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Background/purpose: Appropriate oral health assessment and management can improve the oral health and nutritional status of hospitalized patients. The active participation of dental professionals in the nutritional support team (NST) can help achieve this outcome. However, the participation of dental professionals in NSTs is often limited, indicating the requirement for establishing a remote oral health assessment method. This study aimed to establish a multidisciplinary oral health assessment system using short video recordings with a tablet device. Materials and methods: Fifty inpatients receiving NST aid at the Tokyo Medical and Dental University Hospital were included in this study. The degree of agreement between the oral health assessment performed at the bedside and using the short video recordings of the oral health acquired with a tablet device by a single dentist and the degree of agreement for evaluations performed using the video recordings between multiple professionals were evaluated. The oral health status was assessed using the Oral Health Assessment Tool (OHAT). Results: The intraclass correlation coefficient (ICC) of the OHAT total scores for oral health assessment performed at the bedside and using the videos by a single dentist was 0.914 (95% confidence interval [CI], 0.854–0.950). ICCs of the OHAT total scores for the video assessment performed by dentists and multiple professionals were 0.904 (95% CI, 0.838–0.944) and 0.802 (95% CI, 0.676–0.883), respectively. Conclusion: Comprehensive oral health assessment of patients can be performed by multiple professionals using the short video recordings of the oral health acquired with a tablet device.

Summary: Background: This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS. Methods: TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register—REBEC, under the code RBR-8gpgyd. Study status is “Completed”. Findings: This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54–68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was −0.6% (90% CI −1.0; −0.1) at 3-months and −0.5% (90% CI −0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups. Interpretation: The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic. Funding: This study was funded by the Brazilian Ministry of Health, through the Unified Health System–Institutional Development Support Program (PROADI-SUS).

Background: Heparin-induced thrombocytopenia (HIT) is a complication of heparin exposure associated with high risk for morbidity and mortality. Diagnosis and management are complex due to limitations of laboratory testing and the need for nonheparin anticoagulation. Objectives: To increase the delivery of evidence-based care of patients with suspected and confirmed HIT via electronic consultation (e-consult). Methods: We describe the creation and implementation of an e-consult service for patients with concern for HIT at a large academic medical center. Hematology physicians with HIT expertise performed real-time chart review of all patients with a positive screening immunoassay result and provided written recommendations in their electronic health record. Results: Comparison of outcomes for 1 year before and the year after the e-consult service implementation identified improvements in direct thrombin inhibitor stewardship, increased diagnostic accuracy, and decreased length of stay of patients with confirmed HIT. Conclusion: The e-consult platform is a novel method for rapid, targeted consultative guidance, and this single-institution pilot demonstrates its feasibility and effectiveness to improve the care of patients with suspected and confirmed HIT.

Resumen: La teleconsulta es una consulta sanitaria a distancia que se realiza mediante tecnologías de la información y la comunicación (TIC). Existen diferentes modalidades que requieren de habilidades técnicas y comunicativas específicas. Aunque en España la teleconsulta ocupa una posición destacada, la evidencia a su alrededor es limitada.El artículo aborda la aplicabilidad, barreras, facilitadores y retos futuros de la teleconsulta. Aunque tiene el potencial de mejorar el acceso a la atención sanitaria, así como de ahorrar tiempo y costes tanto para los pacientes como para los profesionales sanitarios, debe enfrentar una serie de desafíos como la brecha digital y la resistencia al cambio. Para superar estos obstáculos y abordar nuevos retos es crucial la confianza de pacientes y profesionales, así como mejorar la formación en las competencias necesarias para optimizar su uso.La investigación futura debe centrarse en proporcionar evidencias sólidas en términos de seguridad y coste-efectividad para asegurar su implementación. Abstract: Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation.This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change.To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential.Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.

While telemedicine applications in low- and middle-income countries are growing rapidly, few studies address the social and organizational factors of implementation essential to sustaining clinician engagement. This study aims to explore clinician experiences and perspectives of a pediatric emergency teleconsultation support program in Sindh, Pakistan, and theories of use behind its implementation in government hospitals. We conducted in-depth interviews with 20 stakeholders of the teleconsultation program, including program administrators (n ​= ​3), teleconsultants (n ​= ​7) and on-site physicians and nurses (n ​= ​10) purposively sampled for maximum variation across perceived fidelity and acceptability on a preliminary questionnaire. Interview questions and probes were designed to elicit rich perspectives on communication structures, enabling and constraining factors, and overall effects of teleconsultation on clinical routines and quality of care. Transcripts were analyzed thematically using combined inductive and deductive coding. We found that, behind the technical adaptation to using telemedicine in the resuscitation room, providers perceived a dynamic reconfiguration of professional roles and routines of consultation according to opportunities and constraints associated with mutual confidence or trust, constructions of distance, subjectivity of information, and the interface of technological artifacts with medical practice. Descriptions of communication patterns revealed an unstable tension between two competing theories of use premised on either inherent contextual differences or presumed asymmetries in expertise. Long-term sustainability of telemedicine applications to pediatric emergency care requires serious consideration of how such conflicting theories of use and their associated assumptions about end-user needs crystallize in practice and affect clinician engagement and perceived benefits to patient care in the future.

Background: In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme., Objectives: To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development., Design: Qualitative focus groups., Methods: Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted., Results: Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes., Conclusions: Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services' goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The integration of teledermatology and artificial intelligence (AI) marks a significant advancement in dermatologic care. This study examines the synergistic interplay between these two domains, highlighting their collective impact on enhancing the accuracy, accessibility, and efficiency of teledermatologic services. Teledermatology expands dermatologic care to remote and underserved areas, and AI technologies show considerable potential in analyzing dermatologic images and performing various tasks involved in teledermatology consultations. Such integration facilitates rapid, precise diagnoses, personalized treatment plans, and data-driven insights. Our explorative study involved designing a GPT-based chatbot named "Dr. DermBot" and exploring its performance in a teledermatologic consultation process. The design phase focused on the chatbot's ability to conduct consultations autonomously. The subsequent testing phase assessed its performance against the backdrop of current teledermatologic practices, exploring the potential of AI and chatbots to simulate and potentially enhance teledermatologic health care. Our study demonstrates the promising future of combining teledermatology with AI. It also brings to light ethical and legal concerns, including the protection of patient data privacy and adherence to regulatory standards. The union of teledermatology and AI not only aims to enhance the precision of teledermatologic diagnoses but also broadens the accessibility of dermatologic services to previously underserved populations, benefiting patients, health care providers, and the overall health care system., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The goal of this article is to provide technical and operational blueprints for two successful global telehealth programs., Methods: The authors designed a physician-to-physician consultation program to provide subspecialty expertise to physicians in war-torn Ukraine. Leveraging secure web applications, telehealth platforms, and image-sharing platforms, the authors repeatedly iterated upon infrastructure and workflows, which in turn facilitated the development of a parallel international program for US Department of State (DOS) employees and families. The authors provide descriptive statistics and metrics of both programs' successes and failures and detail iterative improvements with workflow visuals. To measure the added value of subspecialty imaging consultation, two radiologists performed a retrospective comparative review of the DOS program imaging reports, comparing the initial report to the consult report in consensus, measuring diagnostic report agreement, and rating the clinical impact of identified discrepancies on a three-point scale (mild, moderate, or major). Bivariate analyses using χ 2 tests were conducted to assess associations between diagnostic discrepancies and patient or imaging factors. P values <.05 were considered to indicate statistical significance., Results: The Ukraine program (May 2022 to August 2023) provided 114 patient consultations with 77 subspecialty radiology consults, >50 WhatsApp chats, and >1,000 messages exchanged, with a 92% overall consult request response rate. The DOS program (November 2022 to July 2023) provided 275 consultations with 70 subspecialty radiology consults and a 36% to 38% rate of alternative diagnoses, with 20% rated as incurring moderate or major clinical impact. Bivariate analyses demonstrated no significant patient or imaging association with diagnostic disagreements (P > .05 for all)., Conclusions: Global telehealth infrastructure and multiple applications and platforms can be optimized in a workflow to provide efficient, high-level clinical and imaging consultation services across the globe., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: The coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic., Objectives: To explore musculoskeletal physiotherapists' experiences of using remote consultations in one area of England during the COVID-19 pandemic., Design: Qualitative study using hermeneutic phenomenology based on the approach of Gadamer., Methods: Semi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics., Findings: Musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists., Conclusion: The findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Heparin-induced thrombocytopenia (HIT) is a complication of heparin exposure associated with high risk for morbidity and mortality. Diagnosis and management are complex due to limitations of laboratory testing and the need for nonheparin anticoagulation., Objectives: To increase the delivery of evidence-based care of patients with suspected and confirmed HIT via electronic consultation (e-consult)., Methods: We describe the creation and implementation of an e-consult service for patients with concern for HIT at a large academic medical center. Hematology physicians with HIT expertise performed real-time chart review of all patients with a positive screening immunoassay result and provided written recommendations in their electronic health record., Results: Comparison of outcomes for 1 year before and the year after the e-consult service implementation identified improvements in direct thrombin inhibitor stewardship, increased diagnostic accuracy, and decreased length of stay of patients with confirmed HIT., Conclusion: The e-consult platform is a novel method for rapid, targeted consultative guidance, and this single-institution pilot demonstrates its feasibility and effectiveness to improve the care of patients with suspected and confirmed HIT., (© 2024 The Author(s).)

Purpose: To report a novel protocol for diagnosis of retinal artery occlusions at the point of care using OCT and a remote consult model., Design: Retrospective case series and evaluation of a diagnostic test or technology., Participants: Adult patients who presented with painless monocular vision loss and were diagnosed with a nonarteritic retinal artery occlusion., Methods: OCT machines were placed in the stroke center or emergency department at 3 hospitals within our health system. Patients who presented with painless monocular vision loss were evaluated by the stroke neurology service and an OCT was acquired. The images were interpreted remotely by the retina service. An in-house ophthalmology consult was not required to make the final treatment decision. Eligible patients were treated with intra-arterial tissue plasminogen activator (IA-tPA). Patients were followed by ophthalmology during their admission when an in-house consultation service was available or otherwise evaluated immediately after discharge., Main Outcome Measures: Visual acuity (VA) before and after treatment with IA-tPA; time from last known well (LKW) to treatment; and time from presentation to treatment., Results: In the first 18 months since the protocol went live, 59 patients were evaluated. Twenty-five patients (42%) had a confirmed retinal artery occlusion based on OCT and follow-up examination. Ten patients were eligible for treatment, and 9 patients received treatment with IA-tPA. There was a statistically significant improvement in mean VA from logarithm of the minimum angle of resolution (logMAR) 2.14 to logMAR 0.7 within 24 hours after treatment (P = 0.0001) and logMAR 1.04 after 4 weeks (P = 0.01). Clinically significant improvement was noted in 66% of patients within 24 hours and maintained through 1 month in 56% of all treated patients. The mean time to treatment from LKW was 543 minutes and from presentation at the stroke center was 146 minutes., Conclusions: We report the successful implementation of a remote consult protocol using point-of-care automated OCT. This novel paradigm demonstrates the potential utility of remote consult services for the diagnosis of time-sensitive ophthalmic emergencies., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Published by Elsevier Inc.)

Resumen: Objetivo: Se realiza un estudio observacional antes y después para valorar el efecto de la consulta virtual (eConsulta) sobre la frecuentación posterior que realiza el paciente a su centro de atención primaria una vez ha realizado su primera consulta virtual. Emplazamiento: Población asignada de los Centros de Atención Primaria Masnou-Alella y Ocata-Teià del Institut Català de la Salut. Participantes: Se realiza un muestreo aleatorizado y se comparan 329 pacientes que realizaron eConsultas respecto de 329 pacientes estadísticamente similares en edad, sexo y complejidad médica que no realizaron ninguna eConsulta. Mediciones principales: Se midieron las visitas realizadas con medicina primaria y enfermería de su equipo, tanto presenciales, telefónicas y eConsultas, durante el periodo de estudio. Resultados: Los pacientes que realizaron consultas virtuales mostraron una frecuentación previa en la atención primaria mayor que aquellos que no realizaron eConsultas (4,44 visitas médicas/año versus 3,11). Tras el uso de la eConsulta, después de un año de seguimiento, su frecuentación se redujo hasta niveles del grupo control (3,16 visitas médicas/año versus 3,00). Tras la primera visita virtual, los pacientes redujeron las visitas presenciales en un 28,7%. Conclusiones: La eConsulta podría ser una herramienta eficaz para dar respuesta a las necesidades de los pacientes que no requieran de una visita presencial, en especial en los pacientes más frecuentadores. Abstract: Objective: A «before and after» type observational study was carried out to assess the impact of the virtual consultation (eConsulta) on the frequency with which the patient visits their primary care center once they have had their first virtual consultation. Setting: Assigned population of the primary care center of Masnou-Alella and Ocata-Teià, Catalan Health Institute. Participants: A random sampling was performed and 329 patients who engaged in eConsulta were compared with 329 statistically similar patients in age, sex and medical complexity who did not engage in eConsulta. Principal mediations: Visits with primary care and nursing in their team are measured, both face-to-face, telephone and eConsulta, over the study period. Results: Patients who performed virtual consultations showed a previous frequent attendance in primary care higher than those who did not perform eConsulta (4.44 medical visits year/versus 3.11). Following the use of the eConsulta, after a year of follow-up, frequency was reduced to levels of the control group (3.16 medical visits/year versus 3.00). After the first virtual visit, patients reduced face-to-face visits by 28.7%. Conclusions: The eConsulta could be an effective tool to respond to the needs of patients who do not require a face-to-face visit, especially in the most frequent patients.

Objectives: This was the first urogynaecology specialty nurse teleconsultation offered by a public hospital during COVID-19 for learning pelvic floor exercises. This study assessed patients' perception, acceptance, and satisfaction using 2 validated questionnaires., Methods: In total, 25 patients with stress urinary incontinence attended the teleconsultation via videoconferencing in April 2022, and completed the Telemedicine Perception Questionnaire (TMPQ) and Telemedicine Satisfaction Questionnaire (TSQ). The TMPQ was a 17-item, 5-point Likert scale questionnaire for assessing the acceptability of telemedicine. The TSQ was a 14-item, 5-point Likert scale questionnaire for assessing satisfaction with teleconsultation. The higher the score, the greater the acceptance and satisfaction. Information on demographics, symptom severity by Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7, internet access, and transport arrangements were included., Results: Participants had a mean age of 54.6 ± 7.37 years. Their mean Urogenital Distress Inventory-6 score was 40.60/100 (SD = 17.83) and Impact Questionnaire-7 was 27.90/100 (SD = 19.83). Pre-teleconsultation mean TMPQ score was 59.16 ± 5.78/85. Post-teleconsultation mean score was 64.92 ± 5.21/85, which was 3.64 higher (t = 3.642, df = 24, P = 0.001), indicating a significant increase in positive perception and acceptability. There were fewer concerns with the usage (P = 0.017) and reliability (P = 0.003) of technology, while there was increased agreement that teleconsultation is cost-saving for the health care system (P = 0.003) and offers easier access to health care providers (P = 0.006) after the teleconsultation. Mean TSQ score was 59.85 ± 9.46/70., Conclusion: Our pilot study demonstrated positive perception, high acceptability, and satisfaction from patients' first teleconsultation experience. Further multi-centre studies with the inclusion of a control group would help in understanding patients' needs and for service planning., (Copyright © 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Study Objective: During the COVID crisis, pre-anesthesia teleconsultations were widely used leading to savings in time and money. However, the non-inferiority of this system has not yet been evaluated., Design: Prospective, randomized, controlled, single-blind non-inferiority study., Setting: University hospital., Patients: Patients scheduled for surgery requiring a single pre-anesthesia consultation (PAC)., Intervention: Pre-anesthesia teleconsultation (PATC) from patient's home., Measurements: Primary outcome: concordance between the pre-anesthesia visit (PAV), performed on the day of surgery, and PAC or PATC on: Secondary outcomes: cancellation rate, immediate perioperative complications, patient satisfaction, organization, and economic and ecological costs., Main Results: Out of 172 patients included, 149 were analyzed. PATC was no less effective than PAC in terms of the primary outcome or each of its components: the difference between groups was: - 0.044[90% CI: -0.135; 0.047] (p = 0.0002). There was no difference in cancellation rates (PAC 1.99% vs. PATC 1.27%, p = 0.6) or in immediate perioperative complications (none). Satisfaction was 9.48 (±1.45) in the PAC group and 8.96 (±1.68) in the PATC group (p = 0.0006). In the PATC group, the mean savings per patient were 30 km (± 29), 36 min (± 27), and 18 (± 18) euros, respectively., Conclusions: According to our criteria, PATC was not inferior to PAC for preoperative patient evaluation and may be an interesting economical, ecological alternative., Competing Interests: Declaration of Competing Interest EM received fees as a consultant from Medin+ Company, a telehealth company that does not operate teleconsultation. The other authors have no disclosures to make related to that field., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Traditional on-site missions of plastic surgeons from "high-income countries" in "low- and middle-income countries" are often limited in time and lack proper follow-up. Regular digital collaboration could lead to a more impactful and durable exchange of knowledge for plastic surgeons and residents in both settings., Aims: The aim of this study was to evaluate the satisfaction of the first twelve months of weekly digital meetings, explore advantages/disadvantages, and to provide tools for similar initiatives., Methods: Weekly meetings started from August 2021. An encrypted digital connection allowed residents and plastic surgeons from Uganda and the Netherlands to discuss cases for educational purposes, where treatment options were considered. After twelve months, a survey was sent to participants from both countries to indicate the meetings' strengths, weaknesses, and possible improvements., Results: A total of 18 participants responded to the questionnaire (ten plastic surgeons, six residents, and two researchers). The strengths of the meetings were the accessibility of the meetings, knowledge exchange and practice for residents' final exams. Possible improvements included having a clear format for patient discussion, a session moderator and better internet connectivity. Moreover, a database to assess the impact of the given intervention on the patient cases by evaluating postoperatively (e.g. three months), could further improve clinical care., Conclusions: Virtual patient discussions subjectively contributed to medical education at both locations. Improved digital infrastructure and a collaborative database could further maximize learning capacity. Furthermore, digital proctoring is a promising way to establish sustainable collaborations between high- and low-resource countries., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The COVID pandemic brought the need for more realistic remote consultations into focus. 2D Telemedicine solutions fail to replicate the fluency or authenticity of in-person consultations. This research reports on an international collaboration on the participatory development and first validated clinical use of a novel, real-time 360-degree 3D Telemedicine system worldwide. The development of the system - leveraging Microsoft's Holoportation™ communication technology - commenced at the Canniesburn Plastic Surgery Unit, Glasgow, in March 2020., Methods: The research followed the VR CORE guidelines on the development of digital health trials, placing patients at the heart of the development process. This consisted of three separate studies - a clinician feedback study (23 clinicians, Nov-Dec 2020), a patient feedback study (26 patients, Jul-Oct 2021), and a cohort study focusing on safety and reliability (40 patients, Oct 2021-Mar 2022). "Lose, Keep, and Change" feedback prompts were used to engage patients in the development process and guide incremental improvements., Results: Participatory testing demonstrated improved patient metrics with 3D in comparison to 2D Telemedicine, including validated measures of satisfaction (p<0.0001), realism or 'presence' (Single Item Presence scale, p<0.0001), and quality (Telehealth Usability Questionnaire, p = 0.0002). The safety and clinical concordance (95%) of 3D Telemedicine with a face-to-face consultation were equivalent or exceeded estimates for 2D Telemedicine., Conclusions: One of the ultimate goals of telemedicine is for the quality of remote consultations to get closer to the experience of face-to-face consultations. These data provide the first evidence that Holoportation™ communication technology brings 3D Telemedicine closer to this goal than a 2D equivalent., (Copyright © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada., Methods: We conducted a multiple case study with four cases (ON, QC, MB, NL). Data collection methods included document review (n = 93), meeting observations (n = 65) and semi-structured interviews (n = 40). Each case was analyzed based on Milat's framework., Results: The first scaling-up phase was marked by the rigorous evaluation of eConsult pilot projects and the publication of over 90 scientific papers. In the second phase, provinces implemented provincial multi-stakeholder committees, institutionalized the evaluation, and produced documents detailing the scaling-up plan. During the third phase, efforts were made to lead proofs of concept, obtain the endorsement of national and provincial organizations, and mobilize alternate sources of funding. The last phase was mainly observed in Ontario, where the creation of a provincial governance structure and strategies were put in place to monitor the service and manage changes., Conclusions: Various strategies need to be used throughout the scaling-up process. The process remains challenging and lengthy because health systems lack clear processes to support innovation scaling-up., Competing Interests: Declaration of interest This work was supported by the Canadian Institutes of Health Research [grant number #402867], Réseau-1 Québec, Fonds de recherche Québec-Santé , Research Centre - Charles-Le Moyne, Initiative Patient Partenaire from the University of Sherbrooke, the Manitoba SPOR Primary and Integrated Health Care Innovation Network, C.T. Lamont Primary Health Care Research Centre, and the McGill Observatory on Health and Social Services Reforms. The funders had no role in the design of the study, the data collection and analysis, the interpretation of the results, nor in writing the manuscript. Drs. Liddy and Keely are co–executive directors of the Ontario eConsult Centre of Excellence, funded by the Ontario Ministry of Health. They cofounded the Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service but do not retain any proprietary rights. Dr. Keely answers eConsults through the service, less than 1 per month., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Breast cancer is the most prevalent malignant neoplasm among women. Its treatment comprises different strategies. Telehealth can ensure continuity of care in distant locations. This study aimed to synthesize qualitative evidence of women's experiences with telehealth during the treatment and follow-up of breast cancer. We performed a qualitative systematic review and meta-synthesis. The databases included in the search were: Pubmed, EMBASE, CINAHAL, and Web of Science. The search combined the terms: breast cancer, telemedicine, telehealth, and qualitative study. The studies included were: qualitative design and mixed methods studies with qualitative components. The COREQ Checklist assisted in assessing the quality of included studies and an adaptation of thematic analysis for the qualitative meta-synthesis. We included twelve articles in the review. In the meta-synthesis, 3 themes emerged. (1) Structure: simple design and space to obtain information but in need of adjustments. (2) Usability: about the benefits and limitations of telehealth. (3) Interaction with health professionals. Telehealth is an accepted strategy for the clinical care of women with breast cancer. Patients identified the need for improvements in structure, usability, and interaction. PROTOCOL REGISTRATION: PROSPERO registration number CRD42021228326, registered 06/02/2021., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Since the mid-1990s, more than 500,000 deaths have been attributed to the opioid overdose epidemic, which has created a serious national crisis affecting public health and social and economic welfare. To mitigate these opioid-related overdoses and deaths, interventions targeted at both the patient and community level are needed., Objective: This demonstration project sought to determine whether implementation of a provider-to-provider opioid pain teleconsultation service with a pain specialist was correlated with a reduction in inappropriate opioid use and improve health outcomes., Methods: Individual-level claims data for Health First Colorado Medicaid members were collected between March 1, 2017, and September 30, 2021, for individuals who triggered a provider-to-provider pain management teleconsultation based on receipt of a prescription for an opioid where the member was receiving a high-dose opioid (n = 125) or was opioid-naive (n = 819). The primary outcome measures were a patient's opioid dose less than 200 morphine milligram equivalent (MME) by 6 months after the consult if consult was triggered for high-dose use or discontinuation of an opioid by 12 weeks after consult if the consult was triggered for opioid naivety. Secondary opioid-related health outcomes were also assessed., Results: In the high-dose opioid cohort, 87% of the members had their monthly average MME reduced to less than 200 by 180 days after their consult. More than half of the opioid-naive group had discontinued their opioid by 90 days after their consult., Conclusion: Results indicate that provider-to-provider teleconsultation services with a pain specialist can be an effective intervention at reducing total inappropriate opioid use., (Copyright © 2022 American Pharmacists Association®. All rights reserved.)

Rational: Teleconsultation (TLC) practice, which suddenly arrived in the cancer patients care, has experienced an undeniable quantitative boom given the health context. A quantitative and qualitative assessment of this practice now seems necessary. This study aims to describe the use of TLC by oncologists in the Auvergne-Rhône-Alpes region during the pandemic in order to assess its advantages and limits, and to estimate the barriers encountered and the possible levers for its promotion in oncology., Method: The use of TLC in daily medical practice was evaluated using a descriptive observational survey from October to December 2021. Health's professionals were invited to answer an online survey composed of around thirty questions., Results: Of the 200 oncologists contacted, 72 took part in the survey. Among them, 64 have already made at least one TLC. TLCs represented 25 % of consultations during the confinement period. New cancer patients, the fact of not seeing the patient physically and the absence of the possibility of carrying out a physical examination are the 3 main obstacles to TLC. The mastery of computer tools is one of the main levers. All cancer patients appear eligible for TLC ; the professionals surveyed prefer this solution for certain socio-demographic and medical characteristics of the patients (the fact of living far from the cancer centre, of having a stable clinical situation, of being under surveillance or being treated with oral anti-cancer drugs…). Despite a median level of satisfaction of 63 % estimated by doctors, less than 10 % of medical consultations are currently kept in TLC., Conclusion: TLC is now an integrated practice in oncology but seems more relevant for a specific patient profile and clinical situation. In addition, technical and training constraints still limit its use in clinical practice today., (Copyright © 2022 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: The COVID 19 pandemic has resulted in the increasing use of telemedicine due to the advantages of avoiding viral transmission. Evidence suggests that telemedicine, for certain conditions, may be as effective as face-to-face consultations; however, there is no research to date regarding vascular patients' acceptance or satisfaction with telemedicine during and after the COVID-19 pandemic., Methods: A patient satisfaction interview was designed to survey three aspects of the service: patient acceptability of teleconsultations as a replacement to physical clinics; their views of teleconsultation during the pandemic; and the future role of teleconsultations postpandemic. Patients undergoing remote teleconsultation (either by telephone or video software), between April and June 2020 were suitable for inclusion. Patients were contacted by telephone in August 2020 to undertake the survey. Local "Research and Development" approval was obtained., Results: A total of 333 patients had a consultation with a vascular consultant between April and June 2020, of which 178 were teleconsultations. Successful contact was made with 72 patients, of whom 68 agreed to participate; 10 patients had undergone video consultations, while the remainder had telephone consultations. Teleconsultations were widely viewed as acceptable, and over 90% of patients felt they were beneficial. 91% felt that not needing to travel for appointments was advantageous to them. The option of teleconsultation during the COVID pandemic was valued by 94% of the cohort. While all interviewees felt teleclinics should continue during the pandemic, the majority (74%) also wanted to use teleconsultations for clinic appointments after the pandemic., Conclusions: Telemedicine is viewed by vascular patients as generally acceptable and beneficial for use during the pandemic. The majority of patients wanted future telemedicine appointments postpandemic. Telemedicine services started as a result of the COVID-19 pandemic, which may have been viewed as a temporary measure, should be planned to continue long term., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Teleconsultations are increasingly used to deliver health care, yet guidance on how to maximize health outcomes and ensure the quality and rights-based principles of adolescent health care during teleconsultations is lacking. This scoping review synthesized the literature on teleconsultations with adolescents, with the objective of informing a practical guidance for healthcare professionals., Methods: Eight databases were searched to identify articles published between 2010 and 2020 in English, French, or Spanish that provided evidence or guidance on synchronous teleconsultations with 10- to 19-year-olds. Web sites in six high-income countries and six low- to middle-income countries were also searched and a Google search was conducted. Data were analyzed using narrative synthesis., Results: Of 59 total references, 51 were from high-income countries. References included primary research (n = 21), reviews (n = 13), clinical guidance (n = 9), case reports (n = 9), commentaries (n = 6), and a website (n = 1). Just under half (46%) were descriptive, qualitative, or expert opinion. The main focus was mental health and behavioral disorders., Discussion: Good evidence on the complexities of conducting teleconsultations with adolescents is lacking. Questions remain regarding the scope and acuity of health issues for which teleconsultations are appropriate, their role in overcoming or contributing to inequalities, and the practicalities of conducting consultations., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: To assess the patient experience of Remote Clinical Consultations (RCCs) for head and neck cancer and cleft lip and palate patients undergoing specialist restorative dentistry treatment in the context of a secondary care service., Methods: An online survey was designed; all ninety three patients were invited to participate in its completion following a video or telephone remote clinical consultation with one restorative consultant in Addenbrooke's Hospital between August 2020 and April 2021. The video consultations were carried out via NHS England's Attend Anywhere platform., Results: Sixty three responses were received. Over 70% of patients valued a video or telephone remote clinical consultation rather than an in-person attendance. Patients reported a good experience and would recommend a remote clinical consultation instead of an in-person attendance if no treatment would likely be required. Those who were less likely to recommend a remote clinical consultation were those who had difficulties logging-in to the remote platform or had technical issues., Conclusion: While a number of patients still would have preferred a face-to-face attendance, both telephone and video remote consultations were highly valued by patients, and the overall patient experience was that of acceptance. Benefits of remote consultations perceived by patients included having set time to discuss concerns and queries, becoming familiar with a clinician prior to any treatment, saving time, minimising travel and reducing expenses. Barriers to a positive experience included technical difficulties. This survey contributes to the evidence supporting remote clinical consultations as a practical way of delivering specialist consultations in restorative dentistry, it highlights this virtual process largely relates to the practicalities of service provision and highlights the use of remote consultations for specific appointments., Clinical Significance: This study demonstrates patient feedback to a strategy implemented due to adaptations in working methods required as result of the Covid-19 pandemic. Patients were found to have a positive, accepting experience of both telephone and video remote clinical consultations. the study identifies a high patient acceptability and ability to overcome some of the disadvantages of an in-person attendance including saving time, travel and associated expenses while also contributing to a reduction in CO 2 emissions and potentially improving clinical efficiency and capacity. These findings add to existing evidence and are indicative that remote consultations provide a practical way of delivering specialist communication in restorative dentistry as part of a unique patient pathway., (Copyright © 2021. Published by Elsevier Ltd.)

Competing Interests: Conflicts of Interest None declared.

Objective: Investigating how the spatial and audiovisual conditions in video remote interpreting (VRI) shape communicative interaction in a language-discordant clinical consultation., Methods: We conducted a multimodal analysis of an authentic VRI-mediated consultation with special reference to spatial arrangements, audiovisual conditions, and the healthcare professional's use of embodied communicative resources (body orientation, eye gaze, gestures)., Results: The physician is found to pursue his communicative goals for the consultation by first creating an appropriate spatial and technical environment and then supporting his information-giving and relationship-building actions through the use of nonverbal (embodied) resources like body orientation, gaze and gestures as well as specific turn-management behaviour., Conclusion: VRI allows healthcare professionals to access professional interpreters for language-discordant consultations but requires appropriate technical and spatial arrangements as well as users capable of adapting their communicative behaviour to spatial and audiovisual constraints., Practice Implications: Alongside telephone interpreting, VRI is the solution of choice for language-discordant clinical encounters in times of the Covid-19 pandemic. Its use requires appropriate technical and spatial arrangements as well as specific skills on the part of healthcare professionals to cope with inherent audiovisual constraints., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

The novel coronavirus outbreak (COVID-19) in 2019 resulted in the suspension of all elective hospital procedures during the height of the pandemic in the UK. The Clinic in London is one of the first day-case hospitals to resume cosmetic surgery in a post-COVID-19 clinical environment, whilst also employing the use of virtual consultations. Details of the protocol implemented by the Clinic to allow the safe resumption of cosmetic surgery are stated in this paper. The volume of procedures at the Clinic saw a significant increase post-lockdown; reasons as to why this occurred are also explored in this paper. The disruption of cosmetic practice during lockdown can be said to have resulted in a backlog of procedures once lockdown restrictions began to ease. Whilst this may be true, we believe that there are other confounding factors regarding what may have influenced the rise in cosmetic surgery during the pandemic, including the privacy of working from home and the increased exposure to video conferencing software., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The purpose of the present study was to assess orthopedic and orthopedic trauma patients' willingness to perform hypothetical remote video consultations, possible advantages as well as concerns., Methods: Between June 2019 and November 2019, a survey amongst consecutive regular orthopedic and orthopedic trauma patients at the outpatient clinics from three European level I trauma centers was conducted via paper-based questionnaires, composed of participants` demographics as well as five open and closed questions. Participation was voluntary and anonymity was granted., Results: In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The majority of the participants (57,6%) were eager to use a remote consultation. Participants with an age of more than 55 years were significantly less likely to use a remote consultation than their younger counterparts (OR= 0.18, p=0.003. r 2 =0.141). Among the whole study population, 86.2% stated, that they had a device compatible with an online video consultation. The highest willingness to conduct a video consultation in respect of the participants` occupation was observed in "part-time"-jobs (70.6%), whereas the lowest disposition was seen in retired patients (37.1%) (p= 0.0001). The most stated reason why to conduct a video consultation was "communication of medical findings" (67.8%). The most stated advantage was the "reduction of physical consultations" (66.4%). "No physical examination" was the most frequently stated disadvantage (75.9%)., Conclusion: The majority of orthopedic and orthopedic trauma outpatients would use a video consultation, especially because of commuting and time issues and ideally to communicate medical findings, such as x-ray reports or lab values. Elderly patients appear to be less eager in regard to video consultations. These results may change for even better acceptance in view of a current pandemic situation, as experienced since early 2020. We feel that this assumption may warrant further investigation., Competing Interests: Declaration of Competing Interest All authors certify that no conflicts of interest exist that need to be reported., (Copyright © 2021. Published by Elsevier Ltd.)

Background: In recent years, telemedicine has gained increasing importance in the delivery of pharmaceutical care. The use of video technologies for remote communication between different parties offers the potential to meet the future challenges which arise from the increase in elderly and chronically ill patients. However, the influence of these technologies on patient-related outcomes in pharmaceutical care is not yet sufficiently known., Method: In December 2018 a systematic literature search was conducted in the databases Medline, Cochrane Library and PubPharm. Randomized controlled trials were considered, which investigate real-time video conferencing between pharmacists on the one hand and patients or other healthcare providers on the other hand. The influence on patient related outcomes compared to standard care was assessed. The bias potential was evaluated using the Cochrane Risk-of-Bias instrument. A total of 4 randomized controlled trials could be included., Results: The studies describe partly complex intervention settings with adults and adolescents suffering from asthma, chronic renal failure, HIV infection, hyperlipidemia, hypertension and/or diabetes. None of the studies considers the interprofessional communication of pharmacists with other service providers. No influence on clinical or psychological endpoints was found. In some cases, an increase in adherence and correct medication use is evident. Healthcare utilization is not influenced. In all studies there is an increased risk of systematic bias., Discussion: Teleconsultations with pharmacists can rather be used to ensure the general provision of pharmaceutical care than to improve patient-related outcomes. Further studies are necessary to fully depict the influence of telemedical interventions in pharmaceutical care., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The Curie Institute exclusively cares for cancer patients, who were considered particularly "vulnerable" from the start of the SARS-CoV 2 pandemic. This pandemic, which took the medical world by surprise, suddenly required the Institute's hospital to undergo rapid and multimodal restructuring, while having an impact on everyone to varying degrees. We will examine here how this hospital has coped, with the concern for a new benefit-risk balance, in times of greater medical uncertainty and scarcity of certain resources, for these "vulnerable" patients but also for their relatives and staff. We will highlight by theme the positive aspects and difficulties encountered, and then what could be useful for other hospitals as the pandemic is ongoing., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

This chapter explores ways to reduce the risk of severe acute respiratory syndrome coronavirus-2 transmission to women and staff within gynaecology outpatient clinics. The likely routes of transmission are discussed, namely through droplets, aerosols and fomites. Using the 'hierarchy of control' categories, elimination, substitution, engineering, administration and personal protective equipment, practical strategies for modifying virus exposure are presented. The management of specific clinical conditions are reviewed based on advice prepared by the specialist societies in conjunction with each other and the Royal College of Obstetricians and Gynaecologists. The need to maintain at least a minimal level of gynaecological services is recognised and that this should provide safe, equitable and effective care. Ways to reduce clinic attendance are discussed with the substitution of face-to-face with remote consultations and when this is relevant. Current recommendations for ambulatory procedures, which include colposcopy and hysteroscopy, are considered so that best use is made of reduced resources., Competing Interests: Declaration of competing interest Natalie Farmer: None. Mary Connor receives teaching honoraria and consultancy fees from Medtronic Medical Device Company, Covidien AG, Victor von Bruns-Strasse 19 8212, Neuhausen am Rheinfall, Switzerland., (Copyright © 2021. Published by Elsevier Ltd.)

Confinement within the framework of Covid 19 required organizations in cancer centers, in particular with postponing certain treatments. We interviewed 6080 patients who had a scheduled appointment during this period. 2478 patients gave their opinion regarding access and organization of care, teleconsultation, their concerns and their reasons for satisfaction. While 83 % of them say they are satisfied with the organization of care, 25 % of respondents say they have given up care that they consider essential in 1/3 of cases. The concern related to the follow-up of the cancerous disease takes precedence over that of being infected with the Sars-cov-2 virus, unlike the general population, and relationships with their loved ones are spontaneously cited as a reason for satisfaction. This method captures the experience of patients, despite certain limitations. Such an approach could be used to set up a specific system during normal periods., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on well-being has the potential for serious negative consequences on work, home life, and patient care. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate well-being in oncology over time since COVID-19., Methods: Two online anonymous surveys were conducted (survey I: April/May 2020; survey II: July/August 2020). Statistical analyses were performed to examine group differences, associations, and predictors of key outcomes: (i) well-being/distress [expanded Well-being Index (eWBI; 9 items)]; (ii) burnout (1 item from eWBI); (iii) job performance since COVID-19 (JP-CV; 2 items)., Results: Responses from survey I (1520 participants from 101 countries) indicate that COVID-19 is impacting oncology professionals; in particular, 25% of participants indicated being at risk of distress (poor well-being, eWBI ≥ 4), 38% reported feeling burnout, and 66% reported not being able to perform their job compared with the pre-COVID-19 period. Higher JP-CV was associated with better well-being and not feeling burnout (P < 0.01). Differences were seen in well-being and JP-CV between countries (P < 0.001) and were related to country COVID-19 crude mortality rate (P < 0.05). Consistent predictors of well-being, burnout, and JP-CV were psychological resilience and changes to work hours. In survey II, among 272 participants who completed both surveys, while JP-CV improved (38% versus 54%, P < 0.001), eWBI scores ≥4 and burnout rates were significantly higher compared with survey I (22% versus 31%, P = 0.01; and 35% versus 49%, P = 0.001, respectively), suggesting well-being and burnout have worsened over a 3-month period during the COVID-19 pandemic., Conclusion: In the first and largest global survey series, COVID-19 is impacting well-being and job performance of oncology professionals. JP-CV has improved but risk of distress and burnout has increased over time. Urgent measures to address well-being and improve resilience are essential., Competing Interests: Disclosure SB reports research grant (institution) from AstraZeneca, Tesaro, and GSK; honoraria from Amgen, AstraZeneca, MSD, GSK, Clovis, Genmab, Immunogen, Merck Serono, Mersana, Pfizer, Seattle Genetics, Roche and Tesaro outside the submitted work. KHJL is currently funded by the Wellcome-Imperial 4i Clinical Research Fellowship, and reports speaker honorarium from Janssen outside the submitted work. KP reports personal fees from Astra Zeneca, Eli Lilly, Novartis, Pfizer, Pierre Fabre, Hoffmann La Roche, Mundi Pharma, and PharmaMar; and other fees paid to institution from Vifor Pharma, TEVA, and Sanofi outside the submitted work. CO reports research funding and honoraria from Roche; travel grant and honoraria from Medac Pharma and Ipsen Pharma; and travel grant from PharmaMar outside the submitted work. ML acted as a consultant for Roche, AstraZeneca, Lilly, and Novartis, and received honoraria from Theramex, Roche, Novartis, Takeda, Pfizer, Sandoz, and Lilly outside the submitted work. CBW reports speaker honoraria, travel support, and serving on the advisory board in Bayer, BMS, Celgene, Roche, Servier, Shire/Baxalta, RedHill, and Taiho; speaker honoraria from Ipsen; and advisory board in GSK, Sirtex, and Rafael outside the submitted work. PG reports personal fees from Roche, MSD, BMS, Boehringer Ingelheim, Pfizer, AbbVie, Novartis, Lilly, AstraZeneca, Janssen, Blueprint Medicines, Takeda, Gilead, and ROVI outside the submitted work. TA reports personal fees from Pierre Fabre and CeCaVa; personal fees and travel grants from BMS; grants, personal fees, and travel grants from Novartis; and grants from NeraCare, Sanofi, and SkylineDx outside the submitted work. JBAGH reports personal fees for advisory role in Neogene Tx; grants and fees paid to institution from BMS, MSD, Novartis, BioNTech, Amgen; and fees paid to institution from Achilles Tx, GSK, Immunocore, Ipsen, Merck Serono, Molecular Partners, Pfizer, Roche/Genentech, Sanofi, Seattle Genetics, Third Rock Ventures, and Vaximm outside the submitted work. CH reports private company Hardy People Ltd. outside the submitted work. The remaining authors have declared no conflicts of interest., (Copyright © 2021 ESMO. Published by Elsevier Ltd.. All rights reserved.)

Although some centres have successfully integrated remote clinics into their paediatric urological practice, for many, remote clinics have developed due to the COVID-19 pandemic. One UK-based institution has integrated remote clinics in their practice for over two years and has developed guidelines considering which conditions may be suitable for remote consultations. These guidelines have been appraised by the European Association of Urology Young Academic Urologists paediatric working group. Through practical experience and anticipated difficulties, we have discussed considerations that paediatric urology departments should ponder when integrating remote clinics into their practice as we move forward from the pandemic., Competing Interests: Conflicts of interest The authors report no conflicts of interest., (Copyright © 2021 Journal of Pediatric Urology Company. All rights reserved.)

Introduction: There is an increasing affinity for remote health consultations (including telephone and virtual platforms), enabling new models of accessing services to evolve. Whilst many key skills are transferable from traditional to remote consultations, there is even greater emphasis on verbal communication skills during these interactions., Purpose: This masterclass considers the communication skills required for delivering remote health care consultations, in particular focussing on: 12 interactional features in an opening sequence of a remote call; active listening; how to offer advice using the Ask-Offer-Ask framework; and subtleties in phrasing and prosody when closing a call that may indicate a level of satisfaction (or otherwise)., Implications: In planning for digitally-enabled services to become mainstream, the differences in communication between remote and face-to-face consultations must be recognised and embraced., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice. Where no healthcare professionals are present, telemedicine may be the sole source of expert care. This systematic review appraises and summarizes the current literature regarding telemedicine in patient management on expeditions to remote locations and identifies areas for future research. MEDLINE and EMBASE were systematically searched for relevant articles from 1980 through February 2018. Data were handled according to the PRISMA process and analyzed using type-specific critical appraisal checklists where possible. Two hundred twenty-five articles were identified, 33 of which were included in this systematic review. They encompassed a variety of remote environments, including maritime (13), polar (9), mountainous (5), jungle (1), and multiple austere environments (6). Although some environments were better reported than others, many overarching concepts were generalizable. Through channels of communication that included telephone, radio, videoconferencing, and email, telemedicine has been used effectively in a range of environments to initiate treatment, follow up with patients, and determine the appropriateness of evacuation. Telementoring, in which a remote expert guides a local care provider in performing a procedure or task, is a promising aspect of telemedicine that is currently being developed. As technology advances, the scope of telemedicine will continue to expand. However, each new telemedical development must be shown to do more than simply function in a remote environment. Instead, new technologies should be tested for improved patient, practitioner, or expedition outcomes, within a telemedical system., (Copyright © 2020 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Background: Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine., Methods: Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient., Results: Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922)., Conclusions: Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions., Practical Implications: Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions., (Copyright © 2021. Published by Elsevier Inc.)