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PubMed2003

Telemedicine in the management of young patients with type 1 diabetes mellitus: a follow-up study.

DCCT (Diabetes Control and Complications Trial) study showed that tight metabolic control of diabetes mellitus can delay the onset and/or reduce the frequency of vascular complications. Telemedicine, i.e. telecommunications and information technologies in health care, is a useful tool to achieve the DCCT goals. Our European Community (EC) sponsored Telematic management of Insulin-Dependent Diabetes Mellitus (T-IDDM) project implements a telemedicine service through on a careful analysis of current medical practice. The system is based on two components: Patient Unit (PU) and Medical Unit (MU) connected by a Telecommunication system (TS). PU allows data collection and transmission from the patient's house to the hospital, assists self-monitoring activity and suggests insulin variations. PU communicates patient's current metabolic state the MU. MU assists the physician in periodic evaluation and suggests the prescriptions to communicate back defining a treatment protocol. TS system is based on telephone lines, relying on the Intranet technology. To test the system functionality and potential impact in type 1 diabetes clinical practice, we enrolled 6 patients (4 males and 2 females), aged 9.9-15.8 yrs, with disease duration 2.1-6.4 yrs, intensively treated. One girl run out after a 1-year follow-up HbA1c levels decreased, but not significantly. Insulin requirement reduced, significantly in 2 patients (p = 0.02 and p = 0.07). A positive correlation was between number of links and protocol changes (p = 0.01), between number of protocols changes and HbA1c decrease (p = 0.02). In pediatric patients periodical visits are necessary, but T-IDDM enables continuity of care improving access and activities. An index is represented by the high number of messages between the 2 Units, seeming weekly exchange.

Adolescent↗
PubMed1992

Telemicroscopy. Design considerations for a key tool in telepathology.

The paper introduces telemicroscopy as a mean to establish online telepathology services. It is differentiated between specialized point to point connections with only a few restrictions on one side, and telecommunication links available inexpensive worldwide in the form of the public telephone net on the other side with the restriction of a limited channel capacity. The restrictions imposed by the application of the telephone net (preferentially the ISDN service) are discussed and strategies outlined to overcome these restrictions. It is concluded, that if dedicated broadband connections are available, realtime telemicroscopy links can be realized immediately with available equipment. If a switched and general available telemicroscopy service applying public telecommunication links is favoured, for effective and acceptable ("online") links, computer intelligence has to be introduced to allow effective strategies for data reduction and data transmission. In this field design and development efforts are still necessary.

Costs and Cost Analysis↗
PubMed2003

Citizen Health System: telehealth homecare.

The Citizen Health System (CHS) is a European Commission (CEC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment, and management of chronically ill patients at home in Greece, Spain, and Germany. Such contact centers, using any type of communication technology, and providing timely and preventive prompting to the patients, are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center and in particular the telecommunication infrastructure, the communication protocols and procedures, and finally the educational modules that are integrated into this contact center. We present the procedures followed for two target groups of patients, namely diabetic patients, and congestive heart failure patients, in which two randomized controlled clinical trials are under way. We present examples of the communication means between the contact center medical personnel and these patients, and elaborate on the educational, user, and telecommunication issues involved.

Chronic Disease↗
PubMed2004

Potential applications of smart clothing solutions in health care and personal protection.

The rapid development in the fields of sensor and telecommunication technologies has created completely new possibilities also for the textile and clothing field. New smart textile and clothing systems can be developed by integrating sensors in the textile constructions. Application fields for these added-value products are e.g. protective clothing for extreme environments, garments for the health care sector, technical textiles, sport and leisure wear. Some products have already been introduced on the markets, but generally it can be stated that the development is only in its starting phase, and the expectations for the future are big. Many different aspects have to be considered in the development of the wearable technology products for the health care sector: medical problems and their diagnosis, sensor choice, data processing and telecommunication solutions, clothing requirements. A functional product can be achieved only if all aspects work together, and therefore experts from all fields should participate in the RTD projects. In the EC-funded project DE3002 Easytex clothing and textiles for disabled and elderly people were investigated. Some recommendations concerning durability, appearance, comfort, service and safety of products for different special user groups were defined, based on user questionnaires and seminars, general textile and clothing requirements and on laboratory test series."Clothing Area Network--Clan" is a research project aiming to develop a technical concept and technology needed in enabling both wired and wireless data and power transfer between different intelligent modules (user interfaces, sensors, CPU's, batteries etc.) integrated into a smart clothing system. Fire-fighters clothing system is chosen as the development platform, being a very challenging application from which the developed technology can be transferred to other protective clothing systems.

Absorbent Pads↗
PubMed2004

A comprehensive model for evaluating telemedicine.

Increasingly, telecommunications and advanced information technologies are being used for a variety of activities: clinical, administrative, and education/research. These activities are undertaken with the expectation that health care delivery will be improved. To validate this expectation, a number of investigations have been undertaken to assess the effectiveness and efficiency of the activities. Unfortunately, many of these investigations have either been incomplete or have applied inappropriate techniques in the evaluation process. This is especially true in the attempts to evaluate the cost effectiveness of various telecommunication technologies and service delivery. The model presented here provides a systematic framework that can be used in evaluating the effectiveness, efficiency, and feasibility of telemedicine. The model delineates the different aspects and characteristics of an evaluation across three dimensions-focus (cost, quality, access), level (individual, community, society), and activities (clinical, administration, education/research). These dimensions are interrelated, making comprehensive evaluation difficult.

Computer Simulation↗
PubMed2006

[Medical nanodevices].

Development of implantable medical nanodevices enables us continuous automatic treatment of patients from inside of their body. Bionic devices, interfacing with neural systems and substituting native functions, such as bionic pacemaker, bionic pressure controller are candidates to miniaturize. For such miniaturization, efforts to reduce size of power supply (e.g., biological fuel cell) and to establish reliable high-throughput, low power telecommunication (e.g., spread spectrum telecommunication) are required. Simple devices such as pacemakers would benefit from miniaturization by lowering invasion and by developing a new usage such as ventricular resynchronization.

Animals↗
PubMed2005

Numerical study of the spectral 3-D green's function singularities for piezoelectric SAW components.

This article deals with the numerical study of the singularities appearing in the spectral 3-D Green's function associated with the piezoelectric surface acoustic wave components (so-called SAW components). These electrical units are currently used today in several devices produced by the telecommunications industry (radio, TV, radar, and digital telecommunication systems). The need to improve their performance has motivated engineers and researchers to use mathematical modeling intensively, in particular the integral equations technique here used, which requires the computing of the associated Green's function and the study of its properties.

Computer Simulation↗
PubMed1990

CD-ROM MEDLINE use and users: information transfer in the clinical setting.

Effective delivery of biomedical information to health professionals depends on the availability of systems that are compatible with the information-seeking patterns of health professionals. MEDLINE is a major source of biomedical information, but has been available primarily through libraries via telecommunications networks. The recent availability of MEDLINE on CD-ROM has made it possible to provide MEDLINE directly to clinicians without the associated problems of telecommunications and online use charges. The MEDLINE on CD-ROM Evaluation Forum sponsored by the National Library of Medicine reported on clinicians' use of CD-ROM MEDLINE at seven different clinical settings. This article summarizes the findings from these sites and places them in the context of current understanding of information-seeking behaviors of health professionals. Key issues in the design and development of information technologies in the clinical setting are also articulated.

Ambulatory Care Information Systems↗
PubMed1990

Injuries and illnesses aboard research vessels of the University National Oceanographic Laboratory System.

The University National Oceanographic System operates a fleet of vessels to carry out its scientific projects. Illnesses and injuries at sea are handled by first responders aboard the vessels in consultation with land-based physicians at a telecommunications response center in the United States. During the period 1985 to 1987, 122 cases among regular and scientific crew required medical consultation by telecommunications. Of these, 31% were injuries, 34% were medical cases (infected), 12% were sexually transmitted diseases, and 23% were medical cases (noninfected). Evacuation from the vessel, vessel diversion, or repatriation of the patient was required for 20% of all cases; of these, 48% were for injuries, 36% for noninfected medical illnesses, and 16% for infected medical cases. Rates of illness and injury were calculated using the crew days at sea as a denominator.

Adult↗
PubMed1988

A home-based pulmonary function monitor for cystic fibrosis.

As care for the chronically ill makes increasing demands upon our medical system, cost-effective methods for addressing those demands are being sought. The use of self-monitoring coupled with telecommunication of results to the health-care provider can be expected to provide a partial solution in the appropriate clinical setting. An electronic spirometer with telecommunication ability for use by cystic fibrosis patients in the home has been developed.

Analog-Digital Conversion↗
PubMed1987

The past, present, and future of continuing medical education. Achievements and opportunities, computers and recertification.

Changes in continuing medical education (CME) during the past three decades have been controversial and complex. A 1950s-style, small-scale, voluntary activity has evolved, in 1987, into broad-scale programs with accredited sponsors and with ties to relicensure. Within the next three decades, CME will be directed by methods chosen by specialty boards for recertification and by exploitation of computer and telecommunication technology. Written recertification examinations can waste physicians' time studying material that will not improve care of their patients. We hope improved methods of analysis of individual practices, on-the-spot access to pertinent medical information, and better communication among physicians can be incorporated into recertification procedures. Policies established now will shape CME for decades to come. We encourage a coordinated effort by medical specialty boards, medical societies, hospitals, medical schools, computer corporations, telecommunication firms, granting agencies, and the National Library of Medicine to ensure the most effective and efficient recertification and CME policies.

Accreditation↗
PubMedDate not supplied

Telecommuters: the work force of the future.

Telecommuters are the work force of the future. The dawning of the information age, with its explosion of telecommunication technology, presents new opportunities for healthcare agencies to extend their borders far beyond traditional physical boundaries. The virtual workplace can become a reality and position healthcare agencies to be geographically dispersed throughout their community. The authors describe a pioneering effort to use telecommunications to retain a valuable employee and create a healthcare agency's first virtual workplace. Strategies for success in telecommuting also are provided from both the telecommuter's and the manager's viewpoints.

Computer Communication Networks↗
PubMed1995

The evolution of the implanted pacemaker's window to the world.

An implanted pacemaker can only communicate with the outside world through its window, i.e., the clinical programmer. Since its inception, the pacemaker has evolved from a non-programmable device to a complex device. Therefore, programming a modern implantable pacemaker could be very challenging for non-experienced or infrequent users. Various programmer-based automatic functions have been developed to reduce programming time and complexity and to obtain accurate measurements. With increasing interests in the telecommunications and information exchange, these programmer-based automatic functions are pushing forward a future vision that automatic pacemaker follow-up procedures via telecommunications are possible for patients located in any corner of the globe.

Biomedical Engineering↗
PubMedDate not supplied

Telepreventive medicine.

There have been dramatic improvements in health during the past 50 years, and public health measures have made a major contribution. Much of public health consists of information transfer. The application of telecommunications technology to public health and preventive medicine would enhance our ability to transmit information and improve global health. The idea of telemedicine has received considerable attention but has not thus far included preventive medicine. We have outlined a global electronic health network with seven main components: connectivity, telemonitoring of disease, "distance education" for public health workers, electronic connection of nongovernment organizations, a combined degree in public health and communications, an electronic scientific research server, and a home page on the World Wide Web. A commitment to the integration of telecommunications and public health holds great promise for improving the health status of the world's population.

Computer Communication Networks↗
PubMed1997

[Cellular phone interference with medical instruments].

Cellular telephones and other telecommunication equipment occasionally cause malfunctioning of medical equipment, including life-support equipment. We review such malfunctioning and relate it to Israeli and Worldwide standards, analyzing the characteristics of the interference in terms of amplitude and frequency. The results of a controlled study of interference by cellular telephones and portable 2-way radios with medical devices in our clinical departments are also presented. The levels of background environmental electromagnetic noise at several sites in both Hadassah hospitals (Ein Karem and Mount Scopus) were measured, as well as signal levels of cellular telephones and other communication equipment at various distances and in various areas. We recommend 2 different levels of restrictions on the use of this equipment within the hospital. These include prohibition of the use of wireless telecommunication equipment in intensive care areas and operating theaters. In all other areas it is recommended to turn off the cellular telephone within 1 meter of medical devices and not to transmit (but only to receive) calls with a portable 2-way radio within a 5 meter distance of medical devices.

Electromagnetic Fields↗
PubMed1997

[Application of Internet technology in public health].

Recent advances in telecommunication technology have been enormous. Application of this technology in public health has the potential to markedly improve global health through better surveillance and information systems. With this assumption the GHNet was established in 1994 by representatives from academia, WHO, Pan American Health Organization, the World Bank, NASA, IBM, and AT & T. The GHNet consists of seven components: 1) promotion of networking with the Internet among people in public health; 2) disease tele-monitoring; 3) distance learning system with the internet; 4) connection of non-governmental health organizations; 5) training cyberdocs who are educated in both public health and telecommunications; 6) establishment of an electronic scientific research server; and 7) a home page on the World Wide Web (WWW). In order to effectively incorporate the Internet into the field, connectivity and knowing how to use it are of critical concern. More and more facilities are connected to the Internet in Japan. However, few courses teaching how to utilize the Internet are provided for people in this field. An Internet training course for people in public health was held as joint venture of the World Health Organization (WHO) and the Global Health Network (GHNet) on October 31, 1996, at the 55th Annual Meeting of Japanese Society of Public Health. Most of the participants for the course were from local public health departments and very few had previous experience with the Internet before the course. During this course participants learned how to use e-mail, how to find health resources on the WWW, how to construct a home page, and how the Internet could be utilized to improve public health, with their computers actually hooked to the Internet. From this experience, we found that this kind of course is feasible and beneficial and hope that this course would serve as a model for training people in public health.

Computer Communication Networks↗
PubMed1997

Lessons for the health care industry from America's experience with public utilities.

In the United States, the traditional public utilities, power and telecommunications, along with health care, are being deregulated and becoming increasingly competitive, especially on price. Regulation of the public utilities has occurred for the past century not simply because they have been monopolies, but, more importantly, because they are "industries affected with the public interest," that is industries which: 1. provide an essential service, 2. benefit from public prequisites, and 3. would cause great public harm if mismanaged. Consequently, the presence of competition in these industries does not negate the need for regulation. Regulation of these industries is best understood as being along the three sides of a "triangle of public interests"--quality, public accountability, and universal service. Examples are provided of these types of regulation in power and telecommunications, even in current "deregulatory" legislation. Health care reform activists in the United States have lately paid attention mostly to the first two legs of the triangle; they are encouraged to focus creatively on the third leg--universal health care.

Economic Competition↗
PubMed1998

Cardiovascular disease. Physician attitudes toward prevention and treatment.

OBJECTIVE: Survey of physician attitudes toward practising cardiovascular disease prevention. DESIGN: Questionnaire administered via telecommunication from 1992 through 1994. SETTING: The FAMUS (Family Medicine, University of Sherbrooke) project, between 1992 and 1996, used weekly telecommunication to collect data from 200 general practitioners throughout the province of Quebec on cardiovascular disease risk factors and their treatment. PARTICIPANTS: Of 200 physicians contributing to the FAMUS project, 156 completed questionnaires (response rate 78%). MAIN OUTCOME MEASURES: Variations in attitudes to prevention policy and risk factor interventions. RESULTS: Survey results revealed physicians knew important risk factors for cardiovascular disease but differed in attitudes toward efficacy of treatment. Intervention to control cholesterol was thought to be very effective by 21.2% (95% confidence interval [CI] 21.2 +/- 6.4) and without effect by 10.3% (95% CI 10.3 +/- 4.8). Intervention to improve dietary habits was considered ineffective by 48.1% (95% CI 48.1 +/- 7.8). Confidence in managing risk factors varied; most respondents described themselves as only moderately skilled. A few practitioners (30.1%; 95% CI 30.1 +/- 7.2) acknowledged practice guidelines as an important source of information on which to base preventive interventions. Only 14.7% (95% CI 14.7 +/- 5.6) of those surveyed included remuneration as contributing to their implementation of prevention activities in practice. CONCLUSIONS: Variations in physician attitudes could influence risk factor intervention. Interventions to change lifestyle are associated with uncertainty about patient compliance, efficacy of treatment, and ability to effect lifestyle changes.

Adult↗