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This report presents a series of recommendations derived from deliberations of the G8 countries Subproject 4 Group (SP4 Group) of the Global Health Care Applications Project entitled, A Teleconsultation Practice Guideline. The recommendations provide an initial step toward developing a general guideline platform for the practice of telemedicine/teleconsultation.
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The NAS-NRC Twin Registry is one of the oldest, national population based-twin registries in the United States. It consists of 15,924 white male twin pairs born in the years 1917-1927 (inclusive) both of whom served in the armed forces. The registry, which has been in operation more than 30 years, has collected data from a variety of sources. Records-based, computerized data have come largely from the Department of Veterans Affairs, and there have been three major epidemiologic questionnaires, undertaken roughly every 15 years. Classic twin studies on a variety of medical conditions were the early focus of the registry, which now has a strong focus on chronic disease epidemiology. Work on a DNA specimen bank has been proceeding slowly, but is now a top priority, due to the increasing force of mortality in this twin cohort.
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UNLABELLED: To establish a guideline for the use of teleconsultation, which is one of the most important applications in telemedicine beeing perfomed very frequently in daily medical practice in almost any field of medicine. EVIDENCE: The recommendations are based on expert knowledge, because of the lack of evidence based data in the telemedical scientific literature. In addition, scientific articles of the highest level of evidence available published between 1970 and 1999 were reviewed. DEVELOPEMENT AND CONSENUS PROCESS: A guideline draft was prepared using the attributes of clinical practice guidelines developed by the Institute of Medicine (IOM) of the National Academy of Sciences. This draft was reviewed by telemedicine experts and the content of the guideline was approved by 100% group consensus in 5 meetings held between 1997 and 2000 by a panel of members of the Subproject 4 Group of the Global Health Care Application Project of the G8 countries. CONCLUSIONS: The guideline gives recommendations on all aspects of teleconsultation in any field of medicine and will be updated regularly implementing new evidence.
The Centers for Disease Control (CDC) shaped the basic development and direction of the HIV/AIDS Prevention Program through technical support and financial assistance for State and local health departments and other organizations. Through this provision of support, CDC has responded to the course of the human immunodeficiency virus (HIV)-acquired immunodeficiency syndrome (AIDS) epidemic by creating programs to preserve the safety of the blood supply, by developing counseling and testing centers, by promoting "safer sex," by promoting health education and risk reduction, by evaluating existing services, by disseminating new technology, and by targeting new at-risk behaviors as the infection spread. Funding has also been used to respond to congressional mandates, evaluations of program effectiveness, and the National Academy of Sciences report, "Confronting AIDS: Directions for Public Health, Health Care, and Research."
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This article begins with some history of the derivation of 40 CFR Part 191, the U.S. Environmental Protection Agency (EPA) standard that governs the geologic disposal of spent nuclear fuel and high-level and transuranic radioactive wastes. This is followed by criticisms of the standard that were made by a Sub-Committee of the EPA Science Advisory Board, by the staff of the U.S. Nuclear Regulatory Commission, and by a panel of the National Academies of Science and Engineering. The large disparity in the EPA approaches to regulation of disposal of radioactive wastes and disposal of hazardous, long-lived, nonradioactive chemical waste is illustrated. An examination of the intertwined matters of intergenerational equity and the discounting of future health effects follows, together with a discussion of the conflict between intergenerational equity and intragenerational equity. Finally, issues related to assumptions in the regulations concerning the future state of society and the biosphere are treated, as is the absence of any national philosophy or guiding policy for how to deal with societal activities that pose very long-term risks.
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