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At least 577 records · Page 32Linked to original sources
PubMed1997

Telephone consultations at the emergency service, Copenhagen County: analysis of doctor-patient communication patterns.

BACKGROUND: Experience from 10 telephone consultation courses in 1995, arranged for the emergency service in Copenhagen County, has demonstrated that this type of communication requires specific skills on the doctor's part, especially because the doctor cannot see the patient, patients are frequently in some sort of 'crisis' and, on the basis of limited information, the doctor in charge has to arrive at a prompt diagnosis in order to advise or refer the patient. METHODS: Using video-supervised role-play we compiled and organized the experience of 152 doctors. During the courses we developed principles to help doctors to optimize the information output and reliability of their telephone consultations. The doctors playing their 'patients" role had the opportunity to experience the situation from the patient's point of view and were later able to give the 'doctor' valuable feed-back. RESULTS AND CONCLUSIONS: This 'experimental consultation procedure' constitutes a new research method, at the interface between educational and traditional scientific research. The process in question is a feed-back one, in which findings can be applied and tested instantly, or with little delay, to produce new results. These can be put to use in practical clinical work and tested in new 'laboratory experiments'.

Communication↗
PubMed1995

Home reporting for the nuclear clinician?

The computer-based 'home office' is becoming a widely accepted mode of operation for modern businesses. It is implausible to believe that a nuclear medicine department can be covered permanently at a distance by a single physician, but it should be possible to provide cover for colleagues during sickness or at night or weekends. We have used a 486 PC with a high-resolution screen and software provided by LINK Medical Ltd to obtain images from hospital sites using a modem link to ADAC, Bartec and Nuclear Diagnostic SUN workstations. The data were transferred via standard telephone lines to the homes of two of the authors. During a trial period lasting several months, 60 lung scans, 20 bone scans, 1 gastrointestinal bleeding study, 4 leukocyte scans, 5 bone tomograms, 9 renograms, 6 myocardial perfusion tomograms and 2 gated cardiac studies were transferred. The system allowed transfer of a 128 x 128 eight-view lung scan to be completed in approximately 2 min. The program on the PC allowed alteration of individual image contrast, image rotation, cine display and a variety of colour scales to enhance image interpretation. A system to transfer chest X-rays has been developed and typical transfer times are approximately 3.5 min. Within the viewing protocol on the PC, a reporting window was available with the ability to fax the report directly to the hospital. The system allowed consultants who live at a distance from their nuclear medicine departments to provide cover and is now used as an integral part of our out-of-hours service. The system also allows cover of satellite units or to provide cover for junior staff at night or weekends.

Computer Communication Networks↗
PubMed2002

Telemedicine in the service of peace.

Ophthalmology is well suited to telemedicine, since optical and imaging devices provide the basis for virtually all ophthalmic patient evaluations. We established the Middle East Ophthalmology Network among ophthalmologists working in 10 major ophthalmology centres in Israel, Jordan, Morocco, the Palestinian Authority and Tunisia. The project offered some 50 physicians around the Middle East the opportunity to benefit from sharing clinical consultation for diagnosis and management decisions beyond physical and political boundaries. In the first year, over 100 consultations took place. The system overcame some of the constraints imposed by the uneven distribution of medical resources and expertise in the region, reduced professional isolation, encouraged more collaboration between physicians and offered peace dividends from cooperation between physicians across the political divide.

Humans↗
PubMed2004

The impact of teleconsultations at a referential centre on the management of pulmonary patients.

Teleconsultation services at referential centres are an important area of telemedicine development. The implementation of such scenarios brings high-level competencies to peripheral hospitals through telecommunication links. Pulmonary teleconsultations were one of the key aspects of Krakow Centre of Telemedicine (KCT) activities conducted in 2002-2003. The role of the referential centre for respiratory medicine was played by the Division of Interventional Pulmonology, Jagiellonian University Medical College. Peripheral centres were pulmonary wards situated in local hospitals or policlinics located 20-80 km from Krakow. These hospitals were equipped with PC-based telemedical workstations and ISDN lines (256 kbps). Dedicated software (Telenegatoscope) was used for real-time discussions among physicians on medical images (X-rays, CTs) sent from peripheral centres to the referential centre. Images inserted in light boxes were cropped at peripheral centres with a high-resolution digital camera. During the pilot phase, about 40 pulmonary patients were referred via telemedical links to the University Hospital. The frequency of soliciting a second opinion at the referential centre was analyzed for each main type of disease. Top positions are currently occupied by diagnoses of lung cancer, pleural fluid of unknown origin, asbestosis and tuberculosis. About 70% of the patients referred for virtual consultation were admitted for further diagnostics and treatment in an ambulatory or inpatient mode at the Division of Interventional Pulmonology. The review of teleconsultations results indicates that teleconferencing contacts, even if conducted through relatively limited bandwidth, may bring considerable benefits to patients requiring complex diagnostic and sophisticated, procedures available at the referential university hospital.

Community Health Services↗
PubMed2002

Child advocacy outreach: using telehealth to expand child sexual abuse services in rural Kentucky.

We evaluated the use of videoconferencing as an educational and consultative tool for physicians and mental health staff providing services for child victims of sexual abuse in rural Kentucky. The number of counties with access to sexual abuse examinations by a qualified physician increased from 16 to 23 in the first year and to 54 in the second. The number of cases increased from 77 to 83 in the first year and to 339 in the second year. The number of consultations increased from zero to eight in the first year and to 74 in the second year. A user survey showed that the equipment supported clinical decision making, was useful and was easy to use. However, it was not as effective for case conferencing as for one-to-one interactions. Rural health professionals knowledge of child sexual abuse increased.

Child↗
PubMed2000

The teleconsultation service ENDOTEL. Implementation and first experiences.

The multimedia teleconsultation service ENDOTEL launches in May 2000 with its asynchronous component. In the initial phase, three hospitals and four general practitioners use the service to consult a specialist in the domain of gastroenterology and endoscopy. By validation of the patient information, i.e. videos, voice clips, still images and text, the experts can decide the further proceeding, for example, whether a patient shall be transported to a specialized hospital or not (cost-saving). We report about the experiences during the initiation and the first months of operation.

Endoscopy, Gastrointestinal↗
PubMed1998

A telemedicine consultative service for the evaluation of patients with urolithiasis.

OBJECTIVES: A 6-month pilot teleconsultative project linking Georgetown University Medical Center (GUMC) in Washington, DC, and City Hospital in Martinsburg, West Virginia, 90 miles away, was designed to assess the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis. METHODS: The telemedicine system designed and tested for this project was based on a PC-based platform. Videoconferencing and review of the patient's imaging studies were performed over an Integrated Service Digital Network (ISDN) with 3 Basic Rate (BRI) ISDN lines providing a 336-kilobytes/s bandwidth through an Inverse Multiplexor (IMUX). Treatment options were recorded for the clinical trial group and a simulated study group by the consulting urologist after the initial telephone consultation, after the telemedicine consultation, and after examination of those patients transferred to GUMC. RESULTS: A total of 32 telemedicine consultations were performed: 14 in the clinical trial group and 18 in the simulated study group. The recommendation of the consulting urologist at the tertiary center was altered in 12 patients (37.5%) after the telemedicine consultation compared with the recommended treatment after the initial telephone consultation. CONCLUSIONS: In the evaluation of patients with urolithiasis, this telemedicine application enhanced the clinical decision-making process by allowing for improved quality of care through immediate access and effective transfer of information between the referring urologist, the patient, and the stone center specialist.

Adult↗
PubMed2005

Using e-mail in the management of tuberculosis patients, north-west Russia.

SETTING: Ten health care institutions in north-west Russia. OBJECTIVE: To improve the management of tuberculosis patients using e-mail. DESIGN: Over an 18-month period, all outgoing and incoming e-mails at the Arkhangelsk Regional Tuberculosis Centre were saved and categorised. All e-mails relating to distance learning were logged, and a consensus panel discussed and answered questionnaires regarding 47 e-mail-based second opinions. RESULTS: e-mail was found to speed up communication and increase the availability of specialist advice. Distance learning was positively received, but was used in moderation. For six of 47 consultations (13%), the consensus panel deemed that fast access to a second opinion saved lives. In 30 consultations (64%), the patient was saved a round trip to a specialist centre. In 24 consultations (51%), the panel considered that the patients had started correct treatment between 1 week and 1 month earlier than without e-mail access. In 11 of these consultations, 23% of the total, the patient was found to be infectious. The learning effects of second opinions were recognised. CONCLUSION: General e-mail use and the second opinion service in particular were found to be useful. Further studies are needed to investigate the advantages and disadvantages of using e-mail as a tool in the management of TB.

Education, Distance↗
PubMed2003

The quality of medical records in teleconsultation.

We collected and examined the medical records from telemedicine cases dealt with by the telemedicine centre of Shanghai Hospital No. 85. This centre handles the second largest number of teleconsultations in the entire network. There were 658 telemedicine cases in total. The medical records included the patient record in 599 cases (91%), transmitted images in 392 cases (60%), the consultant's opinion in 595 cases (90%) and a video-recording of the teleconsultation in 203 cases (31%). The quality of patient records was reviewed and found to be acceptable in 58% of cases. In total, 1794 radiology images (85% of all images) were transmitted via the telemedicine network. The consultant considered 352 of them (20%) to be unreadable on the screen (i.e. 80% of radiology images were considered to be acceptable). For optimum performance of telemedicine, the patient record and associated images should be delivered in advance and the relevant parts of the patient record should be available during a teleconsultation. Three aspects of the management of the medical records for teleconsultations are particularly important: multimedia collection, standardization of patient/record identification and classification, and information management.

Humans↗
PubMed2006

Telegenetic medicine: improved access to services in an underserved area.

We used telemedicine to improve genetics services to patients in the rural northwestern region of Florida. Patients were first seen via videoconference by a genetic counsellor, who obtained family and medical history. A local paediatrician then performed the physical examination, and a plan for evaluation was established. The videoconferencing equipment was connected at a bandwidth of 384 kbit/s, using three ISDN lines. During the first three telemedicine clinics, seven patients were evaluated and then returned to the centre for a face-to-face consultation with the clinical geneticist. No new diagnoses were made face-to-face that had not been identified by telemedicine. No diagnoses made by telemedicine were judged to be wrong when the child was evaluated face-to-face. During a two-year study of patient satisfaction with 12 telegenetics clinics, the 50 families evaluated via videoconferencing were asked to complete surveys; 40 surveys were returned (a response rate of 80%). All individuals either strongly agreed or agreed that the evaluation of their child was appropriate, sufficient and sufficiently protective of their child's privacy. The waiting time for a new patient consultation with the clinical genetics team was 16.9 months (SD 1.9) at the start and 3.0 months (SD 1.0) at the end of the trial period. The difference was significant (t-test, P < 0.0001). Telegenetics allows more rapid assurance that a genetic syndrome has not been identified, or a quicker initial evaluation and diagnosis for children who do have an identifiable genetic syndrome.

Child↗
PubMed2006

Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers.

We examined the feasibility and acceptance of teledermatology for wound management of patients with chronic leg ulcers by home-care nurses. Forty-one chronic leg ulcers of different origin in 14 patients were included. After an initial in-person visit in which leg ulcers were assessed and classified, and underlying diseases noted, follow-up visits were done by home-care nurses. Once a week 1-4 digital images of the wound and surrounding skin and relevant clinical information were transmitted via a secure Website to an expert at the wound care centre. The experts provided an assessment of wound status and therapeutic recommendations. In 89% of the 492 teleconsultations, the quality of images was sufficient or excellent and the experts were confident giving therapeutic recommendations. Treatment modalities were changed or adapted in one-third of the consultations. There was a significant decrease in visits to a general physician or the wound care centre. The acceptance of teledermatology was high in patients, home-care nurses and wound experts. Teledermatology offers great potential for chronic wound care and seems to be accepted both by patients and health-care persons.

Austria↗
PubMed2000

Use of telemedicine for children with special health care needs.

OBJECTIVE: In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine. DESIGN: A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed. RESULTS: Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30). CONCLUSIONS: In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Adolescent↗
PubMed2004

Resources for inflight medical care.

With the anticipated growth of air travel, inflight illness and injury are expected to increase as well. This is because more elderly people and people with preexisting disease are taking to the air. Although inflight medical events and deaths are uncommon, physician passengers are occasionally called upon to render care. Resources for the physician may include emergency medical kits, automatic external defibrillators (AEDs), ECG monitors, portable oxygen bottles, and first-aid kits. Most airlines provide around-the-clock air-to-ground radio consultation either with their own medical department personnel or contracted medical consultants. Furthermore, some flight attendants are trained in cardiopulmonary resuscitation, first-aid, and operation of AEDs. This paper describes those inflight resources available to a physician who is called upon to treat an ill or injured passenger. In a broader sense, it is also providing advice to physicians who administer inflight medical care. The Aviation Medical Assistance Act of 1998 ("Good Samaritan act") is also discussed.

Aerospace Medicine↗
PubMed2004

Designing a framework for the evaluation of paediatric telepsychiatry: a participatory approach.

While there is a great deal of interest in evaluating participants' experiences of teleconsultation programmes, specific frameworks for such evaluations are scarce. We have conducted a multi-stage consultation to develop a framework for the study of a paediatric telepsychiatry programme. Emphasis was placed on ensuring the participation of stakeholders in the design and response stage of the evaluation. A three-part approach was taken that comprised an opinion scan, focus groups and individual interviews. This resulted in the identification of specific areas of enquiry for the evaluation. One of the key points to emerge was that attending to context is vital. In the case of telepsychiatry, it is critical to understand the nuances of the local community for whom consultations are being provided. This involves considering the 'social ecology' of each evaluation site. The evaluation should take the form of a dialogue between the evaluators and those being evaluated, in order to maximize the uptake and integration of its findings. The framework we have developed should be viewed as a guide that is general enough to be used in the design of many different types of telepsychiatry programme.

Child↗
PubMed2005

Rural jail telepsychiatry: a pilot feasibility study.

New York State has a large rural population, and many of the jails in rural areas have minimal or no psychiatric services available on site. Cost of transport to off-site psychiatric services and the safety issues related to moving inmates from a secure building may limit inmate access to appropriate psychiatric services. This feasibility study describes a project that provided telepsychiatric consultation to increase access to psychiatric treatment in an underserved rural jail in upstate New York. Subjects were consenting jail inmates who requested or were found to be in need of psychiatric care. The project provided interactive two-way audio-video communication between the psychiatrist located in an urban university medical center and subjects who were incarcerated 182 miles away. During the project period, 15 inmates were assessed and treated in 37 consultations. Subjects were predominantly young white males with anxiety, mood, and substance use disorders. Services were readily accepted by inmates and staff. Telepsychiatric examination and treatment appears to be a feasible method to increase access to mental health care in rural jails. Future advocacy for increased mental health services in rural areas in criminal justice setting is likely to depend on further evidence of favorable cost benefit.

Adult↗
PubMed2002

Client satisfaction in a feasibility study comparing face-to-face interviews with telepsychiatry.

We carried out a pilot study comparing satisfaction levels between psychiatric patients seen face to face (FTF) and those seen via videoconference. Patients who consented were randomly assigned to one of two groups. One group received services in person (FTF from the visiting psychiatrist) while the other was seen using videoconferencing at 128 kbit/s. One psychiatrist provided all the FTF and videoconferencing assessment and follow-up visits. A total of 24 subjects were recruited. Three of the subjects (13%) did not attend their appointments and two subjects in each group were lost to follow-up. Thus there were nine in the FTF group and eight in the videoconferencing group. The two groups were similar in most respects. Patient satisfaction with the services was assessed using the Client Satisfaction Questionnaire (CSQ-8), completed four months after the initial consultation. The mean scores were 25.3 in the FTF group and 21.6 in the videoconferencing group. Although there was a trend in favour of the FTF service, the difference was not significant. Patient satisfaction is only one component of evaluation. The efficacy of telepsychiatry must also be measured relative to that of conventional, FTF care before policy makers can decide how extensively telepsychiatry should be implemented.

Adolescent↗
PubMed2004

Mobile phone photo messaging assisted communication in the assessment of hand trauma.

BACKGROUND: The aim of the present study was to incorporate the use of mobile phone photo-messaging into clinical practice, in order to explore its potential advantages and limitations in the context of communication between the registrar and consultant for the assessment of hand trauma. METHODS: Two Nokia 7650 mobile phones (Nokia, Sydney, Australia) were obtained. These were used for correspondence between the registrar and the consultant for all hand trauma seen in the emergency department over a 2-month period. RESULTS: There were 27 cases recorded. Deductions were drawn form the use of the phone and the collected data was qualitatively interpreted. CONCLUSION: The present paper describes our findings and approval of the use of mobile phones with photo-messaging capabilities for the purpose of enhancing communication in a clinical setting. Low cost and ease of use make the phones easily incorporated into clinical practice.

Cell Phone↗
PubMed2004

Email consultations in general practice.

BACKGROUND: Email is an established method of communication in business, leisure and education but not yet health care. AIM: To evaluate an email service enabling communication between patients and their general practice regarding repeat prescriptions, appointment booking and clinical enquiries. DESIGN: Qualitative analysis of interactions and an electronic user survey. SETTING: An urban practice in Dundee, Scotland. PARTICIPANTS: 150 patients aged 24 to 85. METHODS: We set up a practice facility to allow our patients to use email to book appointments, order repeat prescriptions and consult their general practitioner (GP). RESULTS: Patient satisfaction with the service was very high. Patients specifically commended the practice for setting up a facility to allow communication outside standard working hours and for the ease of ordering repeat prescriptions. Patients were pleased to have a means of seeking their doctor's comment or opinion without bothering him or her by making and attending a formal face-to-face consultation. Email dialogue was polite, factual, but less formal than standard letters. Staff did not experience any perceptible rise in workload. CONCLUSIONS: Use of an email consultation facility worked well within an urban practice, was deemed helpful by patients, and resulted in no apparent increase in GP workload. Our results suggest that there may be an unmet need amongst patients for clinical email services, and that such services may have positive outcomes for patients and practices.

Adult↗