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PubMed2004

Implementing telemedicine technology: lessons from India.

Information and communications technologies have universally helped to bridge the digital divide. As an application of ICT, telemedicine is an efficient pathway for enabling health care delivery. Developing countries, too, have started reaping the benefits of this evolutionary technology, but realisation of such dreams has not been swift. The implementation of a pilot scheme in telemedicine in India has been confounded with challenges right from the very start. One of the prime lessons to be learnt from the implementation of a pilot project in a developing country is to keep the objectives of the project in small modules and to keep the deliverables within sight. An account of some of the challenges faced while developing telemedicine technology in India serves as a useful example for upcoming telemedicine programmes in Third World countries.

Benchmarking↗
PubMed2005

Digital cine angiography permits radiation dose reduction without reduction in image quality.

PURPOSE: To investigate how much the radiation dose in digital cine angiography (DCA) systems can be reduced while maintaining an image quality equivalent to that of conventional cine angiography (CCA). MATERIALS AND METHODS: Simulated vessel phantoms were subjected to DCA and CCA. In DCA, the input dose value to the image intensifier built in the system was 0.10, 0.12, 0.14, 0.17, 0.2, and 0.24 microGy. The detectability for simulated vessel phantoms was visually evaluated by five observers. The radiation dose was measured using radiofluorescent glass-rod dosimeters. Doses of digital cine imaging were measured as relative values with the dose of CCA considered as 1.0. RESULTS: The relative DCA/CCA values in DCA, measured by radiofluorescent glass-rod dosimeters, ranged from 0.414 to 0.901 for simulated vessel phantoms CONCLUSION: DCA allows a reduction by 59% of the radiation dose compared with CCA without reduction of image quality.

Analysis of Variance↗
PubMed1991

Radiation doses to patients and personnel involved in embolization of intracerebral arteriovenous malformations.

Radiation doses to patients and personnel were measured during 5 embolization procedures in 5 different patients. Thermoluminescent dosimeters were used to measure the absorbed doses in different points of the skin of patients as well as personnel. A transmission ionization chamber was used to determine the energy imparted in the patients. The effective dose equivalent HE during the procedures was estimated to be in the range of 6 to 43 mSv to the patients, 10 to 26 microSv to the radiologist in charge of the embolizations, 3 to 24 microSv to the assisting radiographer and 13 to 86 microSv to the nurse anesthetist. Radiation doses to the patients were considerable but the estimated risks from radiation were low compared to the risks of the arteriovenous malformation itself and the hazards of the embolization. The annual radiation doses to the personnel were well below established dose limits.

Adult↗
PubMed1989

Use of an AAPM (American Association of Physicists in Medicine) DSA phantom in quality assurance.

The performance of nine DSA units installed in Finnish hospitals was evaluated by means of an AAPM DSA phantom. The spatial resolution, low-contrast performance, contrast linearity, subtraction artifacts and radiation exposure were studied. The spatial and contrast resolution agree well with those published in the literature. No serious artifacts or false recording in subtraction images were noted.

Angiography, Digital Subtraction↗
PubMed1986

Observer error in blood pressure measurement.

This paper describes an experiment undertaken to determine observer error in measuring blood pressure by the auscultatory method. A microcomputer was used to display a simulated mercury manometer and play back tape-recorded Korotkoff sounds synchronized with the fall of the mercury column. Each observer's readings were entered into the computer, which displayed a histogram of all readings taken up to that point and thus showed the variation among observers. The procedure, which could easily be adapted for use in teaching, was used to test 311 observers drawn from physicians, nurses, medical students, nursing students and others at nine health care institutions in Ottawa. The results showed a strong bias for even-digit readings and standard deviations of roughly 5 to 6 mm Hg. The standard deviation for the systolic readings was somewhat smaller for the physicians as a group than for the nurses (3.5 v. 5.9 mm Hg). However, the standard deviations for the diastolic readings were roughly equal for these two groups (approximately 5.5 mm Hg).

Auscultation↗
PubMed2001

Perceived headache associations in Singapore: results of a randomized national survey.

We attempted to discern commonly perceived associations between headache symptomatology and various clinical and social parameters based on the results of a nationwide randomized survey involving 2096 respondents. A questionnaire incorporating demographic data, headache characteristics, and management as well as basic health screening was administered by trained interviewers to those aged 12 years and older. A digital semiautomated blood pressure monitor, a Snellen chart, and urinalysis sticks were used to gather clinical information. Elevated blood pressure, poor visual acuity, and fewer hours of nightly sleep did not positively correlate with headaches of increased frequency, intensity, or duration. On the contrary, an age-dependent negative trend was observed with regard to blood pressure and visual acuity. Individuals who performed shift work had more frequent, although not more intense or long-lasting, headaches. Income had no effect on headache prevalence or severity. Our findings are at variance with common perceptions of headache in the region. They highlight the need for informed counseling of patients presenting to medical attention with headaches and suggest that serious intracranial disease should be excluded in atypical headaches even if perceived associations are present.

Adolescent↗
PubMed2001

Decision criteria and characteristics of Norwegian general dental practitioners selecting digital radiography.

OBJECTIVES: To evaluate Norwegian general dental practitioners' decision criteria and characteristics for choosing digital radiographic equipment. METHODS: A questionnaire was sent to all dental practitioners in Norway (n = 3940). They were categorised on the basis of their responses as either a 'digital radiography' (DR) or 'non-digital radiography' (non-DR) dentist. Demographic, clinical, and electronic technology variables were recorded. Dentists ranked on a six-point scale their reasons for choosing or not choosing digital radiography. Their responses were analysed by logistic regression. RESULTS: Two thousand, one hundred and ninety-nine dentists (56%) replied. Three hundred and nine (14%), (219 men, 86 women and four not stated) had chosen to use digital radiography. The logistic regression analysis revealed that gender, age and years in dentistry were not significant factors in determining their decision, whereas working in a private or group practice was. The number of computers in the practice was the most important of the electronic technology variables. The non-DR dentists strongly agreed that 'digital radiography is too expensive' and were 'satisfied with film'. The DR dentists strongly agreed that the 'use of chemicals can be avoided', 'patient dose is reduced', and 'archiving is facilitated'. CONCLUSION: Working in a private or group practice or using multiple computers were significant factors in choosing digital radiography.

Adult↗
PubMed2006

[Computer-based health care research in the competence network inflammatory bowel disease. Handling of bowel diseases in general practice].

BACKGROUND: Consultations due to most different bowel diseases and abdominal symptoms are common in primary care. However, little is known about the concrete situation in the general practitioner's office so far. In this study, practitioners involved in the actual treatment of patients with bowel diseases document their medical strategies by the use of an internet-based data entry system. Hence, with the support of an internet-based data collection tool, health care research has started to break new ground. METHODS: Following the programming of a digital data collection system and the installation of a nationwide research network of general practitioners interested in this matter, participating physicians communicated anonymised data on medical care of patients with various abdominal problems and intestinal/bowel diseases to the principal study investigators for 12 months, thereby using a computer-based data entry system (via internet). RESULTS: Within the 12 months of observation, 94 general practitioners documented 1,584 patient contacts by using the new data collection system. Accordingly, the most frequent reasons for consultation were abdominal pain (39%) and a change in stool habits (28%), each over a period of > 21 days. Women reported abdominal pain more often than men. Furthermore, the willingness to cooperate with specialists (hospitalization, referrals) was high among participating physicians, in reference to abdominal problems, thereby not demonstrating gender specificity. In the majority of cases, computer-assisted data entry took place outside regular consultation hours, and physicians frequently documented more than one patient within one session. CONCLUSION: High numbers of hospitalizations and specialist referrals, as shown in this study, points toward a high intensity of medical attendance necessary for patients with unspecific symptoms of the bowel or related abdominal problems. Computer-assisted data entry systems, however, represent a challenging yet still realizable way of data collection. This procedure should be brought forward for future projects in health care research.

Adult↗
PubMed1993

Factors influencing the use of primary care physicians and public health departments for childhood immunization.

The purpose of the study was to examine factors influencing the use of primary care physicians and public health departments for childhood immunization for patients in rural and urban areas. A telephone survey employing probability sampling (random digit dialing) was conducted to obtain data from a sample of adults (> or = 18 years) living in Kentucky. Data are from 97 households with children under age 5 living in the home. The majority of the respondents (95%) reported that their children had received immunizations. The primary locations for receipt of immunizations were the health department (51%) and a primary care physician's office (37%). Sixty-five percent of those who used the health department for childhood immunizations reported that they did so for financial reasons. Individuals who received immunizations from the health department were more likely than those who received them at a primary care physician's office to have incomes at or below the poverty level and live in a rural area. The results of a logistic regression computed on use of the health department or primary care physician for immunizations indicated rural/urban residence as the only significant predictor, with urban residents 3.7 times more likely than rural residents to receive immunizations from a primary care physician. These results suggest that many families in rural areas have primary care physicians, but use the health department for their routine childhood immunizations. The results support previous data which indicate that delivery of childhood immunizations by primary care physicians is less available to rural than urban individuals.

Adult↗
PubMed2004

The electronic health record: a leap forward in patient safety.

In his review of patient safety issues in the Canadian healthcare system, Dr. Matthew Morgan states that "coordinated national EHR initiatives will cost less, save lives and prevent harm when compared to the status quo." Canada Health Infoway is spearheading this initiative in Canada. Infoway's No. 1 guiding principle for investment is that projects undertaken must "enhance the quality of patient care, healthcare services and patient safety." They must also support the development and adoption of pan-Canadian interoperable EHR solutions. Infoway is working in seven major areas to improve electronic access to accurate and timely health information in order to reduce errors, facilitate accurate diagnoses and speed treatment. These areas include the building blocks of the EHR: infostructure, registries, digital imaging systems, and drug and laboratory information systems. Infoway is also developing and expanding telehealth networks to increase the scope of the Canadian healthcare system. Infoway was recently mandated to develop a public health surveillance system for infectious diseases to give healthcare providers a tool for tracking and managing disease outbreaks in the Canadian population. These systems will improve safety, quality, accessibility, cost-efficiency and the sustainability of the healthcare system. Patient safety is a cornerstone of Infoway's activities.

Canada↗
PubMed2001

Health InfoNet of Jefferson County: collaboration in consumer health information service.

Health InfoNet of Jefferson County is a new collaborative consumer health information service of the Jefferson County public libraries and the UAB Lister Hill Library of the Health Sciences. Working with the input and cooperation of local voluntary health agencies, health care professionals and other health information providers, the intent is to improve the efficiency with which consumers might access such information while avoiding duplication of effort on the part of the information providers. Various considerations in InfoNet's mission include providing service not only to established library and Internet users, but also those on the other side of the "digital divide" as well as those with low literacy skills or English as a second language. The role of health care professionals in guiding their patients to the best consumer health information resources is emphasized.

Alabama↗
PubMed2000

[Digital imaging system are rapidly introduced in Swedish departments of radiography. This calls for new strategic planning].

Diagnostic radiology in Sweden is changing rapidly to digital (filmless) technique. The advantages are more rapid delivery of radiologic service, better working conditions and less negative effects on the environment. Teleradiology is also facilitated. The Swedish Board of Health and Welfare has investigated the speed with which this change is taking place. In 1998, 26 of the 118 departments of diagnostic radiology had already turned digital; it is estimated that in the near future at least five departments will become fully digital each year. For planning purposes, less emphasis should be put on the supply of radiographic film, and more on telecommunications, computer hardware and digital storage.

Clinical Competence↗
PubMed1996

Is health status related to residence in medically underserved areas? Evidence and implications for policy.

This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non-MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non-MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20-item Short-Form Health Survey's (SF-20) six subscales. After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non-MUAs for the physical functioning, role functioning, general mental health, self-perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable "education" was a consistent predictor of each of the health status subscales. Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non-MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage designation criteria.

Adult↗
PubMed1996

Measuring the need for medical care in an ethnically diverse population.

OBJECTIVE: To examine measures of need for health care and their relationship to utilization of health services in different racial and ethnic groups in California. DATA SOURCE: Telephone interviews obtained by random-digit dialing and conducted between April 1993 and July 1993 in California, with 7,264 adults (ages 18-64): 601 African Americans, 246 Asians, 917 Latinos interviewed in English; 1,045 Latinos interviewed in Spanish; and 4,437 non-Latino whites. STUDY DESIGN: A cross-sectional survey was conducted from a stratified, probability telephone sample. DATA COLLECTION: Interviews collected self-reported indicators of need for health care: self-rated health, activity limitation, major chronic conditions, need for ongoing treatment, bed days, and prescription medication. The outcome was self-reported number of physician visits in the previous three months. PRINCIPAL FINDINGS: Compared to whites, one or more of the other ethnic groups varied significantly (p < .05) on each of the six need-for-care measures after adjustment for health insurance, age, sex, and income. Latinos interviewed in Spanish reported lower percentages and means on five of the need measures but the highest percentage with fair or poor health (32 percent versus 7 percent in whites). Models regressing each need measure on the number of outpatient visits found significant interactions of ethnic group with need compared to whites. After adjustment for insurance and demographics, the estimated mean number of visits in those with the indicator of need was consistently lower in Latinos interviewed in Spanish, but the differences among the other ethnic groups varied depending on the measure used. CONCLUSION: No single valid estimate of the relationship between need for health care and outpatient visits was found for any of the six indicators across ethnic groups. Applying need adjustment to the use of health care services without regard for ethnic variability may lead to biased conclusions about utilization.

Adolescent↗
PubMed2000

Use of direct digital radiography at remote dental facilities.

Digital radiography is changing the practice of dentistry today. This technology offers many advantages compared with conventional radiographic techniques. These advantages include faster imaging times, elimination of conventional dental film/chemicals and processing equipment, reduced radiation exposure, the ability to enhance images, and digitization of images for storage and electronic transfer. The U.S. Air Force Dental Corps completed an evaluation of digital radiography to assess its potential use by deployed units in the field. The Schick Computed Dental Radiography Kit was selected for testing and sent to two remote sites in Saudi Arabia for analysis. After completion of a 6-month evaluation, this system was rated favorably by the evaluators and was determined to be an excellent alternative for field-use radiography. As a result of this study, digital radiography is now being integrated in all expeditionary medical support units for future field deployments.

Attitude of Health Personnel↗
PubMed1988

A procedure for linking psychosocial job characteristics data to health surveys.

A system is presented for linking information about psychosocial characteristics of job situations to national health surveys. Job information can be imputed to individuals on surveys that contain three-digit US Census occupation codes. Occupational mean scores on psychosocial job characteristics-control over task situation (decision latitude), psychological work load, physical exertion, and other measures-for the linkage system are derived from US national surveys of working conditions (Quality of Employment Surveys 1969, 1972, and 1977). This paper discusses a new method for reducing the biases in multivariate analyses that are likely to arise when utilizing linkage systems based on mean scores. Such biases are reduced by modifying the linkage system to adjust imputed individual scores for demographic factors such as age, education, race, marital status and, implicitly, sex (since men and women have separate linkage data bases). Statistics on the linkage system's efficiency and reliability are reported. All dimensions have high inter-survey reproducibility. Despite their psychosocial nature, decision latitude and physical exertion can be more efficiently imputed with the linkage system than earnings (a non-psychosocial job characteristic). The linkage system presented here is a useful tool for initial epidemiological studies of the consequences of psychosocial job characteristics and constitutes the methodological basis for the subsequent paper.

Decision Making↗
PubMed2005

Screening by prostate-specific antigen and digital rectal examination in relation to prostate cancer mortality: a case-control study.

BACKGROUND: The potential role of prostate cancer screening in reducing mortality is uncertain. To examine whether screening with the prostate-specific antigen (PSA) test or digital rectal examination is associated with reduced prostate cancer mortality, we conducted a population-based case-control study in 4 health maintenance organizations. METHODS: Cases were 769 health plan members who died because of prostate adenocarcinoma during the years 1997-2001. We randomly selected 929 controls from the health plan membership and matched them to cases on health plan, age, race, and membership history. Medical records were used to document all screening tests in the 10 years before and including the date on which prostate cancer was first suspected. RESULTS: Among white participants, 62% of cases and 69% of controls had a least 1 screening PSA test or digital rectal examination (odds ratio = 0.73; 95% confidence interval = 0.55-0.97). The corresponding proportions for blacks were 59% and 61% (1.0; 0.59-1.4). Most screening tests were digital rectal examinations; therefore, in the subgroup with no history of PSA screening, the association between digital rectal screening and prostate cancer mortality was similar to the overall association (0.65 [0.48-0.88] among whites; 0.86 [0.53-1.4] among blacks). Very few men received screening PSA without screening digital rectal examination (6% of cases and 7% of controls among whites). CONCLUSIONS: Digital rectal screening was associated with a reduced risk of death due to prostate cancer in our population. Because of several data limitations, this study could not accurately estimate the effect of PSA screening separate from digital rectal examination.

Adenocarcinoma↗