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PubMed2000

A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing.

We used a PC-based videoconferencing system to conduct child psychiatry assessments. The telecommunications link was six digital lines, giving a total bandwidth of 336 kbit/s. Twenty-three patients (aged 4-16 years), accompanied by their parents, completed two psychiatric assessments, one via videoconferencing and another face to face (FTF). The order of assessments was randomized. Questionnaires were used to record the diagnosis, treatment recommendations and the psychiatrists', patients' and their parents' satisfaction with each assessment. An independent evaluator concluded that in 22 cases (96%) the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF. The psychiatrists stated that videoconferencing assessments were an adequate alternative to FTF assessments and did not interfere with diagnosis. However, the responses from the psychiatrist satisfaction questionnaire showed that they preferred FTF assessments. No significant difference was found in the patients' or parents' satisfaction responses after the two types of assessment. The majority of children (82%) 'liked' using the telepsychiatry system and six (26%) preferred it to a FTF assessment. Most parents (91%) indicated that they would prefer to use the videoconferencing system than to travel a long distance to see a psychiatrist in person.

Adolescent↗
PubMed1996

Videoconferencing in psychiatry: a survey of use in northern Norway.

A survey of the use of videoconferencing in mental health care was carried out in northern Norway. A questionnaire was distributed to all user institutions in northern Norway at the same time that ISDN became available, in mid-1995. The questionnaire completion rate for locations recorded as participants in videoconferencing sessions was 62%. Within six months, a total of 1028 persons had participated in 140 videoconferencing sessions from 35 institutions. The purposes of videoconferencing included meetings (50%), supervision, training and teaching (31%), clinical consultations (14%) and tests or demonstrations (5%). The alternative forms of contact which videoconferencing replaced included travel (59%), no contact (25%), telephone (14%), and mail or fax (2%). No problems were reported in 55% of the sessions; in 19% there were audio problems, in 14% there were picture problems, in 5% attempts to connect failed and in 5% disconnection occurred. The majority of users (87%) reported that they were satisfied or very satisfied with the facility; 8% were uncertain and 5% were less satisfied or totally dissatisfied. Continued surveying will provide longitudinal data on the diffusion of telepsychiatry in northern Norway.

Attitude of Health Personnel↗
PubMed1999

An evaluation of an Australian videoconferencing project for child and adolescent telepsychiatry.

A user satisfaction survey of videoconferencing services for child and adolescent mental health was carried out over a two-year period in Victoria, Australia. The aims of the survey were to evaluate key utilization areas, effect on professional practice, and advantages and disadvantages of the videoconferencing service. Eighty questionnaires were sent out and 58 (73%) were returned. Consultations were reported as the most frequent use of videoconferencing equipment (62%), followed by clinical use (59%), supervision (36%), teaching (19%) and administration (14%). Fifty-seven per cent of respondents reported that videoconferencing had affected professional practice. Advantages of the services included cost savings (52%) while disadvantages included technological problems (40%). The findings show the benefits of videoconferencing for improving the delivery of mental health care in rural Australia.

Adolescent↗
PubMed2006

Comparison of students' performance in and satisfaction with a clinical pharmacokinetics course delivered live and by interactive videoconferencing.

OBJECTIVES: To compare students' performance in and course evaluations for a clinical pharmacokinetics course taught in a traditional classroom setting, and for the same course taught via interactive videoconferencing. METHODS: The course was taught in a traditional classroom setting to 38 students, and in asynchronous sessions via interactive videoconferencing to 75 students at a distant site. A course evaluation was administered to each group at the conclusion of the courses. RESULTS: The students in the live classroom setting had a higher mean final course grade of 90.7% compared to the mean final course grade (87.8%) of students in the interactive videoconferencing group (P = 0.024). The mean evaluation score for students in the videoconferencing class were higher than for students in the live classroom setting (4.73 vs. 4.58; P < 0.001). CONCLUSIONS: Students in both the classroom setting and interactive videoconferencing setting performed well and had a high overall perception of the course.

Choice Behavior↗
PubMed2005

Remote presence proctoring by using a wireless remote-control videoconferencing system.

Remote presence in an operating room to allow an experienced surgeon to proctor a surgeon has been promised through robotics and telesurgery solutions. Although several such systems have been developed and commercialized, little progress has been made using telesurgery for anything more than live demonstrations of surgery. This pilot project explored the use of a new videoconferencing capability to determine if it offers advantages over existing systems. The video conferencing system used is a PC-based system with a flat screen monitor and an attached camera that is then mounted on a remotely controlled platform. This device is controlled from a remotely placed PC-based videoconferencing system computer outfitted with a joystick. Using the public Internet and a wireless router at the client site, a surgeon at the control station can manipulate the videoconferencing system. Controls include navigating the unit around the room and moving the flat screen/camera portion like a head looking up/down and right/left. This system (InTouch Medical, Santa Barbara, CA) was used to proctor medical students during an anatomy class cadaver dissection. The ability of the remote surgeon to effectively monitor the students' dissections and direct their activities was assessed subjectively by students and surgeon. This device was very effective at providing a controllable and interactive presence in the anatomy lab. Students felt they were interacting with a person rather than a video screen and quickly forgot that the surgeon was not in the room. The ability to move the device within the environment rather than just observe the environment from multiple fixed camera angles gave the surgeon a similar feel of true presence. A remote-controlled videoconferencing system provides a more real experience for both student and proctor. Future development of such a device could greatly facilitate progress in implementation of remote presence proctoring.

Computer-Assisted Instruction↗
PubMed2002

Restructuring rural continuing medical education through videoconferencing.

We piloted a videoconferencing continuing medical education programme for rural physicians in Alberta and compared its feasibility, acceptability and cost implications with currently existing telephone conferencing and regional conference programmes. Videoconferencing clearly had advantages over telephone conferencing but was not as well appreciated by consumers as the existing regional conference programme. Nonetheless, the videoconferencing programme, although somewhat more costly than telephone conferencing, was associated with considerable cost-savings compared with the regional conference programme. On balance, we concluded that further development of the videoconferencing programme is warranted and we will slowly replace existing telephone conferencing programmes. However, there remains a need for the current regional conference programme.

Alberta↗
PubMed2000

Training for surgeons using digital satellite television and videoconferencing.

The TETRASUR project (TELematics TRAining for SURgeons) has investigated the effectiveness of distance-learning technologies in the delivery of training for doctors who are studying for membership of the Royal College of Surgeons. Digital satellite television receivers and ISDN videoconferencing equipment have been installed in hospitals to deliver the course modules, including a series of live television programmes transmitted by satellite. ISDN videoconferencing was integrated, live, into the satellite broadcasts to bring in guest lecturers and for interactive discussions with the trainee doctors. Videoconferencing was also used for seminars and discussion groups. These methods proved to be effective and popular with the doctors, although there was some dissatisfaction with the visual quality of the ISDN videoconferencing at 128 kbit/s. Efforts are now being made to improve the quality of the video feed from remote sites using ISDN at 384 kbit/s.

Education, Distance↗
PubMed2000

Upgrading rural Japanese nurses' respiratory rehabilitation skills through videoconferencing.

We examined the effect of distance learning on nurses' clinical skills in a rural Japanese hospital. The subject matter was respiratory rehabilitation. After one face-to-face session, who 30 min sessions were delivered by videoconferencing to staff nurses working in a 100-bed rural hospital 250 miles (400 km) from Sapporo Medical University. A self-rating questionnaire was distributed before and after the sessions. Responses were collected from 15 out of 32 nurses participating in the face-to-face session (47%). Before the first videoconferencing session, 'always use' and 'sometime use' the new skills were rated by 67% of nurses, but after the second videoconferencing session 'always use' and 'sometimes use' were rated by 73% and 'never use' at 0%. This implies that there was increased use of new skills after the second session, although the difference was not significant. The nurses' opinions about the effectiveness for patients increased from 8% to 27% after the second session, which was significant. The pilot project indicated the usefulness of distance learning for upgrading nurses' clinical practice in one rural Japanese hospital and suggested ways in which videoconferencing can be used in future.

Attitude of Health Personnel↗
PubMed2001

Videoconferencing in the Queensland health service.

Videoconferencing was introduced in the Queensland health service in 1995. By the end of 1999, there were more than 150 videoconferencing units in health facilities around the state. Six audits of videoconferencing usage were conducted using similar methodology at six-month intervals from November 1997 to May 2000. Between November 1997 and November 1999, the number of calls more than doubled, from 566 to 1378. Hours of usage almost trebled, from 671 to 1724. The average duration of calls remained similar, at about 1 h 12 min. The proportion of calls involving more than two sites (multipoint videoconferences) increased from 44% to 65%. The majority of the activity was for education (including training). Videoconferencing was also used for administration and clinical care. Mental health staff were the heaviest users, but use by health professionals from other specialty areas increased during the study period. The Queensland health service has realized a number of important benefits from telehealth.

Community Networks↗
PubMed2002

Evaluation of videoconferenced grand rounds.

We evaluated various aspects of grand rounds videoconferenced from a tertiary care hospital to a regional hospital in Nova Scotia. During a five-month study period, 29 rounds were broadcast (19 in medicine and 10 in cardiology). The total recorded attendance at the remote site was 103, comprising 70 specialists, nine family physicians and 24 other health-care professionals. We received 55 evaluations, a response rate of 53%. On a five-point Likert scale (on which higher scores indicated better quality), mean ratings by remote-site participants of the technical quality of the videoconference were 3.0-3.5, with the lowest ratings being for ability to hear the discussion (3.0) and to see visual aids (3.1). Mean ratings for content, presentation, discussion and educational value were 3.8 or higher. Of the 49 physicians who presented the rounds, we received evaluations from 41, a response rate of 84%. The presenters rated all aspects of the videoconference and interaction with remote sites at 3.8 or lower. The lowest ratings were for ability to see the remote sites (3.0) and the usefulness of the discussion (3.4). We received 278 evaluations from participants at the presenting site, an estimated response rate of about 55%. The results indicated no adverse opinions of the effect of videoconferencing (mean scores 3.1-3.3). The estimated costs of videoconferencing one grand round to one site and four sites were C dollars 723 and C dollars 1515, respectively. The study confirmed that videoconferenced rounds can provide satisfactory continuing medical education to community specialists, which is an especially important consideration as maintenance of certification becomes mandatory.

Attitude of Health Personnel↗
PubMed2002

Transfer of knowledge from the specialist to the generalist by videoconferencing: effect on diabetes care.

We conducted a 12-month prospective interventional study of videoconferencing between primary and secondary care. A treatment network consisting of a diabetes specialist and four general practitioners was established. The communications medium was PC-based videoconferencing via ISDN at 128 kbit/s. A total of 154 type 2 diabetic patients entered the study. The specialist was contacted 94 times via videoconferencing. Metabolic and haemodynamic parameters were significantly improved over the course of the study: the mean HbA1c level fell from 8.1% to 7.8%, systolic blood pressure from 156 to 148 mmHg and diastolic blood pressure from 88 to 83 mmHg. The study demonstrated that therapeutic counselling by videoconferencing is feasible in diabetes care and suggests that it reduces hospital admissions and improves the quality of care.

Adult↗
PubMed1998

Videoconferencing as a medical educational tool: first experience in Argentinean public hospital.

Authors present their experience with first medical videoconferencing program developed in a public Argentinean hospital. Both modalities--room and desktop videoconferencing--were used. The program was exclusively used for educational purposes. A total of twelfth videoconferencing were successfully made using all resources. They included surgical procedures, magisterial lessons, grand rounds, etc. The project proved that videoconferencing is a cost-effective medical education tool, even in developing countries.

Argentina↗
PubMed2006

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.

Adult↗
PubMed2005

Coordinated care planning for elderly patients using videoconferencing.

We studied the transfer of information during coordinated care planning between a university hospital and a local health care centre/social welfare department about 35 km away. During a seven-month study period, 10 sessions were conducted by videoconferencing and seven sessions were conducted by face-to-face conferencing. Videoconferencing reduced the time required for each coordinated care-planning session from an average of 60 to 45 min. There was also an increase in the number of participating professional categories. Travel time for the staff in the face-to-face group was 60-180 min each. Use of a care-planning report during the sessions resulted in improved quality of documentation, which contributed to better care following discharge. The technical problems that occurred did not detract from the beneficial experience of participating. Interviews with next of kin showed that they had been able to influence the content of the care during the care-planning sessions. Videoconferencing proved useful in coordinated care planning. It resulted in time saved due to reduced travel time, participation by more staff categories and an enhancement of the documentation quality.

Aged↗
PubMed1999

Technical validation of low-cost videoconferencing systems applied in orthopaedic teleconsulting services.

Investigation on the applicability of low-cost videoconferencing (VC) for health care services is becoming a real need. Reduced resources drive the administrators to evaluate inexpensive solutions for telemedicine. Considering this scenario, this work is a preliminary step to validate, from a technical point of view, if low-cost VC systems could be suitable for orthopaedic teleconsulting services. For this purpose, four different videoconferencing systems were tested. Each VC system was composed of a computer and a VC device installed in. VC devices were chosen among the most popular and distributed products (made by Intel, PictureTel and Aethra). The Telemedicine Benchmark, a specific tool defined by the authors, was applied to measure the overall systems performances in terms of time delays during basic rate ISDN connections (128 Kbit/s). Results showed that it is possible to apply low-cost videoconferencing systems for orthopaedic teleconsulting services. Most of the systems provided acceptable performance for medical image visualization and real time joint working. Further developments are recommendable to enhance the VC software tools capabilities and to improve software-user interface. reserved.

Costs and Cost Analysis↗
PubMed2000

Videoconferencing: what are the benefits for dental practice?

For more than 3 years members of the TeleDent team from Bristol University have been looking at the potential of videoconferencing technology for dentistry. Here they explain what videoconferencing is and how it can help the GDP. They discuss examples of its most promising uses for the profession, which include professional updating and providing diagnostic support at a distance. They describe the equipment that is needed, the different types of system available and give an indication of costs. A suggested procedure for using the technology for remote referrals is outlined. 'Store and forward' techniques are also discussed. These do not involve a live video but involve the sending of static electronic files. This approach is compared with videoconferencing, and the article looks at the question of which will be best suited to the GDP, and for what purposes.

Computer Systems↗
PubMed2001

Videoconferencing can be used to assess neonatal resuscitation skills.

OBJECTIVE: To examine the hypothesis that an instructor in a remote site can accurately assess the practical skills of a provider performing a simulated neonatal resuscitation (megacode) using videoconferencing. METHODS: Using volunteer NRP providers and instructors, two local telemedicine sites were linked using six telephone lines. Camera angles, sound settings and equipment placement were optimized. Instructors tested providers at the other site. Instructors recorded their observations on checklists based on those of the Neonatal Resuscitation Program (NRP), and all participants completed feedback forms and gave verbal feedback. Based on the results of the pilot study, the protocol and recording tools were developed, and providers at a rural centre were tested. Tests were carried out with local and remote instructors. Observations of local and remote instructors were collected independently, and compared. Opinions of providers were also collected. RESULTS: Observations of the local and remote instructors on the performances of the providers were consistent; 15 of 18 megacodes reached the required standard. Six telephone lines were required for transmission without noticeable delay in sound transmission. Viewing quality was sufficient for remote instructors to provide feedback on ventilation technique. Providers indicated that videoconferencing did not interfere with their performance and would willingly repeat the experience. Cronbach's alpha for assessment of the technical features was 0.80 or greater for all groups. CONCLUSIONS: Videoconferencing can be used to test resuscitation providers in remote centres. It can enhance neonatal resuscitation education in areas where experienced instructors are in short supply.

Clinical Competence↗
PubMed2003

Evaluating surgeons' informed decision making skills: pilot test using a videoconferenced standardised patient.

BACKGROUND: Standardised patients (SPs) are effective in evaluating communication skills, but not every training site may have the resources to develop and maintain SP programmes. OBJECTIVES: To test whether videoconferencing technology (VT) could enable an interaction between an SP and an orthopaedic surgeon that would allow the SP to accurately evaluate the surgeon's informed decision making (IDM) skills. We also assessed whether this sort of interaction was acceptable to orthopaedic surgeons as a means of learning IDM skills. METHODS: We trained an SP to represent a 75-year-old woman considering hip replacement surgery. Orthopaedic surgeons in Chicago individually consulted with the SP in Philadelphia; each participant could see and hear the other on large television screens. The SP evaluated the surgeons' advice using a 23-item checklist of IDM elements, and gave each surgeon verbal and written feedback on his IDM skills. The surgeons then gave their evaluations of the exercise. RESULTS: Twenty-two surgeons completed the project. The SP was > or = 80% accurate in classifying 20 of the 23 IDM skills when compared to a clinician rater. Although 12 (55%) of the orthopaedic surgeons felt that some aspects of the technology were distracting, most were pleased with it, and 19 of 22 (86%) would recommend the videoconferenced SP interaction to their colleagues as a means of learning IDM skills. CONCLUSIONS: These results suggest that VT allows accurate evaluation of IDM skills in a format that is acceptable to orthopaedic surgeons. Videoconferencing technology may be useful in long-distance SP communication assessment for a variety of learners.

Adult↗