Obesity in total laparoscopic hysterectomy for early stage endometrial cancer: health gain and inpatient resource use.

OBJECTIVE: To explore relationships between BMI (morbid/severe obesity; BMI ≥ 35 kg/m2 vs. non morbid/severe obesity; BMI < 35 kg/m2), postoperative health gain and hospital resource use for women who receive a Total Laparoscopic Hysterectomy (TLH) for early stage endometrial cancer. DESIGN: Secondary analysis of RCT data (LACE Study; Total Abdominal Hysterectomy vs. TLH). SETTING: 20 tertiary gynaecological cancer centres in Australia, New Zealand and Hong Kong. POPULATION: About 404 women who received TLH to treat early stage endometrial cancer. METHODS: For women with BMI < 35 vs. BMI ≥ 35 kg/m2, we compared (i) postoperative health gain, using utility scores derived from responses to the EQ-5D-3L health-related quality of life instrument, and (ii) inpatient hospital resource use, using adverse events, surgery duration and postoperative length of stay as indicators, to 6 months post-surgery. MAIN OUTCOME MEASURES: Health gain, resource use. RESULTS: Mean postoperative health gain was 0.07 units, and did not vary by BMI. Women with a BMI ≥ 35 had an increased rate of severe postoperative AEs (BMI ≥ 35 RR = 1.95, P = 0.02), and the surgery took on average 9.6 min longer (BMI < 35 kg/m2 122.5 min 95% CI 117.4-127.8; BMI ≥ 35 kg/m2 132.1 min 95% CI 126.3-138.2; P = 0.02). CONCLUSION: While postoperative health gain for women with BMI ≥ 35 was similar to that of women with lower BMI, the gain was achieved at the expense of greater resource use. Further work could definitively quantify the excess cost of TLH for obese patients with endometrial cancer, and investigate the potential for non-surgical treatment options, at least for those women at high risk of postoperative AEs.

Education and training to support the use of clinical telehealth: A review of the literature.

Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

Radiological interpretation of images displayed on tablet computers: a systematic review.

OBJECTIVE: To review the published evidence and to determine if radiological diagnostic accuracy is compromised when images are displayed on a tablet computer and thereby inform practice on using tablet computers for radiological interpretation by on-call radiologists. METHODS: We searched the PubMed and EMBASE databases for studies on the diagnostic accuracy or diagnostic reliability of images interpreted on tablet computers. Studies were screened for inclusion based on pre-determined inclusion and exclusion criteria. Studies were assessed for quality and risk of bias using Quality Appraisal of Diagnostic Reliability Studies or the revised Quality Assessment of Diagnostic Accuracy Studies tool. Treatment of studies was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: 11 studies met the inclusion criteria. 10 of these studies tested the Apple iPad(®) (Apple, Cupertino, CA). The included studies reported high sensitivity (84-98%), specificity (74-100%) and accuracy rates (98-100%) for radiological diagnosis. There was no statistically significant difference in accuracy between a tablet computer and a digital imaging and communication in medicine-calibrated control display. There was a near complete consensus from authors on the non-inferiority of diagnostic accuracy of images displayed on a tablet computer. All of the included studies were judged to be at risk of bias. CONCLUSION: Our findings suggest that the diagnostic accuracy of radiological interpretation is not compromised by using a tablet computer. This result is only relevant to the Apple iPad and to the modalities of CT, MRI and plain radiography. ADVANCES IN KNOWLEDGE: The iPad may be appropriate for an on-call radiologist to use for radiological interpretation.

Using videotelephony to support paediatric oncology-related palliative care in the home: from abandoned RCT to acceptability study.

Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours 'on-call' service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation. Trial registration ACTRN 12606000311550.