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PubMed1983

[Data telecommunication in electric response audiometry (ERA)].

Telephone-lines suit for the transmission also of digital data along long distances. In ERA this technique is favourable. --because the application of a computer is necessary anyway and the primarily analogous data have to be transformed to digital ones anyhow and --because the expenses for purchase, maintainance and operation of the complete equipment stress practices and small hospitals disproportionately. To test "ERA via telephone" we established outstations, the peripheral measuring equipment of which was composed of commercially available devices (Digital Equ. Corp.); only the computer controlled stimulator originated from our own construction. The communication software between central and peripheral station was written in a way that the realtime feature of the registration was preserved and, therefore, only about 30 min are necessary to obtain the intensity-latency time-function (P6/JV) of both ears.

Audiometry↗
PubMed1995

[Psychotherapeutic counselling via telecommunication networks].

The article discusses the effects that video conferencing in psychotherapy (distant therapy) may have upon the interaction between client and therapist. Experiences from distant therapy in North Norway, as well as earlier studies, are discussed in relation to factors such as client power and control, regulation of intimacy, and verbalization. The experiences indicate that physical presence--which is intuitively perceived as the ideal in relation to which the distant therapy settings are assessed--should be treated instead as a variable which can have positive and/or negative effects on a given therapeutic process.

Child↗
PubMed1996

[Possibilities of telecommunications in surgery].

In contrast to telesurgery, telepresence involves only the audiovisual dialogue between the local surgeon and a remote expert; the latter, however, is able to actively monitor the operation by giving his judgement and recommendations. Under clinical conditions, telepresence may have the potential to facilitate intraoperative consultation of remote experts or even tele-assistance. Technical requirements consist of a suitable telemanipulation device (remotely controlled camera and indicator) and a high-duty communication system for real-time transmission of the operating site and the control signal. A minimum of 2 Mbyte/s of transmission capacity is recommended.

Computer Systems↗
PubMed1997

[Telepathology and present experience based on use of the SHARED telecommunication project].

Telemedicine is rather new activity covering various approaches in order to fulfill the main task which can be expressed in more comprehensive words such as "remote medicine" or "medicine on distance". One of definitions of telemedicine given by the European Commission for Telemedicine says that "telemedicine is fast access to distributed medical expert knowledge using telemedicine and information technologies regardless of actual location of a patient or relevant information". The first connection has been established with Zagreb, Croatia in September by means of PHAROS. In October 1996 the Institute of Pathology with the Radiology and Ophthalmology Clinics of University hospital of Sarajevo has joined the experimental project "SHARED" (a telemedicine initiative to support remote health care structure, proposed by the San Raffaele International Biomedical Science Park with Stato Maggiore della diffesa and European Space Agency). Due to problems in infrastructure and lack of experts, small country like Bosnia and Herzegovina (BiH) sees telemedicine as future in its health care organizing.

Bosnia and Herzegovina↗
PubMed1999

Video networking of cardiac catheterization laboratories.

BACKGROUND: The purpose of this study was to assess the feasibility and accuracy of a video telecommunication network to transmit coronary images to provide on-line interaction between personnel in a cardiac catheterization laboratory and a remote core laboratory. METHODS: A telecommunication system was installed in the cardiac catheterization laboratory at Kaiser Hospital, Los Angeles, and the core laboratory at the University of California, Irvine, approximately 40 miles away. Cineangiograms, live fluoroscopy, intravascular ultrasound studies and images of the catheterization laboratory were transmitted in real time over a dedicated T1 line at 768 kilobytes/second at 15 frames/second. These cases were performed during a clinical study of angiographic guidance versus intravascular ultrasound (IVUS) guidance of stent deployment. During the cases the core laboratory performed quantitative analysis of the angiograms and ultrasound images. Selected images were then annotated and transmitted back to the catheterization laboratory to facilitate discussion during the procedure. RESULTS: A successful communication hookup was obtained in 39 (98%) of 40 cases. Measurements of angiographic parameters were very close between the original cinefilm and the transmitted images. Quantitative analysis of the ultrasound images showed no significant difference in any of the diameter or cross-sectional area measurements between the original ultrasound tape and the transmitted images. The telecommunication link during the interventional procedures had a significant impact in 23 (58%) of 40 cases affecting the area to be treated, the size of the inflation balloon, recognition of stent underdeployment, or the existence of disease in other areas that was not noted on the original studies. CONCLUSIONS: Current video telecommunication systems provide high-quality images on-line with accurate representation of cineangiograms and intravascular ultrasound images. This system had a significant impact on 58% of the cases in this small clinical trial. Telecommunication networks between hospitals and a central core laboratory may facilitate physician training and improve technical skills and judgement during interventional procedures. This project has implications for how multicenter clinical trials could be operated through telecommunication networks to ensure conformity with the protocol.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Calling emergency medical services for acute stroke: a study of 9-1-1 tapes.

OBJECTIVE: To obtain a better understanding of how stroke events are communicated to 9-1-1 telecommunicators, and how telecommunicators and emergency medical services (EMS) personnel respond to such calls. METHODS: The authors identified 104 patients with a hospital discharge diagnosis of stroke or transient ischemic attack who were transported to hospital by ambulance in two North Carolina counties during 1999 and 2000. Ambulance call reports were abstracted and linked to 9-1-1 call center audiotapes, which were transcribed and verified. RESULTS: Of the 104 calls, 44 were made by medical personnel, 38 by a family member, eight by a bystander or neighbor, five undetermined, and three by other nonmedical personnel. In only six instances (6%) was the call placed by the patient. The most common symptoms reported were altered mental status (40%), trouble walking (32%), impaired speech (27%), and abnormal breathing (27%). Although the word "stroke" was often used (45%), 9-1-1 telecommunicators classified the calls as a stroke in only 31% of cases. However, in the majority of cases (79%), paramedics were dispatched at the highest priority. The median time from dispatch of EMS to patient arrival at the hospital was 41 minutes, approximately half of which was spent at the scene. CONCLUSION: Although typical stroke symptoms are commonly described, calls are often not classified as "strokes" by telecommunicators. Nevertheless, because of the symptoms reported during the calls, the majority of cases are treated as high priority by telecommunicators.

Aged↗
PubMedDate not supplied

Discrete-event simulation of a wide-area health care network.

OBJECTIVE: Predict the behavior and estimate the telecommunication cost of a wide-area message store-and-forward network for health care providers that uses the telephone system. DESIGN: A tool with which to perform large-scale discrete-event simulations was developed. Network models for star and mesh topologies were constructed to analyze the differences in performances and telecommunication costs. The distribution of nodes in the network models approximates the distribution of physicians, hospitals, medical labs, and insurers in the Province of Saskatchewan, Canada. Modeling parameters were based on measurements taken from a prototype telephone network and a survey conducted at two medical clinics. Simulation studies were conducted for both topologies. RESULTS: For either topology, the telecommunication cost of a network in Saskatchewan is projected to be less than $100 (Canadian) per month per node. The estimated telecommunication cost of the star topology is approximately half that of the mesh. Simulations predict that a mean end-to-end message delivery time of two hours or less is achievable at this cost. A doubling of the data volume results in an increase of less than 50% in the mean end-to-end message transfer time. CONCLUSION: The simulation models provided an estimate of network performance and telecommunication cost in a specific Canadian province. At the expected operating point, network performance appeared to be relatively insensitive to increases in data volume. Similar results might be anticipated in other rural states and provinces in North America where a telephone-based network is desired.

Community Networks↗
PubMed2000

[Telematics in geriatrics--potentials, problems and application experiences].

Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies. This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N = 13, mean age 72 yrs), care giving relatives (N = 8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test. In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.

Aged↗
PubMed1995

Expert consultation by use of telepathology--the Heidelberg experiences.

The benefits and constraint using visual telecommunication in pathology (telepathology) are described based upon the experiences of the authors for more than 4 years. The experiences include first trials in visual telecommunication to analyze image quality, transfer rates, handling of commercially available equipment, and need for routinely diagnostic work followed by routinely expert consultations in frozen sections. A quality control study on diagnostic reliability of bronchial carcinomas was performed later, and the diagnosticly different cases were reclassified by a panel of pathologists using visual telecommunication. The latest experiences are based upon routinely expert consultations in morphologically difficult cases by ISDN-based telecommunication. As a result, image quality and transfer rates are sufficient to permit efficient expert contribution to diagnostically difficult cases in 30-50% of transmitted cases in both common telephone lines and ISDN connections. No influence of various staining procedures, immunohistology, or in situ hybridization on image quality or transfer rates were observed. The area of transmitted images is still too small, and the reliability of ISDN lines is still not sufficient for remote control service in Germany. The handling of commercially available equipment needs to be improved; however, as a general result, telepathology will probably improve the diagnostic quality and access in histopathology within the coming years.

Clinical Laboratory Techniques↗
PubMed1998

History, structure, and function of the Internet.

The Internet stands at the forefront of telecommunications in medicine. This worldwide system of computers had its beginnings in networking projects in the United States and western Europe in the 1960s and 1970s. The precursor of the Internet was ARPANET, a long-distance telecommunication network funded by the Department of Defense that linked together computers throughout the United States. In the 1980s, ARPANET was superseded by NSFNET, a series of networks created by the National Science Foundation, which established the present-day structure of the Internet. The physical structure of the Internet resembles and is integrated with the telephone system. Long-distance data transport services are provided by large telecommunication companies, called network service providers (NSPs), through high-capacity, high-speed national and international fiber optic cables. These transport services are accessed through Internet service providers, ISPs. ISPs, the equivalent of regional Bell operating companies, provide the physical link to the NSPs for individuals and organizations. Telecommunications on the Internet are standardized by a set of communications protocols, the TCP/IP protocol suite, that describe routing of messages over the Internet, computer naming conventions, and commonly used Internet services such as e-mail. At present, the Internet consists of over 20 million computer worldwide and is continuing to grow at a rapid rate. Along with the growth of the Internet, higher speed access methods are offering a range of new services such as real-time video and voice communications. Medical education, teaching, and research, as well as clinical practice, will be affected in numerous different ways by these advances.

Computer Communication Networks↗