Effectiveness Of Teleconsultation Research Articles

Effect of teleconsultation on the application of thrombolytic therapy in stroke patients in the emergency department.

Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions. This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication. Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement. Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.

Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis

The popularity of teleconsultation during the COVID-19 pandemic enabled increased accessibility for individuals with type 2 diabetes mellitus (T2DM). However, previous studies did not distinguish between synchronous and asynchronous teleconsultation....

Caregiver Satisfaction and Effectiveness of Teleconsultation in Children and Adolescents With Migraine During the Ongoing COVID-19 Pandemic.

The ongoing COVID-19 pandemic and the lockdown measures have forced clinicians across the world to look on telemedicine. Although migraine as such seems an ideal option for telemedicine, a systematic study reviewing feasibility, efficacy, and advantages of current advanced telecommunication technologies in children with migraine is lacking. Clinical details of telephonic consultations performed between March 25 and June 4, 2020, including migraine characteristics, analgesic/prophylactic drug regimens, headache frequency/severity/disability, compliance, drug-related/unrelated adverse effects and unavailability of drugs were recorded. Suitable change in the dose/commercial brand of drug regimen and the addition of new drugs were done as required. Voice call, text messages, picture/video messages, and all other possible measures were used to accumulate maximum clinical information in real time. Unless contacted for trivial reasons, most children were later followed up telephonically to ensure health care concern was resolved and to fill up one 6-item trichotomous quality control questionnaire. A total of 146 telephone consultations were performed in 51 participants. Thirty-six patients were identified to have 42 significant clinical events (worsening clinical status/partial response to medications [18; 44%], drug-related adverse effects [10; 19%], unrelated systemic complaints [7; 13%], and worsening of headache due to stress/triggers [7; 13%]). In the rest of the patients, the query of the caregiver included concern regarding COVID-19-related symptoms. Twenty-nine children required increment in drug dose or addition of new drug or commercial brand. Around 90% of caregivers were satisfied with the quality of teleconsultation. Teleconsultation is a feasible and efficacious option, with excellent caregiver satisfaction for children with migraine.

Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country

IntroductionThe ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects. MethodsClinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time. ResultsA total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice. ConclusionTeleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.

The Effect of Telemedicine Consultation on Outcomes in Patients with Intracerebral Hemorrhage

RELEVANCE. Telemedicine solves the problem of the availability of highly qualified personnel at the decision-making stage in the management of patients with intracerebral hemorrhage. AIM OF STuDY We set out to evaluate the effect of teleconsultation on outcomes in patients with intracerebral hemorrhage 30 days after the event.MATERIAL AND METHODS. A prospective, open, nonrandomized clinical trial in two parallel groups. The first group included adult patients up to 80 years of age with a hemorrhagic stroke from 4 to 36 points according to NIHSS due to unilateral supratentorial intracerebral hematoma of non-aneurysmal genesis, who were examined by a neurosurgeon and resuscitator of the Regional Vascular Center in a ward. The second group included similar patients, but they received telemedicine consultation of the above specialists. The primary endpoint of the study was mortality 30 days after the onset of the stroke. The hypothesis of non-superiority was tested where the 95% confidence interval (CI) for the difference in mortality between the groups should not go over 15 percentage points.RESULTS. A total of 140 patients (70 in each group) with intracerebral hematomas were studied. Mortality in the bedside group was 14.3% (CI 7.1%; 24.7%), and in the remote group it was 25.7% (16.0%; 37.6%), p=0.091. However, there was no evidence of superiority, since the difference between the groups in mortality was 11.4 with CI from –0.07 to 24.5 percentage points, which was beyond the predefined limit.CONCLUSIONS. At the current level of development of medicine and information technology, telemedicine cannot fully replace the traditional (bedside) consultation of an expert level of neurosurgeon and neuroresuscitator in patients with intracerebral hematomas.Authors declare lack of the conflicts of interests.

Need for teleconsultation among the emergency medicine and critical care personnel during pre-hospital transport in a tertiary care unit

Background: Time being the most crucial factors in emergency medicine, teleconsultation enables patient assessment by specialists, immediate reception of appropriate treatment guidelines until the patient's arrival at hospital.Methods: Our study evaluated the need for teleconsultation among the emergency physicians (EP) and emergency technicians (ET) in a tertiary care hospital. Cross-sectional study conducted in Department of Emergency Medicine, a tertiary care setting. Pretested semi-structured questionnaire was given to EP and ET. Various parameters like the need for teleconsultation, the minimum time required for EMS (emergency medical services) to arrive at the scene and to the hospital, effectiveness of teleconsultation in prehospital care were evaluated.Results: SPSS version 18.0 was used. 24 EP and 36 ET participated in the study. The minimum time required for the EMS to arrive at the scene and then to hospital was calculated indirectly to be &gt; 30 min. There was a significant difference among the EP an ET in interpreting common emergency condition p = 0.029 and criticality assessment p=0.035.The training of EMS staffs was adequate. Both EP and ET were able to adhere recent guidelines during prehospital transport. All the study participants (100%) felt the need for teleconsultation which would improve the patient management during the prehospital period.Conclusions: Teleconsultation has the potential to improve patient safety and quality of treatment in a prehospital setting and should be further evaluated.

The Effect of Tele-Consultation Between a Hospital-Based Nurse and a COPD Patient.

Patients admitted with exacerbation COPD (AECOPD) were at hospital discharge randomly assigned (1:1) to either daily teleconsultation for one week between hospital-based telenurses and patients with severe COPD or conventional treatment. Addition of one week of teleconsultations was as safe and effective as conventional treatment, but it did not significantly reduce readmissions or affect mortality.

Fetal telemedicine: six month pilot of real-time ultrasound and video consultation between the Isle of Wight and London.

Prospective audit of first six months. Referral from a district general hospital on the Isle of Wight to a comprehensive tertiary referral service, the Centre for Fetal Care at Queen Charlotte's Hospital 120 km away in London. Women whose pregnancy was suspected, or at risk, of fetal abnormality. Remote consultation by transmitting ultrasound and video in real-time over ISDN 30 telephone lines. Contemporaneous questionnaire to referring practitioner and patient. Frequency, indication, technical success and duration of consultation. Qualitative and semi-quantitative image quality. Effect of teleconsultation on need for physical referral. Twenty-nine women underwent 39 teleconsultations, and image quality was sufficient for diagnosis in all but one. Fetal abnormalities were present in 76%. Referral in person was required for only four women, significantly fewer than the 13 the referring hospital indicated would have been physically referred in the absence of this service (P < 0.001). Most mothers were counselled by the specialist "face-to-face' over the link, and 80% felt teleconsultation reduced their anxiety. A fetal telemedicine service is technically and clinically feasible. This demonstration suggests that such a service reduces the need for physical referral while increasing the rate of consultation, allowing better selection of patients who might benefit from referral. Further evaluation in a variety of clinical settings is now indicated, along with cost-benefit analysis.