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At least 829 records · Page 46Linked to original sources
PubMed2005

Monitoring a remote phototherapy unit via telemedicine.

BACKGROUND: The delivery of effective phototherapy to patients with psoriasis living in areas devoid of dermatologists is difficult. Telemedicine has proven useful in the delivery of health care in such locations. OBJECTIVE: This evidence-based study sought to investigate the use of telemedicine in the monitoring of phototherapy of psoriasis patients located in a Nova Scotia region with no dermatologist. METHODS: Psoriatic patients were reviewed six months before and after protocols and monitoring were instituted. First, charts of 23 patient treated with phototherapy were reviewed from the Aberdeen Hospital in New Glasgow. Patients were either self-referred or referred by a family physician and occasionally a dermatologist. Treatments were not monitored by a specialist. Second, a group of 33 patients receiving treatment were supervised via telemedicine by a dermatologist 250 km away in Halifax. RESULTS: During the study period, treatment time decreased from 140 to 37 days. In the monitored group, 40% more patients were clear of psoriasis at time of discharge. The number of patients with side effects decreased. The number of self-and family practice-referred patients dropped; the clinic became a referral center for dermatologists. CONCLUSION: Telemedicine provided an excellent way to monitor patients receiving phototherapy in an area without a dermatologist. Overall, patient care improved: More patients were treated effectively with better outcomes and fewer side effects.

Adult↗
PubMed2004

Review of technology: planning for the development of telesonography.

Teleradiology allows contemporaneous interpretation of imaging exams performed at some distance from the interpreting radiologist. The transmitted images are usually static. However, there is benefit to real-time review of full-motion ultrasound (US) exams as they are performed. Telesonography is transmission of full-motion sonographic data to a remote site. We hypothesize that US exams, read after having been compressed utilizing Motion Picture Experts Group version 4 (MPEG-4) compression scheme, transmitted over the Internet as streaming multimedia, decompressed, and displayed, are equivalent in diagnostic accuracy to reading the examinations locally. MPEG-4 uses variable compression on each image frame to achieve a constant output bit rate. With less compression, the bit rate rises, and the only way the encoder can contain bit rate within the set bandwidth is by lowering frame rate or reducing image quality. We review the relevant technologies and industry standard components that will enable low-cost telesonography.

Biomedical Technology↗
PubMed2006

Synchronized, interactive teleconferencing with digital cardiac images.

St James's Hospital is a tertiary referral center for percutaneous intervention and cardiothoracic surgery for a number of referring hospitals. This article reports on the development and implementation of a synchronized, interactive teleconferencing system for cardiac images that links St. James's Hospital with a remote site (Sligo General Hospital) and overcomes the problems of transmission of large image files. Teleconferencing was achieved by setting up lossless auto transmission of patient files overnight and conferencing the next morning with linked control signals and databases. As a suitable product was not available, a commercially new software was developed. The system links the imaging databases, monitors and synchronizes progress through imaging sequences, and links a range of image processing and control functions. All parties to the conference are ensured that they are looking at the same images as they are played or at specific aspects of an image that the other party is highlighting. The system allows patient management decisions to be made at a weekly joint teleconference with cardiothoracic surgeons and interventional cardiologists from both sites. Rapid decision making was facilitated with 70% of decisions obtained within 24 h, and 88% within 1 week of their procedure. In urgent cases, data can be transmitted within 20 min of the diagnostic procedure. The system allows increased access to angiography for patients living in rural areas, and provides a more focused referral for revascularization. Participation of the referring cardiologist has improved the quality of decision making.

Academic Medical Centers↗
PubMed2005

Retrospective economic evaluation of the Hellenic Air Force Teleconsultation Project.

Hellenic Air Force introduced its teleconsultation project in 2002 by the establishment of PC-based videoconference links between the Central Air Force Hospital in Athens, Greece and several remote camps in order to serve the personnel and their dependants. A retrospective cost-minimization analysis was conducted for 38 remote subjects that were telemedically examined, instead of being referred to the hospital. For the evaluation of the annual cost of both procedures (telemedicine and referral), the fixed and variable costs were estimated. Furthermore, a simplified sensitivity analysis was conducted. The telemedical system proved to be cost-effective even for the limited number of 38 enrollees. Sensitivity analysis suggested that upon upgrade of the service as an integral component of daily care with subsequent higher number of beneficiaries and users of the system, the cost of each session would decrease dramatically. Current technology indicates that telemedical systems could provide efficient and cost-effective care to eligible enrollees.

Cost Control↗
PubMed2006

The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome.

The objective of this study was to compare continuous positive airway pressure (CPAP) use, functional status, and client satisfaction in obstructive sleep apnea syndrome (OSAS) patients randomized to either telemedicine support or traditional care. In our university-affiliated sleep disorders center, patients with OSAS who were initiating CPAP therapy were randomized to receive telemedicine support vs traditional follow-up care for 30 days. The telemedicine group received a "Health Buddy" computer that provided daily Internet-based informational support and feedback for problems experienced with CPAP use. At 30 days, there were no significant differences in the hours of CPAP use between groups receiving traditional care (M = 4.22, SD+/-2.05) and telemedicine support (M = 4.29, SD+/-2.15), p = 0.87, or in the proportion of nights with CPAP use between the traditional (M = 50%+/-33.8) and telemedicine groups (M = 47%+/-34.2), p=0.61. No significant differences were found between groups in functional status (M = 2.27+/-4.56 vs M = 2.03+/-3.88, respectively, p = 0.76) or client satisfaction (M = 28.0+/-3.51 vs M = 28.5+/-3.05, p = 0.43). Patients in the telemedicine and traditional groups had similar CPAP use, functional status, and client satisfaction. The data suggest that telemedicine support as provided by our model compares favorably with traditional care. As a provider-extender, telemedicine support for patients initiating use of CPAP may allow for greater practice efficiency while maintaining quality of care.

Adult↗
PubMed2006

Downlink power control in multi-code CDMA for mobile medicine.

In this paper, we propose a downlink power-control mechanism to be applied in a multi-code code division multiple access (CDMA) mobile medicine system. The mobile medicine system can provide (i) measured blood pressure and body temperature, (ii) medical signals measured by the electrocardiogram (ECG) device, (iii) mobile patient's history, (iv) G.729 audio signals, (v) Joint Photographic Experts Group 2000 Medical images and Moving Picture Experts Group 4 charge-coupled device sensor video signals. By utilizing a multi-code CDMA spread spectrum communication system with downlink power-control strategy, it is possible for this system to meet the quality of service requirements of a mobile medicine network. In addition, such a system can maximize the resource utilization. For different messages to be sent, the power is controlled according to the requisite bit error rate (BER). Higher transmission power is given to the media with lower BER requirement. Numerical analysis shows that the ratios of transmission power for voice, video, and data virtual channels is approximately 1:2:13 when the BERs for voice, video, and data are 10(wedge)(- 3), 10(wedge)(- 4), and 10(wedge)(- 7), respectively. This power ratio is similar to the ratio of signal-to-noise plus interference power ratio for voice, video, and data during transmission. For the purpose of verifying the proposed argument, a simulation has been done and the results match the derivation very well.

Blood Pressure Determination↗
PubMed1995

The rural and global medical informatics consortium and network for radiology services.

Telemedicine systems that provide health delivery services to rural clinics and hospitals are being demonstrated in clinical settings. This paper summarizes the research and consortia projects at the University of Arizona Medical Center. The paper describes the Rural and Global Picture Archiving and Communications (PACS) environment developed under a National Science Foundation grant. The Rural and Global PACS environment includes many workstations, database, and networking components and is treated as a large distributed system. These components are described in this paper. The multimedia services for radiology provided by the Rural and Global PACS are described and their performance is measured. Finally, the current research work using the Open Software Foundation's distributed computing environment (OSF DCE) services is described. An OSF DCE testbed for the Rural and Global PACS is described and the rationale of using OSF DCE in the project is presented.

Arizona↗
PubMed1996

A telemedicine system for remote cooperative medical imaging diagnosis.

Telemedicine is changing the classical form of health care delivery, by providing efficient solutions to an increasing number of new situations: here we consider those which require some type of computer-supported cooperative work (CSCW) between health care professionals located in different clinical sites. This paper presents the design and development of a telemedicine system for remote computer-supported cooperative medical imaging diagnosis. The main and novel component of our system is a new CSCW distributed architecture, comprised by a collaborative toolkit to add audioconferencing, telepointing, window sharing, user's coordination and application synchronization facilities, either to existing or new medical imaging diagnosis applications. In comparison with existing CSCW products, mainly based on centralized architectures, our distributed toolkit is specially designed for telemedicine applications: to allow different levels of sharing between participants, to improve user feedback in highly interactive user interfaces, and to optimize the required communication bandwidth in order to implement a telemedicine CSCW application on almost any telecommunication network. This telemedicine CSCW system has been applied to build a cooperative medical imaging diagnosis application, in which two doctors, located in different hospitals, need to achieve a cooperative diagnosis on haemodynamic studies using cardiac angiography images. The design of the graphical user interface for this kind of telemedicine CSCW systems, a critical component which conforms any telemedicine application, is also addressed with a new methodological approach, to assure the system usability and final user acceptance. The telemedicine cardiac angiography pilot has been implemented, tested and evaluated within the Research Project 'FEST-Framework for European Services in Telemedicine' funded by EU AIM Programme.

Attitude to Computers↗
PubMed1995

Anticipated response to three common injuries by rural and remote area residents.

Three progressively worsening injury scenarios were used to determine the influence of distance from medical services on the anticipated illness behaviour of rural and remote area residents. A total of 801 householders were interviewed in two rural areas of Queensland, Australia (320 in a coastal area and 481 in an inland area). There was a consistent trend with distance of decreasing willingness to seek immediate care at each injury stage. As the severity of each scenario increased, there was a convergence in anticipated action. Inland area respondents were less likely to seek medical care at each stage of the injuries than coastal area respondents. Distant respondents were more likely to telephone for medical advice before seeking care. When this was taken into account, there was less difference in anticipated action by distance, although those further from medical services still indicated a propensity to delay action in the less serious injuries.

Adult↗
PubMed1995

The development of a method for measuring anticipated illness behaviour in three common injuries.

This note outlines the rationale, development and validation of three injury scenarios as objective measures of anticipated illness behaviour. The measures were originally developed to consider differences in illness behaviour with distance from medical services in rural and remote areas of Queensland, Australia. However, the measures have a more universal applicability than the purpose for which they were developed. Unlike other measures of illness behaviour, the scenarios each incorporate a number of progressively worsening stages which permit the mapping of changes in individual or group behaviour. By working through conditions stage by stage, the likelihood of individual variations in interpretation of condition severity is greatly reduced and so a better understanding of people's responses to these conditions is obtained. In a survey of 800 rural households, each scenario met the proposed criteria of: (i) increasing urgency of action with increasing condition severity; and (ii) increasing agreement about urgency of action with increasing severity. The fractured limb scenario was perceived by respondents (in terms of urgency and agreement about type of action) as the most serious condition. There was little difference in perceived seriousness for the other two conditions.

Adult↗
PubMed1996

Technological advances in teleradiology.

Teleradiology consists of a set of added-value telematic services, implemented over an advanced telecommunications infrastructure and supported by different information technologies and related applications. The main goal of teleradiology is to provide different levels of support for remote diagnostic imaging procedures. This paper considers technological advances in this important area, including a discussion of the various added-value telematic services, applications supporting these services, and the required information technology and telecommunications infrastructure. Teleradiology is also considered in the general context of an integrated regional health telematics network, emphasizing its role and its interaction with other information and networking services.

Computer Communication Networks↗
PubMed2005

Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children.

Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services.

Anxiety Disorders↗
PubMed2006

Remote treatment of bulimia nervosa and binge eating disorder: a randomized trial of Internet-assisted cognitive behavioural therapy.

The present study investigated the efficacy of self-help based on cognitive behaviour therapy in combination with Internet support in the treatment of bulimia nervosa and binge eating disorder. After confirming the diagnosis with an in-person interview, 73 patients were randomly allocated to treatment or a waiting list control group. Treated individuals showed marked improvement after 12 weeks of self-help compared to the control group on both primary and secondary outcome measures. Intent-to-treat analyses revealed that 37% (46% among completers) had no binge eating or purging at the end of the treatment and a considerable number of patients achieved clinically significant improvement on most of the other measures as well. The results were maintained at the 6-month follow-up, and provide evidence to support the continued use and development of self-help programmes.

Adult↗
PubMed2006

Group prevention of depression and anxiety symptoms.

To prevent depression and anxiety, we delivered a brief, classroom-based cognitive-behavioral workshop along with ongoing Web-based materials and e-mail coaching to college students at risk for depression. At risk was defined as having mild to moderate depressive symptoms on a self-report measure of depression. Two hundred forty students were randomized into either an eight-week workshop that met in groups of 10, once per week for 2 h or into an assessment-only control group. We plan to track participants for 3 years after the workshop and here we report the 6 month preventive effects on depression and anxiety. The workshop group had significantly fewer depressive symptoms and anxiety symptoms than the control group, but there was no significant difference between the conditions on depression or anxiety episodes at 6 month follow up. The workshop group had significantly better well being than the control group, and the workshop group had significantly greater improvement in optimistic explanatory style than the control group. Improved explanatory style was a significant mediator of the prevention effects from pre- to post-workshop for depressive and anxiety symptoms, as well as for improved well being.

Adult↗
PubMed2006

Randomized controlled trial of telephone case management in Hispanics of Mexican origin with heart failure.

BACKGROUND: Disease management is effective in the general population, but it has not been tested prospectively in a sample of solely Hispanics with heart failure (HF). We tested the effectiveness of telephone case management in decreasing hospitalizations and improving health-related quality of life (HRQL) and depression in Hispanics of Mexican origin with HF. METHODS AND RESULTS: Hospitalized Hispanics with chronic HF (n = 134) were enrolled and randomized to intervention (n = 69) or usual care (n = 65). The sample was elderly (72 +/- 11 years), New York Heart Association class III/IV (81.3%), and poorly educated (78.4% less than high school education). Most (55%) were unacculturated into US society. Bilingual/bicultural Mexican-American registered nurses provided 6 months of standardized telephone case management. Data on hospitalizations were collected from automated systems at 1, 3, and 6 months after the index hospital discharge. Health-related quality of life and depression were measured by self-report at enrollment, 3, and 6 months. Intention to treat analysis was used. No significant group differences were found in HF hospitalizations, the primary outcome variable (usual care: 0.49 +/- 0.81 [CI 0.25-0.73]; intervention: 0.55 +/- 1.1 [CI 0.32-0.78] at 6 months). No significant group differences were found in HF readmission rate, HF days in the hospital, HF cost of care, all-cause hospitalizations or cost, mortality, HRQL, or depression. CONCLUSION: These results have important implications because of the current widespread enthusiasm for disease management. Although disease management is effective in the mainstream HF patient population, in Hispanics this ill, elderly, and poorly educated, a different approach may be needed.

Aged↗
PubMed2004

Distant diagnosis.

Effective communications are essential for any operation and for management of health-related problems. Telemedicine has altered profoundly the manner in which primary care physicians can interact with hospitals and specialists. As dedicated medical ICT systems evolve, medical care will be delivered to patients in remote locations in a more efficient and cost-effective way. Companies invariably have a vision that healthcare decisions benefiting patient care should be made anytime and anywhere in a model that facilitates care at the point of need. The development of telemedicine programs is inevitable as business globalization expands to more challenging cultural and geographic areas.

Diagnostic Imaging↗
PubMed2004

The North Carolina DIAL EC project: increasing access to emergency contraceptive pills by telephone.

OBJECTIVES: To evaluate a telephone prescription service designed to increase access to emergency contraceptive pills (ECPs) in North Carolina. METHODS: Women who wanted ECPs called a toll-free number and were screened over the telephone. Prescriptions were faxed to pharmacies chosen by callers. RESULTS: In 29 months, the service issued 9745 prescriptions to 7774 callers. Forty percent of callers were teens. Only 16% of callers received more than one prescription. Most callers heard about the service through referrals from Planned Parenthood staff and word-of-mouth. CONCLUSIONS: This service was successful in providing prompt access to ECPs to women throughout the state. Frequent use of the service by individual women was uncommon. Callers preferred to obtain ECPs from local pharmacies rather than from Planned Parenthood health centers, despite generally higher prices at pharmacies.

Adolescent↗
PubMed2005

Teleradiology: threat or opportunity?

The rapid advances in information technology and communication bandwidth have spawned an equally rapid development of clinical teleradiology. Current computer technology and communication capability allow easy transfer of diagnostic images, of any complexity, to any location in the world. This provides the opportunity to acquire swift primary and secondary diagnostic opinions from the remotest of locations, often at economically attractive rates, with the potential for easing the burden on hard-pressed departments of radiology. However, this comes at the potential cost of distancing the clinical radiologist from the patient, with consequent impact upon direct clinical care. As this technology advances across the world, it is vital that UK radiologists are familiar with the clinical implications, the medicolegal framework within which the field operates and the associated governance issues. This paper reviews current practice and discusses the associated risks.

Computer Security↗