Pilot study of telemedicine for the initial evaluation of general surgery patients in the clinic and hospitalized settings

Caleb Schroeder ⁎

Mary Lanning Healthcare, 715 N Kansas Ave., Suite 205, Hastings, NE, 68901

article info

Article history:

Received 7 February 2019

Received in revised form 5 June 2019

Accepted 17 June 2019

Available online 12 July 2019

Background: Telemedicine has had limited implementation for general surgery. The purpose of this study was to evaluate telemedicine for the initial evaluation of patients in the clinic and hospital settings.

Methods: Synchronous telemedicine consults were conducted by a single surgeon to a rural hospital and clinic. Reasons for consult, adequacy of consult, days saved by telemedicine consult compared to standard practice, correlation of telemedicine and in-person physical exam, and number of patients who required procedures were evaluated.

Results: On average, patients were evaluated 7.4 days more rapidly than if the consult had been done by our standard practice. Telemedicine was adequate for all patients in this study.

Conclusions: This is the first study using telemedicine for the initial consult of general surgery patients in the hospitalized and clinic setting in North America. The physical exam remains an important component of the general surgery evaluation, and special attention must be considered when structuring the telemedicine program. Telemedicine is an effective and expedient way to provide consultation for general surgery patients. Further study is needed to determine which general surgery issues are not amendable to telemedicine consultation, and to determine other surgical specialties that could utilize telemedicine in their practice.

© 2019 The Author. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Artificial Intelligence–Assisted System in Postoperative Follow-up of Orthopedic Patients: Exploratory Quantitative and Qualitative Study

Yanyan Bian* , MD; Yongbo Xiang* , MD; Bingdu Tong, MA; Bin Feng, MD; Xisheng Weng, MD

Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College,

Beijing, China

* these authors contributed equally

Corresponding Author:

Xisheng Weng, MD Department of Orthopedic Surgery Peking Union Medical College Hospital Chinese Academy of Medical Science and Peking Union Medical College No 1 Shuaifuyuan, Dongcheng District Beijing, 100073 China Phone: 86 13021159994

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Abstract

Background: Patient follow-up is an essential part of hospital ward management. With the development of deep learning algorithms, individual follow-up assignments might be completed by artificial intelligence (AI). We developed an AI-assisted

follow-up conversational agent that can simulate the human voice and select an appropriate follow-up time for quantitative, automatic, and personalized patient follow-up. Patient feedback and voice information could be collected and converted into text data automatically.

Objective: The primary objective of this study was to compare the cost-effectiveness of AI-assisted follow-up to manual follow-up of patients after surgery. The secondary objective was to compare the feedback from AI-assisted follow-up to feedback

from manual follow-up.

Methods: The AI-assisted follow-up system was adopted in the Orthopedic Department of Peking Union Medical College Hospital in April 2019. A total of 270 patients were followed up through this system. Prior to that, 2656 patients were followed

up by phone calls manually. Patient characteristics, telephone connection rate, follow-up rate, feedback collection rate, time spent, and feedback composition were compared between the two groups of patients.

Results: There was no statistically significant difference in age, gender, or disease between the two groups. There was no significant difference in telephone connection rate (manual: 2478/2656, 93.3%; AI-assisted: 249/270, 92.2%; P=.50) or successful follow-up rate (manual: 2301/2478, 92.9%; AI-assisted: 231/249, 92.8%; P=.96) between the two groups. The time spent on 100 patients in the manual follow-up group was about 9.3 hours. In contrast, the time spent on the AI-assisted follow-up was close to 0 hours. The feedback rate in the AI-assisted follow-up group was higher than that in the manual follow-up group (manual: 68/2656, 2.5%; AI-assisted: 28/270, 10.3%; P<.001). The composition of feedback was different in the two groups. Feedback from the AI-assisted follow-up group mainly included nursing, health education, and hospital environment content, while feedback from the manual follow-up group mostly included medical consultation content.

Conclusions: The effectiveness of AI-assisted follow-up was not inferior to that of manual follow-up. Human resource costs are saved by AI. AI can help obtain comprehensive feedback from patients, although its depth and pertinence of communication need to be improved.

(J Med Internet Res 2020;22(5):e16896) doi: 10.2196/16896

KEYWORDS

artificial intelligence; conversational agent; follow-up; cost-effectiveness

The impact of COVID-19 on gastric cancer surgery: a single-center retrospective study

Yu-xuan Li1† , Chang-zheng He1† , Yi-chen Liu1† , Peng-yue Zhao1 , Xiao-lei Xu1 , Yu-feng Wang2 , Shao-you Xia1* and Xiao-hui Du1

Abstract

Background:The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients.

Methods: The ‘COVID-19’ period was defined as occurring between 2020 and 01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study.

Results: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2, 20]; p = 0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p = 0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p < 0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p = 0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p < 0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR: 7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p = 0.006).

Conclusion: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.

Keywords: Gastric cancer, Coronavirus disease 2019, COVID-19, Retrospective analysis

Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic

Grace F. Chao, MD, MSc, Kathleen Y. Li, MD, MSc, [...], and Chad Ellimoottil, MD, MSc

Additional article information

Associated Data

Supplementary Materials

Key Points

Question

What were telehealth use patterns across surgical specialties before and during the COVID-19 pandemic?

Findings

In this statewide cohort study that included 4405 surgeons, telehealth use grew substantially during the early pandemic period and declined during the later period; this use varied by surgical specialty. Compared with 2019 visit volume, telehealth salvaged only a small portion of 2020 surgical visits.

Meaning

Telehealth is being used in surgical fields at rates higher than before the pandemic, and its use varies across surgical specialties.

星期一, 25 4月 2022

Rapid Killing and Biofilm Inhibition of Multidrug‐ Resistant Acinetobacter baumannii Strains and Other Microbes by Iodoindoles

Chaitany Jayprakash Raorane †, Jin‐Hyung Lee † and Jintae Lee *

       School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, Korea; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (C.J.R.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (J.‐H.L.) * Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。; Tel.: +82‐53‐810‐2533; Fax: +82‐53‐810‐4631 † These authors contributed equally to this work. Received: 23 June 2020; Accepted: 12 August 2020; Published: 14 August 2020

Abstract: Multi‐drug resistant Acinetobacter baumannii is well‐known for its rapid acclimatization in hospital environments. The ability of the bacterium to endure desiccation and starvation on dry surfaces for up to a month results in outbreaks of health care‐associated infections. Previously, indole and its derivatives were shown to inhibit other persistent bacteria. We found that among 16 halogenated indoles, 5‐iodoindole swiftly inhibited A. baumannii growth, constrained biofilm formation and motility, and killed the bacterium as effectively as commercial antibiotics such as ciprofloxacin, colistin, and gentamicin. 5‐Iodoindole treatment was found to induce reactive oxygen species, resulting in loss of plasma membrane integrity and cell shrinkage. In addition, 5‐iodoindole rapidly killed three Escherichia coli strains, Staphylococcus aureus, and the fungus Candida albicans, but did not inhibit the growth of Pseudomonas aeruginosa. This study indicates the mechanism responsible for the activities of 5‐iodoindole warrants additional study to further characterize its bactericidal effects on antibiotic‐resistant A. baumannii and other microbes.

Keywords: Acinetobacter baumannii; antibiotics; biofilm; 5‐iodoindole; membrane damage 

星期日, 24 4月 2022

Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review

Eyitayo Omolara Owolabi1 • Tamlyn Mac Quene1 • Johnelize Louw1 • Justine I. Davies1,2,3 • Kathryn M. Chu1,4

Accepted: 10 March 2022 The Author(s) under exclusive licence to Socie´te´ Internationale de Chirurgie 2022

1 Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa

2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK

3 Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, South Africa

4 Department of Surgery, University of Botswana, Gaborone, Botswana

Abstract

       Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking.

       Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes.

       Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes.