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PubMed1979

Vaccination against influenza: a five-year study in the Post Office.

An injection of influenza vaccine was offered to approximately 60 000 Postal and Telecommunications staff at the beginning of five successive winters. The sickness absence of this group, which included those who accepted the offer of vaccine as well as those who did not, was compared throughout the winter with that of a similar number of employees who were not offered vaccine. The two groups, ;vaccinated' and control, comprised the staff of nearly 400 Post Office units scattered throughout Great Britain, the units of the two groups being matched as far as practicable for numbers employed, type of work, region and type of location.The proportion who accepted vaccine fell from 42% in the first year (when only 26 000 Telecommunications employees were offered vaccine) to 35% in the second year, and 25% by the fifth year.With the exception of Telecommunications employees in 1972-73, the sickness absence rate of the group offered vaccine was less than that of the group not offered vaccine, and the difference was evident during the winter observation periods both when influenza was prevalent and when it was not. In the last four years of the study the average difference in sickness absence between the ;vaccinated' and control groups was 1.26 days per 100 employees per week during and 1.12 days outside the influenza periods. Moreover, the difference during the influenza periods was greater than could be expected from the acceptance rate of vaccine and the estimated attack rate of influenza. The apparent reduction in sickness absence of the group offered vaccine in comparison with the group not offered vaccine represented an appreciable saving in cost.It is suggested than an annual influenza vaccination campaign in industry may produce financial benefit, but that only a proportion of the benefit is due to an improvement in health.

Absenteeism↗

PubMedDate not supplied

The psychosocial impact of interactive computer use within a vulnerable elderly population: a report on a randomized prospective trial in a home health care setting.

Quality of care for vulnerable elderly clients makes it important to consider the psychosocial effects of interactive computer use as a means to communicate for social, functional, and/or health care purposes in a home health care setting. In a 3-month randomized prospective trial, telecommunications terminals were installed in the private residences of computer-illiterate persons, 65-years-of-age and older, providing visiting nurses the opportunity to teach computer use with three different training methods. The control group had similar weekly nurse visits, but no computer terminal use. Pre-posttests using the Rosenberg Self-Esteem Scale and the Geriatric Depression Scale compared change in self-esteem and depression scores of computer-use clients with the scores of the control group clients. Interactive computer use, alone, did not significantly change scores. Compared to the control group, however, there was a significant change toward improved self-esteem and depression when interactive computer use was accompanied with weekly nurse computer training. Weekly training with a significant other, as a substitute for the nurse trainer, significantly improved self-esteem scores but not depression scores. Interactive computer use was not associated with decreased self-esteem or increased depression. Attitude changes and responses to the particular telecommunication service used in this study were mixed, suggesting future research should be based on improved telecommunication systems with access to programs that have greater practical application to the needs of elderly clients.

Aged↗

PubMed1995

Current issues in telepathology.

Telepathology involves rendering diagnostic opinions on specimens at remote locations using computer and telecommunications technologies. Consultations are a routine practice pattern in pathology, as there is a large amount of diagnostic and prognostic information available from the examination of biopsy material that requires an extensive knowledge of diseases and their clinical implications. Pathologists therefore frequently request opinions from those who subspecialize in various diseases. The use of video technology to examine and consult on microscopical slides has been validated, although sparsely and with a number of technical issues as yet unresolved. There are two principal paradigms for telepathology: remote dynamic screening by robotic video microscopy and remote diagnosis from selected still video microscopical images. The former is more appealing to most pathologists; however, it requires very high speed telecommunications links that are expensive and may not be available in a given location. The latter method entails a significant reduction in the data on which the diagnosis is rendered, as one is dependent on the fields selected at the remote location. In addition, there are hybrid systems that combine limited robotic capabilities with high-resolution still images. Image compression can increase the number of images that can be transmitted over an otherwise-limiting telecommunications infrastructure. JPEG is the current standard for such compression. Despite certain limitations, telepathology has been demonstrated successfully at several sites around the world. As this technology matures, systems will offer higher resolution, standardization of file formats, and better compression at lower cost.

Computer Communication Networks↗

PubMedDate not supplied

Digital imagery/telecytology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Optical digital imaging and its related technologies have applications in cytopathology that encompass training and education, image analysis, diagnosis, report documentation and archiving, and telecommunications. Telecytology involves the use of telecommunications to transmit cytology images for the purposes of diagnosis, consultation or education. This working paper provides a mainly informational overview of optical digital imaging and summarizes current technologic resources and applications and some of the ethical and legal implications of the use of these new technologies in cytopathology. CONSENSUS POSITION: Computer hardware standards for optical digital imagery will continue to be driven mainly by commercial interests and nonmedical imperatives, but professional organizations can play a valuable role in developing recommendations or standards for digital image sampling, documentation, archiving, authenticity safeguards and teleconsultation protocols; in addressing patient confidentiality and ethical, legal and informed consent issues; and in providing support for quality assurance and standardization of digital image-based testing. There is some evidence that high levels of accuracy for telepathology diagnosis can be achieved using existing dynamic systems, which may also be applicable to telecytology consultation. Static systems for both telepathology and telecytology, which have the advantage of considerably lower cost, appear to have lower levels of accuracy. Laboratories that maintain digital image databases should adopt practices and protocols that ensure patient confidentiality. Individuals participating in telecommunication of digital images for diagnosis should be properly qualified, meet licensing requirements and use procedures that protect patient confidentiality. Such individuals should be cognizant of the limitations of the technology and employ quality assurance practices that ensure the validity and accuracy of each consultation. Even in an informal teleconsultation setting one should define the extent of participation and be mindful of potential malpractice liability. ONGOING ISSUES: Digital imagery applications will continue to present new opportunities and challenges. Position papers such as this are directed toward assisting the profession to stay informed and in control of these applications in the laboratory. Telecytology is an area in particular need of studies of good quality to provide data on factors affecting accuracy. New technologic approaches to addressing the issue of selective sampling in static image consultation are needed. The use of artificial intelligence software as an adjunct to enhance the accuracy and reproducibility of cytologic diagnosis of digital images in routine and consultation settings deserves to be pursued. Other telecytology-related issues that require clarification and the adoption of workable guidelines include interstate licensure and protocols to define malpractice liability.

Computer Communication Networks↗

PubMed2000

An evaluation of satisfaction with telemedicine among health-care professionals.

A survey was conducted among non-doctor health-care professionals in six rural counties in Missouri. The purpose of the survey was to establish baseline data to evaluate the effect of changes in the health-care sector, especially technology changes, on the job satisfaction, career satisfaction, relationships and communication activities of health professionals. The survey included three rural counties in which integrated telecommunication and interactive video telemedicine services were being installed, but before significant activities had begun, and three comparator counties without substantial integrated telecommunications infrastructure and telemedicine services. During a one-month study period, 1108 questionnaires were distributed. The total response rate was 50.1% (n = 555). Of the respondents, 30.3% indicated that technology in health-care was having a large effect on their work, although only 18.2% indicated that telemedicine and telecommunications were having a large effect. No systematic differences were found among the health professionals in the two communities at the time telemedicine equipment was being installed.

Health Knowledge, Attitudes, Practice↗

PubMed2003

The principles of telemedicine in practice.

Telemedicine (distance medicine) represents a field of medicine that has been in a tremendous expansion over the last couple of years thanks to the fast development of telecommunications and reduction of their costs. It enables a direct communication (visual) between the peripheral hospitals and referral facilities in the interior of the country as well as a connection of centres with referral centres abroad in the fields of diagnostics, consultations or education. The main objective is to encourage interest in telemedicine among physicians and other health care experts, initiate an exchange of opinions, and experience about the application of telecommunication technology in medicine, so to reach a common perception of its role in the context of future development of the health care system in Bosnia and Herzegovina. As a standard, current equipment consists of computers, which are equipped with frame grabbers and communication modem for communication through a public telecommunication system. Input data can all be visual data (X-Ray, CT, MRI, ultrasound, ECG, histological finding, cariogram, and of course photos of the patients, of operational/surgical field. The Institute of Pathology of the Sarajevo Medical Faculty has actively participated in the experimental project "SHARED" (1996-2000) together with the Radiology and Ophthalmology Clinic of the Sarajevo Clinical Centre. The past experience in using telemedicine has shown that the introduction of such a telemedicine system in B&H would be of great significance in the future in the context of providing better and more efficient health services to the patients. In practice, that means a more simple approach to some services and data for patients, a better and faster circulation of information and experience of medical experts and health care workers with cost control at the same time.

Journal Article↗

PubMed1995

Medical resources on the Internet.

Advances in telecommunications technology in the last decade have fostered the development of computer networks that allow access to vast amounts of information and services. Of the many computer networks that have been developed, the most prominent is the Internet. Originally intended to be a way to share computing resources among academic and research institutions in the United States, the Internet has gradually evolved into a worldwide network of computers that provides various services reflecting the eclectic nature of its component networks. The recent upsurge in interest in the Internet is due to several mutually reinforcing factors: increased ease and availability of access to the Internet, lower access charges, faster communications, and more organizations offering commercial and noncommercial services over the Internet. Of particular interest to the medical community is the large and increasing number of technical, scientific, and biomedical resources that can be accessed through the Internet. Most large medical centers have publicly accessible information, and some large organizations, such as the National Institutes of Health, have extensive databases and services that can be used by medical researchers, clinicians, and educators. In addition, many medical organizations and some medical journals are advertising their services over the Internet and can be contacted through electronic mail. As the cost of telecommunications decreases and the speed of telecommunications increases, new forms of computer communication, such as long-distance, real-time audio, and video services will become available. Computer networks in general and the Internet in particular are likely to play more important roles in many aspects of medicine in the future.

Computer Communication Networks↗

PubMed1994

Carriers of healthcare's load of information.

As the market for telemedicine products and services expands, many long distance telecommunications carriers and regional Bell operating companies developed strategies for meeting healthcare's needs. Some initiated projects to display their capabilities or to receive returns on investments in telecommunications infrastructures. Their capabilities and use of advanced technologies vary. The level of their healthcare commitment and involvement also varies. Regional Bell companies compete fiercely with each other and with national carriers for consulting and implementation contracts, unrestricted by service area boundaries. On the following pages, representatives from most of the major telecommunications carriers express their firms' healthcare strategies and offer synopses of their notable healthcare projects. For many, their resources are vast, their expertise undisputed. Access to high-quality healthcare services stands to benefit from their involvement.

Health Services Needs and Demand↗

PubMed1999

Telemedicine: an overview.

Telemedicine--the use of telecommunications and computer technology to provide medical information and services at a distance--is growing in popularity. Because of the rapid advances being made in the technology, more and more clinical applications can now be performed via telemedicine. However, the decision to adopt telemedicine should be made only if a clinical need for this technology can be demonstrated. And successful implementation and operation depend on specifically designing the technical infrastructure--that is, the computer hardware and software and the telecommunications system--to meet this clinical need. But even more important is making sure that everyone involved in such a program, including clinicians, telecommunications suppliers, and patients, understands the objectives, benefits, and particular requirements of telemedicine. In this Guidance Article, we provide an overview of the issues surrounding telemedicine. We present examples of successful telemedicine programs, along with guidance for facilities considering programs of their own. We also outline the barriers to successful implementation. And we discuss how, once a telemedicine program is in place, facilities can evaluate the effect of the program on their delivery of healthcare. In supplementary articles, we discuss the technology used for telemedicine and provide a list of telemedicine resources for readers who wish to learn more about the subject.

Confidentiality↗

PubMed1998

The strategic plans of OTE concerning the development of telemedicine applications based on the Euro-ISDN technology.

OTE SA, the Hellenic Telecommunications Organization, is the major public network operator of Greece and aims to actually promote all services made available through this technology and more peculiarly that of telemedicine. Through its modernization plan in progress, OTE aims at providing wide/range, high/quality competitive services on the basis of customer oriented policies. Its activities cover, besides basic telephony (5.9 million lines), data communications, leased lines, maritime communications and value-added services. The public health service has a lot to profit from efficient use of telecommunications. The greatest challenge the health service is faced with, is the growing gap between the expectations of the population, and the resources that society can set-aside for health purposes. Increasing the level of efficiency and co-operation is therefore the best probable response to the challenge. Telecommunications may contribute to a more effective utilization of resources, typing together those that could be in benefit of the health sectors in the process of implementing a large number of telemedical services.

Greece↗

PubMed1999

Remote Communities Services Telecentre Project.

The delivery of teleservices to rural communities is challenged by the high cost of infrastructure and maintenance. This is compounded if land-based telecommunication links are absent or if bandwidth is limited, as is the case in many areas of the world. The concept of the Remote Communities Services Telecentre (RCST) is a shared-use facility that can be implemented in rural and remote communities to provide telelearning, telehealth, communications, and information access services. This can be through conventional telephony or cable or, as more likely in remote regions, through the use of a shared wireless facility using satellite. This model is being implemented as a wireless network in the Province of Newfoundland through collaboration between the Telemedicine and Educational Technology Resources Agency (TETRA) of Memorial University and a number of partners. Private sector partners in St John's include Collaborative Network Technologies Inc. (CNTI) and FutureWorks Inc. Partners in Ottawa include Telesat Canada, QTECH Hybrid Systems, and the Communications Research Centre. Funding support has been provided by the Canadian Network for the Advancement of Industry, Research and Education (CANARIE); Operation ONLINE of Newfoundland and Labrador; and the European Space Agency. The Newfoundland partners were part of the Team Canada exhibitors group at the G7 Information Minister's Summits in 1995 (Brussels) and 1996 (Johannesburg). The TETRA Centre at Memorial University has previously been involved with international telehealth and telelearning projects in Africa and the Caribbean. This presentation will discuss the RCST project as a model for widespread implementation in the belief that many rural communities world-wide which currently lack adequate wired telecommunications, will opt strategically for a wireless solution given technologic and economic realities. The concept of the Remote Communities Services Telecentre (RCST) is to provide a telecommunications resource facility in small remote communities that have limited communications infrastructure. Such communities are found throughout the world, in lesser-developed and developed countries. In Canada, these communities tend to be in the north. The Telemedicine and Educational Technology Resources Agency (TETRA) of Memorial University has considerable experience in the delivery of services in education and health to such northern Canadian communities.

Computer Systems↗

PubMed1997

An overview of telemedicine.

Greater attention has been given recently to information technology and telecommunication reforms and their use for the improvement of health care service delivery. Broadly defined, telemedicine is the use of advanced telecommunications technologies for the purposes of making diagnoses, conducting research, transferring patient data, and/or improving disease management and treatment in remote areas. The emphasis is on use of telecommunications technologies at remote sites. This article provides a brief overview of telemedicine, its potential clinical applications, and the various benefits and leading issues surrounding it. It also describes selected telemedicine projects conducted at the University of Maryland School of Medicine in Baltimore.

Computer Communication Networks↗

PubMed1977

A clinical evaluation of four alternative telemedicine systems.

A comparison was made of four alternative telecommunication systems used in delivering primary health care to remote populations. The media were color television, black and white television, still frame black and white television, and hands-free telephone. The patient population was that of a large organization in a Canadian province, a major component of a societal system. Over 1000 patients who came to a clinic seeking medical attention were examined remotely by one of the four systems. In addition, they were examined in the physical presence of a doctor at the clinic. The diagnoses, patient management programs, etc., of the clinic physician were used as the basis for comparison. We found no significant differences in diagnostic accuracy, proportion of supporting investigations requested, e.g., laboratory tests and X rays, time taken for the diagnostic consultations and the effectiveness of patient management across the four communication modes. On the contrary, in some instances it was found that behavior across the modes was significantly similar. Even patient attitudes showed only a slight preference for the more sensory rich modes of communication. It was concluded that there is little to distinguish the effectiveness of the four telecommunication modes when used for remote diagnostic consultations. Therefore, the cheapest mode is the most cost-effective. Phase four of the research program will compare the effects of the two least costly modes, still frame television and hands-free telephone, in an operational system in northern Ontario.

Attitude↗

PubMedDate not supplied

Interactive voice response system (IVRS) in health care services.

Recent advances in telecommunications technology have created opportunities to enhance the quality of health care services through telehealth, the use of telecommunications and information technologies to deliver health care. However, the diverse technologies and applications encompassed by telehealth have tended to confuse discussions of the effectiveness of these programs. An interactive voice response system (IVRS) is a simple, yet effective telehealth application that improves access to health care by continuing care beyond the hospital setting, with specially tailored programs that are easily accessible to patients around the clock. Often described as a telephone connected to a "talking computer," an IVRS allows patient interaction for data collection or to deliver recorded telephone messages related to medication compliance or behavior modification. Despite easy access to touchtone telephone services and growing familiarity with IVRS, many health care providers are unaware of these programs. This paper reviews the infrastructure of IVRS technology and its uses in health care.

Continuity of Patient Care↗

PubMed2000

Minimally invasive surgical training solutions for the twenty-first century.

Despite the tremendous impact of laparoscopic cholecystectomy on the practice of surgery over the past 9 years, minimally invasive surgery faces many challenges that must be addressed. SAGES and the American College of Surgeons already have defined guidelines that, if properly implemented, could eliminate most of these challenges. Medical educators must formulate a detailed program as to how these guidelines can be widely deployed with acceptable effectiveness. The current educational philosophies and techniques will not ensure widespread access to a standardized program that would support the achievement of the goals set forth by major surgical governing bodies. Therefore, new educational strategies and techniques that are assisted with the integration of cost-effective technology are needed. Suggested solutions include the deployment of a standardized, objective-based skill-development program that has a large database to evaluate the progress of participants. Next, the Internet, with its ability to transfer content with the click of a mouse, will play an increasing role in distant education. Video and audio streaming techniques will allow the deployment of content previously shackled to a CD-ROM platform. CD-ROM interactive technology also can help in developing clinical judgment with innovative strategies, such as Objective-Based Clinical Competency Evaluation Scenarios. Telecommunications will fuse the components of a coordinated distant learning strategy. Also, telecommunications will allow the availability of new training capabilities in the form of teleproctoring and telementoring to hospitals, no matter what their size or location. All of these components combined enable the realization of a continuing education program in minimally invasive surgery that is readily available to hospitals worldwide. Last, institutions, resident training programs, and individual surgeons must commit the time to partake in these cutting-edge programs for challenges facing us to be completely eliminated. A high priority must be placed on the resolution of these issues.

Education, Medical↗

PubMed2001

Resisting and promoting new technologies in clinical practice: the case of telepsychiatry.

New telecommunications technologies promise to profoundly change the spatial and temporal relationship between health professional and patient. This paper reports results from an ethnographic study of the introduction of a videophone or 'telemedicine' system intended to facilitate faster and more convenient referral of patients with anxiety and depression in primary care, to a community mental health team. We explore the reasons for contest over the telemedicine system in practice, contrasting professionals' critique of the technology in play with a more fundamental problem: the extent to which the telecommunications system threatened deeply embedded professional constructs about the nature and practice of therapeutic relationships.

Anxiety Disorders↗

PubMed1992

Radiology on the air. A continuing medical education experiment.

RATIONALE AND OBJECTIVES: The purpose of Radiology on the Air was to assess the technical and educational feasibility of providing radiologic continuing medical education via a fully interactive live telecommunications network. METHODS: Thirty-nine radiologic conferences were broadcast over the communications network of the Microelectronics Center of North Carolina (MCNC). Category 1 credit for the Physicians Recognition Award of the American Medical Association was available to participants who returned a completed program evaluation sheet by mail. RESULTS: Three participating academic institutions regularly offered the programming to a total of 684 participants, of whom 129 viewed programs at distant sites. Despite adequate-to-excellent technical quality and positive feedback concerning educational content, no continuing medical education (CME) credits were issued by the parent institution. CONCLUSIONS: The Radiology on the Air experiment suggests that a live telecommunications network is a capable vehicle for providing CME in radiology.

Education, Medical, Continuing↗

PubMed1996

Telemedicine and developing countries.

A committee was established by the International Telecommunication Union in 1994 to study telemedicine, with particular reference to developing countries. A questionnaire was used to gather data. Fifty-eight responses were received, two-thirds from developing countries. In most developing countries the user did not pay for the telemedicine service, at least not directly. There were few instances of a commercial telemedicine service, and in most countries the telemedicine service was subsidized by the government or another party. The telemedicine 'value chain' describes how equipment suppliers, telecommunications operators and health-care professionals deliver their products or services to the client, who is eventually the ultimate user. Quite different configurations are conceivable, and an analysis of what could be a sustainable, cost-effective value chain in developing countries is required. It is clear that the rapidly growing interest in telemedicine challenges the leaders of the medical establishment to rethink the ways they provide their services and to address the medical needs of areas where such services are absent or in short supply.

Cost-Benefit Analysis↗