文献精选
Caleb Schroeder ⁎
Mary Lanning Healthcare, 715 N Kansas Ave., Suite 205, Hastings, NE, 68901
article info
Article history:
Received 7 February 2019
Received in revised form 5 June 2019
Accepted 17 June 2019
Available online 12 July 2019
Background: Telemedicine has had limited implementation for general surgery. The purpose of this study was to evaluate telemedicine for the initial evaluation of patients in the clinic and hospital settings.
Methods: Synchronous telemedicine consults were conducted by a single surgeon to a rural hospital and clinic. Reasons for consult, adequacy of consult, days saved by telemedicine consult compared to standard practice, correlation of telemedicine and in-person physical exam, and number of patients who required procedures were evaluated.
Results: On average, patients were evaluated 7.4 days more rapidly than if the consult had been done by our standard practice. Telemedicine was adequate for all patients in this study.
Conclusions: This is the first study using telemedicine for the initial consult of general surgery patients in the hospitalized and clinic setting in North America. The physical exam remains an important component of the general surgery evaluation, and special attention must be considered when structuring the telemedicine program. Telemedicine is an effective and expedient way to provide consultation for general surgery patients. Further study is needed to determine which general surgery issues are not amendable to telemedicine consultation, and to determine other surgical specialties that could utilize telemedicine in their practice.
© 2019 The Author. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Yanyan Bian* , MD; Yongbo Xiang* , MD; Bingdu Tong, MA; Bin Feng, MD; Xisheng Weng, MD
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College,
Beijing, China
* these authors contributed equally
Corresponding Author:
Xisheng Weng, MD Department of Orthopedic Surgery Peking Union Medical College Hospital Chinese Academy of Medical Science and Peking Union Medical College No 1 Shuaifuyuan, Dongcheng District Beijing, 100073 China Phone: 86 13021159994
Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
Abstract
Background: Patient follow-up is an essential part of hospital ward management. With the development of deep learning algorithms, individual follow-up assignments might be completed by artificial intelligence (AI). We developed an AI-assisted
follow-up conversational agent that can simulate the human voice and select an appropriate follow-up time for quantitative, automatic, and personalized patient follow-up. Patient feedback and voice information could be collected and converted into text data automatically.
Objective: The primary objective of this study was to compare the cost-effectiveness of AI-assisted follow-up to manual follow-up of patients after surgery. The secondary objective was to compare the feedback from AI-assisted follow-up to feedback
from manual follow-up.
Methods: The AI-assisted follow-up system was adopted in the Orthopedic Department of Peking Union Medical College Hospital in April 2019. A total of 270 patients were followed up through this system. Prior to that, 2656 patients were followed
up by phone calls manually. Patient characteristics, telephone connection rate, follow-up rate, feedback collection rate, time spent, and feedback composition were compared between the two groups of patients.
Results: There was no statistically significant difference in age, gender, or disease between the two groups. There was no significant difference in telephone connection rate (manual: 2478/2656, 93.3%; AI-assisted: 249/270, 92.2%; P=.50) or successful follow-up rate (manual: 2301/2478, 92.9%; AI-assisted: 231/249, 92.8%; P=.96) between the two groups. The time spent on 100 patients in the manual follow-up group was about 9.3 hours. In contrast, the time spent on the AI-assisted follow-up was close to 0 hours. The feedback rate in the AI-assisted follow-up group was higher than that in the manual follow-up group (manual: 68/2656, 2.5%; AI-assisted: 28/270, 10.3%; P<.001). The composition of feedback was different in the two groups. Feedback from the AI-assisted follow-up group mainly included nursing, health education, and hospital environment content, while feedback from the manual follow-up group mostly included medical consultation content.
Conclusions: The effectiveness of AI-assisted follow-up was not inferior to that of manual follow-up. Human resource costs are saved by AI. AI can help obtain comprehensive feedback from patients, although its depth and pertinence of communication need to be improved.
(J Med Internet Res 2020;22(5):e16896) doi: 10.2196/16896
KEYWORDS
artificial intelligence; conversational agent; follow-up; cost-effectiveness
Yu-xuan Li1† , Chang-zheng He1† , Yi-chen Liu1† , Peng-yue Zhao1 , Xiao-lei Xu1 , Yu-feng Wang2 , Shao-you Xia1* and Xiao-hui Du1
Abstract
Background:The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients.
Methods: The ‘COVID-19’ period was defined as occurring between 2020 and 01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study.
Results: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2, 20]; p = 0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p = 0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p < 0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p = 0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p < 0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR: 7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p = 0.006).
Conclusion: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.
Keywords: Gastric cancer, Coronavirus disease 2019, COVID-19, Retrospective analysis
Grace F. Chao, MD, MSc, Kathleen Y. Li, MD, MSc, [...], and Chad Ellimoottil, MD, MSc
Additional article information
Associated Data
- Supplementary Materials
Key Points
Question
What were telehealth use patterns across surgical specialties before and during the COVID-19 pandemic?
Findings
In this statewide cohort study that included 4405 surgeons, telehealth use grew substantially during the early pandemic period and declined during the later period; this use varied by surgical specialty. Compared with 2019 visit volume, telehealth salvaged only a small portion of 2020 surgical visits.
Meaning
Telehealth is being used in surgical fields at rates higher than before the pandemic, and its use varies across surgical specialties.
