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PubMed2007

Impact of telemedicine on pediatric neuro-oncology in a developing country: the Jordanian-Canadian experience.

BACKGROUND: Telemedicine is widely used in industrialized countries for educational purposes. Twinning experiences using telemedicine between institutions in industrialized and developing countries (DC) have been limited. Pediatric neuro-oncology is a complex multidisciplinary discipline that is underserved in most of DC and provides a model to test the feasibility of such tool for twinning purposes. METHODS: A computer, an EMLO visual presenter HV-7600SX document camera, and a TANDBERG 6000 model videoconference unit were used to present data. For connectivity, we used a six-channel ISDN telephone line. Each channel is 64 megabytes/sec. RESULTS: Between December 2004 and May 2006, 20 sessions of videoconference were held between King Hussein Cancer Center and the Hospital for Sick Children to discuss 72 cases of 64 patients with various brain tumors (5 patients were discussed twice and 1 patient four times). In 23 patients (36%), major changes from original plan were recommended on different aspects of the care. In 21 patients (91%), those recommendations were followed, with potentially significant positive impact on patients' care. CONCLUSIONS: Videoconferencing is a feasible and practical twinning tool in pediatric neuro-oncology with a potentially major impact on patient care.

Brain Neoplasms↗
PubMed2005

Digital technologies and quality improvement in cancer surgery.

Telecommunications, multimedia and computer technologies will introduce marked changes in the management of cancer. New modalities in the representation of patient's medical records using computer technology products and services allow unlimited cross-sharing of information. Education taught through multimedia methods, and through the Internet, is available anywhere and any time just like surgical simulation, robotics and virtual reality. Thanks to computer and IT technologies, surgeons will be able to acquire, assess and validate new surgical procedures or concepts from any geographical location. Live demonstrations shared via videoconferencing facilitate mental development through the acquisition of the cognitive aspects of surgical procedures. Virtual reality is a major improvement in the processing of medical imaging. As a result, the interpretation and the simulation of therapeutic approaches to patients with cancer are facilitated through transparency, navigation and manipulation. The Internet eventually offers uninterrupted communication links between healthcare providers (teaching, training or multidisciplinary telementoring included). Computer and IT technologies will undoubtedly contribute to standardized cancer treatment modalities and determined guidelines for good clinical practice worldwide.

Computer-Assisted Instruction↗
PubMed2004

Assessment of patients' acceptance of and satisfaction with teledermatology.

Teledermatology refers to the use of information and communication technologies (such as videoconferencing or transmission of digital images) to enable the practice of diagnostic dermatology between participants separated by geographic distance. The objective of this study was to critically review the quality of evidence about patient satisfaction with teledermatology applications. Sample size, reporting of validity and reliability, used instrument and its underlying constructs were determined for all studies where information was available. Fourteen studies were identified, five refer to store-and-forward applications, the remaining ones describe video-based systems. The systematic review demonstrated that methodological deficiencies in the published research impact the generalizability of findings. The two types of teledermatology (video-based and store-and-forward) require different satisfaction instruments as they are based on different contexts of care delivery, with video-mediated communication being key in the former and patients' absence from the diagnostic process in the latter mode of care delivery.

Dermatology↗
PubMed2004

Telepsychiatry treatment outcome research methodology: efficacy versus effectiveness.

The use of videoconferencing technology to provide mental health services (telepsychiatry) offers hope for addressing longstanding problems regarding work force shortages and access to care, especially in remote or rural areas. However, data on treatment outcomes (i.e., based on randomized clinical trials) from telepsychiatry applications are virtually nonexistent, representing an important gap in the literature. An important methodological decision point in developing treatment outcome research is whether to take an efficacy or effectiveness approach. Efficacy approaches offer enhanced internal validity; however, they may have limited generalizability to real-world settings. Effectiveness approaches offer enhanced external validity. But, they are typically less controlled than efficacy studies, thereby limiting the assumptions that can be made about causality. The current state of telepsychiatry research necessitates efficacy studies, the outcomes from which can be used to inform future effectiveness studies.

Health Services Research↗
PubMed2006

Randomized clinical trial of telepsychiatry through videoconference versus face-to-face conventional psychiatric treatment.

Although telepsychiatry in the form of videoconferencing has been well received in terms of increasing access to care and user satisfaction, few data on treatment outcomes and efficacy from telepsychiatry applications are available at the present time. This paper evaluates the efficacy of telepsychiatry through videoconference in the treatment of mental disorders by comparing to face-to-face conventional (F2FC) treatment. We carried out a randomized clinical trial where 140 psychiatric outpatients were randomized to either F2FC treatment or videoconference telepsychiatry (VCTP) treatment. Patients were diagnosed according to International Classification of Diseases, 10th edition (ICD-10) criteria using the Composite International Diagnostic Interview. Treatment involves eight consultations lasting 30 minutes over the 24-week study period. Patients received pertinent psychotropic medication plus cognitive- behavioral therapy during sessions. The same psychiatrist diagnosed and treated all the patients that were recruited from the Community Mental Health Centre of San Sebastian de la Gomera, in the Canary Islands. Change in psychiatric test scores served as the primary efficacy criterion. Efficacy was determined by comparing baseline (visit 1) Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales as well as Global Indexes (GSI, PSDI, and PST) from SCL-90R with scores obtained at the end of the study period (week 24). Response was defined as a CGI-I score of 1 or 2. Reliable Change Indexes were computed in SCL-90R Global Indexes scores. Of 140 patients randomized, 130 completed 24 weeks of treatment. Only 4 patients dropped out prematurely from the study in VCTP and 6 in F2FC. The study involves 534 teleconsultations, 522 F2FC consultations, and more than 500 hours of clinical practice. Significant improvements were found on the CGI and SCL-90- R Global Indexes scores of both treatment groups, showing clear clinical state improvement. No statistically significant differences were observed when the efficacy of VCTP treatment was compared to F2FC psychiatric treatment efficacy. This study demonstrated that telepsychiatry treatment through videoconference has equivalent efficacy to F2FC psychiatric treatment. Telepsychiatry showed to be an effective mean of delivering mental health services to psychiatric outpatients living in remote areas with limited resources.

Adult↗
PubMed2006

Cost effectiveness, safety, and satisfaction with video telepsychiatry versus face-to-face care in ambulatory settings.

Videoconference telepsychiatry provides an alternative for the psychiatric treatment of mental health patients who reside in remote communities. The objective of this study was to compare institutional ambulatory and hospitalization costs, treatment adherence, patient and physician satisfaction, and treatment safety between mental healthcare via videoconferencing and care provided in person. Data collected for 1 year of telepsychiatry treatment was compared to that of the preceding year and a matched comparison group. Twenty-nine patients from Or Akiva and 20 patients from Reut Hostel in Hadera who met the inclusion criteria agreed to participate; 24 and 15 patients, respectively, completed the study. Forty-two matched patients, who continued face-to-face interviews, comprised the comparison group. Drop-out patients and those who did not consent to telepsychiatry treatment were not involved. During the year of telepsychiatry treatment, patients and physicians were satisfied and treatment was safe. However, 1 hour of telepsychiatry treatment was more expensive than face-to-face care, and a tendency of increased hospitalizations was noted. Adherence ratios before and during telepsychiatry treatment were similar, but were twice as high versus the comparison group. The limited sample size precludes the drawing of definite conclusions, and further studies involving a larger study population and longer duration of investigation is warranted.

Adult↗
PubMed2005

Remote working: survey of attitudes to eHealth of doctors and nurses in rural general practices in the United Kingdom.

BACKGROUND: Health professionals in rural primary care could gain more from eHealth initiatives than their urban counterparts, yet little is known about eHealth in geographically isolated areas of the UK. OBJECTIVE: To elicit current use of, and attitudes towards eHealth of professionals in primary care in remote areas of Scotland. METHODS: In 2002, a questionnaire was sent to all general practitioners (n=154) in Scotland's 82 inducement practices, and to 67 nurses. Outcome measures included reported experience of computer use; access to, and experience of eHealth and quality of that experience; views of the potential usefulness of eHealth and perceived barriers to the uptake of eHealth. RESULTS: Response rate was 87%. Ninety-five percent of respondents had used either the Internet or email. The proportions of respondents who reported access to ISDN line, scanner, digital camera, and videoconferencing unit were 71%, 48%, 40% and 36%, respectively. Use of eHealth was lower among nurses than GPs. Aspects of experience that were rated positively were 'clinical usefulness', 'functioning of equipment' and 'ease of use of equipment' (76%, 74%, and 74%, respectively). The most important barriers were 'lack of suitable training' (55%), 'high cost of buying telemedicine equipment' (54%), and 'increase in GP/nurse workload' (43%). Professionals were concerned about the impact of tele-consulting on patient privacy and on the consultation itself. CONCLUSIONS: Although primary healthcare professionals recognize the general benefits of eHealth, uptake is low. By acknowledging barriers to the uptake of eHealth in geographically isolated settings, broader policies on its implementation in primary care may be informed.

Adult↗
PubMed2005

Establishing joint attention in remote talks with the elderly about health: a study of nurses' conversation with elderly persons in teleconsultations.

This study is a contribution to the sparsely studied field of nurses' teleconsultations with frail elderly people. The aim was to describe how talk and interaction are accomplished and by what means problems are handled that emerge from the fact that the communication is conducted via videoconferencing techniques. Recordings were made of 22 sessions of teleconsultation between nurses and elderly nursing home residents aided by enrolled nurses. The data were analysed with a qualitative method inspired by conversation and discourse analysis. The findings indicate that in order to create a joint attention the participants often had to verbally confirm and reconfirm that contact had been established. The triad of participants played a special part in maintaining the joint attention through compensating for the contextual aspect of the medium's limitations and the demented elderly person's communication problems. 'Talks about the communication' and passages of social talk took place when the nurse or the staff member wanted to re-establish and maintain joint attention. The joint attention seemed connected to a special sort of eye contact and gaze and to the type of camera projection that was used. One conclusion was that to create joint attention in nurses' teleconsultations with frail elderly people, the limitations in transferring communication cues and the limitations of what the camera can reveal of the general context could, to some extent, be made up for by verbal communication within the triad of participants. Another conclusion was that these limitations in the context of interaction in some situations also seemed to be an advantage for the demented elderly and contributed to increased attention.

Aged↗
PubMed2004

Teledentistry in the United States: a new horizon of dental care.

Teledentistry has been developing since 1994 as a means to allow dental professionals to communicate with one another over long distances. It allows collaboration by multiple practitioners regarding a patient and the necessary treatment for this patient. Teledentistry can be greatly utilized with rural communities or those of underserved populations. It would increase the accessibility of specialists, besides decreasing time and cost associated with specialty consultations. Real-time videoconferencing and store and forward techniques are the mostly commonly used methodologies for teledentistry. Teledentistry will become more widely seen and utilized by the increase in digital media found in dental practices.

Dental Health Services↗
PubMed2005

Can telemedicine contribute to fulfill WHO Helsingborg Declaration of specialized stroke care?

BACKGROUND: Providing stroke unit treatment for all stroke patients is a cross-national goal as stated in the WHO Helsingborg Declaration. In order to achieve specialized stroke care for a large area, two stroke centers and 12 community hospitals established an integrative stroke network. This evaluation was performed to analyze achieved advances in stroke management. METHODS: Core network elements are: (1) establishing stroke wards in all hospitals; (2) continuous training in stroke treatment; (3) telemedicine service staffed by a 24 h/day 'strokologist' with capability for high-speed videoconferencing and transfer of CT/MRI images. Data were prospectively documented in the databank of the telestroke service, in the Bavarian Stroke Registry and in the controlling departments. RESULTS: In 2003, 4,179 stroke patients were admitted to the regional network hospitals. Between February 2003 and January 2004 a total of 2,182 teleconsultations were conducted. 250 teleconsultations yielded a nonvascular diagnosis. Indicators for stroke management quality improved compared with other hospitals without stroke unit: the frequency of CT/MRI within 3 h was 59% compared to 46%, frequency of speech therapy 36% (21%), and of occupational therapy 38% (12%). Eighty-six (2.1%) of the patients received systemic thrombolysis compared to 10 patients in the preceding year. Mean length of in-hospital stay decreased from 12.4 in 2002 to 9.7 days in 2003. CONCLUSIONS: This stroke network concept leads to a substantial improvement of stroke management. Telemedicine contributes to an early etiological assessment and fills the gap of specialized stroke expertise in neurologically underserved areas.

Acute Disease↗
PubMed2006

Feasibility of telecognitive assessment in dementia.

Videoconferencing (VC) technology has been used successfully to provide psychiatric services to patients in rural and otherwise underserved settings. VC-based diagnostic interviewing has shown good agreement with conventional face-to-face diagnosis of dementia in several investigations, but extension of this technology to neurocognitive assessment has received little attention. To this end, the authors administered a brief battery of common neuropsychological tests via VC technology (telecognitive) and traditional face-to-face methods to 14 older persons with mild cognitive impairment (MCI) and 19 persons with mild to moderate Alzheimer's disease (AD). Highly similar test scores were obtained when participants were tested in-person or via VC. Telecognitive assessment appears to be a valid means to conduct neuropsychological evaluation of older adults with cognitive impairment. Furthermore, continued development of VC technology has implications for expanding neuropsychological assessment options in under-served populations.

Aged↗
PubMed2004

Benefits of multidisciplinary case conferencing using audiovisual compared with telephone communication: a randomized controlled trial.

Multidisciplinary case conferencing using a video-link was compared with multidisciplinary case conferencing by telephone. One hundred patients were randomized to either videoconferencing (intervention group, 50 patients) or audioconferencing (control group, 50 patients). The effectiveness of the intervention compared with the control was evaluated in terms of: the number of conferences per patient, average length of conference, length of treatment, number of occasions of service, degree of multidisciplinary team involvement, recorded level of communication, quality of the management plan (in terms of the number of points contained in it) and staff satisfaction. The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed.

Attitude of Health Personnel↗
PubMed2004

Paediatric telecardiology services in Queensland: a review of three years' experience.

Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day-17 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequent elective transfer at the appropriate time for treatment. Only one child (1%) required urgent transfer to the tertiary centre for specialist care and surgery. Telecardiology was effective in accurately identifying congenital heart disease. Paediatric telecardiology is an evolving modality of assessment and communication, and is likely to result in continued improvements in patient care, patient outcomes and parental satisfaction, in provincial centres removed from the tertiary cardiac centre.

Adolescent↗
PubMed2004

The successes and challenges of developing a prison telepsychiatry service.

Prisoners are not typical of the general population with regard to their health needs, as they have a disproportionately high incidence of mental health problems and drug misuse. Health-care delivery in prison faces a significant number of challenges not experienced by other health-care organizations. Telepsychiatry is one strategy to improve the accessibility and quality of mental health-care in the prison setting. Despite some initial challenges, a telepsychiatry service was successfully established between a medium-secure unit in Fareham, Hampshire, and a category B training prison on the Isle of Wight. A low-cost, PC-based videoconferencing system was used, connected by ISDN lines at 128 kbit/s. A valuable lesson that was learnt was the importance of having the support of key individuals in a prison setting.

Delivery of Health Care↗
PubMed2005

A comparison of face-to-face versus remote assessment of neonatal resuscitation skills.

The neonatal resuscitation skills of 30 third-year medical students were assessed in real time by a face-to-face examiner in the same room as the student, and by a remote examiner located in a separate room using the ANAKIN system. The ANAKIN system combines an instrumented manikin simulator, computer-based assessment and high-bandwidth videoconferencing. The students were assessed while performing a neonatal resuscitation megacode using the ANAKIN system. Students were satisfied with the ANAKIN system as an assessment system and were not intimidated by its use. However, the correlation between the face-to-face and remote examiner's mean total performance assessment scores was 0.27, which was not significant (P=0.14). The results indicated variation between the examiners' performance scores in a number of key technical skill areas. The findings from this study have implications for the use of technology-mediated systems in assessing resuscitation skills. Examiner orientation is critical for individuals using such systems. These persons must be comfortable and confident in using the technology. Interface and design features of the system need to be carefully scrutinized and tested.

Clinical Competence↗
PubMed2005

Using telemedicine to provide post-discharge support for patients with spinal cord injuries.

We are conducting a randomized controlled trial of telemedicine with patients with spinal cord injuries in their own homes. Internet videoconferencing is used at a bandwidth of 128 kbit/s. Data collection began in March 2004. Twelve patients had entered the study by August 2004, but none had completed it. Preliminary results in one case suggest that telemedicine provided various benefits: (1) the patient received advice he would probably not have solicited; (2) it enabled an expert to view the entry site of a pin in the patient's halo brace, to determine whether the general practitioner should be contacted to arrange a swab; (3) it made it easier for the interviewer to understand family interactions during the session. Telemedicine offers an additional tool in the care of geographically widespread outpatients.

Acute Disease↗
PubMed2005

Adapting the Roter interaction analysis system for telemedicine: lessons from four specialty clinics.

Four specialists (a child psychiatrist, an oncologist, a cardiologist and a rheumatologist) conducted telemedicine clinics using videoconferencing at a bandwidth of 128-384 kbit/s. The consultations were videorecorded. The coded interactions from the first two patients recruited from each of the four telemedicine clinics were analysed. Tapes were coded by two raters. We adapted the Roter interaction analysis system (RIAS) for the telemedicine context. Utterances were coded into socio-emotional and task-focused categories. There were 1055 utterances in total. Providers generated significantly more utterances across categories than patients. In the patient-provider interactions, only 2% of the total utterances related to the technology. The predominance of socio-emotional utterances compared with task-focused utterances for providers was contrary to our expectations. Further studies are required to establish the reliability of the adapted RIAS measure and to increase understanding of telemedicine communication patterns.

Child↗
PubMed2005

Telemedicine in radiotherapy: a study exploring remote treatment planning, supervision and economics.

In January 2002, the departments of radiotherapy at the University Hospital of North Norway and the Norwegian Radium Hospital were connected through a 2 Mbit/s digital telecommunication line. The treatment planning systems at the two institutions were connected and videoconferencing units were installed. We explored the feasibility of remote treatment planning, supervision, second opinions and education. Tests involved two dummy cases and six patients. Remote simulation procedures were carried out for five patients. A cost-minimization analysis was performed. Treatment planning was not completely successful as the software could not handle plans including bolus or weighting between the fields. Remote supervision was possible. A common patient record and radiotherapy system, including digital imaging, digital prescription and approval forms and digital signature, were felt to be desirable. The threshold (break-even point) comparing the costs of telemedicine with those of transportation by air was 12 patients/year. Telemedicine in radiotherapy appears to be feasible, but some limitations must be overcome.

Adolescent↗