In-person Physical Examinations Research Articles

Safety and efficacy of a new covered stent in hemodialysis vascular access outflow stenosis: A Brazilian multicenter retrospective study.

Vascular stenosis commonly leads to dysfunction in hemodialysis vascular access. Although percutaneous transluminal angioplasty is an established treatment, stent utilization has increased in the last decade as an alternative solution to extend the access function. This study evaluated the safety and initial results of a new impermeable covered stent for treating vascular access outflow stenosis. Investigators retrospectively analyzed 114 hemodialysis patients treated with polytetrafluorethylene-covered stents from September 2018 to September 2022 across four centers. Lesions treated were de novo or restenotic and located in the venous graft anastomosis, outflow segment, cephalic arch, and basilic swing point. Patients were followed by in-person physical examination at 1, 3, and 6 months, and Duplex ultrasound was performed to evaluate the vascular access circuit and in-stent restenosis. The primary efficacy endpoint was target lesion primary patency at 1, 3, and 6 months. Secondary endpoints included access circuit primary patency and secondary patency at 1, 3, and 6 months. The primary safety endpoint was freedom from local or systemic serious adverse events through 30 days post-procedure. Forty-four patients had thrombosed access at the initial presentation, and 41 patients presented with recurrent stenosis. The target lesion primary patency rates at 1, 3, and 6 months were 100%, 89.4%, and 74%, respectively. The access circuit primary patency rates were 100% at 1 month, 85% at 3 months, and 62.7% at 6 months. The secondary patency rates at 1, 3, and 6 months were 100%, 96.4%, and 94.6%, respectively. In the adjusted multivariate Cox regression analysis, only recurrent lesions and female gender were associated with reduced primary patency rates. No serious adverse event was observed through the first 30 days post-procedure. In this retrospective analysis, a new covered stent was shown to be safe and effective for treating peripheral outflow stenosis in vascular access.

A perspective on the scope of videoconferencing-based telemedicine in respiratory diseases outpatient clinic.

Telemedicine is rapidly expanding across various fields worldwide. While it finds application in respiratory diseases due to the imperative need for protection against the risk of transmission and the close monitoring of patients with chronic diseases, there is a scarcity of publications detailing telemedicine experiences in respiratory diseases. This study aims to retrospectively evaluate the prospective management of patients with respiratory diseases through videoconference-based telemedicine, intending to establish a foundation for its judicious application in pulmonology cases. In this descriptive study, anonymized medical records of all 478 patients assessed via videoconference-based telemedicine over an eight-month period from June 2020 to February 2021 were reviewed. The analysis included demographic characteristics, disease history, attendance methods, the necessity for in-person physical examination after the initial videoconference (VC) session, the inclusion of investigations, pre-diagnosis, diagnosis processes, follow-up period, and outcomes. Follow-up data for all patients included in the study were reviewed at the end of June 2021. Median age of the patients was 55 (44-67), with a male predominance of 55%. Approximately 30% resided in a city other than the one in which the physician offering telemedicine was situated. Seventy-nine (16.7%) individuals received telemedicine via VC sessions without the requirement for any in-person examinations. The most prevalent disease among those who applied for telemedicine was asthma. Median duration of the initial VC session was 13 (8-18) minutes. At least half of the individuals seeking videoconference-based telemedicine for chronic respiratory disorders, such as asthma, COPD, and interstitial lung disease, had previously been followed by either the telemedicine provider or another physician in the same hospital. However, the vast majority of telemedicine applications in disease categories such as COVID, post-COVID, pulmonary nodules, and lung cancer were submitted by first-time applicants. This pioneering study suggests that videoconference-based telemedicine may be an alternative/complementary tool for patients, particularly those with chronic respiratory diseases.

Multidisciplinary prostate cancer consultation at home: Does the virtual visit platform adversely affect care for elderly patients or impact treatment recommendations?

1521 Background: Amidst the COVID-19 pandemic, Hartford Healthcare (HHC) implemented a multidisciplinary virtual visit prostate cancer clinic (MDVV) to allow patients to receive cancer consultations at home. This clinic has shown significant logistical advantages for provision of coordinated cancer care. To evaluate concerns regarding usability of the telehealth platform for elderly patients, and the absence of in person physical exam at initial consult, we evaluated the MDVV in terms of patient satisfaction based on age, as well as for differences in treatment recommendations after patients were seen in-person at a pre-treatment follow up visit. Methods: Patients with newly diagnosed or progressive prostate cancer were offered a MDVV consultation. Those who assented had sequential virtual consultations with a urologic surgeon, a radiation oncologist, and a medical oncologist, followed by a group conference with all 3 specialists, and were guided through the visit by a nurse navigator. Patients then completed a 7 item satisfaction survey using a 5 point Likert scale evaluating their perception of the efficacy, efficiency, coordination, and overall value of the clinic. Responses were stratified by age group and compared. Chart review determined the impact of subsequent in person office visit on treatment recommendations, and the proportion of patients who underwent staging imaging according to NCCN guidelines. This was compared with a cohort of consecutive patients who completed traditional consults with two high volume prostate cancer surgeons immediately before the pandemic. Results: A total of 161 patients with newly diagnosed or progressive prostate cancer received a MDVV consultation from August 2020 – February 2023. Patient age ranged from 47-84 years (9% < 60 yrs, 52% 60-70 yrs, 34% 70-80 yrs, 5% >80 yrs). The median score for patient satisfaction on all 7 domains was 1 (strongly agree), and did not differ between age groups. There were no instances of a change in treatment recommendation after follow up in person office visit. While 100% of the MDVV cohort received multidisciplinary consultation before treatment, only 14/50 traditional cohort patients (28%) ultimately received the same (p<.001). 100% of MDVV patients underwent imaging according to NCCN guidelines, compared with 33/50 (66%) of traditional patients (p<.001). Conclusions: A virtual format for a multidisciplinary prostate cancer clinic is a logistically advantageous, effective means of offering in-home consultation to prostate cancer patients, leading to high patient satisfaction, regardless of age. The absence of in-person physical examination at initial consultation did not ultimately impact treatment recommendations. This format also improved access to multidisciplinary consultation and increased adherence to imaging guidelines.

Evaluation of patients referred to the spine clinic via telemedicine and the impact on diagnosis and surgical decision-making.

Telemedicine encounters are expanding in utility for outpatient care and evaluation, partially as a necessity during the COVID-19 pandemic. It is unclear if telemedicine evaluation is comparable to in-person assessment of patients with spinal pathology undergoing surgical consultation. The objective of this study was to determine if treatment plans change for spine patients evaluated in person following an initial telemedicine consultation. Patients referred to the authors' comprehensive spine center were evaluated first via telemedicine and then in clinic. Telemedicine evaluations were conducted via video evaluation with an attending surgeon. Demographic data including age, gender, and distance traveled from the clinic were retrospectively recorded. A chart review retrieved symptoms, radiographic details, and past medical history. The primary outcome was if the treatment plan changed (plan change [PC]) after seeing the patient in the clinic. Chi-square tests and binary logistical regression produced uni- and multivariate analyses. There were 152 new patients seen via telemedicine and in person. Pathology was present in the cervical (28.3%), thoracic (9.9%), and lumbar (61.8%) spine. The most common symptom was pain (72.4%), followed by radiculopathy (66.4%), weakness (26.3%), myelopathy (15.1%), and claudication (12.5%). There were 37 patients (24.3%) for whom there was a PC after clinic evaluation, and of those, only 5 (3.3%) were due to physical examination (PCPE) findings. On univariate analysis, a longer duration between telemedicine and clinic visit (odds ratio [OR] 1.094 per 7 days, p = 0.003), having pathology in the thoracic spine (OR 3.963, p = 0.018) and lack of sufficient imaging (OR 25.455, p < 0.0001) were predictive of a PC. Having pathology in the cervical spine (OR 9.538, p = 0.047) and adjacent-segment disease (OR 11.471, p = 0.010) were predictive of a PCPE. This study demonstrates that telemedicine may be an effective modality for the initial evaluation of spine surgical patients, without compromising decision-making in the absence of an in-person physical examination.

Assessment of Pediatric Telemedicine Using Remote Physical Examinations With a Mobile Medical Device

The number of innovations in health care based on the use of platforms, digital devices, apps, and artificial intelligence has grown exponentially in recent years. When used correctly, these technologies allow inequities in access to health care to be addressed by optimizing care and reducing social and geographic barriers. However, most of the technological health care solutions proposed have not undergone rigorous clinical studies. To assess the concordance between measurements from a remote physical examination using a mobile medical device and measurements from a conventional in-person physical examination. This nonrandomized controlled trial was conducted from January 1 to December 31, 2020. The clinical parameters compared were heart rate; body temperature; heart, lung, and abdominal auscultation; otoscopy; throat and oral examination; and skin examination. A total of 690 patients with clinical stability and various symptoms who were seen in the emergency department of 2 Brazilian pediatric hospitals were eligible to enter this study. The primary outcome was concordance between measurements from a telemedicine physical examination using a mobile medical device and measurements from a conventional in-person physical examination. The secondary outcome was the specificity and sensitivity of the digital device, considering the conventional in-person consultation as the gold standard. Among 690 patients, the median (IQR) age at study entry was 5 (1-9) years; 348 (50.4%) were female, and 331 (48.0%) presented with a chronic disease. Regarding the primary outcome, the concordance values were 90% or greater for skin examination (94% for rash, 100% for hemorrhagic suffusion, and 95% for signs of secondary infection), characteristics of the mucosa (98% for hydration and 97% for coloring), and heart (95% for murmur, 97% for rhythms, and 98% for sounds), lung (91% for adventitious sounds, 97% for vesicular sounds, and 90% for fever), and abdominal (92% for abdominal sounds) auscultations. Concordance values were lower for otoscopy (72% for the ear canal and 86% for the tympanic membrane), throat and oral examination (72%), and rhinoscopy (79% for mucosa and 81% for secretion). The specificity was greater than 70% (ranging from 74.5% for the ear canal to 99.7% for hemorrhagic suffusion) for all variables. The sensitivity was greater than 52% for skin examination (58.0% for rash and 54.8% for signs of secondary infection), throat and oral examination (52.7%), and otoscopy (66.1% for the ear canal and 64.4% for the tympanic membrane). In this study, measurements from remote physical examination with a mobile medical device had satisfactory concordance with measurements from in-person physical examination for otoscopy, throat and oral examination, skin examination, and heart and lung auscultation, with limitations regarding heart and lung auscultation in infants and abdominal auscultation in children of all ages. Measurements from remote physical examination via a mobile medical device were comparable with those from in-person physical examination in children older than 2 years. These findings suggest that telemedicine may be an alternative to in-person examination in certain contexts and may help to optimize access to health care services and reduce social and geographic barriers. Brazilian Registry of Clinical Trials Identifier: RBR-346ymn.

In Patients Admitted to a Home Rehabilitation Service, Is Remote Completion of the Patient-Generated Subjective Global Assessment Physical Examination Using Still Images Captured by Allied Health Assistants a Valid Alternative to an In-Person Physical Examination?

There is increasing provision of telehealth services, including nutrition services. However, remote nutrition assessments are challenging due to difficulties in conducting physical assessments remotely, a crucial component of assessing nutritional status. The aim of this study was to evaluate whether remote completion of the Patient-Generated Subjective Global Assessment physical examination using still images captured by allied health assistants (AHAs) is a valid alternative to an in-person physical examination in patients admitted to a home rehabilitation service. This study was cross-sectional in design. This study involved 104 adults admitted to the home rehabilitation service at Southern Adelaide Local Health Network, Adelaide, Australia, over 2 sampling periods in 2019 and 2020 who were receiving home visits by an AHA and were engaged in rehabilitation activities. Validity of the still image-based physical assessment was determined using still images collected by an AHA and an in-person physical assessment completed by a dietitian from each participant. A dietitian blinded to the in-person results later assessed the de-identified still images to determine the presence and extent of deficit at each anatomical site and overall physical examination component of the Patient-Generated Subjective Global Assessment. Percentage agreement, weighted κ, sensitivity, and specificity between the still image based and in-person physical examinations were determined to assess agreement between the 2 methods of assessment. The still image based physical examination achieved a percentage agreement of 75% against the in-person examination, with a weighted κ of 0.662 (95% confidence interval 0.516-0.808) and a sensitivity-specificity pair of 76.6% and 89.1%. Physical examination using still images collected by AHAs achieved percentage agreement, κ, and sensitivity and specificity compared with an in-person physical examination that is consistent with or superior to commonly adopted nutrition screening and assessment tools. There is potential for implementation of this method to facilitate remote nutritional assessments by dietitians; however, further work is needed to ensure dietitians are able to assess still images reliably.

Perceptions of telemedicine at a pediatric otolaryngology-head and neck surgery program

ObjectiveWith few studies investigating the effectiveness of telemedicine (TM) in pediatric otolaryngology (ear, nose, and throat; ENT), its role in clinical practice is unclear. The objective of this study was...

Clinician Perspectives on Providing Concussion Assessment and Management via Telehealth: A Mixed-Methods Study.

To examine clinician perspectives regarding the use of telehealth for concussion assessment and management. A Pan-Canadian survey. Twenty-five purposively sampled multidisciplinary clinician-researchers with concussion expertise (female, n = 21; physician, n = 11; and other health professional, n = 14). Sequential mixed-method design: (1) electronic survey and (2) semistructured interviews with focus groups via videoconference. Qualitative descriptive design. Survey : A 59-item questionnaire regarding the suitability of telehealth to perform recommended best practice components of concussion assessment and management. Focus groups : 10 open-ended questions explored survey results in more detail. Clinicians strongly agreed that telehealth could be utilized to obtain a clinical history (96%), assess mental status (88%), and convey a diagnosis (83%) on initial assessment; to take a focused clinical history (80%); to monitor functional status (80%) on follow-up; and to manage symptoms using education on rest (92%), planning and pacing (92%), and sleep recommendations (91%); and to refer to a specialist (80%). Conversely, many clinicians believed telehealth was unsuitable to perform a complete neurologic examination (48%), cervical spine (38%) or vestibular assessment (61%), or to provide vestibular therapy (21%) or vision therapy (13%). Key benefits included convenience, provision of care, and patient-centered approach. General and concussion-specific challenges included technology, quality of care, patient and clinician characteristics, and logistics. Strategies to overcome identified challenges are presented. From the perspective of experienced clinicians, telehealth is suited to manage symptomatic concussion patients presenting without red flags or following an initial in-person assessment, but may have limitations in ruling out serious pathology or providing return-to-sport clearance without an in-person physical examination.

Reliability and accuracy of telemedicine-based shoulder examinations.

Telemedicine has become a critical component in the evaluation and management of patients with shoulder pathology. However, the interobserver reliability of findings on virtual physical examination relative to in-person evaluation is unclear. The purpose of this study was to determine the reliability of prerecorded video telemedicine for the evaluation of shoulder pathology compared with traditional in-person physical examination. New patients with unilateral shoulder pain presenting to a single-surgeon shoulder clinic were recruited between July and November 2020. In 1 visit, patients were evaluated with standardized in-person and video-guided telemedicine physical examinations in randomized order. Patients were evaluated for range of motion (ROM) and symptoms including pain, weakness, and apprehension. The telemedicine examination was recorded and consisted of a video guide displaying self-directed shoulder examination maneuvers that patients performed during remote coaching by an independent non-physician observer. The in-person physical examination was performed by the treating physician. The telemedicine videos were evaluated by two independent observers for interobserver reliability. The treating physician subsequently evaluated the telemedicine videos after a minimum two-month washout period for intraobserver reliability and intra-platform reliability. Interobserver and intraobserver reliability analyses were conducted using Kuder-Richardson formula 20 (KR-20). Specificity and likelihood ratios were calculated with P < .05 representing statistical significance. A total of 32 patients (17 male and 15 female patients; average age, 50.2±16.2 years) were included in the analysis. Overall Kuder-Richardson formula 20 (KR-20) reliability across 40 physical examination maneuvers was 0.391±0.332 (76.4%±15.4% agreement) between the in-person and telemedicine examinations. Telemedicine maneuvers examining ROM limitations had the highest degree of reliability, sensitivity, specificity, and likelihood of also producing a positive finding on the in-person examination (0.700±0.114, 66.5%, 81.0%, and 6.06, respectively). Telemedicine maneuvers identifying apprehension associated with glenohumeral instability were found to have the lowest reliability, sensitivity, and likelihood of producing a positive finding on the in-person examination (0.170±0.440, 23.5%, and 0.518, respectively). All patients were satisfied with their telemedicine experience. The overall reliability of a non-physician-directed video-guided telemedicine examination ranged from unacceptable to good. Shoulder ROM limitations identified during the telemedicine examinations were found to be the most reliable, whereas evaluations of instability were found to be the least reliable. Although initial telemedicine evaluation by a non-physician may be appropriate for ROM evaluation, in-person physician evaluation is recommended to confirm suspected diagnoses, especially if clinical concern for shoulder instability exists. Alternative methods of telemedicine delivery should be explored to improve the reliability of self-directed physical examination maneuvers.

A comparison of virtual and in-person instruction in a physical examination course during the COVID-19 pandemic.

To compare virtual and in-person physical examination (PE) learning among chiropractic students. Preexisting assessment data from 69 students enrolled in a Head and Neck PE course were analyzed for this study. The course comprised three 50-minute labs and one 50-minute lecture each week. Students had the option to attend the lab class in person or online. The virtual classroom was broadcasted simultaneously with the in-person class. Relevant class materials, including slides and videos, were available to all students on the learning management system. Student performance was evaluated through 8 weekly quizzes and 2 objective structured clinical examinations (OSCEs). Data for after-school practice and learning for each topic were also collected. Our results indicated that OSCE and weekly quiz scores were positively correlated with in-person class attendance (p = .000, r = .619 and p = .000, r = .488, respectively). Participants were broken down into 2 groups: (1) higher than 50% attendance rates and (2) 50% or lower attendance rates. The mean OSCE (p = .000) and quiz scores (p = .001) for group 1 (49.41 ± .72 and 22.48 ± 1.06) were significantly higher than those for group 2 (48.13 ± 1.30 and 21.22 ± 1.29). By contrast, the mean number of videos watched was lower for group 1 compared with group 2 (3.23 ± 2.61 vs 5.70 ± 3.35, p = .011). There were no significant differences in the number of practices between the 2 groups (p = .18). Students who participated in in-person PE learning outperformed those in virtual learning in this study.

Do Postoperative Telehealth Visits Require a High Rate of Redundant In-Person Evaluation After Upper Extremity Surgery?

BackgroundTelehealth platforms may save resources for patients and providers, but the precise impact of their incorporation during the postoperative period is not well understood. The goal of this study is to determine whether telehealth incorporation in the postoperative period leads to an overall increase in healthcare utilization after upper extremity surgery.MethodologyPatients seen for a postoperative telehealth visit after upper extremity surgery were randomly selected and retrospectively enrolled. Complications and the total number of postoperative visits before clinical discharge were recorded and compared to controls matched by surgery type and surgeon.ResultsA total of 56 patients were seen for 60 telehealth visits. The most common surgical procedures were distal radius open-reduction internal fixation (n = 8), open carpal tunnel release (n = 8), and endoscopic carpal tunnel release (n = 6). One telehealth visit (1.7%) required conversion to in-person evaluation due to suspected superficial infection necessitating in-person physical examination. The average number of postoperative visits prior to clinical discharge was 2.6 in the telehealth group compared to 2.7 in matched controls (p = 0.886). Complication rates were similar between groups.ConclusionsThe rate of necessary in-person evaluation after postoperative telehealth visits was less than 2%. The incorporation of telehealth visits did not appear to increase healthcare utilization after upper extremity surgery. Accordingly, the postoperative period is likely an ideal application for safe and effective telehealth implementation.

Abstract- Poster

Background –There are no studies conducted till now for assessing reliability of physical examination done virtually in the context of telepsychiatry, with only 2 studies examining the reliability of visual observations in telepsychiatry and showing contrasting results. Hence need to validate physical examination done virtually.Aims -To compare the reliability of tele-psychiatric assessments in picking up and assessing the severity of Extra Pyramidal Side Effects(EPSE) of antipsychotic medications in comparison with that of In-person physical examination (gold standard).Methods -An observational cross-sectional study where a total of 121 patients with primary psychiatric disorders on antipsychotic medications were recruited from clinical services of NIMHANS in a convenient fashion. A sequential procedure was carried out where an in-person physical examination looking for EPSE along with application of relevant scales was done by an independent examiner. This was immediately followed by a Virtual Physical Examination(ViPE) carried out by another blinded researcher using a 17 question scale created specifically for the ViPE. The scales used to assess severity of antipsychotic side effects were Abnormal Involuntary Movements Scale(AIMS) and Barnes Akathisia Rating Scale(BARS).Results –A total of 54 patients were found to have EPSE in in-person physical examination as opposed to 52 patients in VIPE. The measure of agreement in picking up EPSE between in-person physical examination and VipE was statistically significant (kappa coefficient – 0.832,significance<0.001).The agreement in severity of EPSE as compared on the Global outcome of severity AIMS scale 8(kappa coefficient – 0.777,significance<0.001) and Global assessment of severity of akathisia in BARS (kappa coefficient – 0.920,significance<0.001) were also statistically significant.Conclusion –ViPE is a reliable method to pick up and assess the severity of EPSEs.

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Background – There are no studies conducted till now for assessing reliability of physical examination done virtually in the context of telepsychiatry, with only 2 studies examining the reliability of visual observations in telepsychiatry and showing contrasting results. Hence need to validate physical examination done virtually.Aims - To compare the reliability of tele-psychiatric assessments in picking up and assessing the severity of Extra Pyramidal Side Effects(EPSE) of antipsychotic medications in comparison with that of In-person physical examination (gold standard).Methods - An observational cross-sectional study where a total of 121 patients with primary psychiatric disorders on antipsychotic medications were recruited from clinical services of NIMHANS in a convenient fashion. A sequential procedure was carried out where an in-person physical examination looking for EPSE along with application of relevant scales was done by an independent examiner. This was immediately followed by a Virtual Physical Examination(ViPE) carried out by another blinded researcher using a 17 question scale created specifically for the ViPE. The scales used to assess severity of antipsychotic side effects were Abnormal Involuntary Movements Scale(AIMS) and Barnes Akathisia Rating Scale(BARS).Results – A total of 54 patients were found to have EPSE in in-person physical examination as opposed to 52 patients in VIPE. The measure of agreement in picking up EPSE between in-person physical examination and VipE was statistically significant (kappa coefficient – 0.832 ,significance<0.001).The agreement in severity of EPSE as compared on the Global outcome of severity AIMS scale 8(kappa coefficient – 0.777 ,significance<0.001) and Global assessment of severity of akathisia in BARS (kappa coefficient – 0.920 ,significance<0.001) were also statistically significant.Conclusion – ViPE is a reliable method to pick up and assess the severity of EPSEs.

Ovarian cancer recurrence detection may not require in-person physical examination: an MSK team ovary study

ObjectiveGiven the inconvenience and financial burden of frequent ovarian cancer surveillance and the risks of in-person visits due to COVID-19, which have led to the acceleration of telehealth adaptation, we...

Connecting the World of Healthcare Virtually: A Scoping Review on Virtual Care Delivery.

Virtual care extends beyond the walls of healthcare organizations to provide care at a distance. Although virtual care cannot be regarded as a solution for all health-related inquiries, it provides another care delivery channel for specific patient populations with appointments that do not require in-person physical examinations or procedures. A scoping review was conducted to define the meaning of virtual care, understand how virtual care has influenced the healthcare industry and is being expanded to complement the existing healthcare system, and describe the outcomes of using virtual care for patients and providers. Findings from the scoping review suggest that virtual care encompasses the provision of care using advanced video conferencing technology to support remote care that takes place between patients and providers and the use of virtual reality technology to simulate care environments. Some of virtual care’s use in healthcare includes application to pain and anxiety management, virtual consultations and follow-up visits, rehabilitation and therapy services, outpatient clinics, and emergency services. Lastly, from a provider and patient perspective, while both saw benefits of virtual care and scored the service relatively high on satisfaction after using virtual care, the greatest barrier to using virtual care may be technological challenges.

Telemedicine in Orthopedic Oncology During COVID-19: Patient Satisfaction, Reimbursement, and Physical Examination Competency.

The coronavirus disease 2019 (COVID-19) pandemic forced many institutions to implement telemedicine to facilitate continued patient care at a distance. The quality of patient care with telemedicine in orthopedic oncology has not been assessed. Between March and June 2020, a telephone survey of 64 patients was conducted in an academic orthopedic oncology practice. Patient satisfaction was assessed with a Likert scale metric, open-ended feedback, and direct comparisons between telemedicine and in-office visits. Billing and collection financial data of the telemedicine cohort and of a separate cohort of in-office visits during the same time period were compared. The clinical competency of telemedicine visits was measured by delayed or missed diagnoses and surgical site infections that may be attributable to lack of an in-person physical examination. Overall, patients were largely satisfied with their telemedicine experience. More than 90% of patients described telemedicine as equal to or better than in-office visits regarding convenience, time, privacy, and overall quality. Patients reported that better assessment of their physical condition may be indicated, particularly in early postoperative and early sarcoma surveillance visits. Two of 64 patients had adverse events (both local recurrences) potentially attributable to lack of an in-person physical examination. Institutional financial reimbursement of telemedicine visits was comparable to that of in-office visits. These findings have supported continued use of telemedicine in our practice, particularly for patients traveling significant distance and those returning for sarcoma surveillance. However, the limitations of lack of an in-person physical examination should be considered on a case-by-case basis. [Orthopedics. 2021;44(5):274-279.].

Assessing Patient Satisfaction with Live-Interactive Teledermatology Visits During the COVID-19 Pandemic: A Survey Study.

Introduction: Coronavirus disease 2019 (COVID-19) has brought teledermatology to the forefront. Understanding patients' experiences will clarify its benefits and limitations. Materials and Methods: Patients evaluated through live-interactive teledermatology at New York University Langone Health March-June 2020 were surveyed. Patient demographics, satisfaction with, and preferences between teledermatology and in-person visits across four domains (visit preparation, provider communication, physical examination, and treatment plan/follow-up) were collected. Results/Discussion: Of 602 respondents, >70% indicated at least equal satisfaction compared with in-person visits across all domains. More than a quarter of patients were dissatisfied with the virtual examination and more than half preferred in-person examinations. Male gender was associated with treatment plan/follow-up satisfaction (p = 0.03). Patients ≥66 years preferred in-person visit preparation, communication, and treatment plan/follow-up (all p < 0.01). New patients were less satisfied with teledermatology communication (p = 0.02) and treatment plan/follow-up (p < 0.01) but preferred teledermatology visit preparation (p = 0.01). Conclusions: Patients were satisfied with live-interactive teledermatology during the COVID-19 pandemic, although preferred in-person physical examinations. Satisfaction and preferences varied between patient populations.

Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has shifted the dynamics of health care and neurosurgical practice. Elective surgeries were suspended for 8 weeks in Kentucky. Our objective was to determine if telehealth (TH) visits could be sustained as an alternative to in-person visits.MethodsDeidentified data on TH usage, in-person clinic visits, and inpatient and neurosurgical case volumes from March 2, 2020 to June 26, 2020 were obtained for retrospective analysis.ResultsTH use increased soon after the case suspension started and then decreased to little usage. The number of in-person visits were significantly lower during elective case suspension compared with when cases were resumed. Twenty-five percent of all visits during the suspension were conducted using TH. Thirty-nine percent of TH-visit patients were new patients, 11% were preoperative, 10% were postoperative, and 39% were other existing patients. Forty-eight percent of TH visits resulted in a later in-person clinic visit. After the suspension, in-person visits rebounded to 98% of the prepandemic numbers and TH visits were low.ConclusionsTH visits were challenging due to the need for in-person physical examinations in neurosurgery. TH temporarily accommodated patient needs during the pandemic but could not totally replace in-person visits and was not sustained after 3.5 months of use. Video TH visits worked well for nonurgent issues, such as minor visual examinations. Our findings could help guide the implementation of TH should similar circumstances arise again.

Physical Examination of the Spine Using Telemedicine: A Systematic Review.

Study Design:This is a systematic review.Objective:To systematically review (1) the reliability of the physical examination of the spine using telehealth as it pertains to spinal pathology and (2) patient satisfaction with the virtual spine physical examination.Methods:We searched EMBASE, PubMed, Medline Ovid, and SCOPUS databases from inception until April 2020. Eligible studies included those that reported on performing a virtual spine physical examination. Two reviewers independently assessed all potential studies for eligibility and extracted data. The primary outcome of interest was the reliability of the virtual spine physical exam. Secondary outcomes of interest were patient satisfaction with the virtual encounter.Results:A total of 2321 studies were initially screened. After inclusion criteria were applied, 3 studies (88 patients) were included that compared virtual with in-person spine physical examinations. These studies showed acceptable reliability for portions of the low back virtual exam. Patient satisfaction surveys were conducted in 2 of the studies and showed general satisfaction (>80% would recommend).Conclusions:These results suggest that the virtual spine examination may be comparable to the in-person physical examination for low back pain, though there is a significant void in the literature regarding the reliability of the physical examination as it pertains to specific surgical pathology of the spine. Because patients are overall satisfied with virtual spine assessments, validating a virtual physical examination of the spine is an important area that requires further research.

Medical Education and the Momentum for Virtual Care: Integration of Learners Into Telemedicine.

Medical Education and the Momentum for Virtual Care: Integration of Learners Into Telemedicine.