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PubMedDate not supplied

Collaborative teaching. A strategy for interactive telecourses.

The use of telecommunication technology in nursing education is increasing dramatically. Interactive television courses are effective and efficient in overcoming barriers of distance and access. Faculty members using the technology find many opportunities for innovation and creativity as courses are implemented. The authors describe a nursing graduate course offered collaboratively between two schools of nursing.

Education, Nursing, Graduate↗
PubMed1998

Blood lead concentration and biological effects in workers exposed to very low lead levels.

A longitudinal study was carried out on two groups of workers engaged in tin/lead alloy welding in the telecommunication sector. The risk of exposure was evaluated by measuring levels of airborne lead (PbA) and the amount of lead absorbed (PbB). The-correlated effects were assessed by determining zinc protoporphyrin (ZPP) and hemoglobin levels (Hb) and red blood cell (RBC) count. We also recorded subjective symptoms reported by workers. One group of welders composed of 365 subjects underwent two monitoring sessions performed in 1991 and 1995, respectively (Group A). A second group of welders (whose number fluctuated between 148 and 247 subjects) underwent yearly testing for 7 consecutive years (1988-1994; Group B). Results indicated a very low risk of lead exposure during microwelding operations (PbA range, 1.5-24 micrograms/m3). In fact, blood concentrations of Pb (range, 5-55, micrograms/dL) among both groups of welders were significantly higher than those in the general population in Rome (PbB range, 5-16 micrograms/dL); nevertheless, they were significantly lower than the Occupational Safety and Health Administration's permissible exposure limits ZPP determined only in Group B of welders ranged from 5 to 16 micrograms/dL (median, 22 micrograms/dL). No variation was found in the other biological parameters investigated, and no health effects were observed. During the study period, the introduction of some technological innovations led to a further reduction in Pb exposure and, subsequently, to its total elimination. PbB concentrations gradually declined to lower values (6-36 micrograms/dL), and it was interesting to note that ZPP concentrations also decreased to normal levels (range, 2-47 micrograms/dL; median, 11 micrograms/dL), demonstrating that the effect of lead on heme synthesis may occur even at very low levels of Pb exposure.

Adult↗
PubMed2001

The impact of a worksite health promotion program on short-term disability usage.

This study examined the impact of a worksite health promotion program on short-term disability (STD) days in a large telecommunications company. The evaluation used a quasi-experimental, multiple time-series design with between-group comparison of workdays lost due to STD to determine impact. The study period was 3 years and included 1628 employees on STD leave. Self-selected program participants were compared with non-participants on net days lost at three assessment points: the year before the launch of the program, and each of 2 years post-launch. A comprehensive health promotion program was developed to reduce health care costs, improve employee satisfaction, and enhance the employer's image. Key features of the program included reimbursement for employees participating in the Health Risk Assessment and in wellness or fitness activities. Other features included occupational health services, targeted interventions for high-risk employees, self-care materials, and a nurse advice line. Results revealed no significant differences at baseline between participants and non-participants for net days lost while on STD leave. At the post-program launch, non-participants' net days lost significantly increased from 33.2 to 38.1 when controlled for age, gender, job type, tenure, and STD category, whereas the participant group average net days lost decreased from 29.2 to 27.8. After adjusting for baseline differences, we found a 6-day difference between groups, which represented a 20% program impact. This study found that participation in a health promotion reimbursement program had a significant impact on average net days lost for employee STD absence. These findings represented potential savings in excess of $1,371,600 over a 2-year period. Future program evaluation efforts will address the impact on medical care costs related to program participation.

Absenteeism↗
PubMedDate not supplied

Telemedicine: an emerging health care technology.

Telemedicine uses advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers. All telemedicine applications require the use of the electronic transfer of information. Telemedicine encompasses computer technologies using narrow and high bandwidths for specific types of information transmission, broadcast video, compressed video, full motion video, and even virtual reality. There are many types of common medical devices that have been adapted for use with telemedicine technology, and many clinical services can be provided via telemedicine to patients who live in physician shortage areas. The greatest challenges for telemedicine in the twenty-first century are financing, safety standards, security, and infrastructure.

Biomedical Technology↗
PubMed2004

The application of two health and productivity instruments at a large employer.

We applied two productivity instruments (the Work Productivity Short Inventory and the Work Limitations Questionnaire) to the same employees working at a large telecommunications firm. In this work we note differences in productivity metrics obtained from these instruments and offer reasons for those differences that may be related to their design. Within this sample, average at-work productivity (presenteeism) losses were 4.9% as measured by the WLQ and 6.9% as measured by the WPSI. These translated into losses of approximately $2000 to $2800 per employee per year, respectively. Total productivity losses were usually not associated with demographics or job type but were associated with perceived health status and the existence of particular medical conditions. Both instruments may be useful for employers who want to estimate productivity losses and learn where to focus their energy to help stem those losses.

Absenteeism↗
PubMed2002

Developments in radar and remote-sensing methods for measuring and forecasting rainfall.

Over the last 25 years or so, weather-radar networks have become an integral part of operational meteorological observing systems. While measurements of rainfall made using radar systems have been used qualitatively by weather forecasters, and by some operational hydrologists, acceptance has been limited as a consequence of uncertainties in the quality of the data. Nevertheless, new algorithms for improving the accuracy of radar measurements of rainfall have been developed, including the potential to calibrate radars using the measurements of attenuation on microwave telecommunications links. Likewise, ways of assimilating these data into both meteorological and hydrological models are being developed. In this paper we review the current accuracy of radar estimates of rainfall, pointing out those approaches to the improvement of accuracy which are likely to be most successful operationally. Comment is made on the usefulness of satellite data for estimating rainfall in a flood-forecasting context. Finally, problems in coping with the error characteristics of all these data using both simple schemes and more complex four-dimensional variational analysis are being addressed, and are discussed briefly in this paper.

Algorithms↗
PubMed1997

Dynamic image data compression in spatial and temporal domains: theory and algorithm.

Advanced medical imaging requires storage of large quantities of digitized clinical data. These data must be stored in such a way that their retrieval does not impair the clinician's ability to make a diagnosis. In this paper, we propose the theory and algorithm for near (or diagnostically) lossless dynamic image data compression. Taking advantage of domain-specific knowledge related to medical imaging, the medical practice and the dynamic imaging modality, a compression ratio greater than 80:1 is achieved. The high compression ratios are achieved by the proposed compression algorithm through three stages: 1) addressing temporal redundancies in the data through application of image optimal sampling, 2) addressing spatial redundancies in the data through cluster analysis, and 3) efficient coding of image data using standard still-image compression techniques. To illustrate the practicality of the proposed compression algorithm, a simulated positron emission tomography (PET) study using the fluoro-deoxy-glucose (FDG) tracer is presented. Realistic dynamic image data are generated by "virtual scanning" of a simulated brain phantom as a real PET scanner. These data are processed using the conventional [8] and proposed algorithms as well as the techniques for storage and analysis. The resulting parametric images obtained from the conventional and proposed approaches are subsequently compared to evaluate the proposed compression algorithm. As a result of this study, storage space for dynamic image data is able to be reduced by more than 95%, without loss in diagnostic quality. Therefore, the proposed theory and algorithm are expected to be very useful in medical image database management and telecommunication.

Algorithms↗
PubMed2002

A novel codification scheme based on the "VITAL" and "DICOM" Standards for telemedicine applications.

The field of interest discussed in this study is a novel codification scheme for (vital signs) medical device communication and patient monitoring data interchange, into the context of effective home care service provisioning. With medical technology having developed in isolation and major manufacturers developing their own proprietary communication protocols, which preclude connection to devices from different manufacturers, and with healthcare trends having evolved, pointing to primary care, telecare and home care monitoring, there is an increasing need for technical standardization in healthcare environments and the development of protocols that enable communication in a structured and open way. In this study, a novel codification scheme has been developed, based on two healthcare informatics standards, the VITAL and DICOM Sup. 30, in addressing the robust interchange of waveform and medical data for a home care application. Based on this scheme, we created a real-time facility, consisting of a base unit and a telemedicine (mobile) unit, that enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-lead ECG, pulse rate, blood pressure and SpO2) of the patient. This paper presents an object-oriented design with unified modeling language (UML) of a class hierarchy for exchanging the acquired medical data and performing alert management, and investigates the applicability of the proposed scheme into a commercial patient-connected medical device, thus addressing service and functionality requirements with focus on home-care applications. The system has been validated for technical performance over several telecommunication means and for clinical validity via real patient-involved pilot trials.

Database Management Systems↗
PubMed2005

A direct-sequence spread-spectrum communication system for integrated sensor microsystems.

Some of the most important challenges in health-care technologies have been identified to be development of noninvasive systems and miniaturization. In developing the core technologies, progress is required in pushing the limits of miniaturization, minimizing the costs and power consumption of microsystems components, developing mobile/wireless communication infrastructures and computing technologies that are reliable. The implementation of such miniaturized systems has become feasible by the advent of system-on-chip technology, which enables us to integrate most of the components of a system on to a single chip. One of the most important tasks in such a system is to convey information reliably on a multiple-access-based environment. When considering the design of telecommunication system for such a network, the receiver is the key performance critical block. The paper describes the application environment, the choice of the communication protocol, the implementation of the transmitter and receiver circuitry, and research work carried out on studying the impact of input data characteristics and internal data path complexity on area and power performance of the receiver. We provide results using a test data recorded from a pH sensor. The results demonstrate satisfying functionality, area, and power constraints even when a degree of programmability is incorporated in the system.

Biosensing Techniques↗
PubMed2004

Biomechanical and perceptual constraints on the bandwidth requirements of sign language.

Access to telecommunication systems by deaf users of sign language can be greatly enhanced with the incorporation of video conferencing in addition to text-based adaptations. However, the communication channel bandwidth is often challenged by the spatial requirements to represent the image in each frame and temporal demands to preserve the movement trajectory with a sufficiently high frame rate. Effective systems must balance the portion of a limited channel bandwidth devoted to the quality of the individual frames and the frame rate in order to meet their intended needs. Conventional video conferencing technology generally addresses the limitations of channel capacity by drastically reducing the frame rate, while preserving image quality. This produces a jerky image that disturbs the trajectories of the hands and arms, which are essential in sign language. In contrast, a sign language communication system must provide a frame rate that is capable of representing the kinematic bandwidth of human movement. Prototype sign language communication systems often attempt to maintain a high frame rate by reducing the quality of the image with lossy spatial compression. Unfortunately, this still requires a combined spatial and temporal data rate, which exceeds the limited channel of residential and wireless telephony. While spatial compression techniques have been effective in reducing the data, there has been no comparable compression of sign language in the temporal domain. Even modest reductions in the frame rate introduce perceptually disturbing flicker that decreases intelligibility. This paper introduces a method through which temporal compression on the order of 5:1 can be achieved. This is accomplished by decoupling the biomechanical or kinematic bandwidth necessary to represent continuous movements in sign language from the perceptually determined critical flicker frequency.

Adult↗
PubMed1994

Sketching the future: trends influencing nursing informatics.

Technologies emerging in the fields of telecommunications, video and digital imaging, and microprocessing are shaping the future of nursing practice. To measure up to the future needs of nursing, nurses of today must have the vision and desire to become computer aware and technologically literate. Hypothetical future situations pose challenges related to current nursing informatics and artificial intelligence issues. Discussion includes technology issues related to the lifetime clinical health record. Areas that the Center for Nursing Research considers priorities for informatics suggest directions for nursing technology efforts. This article calls on all nurses to become active in designing and molding future clinical practice systems.

Computer Literacy↗
PubMedDate not supplied

Telemedicine and the national information infrastructure: are the realities of health care being ignored?

Health care is shifting from a focus on hospital-based acute care toward prevention, promotion of wellness, and maintenance of function in community and home-based facilities. Telemedicine can facilitate this shifted focus, but the bulk of the current projects emphasize academic medical center consultations to rural hospitals. Home-based projects encounter barriers of cost and inadequate infrastructure. The 1996 Telecommunications Act as implemented by the Federal Communications commission holds out significant promise to overcome these barriers, although it has serious limitations in its application to health care providers. Health care advocates must work actively on the federal, state, and local public and private sector levels to address these shortcomings and develop cost effective partnerships with other community-based organizations to build network links to facilitate telemedicine-generated services to the home, where the majority of health care decisions are made.

Community Networks↗
PubMedDate not supplied

Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) project: technical implementation.

The Columbia University Informatics for Diabetes Education and Telemedicine IDEATel) project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine. The focal point of the intervention is the home telemedicine unit (HTU), which provides four functions: synchronous videoconferencing over standard telephone lines, electronic transmission for fingerstick glucose and blood pressure readings, secure Web-based messaging and clinical data review, and access to Web-based educational materials. The HTU must be usable by elderly patients with no prior computer experience. Providing these functions through the HTU requires tight integration of six components: the HTU itself, case management software, a clinical information system, Web-based educational material, data security, and networking and telecommunications. These six components were integrated through a variety of interfaces, providing a system that works well for patients and providers. With more than 400 HTUs installed, IDEATel has demonstrated the feasibility of large-scale home telemedicine.

Case Management↗
PubMed2001

Reliability of telepsychiatry assessments: subjective versus observational ratings.

Geriatric patients in underserved areas could benefit from the use of telecommunications to expand access to mental health services. It is important to determine the clinical limitations of using videoconferencing for psychiatric assessments, particularly in the elderly. The goal of this study was to test the hypothesis that videoconferencing ratings based on visual observations of behavior would be less reliable than ratings based on patients' verbal reports of symptoms. Videoconferencing assessments of 30 geriatric patients using low-bandwidth (ISDN) equipment were compared to gold standard face-to-face assessments. The Brief Psychiatric Rating Scale (BPRS) was dichotomized into subjective items based on patients' verbal reports and observational items based on visual ratings of behavior. Reliability of the BPRS subjective items was consistently higher than for the observational items. Future studies should emphasize the accuracy of telemedicine ratings that require visual observation of behavior, which is crucial to clinical assessment of psychogeriatric conditions.

Aged↗
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 needs assessment of the potential users of a South Pacific telehealth service.

Qualitative methods such as focus groups, individual interviews, case studies and participant observation were used to complete a needs assessment for a telehealth service in the South Pacific. Participants from the Cook Islands and Fiji were able to identify extensive uses for a telehealth service, but also identified barriers to its implementation. These included the extremely limited telecommunications and electrical infrastructure found in South Pacific countries, the high cost of Internet access and staffing shortages. The effective implementation of a telehealth site will probably require the use of clinician drivers with an interest in telehealth to encourage colleagues less enthusiastic to change their work practices. Telehealth in the South Pacific would improve services across a wide geographical area, but initial and continuing costs would be high due to the lack of infrastructure.

Attitude of Health Personnel↗
PubMed2005

Telemedicine room design.

Proper design of rooms for telemedicine store-and-forward and realtime interactive consultations is critical. The challenge is to incorporate communication technology into medical practice to facilitate efficient communication and effective patient care. If this is done properly, the technology becomes unnoticeable to those involved in the telemedicine interaction. This article describes some of the steps that can be taken in a telemedicine room design to achieve this goal. Room location, treatments, background, lighting, power and telecommunications aspects are reviewed. Although every room design will have its own unique challenges, adhering to these basic principles will provide an excellent foundation to begin with.

Environment, Controlled↗
PubMed2002

Pastoral hermeneutics and the challenge of a global economy: care to the living human Web.

The author discusses the relationship between a pastoral hermeneutics and the current social context as determined by international communication and globalization. He explores the influence of telecommunications on the human quest for meaning and the implication of this for pastoral care and counseling. A paradigm shift is proposed in terms of care to the living human web. A pastoral assessment which interprets the undergirding philosophy and belief system of globalization and its influence on human dignity is suggested; and a pastoral ministry which takes up its prophetic task and voices the needs of people in terms of a "globalization from below" is explicated.

Attitude to Health↗