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Authors: Amy Purohit,A James SmithB and Arthur HibbleC
ABSTRACT
In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70–372 kg CO2e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.
KEYWORDS: telemedicine, sustainability, e-health, carbon footprint
DOI: 10.7861/fhj.2020-0080
Sang-goo Lee 1, Seong K. Mun, Prakash Jha, Betty A. Levine and Duk-Woo Ro Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University Medical Center, Washington, DC 20007, USA E-mail: {lee, mun, jhap, levine, ro}@isis.imac.georgetown.edu
Abstract
Telemedicine is many things to many people. Only until a few years ago, telemedicine was equated to video teleconferencing between physicians, while nowadays, perhaps the most active area in telemedicine is the store-and-forward model. There is a big shift from private and dedicated modes of communications to connectivity through the Internet. Presented is a collection of applications that provide snapshots of this diversity. The key technical challenges identified from these experiences are connectivity and integration. Also, at issue are the evolution process through which a telemedicine application evolves and the ability to choose the right set of technology for the diverse type of telemedicine applications. With the projected improvements in speed and quality of the Internet, wireless communication, and personal computational devices, it is expected that various concepts of telemedicine will develop into standard practices in tomorrow’s health care.
Arvind Kumar, MS, Siddhartha Sinha, MS, Javed Jameel, MS and Sandeep Kumar, MS *
Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
Received 22 June 2021; revised 13 August 2021; accepted 3 September 2021; Available online 18 October 2021
Abstract
Objectives: In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice.
Methods: We systematically searched the database of Thomson Reuters Web of Science for telemedicinerelated articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review.
Results: Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review.
Conclusion: Telemedicine can satisfactorily cover a major proportion of patients’ visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
Keywords: Bibliometric analysis; COVID-19; Orthopaedics; Telemedicine; Trends
M. Augestad1,2,4 , A. M. Sneve3 and R.-O. Lindsetmo3
1Department of Surgery, Sandnessjøen Hospital, Sandnessjøen, and 2Department of Quality and Research and 3Division of Surgery and Women’s Health, University Hospital of North Norway, Tromsø, Norway, and 4Department of Colorectal Surgery, Columbia University Hospital, New York, USA Correspondence to: Dr K. M. Augestad, Department of Quality and Research, University Hospital of North Norway, 9037 Breivika, Tromsø, Norway (e-mail: 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。)
Background: A stoma has severe impact on the patient’s quality of life (QoL). Postoperative home community follow-up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL.
Methods: A university hospital and five district medical centres participated. Patients with a stoma were randomized to follow-up by either TC (intervention) or hospital (control). Stoma nurses performed the clinical examination at the TC studio, aided remotely by hospital nurses and surgeons. The primary endpoint was the EQ-5D™ index score; secondary endpoints were the Stoma Quality-of-Life Scale, the OutPatient Experiences Questionnaire, and use of hospital resources.
Results: A total of 110 patients were randomized to hospital (58 patients) or TC (52) follow-up; 64 patients (hospital 38, TC 26) were followed for more than 12 months and 246 consultations (hospital 151, TC 95) were performed. There were no differences in QoL: EQ-5D™ index score (P = 0⋅301) and EQ-5D™ visual analogue scale (VAS) score (P = 0⋅775); Work/Social Function (P = 0⋅822); Sexuality/Body Image (P = 0⋅253) and Stoma Function (P = 0⋅074). Hospital follow-up performed better for organization of care (staff collaboration, P = 0⋅004; met same persons, P = 0⋅003) and communication (surgeon understandable, P < 0⋅001; surgeon caring P = 0⋅003). TC did not increase the number of hospital consultations (P = 0⋅684) and reduced the number of journeys of more than 8 h (P = 0⋅007).
Conclusion: Telemedicine follow-up by stoma nurses did not improve the QoL of patients, but decreased the readmission rate and burden of travel. Registration number NCT01600508 (https://www. clinicaltrials. gov).
Presented to the Annual Meeting of the Norwegian Surgical Association, Oslo, Norway, October 2019
Paper accepted 5 December 2019
Published online 26 February 2020 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.11491
