Telehealth utilization during the Covid-19 pandemic: A systematic review.

Objectives:Identify and summarize the available literature on the acceleration in the use of telemedicine in the midst of the COVID-19 pandemic, with an aim to provide justification and guidance fo...

https://journals.sagepub.com/doi/pdf/10.1177/2150132720980612

Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review.

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Medicare and Medicaid Services pledged payment for telehealth visits for the duration of this public health emergency in an effort to decrease COVID-19 transmission and allow for deployment of residents and attending physicians to support critical-care services. Although the COVID-19 pandemic has vastly expanded telehealth use, no studies to our knowledge have analyzed the implementation and success of telehealth for orthopaedic trauma. This population is unique in that patients who have experienced orthopaedic trauma range in age from early childhood to late adulthood, they vary across the socioeconomic spectrum, may need to undergo emergent or urgent surgery, often have impaired mobility, and, historically, do not always follow-up consistently with healthcare providers. QUESTIONS/PURPOSES: (1) To what extent did telehealth usage increase for an outpatient orthopaedic trauma clinic at a Level 1 trauma center from the month before the COVID-19 stay-at-home order compared with the month immediately following the order? (2) What is the proportion of no-show visits before and after the implementation of telehealth? METHODS: After nonurgent clinic visits were postponed, telehealth visits were offered to all patients due to the COVID-19 stay-at-home order. Patients with internet access who had the ability to download the MyChart application on their mobile device and agreed to a telehealth visit were seen virtually between March 16, 2020 and April 10, 2020 (COVID-19) by three attending orthopaedic trauma surgeons at a large, urban, Level 1 trauma center. Clinic schedules and patient charts were reviewed to determine clinical volumes and no-show proportions. The COVID-19 period was compared with the 4 weeks before March 16, 2020 (pre-COVID-19), when all visits were conducted in-person. The overall clinic volume decreased from 340 to 233 (31%) between the two periods. The median (range) age of telehealth patients was 46 years (20 to 89). Eighty-four percent (72 of 86) of telehealth visits were postoperative and established nonoperative patient visits, and 16% (14 of 86) were new-patient visits. To avoid in-person suture or staple removal, patients seen for their 2-week postoperative visit had either absorbable closures, staples, or nonabsorbable sutures removed by a home health registered nurse or skilled nursing facility registered nurse. If radiographs were indicated, they were obtained at outside facilities or our institution before patients returned home for their telehealth visit. RESULTS: There was an increase in the percentage of office visits conducted via telehealth between the pre-COVID-19 and COVID-19 periods (0% [0 of 340] versus 37% [86 of 233]; p < 0.001), and by the third week of implementation, telehealth comprised approximately half of all clinic visits (57%; [30 of 53]). There was no difference in the no-show proportion between the two periods (13% [53 of 393] for the pre-COVID-19 period and 14% [37 of 270] for the COVID-19 period; p = 0.91). CONCLUSIONS: Clinicians should consider implementing telehealth strategies to provide high-quality care for patients and protect the workforce during a pandemic. In a previously telehealth-naive clinic, we show successful implementation of telehealth for a diverse orthopaedic trauma population that historically has issues with mobility and follow-up. Our strategies include postponing long-term follow-up visits, having sutures or staples removed by a home health or skilled nursing facility registered nurse, having patients obtain pertinent imaging before the visit, and ensuring that patients have access to mobile devices and internet connectivity. Future studies should evaluate the incidence of missed infections or stiffness as a result of telehealth, analyze the subset of patients who may be more vulnerable to no-shows or technological failures, and conduct patient surveys to determine the factors that contribute to patient preferences for or against the use of telehealth. LEVEL OF EVIDENCE: Level III, therapeutic study.

What Was the Change in Telehealth Usage and Proportion of No-show Visits for an Orthopaedic Trauma Clinic During the COVID-19 Pandemic?

Deferring Elective Urologic Surgery During the COVID-19 Pandemic: The Patients' Perspective.

The global urgency surrounding the COVID-19 pandemic caused by the SARS-CoV-2 virus underscores the need for effective strategies in promptly controlling its spread and ensuring accurate diagnosis. This review delves into the potential of optical nanophotonic biosensors to facilitate rapid and precise detection of SARS-CoV-2 biomarkers, thereby enabling telehealth-based diagnosis of COVID-19. A comprehensive analysis covers various optical biosensor modules, including interferometric optical methods, resonance shifts, plasmonic optics, colorimetric, fluorescence, surface-enhanced Raman scattering (SERS), and bio-nanophotonics, all applied in the context of COVID-19 diagnosis. Additionally, the review explores the integration of telemedicine services, such as telehealth, telemonitoring, telemanagement, telescreening, and teleconsultation, with nanophotonic biosensors, emphasizing their roles in diagnosing COVID-19. The examination provides valuable insights into the pros and cons of utilizing optical biosensors within telemedicine systems for COVID-19 patient diagnosis. The review concludes by suggesting that by improving the sensitivity and specificity of biosensors, telehealth-based diagnostic tools can significantly enhance patient outcomes and mitigate the transmission of COVID-19. The integration of optical biosensors with other diagnostic technologies is proposed as a means to boost the overall efficiency of telehealth-based diagnostic systems, potentially saving numerous lives in future pandemic scenarios. 

State-of-the-art telemodule-enabled intelligent optical nano-biosensors for proficient SARS-CoV-2 monitoring

To identify the periprostatic structures associated with early return of urinary continence after radical prostatectomy (RP).

Evaluating post radical prostatectomy mechanisms of early continence

Proteinaceous Renal Stones in a Kidney Transplant Candidate Presenting as Bilateral Filling Defects Suspicious for Upper Urinary Tract Transitional Cell Carcinoma.

Background Patient understanding of cancer-associated risk influences treatment preferences and is vital for making informed treatment decisions. Although patients traditionally relied on physician visits for cancer information, most adults now use the Internet as a primary source of health information. Objective To evaluate whether US adults can accurately estimate survival for hypothetical prostate cancer patients using unrestricted Internet searching and an online nomogram. Design, setting, and participants Adults were recruited at the Minnesota State Fair. Participants were shown a pathology report for a prostatectomy cancer specimen and asked to estimate the patient’s 15-yr survival using an unrestricted Internet search. Participants were then asked to re-estimate using a freely available, validated prostate cancer nomogram. Outcome measurements and statistical analysis Participants’ answers were compared to a “reference” estimate and a “ballpark” estimate of ±10 percentage points of the “reference” value. Results and limitations A total of 129 participants met the inclusion criteria and generated complete responses. Only 12% (95% confidence interval [CI] 7.8–19.2%) were within the “ballpark” estimate when using unrestricted Internet searching for overall survival estimates. 23% (95% CI 16.8–31.3%) correctly used the nomogram and 51% (95% CI 42.6–59.6%) estimated within the “ballpark” when using the nomogram. Conclusions Use of an unrestricted Internet search often yields inaccurate estimations of life expectancy, while estimations significantly improve with nomogram use. Physicians should educate and guide patients towards credible online health resources, facilitate their effective use, and engage in discussion with patients regarding the utility of this information. Patient summary The general public finds it difficult to estimate prostate cancer survival using unrestricted Internet searches. Most patients would benefit from Internet guidance from their clinicians to better understand prostate cancer pathology reports.

Prostate Cancer Survival Estimates by the General Public Using Unrestricted Internet Searches and Online Nomograms.

https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1367&context=urology_articles

Managing Urology Consultations During COVID-19 Pandemic: Application of a Structured Care Pathway.

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Evaluating post radical prostatectomy mechanisms of early continence

Proteinaceous Renal Stones in a Kidney Transplant Candidate Presenting as Bilateral Filling Defects Suspicious for Upper Urinary Tract Transitional Cell Carcinoma.

Prostate Cancer Survival Estimates by the General Public Using Unrestricted Internet Searches and Online Nomograms.

Managing Urology Consultations During COVID-19 Pandemic: Application of a Structured Care Pathway.