The effectiveness of telepsychiatry: thematic review

Aims and method This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. Results We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. Clinical implications The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.

Virtual Non-Contrast versus True Non-Contrast Computed Tomography: Initial Experiences with a Photon Counting Scanner Approved for Clinical Use

The present study evaluates the diagnostic reliability of virtual non-contrast (VNC) images acquired with the first photon counting CT scanner that is approved for clinical use by comparing quantitative image properties of VNC and true non-contrast (TNC) images. Seventy-two patients were retrospectively enrolled in this study. VNC images reconstructed from the arterial (VNCa) and the portalvenous (VNCv) phase were compared to TNC images. In addition, consistency between VNCa and VNCv images was evaluated. Regions of interest (ROI) were drawn in the following areas: liver, spleen, kidney, aorta, muscle, fat and bone. Comparison of VNCa and VNCv images revealed a mean offset of less than 4 HU in all tissues. The greatest difference between TNC and VNC images was found in spongious bone (VNCv 86.13 HU ± 28.44, p < 0.001). Excluding measurements in spongious bone, differences between TNC and VNCv of 10 HU or less were found in 40% (VNCa 36%) and differences of 15 HU or less were found in 72% (VNCa 68%) of all measurements. The underlying algorithm for the subtraction of iodine works in principle but requires adjustments. Until then, special caution should be exercised when using VNC images in routine clinical practice.

Validating a Reading Assessment Within the Cognitive Diagnostic Assessment Framework: Q-Matrix Construction and Model Comparisons for Different Primary Grades

Cognitive diagnostic assessment (CDA) has been developed rapidly to provide fine-grained diagnostic feedback on students’ subskills and to provide insights on remedial instructions in specific domains. To date, most cognitive diagnostic studies on reading tests have focused on retrofitting a single booklet from a large-scale assessment (e.g., PISA and PIRLS). Critical issues in CDA involve the scarcity of research to develop diagnostic tests and the lack of reliability and validity evidence. This study explored the development and validation of the Diagnostic Chinese Reading Comprehension Assessment (DCRCA) for primary students under the CDA framework. Reading attributes were synthesized based on a literature review, the national curriculum criteria, the results of expert panel judgments, and student think-aloud protocols. Then, the tentative attributes were used to construct three booklets of reading comprehension items for 2–6 graders at three key stages. The assessment was administered to a large population of students (N = 21,466) in grades 2–6 from 20 schools in a district of Changchun City, China. Q-matrices were compared and refined using the model-data fit and an empirical validation procedure, and five representative cognitive diagnostic models (CDMs) were compared for optimal performance. The fit indices suggested that a six-attribute structure and the G-DINA model were best fitted for the reading comprehension assessment. In addition, diagnostic reliability, construct, internal and external validity results were provided, supporting CDM classifications as reliable, accurate, and useful. Such diagnostic information could be utilized by students, teachers, and administrators of reading programs and instructions.

Healing From a Distance: A Cross-sectional Study on the Diagnostic Reliability of Store-and-Forward Teledermatology (Preprint)

UNSTRUCTURED Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair, and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. The purpose of this study was to evaluate the diagnostic reliability of teledermatology. A cross-sectional study was conducted among patients from 2 government hospitals. A total of 39 patients were seen in a face-to-face setting and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken and were shown to 3 consultant teledermatologists, who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. The Cohen kappa was used to assess agreement in the evaluations between the teledermatology and face-to-face diagnoses by senior resident raters #1 and #2. Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #2. The agreement between the ratings of senior residents #1 and #2 ranged from fair to substantial. The findings of the study showed that the diagnostic concordance of in-person clinicians and teledermatologists ranges from fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Although face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible.

Healing From a Distance: A Cross-sectional Study on the Diagnostic Reliability of Store-and-Forward Teledermatology

Background Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair, and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. Objective The purpose of this study was to evaluate the diagnostic reliability of teledermatology. Methods A cross-sectional study was conducted among patients from 2 government hospitals. A total of 39 patients were seen in a face-to-face setting and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken and were shown to 3 consultant teledermatologists, who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. The Cohen kappa was used to assess agreement in the evaluations between the teledermatology and face-to-face diagnoses by senior resident raters #1 and #2. Results Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #2. The agreement between the ratings of senior residents #1 and #2 ranged from fair to substantial. Conclusions The findings of the study showed that the diagnostic concordance of in-person clinicians and teledermatologists ranges from fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Although face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible. Conflicts of Interest None declared.

Is sobriety from alcohol necessary for evaluation of patients presenting with suicidal ideation?

BackgroundIt is commonly assumed that patients intoxicated with alcohol are unreliable with respect to their statements of suicidal intent, however no prior literature evaluates the impact of sobriety on suicidal ideation (SI). In typical emergency department (ED) settings, a common practice is to wait until intoxicated suicidal individuals have reached a legally sober limit (ethanol level less than 80 mg/dL) to evaluate safety. We are not aware of any study that establishes the diagnostic reliability of the clinical suicidal ideation evaluation as a function of alcohol intoxication.MethodsThis study is a retrospective review of medical records for patients evaluated in a pre-COVID Midwestern ED for one calendar year. Cases were generated for review based on criteria of having a Psychiatric SW (Social Work) consult and blood alcohol level drawn while in the ED on every Wednesday and Friday of 2017 which produced 1084 cases for review. Chi-square analysis was used for comparison of variables of suicidal ideation with or without alcohol intoxication as defined by blood alcohol level (BAL) ≥80 mg/dL.ResultsIn reference to our initial hypothesis, patients presenting with suicidal ideation and concurrent alcohol intoxication were no longer reporting suicidal ideation at sobriety in 69% of cases, compared to 38% for patients without alcohol levels on presentation. Chi-square analysis demonstrated p=0.000012.ConclusionThe goal of the present study was to demonstrate, with empirical data, a relationship between alcohol intoxication and suicidal ideation. Our data suggests that patients presenting to the ED with complaints related to suicidal behavior who are found to have concurrent alcohol intoxication are more likely to deny suicidal ideation when sober than patients with similar presenting complaints and no alcohol intoxication.

Healing from a distance: A cross-sectional study on the diagnostic reliability of store-and-forward Teledermatology (Preprint)

BACKGROUND Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. OBJECTIVE The purpose of this study is to evaluate the diagnostic reliability of teledermatology. METHODS A cross-sectional study was conducted among patients from Culion Sanitarium and General Hospital and Rizal Medical Center. Thirty-nine patients were seen face-to-face and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken, and were shown to three consultant teledermatologists who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. Cohen’s Kappa was used to determine the agreement of the evaluations between the teledermatology and face to face diagnoses by senior residents 1 and 2. RESULTS Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater 1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater 2. The agreement between the agreement ratings of senior residents 1 and 2 were fair to substantial. CONCLUSIONS The findings of the study show that the diagnostic concordance of in-person clinicians and teledermatologists are fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Though face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible.

Healing From a Distance: A Cross-sectional Study on the Diagnostic Reliability of Store-and-Forward Teledermatology (Preprint)

BACKGROUND Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair, and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. OBJECTIVE The purpose of this study was to evaluate the diagnostic reliability of teledermatology. METHODS A cross-sectional study was conducted among patients from 2 government hospitals. A total of 39 patients were seen in a face-to-face setting and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken and were shown to 3 consultant teledermatologists, who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. The Cohen kappa was used to assess agreement in the evaluations between the teledermatology and face-to-face diagnoses by senior resident raters #1 and #2. RESULTS Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #2. The agreement between the ratings of senior residents #1 and #2 ranged from fair to substantial. CONCLUSIONS The findings of the study showed that the diagnostic concordance of in-person clinicians and teledermatologists ranges from fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Although face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible.

Diagnostic Reliability in the Assessment of Degradation in Precast Concrete Elements

In the past century, precast reinforced concrete has become the most widely used construction material in infrastructure engineering, especially for long-span structures. Nowadays, a growing research area concerns the assessment of concrete strength degradation due to environmental exposure and reinforcement corrosion. This paper reports an experimental campaign on some prefabricated concrete elements that were exposed to atmospheric agents for approximately 20 years. The campaign took the uncommon opportunity to access the full inspection and sampling of rebar. The included activities had different invasiveness and encompassed inspections, core sampling, corrosion potential mapping, compressive strength tests, as well as neutralization depth assays on cored surfaces, on chisel-split surfaces, and on drilling powders. The results bring together a global diagnostic picture of very limited degradation and of elements that are fully able to attend their design service life; the latter is estimated to be considerably higher than 20 years and to exceed 75 years if the concrete mix does not show quality issues. Results also permit drawing considerations on a hierarchy of diagnostic reliability in the evaluation of RC degradation, in which concrete core sampling plays the role of golden standard.

Diagnostic Accuracy of Cystic Lesions Using a Pre-Programmed Low-Dose and Standard-Dose Dental Cone-Beam Computed Tomography Protocol: An Ex Vivo Comparison Study

Background: This study aimed to analyze the diagnostic reliability of radiographic assessment of cystic lesions using a pre-set, manufacturer-specific, low-dose mode compared to a standard-dose dental cone-beam computed tomography (CBCT) imaging protocol. Methods: Forty pig mandible models were prepared with cystic lesions and underwent both CBCT protocols on an Orthophos SL Unit (Dentsply-Sirona, Bensheim, Germany). Qualitative and quantitative analysis of CBCT data was performed by twelve investigators independently in SIDEXIS 4 (Dentsply-Sirona) using a trial-specific digital examination software tool. Thereby, the effect of the two dose types on overall detectability rate, the visibility on a scale of 1 (very low) to 10 (very high) and the difference between measured radiographic and actual lesion size was assessed. Results: Low-dose CBCT imaging showed no significant differences considering detectability (78.8% vs. 81.6%) and visibility (9.16 vs. 9.19) of cystic lesions compared to the standard protocol. Both imaging protocols performed very similarly in lesion size assessment, with an apparent underestimation of the actual size. Conclusion: Low-dose protocols providing confidential diagnostic evaluation with an improved benefit–risk ratio according to the ALADA principle could become a promising alternative as a primary diagnostic tool as well as for radiological follow-up in the treatment of cystic lesions.