Second Opinion Research Articles

A literature review of email-based telemedicine.

A structured analysis of peer-reviewed literature about the delivery of health services by email was undertaken for this review. A total of 185 articles were included in the analysis. These articles were thematically categorised for medical specialty, participants, sub-topic, study design and service-delivery application. It was shown that email-based telemedicine can be practiced in a large number of medical specialties and has application in primary consultation, second opinion consultation, telediagnosis and administrative roles (e.g. e-referral). Email has niche applications in low-bandwidth, image-based specialties (e.g. dermatology, pathology, wound care and ophthalmology) where attached digital camera images were used for telediagnosis. Diagnostic accuracy of these images was the predominant topic of research and results show email as a valid means of delivering these medical services. Email is also often used in general practice as an adjunct for face-to-face consultation. Further, a number of organisations have significantly improved the efficiency of their outpatient services when using email as a triage or e-referral system. Email-based telemedicine provides specialist medical opinion in the majority of reviewed services and is most likely to be instigated by the patient's primary care giver. However, email-consultations between patient and primary care and patient and secondary care are not uncommon. Most email services are implemented using ordinary email. However, a number of organisations have developed purpose-written email applications to support their telemedicine service due to impediments of using ordinary email. These impediments include lack of management tools for: the allocation and auditing of cases for a timely response and the co-ordination of effort in a multi-clinician, multi-disciplinary service. The ability to encrypt ordinary email thereby securing patient confidentiality is also regarded as difficult when using ordinary email. Hence, alternative web-based email applications where the encryption can be implemented using the more user-friendly HTTPS have become popular. Much of the reviewed literature is descriptive or anecdotal and hence, suffers from lack of conclusive results regarding positive patient outcomes. This may account for email-based telemedicine generally being regarded as underutilised. However, the potential is well recognised.

Second Opinion: Getting Through the Shift

Second Opinion: Getting Through the Shift

Commission accused of appointing too few second-opinion doctors

Commission accused of appointing too few second-opinion doctors

Second Opinion: Family: The Anti-ED

Second Opinion: Family: The Anti-ED

Patient satisfaction in neurological second opinions and tertiary referrals

Although the number of neurological second opinions (SOs) and tertiary referrals (TRs) is increasing, only little is known about expectations and patient satisfaction in this group of patients. Therefore, the purpose of this study was to explore expectations of patients who get a neurological SO or TR and to assess patient satisfaction in these groups of patients. All new patients attending an academic neurological day-care clinic in a 6-month period were investigated. Demographic characteristics, duration of symptoms, expectations and motivation, new diagnoses and treatment consequences were studied, and patient satisfaction with the previous physician and the day-care clinic physician was assessed. Three hundred consecutive patients (183 SOs and 117 TRs) were evaluated. SO patients were younger (47 years vs. 51 years), and their duration of symptoms was longer (24 vs. 13 months) than TR patients. Most patients expected a new diagnosis or treatment (60%). SO patients were equally as satisfied with the day-care clinic consultation as TR patients (overall satisfaction using a VAS-score ranging 0–10: 7.4 vs. 7.5; p = 0.81), and significantly less satisfied with the referring physician (overall satisfaction: 5.6 vs. 7.0; p < 0.001). SO patients, in particular, were more satisfied with the degree of information and emotional support provided by the consulting neurologist as compared to the referring physician. Receiving a new diagnosis and/or treatment advice did not influence satisfaction. A day-care admission for neurological SO and TR leads to an increase of patient satisfaction, irrespective of making a new diagnosis or initiation of a new treatment.

Second Opinion: Why You Should Keep Going Back to the ED, Despite the Uncertainty

Second Opinion: Why You Should Keep Going Back to the ED, Despite the Uncertainty

412 THE VALUE OF MANDATORY SECOND OPINION PATHOLOGY REVIEW IN THE INTERPRETATION OF PROSTATE NEEDLE BIOPSIES PRIOR TO RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010412 THE VALUE OF MANDATORY SECOND OPINION PATHOLOGY REVIEW IN THE INTERPRETATION OF PROSTATE NEEDLE BIOPSIES PRIOR TO RADICAL PROSTATECTOMY Fadi Brimo, Luciana Schultz, and Jonathan Epstein Fadi BrimoFadi Brimo More articles by this author , Luciana SchultzLuciana Schultz More articles by this author , and Jonathan EpsteinJonathan Epstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.481AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We determined the value of mandatory second opinion pathology review in the interpretation of prostate needle biopsies prior to radical prostatectomy (RP). METHODS The original and reviewed needle biopsy pathology reports for all cases referred to our institution for RP over a 1 year period were compared. A major discrepancy in GS was defined as a change that places the patient in a different risk stratification category (GS of 6, 7, and 8-10). A significant difference in the reporting of the highest percentage of cancer in a single core was defined as a difference >30% between the two reports. RESULTS 855 cases were included. All had an original diagnosis of prostatic adenocarcinoma (PCa). Of these, 844/855 (98.8%) were diagnosed as carcinoma upon review. Nine (1%) cases were diagnosed as atypical and 2 (0.2%) as benign upon review. A major discrepancy in GS between the original and the reviewed reports was present in 124 (14.7%) of cases; of those the majority 67 (54%) were downgraded upon review. 80 cases (64.5%) of the disagreements were between GS 6 and 7. Of the 777 cases in which the number of positive cores was reported in both reports, 71 (9.1%) had discrepancies upon review; the difference was one core in 53/71 cases (75%). The number of positive cores was reported to be higher in 45/71 (63.4%) after review. A significant difference in the highest percentage of cancer in a single core was present in 76/844 (9%) evaluable cases; in all of these cases, the extent of cancer was underestimated in the original report. In 60/76 (78.9%) cases, cancer was reported to involve the core discontinuously on review. Perineural invasion was reported to be present in 138/844 (16.3%) cases after revision, from which this information was lacking in 37 of the original reports. Finally, in 4 cases, presence of extra-prostatic extension was noted on the needle biopsy only upon review. CONCLUSIONS Compared to a smaller study done over 10 years ago at our institution, the percent of cancers that could not be confirmed was identical at 1.2%. Also, a non-significant proportion of cases had a significant change in Gleason grade. This study is the first to analyze concordance upon review for number of positive cores and maximum percent positive in a core with a 9% discrepancy in both. Mandatory second opinion on prostate needle biopsies can, in a minority of cases, result in significantly different reports that may affect therapy. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e163 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fadi Brimo More articles by this author Luciana Schultz More articles by this author Jonathan Epstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Second Opinion: Capable — and Proud of It — in a World of Voluntary Incapacity

Second Opinion: Capable — and Proud of It — in a World of Voluntary Incapacity

1024 IMPACT OF SECOND OPINION PATHOLOGY REVIEW IN THE MANAGEMENT OF PATIENTS WITH BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 20101024 IMPACT OF SECOND OPINION PATHOLOGY REVIEW IN THE MANAGEMENT OF PATIENTS WITH BLADDER CANCER Tudor Borza, Ashleigh Eberly, and David Wood Tudor BorzaTudor Borza More articles by this author , Ashleigh EberlyAshleigh Eberly More articles by this author , and David WoodDavid Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2059AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have shown significant changes in management when transurethral bladder resections (TURBT) are re-reviewed at the treating institution. With recent emphasis on proper pathologic analysis of TURBT specimens we determined the impact on the management of patients diagnosed with bladder cancer by re-reviewing the TURBT specimen from an outside institution. METHODS We conducted a retrospective review of all patients who underwent cystectomy at our institution between January 2005 and January 2008. 142 of the 211 patients identified had a re-review of an outside TURBT at our institution. In these cases, the agreement between the grade and stage from the outside institution pathology report and our second opinion report was calculated, as was the agreement of the individual pathology reports to the gross surgical specimen. An in depth chart review was performed in cases where disagreement occurred between the outside report and our pathology report to determine whether this affected treatment. RESULTS Agreement between the outside and in house grade occurred in 98% of patients. Low grade tumors comprised 4% of total cases and downgrading accounted for all discrepancies. Agreement between the outside biopsy and cystectomy grade and the in house and cystectomy grade occurred in 78% and 80% of cases, respectively. Downgrading accounted for 17% of the discrepancies in the outside biopsy comparison and 18% in the in house comparison. The majority of discrepancies were cases where there was no remaining tumor at the time of cystectomy. Exact agreement in stage was noted in 95% of cases when comparing outside to in house biopsy reports. Understaging accounted for 2% of the discrepancies. Comparison of outside report to cystectomy and in house report to cystectomy revealed agreement in 21% and 20%, respectively. None of the discrepancies between the outside pathology and our in house report changed management. CONCLUSIONS Agreement in grade and stage between outside pathology reports and in house pathology review occurred in the vast majority of cases. There was poor correlation between both the outside or in house pathology review and the final pathologic stage at the time of cystectomy. Management is not impacted by re-review of outside TURBT specimens. Ann Arbor, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e398 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tudor Borza More articles by this author Ashleigh Eberly More articles by this author David Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Second Opinion

Second Opinion

Second Opinions in Pathology

Second Opinions in Pathology

Mandatory Second Opinion in Cytopathology

Mandatory Second Opinion in Cytopathology

9. A Second Opinion and Surroundings.

9. A Second Opinion and Surroundings.

Second Opinions

Second Opinions

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion

Second Opinion