Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Remote Consultation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources

[Telephone consultation in child neurology practice: quantification and contents].

INTRODUCTION: The workload of telephone consultations has been scarcely studied except at the Emergency Units, in spite of the considerable amount of time consumed by the task in normal practice. OBJECTIVE: To asses the workload of telephone consultations in a Neuropediatric Unit, during normal working hours. METHODS: A prospective analysis of all calls received during a year, at the out-patient hospital-based neuropediatric clinic. RESULTS: 150-200 telephone consultations were received every month, decreasing during the holiday seasons. They amount to two thirds of the face-to-face contacts at the clinic, during the same period of time, and require about 10% of our day-time working hours. Disorders more likely to produce the calls: epilepsy (40%), mental retardation (19%), cerebral palsy (11%), all others with a frequency lower than 5%. These percentages, and those of hydrocephalus, autism and spina bifida, are similar to those encountered in normal practice, while headaches, speech delay, hyperactivity, syncopes, etc. produced half the number of calls expected; myopathies doubled the number of calls expected. The monthly frequency of calls varied significatively, along the year, for epilepsy, mental retardation, hyperactivity, migraine and autism. Calls were made especially by the family (49%), but it depends of the purpose and the patient's diagnosis. The purpose was most frequently to consult about the symptomatology of the illness; treatments produced 7% of calls; and discussion about citations, 19.5%, regardless of the diagnosis. CONCLUSION: In neuropediatric practice, telephone consultations should be recognized and provided for in order to manage effectively the clinical demand.

Child↗

A profile of communication in primary care physician telephone consultations: application of the Roter Interaction Analysis System.

BACKGROUND: Telephone consultations are a part of everyday practice, there is surprisingly little research on the subject. AIM: To describe the variation of consulting skills within a body of telephone consultations in primary care, highlighting the performance of one method of assessing the process of the consultation-- the Roter Interaction Analysis System-- with telephone consultations. DESIGN OF STUDY: Cross sectional study of 43 recordings of telephone consultations with GPs. SETTING: One rural county in the Midlands. METHOD: Recordings were made of 8 GPs, purposively selected for maximum variance in one region of the UK. Forty-three consultations were coded using the Roter Interaction Analysis System. From the descriptive categories, six composite categories were compiled reflecting a number of domains of interaction in a consultation: rapport, data gathering, patient education and counselling, partnership building, doctor dominance and patient-centredness. Analysis of variance was undertaken to explain variations between consultations for the different domains. Comparison was made to findings from similar work for face-to-face consultations. RESULTS: These telephone consultations feature more biomedical information exchange than psychosocial or affective communication. Length of interaction accounts for much of the variation seen between consultations in the domains of rapport, data gathering, patient education and counselling and partnership. Male doctors are more patient centred in this study. There is the suggestion of more doctor dominance and a less patient-centred approach when comparisons are made with previous work on face-to-face consultations. CONCLUSIONS: Although the telephone is increasingly being used to provide care, this study highlights the fact that telephone consultations cannot be taken as equivalent to those conducted face to face. More work needs to be done to delineate the features of telephone consultations.

Adult↗

[Support by telecommunication of decisions in diagnostic pathology. Experience with the first telepathology system in Hungary].

The term of telepathology can be determined as diagnostic work of the pathologist at distance via an interactive telecommunication connection in which the image of the specimen appears on a monitor instead of viewing it directly through a microscope. Being a part of the telemedicine, the fast development of the telepathology is based on the revolution of the new digital technology. Technical advances of telecommunication and of image procession in the latest 80s have provided the means to transfer huge amount of visual information in narrow communication bandwidth in two direction link. In 1995 multiple live image transmission with simultaneous voice transfer has been performed between the Department of Pathology of MI Central Hospital and 1.st Institute of Pathology and Experimental Cancer Research of Semmelweis Medical University, Budapest. Transfer rate via ISDN channel was 128 kbit/sec. The first live image telemedicine system in CCE/NIS countries has achieved transmission of cytological smears, frozen sections and paraffin embedded slides supplemented with immunohistochemical preparations. Quality of visual information using video-conference software of standard H.320 was suitable for diagnosis. Development of global telepathology services depends on compatibility of different systems and on comprehensive examinations of cost, accessibility and quality for the clients and providers of telemedicine. Recent paper surveys shortly the historical development of the telepathology, analyses the essence of the new consultation technology, summaries the first experiences in Hungary and raises some questions have to be answered in the near future.

Academies and Institutes↗

Internet-based telehealth system for the treatment of agoraphobia.

In this work that is being validated within the VEPSY project, we present a system that allows the patient to continue a psychological virtual reality treatment from his or her home PC as complementary therapy. In the consulting room, we have been using virtual therapy for panic disorder and agoraphobia treatment to expose the patient to several situations. For the complementary therapy, a structured treatment via the Internet has been prepared, which consists of several parts: an assessment protocol; a structured treatment protocol organized in several blocks (such as psychoeducation and exposure); and an outcome protocol. The same situations as in the consulting room have been selected for the exposure, but each of them has been divided into several virtual environments with specific characteristics that limit its difficulty level. The stimuli that are used at each level are controlled automatically by the system. The information of the patient is stored in a database, which is placed in a remote server using XML format and used to control which stages of the treatment he or she can access. The psychologist can limit the evolution of the patient. The virtual environments are installed in the patient's PC, and they are implemented with a mechanism that ensures that they can only be run when the patient connects to the web. The user should not have any special virtual reality hardware at home, so head rotations have been simulated with the navigation system.

Agoraphobia↗

Consumer satisfaction with telemedicine child psychiatry consultation in rural Kentucky.

Forty-three rural Kentucky families who obtained child psychiatry consultation during the initial eight months of the University of Kentucky's telemedicine program completed questionnaires assessing their satisfaction with telemedicine. Respondents were 46 parents and nine children. All respondents reported that they were very satisfied with the consultation; all of the children and 98 percent of the parents reported that they were as satisfied with the telemedicine consultation as with an in-person visit. Few respondents reported nervousness about using the equipment. These results suggest that child psychiatry consultation via telemedicine provides high levels of satisfaction for both children and adults.

Academic Medical Centers↗

Telemedicine for new neurological outpatients: putting a randomized controlled trial in the context of everyday practice.

In a retrospective review, the telemedical management of 65 outpatients from a randomized controlled trial (RCT) of telemedicine for non-urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial, with that of 150 outpatients seen in the neurology clinics of district general hospitals and with that of 102 neurological outpatients seen by general physicians. Outcome measures were the numbers of investigations and of patient reviews. The telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of reviews they received. Patients from the RCT seen face to face had significantly fewer investigations but a similar number of reviews to the other 150 patients seen face to face by neurologists (the disparity in the number of investigations may explain the negative result for telemedicine in that RCT). Patients with neurological symptoms assessed by general physicians had significantly more investigations and were reviewed significantly more often than all the other groups. Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow-ups than those patients managed by general physicians. The results suggest that management of new neurological outpatients by neurologists using telemedicine is similar to that by neurologists using a face-to-face consultation, and is more efficient than management by general physicians.

Adolescent↗

How to do a telemedical consultation.

In a telemedical consultation, medical information is sought at a distance. Two techniques may be used: asynchronous ('store and forward') and synchronous ('realtime'). Asynchronous consultations have the advantage that the two parties do not have to be available simultaneously; email, for example, has been used successfully for teledermatology. Synchronous consultations depend on communication media such as the telephone, radio or videoconferencing. Successful videoconferencing will involve consideration of four factors: the environment, session initiation, dialogue and session closure. The environment is very important for good-quality consultations and involves planning, equipment and training. Recognizing the advantages and limitations of the available media combined with appropriate planning and training will maximize the utilization of teleconsultations.

Delivery of Health Care↗

Emergency eye care in rural Australia: role of internet.

PURPOSE: Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia. METHODS: The teleophthalmology service was initiated in the Carnarvon Regional Hospital (CRH) of the Gascoyne region in Western Australia. A digital, slit lamp and fundus camera were used for the service. Economic data was gathered from the Department of Health of Western Australia (DOHWA), the CRH and the Lions Eye Institute. RESULTS: During the study period (January-December, 2003) 118 persons took part in teleophthalmology consultations. Emergency cases constituted 3% of these consultations. Previous year, there were seven eye-related emergency evacuations (inter-hospital air transfers) from the Gascoyne region to City of Perth. CONCLUSIONS: Analysis demonstrates implementation of internet-based health services has a marked impact on rural emergency eye care delivery. Internet is well suited to ophthalmology for the diagnosis and management of acute conditions in remote areas. Integration of such services to mainstream health care is recommended.

Adolescent↗

The effect of decreasing digital image resolution on teledermatology diagnosis.

OBJECTIVE: To determine the effect of degraded digital image resolution (as viewed on a monitor) on the accuracy and confidence of dermatologic interpretation. MATERIALS AND METHODS: Eight dermatologists interpreted 180 clinical cases divided into three Logical Competitor Sets (LCS) (pigmented lesions, non-pigmented lesions, and inflammatory dermatoses). Each case was digitized at three different resolutions. The images were randomized and divided into (9) 60-image sessions. The physicians were completely blinded concerning the image resolution. After 60 seconds per image, the viewer recorded a diagnosis and level of confidence. The resultant ROC curves compared the effect of LCS, level of clinical difficulty, and resolution of the digital image. One-way analysis of variance (ANOVA) compared the curves. RESULTS: The areas beneath the ROC curves did not demonstrate any consistently significant difference between the digital image resolutions for all LCS and levels of difficulty. The only significant effect observed was amongst pigmented lesions (LCS-A) where the ROC curve area was significantly smaller in the easy images at high resolution compared to low and medium resolutions. For all other ROC curve comparisons within LCS-A, at all other levels of difficulty, as well as within the other LCS at all levels of difficulty, none of the differences was significant. CONCLUSION: A 720 x 500 pixel image can be considered equivalent to a 1490 x 1000 pixel image for most store-and-forward teledermatology consultations.

Analysis of Variance↗

Off-the-cuff cellular phone consultations in a family practice.

In Israel the public tends to make use of informal medicine alongside organized health services, and cellular phones now allow contact with physicians at almost any time or place. For three months in 1999 a family physician documented all consultations on medical subjects conducted by cellular phone, the phone being available 24 hours a day. There were 94 cellular phone medical consultations, of mean duration 5.8 min (range 2-18). Only 11 took place over the weekend, and 63 took place while the clinic was open. The most common reasons for consultation were advice on treatment (29%) and a second opinion (28%). In 48 cases the consultation was for a close relative rather than the caller. In 42 cases the request for consultation came while the physician was busy with other patients. The results of this small personal study confirm that the practice of informal consultations now extends to the cellular phone. Technologies of this sort demand new rules of conduct, if we are to avoid the various hazards of off-the-cuff medicine.

Family Practice↗

Realtime teleconsultations versus face-to-face consultations in dermatology: immediate and six-month outcome.

We evaluated the outcome of both realtime teleconsultations and face-to-face consultations in dermatology. Forty-six patients were enrolled in an open controlled study. Twenty-nine patients (60%) answered the questionnaire sent to them after six months. Over the six-month follow-up, similar proportions of the two patient groups had visited a general practitioner or a specialist in the consulting hospital. At follow-up, overall patient satisfaction with the consultation, measured on a linear analogue scale (0-10), had fallen only slightly and to the same extent after both types of consultation, that is by 1.2 (SD 3.7) after realtime teleconsultations and by 1.4 (SD 4.5) after face-to-face consultations. The proportions of patients who would prefer the same mode of consultation for their next appointment had decreased from 83% to 50% in the realtime teleconsultation group and from 83% to 62% in the face-to-face consultation group. However, in neither group was the change significant. The study suggests that patient satisfaction with teleconsultation is well preserved after six months.

Adult↗

[The Internet in oral medicine and maxillofacial surgery].

The authors give an Internet short historical record, then describe the different services offered and the possible applications for oral and maxillo-facial surgery. Electronic-mail (E-mail) provides the ability to compose, send and receive messages through the computer and allows exchanging informations with colleagues around the world. Programs, files and graphics can be transferred from one computer to another. The "news groups" are interesting in various subjects and allow a team work. We find several hundred sites about maxillo-facial surgery. These sites present a medical department, diagnosis problems or therapeutic solutions, medical press. Any information submitted is insecure and could be observed by a third party while in transit. Internet potential (educational benefits, digital access to medical literature, online consultation service) is mentioned in the end of the article.

Communication↗

Early experience using telemedicine for neonatal surgical consultations.

BACKGROUND/PURPOSE: Telemedicine affords the opportunity to extend the presence of surgical evaluation to centers without an on-site pediatric surgeon. However, concern for cost, accuracy of diagnosis, and physician acceptance have limited its use. METHODS: Using a low-cost, desktop computer-based system, this study was designed to test the effectiveness of telemedicine in neonatal surgical consultation. RESULTS: Early experience with six video-teleconference (VTC) and six store-and-forward consultations are presented. Diagnosis was established accurately in all cases. With the three intestinal cases (jejunal atresia, duplication cyst, and r/o malrotation), diagnostic studies were guided by the images transmitted with the consult. Earlier care could be implemented in other cases. Technical problems were encountered primarily with the VTC modality, which also proved more consuming of physician time. CONCLUSIONS: Telemedicine was used successfully in each case and proved accurate in diagnosis and guiding further evaluation. This is the first report of the use of telemedicine for surgical consultation in the intensive care nursery.

General Surgery↗

Reliability and accuracy of dermatologists' clinic-based and digital image consultations.

BACKGROUND: Telemedicine technology holds great promise for dermatologic health care delivery. However, the clinical outcomes of digital image consultations (teledermatology) must be compared with traditional clinic-based consultations. OBJECTIVE: Our purpose was to assess and compare the reliability and accuracy of dermatologists' diagnoses and management recommendations for clinic-based and digital image consultations. METHODS: One hundred sixty-eight lesions found among 129 patients were independently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the examiners' diagnoses and the reliability of their management recommendations were compared. RESULTS: Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0. 54 (95% confidence interval [CI], 0.46-0.61) and was 0.92 (95% CI, 0. 88-0.96) when ratings included differential diagnoses. Digital image consultants provided diagnoses that were comparably reliable to the clinic-based examiners. Agreement on management recommendations was variable. Digital image and clinic-based consultants displayed similar diagnostic accuracy. CONCLUSION: Digital image consultations result in reliable and accurate diagnostic outcomes when compared with traditional clinic-based consultations.

Adult↗

Our experience with telemedicine in traumatology and orthopedics.

BACKGROUND: Telemedicine widely takes root in all branches of modern medicine including traumatology and orthopedics. The main goal of this work was to present our experience with asynchronic teleconsultation in daily clinical practice, in particular in the treatment of polytrauma patients. METHODS: Throughout 2000 and 2003, we carried out 144 teleconsultations for 92 men and 52 women (age range three months to 80 years). Of these, we were the inquiring party in 51 cases, the consulting one in 88 cases, and the mediator in five cases. Time passed till the completion of consultations ranged from 12 to 24 hours. RESULTS: The number of consultants was one, two, three, and more in 99, 22, 3, and 15 teleconsultations, respectively. The most common questions (n=128) were those of treatment tactics. In the majority of cases, the consultant approved of the diagnosis suggested by the inquirer and formulated or corrected the scheme of the treatment. The majority of teleconsultations were concerned with various problems of traumatology (n=83) and orthopedics (n=31). For each clinical case, we received a mean of 2.6 replies (range 1 to 8). The effectiveness of the suggested treatment methods accounted for approximately 80% in final decision making. Teleconsultations provided considerable benefits in the treatment of polytrauma patients, including decreases in in-hospital treatment necessities (16%), in complication rates (9.2%) and their severity, the relative risk of developing complications (10%), and in the need for re-hospitalization (0.4%). CONCLUSION: In view of our experience, we recommend that asynchronic consultations on the basis of the Internet-technology be more commonly used in the treatment of polytrauma patients.

Adolescent↗

Patients' experiences of receiving telephone advice from a GP co-operative.

BACKGROUND: The use of the telephone to deliver health care advice has increased considerably in recent years. Little research has been carried out to explore the experience of patients who receive such advice and its acceptability. OBJECTIVES: The aim of this study is to describe the expectations of patients, or third party callers, who had contacted a GP out-of-hours co-operative and their satisfaction with telephone advice received. METHODS: Semi-structured interviews were conducted by telephone 7-10 days after contact with one inner city GP co-operative. RESULTS: A total of 47 telephone consultations were followed up with an interview. Of these, 23 (48.9%) callers had expected to be offered a home visit when they called. Reasons for wanting a home visit were either to do with the nature of the condition and its perceived severity, problems in being able to attend the primary care centre and the risks of travel, or because of problems in communicating over the telephone. Satisfaction with telephone consultations centred mostly on the doctor being able to provide reassurance and give adequate time to allay concerns. The most common reasons given for dissatisfaction were the caller feeling that the doctor could not make a correct diagnosis without having seen the patient, or the caller being made to feel that they were wasting the doctor's time. Many patients were anxious about their ability to describe symptoms over the telephone, or understand and follow the advice that they received. CONCLUSIONS: There appears to be a need for patients to be better informed about the service they can expect to receive from GP co-operatives. Recent developments such as NHS Direct may have an influence on the telephone consultation rate to GP co-operatives.

Adolescent↗

Doctors go dot.com.

Need to consult with a specialist? Want a prescription written fast? New Web sites offer a stunning array of medical services online. Here's what's out there--and how to use it wisely.

Internet↗

Diagnostic accuracy of an international static-imaging telepathology consultation service.

Static-image and dynamic- (real-time) image telepathology are competing technologies. Although some studies suggest that the diagnostic accuracy of the dynamic-image telepathology approaches the accuracy of light microscopy, few reports have documented the diagnostic accuracy of static-image telepathology as used in the setting of an actual surgical pathology consultation practice. We report the results of an analysis of 171 telepathology consultation cases submitted to the Arizona-International Telemedicine Network (AITN). Digital images were submitted by pathologists from six participating institutions in Arizona, Mexico, and China. Telepathologists could render a telepathology diagnosis (TP) or defer rendering a diagnosis to obtain additional video images, glass slides for detailed analysis, or to obtain tissue blocks for special studies such as immunohistochemistry. The telepathologists rendered diagnoses for 144 cases and deferred 27 cases. Two pathologists retrospectively evaluated-glass slides from each case and rendered a consensus glass slide (GS) "truth" diagnosis. There was 88.2% concordance between TP and GS diagnoses (127 of 144 diagnoses). Concordance of 96.5% was achieved for clinically important diagnoses (139 of 144 diagnoses). Telepathologists deferred making a diagnosis to obtain glass slides for conventional light microscopy in 14 cases (8.1%) and for results of immunohistochemistry studies in 13 cases (7.6%). Thus, correct diagnoses were rendered by static-image telepathology in 127 of 171 cases (74.3%) at the time of telepathology diagnostic sessions. Inappropriate field selection and sampling biases of referring pathologists, as well as a tendency of static-image telepathologists to underestimate the complexity of some cases, may reduce the value of consultations based on the viewing of static images.

Humans↗