E-consensus on telemedicine in proctology: A RAND/UCLA-modified study

Gallo, Gaetano; Grossi, Ugo; Sturiale, Alessandro; Tanna, Gian Luca Di; Picciariello, Arcangelo; Pillon, Sergio; Mascagni, Domenico; Altomare, Donato F.; Naldini, Gabriele; Perinotti, Roberto; Bottini, C.; Bracchitta, S; Brusciano, Luigi; Caminati, Filippo; Cantarella, Francesco; Celentano, Valerio; Nardi, Gianpiero Cione Paola De; Ferrara, Francesco; Folliero, C.; Giamundo, Paolo; I, Giani; Giannini, Ivana; Giuffrida, Maria Carmela; Infantino, A.; Torre, Marco La; Lauretta, A.; Lisi, Giorgio; Losacco, L; Maffioli, Anna; Mancini, Stefano; Marino, F.; Martellucci, Jacopo; Meinero, Piercarlo; Milito, G; Mistrangelo, Massimiliano; Mori, Lorenzo; Orlandi, Simone; Pata, Francesco; Pessia, Beatrice; Pietroletti, R; Pozzo, M; Pucciani, Filippo; Ratto, Carlo; Romano, Lucia; Roveroni, Maurizio; Santoro, Giulio Aniello; Serventi, A.; Telesco, Davide; Testa, A.; Tonello, Paolo; Tricomi, N.; Trompetto, Mario; Tutino, Roberta; Zaffaroni, G; Mayol, Julio

doi:10.1016/j.surg.2021.01.049

Cited by 29 publications

(30 citation statements)

References 32 publications

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“…Telemedicine is particularly challenging in patients considering surgery [ 32 , 33 ]. In this study, a smaller proportion of surgical patients were seen initially via telemedicine, potentially reflecting physician or patient preference to meet in-person when considering surgery.…”

Section: Discussionmentioning

confidence: 99%

Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

et al. 2021

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Background To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. Methods This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. Results 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). Conclusions Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.

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Section: Discussionmentioning

confidence: 99%

Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

et al. 2021

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“…Indeed, an outpatient evaluation was deemed appropriate to plan the correct surgical treatment according to the experts. In a previous consensus exercise defining the role of telemedicine in proctology [5], the majority of respondents (35/47 [74%]) recommended an in-person assessment to avoid cancer misdiagnosis. Indeed, the study highlighted poor acceptability of telemedicine as first-line assessment for the majority of proctologic disorders except for the diagnosis and management of pilonidal disease and ostomy patients.…”

Section: Discussionmentioning

confidence: 99%

“…Fifty-four experts (Telemedicine in Colorectal Surgery Italian Working Group, nominated by the Italian Society of Colorectal Surgery) on the basis of both previously published research and clinical experience in the field of colorectal practice, were invited to join the e-consensus. The consensus methodology was derived from the RAND/UCLA appropriateness method [6], an established approach previously used in the coloproctology field [5,7].…”

Section: Methodsmentioning

confidence: 99%

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E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study

et al. 2021

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Coronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders’ median age was 44.5 (IQR 36–60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated. Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01139-8.

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“…Telemedicine is the provision of healthcare services and the exchange of healthcare information using information and communication technology across distances [ 8 , 9 ]. It is used in multiple areas of clinical practice, e.g., surgical practices [ 10 – 12 ], management of chronic diseases [ 13 ], addiction management [ 14 ] and palliative care [ 15 , 16 ]. The necessity for and utilization of telemedicine has significantly accelerated, when many in-person clinical activities are deferred or suspended, as a result of the on-going coronavirus disease of 2019 (Covid-19) pandemic [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Sequential Multiple Assignment Randomized Trial (SMART) to identify optimal sequences of telemedicine interventions for improving initiation of insulin therapy: A simulation study

Yan

Matchar

Sivapragasam

et al. 2021

BMC Med Res Methodol

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Background To examine the value of a Sequential Multiple Assignment Randomized Trial (SMART) design compared to a conventional randomized control trial (RCT) for telemedicine strategies to support titration of insulin therapy for Type 2 Diabetes Mellitus (T2DM) patients new to insulin. Methods Microsimulation models were created in R using a synthetic sample based on primary data from 63 subjects enrolled in a pilot study of a smartphone application (App), Diabetes Pal compared to a nurse-based telemedicine strategy (Nurse). For comparability, the SMART and an RCT design were constructed to allow comparison of four (embedded) adaptive interventions (AIs). Results In the base case scenario, the SMART has similar overall mean expected HbA1c and cost per subject compared with RCT, for sample size of n = 100 over 10,000 simulations. SMART has lower (better) standard deviations of the mean expected HbA1c per AI, and higher efficiency of choosing the correct AI across various sample sizes. The differences between SMART and RCT become apparent as sample size decreases. For both trial designs, the threshold value at which a subject was deemed to have been responsive at an intermediate point in the trial had an optimal choice (i.e., the sensitivity curve had a U-shape). SMART design dominates the RCT, in the overall mean HbA1c (lower value) when the threshold value is close to optimal. Conclusions SMART is suited to evaluating the efficacy of different sequences of treatment options, in addition to the advantage of providing information on optimal treatment sequences.

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E-consensus on telemedicine in proctology: A RAND/UCLA-modified study

Cited by 29 publications

References 32 publications

Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study

Sequential Multiple Assignment Randomized Trial (SMART) to identify optimal sequences of telemedicine interventions for improving initiation of insulin therapy: A simulation study

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