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At least 811 records · Page 45Linked to original sources
PubMed2002

[Telemedicine: interaction between clinic and general practice].

BACKGROUND: The rapid development of information and communication technologies has led to a change of many practical aspects of professional and private life. These technologies also influence interactions between hospitals and outpatient units. METHODS: This paper provides an overview over current telemedical developments with effects on interactions between in- and outpatient units. RESULTS AND CONCLUSIONS: Probably the most important application of telemedicine in Germany is not distant patient care but an improved communication structure between different health care providers. Candidates for first routine applications are electronic medical reports and teleconsultations. The widespread use of telemedicine will be accompanied by an increased standardisation in medicine.

Forecasting↗
PubMed2004

[Malignant lymphoma competence network].

The competence network Malignant Lymphomas is one out of 3 oncological networks which have been funded by the German Federal Ministry of Education and Research since 1999. The network's activities are based on the work of the German lymphoma research groups, which have led to significant progress in the diagnosis and therapy of malignant lymphoma over the last few years. Based on this infrastructure, the network aims to establish a professional quality management for the diagnostics and treatment of malignant lymphomas. Key aspects of activity include: 1st the establishment of an IT-based information and communication platform, 2nd IT-based networking of study groups and collaborating centres of pathology and radiotherapy, 3rd epidemiological and health care-economical research, 4th research on improved and new therapeutical approaches, 5th evidence-based medicine. Further information is presented in http://www.lymphome.de.

Biomedical Research↗
PubMed2004

[HIV/AIDS competence network research group presents first results].

Germany's clinical HIV research efforts are underrepresented on an international level. This deficit is primarily due to a lack of clinical studies involving patients from across the country and the fact that no national patient cohort system exists in Germany which could provide a basis for such clinical studies. The competence network HIV/AIDS is filling this shortcoming by serving as a comprehensive, nationwide research alliance. The establishment of a patient cohort is linked to 20 projects. The success of this new structure is becoming visible.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[Telemedicine stroke department network. Introduction of a telemedicine pilot project for integrated stroke management in South Bavaria and analysis of its efficiency].

More than 100 stroke units have been established in Germany. In rural areas, however, acute stroke care needs to be improved. In order to advance clinical stroke therapy, two specialized stroke centers founded a telemedicine network (TEMPiS) among 12 community hospitals in eastern Bavaria. Each network hospital established specialized stroke wards where qualified teams manage acute stroke patients. Twenty-four hours daily, physicians in local hospitals are able to contact the stroke centers via videoconferencing including transmission of digital DICOM data. To study the efficacy of this network, a controlled trial will be performed. Five TEMPiS-network hospitals will be matched with five other hospitals equal in size, catchment area, and diagnostic techniques. For about 1 year, all consecutive stroke cases in the matched study hospitals will be prospectively recorded in a database. Neurological deficits will be quantified on the National Institute of Health Stroke Scale within 24 h after stroke onset. Mortality and institutional care as a combined primary endpoint will be assessed after 3 and 12 months. Furthermore, functional outcome according to the modified Rankin scale, Barthel score, and quality of life will be assessed using a standard telephone interview. Data acquisition started in July 2003, and final results are expected in 2005.

Centralized Hospital Services↗
PubMed2002

[Teleradiology--blessing or curse? 4 years routine in the North Hessia teleradiology data network].

Several hospitals in northern Hessen, not having their own radiology departments, want to run CT-scanners with the goal of improving medical quality. They requested co-operation from the Radiological Institute in the Hardtwaldklinik I in Bad Zwesten. Therefore a teleradiological network was developed, which enables the exchange of radiological-images and -reports between 19 hospitals today. An elementary requirement for this co-operation is an efficient and functional computer infrastructure and verified co-operation contracts. The conception, structure and development of the program, as well as associated difficulties are presented and discussed from different perspectives in the light of the controversy among experts. The results, experiences and benefits gained in four years, in which the teleradiological network of northern Hessen has been in place, demonstrate the importance and possibilities of teleradiology as an element of telemedicine. Teleradiology/telediagnostics improves the quality of patient care in smaller hospitals located in less-populated areas and present possibilities to optimize and integrate health care structures, taking economic considerations into account.

Computer Communication Networks↗
PubMed2002

[University clinics as centers of radiologic performance alliances in the ambulatory and inpatient sector].

PROBLEM: Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. METHODS: The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the "Imaging services--teleradiological center of excellence". Legal, technical and organizational prerequisites were analyzed. RESULTS: Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. CONCLUSION: Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services.

Delivery of Health Care↗
PubMed2002

[Evaluation of CHILI teleradiology network 4 years after clinical implementation].

The CHILI teleradiology network has more than 60 installations in Germany and the USA. Radiological images and cardiological multiframe series are exchanged in clinical routine. This article investigates in what way and how often the system is used. This is done by means of accounting files that are produced automatically by the system. User functions, transmission protocols, data quantity, frequencies and time of data transmission and teleconferences are evaluated and discussed in this paper. Different application scenarios have been identified and are described and analyzed as well. An important result is, that the system is not merely an emergency system. Instead, it is used in daily routine as a multifunctional, multimodality workstation with advanced features for teleradiology and telecardiology.

Computer Communication Networks↗
PubMed2002

[Geometry of laparoscopy, telesurgery, training and telementoring].

Laparoscopic surgery in general is handicapped by the reduction of the range of motion from 6 to 4 degrees of freedom. This has a major impact on technically difficult procedures such as laparoscopic radical prostatectomy. Solutions for this problem include understanding the geometry of laparoscopy with sophisticated training programs, but also newly developed surgical robots, computer simulators, and telementoring. This article evaluates the value of these alternatives based on own experience and an analysis of the current literature. Our experience with robot-assisted surgery includes 244 laparoscopic radical prostatectomies using a voice-controlled camera arm (AESOP) and 6 telesurgical interventions with the da Vinci system. Additionally, experimental studies were performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and computer simulation. Three-dimensional systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets, or reduced brightness. At present, there are only two robotic surgical systems (ZEUS, da Vinci) in clinical use for telesurgery, of which only the da Vinci provides stereovision and all 6 degrees of freedom (DOF). In the meantime, more than 100 laparoscopic radical prostatectomies have been performed with this system. However, there was no evidence of any advantages over the conventional laparoscopic approach. The ZEUS in combination with the telecommunication system SOKRATES is the only device that enables telemanipulation and telementoring over long distances (i.e., transatlantic). Robotic surgery represents a turning point in surgical research. However, broad use of robotic systems is limited mainly because of high investment and running costs. Whereas audiovisual telementoring will play a clear role in future training concepts, the need for telemanipulation or telesurgery has not yet been clarified.

Computer Simulation↗
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↗
PubMed2002

Evaluation of a "no-cost" Internet technology-based system for teleradiology and co-operative work.

The aim of this study was to assess the suitability of a no-cost system based on standard Internet technology components for teleradiology. The system was composed of free software (communication, DICOM viewer, compression) and standard off-the-shelf hardware components. For different image (CR, CT, MR) and network types (LAN and ISDN) the File Transfer, Audio and Video Conference, and Co-operative Work properties were examined and compared with the literature referring to standard complete packages and dedicated teleradiology systems. The main advantages of the no-cost system are: price; ease of use; independence from specific hardware; and potential connection to any possible partner. The performance of the File Transfer and the Audio and Video Conference was comparable to the other system groups with slight disadvantages in the usability. For Co-operative Work the employed "application sharing" technology does not meet the clinical requirements, which applies identically to the standard complete packages. Here the specialized systems prove superior, although they are proprietary. With minimal restraints the evaluated no-cost solution can be used for File Transfer and Conference scenarios. The usage for Co-operative Work with ISDN is not recommended, unless for the purpose of gaining experience or when dealing with small amounts of cases or images.

Computer Systems↗
PubMed1997

[Scientific role of German ophthalmology in the European telecommunication project OPHTEL].

BACKGROUND: In Denmark, France, Germany, Great Britain and Italy, the OPHTEL project combines clinical centers of ophthalmology and internal medicine, an institute for medical informatics and health services research, a publishing company and different industrial partners in the EDP market. AIMS: With the aid of visual telecommunication and rapid data transfer, methods and conditions will be developed and proved so that any physician can very easily obtain sufficient information for treating his patient. Thus, the regional differences in the quality of structured health service (e.g., urban/ rural) will be overcome throughout Europe. SCIENTIFIC TASKS: A multilingual diagnostic and therapeutic thesaurus has to be worked out in order to create standards for communication and quality control. Based on literature, images and image analysis in a knowledge-based data bank, a monitoring system (containing watch-dog functions) and the basic aspects of an ophthalmological patient/disease register will be investigated. (In parallel, a technical development of synchronous and asynchronous telecommunication between eye physicians is taking place in close cooperation with the regional Bavarian project Teleopathalmology in Bavaria on-line). RESULTS: State of the art 6 months after starting the project:the knowledge-based image data bank has been founded and also an ophthalmological 8 language thesaurus and definition standard. All data transfer lines are installed. DISCUSSION: The project is taking place amid diverging sections of medicine: ophthalmology and internal medicine, health politics and data protection, individual treatment and common interest (health care), product management and office organization. Thus, the scientific quality of the transferred ophthalmological content must undergo sophisticated controls. FUTURE STEPS: Intense cooperation with the big German associations for ophthalmology (DOG, BVA) and the European ophthalmological societies concerning EDP, classification and quality control.

Computer Communication Networks↗
PubMed1997

[Calibration of clinical databanks with "virtual patients"].

The scientific value of multicenter studies is still questionable, as there are no methods available that allow to determine whether in fact identical items are recorded in the same way in different centers. Subjective classifications (for example according to the New York Heart Association (NYHA)), definitions of items, documentation habits and procedures may not be comparable in different hospitals. For that reason the concept of a "virtual patient" for calibration of database systems was developed as a new methodological approach. The "virtual patients" describes a computer program that includes and uses multimedia-tools to represent an exactly defined patient. A sound card enables a patient to talk and to represent intracardial and intrapulmonary sounds. Additional information including echocardiographic sequences, perioperative video sequences, x-ray analysis, angiograms, etc. is represented in the program. Thus during the perioperative course of a patient the complete relevant pre-, intra- and postoperative information regarding the patient is provided. Any physician participating in a multicenter study is asked to record the data of this virtual patient and to store it in a database system using the sheets applied in a multicenter study. As the patient is exactly defined (virtual patient) incorrect classifications and incomplete recordings, etc. can easily be detected and discussed. The virtual patient is a tool that allows calibration of database systems by direct comparison of the documentation technique between different physicians and different hospitals participating in multicenter studies. It is thus a multimedia-instrument to support standardization and quality assurance of database systems.

Calibration↗
PubMed2005

After-hours paediatric telephone triage and advice: the Neuchâtel experience.

UNLABELLED: Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice (TTA) system. To determine whether other Swiss public paediatric departments practiced formal TTA, we conducted a nation-wide postal survey. To delineate who used our call centre and for what reasons, we embarked on a retrospective study of all the 1997/2000 calls. Most of the units run a TTA (27/35) but few specifically train their staff (14/27). A 43% increase in call numbers was seen between 1997 (3242) and 2000 (4628). During week-days, most of the calls were between 6 and 11 pm and at weekends, a mid morning activity peak was seen. Some 75% of calls were for children aged 5 years or less. Fever, earache and cough accounted for 42% of the main complaints. Of all calls, 27% were dealt by nurses' advice only. About 15% of the calls were transferred to the on-call resident. About 50% led to a same day ED appointment. CONCLUSION: Nurse-led paediatric telephone triage and advice is common in Switzerland where training seems to be irregular. Our data can help units to better plan an eventual paediatric telephone triage and advice service.

After-Hours Care↗
PubMed2000

Telesurgical laparoscopic cholecystectomy between two countries.

Telesurgery is a form of operative videoconferencing in which a remotely located surgeon observes a procedure through a camera and provides visual and auditory feedback to the operative site. With the use of more robotic devices in laparoscopic surgery, various forms of telesurgery have been tried. We describe the first two international telesurgical, telementored, robot-assisted laparoscopic cholecystectomies performed in the world, between the Johns Hopkins Institute, Baltimore, Maryland, USA, and the National University Hospital, Singapore.

Cholecystectomy, Laparoscopic↗
PubMed2001

Evaluation of telesurgical (robotic) NISSEN fundoplication.

BACKGROUND: The laparoscopic surgical approach has proven its benefit for the patient. There are however several shortcomings, which have triggered considerable research for improvement. One improvement may be the introduction of telesurgery by the interposition of a computer interface between surgeon and patient. MATERIAL AND METHODS: A prospective randomized study was conducted in an advanced laparoscopic procedure, Nissen fundoplication. The control group underwent the conventional laparoscopic approach, while the investigational group underwent the telesurgical approach. RESULTS: Feasibility was 100%. The procedure was more time consuming in the Telesurgical group, at all stages of the operation. Mortality was nil and morbidity was comparable in both groups. CONCLUSION: The telesurgical approach is feasible in advanced laparoscopic procedures like Nissen fundoplication. At the present time there is however no obvious added benefit from this new technique.

Adolescent↗
PubMed2005

Construction of a remote radiotherapy planning system.

BACKGROUND: We constructed a remote radiotherapy planning system, and we examined the usefulness of and faults in our system in this study. METHODS: Two identical radiotherapy planning systems, one installed at our institution and the other installed at an affiliated hospital, were used for radiotherapy planning. The two systems were connected by a wide area network (WAN), using a leased line. Beam data for the linear accelerator at the affiliated hospital were installed in the two systems. During the period from December 2001 to December 2002, 43 remote radiotherapy plans were made using this system. RESULTS: Data were transmitted using a file transfer protocol (FTP) software program. The 43 radiotherapy plans examined in this study consisted of 13 ordinary radiotherapy plans, 28 radiotherapy plans sent to provide assistance for medical residents, and 2 radiotherapy plans for emergency cases. There were ten minor planning changes made in radiotherapy plans sent to provide assistance for medical residents. CONCLUSION: Our remote radiotherapy planning system based on WAN using a leased line is useful for remote radiotherapy, with advantages for both radiation oncologists and medical residents.

Hospital Information Systems↗