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Use and reporting of outcome measures in randomized trials for anti-neutrophil cytoplasmic antibody-associated vasculitis: a systematic literature review.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: A comprehensive review of outcome measures used in randomized controlled trials (RCTs) of ANCA-associated vasculitis (AAV) could advance trial conductance for this disease.
Methods: A systematic literature review of outcome measures (as specified in methods section as primary and/or secondary outcomes) in RCTs of AAV was conducted. Medline, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception until April 30, 2019 for RCTs enrolling patients with granulomatosis with polyangiitis and/or microscopic polyangiitis. Outcome measures were organized according to domains (e.g. disease activity) and instruments [e.g. Birmingham Vasculitis Activity Score (BVAS)].
Results: Out of 1101 identified records, 68 RCTs were eligible. Disease activity was an outcome domain collected in 67 (98%) of the RCTs. The BVAS was the most widely used instrument for disease assessment but definitions for remissions and relapse varied for the purpose of primary endpoint definitions. Damage, most often assessed by the Vasculitis Damage Index, was an outcome in 30 (44%) of the RCTs. Mortality was specified as an outcome in 26 (38%) studies. The following outcome domains were assessed: patient-reported outcomes (PROs) in 28 (41%), drug exposure/safety in 58 (85%), and biomarkers [acute phase reactants, ANCA levels] in 24 (35%). Timing for outcome assessment differed substantially, with 3, 6, or 12 months being the most frequent time points.
Conclusion: Outcome measures used in trials in AAV commonly included vasculitis-specific tools for disease assessment, but with heterogeneity in endpoint-definitions and timing of assessments. Other core outcomes in AAV, including PROs, and damage measures, are often omitted in AAV trials.
Keywords: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis; Clinical trials; Outcome measures.American College of Rheumatology
European League Against Rheumatis
A Survey of the attitude of physiotherapists at Landspitali University Hospital to Continuous Professional Development
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBakgrunnur
Í siðareglum og reglugerð um sjúkraþjálfara og lögum um
heilbrigðisstarfsmenn eru ákvæði um að sjúkraþjálfari viðhaldi
þekkingu sinni og faglegri færni og tileinki sér nýjungar er varða
starfið.
Markmið
Að kanna viðhorf sjúkraþjálfara til starfsþróunar og áhuga þeirra
á námskeiðum.
Aðferðir:
Ópersónugreinanlegur spurningarlisti á rafrænu formi var sendur
til allra sjúkraþjálfara á Landspítala (N:74). Hann skiptist í
almennar lýðfræðilegar spurningar, spurningar um gagnsemi,
hvata, hindranir, kostnaðarþátttöku og umbun við starfsþróun auk
áhuga á námskeiðum. Spurningalistinn var unninn í Lime Survey
forritinu, úrvinnsla gagna unnin i Excel forritinu. Notast var við
lýsandi tölfræði við túlkun niðurstaðna.
Niðurstöður
Fjörutíu og níu sjúkraþjálfarar svöruðu könnuninni (66%). Allir
voru mjög sammála/ sammála um gagnsemi starfsþróunar. Mikill
meirihluti taldi að setja ætti kröfur um árlega starfsþróunarskyldu.
Helstu hvatar til að sinna starfsþróun voru að koma í veg fyrir
kulnun í starfi, aukin starfsánægja, að verða betri starfsmaður og
auka virði fagstéttarinnar. Helstu hindranir gegn því að sinna
starfsþróun voru vinnuálag og mannekla á vinnustað.
Flestir vildu fara á námskeið/ráðstefnu ef vinnuveitandi/
stéttarfélag greiddi kostnaðinn að fullu eða að hluta en 20% voru
mjög sammála eða sammála því ef greiða þyrfti allan kostnað
sjálfur. Langflestir vildu fá umbun fyrir að sinna starfsþróun.
Mestur áhugi var á sértækum námskeiðum innan sjúkraþjálfunar
og áhugahvetjandi samtali.
Ályktanir
Mikilvægt er að draga úr vinnuálagi í sjúkraþjálfun á Landspítala
til að skapa svigrúm og uppfylla þarfir starfseminnar og
starfsmannanna fyrir starfsþróun. Koma þarf á árlegri starfsþróunarskyldu. Markviss starfsþróun stuðlar að aukinni þekkingu,
faglegri hæfni og aukinni starfsánægju með hagsmuni skjólstæðinganna að leiðarljósi.
Lykilorð: Starfsþróun, starfsþróunarskylda, viðhorf, kulnun,
starfsánægja.Authors: Sigrún Knútsdóttir1, Halldóra Eyjólfsdóttir1
1: Project manager on Continuous Professional Development and
clinical adviser on Spinal Cord Injury, Physiotherapy department
Landspitali
2. Specialist in women´s health physiotherapy, research
physiotherapist, Physiotherapy department Landspitali
Background
Physiotherapists have an obligation to maintain their knowledge,
professional skills and aquire new skills according to the ethical
rules and regulations of physiotherapists and the law for health
professionals.
The Purpose was to investigate the attitude of physiotherapists
towards Continous Professional Development (CPD) and interest
for courses.
Methods
An anonymous electronic questionnaire was sent to all
physiotherapists at Landspitali (N:74) with demografic questions
and questions on the usefulness, motivations, barriers, cost and
rewards for participating in CPD and interest for courses. The
Lime Survey and Excel programs were used. Descriptive statistics
were used to interpret the results.
Results
Forty nine answered the questionnaire (66%). All strongly agreed/
agreed that CPD was useful. A great majority considered that CPD
should be mandatory. The main motivations for participating in
CPD were to prevent burnout, increase job satisfaction, become
a better practitioner and increase the status of the profession.The
main barriers were workload and a lack of staff to participate in
CPD. A great majority was willing to participate in a course/
conference if the employer /trade union paid the cost fully or
partly, 20% were willing to participate if they had to pay
themselves. A great majority wanted rewards for participating in
CPD.
Conclusions
It is important to decrease the workload of physiotherapists in
Landspitali to create a better opportunity and fulfill the
requirements for CPD. A mandatory CPD should be implemented.
A structured CPD will promote increased knowledge, professional
skills and job satisfaction for the benefit of the patients.
Key words: Continuous Professional Development (CPD),
Mandatory CPD, Burn-out, job satisfaction
Plug into the Future!
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Í þjónustu við lífið - líknarmeðferð og helstu áskoranir
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThis article introduces palliative care and views
the work of the physical therapist within the
palliative care setting from a hospital chaplain´s
perspective. The main focus is on communication
and being with persons in times of distress and
some guidelines are provided of how the physical
therapist and health care professionals can take
care of themselves within this working environment.
Palliative care is a wholistic care where the
emphasis is on the various needs of the patient and
his or her family, that is the physical, psychological,
social and spiritual dimensions of the human
being. Palliative care provides service to the
patient and families and sees the entity as the unit
of care. The physical therapist is a member of the
interdisciplinary palliative care team and has an
important role in the team as other health care professionals. The
challenges are indisputable as people can have a heavy load of
symptom burden and are grieving the changes in life in the
nearness of death. The main emphasis of physical therapy is to
maximize mobility and address the physcial and functional
dimensions. The physical therapist inevitably is confronted with
grief where conversations take place concerning existential
questions. Dignity, compassion, care and practicing various forms
of listening are fundamental components in this work as well as
being with the person in need. The physical therapist must as other
health care professionals have the learning attitude of building a
strong professional identity as well as strong self awareness and
be able to use methods such as supervision, collegial support and
other constructive means in caring for themselves in a demanding
professional role. To seek for harmony and practice self care and
compassion in both working life and personal life is of utmost
importance
Sudden loss of consciousness due to artery of Percheron infarction
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBrátt heilaslag á grunni lokunar á Percheron-slagæð til miðheila og
stúku er sjaldgæf og snúin greining vegna ósértækra klínískra einkenna. Skjót greining og meðferð er afar mikilvæg þar sem um er að
ræða brátt og alvarlegt ástand. Hér er kynnt tilfelli ungrar konu sem
fékk skyndilegan höfuðverk og skerta meðvitund. Sjáöldur voru misvíð
og brugðust illa við ljósáreiti og iljaviðbrögð voru jákvæð beggja megin.
Fram komu flogalíkar hreyfingar í öllum útlimum. Tölvusneiðmynd af
heila og heilaæðum var eðlileg en bráð segulómun sýndi byrjandi drep í
stúku beggja megin. Á grunni einkenna og segulómunar fékk sjúklingur segaleysandi meðferð í æð 70 mínútum eftir komu á bráðamóttöku
og náði sér að fullu.Acute cerebral infarction due to occlusion of the artery of Percheron (AOP) is rare and
poses a diagnostic challenge due to unspecific clinical symptoms. A prompt diagnosis and
treatment is vital due to a potentially very serious outcome. Here we represent a healthy
young woman who developed sudden headache and loss of consciousness. At admission
she was unconscious with GCS of 4, pupils were unevenly dilated and poorly reactive and
the plantar reflex was upward bilaterally. She had seizure like movements in all limbs. CT of
brain and CT angiography were normal but acute MRI showed bilateral paramedian thalamic
diffusion restriction. The patient was treated with i.v. thrombolysis (tPA) 70 minutes after
hospital arrival and recovered fully
Body dysmorphic disorder in Iceland
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadLíkamsskynjunarröskun (LSR; e. body dysmorphic disorder) er geðröskun sem einkennist af
þráhyggju um útlitsgalla sem er ekki til staðar. Þessum hugsunum fylgir mikil vanlíðan og skerðing
á virkni. Megintilgangur rannsóknarinnar var að (a) meta algengi LSR í almennu úrtaki á Íslandi og
(b) bera saman bakgrunn og klínísk einkenni þeirra sem skimast með LSR við þá sem skimast með
almenna kvíðaröskun (AKR) og þátttakendur sem ekki skimast með einkenni þessara geðraskana
(samanburðarhópur). Þátttakendur voru 854. Alls skimuðust 34 (4%) þátttakendur með LSR (88%
konur) og 50 (6%) með AKR (64% konur). Þátttakendur sem skimuðust með LSR voru líklegri til að
vera einhleypir, atvinnulausir og í veikindaleyfi eða öryrkjar en þátttakendur án LSR eða AKR. Þeir
sem skimuðust með LSR sýndu jafnframt fleiri einkenni þunglyndis og streitu en einstaklingar í
samanburðarhópi og voru líklegri til að hafa sjálfsvígshugsanir og að hafa gert tilraun til sjálfsvígs.
Að jafnaði var ekki munur á hópunum sem skimuðust með LSR og AKR en þó var hærra hlutfall
einstaklinga, sem skimuðust með LSR, sem hafði gert sjálfsvígstilraun. Niðurstöður benda til þess
að LSR sé algeng geðröskun í almennu þýði sem hafi margvísleg neikvæð áhrif á líf fólks. Það er
mikilvægt að auka þekkingu meðal almennings og heilbrigðisstarfsfólks á LSR, helstu einkennum
hennar og viðeigandi meðferð við röskuninni.
Efnisorð: líkamsskynjunarröskun, útlitsgallar, algengi, skimun, almenn kvíðaröskun.Body Dysmorphic Disorder (BDD) is a psychiatric disorder
characterized by a preoccupation with a perceived
defect in physical appearance that is not noticeable to
others or appears to be slight. The aims of this study
were to examine the prevalence of BDD in the general
population in Iceland and to compare background characteristics
and clinical symptoms of individuals with BDD
to individuals with generalized anxiety disorder and a
comparison group of individuals with neither disorder.
Data was gathered from 854 individuals, from women
attending a cancer screening program in Iceland (n = 689)
and a random sample of men from the general population
(n = 709). In a web-based questionnaire, BDD was
assessed with the Body Dysmorphic Disorder Questionnaire.
Participants were classified into three groups: BDD
group (34 individuals), GAD group (50 individuals) and
comparison group (770 individuals).
Overall, results indicated 4% prevalence of BDD. Individuals
with BDD were more likely to be single, unemployed,
on a medical leave and on disability than the
comparison group. They were also more likely to suffer
from symptoms of depression and anxiety than the latter
group. There were few differences between the BDD
group and the GAD group; however, the individuals
who were screened with BDD were more likely to have
a past suicidal attempt. In conclusion, BDD appears to
be a common psychiatric disorder in a general population
in Iceland and associated with considerable impairment
in functioning.
Keywords: Body dysmorphic disorder, prevalence, assessment
clinical features, generalized anxiety disorder.
Hrefna Harðardóttir, MPH, Department of Medicine,
University of Iceland. Arna Hauksdóttir, professor,
Department of Medicine, University of Iceland. Heiðrún
Hlöðversdóttir, MPH, Department of Medicine, University
of Iceland. Unnur Anna Valdimarsdóttir, professor,
Department o
Children‘s Depression Inventory: Systematic review of psychometric properties in Iceland
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadÞunglyndiskvarði fyrir börn (e. Children‘s Depression Inventory (CDI)) er notaður til skimunar
á þunglyndiseinkennum barna og er í töluverðri notkun hérlendis. Markmið þessarar greinar
er að meta próffræðilega eiginleika kvarðans í íslenskum úrtökum með kerfisbundnu yfirliti. Af
2.873 heimildum, sem höfundar skimuðu, stóðu 28 heimildir eftir um próffræðilega eiginleika
CDI á Íslandi. Niðurstöður voru almennt svipaðar og erlendis. Eins og búast mátti við mældist
meðaltal hærra í klínískum úrtökum en almennum og stúlkur skoruðu hærra en drengir. Innra
samræmi heildartölu CDI var nokkuð hátt bæði í almennu og klínísku úrtaki. Samleitniréttmæti
kom vel út þar sem CDI var með háa fylgni við aðra þunglyndiskvarða en niðurstöður rannsókna
á aðgreiningarréttmæti voru ekki allar á sama máli þar sem fylgni CDI sýndi í sumum tilvikum
háa fylgni við kvíðakvarða en í öðrum lága fylgni. Í einni rannsókn með innlagnarúrtaki úr BUGL
kom í ljós að forspárréttmæti CDI var gott við alvarlega þunglyndisgreiningu DSM-IV en ekki við
þunglyndisgreiningu ICD-10. Niðurstöður tveggja leitandi þáttagreininga sýndu að atriði hlóðust á
þrjá þætti en ekki fimm eins og niðurstöður í stöðlunarúrtaki bentu til. Þörf er á frekari rannsóknum
á forspárréttmæti, til dæmis á heilsugæslustöðvum og á göngudeildarúrtaki á BUGL. Mikilvægt
er að kanna forspárréttmæti betur til að kanna notagildi til skimunar á börnum með þunglyndi.
Einnig er þörf á frekari rannsóknum á staðfestandi þáttagreiningu og engar rannsóknir fundust
á endurtektaráreiðanleika í íslensku úrtaki. Almennt virðast próffræðilegir eiginleikar CDI vera
viðunandi miðað við sambærilega kvarða sem notaðir eru hérlendis. Helstu styrkleikar eru innra
samræmi og hátt samleitniréttmæti.
Efnisorð: þunglyndiskvarði fyrir börn, þunglyndi, Children’s Depression Inventory, CDI, kerfisbundið
yfirlit, próffræðilegir eiginleikar, íslensk börn.Children‘s Depression Inventory (CDI) is used to screen
for symptoms of depression in children and is widely used
in Iceland. The purpose of this article is to systematically
review the psychometric properties of the CDI in Icelandic
samples. Out of the 2,873 sources, which the authors
screened, 28 sources remained that contained psychometric
data of the CDI in Iceland. Overall, the psychometric
properties were similar to previous studies of the CDI
abroad. As expected, the mean was higher in clinical
samples than in the general population, and girls scored
higher than boys in said sample. Internal consistency of
the total score for CDI was relatively high in both general
and clinical samples. Concurrent validity was acceptable
since CDI had strong correlation with other rating scales
for depression. However, studies on discriminant validity
showed inconsistancy in correlation to anxiety scales as
some had strong correlation and others weak correlation.
In one study, using inpatient sample, the predictive validity
for CDI was acceptable for DSM-IV major depression
but not for ICD-10 depression. We found two studies
that reported on exploratory factor analysis. The results
showed that items loaded on three factors, instead of five,
as the result of what the standardized sample had indicated.
Further research on predictive validity is needed,
for example in primary health care centers and in clinical
outpatient samples. Further information on the predictive
validity could increase the utility of the CDI as a depression
screening instrument. Additionally, further reasearch
is needed on the factor structure test-retest reliability as
we did not find any studies related to these topics. In
general, the psychometric properties of CDI seem to be
acceptable compared to other similar depression scales
that are being utilized in Iceland. The main strengths of
CDI in Iceland is high internal consistency and strong
concurrent validity.
Keywords: Children’s Depression Inventory, CDI, depression,
systematic review, psychometric properties, Icelandic
childre
Long term outcome of valve repair for degenerative mitral valve disease in Iceland
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR
Hrörnunartengdur míturlokuleki er helsta ábendingin fyrir míturlokuviðgerð á Vesturlöndum. Tilgangur rannsóknarinnar var að kanna
langtímalifun og fylgikvilla míturlokuviðgerða vegna hrörnunartengds
leka á Íslandi.
EFNI OG AÐFERÐIR
Rannsóknin var afturskyggn og náði til 101 sjúklings (meðalaldur 57,7
ár, 80,2% karlar) sem gengust undir míturlokuviðgerð vegna hrörnunartengds leka á Landspítala 2004-2018. Skráðar voru ábendingar
fyrir aðgerð, niðurstöður hjartaómunar fyrir aðgerð og aðgerðartengdir
þættir. Snemmkomnir (<30 daga) og síðkomnir fylgikvillar voru skráðir
og reiknuð 30 daga dánartíðni. Langtímalifun og MACCE (major adverse
cardiac and cerebrovascular event) frí lifun var áætluð með aðferð
Kaplan-Meier og borin saman við almennt þýði af sama kyni og aldri.
Miðgildi eftirfylgdartíma var 83 mánuðir.
NIÐURSTÖÐUR
Að meðaltali voru gerðar 6,7 (bil 1-14) míturlokuviðgerðir árlega og
fengu 99% sjúklinga gervihring. Brottnám á aftara blaði var framkvæmt
í 82,2% tilfella og Gore-Tex® gervistög notuð hjá 64,4% sjúklinga.
Alvarlegir fylgikvillar greindust hjá 28,7% sjúklinga, algengastir voru
hjartadrep tengt aðgerð (11,9%) og enduraðgerð vegna blæðingar (8,9%).
Þrjátíu daga dánarhlutfall var 2%, miðgildi dvalar á gjörgæslu einn
dagur og heildarlegutími 8 dagar. Einn sjúklingur þurfti enduraðgerð
síðar vegna endurtekins míturlokuleka. Fimm ára lifun eftir aðgerð
var 93,5% (95%-ÖB: 88,6-98,7) og 10 ára lifun 85,3% (95%-ÖB: 76,6-
94,9). Fimm ára MACCE-frí lifun var 91,1% (95%-ÖB: 85,3-97,2) og eftir
10 ár 81,0% (95%-ÖB: 71,6-91,6). Ekki reyndist marktækur munur á
heildarlifun rannsóknarhópsins samanborið við samanburðarþýðið
(p=0,135, log-rank próf).
ÁLYKTUN
Árangur míturlokuviðgerða vegna hrörnunartengds leka er
sambærilegur við árangur á stærri hjartaskurðdeildum erlendis.
Almennt farnast þessum sjúklingum ágætlega til lengri tíma þrátt fyrir
að snemmkomnir fylgikvillar séu tíðirOBJECTIVES: Degenerative mitral valve disease is the most common indication for mitral
valve repair in the Western world. The aim of this study was to study the long term outcome of
mitral valve repair for degenerative mitral valve regurgitation in Iceland.
MATERIAL AND METHODS: A retrospective study of 101 consecutive mitral valve repair
patients (average age 57.7 years, 80.2% male) operated in Iceland 2004-2018 for degenerative
mitral valve regurgitation. Long term survival and MACCE (major adverse cardiac and
cerebrovascular event) free survival was estimated using the Kaplan-Meier method and
compared to age and gender matched reference population. Median follow-up time was 83
months.
RESULTS: On average there were 6,7 (range 1-14) mitral valve repairs performed annually
with 99% of the patients receiving ring annuloplasty. A total of 82 (82,2%) underwent resection
of the posterior leaflet and 64.4% recieved Gore-Tex®-chordae. Major early complications
occured in 28.7% of cases, most commonly perioperative myocardial infarction (11.9%) and
reoperation for bleeding (8.9%). Mortality within 30 days was 2%, the median duration of
intensive care unit stay was one day and the median hospital length of stay was 8 days. One
patient needed reoperation later for recurrent mitral regurgitation. Five and ten year MACCEfree survival was 91.1% (95%-CI: 85.3-97.2) and 81.0 (95%-CI: 71.6-91.6), respectively. Five year
survival was 93.5% (95-CI: 88.6-98.7) and 10 year survival 85.3% (95%-CI: 76.6-94.9), which was
not different from an age and gender matched reference population (p=0.135, log-rank test).
CONCLUSION: Outcomes of mitral valve repair due to degenerative mitral regurgitation
is good in Iceland and results are comparable to larger institutions overseas. Long term
prognosis is generally good although early postoperative complications often occur.Vísindasjóður Landspítala, Rannsóknarsjóður Háskóla Íslands og Minningarsjóður Helgu Jónsdóttur og Sigurliða Kristjánssona
COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadIntroduction: Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems.
Material and methods: This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS-CoV-2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID-19-related.
Results: In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID-19. The risk of admission due to COVID-19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID-19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID-19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported.
Conclusions: The risk of admission due to COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.
Keywords: COVID-19; cohort studies; obstetric delivery; pregnancy; pregnancy complications; pregnancy outcome; prospective studies; severe acute respiratory syndrome coronavirus 2.Nordic Federation of Societies of Obstetrics and Gynecology (NFOG
Evaluation of a Novel Teleradiology Technology for Image-Based Distant Consultations: Applications in Neurosurgery.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadIn emergency settings, fast access to medical imaging for diagnostic is pivotal for clinical decision making. Hence, a need has emerged for solutions that allow rapid access to images on small mobile devices (SMD) without local data storage. Our objective was to evaluate access times to full quality anonymized DICOM datasets, comparing standard access through an authorized hospital computer (AHC) to a zero-footprint teleradiology technology (ZTT) used on a personal computer (PC) or SMD using national and international networks at a regional neurosurgical center. Image datasets were sent to a senior neurosurgeon, outside the hospital network using either an AHC and a VPN connection or a ZTT (Image Over Globe (IOG)), on a PC or an SMD. Time to access DICOM images was measured using both solutions. The mean time using AHC and VPN was 250 ± 10 s (median 249 s (233-274)) while the same procedure using IOG took 50 ± 8 s (median 49 s (42-60)) on a PC and 47 ± 20 s (median 39 (33-88)) on a SMD. Similarly, an international consultation was performed requiring 23 ± 5 s (median 21 (16-33)) and 27 ± 1 s (median 27 (25-29)) for PC and SMD respectively. IOG is a secure, rapid and easy to use telemedicine technology facilitating efficient clinical decision making and remote consultations.
Keywords: clinical decision-making; neurosurgery; remote consultation; telemedicine; teleradiology