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At least 595 records · Page 33Linked to original sources
PubMed2002

Videoconferencing in facilities providing care for elderly people.

Two studies were conducted to test the feasibility of delivering care by videoconferencing to facilities providing care for elderly people. Both used equipment connected by ISDN lines at 384 kbit/s. During the first study, no consultations, care plans or assessments were conducted. During the second study, 120 assessments were conducted in just over two weeks, both face to face and by videoconference. Why was one project so successful and the other not? The reasons related to ownership, planning, participants and location. A comparison of the two projects highlights some of the considerations necessary to ensure the success of any telehealth project.

Aged↗
PubMed2001

Combined robotic and nonrobotic telepathology as an integral service component of a geographically dispersed laboratory network.

To achieve real-time connectivity between its 8 hopital-based laboratories, Veterans Integrated Service Network (VISN) 12, headquartered in Chicago, IL, has implemented a hybrid dynamic store-and-forward (HDSF) telepathology network that extends across portions of 3 states. The majority of diagnostic telepathology functions are provided to the 3 hospitals (Iron Mountain, MI; Tomah, WI; and North Chicago, IL), which lack on-site pathologists and are serviced by the 4 pathologists located in Milwaukee, WI. In surgical pathology, routine primary diagnosis, frozen section diagnosis, and clinical consultation are provided with telepathology. In addition, autopsy and specialty clinical conferences are frequently performed by using telepathology. Telepathology has been applied to a variety of areas within clinical pathology as well, including protein electrophoresis, immunoelectrophoresis, peripheral blood smears, body fluids, microbiology, and distance learning. Implementation of telepathology has allowed VISN 12 to reach the goal of providing a single standard of accurate and timely pathology service, even at small sites that lack an on-site pathologist.

Computer Communication Networks↗
PubMed2001

Store-and-forward teleneurology in developing countries.

We assessed the feasibility of a store-and-forward email teleneurology service between a UK neurologist and a rehabilitation hospital in Bangladesh. Over 12 months, email advice was requested for 12 patients (mean age 43 years, range 15-57 years). Each patient generated an average of 5.2 email messages. Eight cases were considered complicated by the neurologist, who would have preferred a video-link consultation for these. The referring doctor found the neurologist's advice beneficial in 75% of the complex cases and in all of the more straightforward cases. Patient care was changed in 50% of the cases as a result of the specialist advice and one patient transfer out of the country was avoided. Store-and-forward teleneurology is effective for delivering expert neurological advice.

Adolescent↗
PubMed1999

[Consultation per video-conferencing with regional hospitals: the MEDKOM project of the Hannover Medical University].

Consultations between doctors are necessary tools for decisions in diagnosis and treatment of patients. The mainstay is a sound communication between the participants, using verbal and audio-visual means. Usually clinical findings and imaging results are included. Using video technology with ISDN (integrated services digital network), such consulting can be performed across any distance. The department of hematology and oncology of the Medical School Hanover has introduced such a system in 1989 for conferencing with 12 regional hospitals and two private practices. It is now a well recognized and established system being applied for 270 sessions and for 1100 Patients per year. It is an integrated part of the co-operation, also allows medical education and quality improvement.

Computer Systems↗
PubMed2005

Prehospital thrombolysis perfomed by a ship's nurse with on-line physician consultation.

Prehospital thrombolysis for acute ST-elevation myocardial infarction (STEMI) has been shown to improve recovery from myocardial function. We describe prehospital thrombolytic treatment in two patients suffering from STEMI complicated by ventricular fibrillation (VF) on a passenger ship. The importance of a functioning Emergency Medical Service (EMS) system providing guidance for paramedical personnel is discussed briefly. Both our patients survived and returned back to normal life. It is concluded that EMS physician guided prehospital thrombolytic treatment may offer an important therapeutic option for nurses or paramedics in locations out of reach of ordinary EMS services.

Aged↗
PubMed2000

Telemedicine use in two nurse-led minor injuries units.

Telemedicine links were established between two nurse-led minor injuries units (MIUs) located in community hospitals and an accident and emergency department in a district general hospital. Telemedicine consultations were logged. During the first year of operation, telemedicine use was surprisingly constant, there being an average of 36 calls a month from one MIU and 16 from the other. Possible reasons for this include the clinical protocols under which nurses could refer patients to hospital. The average duration of teleconsultations was 3.5 min. Although the MIUs dealt with roughly similar numbers of patients, approximately 600-700 per month, the proportion for whom telemedicine was used was very different, at 5.2% and 2.3%.

Humans↗
PubMed1997

[Establishment of a laboratory information office in response to the expanding need for consultation--actual situation of the laboratory information room, Clinical Laboratory Department, Kitasato University Hospital].

Due to the advancement, segmentation and specialization of the medical care, laboratory examinations covered by the National Health Insurance (NHI) tariff have exceeded several hundred, and it is not possible for medical staff to be familiar with all of these and to utilize them appropriately. There is an urgent need for laboratory information for physicians, nurses, and other health professionals. Accordingly, our Clinical Laboratory Department, Kitasato University Hospital, established a "Laboratory Information (Consultation) Office" in July 1995 to provide consultations on clinical laboratory tests to those engaged in daily clinical practice and in medical research. The office is situated on the second floor of the Laboratory Building of the Kitasato University Hospital. One laboratory technician and one laboratory physician (clinical pathologist) are stationed there. They are available for telephone consultations from 9:00 to 17:00 on weekdays, except for holidays, and from 9:00 to 13:00 on the first, third and fifth Saturdays. In addition, since January 1997, this office also has been open to members of medical associations in various cities in our area. To cope with requests for laboratory information, including whether an examination is covered the NHI tariff, selection of appropriate screening examinations and availability of new laboratory tests, consultations by fax are accepted at any time, even after regular working hours. As a post-graduate education program, the clinical laboratory physicians study specimen handling analytical methods and interpretation of results. At medical staff meeting, personnel from the Laboratory Information Office provide clarification on the types of consultations offered, address complex questions and find resolutions for rarely encountered and difficult laboratory issues. At these meetings, a summary of new laboratory examinations also is presented. This system of an information office where full-time laboratory physicians and laboratory technicians are stationed is the first such attempt in Japan. It may be considered a pilot project to determine if such a system may be applied to other laboratory departments in the future.

Clinical Laboratory Information Systems↗
PubMed2002

Perioperative cataract OP management by means of teleconsultation.

BACKGROUND: Teleconsultation services have the potential to improve the communication among different medical care providers and between them and the patient. Increasing effectiveness in the shape of a savings in time or cost is often the result of better communication. METHODS: A study was performed in order to demonstrate the feasibility of teleconsultation services, using the perioperative management of cataract patients as an example, and to provide data on the quality, acceptance and effectiveness of these services in comparison with a control group experiencing normal treatment. RESULTS: Over a period of 3 months 42 patients of the teleconsultation group and 20 controls were studied. There were two referring ophthalmologists and three surgeons. The teleconsultation group had one consultation fewer with the ophthalmic surgeon because of the teleconsultation service. Patient satisfaction was slightly higher using the new technology. Patients would like to see this technique used again should surgery on the second eye become necessary. CONCLUSIONS: Teleconsultation services are ready to support and improve perioperative cataract management. Patients' confidence in their medical treatment was increased by using teleconsultation services. Physicians will expand the use of teleconsultation.

Cataract↗
PubMed1999

Teledermatology in a capitated delivery system using distributed information architecture: design and development.

OBJECTIVE: This report describes the design, development, and technical evaluation of a teledermatology system utilizing digital images and electronic forms captured through, stored on, and viewed through a common web server in an urban capitated delivery system. MATERIALS AND METHODS: The authors designed a system whereby a primary care physician was able to seek a dermatologic consultation electronically, provide the specialist with digital images acquired according to a standardized protocol, and review the specialist response within 2 business days of the request. The settings were two primary care practices in eastern Massachusetts that were affiliated with a large integrated delivery system. Technical evaluation of the effectiveness of the system involved 18 patients. Main outcome measures included physician and patient satisfaction and comfort and efficiency of care delivery. RESULTS: In 15 cases, the consultant dermatologist was comfortable in providing definitive diagnosis and treatment recommendations. In 3 cases, additional information (laboratory studies or more history) was requested. There were no instances where the dermatologist felt that a face-to-face visit was necessary. CONCLUSIONS: This novel approach shows promise for the delivery of specialist expertise via the internet. Cost-effectiveness studies may be necessary for more widespread implementation.

Computer Systems↗
PubMed2001

Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population.

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.

Aged↗
PubMed1997

Telesurgical mentoring. Initial clinical experience.

BACKGROUND: Minimally invasive surgical techniques yield significant individual, economic, and social benefits when performed by experienced surgeons. Unfortunately, many of these techniques, such as laparoscopy, are associated with steep learning curves, and the incidence of complications has clearly been shown to be inversely related to experience. The initial high complication rate and the dearth of experienced endoscopic surgeons have raised concerns over training, granting of hospital privileges, and most importantly patient safety. The goal of this study was to employ current telecommunications technology in a system for the mentoring of relatively inexperienced surgeons. Therefore, we created a telesurgical system that would allow an endoscopic specialist at a central site to offer guidance and assistance to a surgeon during a laparoscopic procedure. METHODS: We developed a system that connected a central site and an operative site, a distance of approximately 3.5 miles, via a single T1 (1.54 Mbs) point-to-point communications link. The system provided real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to electrocautery for tissue cutting or hemostasis. RESULTS: Seven patients underwent laparoscopic procedures using the telesurgical consultation system over the communications link. In all cases, the primary surgeon had limited experience with the laparoscopic approach but still had the basic skills required to obtain intraperitoneal access. All seven cases were completed successfully without complications. CONCLUSION: These initial studies have demonstrated the feasibility, effectiveness, and safety of telementoring. Telesurgical applications have the potential to greatly improve surgical education credentialing, and patient care by offering patients and their surgeons global access to surgical specialists.

Humans↗
PubMed1998

Evaluation of telemedical support to a free-standing minor accident and treatment service.

We studied all patients attending a free-standing minor accident and treatment service (MATS) run by emergency nurse practitioners (ENPs). In a six-month period, 5563 patients were seen in the MATS, of whom 2843 (51%) were new attenders. A teleconsultation was carried out with 150 of these patients (2.7% of all cases). The most common reason (39%) was to discuss a radiograph with an accident and emergency consultant. The accuracy of the telemedicine-assisted radiographic diagnosis was checked subsequently by a review panel. The ENPs' working diagnoses (made by viewing the films) had a sensitivity of 90% and a specificity of 96%; this was improved by telemedicine assistance to 97% and 99%, respectively. The telemedicine patients were also surveyed several months after being seen in the MATS; their replies indicated that the telemedicine diagnoses had been correct.

Accidents↗
PubMed2003

Using information technology to improve the management of chronic disease.

Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay.

Australia↗
PubMed2000

Telemedicine in Majuro Hospital, Marshall Islands.

Since March 1998 up to June 2000, telemedicine activities in Marshall Islands have mainly been for Referrals to Tripler Army Medical Center (TAMC) in Hawaii. The activities are based on a computer which has the Internet connection and accessories including a digital camera, flatbed scanner with a transparency adapter, color printer, a video printer, ophthalmoscope, otoscope and a video Lens, all of which were donated by Project Akamai in Hawaii. Two sessions of training were conducted by representatives from Akamai Project and from PBMA at the very beginning of the establishment of the unit, to all levels of Health Care Providers in Ministry of Health in Majuro. The computer and Internet facility is available 24 hours. Since March 1998 to June 2000, there had been 144 telemedicine consultations to TAMC. Out of a total of 326 off-island referrals for the same period, approximately 80 patients have been sent to TAMC using the PIHCP/Telemedicine program. This accounts for approximately 25% of total off-island referrals. This represents a significant reduction in cost. In addition to cost reduction the telemedicine unit most important impact is on the health providers, especially the physicians working at Majuro Hospital. Availability of medical information through internet has helped them to feel less isolated from the constantly changing field of medical science.

Hospitals, Community↗
PubMed1995

Telemedicine: delivering medical expertise across the state and around the world.

Many aspects of medical care can now be delivered at a distance using telemedicine technology. Rapid video and computer-based communication of medical information makes it possible for a physician to "examine" a patient located in another city, to view highly detailed medical images, to consult with distant subspecialists, or to supervise complex medical procedures. This same technology can bring scattered health-care workers together for joint teaching conferences. The Yale Telemedicine Center has initiated a number of such programs ranging from providing consultations in real time to physicians in Saudi Arabia, to interpreting medical images across town or across the state. Telemedicine will become a powerful tool for managed health-care organizations which are responsible for the medical needs of widely distributed patients in a vertically integrated health-care delivery system. This paper reviews the evolution of telemedicine, its technical fundamentals, specific medical applications, and the activities of the Yale Telemedicine Center. Evolving uses for telemedicine in Connecticut are described.

Connecticut↗
PubMed2006

How we do it: cost-benefit analysis of implementing a telephone review system in an ENT outpatient setting.

There is an increasing pressure on the National Health Service (NHS) hospital consultants to reduce the waiting times. We have used an optional telephone review for a certain number of our outpatients so as to reduce the need for their in-person attendance. The result of our study, which was conducted in two phases, showed that almost half of the telephone follow-up patients (48%) were discharged over the phone. There was a direct saving of approximately 30 pounds per patient having a telephone follow-up.

Appointments and Schedules↗
PubMedDate not supplied

eCare and eHealth: the Internet meets health care.

Increasing use of the Internet by consumers in general is being reflected in greater reliance on this medium for health information and health care. Patients are consulting the Web for medical information and resources from databases that are generally accessible to the public as well as physicians. In addition, interactions between physicians and patients via e-mail present an opportunity for greater efficiency in medical practice. Though physicians have been somewhat reluctant to embrace this modality, it offers significant opportunities for enhancing patient care without undue liability. Issues of confidentiality and security of medical information are also discussed.

Community Participation↗
PubMed2003

[NADIS 2000, development of an electronic medical record for patients infected by HIV, HBV and HCV].

OBJECTIVE: to develop an electronic medical record for patients living with HIV, HBV or HCV in order to improve their management, facilitate communication between all the caregivers, and to create a useful medical database for research and assessments. This project (NADIS 2000) involved 6 centres of Infectious Diseases in France in partnership with Fédialis Médica (subsidiary of the GSK group in France). METHODS: A specifications sheets was drawn-up by a piloting Committee regrouping the various correspondents in each centre and a computer expert representing Fédialis Médica. A Scientific and Development committee regrouped the heads of departments of each centre and the representatives from Fédialis Médica and GSK and was charged with defining the general concept of the project and guaranteeing the scientific and clinical aspects. RESULTS: NADIS 2000 version 1.0 was activated in the departments of infectious diseases in Nice and Toulouse in November 2000 and in others Units at the end of 2001. NADIS 2000 permitted real-time use by the physicians in the Outpatients and Day-care Units and was easily handled by all the practitioners. Its use was eased by the principles clearly defined before its application (department project, progressive but exhaustive use), an intuitive interface simulating a consultation, and functions proposing direct benefits for the physicians (graphical visualization of the biological variables, printing of prescriptions and letters). CONCLUSION: The activation and input methods of NADIS 2000 are user friendly and the physicians find it rapidly easy to use. New functional aspects are being developed as well as its use in other hospital departments.

Computer Communication Networks↗