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PubMed1998

[Utility of PC-based videoconference systems in surgery].

Growing complexity of performance processes in medicine require a quicker and more consistent flow of information, even between distant sites of health care. The Regensburg model, a realisation of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing--systems shows the use of modern telecommunications especially in medical spheres. In project-related evaluations, the efficacy of these systems as well as their use can clearly be proven. Through a quicker flow of information, quality improvements for all participants resulted, and to some extent considerable costs for health care were avoided or lowered.

Evaluation Studies as Topic↗
PubMed2005

Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation.

BACKGROUND: Pediatric subspecialists are often separated from the children who need them by distance, time, or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers. OBJECTIVE: To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings. DESIGN: Prospective trial. SETTING: Twenty-two military treatment facilities in the Pacific. PARTICIPANTS: Primary care providers, pediatric consultants, and 5 reviewers. MAIN OUTCOME MEASURES: Consult response time, physician panel review, and evacuation cost avoidance. RESULTS: There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 +/- 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P < .01 for all). Routine air evacuations to a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of $185 408. CONCLUSIONS: The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.

Adolescent↗
PubMed2006

Telemedicine and electronic health information for clinical continuity in a mobile surgery program.

INTRODUCTION: An intermittent surgical services program in rural Ecuador was able to benefit from close collaboration between surgeons and primary care physicians through the use of telemedicine technologies. METHODS: Inexpensive telemedicine workstations capable of patient documentation, imaging, and video-conferencing at extremely low bandwidth were established in collaborative primary care sites in rural Ecuador. Patients were screened for intermittent surgical services by primary caregivers according to the surgeons' guidelines. Real-time and store-and-forward telemedicine allowed appropriate collaborative, informed decision-making. Surgery was performed, and postoperative care was similarly handled by on-site, familiar primary caregivers. RESULTS: To date, this system has been used in more than 124 patient encounters (74 preoperative and 50 postoperative visits). The system allowed advance screening of patients on the part of the surgeons, leading to cancellations for 9 patients. Postoperatively, the system allowed 100% concurrence in postoperative diagnoses between the primary caregivers and the surgeons. CONCLUSIONS: Inexpensive, low-bandwidth telemedicine solutions can support intermittent surgical services by providing patients to have contact with specialist care through their familiar, local primary caregivers.

Ecuador↗
PubMed2006

Telepsychiatry with incarcerated youth.

PURPOSE: Incarcerated adolescents have a high prevalence of psychiatric disorders but lack psychiatrists to provide ongoing care. Telepsychiatry may provide one solution to treating this underserved population. METHODS: Interactive video conferencing was used to connect a minimum security correctional facility with a regional telemedicine program. Clinical records were reviewed to examine utilization, demographics, diagnoses, pharmacotherapy, and patient satisfaction. RESULTS: During the 29-month study period, 115 youth were treated using 275 telepsychiatry visits. Substance-use, behavioral, and emotional disorders were highly prevalent. Eighty percent (80%) of the youth were successfully prescribed medications. Youth expressed confidence with the psychiatrist's recommendations but expressed concerns about privacy. CONCLUSIONS: Telepsychiatry can successfully deliver services to incarcerated adolescents with a wide range of psychiatric needs. A patient-centered approach that directly assesses adolescents' satisfaction is recommended to ensure youths' optimal involvement in needed services.

Adolescent↗
PubMed2006

Telestroke: extending stroke expertise into underserved areas.

Telestroke systems offer the opportunity to extend stroke-care expertise into rural and underserved areas. These systems are being used to give alteplase to patients with stroke in previously underserved areas safely, effectively, and rapidly. Telestroke will probably play a large part in improving the quality of stroke care and in enrolling patients into clinical trials in rural and community hospitals. One such telestroke system, REACH (remote evaluation of acute ischaemic stroke), is a low-cost, web-based system that allows the consultant to access the system from work, home, or on the road. REACH is presently being used to give alteplase and guide acute stroke care in eight rural community hospitals in Georgia.

Female↗
PubMed2006

Telestroke: effective networking.

Although stroke units and systemic thrombolysis are effective, use of these two treatment methods is restricted because of a widespread lack of expertise. New telecommunication technologies can help to overcome the lack of emergency-provider support in neurologically underserved areas. The status of "telestroke" as the application of telemedicine for acute stroke is presently passing from feasibility to routine use. Teleneurological examination is reliable and systemic thrombolysis can be extended with telemedical consultation. Telestroke, however, offers even more potential in overall acute stroke management. On the one hand, it provides rapid access to specialised interventions through initiation of interhospital transfers, and on the other hand, it might lead to major improvements in basic on-site stroke therapy.

Computer Communication Networks↗
PubMed2006

"Distributed proton radiation therapy"--a new concept for advanced competence support.

The increased interest in high precision radiation therapy is to a large extent driven by the potential of modern imaging technology. The aim of this project was to analyse how an expensive proton facility best could support a multi-centre health care system. We have developed a model for distributed expert collaboration where all clinical experts will work close to their patients in regional centres. Patients who are candidates for proton therapy will be examined and dose-planned at their regional clinic, discussed in a fully information supported video conference and digitally made available at the proton treatment facility. The proton facility itself will be placed near a communication centre easily reached by all patients where they will be treated under full responsibility of their own physician at the home clinic. This concept has been analysed in detail both with respect to the overall functionality and with respect to possible weaknesses. It was found that the concept of distributed radiation therapy, as proposed here, will offer a stable clinical solution for advanced radiation therapy. It will support the spread of knowledge, serve as a fully developed backup system and the concept will further serve as an efficient base for clinical research.

Ambulatory Care Facilities↗
PubMed2004

Effect of camera resolution and bandwidth on facial affect recognition.

This preliminary study explored the effect of camera resolution and bandwidth on facial affect recognition, an important process and clinical variable in mental health service delivery. Sixty medical students and mental health-care professionals were recruited and randomized to four different combinations of commonly used teleconferencing camera resolutions and bandwidths: (1) one chip charged coupling device (CCD) camera, commonly used for VHSgrade taping and in teleconferencing systems costing less than $4,000 with a resolution of 280 lines, and 128 kilobytes per second bandwidth (kbps); (2) VHS and 768 kbps; (3) three-chip CCD camera, commonly used for Betacam (Beta) grade taping and in teleconferencing systems costing more than $4,000 with a resolution of 480 lines, and 128 kbps; and (4) Betacam and 768 kbps. The subjects were asked to identify four facial affects dynamically presented on videotape by an actor and actress presented via a video monitor at 30 frames per second. Two-way analysis of variance (ANOVA) revealed a significant interaction effect for camera resolution and bandwidth (p = 0.02) and a significant main effect for camera resolution (p = 0.006), but no main effect for bandwidth was detected. Post hoc testing of interaction means, using the Tukey Honestly Significant Difference (HSD) test and the critical difference (CD) at the 0.05 alpha level = 1.71, revealed subjects in the VHS/768 kbps (M = 7.133) and VHS/128 kbps (M = 6.533) were significantly better at recognizing the displayed facial affects than those in the Betacam/768 kbps (M = 4.733) or Betacam/128 kbps (M = 6.333) conditions. Camera resolution and bandwidth combinations differ in their capacity to influence facial affect recognition. For service providers, this study's results support the use of VHS cameras with either 768 kbps or 128 kbps bandwidths for facial affect recognition compared to Betacam cameras. The authors argue that the results of this study are a consequence of the VHS camera resolution/bandwidth combinations' ability to improve signal detection (i.e., facial affect recognition) by subjects in comparison to Betacam camera resolution/bandwidth combinations.

Adult↗
PubMed2004

A pilot study of feasibility and efficacy of telemedicine-delivered psychophysiological treatment for vascular headache.

Headache is a common complaint. Psychological treatment has been effective in managing the symptoms of vascular (migraine and combined migraine-tension) headache. Traditional office-based treatment may be inconvenient for many patients in terms of time and travel constraints, thereby limiting access. Telemedicine has emerged as a promising delivery medium to address these barriers to access. However, the efficacy of remotely delivered treatment for vascular headache remains untested. This case series is a preliminary evaluation of effectiveness and feasibility of an analogue telemedicine system for delivery of psychophysiological treatment for vascular headache. Three of four subjects showed improvement. These findings are encouraging for follow-up study of the clinical utility and broader viability of headache treatment via distance technology.

Feasibility Studies↗
PubMedDate not supplied

Implementing a nursing program via live interactive video: lessons learned.

Flexibility in scheduling and sensitivity to meeting the educational needs of today's diverse student population is a must in nursing education. The authors present an overview of how a college of nursing implemented an entire generic BSN program via live interactive television for nursing students 45 miles from the main campus. The authors describe the experience of initiating the program, facilitating faculty and student adaptation to the challenges of live interactive video education, and a summary of the first five years.

Education, Distance↗
PubMed2006

Taking the call-bell home: a qualitative evaluation of Tele-HomeCare for children.

Tele-HomeCare (THC) delivers health care at home using telephone technologies. A THC service was developed as an adjunct to existing hospital and community care systems. It connected healthcare providers to children and families at home, during the initial transition from hospital to home, using video-conferencing phones and remote vital signs monitors. The goal was to support the transition from hospital to home, for children with subacute healthcare needs. This paper reports the qualitative evaluation of THC and describes the experiences of families supported by THC. A total of 16 mothers, four fathers and two adolescents from 16 families participated in a series of interviews conducted before, during and after THC. The interviews focused on the impact of THC on the children, on the families, and on their overall healthcare experience. Analysis of their accounts identified three subthemes: the stable child, a sense of security, and the healthcare-proficient parent. These subthemes were consistent across all time points and participants. Together they contributed to the overall effect of THC: the timely reunification of the family at home. THC was consistently reported to be an important resource that supported children and families during the transition from hospital to home. The benefits to children and families observed in this study may have also been a consequence of returning to their home environment, since THC allowed these children to be discharged home at a much earlier period. However, our findings are consistent with previous reports of the benefits of THC. Thus, THC is a successful method of healthcare service delivery that enables a safe return home with professional support provided remotely.

Adolescent↗
PubMed2004

Retrospective review of teledermatology in the Waikato, 1997-2002.

We reviewed scheduled interactive teledermatology consultations from 1997 to 2002 between the Department of Dermatology of Health Waikato in Hamilton and remote sites at Taumarunui Hospital, Taupo Health Centre and the Ranolf Medical Centre, Rotorua, in New Zealand. Eighty-five per cent of 384 appointments were attended and most non-attendances were unexplained. The reason for consulting a dermatologist was inflammatory skin disease in 74% of cases, cutaneous infection in 10%, a skin lesion in 12% and no diagnosis was made in 4%. Follow ups were arranged for 41%, mainly by telemedicine (74%). Despite the apparent success of 75% of consultations and positive feedback from patients attending them, the service has not proved sustainable long-term. This is because of other priorities for the delivery of health care, lack of support by clinicians and administrators, and ongoing financial costs.

Adolescent↗
PubMed2005

Reducing professional isolation: Support Scheme for Rural Specialists.

The Support Scheme for Rural Specialists project is a federally funded initiative aimed at reducing professional isolation among rural medical specialists. The Australasian College of Dermatologists became involved in this project in July 2003. We report the results of a survey designed to collect demographic data and establish a technology option for remote delivery of metropolitan clinical meetings. These are a major component of continuing professional development activity among metropolitan colleagues. An interactive compact disk format was developed, containing recorded footage and presentation slides from meetings, which replicated attendance as closely as possible. Following distribution to rural dermatologists, continuing professional development points were awarded for viewing and appraising the 'virtual' meeting on compact disk. Evaluation of the technology found a statistically significant increase in continuing professional development involvement. The success of this project has led to its expansion, refinement and continuation in 2004.

Australia↗