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At least 37 records · Page 2Linked to original sources
PubMed1996

"Telepsychometry": a remote psychometry consultation in clinical gerontology: preliminary study.

OBJECTIVE: Evaluation of the clinical feasibility of remote psychometric consultation with elderly patients. METHODS: Remote consultation with six women and four men (average age 87) was compared with a standard consultation. An interview and two psychometric tests were used: the Mini-Mental Status Examination (MMSE) and the Clock Face Test (CFT), which were administered by a clinical psychologist and controlled by a psychologist observer who remained in the room with the patient. The experimental setting consisted of two rooms linked by a coaxial cable. Each room was equipped with a camera, television screen, and microphone. The clinician was able to operate the mobile camera in the patient's room by remote control. The clinician was assisted by a computer, which helped to focus on standardized points. A video camera recorded the consultation for documentation purposes. RESULTS: Decreased performance was observed in the remote versus the standard consultation for both tests (MMSE: p = 0.008; CFT: p = 0.006). Physiologic hearing loss may have been responsible for a fall in the patients' attention. CONCLUSION: Remote psychometric consultation can be applied successfully to the psychological examination of elderly patients provided that communication problems are solved.

Aged↗
PubMed2001

Evaluating a telemedicine system to assist in the management of dermatology referrals.

BACKGROUND: Teledermatology systems fall into two categories: live video or store-and-forward. In the former, video-conferencing equipment is used to connect a patient with a remote consultant. This method has been evaluated as an aid to dermatology, but it is expensive both in terms of capital and running costs. Video consultations are generally longer than conventional ones and harder to schedule. Some authors have considered store-and-forward as an alternative to live video: instead of a consultation, specialists could make a rapid inspection of a transmitted still image. OBJECTIVES: A study was conducted to evaluate the role of telemedicine in the dermatology outpatients department of a district general hospital (Whittington Hospital NHS Trust, London, U.K.). METHODS: One hundred and ninety-four patients were seen by one of two consultant dermatologists. A nurse used a video camera to store digital images of each patient's problem and compiled a history from the GP's referral letter. The images were reviewed 13 months later by both dermatologists; they recorded a provisional diagnosis and an assessment of how urgent an appointment would have been made given the information provided by the system. A third consultant graded the level of agreement between the telemedicine diagnoses and the face-to-face consultations. RESULTS: High levels of agreement were found between the diagnoses of the dermatologists using the system to inspect images and those of the dermatologist who saw the patients (77%). Consultants using the system recommended fewer urgent appointments (32% compared with 64%) and felt that in 31% of cases the patient did not need to be seen. In 15% of these cases (5% of the total), however, their diagnosis differed significantly from that of the consultant who saw the patient. Had the system been in use, 14% of patients conventionally assigned a non-urgent appointment would have been seen urgently. CONCLUSIONS: The images allowed a reasonably accurate diagnosis. The software was not reliable (six cases could not be viewed), or easy to use (it took approximately an hour to view 20 cases) but an improved version could be used in triaging outpatient appointments.

Correspondence as Topic↗
PubMed1997

Remote medical consultation for vestibular disorders: technological solutions and case report.

Complaints of vertigo and imbalance are common presentations to primary care physicians, yet there are few specialists who diagnose and treat these problems as a significant part of their practices. We demonstrated the feasibility of remote consultation for a patient presenting with vertigo using a two-way digital video and audio network. It was possible to take an appropriate history, examine the patient, and provide a diagnosis and treatment. The patient had a common problem that causes dizziness: benign positional vertigo (BPV). An essential component of the examination was the use of a head-mounted display with embedded cameras. The cameras allowed viewing of the patient's eye movements, which were diagnostic.

Dizziness↗
PubMed2005

Evaluation of the benefits for the patient arising from an inter-hospital teleradiology network in a French administrative area.

We conducted a prospective study of the teleradiology network which connects 15 hospitals in the Aquitaine area. All transmissions sent over a one-year period were examined (data transmitted at the time of the remote consultation and health outcomes of patients from their medical records). For emergency cases, the main outcome measure of effectiveness was the proportion of avoided transfers. For non-emergency cases, the main outcome measure of effectiveness was the proportion of transfers, hospitalizations and consultations avoided. There were 737 transmissions, of which 664 (90%) met the inclusion criteria. Of these, 562 (85%) were for emergency care and 102 (15%) for non-emergency care. In emergency care, the pathologies most often associated with a remote consultation were cerebral pathologies (88%) and traumatic spinal pathologies (8%); the proportion of avoided transfers was 48%. In non-emergency care, the specialties most often concerned with remote consultations were neurology/neurosurgery (36%), cardiology and pulmonary diseases (17%) and gastroenterology (14%). Transfer was avoided for 37% of the patients and hospitalization for 12%. An additional consultation occurred after remote consultation for 2% of the patients. The results confirm the effectiveness of an inter-hospital teleradiology network.

Adolescent↗
PubMed2001

A pilot study of the technical quality of telemedical consultations for remote trauma management.

The technical performance of a telemedical system when used for remote trauma management was compared with face-to-face consultation. Two rooms, 20 yards apart, were linked telemedically in the same Accident & Emergency Department. Two hundred patients, with 'minor' and 'moderate' injuries, underwent the two types of consultation. The Accident & Emergency consultant marked physical parameters using a five-point pre-determined Likert scale. The following parameters were thought to be of excellent quality when compared to face-to-face consultation: overhead fluorescent lighting for the background illumination, video lighting for a close-up view, sound quality after volume adjustment, echo-cancellation after adjustment and lip synchronization. However, the following parameters scored poorly: sound before volume adjustment, echo-cancellation before adjustment, fine and coarse movements. It can be concluded that the quality of lighting and image quality are good in telemedicine. Sound and movement still present some problems. This technology is likely to be used more frequently for remote trauma management.

Humans↗
PubMed2004

A system for telephone and secure email consultations, with automatic billing.

Doctors have traditionally provided medical advice during face-to-face consultations. A new remote consultation service has been developed based on an interactive voice response system and Internet-based technologies. If the doctor is unavailable, a return call can be requested at a mutually convenient time. The patient's credit card is billed automatically. All that is required of the doctor and patient is access to any telephone. A dial-in dictation and transcription facility allows documentation. The service was launched in late 2003. After six months, there were approximately 55 doctors registered in five Australian states and approximately 500 patients registered. Two hundred and fifty consultations were selected randomly for analysis. Of these, 84% were conducted by telephone and 16% by email. The mean fees charged were AUS$17.11 for telephone and AUS$12.93 for email consultations. The mean duration of telephone consultations was 4.3 min. Call duration ranged from a few seconds to 20.5 min.

Australia↗
PubMed2001

An experimental inter-expert telepathology network using static imaging.

AIMS: To set up a network for remote consultation using static imaging telepathology via Internet connection between pathologists in different European countries, and to collect some numerical and subjective impressions on the usefulness of this form of telepathology. METHODS: A static image remote consultation network between 11 pathologists in nine European countries was set up; all pathologists were equipped with the same telepathology system. The pathologists formed three subject oriented subgroups concerned with prostate, melanoma, and soft tissue sarcoma pathology. Each pathologist sent and received a small number of cases, and data on each case were collected and analysed. The whole experiment was controlled through a World Wide Web site. RESULTS: A total of 56 case consultations on 34 different cases were exchanged. The average case document contained seven images, and contained 1.97 Mbytes of data. For cases in which data were recorded, average case preparation and remote consultation time was 55 minutes and 9.2 minutes, respectively. Transmission times averaged 3.9 minutes. In subjective impressions, reservations were expressed in several cases regarding the confidence that could be given to the diagnosis from the images presented. CONCLUSIONS: Remote consultation by telepathology via the Internet is now technically feasible and reasonably user friendly, but is only suitable as a method of disease diagnosis in some cases.

Diagnostic Imaging↗
PubMed1997

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↗
PubMed1975

Comparison of television and telephone for remote medical consultation.

Television and telephone communications were randomly used to compare their effectiveness in allowing consultation between a hospital-based physician and remote nurse practitioners. Visits using television for consultation averaged 50 minutes as compared with 40 minutes for telephone. This difference was caused by longer work-ups before the consultation, longer delays after it was requested, and longer consultations, themselves, on television. However, television consultations resulted in significantly fewer immediate referrals of patients to hospital physicians: 6 plus or minus 1 as compared to 12 plus or minus 1 per cent (mean plus or minus S.E.M) OF ALL TELEPHONE CONSULTATIONS (P SMALLER THAN 0.005). Although no overall difference in satisfaction was documented between the results of television and telephone consultations, participants preferred the former for medical decision making and cited it for allowing more social interaction than telephone. These findings suggest that television may have its greatest value in remote sites where the sense of isolation is great and the need to reduce long-distance referrals offsets the costs of the system.

Community Health Services↗
PubMed1996

Diagnostic accuracy in remote expert consultation using standard video-conference technology.

An international multicenter study (Germany, Sweden, and Switzerland) was performed to investigate the feasibility and diagnostic reliability of standard video-conferencing (VC) technology for remote expert consultation in radiology. Three high-spatial-resolution films (hand-bone, mammography, chest) and two low-spatial-resolution image sets (liver CT and MRI) were studied (total 446 images taken from different examinations). The images were recorded by a video camera, transmitted via public broadband networks, and displayed on a video monitor. The resolution of the recorded images varied from 2.4 lp/mm to 4.8 lp/mm at maximum zoom. After 3-4 months, the images were reexamined using conventional light-box reading. Diagnostic reliability was evaluated by receiver operating characteristics (ROC) analysis. With video conferencing, there was a noticeable loss of diagnostic accuracy for the high-spatial-resolution films, whereas for liver CT and liver MRI images VC reading seemed to be satisfactory (average area value difference < 0.02).

Feasibility Studies↗
PubMedDate not supplied

Telemedicine ophthalmology consultation in remote Queensland.

OBJECTIVE: To assess the use of remote telemedicine ophthalmology in patients presenting to an emergency department with acute eye problems. DESIGN: A prospective review from 1 December 1996 to 28 February 1997 of referral patterns and telemedicine consultations, comparing referral patterns with the same period one year before. PARTICIPANTS AND SETTING: 24 patients presenting to the emergency department of a remote base hospital in Queensland with an acute ophthalmological problem requiring a specialist opinion. MAIN OUTCOME MEASURES: Clinical outcomes; use of the Patient Transit Scheme for isolated patients; acceptability to patients and doctors; and ophthalmologists' opinions of the system. RESULTS: No adverse outcomes were identified. Patients transferred for urgent assessment fell from 17 for the corresponding period in the previous year to four during the study period, while respective numbers of patients requiring non-urgent transfers (for surgery or postoperative review) during the same periods were 41 and 30. Both patients and staff (including the ophthalmologists) found the telemedicine facility very acceptable. CONCLUSION: Ophthalmology is well suited to telemedicine for the diagnosis and management of acute conditions and postoperative assessment of patients in remote areas. It offers considerable potential benefits to patients, and enhances the skills of local practitioners.

Acute Disease↗
PubMed1997

Psychological impact of a remote psychometric consultation with hospitalized elderly people.

Teleconsultation is a potentially useful approach to the psychological assessment of elderly patients. We assessed the psychological impact of a videolinked psychometric consultation in a sample of hospitalized elderly people. The 15 patients, none of whom had a psychiatric history, participated in a video-consultation and a conventional face-to-face consultation. The mean age of the patients was 88 years. Each consultation consisted of a preliminary interview with a psychologist and two psychometric tests which evaluated the patient's cognitive function (the Mini-Mental State Examination and the Clock Face Test). A second psychologist, who acted as an observer, assessed the patients' attitudes to the two types of consultation. Although most patients (11 of the 15) expressed a preference for the face-to-face consultation, the video-consultations were judged to be acceptable by the patients and the psychologists. The experience of teleconsultation could be improved by practice on the consultant's part and by some technical modifications. Finally, some differences in test scores were observed and further work is required to evaluate the reliability of different psychometric tests when used by videolink.

Aged↗
PubMed2003

[Telemedicine system for remote medical consultation. Internal medicine patients cared for in Italy from Angola].

Thirty-five patients, living in Italy and bearing chronicle internal diseases, have been followed by a senior specialist, displaced to Angola for three months. The senior specialist was assisted by a junior physician, who was in touch with the patients in Italy. Both of them were provided with a network equipped portable personal computer. Five patients dropped-out. At least 4 of them were brought about by the method. Despite the senior specialist has always fed back the junior physician within 48 hours as a maximum, in 8 patients the time was too long to challenge acute complications of the diseases, requiring urgent decisions or consultations by extra-expertise. The transmission of X-ray, ultrasound and radionuclide scan pictures was satisfactory. The rapid development of both hardware and software and the high technology network like ISDN will enable to overcome most of the problems and keep the patient and the doctor in a narrow contact. But project inputting telematic and informatic systems into the developing countries are expectedly to be poorly sustainable.

Angola↗
PubMed2000

The role of the Picasso phone system in distance consultation for remote Pacific Islands.

The U.S. affiliated Pacific Island nations spend an average of over 10% of total health budget on off-island referral care to tertiary centers. Tripler Army Regional Medical Center (TAMC) has been the major provider of this service for many years. Prior to 1995 communication to consultants at TAMC was by long distance telephone, fax and regular mail. Connecting to a specialist sometimes took hours and clearly a better communication link was needed. The AT&T Picasso phone, an instrument the size of a small briefcase was developed to reliably transmit still images over the regular phone. Freeze-frame images captured at the sending end by a cam recorder were transmitted to a remote receiver unit, where they were displayed and stored. A typical medical consultation involved about three images, with each transmission over the 28.8 Kbps modem taking about one minute. A separate consultation form submitted by fax to TAMC was attached to the transferred images. Four Picasso phones were used to test their usefulness in linking isolated Pacific islands to a metropolitan medical center. For the first time ever, coloured patient images, data, X-rays etc were transmitted with a faxed written medical report. The Picasso phone was the spark of the Telemedicine development in the US affiliated Pacific islands.

Humans↗
PubMedDate not supplied

Consulting with radiologists outside the hospital by using Java.

A Java-based teleradiology system that makes use of the Internet has been developed. Using this system, an on-call, off-duty radiologist can make diagnoses and perform consultations easily by reviewing the transferred images at home. The image accessibility of the system allows a hospital with such a system to assist an affiliated rural hospital without a full-time radiologist. The system consists of three components: the image server subsystem, the database server subsystem, and the client subsystem. All client subsystems of the system are designed to be symmetric. Users may retrieve images, manipulate them, and perform remote consultations. In addition, a user may add annotations to an image area of interest. Screen synchronization is achieved by means of the command-passing technique and local command execution to reduce the network bandwidth and transmission demands; user interaction is achieved by means of a synchronized indicator for pointing out areas of interest and dialog windows for conversation. Because Java programs can run on heterogeneous platforms, the need for system maintenance and user training is minimized. Although the drawback of Internet bandwidth still exists, the system enables platform-independent teleradiology via the Internet and allows easy and cost-effective remote consultation.

Humans↗
PubMed2006

Integrated telemedicine applications and services for oncological positron emission tomography.

TENPET (Trans European Network for Positron Emission Tomography) aims to evaluate the provision of integrated teleconsultation and intelligent computer supported cooperative work services for clinical positron emission tomography (PET) in Europe at its current stage, as it is a multi-centre project financially supported by the European Commission (Information Society, eTEN Program). It addresses technological challenges by linking PET centres and developing supporting services that permit remote consultation between professionals in the field. The technological platform (CE-marked) runs on Win2000/NT/XP systems and incorporates advanced techniques for image visualization, analysis and fusion, as well as for interactive communication and message handling for off-line communications. Four PET Centres from Spain, France and Germany participate to the pilot system trials. The performance evaluation of the system is carried out via log files and user-filled questionnaires on the frequency of the teleconsultations, their duration and efficacy, quality of the images received, user satisfaction, as well as on privacy, ethical and security issues. TENPET promotes the co-operation and improved communication between PET practitioners that are miles away from their peers or on mobile units, offering options for second opinion and training and permitting physicians to remotely consult patient data if they are away from their centre. It is expected that TENPET will have a significant impact in the development of new skills by PET professionals and will support the establishment of peripheral PET units. To our knowledge, TENPET is the first telemedicine service specifically designed for oncological PET. This report presents the technical innovations incorporated in the TENPET platform and the initial pilot studies at real and diverse clinical environments in the field of oncology.

Artificial Intelligence↗
PubMed1978

Gold award: providing psychiatric care and consultation in remote Indian villages--Department of Psychiatry, University of Toronto, Toronto, Ontario.

Faculty of the University of Toronto department of psychiatry take several trips a year to remote Indian villages in northwestern Ontario to deliver care to the Cree and Ojibway people and to provide consultation and training to the service delivery providers in the area. The program is part of a larger medical program operated by the university and financed by the Canadian government. Psychiatrists face numerous cultural and language obstacles in addition to harsh weather conditions and limited means of communication in the vast Sioux Lookout zone. When they are back in Toronto, they keep in touch via two-way radio with professional staff in the zone for ongoing consultations.

Awards and Prizes↗
PubMed2005

Cost-minimization analysis of a wide-area teleradiology network in a French region.

OBJECTIVE: The objective of our study was to perform a cost-minimization analysis of a wide-area teleradiology network. DESIGN: A prospective analysis of all transmissions over 1 year (data transmitted at the time of the remote consultation, and health outcomes of patients from medical record). INTERVENTION: The inter-hospital teleradiology network of the Aquitaine area (RIHRA) is a telemedicine system enabling the management of remote emergencies and elective radiology consultations. MAIN OUTCOME MEASURE: A cost-minimization study enabled a comparison of care procedures following the use of the network with those which would have been implemented without the network. The outcome measures of effectiveness were the transfers, hospitalizations, and consultations avoided or added. Fixed and variable costs were estimated. RESULTS: Among the 664 transmissions included in the study, 562 (85%) were performed in emergency and 102 (15%) for elective (non-emergency) cases. In emergency, 48% of transfers were avoided. For elective teleconsultations, a transfer was avoided for 37% of the patients and hospitalization for 12%. An extra consultation occurred after remote consultation for 2% of the patients. Annual saving can be estimated at 102,779 EUR for the Aquitaine area. CONCLUSIONS: This study underlines the efficiency of an inter-hospital teleradiology network. A qualitative evaluation of the impact of the use of the system should be carried out to improve technical and organizational operations.

Cost Control↗