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PubMed2005

Evaluation of the Western Australian Department of Health telehealth project.

In 1999, the Department of Health in Western Australia began a telehealth project, which finished in 2004. The 75 videoconferencing sites funded by the project were part of a total state-wide videoconference network of 104 sites. During the period from January 2002 to December 2003, a total of 3,266 consultations, case reviews and patient education sessions took place. Clinical use grew to 30% of all telehealth activity. Educational use was approximately 40% (1,416 sessions) and management use was about 30% (1,031 sessions). The average overhead cost per telehealth session across all regions and usage types was 192 Australian dollars. Meaningful comparisons of the results of the present study with other public health providers were difficult, because many of the available Websites on telehealth were out of date. Despite the successful use of telehealth to deliver clinical services in Western Australia, sustaining the effort in the post-project phase will present significant challenges.

Delivery of Health Care↗
PubMed2005

Attitudes of breast cancer professionals to conventional and telemedicine-delivered multidisciplinary breast meetings.

We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital. Positive attitudes to videoconferencing were more common among participants with previous experience of telemedicine (Spearman's rank correlation 0.26, P = 0.91). Common themes emerging from the interviews about telemedicine-delivered MDTs included group leadership, meeting efficiency, group interaction, group atmosphere and technical quality of communication. Most participants were satisfied with standard breast MDTs. Nurses and allied health professionals were least supportive of telemedicine.

Analysis of Variance↗
PubMed2005

Realtime telemedicine for paediatric otolaryngology pre-admission screening.

We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a pre-admission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 13 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaediatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.

Adolescent↗
PubMed2005

Development of a pilot telemedicine network for paediatric oncology in Brazil.

We established a pilot telemedicine network for paediatric oncology in Brazil, linking the School of Medicine at the University of Sao Paulo in Sao Paulo City to the 'Hospital de Base' in Porto Velho, Rondonia, located in the Amazon region, 3,000 km away. The videoconferencing link used ISDN transmission at 384 kbit/s. The network was used for patient screening, follow-up, treatment monitoring and other activities. Between March 2000 and 2002, 69 videoconferences were held for 33 patients, 29 with cancer. During this period, 16 patients required transfer, 18 patients died and 11 achieved cancer remission. The main cause for patient mortality (infection) was not one that could be addressed directly by telemedicine. Using the School of Medicine as a benchmark, the average mortality rate for paediatric cancer patients in the pilot was higher. However, it was lower than previous levels observed at Rondonia (62% versus 80%).

Brazil↗
PubMed2006

Use of 3G mobile phone links for teleconsultation between a moving ambulance and a hospital base station.

We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10-15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor.

Ambulances↗
PubMed2006

Telestroke: a multi-site, emergency-based telemedicine service in Ontario.

A telestroke service was established in Ontario in 2002. Six neurologists on four campuses of two academic health centres of the University of Toronto participated in the call roster to support emergency physicians in two northern cities, North Bay and Sudbury. Videoconferencing units were provided in the hospitals and in the homes of the neurologists. PC workstations were used to access computed tomography (CT) images. In the first 34 months' operation, a total of 88 patient consultations were conducted. Twenty-six patients received tissue plasminogen activator (t-PA). Although the number of consultations was relatively low, the feasibility of telemedicine for acute stroke care was demonstrated. The economics remain to be explored. The telestroke model is a viable alternative to the provision of acute stroke care for communities that have CT scanners, but no access to a resident neurologist.

Emergency Medical Services↗
PubMed2006

Parental support: mothers' experience of electronic encounters.

Five mothers with normal pregnancies and healthy children met regularly during the infants' first year through an e-meeting portal. The technology made it possible to meet using realtime videoconferencing through the Web, both one to one and in groups. An experienced child-health nurse was the leader of the group. The intervention data included interviews and diary notes. Personal tape-recorded narrative interviews were conducted with the mothers, one midway through the study and one at the end. Qualitative content analysis was applied to the data and two major categories were identified: feeling support through confirmation and solidarity, and the technology presents possibilities and limitations. The mothers felt that sharing experiences with others was supportive and that having new friends reduced their feeling of loneliness. The mothers discussed the technology as fun and exciting. However, they were disturbed by sound problems and the realities of caring for an infant. The opportunity to meet other mothers in the same situation via electronic encounters and to share experiences of being a mother facilitated everyday life for these mothers.

Adult↗
PubMed2006

Tele-treatment of patients with amyotrophic lateral sclerosis (ALS).

Management of patients with amyotrophic lateral sclerosis (ALS) mainly consists of (psycho) social support and advice on activities of daily living. We evaluated the effects of tele-treatment in addition to the conventional method of care in four patients with ALS. A Web application was built with information about ALS and a link to the tele-treatment environment. The latter contained a chat room and a link to start personal computer (PC)-based videoconferencing with a rehabilitation physician. The effect on quality of care was evaluated by questionnaires and interviews. The interviews showed that patients were satisfied with tele-treatment and experienced a pleasant contact during teleconsultations. The rehabilitation physician experienced acceptance of tele-treatment by the patients and a decrease in the time needed for travelling. Tele-treatment was especially suitable for discussing the practical issues about ALS. On the other hand, psychosocial and emotional issues still needed to be discussed during traditional face-to-face contact. Therefore tele-treatment should only be given in addition to face-to-face contact, rather than as a replacement for it.

Adult↗
PubMed2006

Diagnosis, access and outcomes: Update of a systematic review of telemedicine services.

Telemedicine services are being increasingly used. Although insurers and other payers are covering some services in the USA, the rationale for these coverage decisions is not always evidence-based. We reviewed the literature for telemedicine services that substitute for face-to-face medical diagnosis and treatment. We focused on three types of telemedicine services: store-and-forward, home-based and office/hospital-based services. Studies were included if they were relevant to at least one of the three study areas, addressed at least one key question and contained reported results. We excluded articles that did not study a service requiring face-to-face encounters (i.e. teleradiology was excluded). Our search initially identified 4083 citations. After review, 597 were judged to be potentially relevant at the title/abstract level. Following a full-text review, 106 studies were included. Store-and-forward services have been studied in many specialties, the most common being dermatology, wound care and ophthalmology. The evidence for their efficacy is mixed. Several limited studies showed the benefits of home-based telemedicine interventions in chronic diseases. Studies of office/hospital-based telemedicine suggest that telemedicine is most effective for verbal interactions, e.g. videoconferencing for diagnosis and treatment in specialties like neurology and psychiatry. There are still significant gaps in the evidence base between where telemedicine is used and where its use is supported by high-quality evidence. Further well-designed research is necessary to understand how best to deploy telemedicine services in health care.

Delivery of Health Care↗
PubMed2006

Performance of a wireless telemedicine system in a hospital accident and emergency department.

We developed a mobile, wireless videoconferencing system suitable for use in a hospital accident and emergency (A&E) department. Four consultants, eight junior doctors and 11 nurses working in the A&E department tested the system. Transmission of three types of data (audio, still images and video) was tested. The audio for the breath and heart sounds was judged to have some disturbance. One consultant rated the diagnostic quality as good and one rated it as fair. The quality of the still images was judged to be from fair to excellent. The quality of the video was rated as good. Possible interference between the wireless local-area network and various medical devices in the A&E department were examined, but none was detected. The four consultants who tested the system were very positive in their initial comments. Eight of the 11 nurses remained sceptical about its use. Of a total of 20 patients who answered a survey, 13 were slightly anxious about the use of the system to transmit their data to a distant point. Overall, the performance of the system was satisfactory for use in the A&E role.

Attitude of Health Personnel↗
PubMedDate not supplied

Development of a teletechnology protocol for in-home rehabilitation.

Our ability to provide in-home rehabilitation is limited by distance and available personnel. We may be able to meet some rehabilitation needs with videoconferencing technology. This article describes the feasibility of teletechnology for delivering multifactorial, in-home rehabilitation interventions to community-dwelling adults recently prescribed a mobility aid. We used standard telephone lines to provide two-way video and audio interaction. The interventions included prescription of and/or training in functionally based exercises, home-hazard assessment, assistive technology, environmental modifications, and adaptive strategies. Patients were evaluated in three transfer and three mobility tasks, and appropriate treatment was provided over the course of four visits. To date, 13 of the 14 subjects enrolled in the rehabilitation study have completed all four visits (56 visits total). Equipment-related problems were most common early in the study, particularly on the initial visit to a subject's house. We identified (mean +/- standard deviation [SD]) 13.1 +/- 7.9 mobility/self-care problems per subject and made 12.5 +/- 8.3 recommendations per subject to address those problems. At 6-week follow-up, 60.1 percent of our recommendations had been implemented. The greatest number of problems was identified for tub transfers (mean +/- SD = 3.4 +/- 1.4), the greatest number of recommendations was made for toilet transfers (mean +/- SD = 3.1 +/- 3.4), and the most frequently implemented recommendations were for transition between locations. Overall, our results show promise that both the telerehabilitation technology and intervention procedures are feasible.

Biomedical Technology↗
PubMed2005

Telehealth. Video stars.

Videoconferencing can help the NHS make the best use of limited resoure It allows patients in remote areas have virtual consultations in their GP surgery. The technology aids training. Surgeons and consultants of the future can be tutored at multiple sites simultaneously.

Efficiency, Organizational↗
PubMed2005

Telehealth for wound management in long-term care.

Telehealth facilitates provision of healthcare services at distant sites using electronic communications. A pilot project utilizing telehealth was initiated in a long-term care community to assess the wounds of geriatric residents. Over a 1-year period, nine patients requiring a total of 21 visits were evaluated by an offsite University of Virginia Health System wound nurse practitioner via telecommunication. Traditionally, frail elders are seen in the local wound care clinic, necessitating often costly and physically strenuous transport. The technology in this program incorporated use of a videoconferencing device, television monitor, and a patient camera. Average round trip cost savings for transporting immobile residents was $650; hence, substantial cost containment was achieved. In addition, quality of care improved because residents were not required to leave their facility for the 3 to 4 hours required to travel to and from the clinic. Although no formal satisfaction surveys were administered, resident and family response to the service was favorable. With continued documentation of patient satisfaction and cost savings, this service eventually may be available to other long-term care facilities in the area.

Aged↗
PubMed1999

Breast cancer genetics and managed care. The Kaiser Permanente experience.

In 1996, with evolution of the science of cancer genetics and the advent of commercially available BRCA1 and later BRCA2 testing, Kaiser Permanente began to apply these advances in clinical practice. Recommendations for referral to genetic counseling were developed in 1997 as the Clinical Practice Guidelines for Referral for Genetic Counseling for Inherited Susceptibility for Breast and Ovarian Cancer. Implementation of these guidelines with associated protocols in Kaiser Permanente's Northern California Region has occupied the ensuing years and includes dissemination of the high-risk guidelines for breast and ovarian cancer, dissemination of patient and physician educational materials on the breast cancer guidelines, monthly classes and taped healthphone messages for patients, interactive videoconferencing for physicians, a training seminar for medical geneticists who will counsel patients at risk, publication of articles on breast cancer and genetic risk in health plan member- and physician-directed magazines, identification and training of clinical specialists and supporting clinicians to care for patients before and after counseling, individual counseling and testing of patients and families, and development of a data registry. Implementing the guidelines helped us communicate the uncertainty surrounding breast cancer testing, and we were obliged to learn more about ethical, legal, societal, and insurance controversies surrounding genetic testing. Given the lack of effective prevention for breast or ovarian cancer and the difficulty of treatment, the appropriate use of genetics in patient care is essential. In the near future, we will see the need for cancer genetics to become an integral part of practice throughout the spectrum of health care. We at Kaiser Permanente feel that the breast cancer guideline project is the first step in this process.

BRCA1 Protein↗
PubMed1997

The ContiNet of the International Continence Society.

This is an account of the International Continence Society's ContiNet--the web server linking up continence organisations worldwide with provision to upload or download vast data stores of information on continence via e-mail, FTP, mailing lists, and special tools to seek information using "search engines." Special communication devices using internet voice/phone mail and real-time "text" or "voice" chats permit conversation globally over normal phone lines linked to the Net at local telephone rates. Special features of ContiNet include announcements of upcoming conventions, information for professionals and laypeople, and the capability to conduct research via the net and conduct consultations and discussions via newsgroups. In-built devices requiring special IDs and passwords permit privacy and security for users. Simple instructions are provided on how to get your PC up and running and get connected to fellow members of ICS, link up with national continence societies, or simply surf for professional enrichment and leisure. With the advent of advanced multimedia capabilities, the current poor quality videoconferencing on the Net will be replaced by excellent videophones by 1998.

Computer Communication Networks↗
PubMed2000

Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education.

BACKGROUND: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures. METHODS: A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. RESULTS: This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge (p < .05) and improving self-reported competency (p < .05) in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.

Adult↗
PubMed2001

Current state of distance continuing medical education in North America.

BACKGROUND: Every continuing medical education (CME) provider is confronted one day or another with deciding whether to develop distance education programs that may enhance access to CME for health professionals. To make a judicious decision, one needs to understand the features of distance education and the experiences of other providers. METHODS: Since there was a lack of information in the literature regarding the actual state of distance CME in North America, a Web-based survey aimed at CME providers was conducted including a description of the providers, the users, the activities offered, the technologies employed, and the administration of the systems. RESULTS: The results from this study indicate that the majority (68%) of CME providers had not developed distance education programs at the time of the survey; 30% of the providers, mainly from private companies, were offering nondegree distance education programs, and 2% of the university providers were offering degree programs. The technologies mainly used to develop distance education programs were printed material (69%), videoconferencing (58%), and, to a lesser degree, videotape. The revenue sources to develop degree programs were government funding, tuition, and fees. Other sources such as commercial support and sales were used for nondegree programs. IMPLICATIONS: This study revealed that there was considerable interest in distance education, especially from the organizations not offering this type of program. Since distance CME features are now better known, this is a step toward the advancement and development of more and better distance education programs.

Education, Distance↗
PubMed2000

Development and use of a virtual NMR facility.

We have developed a "virtual NMR facility" (VNMRF) to enhance access to the NMR spectrometers in Pacific Northwest National Laboratory's Environmental Molecular Sciences Laboratory (EMSL). We use the term virtual facility to describe a real NMR facility made accessible via the Internet. The VNMRF combines secure remote operation of the EMSL's NMR spectrometers over the Internet with real-time videoconferencing, remotely controlled laboratory cameras, real-time computer display sharing, a Web-based electronic laboratory notebook, and other capabilities. Remote VNMRF users can see and converse with EMSL researchers, directly and securely control the EMSL spectrometers, and collaboratively analyze results. A customized Electronic Laboratory Notebook allows interactive Web-based access to group notes, experimental parameters, proposed molecular structures, and other aspects of a research project. This paper describes our experience developing a VNMRF and details the specific capabilities available through the EMSL VNMRF. We show how the VNMRF has evolved during a test project and present an evaluation of its impact in the EMSL and its potential as a model for other scientific facilities. All Collaboratory software used in the VNMRF is freely available from www.emsl.pnl.gov:2080/docs/collab.

Communication↗