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Fine-needle aspiration cytology of the breast: a preliminary report on telepathology through Internet multimedia electronic mail.

Telepathology is a field of telemedicine that enables the exchange of histologic and cytologic images for consultations among pathologists of two or more remote institutions, through a suitable communication channel. The Internet can connect several scientific and medical institutions because of the existence of a set of standard protocols that allow different computers to communicate; multimedia electronic mail is one such protocol, which allows asynchronous transmission of multimedia documents, i.e., including text, images, movies, and sounds. The aim of the present article is to test a novel approach in which Internet multimedia electronic mail is used as a communication medium to obtain an asynchronous telepathology tool for remote consultation. To assess the diagnostic validity of the method, 48 cases of fine-needle aspiration cytology of breast lesions were sent from Udine to Trento, Italy. Comparisons between local and remote diagnoses, and cytologic diagnoses versus subsequent histologic reports demonstrated that Internet multimedia electronic mail is suitable for remote consultation. Internet multimedia electronic mail thus presents an additional diagnostic tool that is easy to use, available on a wide range of computers, and inexpensive, because its cost is independent of distance.

Biopsy, Needle↗

The Mailbase hand surgery electronic mailing list.

Hand - an Internet based electronic mailing list - enables surgeons with a common interest in hand surgery to share experiences and engage in worldwide electronic scholarly discussion. This paper examines the thinking behind the setting up of this list and gives examples of how the list is being used.

General Surgery↗

[E-mail in psychotherapy--an aftercare model via electronic mail for psychotherapy inpatients].

We introduce an aftercare program for psychotherapy inpatients, which is based on regular communication via E-mail. The organizational and operational structure of the program are described within the context of computer mediated communication. First results on utilization and acceptance are reported. In comparison to patients who did not participate in either aftercare program of the clinic, the E-mail participants are younger and higher educated. Inpatient treatment of the participants was three days shorter in duration than that of non participants. Both groups were similar with regard to symptom distress at discharge from hospital. A low dropout rate of 8%, the high activity and satisfaction emphasize the positive acceptance of the program. Therapists' E-mail activity turned out to be important for the participants. Neither age, internet experience or symptom related variables nor the own E-mail activity were associated with participants' evaluation of the new service. Based on these first positive experiences the perspectives of using E-mail in psychotherapy will be discussed.

Adult↗

Electronic mail: an imperative for healthcare epidemiologists.

Electronic mail (e-mail) offers the potential for near-instantaneous transfer of messages and files across thousands of miles. The same message can be sent simultaneously to multiple recipients and forwarded without retyping. Messages can be sent or read at any time, eliminating "telephone tag," and, because the system is paperless, lost, blurred, and incomplete, facsimile transmissions can be minimized. Additionally, e-mail is less expensive than overnight letter services or long-distance faxes. All healthcare epidemiologists should enter the information superhighway using e-mail. This article provides basic information needed to understand and begin using e-mail.

Computer Communication Networks↗

Sex differences in perceived outcomes of electronic mail interactions.

Researchers have found that sex plays a crucial role in perceptions of usability, graphical accents, and general satisfaction within computer-mediated interactions. 192 students (71 men and 121 women) responded to 12 items taken from the Electronic Mail Outcome Scale related to their perceived Appropriateness, Effectiveness, and Satisfaction obtained through electronic mail interactions. Analysis indicated no significant differences between men and women in reference to either Effectiveness or Satisfaction; however, women were more sensitive to social expectations within electronic mail interactions than men.

Adult↗

A survey of patient access to electronic mail: attitudes, barriers, and opportunities.

The use of electronic mail (e-mail) is increasing among both physicians and patients, although there is limited information in the literature about how patients might use e-mail to communicate with their physician. In our university-based internal medicine clinic, we have studied attitudes toward and access to e-mail among patients. A survey of 444 patients in our clinic showed that 46% of patients in the clinic use e-mail, and 89% of those with e-mail use it at work. Fifty-one percent would use e-mail all or most of the time to communicate with the clinic if it were available, and many of the communications that currently take place by phone could be replaced by e-mail. Barriers to e-mail use include privacy concerns among patients who use e-mail in the workplace, choosing the appropriate tasks for e-mail, and methods for efficiently triaging electronic messages in the clinic.

Adult↗

Use of electronic mail for postoperative follow-up after ambulatory surgery.

The authors report on a patient who used electronic mail to report satisfactory recovery from ambulatory surgery and anesthesia. The potential benefits and pitfalls of using electronic mail for patient follow-up and communication, as well as research purposes, are reviewed. Potential benefits include cost savings, ease in collecting quality improvement data, and the potential for increased reporting of unpleasant events. Potential pitfalls include lack of universal access (with racial and socioeconomic differentials), privacy and security concerns, and potential slow responses to messages that might require emergent responses or actions.

Adult↗

Physicians' use of and attitudes toward electronic mail for patient communication.

To assess physicians' use of and attitudes toward electronic mail (e-mail) for patient communication, we conducted a mail-in survey of physicians who see patients in outpatient clinics affiliated with a large academic medical center (N = 283). Seventy-two percent of physicians reported using e-mail to communicate with patients, averaging 7.7 e-mails from patients per month. The lowest level of use was by community-based primary care physicians (odds ratio, 0.22; 95% confidence interval, 0.08 to 0.59). Those physicians who reported using e-mail with patients reported high satisfaction with its use. Although physicians were concerned about the confidentiality of e-mail, few discussed this issue with patients.

Adult↗

Internet electronic mail: a tool for low-cost telemedicine.

Electronic mail, in addition to the sending of text messages, may be used to transfer multimedia and privacy-enhanced messages. Email can be used for so-called store-and-forward telemedicine, which can be particularly useful for remote consultations. This paper reviews the standards used in Internet email, from communication protocols to the message formats, and pays special attention to multimedia and confidential messages; it then describes some email-based telemedicine applications. The problems of the Internet are principally the lack of any guarantee of quality of service and the low bandwidth; intranets can guarantee appropriate performance.

Computer Communication Networks↗

Computer-assisted instruction using electronic mail.

A major challenge to nursing staff development departments is how to reach individual staff members with new information in a limited period of time. Attendance at classroom instruction is not always feasible. The use of electronic mail to provide instruction to learners can be an effective teaching strategy. Advantages are immediate accessibility to the learner and the opportunity to tailor the program to meet specific hospital requirements or individual learning needs. Tips on how to develop and send instructional modules through electronic mail are included in this article.

Computer-Assisted Instruction↗

Telepathology using Internet multimedia electronic mail: remote consultation on gastrointestinal pathology.

The feasibility of using the Internet for remote pathology consultation was examined. We assessed the diagnostic agreement between two groups of pathologists who independently evaluated histopathological cases exchanged by Internet electronic mail. The exchange was between two different workstations using readily available software not specifically developed for telemedicine. Data and images from 76 cases were transmitted to four pathologists. An average of 4.5 images per case were transmitted at compression ratios of between 6:1 and 40:1, corresponding to 250 kByte of data per case. In two cases the remote pathologists could not make a diagnosis. Agreement was reached in 63 of the other 74 (kappa = 0.79). In 11 cases (15%) there was a misdiagnosis. However, the results are encouraging and suggest that Internet electronic mail can be used successfully for remote consultation in pathology.

Computer Communication Networks↗

A randomized study of electronic mail versus telephone follow-up after emergency department visit.

This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. Secondary outcome was the median time of response. There were 1561 patients initially screened. Of these, 444 had e-mail and were included in the study. Half were contacted by telephone and the rest via e-mail. Our telephone contact rate was 58% (129/222) after two calls in a 48-h period and our e-mail contact was 41% (90/222). The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.

Adult↗

Emerging technology: remote analysis of traumatic musculoskeletal radiographs transmitted by electronic mail.

OBJECTIVES: To determine whether remote analysis of radiographs via electronic mail (e-mail) had an impact on treatment decision-making. DESIGN: Prospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-five cases randomly selected from previous emergency room consultation. INTERVENTION: Textual descriptions obtained from emergency medicine physicians were compared with computer-digitized images of radiographs sent via e-mail and with the actual radiographs. Four board-certified orthopaedic surgeons reviewed all three forms of data to determine fracture diagnosis and treatment plans. MAIN OUTCOME ASSESSMENT: Diagnosis and treatment plans were obtained via written questionnaire after review of each group of data (textual, digitized image, and actual radiograph). Results were then compared across groups to determine whether digitized images were better than textual descriptions and equivalent to actual radiographs. RESULTS: Statistical analysis revealed a significant improvement in the frequency of correct diagnosis and treatment planning when digitized images were used (91 percent) compared with textual descriptions alone (48 percent) (p < 0.001). The difference in correct diagnosis and treatment plans between digitized images and actual radiographs was not statistically significant (p = 0.27). CONCLUSION: Digitized radiographs sent via e-mail can significantly improve accuracy of diagnosis and treatment compared with a simple verbal description.

Computer Communication Networks↗

Ergonomics guidelines for designing electronic mail addresses.

The aim was to design a human-centred electronic mail (e-mail) address system based on networking technology and cognitive ergonomics. Based on the background literature and the results of users' survey, a conceptual model is developed for designing e-mail addresses. This model consists of e-mail address components of formats, domain length, meaningfulness, orientation and information type pertaining to recall, information association and categorization. Five hypotheses were proposed to test the conceptual model, and four experiments were conducted with 85 participants to test the hypotheses. The dependent variables were performance time, error rate and degree of satisfaction, and the independent variables were components of the e-mail addresses. The main results indicate that for a recall task, significantly lower total performance time (26.2%) and error rate (75%) were found for the hybrid formats (digits and letters) than for the letter format, and up to four characters was the best single domain length. For an information association task, embedding both geographical and organizational information significantly decreased the response time (10.9%) in comparison with only embedding organizational information. For a categorization task, embedding both geographical information and organizational information significantly decreased response time (40.7%) in comparison with only embedding organizational information. This research demonstrates the importance of human-centred design and provides guidelines in effectively designing e-mail addresses.

Computer Communication Networks↗

Do electronic mail discussion lists act as virtual colleagues?

Anesthesiology Discussion Group (ADG), an electronic mail (email) discussion list, has previously been shown to be a clinically oriented, cost-effective form of telemedicine. ADG is composed of an international collection of anesthesia providers. Discussions with colleagues are generally informal in nature and are examples of types of information-seeking behavior which frequently occur in hallways or lounges of a hospital or clinic. Information-seeking occurs when a health care provider searches for information which will be used to solve or satisfy a patient's problem or need. We surveyed practitioners who had previously submitted non-rhetorical, clinical questions to the group. After analysis of the questionnaire results, we conclude that ADG is a valuable resource used for information-seeking and is a clinically effective form of telemedicine. Many of the respondents indicated that they used ADG to obtain second opinions from the collective expertise of group members. Respondents also indicated that they were generally satisfied with the quality of responses and would not hesitate to use ADG for future clinical questions.

Anesthesiology↗

The role of an electronic mail system in the educational strategies of a residency in obstetrics and gynecology.

Computerized electronic mail (E-mail) systems provide a rapid means of data sharing and are used in a variety of commercial and industrial settings for the widespread distribution of memoranda. We adapted an E-mail system to our program to determine the feasibility of incorporating such a system into didactic resident education in obstetrics and gynecology and to assess resident response to this form of computer-based learning. The system was programmed to distribute one review question per day to 24 resident physicians for 60 days. Residents were given 24 hours to respond and comment. Each question was discussed and appropriate references distributed within 48 hours of presentation. All questions and responses were then stored in an electronic file folder for later review. An examination was given at completion of the project (post-test), and these scores were compared to performance during the project (pre-test). An anonymous questionnaire was distributed upon completion of the project to assess the residents' overall satisfaction with the program. The system was well received by the residents. On a scale of 1 to 6 (1 = lowest; 6 = highest), resident satisfaction was high, with an overall average rating of 5.0. Using this scale, residents assessed their frustration level as 1.5. Average daily participation was 85%. An average of 9 minutes was required to complete each question and review prior responses and discussion; this interval was not significantly different among the postgraduate years. Scores on the examination at project completion were significantly higher than performance during the project.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗

Sequence analysis by electronic mail: a tool for accessing Internet e-mail servers.

A new utility program, MSU, is described that simplifies the use of electronic mail servers for sequence analysis. Service descriptions are defined in external control files which can be changed without affecting the main program. This approach makes MSU a highly flexible tool that allows easy modification, extension and customization of service descriptions to suit users' personal requirements.

Databases, Factual↗

Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance.

Women who ingest their oral contraceptive pill (OCP) as part of a daily routine are more likely use their OCPs correctly. This trial examines the feasibility of an electronic-mail (e-mail) reminder system to improve OCP compliance. An e-mail reminder was sent to 50 new OCP users daily for 3 months. Subjects sent an e-mail reply to confirm receipt. OCP compliance was recorded on diaries. Four subjects were discontinued for not checking their e-mail. Active participants missed a median of 18% of the e-mail reminders (range: 0-65%). A follow-up visit was scheduled after completion of three OCP cycles. Of the 40 subjects returning completed diaries, 50% missed no active pills at all and 20% missed at least one in each cycle. Most found the daily e-mail somewhat (65%) or very helpful (19%) for OCP compliance. Of those continuing OCPs, 64% wanted to continue receiving e-mail reminders at the completion of the study. Because inconsistent OCP use is a significant cause of unplanned conception, the use of e-mail to improve OCP compliance has the potential to decrease unintended pregnancies.

Adolescent↗