Sabine Schmidt-Weitmann

Validation of PRISM (Pictorial Representation of Illness and Self Measure) as a novel visual assessment tool for the burden of suffering in tinnitus patients

BackgroundChronic subjective tinnitus is a frequent condition that affects the subject’s quality of life. The lack of objective measures of tinnitus necessitates the use of self-reporting and often time-consuming questionnaires for evaluating tinnitus severity. The Pictorial Representation of Illness and Self Measure (PRISM) is a two dimensional pictorial method to assess the burden of suffering. Patients illustrate their burden of suffering by the distance from a “self” to an illness circle, whereby a shorter distance indicates a higher burden of suffering. The aim of this prospective observational study was to validate the burden of suffering measured with PRISM in tinnitus patients by comparing it with different standardized questionnaires currently used in tinnitus evaluation.MethodsA total of 188 patients filled out an online-based survey including sociodemographic variables and the following questionnaires: Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), WHO Quality of Life-Questionnaire (WHOQOL-BREF), and the Beck Depression Inventory (BDI). The subtle differences in the burden of suffering were accessed by using PRISM as an iPad version. Based on PRISM performance patients could easily be assigned in three groups, these being mildly, moderately, or severely affected akin to the standard questionnaires.ResultsThe burden of suffering measured with PRISM correlated with the tinnitus severity (THI and TQ), depressive symptoms (BDI), and health related quality of life (WHOQOL-BREF) (all p ≤ 0.001). In the three PRISM groups tinnitus severity (THI and TQ), and depressive symptoms (BDI) differed significantly (all p ≤ 0.01).ConclusionPRISM is an easily understood and time saving method for the assessment of burden of suffering in tinnitus patients. In daily clinical practice PRISM can help to identify patients with decompensated tinnitus that require more intensive treatment.

Psychological online consultation service attracts men: a new approach to close the gap between being ill and being treated.

BACKGROUND Since 1999, the University Hospital Zurich (Zurich, Switzerland) has offered an e-mail-based consultation service for individual health concerns where anonymous questions can be asked to an online doctor. This study aimed at the characterization of the user profile, the content of the question, and the answers given specific in the field of psychiatry. MATERIALS AND METHODS In total, 3,148 questions were asked from 2008 to 2010. Of these, 209 (6.6%) requests were selected by International Classification of Diseases-10 and International Classification of Primary Care codes relevant for psychiatry and included in the retrospective qualitative study. The content analysis of the requests was supported by means of the Mayring inductive category system using a professional text analysis program (MAXQDA). RESULTS Of the users, 45.9% were female, and 46.9% were male. The mean age was 37.4 years. The main topics of the request were somatoform, somatization, and hypochondriac disorders in 18.4%, behavioral syndromes in 17.9%, and mood disorders in 15.4%. The reason stated most frequently for using the service was looking for a second opinion. The doctors responded with detailed information about disease and treatment and in 70.8% recommended consultation of a physician. CONCLUSIONS Telemedicine is suggested to empower patients by developing health literacy with professional advice. The gender ratio of the users is almost equal, although the prevalence of psychological diseases in the general population is higher in women than in men. Psychological online consultation may potentially reach mentally ill individuals who do not have or did not seek professional help yet, and it seems to be especially attractive for men.

Body weight telemetry is useful to reduce interdialytic weight gain in patients with end-stage renal failure on hemodialysis.

Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate.

Teleconsultation in vascular surgery: a 13 year single centre experience

The University Hospital of Zurich has provided an email-based medical consultation service for the general public since 1999. We examined the enquiries in a 13-year period to identify those related to vascular surgery (based on 22 ICD-10 codes specific for vascular surgery). There were 40,062 questions, of which 643 (2%) were selected by ICD-10 codes. After exclusion of diagnoses not relevant to vascular surgery, 139 questions remained, i.e. an average rate of about one per month. The mean age of the users was 43 years (range 19–88). Most users (61%) were women. The majority of users asked questions about their own health problems (79%) with varicose veins and spider veins accounting for 63% of all questions. Arterial diseases accounted for 30%. The patient’s intention in contacting the service was to obtain advice on treatment options (37%), information about a diagnosis or symptoms (27%), or a second opinion (15%). The online service responded with detailed information and advice (87%) and suggested a referral to the family doctor or a specialist in 75%. Most patients (82%) rated the service overall as good or very good. It appears likely that telemedicine and in particular email teleconsultations will increase in vascular surgery in the future.

Medical online consultation service regarding maxillofacial surgery.

OBJECTIVE The University Hospital of Zurich provides a medical online consultation service since 1999. Our aim was to characterise the users of an online consultation with queries regarding maxillofacial surgery, to analyse the content of their questions and to study the actions by the internet doctors with the ambition of defining whether the telemedical consultation is a useful tool in this surgical field. MATERIALS AND METHODS The procedure of inductive category development described by MAYRING was used. A professional text analysis program MAXQDA supported the process of analysis. 204 questions were evaluated. RESULTS Men sent 37% of the questions, 48% originated by women, mean age was 38 years. Often they asked for information about medical therapies or pharmaceuticals (n=74) and about specific disease or an injury (n=26). The three most common maxillofacial surgery topics were sinusitis (n=21), aphthae in the mouth (n=17) and basal cell carcinoma (n=14). CONCLUSIONS Online consultation is not only understood as a first contact with the healthcare system but also as a centre to get professional further and detailed information and advice after a doctor visit, especially about chronic diseases and infections. Online consultation can complement the traditional healthcare and conventional physician-patient relationship in maxillofacial surgery.

The University Hospital Zurich Offers a Medical Online Consultation Service for Men With Intimate Health Problems

The University Hospital of Zurich offers a text-based, Medical Online Consultation Service to the public since 1999. Users asked health questions anonymously to tele-doctors. This study focused on the characteristics of male enquirers with intimate health problems, the content of their questions, the medical advice given by tele-doctors and the rating of the service to prove the benefit of an online service for medical laymen. This retrospective study included 5.1% of 3,305 enquiries from 2008 to 2010 using the International Classification of Diseases-10 and International Classification of Primary Care codes relevant for intimate and sexual health problems in men. A professional text analysis program (MAXQDA) supported the content analysis, which is based on the procedure of inductive category development described by Mayring. The average age was 40 years, 63.1% enquirers had no comorbidity, in 62.5% it was the first time they consulted a doctor, and 70.2% asked for a specific, single, intimate health issue. In 64.3%, the most important organ of concern was the penis. Overall, 30.4% asked about sexually transmitted diseases. In 74.4% a doctor visit was recommended to clarify the health issue. The rating of the problem solving was very good. The service was mainly used by younger men without comorbidity and no previous contact with a doctor with regard to an intimate health problem. The anonymous setting of the teleconsultation provided men individual, professional medical advice and decision support. Teleconsultation is suggested to empower patients by developing more health literacy.

["Doc2Patient" -16 years' experience of the Medical Online Consultation Service at the University Hospital Zurich].

The increasing availability of telemedicine services and the transition to an information society allow the increased use of telemedicine in everyday medical practice. This requires acceptance of telemedicine as a powerful, additional pillar in the overall architecture of the health system. The implementation is still between the poles of the large variety of telemedicine applications and their realization. The University Hospital of Zurich looks back on 16 years of experience in the field of online medical advice. The quality of advice is continuously monitored and evaluated. Scientific evaluations analyze the profile of the questioner and their requests in order to optimize the services. Medical online advice conducted ethically correct can improve health literacy and increase the autonomy of medica/laypersons.

Kompetenzen in der Telemedizin sind essentiell

The measurement and collection of health and fitness data as well as the telemedicine consultation supports the autonomy and self-determination of the responsible citizen concerning his health issues and promotes patient empowerment. However the patient is often over extended by an increasing and extensive data and information overload. He needs the help and the advice of a trustworthy doctor for guidance. While telemedical consultation, care or intervention is carried out, the telemedicine application represents a favored option and provides an immediate consequence of action for the patients health issue. The quality stands and falls with training, continuing education and in particular with the telemedical expertise of the doctors involved

Medical online consultation service in gastroenterology at the University Hospital Zurich

Abstract Background: Since 1999, the University Hospital Zurich (Switzerland) offers an e-mail based online consultation where patients can ask online doctors anonymous questions about individual health concerns. This study aimed at the characterization of the patient, the content of the question and the recommendations given specifically in the field of gastroenterology. Methods: In total, 3,489 inquiries were asked from July 2010 to December 2015. Based on the International Classification of Diseases ICD-10 and the Primary Care Code ICPC-2 252 (7.2%) inquiries were included in the retrospective qualitative study. The content of the requests was qualitatively evaluated by inductive categorization using a professional text analysis program (MAXQDA). Results: Of the users, 49.2% were male, 49.6% female. The mean age was 47.9 years. Main topics of the questions were bowel diseases in 29.8% (infectious in 6%, non-infectious in 7.1%, other bowel diseases in 16.7%). Most often patients suffered from abdominal pain (32.7%), diarrhea (22.7%), general weakness (22.7%) or epigastric pain (17.1%). Half (48.8%) of the questioners inquired about a second opinion while 25% asked for medical advice. The online doctors responded with detailed information about therapy (73.4%), explained a specific disease (63.9%) or provided decision support (13.9%). Most patients rated the clarity of the answer as good or very good (95.2%). Conclusion: An e-mail based teleconsultation in the field of gastroenterology can provide individual advice and empowers patients by improving their health literacy. Patients with bowel diseases have high expectations to obtain professional medical advice and need support in their decision-making process.

[Acceptance and feasibility of medical telemonitoring plus individual teleconsultation -A two years research and development project at the University Hospital Zurich].

Zusammenfassung. Das Forschungs- und Entwicklungsprojekt „Long Independent Living Assistant (LILA)“, welches von der Kommission fur Technologie und Innovation (KTI) finanziell unterstutzt wird, basiert auf den Resultaten und Erfahrungen der langjahrigen Onlineberatung des Universitatsspitals Zurich. Im Vordergrund steht die Entwicklung und Aufgleisung einer umfassenden telemedizinischen Dienstleistung mit dem Versuch, den Burgern und Patienten zuhause mehr Sicherheit zu geben und den Hausarzt zu unterstutzen und zu entlasten. Kernelemente des Projektes umfassen das Telemonitoring von Vitalwerten kombiniert mit einer individuellen Teleberatung uber die Kommunikationskanale Telefon, E-Mail und Video. Technisch wird die Dienstleistung unterstutzt von einer internetbasierten Dokumentations- und Kommunikationsplattform mit einer integrierten Patientenakte. In einer einjahrigen Konzeptionsphase wurden Einzelinterviews und Gruppendiskussion mit den Probanden durchgefuhrt, die Ergebnisse sind kontinuierlich in da...