南沙某岛礁医院皮肤病远程会诊的实施与分析

目的 分析南沙某岛礁医院皮肤病远程会诊病例所具有的特点,对远程会诊中的相关问题进行探讨,以提升皮肤病的诊疗水平。方法 应用皮肤病检测仪对南沙某岛礁医院皮肤科就诊的部分患者进行远程会诊,分析会诊病例的病种组成,并调查患者对远程会诊的满意度。结果 远程会诊共完成75例,排名前3位的病种分别是体股癣、红火蚁蜇伤、病毒疣。远程会诊的满意度调查结果显示,非常满意60例,比较满意12例,基本满意3例,满意率达96.0%。结论 岛礁皮肤病远程会诊的病例以感染性皮肤病和虫媒叮咬为主,与环境和气候因素相关,日常生活中需要加强防护;患者对远程会诊的满意度高,远程会诊值得进一步推广。     

医联体远程医疗服务问卷调查分析

目的:为了解远程医疗服务对患者、基层医生以及医联体管理人员的实际意义,探索医联体医院未开展远程医疗服务或远程医疗服务量低的原因并优化服务.方法:通过问卷调查的形式,分别对牵头医院医生,医联体医院患者、医生及管理人员从7个维度进行调研.结果:远程医疗服务满意度高;发现相关问题:医联体医院配合度低、远程医疗相较于线下医疗优...     

基于扩展UTAUT模型的延安市医联体医生远程会诊使用意愿的实证研究

目的:研究医生远程会诊使用意愿及其影响因素,为促进医联体开展远程会诊工作提供参考。方法:基于UTAUT模型,新增学历、科室、医院等级及使用经验4个调节变量构建医生远程会诊使用意愿概念模型,对问卷数据进行分析。结果:绩效期望(P<0.05)、努力期望(P<0.05)、群体影响(P<0.001)、促进因素(P<0.001)均与使用意愿显著正相关,各调节变量对于4条路径的调节作用具有显著差异。结论:远程会诊对医生工作具有积极作用,但现实中仍存在某些阻滞医生使用远程会诊的因素,可考虑加强对医生尤其是高年龄段医生和患者的远程会诊相关知识与信息的宣传力度,倒逼医生提高其使用积极性、提供远程会诊实践机会与平台、培养“意见领袖”、促进医联体内医疗服务均等化发展,来提高医生远程会诊使用意愿。     

不同等级医院远程医疗服务实施情况调查研究

目的/意义 了解不同等级医院远程医疗服务开展情况,分析远程医疗服务开展过程,为远程医疗良性发展提供参考。方法/过程 采用在线问卷调查方式,收集我国26个省(直辖市、自治区)的医院远程医疗服务数据。利用SPSS 25.0软件,采用描述性分析、χ2检验、秩和检验等分析远程医疗开展时间、服务类型、业务量、远程会诊开展情况。结果/结论 72.0%三级医院和82.2%二级医院于2011年开始开展远程医疗服务,服务类型以远程会诊、远程教育、远程心电诊断、远程影像诊断、远程病理诊断为主,服务类型有待扩展,远程会诊响应时长应进一步缩短,以提升远程医疗服务效率和服务质量。     

远程医疗会诊系统在现代医院管理中的应用

随着通讯网络及多媒体技术的快速发展,患者可以足不出户就可以与医生进行病情交流、并做出前期诊断等。同时,开展远程医疗教育活动,使广大医务人员能够在第一时间了解在疾病治疗中的最新动向及最新知识。医学远程会诊及教育系统的发展也随着医学需要而迅速发展,为医院管理、信息化建设、社区保健服务、继续教育、远程医疗教学等发挥着重要作用;我院从1999年起,开通远程医疗服务以来共组织各种疑难病例或少见病例会诊47名,通过总结发现,远程会诊可为医院带来直接与间接的社会、经济效益。1优点1.1为危重病人的抢救赢得了时间在基层医院遇到未…     

基于WEB模式远程会诊申请及医学影像格式转换系统实现

远程医学使用远程通信技术和计算机多媒体技术提供医学信息和服务,为病人节省了时间和费用。目前我院的远程会诊在应用中还存在很多手动因素,如会诊单需医生手写,检查结果需使用扫描仪扫描成图片传送给对方专家等。这样既降低了医疗效率,同时因扫描仪质量原因可能造成得到的图片噪点多、局部模糊、失真等结果,给远程专家准确诊断增加了困难和小确定因素。为提高医院医疗工作效率和远程会诊质量,实现了一个基于Tomcat的网络会诊预约系统,医生通过浏览器点击儿次鼠标键盘即可提交会诊申请,病人的基本信息及诊断信息都可以直接由服务器从数据库提取,病人的检查、榆验结果包括PACS影像可以直接被转换为占用空间较小的JPG格式提取并传输,大大提高了远程会诊的办公效率,为医生和患者节省了宝贵时间。     

整合医学模式下远程视频会诊服务体系的成效及价值

目的 分析整合医学模式下远程视频会诊服务发展现状,展望远程视频会诊医疗服务平台可提供的其他医疗服务.方法 选取2015年11月至2019年12月河南省人民医院18364例远程会诊病例,描述申请会诊医院辐射距离、会诊科室、会诊类型等特点,分析会诊目的,调查申请医生对远程会诊的满意度.结果 远程会诊医院间距离为>100～2...     

远程医学的三大支撑技术

远程医学(Telemedicine)是通过远程通信技术和计算机多媒体技术,来实现对医学信息的远程采集、传输、处理和查询,以达到异地疾病诊治、远程教学、卫生保健服务、共享医疗信息资源等医疗目的.具体地说,远程医学包括远程医学影像、远程医学病理、远程咨询及会诊、远程医学教育、远程医学信息数据共享等,而医疗保健技术、远程通信技术、信息处理技术便是远程医学的三大关键技术.     

浅谈远程医疗的应用与发展

远程医疗是计算机网络和现代通讯技术、现代医学技术相结合的产物。它通过通讯和信息处理技术提供异地间的信息储存和处理手段以及传送图像、声音、文件、数据等医疗活动。远程医疗包括远程诊断、远程会诊咨询及护理、远程教育、远程医疗信息服务等所有医学活动。患者可以跨越地域的限制,选择远方城市的专家看病治疗,利用计算机、通信与信息系统技术为患者提供快捷、方便、高效和经济的医疗服务。本文介绍了远程医疗发展的现状,实际开展应用中存在的问题,并对远程医疗未来的发展进行了展望。     

基于Web服务的远程医疗会诊系统研究

针对全军远程医疗会诊系统存在的不足,结合全军远程医学信息网建设现状,设计了基于Web服务的远程医疗会诊系统,并对其体系结构、协作关系及各子系统的功能进行了详细的阐述.基于Web服务构建远程医疗会诊系统,不仅实现了与医院信息系统的良好集成,更重要的是全面提高了远程医疗会诊质量.     

社区居民就医意愿与社区卫生服务利用情况调查

采用分层随机抽样方法,对北京市方庄社区10000名居民进行问卷调查,调查居民就医去向、对社区卫生服务项目的利用情况、首诊选择社区的原因等。实际9497名受调查者中去社区卫生服务中心（站）就诊的主要目的是看病（2828例,29．8％）和开药（2677例,28．2％）;居民愿意到社区首诊的原因前三位依次为：就近方便、收费低、解释病情清晰,最后一个原因才是信任医生（3729例,39．3％）。说明居民对社区卫生服务机构的功能认识不足,对社区医生的信任度不高。     

Assessment of dermatologists’ perception of utilizing teledermatology during COVID-19 pandemic in Saudi Arabia

Objectives:To assess teledermatology (TD) perception among dermatologists in the Kingdom of Saudi Arabia during the COVID-19 pandemic and to identify the most common advantages and disadvantages of TD.Methods:We conducted a cross-sectional survey-based study to address Saudi dermatologist perceptions of TD from July 2020 to December 2020, during Covid-19 pandemic.Results:Out of 664 emails sent, 107 complete responses were returned. Approximately 40.2% used TD through phone calls, followed by those who used a virtual clinic (32.7%). Also, the best way to use TD, according to respondents, was for triage before inpatient and outpatient visits. When we compared the use of TD in the outpatient and inpatient settings, outpatient responses always had more positive attitudes than inpatients. The most important benefit of TD is to reduce the risk of pandemic infections (69%). More than half of the participants sometimes used TD for diagnosis (n=63, 58.9%) and management (n=59, 55.1%), and 69 (64.5%) considered using it in the future.Conclusion:Our survey-based study indicates that TD is an important part in the future dermatology because our participants agreed that TD decreases cost, increases access to dermatology care, and reduces the risk of pandemic infections. And it is necessary to establish an infrastructure for TD that protects patient’s privacy and ensures accurate diagnosis.     

Understanding the Need of Health Care Providers for Teleconsultation and Technological Attributes in Relation to The Acceptance of Teleconsultation in Malaysia: A Mixed Methods Study

The aim of this study was to explore the importance of service need along with perceived technology attributes in potentially influence the acceptance of teleconsultation. The study was conducted based on the concurrent triangulation design involving qualitative and quantitative study methods. These entailed interviews with key informants and questionnaires survey of health care providers who practiced in the participating hospitals in Malaysia. Thematic analysis involving iterative coding was conducted on qualitative data. Scale reliability test and hypothesis testing procedures were performed on quantitative data. Subsequently, both data were merged, compared and interpreted. In particular, this study utilized a qualitative priority such that a superior emphasis was placed on the qualitative method to demonstrate an overall understanding. Based on the responses of 20 key informants, there was a significant need for teleconsultation as a tool to extend health services to patients under constrained resources and critical conditions. Apparently, the latest attributes of teleconsultation technology have generally met users' expectation but rather perceived as supportive facets in encouraging the usage. Concurrently, based on the survey engaging 72 health care providers, teleconsultation acceptance was statistically proven to be strongly associated with service need and not originated exclusively from the technological attributes. Additionally, the results of this study can be used to promote teleconsultation as an effective means in delivering better health services. Thus, the categories emerged from this study may be further revised and examined for explaining the acceptance of teleconsultation technology in other relevant contexts.     

Teledermatology in Air Force: Our Experience

Background

Teledermatology is the science of telemedicine applied to the field of dermatology, with an aim to avoid travelling to nearest specialist facility.

Methods

Patients from Air Force Stations Jaisalmer, Naliya, 5 Air Force Hospital, Jorhat and 9 Air Force Hospital, Halwara were consulted by the dermatologist at Command Hospital (Air Force) Bangalore through the telemedicine network provided by ISRO, Bangalore from March 06 to May 08.

Result

115 patients underwent teledermatology consultation using virtual teleconference (VTC) and this was compared with Store and Forward (S and F) consultation at all four stations as well as Face to Face (FTF) consultation at 5 Air Force Hospital Jorhat. Diagnosis concordance was 52.5% and 53% for Jorhat and Halwara for VTC vs S and F, while it was 75% and 25% for Jaisalmer and Naliya. For VTC vs FTF, the concordance improved to 60.66% and for S and F vs FTF it improved to 91.8%. Concordance was better for localized lesions than for generalized lesions especially of the papulosquamous group of disorders. Another reason for the discordance with VTC was poor resolution of cameras at the peripheral units.

Conclusion

Teledermatology is useful for patient care in the absence of local specialist cover and the patients have to travel long distances resulting in loss of manhours. However, better camera resolution at peripheral centres will result in greater concordance.Key Words: Teledermatology, Virtual teleconference, Store and forward, Face to face     

探索基于供方视角医院互联网医疗服务适宜开展的服务项目

目的 从医疗服务供方视角对现阶段及未来适宜通过互联网医疗开展的服务项目进行探讨,明确现阶段互联网医疗服务发展的瓶颈,为促进互联网医疗服务提质扩面与高质量发展提供循证依据与政策建议。方法 通过文献检索形成《互联网医疗服务适宜开展项目调查研究问卷》,在自愿参与研究的前提下于2020年1至6月,通过电子问卷调查的方式进行问卷收集。采用Excel 2010及SPSS 21.0进行数据分析。结果 研究共收集问卷614份,其中有效问卷582份,有效率为94.79%。研究对象以青年医务人员为主,涵盖医师、护士、技师及学生。68.73%的研究对象表示“对互联网医疗服务相关工作关注或比较关注”;但50%以上的研究对象表示“对本专业范围内互联网医疗服务相关工作前沿的了解程度一般”;目前适宜开展的互联网医疗/健康服务排名前5位的为:健康管理、图文咨询、疾病复诊、疾病筛查与疑难病会诊,与未来适宜开展的服务项目基本一致。结论 医务人员对开展互联网医疗服务具有较高的认同度,但在技术方面的了解程度有待深入,现阶段互联网医疗以咨询、会诊及复诊为主,通过互联网医疗方式实现相对复杂的诊疗服务的能力还有待提高,在未来工作中应不断提升信息化水平,缩小区域间医疗服务能力差距,促进整体医疗服务能力的不断提升与区域间医疗服务协同发展。     

远程会诊在联网医院应用调查分析

目的：研究远程医疗会诊在联网医院推广情况及影响因素.方法：对解放军总医院联网770家医院进行问卷调查.结果：发放问卷770份,收回384份,应答率49.9％,合格269份,合格率34.9％.其中地方医院回复88份,军队医院回复181份.联网医院对专家学科需求有内科临床部、外科临床部、门诊部、医技部,需求最多临床部为外科临床部.结论：远程医疗会诊在联网医院的使用评价度高,实际使用率低,与会诊收费、医院重视度、医师水平、宣传不到位有密切关系,应予以关注.     

Comparison of activity level and service intensity of male and female physicians in five fields of medicine in Ontario.

OBJECTIVE: To examine the extent to which physician's sex explains variation in the activity level and service intensity of a cohort of physicians in each of five medical fields after other sources of variation are taken into account. DESIGN: Data from the Ontario Ministry of Health (MOH) and the CMA were analysed by means of multivariate regression techniques for panel data. SETTING: Ontario. PARTICIPANTS: A total of 137 dermatologists, 974 general internists, 330 pediatricians and 941 psychiatrists and a random sample of 2771 family physicians and general practitioners who met the eligibility criteria. Physicians were eligible if they billed the MOH for at least three quarters in 1983, did not bill as a medical laboratory director, provided direct patient care, did not have an alternative funding arrangement with the MOH, remained in the same specialty throughout the study period (1983-90) and billed from an Ontario address. OUTCOME MEASURES: Three measures of total activity level (annual number of services provided, annual fee-for-service billings and annual mean number of patients seen per quarter) and one measure of service intensity (annual mean number of services per patient per quarter). RESULTS: Although several variables (e.g., full-time work status, age, type of practice and recent practice move) influenced the four measures examined, physician's sex contributed significantly to explaining variation in activity in 70% of the regression equations. The women provided 33.0% fewere services per year than the men in family and general practice (p < 0.001), 25.0% fewer services in general internal medicine (p < 0.01), 22.1% fewer services in pediatrics (p < 0.05) and 22.3% fewer services in psychiatry (p < 0.001). Total billings by the women in these fields were also significantly less than those of their male colleagues, the difference being greatest among the family physicians and general practitioners (28.0%) and the general internists (27.0%) (p < 0.001). The women in these four fields saw significantly fewer patients per quarter than their male colleagues, the difference being greatest in psychiatry (33.0%) (p < 0.001). Sex affected service intensity in three fields. The female psychiatrists (14.8%) (p < 0.001) and general intenists (5.5%) (p < 0.10) provided more services per quarter than their male colleagues, whereas the female family physicians and general practitioners delivered 2.2% fewer services per patient per quarter than their male colleagues (p < 0.01). In two specialties differences between women aged 40 years or less and those over 40 years were observed. In general internal medicine the younger women had higher activity levels than the older women (p < 0.01). Conversely, in dermatology the younger women had lower activity levels (p < 0.05) and provided fewer services per patient per quarter (p < 0.001) than the older women. CONCLUSIONS: Although physician's sex explained much of the variation in activity level and service intensity, even after other important correlates were controlled for, the type and extent of differences observed between female and male physicians depended on the particular medical field examined. To understand the effect of the large increase in the number of women on the physician workforce, more detailed analyses by medical field are needed of the volume, mix and intensity of services provided by men and women, with adjustment for any possible differences in the patients seen in their practices.     

Do-not-resuscitate orders

Do-Not-Resuscitate (DNR) orders were audited in October and December 1989 at the teaching hospital of the University of Florida College of Medicine in Gainesville. October audit results were presented at a medical staff meeting in November to determine if education would improve compliance. There were 22 DNR orders in October, 17 (77%) were out of compliance with hospital policy due to failure to obtain written consultation from a second attending. Although not required by hospital policy, there were 11 instances (50%) in which patients (or families) were required to provide written documentation of their wishes (a living will) before the attending would write the order. There were 22 DNR orders in December, eight (36%) were out of compliance due to failure to obtain written consultation from a second attending. There were no instances of attendings' requiring patients (or families) to provide written documentation of their wishes. Education improved compliance with hospital DNR policy, but physicians were still reluctant to obtain consultation from colleagues.     

Corticosteroid phobia: a questionnaire study using TOPICOP score

INTRODUCTIONTopical corticosteroids (TCS) are commonly used in dermatology for their anti-inflammatory action. The recent development of the TOPICOP© (Topical Corticosteroid Phobia) scale to assess steroid phobia has made the quantification and comparison of steroid phobia easier. The objective of this study was to assess the degree of steroid phobia at our institute and identify sources from which patients obtain information regarding TCS.METHODSA cross-sectional survey was performed of dermatology patients regardless of steroid use. TOPICOP scale was used for the survey. Sources from which patients obtained information were identified and their level of trust in these sources assessed.RESULTS186 surveys were analysed. The median domain TOPICOP subscores were 38.9% (interquartile range [IQR] 27.8%–50.0%, standard deviation [SD] 24.4%) for knowledge and beliefs, 44.4% (IQR 33.3%–66.7%, SD 24.4%) for fears and 55.6% (IQR 33.3%–66.7%, SD 27.2%) for behaviour. The median global TOPICOP score was 44.4% (IQR 33.3%–55.6%, SD 17.6%). Female gender was associated with higher behaviour, fear and global TOPICOP scores. There was no difference in the scores based on disease condition, steroid use, age or education. Dermatologists were the most common source of information on topical steroids and trust was highest in dermatologists.CONCLUSIONThe prevalence of steroid phobia in our dermatology outpatient setting was moderately high, with gender differences. Dermatologists were the most common source of information on TCS, and it was heartening to note that trust was also highest in dermatologists. Strategies to target steroid phobia should take into account these factors.     

Quality of life assessment among patients suffering from different dermatological diseases

Objectives:To assess the quality of life (QoL) of patients with different dermatological diseases. Multiple international studies have evaluated the QoL among patients with different dermatological diseases; however, few studies of this kind have been conducted in Saudi Arabia.Methods:This quantitative, observational, cross-sectional study was carried out in the dermatology outpatient clinics of King Saud University Medical City, Riyadh, Saudi Arabia, from September 2019 until February 2020. Data was collected using the validated Arabic version of the Dermatology of Life Quality Index (DLQI).Results:A total of 391 patients ≥18 years participated in the study. The mean age of participants was 33 years (18-75 years). Most participants in this study reported that their dermatological disease had a small or no effect on their QoL (62.5%). The majority of patients who had acne vulgaris (79.7%), vitiligo (79.3%), hair disorders (76.9%), or rosacea (71.5%) reported a small to no effects on their QoL. However, diseases that reflected the largest percentages of a large to extremely large effect on QoL were urticaria (37.1%), eczema (26.6%), and psoriasis (24%). A total of 42.9% of the participants suffered from lichen planus and 66.7% of participants suffered from cutaneous neoplasms reported a moderate effect on their QoL.Conclusion:Understanding the impact of different dermatological diseases on QoL can help dermatologists to improve thier patients’ QoL. Therefore, we recommend that further studies on this topic be conducted in multiple health centers.