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Non-Hodgkin's lymphomas and occupation in Sweden.

OBJECTIVES: To investigate whether there is a risk excess of non-Hodgkin's lymphoma among Swedish workers associated with particular occupations. METHODS: The base population was made up of Swedish men (1,779,646) and women (1,101,669) who were gainfully employed at the time of the 1970 census, had also been present in the 1960 census and were still alive and older than 24 years as of 1 January, 1971. They were followed up for 19 years until the end of 1989. Age-period standardised incidence ratios were computed in a dataset linking cancer diagnoses from the Swedish national cancer register to occupational and demographic data obtained in the census of 1970. Log-linear Poisson models were fitted, allowing for geographical area. Risk estimators per occupation were also computed for workers reporting the same occupation in 1960 and 1970, a more specifically exposed group. RESULTS: There were 7,610 non-Hodgkin's lymphomas reported in the study cohort, 5,391 cases in men and 2,219 in women. A relative risk of over 1.20 and statistically significant was observed in men among accountants and auditors, secretaries and typists, auctionists, non-specified rail and road transport workers, telecommunications traffic officers, telegraph and radio operators, photographic-laboratory workers and other production and related work. The risk excess was confirmed in men with the same occupation in both censuses. In women, only three occupations achieved statistical significance: metal platers and coaters, truck and conveyor operators and store and warehouse workers. CONCLUSIONS: The risk excess observed in telecommunication and transport workers could be explained by electromagnetic radiation exposure. We did not find a risk excess in agricultural occupations, that has been largely documented by other study groups.

Female↗

Clinical efficacy of telemedicine in emergency radiotherapy for malignant spinal cord compression.

The authors developed a Telecommunication-HElped Radiotherapy Planning and Information SysTem (THERAPIST), then estimated its clinical benefit in radiotherapy in district hospitals where consultation with the university hospital was required. The system consists of a personal computer with an image scanner and a digital camera, set up in district hospitals and directly connected via ISDN to an image server, and a treatment planning device set up in a university hospital. Image data and consultative reports are sent to the server. Radiation oncologists at the university hospital determine a treatment schedule and verify actual treatment fields. From 1998 to 1999, 12 patients with malignant spinal cord compression (MSCC) were treated by emergency radiotherapy with the help of this system. Image quality, transmission time, and cost benefit also were satisfactory for clinical use. The mean time between the onset of symptoms and the start of radiotherapy was reduced significantly from 7.1 days to 0.8 days (P < .05) by the introduction of the system. Five of 6 nonambulant patients became ambulant after the introduction of THERAPIST compared with 2 of 8 before the introduction of THERAPIST. The treatment outcome was significantly better after the introduction of the system (P < .05), and suggested to be beyond the international standard. The telecommunication-helped radiotherapy and information system was useful in emergency radiotherapy in district hospitals for patients with MSCC for whom consultation with experienced radiation oncologists at a university hospital was required.

Cost-Benefit Analysis↗

[Dermatology in telemedicine. Possibilities and limits].

Telemedicine including teledermatology is the application of telecommunication technology for the purpose of diagnostics, planning and guiding of therapy and education. With the possibility to gain fast access to specialty knowledge, telemedicine makes it possible to deliver health care to patients at distant sites. By participating in telemedical consultations, patients receive accurate diagnosis in a rapid manner and save travel costs and time. Due to recent advances in computing and telecommunications technology, telemedicine will assume a more and more important role in future health care delivery. Telemedicine is utilized by almost all medical specialties but to varying degrees. Dermatology as a visually based specialty is predestined to use the various capabilities of telemedicine. The main applications so far include teledermatohistology and clinical teledermatology. The objective of this paper is to present the current status of teledermatology as part of telemedicine with a look toward future applications.

Dermatology↗

Telepsychiatry and geriatric care.

The use of telecommunications--telephone, computer, videoconferencing equipment--to provide mental health services at a distance has grown rapidly. This review encompasses reports from programs that provide telepsychiatry services, including telephone- and computer- based education and support services, telephone screening for dementia, and the use of videoconferencing to provide psychiatric consultations, health education, and administrative support. The extensive experience to date supports the value of telepsychiatry. Applications in geriatric settings and research involving geriatric subjects are reviewed. Cost analyses and economic evaluations of telepsychiatry are preliminary at this time and need further refinement. There is great potential for using telecommunications to expand access to mental health services to underserved geriatric populations.

Aged↗

Technological advances in teleradiology.

Teleradiology consists of a set of added-value telematic services, implemented over an advanced telecommunications infrastructure and supported by different information technologies and related applications. The main goal of teleradiology is to provide different levels of support for remote diagnostic imaging procedures. This paper considers technological advances in this important area, including a discussion of the various added-value telematic services, applications supporting these services, and the required information technology and telecommunications infrastructure. Teleradiology is also considered in the general context of an integrated regional health telematics network, emphasizing its role and its interaction with other information and networking services.

Computer Communication Networks↗

Changing paradigms in dermatology: information technology.

Medicine and specifically, dermatology, is undergoing enormous changes in the way in which it is practiced. Much of this is a result of a fundamental change in the manner in which information is exchanged through information technology. With the advent of more advanced telecommunications, imaging capabilities and information transfer, the very ways in which we examine patients, develop diagnoses and plan treatments as dermatologists have changed dramatically. This chapter will briefly review the development of personal computers and the Internet, as well as changes in telecommunications capabilities and how these changes have already altered how we see patients and care for them, as well as how new advances may continue to change the world of medicine and dermatology in the near future.

Confidentiality↗

Health care consumers' experiences of information communication technology--a summary of literature.

BACKGROUND: There is an increasing interest in reaching consumers directly through the Internet and different telecommunication systems. The most important contacts in health care will always be the face-to-face meetings, but the tools of health informatics can be seen as a means to an end, which is to provide the best possible health care. A variety of applications have been described in different references. To our knowledge there has been no review of a research-based state of the art in the field of consumers' experiences in using different applications in health informatics. According to the benefits in using information communication technology (ICT) as being cost-effective and timesaving it is of great importance to focus on and examine consumers' experiences. It is important that it is user friendly and regarded as valuable and useful. AIM: The aim of this study was to describe consumers' subjective experiences of using electronic resources with reference to health and illness. DESIGN AND/OR METHOD: A systematic literature search was performed in databases CINAHL, Medline and Cochrane, as well as a manual search. Retrieved references (n=14) were appraised according to their scientific structure and quality. A broad search was performed in order to find as many different applications as possible. Our primary intention was to identify existing references describing consumers' experiences with ICT. RESULTS: In spite of this broad search few references were found. Twelve references remained and three themes were identified: support and help, education and information, and telecommunication instead of on-site visiting. Consumers felt more confident and empowered, their knowledge increased and their health status improved due to the ICT resources. Lack of face-to-face meetings or privacy did not appear to be a problem. CONCLUSION: ICT can improve the nurse-patient relationship and augment well-being for consumers. More research is needed to measure consumers' experiences and factors that influence it.

Biotechnology↗

The use of multi-media messaging in the referral of musculoskeletal limb injuries to a tertiary trauma unit using: a 1-month evaluation.

OBJECTIVES: New developments in telecommunications will have a profound effect on the delivery of medical care throughout the world. In Northern Ireland three trauma centres provide fracture care for their own and surrounding Emergency Departments. All trauma referrals are currently taken by telephone. It is our experience that the verbal description of the radiographs of a musculoskeletal limb injury can be inaccurate, necessitating us to view the plain films of the patient. By utilising a recent advance in telecommunications technology, the launch of mobile handsets with multi-media messaging (MMS) service capability, it is now possible to digitally capture and instantly send an image of a plain film. PURPOSE: To evaluate the use of multi-media messaging as a supplement to the telephone referral of musculoskeletal limb injures. METHOD: : Following a referral using, the emergency physician and the trauma surgeon evaluated the multi-media consult through a survey questionnaire. RESULTS: Between the 1st December 2003 and the 1st January 2004, 46 multi-media consultations were performed. Picture quality was acceptable in all but one of the referrals. In 35 of the 46 referrals the multi-media image of the plain films was felt to improve the management of the patient. In 8 of the 46 referrals the multi-media image of the plain films was felt to change the management of the patient. CONCLUSION: A multi-media messaging store- and forward telemedicine system has potential to facilitate the rapid, cost-effective management of musculoskeletal limb injuries thereby enhancing clinical care.

Adolescent↗

The telemedicine information exchange: an online resource.

Telemedicine is the use of telecommunications to provide health care services at a distance. It has grown from mostly government-subsidized research initiatives into a fledgling industry. This growth was fueled by decreasing costs of telecommunications and information technologies and fanned by rising health care costs. The telemedicine information exchange (TIE) (http:(/)/tie.telemed.org), developed by the Telemedicine Research Center in Portland, OR, is both a product and a vehicle of this rapid growth. It facilitates collection of telemedicine information from many sources, providing an easy-to-use hypertext format. This article describes the TIE's development, advantages and disadvantages of a web-based online library, and it's codevelopment with a rapidly expanding industry.

Costs and Cost Analysis↗

Telemedicine: a new dimension in the practice of medicine.

Telemedicine has drawn increasing attention as one of the emerging service delivery vehicles running on the information highway. Until recently, the adoption of telemedicine has been discouraged by the cost of telecommunications and equipment and by the lack of infrastructure, standards, and evidence of cost-effectiveness and cultural acceptance. Although there have been attempts to reduce costs by making use of computer communication networks, they were technically limited by slow network speed and the lack of real-time audio/video compression technology. Ongoing technologic advances in telecommunications, imaging, multimedia computers, and information systems are making interactive telemedicine increasingly possible as high-speed video, voice, and data services are brought to large segments of the general population. The current synergy between health reform initiatives, which are redefining how health care services are accessed and delivered, and advances in technologies that support telemedicine has resulted in a proliferation of telemedicine projects. However, there is still no proof that telemedicine is necessarily cost-effective for a broad set of applications. Each prospective application requires its own business case analysis. Within the current environment, the development of a telemedicine strategy should be based on a sound knowledge of the current and future potential of telemedicine to improve health care access and quality while containing and possibly reducing health care costs.

Humans↗

Otolaryngology and the Internet.

During the past 25 years, the Internet has grown tremendously. Starting as four academic computers linked by the Department of Defense, it has become a major technical and cultural entity that is accessible to millions of persons outside the realm of government and academia. The field of medicine has been well served by this telecommunications system, in which many applications have been developed to assist in research, clinical medicine, and education. More recently, resources of specific interest to otolaryngologists have been implemented at various academic departments and national organizations. This review is intended to simplify the Internet for otolaryngologists who do not have extensive experience in computers or telecommunication. The Internet is described in basic, minimally technical terms, and specific examples are provided of ways that on-line resources can be used in the practice of otolaryngology-head and neck surgery.

Communication↗

Remote verification in radiotherapy using digitally reconstructed radiography (DRR) and portal images: a pilot study.

PURPOSE: To use digitally reconstructed radiography (DRR) and digitally compressed portal images in distant consultation using a telecommunications network, the verification performance of DRR and digitally compressed portal images on the image console was investigated. METHODS AND MATERIALS: A human thoracic phantom was scanned with computed tomography (CT). Radiotherapy was planned at 5 different anatomic locations. A digitally reconstructed radiograph was made; verification films of the phantom were then taken with 6-MV X-rays. The treatment center was intentionally dislocated. Fifty sets of DRR and portal images were seen by 7 doctors on a conventional view-box (view-box method) to judge whether the treatment center was dislocated. These image sets were digitalized by a film scanner, compressed to 1/10 Joint Photographic Experts Group (JPEG) format, and compared on an image console by the same physicians (image-console method). The verification performance of the image console method was compared with that of the view-box method by means of receiver operating characteristic (ROC) analysis. Clinically, 159 portal-image-sets were verified with the image-console method and the appropriateness of the decision was later assessed by the view-box method. RESULTS: The accuracy of the treatment verification was estimated to be 88.8% by the conventional view-box method and 88.3% by the image-console method. There was no statistically significant difference in the verification performances of the conventional method (Az = 0.86+/-0.02) and the image console method (Az = 0.84+/-0.07). Frequent digital image-processing modification was positively related to the accuracy of verification. Clinically, there were 3 (1.8%) major corrections, 31 (19.5%) minor corrections, and 123 cases with no correction. No further correction was called for by the re-evaluation using the view-box method. CONCLUSION: The verification performance of DRR and digitally compressed portal images on the image console was as accurate as the conventional method. Distant consultation using DRR and portal images through telecommunication is usable in clinical practice.

Humans↗

Health risks from the use of mobile phones.

Widespread concerns have been raised about the possibility that exposure to the radiofrequency (RF) fields from mobile telephones or their base stations could affect people's health. Such has been the rapid growth of mobile telecommunications that there will be about one billion mobile phone users before 2005. Already there are more mobile than fixed-line users. Developing countries are establishing mobile telecommunications rather than the more expensive fixed-line systems. Thus, if there is any impact on health from mobile telephones, it will affect everyone in the world. The World Health Organization (WHO) established the International EMF Project in 1996 to evaluate the science, recommend research to fill any gaps in knowledge and to conduct formal health risk assessments of RF exposure once recommended research had been completed. In addition, the UK government established an independent expert group to review all the issues concerning health effects of mobile telephones and siting of base stations. Cancer has been suggested as an outcome of exposure to mobile telephones by some scientific reports. This paper reviews the status of the science and WHO's programme to address the key issues. In addition, the main conclusions and recommendations of the UK expert group will be summarised.

Brain↗

Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications.

BACKGROUND: Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. STUDY DESIGN: Telemedicine and telementoring were applied using low-bandwidth mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing system, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly, surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. RESULTS: Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps. CONCLUSIONS: Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by limiting travel, expanding services to patients, and increased patient quality assurance.

Ecuador↗

The present and future of telemedicine in Japan.

Telemedicine has always developed in close relation with communication technology. When only aural telephones were used, several experiments of telemedicine were carried out by utilizing telephone lines. When INS64 (ISDN with 64 kbits) and telecommunication satellites came onto the scene, experiments for telemedicine began to be conducted accordingly using the cutting-edge technology of the time. In this paper, one of the three categories of telemedicine, mainly tele-consultation that includes tele-pathology and tele-radiology, will be discussed with some examples conducted in Japan. As time goes on, the aim of telemedicine has also been changing. In 1996, the Japanese government gave the go ahead for telemedicine along its deregulation policies. Telemedicine including tele-home care in the 21st century will use the Internet and digital HDTV (high-definition TV) technology for information and data management interchangeably both at domestic and global levels in the medical environment. Also, our dream of a hyper-hospital or virtual hospital will be realized in cyberspace before long, but first we may have to overcome several tough problems such as the protection of privacy data, malpractice and vulnerability of technology relevant to the Internet and telecommunications satellite system as a whole.

Computer Communication Networks↗

Communicating original research in chemistry and related sciences.

The availability of scientific information in electronic form is the convergence of traditional journal publishing, electronic communications, and the widespread availability of computer technology. This revolution in scientific communication has its roots in developments that started in the mid-19th century and culminated with the extraordinary progress in telecommunications and computer technology in the latter years of the 20th century. Eighty-three percent of scientific journals are now available online. The benefits of electronic journals include rapid publication, instantaneous linking to external information sources, and the capability to deliver new types of information. To date neither electronic-only nor preprint servers have been well received by the chemical sciences community. Continued advances in telecommunications, computer technology, and acquisition of scientific data in structured formats hold promise for even greater advances in communication of scientific information.

Journal Article↗

Automated telephone conversations to assess health behavior and deliver behavioral interventions.

The medical care system is not very effective in modifying health behavior of individuals, in particular, ensuring patient compliance with medication regimens, healthy diets, regular physical activity, and regular health screening, and in the avoidance of substance abuse. Telephone-Linked Care (TLC) is a telecommunications technology that enables computer-controlled telephone counseling with patients in their homes. It has been applied to the task of improving a number of different health behaviors. Randomized controlled studies suggest that use of the system for as little as 3 months is associated with improvement in adherence to medication regimens, dietary change in hypercholesterolemia, and increased physical activity among sedentary individuals. Future work involves applying the technology to other important health behaviors, optimally using health behavior theory in the system design, targeting use of TLC to the most appropriate patient groups, incorporating new computer and telecommunications technology into the system, and interfacing TLC into the health care delivery system.

Aged↗

A fast low-power optical memory based on coupled micro-ring lasers.

The increasing speed of fibre-optic-based telecommunications has focused attention on high-speed optical processing of digital information. Complex optical processing requires a high-density, high-speed, low-power optical memory that can be integrated with planar semiconductor technology for buffering of decisions and telecommunication data. Recently, ring lasers with extremely small size and low operating power have been made, and we demonstrate here a memory element constructed by interconnecting these microscopic lasers. Our device occupies an area of 18 x 40 microm2 on an InP/InGaAsP photonic integrated circuit, and switches within 20 ps with 5.5 fJ optical switching energy. Simulations show that the element has the potential for much smaller dimensions and switching times. Large numbers of such memory elements can be densely integrated and interconnected on a photonic integrated circuit: fast digital optical information processing systems employing large-scale integration should now be viable.

Journal Article↗