Four Tips for Improving Video Telehealth Patient-Clinician Communication.

This JAMA Insights explores the differences between in-person and telehealth encounters between patients and clinicians and offers clinicians guidance on how to improve communication with patients when meeting virtually.

Prehospital neurologic assessment using mobile phones: Comparison between neurologists and emergency physicians.

BACKGROUND: Ambulance-based telestroke may be a promising solution to improving stroke care. We assessed the technical feasibility and reliability of prehospital evaluations using commercial mobile phones with fifth-generation wireless communication technology. METHODS: Six standardized patients portrayed scripted stroke scenarios during ambulance transport in an urban city and were remotely evaluated by independent raters using tablets (three neurologists and three emergency physicians) in a hospital, assisted by paramedics (trained in National Institute of Health Stroke Scale [NIHSS] assessment) in the ambulance; commercial cellular networks were utilized for videoconferencing transmission. The primary outcomes were mean difference (MD) and correlation of NIHSS scores between the face-to-face and remote assessments. We also examined the Bland-Altman plot for itemized NIHSS components, and Kaplan-Meier curves were used to compare the differences in the duration of the two evaluations between neurologists and emergency physicians. RESULTS: We conducted 32 ambulance runs and successfully completed all NIHSS examinations. No significant difference was found between the face-to-face and remote evaluations (MD, 0.782; 95% confidence interval [CI], -0.520-0.395). The correlation of NIHSS scores between the two methods was 0.994 (95% CI, 0.945-1.026), and three items exhibited the highest frequency of runs, with score differences between the two methods. There were no significant differences between neurologists and emergency physicians in the mean evaluation duration and NIHSS scores for the two methods. CONCLUSION: Prehospital evaluation using commercial mobile phones with fifth-generation wireless communication technology is feasible and reliable during ambulance transport in urban areas. Emergency physicians and neurologists performed similarly in stroke evaluations.

Addressing Pediatric Developmental and Mental Health in Primary Care Using Tele-Education.

This study evaluates the effectiveness of an early childhood tele-education program in preparing community pediatric clinicians to manage developmental and mental health disorders in young children. Community pediatric clinicians from rural, underserved, or school-based health center practices in the mid-Atlantic region participated in a weekly tele-education videoconference. There was a significant knowledge gain evidenced by the percentage of questions answered correctly from pre- to post- didactic exposure (P < .001). Participants reported an increase in knowledge from pre- (P < .001) and in confidence from pre- to post- participation (P < .001). Practice management changes demonstrated an encouraging trend toward managing patients in the Medical Home, as compared with immediately deferring to specialists following participation. This early childhood tele-education videoconferencing program is a promising response to the urgent need to confidently increase the role of pediatricians in the provision of care for childhood developmental and mental health disorders.

Helping patients connect remotely with their loved ones modulates distress in healthcare workers: a tend-and-befriend hypothesis for COVID-19 front liners.

The no-visitor policies endorsed by healthcare organizations to limit COVID-19 virus risk exposure have unfortunately contributed to the isolation of patients further exacerbating distress in relatives and frontline healthcare workers. To contrast such effects, many healthcare institutions have adopted technology-based solutions helping patients and families communicate online through the aid of virtual devices. To date, no study has investigated whether facilitating patient-family videocalls would mitigate distress levels in frontline healthcare professionals. Caring for emotional needs of patients by re-establishing affiliative connections interrupted by the pandemic through patient-family videocalls is expected to mitigate distress in engaged healthcare workers as an example of a tend-and-befriend response to stress caused by the pandemic. We tested this hypothesis in a cross-sectional study conducted during 1-30 June 2020, involving 209 healthcare workers (nurses = 146; physicians = 63) engaged in the COVID-19 frontline in Italy. Half of participants in our sample (n = 107) had assisted efforts aimed at connecting patients remotely with families through videocalls. Psychological distress measures included symptoms of burnout, post-traumatic stress, anxiety, depression, and difficulty in sleep and wakefulness. Partially in line with our expectations we found a modulation effect specific for professional category: nurses assisting patient-family videocalls reported significantly lower levels of distress and a better quality of wakefulness compared to those who did not, whereas physicians reported higher levels of distress during such virtual communications. We interpret these findings from the perspective of patient-family communication and differences in skills and training between nurses and physicians. These findings highlight that technology-based solutions aimed at reducing barriers and alleviating distress in healthcare settings should be promoted in concert with skill enhancement training for healthcare professionals especially in terms of communicating online and communicating difficult topics with patients and families.

La política de no recibir visitas que ha sido legitimada por organizaciones de atención de salud para limitar el riesgo de la exposición al virus COVID-19 ha contribuido en forma desafortunada al aislamiento de los pacientes, lo que aumenta el malestar/angustia en familiares y en trabajadores de salud de la primera línea. Para contrastar tales efectos, muchas instituciones de salud han adoptado soluciones basadas en la tecnología para ayudar a pacientes y familiares a comunicarse en línea a través de la ayuda de dispositivos virtuales. Hasta la fecha, ningún estudio ha investigado si es que la facilitación de video llamadas paciente-familiares pudiese mitigar el nivel de angustia en profesionales de salud de primera línea. Se espera que el cuidado de las necesidades emocionales de los pacientes mediante el restablecimiento de conexiones afilativas interrumpidas por la pandemia a través de video llamadas entre el paciente y la familia ayude a mitigar la angustia en los trabajadores de la salud como un ejemplo de una respuesta de "cuidar y hacer amigos" a la angustia causada por la pandemia. Probamos esta hipótesis en un estudio transversal realizado entre el 01 y el 30 de junio del 2020, en la que participaron 209 trabajadores de la salud (enfermeras=146; médicos=63) involucrados en la atención de la primera línea del COVID-19 en Italia. La mitad de los participantes en nuestra muestra (n=107) habían asistido a esfuerzos destinados a conectar a los pacientes en forma remota con sus familias a través de video-llamadas. Las medidas de angustia psicológica incluyeron síntomas de burnout, estrés postraumático, ansiedad, depresión, dificultad para dormir y estar despiertos. Parcialmente en línea con nuestras expectativas, encontramos un efecto modulador específico para la categoría profesional: Las enfermeras que asistían las video llamadas de los pacientes con sus familias reportaron significativamente menor nivel de angustia y una mejor calidad de vigilia en comparación con las que no lo hicieron, mientras los médicos reportaron mayores niveles de angustia durante tales comunicaciones virtuales. Interpretamos estos hallazgos desde la perspectiva de la comunicación paciente-familia y las diferencias en las habilidades y formación entre las enfermeras y los médicos. Estos hallazgos destacan que las soluciones basadas en la tecnología destinadas a reducir las barreras y aliviar la angustia en los entornos de atención de salud deben promoverse junto con la capacitación para la mejora de habilidades para profesionales de la salud especialmente en términos de comunicarse en línea y comunicar temáticas difíciles a pacientes y familiares.

A Novel Virtual Wet Lab-Using a Smartphone Camera Adapter and a Video Conference Platform to Provide Real-Time Surgical Instruction.

PURPOSE: Proctored surgical instruction has traditionally been taught through in-person interactions in either the operating room or an improvised wet lab. Because of the COVID-19 pandemic, live in-person instruction was not feasible owing to social distancing protocols, so a virtual wet lab (VWL) was proposed and implemented. The purpose of this article is to describe our experience with a VWL as a Descemet membrane endothelial keratoplasty (DMEK) skills-transfer course. This is the first time that a VWL environment has been described for the instruction of ophthalmic surgery. METHODS: Thirteen participant surgeons took part in VWLs designed for DMEK skills transfer in September and October 2020. A smartphone camera adapter and a video conference software platform were the unique media for the VWL. After a didactic session, participants were divided into breakout rooms where their surgical scope view was broadcast live, allowing instructors to virtually proctor their participants in real time. Participants were surveyed to assess their satisfaction with the course. RESULTS: All (100%) participants successfully injected and unfolded their DMEK grafts. Ten of the 13 participants completed the survey. Respondents rated the experience highly favorably. CONCLUSIONS: With the use of readily available technology, VWLs can be successfully implemented in lieu of in-person skills-transfer courses. Further development catering to the needs of the participant might allow VWLs to serve as a viable option of surgical education, currently limited by geographical and social distancing boundaries.

Older Adults' Attitudes Toward Virtual Volunteering During the COVID-19 Pandemic.

This study explored older adults' technology use patterns and attitudes toward virtual volunteering during the COVID-19 pandemic. A 22-item survey was administered to 229 volunteers in the St. Louis region who tutor children through the Oasis Intergenerational Tutoring program. Although most respondents are familiar with technology and expressed that they are likely to volunteer virtually, their responses varied significantly by age, education, gender, income, and school districts. Some tutors expressed that virtual volunteering may eliminate barriers to in-person volunteering, while others were concerned with establishing a personal connection with students online. These findings suggest that tutors anticipate both benefits and challenges with virtual volunteering and that efforts to engage older adults during the pandemic should factor in prior use of technology and ensure that different subgroups are not marginalized.

[From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants]. / Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.

INTRODUCTION AND AIM: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. MATERIAL AND METHODS: Narrative description of the adopted measures; Online survey among participants. RESULTS: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). CONCLUSIONS: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.

TITLE: Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.Introducción y objetivo. La pandemia de COVID-19 ha trastornado la actividad hospitalaria, incluyendo la docente. Se describe el cambio de un sistema presencial a otro de sesiones en línea en un servicio de neurología, y se analizan la satisfacción y las opiniones de los usuarios. Material y métodos. Exposición de las medidas adoptadas para pasar a modalidad en línea y análisis de una encuesta entre los participantes. Resultados. Se pasó de tres a dos sesiones semanales, con restricción del público presencial. El público virtual superó al presencial. Contestaron la encuesta 49 participantes, un 51% mujeres, con una media de 40,5 años (rango: 25-65). La satisfacción de los asistentes fue mayor para las sesiones presenciales (8,68) que para las en línea (8,12) (p = 0,006). Existía una correlación inversa significativa entre la edad y la satisfacción con las sesiones en línea (r = ­0,37; p = 0,01) que no se daba para las sesiones presenciales. El 75,5% fue partidario de mantener las sesiones virtuales cuando se eliminaran las restricciones de aforo. Una mayoría (87,8%) apoyó sesiones interhospitalarias y recomienda que las autoridades sanitarias faciliten aplicaciones informáticas seguras (53,1%). Conclusiones. La introducción de sesiones virtuales es una medida fácil de implementar en un servicio de neurología, con un alto grado de satisfacción de los usuarios, aunque menor que con las sesiones presenciales. Existen problemas no resueltos respecto al uso de plataformas comerciales y conexión interhospitalaria. Sería recomendable que las autoridades sanitarias y educativas desarrollaran aplicaciones seguras y fomentaran la educación médica en línea.

Teleproctoring for Neurovascular Procedures: Demonstration of Concept Using Optical See-Through Head-Mounted Display, Interactive Mixed Reality, and Virtual Space Sharing-A Critical Need Highlighted by the COVID-19 Pandemic.

BACKGROUND AND PURPOSE: Physician training and onsite proctoring are critical for safely introducing new biomedical devices, a process that has been disrupted by the pandemic. A teleproctoring concept using optical see-through head-mounted displays with a proctor's ability to see and, more important, virtually interact in the operator's visual field is presented. MATERIALS AND METHODS: Test conditions were created for simulated proctoring using a bifurcation aneurysm flow model for WEB device deployment. The operator in the angiography suite wore a Magic Leap-1 optical see-through head-mounted display to livestream his or her FOV to a proctor's computer in an adjacent building. A Web-based application (Spatial) was used for the proctor to virtually interact in the operator's visual space. Tested elements included the quality of the livestream, communication, and the proctor's ability to interact in the operator's environment using mixed reality. A hotspot and a Wi-Fi-based network were tested. RESULTS: The operator successfully livestreamed the angiography room environment and his FOV of the monitor to the remotely located proctor. The proctor communicated and guided the operator through the procedure over the optical see-through head-mounted displays, a process that was repeated several times. The proctor used mixed reality and virtual space sharing to successfully project images, annotations, and data in the operator's FOV for highlighting any device or procedural aspects. The livestream latency was 0.71 (SD, 0.03) seconds for Wi-Fi and 0.86 (SD, 0.3) seconds for the hotspot (P = .02). The livestream quality was subjectively better over the Wi-Fi. CONCLUSIONS: New technologies using head-mounted displays and virtual space sharing could offer solutions applicable to remote proctoring in the neurointerventional space.

The effect of a micro-visual intervention on the accelerated recovery of patients with kinesiophobia after total knee replacement during neo-coronary pneumonia.

BACKGROUND: The global neo-coronary pneumonia epidemic has increased the workload of healthcare institutions in various countries and directly affected the physical and psychological recovery of the vast majority of patients requiring hospitalization in China. We anticipate that post-total knee arthroplasty kinesiophobia may have an impact on patients' postoperative pain scores, knee function, and ability to care for themselves in daily life. The purpose of this study is to conduct a micro-video intervention via WeChat to verify the impact of this method on the rapid recovery of patients with kinesiophobia after total knee arthroplasty during neo-coronary pneumonia. METHODS: Using convenience sampling method, 78 patients with kinesiophobia after artificial total knee arthroplasty who met the exclusion criteria were selected and randomly grouped, with the control group receiving routine off-line instruction and the intervention group receiving micro-video intervention, and the changes in the relevant indexes of the two groups of patients at different time points on postoperative day 1, 3 and 7 were recorded and analyzed. RESULTS: There were no statistical differences in the scores of kinesiophobia, pain, knee flexion mobility (ROM) and ability to take care of daily life between the two groups on the first postoperative day (P > .05). On postoperative day 3 and 7, there were statistical differences in Tampa Scale for kinesiophobia, pain, activities of daily living scale score and ROM between the two groups (P < .01), and the first time of getting out of bed between the two groups (P < .05), and by repeated-measures ANOVA, there were statistically significant time points, groups and interaction effects of the outcome indicators between the 2 groups (P < .01), indicating that the intervention group reconstructed the patients' postoperative kinesiophobiaand hyperactivity. The level of pain awareness facilitates the patient's acquisition of the correct functional exercises to make them change their misbehavior. CONCLUSIONS: WeChat micro-video can reduce the fear of movement score and pain score in patients with kinesiophobia after unilateral total knee arthroplasty, shorten the first time out of bed, and improve their joint mobility and daily living ability. ETHICS: This study has passed the ethical review of the hospital where it was conducted and has been filed, Ethics Approval Number: 20181203-01.

Implementation and evaluation of eight virtual surgical electives for medical students during the COVID-19 pandemic.

BACKGROUND: Eight novel virtual surgery electives (VSEs) were developed and implemented in April-May 2020 for medical students forced to continue their education remotely due to COVID-19. METHODS: Each VSE was 1-2 weeks long, contained specialty-specific course objectives, and included a variety of teaching modalities. Students completed a post-course survey to assess changes in their interest and understanding of the specialty. Quantitative methods were employed to analyze the results. RESULTS: Eighty-three students participated in the electives and 67 (80.7%) completed the post-course survey. Forty-six (68.7%) respondents reported "increased" or "greatly increased" interest in the course specialty completed. Survey respondents' post-course understanding of each specialty increased by a statistically significant amount (p-value = <0.0001). CONCLUSION: This initial effort demonstrated that VSEs can be an effective tool for increasing medical students' interest in and understanding of surgical specialties. They should be studied further with more rigorous methods in a larger population.

Videoconferencing for multidisciplinary team meetings in the coronavirus disease era - human factors awareness and recognition.

BACKGROUND: The coronavirus disease 2019 pandemic has led to the birth of videoconference multidisciplinary teams, which are now commonplace. This remote way of deciding care demands a new set of rules to ensure the quality of the complex decisions that are made for the patient group needing multidisciplinary care. Videoconference multidisciplinary teams bring with them novel forms of distraction that are under-appreciated and can impair decision-making. METHOD: A practical checklist was generated as applied to videoconference multidisciplinary teams using the principles of human factors awareness and recognition. RESULTS: Some of the strategies that should be adopted to minimise errors arising from human factors are: information technology support, a suitable environment to dial in, a global checklist employed prior to the videoconference, visible participants, avoiding distractions from other sources (e.g. e-mail, mobile phone), a videoconference sign-out and rapid dissemination of the outcomes sheet. CONCLUSION: This article presents a framework that uses human factors principles applied in this setting, which will contribute to enhanced patient safety, team working and a reduction in medical errors.

Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction.

BACKGROUND: Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. OBJECTIVE: Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. METHODS: We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). RESULTS: Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. CONCLUSIONS: A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10913.

Use of Reimbursed Psychology Videoconference Services in Australia: An Investigation Using Administrative Data.

BACKGROUND: In November 2017, the Australian government approved reimbursement for psychology consultations conducted by videoconference under the Better Access initiative to address inequitable access of mental health services across regions in Australia. OBJECTIVE: This project uses publically available activity data from the Medicare Benefits Scheme to quantify the uptake of videoconference for psychology resulting from the initiative change. METHODS: Data were extracted from the Medicare Benefits Schedule item reports using the item codes for standard consultations and the new item codes for videoconference consultations. Activity data from 2 years before and the first year of the change to the Better Access initiative were compared to examine the uptake of videoconference for psychology. Data were stratified by allied health profession, sex, age and state jurisdiction. RESULTS: In the 1-year period after the introduction of reimbursed videoconference consultations, approximately 5.7 million in-person consultations and 4141 videoconference consultations were funded by Medicare in Australia. Videoconference consultations comprised 0.07% of the total consultations performed in that 1-year period and showed an increased trajectory. The results can guide future research into evaluating the clinical outcomes of patients via both in-person and videoconference delivery modes. CONCLUSIONS: Videoconference mental health services were used in the first year that they were available, although they only accounted for a small percentage of all mental health consultations provided by allied health professionals. This finding lays the foundation for future work which could examine the effectiveness of the scheme in reducing inequity and investigating the economic benefits of the expanded initiative to the government and society.

Use of Wearable Technology in Remote Evaluation of Acute Stroke Patients: Feasibility and Reliability of a Google Glass-Based Device.

BACKGROUND: Telestroke is an efficient, cost-effective way to standardize care and improve access to immediate neurologic expertise for rural hospitals and other underserved areas. Hands-free wearable technology potentially allows for faster evaluations that fit easily within prehospital workflows and could improve prehospital triage of stroke patients to appropriate receiving stroke centers. The goal of this study is to assess the feasibility and inter-rater reliability of wearable eyeglass video technology in assessing stroke-related neurologic deficits in patients with suspected acute stroke. METHODS: Consecutive patients with suspected stroke were evaluated concurrently by an on-site neurologist using wearable eyeglass video technology and a remotely located neurologist viewing the patient through an online platform. Inter-rater reliability in assigning National Institutes of Health Stroke Scale (NIHSS) scores was evaluated using inter-rater correlation coefficient (ICC) and weighted kappa scores. RESULTS: Among 17 enrolled patients, mean age was 58 (SD ± 20) and 29% were female. There was a high degree of correlation in total NIHSS score (ICC .99 and weighted kappa .88) and across all NIHSS subitems (ICC .81-1 and weighted kappa .68-1) between the examiner evaluating remotely via wearable eyeglass video technology with access to the patient and the in-person examiner. The maximum difference between the 2 NIHSS scores was 3. CONCLUSIONS: The use of wearable eyeglass video technology in telestroke is feasible and reliable. Use of this technology in the prehospital setting has the potential to improve early assessment of patients with acute stroke symptoms and to facilitate transfer to appropriate stroke centers in the regional systems of care.

Primera experiencia en telemedicina dentro de un programa nacional / First experience in telemedicine within a national program

El Programa Nacional de Cardiopatías Congénitas (PNCC) inició el Proyecto de telemedicina en Cardiopatías Congénitas (CC) en el 2015. Los principales objetivos son promover el asesoramiento para el diagnóstico cardiológico en la patología compleja del niño o del feto, promover el conocimiento de patologías complejas de baja prevalencia para su pesquisa precoz, acompañar el proceso de mejora continua en el diagnóstico de CC en hospitales de referencia provinciales y promover la docencia y la capacitación entre los distintos actores de la red. Las videoconferencias fueron el principal método de contacto. Las provincias que más participaron fueron Buenos Aires, Neuquén y Misiones; el 55% de las consultas correspondieron a pacientes portadores de CC, un 20% a embarazadas con diagnóstico fetal de CC, 14% de arritmias y 11% otros motivos. Se mostraron imágenes de ecocardiografía en la mayoría de las conexiones.En un 35% se modificaron conductas, evitando el traslado de pacientes en un 23%. Conclusión: La telemedicina en CC representa una alternativa que llega de modo más efectivo al médico a través de la consulta y respuesta a distancia, optimizando los diagnósticos y las derivaciones oportunas. Además, difunde el conocimiento entre los centros de baja a los de alta complejidad, disminuye las asimetrías en el diagnóstico para los pacientes del interior del país, evita el traslado innecesario de pacientes y afianza el trabajo en red. Se presenta como un modelo innovador para la réplica hacia otras especialidades.(AU)

In 2015, the Project of Telemedicine for Congenital Heart Defects (CHD) was initiated for the National Program of Congenital Heart Disease (NPCHD). The main aims are to provide counseling for the cardiology diagnosis in complex conditions in the child or the fetus, promote knowledge on complex diseases of low prevalence for early screening, accompany the process of continuous improvement in the diagnosis of CHD at provincial reference hospitals, and encourage teaching and training of the different participants in the network. Videoconferences were the main method of interaction. The provinces that participated the most were Buenos Aires, Neuquen, and Misiones; 55% of the consultations concerned patients with CHD, 20% pregnant women with a prenatal diagnosis of CHD, 14% arrhythmias, and 11% other reasons. Echocardiography images were shown in the majority of the contacts. In 35% behaviors were modified, avoiding the transfer of patients in 23%. Conclusion: In CHD, telemedicine is an alternative that reaches physicians more effectively through outreach consultation and response, optimizing timely diagnosis and referrals. In addition, this modality disseminates knowledge among low-level and high-level centers, reduces asymmetries in diagnosis for patients from the provinces, avoids unnecessary transfer of patients, and strengthens networking. This innovative modality may serve as a model for other specialties. (AU)

Technologies of Exposure: Videoconferenced Distributed Medical Education as a Sociomaterial Practice.

PURPOSE: Videoconferencing-a network of buttons, screens, microphones, cameras, and speakers-is one way to ensure that undergraduate medical curricula are comparably delivered across distributed medical education (DME) sites, a common requirement for accreditation. However, few researchers have critically explored the role of videoconference technologies in day-to-day DME. The authors, therefore, conducted a three-year ethnographic study of a Canadian undergraduate DME program. METHOD: Drawing on 108 hours of observations, 33 interviews, and analysis of 65 documents-all collected at two campuses between January 2013 and February 2015-the authors explored the question, "What is revealed when we consider videoconferencing for DME as a sociomaterial practice?" RESULTS: The authors describe three interconnected ways that videoconference systems operate as unintended "technologies of exposure": visual, curricular, and auditory. Videoconferencing inadvertently exposes both mundane and extraordinary images and sounds, offering access to the informal, unintended, and even disavowed curriculum of everyday medical education. The authors conceptualize these exposures as sociomaterial practices, which add an additional layer of complexity for members of medical school communities. CONCLUSIONS: This analysis challenges the assumption that videoconferencing merely extends the bricks-and-mortar classroom. The authors discuss practical implications and recommend more critical consideration of the ways videoconferencing shifts the terrain of medical education. These findings point to a need for more critically oriented research exploring the ways DME technologies transform medical education, in both intended and unintended ways.

Designing Home-Based Telemedicine Systems for the Geriatric Population: An Empirical Study.

Background and Introduction: Telemedicine, the process of providing healthcare remotely using communication devices, has the potential to be useful for the geriatric population when specifically designed for this age group. This study explored the design of four video telemedicine systems currently available and outlined issues with these systems that impact usability among the geriatric population. Based on the results, design suggestions were developed to improve telemedicine systems for this population. MATERIALS AND METHODS: Using a between-subjects experimental design, the study considered four telemedicine systems used in Medical University of South Carolina. The study was conducted at a local retirement home. The participant pool consisted of 40 adults, 60 years or older. The dependent measures used were the mean times for telemedicine session initiation and video session, mean number of errors, post-test satisfaction ratings, the NASA-Task Load Index (NASA-TLX) workload measures, and the IBM-Computer Systems Usability Questionnaire measures. RESULTS: Statistical significance was found among the telemedicine systems' initiation times. The analysis of the qualitative data revealed several issues, including lengthy e-mail content, icon placement, and chat box design, which affect the usability of these systems for the geriatric population. DISCUSSION: Human factor-based design modifications, including short, precise e-mail content, appropriately placed icons, and the inclusion of instructions, are recommended to address the issues found in the qualitative study.

Korean Version of the Mini-Mental State Examination Using Smartphone: A Validation Study.

BACKGROUND: Stroke often leads to disability, and poststroke survivors often have limited accessibility to medical facilities. INTRODUCTION: For such patients, mobile videoconferencing technology offers an opportunity to perform follow-up assessment and appropriate management of cognitive impairment. We aimed to determine the validity of the Korean version of the Mini-Mental State Examination (MMSE-K) when administered using a smartphone. MATERIALS AND METHODS: Thirty patients with ischemic or hemorrhagic stroke were included in this study (20 males, 10 females; mean age, 69.8 ± 12.9 years). Both face-to-face and remote assessments of cognitive function through MMSE-K were performed for each patient at an interval of at least 3 days. Additionally, an in-person collaborator evaluated the MMSE-K score during the remote assessment. A smartphone and a tablet were used by the patient and the examiner, respectively, and remote connection was mediated using a dedicated videoconferencing application. The MMSE-K scores obtained through face-to-face, remote, and in-person assessments were compared using the Wilcoxon signed rank test and the Spearman correlation analysis. RESULTS: There was good agreement between face-to-face and remote assessments, as well as between remote assessment and in-person collaborator's evaluation regarding total MMSE-K score and subscores for each MMSE-K domain (orientation, memory, attention/calculation, language, and visuospatial function). DISCUSSION: Remote assessment can be a useful clinical evaluation method, and this study confirmed the validity. CONCLUSIONS: The smartphone represents a promising tool for the assessment of cognitive function in clinical practice, but further research into the intra- and inter-rater reliability of observations is warranted.