Telemedicine Use during the COVID-19 Pandemic: Results of an International Survey

Author(s):  
Farhan Ahmad ◽  
Robert W. Wysocki ◽  
Neil White ◽  
Marc Richard ◽  
Mark S. Cohen ◽  
...  

Abstract Objective The aim of the study is to survey hand surgeons' perspectives on telemedicine during the coronavirus disease 2019 (COVID-19) pandemic and intended applications after the pandemic. Methods Online surveys were sent to 285 Canadian and American surgeons in late April and early May 2020. Results Response rate was 63% (180)—84% (152) American and 16% (28) Canadian. Forty-three percent (76) of respondents were in private practice, 36% (64) academics, 13% (24) privademics, and 6% (12) hospital employed. The most common telemedicine platform was Zoom. During the pandemic, 42% of patient visits were conducted via telemedicine; however, 37% required a subsequent in-person office visit. The most common complaint by surgeons was the inability to provide routine in-office procedures. The most beneficial feature was ease of use, and the most frustrating feature was connectivity difficulty. Time spent was similar to in-person visits, and surgeons were likely to recommend their platforms. Surgeons were neutral about using telehealth in the future and were most likely to use it for follow-up visits. New patient visits for traumatic injuries or fractures were of limited value. Canadians used telemedicine for a greater proportion than Americans (50 vs. 40%, p <0.05) and spent more time than in-person visits (7/10 vs. 5/10, p <0.05). Americans were more likely to use telemedicine for postoperative follow-up visits (6/10 vs. 4/10, p <0.05) and in mornings before clinic opens (4/10 vs. 2/10, p <0.05). Private practices were more likely to use telemedicine for future allied health provider visits than all other practice types (p <0.05). Conclusion Telemedicine comprised nearly half of patient encounters during the COVID-19 pandemic, but limitations remain.

Context: Surgical specialists have unique considerations when selecting and using electronic health records (EHRs). Aim: We sought to identify key factors and considerations during system selection and implementation for the surgical subspecialist. Case study: Insights from system selection and implementation for a start-up plastic surgery private practice were used to inform a broader set of principles for surgical subspecialists in private practice selecting and using EHRs. What can be learned: The nature of the provider-patient relationship is episodic and such as maintaining inventory, managing images, annotating images, documenting and billing in-office procedures, and integration of cash-based and insurance payment. Conclusion: Surgeons in private practice and as part of larger institutions can use insights from this case study to inform their own efforts in system selection and optimization for ongoing use.


2019 ◽  
Vol 7 (4) ◽  
pp. 520-544 ◽  
Author(s):  
Andreas C Goldberg ◽  
Pascal Sciarini

Abstract This article assesses whether—and to what extent—turnout bias in postelection surveys is reduced by adding a short nonresponse follow-up (NRFU) survey to a mixed-mode survey. Specifically, we examine how the NRFU survey influences response propensities across demographic groups and political factors and whether this affects data quality. We use a rich dataset on validated voter turnout data, collected across two different ballots. In addition to the main survey that comprises computer-assisted telephone interviews (CATI) and web respondents, both studies include a short follow-up mail survey for nonrespondents. The results demonstrate that collecting extra information from additional respondents on so-called “central” questions is worth the effort. In both studies, the NRFU survey substantially increases representativeness with respect to sociodemographic and participation variables. In particular, voters and politically active citizens are more accurately represented in the NRFU survey. This tends to result in better estimates of turnout determinants in the final (combined) sample than is seen from CATI/web respondents only. Moreover, the increase in response rate and the decrease in nonresponse bias comes at almost no price in terms of measurement errors. Vote overreporting is only slightly higher in the mail follow-up survey than in the main CATI/web survey.


2017 ◽  
Vol 33 (3) ◽  
pp. 625-657 ◽  
Author(s):  
Kirstin Early ◽  
Jennifer Mankoff ◽  
Stephen E. Fienberg

Abstract Online surveys have the potential to support adaptive questions, where later questions depend on earlier responses. Past work has taken a rule-based approach, uniformly across all respondents. We envision a richer interpretation of adaptive questions, which we call Dynamic Question Ordering (DQO), where question order is personalized. Such an approach could increase engagement, and therefore response rate, as well as imputation quality. We present a DQO framework to improve survey completion and imputation. In the general survey-taking setting, we want to maximize survey completion, and so we focus on ordering questions to engage the respondent and collect hopefully all information, or at least the information that most characterizes the respondent, for accurate imputations. In another scenario, our goal is to provide a personalized prediction. Since it is possible to give reasonable predictions with only a subset of questions, we are not concerned with motivating users to answer all questions. Instead, we want to order questions to get information that reduces prediction uncertainty, while not being too burdensome. We illustrate this framework with two case studies, for the prediction and survey-taking settings. We also discuss DQO for national surveys and consider connections between our statistics-based question-ordering approach and cognitive survey methodology.


2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 446-446
Author(s):  
Marc-Oliver Grimm ◽  
Bernd Schmitz-Dräger ◽  
Uwe Zimmermann ◽  
Barbara Grün ◽  
Gustavo Bruno Baretton ◽  
...  

446 Background: Several PD-1 immune-checkpoint inhibitors including Nivolumab (Nivo) are approved in urothelial cancer. Recently, in the front line setting, improved activity of combined PD-L1 and CTLA4 immune-checkpoint inhibition has been reported and a phase III trial with Nivolumab + Ipilimumab (Nivo+Ipi) is ongoing. Here we report a response-based tailored approach starting treatment with Nivo monotherapy using Nivo+Ipi as immunotherapeutic “boost”. Methods: Between July 2017 and April 2019 86 patients were enrolled and treated according to protocol version 3 (cohort 1). Patients started with Nivo 240 mg Q2W induction. After 4 dosings and tumor assessment at week 8 (i) responders (PR/CR) to Nivo monotherapy continued with maintenance while (ii) patients with stable (SD) or progressive disease (PD) received 2 cycles Nivo3+Ipi1 followed by another 2 cycles Nivo1+Ipi3 if not responding. Median follow-up is 8.7 months. The primary endpoint is confirmed investigator-assessed objective response rate (ORR) per RECIST1.1. Secondary endpoints include activity of Nivo monotherapy at week 8, remission rate with Nivo+Ipi “boosts”, safety, overall survival and quality of life. Results: Of the patients 42, 39 and 5 were first, second and third line, respectively. Median age was 67 years (range 45-84), 61 patients (71 %) were male and 25 female. ORR with Nivo monotherapy at first assessment (week 8) was 29 % and 23 % in first and second/third line, respectively. Of the patients 41 received Nivo+Ipi “boosts” after week 8 while 12 received later “boosts”. Best overall response (BOR) rate with Nivo induction ± Nivo+Ipi “boosts” was 48 % and 27 % in first and second/third line, respectively. In first line 7/17 (41 %) patients receiving Nivo+Ipi after week 8 had an improved response compared to 2/24 (8.3 %) in second/third line. Of the patients who continued with Nivo maintenance after week 8 and received later “boosts” 2/12 (17 %) had a PR and 2/12 (17 %) improved to SD. Treatment-related AEs will be presented. Conclusions: TITAN–TCC explores a response-driven use of Nivo+Ipi as an immunotherapeutic “boost”. In first line, this significantly improved ORR compared to the expected response rate of Nivo monotherapy, providing further evidence to the added value of Ipi in combination with Nivo. Further follow-up is ongoing to characterize duration and depth of response. Clinical trial information: NCT03219775 . Research Sponsor: Bristol-Myers Squibb[Table: see text]


2018 ◽  
Vol 10 (5) ◽  
pp. 524-531 ◽  
Author(s):  
John Raimo ◽  
Sean LaVine ◽  
Kelly Spielmann ◽  
Meredith Akerman ◽  
Karen A. Friedman ◽  
...  

ABSTRACT Background  Residents and practicing physicians displaying signs of stress is common. It is unclear whether stress during residency persists into professional practice or is associated with future burnout. Objective  We assessed the persistence of stress after residency and its correlation with burnout in professional practice. We hypothesized that stress would linger and be correlated with future burnout. Methods  A prospective cohort study was conducted over 10 years using survey instruments with existing validity evidence. Residents over 3 academic years (2003–2005) were surveyed to measure stress in residency. Ten years later, these residents were sought out for a second survey measuring current stress and burnout in professional practice. Results  From 2003 to 2005, 143 of 155 residents participated in the initial assessment (92% response rate). Of those, 21 were excluded in 2015 due to lack of contact information; follow-up surveys were distributed to 122 participants, and 81 responses were received (66% response rate and 57% of original participants). Emotional distress in residency correlated with emotional distress in professional practice (correlation coefficient = 0.45, P &lt; .0001), emotional exhaustion (correlation coefficient = 0.30, P = .007), and depersonalization (correlation coefficient = 0.25, P = .029). Multivariate linear regression showed that emotional distress in residency was associated with future emotional distress (β estimate = 0.57, P = .005) and depersonalization (β estimate = 2.29, P = .028). Conclusions  We showed emotional distress as a resident persists into individuals' professional practice 10 years later and has an association with burnout in practice.


2014 ◽  
Vol 74 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Ellen Funkhouser ◽  
Jeffrey L. Fellows ◽  
Valeria V. Gordan ◽  
D. Brad Rindal ◽  
Patrick J. Foy ◽  
...  

2018 ◽  
Vol 1 (1) ◽  
pp. 38-41
Author(s):  
Leonard Salles De Almeida

Background: The degree of efficacy and duration of effect of Intragastric Balloons (IGBs) can be variable and unpredictable. The Spatz Adjustable Intragastric Balloon (AIGB) was developed to address these issues by extending implantation to 1 year, decreasing balloon volume for intolerance and increasing volume for decreased balloon effect.Aims: To determine the efficacy and response rate of the Spatz3 AIGB.Methods: Results of 379 consecutive patients (pts) implanted with the Spatz3 AIGB were retrospectively reviewed (3 lost to follow up). Mean BMI 35.5; mean weight (wt) 97.5 kg; mean excess wt 29.1 kg; mean balloon volume 600ml. Balloon volume adjustments were offered: Down adjustments for intolerance and up adjustments for decreased balloon effect.Results: The mean implantation time of 376 pts was 10.6 months yielding mean wt loss 14.9 kg; mean 15.1% Total Body Wt Loss (%TBL) and 58% Excess Wt Loss(%EWL). Response rate (> 25%EWL) was achieved in 79% (297/376) of pts. Down adjustments in 95 pts (mean 2.4 months; mean -152.4 ml) allowed 76/95 (80%) to continue IGB therapy for at least 6 months (mean 9.1 months). Up adjustments in 205/376 (54.5%) pts (mean 5.8 months; mean + 179.2 ml) yielded additional mean wt loss of 6.5 kg. There was 1 gastric ulcer (0.27%). One balloon deflated at 7.4 months and 4 others deflated after 1 year (13-23 months).Conclusions: In this retrospective review of 376 Spatz3 AIGB patients, up adjustments yielded a mean 6.5kg extra wt loss for those with wt loss plateau, and down adjustments alleviated early intolerance. These two adjustment functions may be instrumental in yielding a successful outcome (> 25% EWL) in 79% of pts.


2013 ◽  
Vol 9 (1) ◽  
pp. 171-179
Author(s):  
Hanna Edebol ◽  
Lars Helldin ◽  
Torsten Norlander

Objective: Two measures of the response rate and the optimal treatment response for adult ADHD were evaluated using methylphenidate. The hypotheses were that Prediction of ADHD (PADHD) defines remission, the Weighed Core Symptom (WCS) scale registers direct effects of medication and that WCS may indicate the optimal dose level during titration. Design: PADHD and WCS were analyzed at baseline and after intake of low doses of either short-acting or modified-release formulations of methylphenidate, MPH (Study I), during titration with modified-release formulations of MPH (18/27, 36, 54, 72 mg) and at three months follow-up (Study II). Patients: Study I consisted of 63 participants (32 females) and Study II consisted of 10 participants (6 females) diagnosed with ADHD and who was to start with treatment. Outcome measures: Prediction of ADHD (PADHD) indicates the occurrence of ADHD (No, Yes) and the Weighed Core Symptom scale (WCS) quantifies ADHD from 0 to 100 (max-min). Results: The number of clinical cases of ADHD decreased after methylphenidate treatment according to PADHD. WCS increased (p < 0.001) from 9.75 (SD = 12.27) to 47.50 (SD = 29.75) with about 10 mg of methylphenidate (N = 63). During titration, symptoms improved after 18/27 mg and 36 mg of methylphenidate and baseline-follow up comparisons showed WCS increments (p = 0.005) from 31.00 (N = 10, SD = 26.85) to 69.00 (N = 10, SD = 22.34). Conclusions: PADHD defined remission and WCS measured therapeutic effects of methylphenidate in adult ADHD.


2011 ◽  
Vol 3 (3) ◽  
pp. 146
Author(s):  
Kenneth C. Schneider ◽  
James C. Johnson

This article examines the impact of follow-up techniques (designed to increase the survey response rate) on uninformed responses to factual survey questions. Such questions of fact can be used as filters to measures a respondents base of information, knowledge or experience on a topic prior to measuring his/her opinions on that topic, but only if uninformed responses are less likely to be given to the factual filter questions than to the opinion/attitude questions. Previous research suggests that response pressure (including follow-up contact) tends to exacerbate the uninformed response rate to opinion or attitude questions. However, the research reported here suggests that is not so with factual questions; follow-up contract does not result in increased levels of uninformed response to questions of fact.


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