Teledermatology Adaptations in the COVID-19 Era

The COVID-19 pandemic has required health services worldwide to adapt to dramatically changing healthcare needs and risks across all medical specialties. In the dermatology department at Princess Alexandra Hospital, Brisbane, Australia, we developed and implemented a teledermatology system with 1 week's notice to help reduce infection risk bidirectionally, while saving patients many hours of travel and waiting time with acceptable technological substitutes for the clinical encounters. In this study, we report the efficacy and tolerability of our telephone consultation and store and forward imaging system, including patient experience from validated survey data. Our design, implementation and usage of a remote-default system provides experience and lessons to draw upon in developing future telemedicine systems to address dermatology service maldistribution – an issue affecting large areas of Australia – as well as preparedness for future infection mitigation requirements.

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A systematic review of the efficacy of telemedicine for making diagnostic and management decisions

Journal of Telemedicine and Telecare ◽

10.1258/135763302320272167 ◽

2002 ◽

Vol 8 (4) ◽

pp. 197-209 ◽

Cited By ~ 87

Author(s):

William Hersh ◽

Mark Helfand ◽

James Wallace ◽

Dale Kraemer ◽

Patricia Patterson ◽

...

Keyword(s):

Systematic Review ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Management Decisions ◽

Medical Specialties ◽

Face To Face ◽

Home Based ◽

Reasonable Evidence ◽

Physical Examinations ◽

Store And Forward

We conducted a systematic review of the literature to evaluate the efficacy of telemedicine for making diagnostic and management decisions in three classes of application: office/hospital-based, store-and-forward, and home-based telemedicine. We searched the MEDLINE, EMBASE, CINAHL and HealthSTAR databases and printed resources, and interviewed investigators in the field. We excluded studies where the service did not historically require face-to-face encounters (e.g. radiology or pathology diagnosis). A total of 58 articles met the inclusion criteria. The articles were summarized and graded for the quality and direction of the evidence. There were very few high-quality studies. The strongest evidence for the efficacy of telemedicine for diagnostic and management decisions came from the specialties of psychiatry and dermatology. There was also reasonable evidence that general medical history and physical examinations performed via telemedicine had relatively good sensitivity and specificity. Other specialties in which some evidence for efficacy existed were cardiology and certain areas of ophthalmology. Despite the widespread use of telemedicine in most major medical specialties, there is strong evidence in only a few of them that the diagnostic and management decisions provided by telemedicine are comparable to face-to-face care.

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Design and Implementation of a Calibrated Store and Forward Imaging System for Teledermatology

Journal of Medical Systems ◽

10.1023/b:joms.0000041172.70027.a0 ◽

2004 ◽

Vol 28 (5) ◽

pp. 455-467 ◽

Cited By ~ 17

Author(s):

Ilias Maglogiannis

Keyword(s):

Imaging System ◽

Design And Implementation ◽

Store And Forward

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Assessing Patient Experience and Healthcare Quality of Dental Care Using Patient Online Reviews in the United States: Mixed Methods Study

Journal of Medical Internet Research ◽

10.2196/18652 ◽

2020 ◽

Vol 22 (7) ◽

pp. e18652

Author(s):

Ye Lin ◽

Y Alicia Hong ◽

Bradley S Henson ◽

Robert D Stevenson ◽

Simon Hong ◽

...

Keyword(s):

United States ◽

Patient Experience ◽

Dental Care ◽

Healthcare Providers ◽

Healthcare Quality ◽

Online Reviews ◽

The United States ◽

Care Quality ◽

Medical Specialties ◽

Data Source

Background Over the last two decades, patient review websites have emerged as an essential online platform for doctor ratings and reviews. Recent studies suggested the significance of such websites as a data source for patients to choose doctors for healthcare providers to learn and improve from patient feedback and to foster a culture of trust and transparency between patients and healthcare providers. However, as compared to other medical specialties, studies of online patient reviews that focus on dentists in the United States remain absent. Objective This study sought to understand to what extent online patient reviews can provide performance feedbacks that reflect dental care quality and patient experience. Methods Using mixed informatics methods incorporating statistics, natural language processing, and domain expert evaluation, we analyzed the online patient reviews of 204,751 dentists extracted from HealthGrades with two specific aims. First, we examined the associations between patient ratings and a variety of dentist characteristics. Second, we identified topics from patient reviews that can be mapped to the national assessment of dental patient experience measured by the Patient Experience Measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey. Results Higher ratings were associated with female dentists (t71881=2.45, P<.01, g=0.01), dentists at a younger age (F7, 107128=246.97, P<.001, g=0.11), and those whose patients experienced a short wait time (F4, 150055=10417.77, P<0.001, g=0.18). We also identified several topics that corresponded to CAHPS measures, including discomfort (eg, painful/painless root canal or deep cleaning), and ethics (eg, high-pressure sales, and unnecessary dental work). Conclusions These findings suggest that online patient reviews could be used as a data source for understanding the patient experience and healthcare quality in dentistry.

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Assessing Patient Experience and Healthcare Quality of Dental Care Using Patient Online Reviews in the United States: Mixed Methods Study (Preprint)

10.2196/preprints.18652 ◽

2020 ◽

Author(s):

Ye Lin ◽

Y Alicia Hong ◽

Bradley S Henson ◽

Robert D Stevenson ◽

Simon Hong ◽

...

Keyword(s):

United States ◽

Patient Experience ◽

Dental Care ◽

Healthcare Providers ◽

Healthcare Quality ◽

Online Reviews ◽

The United States ◽

Care Quality ◽

Medical Specialties ◽

Data Source

BACKGROUND Over the last two decades, patient review websites have emerged as an essential online platform for doctor ratings and reviews. Recent studies suggested the significance of such websites as a data source for patients to choose doctors for healthcare providers to learn and improve from patient feedback and to foster a culture of trust and transparency between patients and healthcare providers. However, as compared to other medical specialties, studies of online patient reviews that focus on dentists in the United States remain absent. OBJECTIVE This study sought to understand to what extent online patient reviews can provide performance feedbacks that reflect dental care quality and patient experience. METHODS Using mixed informatics methods incorporating statistics, natural language processing, and domain expert evaluation, we analyzed the online patient reviews of 204,751 dentists extracted from HealthGrades with two specific aims. First, we examined the associations between patient ratings and a variety of dentist characteristics. Second, we identified topics from patient reviews that can be mapped to the national assessment of dental patient experience measured by the Patient Experience Measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey. RESULTS Higher ratings were associated with female dentists (t71881=2.45, P<.01, g=0.01), dentists at a younger age (F7, 107128=246.97, P<.001, g=0.11), and those whose patients experienced a short wait time (F4, 150055=10417.77, P<0.001, g=0.18). We also identified several topics that corresponded to CAHPS measures, including discomfort (eg, painful/painless root canal or deep cleaning), and ethics (eg, high-pressure sales, and unnecessary dental work). CONCLUSIONS These findings suggest that online patient reviews could be used as a data source for understanding the patient experience and healthcare quality in dentistry.

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Abstract 15897: Patient Experience With Telemedicine in Adults With Congenital Heart Disease

Circulation ◽

10.1161/circ.142.suppl_3.15897 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anudeep Dodeja ◽

Matt Granger ◽

Deboarah Mitchell ◽

Rosemary Chumita ◽

tracey sisk ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Patient Experience ◽

Congenital Heart ◽

Healthcare Delivery ◽

Clinic Visit ◽

Healthcare Research ◽

Healthcare Needs ◽

Patient Reported ◽

Clinic Visits

Introduction: COVID19 pandemic has resulted in drastic changes in healthcare delivery with increase in use of telemedicine. There is limited data on patient experience with telemedicine in adults with congenital heart disease (ACHD). Hypothesis: We hypothesized that ACHD patients would prefer in-person clinic visits over telemedicine, and this would be especially true for patients > 65 years who may be at a higher risk of experiencing technical limitations. Methods: We conducted a nurse administered telephone survey (Figure 1A) based on Agency for Healthcare Research and Quality recommendations to assess patient experience after ACHD telemedicine visits from March 2020 to June 2020. Results: Of 216 patients who had ACHD telemedicine visits, 136 (63%) agreed to participate in the survey. Mean age was 45 + 18 years, majority (65%) being video encounters. Most (98%) said that the telemedicine visit was successful in addressing their healthcare needs. Only 21 (15%) patients reported technical issues. Most patients (76%) were likely to choose telemedicine in the future instead of an in-person clinic visit provided testing was done separately. Given a choice between in-person clinic visit and telemedicine: 103 (76%) preferred telemedicine, 25 (18%) preferred in-person clinic visits, and 8 (6%) had no preference (Figure1B). Of the 25 patients over 65 years, 19 (76%) would choose telemedicine over the in-person clinic, and only one patient reported technical difficulties. Conclusion: In conclusion, patients reported a positive experience with ACHD telemedicine, which was true even among elderly patients. Technical limitations were infrequent even amongst the elderly. Majority of patients felt that their healthcare needs were addressed and would consider telemedicine over clinic visits if given a choice. This data is vital as payors move away from supporting telemedicine and hospitals restructure, with and without ongoing COVID 19 concerns.

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Evaluation of a telemedicine demonstration project in the Magdalene Islands

Journal of Telemedicine and Telecare ◽

10.1258/135763303321327948 ◽

2003 ◽

Vol 9 (2) ◽

pp. 89-94 ◽

Cited By ~ 14

Author(s):

Jean-Paul Fortin ◽

Marie-Pierre Gagnon ◽

Alain Cloutier ◽

Françoise Labbé

Keyword(s):

Health Care ◽

Health Care Providers ◽

Real Life ◽

Care Providers ◽

Medical Specialties ◽

Psychosocial Services ◽

Regional Medical ◽

Store And Forward ◽

Medical Referral ◽

Structured Approach

The Magdalene Islands are an archipelago located in the middle of the Gulf of St Lawrence, more than 1000 km away from supra-regional medical referral centres. We have implemented and evaluated a telemedicine network for the local hospital on the Magdalene Islands. During a 13-month study period, 118 transmissions were made. Orthopaedics and radiology were the medical specialties that used telemedicine most frequently. Store-and-forward imaging was the technique used most often because of the large number of transmissions in orthopaedics and radiology. Various medical specialties and psychosocial services used videoconferencing, while realtime imaging (ultrasound) was used in gynaecology and obstetrics. A combination of videoconferencing and imaging was used for otolaryngology. A total of 101 individual patients benefited from a teleconsultation during the study period. Eight emergency transfers were avoided and 15 patients who would have required elective transfer were managed locally by telemedicine. For health-care providers, telemedicine seemed to be an acceptable way of delivering specialized services. Nevertheless, demonstration projects in telemedicine are quite different to 'real life' telemedicine utilization. Deployment of telemedicine in the health-care system as a whole will require a more structured approach.

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New Aspects in the Design of Electron Optical Magnification Systems

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010009628x ◽

1972 ◽

Vol 30 ◽

pp. 606-607

Author(s):

Willem H.J. Andersen

Keyword(s):

Electron Microscope ◽

Imaging System ◽

Chromatic Aberration ◽

Research Tool ◽

Energy Losses ◽

Objective Lens ◽

Theoretical Limit ◽

Optical Magnification ◽

Chromatic Aberrations ◽

High Degree

Electron microscope design, and particularly the design of the imaging system, has reached a high degree of perfection. Present objective lenses perform up to their theoretical limit, while the whole imaging system, consisting of three or four lenses, provides very wide ranges of magnification and diffraction camera length with virtually no distortion of the image. Evolution of the electron microscope in to a routine research tool in which objects of steadily increasing thickness are investigated, has made it necessary for the designer to pay special attention to the chromatic aberrations of the magnification system (as distinct from the chromatic aberration of the objective lens). These chromatic aberrations cause edge un-sharpness of the image due to electrons which have suffered energy losses in the object.There exist two kinds of chromatic aberration of the magnification system; the chromatic change of magnification, characterized by the coefficient Cm, and the chromatic change of rotation given by Cp.

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Some Quantification Problems in Parallel EELS Images

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100133771 ◽

1990 ◽

Vol 48 (2) ◽

pp. 36-37

Author(s):

G. Botton ◽

G. L’Espérance ◽

M.D. Ball ◽

C.E. Gallerneault

Keyword(s):

Electron Microscope ◽

Imaging System ◽

Signal To Noise Ratio ◽

Scanning Transmission Electron Microscope ◽

Acquisition Time ◽

Thickness Variation ◽

Transmission Electron ◽

Distribution Of Elements ◽

Scanning Transmission ◽

Present Distribution

The recently developed parallel electron energy loss spectrometers (PEELS) have led to a significant reduction in spectrum acquisition time making EELS more useful in many applications in material science. Dwell times as short as 50 msec per spectrum with a PEELS coupled to a scanning transmission electron microscope (STEM), can make quantitative EEL images accessible. These images would present distribution of elements with the high spatial resolution inherent to EELS. The aim of this paper is to briefly investigate the effect of acquisition time per pixel on the signal to noise ratio (SNR), the effect of thickness variation and crystallography and finally the energy stability of spectra when acquired in the scanning mode during long periods of time.The configuration of the imaging system is the following: a Gatan PEELS is coupled to a CM30 (TEM/STEM) electron microscope, the control of the spectrometer and microscope is performed through a LINK AN10-85S MCA which is interfaced to a IBM RT 125 (running under AIX) via a DR11W line.

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Multi-mode light microscopy of microtubule assembly dynamics and chromosome movement in vivo and In vitro

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100166117 ◽

1996 ◽

Vol 54 ◽

pp. 730-731

Author(s):

E. D. Salmon ◽

J. C. Waters ◽

C. Waterman-Storer

Keyword(s):

Imaging System ◽

Ccd Camera ◽

Transmitted Light ◽

Microtubule Assembly ◽

Live Cells ◽

Optical Efficiency ◽

Multiple Band ◽

Multi Mode

We have developed a multi-mode digital imaging system which acquires images with a cooled CCD camera (Figure 1). A multiple band pass dichromatic mirror and robotically controlled filter wheels provide wavelength selection for epi-fluorescence. Shutters select illumination either by epi-fluorescence or by transmitted light for phase contrast or DIC. Many of our experiments involve investigations of spindle assembly dynamics and chromosome movements in live cells or unfixed reconstituted preparations in vitro in which photodamage and phototoxicity are major concerns. As a consequence, a major factor in the design was optical efficiency: achieving the highest image quality with the least number of illumination photons. This principle applies to both epi-fluorescence and transmitted light imaging modes. In living cells and extracts, microtubules are visualized using X-rhodamine labeled tubulin. Photoactivation of C2CF-fluorescein labeled tubulin is used to locally mark microtubules in studies of microtubule dynamics and translocation. Chromosomes are labeled with DAPI or Hoechst DNA intercalating dyes.

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Correlation of Pore Structure and Permeability by SEM-Image Analysis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100180896 ◽

1990 ◽

Vol 48 (1) ◽

pp. 428-429

Author(s):

C. A. Callender ◽

Wm. C. Dawson ◽

J. J. Funk

Keyword(s):

Image Analysis ◽

Pore Structure ◽

Imaging System ◽

Pore Space ◽

Simulation Models ◽

Image Analyzer ◽

Imaging Data ◽

Sem Images ◽

Thin Sections ◽

Rock Types

The geometric structure of pore space in some carbonate rocks can be correlated with petrophysical measurements by quantitatively analyzing binaries generated from SEM images. Reservoirs with similar porosities can have markedly different permeabilities. Image analysis identifies which characteristics of a rock are responsible for the permeability differences. Imaging data can explain unusual fluid flow patterns which, in turn, can improve production simulation models.Analytical SchemeOur sample suite consists of 30 Middle East carbonates having porosities ranging from 21 to 28% and permeabilities from 92 to 2153 md. Engineering tests reveal the lack of a consistent (predictable) relationship between porosity and permeability (Fig. 1). Finely polished thin sections were studied petrographically to determine rock texture. The studied thin sections represent four petrographically distinct carbonate rock types ranging from compacted, poorly-sorted, dolomitized, intraclastic grainstones to well-sorted, foraminiferal,ooid, peloidal grainstones. The samples were analyzed for pore structure by a Tracor Northern 5500 IPP 5B/80 image analyzer and a 80386 microprocessor-based imaging system. Between 30 and 50 SEM-generated backscattered electron images (frames) were collected per thin section. Binaries were created from the gray level that represents the pore space. Calculated values were averaged and the data analyzed to determine which geological pore structure characteristics actually affect permeability.

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