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At least 523 records · Page 29Linked to original sources
PubMed2000

Low (Sub-1-volt) halfwave voltage polymeric electro-optic modulators achieved by controlling chromophore shape

Electro-optic (EO) modulators encode electrical signals onto fiber optic transmissions. High drive voltages limit gain and noise levels. Typical polymeric and lithium niobate modulators operate with halfwave voltages of 5 volts. Sterically modified organic chromophores have been used to reduce the attenuation of electric field poling-induced electro-optic activity caused by strong intermolecular electrostatic interactions. Such modified chromophores, incorporated into polymer hosts, were used to fabricate EO modulators with halfwave voltages of 0.8 volts (at a telecommunications wavelength of 1318 nanometers) and to achieve a halfwave voltage-interaction length product of 2.2 volt-centimeters. Optical push-pull poling and driving were also used to reduce halfwave voltage. This study, together with recent demonstrations of exceptional bandwidths (more than 110 gigahertz) and ease of integration (with very large scale integration semiconductor circuitry and ultra-low-loss passive optical circuitry) demonstrates the potential of polymeric materials for next generation telecommunications, information processing, and radio frequency distribution.

Journal Article↗
PubMed2000

Technical aspects of telepathology with emphasis on future development.

Pathology undergoes presently changes due to new developments in diagnostic opportunities and cost saving efforts in health care. Out of the wide field of telepathology the paper selects three prototype applications: telepathology in teleeducation, expert advice for preselected details of a slide and finally telepathology for remote diagnosis. The most challenging field for remote diagnosis is the application in the frozen section scenario. The paper starts with the mental experiment to map conventional procedures to counterparts in telepathology. Technical opportunities and economical restrictions of telepathology equipment are discussed with respect to the components: electronic camera, display devices, haptic sensors and displays, available telecommunication channels and telepathology software. As an example and for illustration of the state of the art for an advanced telemicroscopy system able to perform remote frozen section diagnosis, the HISTKOM equipment is presented in more details. The section concerning future developments regards the aspects of the acceptance by tentative users, legal aspects, costs and affordability of equipment, the market for equipment components and the adequate telecommunication services. Further is regarded the mutual influence of properties of existing systems and application experiences gained with them on the next generation of equipment and application software. Conclusions and references close the paper.

Frozen Sections↗
PubMed1999

"Telestroke" : the application of telemedicine for stroke.

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.

Acute Disease↗
PubMed2002

Development and use of online mental health services in Greece.

E-mental health refers to the use of telecommunication and information technology in mental health services. In Greece, ordinary telephone communications have been used to provide mental health services, such as a psychiatric crisis intervention line (METB). E-psychiatry is a relatively new approach to delivering psychiatric services through the Internet. We have developed an e-psychiatry Website, Glaucopis-net. The main objective is to provide information on a broad range of psychiatric conditions, such as dementia, depression and anxiety. Email mental health services will be offered as an alternative way of accessing help. Confidentiality issues concerning patient records and personal data will be treated in accordance with Greek legislation. Glaucopis-net will integrate new telecommunication and information services with classical mental health services.

Greece↗
PubMed2006

Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?

BACKGROUND: The ongoing policy debate about the value of communications technology in promoting development objectives is diverse. Some view computer/web/phone communications technology as insufficient to solve development problems while others view communications technology as assisting all sections of the population. This paper looks at evidence to support or refute the idea that fixed and mobile telephones is, or could be, an effective healthcare intervention in developing countries. METHODS: A Web-based and library database search was undertaken including the following databases: MEDLINE, CINAHL, (nursing & allied health), Evidence Based Medicine (EBM), POPLINE, BIOSIS, and Web of Science, AIDSearch (MEDLINE AIDS/HIV Subset, AIDSTRIALS & AIDSDRUGS) databases. RESULTS: Evidence can be found to both support and refute the proposition that fixed and mobile telephones is, or could be, an effective healthcare intervention in developing countries. It is difficult to generalize because of the different outcome measurements and the small number of controlled studies. There is almost no literature on using mobile telephones as a healthcare intervention for HIV, TB, malaria, and chronic conditions in developing countries. Clinical outcomes are rarely measured. Convincing evidence regarding the overall cost-effectiveness of mobile phone " telemedicine" is still limited and good-quality studies are rare. Evidence of the cost effectiveness of such interventions to improve adherence to medicines is also quite weak. CONCLUSION: The developed world model of personal ownership of a phone may not be appropriate to the developing world in which shared mobile telephone use is important. Sharing may be a serious drawback to use of mobile telephones as a healthcare intervention in terms of stigma and privacy, but its magnitude is unknown. One advantage, however, of telephones with respect to adherence to medicine in chronic care models is its ability to create a multi-way interaction between patient and provider(s) and thus facilitate the dynamic nature of this relationship. Regulatory reforms required for proper operation of basic and value-added telecommunications services are a priority if mobile telecommunications are to be used for healthcare initiatives.

Journal Article↗
PubMed2003

Integration of telemedicine in graduate medical informatics education.

An essential part of health informatics is telemedicine, the use of advanced telecommunications technologies to bridge distance and support health care delivery and education. This report discusses the integration of telemedicine into a medical informatics curriculum and, specifically, a framework for a telemedicine course. Within this framework, the objectives and exit competencies are presented and course sections are described: definitions, introduction to technical aspects of telemedicine, evolution of telemedicine and its impact on health care delivery, success and failure factors, and legal and ethical issues. The emphasis is on literature review tools, practical exposure to products and applications, and problem-based learning. Given the rapid advances in the telecommunication field, keeping the course material up to date becomes a challenge for the instructor who at the same time aims to equip students with the knowledge and tools they will need in their future role as decision makers to detect a need for, design, implement, maintain, or evaluate a telemedicine application.

Cost Savings↗
PubMed2001

Telemedical work and cooperation.

In telemedicine, cooperation occurs via telecommunication. This represents a new situation for medical cooperation. Whether such cooperation works poorly or well will be important with an increasing volume of telemedicine. When personnel are involved in external cooperation, as in telemedicine, the question of cooperation within one's own organization also arises. To investigate these matters, qualitative interviews were performed with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. The results showed that cooperating by telecommunication mainly worked well. The cooperation may be influenced by factors such as personality, knowing each other personally, preparation and experience. Telemedical teamwork may be improved by factors like experience and education. Working with telemedicine did not reduce the personnel's cooperation within their own organizations, but rather improved it, although this effect was slight and most commonly involved improved knowledge of others. In general, the findings concerning cooperation and telemedicine were positive.

Humans↗
PubMed2002

Logistical aspects of large telemedicine networks. 2: Measurement of network activity.

We carried out a retrospective review of the videoconference activity records in a university-run hospital telemedicine studio. Usage records describing videoconferencing activity in the telemedicine studio were compared with the billing records provided by the telecommunications company. During a seven-month period there were 211 entries in the studio log: 108 calls made from the studio and 103 calls made from a far-end location. We found that 103 calls from a total of 195 calls reported by the telecommunications company were recorded in the usage log. The remaining 92 calls were not recorded, probably for one of several reasons, including: failed calls - a large number of unrecorded calls (57%) lasted for less than 2 min (median 1.6 min); origin of videoconference calls - calls may have been recorded incorrectly in the usage diary (i.e. as being initiated from the far end, when actually initiated from the studio); and human error. Our study showed that manual recording of videoconference activity may not accurately reflect the actual activity taking place. Those responsible for recording and analysing videoconference activity, particularly in large telemedicine networks, should do so with care.

Journal Article↗
PubMed1996

Organization and activities of the International Radio Medical Centre (CIRM).

The International Radio Medical Centre (CIRM) was founded in 1935, to provide free medical assistance by radio to ships with no doctor on board and others who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. The results achieved by the Centre over 61 years include medical assistance to 42,935 patients on board ships (as well as on small islands and aircraft), with 375,264 medical messages received and transmitted. CIRM is organized into a medical service, a telecommunications service and a studies section. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case. If necessary the medical service will coordinate the patient's hospitalization at the nearest port with suitable medical facilities or arrange the patient's transfer to another ship with a doctor on board, or an airlift. The telecommunications service receives requests for assistance, locates the ship or whoever made the request, passes the call to the doctor on duty, and relays the doctor's response to those requesting assistance. The studies section, established in 1957-58, researches occupational pathologies of sailors and contributes to their prevention. This provides a scientific basis for improving medical assistance to sailors at sea.

Emergencies↗
PubMed1997

The possible use of telemedicine in developing countries.

Telemedicine may be a useful technique for delivering health care in the developing world. However, there is little practical experience to draw on and real concerns that if additional resources were to become available telemedicine might not be the most appropriate use for them. The logical steps to determine the place of telemedicine in the developing world therefore appear to be: (1) to identify potential telemedicine projects-the Telecommunication Development Bureau of the International Telecommunication Union is trying to do this and has recently sponsored missions to various countries in Africa and Asia; (2) to carry out properly controlled pilot projects in order to demonstrate technical feasibility and to quantify the benefits to the healthcare system; (3) to calculate the costs of large-scale deployment. Assuming that telemedicine is shown to be beneficial, it is only at this final stage that a rational decision can be made about whether telemedicine would be an appropriate use of additional resources in a developing country, as opposed to alternative uses of those resources to solve other important problems of health care.

Delivery of Health Care↗
PubMed1999

Information technology and under-served communities.

Advances in information technology (IT) and telecommunications offer many potential benefits to Australia's under-served communities. However, there is also a risk that some of these communities will only be further disadvantaged, as IT will not contribute greatly to bringing groups such as the mentally ill and illiterate into the mainstream of the community. However, other under-served groups may experience service improvements. For people who do not have English as their first language, IT developments provide opportunities for cheaper and easier service and information delivery in their own languages. Telemedicine and IT also have the potential to make working in rural areas more attractive. On the other hand, telemedicine may be used as a means to bypass local health service providers, as has happened with other service industries. The health sector, though, is well behind these other industries in adopting IT and telecommunications. The growth of telemedicine projects is one indication that progress is being made, however. Two case studies--of telepsychiatry, and of medical education at Flinders University--provide examples of major Australian successes. The medical workforce implications will involve the overall numbers and mix of practitioners, their geographical distribution, changing professional boundaries and changing skill requirements. The only certain effect is that if IT changes the nature of medical work, large numbers of medical practitioners will need to improve their computer skills and older practitioners will find this most difficult.

Australia↗
PubMed2006

Ultrafast laser waveguide writing: Lithium niobate and the role of circular polarization and picosecond pulse width.

For the first time to our knowledge, ultrafast laser writing has generated room-temperature stable guided-wave optics in bulk lithium niobate for the telecommunication spectrum. Among a seven-dimensional parameter space for waveguide optimization, two frequently overlooked parameters, pulse duration and polarization, were found to be key in overcoming undesired nonlinear optical responses imposed by this material. Single-mode waveguides were best formed with circularly polarized light having a relatively long pulse duration of approximately 1.0 ps. The waveguides were highly polarization dependent and guided in both telecommunication bands near 1300 and 1550 nm, exhibiting losses as low as 0.7 dB/cm.

Journal Article↗
PubMed2002

[Telereha--special challenges for telemedicine in geriatric rehabilitation].

Modern telecommunication technology has the potential to improve the quality of life for elders with physical and mental impairments as well as for their caregiving relatives. This can be viewed as an opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Results of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients caregiving relatives and geriatric professionals, showed that participants regard telecommunicational and communicational needs.

Aged↗
PubMed2003

The effect of gesture on speech production and comprehension.

Hand gestures are ubiquitous in communication. However, there is considerable debate regarding the fundamental role that gesture plays in communication and, subsequently, regarding the value of gesture for telecommunications. Controversy exists regarding whether gesture has a primarily communicative function (enhancing listener comprehension) or a primarily noncommunicative function (enhancing speech production). Moreover, some have argued that gesture seems to enhance listener comprehension only because of the effect gesture has on speech production. The purpose of this study was to examine the extent to which gesture enhances listener comprehension and the extent to which the effect of gesture on listener comprehension is mediated by the effects of gesture on speech production. Results indicated that gesture enhanced both listener comprehension and speech production. When the effects of gesture on speech production were controlled, the relationship between gesture and listener comprehension was reduced but still remained significant. These results suggest that gesture aids the listener as well as the speaker and that gesture has a direct effect on listener comprehension, independent of the effects gesture has on speech production. Implications for understanding the value of gestural information in telecommunications are discussed. Potential applications of this research include the design of computer-mediated communication systems and displays in which the visibility of gestures may be beneficial.

Communication↗
PubMedDate not supplied

Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship systematic review and expert survey.

BACKGROUND: Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails. OBJECTIVE: To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction. METHODS: Systematic review of the literature, professional, and ethical codes; and consultation with experts. RESULTS: Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures. CONCLUSIONS: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.

Humans↗
PubMed1994

Making global telemedicine practical and affordable: demonstrations from the Middle East.

OBJECTIVE: The purpose of this study was to demonstrate the first use of voice-grade telephone lines for the international transmission of both high-resolution digital images (radiology and pathology) and video in near real-time. MATERIALS AND METHODS: Eight live demonstrations were performed from the United Arab Emirates and the Kingdom of Saudi Arabia at the invitation of the respective ministries of health. Thirty radiologic studies (CT, MR, and radiographs) were digitized, compressed, and transmitted to Cambridge, MA, where they were interpreted on diagnostic workstations (1792 x 2252 display matrix) by a team of subspecialist radiologists. Near real-time image transmission was achieved by combining wavelet-based image compression (average compression ratio of 23:1) and multiplexing technology that used four phone lines simultaneously. During each demonstration, one pathology image was transmitted from Cambridge to the demonstration site, where it was interpreted by a visiting pathologist. Video-conferencing was implemented with a 64-kilobits-per-sec leased line from the United Arab Emirates and with four multiplexed telephone lines from Saudi Arabia. RESULTS: For teleradiology and telepathology, transmission times ranged from 2-5 min per image. Image fidelity was judged to be of diagnostic quality in all transmitted cases. The video link to the United Arab Emirates was highly reliable. Bandwidth for videoconferencing from Saudi Arabia was marginal on four voice-grade telephone lines, resulting in some downtime (10-20%). Live consultations provided by subspecialists in Cambridge assisted in the management of patients at both venues. The system was well received by both the referring physicians in the Middle East and the participants in the United States. CONCLUSION: Image compression and multiplexing technologies enabled high-resolution teleradiology and telepathology as well as real-time video consultations over international telephone lines. While telecommunications systems are advancing rapidly in many parts of the world, those areas most in need of telemedicine services are likely to be the last to upgrade their telecommunications infrastructures. This "proof of concept" article outlines a practical and affordable approach that makes telemedicine more accessible to underserved areas worldwide.

Humans↗
PubMedDate not supplied

[Telemedicine and cardiology].

INTRODUCTION: Telecommunications and information technology provide clinical care at distance by means of telemedicine. Hospitals and other health care facilities use medical telemetry devices for monitoring patients' vital signs. These portable devices are used for measuring patient vital signs such as ECG, blood pressure, heart rate, respiration, capnography (CO2) and other important parameters and then transmit these information to a remote location using a nearby receiver. APPLICATION OF TELEMETRY: Eliminating the need for wired connection with the patient, monitors allow, otherwise bedridden patients to be mobile, which shortens the recovery time. Wireless technology is also useful in the emergency care units, because emergency physicians need not leave their patients while consulting a handheld wireless device. This equipment also enables a paramedic to communicate with emergency physicians for early assessment, well before patients' arrive in hospital. TELEMEDICINE: Certain types of medical telemetry devices may be used in home conditions. Telemetry can provide monitoring and home health care services at distance, using advanced telecommunications and information technology in patients with reasonably stable, but a severe, chronic, difficult condition and caring home environment. This information can enable health-care providers to effectively manage treatment without need for acute emergency treatment and hospitalization. CONCLUSION: Hospitals worldwide are under constant pressure to decrease healthcare cost and to improve treatment outcome. Telemedicine and home health care may be one of the solutions for the problem.

Cardiology↗
PubMed1999

NASA/DARPA advanced communications technology satellite project for evaluation of telemedicine outreach using next-generation communications satellite technology: Mayo Foundation participation.

OBJECTIVE: To describe the development of telemedicine capabilities-application of remote consultation and diagnostic techniques-and to evaluate the feasibility and practicality of such clinical outreach to rural and underserved communities with limited telecommunications infrastructures. MATERIAL AND METHODS: In 1992, Mayo Foundation (Rochester, Minn, Jacksonville, Fla, and Scottsdale, Ariz), the National Aeronautics and Space Administration, and the Defense Advanced Research Projects Agency collaborated to create a complex network of fiberoptic landlines, video recording systems, satellite terminals, and specially developed data translators linking Mayo sites with other locations in the continental United States on an on-demand basis. The purpose was to transmit data via the asynchronous transfer mode (ATM) digital communications protocol over the Advanced Communications Technology Satellite. The links were intended to provide a conduit for transmission of data for patient-specific consultations between physicians, evaluation of medical imagery, and medical education for clinical staffs at remote sites. RESULTS: Low-data-rate (LDR) experiments went live late in 1993. Mayo Clinic Rochester successfully provided medical consultation and services to 2 small regional medical facilities. High-data-rate (HDR) experiments included studies of remote digital echocardiography, store-and-forward telemedicine, cardiac catheterization, and teleconsultation for congenital heart disease. These studies combined landline data transmission with use of the satellite. The complexity of the routing paths and network components, immaturity of available software, and inexperience with existing telecommunications caused significant study delays. CONCLUSIONS: These experiments demonstrated that next-generation satellite technology can provide batch and real-time imagery for telemedicine. The first-generation of the ATM and satellite network technology used in these experiments created several technical problems and inconveniences that should be overcome as the network infrastructure matures.

Feasibility Studies↗