Telemedicine Consultation as an Indicator of Local Telemedicine Champions' Contributions, Health Care System Needs or Both: Tales from Two Continents.

Background: Telemedicine systems increase access to care, particularly in remote and developing countries. Nationwide telemedicine programs in Cabo Verde and Albania have been built by the International Virtual e-Hospital Foundation (IVeH) and based on the effective Initiate-Build-Operate-Transfer (IBOT) strategy. The aim of this study was to compare the clinical results between the two programs and examine the relationship between the clinical teleconsultations as an indicator of health care system needs and the contribution of local telemedicine champions. Methods: Data were prospectively collected between 2014 and 2018 from Albania and Cabo Verde. Telemedicine champions were defined as programs, physicians, or hospitals who have contributed at least 100 telemedicine consultations during the study periods. Chi-squared test was utilized to analyze the data. Results: There were 2,442 teleconsultations in Cabo Verde and 2,724 teleconsultations in Albania during the study periods. Using the 100-consultation benchmark as the indicator of telemedicine champion, we identified radiology (n = 1,061), neurotrauma (n = 742), and general neurology or stroke (n = 489) as champion clinical disciplines in Albania. With the same method of 100 consultations, we identified eight champion clinical disciplines in Cabo Verde, including neurology (n = 720), cardiology (n = 313), orthopedics (n = 190), surgery (143), endocrinology (141), otolaryngology (n = 139), urology (n = 139), and dermatology (126). The patient transfer/nontransfer ratio was 0.5 in Cabo Verde and 0.3 in Albania (p < 0.001). Three hospitals in Albania and eight community hospitals/health care centers in Cabo Verde requested the majority of teleconsultations. Two main hospitals in Cabo Verde and Albania responded to the consultations. Conclusion: The successful implementation of a telemedicine program depends on many factors. However, physician champions, who eventually create clinical discipline champions, and represent the hospital champions, are the backbone of the sustainability and progress of any telemedicine program. The number of consultations reflects the lack of local specialty expertise to provide health care service and thus can be used for future planning and investment.

Laparoscopy: A Better Approach for Perforated Duodenal Ulcer.

Background Laparoscopic surgery is becoming the gold standard for most abdominal surgeries in recent times. Laparoscopic repair of perforated duodenal ulcer (PDU), however, is still an area of debate. The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair. Methods In this cross-sectional study, patients were consecutively sampled. Out of 101 patients with clinically diagnosed PDU, 36 patients underwent laparoscopic Graham patch repair and 65 underwent open Graham patch repair in a tertiary care academic hospital. Open repair was via upper midline incision, and laparoscopic repair by the three-port technique. The following stages were calculated: operative time, duration of postoperative analgesia, time taken to mobilize, and patient length of stay after the operation. Results The mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively). Mean postoperative analgesia requirement, time taken to mobilize, and hospital stay were significantly shorter after laparoscopy than after open repair (1.21 days, 9.32 hours, and 3.12 days vs 3.83 days, 16.20 hours, and 4.85 days, respectively). Three patients (8%) in the laparoscopy group and 35 (54%) in the open repair group had postoperative complications. Conclusions Laparoscopic repair of PDU is a safe approach and better than open repair in terms of operative time with the right level of expertise only, postoperative analgesia requirement, mobilization, duration of hospital stay, and incidence of postoperative respiratory and wound complications.

Increased Access to Care through Telemedicine in Albania: An Analysis of 2,724 Patients.

Introduction: The Integrated Telemedicine and e-Health program (ITeHP) of Albania, built by the International Virtual e-Hospital Foundation (IVeH), has improved access to high-quality health care, particularly in high demanding specialty disciplines. We aimed to test the hypothesis that the majority of patients in remote and regional hospitals can be managed using telemedicine and will prevent unnecessary transfers. Methods: A retrospective analysis of prospectively collected data of patients seen between January 2014 and September 2018 was conducted. Patient demographics, type of teleconsultation modality used, and patient disposition were analyzed. The comparison of continuous data was performed with t-test or Mann-Whitney test. The categorical data were tested with chi-squared test and analysis of variance. Results: There were 2,842 patients seen in all the clinical disciplines during the study period. We excluded tele-autism and incomplete data. There were 2,724 records eligible for study. The most frequent consulting clinical programs (82.9%) were teleradiology (39.0%), teleneurotrauma (27.2%), and teletestroke (16.7%). The majority of patients (77.9%) were kept at regional centers and did not require transfer (p < 0.001) to a tertiary center. Of those transferred, 70.3% were male (p < 0.001), of which 81.6% were for transferred due to neurotrauma. Conclusion: The telemedicine program in Albania has improved access to specialized care in a number of specialty clinical disciplines, particularly in potentially life-threatening and time-sensitive conditions such as neurotrauma. Almost 80% of patients did not require transfer to tertiary centers and were kept for further treatment at the regional centers.