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PubMed2001

Cognitive-behavioural therapy via videoconferencing to a rural area.

OBJECTIVE: This case report describes the use of cognitive-behavioural therapy via two-way, interactive audiovisual videoconferencing and identifies issues involved in using this form of technology to provide therapy. CLINICAL PICTURE: A 38-year-old married woman living in rural South Australia presented with panic disorder with agoraphobia and major depression. The patient had refused antidepressant treatment. TREATMENT: The patient was treated with 12 sessions of cognitive-behavioural therapy delivered via videoconferencing. OUTCOME: Anxiety and depressive symptoms resolved with concomitant improvement in function. CONCLUSIONS: Providing this form of therapy via videoconferencing can be effective.

Adult↗
PubMed2001

Telemedicine in a box: overcoming complexity and high-cost telemedicine barriers using self-contained videoconferencing units.

This report describes our experience using low-and moderate-cost videoconferencing systems for telemedicine. After determining that low-cost systems using a standard personal computer and personal computer camera were unsatisfactory, a demonstration project was carried out using a $4000 self-contained videoconferencing unit (telemedicine in a box), using eight simulated telemedicine consultation scenarios. The quality of the videoconferencing was good for all eight scenarios. All eight consultation simulations demonstrated different ways of improving patient care. Two of the major problems hindering the broad proliferation of telemedicine (high cost and high complexity) are solved by the telemedicine in a box concept. Focussing on the telemedicine in a box concept when planning a telemedicine system will improve its feasibility in the real world of health care.

Humans↗
PubMedDate not supplied

The evolution and evaluation of videoconferencing technology for graduate nursing education.

The Integrated Services Digital Network H.323 (ISDN), which has been in use for the past 20 years often requires a dedicated telephone line and other equipment to implement. Consequently, expansion of ISDN-based videoconferencing requires infrastructure not always accessible in those areas that are most in need of technological connections. New H.323 technology using Internet Protocol H.320 (IP) connectivity can accommodate the use in a variety of videoconferencing software and fill this void as demonstrated by an experiment conducted live at the Syllabus Web '99 conference. When a faculty group were unable to secure ISDN connections to demonstrate their clinical evaluation of Family Nurse Practitioner (FNP) students using videoconferencing technology, an ad hoc group of computer experts, educators, instructional design specialists, and corporate sponsors collaborated to design a multipoint PC-based connection using IP connectivity. This article describes the first application of this technology, the evolution of ISDN and IP systems in nursing education and practice, and suggests appropriate future trends for their utility in nursing.

Computer-Assisted Instruction↗
PubMed1996

Medical teaching at a peripheral site by videoconferencing.

The departments of Child Health and Mental Health of Aberdeen University's Medical Faculty recently took part in a 3 month trial assessing the potential of videoconferencing as a medium for teaching students on peripheral hospital attachments. The equipment used was British Telecom's VC7000 Videoconferencing System and an ISDN2 (integrated services digital network) connection, which was installed between two sites. The locations used were a teaching room in the Royal Aberdeen Children's Hospital and the Paediatric Unit at Raigmore Hospital in Inverness. This paper describes the resources required to support the trial, the methods used to run it and the results of staff and student evaluation of the trial. Evaluation forms were completed and returned by eight members of staff and by 30 fourth- and fifth-year medical students. The results indicated that, although after this particular trial both staff and students rated the overall usefulness as low, they attributed this to technical problems and limitations specific to the type of equipment used rather than to the method itself. The overall impression was that videoconferencing with ISDN has potential as a teaching tool in the medical undergraduate course but that further improvements in image quality and voice switching are required.

Education, Medical, Undergraduate↗
PubMed1998

Videoconferencing: practical advice on implementation.

Videoconferencing provides a useful tool for improving information flow, with clinical, educational and administrative uses being particularly relevant to rural and remote Australia. This paper describes the range of possible uses for computer-based videoconferencing and describes the authors' experience in delivering rural medical education in North Queensland via videoconference. Principles that ensure successful videoconferencing are outlined and are applicable to a variety of formats and uses. They include the need to keep it simple, the importance of thorough preparation, and ensuring that education drives technology, rather than the converse.

Education, Medical↗
PubMed2002

Health professionals' attitudes to videoconferencing in paediatric health-care.

This study surveyed staff involved in paediatric health-care in the state of New South Wales. Questionnaires were sent to: 139 medical professionals in paediatric public health; 157 medical professionals in private practice; 179 nurses; and 125 allied health staff. There were 188 completed surveys (31%). The results showed higher endorsement of videoconferencing for educational or psychosocial applications than for patient management or treatment planning. Medical professionals (especially those in private practice) tended to give the lowest ratings for the potential usefulness of telemedicine. Apart from ratings for various effects of time and distance in the work setting, rural and non-rural professionals generally showed no significant differences, especially in attitudes to and understanding of telemedicine. Hierarchical regression analysis showed that ratings for the future use of videoconferencing (if it were available), in particular ratings for future use of telecommunications technology (e.g. email, telephone conferencing), were determined by factors largely independent of access to telemedicine. The data assist in interpreting the under-use of videoconferencing in health-care.

Attitude of Health Personnel↗
PubMed2002

A cost-minimization analysis of orthopaedic consultations using videoconferencing in comparison with conventional consulting.

We compared the costs of conventional outpatient visits to the surgical department of the University Hospital of Oulu with those of videoconferencing between the primary care centre in Pyhäjärvi and the University Hospital (separated by 160 km). The cost data were obtained from a randomized controlled trial that included 145 first-admission and follow-up orthopaedic patients. In the telemedicine group the annual fixed costs were 6074 in the hospital and 3910 in the primary care centre. The additional variable costs were 2 in the hospital and 19 in primary care. At a workload of 100 patients, the total cost, including travel and indirect costs, was 87.8 per patient in the telemedicine group and 114.0 per patient in the conventional group (i.e. a total cost saving from the use of teleconsultation of 2620). A cost-minimization analysis showed that telemedicine was less costly for society than conventional care at a workload of more than 80 patients per year. If the distance to specialist care were reduced from 160 km to 80 km, the break-even point increased to about 200 patients per year. Wider utilization of the videoconferencing equipment for other purposes, or the use of less expensive videoconferencing equipment, would make services cost saving even at relatively short distances. The study showed that orthopaedic outpatient telecare can be cost minimizing.

Costs and Cost Analysis↗
PubMed2002

The accuracy of length and angle measurement in videoconferencing teleradiology.

Telemedicine was used to make measurements on a series of radiographs. The first group consisted of 25 radiographs of the cervical spine; four lengths were measured on each. The second group consisted of 100 wrist radiographs showing Colles fractures; the degree of backward angulation of the distal fragment was measured on each. Measurements were made via a videoconferencing link. The consultant used the shared white boarding facility to indicate where on the film the measurements were to be made. The videoconferencing link was used to check that the measurements were being made correctly and a nurse measured lengths and angles. In addition, the consultant used the link to read the scales on the measuring instruments for himself. Four different methods of measuring length were tested and three methods of measuring angle. A transparent plastic ruler was best for measuring length-the emergency nurse practitioner and the consultant made almost all measurements to an accuracy of 1 mm. A protractor with pen marker was best for measuring angles; all were made to within 2 degrees. Simple methods can be used to measure lengths and angles in videoconferencing teleradiology.

Cervical Vertebrae↗
PubMed2004

The use of international videoconferencing as a strategy for teaching medical students about transcultural psychiatry.

Videoconferencing is an innovative method that potentially allows medical students exposure to international teachers in refugee mental health who would otherwise be inaccessible. This article reports a pilot study using videoconferencing with international teachers from Australia, Sweden and the USA participating in the training of ten senior Swedish medical students. Interviews with an actual and a simulated patient were conducted at the U.S. and Australian sites respectively, followed by discussions involving those two sites with students and their supervisors in Sweden. Students evaluated the method favourably, as did the teachers, although the brevity of the program was seen as a limitation. Teachers noted the importance of preparing students and patients and ensuring that the technology operates smoothly to ensure success. Although cost-effective in teaching medical students in developed countries, videoconferencing may still be out of the reach of training programs in many developing countries where it is most needed.

Adult↗
PubMed2004

Medical student evaluations of lectures attended in person or from rural sites via interactive videoconferencing.

BACKGROUND: Interactive videoconferencing may be an effective way for medical students on remote rotations to attend teaching sessions at the main campus. PURPOSE: To compare medical student evaluations of lectures for those attending in person and those attending through interactive videoconferencing. METHODS: Lecture evaluations were completed by medical students on University of Vermont College of Medicine clinical clerkship rotations. Students on clerkships at rural sites attended lectures using our telemedicine network. Responses from in-person and remote attendees were compared. RESULTS: Evaluation forms for 110 lectures were received from 648 in-person and 255 remote attendees. All evaluation items were rated "good" or "excellent" by at least 95% of in-person attendees. Over 90% of remote attendees rated nontelemedicine evaluation items, such as appropriateness of lecture topic for students, as good or excellent. Ratings of telemedicine-specific questions, such as ability to hear the lecturer, were lower. CONCLUSIONS: Level of satisfaction was high for most aspects of remote lecture attendance, although not quite as high as for in-person attendance. Improved technical reliability would likely increase remote attendee satisfaction. Overall, lecture attendance using videoconferencing was found to be an acceptable alternative to travel for medical students in rural clerkships.

Computer-Assisted Instruction↗
PubMed2002

Videoconferenced continuing medical education in Nova Scotia.

Videoconferencing has been used for continuing medical education (CME) in Nova Scotia since a pilot project to four communities in 1995. The Nova Scotia Telehealth Network was developed after the pilot project. Using the network, the videoconferenced CME programme expanded over the next few years until in, 2000-1, 66 programmes were broadcast to 38 sites. During the expansion of the programme, we improved video quality and developed efficient methods of: scheduling and planning the content of the videoconferences; training faculty presenters in videoconferencing techniques; and evaluation. We consider this programme represents a success. However, several aspects could be improved. Faculty members still need encouragement to make visual aids legible by videoconference and to provide handouts. Also, there has been little upgrading of equipment over the past four years and some reduction in the reliability of connections.

Education, Distance↗
PubMed2003

Videoconferencing for orthopaedic outpatients: one-year follow-up.

We studied whether consultations via videoconferencing and traditional outpatient clinic visits differ in terms of the implementation of the patient management plan during a one-year follow-up. First-admission and follow-up orthopaedic patients were randomly allocated to an outpatient visit at the surgical department of Oulu University Hospital or to videoconferencing at a health centre in Pyhäjärvi. In a prospective one-year study, there were 145 consecutive orthopaedic patients who met the inclusion criteria: 84 referred for their first visit to a specialist and 61 of them for follow-up. There were 66 males (46%) in the study population. Over half the patients had some form of regenerative arthritis: 15% had hip arthritis, 33% knee arthritis and 4% other arthritis. There were no differences in the implementation of the management plan between the two groups. The study showed that videoconferencing is a valid alternative to outpatient clinic visits for orthopaedic specialist consultations.

Ambulatory Care↗
PubMed2003

An exploratory study of language interpretation services provided by videoconferencing.

We explored the feasibility and acceptability of the remote provision of a language interpretation service during general practice consultations. Three methods were used to provide an interpretation service: a physically present interpreter (PI), a remote interpreter accessed using an ISDN videoconferencing link at 128 kbit/s (VI) and a remote interpreter accessed by telephone (TI). Thirty-six non-English-speaking patients were invited to take part and 35 agreed to do so. Twenty-nine (83%) of the patients recruited were female. The age range of the participants was 24-51 years. Fourteen consultations took place with a physically present interpreter, 11 using videoconferencing and 10 using the telephone. Mean scores on the Patient Enablement Instrument were 5.2 for the PI group, 2.3 for the VI group and 5.1 for the TI group. Mean scores on the Medical Interview Satisfaction Scale were 5.3 for the PI group, 4.9 for the VI group and 5.3 for the TI group. The visual quality and sound quality of remote interpreting were satisfactory. Both videoconferencing and hands-free telephones can deliver an acceptable interpreting service in primary care.

Adult↗
PubMed2003

Introducing videoconferencing into educational oncopathology seminars: technical aspects, user satisfaction and open issues.

We used set-top videoconferencing equipment connected by ISDN at 384 kbit/s for six educational seminars held between the University of Udine (the local site) and the National Cancer Institute in Aviano (the remote site), 60 km away. User satisfaction was evaluated by questionnaire. The median length of seminars was 58 min (range 48-61 min), followed by a 20 min (15-26 min) discussion. Eighty-two users answered the questionnaire (a 43% response rate): 56 in Udine (a median of 11 per seminar) and 26 in Aviano (a median of 5 per seminar). Answers to the questions were similar at the two sites. Videoconferencing did not affect the users' experience of attending the seminars, as both interest and clarity were similar at the local and remote site. The results suggested that videoconferencing is a viable method for delivering seminars in oncopathology, where image quality is important.

Adult↗
PubMed2003

Implementation of videoconferencing to support a managed clinical network in Scotland: lessons learned during the first 18 months.

Managed clinical networks (MCNs) are usually built on established groups of health professionals from both acute and primary care sectors. We have used videoconferencing to support the gynaecological oncology MCN in the west of Scotland. Videoconferencing was implemented simultaneously at five sites in 2001 and DICOM image-capture software was added in 2003. Videoconferencing and live PC links allowed the multidisciplinary teams to discuss individual cancer diagnoses without the extensive travelling previously required. Our experience of the implementation suggests that local ownership is crucial. In the present project, each of the stakeholders had an important role in the delivery of a successful system. High-quality project management is required during implementation and for some time thereafter to achieve sustainability.

Computer Communication Networks↗
PubMed2003

Feasibility of and satisfaction with the use of low-bandwidth videoconferencing for examination of undergraduate students.

We investigated the feasibility and students' acceptance of Internet-based videoconferencing as a communications method during examinations. Thirty-nine second-year dental students took an interactive examination in periodontology, comprising self-assessment, essay writing, discussion and feedback. The students were randomly divided into two groups, which were examined through the standard classroom procedure (n =15) or through Internet-based videoconferencing (n =24). Students evaluated the experience using a standardized questionnaire. The technology proved to be reliable. The interactive examination technique was well accepted, although there was significantly less satisfaction in the videoconference group (P <0.01). There were no significant differences in the performance of students between the two modalities. Interaction was stressed as one of the major strengths of the examination by students in the conventional group, but it appeared to be less appreciated by the videoconference group. Internet-based videoconferencing can successfully facilitate a highly structured assessment, although students seem to prefer classroom assessment.

Attitude of Health Personnel↗
PubMed2004

Videoconferencing in child and adolescent telepsychiatry: a systematic review of the literature.

A systematic review of child and adolescent telepsychiatry was conducted. It was based on a search of the electronic databases MEDLINE and PsycINFO covering the period 1966 to June 2003. Studies were selected for review if they concerned videoconferencing for patient care or consultation, evaluated a clinical service or education, or assessed satisfaction with videoconferences. Twenty-seven articles were identified that fulfilled the selection criteria. These comprised two reports of randomized controlled experiments, 10 of descriptive questionnaire studies or observational surveys, seven case studies and eight other reports. Only three of the studies presented some calculations of cost-effectiveness. When classified by 'Quality of Evidence' criteria, only two studies were in category I (the highest), one was in II-2 and the rest fell into category III (the lowest). Most studies of child and adolescent telepsychiatry examined satisfaction with videoconferencing or described programmes or care regimens. Videoconferencing seemed to improve the accessibility of services and served an educational function. Some papers also mentioned savings in time, costs and travel. Problems with non-verbal communication and the audiovisual quality of the videoconference were mentioned as drawbacks. Telepsychiatry therefore seems to offer several benefits, at least in sparsely populated regions. Well designed and properly controlled trials are required to evaluate the clinical value of this promising method in child psychiatry, where there is a constantly increasing need for services.

Adolescent↗
PubMed1998

The use of videoconferencing for telepsychiatry in Finland.

Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours in 1997. During 1997, 45% of the time was used for teaching, 26% for occupational counselling, consultations and therapies, 23% for training and 6% for administration (mainly testing the connections). In a survey, 37 participants rated aspects of the quality of the videoconferences on a scale from 4 (poor) to 10 (excellent). The audio quality had a mean value of 8.0 (SD 0.9), the picture quality 7.5 (SD 1.5), and the general value of the videoconference was rated 7.5 (SD 1.0). Preliminary results with telepsychiatry in Finland have been promising. Interactive videoconferencing provides an easy, fast and relatively inexpensive method of providing psychiatric services over long distances.

Finland↗