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 469 records · Page 26Linked to original sources
PubMed2001

Telepsychiatry consultations to a rural nursing facility: a 2-year experience.

This report describes the operation of a telepsychiatry consultation service provided from an academic medical center to a skilled nursing facility in a rural setting. Seventy-one consultations via low-cost ISDN videoconferencing equipment were provided over the 2-year period to 40 patients. The average duration of the consultation period was about 3 months. A wide variety of diagnostic conditions were encountered, with the majority being either depression or dementia-related behavior problems. Advantages of the program included the ability to respond promptly to rural patients' clinical needs, the flexibility to consult more frequently if clinically indicated, and more efficient use of the consultant's time, as travel time was eliminated. The program is an example of how telepsychiatry can successfully expand access to mental health services to residents of long-term care facilities.

Aged↗
PubMed1997

Program activity in the second year of the Rural Telemedicine Grant Program Part 2.

Part 1, in our last issue, detailed the activity levels, number and types of consults, and transmission costs of the 13 telemedicine networks funded in 1994 by the Office of Rural Health Policy's Rural Telemedicine Grant Program. This concluding section presents the authors' conclusions drawn from the objective data in Part 1.

California↗
PubMed2000

Teleconsultations in Pohnpei State, Federated States of Micronesia.

A case report of 6 years old female who sustained a difficult right subtronchanteric fracture of the femur is outlined. She was treated successfully, with local materials, over the internet with assistance of the orthopaedic surgeons at the Tripler Army Medical Center in Honolulu. Pohnpei State spends 10% of the health budget in referring patients off-island for tertiary treatments and this serves less than 1% of the total population. Before the use of the internet, approximately $US1,500 per month was spend on telephone bills, for outside consultations. After connection to the internet and the consult webpage, particularly at Tripler, this cost was reduced to below $US500 per month. To date, fifty consults, via the Internet, have been sent to the TAMC Consult Webpage. The introduction of this service has resulted in cost saving in terms of referral communication and perhaps avoided unnecessary off island evacuations. The difficulties so far have been limitation of on-line access and computer illiteracy amongst physicians.

Child↗
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↗
PubMed2005

Can subspecialty cancer consultations be delivered to communities using modern technology?--A pilot study.

The objective of this project was to evaluate patient and physician acceptance of subspecialty oncologic teleconsultation for distant communities. Many newly diagnosed cancer patients have to travel several hours and long distances to attend specialty medical oncology consultations at our regional cancer center in Victoria, BC. Difficulties in recruiting of oncologists in Vancouver Island have prompted the search for other means to deliver subspecialty consultation closer to home. Teleconsultation seemed a possible model. Hence, 30 sequential patients with gastrointestinal (GI) malignancy referred from the Central Island region were seen after an informed consent via videoconferencing and 30 sequential patients were seen face to face in Victoria by one oncologist. Patients and the oncologist filled out a satisfaction questionnaire. The age, sex, proportion of patients who subsequently received chemotherapy, and the number of other co-morbid conditions were similar in both groups. No difference was observed in patient satisfaction whether patients were seen via videoconference or in person. However, the oncologist felt the video did not go as well as face-to-face consultation. Patients were very satisfied with teleconsultation, and it saved them hours of travel.

Aged↗
PubMed1999

End-user point of view to establish real-time broadband ATM connection over Europe.

There have so far been few discussions about how the international broadband services will be created in practice. In this paper we concentrate on two separate international telemedicine trials in which Satakunta Central Hospital took part in the HIM project. In these trials we tested real-time video consultation over the international point-to-point ATM network connection between hospitals in Finland, Portugal and Germany. The quality of the consultations were clinically first-rate in both trials. The technological lesson learned from these trials was valuable for the operators in establishing broadband connections in Europe. The network connection was analysed based on transmission capabilities of the network connection.

Computer Communication Networks↗
PubMedDate not supplied

Low-bandwidth, low-cost telemedicine consultations in rural family practice.

BACKGROUND: Telemedicine, based on the use of interactive video consultations, is being used more commonly in rural settings. This development is potentially important to rural patients because there are fewer physicians, particularly specialist physicians, in rural areas. Declining costs of telemedicine equipment and transmission have created increased access to these technologies for rural family physicians and their patients. METHODS: This study considers satisfaction levels of rural family physicians, academic-based specialists, and rural patients in 130 consultations between rural physicians, rural patients, and urban academic specialists. To increase the practicability for rural use, low-cost equipment and low-bandwidth digital telephone transmission lines were utilized. Data were collected using questionnaires that were completed by patients, family physicians, and specialist consultants after each consultation. RESULTS: All categories of participants noted very high levels of satisfaction. CONCLUSION: Telemedicine-based consultations are well accepted by rural patients, rural family physicians, and urban academic specialist consultants. This approach could offer a useful adjunct to rural health care.

Attitude of Health Personnel↗
PubMedDate not supplied

[The first system of image transmission and neurosurgical telecommunication in Poland].

OBJECTIVE: The goal was to develop a fast and efficient neurosurgical teleconsulting network to improve acute neurosurgical patient care, to reduce transport costs and unnecessary occupation of neurosurgical beds. METHODS: Modems with 56 kilobits/s data transmission speed are used. CT images are transmitted straight from CT scanner via modem/telephone lines to receiving personal computer in Department of Neurosurgery. Receiving PC runs with Microsoft Windows operating system and the network software MultiView (EMED, Inc.). Network connects Department of Neurosurgery Polish Academy of Sciences in Warsaw with transmitting hospitals in Ciechanów and Ostrołeka. RESULTS: The system is fast, one study consisting 18 images is transmitted in about 5 minutes and it is simple to use, to date more than 1000 CT images have been transmitted. Operator acceptance has been very high. The system has improved acute neurosurgical patient care. Transfer of appropriate patients has been accelerated and unnecessary transfer is almost eliminated. CONCLUSION: Applied Neurosurgical Teleconsulting System has significantly improved acute neurosurgical patient care and has reduced transport expenses. Better availability of neurosurgical consultation has been achieved. The network is simple to use and has gained physician acceptance. It has to be emphasized that the creation and using of the system is relatively not expensive.

Computer Communication Networks↗
PubMed2006

[Design and implementation of a medical record management subsystem as a part of a telemedical system].

This paper introduces the work on the design and implementation of a medical record management subsystem, which is a part of a telemedicine system based on Microsoft .NET. First, an analysis is given on components and structure of medical record, together with an explanation for what is needed in a teleconsultation, how they should be organized and realized in a database, and how to deal with consultation data granularity using XML in combination with database; second, the work done during the realization stage is expatiated, including system analysis and design, database design, and system implementation.

Database Management Systems↗
PubMed2006

Use of secure e-mail and telephone: psychiatric consultations to accelerate rural health service delivery.

Telemedicine is one strategy to improve the accessibility and quality of specialty healthcare to rural settings. After nearly 10 years of video evaluation of patients in rural primary care, telephone and e-mail physician-to-physician consultations were initiated to supplement video and hasten treatment initiation. This paper proposes a model of using telephone and e-mail consultations before or in place of video consultations, because the latter are not always available or timely. Two cases are presented in depth to delineate clinical, consultation, and health services issues. Early use of telephone appears to accelerate the telepsychiatric consultation and resulted in clinical improvement for patients. Primary care providers (PCPs) appeared satisfied with the process of these consultations. The average duration of consultation was about 10 minutes for each party. Telephone and e-mail consultation appear satisfactory to providers and inexpensive, but need to be further evaluated in terms of clinical, health service, and cost outcomes.

Adult↗
PubMed1997

[Electronic medical consultation].

This short paper introduces various preprogrammed and knowledge-based decision support methods. Fundamentals of case-based reasoning, clinical algorithms, statistical decision theory, decision trees, rule-based systems, causal networks and mathematical models that can be used to store and manipulate medical knowledge are reviewed. This brief introduction can serve as a guide to papers illustrating the use of different methodologies in clinical practice.

Humans↗
PubMed2004

Patients and the Internet: a demographic study of a cohort of orthopaedic out-patients.

The Internet is a rich source of medical information but relatively few studies have evaluated its use by patients who seek medical information. The purpose of this study is to assess the demographics of Internet access and attitudes towards the Internet in a cohort of orthopaedic out-patients. Four hundred and three patients attending the orthopaedic outpatient fracture clinic completed a questionnaire consisting of six divisions including personal information, facility to access the Internet and their attitudes towards the information retrieved. Fifty per cent of the patients accessed the Internet, either from home or office and the maximum usage being in the younger age group. Twenty-nine per cent of the patients were aware of the medical information available through the Internet. 19% patients would like to have a consultation through the Internet, the maximum being in the middle-aged group. 70% of those patients who accessed the medical information reported that the Internet information was different than that obtained at consultation with the doctor at the out-patient clinic. This study reveals that the Internet use by patients is still limited. If an increased percentage of medical conditions is to be addressed through the Internet, involving patient information, on-line consultations, prescriptions and referrals, then a substantial amount of patient education and training is required

Access to Information↗
PubMed2003

A pilot telemedicine project in the Privolzhsky District, Russia.

The geography of Russia and the complex structure of the Russian health-care system make telemedicine systems especially appropriate. The telemedicine project described here deploys a telemedicine system in Nizhny Novgorod with further integration into the Privolzhsky District telemedicine network. It started with the creation of a telemedicine center with high-speed dedicated communication links to various medical institutions in Moscow, interregional telemedicine centers, and several district hospitals in rural areas of the Privolzhsky district. In addition to this specialized network, training by telemedicine specialists from the Space Biomedical Center at Moscow State University was provided along with teleconsultations with specialists from the most advanced medical institutions in Moscow. Consultations were carried out via the interregional telemedicine center on a contractual basis. The regional telemedicine network linked nearly 78 medical sites. This system provided approximately 500 teleconsultations and 100 educational sessions within the past 3 years.

Pilot Projects↗
PubMed2001

Subspecialty adnexal ophthalmological examination using telemedicine.

We studied the clinical outcome of examination of a group of patients with adnexal (eyelid and orbit) conditions. Seventeen patients with adnexal problems were assessed by an ophthalmologist at a distance using telemedicine, and then subsequently by an ophthalmologist in a face-to-face consultation. Measurements such as palpebral aperture, levator muscle function and eyelid skin crease position were recorded. The clinical outcomes from both consultations were recorded independently by the consultants and then compared. The study showed that certain adnexal conditions, such as congenital and involutional ptosis, could be accurately assessed using telemedicine, but that other conditions, such as socket problems in patients who had a previous enucleation or those with non-specific ocular pain with less clear-cut features, were better assessed in a face-to-face consultation. Overall, teleconsultations appeared to be suitable for the assessment of uncomplicated ptosis but not for less well defined conditions. Other factors, such as family dynamics and language problems, also limited the usefulness of the technique.

Communication Barriers↗
PubMed2006

The comparative impact of video consultation on emergency neurosurgical referrals.

OBJECTIVE: Neurosurgical resources are concentrated in tertiary referral centers, whereas emergencies identified from district general hospitals are traditionally referred by telephone consultation (TC). Recent advances in communication technology offer the alternative options of teleradiology (TR) and video consultation (VC). This study aimed to determine the differences among these three consultation methods on the basis of their process-of-care indicators, clinical outcomes, and cost-effectiveness. METHODS: Patients with emergency neurosurgical conditions (head injury, stroke, and miscellaneous) from a district general hospital were randomized to three different modes of consultation: TC, TR, or VC. Process-of-care indicators (postresuscitation Glasgow Coma Scale score, consultation time required, diagnostic accuracy, and transfer decision and safety), 6-month clinical outcome, and cost-effectiveness of the three consultation modes were correlated. RESULTS: In a 3-year period, 710 patients were recruited and randomized to the three consultation modes (n = 235, 239, and 236, respectively). Demographic and clinical data were comparable. TR and VC showed a definite advantage in diagnostic accuracy over TC (89.1 and 87.7% versus 63.8%; P < 0.001). However, duration of the corresponding consultation process was longer for TR and VC than TC (1.01 and 1.3 h versus 0.70 h). A high failure rate (30%) was noted in VC. Thirty-three percent of patients were transferred to the neurosurgical center after consultation. The difference in consultation modes did not have an impact on transfer rate and safety. There was a trend toward more favorable outcome (61%; P = 0.12) and a reduced mortality (25%; P = 0.025) in TR compared with TC (54 and 34%, respectively) and VC (54 and 33%, respectively). The mean cost per patient in the VC group was slightly higher than the other two groups (TC versus TR versus VC = 14,000 US dollars versus 14,400 US dollars versus 16,300 US dollars, respectively), but the differences were not statistically significant. CONCLUSION: Emergency neurosurgical consultation assisted by TR and VC achieved a higher diagnostic accuracy in comparison with conventional TC. Although VC did not show an advantage over TR in process-of-care indicators, clinical outcome, and cost, it has been proven to be a safe mode of consultation in emergency neurosurgery.

Adult↗
PubMed1997

Patient satisfaction with multispecialty interactive teleconsultations.

Satisfaction with teleconsulting was evaluated for 96 patients using the Kentucky TeleCare telemedicine network. Consultant specialties included psychiatry (41), dermatology (24), clinical nutrition (20), anaesthesia (3), infectious diseases (3), rheumatology (2), internal medicine (1), neurology (1) and paediatric pulmonology (1). The results indicated a high level of patient satisfaction, with a mean score of 6.8 (on a 7-point Likert scale with 1 = strongly disagree and 7 = strongly agree) for the question 'Overall, I was very satisfied with today's consultation'. The results indicated that the majority of patients were satisfied with the telemedicine encounter although a minority, 16%, would have preferred to have seen the specialist in person.

Adolescent↗
PubMed2002

Otolaryngology consultations by real-time telemedicine.

We aimed to assess the value of real-time telemedicine using low cost videoconferencing equipment for otorhinolaryngology consultations. A general practitioner, using low cost videoconferencing equipment, presented patients to an otorhinolaryngologist. After history taking and clinical examination, investigations were requested if required and a diagnosis and management plan formulated. The patients were then seen, by the same otorhinolaryngologist, for a conventional face-to-face consultation. Differences in the history, clinical examination and investigation requests were reported. The accuracy of diagnosis and correlation of management plans between the two consultations were analysed. Forty-three patients were admitted to the study but one, a young child, refused examination either by tele-link or the conventional approach and had to be excluded. There were thus 42 patients with 55 diagnoses included in the trial, 26 (62%) females and 16 (38%) males. Age range was 5 months to 70 years. There was no difficulty with any of the patients in obtaining an accurate history and ordering investigations, if required, via the telelink. Clinical examination during the tele-link consultation was inadequate for eight out of the first 20 patients, resulting in a wrong diagnosis in three patients and a missed diagnosis in five patients. All of the next 22 patients had a correct diagnosis and management plan. Comparison of data from the two types of consultation showed that a correct diagnosis and management plan was made in 34 patients. Low cost real-time telemedicine is a useful technique, providing reliable otorhinolaryngology consultations in a general practice setting. However initial difficulties due to inexperience in using the equipment need to be overcome.

Adolescent↗
PubMed2003

Study shows big PMPM savings for groups that use online consultations.

A new study shows the use of online consultations saves physicians nearly $2 PMPM for office visits. Blue Shield of California is leading a trend among a growing number of health plans who are beginning to see the value in "cyber visits," and are paying doctors to use them.

Blue Cross Blue Shield Insurance Plans↗