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New prospective implementation study: remote monitoring of digital flaps using the Pixacare tool.

Tanguy Chevalier, a student at Lille's Henri Warembourg Faculty of Medicine, has submitted the following topic for his Doctor of Medicine thesis: "Télésurveillance des flats digitaux via l'outil Pixacare : Étude prospective de mise en application". Defended on October 20, 2023, this thesis highlights the modalities of a remote monitoring system for post-operative care in hand surgery via the Pixacare tool.

1. Background and need for telemonitoring.

In France, hand injuries represent a major public health issue, with around 1.4 million cases per year, many of which require specialized surgery. The complexity of these operations, particularly in the case of digital flap surgery, raises a crucial challenge: ensuring effective and appropriate post-operative follow-up.

Digital flap surgery plays an essential role not only in restoring finger functionality after complex trauma, but also in maintaining their aesthetic appearance. This delicate operation requires meticulous follow-up to monitor healing and prevent possible complications. However, the limited number of specialized centers and the need for frequent follow-up pose problems of accessibility, particularly for geographically remote patients.

In this context, telemonitoring is emerging as a promising solution capable of lightening the burden of post-operative follow-up. By enabling remote follow-up, remote monitoring tools such as Pixacare offer the possibility of monitoring the progress of flaps without the constraints associated with frequent travel, while ensuring specialized, personalized care.

2. Application and benefits of Pixacare.

Remote monitoring of healing.

Pixacare has proved a promising tool in Tanguy Chevalier's study of remote monitoring of digital flaps. This innovative method involves regular photographic monitoring of flaps, enabling doctors to monitor the progress of healing remotely. Thanks to Pixacare, healthcare professionals can quickly and accurately assess the condition of flaps, without necessarily requiring the physical presence of the patient.

Fewer face-to-face consultations.

One of the major benefits of remote monitoring via Pixacare is the significant reduction in the number of face-to-face consultations. Not only would this mean fewer hospital visits, it would also reduce the cost and inconvenience of travel, especially for patients living far from specialist centers.

Involving the patient in the healing process.

In addition, Pixacare encourages greater patient involvement in their own healing process. Thanks to the app's simple, accessible technology, patients become active players in their own care, regularly sending photos of their flaps for evaluation. This aspect of the app empowers patients and gives them a more active role in their care.

3. Results and comments.

Typical patient profile.

Tanguy Chevalier's study revealed significant results in the use of Pixacare for remote monitoring of digital flaps. The typical profile of patients involved in the study was predominantly male, with an average age of 42, often engaged in manual occupations. This demographic reflects the general profile of patients treated at SOS Hands centers.

Inter-observer agreement.

Regarding the reliability of the photo analysis carried out via Pixacare, the study revealed an inter-observer agreement coefficient of 0.64, indicating a high degree of concordance.

Patient and caregiver satisfaction.

In terms of satisfaction, patients expressed a high degree of contentment, with an average of 4.63 out of 5. This high level of satisfaction clearly indicates that remote monitoring via Pixacare has been well received by patients, who appreciate the convenience and effectiveness of this mode of monitoring.

Feedback from the paramedical team was also largely positive. Nurses reported feeling better supported and less isolated, particularly when dealing with less routine cases such as digital flaps. Pixacare's integrated messaging system was also praised for facilitating more direct and effective communication with the surgical team.

4. Limits and challenges.

Although the use of Pixacare in remote monitoring of digital flaps has shown promising results, Tanguy Chevalier's study also highlighted several challenges and limitations in its application.

Implementation challenges.

One of the main challenges encountered during the study was the multiplicity of operators involved. The "SOS Main" Service operates with a variety of surgeons and practitioners from different practices and the CHU, which created difficulties in homogeneous patient recruitment and uniform data collection. This diversity introduced a potential bias in patient recruitment and, consequently, in the study results.

In addition, photo quality proved to be a limiting factor. Some images could not be used for analysis due to insufficient quality or framing problems. These problems underline a limitation in the practical application of remote monitoring.

The importance of collaboration and training. 

The study highlighted the crucial importance of collaboration between different healthcare professionals for the success of telemonitoring. Theactive involvement andcommitment of the entire medical team is essential to ensure effective and accurate monitoring.

What's more, users need to be properly trained in how to take pictures. To guarantee image quality, it is crucial that all those involved, including patients, are trained to focus on the correct visualization of the area of interest.

5. Strengths and future prospects. 

Tanguy Chevalier's study, focusing on the use of Pixacare for remote monitoring of digital flaps, revealed several significant strengths, while opening up promising future prospects for remote monitoring.

Secure data and save time.

One of the most notable aspects of Pixacare is its ability to effectively secure healthcare data. In a world where the protection of medical data is increasingly crucial, Pixacare offers a reliable solution for the secure storage and sharing of medical images. This feature meets a growing need for security in the field of digital health.

What's more, using Pixacare has proven to save healthcare professionals a considerable amount of time. The ease and speed of acquiring and sorting medical photographs with Pixacare has led to a significant reduction in the time spent on these tasks, compared with conventional methods. This time-saving translates into improved care efficiency and optimization of medical resources.

The future potential of remote monitoring. 

The study opens up exciting prospects for the future of remote monitoring in the medical field. The efficiency and practicality demonstrated by Pixacare in digital flap monitoring suggest potential applications in other surgical fields. For example, remote monitoring could prove beneficial in the follow-up of burn patients, or in the management of chronic or surgical wounds.

What's more, the benefits of telemonitoring could extend beyond urban areas, improving access to care in rural or remote regions. The reliability and convenience of telemonitoring, as demonstrated by Pixacare, could lead to more equitable and accessible care, offering valid alternatives to face-to-face consultations, without replacing them.

Tanguy Chevalier's thesis shows that Pixacare is an interesting tool for remote monitoring of digital flaps. In fact, it makes it possible to space out face-to-face post-operative consultations when progress is favorable. What's more, feedback from patients has been positive, and they have appreciated being involved in their follow-up. In this way, telemonitoring paves the way for more flexible post-operative management and greater patient involvement.

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