery of eye care services to rural and remote populations. This study demonstrates a high level of overall satisfaction with teleophthalmological video consultation and patients are accepting of this emerging consultation modality, regardless of age.

Identifying and assessing strategies for evaluating the impact of mobile eye health units on health outcomes.

OBJECTIVE: To identify and assess strategies for evaluating the impact of mobile eye health units on health outcomes. DESIGN: Systematic literature review. SETTING: Worldwide. PARTICIPANTS: Peer-reviewed journal articles that included the use of a mobile eye health unit. MAIN OUTCOME MEASURE(S): Journal articles were included if outcome measures reflected an assessment of the impact of a mobile eye health unit on health outcomes. RESULTS: Six studies were identified with mobile services offering diabetic retinopathy screening (three studies), optometric services (two studies) and orthoptic services (one study). CONCLUSION: This review identified and assessed strategies in existing literature used to evaluate the impact of mobile eye health units on health outcomes. Studies included in this review used patient outcomes (i.e. disease detection, vision impairment, treatment compliance) and/or service delivery outcomes (i.e. cost per attendance, hospital transport use, inappropriate referrals, time from diabetic retinopathy photography to treatment) to evaluate the impact of mobile eye health units. Limitations include difficulty proving causation of specific outcome measures and the overall shortage of impact evaluation studies. Variation in geographical location, service population and nature of eye care providers limits broad application.

Understanding Indigenous patient attendance: A qualitative study.

OBJECTIVE: To better understand Indigenous patient non-attendance at medical specialty appointments by learning from the patients attending their scheduled outreach ophthalmology clinic appointment. DESIGN, SETTING AND PARTICIPANTS: A qualitative study using face-to-face, semi-structured interviews with 69 Indigenous Australian ophthalmology patients and 8 clinic workers at one urban and one rural Aboriginal Medical Service (AMS) over the period from April 2015 to November 2015. MAIN OUTCOME MEASURES: Explored motivations and enablers for attending patients to guide best practice for specialist outreach clinics. RESULTS: The main themes emerging from the interviews included: clinic staff are persistent in their efforts to organise outreach ophthalmology clinics; both motivated and reluctant patients attend medical appointments; and reluctant patients are more likely to be unaware of their referral pathway. Health literacy and clinic staff triggered the reluctant patient to attend. CONCLUSION: Indigenous patients attend their outreach ophthalmology appointments based on various motivations. Clinic staff who recognise reluctant patients can communicate through a sensitive, patient-centred approach that helps the patient realise the importance of the appointment thus creating motivation and promoting attendance. The efforts of the clinic staff, through their patient reminding, transport provision and patient-centred communication suggest that they are the enablers of Indigenous patient attendance at AMS outreach ophthalmology clinics.

Real-time teleophthalmology versus face-to-face consultation: A systematic review.

Introduction Advances in imaging capabilities and the evolution of real-time teleophthalmology have the potential to provide increased coverage to areas with limited ophthalmology services. However, there is limited research assessing the diagnostic accuracy of face-to-face teleophthalmology consultation. This systematic review aims to determine if real-time teleophthalmology provides comparable accuracy to face-to-face consultation for the diagnosis of common eye health conditions. Methods A search of PubMed, Embase, Medline and Cochrane databases and manual citation review was conducted on 6 February and 7 April 2016. Included studies involved real-time telemedicine in the field of ophthalmology or optometry, and assessed diagnostic accuracy against gold-standard face-to-face consultation. The revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool assessed risk of bias. Results Twelve studies were included, with participants ranging from four to 89 years old. A broad number of conditions were assessed and include corneal and retinal pathologies, strabismus, oculoplastics and post-operative review. Quality assessment identified a high or unclear risk of bias in patient selection (75%) due to an undisclosed recruitment processes. The index test showed high risk of bias in the included studies, due to the varied interpretation and conduct of real-time teleophthalmology methods. Reference standard risk was overall low (75%), as was the risk due to flow and timing (75%). Conclusion In terms of diagnostic accuracy, real-time teleophthalmology was considered superior to face-to-face consultation in one study and comparable in six studies. Store-and-forward image transmission coupled with real-time videoconferencing is a suitable alternative to overcome poor internet transmission speeds.

Optometric use of a teleophthalmology service in rural Western Australia: comparison of two prospective audits.

BACKGROUND: Lions Outback Vision provides a telehealth service ('the telehealth service') to rural and remote communities in Western Australia aiming to deliver timely ophthalmic care to this underserved population. A number of barriers to its use were identified by an initial prospective audit. A multifaceted intervention was designed to increase the use of the telehealth service by optometrists. METHODS: Optometrists referred patients from rural and remote Western Australia to the telehealth service. Two five-month prospective audits of the telehealth service were compared. The first, in 2012, was prior to the implementation of the intervention. The second, in 2014, was during the period of the intervention, which included logistical support, remuneration to optometrists, a more user-friendly referral pathway and awareness raising. The outcome measures were the number of consultations conducted during the two audit periods and other quantitative changes to the telehealth service. RESULTS: After implementation of the intervention, use of the telehealth service increased 3.5 fold. A greater percentage of referrals were for non-urgent conditions (145 [69 per cent] versus 16 [32 per cent], p < 0.001) and less consultations recommended follow up with an ophthalmologist in clinic (42 [20 per cent] versus 17 [28 per cent], p = 0.04). Imaging studies were frequently used to supplement information provided by the referrer to the specialist during both audit periods. CONCLUSIONS: Optometrists used the telehealth service more frequently after the implementation of an intervention that addressed the barriers to its use. This has a number of potential benefits to rural and remote ocular health service provision in Australia.

Evaluating a health video on diabetic retinopathy.

Issue addressed Indigenous Australians are 14 times more likely than non-Indigenous Australians to develop diabetic retinopathy (DR). Blindness can be prevented in 98% of cases if DR is identified and treated early. While the National Health and Medical Research Council recommend annual screening for Indigenous Australians, screening attendance rates remain low. The objective of this study was to evaluate whether a targeted health promotion intervention improved patient compliance and screening rates. Methods Bad Sugars, Bad Eyes - a culturally appropriate video targeting DR awareness and the importance of screening among Indigenous Australians - was developed at the Lions Eye Institute, Western Australia. The study used a patient questionnaire pre and post viewing of the video, as well as semi-structured interviews with Aboriginal Health Workers, to explore the influence the resource had on patient knowledge and attitudes. Eighty-four participants, currently involved in DR screening programs, were recruited from Aboriginal Medical Services (AMS) and Aboriginal Community Controlled Health Services (ACCHS). Results The video was found to increase patient knowledge about key DR issues as well as alter patient attitudes identified as potential barriers to screening. The areas most affected by the video resource were knowledge of recommended screening intervals, the severity of potential visual complications if DR is left undiagnosed and untreated and that screening is needed even when asymptomatic. Aboriginal Health Workers positively evaluated the video, all rating it as 'very' culturally appropriate, understandable and relatable. Conclusion The findings of this study suggest that Indigenous DR screening attendance rates could be increased through the expanded use of this video. So what? Indigenous DR screening attendance rates remain low, despite annual recommendations by the National Health and Medical Research Council. This gap needs to be addressed.