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.

SourceResearch connectionFrom yearThrough year

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

At least 433 records · Page 24Linked to original sources

PubMed1997

Use of store and forward technology for vascular nursing teleconsultation service.

Accurate assessment is critical in planning appropriate therapeutic management of a patient with a vascular wound. However, several factors may inhibit wound assessment by trained professionals or subspecialists. Multiple co-morbidities and lack of transportation and finances contribute to problems with access to specialty clinics for both rural and urban patients with vascular disease. To assess the application of telemedicine in meeting the needs of rural patients with vascular disease, the vascular nurse clinician of a regional medical network was incorporated into a telemedicine research project that used a still-image transmission system known as the Picasso telephone, which allows a diagnostic quality image to be transmitted over a regular telephone line. Telephone consultation between sender and receiver occurs simultaneously at the time of image transmission. Because images can be collected and stored for future reference, this technology is commonly called "store and forward" technology. The application of advanced technology in a rural health care environment has the potential to reduce costs for both patient and managed care insurance plans, allow for expert consultation from distant centers, and promote collegiality and learning among professionals.

Aged↗

PubMed2006

Consultation times in emergency telemedicine using realtime videoconferencing.

We reviewed 2135 consecutive emergency teleconsultations, which were received at an academic emergency department from state correctional facilities. During the 52-week study period, an average of 5.8 video-consultations per day were performed. A total of 1522 consultations (71%) had complete start and end consultation times, and were included in the analysis. Of these, 923 were managed primarily by emergency medicine residents and physician assistants, while the remaining 599 were managed by attending physicians alone. Following consultation, the disposition of the patients included 940 who were transported to the emergency department, 351 who were discharged to the general facility population and 193 who were admitted to the local infirmary. Overall, 38% of patients avoided a journey to the emergency department. The average consultation time was 17 min (95% confidence interval [CI], 10-24). The average consultation time for residents and physician assistants was 16 min (95% CI, 8-24) and it was 19 min (95% CI, 11-27) for attending physicians. Consultation time for patients not transported to the emergency room was 21 min (95% CI, 13-29), while for patients transferred to an emergency department, consultation time was 15 min (95% CI, 9-21). These results may assist in planning the workforce requirements for emergency department-based telemedicine services.

Delivery of Health Care↗

PubMed2006

Patient satisfaction levels during teleophthalmology consultation in rural South India.

The application of new technologies for analysis of retinal images, neural networks for automated retinopathy grading, and teleophthalmology have been shown to have great value in ophthalmology. India has only one ophthalmic surgeon for every 107,000 population. Given this situation, teleophthalmology can play a vital role in addressing to the eye care needs of the country. The objective of this study was to assess patient satisfaction levels and factors influencing it during teleophthalmology consultation in India. A patient satisfaction questionnaire was prepared to assess the prominent aspects of patient satisfaction, including teleophthalmology screening, confidence in the technology used to transfer the fundus images, comprehensiveness of information available to the doctor in the central hub, and graded the opinion regarding the teleophthalmology. A cross-sectional survey among patients who attended a teleophthalmology screening conducted across eight villages in rural Tamilnadu. Responses were then subjected to qualitative analysis and conclusions made. The number of respondents was 348. Of this, 56.4% were males. The mean age of was 50 +/- 17 years. Age ranged from 2 years to 83 years. 44.4% of the respondents were satisfied with teleophthalmology screening. (95% confidence interval [CI]: 38.58%-49.42%) No association was found between age, gender, education, and occupation, respectively, with satisfaction levels. We found that patients who asked questions during the screening were 2.18 times more likely to be satisfied with teleophthalmology than those who did not (odds ratio [OR] = 2.19, 95% CI 1.37-3.5). This study highlights sentiments of the rural subjects when they underwent teleophthalmology consultations. This study provides valuable insights about patient's preferences and satisfaction levels with this newer technology.

Adult↗

PubMed2005

Telegenetics in Maine: Successful clinical and educational service delivery model developed from a 3-year pilot project.

PURPOSE: The goal of this 3-year pilot project was to increase accessibility to genetics educational and clinical services in Maine. METHODS: Southern Maine Genetics Services, Foundation for Blood Research in collaboration with Maine Telemedicine Services established telemedicine capacity to link with rural health care centers located in Northern, Central, and Southern Maine and public health nursing statewide for the provision of genetics clinical and educational services. Core partners included a rural family practice residency program, a rural pediatric practice in northern Maine, and public health nurses statewide. The telegenetics model created was based on development and implementation of a preventive and medical management technology solution, conducting a pilot study to collect data, and approaching insurance companies for reimbursement. Evaluation included surveys on the quality, acceptability, and usefulness of genetics services delivered via telemedicine, telephone interviews, and decision-making confidence evaluations. RESULTS: During the project period, 24 rural clinical sites participated. In total, 93 presentations were given, and 125 patients were evaluated. Sixty-four percent of patients evaluated were pediatric. Despite site coordinator efforts to complete satisfaction surveys, the provider and patient response level was low (18% and 25%, respectively). Of those evaluations received, provider and patient response to telegenetics was positive. Decision-making confidence for genetics and neurology consultants was high. Our experience contributes to the development of telegenetics models that can be used in other rural states.

Genetic Counseling↗

PubMed2003

Telemedicine and neurosurgery: experience of a regional unit based in South Africa.

We carried out a retrospective analysis of all emergency referrals to the neurosurgery department of the Wentworth Hospital from 1996 to 1999. The hospital provided a service to seven peripheral hospitals with computerized tomography (CT) scanners and 46 hospitals without, in the province of KwaZulu Natal. By the end of the study, six of the hospitals with CT scanners had facilities for teleradiology and the mean patient return rate had fallen to 17%. In comparison, almost half the patients seen from the hospitals with no CT scanners were returned to hospital after assessment at the Wentworth Hospital. We also carried out a prospective analysis of 100 consecutive teleradiology-assisted consultations from January to March 2000. Of the 57 patients (79%) who remained at their referral hospitals, 45 had a good outcome, while the other 12 (21%) patients had a poor outcome. The implementation of teleradiology-assisted consultation decreased the number of inappropriate inter-hospital transfers while maintaining appropriate patient care and improving outcome.

Adult↗

PubMed2006

Diagnostic value of written referral and/or images for skin lesions.

We examined whether it is possible for a dermatologist to diagnose benign and malignant skin lesions by telemedicine, given a comprehensive history and/or clinical images. A medical student recorded a standardized history and description of 109 skin lesions and took digital photographs of the presenting lesion(s) immediately prior to a normal outpatient dermatology consultation. About 52 dermatologists were invited to participate in online diagnosis. In all, 38 took part and they were provided with the text and/or the image(s) online on a secure Website. When the images and text were provided, 53% of teledermatology diagnoses were the same as the face-to-face diagnosis. When images alone were provided, 57% of diagnoses were the same. When text alone was provided, 41% of diagnoses were the same. The relatively low diagnostic concordance may have been due to the inexperience of many teledermatologists and poor quality image display systems. The teledermatologists were less confident in their diagnoses than face-to-face specialists, especially in the absence of images. The teledermatology management plan was more likely to include biopsy, excision or review than was the case at the face-to-face consultation. Teledermatology may result in an increase in follow-up appointments and surgical procedures.

Adolescent↗

PubMed2003

Outcomes of dual-protease inhibitor salvage therapy in human immunodeficiency virus-infected patients referred to a telephone consultation service.

OBJECTIVE: To determine the clinical outcomes of dual-protease inhibitor salvage therapy in heavily experienced patients after their providers consulted the National HIV Telephone Consultation Service (Warmline, 800-933-3413). DESIGN: Observational survey study. SETTING: Consultation service for United States health care providers. PATIENTS: Thirty-one human immunodeficiency virus (HIV)-infected patients who had received previous treatment with at least two protease inhibitor--or nonnucleoside reverse transcriptase inhibitor--based regimens and had a viral load of at least 1000 copies/ml. INTERVENTION: Patients whose providers consulted Warmline regarding antiretroviral salvage regimens were identified through a review of telephone calls from January-July 2001. Virologic and immunologic outcomes were determined for patients who had received a regimen containing either ritonavir and indinavir or ritonavir and amprenavir. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were percentages of patients with a viral load less than 500 copies/ml at 3 and 6 months and changes in log10 viral load and CD4+ cell count at 3 and 6 months compared with baseline values. By using intent-to-treat analysis, a viral load less than 500 copies/ml was achieved in 35% of the 31 patients at 3 months and in 32% of them at 6 months. By using as-treated analysis, this outcome was achieved in 48% of 23 patients who continued therapy at 3 months and in 59% of 17 patients who continued therapy at 6 months. At 3 months (23 patients) and 6 months (17 patients), respectively, changes in viral load were -1.7 log10 copies/ml (p<0.001) and -1.4 log10 copies/ml (p<0.001), and changes in CD4+ cell count were +99 cells/mm3 (p<0.001) and +95 mm3 (p=0.012), compared with baseline. CONCLUSION: Significant improvements in virologic and immunologic markers occurred in patients heavily experienced with antiretroviral therapy after starting dual-protease inhibitor treatment regimens. Salvage therapy guided by Warmline consultation appears to be beneficial for this patient population with limited treatment options.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Transcontinental consults in surgical pathology via the Internet.

An efficient and inexpensive electronic system to submit surgical pathology cases in consultation via the Internet is presented. A transcontinental pilot study showed a high degree of concordance between the diagnosis provided by the consultant on the basis of the pathology images and that given after examining the corresponding microscopic slides.

Adult↗

PubMed1997

Teleradiology consultation for a rural hospital: patterns of use.

RATIONALE AND OBJECTIVES: The authors documented quantitatively how teleradiology was used for contemporaneous consultation with a radiologist by physicians at a small rural hospital. MATERIALS AND METHODS: The authors collected 31/2 years worth of data at a small hospital on all patients (n = 327) for whom a radiologist's consultation by teleradiology was requested and compared the data with those from a control group of 309 patients whose studies were interpreted at the same hospital. RESULTS: Teleradiology consultation was requested by the attending physician in 3.6% (519 of 14,586) of all examinations performed during the study period. Physicians requested teleradiology consultation most often for patients with multiple examinations (average 1.59 vs 1.35 for controls). Examinations of infants were 10 times more prevalent in the teleradiology group than in the control group. The indication for most (52%) teleradiology consultations was trauma. Requests for interpretation of spine and abdominal radiographs were relatively more frequent than were those of other studies. CONCLUSION: Physicians in this rural practice used contemporaneous radiologic consultation for selected specific examinations, with emphasis on examinations for trauma, spine, abdomen, and the infant age group.

Adolescent↗

PubMed2001

Online consulting. The experience of a commercial service.

Doctor Global Ltd began online consulting in April 1999. It was one of the first online medical consulting services in the world. Doctor Global does not derive a significant portion of its income from providing or supervising online consultations via its Website, although experience with enabling them has been important for the development of its core product, a consumer-oriented Web-based electronic medical record.

Attitude of Health Personnel↗

PubMed2003

Online doctor-patient communication tool saves time on phone.

Online tool enables patients to consult with physicians maore efficiently. The Medical Clinic of North Texas recently implemented an online communication tool that enables physicians and patients to communicate electronically, resulting in greater efficiency and improved patient care.

Ambulatory Care Information Systems↗

PubMed2004

An analysis of unsuccessful teleconsultations.

Over six years, 4317 teleconsultations were scheduled in the Arizona Telemedicine Program. A total of 402 scheduled teleconsultations (9.3%) did not take place. A review showed that 254 were cancelled but eventually took place (5.9%), while 148 never took place (3.4%). The cost of a teleconsultation to the service provider was, at minimum, 228 US dollars. Telepsychiatry accounted for all the missed consultations that eventually took place, and 92% of these were from three of the six sites referring telepsychiatry patients. Pain management (23%) and psychiatry (21%) accounted for the largest proportions of teleconsultations that never took place. Telepsychiatry cases accounted for 71% of all unsuccessful consultations and accounted for only 34% of successful teleconsultations during the same period. Most missed teleconsultations had been scheduled as realtime sessions (84%). The most common reason for unsuccessful teleconsultations was that the patient did not attend (26%), followed by the patient having to be seen in person (17%). Although all referring sites had unsuccessful cases, certain sites accounted for more than others. These were sites that scheduled more telepsychiatry consultations than the others. The proportion of unsuccessful cases per site ranged from 4% to 17% of the total number of scheduled teleconsultations.

Adult↗

PubMed1999

Expert consultation for cervical carcinoma smears. Reliability of selected-field videomicroscopy.

OBJECTIVE: To evaluate the diagnostic accuracy of videomicroscopy image selection for expert consultation in cervical cytology. STUDY DESIGN: One hundred diagnostically difficult cervical cytologic smears were selected and rescreened by a general pathologist who chose, from each slide, four or five fields featuring abnormal cells. Video images were digitized and stored on a 512 x 512-pixel matrix using an image acquisition and transmission system. Five experts each reviewed 20 of the 100 cases, and a sixth reviewed all 100 cases. Diagnoses based on selected digitized images were compared to those based on conventional examination of whole slides. RESULTS: Intraobserver agreement was fair to excellent for all six experts (kappa value: 0.47-0.81); it was complete or acceptable in 68.4-85% of cases. Compared to the reference diagnosis, interobserver agreement was not significantly different whether cases were examined by screening the entire slide or by videomicroscopy of selected fields. The marked discordance in four cases concerned very small cells the significance of which was misinterpreted on videomicroscopy because of poor image quality due to lack of focus setting. CONCLUSION: This exploratory study showed that selection of videomicroscopy images seems as reliable as conventional examination of slides for expert consultation on diagnostically difficult cervical cytologic smear cases.

Adult↗

PubMedDate not supplied

[Telemedicine in pediatric oncology].

UNLABELLED: The telemedicine project of the Competence Net Pediatric Oncology of the German/Austrian Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) has as an initial step of its work-programme sent out a questionnaire to the 54 largest pediatric hematology/oncology units in Germany. Institutions were asked for their experience, motivation, existing infrastructure, and anticipated benefits and obstacles regarding the implementation of telemedicine in patient care and research. Of the 54 largest German Pediatric Oncology institutions asked, 46 completed the questionnaire (85 %). RESULTS: 1. The need for further detailed information on implementation and for help in technical realization of telemedicine applications was expressed by all participants. 2. The majority expected practical advantages from telemedicine communication and anticipated that telemedicine will increase quality in treating children with cancer. 3. Expert consultation (study chairman, reference radiologists) is stated as to be most important. 4. Thirty-three of 46 physicians (72 %) believe that telemedicine will reduce costs in medical care within the next years. 5. It is anticipated that the introduction of telemedicine is time consuming. 6. The lack of available medical informatics competence and manpower was regarded as the most important obstacle. 7. Data security and standardization, transfer speed and transmission quality are considered most important. 8. Most of the institutions (91 %) use computers in the management of patients. Fourty-four (96 %) are connected to the Internet. 9. Thirty-seven of 46 institutions were prepared to invest in the implementation of telemedicine. This analysis demonstrates that the use of telemedicine is expected to become standard in pediatric oncology, while the existing infrastructure and status of information regarding this subject at present are insufficient. The most pressing practical need for telemedicine applications is seen in the field of electronic expert consultation. Hence, the Telemedicine-Project of the GPOH Competence Net will focus on this aspect first.

Attitude of Health Personnel↗

PubMed1998

Patient satisfaction with telemedicine consultation in primary care: comparison of ratings of medical and mental health applications.

OBJECTIVE: To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients. METHODS: Satisfaction ratings from 34 mental health encounters were compared with ratings from a convenience sample of 59 non-mental health encounters on four aspects of satisfaction: self-reported ability to speak freely; probability of further use of telemedicine; perceived experience of telemedicine personnel; and relative preference for a telemedicine visit compared with a face-to-face visit. The study was conducted in the context of the Telemedicine Program at the University of California, Davis. RESULTS: No significant differences in satisfaction were found between mental health and non-mental health encounter groups for any of the four aspects of satisfaction. CONCLUSIONS: Ratings from patients receiving mental health consultation using telemedicine yielded levels of satisfaction similar to those found in telemedicine consultations in non-mental health medical areas. The results support telemedicine as a means to extend mental health consultation to rural primary-care patients.

Adjustment Disorders↗

PubMed1996

Teledermatology in the Highlands of Scotland.

A pilot study of telemedicine consultations of 51 dermatology patients showed that the technology worked well, with the diagnosis being able to be made in most patients and over half of the patients being able to be dealt with through this medium only. It could therefore have a valuable screening role. However, many of the patients, in spite of the obvious advantage of an immediate consultant opinion, felt it would be more appropriately used as a review technique.

Adolescent↗

PubMed1999

Concerns and confidence of general practitioners in providing telephone consultations.

BACKGROUND: In recent years the number of telephone consultations provided out of hours has increased. However, most general practitioners (GPs) have received little training in this area despite the specific skills needed to compensate for lack of visual information. Moreover, there has been no research exploring GPs' concerns and training needs in telephone consulting. AIM: To assess GPs' concerns and levels of confidence in providing telephone consultations in order to inform the development of a new training course. METHOD: Prior to attending the course, GPs were surveyed by interview or self-completion questionnaire to explore their confidence in providing telephone consultations. RESULTS: Thirty-eight GPs participated, and the sample was highly skewed towards females. The average age of participants was 42 years, 5 years less than the mean for GPs in the area. Low levels of confidence were reported by GPs in providing telephone consultations out of hours. A number of characteristics were common to telephone consultations described as difficult. The most important were lack of visual clues and lack of information about the patient, both of these were heightened in the out-of-hours period. Organizational factors leading to reduced confidence levels were also identified. CONCLUSIONS: This study demonstrates low levels of confidence among GPs conducting telephone consultations, and highlights contributing factors. Although it is not clear how far these results can be generalized, they demonstrate the need to consider telephone consulting skills training in the context of new out-of-hours arrangements. The results have been used to develop a two-day course.

Adult↗

PubMed1998

Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: is clinical management by realtime teledermatology possible?

Results from phase 1 of the UK Multicentre Teledermatology Trial demonstrated the diagnostic accuracy of realtime teledermatology using low-cost equipment. Phase 2 of the trial aimed to assess its effectiveness as a management tool for dermatological disease. Teledermatology consultations were organized between two health centres and two hospitals in Northern Ireland using low-cost videoconferencing equipment. For 205 patients seen by a dermatologist over the video-link a diagnosis and management plan were recorded. A subsequent face-to-face consultation was arranged on the same day to confirm the diagnosis and treatment regime. A comparison of these management plans revealed that the same plan was recommended in 64% of cases; the teledermatologist was unable to advocate a suitable management plan in 19% of cases; a suboptimal treatment plan was suggested by the teledermatologist in 6% of cases; and in 11% of cases, the teledermatologist suggested an inappropriate treatment plan. These findings indicate that appropriate clinical management was possible in approximately two-thirds of dermatology consultations via the video-link.

Adolescent↗