Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

1998 ◽  
Vol 4 (2) ◽  
pp. 95-100 ◽  
Author(s):  
M A Loane ◽  
R Corbett ◽  
S E Bloomer ◽  
D J Eedy ◽  
H E Gore ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Management ◽  
Low Cost ◽  
Treatment Plan ◽  
Management Plan ◽  
Face To Face ◽  
Management Plans ◽  
Video Link ◽  
The Uk ◽  
Management Recommendations

Diagnostic accuracy and management recommendations of realtime teledermatology consultations using low-cost telemedicine equipment were evaluated. Patients were seen by a dermatologist over a video-link and a diagnosis and treatment plan were recorded. This was followed by a face-to-face consultation on the same day to confirm the earlier diagnosis and management plan. A total of 351 patients with 427 diagnoses participated. Sixty-seven per cent of the diagnoses made over the video-link agreed with the face-to-face diagnosis. Clinical management plans were recorded for 214 patients with 252 diagnoses. For this cohort, 44 of the patients were seen by the same dermatologist at both consultations, while 56 were seen by a different dermatologist. In 64 of cases the same management plan was recommended at both consultations; a sub-optimum treatment plan was recommended in 8 of cases; and in 9 of cases the video-link management plans were judged to be inappropriate. In 20 of cases the dermatologist was unable to recommend a suitable management plan by video-link. There were significant differences in the ability to recommend an optimum management plan by video-link when a different dermatologist made the reference management plan. The results indicate that a high proportion of dermatological conditions can be successfully managed by realtime teledermatology.

Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: is clinical management by realtime teledermatology possible?

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 3-5 ◽  
Author(s):  
M A Loane ◽  
H E Gore ◽  
S E Bloomer ◽  
R Corbett ◽  
D J Eedy ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Clinical Management ◽  
Low Cost ◽  
Treatment Plan ◽  
Phase 1 ◽  
Management Plan ◽  
Management Tool ◽  
Dermatological Disease ◽  
Video Link ◽  
The Uk

Results from phase 1 of the UK Multicentre Teledermatology Trial demonstrated the diagnostic accuracy of realtime teledermatology using low-cost equipment. Phase 2 of the trial aimed to assess its effectiveness as a management tool for dermatological disease. Teledermatology consultations were organized between two health centres and two hospitals in Northern Ireland using low-cost videoconferencing equipment. For 205 patients seen by a dermatologist over the video-link a diagnosis and management plan were recorded. A subsequent face-to-face consultation was arranged on the same day to confirm the diagnosis and treatment regime. A comparison of these management plans revealed that the same plan was recommended in 64% of cases; the teledermatologist was unable to advocate a suitable management plan in 19% of cases; a suboptimal treatment plan was suggested by the teledermatologist in 6% of cases; and in 11% of cases, the teledermatologist suggested an inappropriate treatment plan. These findings indicate that appropriate clinical management was possible in approximately two-thirds of dermatology consultations via the video-link.

Effect of camera performance on diagnostic accuracy: preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

1997 ◽  
Vol 3 (2) ◽  
pp. 83-88 ◽  
Author(s):  
M A Loane ◽  
H E Gore ◽  
R Corbett ◽  
K Steele ◽  
C Mathews ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Diagnostic Accuracy ◽  
Low Cost ◽  
Single Chip ◽  
Face To Face ◽  
Video Cameras ◽  
Dermatology Clinic ◽  
The Uk ◽  
Missed Diagnoses ◽  
Made In

The diagnostic accuracy of realtime teledermatology was measured using two different video cameras. One camera was a relatively low-cost, single-chip device camera 1 , while the other was a more expensive, three-chip camera camera 2 . The diagnosis obtained via the videolink was compared with the diagnosis made in person. Sixty-five new patients referred to a dermatology clinic were examined using camera 1 followed by a standard face-to-face consultation on the same day. A further 65 patients were examined using camera 2 and the same procedure implemented. Seventy-six per cent of conditions were correctly diagnosed by telemedicine using camera 2 compared with 62 using camera 1. A working differential diagnosis was obtained in 12 of cases using camera 2 compared with 14 using camera 1. The percentage of `no diagnosis`, wrong and missed diagnoses was halved using camera 2 compared with camera 1. These results suggest that the performance of the more expensive camera was superior for realtime teledermatology.

Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: Effect of camera performance on diagnostic accuracy

1997 ◽  
Vol 3 (1_suppl) ◽  
pp. 73-75 ◽  
Author(s):  
M A Loane ◽  
H E Gore ◽  
R Corbett ◽  
K Steele ◽  
C Mathews ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Low Cost ◽  
Single Chip ◽  
Trial Effect ◽  
Face To Face ◽  
Video Cameras ◽  
Dermatology Clinic ◽  
The Uk ◽  
Missed Diagnoses ◽  
Made In

The diagnostic accuracy of realtime teledermatology was measured using two different video cameras. One camera was a relatively low-cost, single-chip device (camera 1), while the other was a more expensive three-chip camera (camera 2). The diagnosis obtained via the videolink was compared with the diagnosis made in person. Sixty-five new patients referred to a dermatology clinic were examined using camera 1 followed by a standard face-to-face consultation. A further 65 patients were examined using camera 2 and the same procedure applied. Seventy-six per cent of conditions were correctly diagnosed by telemedicine using camera 2 compared with 59% using camera 1. A working differential diagnosis was obtained in 12% of cases using camera 2 compared with 17% using camera 1. The percentage of ‘no diagnosis’, wrong and missed diagnoses was halved using camera 2 compared with camera 1. These results suggest that the performance of camera 2 was superior to that of camera 1 for realtime teledermatology.

scholarly journals P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mia Rodziewicz ◽  
Terence O'Neill ◽  
Audrey Low
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Management Plan ◽  
Service Development ◽  
Telephone Consultation ◽  
Face To Face ◽  
Communication Difficulties ◽  
Strongly Agree ◽  
The Uk

Abstract Background/Aims  Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods  All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results  233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion  Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure  M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

Could a low-cost audio-visual link be useful in rheumatology?

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 35-37 ◽  
Author(s):  
L E Graham ◽  
S Mcgimpsey ◽  
S Wright ◽  
G Mcclean ◽  
J Carser ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Junior Doctor ◽  
Low Cost ◽  
Clinical Signs ◽  
Final Diagnosis ◽  
Provisional Diagnosis ◽  
Face To Face ◽  
Significant Difference ◽  
Small Joint

We have investigated prospectively the diagnostic accuracy, specialist satisfaction and patient–specialist rapport of a low-cost audio-visual link between a junior doctor with a patient and a consultant rheumatologist. Using a telephone link and subsequently a video-phone link, 20 patients, with various rheumatological problems, were presented by a junior doctor to the consultant rheumatologist for provisional diagnosis. All patients were then seen face to face by the consultant, when a final diagnosis was made. An independent consultant rheumatologist made a ‘gold standard’ diagnosis. Thirty-five per cent of diagnoses were made correctly over the telephone and 40% over the video-phone – there was no significant difference in the diagnostic accuracy between these two methods of communication. Rapport over the video-phone was universally poor. Where it was important, clinical signs could not be visualized over the video-phone and in more than 85% of cases small joint swellings could not be seen clearly.

scholarly journals The King’s College London Coronavirus Health and Experiences of Colleagues at King’s Study: SARS-CoV-2 antibody response in a higher education sample

2021 ◽  
Author(s):  
Daniel Leightley ◽  
Valentina Vitiello ◽  
Alice Wickersham ◽  
Katrina A.S. Davis ◽  
Gabriella Bergin-Cartwright ◽  
...  
Keyword(s):  
Higher Education ◽  
Low Cost ◽  
Phase 1 ◽  
Phase 2 ◽  
Antibody Testing ◽  
Face To Face ◽  
King's College ◽  
Positive Antibody ◽  
The Uk ◽  
Test Result

AbstractObjectiveTo assess the feasibility of home antibody testing as part of large-scale study, the King’s College London Coronavirus Health and Experiences of Colleagues at King’s (KCL CHECK).MethodsParticipants of the KCL CHECK study were sent a SureScreen Diagnostics COVID-19 IgG/IgM Rapid Test Cassette to complete at home in June 2020 (phase 1) and September 2020 (phase 2). Participants were asked to upload a test result image to a study website. Test result images and sociodemographic information were analysed by the research team.ResultsA total of n=2716 participants enrolled in the KCL CHECK study, with n=2003 (73.7%) and n=1825 (69.3%) consenting and responding to phase 1 and 2. Of these, n=1882 (93.9%; phase 1) and n=1675 (91.8%; phase 2) returned a valid result. n=123 (6.5%; phase 1) and n=91 (5.4%; phase 2) tested positive for SARS-CoV-2 antibodies. A total of n=1488 participants provided a result in both phases, with n=57 (3.8%) testing positive for SARS- CoV-2 antibodies across both phases, suggesting a reduction in the number of positive antibody results over time. Initial comparisons showed variation by age group, gender and clinical role.ConclusionsOur study highlights the feasibility of rapid, repeated and low-cost SARS-CoV-2 serological testing without the need for face-to-face contact.What is already known about this subject?Higher education institutions have a duty of care to minimise the spread and transmission of COVID-19 in its campuses, and among staff and students. The reopening of higher education buildings and campuses has brought about a mass movement of students, academics and support staff from across the UK. Serological antibody studies can assist by highlighting groups of people and behaviours associated with high risk of COVID-19.What are the new findings?We report a framework for SARS-CoV-2 serological antibody testing in an occupational group of postgraduate research students and current members of staff at King’s College London. Over two phases of data collection, 6.5% (phase 1) and 5.4% (phase 2) tested positive for SARS-CoV-2 antibodies, with only 3.8% testing positive for antibodies in both phases, suggesting a reduction in positive antibody results over time.How might this impact on policy or clinical practice in the foreseeable future?Our study highlights the feasibility of rapidly deploying low-cost and repeatable SARS-CoV-2 serological testing, without the need for face-to-face contact, to support the higher education system of the UK.

scholarly journals Design and implementation of an acute Trauma and Orthopaedic ePlatform (TOP) referral system utilising existing secure technology during the COVID-19 pandemic

2020 ◽  
Vol 1 (6) ◽  
pp. 293-301
Author(s):  
Tom Vincent McIntyre ◽  
Enda Gerard Kelly ◽  
Trevor Clarke ◽  
Connor J. Green
Keyword(s):  
Point Of Care ◽  
Management Plan ◽  
Secure Messaging ◽  
Musculoskeletal Infection ◽  
Fracture Clinic ◽  
Face To Face ◽  
Significant Difference ◽  
Management Plans ◽  
Electronic Referral ◽  
Definitive Management

Introduction Virtual fracture clinics (VFCs) are being increasingly used to offer safe and efficient orthopaedic review without the requirement for face-to-face contact. With the onset of the COVID-19 pandemic, we sought to develop an online referral pathway that would allow us to provide definitive orthopaedic management plans and reduce face-to-face contact at the fracture clinics. Methods All patients presenting to the emergency department from 21March 2020 with a musculoskeletal injury or potential musculoskeletal infection deemed to require orthopaedic input were discussed using a secure messaging app. A definitive management plan was communicated by an on-call senior orthopaedic decision-maker. We analyzed the time to decision, if further information was needed, and the referral outcome. An analysis of the orthopaedic referrals for the same period in 2019 was also performed as a comparison. Results During the study period, 295 patients with mean age of 7.93 years (standard error (SE) 0.24) were reviewed. Of these, 25 (9.8%) were admitted, 17 (5.8%) were advised to return for planned surgical intervention, 105 (35.6%) were referred to a face-to-face fracture clinic, 137 (46.4%) were discharged with no follow-up, and seven (2.4%) were referred to other services. The mean time to decision was 20.14 minutes (SE 1.73). There was a significant difference in the time to decision between patients referred to fracture clinic and patients discharged (mean 25.25 minutes (SE 3.18) vs mean 2.63 (SE 1.42); p < 0.005). There were a total of 295 referrals to the fracture clinic for the same period in 2019 with a further 44 emergency admissions. There was a statistically significant difference in the weekly referrals after being triaged by the VFC (mean 59 (SE 5.15) vs mean 21 (SE 2.17); p < 0.001). Conclusion The use of an electronic referral pathway to deliver a point of care virtual fracture clinic allowed for efficient use of scarce resources and definitive management plan delivery in a safe manner. Cite this article: Bone Joint Open 2020;1-6:293–301.

To prescribe or not to prescribe: enhancing safety in remote prescribing

2019 ◽  
Vol 1 (3) ◽  
pp. 139-144
Author(s):  
Alison Burton Shepherd
Keyword(s):  
Health Professionals ◽  
General Medical Council ◽  
Access To Healthcare ◽  
Medical Council ◽  
Face To Face ◽  
Video Link ◽  
The Uk ◽  
Nurses And Midwives

From time to time, it may be appropriate to use a telephone, or other non-face-to-face medium to prescribe medicines and treatment for patients. Non face-to-face media include telephone, fax, email, video link, or websites. This concept is known as remote prescribing and refers to prescribing for patients who are physically ‘remote’ or not in the same vicinity as the clinician ( Broadhead, 2011 ). Secondly, the term can also refer to an area of the UK described as being geographically ‘remote’, where direct face-to-face access to healthcare can be poor ( General Medical Council, 2017 ). Remote prescribing has been described as an important facility in healthcare, providing patients with greater accessibility to their medications and treatment ( Griffiths, 2018 ). However, remote prescribing is only acceptable in exceptional circumstances. The aim of this article is to identify and discuss clinical situations in which remote prescribing is acceptable, with an onus on safety. Broadhead (2011) proposes that the medical guidance for remote prescribing is analogous for other health professionals, including nurses and midwives who prescribe remotely using different forms of technology. Therefore, these guidelines will be referred to throughout this article.

Teledermatology—high technology or not?

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 31-32 ◽  
Author(s):  
P V Harrison ◽  
B Kirby ◽  
Y Dickinson ◽  
R Schofield
Keyword(s):  
Diagnostic Accuracy ◽  
General Practitioners ◽  
Low Cost ◽  
High Technology ◽  
Relevant Information ◽  
Management Plan ◽  
Diagnostic Ability ◽  
Photographic Images ◽  
Dermatology Clinic ◽  
Malignant Lesions

As an alternative to attending a conventional dermatology clinic, patients had a high-resolution conventional photographic image taken by a professional medical photographer. The photographic images were viewed by a dermatologist together with referral details from the general practitioner and any other relevant information from the patient's notes. From the images, a dermatological diagnosis was derived and a management plan for each patient instituted. After treatment, histological assessment of the tumours allowed diagnostic accuracy to be determined. The preliminary diagnostic accuracy (71%) was greater than that of the referring general practitioners (49%). However, when the diagnostic ability of the method to detect the nature of malignant lesions was examined, telemedicine was able to detect malignancies in 94% of cases compared with only 70% detected by general practitioners. The results of the present study indicate that teledermatology is achievable using a low-technology, low-cost approach.

scholarly journals Design and implementation of an acute Trauma and Orthopaedic ePlatform (TOP) referral system utilising existing secure technology during the COVID-19 pandemic

2020 ◽  
Vol 1 (6) ◽  
pp. 293-301
Author(s):  
Tom Vincent McIntyre ◽  
Enda Gerard Kelly ◽  
Trevor Clarke ◽  
Connor J. Green
Keyword(s):  
Point Of Care ◽  
Management Plan ◽  
Secure Messaging ◽  
Musculoskeletal Infection ◽  
Fracture Clinic ◽  
Face To Face ◽  
Significant Difference ◽  
Management Plans ◽  
Electronic Referral ◽  
Definitive Management

Introduction Virtual fracture clinics (VFCs) are being increasingly used to offer safe and efficient orthopaedic review without the requirement for face-to-face contact. With the onset of the COVID-19 pandemic, we sought to develop an online referral pathway that would allow us to provide definitive orthopaedic management plans and reduce face-to-face contact at the fracture clinics. Methods All patients presenting to the emergency department from 21March 2020 with a musculoskeletal injury or potential musculoskeletal infection deemed to require orthopaedic input were discussed using a secure messaging app. A definitive management plan was communicated by an on-call senior orthopaedic decision-maker. We analyzed the time to decision, if further information was needed, and the referral outcome. An analysis of the orthopaedic referrals for the same period in 2019 was also performed as a comparison. Results During the study period, 295 patients with mean age of 7.93 years (standard error (SE) 0.24) were reviewed. Of these, 25 (9.8%) were admitted, 17 (5.8%) were advised to return for planned surgical intervention, 105 (35.6%) were referred to a face-to-face fracture clinic, 137 (46.4%) were discharged with no follow-up, and seven (2.4%) were referred to other services. The mean time to decision was 20.14 minutes (SE 1.73). There was a significant difference in the time to decision between patients referred to fracture clinic and patients discharged (mean 25.25 minutes (SE 3.18) vs mean 2.63 (SE 1.42); p < 0.005). There were a total of 295 referrals to the fracture clinic for the same period in 2019 with a further 44 emergency admissions. There was a statistically significant difference in the weekly referrals after being triaged by the VFC (mean 59 (SE 5.15) vs mean 21 (SE 2.17); p < 0.001). Conclusion The use of an electronic referral pathway to deliver a point of care virtual fracture clinic allowed for efficient use of scarce resources and definitive management plan delivery in a safe manner. Cite this article: Bone Joint Open 2020;1-6:293–301.

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