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At least 451 records · Page 25Linked to original sources
PubMed2002

Telemedicine applications for the regional paediatric cardiology service in Northern Ireland.

The regional paediatric cardiology centre in Northern Ireland has a telemedicine network linking the neonatal units of three district general hospitals using ISDN and IP-compliant equipment. We have previously reported the use of ISDN transmission at 128 kbit/s for remote echocardiography. In a series of 61 patients, a total of 59 transmitted scans were of sufficient diagnostic quality to confirm or exclude the presence of major congenital heart disease (CHD). There were three diagnostic errors (7%). Subsequently, we have examined the use of ISDN transmission at 384 kbit/s. Echocardiographic studies were carried out on 21 patients and all were followed up. Fourteen patients (67%) had CHD confirmed. There were two diagnostic errors (10%). Our experience of transmitting live echocardiographic images suggests that ISDN at 384 kbit/s provides the optimum balance between the clarity of the transmitted images and costs. We expect that IP videoconferencing will offer similar quality but at a lower running cost, and are currently assessing it in a pilot study. All sites within our network will remain capable of ISDN transmission until the efficacy and reliability of IP transmission has been demonstrated in a controlled trial. The clinical telemedicine service has led to the earlier diagnosis of and instigation of appropriate treatment for CHD.

Computer Communication Networks↗
PubMed2002

Patient-focused urban tele-ophthalmology services.

Since 2000, routine tele-ophthalmology services have been provided by St Erik's Eye Hospital to three large urban primary care centres in Stockholm. Diagnostic support from the specialist eye hospital to primary care centres uses video slit-lamps and realtime videoconferencing. After the initial introduction period at the primary care centres, the number of teleconsultations stabilized at a very low level. Despite this, the general practitioners learned to handle more diagnostic conditions by themselves and to identify what diagnostic situations should be referred to a specialist without having to consult the specialist beforehand via telemedicine. The availability of instant eye expertise via telemedicine therefore proved to be an excellent on-the-job training tool to develop and maintain the diagnostic competence of general practitioners. Patient satisfaction was high.

Eye Diseases↗
PubMed2002

Using commercially available technology to assist in the delivery of person-centred health and social care.

Videoconferencing (via ISDN at 128 kbit/s) was used between a service provider, the South and East Belfast Health and Social Services Trust, and clients at home. The equipment was used successfully by various health-care workers and was sufficient for the clinical requirements of professional staff. Our experience demonstrated that there are clinical benefits of telecare. The users perceived that the technology added to the quality of their lives. Clients reported feeling less isolated, more secure at home and more in control. The Trust is currently commissioning purpose-built accommodation for adults with cognitive impairment. The residents will be people who are on the verge of requiring institutional care. Presence sensors, appliance and door contacts will allow lifestyle patterns to be monitored. The system will notify the service provider's staff of variations from the norm for each resident.

Adult↗
PubMed2002

Technical innovations in international e-nursing.

Saudi Arabia faces a severe shortage of nurses. An online nursing degree is being introduced as one approach to this problem. In 1999, the College of Nursing and Health Science at George Mason University formed a strategic partnership with IMED Link, a private telehealth company, to deliver online nursing education. Nine courses have been developed so far, including nursing assessment. The educational material will be distributed via Saudi Arabia's telemedicine network. The courses will be led by professors of nursing at George Mason University using videoconferencing, coupled with online computer classes and Internet tools. Both nursing content and expertise in Web technologies are necessary to develop a successful e-nursing programme.

Curriculum↗
PubMed2002

Design and performance of a multicentre, randomized controlled trial of teleconsulting.

We have designed and performed a multicentre, randomized controlled trial of teleconsulting. The trial investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing as an alternative to general practitioner referral to a hospital specialist. The participating general practitioners referred a total of 3170 patients who satisfied the entry criteria. Of these, 1040 (33%) failed to provide consent or otherwise refused to participate in the trial. Of the patients recruited to the trial, a total of 1902 (91%) completed and returned the baseline questionnaire. Although the trial was successful in recruiting sufficient patients and in obtaining high questionnaire response rates, the findings will require careful interpretation to take account of the limits which the protocol placed on the ability of general practitioners to select patients for referral.

Family Practice↗
PubMed2002

Design of a centralized telemedicine model in Palestine.

To provide patients with easy-access telemedicine services in Palestine, a simple and low-cost telemedicine system has been established. The system is based on a star topology network between local hospitals and a main telemedicine centre. In a pilot trial, a computerized tomography image was transmitted from a local hospital connected to the telemedicine service centre by ISDN (128 kbit/s). A videoconferencing discussion between the two ends was held. The performance of the system was satisfactory. The transmission time for a 1 MByte image was about 60 s. A conference was conducted to discuss this real clinical case by use of interactive sharing of the medical record. The session lasted 20 min. Encouraging results were obtained. The pilot study suggests that telemedicine can overcome existing isolation problems of cities and villages and the difficulties of transferring patients from one location to another.

Algorithms↗
PubMed2005

User satisfaction with a telemedicine amputee clinic in Saskatchewan.

A group of 15 patients with amputee-related diagnoses were given a satisfaction survey after telemedicine assessment. Most of the videoconferencing sessions used an IP connection at 768 kbit/s. The patients were seen at four sites. The average connection time was less than 5 min and the average time for a session was approximately 40 min. Thirteen questions required scaled responses (poor, fair, good, excellent) and two required yes/no answers. The 13 categories broadly related to satisfaction with the telemedicine service and the quality of specialist care. In all categories, 97% of the responses fell in the good to excellent range. Concerns were raised about ease of access to local telemedicine sites, connection waiting times and lack of familiarity with telemedicine technology. The study showed that telemedicine was acceptable to patients with amputations and provided a reliable assessment of the amputee.

Adult↗
PubMed1995

An evaluation of the use of interactive television in an acute psychiatric service.

This study reports the results of the use of a low-cost videoconferencing system (LCVC) for communication in an acute psychiatric service. Qualitative research methodology was used to examine the use of the LCVC in interactions between psychiatrists, patients and nursing staff, including information on refusals. One hundred and five clinical interactions were studied over four months. The LCVC proved technically reliable and compatible with the performance of a wide range of clinical tasks. However, the results suggest the need for better understanding of the nature and origins of the attitudes that users bring to the use of such communications technology. A framework is presented for the classification of user responses in terms of preexisting attitudes of the users, technological limitations of the system and the mental state of the users. The study demonstrated the potential for interactive television to support many of the communication tasks necessary in a dispersed psychiatric service and for telepsychiatry to become a major method of service provision.

Community Mental Health Services↗
PubMed1995

Telemedicine in rural areas. Experience with medical desktop-conferencing via satellite.

Cooperation between physicians in hospitals in rural areas can be assisted by desktop-conferencing using a satellite link. For six weeks, medical desktop-conferencing was tested during daily clinical conferences between the Virchow-Klinikum, Berlin, and the Medical Academy, Wroclaw. The communications link was provided by the German Telekom satellite system MCS, which allowed temporary connections to be established on demand by manual dialling. Standard hardware and software were used for videoconferencing, as well as software for medical communication developed in the BERMED project. Digital data, such as computed tomography or magnetic resonance images, were transmitted by a digital data channel in parallel to the transmission of analogue video and audio signals. For conferences involving large groups of people, hardware modifications were required. These included the installation of a video projector, adaptation of the audio system with improved echo cancellation, and installation of extra microphones. Learning to use an unfamiliar communication medium proved to be uncomplicated for the participating physicians.

Germany↗
PubMed2002

Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250].

BACKGROUND: Appropriate information flow is crucial to the care of patients, particularly at the interface between primary and secondary care. Communication problems can result from inadequate organisation and training, There is a major expectation that information and communication technologies may offer solutions, but little reliable evidence. This paper reports the design and performance of a multi-centre randomised controlled trial (RCT), unparalleled in telemedicine research in either scale or range of outcomes. The study investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing to perform joint tele-consultations as an alternative to general practitioner referral to the hospital specialist in the outpatient clinic. METHODS: Joint tele-consultation services were established in both the Royal Free Hampstead NHS Trust in inner London, and the Royal Shrewsbury Hospitals Trust, in Shropshire. All the patients who gave consent to participate were randomised either to joint tele-consultation or to a routine outpatients appointment. The principal outcome measures included the frequency of decision by the specialist to offer a follow-up outpatient appointment, patient satisfaction (Ware Specific Questionnaire), wellbeing (SF12) and enablement (PEI), numbers of tests, investigations, procedures and treatments. RESULTS: A total of 134 general practitioners operating from 29 practices participated in the trial, referring a total of 3170 patients to 20 specialists in ENT medicine, general medicine (including endocrinology, and rheumatology), gastroenterology, orthopaedics, neurology and urology. Of these, 2094 patients consented to participate in the study and were correctly randomised. There was a 91% response rate to the initial assessment questionnaires, and analysis showed equivalence for all key characteristics between the treatment and control groups. CONCLUSION: We have designed and performed a major multi-centre trial of teleconsultations in two contrasting centres. Many problems were overcome to enable the trial to be carried out, with a considerable development and learning phase. A lengthier development phase might have enabled us to improve the patient selection criteria, but there is a window of opportunity for these developments, and we believe that our approach was appropriate, allowing the evaluation of the technology before its widespread implementation.

Adult↗
PubMed2000

Interactive television for an urban adult mental health service: the Guy's Psychiatric Intensive Care Unit Telepsychiatry Project.

We carried out a feasibility study of an interactive television (IATV) system to enhance the provision of psychiatric intensive care services to a remote adult acute psychiatric ward in the same National Health Service mental health trust. The system used videoconferencing equipment connected by ISDN at 128 kbit/s. The system was used for patient referral, assessment and monitoring by staff at the remote site 8 km away.

Adult↗
PubMed2000

Improving quality of life for dialysis patients through telecare.

Home dialysis can improve the care and quality of life for patients with renal failure. We have explored the possibility of extending home care to more patients needing continuous ambulatory peritoneal dialysis (CAPD) using telemedicine. We tested videoconferencing support for five CAPD patients using low-cost ISDN equipment (128 kbit/s). Initial results indicated that it was possible to integrate videocommunication into the daily routine of the clinic and the response from patients was surprisingly positive. Selection of appropriate, affordable technology and the ISDN service support by the telecommunications provider proved to be considerably more difficult than anticipated. The first indications also suggest medical advantages for home teledialysis.

Germany↗
PubMed2000

Telemedicine services to a county jail.

Local and county jails rarely offer telepsychiatry services to their inmates. We have established a telepsychiatry pilot project between the Kansas University Medical Center and the Lyon County Jail in Emporia, Kansas. A total of 264 telepsychiatry consultations were conducted with jail inmates. Of these, 70 were initial evaluations and 194 were follow-up visits; only one inmate refused to be seen. Approximately one-third of all inmates were seen for psychiatric consultation within one week of their incarceration and 68% were seen within one month of incarceration. Among lessons learned during the first year of service were: the monthly demand for consultations was five times greater than projected; moderately to severely ill inmates with a broad range of psychiatric illness can be seen and treated effectively using videoconferencing; and the technology was accepted by the jail personnel and the inmates alike and integrated into the jail's routine in terms of the delivery of psychiatric care.

Adult↗
PubMed2000

An exploratory survey of the applications of telemedicine in Ghana.

We examined the use of telemedicine at two major medical institutions in Ghana. Doctors and administrators were surveyed to assess their knowledge of computers and familiarity with telemedicine. The use of modern telecommunications and information technology products within the health service was also examined. Thirty questionnaires were distributed to staff at the two hospitals, one urban and one rural. Twenty were returned (a response rate of 67%). Although most of the respondents were computer literate, they were less familiar with telemedicine applications. Only a minority of the respondents were participating in an information-sharing network, transmitting information by fax or telephone, or had Internet access. Financial constraint appeared to be the major barrier to establishing information-sharing networks. Other constraints were technological and organizational. The respondents expressed an interest in using telemedicine, having access to health-care databases and specific telemedicine applications such as tele-education and videoconferencing. Staff in the urban hospital were more likely to be familiar with telemedicine and more likely to have access to information technology than those in the rural hospital.

Ghana↗
PubMed2000

Teledermatology--the requirements of dermatologists in private practice.

Eighty-four dermatologists in private practice in Bavaria were surveyed by postal questionnaire. Of the 45 who responded (a 54% response rate), 96% used a computer in their private practice. Fifty-seven per cent of respondents owned systems with Pentium processors, while 23% were still using 386 or 486 processors. Most of them used the Windows 95, UNIX or Apple operating system. Of the respondents who had a modem, 74% used ISDN. There were few modems connected to the ordinary telephone network. Of all respondents, 56% used email regularly. Several possible teledermatology applications were proposed in the survey (i.e. teleconsultation, on-line/off-line videoconferencing, email attachments). Fifty-six per cent of respondents said that they would perform teleconsultations with dermatology clinics, 40% preferred a teleconsultation via telephone and computer, and 42% sending files via email. The survey demonstrated that a high proportion of dermatologists in private practice would use a teledermatology service.

Adult↗
PubMed2000

Do community alarm users want telecare?

Previous surveys have suggested that community alarm users are in general satisfied with the service provided. However, there is also evidence that users would like additional options that could be provided by a telecare system. Inner-city users of community alarms were consulted about their current systems and the extension of these to incorporate telecare options. The users lived in 160 homes in three multistorey apartment blocks. The average age of the 176 users surveyed was 76 years. Seventy-seven per cent of users were interested in automatic fall detection, 68% in lifestyle monitoring, 57% in telemedicine and 46% in videoconferencing. Nineteen of those interviewed (11%) did not want any of the suggested enhancements. The survey showed that elderly people are not technophobes, since 58% possessed either a microwave oven or a video-recorder, and also showed that the majority were prepared to accept new technologies that would support their independence.

Aged↗
PubMed2000

Telehealth in speech pathology: applications to the treatment of stuttering.

The potential value of telecommunications systems in treating communication disorders is being increasingly recognized. This mode of service delivery shows particular promise in giving patients access to specialist services for problems like stuttering, which are difficult to manage and often require long-term follow-up support. The Institute for Stuttering Treatment and Research at the University of Alberta has used videoconferencing to provide follow-up support to geographically remote adults who have undergone intensive treatment on site.

Alberta↗
PubMed2000

The design and implementation of an off-the-shelf, standards-based tele-ultrasound system.

We developed an off-the-shelf system to transfer DICOM-compliant ultrasound images from a small rural hospital in northern Alberta to an urban radiology clinic in Calgary. The transfer time was less than 30 s per image. The radiologist could then review the case and release the patient. The radiologist could also switch to realtime videoconferencing mode and direct the rural ultrasound technician to obtain additional images of the patient.

Alberta↗