Abdominal Aortic Aneurysm Clinical Trial
Official title:
Telesonography Adaptation and Use to Improve the Standard of Patient Care Within a Dominican Community
The role of teleradiology has far reaching implications for the health of remote and
underserved populations. The ability to coordinate radiographic evaluation and diagnosis from
a distance has the potential to raise the standard of patient care throughout the world.
Perhaps the safest and most cost effective mode of teleradiology today is telesonography. The
current project attempts to determine the extent that telesonography improves the standard of
care within a rural government-run primary clinic within the Dominican Republic. The work
reported herein is intended to compare the use of telesonography to the current standard of
sonographic examination (referral to government hospital 60km from target clinic). The study
was conducted by randomly assigning 100 patients with clinical indications for sonographic
examination into experimental and control groups. Following a 60-day implementation period,
the following research questions will be addressed: 1) To what extent does the use of
asynchronous telesonography increase the percentage of definitive diagnoses based on the
total number of scans (definitive diagnoses / total number of scans)? 2) To what extent does
the use of asynchronous telesonography increase the continuity of care for patients? 3) To
what extent does the elapsed time between scanning and final radiological interpretation
decrease with the use of asynchronous telesonography? This study will also look at the
history of telemedicine / telesonography and its dissemination into the mainstream practice
of medicine, explore training protocols that may be used to assist others to establish new
telesonography programs in a developing nations, and discuss both advances and persistent
barriers to the implementation of telesonography programs.
Hypothesis:
The use of a store-and-forward telesonography system in this setting will increase the speed
and number of final diagnoses per scan received by the target clinic and will increase the
continuity of care by increasing the number and speed of follow-up appointments to the target
clinic.
The aim of this project is comparable to the diagnostic imaging goals of the WHO including 1)
make safe and reliable diagnostic imaging services available to as many as possible; 2)
advise, guide and support those working in the field developing and maintaining diagnostic
imaging services; 3) promote the importance of safe and appropriate diagnostic imaging
services (WHO, 2007).
This project will use teleultrasound to rapidly diagnose and rule-out abdominal,
retroperitoneal, and pelvic pathologies within the sole government-run ambulatory clinic of
Veron, Dominican Republic. The clinic's patient records as well as the expert opinion of the
clinic's physicians indicate a need for this diagnostic modality. These sources indicate a
number of individuals with symptomologies suggestive of abdominal, retroperitoneal, and
pelvic pathology including fever, abdominal pain, abdominal tenderness, abnormal menses, etc.
(see appendix D). Given the large number of construction projects and transportation
accidents within this area, it is not uncommon for individuals to present with blunt
abdominal trauma. Combine these reasons and other patient indications with the clinic's
remote location and the difficulty and/or resistance of members within this community to
undergo timely radiological evaluation, and the utility of telesonography becomes immediately
recognizable.
If the use of telesonography within this setting is shown to be feasible through this work,
future projects will center on the education of native Dominican health care providers
regarding the use and long-term operation of telesonography. This study could serve as a
gateway to the permanent establishment of high-quality telesonography within this region of
the DR. This project could also serve to augment the medical and technological knowledge of
both the native health care workers and visiting U.S. medical students.
This study will contribute to the body of knowledge on telesonography by determining to what
extent this technology can improve the standard of patient care within this setting. The
results of this study will have implications to the practice of medicine within Veron and
similar settings within the developing world. The further development of telesonography
within this setting is important because it may improve the efficiency of health care through
increased diagnoses, decreased time to diagnoses, and increased continuity of care.
While this pilot study focuses mainly on transabdominal evaluation of abdominal,
retroperitoneal, and pelvic structures, long-term use of telesonography at the clinic could
expand to include regular fetal monitoring, vascular studies, and perhaps interventional
procedures granted the clinic physicians are provided with the appropriate training. Given
the majority of health disparities within the DR are related to maternal, pre/perinatal, and
circulatory pathologies, using telesonography to target these specific abnormalities will be
the ultimate goal of a continuing telemedical presence.
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