Evaluation of the Education "Clinical Telemedicine/e-Health" in the Curriculum of Medical Students at the University of Zurich.

BACKGROUND: Digitalization and patient empowerment result in new requirements and challenges. In response, the module "Clinical Telemedicine/e-Health" was implemented by the Faculty of Medicine of Zurich in 2008. The module was systematically evaluated to determine if the students would benefit from this course. In 2011, 2015, and 2016 further evaluations were performed. METHOD: In 2008 and 2009, students evaluated 16 statements. We calculated the combined mean value and medians for both evaluations. In 2011, the same evaluation was conducted, and the results were compared through U-test. In 2015, students were asked about the application and benefits of telemedicine; the answers were analyzed qualitatively and quantitatively. In 2016, the University of Zurich created an online survey which integrated three of the statements from the original evaluations. RESULTS: Every mean value of the combined evaluations of 2008/2009, 2011, and 2016 achieved a score of over 4 on a 6-point scale. In 2011, and also again in 2016, the overall satisfaction and understanding of telemedicine as a supplement in traditional medical consultations increased as follows: 4.71 ± 0.74 versus 4.86 ± 0.93 versus 5.1 ± 1.5 and, respectively, 5.02 ± 0.96 versus 5.25 ± 0.81 versus 5.7 ± 0.6. In the 2015 evaluation, 93% of students indicated that they would use telemedicine for chronically ill and elderly patients. CONCLUSION: The positive assessment of the module indicates the successful introduction of the topics of telemedicine and e-health to medical students at the University of Zurich. Throughout the course, the students gained confidence and basic skills.

Psychological online consultation service attracts men: a new approach to close the gap between being ill and being treated.

BACKGROUND: Since 1999, the University Hospital Zurich (Zurich, Switzerland) has offered an e-mail-based consultation service for individual health concerns where anonymous questions can be asked to an online doctor. This study aimed at the characterization of the user profile, the content of the question, and the answers given specific in the field of psychiatry. MATERIALS AND METHODS: In total, 3,148 questions were asked from 2008 to 2010. Of these, 209 (6.6%) requests were selected by International Classification of Diseases-10 and International Classification of Primary Care codes relevant for psychiatry and included in the retrospective qualitative study. The content analysis of the requests was supported by means of the Mayring inductive category system using a professional text analysis program (MAXQDA). RESULTS: Of the users, 45.9% were female, and 46.9% were male. The mean age was 37.4 years. The main topics of the request were somatoform, somatization, and hypochondriac disorders in 18.4%, behavioral syndromes in 17.9%, and mood disorders in 15.4%. The reason stated most frequently for using the service was looking for a second opinion. The doctors responded with detailed information about disease and treatment and in 70.8% recommended consultation of a physician. CONCLUSIONS: Telemedicine is suggested to empower patients by developing health literacy with professional advice. The gender ratio of the users is almost equal, although the prevalence of psychological diseases in the general population is higher in women than in men. Psychological online consultation may potentially reach mentally ill individuals who do not have or did not seek professional help yet, and it seems to be especially attractive for men.

Long-term effects of 3-month telemetric blood pressure intervention in patients with inadequately treated arterial hypertension.

BACKGROUND AND AIM: We have shown that better blood pressure (BP) control can be achieved by using 3-month telemetric BP measurement (TBPM) in comparison with a standard-care control group (C-G). The present analysis should clarify if this will also lead to a better middle- and long-term BP control. SUBJECTS AND METHODS: Fifty-seven patients finished the main study. After the 3 months no TBPM was performed. For 40 patients, 18 from the TBPM group (TBPM-G) and 22 from the C-G, we obtained ambulant BP measurements (ABPMs) with a mean follow-up of 20 months. Seventeen patients were lost to follow-up. BP target values were defined as ABPM ≤130/80 or ≤125/75 mm Hg with diabetes or renal failure. RESULTS: At the end of the follow-up, the systolic BP was 121.2±11.2 mm Hg in TBPM-G and 130.7±10.4 mm Hg in C-G, and the diastolic BP was 72.8±10.9 versus 77.0±7.1 mm Hg, respectively. Fifty-six percent in TBPM-G versus 40% in C-G (p=0.024) had a controlled BP as defined by ABPM criteria. CONCLUSIONS: TBPM helps achieve BP target values in patients with previously inadequately treated arterial hypertension, and the benefit is sustained. Beyond its immediate application, in comparison with standard treatment, TBPM allows for a better BP adjustment in the long term as well.

[Competences in telemedicine are essential]. / Kompetenzen in der Telemedizin sind essentiell.

The measurement and collection of health and fitness data as well as the telemedicine consultation supports the autonomy and self-determination of the responsible citizen concerning his health issues and promotes patient empowerment. However the patient is often over extended by an increasing and extensive data and information overload. He needs the help and the advice of a trustworthy doctor for guidance. While telemedical consultation, care or intervention is carried out, the telemedicine application represents a favored option and provides an immediate consequence of action for the patient's health issue. The quality stands and falls with training, continuing education and in particular with the telemedical expertise of the doctors involved

["Doc2Patient" -16 years' experience of the Medical Online Consultation Service at the University Hospital Zurich]. / "Doc2Patient" - 16 Jahre Erfahrung in Medizinischer Onlineberatung am Universitätsspital Zürich.

The increasing availability of telemedicine services and the transition to an information society allow the increased use of telemedicine in everyday medical practice. This requires acceptance of telemedicine as a powerful, additional pillar in the overall architecture of the health system. The implementation is still between the poles of the large variety of telemedicine applications and their realization. The University Hospital of Zurich looks back on 16 years of experience in the field of online medical advice. The quality of advice is continuously monitored and evaluated. Scientific evaluations analyze the profile of the questioner and their requests in order to optimize the services. Medical online advice conducted ethically correct can improve health literacy and increase the autonomy of medica/laypersons.

[Acceptance and feasibility of medical telemonitoring plus individual teleconsultation -A two years research and development project at the University Hospital Zurich]. / Akzeptanz und Machbarkeit von medizinischem Telemonitoring plus individueller Teleberatung - 2 Jähriges Forschungs- und Entwicklungsprojekt am Universitätsspital Zürich.

The research and development project "Long Independent Living Assistant (LILA)'; which is financially supported by the Commission for Technology and lnnoyation (KTI}, is based on the results and experiences of many years of the Medical Online Consultation Service at the University Hospital Zurich.The focus is on development and provision of a comprehensive, telemedicine service. Citizens and patients should be provided more safety at home and the family doctor should be supported by the service. Core elements of the project include the telemonitoring of vital signs combined with an individual teleconsultation via telephone, email and video. Technically, the. service is supported by a web-based documentation and communication platform with an integrated patient record. In a one-year planning phase, individual interviews and group discussions were conducted with the participants of the study. The results are continuously incorporated into the concept. The subsequent pilot phase analyzed the developed tetemedical approach and leads to further improvements. The aim of the study is the evaluation of the needs, feasibility and acceptance of telemedicine services from the perspective of the user, taking into account their social environment~

Body weight telemetry is useful to reduce interdialytic weight gain in patients with end-stage renal failure on hemodialysis.

Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate.

High-dose atorvastatin in peripheral arterial disease (PAD): effect on endothelial function, intima-media-thickness and local progression of PAD. An open randomized controlled pilot trial.

Beneficial effects of aggressive lipid-lowering with high-dose atorvastatin (80 mg/day) have been demonstrated in patients with coronary and cerebrovascular disease. The impact of such a therapy in patients with peripheral arterial disease (PAD) is less known so far. Here we studied the effects of high-dose atorvastatin on brachial artery endothelial function, common carotid intima-media thickness (IMT) and local progression of PAD in these patients. One hundred of 500 patients screened with documented PAD were randomly assigned to receive 80 mg of atorvastatin daily for six months or to continue on conventional medical treatment. Ninety-six percent of patients in the control group were on standard statin treatment. High resolution B-mode ultrasonography was used to study brachial artery flow-mediated dilation (FMD), IMT and ankle-brachial index (ABI) at baseline and at six months. FMD and IMT at baseline and at six months were 4.1 (0.06-8.6) versus 5.0 (0.76 vs. 8.1) %, p = 0.96, and 0.76 (0.66-0.82) versus 0.73 (0.63-0.81) mm, p = 0.41, respectively, in the atorvastatin group, and 2.66 (-1.9-6.9) versus 3.65 (0.0-8.6)%, p = 0.02, and 0.78 (0.71-0.90) versus 0.77 (0.70-0.90) mm, p = 0.48, in the control group. ABI at baseline and at six months was not different in either group. LDL cholesterol was reduced from 2.53 (2.21-3.28) to 1.86 (1.38-2.29) mM (p < 0.0001) in the atorvastatin group, whereas levels remained stable in the control group [2.38 (1.94-3.16) vs. 2.33 (1.82-2.84) mM, p = 0.61]. Major adverse cardiovascular events occurred in 2.1% in the atorvastatin group and 1.9% in the control group (p = 0.61). In conclusion, in this pilot trial aggressive lipid-lowering with 80 mg of atorvastatin daily for six months had no effect on brachial artery FMD in patients with PAD. IMT and ABI were also similar in patients with and without high-dose atorvastatin at six months.

[Health Topics of Medical Online Inquiries at the University Hospital of Zurich: Experiences of the Last 12 Years]. / Gesundheitliche Themen medizinischer Online-Anfragen am UniversitätsSpital Zürich: Erfahrungen der letzten 12 Jahre.

BACKGROUND: Digitization in the healthcare sector leads to new requirements and challenges in the doctor-patient relationship. Since 1999, the UniversitätsSpital Zürich has been offering a web-based medical online consultation service for laymen. The aim of the retrospective study was to analyze which health topics are of special interest for the inquirers. METHOD: All questions and answers between 2005 and 2016 were included. The calculation of the frequencies included the ICD-10 chapters, the age and gender of the inquirers, the number of recommended visits to the doctor, as well as the rating of the service. Changes in the frequencies were examined by regression analysis. RESULTS: The mean age of the 23 131 inquirers was 37.9 ±â€Š16.63 years. The age as well as the proportion of male inquirers increased significantly with yearly 1.22 years respectively 1.6 % male proportion. The most common health issues according to the ICD-10 classification included symptom-oriented or general inquiries about complaints without a particular disease (chapter XVIII:13.8 % and XXI: 11.6 %), followed by inquiries about the skin (XII: 8.8 %), about the musculoskeletal system (XIII:7.5 %) and to the genitourinary system (XIV:7.4 %). The inquiries to Chapters XVIII and II (new formations) increased significantly. With "good" to "very good" 80.2 % of the users rated the benefit and with 96.7 % the comprehensibleness of the online answers. DISCUSSION: A web-based online consultation service can strengthen patient empowerment and the health literacy of medical laymen through the individual provision of health information. This included, in particular, unclear symptoms and findings without diagnosis. The advantages of an anonymous online consultation were used especially regarding intimate questions and progressively by men. The increase in inquiries concerning new formation may be due to the complex treatment strategies in the field of oncology.

The University Hospital Zurich Offers a Medical Online Consultation Service for Men With Intimate Health Problems.

The University Hospital of Zurich offers a text-based, Medical Online Consultation Service to the public since 1999. Users asked health questions anonymously to tele-doctors. This study focused on the characteristics of male enquirers with intimate health problems, the content of their questions, the medical advice given by tele-doctors and the rating of the service to prove the benefit of an online service for medical laymen. This retrospective study included 5.1% of 3,305 enquiries from 2008 to 2010 using the International Classification of Diseases-10 and International Classification of Primary Care codes relevant for intimate and sexual health problems in men. A professional text analysis program (MAXQDA) supported the content analysis, which is based on the procedure of inductive category development described by Mayring. The average age was 40 years, 63.1% enquirers had no comorbidity, in 62.5% it was the first time they consulted a doctor, and 70.2% asked for a specific, single, intimate health issue. In 64.3%, the most important organ of concern was the penis. Overall, 30.4% asked about sexually transmitted diseases. In 74.4% a doctor visit was recommended to clarify the health issue. The rating of the problem solving was very good. The service was mainly used by younger men without comorbidity and no previous contact with a doctor with regard to an intimate health problem. The anonymous setting of the teleconsultation provided men individual, professional medical advice and decision support. Teleconsultation is suggested to empower patients by developing more health literacy.

Impact of automatic adjustment of stimulation outputs on pacemaker longevity in a new dual-chamber pacing system.

INTRODUCTION: Automatic capture verification using the Autocapture (AC) feature enabled by paced evoked response detection and delivery of high energy back-up pulses intends to increase patient safety. Furthermore, adjustment of stimulation outputs can save energy and potentially improve pacemaker (PM) longevity. The purpose of this study was to evaluate the theoretical longevity of a new dual chamber PM with the integrated AC feature (Affinity DR, St. Jude Medical) in comparison to the longevity of a previous model from the same manufacturer without AC (Trilogy DR). METHOD: Affinity PMs were implanted in 16 patients and connected to a compatible lead with low polarization properties. AC was activated when the evoked response was significantly higher than the polarization voltage. Theoretical PM longevity was calculated with and without AC during follow-up. The measured and calculated values were compared to measurements in 19 patients, who consecutively received Trilogy-PMs during the same time period. RESULTS: In only one patient the evoked response was not adequate, and as a result, AC was not programmed. The calculated longevity of the Affinity-PMs 79 +/- 28 days after implantation was significantly higher in comparison to the Trilogy-PMs (Affinity-PMs: 8.9 +/- 1.2 years without and 9.5 +/- 1.1 years with AC; Trilogy-PMs: 6.5 +/- 0.8 years) (p < 0.005). CONCLUSION: The AC feature is an optional algorithm that can be activated in most patients and it significantly prolongs predicted battery longevity due to automatic adjustment of stimulation outputs.

Teleconsultation in vascular surgery: a 13 year single centre experience.

The University Hospital of Zurich has provided an email-based medical consultation service for the general public since 1999. We examined the enquiries in a 13-year period to identify those related to vascular surgery (based on 22 ICD-10 codes specific for vascular surgery). There were 40,062 questions, of which 643 (2%) were selected by ICD-10 codes. After exclusion of diagnoses not relevant to vascular surgery, 139 questions remained, i.e. an average rate of about one per month. The mean age of the users was 43 years (range 19-88). Most users (61%) were women. The majority of users asked questions about their own health problems (79%) with varicose veins and spider veins accounting for 63% of all questions. Arterial diseases accounted for 30%. The patient's intention in contacting the service was to obtain advice on treatment options (37%), information about a diagnosis or symptoms (27%), or a second opinion (15%). The online service responded with detailed information and advice (87%) and suggested a referral to the family doctor or a specialist in 75%. Most patients (82%) rated the service overall as good or very good. It appears likely that telemedicine and in particular email teleconsultations will increase in vascular surgery in the future.

Medical online consultation service in CAM at the University Hospital Zurich.

BACKGROUND: The University Hospital Zurich offers medical online consultation services in individual health concerns. We examined the need for users' information in the field of CAM. For this purpose, the content of the questions, the users' profiles, and the online responses of the physicians were analyzed. METHODS: The retrospective study analyzed 154 (1.3%) out of 11,827 questions and responses, selected by a literature-based keyword list between 2006 and 2007. They were evaluated by means of an inductive category system described by Mayring using a professional text analysis program (MAXQDA). Frequencies and mean values of the categories were statistically determined. RESULTS: Users (aged 39.2 ± 16, females 61%) asked questions, which were in 73% allocated to herbal medicine, 7% to homeopathy, and 2% to acupuncture. The questions referred to medical fields, such as gynecology (18%), dermatology (13%), psychiatry (11%), and oncology (8%). One third of the responses provided detailed information about herbal treatment options. CONCLUSIONS: The email-based online consultation service was used as a source of medical information in order to get more professional consultation in the field of CAM. Future scientific evaluation should investigate if online consultation services which are embedded in an environment of highly qualified health professionals may contribute to a better health literacy and empowerment of the patients.

Medical online consultation service regarding maxillofacial surgery.

OBJECTIVE: The University Hospital of Zurich provides a medical online consultation service since 1999. Our aim was to characterise the users of an online consultation with queries regarding maxillofacial surgery, to analyse the content of their questions and to study the actions by the internet doctors with the ambition of defining whether the telemedical consultation is a useful tool in this surgical field. MATERIALS AND METHODS: The procedure of inductive category development described by MAYRING was used. A professional text analysis program MAXQDA supported the process of analysis. 204 questions were evaluated. RESULTS: Men sent 37% of the questions, 48% originated by women, mean age was 38 years. Often they asked for information about medical therapies or pharmaceuticals (n=74) and about specific disease or an injury (n=26). The three most common maxillofacial surgery topics were sinusitis (n=21), aphthae in the mouth (n=17) and basal cell carcinoma (n=14). CONCLUSIONS: Online consultation is not only understood as a first contact with the healthcare system but also as a centre to get professional further and detailed information and advice after a doctor visit, especially about chronic diseases and infections. Online consultation can complement the traditional healthcare and conventional physician-patient relationship in maxillofacial surgery.