Medica2015_Dienstag

TUESDAY @ MEDICA4 EH @ MEDICA No 2 2015 “Elastoscan is the first tool to allow us rather clear differentiation of let’s say a filled cyst and fibroadenoma or carcinoma,” explains Dr Frank Schure and adds “Even mixed carcinoma and fibroadenoma that contain carci- The Issue - To date, a consider- able number of telemedicine projects is either not being evaluated or the results of the evaluations are not, or only partly, published. ‘This obstructs the potential knowledge gain for the healthcare system enormously,’ says Katrin Arnold, and Madlen Scheibe adds: ‘When evaluations of tele- medicine applications are carried out these are of very varied methodical quality.’ Therefore, various studies with methodical weaknesses have limitations as to their validity. There is a lack of interdisciplinarily accepted and mandatory standards. ‘On the whole, the aforementioned problems are a hindrance when it comes to compiling resilient evidence on the effectiveness and cost effectiveness of telemedicine,’ Scheibe explains. ‘Against this background we have developed an evidence- and consen- sus-based set of evaluation princi- ples to accompany the project CCS Telehealth - Eastern Saxony.’ Evaluation principles Due to the aforementioned prob- lems encountered with evaluation to date, there have now been efforts for some years to draft suitable methodological standards. There are big differences in quality with the ground rules for evaluation pub- lished to date – some (groups of) authors formulate their principles on the basis of systematically researched literature, and/or on the basis of a consensus shared by several experts. Others, however, make the process less transparent, which ultimately provides the opportunity to publish subjective, individual opinions. ‘In our research we have systematically researched studies on evaluation principles that are based on system- atic reviews, or on consensus proce- dures,’ Arnold makes clear. ‘From these we have extracted suggestions for evaluation princi- ples which were then subjected to a formal consensus procedure with an interdisciplinary panel of experts. Our multi-stage procedure therefore based itself on the highest develop- mental level for medical guidelines,’ she explains. The agreed evaluation principles provide orientation for best prac- tice in the planning, implementa- tion and publication of telemedi- cine evaluations. They include, for instance, recommendations on study characteristics, outcome parameters and reporting standards (see box). Developed initially for quality assur- ance in the context of the CCS Telehealth Eastern Saxony Project, the intention was very much for these principles to be seized upon by other projects and initiatives. noma are well visible.” ElastoScanTM is a Samsung elastography technol- ogy which produces an elastogram showing the 2D image as well as the stiffness of the tissue in question on a colour-coded image. When breast cancer is suspected the physicians also use the WS80A’s ElastoScanTM function to differentiate tissue struc- tures and to get a first idea of mass dignity. “Thanks to the high 2D reso- lution we can detect breast tumours as small as one to five millimetres,” says Dr Frank Schure. Statistically speaking women who receive treat- ment of cancer lesions smaller than 10 mm have a probability of survival for the next five years of 98.3 percent (smaller than 5 mm: 99.2 percent). Moreover these women usually can undergo breast-conserving surgery and rarely require major plastic sur- gery or chemotherapy. (Tumour reg- istry of the Tumorzentrum Munich, Germany; Institute of. Biometrics; Data 1996-2002; Dr Birtel; Radiology Institute; Hamburg) Frank and Viola Schure use the facilities of their cooperation partner, the hospital Hardheim, to perform breast cancer and other gynaeco- logical surgeries, in total approx. 450 interventions annually across the gynaecological board. Here, another advantage of the WS80A Elite comes into play: the system’s mobility. During surgery the WS80A allows the physicians to easily localise the tumour without having to use mark- ers or clips. “After the incision and the subcutaneous preparation we fixate the tumour under ultrasound guidance with a Kocher clamp – thus we can see the instruments very well,” says Dr Schure. At the same time the physicians delineate the tumour, if the lesion turns out to be spiculate, the ultra- sound system is used to highlight spicules for closer examination. “We can sonographically determine the margins to completely remove the tumour and avoid a second interven- tion,” Dr Viola Schure adds. In short: less loss of breast volume, fewer plas- tic corrections, fewer follow-up inter- ventions and shorter surgery times. As soon as the tumour has been entirely removed it is placed on the instrument table, a marker is applied for the pathologist and ultrasound images are immediately generated. Thus the physicians determine the resection margins right in the operat- ing room and verify that indeed the complete tumour was removed. The tissue is sent to pathology but the fact that it was imaged right then and there,. in the OR, means that the need for re-resection is less likely. “The fact that we do not need to have a second surgery is a major success, because we image the tis- sues immediately post-resection and can assess the margins quite well,” explains Viola Schure. This procedure allowed surgeons to dramatically reduce the number of re-excisions (see: Krekel et al. Lancet Oncol. 2013;14; 48-54; re-excision rate dropped from 17 to 3 percent; excision volume in breast-conserving surgery was reduced by 19 percent). The ultrasound system WS80A is highly versatile and can be used in all types of exams that are performed in a gynaecological practice: vagi- nal, breast and obstetric ultrasound, Doppler and invasive diagnostics, to name a few. Frank and Viola Schure see 6,200 to 6,600 patients per year. “With such a high throughput we need to be able to make accurate diagnoses quickly,” says Dr Viola Schure. “Therefore we need a reli- able ultrasound system with fast responses – and the WS80A fits the bill exactly.” Workflows benefit from the easy operation of the system and the quick boot and shut-down. Moreover, the WS80A is equipped Since December 2014, Dr Viola Schure and Dr Frank Schure have been using three Samsung WS80A Elite ultrasound systems in both sites of their joint practice in Hardheim and Adelsheim, Germany. The WS80A Elite not only offers excellent image quality and versatility in gynaecology, obstetrics and breast imaging, but also ElastoScanTM – a functional package that facilitates the diagnosis and surgery of breast cancer and other breast diseases. Moreover, one of the systems is used in other types of surgical interventions Although there are many telemedically supported care concepts in Germany, most are still model projects. So far, only a minority has become part of nationwide, standard medical care. Methodically solid and thoroughly published evaluations can help to make the effectiveness and cost effectiveness of telemedicine applications more transparent for decision makers. With their recently developed principles for the evaluation of telemedical applications Katrin Arnold and Madlen Scheibe, at the Centre for Evidence Based Healthcare (ZEGV), University Hospital Carl Gustav Carus, Technische Universität Dresden, have created systematic guidelines for this purpose Premium all-rounder for diagnostics and Advancing the evaluation of telemedicine THE PERFECT PARTNER FOR GYNAECOLOGY AND OBSTETRICS: THE SAMSUNG ULTRASOUND SYSTEM WS80A INTERDISCIPLINARILY ACCEPTED AND MANDATORY STANDARDS ARE LACKING To get to know our products, visit us at Medica Hall 9 / C63 Or visit our Website: www.samsung.de/hme Katrin Arnold studied sociology at Technische Universität Dresden. After several years of scientific research work at the Mental Health Services Research Unit at Ulm University she is currently working as a research associate at the Centre for Evidence Based Healthcare at the University Hospital Carl Gustav Carus in Dresden. The core subjects of her research are telemedicine evaluation as well as psychiatric and neonatal care. Madlen Scheibe studied sociology and earned her doctorate in Health Sciences at Technische Universität Dresden. She is currently working as a research associate at the Centre for Evidence Based Healthcare at the University Hospital Carl Gustav Carus in Dresden.The focus of her research is on telemedicine and mobile health, particularly on the evaluation and quality assurance of innovative care concepts and the acceptance of telemedicine by older target groups. Intention ‘We hope that the principles, togeth- er with other current initiatives in the field of telematically supported care concepts, will pave the way for a more wide-ranging use of tele- medicine as part of standard medical care,’ emphasises Katrin Arnold.The methodically solid, regular evalua- EH @ MEDICA No 22015

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