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At least 289 records · Page 16Linked to original sources
PubMed2003

Evaluation of a telemedicine demonstration project in the Magdalene Islands.

The Magdalene Islands are an archipelago located in the middle of the Gulf of St Lawrence, more than 1000 km away from supra-regional medical referral centres. We have implemented and evaluated a telemedicine network for the local hospital on the Magdalene Islands. During a 13-month study period, 118 transmissions were made. Orthopaedics and radiology were the medical specialties that used telemedicine most frequently. Store-and-forward imaging was the technique used most often because of the large number of transmissions in orthopaedics and radiology. Various medical specialties and psychosocial services used videoconferencing, while realtime imaging (ultrasound) was used in gynaecology and obstetrics. A combination of videoconferencing and imaging was used for otolaryngology. A total of 101 individual patients benefited from a teleconsultation during the study period. Eight emergency transfers were avoided and 15 patients who would have required elective transfer were managed locally by telemedicine. For health-care providers, telemedicine seemed to be an acceptable way of delivering specialized services. Nevertheless, demonstration projects in telemedicine are quite different to 'real life' telemedicine utilization. Deployment of telemedicine in the health-care system as a whole will require a more structured approach.

Attitude of Health Personnel↗
PubMed2003

The importance of setting and evaluating standards of telemedicine training.

The importance of appropriate training in the use of videoconferencing equipment for clinical purposes is often underestimated when telemedicine projects are established. We developed a user training programme which was delivered via videoconferencing to a group of 130 nurses. Training was delivered on a one-to-one basis. A questionnaire was developed to evaluate user satisfaction and the effectiveness of training. One hundred and two fully completed questionnaires were returned (a 79% response rate). High levels of satisfaction were obtained but the level of user competence reached 100% only when training was supported by a training manual and at least weekly practice. Before establishing a telemedicine service, the following steps appear to be important: identify the required training competencies; deliver a 'hands on' training programme based on the required training competencies; back up the training programme with an instruction booklet; ensure that trainees have at least weekly practice; measure the level of user competence.

Education, Continuing↗
PubMed2003

The cost of allied health assessments delivered by videoconference to a residential facility for elderly people.

We calculated the cost of providing allied health assessments to high-dependency residents of a rural facility for elderly people. The costs of conducting assessments via videoconferencing were compared with the costs of conducting assessments face to face. The observed costs in a three-month pilot trial were used to estimate the annual costs. Given an annual workload of 1000 occasions of service, each videoconference assessment would cost dollar 84.93, compared with dollar 90.25 for face-to-face assessments. Allied health assessments delivered by videoconferencing became cheaper at workloads of approximately 850 occasions of service annually. Additional increases in the workload further improved the financial viability of this approach to service delivery.

Cost-Benefit Analysis↗
PubMed2003

Assessment of motor speech disorders online: a pilot study.

We have conducted a preliminary validation of an Internet-based telehealth application for assessing motor speech disorders in adults with acquired neurological impairment. The videoconferencing module used NetMeeting software to provide realtime videoconferencing through a 128 kbit/s Internet link, as well as the transfer of store-and-forward video and audio data from the participant to the clinician. Ten participants with dysarthria following acquired brain injury were included in the study. An assessment of the overall severity of the speech disturbance was made for each participant face to face (FTF) and in the online environment; in addition, a 23-item version of the Frenchay Dysarthria Assessment (FDA) (which measures motor speech function) and the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) (which gives the percentage word and sentence intelligibility, words per minute and a rating of communication efficiency) were administered in both environments. There was a 90% level of agreement between the two assessment environments for the rating of overall severity of dysarthria. A 70-100% level of agreement was achieved for 17 (74%) of the 23 FDA variables. On the ASSIDS there was a significant difference between the FTF and online assessments only for percentage word intelligibility. These findings suggest that Internet-based assessment has potential as a reliable method for assessing motor speech disorders.

Adult↗
PubMed2003

Assessment of benefit in tele-ophthalmology using a consensus panel.

A videoconferencing link was established from a hospital in South Africa to Moorfields Eye Hospital in London. A clinician in South Africa used a video slit-lamp and videoconferencing equipment to capture images and communicate with a specialist in London. Over 12 months, 113 cases were discussed in teleconsultations. Case-notes were subsequently obtained for 90 cases (80%). Three consultant ophthalmologists took part in the consensus process, one from the UK and two from South Africa. The consensus panel achieved on average 78-96% agreement on the items rated. In approximately half the cases, the panel judged that teleconsultation had had an effect on diagnosis. In nine cases (10%) there was potential for definite improvement in visual health as a result of tele-ophthalmology and in a further 48 cases (53%) there was potential for possible improvement in visual health. The consensus process identified 35 cases (39%) where there was potential improvement in general health as a result of tele-ophthalmology. Despite the methodological limitations of our approach, it was possible to learn a great deal about the effectiveness of the telemedicine intervention.

Adolescent↗
PubMed2003

The Pentalfa project. 3: participant evaluations of the interactivity of the educational videoconferences and the effectiveness of project promotion.

A distance continuing medical education programme was established at the Katholieke Universiteit Leuven using multipoint videoconferencing via ISDN lines at 384 kbit/s. During each academic year, 24-26 sessions were organized. The interactivity afforded by the videoconferencing was investigated during the first three years of the project. More than 60% of the participants rated the interactivity as good or very good. No differences were found between the sites or over the three years of the project, but female participants were more positive (66% making ratings of good or very good) in this regard than male participants (57%). Also, the effectiveness of the various types of publicity used to promote the programme was analysed. A brochure was the main source of information (62% of participants heard of the programme by this means), followed by direct mailings (27%), posters (15%), personal contact (14%) and the programme's Website (1%). The proportions of participants who heard of the programme through these different means varied with age and gender.

Adult↗
PubMed2003

The Pentalfa project. 4: educational aspects.

A distance continuing medical education programme was established at the Katholieke Universiteit Leuven using multipoint videoconferencing via ISDN lines at 384 kbit/s. During each academic year, 24-26 sessions were organized. During the first three years, a questionnaire was completed by 29% of the 13,489 participants. The effects of the videoconferencing on the information content and the educational effectiveness of seminars was analysed. Overall, participants were satisfied with the educational approach. Fifty-six per cent of the participants found the Pentalfa session easier to follow than conventional seminars. Participants at the peripheral sites and older participants gave higher ratings of the information content and educational effectiveness of the programme than other participants. The training of speakers and moderators was seen as useful, but most speakers could adapt themselves quite easily to the new medium.

Adult↗
PubMed2003

Development of a teleconsultation system for communication between physiotherapists concerning children with complex movement and postural disorders.

We investigated whether a relatively low-cost, PC-based teleconsultation system could be used for interinstitutional communication about children with complex movement and postural disorders. Four paediatric physiotherapists in three different institutions participated. Both email and videoconferencing were tested. Videoconferencing was unsuccessful, as the low-bandwidth analogue lines, used by the majority of the therapists, made the quality of the realtime video-images very poor. However, email with attached video-recordings was successful and the therapists used the system to consult each other about 20 cases. The therapists regarded the system as effective in clinical practice. However, some improvements would be desirable, such as making the system quicker to use and reducing the number of technical errors. Nonetheless, structured communication between physicians about complex postural and movement disorders appears to be promising both for patient referral and for decisions concerning treatment.

Child↗
PubMed2004

Telerehabilitation - a new model for community-based stroke rehabilitation.

Community resources for stroke clients are underdeveloped in Hong Kong and stroke survivors often face difficulties in community reintegration. We have examined the feasibility of using videoconferencing for community-based stroke rehabilitation. The sample comprised 21 stroke patients living at home. All the subjects participated in an eight-week intervention programme at a community centre for seniors. The intervention, which comprised educational talks, exercise and psychosocial support, was conducted by a physiotherapist via a videoconference link. The Berg Balance Scale (BBS), State Self-Esteem Scale (SSES), Medical Outcomes Study 36-item Short Form (SF-36) and a stroke knowledge test were administered at the start and end of the programme. In addition, at the start of the study the Geriatric Depression Scale 15-item Short Form, the Elderly Mobility Scale and the Lawton Instrumental Activities of Daily Living Scale were used to assess subjects' baseline status, and a focus group was also held at the end of the programme to gather qualitative findings. Nineteen subjects completed the eight-week intervention. The baseline functional status was high, although 52% had symptoms of depression. After the intervention, there were significant improvements in BBS, SSES and knowledge test scores and scores on all subscales of the SF-36. All the subjects accepted the use of videoconferencing for delivery of the intervention. The pilot study demonstrated the feasibility, efficacy and high level of acceptance of telerehabilitation for community-dwelling stroke clients.

Aged↗
PubMed2004

A comparison of face-to-face and videoconference administration of the Hamilton Depression Rating Scale.

To determine whether the mode of administration affected the psychometric properties of the Hamilton Depression Rating Scale (HAMD), 21 subjects with an affective disorder were administered two HAMD interviews on the same day, once via videoconference (at 384 kbit/s) and once face-to-face, by two independent interviewers. The interviewers were blind to the results of the other interview. The mean HAMD scores were almost identical (18.4 for videoconferencing and 18.2 for face to face). The intra-class correlation between the two sets of scores was 0.88. When another group of 21 subjects had the HAMD administered in two face-to-face interviews on the same day, the inter-rater reliability was not significantly different from that for the videoconference cohort. Most patients (91%) thought videoconferencing was a useful way to receive a psychological evaluation when other means were unavailable or limited. The study shows the psychometric equivalence of remote and face-to-face HAMD administration.

Adolescent↗
PubMed2004

Diagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients.

Videoconferencing has become a routine technique for the post-acute burns care of children in Queensland. We compared the agreement between clinical assessments conducted via videoconference and assessments conducted in the conventional, face-to-face manner (FTF). A total of 35 children with a previous burn injury were studied. Twenty-five children received three consecutive assessments: first FTF by a consultant in the outpatient department, then by a second consultant who reviewed the patient via videoconference, and then by the second consultant in person. The second consultant also reviewed another 10 children twice. At each review, the following variables were measured: scar colour, scar thickening, contractures, range of motion, the patient's level of general activity, any breakdown of the graft site, and adequacy of the consultation. Agreement between the two consultants when seeing patients FTF was moderately high, with an overall concordance of 85%. When videoconferencing was used, the level of agreement was almost the same, at 84%. If one consultant reviewed patients FTF first and then via videoconference, the overall concordance was 98%; if the process was reversed, the overall concordance was 97%. This study confirms that the quality of information collected during a videoconference appointment is comparable to that collected during a traditional, FTF appointment for a follow-up burns consultation.

Ambulatory Care↗
PubMed2005

Telehealth service delivery for persons with alcoholism.

Videoconferencing at a bandwidth of 384 kbit/s was used in open sessions for subjects with alcohol use disorders (AUD). Study participants received eight sessions of group therapy over a four-week period from an accredited addictions counsellor. Outcome assessment included self-report measures, a qualitative interview and a chart review. Of the 18 subjects who started the study, 14 attended at least four sessions of therapy, completed self-report assessments and the thematic interview. The participants reported high levels of satisfaction with telepsychiatry, found the intervention to be highly credible, had good session attendance and attrition comparable to that expected with conventional same-room treatment. In all, 82% of subjects reported that they would recommend the service to a friend or family member. The results demonstrate the feasibility of using videoconferencing for service delivery to adults with AUD, and encourage the future performance of randomized controlled trials.

Adolescent↗
PubMed2006

Telegenetic medicine: improved access to services in an underserved area.

We used telemedicine to improve genetics services to patients in the rural northwestern region of Florida. Patients were first seen via videoconference by a genetic counsellor, who obtained family and medical history. A local paediatrician then performed the physical examination, and a plan for evaluation was established. The videoconferencing equipment was connected at a bandwidth of 384 kbit/s, using three ISDN lines. During the first three telemedicine clinics, seven patients were evaluated and then returned to the centre for a face-to-face consultation with the clinical geneticist. No new diagnoses were made face-to-face that had not been identified by telemedicine. No diagnoses made by telemedicine were judged to be wrong when the child was evaluated face-to-face. During a two-year study of patient satisfaction with 12 telegenetics clinics, the 50 families evaluated via videoconferencing were asked to complete surveys; 40 surveys were returned (a response rate of 80%). All individuals either strongly agreed or agreed that the evaluation of their child was appropriate, sufficient and sufficiently protective of their child's privacy. The waiting time for a new patient consultation with the clinical genetics team was 16.9 months (SD 1.9) at the start and 3.0 months (SD 1.0) at the end of the trial period. The difference was significant (t-test, P < 0.0001). Telegenetics allows more rapid assurance that a genetic syndrome has not been identified, or a quicker initial evaluation and diagnosis for children who do have an identifiable genetic syndrome.

Child↗
PubMed1997

Medical decision support for remote general practitioners using telemedicine.

A telemedicine link was set up between the casualty department of a remote community hospital and the accident and emergency department of a large urban hospital. The telemedicine link comprised teleradiology, videoconferencing and telepresence. The system was connected by ISDN (128 kbit/s) and also by a satellite link (64 kbit/s). During a one-year clinical trial, 120 teleconsultations took place between the community hospital and the specialist trauma centre, 110 using ISDN and 10 using the satellite link. Teleradiology was used in 116 teleconsultations, videoconferencing in 76, and telepresence in four. Survey results indicated that both the general practitioners running the community hospital and accident and emergency consultants felt that teleconsultation had improved patient care. Communication between clinicians using the telemedicine link avoided the transfer of 70 patients, representing an estimated cost saving of Pounds 65,000.

Emergencies↗
PubMed1997

Intercontinental postmortem studies using interactive television.

For cultural reasons, medical students in the United Arab Emirates (UAE) are not offered postmortem studies. In a collaborative project between the medical schools of Aberdeen University and the UAE University the feasibility, acceptability and effectiveness of telepathology teaching were evaluated. The transmission of postmortem video images at a quality high enough for teaching purposes was achieved at a data transmission speed of 384 kbit/s. Videoconferencing as a method of presentation was viewed by the students as both interesting and useful. All students participating in the telepathology teaching sessions exceeded the minimum acceptable score of 60% in a multiple-choice examination. Although international videoconferencing at 384 kbit/s is expensive, the costs involved in the telepathology project were small in relation to the educational benefits.

Autopsy↗
PubMed1997

Education and training of practice nurses.

Seventeen nurses in eight rural general practices participated in a distance education project. Low-cost videoconferencing equipment was assessed for its suitability in two training sessions, concerning asthma and travel immunization. The intended learning outcomes were reached and although initially apprehensive, the nurses quickly became accustomed to the medium. Videoconferencing has now become an accepted part of in-service training. Technical reliability remains the most important problem.

Asthma↗
PubMed1998

Pathologists' attitudes to implementing telepathology.

If pathologists will benefit so much from using telepathology, why is it taking so long to be introduced? This question has been discussed between experts, but the potential users are rarely asked for their opinions. A questionnaire was sent to the 256 members of the Austrian Society of Pathology; this addressed general aspects of telemedicine, telepathology in frozen-section services and expert consultation, videoconferencing technologies, teleteaching and teletraining. The response rate was 46%. In general, the pathologists thought that telemedicine could become valuable in their daily routine. However, pathologists were most afraid of sampling errors in remote diagnosis and would not readily accept an alternative to the conventional method of looking at a sample. This is only possible using realtime, remotely controlled microscopes. Telepathology systems providing only still images would not be acceptable to most respondents. There was interest in the use of videoconferencing for clinicopathological conferences. Teleteaching and teletraining were seen as welcome additional techniques, but were nevertheless judged unable to replace classical methods of teaching and training.

Attitude of Health Personnel↗
PubMed1998

Portable satellite telemedicine in practice.

The US army's first portable telemedicine unit was built in 1993 and comprised a 'ruggedized' videoconferencing unit. The unit was initially used in the United Nations' operations in Macedonia in February 1994 and subsequently in support of the Mobile Army Surgical Hospitals in Haiti, but its dimensions made it suitable only for locations where a move at short notice was unlikely. The second portable telemedicine unit comprised a PC linked to an Inmarsat B earth station through a modern. The unit allowed videoconferencing at 64 kbit/s. Three and a half years of clinical experience with both units has shown this to be quite adequate for the majority of clinical telemedicine. Portable telemedicine units have been a major benefit to medical commanders in the field.

Bosnia and Herzegovina↗