Virtual Consultations Research Articles

P002 Implementation of a new digital exercise tool in axial spondyloarthritis and a musculoskeletal therapy outpatient department: a service evaluation

Abstract Background/Aims National and international recommendations for the management of axial spondyloarthritis state the importance of providing exercise advice. Furthermore, the NHS digital plan highlights the need for virtual consultations, which was supported by patients’ preferences in our Trust. With a focus on supported self-management and in conjunction with the ‘Aspiring to Excellence' programme, we explored the optimal way of digitally communicating exercises with our patients. Methods In July 2020, partly in response to a reduction in face-to-face appointments due to infection risk, Physiotec (an online digital platform which allows the creation of personalised web-based exercise programmes) was introduced into the rheumatology and therapy outpatient departments. Between July and September 2021, paper and online surveys were sent to patients and online surveys sent to staff, to discover the views of patient and staff users of this programme. Results Data were analysed between July 2020 and July 2021. 41 therapists had used Physiotec, a maximum of 28 staff users at any one time. 21/28 therapists had logged on in the previous 30 days. 3245 exercise programmes had been created in total for 2553 patients. Ratio of patient: therapist ranged from 0 to 217; mean 58; median 40. Patient comments about Physiotec included: “absolutely first class”; “easy to understand”; “tailored to individual needs”; “easy to access”; “environmentally friendly” and “a great prompt”. They liked being able to see their exercises in action through the videos. Patient surveys (n = 68) revealed that Physiotec was used equally across all mediums of therapy consultation: face-to-face, video and telephone. Furthermore, 53% of patients had been given information in a digital format, compared to 1% in 2019. 65% of patients requested that they would like information to be provided in a digital format, compared to 36% in 2019, with 32% specifically requesting an app such as Physiotec. All therapists (n = 24) agreed or strongly agreed that Physiotec should continue and gave it a mean 4.5/5 star rating. Remarks included: “quick and easy to use”; “good variety of exercises”; “helpful for new therapists in devising treatment plans”. They found it to have superior features to previously used digital exercise tools and that, helpfully, paper copies could be printed. Negative comments included that certain exercises were not listed and “technology issues”. Conclusion Physiotec is a highly valued digital exercise tool amongst patients and therapists, supporting self-management. Some patients still prefer paper handouts, which is possible from this digital tool and patient choice remains at the heart of how we deliver our services. As digital technology is a fast-developing area, Physiotec will be re-evaluated in 2 years’ time to decide if it still meets the needs of our patients. Disclosure J. Tomkins: Grants/research support; Physiotec was funded by Novartis and UCB, this work was supported by the ‘Aspiring to Excellence' programme. D. Wallis: Grants/research support; Physiotec was funded by Novartis and UCB, this work was supported by the ‘Aspiring to Excellence' programme.

Realidad aumentada en cirugía hepato-bilio-pancreática. Una tecnología al alcance de la mano

Augmented reality is a technology that opens new possibilities in surgery. Its implementation in a hepatobiliary-pancreatic surgery unit is presented in relation to preoperative planning, intraoperative support and teaching.For surgical planning, 3D CT and MRI reconstructions have been used to evaluate complex cases, making the interpretation of the anatomy more precise and the planning of the technique simpler.At an intraoperative level, it has allowed remote holographic connection between specialists, the substitution of physical elements for virtual elements, and the use of virtual consultation models and surgical guides.In teaching, new lessons include the retransmission of a surgery with the support of virtual elements for a better understanding by the students.Being the experience satisfactory, augmented reality could be applied in the future of hepatobiliary-pancreatic surgery to improve its results.

D2DLive: Iterative live video streaming algorithm for D2D networks

Smart healthcare system incorporates new technologies making healthcare more efficient and more convenient. Virtual consultations provide interactions with healthcare professionals via video technology, which lessens the number of patients visiting health facilities and consequently reduces the risk of infections. Recently, device to device (D2D) communication showed extraordinary abilities to save the available resources and improve the network quality of service (QoS). Some of the existing algorithms for multimedia services over D2D networks consider only the signal to noise ratio (SNR) and ignore temporal requirements, which do not provide optimum performances. So, more efficient transmission mechanisms that improve the users’ QoS are needed to respond quickly to the ever-changing application demands. In response to these challenges, the research community began exploring novel solutions for video streaming, namely: Quantile-based Carrier-sense multiple access (CSMA), Flexible video transmission (Flexi) and Distributed Random approach (DR). However, these solutions introduce higher throughput, and jitter, especially in the case of live streaming. Other solutions are also available in the literature, but most of them cannot efficiently scale to large multi videos, multi-hops multi-user live video streaming. In particular, in most of these techniques, the chunk number, node transmission capacity or specific video delay, and time requirements are not taken into consideration in the path optimization.To overcome these shortcomings, we propose a novel D2DLive video streaming algorithm as a new solution for a higher QoS to improve medical data delivery. For each requested video, the proposed algorithm divides its content into small playable units called chunks that are transmitted using a new network selection algorithm. The proposed algorithm computes iteratively a suboptimal set of paths to be used to forward all the video chunks cooperatively to their destinations. Furthermore, we develop a new weight algorithm to evaluate the performance of the proposed algorithm in adhering to the upload and download capacities for each device while minimizing the transmission delay. Simulation results show that the proposed algorithm outperforms other established methods in terms of full delay, average upload, and download capacities.

MP19-13 NO DETECTABLE ASSOCIATION BETWEEN VIRTUAL SETTING FOR VASECTOMY CONSULTATION AND VASECTOMY COMPLETION RATE

You have accessJournal of UrologyCME1 Apr 2023MP19-13 NO DETECTABLE ASSOCIATION BETWEEN VIRTUAL SETTING FOR VASECTOMY CONSULTATION AND VASECTOMY COMPLETION RATE Ari Bernstein, Hunter Hernandez, Ethan Zhu, Bryce Saba, Eli Rapoport, and Bobby Najari Ari BernsteinAri Bernstein More articles by this author , Hunter HernandezHunter Hernandez More articles by this author , Ethan ZhuEthan Zhu More articles by this author , Bryce SabaBryce Saba More articles by this author , Eli RapoportEli Rapoport More articles by this author , and Bobby NajariBobby Najari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has fueled widespread incorporation of telehealth into Urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual versus in-person consultation. METHODS: All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-squared test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5. RESULTS: 491 patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. 197 (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in-person. 370 (75.4%) of all patients seen for consultation (both virtual and in-person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (p=.91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their pre-operative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present. CONCLUSIONS: Despite the lack of physical examination, virtual vasectomy consultation is both feasible and effective, with rates of vasectomy completion comparable to traditional in-person consultation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e270 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ari Bernstein More articles by this author Hunter Hernandez More articles by this author Ethan Zhu More articles by this author Bryce Saba More articles by this author Eli Rapoport More articles by this author Bobby Najari More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-12 THE TELEMED VASECTOMY CONSULT IS A SAFE ALTERNATIVE TO IN PERSON CONSULTS: A RETROSPECTIVE STUDY IN A HIGH VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP19-12 THE TELEMED VASECTOMY CONSULT IS A SAFE ALTERNATIVE TO IN PERSON CONSULTS: A RETROSPECTIVE STUDY IN A HIGH VOLUME CENTER Phillip Westbrook and Richard Schoor Phillip WestbrookPhillip Westbrook More articles by this author and Richard SchoorRichard Schoor More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In March of 2020, telemedicine health care delivery catapulted from rare to ubiquitous in utilization and since then has been shown to be a safe method of health care delivery for a variety of illnesses. Some debate remains as to whether or not virtual consults can safely be done for pre-operative patients. In January 2021, our office, for reasons of scheduling efficiency, decided to offer men the option of scheduling elective sterilization consults as a telemedicine/virtual-visit, at the men’s own discretion. The present study investigated whether outcomes for elective sterilization were the same or different in men that chose telemedicine consults versus the more traditional in-person consult option. METHODS: Using a CPT code search feature on our electronic health record, completed vasectomy procedures between 12/1/2021 and 8/30/2022 were identified and flagged for chart review. Manual chart review was then undertaken to see if the consult was done in-person (IP) or as a telemedicine (TM) only consult. We then ascertained if the procedure was not attempted (NA), attempted and aborted (AA), or completed (C), and whether or not there were adverse events (AE) following the vasectomies, as defined using the Clavien-Dindo classification system. RESULTS: A total of 253 vasectomy procedures were done by one surgeon during the study period. 113 (45%) had IP consults prior to the vasectomy and 140 (55%) had TM consults prior to the vasectomy. All 253 were completed and none were either NA or AA from either the IP or TM groups. All 253 procedures were done under local anesthetic only. There were no adverse events that reached even a class 1 on the Clavien-Dindo scale from either group. A deeper dive into the data revealed that all vasectomies performed in December 2021 were IP and 15 of the vasectomies done in January were scheduled prior to the policy change. As such, after the policy change was fully implemented, men were ∼2.5 times more likely to opt for TM consults over IP ones (140 TM vs 56 IP). On a side note, 7% of men in the TM group called the office in the immediate post-op period to report a concern, compared to 16% in the IP consult group. One can only speculate on the reasons for this discrepancy. CONCLUSIONS: Telemedicine consults are a safe alternative to in-person consults for men who desire elective sterilization. In the hands of a skilled vasectomist, an IP consult can safely be bypassed. Men that elect to choose the TM consult can expect that they will be able to have their vasectomies completed on the day of the scheduled procedure and will have the same outcomes as men that elect to have in-person consults. The data suggest that Long Island men overwhelmingly prefer TM consults. Offices that are contemplating adopting a TM vasectomy consult policy can do so with confidence. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e270 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Westbrook More articles by this author Richard Schoor More articles by this author Expand All Advertisement PDF downloadLoading ...

The new routine in orthodontic practice post-COVID-19 pandemic: A questionnaire study

Abstract Introduction: The existing screening process of patients and sterilization protocols followed in routine Orthodontic practice have proven to be incapable of limiting the exposure to the COVID-19 virus. Newer and more sophisticated protocols are established and being followed to provide maximum safety to everyone involved in orthodontic procedure. This survey was done to assess knowledge and overall preparedness of orthodontists towards the changes made in the daily Orthodontic practice due to COVID-19 pandemic. Method: An online questionnaire in English language consisting of 17 close ended questions was circulated amongst the Orthodontists across different regions of India. It contained questions regarding various aspects such as personal safety, psychological and financial burden, and patients’ responses to delay in treatment. Out of 90 questionnaires that were circulated, 70 responses were received that matched the inclusion criteria. Forms were filled directly onto the Google-form platform online. Results: Number and percentage were used to compute results on categorical measurements. SPSS (Statistical Package for Social Sciences) (Version 22.0) software was then used to perform statistical analyses. Chi-square test was used to compare the difference in the distribution of responses for the questionnaire. The level of significance (p-value) was set at p < 0.0001. Conclusion: All the respondents emphasized the need for diligent sterilization protocols; spirit, natural ventilation, gloves, mask and face shield along with patient screening was given utmost importance. Orthodontic emergencies were present and virtual orthodontic consultation emerged as a useful tool. Patients’ response to impact of lockdown in on-going treatment was largely negative to neutral. All the responses were statistically significant except personal hygiene and disinfection protocols.

Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics

BackgroundCOVID-19 has caused significant public health problems globally, with catastrophic impacts on health systems. This study explored the adaptations to health services in Liberia and Merseyside UK at the beginning of the COVID-19 pandemic (January–May 2020) and their perceived impact on routine service delivery. During this period, transmission routes and treatment pathways were as yet unknown, public fear and health care worker fear was high and death rates among vulnerable hospitalised patients were high. We aimed to identify cross-context lessons for building more resilient health systems during a pandemic response.MethodsThe study employed a cross-sectional qualitative design with a collective case study approach involving simultaneous comparison of COVID-19 response experiences in Liberia and Merseyside. Between June and September 2020, we conducted semi-structured interviews with 66 health system actors purposively selected across different levels of the health system. Participants included national and county decision-makers in Liberia, frontline health workers and regional and hospital decision-makers in Merseyside UK. Data were analysed thematically in NVivo 12 software.ResultsThere were mixed impacts on routine services in both settings. Major adverse impacts included diminished availability and utilisation of critical health services for socially vulnerable populations, linked with reallocation of health service resources for COVID-19 care, and use of virtual medical consultation in Merseyside. Routine service delivery during the pandemic was hampered by a lack of clear communication, centralised planning, and limited local autonomy. Across both settings, cross-sectoral collaboration, community-based service delivery, virtual consultations, community engagement, culturally sensitive messaging, and local autonomy in response planning facilitated delivery of essential services.ConclusionOur findings can inform response planning to assure optimal delivery of essential routine health services during the early phases of public health emergencies. Pandemic responses should prioritise early preparedness, with investment in the health systems building blocks including staff training and PPE stocks, address both pre-existing and pandemic-related structural barriers to care, inclusive and participatory decision-making, strong community engagement, and effective and sensitive communication. Multisectoral collaboration and inclusive leadership are essential.

Diagnosis, knowledge, perception, and productivity impact of headache education and clinical evaluation program in the workplace at an information technology company of more than 70,000 employees.

Migraine is a highly prevalent, disabling, misunderstood, underdiagnosed, and undertreated neurological disease. It is a leading cause of productivity loss in the workplace. This is the first large-scale company-wide headache education and evaluation program in the workplace. 73,432 (90.5%) Fujitsu employees participated. The prevalence of migraine was 16.7%, tension-type headache 40.7%, and cluster headache 0.5%. After completing the training, 82.9% of participants without headache said they would change their attitude towards colleagues with headache disorders and 72.5% of total participants said their understanding of headache changed. The proportion of employees who thought that headache had a significant impact on people's lives increased from 46.8% to 70.6%; 2971 (4.1%) of all participants were interested in a virtual consultation with a headache specialist as part of the program, more than half of whom had not previously consulted for headache. Approximately 14.7 days per year of full productivity per employee with headache were gained resulting in an annual productivity saving per employee of US$4531. This unique headache workplace program was associated with a high level of participation, an improvement in the understanding of migraine and attitude towards colleagues with migraine, reduction in disability and increased employee productivity, and decreased costs of lost productivity due to migraine. Workplace programs for migraine should be considered for all industry sectors.

IoT-based disease prediction using machine learning

COVID-19 disrupted lives and livelihoods and affected various sectors of the economy. One such domain was the already overburdened healthcare sector, which faced fresh challenges as the number of patients rose exponentially and became difficult to deal with. In such a scenario, telemedicine, teleconsultation, and virtual consultation became increasingly common to comply with social distancing norms. To overcome this pressing need of increasing ‘remote’ consultations in the ‘post-COVID’ era, the Internet of Things (IoT) has the potential to play a pivotal role, and this present paper attempts to develop a novel system that implements the most efficient machine learning (ML) algorithm and takes input from the patients such as symptoms, audio recordings, available medical reports, and other histories of illnesses to accurately and holistically predict the disease that the patients are suffering from. A few of the symptoms, such as fever and low blood oxygen, can also be measured via sensors using Arduino and ESP8266. It then provides for the appropriate diagnosis and treatment of the disease based on its constantly updated database, which can be developed as an application-based or website-based platform.

Utilization of ChatGPT for Plastic Surgery Research: Friend or Foe?

On November 20, 2022, ChatGPT was made available to the general public free of charge. As a large language model (LLM), the software was able to process inquiries by users and generate text based on compiled datasets in a humanist manner. Due to the importance of research in the Plastic Surgery community, we set out to determine if ChatGPT could be utilized to produce novel systematic review ideas relevant to Plastic Surgery. Out of 80 systematic review ideas generated by ChatGPT, we found that the software was highly accurate in creating novel systematic review ideas. Beyond aiding in Plastic Surgery research, ChatGPT has the potential to be used for virtual consultations, pre-operative planning, patient education, and post-operative care for patients. ChatGPT may be a simple solution for the complex problems encountered in Plastic Surgery.

Patient Perspectives on a Pilot Virtual Follow-up Program After Hypertensive Disorders of Pregnancy: A Qualitative Study

BackgroundHypertensive disorders of pregnancy (HDPs) are a risk factor for future cardiovascular disease; therefore, follow-up and implementation of early interventions is recommended. We performed a qualitative study to assess the feasibility and user response to a mobile-health tool and virtual consultation aimed at educating people with an HDP on future cardiovascular risk, and at better understanding patients’ priorities for postpartum care. MethodsParticipants with a history of an HDP in the past 5 years had access to an online educational tool and participated in a virtual consultation to discuss their cardiovascular risks after experiencing an HDP. Participants were invited to a focus group to obtain feedback on their postpartum experience and the Her-HEART program. ResultsA total of 20 female participants were enrolled in the study between January 2020 and February 2021. Of these, 16 participants took part in 1 of 5 focus groups. Participants reported a lack of awareness of future cardiovascular disease risks prior to participating in the program, and identified barriers to counselling, including traumatic birth experiences, inappropriate timing, and competing priorities. Participants reported that the virtual Her-HEART program was an effective avenue to provide counselling on long-term cardiovascular risks. They highlighted the importance of coordinated care pathways and mental health support in postpartum follow-up programs. ConclusionWe have shown the feasibility of providing an educational website and virtual consultation to facilitate counselling in people affected by HDPs. Our results shed light on patient-reported priorities related to the content and delivery of postpartum counselling after an HDP.

Chinese Patients' Virtual Consultation Use of Different Sponsorship Types of Telemedicine Platforms: A Cross-Sectional Study in Zhejiang Province, China.

Background: Virtual consultation has been one of the most prevalent direct-to-consumer telemedicine services in China. However, little is known about patients' virtual consultation use of different sponsorship types of telemedicine platforms. This study aimed to examine Chinese patients' virtual consultation use and identify the factors that affect consultation use of different sponsorship types of platforms. Methods: We conducted a cross-sectional survey on 1,653 participants in tier 1, tier 2, and tier 3 hospitals in 3 cities with different income levels, in Zhejiang Province, in May and June 2019. Multinomial logistic regression analysis was used to identify the factors that affect patients' virtual consultation use of different sponsorship types of platforms. Results: The most frequently used consultation platform was digital health company-sponsored platforms (36.60%), hospital-sponsored platforms (34.57%), doctors' personal social media (11.09%), other company-sponsored platforms (9.24%), and medical e-commerce company-sponsored platforms (8.50%). The patients' virtual consultation use of different sponsorship types of platforms was determined by education levels, monthly income levels, perceived health status, internet use, and city income levels. Conclusions: Chinese patients' virtual consultation service use varied by platform sponsorship type. Digital health company-sponsored platforms owned advantages over other platform types in high-end consumers with higher education levels, higher income levels, living in high-income cities, and active in internet use. This study implied that different sponsorship types of direct-to-consumer telemedicine platforms in China differ from each other in online health care resource allocation, business model, and competitive advantage.

Recommendations to Improve the Nature and Extent of Relationships Among Organizations Within a Network to Enhance Supports for Transgender Survivors of Sexual Assault.

To enhance the provision of comprehensive supports to transgender (trans) survivors of sexual assault, a structurally marginalized group with complex care needs, we developed an intersectoral network of trans-positive health care and community organizations in Ontario, Canada. As a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration, communication, and connection among members. Relational data (eg, activities of collaboration) were collected from June to July 2021, and analyzed using a validated survey tool, Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER). We shared findings in a virtual consultation session with key stakeholders and facilitated discussion to generate action items. Consultation data were synthesized into 12 themes through conventional content analysis. An intersectoral network in Ontario, Canada. Of the 119 representatives of trans-positive health care and community organizations invited to participate in this study, 78 (65.5%) completed the survey. Proportion/count of organizations collaborating with other organizations. Network scores for value and trust. Almost all (97.5%) invited organizations were listed as collaborators, representing 378 unique relationships. The network achieved a value score of 70.4% and trust score of 83.4%. The most prominent themes were "Communication and knowledge exchange channels," "Clearer roles and contributions," "Indicators of success," and "Client voices at the centre." As key antecedents of network success, high value and trust indicate that network member organizations are well positioned to further foster knowledge sharing, define their roles and contributions, prioritize the integration of trans voices in all activities, and, ultimately, achieve common goals with clearly defined outcomes. There is great potential to optimize network functioning and advance the network's mission to improve services for trans survivors by mobilizing these findings into recommendations.

TELEMEDICINE IN ORTHOPAEDIC SURGERY: A SYSTEMATIC REVIEW OF CURRENT EVIDENCE

AimsThe COVID-19 pandemic has triggered transformative change in how clinicians interact with their patients. There has been a shift away from face-to-face toward virtual consultations. However, the evidence to support this change in practice is unclear. The aim of this study was to systematically review the evidence base for virtual consultations for orthopaedics.Materials and MethodsTwo independent reviewers performed a literature search based on PRISMA guidelines, utilizing the MEDLINE, EMBASE and Scopus databases. Only studies reporting outcomes following the use of telemedicine for diagnosis, consultation, rehabilitation, and follow-up were included. Outcomes analyzed were: 1) Patient and clinician satisfaction, 2) Clinical outcome measures, and 3) Cost analysis of traditional vs teleconsultation.ResultsA total of 41 studies were included. Fifteen studies compared clinical outcomes of telemedicine against a matched traditional cohort. Of these 15 studies, two demonstrated non-inferiority, nine showed no statistically significant difference and four found telemedicine to be superior. Eleven studies recorded patient reported outcomes, which demonstrated high patient satisfaction. Nine studies reported decreased costs when telemedicine was compared to traditional care. The remaining 6 studies had varied aims and methodologies that didn't fit well with any of these sub-headings.ConclusionWhile the available evidence is limited, the studies assessed in this systematic review show that telemedicine can deliver high quality healthcare with good clinical outcomes and high patient satisfaction in a cost effective manner. Further studies are required to validate telemedicine for specific trauma and orthopaedic diagnoses.

Emerging Experiences with Virtual Clinical Ethics Consultation: Case Studies from the United States and Malaysia.

AbstractThe COVID-19 pandemic has inspired numerous opportunities for telehealth implementation to meet diverse healthcare needs, including the use of virtual communication platforms to facilitate the growth of and access to clinical ethics consultation (CEC) services across the globe. Here we discuss the conceptualization and implementation of two different virtual CEC services that arose during the COVID-19 pandemic: the Clinical Ethics Malaysia COVID-19 Consultation Service and the Johns Hopkins Hospital Ethics Committee and Consultation Service. A common strength experienced by both platforms during virtual delivery included improved ability for local practitioners to address consultation needs for patient populations otherwise unable to access CEC services in their respective locations. Additionally, virtual platforms allowed for enhanced collaboration and sharing of expertise among ethics consultants. Both contexts encountered numerous challenges related to patient care delivery during the pandemic. The use of virtual technologies resulted in decreased personalization of patient-provider communication. We discuss these challenges with respect to contextual differences specific to each service and setting, including differences in CEC needs, sociocultural norms, resource availability, populations served, consultation service visibility, healthcare infrastructure, and funding disparities. Through lessons learned from a health system in the United States and a national service in Malaysia, we provide key recommendations for health practitioners and clinical ethics consultants to leverage virtual communication platforms to mitigate existing inequities in patient care delivery and increase capacity for CEC globally.

Abstract P4-07-11: Disparities in the uptake of telemedicine and implications for clinical trial enrollment in breast cancer patients

Abstract Purpose/Objectives: Since the COVID-19 pandemic, telemedicine has become an attractive alternative to office visits in routine radiation oncology practice. The purpose of this study was to identify factors associated with patient preference for an initial consult telemedicine visit and correlation with clinical trial enrollment. Materials/Methods: We evaluated breast cancer patients seen during the open enrollment of a prospective randomized controlled non inferiority trial evaluating radiation fibrosis with five versus three fractions from 07/13/2020 to 05/13/2021. Univariate and multivariate logistic regression models were used to identify factors associated with virtual vs in-person initial consultation and enrolled vs not enrolled patients. All statistical tests were two-sided and the null hypothesis was rejected for p< 0.05. Results: We identified 476 patient consultations with 259 office visits and 217 telemedicine visits. On multivariate analysis, increased age, unemployment, chemotherapy receipt and radiation at NYU were associated with decreased usage of telemedicine for consultation visit. Out of 217 patients who underwent a telemedicine initial consultation, 10% were eligible to enroll on the trial and of those eligible, 76% enrolled. Out of 259 patients who underwent office visit initial consultation, 14% were eligible to enroll on the trial and of those eligible, 53% enrolled. Among eligible patients, there was no statistically significant difference in clinical trial enrollment between telemedicine and office visits. There was no statistically significant difference in patient characteristics between enrolled vs not enrolled patients. Conclusion: Though patient and disease characteristics remained similar between patients undergoing telemedicine and office visits consultations, increased age, unemployment and receipt of chemotherapy were associated with lower usage of telemedicine. Those who underwent in person initial consultation were also more likely to subsequently receive their radiation at our clinic. Further studies are needed to better define underlying reasons for patient selection and impact on care and trial enrollment in order to ensure equal access and benefit from telemedicine, especially in already vulnerable patient populations. Citation Format: Camille Hardy Abeloos, Julie Xiao, Cheongeun Oh, Olivier Maisonet, Naamit Gerber. Disparities in the uptake of telemedicine and implications for clinical trial enrollment in breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-11.

Digital Virtual Consultations and Improved Stakeholders’ Health and Wellbeing amongst Hospital Doctors

The past several decades have seen a shift in patient care towards digitalisation, which has ushered in a new era of health care delivery and improved sustainability and resilience of health systems, with positive impacts on both internal and external stakeholders. This study’s aim was to understand the role of digital virtual consultations in improving internal and external stakeholders’ health, as well as wellbeing among hospital doctors. A qualitative research approach was used with semi-structured online interviews administered to hospital doctors. The interviews showed that the doctors viewed digital virtual consultations as supplementary to in-person consultations, and as tools to reduce obstacles related to distance and time. If the necessary infrastructure and technology were in place, doctors would be willing to use these options. Implementing these technologies would improve the medical profession’s flexibility on the one hand; but it might affect doctors’ work–life balance if consultations extended beyond standard working hours.

Virtual-First: A virtual workflow for new patient consultation, engagement and education in orthodontics

Virtual-First is a new patient enquiry system and workflow to provide a screening virtual orthodontic consultation to a potential orthodontic patient. The workflows and systems presented in this paper are an example of how virtual technologies can be integrated by an orthodontic practice, as an additional supplement, to provide a more engaged, educational and screening model for new patients potentially reducing time and costs that are associated with existing traditional orthodontic consultation models. Using Artificial Intelligence (AI) driven technologies, automated or semi-automated responses can be created to increase practice efficiency and reduce administrative time and errors by the orthodontic teams and professionals. This paper also highlights the challenges to technologies and provides advise on improvements in such systems in the future.

Hypoglycemia in patients with COVID-19: risk factors and prevention of complications

The aim of the work is to analyze the available scientific information and generalize the main results of modern research on the causes and risk factors of hypoglycemia in patients with COVID-19. Materials and methods. A search and analysis of full-text articles was carried out in the PubMed, Web of Science, Google Scholar, and Scopus databases. The search was conducted using the key terms: COVID-19 and hypoglycemia, hypoglycemia in COVID-19 patients and treatment of COVID-19 and hypoglycemia from the beginning of the pandemic in December 2019 to July 1, 2022. Results. The analysis of literary sources made it possible to identify three groups of factors that lead to the occurrence of hypoglycemia in patients with COVID-19: peculiarities of the diabetes course in patients with COVID-19 and the influence of concomitant diseases, side effects of certain groups of drugs and methods of therapy and prevention; shortcomings in the organization of treatment and patient care. Hypoglycemia has been shown to be a risk factor for cardiovascular and total mortality in patients with diabetes, may trigger the development of a cytokine storm during COVID-19 disease, and negatively impact mortality and length of hospital stay in COVID-19. Conclusions. To prevent hypoglycemic states in patients, one should avoid sudden changes in the type and dose of hypoglycemic drugs, periodically monitor the HbA1c level, expand the reach of patients with virtual consultations and telemedicine programs. In the case of determining the program of treatment and vaccination against COVID-19 in patients with diabetes mellitus, the known and possible hypoglycemic effects of drugs and vaccines should be taken into account.

Designing Visual Communications Virtual Reality matters in healthcare industry.

Designing visual communications for virtual reality (VR) is a growing area of interest in the healthcare industry, as it has the potential to revolutionize the way medical professionals train, communicate, and treat patients. The use of VR in healthcare can provide an immersive experience that allows users to interact with medical data and visualizations in a more intuitive and natural way. Visual communications design is essential to the effective implementation of VR in healthcare. By designing effective and engaging VR content, medical professionals can enhance their communication with patients, improve their training and decision-making, and ultimately provide better care. In the healthcare industry, VR can be used for a range of applications, such as patient education, medical training, and virtual consultations. By using VR, patients can have a more comprehensive understanding of their medical conditions, which can improve their overall health outcomes. Additionally, VR can provide medical professionals with hands-on training and the ability to practice complex procedures in a safe and controlled environment.