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Patient-initiated transtelephone transmission of electrocardiographic signals in the diagnosis of arrhythmias.

Thirty-one patients who had complained of recurrent palpitations were given transtelephone transmitters of electrocardiographic signals and instructed to use the transmitters while they were having symptoms. From the transcribed electrocardiograms sinus tachycardia was documented in 12 patients, paroxysmal atrial tachycardia in 7, atrial fibrillation in 4, atrial flutter in 3, frequent ventricular premature beats in 4 and ventricular tachycardia in 1. Patient-initiated transtelephone transmission of electrocardiographic signals was found to be an effective means of documenting the nature of symptomatic paroxysmal tachycardia.

Adolescent↗

A computer/GPS guidance system for emergency rescue vehicle location.

The system, as built, has been able to meet all of the original design criteria. In the original rudimentary tests we were sufficiently pleased with the performance to pursue the next step, scheduling trials in the real, small-agency, rural EMS environment. The Federal Communications Commission licensing changes necessary to add the digital data communications to the agency license were probably the most time-consuming portion of the test, with a major delay caused by the turnaround time in the wait for the new license to arrive. Construction of the device to allow "plug and play" installation is possible, with no change in the internal circuitry of the agency transceivers being necessary for the initial testing. To date, all testing has yielded positive results. Tracking the test EMS vehicle throughout the service area (approximately 700 square miles) should prove immensely satisfying.

Ambulances↗

Telepathology is available for transplantation-pathology: experience in Japan using an integrated, low-cost, and high-quality system.

We examined the validity and accuracy of telepathology service in the histological diagnosis of biopsy specimens from human transplanted kidney and liver. The still video images of paraffin sections were transmitted via a two-way telephone by use of a digitized telephone network (Integrated Service Digital Networks, 64 kbits/sec). The images were displayed on monitors and diagnosed by an expert pathologist at Tottori University. The quality of transmitted still images was sufficient for the diagnosis, especially at higher magnifications. The average number of transmitted images was 6.2 in the kidney cases and 7.4 in the liver cases. The average time taken for examination of a case was 13 min (range 10 to 16 min). Of 12 biopsy specimens from transplanted kidneys, 10 were adequately diagnosed with the system. Sampling errors caused inadequate diagnosis in a case of cyclosporin tubulopathy, the still images of which were not transmitted. An expert pathologist rendered the diagnosis in a case showing mesangial sclerosis, which was later diagnosed as possible recurrent glomerulonephritis through direct microscopy. Biopsy specimens from 10 liver transplants were also tested using archival materials. Although the etiology of hepatitis could not be determined in one case, diagnoses by telepathology well agreed with the reported diagnoses made through direct microscopy. Telepathology may be an effective way to provide on-line consultations in transplantation pathology, especially for transplant teams lacking expert pathologists.

Adolescent↗

International standard (C.C.I.T.T.) for transmitting biomedical analogue and digital data on the public telephone network.

Analogue transmission of biomedical signals over the public telephone network has advantages from the economic point of view over digitalized transmission. This paper deals with the special problems encountered with the transmission of biomedical signals. Furthermore, the new international transmission standard C.C.I.T.T. recommendation V. 16 is introduced. This standard has recently been adopted by the relevant study group and has been presented to the Plenary Assembly of the C.C.I.T.T. for final approval. This standard is compatible with the existing public telephone networks. The technical specifications of this standard allow the transmission of the three-channel ECG for diagnostic purposes, e.g., remote processing and computer-assisted evaluation, as well as the transmission of the one-channel ECG with acoustic coupling, e.g., in emergency cases and for pace maker monitoring.

Analog-Digital Conversion↗

Medical applications of analogue and digital telephone data links.

The increasing use of digital computer techniques for the analysis of signals such as the EEG, ECG, plethysmograms and cardiac output curves has led to the use of multichannel analogue frequency modulation telephone data links in the forward direction from the patient to the computer and digital links in the return direction. Single-channel analogue links are also being used for the surveillance of cardiac pacemaker patients and the television Viewphone offers the possibility of a visual contact between two centers. Examples will be given of the use of these various forms of telephone link.

Computers↗

[Home blood pressure monitoring].

Home blood pressure measurement is a simple, precise and highly reproducible method. Its application is possible in a large majority of patients. The method is valid if performed with devices validated according to international criteria and if an appropriate methodology is applied. It is advantegeously used for diagnostic of high blood pressure, particularly white coat hypertension. It allows for an exact appreciation of treatment efficacy and a long term follow-up of blood pressure control. In a majority of patients it improves their compliance to drug treatment. Its precision allows to decrease the number of patients needed in clinical trials. The main obstacle of larger use of home blood pressure monitoring is the need to give a detailed instructions to patients and generally a laborious evaluation of results. The latter could be simplified by using devices transferring measured results directly to physician's computer. However the cost of such instruments remains high. Finally the lack of financial reimbursement of physicians using home blood pressure measurement limits further its larger use.

Blood Pressure Monitors↗