Initial experience with a wireless personal digital assistant as a teleradiology terminal for reporting emergency computerized tomography scans

A new type of terminal device, a wireless personal digital assistant (PDA) based on a GSM digital cellular phone, was used to transmit computerized tomography scans of 21 patients to a neuroradiologist. All transmitted images were suitable for a preliminary consultation and in one case a final report could be made. In 18 cases the findings were compatible with the reference film reading performed later and in three cases there were minor differences of no clinical importance. Transmission of a single image lasted 1 min 30 s and the transmission of a complete brain scan (14 images) took on average 21 min. The total process of transmission and interpretation of a brain examination series took on average 40 min. In this pilot study the neuroradiologist gained essential information in 24% of the cases and beneficial information in 62%. The neuroradiologist considered that the image consultation saved a hospital visit in 15 cases (71%). Although PDA technology is at an early stage of development and has numerous limitations, it is likely that future technical improvements will allow easier clinical consultations for neurosurgeons and neurologists.     

Quality of consultation and the project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN)

OBJECTIVE: Consultation of another physician is one of the requirements for prudent practice. The project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN) is aimed at professionalizing consultation. The objective of this study is to assess whether the quality of consultation was improved through SCEN. METHOD: In four districts all general practitioners (GPs) received a pre-test questionnaire approximately six weeks before the start of the project in the period (n=1224, response 71%). In the period from April 2000 to December 2002, all GPs in districts in which SCEN had been implemented received a written post-test questionnaire one and a half years after the start of the project. This post-test questionnaire was returned by 60% of the GPs (n=3614). RESULTS: In SCEN consultations the attending physicians has no specific relation to the attending physician in 85% of consultations, while this is the case for 31% of other consultations. While before the start of SCEN in 71% of consultations six or seven of the seven criteria for good consultation were met, in SCEN consultations 83% of cases six or seven of these requirements were met. GPS who had consulted a SCEN physician generally were more positive about different aspects than those who consulted another consultant, such as considering the consultant to be able to make an independent judgement (totally agree 74% versus 59%). CONCLUSION: Although the quality of consultation appears to be high for both SCEN physicians and other consultants, the SCEN project further contributed to the quality of consultation. Since GPs attach importance to judgement of SCEN physician and have the intention to use it in future, and the quality of consultation stays high over time, this project is expected to maintain its value.     

口腔专科互联网医院的初步探索

互联网医院对于推进分级诊疗,缓解"看病贵、看病难"问题有重要作用。作者介绍了某三级甲等口腔医院在新型冠状病毒肺炎疫情期间通过口腔专科互联网医院开展免费在线咨询的实践,并分析医生应答率、医生接诊反应时间、患者咨询的专科分布和时段分布等特点。医院依托广东云医院平台,采用两种模式开展在线咨询服务。其中,普通咨询模式采用"多对多"方式,接诊医生团队由主治医师和任职3年以下的副主任医师组成,非工作时间患者也可在线提问。专家咨询模式由任职3年及以上的副主任医师和主任医师采用一对一方式解答患者在工作时间的提问。2020年2月10日至3月22日,普通咨询模式下接受咨询2156人次,专家咨询模式下接受咨询1043人次;后者的接诊反应时间(16.19 min)明显短于前者(27.10 min);各二级专科中,口腔内科咨询量最大(69.30%);普通咨询模式工作时段的咨询量仅占总量的73.47%。今后应优化资源配置、增加人工智能问诊功能、拓展线上线下相结合的口腔诊疗服务模式、完善绩效管理等,以促进口腔专科互联网医院可持续发展。     

How do patients experience consultations at an orthopaedic out-patient clinic?: Eighteen patients comment on video-taped consultations: a qualitative study

The purpose of this study is to describe experiences of communicationin medical consultations, obtained after patients have observedand commented on their own video recorded consultations. Eighteenpatients in an orthopaedic out-patient clinic were randomlyselected and, of these, 10 were men and 8 were women. Nine ofthe visits were first-time consultations and an equal numberwere follow-ups. We explained that we wanted to understand whattakes place between a doctor and patient, both when the experienceis satisfactory and when it is not. Approximately 1 week afterthe consultation, the patient was allowed to watch the videorecording. Prior to viewing this, the patient was instructedthat we were particularly interested in his/her viewpoints andspontaneous reactions. Every time a patient wished to say something,the videotape was stopped and the comments recorded. These commentswere later transcribed. The patients' negative comments (60%)described four kinds of experiences indicating aspects of poorcommunication: i) the patient had difficulty understanding whatthe physician asked, said or did, ii) the physician was insufficientlyprepared for the consultation, iii) the physician questionedthe findings of other doctors and iv) the physician showed alack of understanding.     

An analysis of unsuccessful teleconsultations

Over six years, 4317 teleconsultations were scheduled in the Arizona Telemedicine Program. A total of 402 scheduled teleconsultations (9.3%) did not take place. A review showed that 254 were cancelled but eventually took place (5.9%), while 148 never took place (3.4%). The cost of a teleconsultation to the service provider was, at minimum, 228 US dollars. Telepsychiatry accounted for all the missed consultations that eventually took place, and 92% of these were from three of the six sites referring telepsychiatry patients. Pain management (23%) and psychiatry (21%) accounted for the largest proportions of teleconsultations that never took place. Telepsychiatry cases accounted for 71% of all unsuccessful consultations and accounted for only 34% of successful teleconsultations during the same period. Most missed teleconsultations had been scheduled as realtime sessions (84%). The most common reason for unsuccessful teleconsultations was that the patient did not attend (26%), followed by the patient having to be seen in person (17%). Although all referring sites had unsuccessful cases, certain sites accounted for more than others. These were sites that scheduled more telepsychiatry consultations than the others. The proportion of unsuccessful cases per site ranged from 4% to 17% of the total number of scheduled teleconsultations.     

Consultation times in emergency telemedicine using realtime videoconferencing

We reviewed 2135 consecutive emergency teleconsultations, which were received at an academic emergency department from state correctional facilities. During the 52-week study period, an average of 5.8 video-consultations per day were performed. A total of 1522 consultations (71%) had complete start and end consultation times, and were included in the analysis. Of these, 923 were managed primarily by emergency medicine residents and physician assistants, while the remaining 599 were managed by attending physicians alone. Following consultation, the disposition of the patients included 940 who were transported to the emergency department, 351 who were discharged to the general facility population and 193 who were admitted to the local infirmary. Overall, 38% of patients avoided a journey to the emergency department. The average consultation time was 17 min (95% confidence interval [CI], 10-24). The average consultation time for residents and physician assistants was 16 min (95% CI, 8-24) and it was 19 min (95% CI, 11-27) for attending physicians. Consultation time for patients not transported to the emergency room was 21 min (95% CI, 13-29), while for patients transferred to an emergency department, consultation time was 15 min (95% CI, 9-21). These results may assist in planning the workforce requirements for emergency department-based telemedicine services.     

Digital wireless radiology consultations with a portable computer.

A wireless system for radiological subspecialist consultation based on a portable personal computer and a GSM cellular phone was tested. A link with secure access to the hospital image network was built. A total of 68 emergency computerized tomography (CT) examinations were transmitted. Transmission time via GSM for a single CT image was 1 min and for a complete head scan was 18 min. The transmitted images were acceptable for final diagnosis in 72% of the cases, the rest being acceptable for preliminary diagnosis. The diagnosis from the transmitted images did not change after a later review of the original images in 97% of cases. The wireless link saved a hospital visit by the senior radiologist in 24% of cases. The results show that a remote consultation link can be built with readily available technology and that the technique is useful in radiological subspecialist consultations for CT images.     

Consulta de atención primaria: ¿todo es del médico?

ObjectivesTo find out the proportion of primary healthcare consultations that could be attended by another professional other than the doctor.Designmulticentre cross-sectional study.LocationPrimary healthcare, west-gipuzkoa region, with 17 health centres taking part.ParticipantsReasons for consultation dealt with by 38 doctors over 5 days.Main measurementsAge, sex, frequency, category, initiative, reason for consultation and ideal level of healthcare.ResultsA total of 4,377 patients who generated 5,592 consultations were included. The average frequency was 10 visits/year. The large majority (93.1%) of consultations took place in the centre, 5.4% by telephone and 1.5% were home visits.A total of 74.4% of the consultations were requested, 17.2% arranged by the doctor, 6.4% arranged by protocol, 2% at the request of other professionals, and 8% were urgent.The reasons were; 71.5% (95% CI: 69.8-73.2) were medical clinical, 7.2% (6.2-8.2) minor symptoms, 18.4% (17.1-19.5) bureaucratic, and 2.9% (2.3-3.3) for information.The consultations for medical reasons accounted for 80.5% (79.3-81.7) and 19.5% (18.3-20.7) were for non-medical reasons. Non-medical reasons made up 29.3% of the telephone consultations, 20.2% of the consultations in the centre, and 2.4% of the home visits, as well as 16.7% of the urgent consultations.The ideal level of healthcare was considered to be doctor 80.7%, 13.2% nursing and 2.8% administrative. In the consultations for minor symptoms, nursing was considered the ideal level in 65.3% of cases.ConclusionsOne out of every 5 consultations could be dealt with by a professional other than the doctor, which in 5 hours of consultations would allow 1 hour to be gained which could be used for other activities.     

Prospective case review of a global e-health system for doctors in developing countries

The Swinfen Charitable Trust has managed email consultations for doctors in developing countries since 1999. The process was handled manually for the first three years and then subsequently using an automatic message-handling system. We conducted a prospective review of email consultations between referring doctors and consulting specialists during six months of automatic operation (December 2003 to May 2004). During the study period 125 consultations took place. These concerned a wide range of specialties (e.g. orthopaedics 17%, dermatology 16%, obstetrics and gynaecology 11%, radiology 10%). Of these referrals, 33% (41) were for paediatric cases. Consulting specialists, who were based in five countries, were volunteers. Referring doctors were from 24 hospitals in 12 developing countries. The median time from referral to definitive reply was 1.5 days (interquartile range 0.6-4.9). There was an 85% response rate (n = 106) to a survey concerning the value of the consultation to the referring doctor. All the referring doctors who responded made positive comments about the service and half said that it improved their management of the case. The second-opinion consultation system operated by the Swinfen Charitable Trust represents an example of a global e-health system operated for altruistic, rather than commercial, reasons.     

Validation of self-reported cellular phone use

BACKGROUND: In recent years, concern has been raised over possible adverse health effects of cellular telephone use. In epidemiological studies of cancer risk associated with the use of cellular telephones, the validity of self-reported cellular phone use has been problematic. Up to now there is very little information published on this subject. METHODS: We conducted a study to validate the questionnaire used in an ongoing international case-control study on cellular phone use, the "Interphone study". Self-reported cellular phone use from 68 of 104 participants who took part in our study was compared with information derived from the network providers over a period of 3 months (taken as the gold standard). RESULTS: Using Spearman's rank correlation, the correlation between self-reported phone use and information from the network providers for cellular phone use in terms of the number of calls per day was good (r=0.62, 95% CI: 0.45-0.75), while that of the average duration of each call was rather moderate (r=0.34, 95% CI: 0.11-0.54). Similar results were found when Kappa coefficients were estimated. A value of r=0.56 (Spearman's correlation, CI: 0.38-0.70) was found for cumulative cellular phone use. CONCLUSION: Our study suggests that cellular phone use is easier to recall in terms of number of calls made than in terms of cumulative phone use and should thus be used as the basis for the dose-response analysis.     

Infectious disease consultations in a Japanese tertiary care teaching hospital: a retrospective review of 508 cases

Objective

Limited epidemiological data are available at tertiary care teaching hospitals in Japan. We reviewed infectious disease (ID) consultations in a tertiary acute care teaching hospital in Japan.

Methods

This is a retrospective review of the ID consultations from October 2016 to December 2017. The demographic data, such as requesting department, consultation wards, and final diagnosis, were analyzed.

Results

There were 508 ID consultations during the 15-month study period. Among the 508 consultations, 201 cases (39.6%) were requested from the internal medicine department and 307 cases (60.4%) were requested from departments other than internal medicine. The most frequent requesting departments were Surgery (n?=?102, 20.1%), Pulmonary Medicine (n?=?41, 8.1%), and Plastic Surgery (n?=?35, 6.7%). The most common diagnoses were intra-abdominal (n?=?81, 16.0%), respiratory (n?=?62, 12.2%), and skin and soft tissue infections (n?=?59, 11.6%). ID consultations for disease diagnosis and management were more frequent in the internal medicine group than in the non-internal medicine group (37 cases, 20.8% vs. 40 cases, 13.7%, p?=?0.046), and the number of requests for consultations for noninfectious diseases at the time of final diagnosis was higher in the internal medicine group than in the non-internal medicine group (21 cases, 11.8% vs. 16 cases, 5.5%, p?=?0.0153).

Conclusion

Some physicians prefer ID specialists to identify and solve various medical problems. Internists had a greater tendency to request consultations for diagnostic problems, and noninfectious disease specialists have more requests for consultation at the point of final diagnosis. The role of ID specialists is expanding, from individual patient management to antibiotic stewardship, antibiotic prophylaxis, and development of and adherence to antibiotic protocol implementation based on the hospital’s microbial susceptibility and infection control. Although the number of specialists is limited in Japan, ID services now play an important role for achieving a good outcome in patient management.

     

273例医疗纠纷原因分析

目的探讨医疗纠纷发生的原因,提出相应的防范对策和建议,以期提高医院的管理水平。方法采用回顾性流行病学调查方法,对上海市某综合性医院2011—2013年的273例医疗纠纷进行分析。结果医疗纠纷涉及的主要人员中副高职称以上者占56.8%;外科医疗纠纷发生的比率最高,为40.3%,其次是内科,为27.8%;医源性投诉的比例最高,为72.2%,其中因服务态度导致的医疗纠纷比例为34%;医疗纠纷的处理以选择协商途径的比例最高,为89.7%。结论医源性投诉是医疗纠纷的主要原因,其中服务态度引发的医疗纠纷比率最高。为有效预防医疗纠纷的发生,应加大科室管理力度,健全和落实各项医疗规章制度,引入人民调节机制,积极借鉴国外相关医患矛盾处理制度,提高医疗技术水平和服务质量。     

Diagnoses, requests and timing of 503 psychiatric consultations in two general hospitals

The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time). This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%), adjustment disorder (10.9%) and cognitive disorder (7.6%). In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13). Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.     

Use of outpatient services in Pelotas, Rio Grande do Sul State, Brazil: factors related to above-average number of physician visits

This cross-sectional, population-based study including males and females 20 to 69 years of age from the urban area of Pelotas, Rio Grande do Sul State, Brazil, aimed to verify characteristics associated with above-average number of medical consultations. The mean number of physician consultations in the previous year was 3.2, with a standard deviation of 5.5. The analysis considered two outcomes: individuals with more than eight physician visits per year (one SD above the mean) and more than 14 consultations (two SD above the mean). In the sample of 1,962 individuals, 183 (9.3%) reported more than eight physician consultations in the previous year. Logistic regression compared the outcomes with the following variables: sex, age, diabetes mellitus, hypertension, chronic bronchitis, minor psychiatric disorders, and hospitalization in the previous year. There were 57 individuals (2.9%) with more than 14 consultations during the year. Logistic regression showed significant differences for sex, hypertension, minor psychiatric disorders, and hospitalization in the previous year. The high demand does not always mean inadequate health services, and restricting the demand could result in policies that limit access to care, causing suffering to patients with serious conditions.     

The expression of aversion to medicines in general practice consultations

Although the relevance of patients' views about medicines for their medicine taking behaviour is now well established, little is known about the ways in which these views are discussed in primary care consultations. In particular, many studies have demonstrated patients' aversion to medicines. This paper examines the form that aversion talk takes in the consultation and how doctors respond to patients' expression of aversion to medicines. It is based on a dataset of 35 case studies of general practice consultations in England. In interviews with researchers, aversion to medicines was expressed in 34 of the 35 cases. In consultations with doctors, aversion was expressed in 10 cases. The interactional dimension of aversion talk in consultations was analysed using Conversation Analysis, and two general patterns were identified. Aversion could be used as an interactional resource, or it could be a topic in its own right. If used as an interactional resource, no real discussion of patients' views of medicines took place. When aversion was a conversational topic in its own right, two situations were observed. Firstly, the doctor elicited patients' views directly. Secondly, patients initiated aversive talk using a range of indirect strategies to do so. Even when patients managed to express their aversion to medicines, doctors did not engage them in any real discussion of their views. A scheme of interpretation is suggested to explain these findings. In this scheme patients perceive medicines to be an extension of the doctor and to be beneficial. In this view it is right for doctors to prescribe medicines and for patients to take medicines. The results of this paper suggest that using aversion as an interactional resource might be the only safe way for patients to express their aversion without seeming to breach the social contract.     

The impact of matching the patient's vocabulary: a randomized control trial

BACKGROUND: Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation. OBJECTIVE: The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations. METHODS: The study took place in one inner city general practice. Patients (n=62) were randomized to either matched or unmatched vocabulary consultations when consulting for problems relating to sexual or bodily function or anatomy. Matched consultations required the doctor to use the same vocabulary as the patient. Unmatched consultations required the doctor to use medical vocabulary. Completed questionnaires were received from 60 patients. The main outcome measure was patient satisfaction (using the Medical Interview Satisfaction Scale). This assesses total satisfaction and has four subscales: distress relief; communication comfort; rapport; and compliance intent. Doctor satisfaction with the consultation was also assessed. RESULTS: The results showed that the two groups were comparable for demographic variables and doctor satisfaction. However, patients in the matched consultation group had significantly higher total satisfaction scores and higher ratings of rapport, communication comfort, distress relief and compliance intent than those in the unmatched group. CONCLUSION: The results indicate that a doctor's choice of vocabulary affects patient satisfaction immediately after a general practice consultation and that using the same vocabulary as the patient can improve patient outcomes.     

Evaluation of the benefits for the patient arising from an inter-hospital teleradiology network in a French administrative area

We conducted a prospective study of the teleradiology network which connects 15 hospitals in the Aquitaine area. All transmissions sent over a one-year period were examined (data transmitted at the time of the remote consultation and health outcomes of patients from their medical records). For emergency cases, the main outcome measure of effectiveness was the proportion of avoided transfers. For non-emergency cases, the main outcome measure of effectiveness was the proportion of transfers, hospitalizations and consultations avoided. There were 737 transmissions, of which 664 (90%) met the inclusion criteria. Of these, 562 (85%) were for emergency care and 102 (15%) for non-emergency care. In emergency care, the pathologies most often associated with a remote consultation were cerebral pathologies (88%) and traumatic spinal pathologies (8%); the proportion of avoided transfers was 48%. In non-emergency care, the specialties most often concerned with remote consultations were neurology/neurosurgery (36%), cardiology and pulmonary diseases (17%) and gastroenterology (14%). Transfer was avoided for 37% of the patients and hospitalization for 12%. An additional consultation occurred after remote consultation for 2% of the patients. The results confirm the effectiveness of an inter-hospital teleradiology network.     

The value of case studies

Background: Studies describing GP consultation have identified duration of consultation as an important marker of patient satisfaction. Duration of consultation differs between countries. Objective: The aim of this study was to measure the duration of consultations and the different segments of the consultation in a representative sample of GPs in the Nantes district (France).

Material and methods: 150 GPs in the Nantes district were randomly selected from the telephone directory. A letter of explanation was sent, followed up by a telephone call asking the GPs to receive an observer into their surgery. The observer timed consultations and the different segments of the consultation. Results: 30 out of 150 GPs contacted agreed to participate. 329 consultations were observed. Average duration of consultation was 14 min and 24 s; it was 15 min in non-computerised practices and 12 min and 50 s in computerised practices. Consultations for psychological problems or with many reasons for consulting took longer. Doctors usually talked more than patients, except during long consultations. Patients were not examined in only 2% of consultations. Trainers in general practice had longer consultations. Discussion: Many GPs refused to receive the observer; the ratio of trainers within the group of respondents (40%) was higher than in the general GP population (7–10%). As in other studies, female GPs were overre-presented as active participants. In our sample, the average duration of consultation was longer than in other studies. The finding regarding the duration of consultation in computerised practices may need validation in other studies. EurJ Gen Pract 2000;6:88–92.