Browsing by Author "Hsieh, Ching-Hua"
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- ItemTeleconsultation by using the mobile camera phone for remote management of the extremity wound: a pilot study.(2004-12-16) Tsai, Hui-Hong; Pong, Ya-Ping; Liang, Chi-Cheng; Lin, Pao-Yuan; Hsieh, Ching-HuaTo assess the feasibility of remote management of extremity wound by using a mobile camera phone to transfer clinical images and online communication teleconsultations were carried out on 60 patients between January and August 2003 for 82 extremity wounds presented to the emergency room between residents and consultant plastic surgeons A questionnaire about wound descriptors gangrene necrosis erythema and cellulitis infection as well as clinical opinions regarding treatment with antibiotics or debridement was filled out In this study 3 surgeons were able to make 80 76 66 and 74 agreement respectively in the remote diagnosis regarding presence of gangrene necrosis erythema and cellulitis infection Recognition of gangrene had the highest agreement percent 80 sensitivity 85 and specificity 93 There were 68 to 90 of image sets that could be made with equivalent diagnoses of wound descriptors and 83 of wounds managed as per the remote treatment recommendation regarding whether to use antibiotics or to perform debridement The preliminary results showed that the camera phone is valuable and bears potential for remote management of the extremity wound
- ItemTeleconsultation with the mobile camera-phone in digital soft-tissue injury: a feasibility study.(2004-12-03) Hsieh, Ching-Hua; Tsai, Hui-Hong; Yin, Jir-Wen; Chen, Chih-Yuan; Yang, Johnson Chia-Shen; Jeng, Seng-FengThe purpose of this study was to examine the feasibility of teleconsultation using a mobile camera phone to evaluate the severity of digital soft tissue injury and to triage the injury with regard to management recommendations With a built in 110 000 pixel digital camera pictures of the injured digit s or radiograph were taken by surgical residents in the emergency room and transmitted to another camera phone to be viewed by the remote consultant surgeon A brief medical and trauma history of each patient was relayed also by mobile phone The consultant surgeon then reviewed all of these patients in the emergency room shortly after the initial telemedicine referral Separate triaging for each digital injury into three groups was recorded during remote teleconsultation and according to actual treatment by the attending surgeon as follows group I the injury could be managed with conservative treatment such as secondary intention wound healing or primary closure with or without bone shortening group II skin grafting or local flap coverage was required for management of the injury and group III microsurgery such as replantation or free flap coverage was necessary to deal with the injury Later triaging was also performed individually by three junior plastic residents according to image review and patient referral information Teleconsultation through a mobile camera phone was performed for 45 patients with injuries of 81 digits from January to May of 2003 Of these 81 digital injuries there were 12 cases 15 percent where disagreement of triaging occurred between the teleconsultation and the actual treatment by the attending surgeon In image reviewing there was 79 percent sensitivity and 71 percent specificity in remote diagnosis of the skin defect and 76 percent sensitivity and 75 percent specificity in remote identification of the bone exposure regarding the concordance of opinions of all three surgeons there was significant discordance in triaging in 20 cases 25 percent and the difference in triaging was partly attributed to the inability to show instances of tiny exposed digital bone or tendon in some cases under the low resolution digital image and the situation of a bloody oozing wound In some cases the difficulty in evaluating the probability of primary closure of severely avulsed skin edges or the probability of executing replantation for finger amputation also contributed to different triaging outcomes Two neglected diagnoses of transected digital nerves were found and influenced triaging highlighting the importance of on site physical examination during teleconsultation The telemedicine system using a mobile camera phone based on the global system for mobile communication is feasible and valuable for early diagnosis and triaging of digital soft tissue injury in emergency cases with on line verbal communication and review of the transmitted captured image This system has the advantages of ease of use low cost high portability and mobility With advances in hardware for digital imaging and transmission technology and the development of the third generation advanced mobile phone system in the foreseeable future this system has potential for future applications in telemedicine and telecare