Telemedicine Plus Standard Care Versus Standard Care Only in Specialized Outpatient Palliative Care: A Randomized Controlled Noninferiority Trial.

Background: Patients suffering from incurable diseases are more likely to die in the hospital than at home. Specialized outpatient palliative care (PC) may be able to counteract this tendency. Similarly, potential benefits of telemedicine in health care were scientifically reported. The aim of this research was to compare patients receiving specialized outpatient PC plus telemedicine with those receiving standard specialized outpatient PC only. In this study, telemedicine is assumed to decrease the number of home visits and therefore should not be considered a mere add-on. Methods: This is a randomized controlled noninferiority trial. Recruitment lasted between January 2020 and October 2021. Quality of care was evaluated using the Integrated Palliative Care Outcome Scale (IPOS) at day 0, 7, and 14 after randomization. Change from day 0 to 7 was defined as the primary outcome (noninferiority margin = 4 points). This study was conducted in an urban setting in collaboration with a university hospital and a local specialized outpatient PC service. Results: A total of 196 patients were screened with 34 patients included (18 telemedicine/16 standard care). The mean change in the total score of the IPOS from day 0 to 7 amounted to -1.8 ± 3.9 (telemedicine) versus 1.2 ± 5.7 (standard care). The telemedicine group was statistically not relevantly inferior to the standard care group (t-test for noninferiority, p = 0.005). Conclusions: Although, due to COVID-19, the sample size remained rather small, our findings indicate that telemedical approaches offer a promising and equally effective option to provide specialized outpatient PC. Clinical Trial Registration Number: NCT06054048.

[Bicycle accidents in the course of time in Münster, Germany : Analysis of changes in bicycle accidents over the past 10 years]. / Münsteraner Fahrradunfälle im Wandel der Zeit : Analyse der Entwicklung der Fahrradunfälle in den letzten 10 Jahren.

BACKGROUND: Bicycles have been a popular means of transport for many years. Especially in times of increased climate discussion, the bicycle has moved further into focus as an environmentally friendly and cost-effective means of transport. Bike lanes and roads are becoming more crowded and new means of transport such as pedelecs or e­scooters are emerging. METHODS: A total of four studies by Münster University Hospital on bicycle accidents and the official accident statistics of the Münster police were compared. In the period from 2009 to 2019, three studies were conducted that considered all bicycle accidents and one study that only considered pedelec riders separately. RESULTS: The age distribution as well as main causes of accidents remained almost the same over the years. The number of pedelec accidents has increased. Pedelec riders have a higher average age and a higher proportion of intensive care stays; however, this cohort also has a high rate of helmet wearers. Overall, the willingness to wear a helmet seems to have increased. CONCLUSION: It should be considered that with increasing bicycle traffic, safety measures must be increased accordingly. In this respect, accident prevention should focus on three major areas, engineering, education and enforcement.

[Telemedicine]. / Telemedizin.

The care of patients over long distances has a long tradition. Modern technology offers more and more possibilities for communication. While initially only radio signals could be exchanged, image transmission is now possible without any problems and is part of everyday life in many areas of medicine. Telemedicine includes communication between service providers with each other, with the patient, and also communication in medicine via electronic media. Success factors are the engagement of users, remuneration, legislation, human factors, interoperability, standards, performance indicators and compliance with data protection. The benefits and risks must be carefully weighed against each other. If necessary, telemedicine can bring expertise to the patient, so that not every patient has to be brought to the expert. Thus, optimal care at the optimal place can be made possible.

Telemedical Consultations in Palliative Care: Benefits through Knowledge Exchange and Intercollegiate Collaboration-Findings from the German oVID Project.

(1) Background: As the number of people receiving specialized palliative care (PC) continues to rise, there is a need to ensure the transfer of this expertise from university-based PC departments to primary care hospitals without such in-house access. The present study examines the potential of telemedicine to bridge these gaps. (2) Methods: This is a prospective multi-center feasibility trial. All physicians were appropriately pre-equipped and instructed to conduct telemedical consultations (TCs), which took place within fixed meetings or on-call appointments either related or unrelated to individual patients (allowing TCs also for educational and knowledge exchange purposes). (3) Results: An inquiry for participation was submitted to 11 hospitals, with 5 external hospitals actively cooperating. In the first study section, a total of 57 patient cases were included within 95 patient-related TCs during 80 meetings. Other university disciplines were involved in 21 meetings (26.2%). Therapy adjustments resulted following 25 of 71 affected TCs (35.2%). In 20 cases (21.1%), an on-site consultation at the university hospital was avoided, and in 12 cases (12.6%), a transfer was avoided. Overall, TCs were considered helpful in resolving issues for 97.9% of the cases (n = 93). Yet, technical problems arose in about one-third of all meetings for at least one physician (36.2%; n = 29). Besides, in the second study section, we also conducted 43 meetings between physicians for education and knowledge exchange only. (4) Conclusions: Telemedicine has the potential to transfer university expertise to external hospitals through simple means. It improves collaboration among physicians, may prevent unnecessary transfers or outpatient presentations, and is thus likely to lower costs.

Creating a Telemedicine Network of Specialists in Maternal-Fetal Medicine: A Prospective Cohort Study.

Background: Even before coronavirus disease 2019, integrating telemedicine into routine health care has become increasingly attractive. Evidence regarding the benefits of telemedicine in prenatal care is still inconclusive. As one of the largest sectors of preventive medicine with a relative paucity of specialists in maternal-fetal medicine (MFM), the implementation of telemedicine solutions into prenatal care is promising. Our objective aimed at establishing a telemedicine network of specialists in MFM for interprofessional exchange regarding high-risk pregnancies. Furthermore, the aims were to evaluate the providers' attitude toward the telemedicine solutions and to quantify the number of inpatient appointments that were avoided through interprofessional video consultations. Methods: This prospective trial was part of a larger telemedicine project funded by the European Regional Development Fund. MFM experts were brought together using the ELVI software. A questionnaire was designed for the evaluation of video consultations. The responses were analyzed by the exact McNemar-Bowker test to compare planned procedures before and after video consultation. Results: An interprofessional network of specialists in prenatal ultrasound was established with a total of 140 evaluations for statistical analysis. Interprofessional video communication was viewed favorably by providers. Overall, 47% (33/70) of the scheduled visits were avoided after video consultation. The providers' tendency to refrain from sending their patients to the University Hospital Münster was statistically noticeable (p = 0.048). Conclusions: Interprofessional exchange through video consultation holds great potential in the context of prenatal care. More prospective research is needed to clearly establish the most beneficial standard of care for both patients and providers. Clinical trial registration number: 2019-683-f-S.

Accelerating the Front End of Medicine: Three Digital Use Cases and HCI Implications.

Digital applications in health care are a concurrent research and management question, where implementation experiences are a core field of information systems research. It also contributes to fighting pandemic crises like COVID-19 because contactless information flow and speed of diagnostics are improved. This paper presents three digital application case studies from emergency medicine, administration management, and cancer diagnosis with AI support from the University Medical Centers of Münster and Göttingen in Germany. All cases highlight the potential of digitalization to increase speed and efficiency within the front end of medicine as the crucial phase before patient treatment starts. General challenges for health care project implementations and human-computer interaction (HCI) concepts in health care are derived and discussed, including the importance of specific processes together with user analysis and adaption. A derived concept for HCI includes the criteria speed, accuracy, modularity, and individuality to achieve sustainable improvements within the front end of medicine.

Usability of Electronic Health Records in Germany - An Overview of Satisfaction of University Hospital Physicians.

INTRODUCTION: EHR are a part of daily task of physicians in Germany. This study surveyed the satisfaction of a small group of physicians in German university hospitals using EHR with focus on usability. METHODS: The questioning was carried out by an online survey. Addressed were all physicians working at university hospitals in Germany. RESULTS: The study showed that users are not satisfied with EHR (Grade 3.62). They pointed out some problems in general but reflected many advantages of those systems. CONCLUSION: EHR systems have to develop and adopt to users' tasks. They have to get faster and low error rates must be realized. Existing infrastructure must be improved and rolled out to users especially in times where digital healthcare services gain importance.

Medical Emergency Data and Networks: A German-Canadian Comparison.

A significant number of problems in emergency care are caused by a lack of provider access to pre-existing patient information at the point of care. Medical Emergency Datasets (MEDs) are brief summarizations of an individual's medical history, providing vital patient information to emergency medical providers. The German MED was validated by German physicians and - based on an international research project - also by Canadian physicians. Physicians in both countries considered the content very useful. The MED is currently being introduced in Germany as part of the Telematic Infrastructure. At the same time, the COVID pandemic forced healthcare professionals around the work to optimize the digital information exchange among different healthcare providers. While the exchange of data is important, additional personal expert advice is sometimes vital. Real time virtual support systems (RTVS) were introduced in Germany and Canada to support team-based healthcare delivery, independent of the actual location. Such systems have been implemented for intensive care, emergency medicine, primary care and several other medical specialties. These systems serve as a safety net, a funnel (appropriate utilization; linking patients back to primary care networks - thus reducing fragmented or disrupted services) and a medical network by building interprofessional relationships.

An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial.

BACKGROUND: Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings). OBJECTIVE: This study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. METHODS: We performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ≥18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. RESULTS: Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95% CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95% CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29% (19/66) in the control group to 23.8% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95% CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95% CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95% CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. CONCLUSIONS: Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589.

Satisfaction with and Feasibility of Prenatal Counseling via Telemedicine: A Prospective Cohort Study.

Introduction: Telemedicine has become increasingly important over the past decade. With the pressure of the COVID-19 pandemic, demands for remote health care solutions have seen an unprecedented rise. However, many questions regarding the feasibility and benefits of telemedicine remain. The aim of our study was to evaluate both the technical feasibility and patient satisfaction with video consultations in a tertiary center for obstetric care. Materials and Methods: This prospective single-center trial was part of the larger open Video Service project on telemedicine at the Department of Gynecology and Obstetrics at the University of Münster. Patients requiring prenatal or prepregnancy counseling were included. A questionnaire was designed for the evaluation of patient satisfaction and filled in by both patient and health care provider at the end of the video consultation. Results: Of 80 eligible cases, 75 video consultations were carried out and data from the questionnaire were collected. Overall patient satisfaction was high (95%, 71/75) although technical problems occurred in 37% (29/75) of the appointments. Health care providers' satisfaction was equally high and in 88% (66/75) of cases, remote consultations avoided an in-house visit without effect on health care quality. Conclusions: Remote consultations are feasible and yield high satisfaction rates even in a medical field as sensitive as perinatal medicine. Further research is necessary to determine the cost-effectiveness and effects on perinatal outcome. Health care systems should be offered clear guidance on medicolegal issues and funding of remote consultations to integrate telemedicine into routine health care.

[Telemedicine in the emergency room-An extension with potential? : Results of a recent survey]. / Telemedizin im Schockraum ­ eine Ergänzung mit Potenzial : Ergebnisse einer aktuellen Umfrage.

Critically injured patients pose great challenges for medical personnel in emergency room treatment. How can such a high workload due to a lack of personnel be reduced? Telemedicine can offer solutions here. With the help of external medical expertise, diagnoses and treatment processes are already significantly accelerated and optimized in other specialist areas. This possibility should now also be introduced into the care of critical trauma surgery patients. In this article, current emergency room treatment is reflected, problems are shown and future-oriented solutions are suggested.

Medical Emergency Datasets Can Improve the Comprehensiveness of Handover Information: A Simulation Study.

Background: Access to patients' medical histories can be of vital importance to ensure proper treatment in an emergency. Germany is planning to introduce a medical emergency dataset (MED), accessible through an electronic health card, and comprising important patient information, such as diagnoses, medications, and allergies. Introduction: This article evaluates the effect of MEDs on the comprehensiveness of a physician's documentation and handover process to the emergency department of a hospital. Materials and Methods: In 2 randomized, crossover simulation studies, 72 emergency physicians participated in 2 emergency scenarios, either with or without access to an MED. Subsequently, they had to document the key information (pre-existing conditions, medications, and allergies) and hand it over to a fictional hospital. The influence of the MED on the documentation of key information was analyzed using the two-sided Prescott's exact test. Sensitivity analyses adjusting for scenario were conducted. Results: The results show that in scenarios with an MED, documentation of key information in the handover process was more complete. In the first trial, 2 of 3 key items (pre-existing conditions/information and allergies) presented a statistically noticeable difference in scenarios with the MED. The second trial confirmed these results for all key items. Discussion: The findings indicate that the use of MEDs in emergency care could be beneficial since documentation and handover in scenarios with an MED were superior to current real-world practices. Conclusions: Access to more complete patient information through an MED could help to improve the patient's treatment.

Online Patient Consultation. / Die Online-Videosprechstunde.

New communication technologies allow patients to communicate with their physicians from anywhere using computer or smartphone. Adding video to the mere phone call optimizes the personal contact between patient and physicians regardless of distance. Legal and reimbursements requirements must be taken into account, especially only certified software products must be used. In addition, patient consent is needed and confidentiality must be assured. The video patient consultation can be reimbursed by the health insurance companies. As with all new technologies, the introduction of these video consultations faced some challenges. Although patients and physicians have expressed great interest in this technology, it has been rarely used so far. The current COVID crisis increased the need for video consultations resulting in an increasing use of video patient consultation. It can be expected that this demand will still exists after the COVID crisis.

Evaluating Online Consumer Medication Information Systems: Comparative Online Usability Study.

BACKGROUND: Medication is the most common intervention in health care, and the number of online consumer information systems within the pharmaceutical sector is increasing. However, online consumer information systems can be a barrier for users, imposing information asymmetries between stakeholders. OBJECTIVE: The objective of this study was to quantify and compare the usability of an online consumer medication information system (OCMIS) against a reference implementation based on an interoperable information model for patients, physicians, and pharmacists. METHODS: Quantitative and qualitative data were acquired from patients, physicians, and pharmacists in this online usability study. We administered 3 use cases and a post hoc questionnaire per user. Quantitative usability data including effectiveness (task success), efficiency (task time), and user satisfaction (system usability scale [SUS]) was complemented by qualitative and demographic data. Users evaluated 6 existing systems and 1 reference implementation of an OCMIS. RESULTS: A total of 137 patients, 81 physicians, and 68 pharmacists participated in this study. Task success varied from 84% to 92% in patients, 66% to 100% in physicians, and 50% to 91% in pharmacists. Task completion time decreased over the course of the study for all but 2 OCMIS within the patient group. Due to an assumed nonnormal distribution of SUS scores, within-group comparison was done using the Kruskal-Wallis test. Patients showed differences in SUS scores (P=.02) and task time (P=.03), while physicians did not have significant differences in SUS scores (P=.83) and task time (P=.72). For pharmacists, a significant difference in SUS scores (P<.001) and task time (P=.007) was detected. CONCLUSIONS: The vendor-neutral reference implementation based on an interoperable information model was proven to be a promising approach that was not inferior to existing solutions for patients and physicians. For pharmacists, it exceeded user satisfaction scores compared to other OCMIS. This data-driven approach based on an interoperable information model enables the development of more user-tailored features to increase usability. This fosters data democratization and empowers stakeholders within the pharmaceutical sector.

Great Help for Small People - The Development of a Children's Emergency App.

In order to assist parents in providing rapid first aid to children in case of emergency, a mobile emergency application was developed. The children's emergency app works with intuitive graphics and checklists and combines several functions such as tips for preventing accidents, easy-to-understand instructions for first-aid actions and a search function for the next pediatrician or hospital. This app is not intended to be a substitute, but rather an addition to first aid courses.

[Computer-assisted decision-making for trauma patients]. / Computerassistierte Entscheidungsfindung beim Traumapatienten.

BACKGROUND: In the management of trauma patients in the resuscitation room many time-pressured and critical decisions must continuously be made in complex situations. Even experienced teams frequently make errors in this context. Computer-assisted decision-making systems can predict critical situations based on patient data continuously acquired online. Based on the calculated predictions these systems can suggest the next steps in managing the patient. This review summarizes the current literature on computer-assisted decision-making in the management of trauma patients. OBJECTIVE: A literature review summarizing existing concepts and applications of computer-assisted decision-making support for the management of trauma patients. METHODS: Narrative review article based on an analysis of literature in the German and English languages from the last 10 years. RESULTS: There exist numerous computer-assisted decision-making systems in the field of trauma care. Several studies could show that computer-assisted decision-making can improve the outcome in the preclinical setting, the resuscitation room and in the intensive care unit. For further validation and implementation of these systems, information technological barriers have to be overcome, existing systems need to be adapted to current data protection regulations and large multicenter studies are necessary. CONCLUSION: Computer-assisted decision-making can help to improve the management of trauma patients; however, before a ubiquitous implementation a number of technological and legislative barriers have to be overcome.

Canadian Validation of German Medical Emergency Datasets.

Medical Emergency Datasets (MEDs) are brief summarizations of an individual's medical history, providing vital patient information to emergency medical providers. A recent German study [1] evaluated whether MEDs are useful to local emergency physicians and paramedics, and which health data were relevant to their medical management. To validate of the German study internationally, Canadian physicians and paramedics were recruited to provide feedback on the utility of the German MEDs as well as their specific content. Original documents and surveys were translated to English directly, with a goal of collecting quantitative and qualitative feedback. Overall, physicians and paramedics found the MEDs to be useful in their evaluation of hypothetical medical scenarios. Most of the MED content was very useful, with some items appearing extraneous. The findings of this study will be used to inform future development of MEDs as well as to drive future research.

[How Probable is it That Seniors Using an E-Bike Will Have an Accident? - A New Health Care Topic, Also for Consulting Doctors]. / Zur Unfallwahrscheinlichkeit von Senioren bei der Nutzung von E-Bikes.

BACKGROUND: In Germany there are more than 70 million bicycles. Because of technical progress, over 200,000 electro-assisted bikes were sold in Germany in 2010 alone. In 2013, the number increased to 410,000. Currently more than 1.6 million electric bicycles are used here. One of the largest user groups are seniors. Accident researchers fear an increased risk of accidents/injuries. METHODS: For one year, all cycling accidents involving electric bicycles and senior citizens were collected and analysed in 23 hospitals of the TraumaNetwork NorthWest and by the local police authorities. RESULTS: A comparison of the senior and younger electro-assisted cyclists showed a higher risk of injury for seniors in the initial analysis. A further comparative analysis of severely injured seniors who were riding an electro-assisted bike with those who used a conventional bicycle contradicted this. There was no statistical significance. The risk of an accident increased with age, but not with bicycle type. CONCLUSION: To reduce accidents, driving training and medical precautionary examinations could be used to detect losses of performance, cognitive processing and balance. In the future, they should become an integral part of the health care system and the services of practicing physicians.

A Secure Architecture to Provide a Medical Emergency Dataset for Patients in Germany and Abroad.

The ongoing fragmentation of medical care and mobility of patients severely restrains exchange of lifesaving information about patient's medical history in case of emergencies. Therefore, the objective of this work is to offer a secure technical solution to supply medical professionals with emergency-relevant information concerning the current patient via mobile accessibility. To achieve this goal, the official national emergency data set was extended by additional features to form a patient summary for emergencies, a software architecture was developed and data security and data protection issues were taken into account. The patient has sovereignty over his/her data and can therefore decide who has access to or can change his/her stored data, but the treating physician composes the validated dataset. Building upon the introduced concept, future activities are the development of user-interfaces for the software components of the different user groups as well as functioning prototypes for upcoming field tests.

Emergency Data Management - Overcoming (Information) Borders.

BACKGROUND: In order to improve access to critical patient data in case of emergency, many countries have begun or intend to implement emergency datasets. In Germany, the German Medical Association developed a medical emergency dataset (MED), which provides the possibility to store information on prior diagnoses, medications, allergies and other emergency-relevant information on the German Electronic Health Card. OBJECTIVES: The aim of the study is to evaluate how the MED can be used internationally. METHODS: A total of 64 paper-based emergency data sets were completed by primary care physicians in Germany, and were then evaluated by German clinicians, emergency physicians, and paramedics on the basis of fictitious emergency scenarios. Thirty randomly selected MEDs were then translated into English and will be evaluated by international emergency physicians and paramedics. RESULTS: In Germany, clinicians, emergency physicians and paramedics rated the emergency data set as very useful or useful in more than 70% of the reviewed cases. The international evaluation will start in September 2016, so these results are pending at this time. CONCLUSION: The first study results from Germany indicate high potential benefits of the emergency data set in real patient care situations. The subsequent tests will show whether the MED is also suitable for international use.