Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Remote Consultation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 685 records · Page 38Linked to original sources
PubMed2002

Impact of telemedicine on the practice of pediatric cardiology in community hospitals.

BACKGROUND: Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists. This can result in suboptimal echocardiogram quality, delay in initiation of medical intervention, unnecessary patient transport, and increased medical expenditures. Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pediatric cardiologists. Initial reports suggest that telecardiology is accurate, improves patient care, is cost-effective, enhances echocardiogram quality, and prevents unnecessary transports of neonates in locations that are not served by pediatric cardiologists. OBJECTIVE: We report the largest series to evaluate the impact of telemedicine on delivery of pediatric cardiac care in community hospitals. We hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from community hospitals is accurate, improves patient care, enhances sonographer proficiency, allows for more efficient physician time management, increases patient referrals, and does not result in increased utilization of echocardiography. METHODS: Using desktop videoconferencing computers, pediatric cardiologists guided and interpreted pediatric echocardiograms from 2 community hospital nurseries 15 miles from a tertiary care center. Studies were transmitted in real-time using the H.320 videoconferencing protocol over 3 integrated services digital network lines (384 kilobits per second). This resulted in a frame rate of 23 to 30 frames per second. Sonographers who primarily scanned adult patients but had received additional training in echocardiography of infants performed the echocardiograms. Additional views were suggested as deemed necessary by the interpreting physician, and interpretations were made during the videoconference. The results of the echocardiogram and recommendations for patient care were communicated to the referring physician over the telemedicine system. Analyses of accuracy, patient treatment, echocardiogram quality, time to diagnosis, pediatric cardiologist practice time management, patient referral patterns, and echocardiography utilization were conducted prospectively. RESULTS: A total of 500 studies in 364 patients were transmitted during a 30-month period. The most common indication for echocardiography was to rule out congenital heart disease (208 of 500 studies). Signs and symptoms that prompted this concern included cyanosis, murmur, tachypnea, genetic syndrome, arrhythmia, abnormal fetal echocardiogram, and maternal diabetes. Other indications included suspected patent ductus arteriosus (PDA; 182 of 500 studies), intracardiac clot or catheter position, persistent pulmonary hypertension, and hemodynamic instability. Cardiac diagnoses included complex congenital heart disease (n = 16), noncritical heart disease (n = 107), and PDA (n = 86). Additional diagnoses included persistent pulmonary hypertension (n = 12), septal hypertrophy (n = 18), right atrial mass/clot/vegetation (n = 11), and decreased cardiac function (n = 6). An umbilical venous catheter was visualized in the left atrium in 9% (45 of 500) of all studies. No significant abnormalities were found in 244 studies. Major diagnoses were confirmed by subsequent review of videotape in all studies. Comparison of final videotape interpretation to initial telemedicine diagnosis resulted in 1 minor diagnostic change (membranous versus inlet ventricular septal defect). Echocardiograms were performed in subsequent visits in 264 patients. The diagnosis was altered in 3 patients. Telemedicine had an immediate impact on patient care in 151 transmissions. The most common interventions were indomethacin treatment for PDA (n = 76), retraction of umbilical venous catheters from the left atrium (n = 45), inotropic or anticongestive therapy (n = 19), anticoagulation (n = 8), and prostaglandin infusion (n = 8). Nineteen patients were transported to our hospital because of the telemedicine diagnosis. Inpatient or outpatient cardiology follow-up was recommended in an additional 131 studies and did not result in any change in the initial management. The most common diagnoses in these patients were ventricular septal defect (n = 56), atrial septal defect (n = 21), septal hypertrophy (n = 9), intracardiac thrombosis (n = 8), and pulmonary valve stenosis (n = 4). We speculate that the immediate availability of an echocardiographic diagnosis likely prevented unnecessary transport in 14 cases. Recommendations for additional views or adjustment of echocardiography machine settings were made in 95% of transmissions. Real-time guidance was especially helpful in suprasternal notch and subcostal sagittal imaging. Depth, color Doppler sector size, and color Doppler scale were frequently adjusted from routine adult settings during the teleconference. The average time from request for echocardiogram to completion of the videoconference was 28 +/- 14 minutes. This was significantly shorter than the waiting time (12 +/- 16 hours) for the videotape to be delivered by courier. Telemedicine eliminated the need for consultation in 194 cases and allowed the cardiologist to delay the visit until the end of the day in an additional 26 cases. This resulted in average time savings of 4.2 person-hours/wk based on travel and consultation time. Utilization of echocardiography was similar before (35 of 1000 births) and after (33 of 1000 to 43 of 1000) telemedicine installation. The percentage of neonatal echocardiograms that were interpreted by our practice increased from 63% to 81% at 1 hospital and from 0% to 100% at the other hospital. CONCLUSION: Real-time transmission of neonatal echocardiograms from community hospitals over 3 integrated services digital network lines is accurate and has the potential to improve patient care, enhance echocardiogram quality, aid sonographer education, and have a positive impact on referral patterns and time management without increasing the utilization of echocardiography.

Cardiology Service, Hospital↗
PubMed2001

The present and future of telemedicine in Japan.

Telemedicine has always developed in close relation with communication technology. When only aural telephones were used, several experiments of telemedicine were carried out by utilizing telephone lines. When INS64 (ISDN with 64 kbits) and telecommunication satellites came onto the scene, experiments for telemedicine began to be conducted accordingly using the cutting-edge technology of the time. In this paper, one of the three categories of telemedicine, mainly tele-consultation that includes tele-pathology and tele-radiology, will be discussed with some examples conducted in Japan. As time goes on, the aim of telemedicine has also been changing. In 1996, the Japanese government gave the go ahead for telemedicine along its deregulation policies. Telemedicine including tele-home care in the 21st century will use the Internet and digital HDTV (high-definition TV) technology for information and data management interchangeably both at domestic and global levels in the medical environment. Also, our dream of a hyper-hospital or virtual hospital will be realized in cyberspace before long, but first we may have to overcome several tough problems such as the protection of privacy data, malpractice and vulnerability of technology relevant to the Internet and telecommunications satellite system as a whole.

Computer Communication Networks↗
PubMed2002

Video-conferencing: under-used by rural general practitioners.

The objective was to investigate the use of and value General Practitioners place on video-conferencing as a tool in providing rural health care. The participants were 8 rural general practitioners in rural Victoria towns. I found that six out of the eight GPs did not value video-conferencing as a tool to assist with patient care, and the other two GPs were interested in the technology only for certain aspects of support with patient consultations and continuing education. In conclude that there needs to be a review of whether video-conferencing equipment should continue to be implemented in the same way that it has been so far in Victoria, and of the cost-effectiveness of providing video-conferencing facilities in rural health services. In particular, there needs to be a review of whether more training and support for rural general practitioners is needed to increase the uptake of video-conferencing. Alternatively, analysis can be undertaken of the intrinsic value of using video-conferencing as an interactive tool for obtaining specialist support for patient care or undertaking continuing education via video-conferencing, and the program discontinued if it is found to be unwarranted.

Attitude of Health Personnel↗
PubMed2003

Analysis of user-satisfaction with the use of a teleconsultation system in oncology.

There is an increasing interest in assessing telemedicine as alternative method of delivering high quality cancer treatment to patients living in rural areas. In the Province of Trento (north-east Italy) a tele-oncology system was implemented to provide non-surgical oncological consultation to district general hospitals. The aim of this study was to explore user-satisfaction with the system after 6 months of experimentation. During the on-field validation two questionnaires with open and closed-response questions were distributed to 80 physicians and nurses 6 months apart to investigate the users' expected benefits vs. perceived ones. The two questionnaires were compared to assess how perceived benefits differed from expected ones. Significant differences were found regarding improvements in: the standardization of diagnostic-therapeutic procedures using the Electronic Patient Record (EPR)]; information sharing; data updating; consultation speed; and the possibility to diminish patients' travels through the use of teleconsultation (TC). Physicians' responses showed a significant difference regarding the EPR's effects on relationship with patient, the nurses' responses with regards to its effects on care quality. Physicians felt that both modalities of teleconsultation were useful in enhancing communication with colleagues (86% for the synchronous TC, 80% for the asynchronous TC). Responses indicated that the major difficulties encountered were in the introduction of the system into the daily routine. Despite this, user expectations for its future use in clinical field were considerably high.

Attitude of Health Personnel↗
PubMed1997

A protocol for telemedical consultation.

We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384 kbit/s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 degrees. The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.

Clinical Protocols↗
PubMed2002

[Quality assurance with teleradiology].

Teleradiology offers many applications for quality assurance in medicine. The spectrum reaches from electronic consultations in emergency or special cases and double reading--along with new models of cooperative work and medical networks--to technical quality assurance and integration into interinstitutional and patient controlled health records. Regional teleradiology networks based on server concepts can fulfill the developing technical and organisational requirements. The increasing mobility arising from smaller radiological equipment and improved accessibility to experts with minimized visualisation and reporting systems will change the radiological world of tomorrow, especially in combination with the usage of knowledge based systems in reference data bases and computer assisted diagnosis (CAD). Teleradiology by itself must be liable to quality assurance measurements to prevent unnecessary radiation exposure or danger to the doctor patient relation.

Computer Communication Networks↗
PubMed1997

An economic analysis of teleconsultation in otorhinolaryngology.

A cost comparison of three different methods of providing consultations for ear, nose and throat (ENT) problems was carried out. The study was based on the delivery of ENT examination and treatment to a small primary-care centre without an ENT specialist in northern Norway. The three alternatives evaluated were teleconsultation, a visiting specialist and patient travel to the nearest secondary-care centre. Patient travel was cheaper for patient workloads below 56 per year. For patient workloads above 56 and below 325 patients per year teleconsultation was the cheapest alternative. Above 325 patients per year, the visiting specialist service cost less than either teleconsultation or patient travel. Transfer of medical skills from the specialist to the general practitioner was also accounted for, separately from the main cost calculation. Teleconsultation then became cost-effective for patient workloads above 52 patients per year.

Costs and Cost Analysis↗
PubMed2002

Telehealth for older patients: the Hong Kong experience.

We studied the feasibility, acceptability and cost-effectiveness of using telemedicine to provide geriatric services to residents of nursing homes. A local 200-bed nursing home supported by the community geriatric assessment team (CGAT) participated in a one-year study, during which videoconferencing was used to replace conventional outreach or clinic-based geriatric care. The feasibility of telemedicine was evaluated by participating specialists in a total of 1001 consultations. Other outcome measures included productivity gains, utilization of hospital emergency and inpatient services, and user satisfaction. Telemedicine was adequate for patient care in 60-99% of cases in seven different disciplines. The CGAT was able serve more patients and see them earlier and more frequently. Telemedicine was cheaper than conventional care, and well accepted by health-care professionals as well as clients. Substantial savings were achieved in the study period through a 9% reduction in visits to the hospital emergency department and 11% fewer hospital bed-days. Telemedicine was a feasible means of care delivery to a nursing home and resulted in enhanced productivity and cost-savings. Linking more such institutions to care providers would further increase cost-effectiveness.

Aged↗
PubMed1999

Participant satisfaction and comfort with multidisciplinary pediatric telemedicine consultations.

PURPOSE: The aim of this study was to measure both satisfaction and comfort levels and estimates of cost savings of families with children receiving health care services from a distant pediatric tertiary care center by readily available telecommunications technologies. METHODS: From February 1996 to September 1997, 140 children at a site 840 miles from the tertiary care center were seen during an evaluative trial of telemedicine consultations (TMC). The TMC visit was the initial encounter with the tertiary care specialist for 31 children. After consultation, each family was asked to complete an anonymous quality management survey that asked for estimates of cost savings and assessed their level of comfort and satisfaction with 13 other aspects of the TMC encounter. A 3- or 5-point Likert scale was used for each question. Comfort scores before and after each consultation were compared by chi2 analysis. Logistic regression was used to determine the independent predictors of satisfaction. RESULTS: 104 of the 140 (74%) families responded. Mean patient estimated cost savings was $1,318+/-677. The highest level of comfort was noted by 58% of respondents before TMC and by 77% after (P = .005). On a 5-point scale, 71% scored 5 (completely satisfied). None scored less than 3. The independent statistically significant predictors of satisfaction were concerns about privacy, comfort with the camera, and perceived specialist comfort. CONCLUSIONS: In addition to providing financial savings, TMC is well accepted by families and children. Those using this new technology must give special attention to issues of patient privacy, camera comfort, and specialist comfort.

Child↗
PubMedDate not supplied

Collaborative problem-solving in telemedicine and evidence interpretation in a complex clinical case.

This study examined clinical problem-solving processes in the context of a telemedical consultation, in order to verify to what extent the technological environment preserves the characteristics of medical reasoning that are known to occur in more traditional clinical settings. This study also provided an opportunity for examining certain fundamental aspects of medical reasoning about complex cases. Within a case-study design, we used a theoretical framework and qualitative methods originating from cognitive science. Expert physicians used reasoning strategies commensurate with the complexity of the case. The technological context of the telemedical consultation did not overly contrive the interaction, allowing them to use real-time problem-solving processes characterizing medical reasoning in naturalistic settings. The results also suggest that high levels of expertise in the presence of very complex cases may elicit a particular configuration of problem-solving processes, associating certain reasoning patterns that are usually related to non-expert problem-solving with others that are typical of expertise. We believe that the evaluation of image transmission and diagnostic performance in telemedicine, as well as the determination of its indications and technological configurations, may benefit from taking into account, with the help of cognitive methodologies, the interacting problem-solving modalities that may be encountered in this context.

Adult↗
PubMed2005

Preferences of general practitioners regarding an application running on a personal digital assistant in acute stroke care.

An application was developed to optimize information exchange in acute stroke care, with which general practitioners (GPs) could consult hospital emergency units. However, it was difficult to obtain clear preferences from GPs regarding the functional requirements of the information to be transferred or the architecture of the application. Thirteen GPs volunteered to take part in the study. The GPs used a personal digital assistant in their daily work for a period of six weeks when visiting stroke patients during their evening, night and weekend shifts. A conjoint analysis was conducted to obtain the least and most preferred characteristics of the application, to facilitate implementation on a larger scale. The main outcome was that GPs preferred the decision-support facilities and the presence of information about the patient's medical history.

Adult↗
PubMed1996

Telepathology diagnosis by means of digital still images: an international validation study.

Telepathology affords the means to provide pathological diagnosis and consultation to remote sites. However, before telepathology can become an acceptable medical tool, it will be vital to determine the diagnostic accuracy of this technology. We report the results of a single-blind study of the accuracy of diagnosis performed using computerized still images obtained from a telepathology workstation used in a French telepathology network. Four pathologists, each working alone, reviewed a total of 200 cases of routine surgical pathology (50 cases each), and performed diagnosis based on both computer CD-ROM still images (CD) and conventional glass slides (GS). Concordance between GS and CD diagnosis, as well as accuracy, were determined. Other factors related to performance were also measured, including diagnostic certainty, reasons for uncertainty, and causes of diagnostic error. Overall, there was good agreement between CS and CD diagnosis. There was 87.5% concordance between CS and CD diagnosis, and comparison to consensus (correct) diagnosis showed accuracy of 95.5% and 88.5% for GS and CD diagnosis, respectively. Marked variability in accuracy of CD diagnosis was observed among the four pathologists, and issues related to image selection and/or quality appeared responsible for 60% of the diagnostic errors. The lack of sufficient images and clinical information were frequently cited as reasons for diagnostic uncertainty, as well as feelings of insufficient expertise. It is likely that the opportunity for interaction with the referring pathologist and the use of subspecialty consultants would likely improve the performance of telepathology.

CD-ROM↗
PubMed2005

REACH: clinical feasibility of a rural telestroke network.

BACKGROUND AND PURPOSE: Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas. METHODS: A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia. RESULTS: There were 194 acute stroke consults delivered. Thirty patients were treated with tissue plasminogen activator (tPA). The mean National Institutes of Health Stroke Score (NIHSS) was 15.4, and the median NIHSS was 12.5. The mean onset to treatment time (OTT) was 122 minutes. The OTT dropped from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients. Of the 30 patients treated with tPA, 23% (7) were treated in < or =90 minutes and 60% (18) were treated within 2 hours. There were no symptomatic intracerebral hemorrhages. CONCLUSIONS: The REACH telestroke system permits the rapid and safe use of tPA in rural community hospitals. Over time, the system became more efficient and OTT decreased.

Aged↗
PubMed2003

[Development of telepathology systems between different types of terminals based on the standard for image collaboration command protocol].

In Japan telepathology systems have been developed in medical or pathological environment such as a shortage and an uneven distribution of pathologists. More than 100 telepathology terminals are working mainly for intraoperative quick diagnosis. They cannot communicate with different types each other. In March 2000 the Medical Information System Development Center(MEDIS-DC) successfully demonstrated the interconnection between different types of telepathology terminals based on the Standard for Image Collaboration Command Protocol (SICCP). Nikon, NTTdata and Olympus had joined the development. In February 2002 MEDIS-DC examined these systems for pathological consultations in the fields of Okinawa-Kyoto, Kyoto-Mie and Mie-Okinawa. These successful examinations let us know that telepathology systems need new observation methodologies for telecytology and teleconsultation in addition to the flow for intraoperative quick diagnosis, new GUI guidelines for telepathology terminal design and, education and support for users of their smooth operation. Outcomes of MEDIS-DC activities encourageed us to challenge the next generation telepathology. We found some new trends in telepathology or pathology informatics such as virtual slide technologies and the internet applications in US and Europe. In order to keep Japanese priority, MEDIS-DC telepathology comittee has started investigations to construct a strategy for development of Japanese next generation telepathology.

Computer Terminals↗
PubMed1999

A prospective study of teleconferencing for orthopaedic consultations.

We carried out a prospective study of teleconsulting in orthopaedics. A commercial videoconferencing system was connected by three ISDN lines between the Satakunta Central Hospital in Pori and the Orton Orthopaedic Hospital in Helsinki, 240 km away. A document camera was used to transfer radiographic images and paper documents. Twenty-nine patients who needed an orthopaedic consultation were studied over three months. They were examined by a surgeon in Pori with the aid of teleconferencing and again later in a traditional, face-to-face appointment in Helsinki. Patients and doctors completed questionnaires after the consultations. Technically, the videoconferencing system functioned reliably and the quality of the video was judged to be good. Twenty patients (69%) would not have needed to travel for a face-to-face appointment, because the teleconsultation afforded a definite treatment decision. The orthopaedic surgeons considered all the treatment decisions arising from the teleconsultation good, except in one case which was considered satisfactory. The quality of the radiographic images transferred with the document camera was good or very good in 17 cases and satisfactory in three cases. None of the patients had experienced videoconferencing before; 87% of them thought that teleconsultation was a good or very good method and the rest felt that it was satisfactory. All patients wanted to participate in teleconsultations again and most would have recommended it to other patients.

Adolescent↗
PubMed2000

Patient cost-benefits of realtime teledermatology--a comparison of data from Northern Ireland and New Zealand.

As part of a randomized controlled trial of the costs and benefits of realtime teledermatology in comparison with conventional face-to-face appointments, patients were asked to complete a questionnaire at the end of their consultation. One hundred and nine patients took part in an initial teledermatology consultation and 94 in a face-to-face consultation. The proportion of patients followed up by the dermatologist was almost the same after teledermatology (24%) as after a hospital appointment (26%) and for similar reasons. Two hundred and three questionnaires were completed after the first visit and a further 20 after subsequent visits. Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 min attending the appointment compared with 4.3 h for those seen at the hospital. The results of the present study, as in a similar study conducted in Northern Ireland, show that the economic benefits of teledermatology favour the patient rather than the health-care system.

Computer Systems↗
PubMed2005

[Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation].

INTRODUCTION: Pigmented lesion clinics (PLC's) were developed as a quick referral system for patients with pigmented lesions. However, the most appropriate method of selecting patients who need to be seen in these units is not clearly defined. Teledermatology is a tool whose usefulness as a patient selection system for PLC's needs to be evaluated. OBJECTIVE: To evaluate teleconsultation as a screening system for patients with pigmented lesions in terms of efficacy, accuracy and satisfaction. METHOD: Teleconsultations received at a PLC over a period of 12 weeks were evaluated. Teleconsultation patients reported changes in a pigmented lesion, a lesion that had recently appeared, multiple lesions, symptomatic lesions or concern about a nevus. We calculated the time intervals in sending the teleconsultation report and in patients being seen at the "physical" PLC consultation, the intraobserver, interobserver and pathologist kappa coefficients, as well as the degree of satisfaction of patients and Primary Care (PC) physicians. RESULTS: 219 teleconsultations were evaluated, 49.3 % of which were referred to the "physical" consultation. The most frequent reason for the teleconsultation was concern about a nevus (37.0 %). The teleconsultations received responses in an average time of 43.9 hours, and patients were seen at the "physical" consultation within 2 weeks. The intraobserver agreement was kappa = 0.93 (95 % CI 0.87-0.98); interobserver agreement, kappa = 0.91 (95 % CI 0.87-0.96); and the agreement between the teledermatologist and the pathologist, kappa = 0.79 (95 % CI 0.70-0.89). 86 % of the patients and 91 % of the Primary Care physicians said that they were "very satisfied" with the implementation of this new system. CONCLUSIONS: Teleconsultation is an accurate screening system for patients with pigmented lesions. With this methodology, waiting times for patients with malignant lesions or those suspected of malignancy can be shortened at the same time as the PLC's excess workload is decreased. However, more experience is needed to establish the true usefulness of this filtering system in the early diagnosis of melanoma.

Adolescent↗
PubMed1996

A field trial of the NASA Telemedicine Instrument Pack in a family practice.

BACKGROUND: Previous studies of telemedicine applications have demonstrated that the technology is effective but inefficient. Little attention has been directed to the primary care portion of the connection, especially the use of the medical peripheral devices. This study used a telemedicine testbed that simulates a rural practice environment to describe the effectiveness and efficiency of the NASA Telemedicine Instrument Pack, a small self-contained system of medical peripheral devices. METHOD: This study was an 8-week field trial of a suitcase-sized pack containing a fundus camera, flexible nasopharyngoscope, dermatology macrolens, light source, and video monitor. The pack was first studied in specialty clinics and then was used in a family practice office connected to the consultant node by digital lines. Evaluations were obtained from technicians, patients, and consultants. RESULTS: During 20 video clinic sessions, 59 patients with 38 different diagnoses were examined. The ear, nose, and throat portion of the exam was effective, with some decrement in color and clarity with compression of the signal. The eye portion was marginally effective, limited by a field of view that was too narrow and also by rigorous technician requirements. The skin exam was largely unacceptable primarily because the macrolens did not meet the requirements for color or clarity prior to compression of the signal. CONCLUSIONS: Subsequent design efforts for medical peripheral devices for telemedicine use will require significant modifications to "off the shelf" equipment to be effective and efficient. A family practice telemedicine testbed provides the appropriate environment for such field trials.

Attitude of Health Personnel↗