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At least 883 records · Page 49Linked to original sources
PubMedDate not supplied

Triage issues in an out-of-hospital birth center.

Effective triage in an out-of-hospital birth center helps low-risk women avoid high-risk care. Background issues include the contributions of evidence-based practice, informed consent, patient education, problem-focused documentation, after-hours access to client data, and the value of intuition. Telephone triage, immediate referral, birth center management, and follow-up with counseling are outlined for common out-of-hospital triage problems: first trimester bleeding, nausea and vomiting, second and third trimester bleeding, urinary tract symptoms, decreased fetal movement, contractions < 37 weeks, rupture of membranes, contractions > or = 37 weeks, and "emergency" delivery.

Birthing Centers↗
PubMedDate not supplied

Telephone triage. A challenge for practicing midwives.

Telephone triage is the process by which a health care provider communicates with a client via the telephone and, thereby, assesses the presenting concerns, develops a working diagnosis, and determines a suitable plan of management. Determination of the seriousness of the situation will dictate whether a client can be cared for at a distance or whether a more comprehensive in-person evaluation is in order. The process of telephone triage is fraught with potential problems, including difficulty in establishing a reliable database, environmental distractions, cost concerns, liability issues, and, frequently, inadequate documentation. This article will describe an approach to these concerns by discussing the use of appropriate communication techniques, the development of a working diagnosis, the establishment of a plan of intervention, and the appropriate documentation of care. Such steps will go far toward diminishing the growing legal threats that arise to midwives who utilize this technology to render care to their patients.

Female↗
PubMed1998

Telemedicine. Present applications and future prospects.

Information technology has enabled much of the business community to function in a time and place-independent manner. Health care has lagged in adopting this technology because of tradition, concern for patient security and confidentiality, liability, and licensure issues. This article reviews the current state of telemedicine technology, its applications, and opportunities for further development. Urology is identified as a specialty that stands to benefit from advances in technologies applicable to remote diagnosis, monitoring and care of patients, physician training, and record keeping.

Forecasting↗
PubMedDate not supplied

Medicine in long duration space exploration: the role of virtual reality and broad bandwidth telecommunications networks.

Safety of astronauts during long-term space exploration is a priority for NASA. This paper describes efforts to produce Earth-based models for providing expert medical advice when unforeseen medical emergencies occur on spacecraft. These models are Virtual Collaborative Clinics that reach into remote sites using telecommunications and emerging stereo-imaging and sensor technologies.

Aerospace Medicine↗
PubMed2000

Teleophthalmology: the use of real-time telementoring to remove an orbital tumor.

OBJECTIVE: To determine whether current telemedicine technology can support real-time surgical telementoring to remove an orbital tumor. DESIGN: Interventional case report METHODS: An orbital specialist guided a general ophthalmologist in the removal of a lateral orbital tumor from a site 210 miles away on another island. A 3-mm endoscope connected to a three-chip digital video camera attached to a Concorde 4500 Picture-Tel videoconferencing system was used to transmit images at a rate of 384 kb per second over integrated service digital network lines. MAIN OUTCOME MEASURES: Successful performance and outcome of the telementored procedure comparable to hands-on orbital surgery. RESULTS: The surgical procedure was successfully telementored with uncomplicated removal of the orbital tumor. CONCLUSIONS: Current telemedicine technology can support real-time telementoring to remove an orbital tumor.

Adolescent↗
PubMed2000

Strabismus examination by telemedicine.

OBJECTIVE: To evaluate the reliability of strabismus assessment using telemedicine (TM) technology. DESIGN: Two prospective interobserver agreement studies. One study compared the agreement between a standard and a TM examination, whereas the other assessed agreement between two independent standard examinations. PARTICIPANTS: Strabismus patients over 4 years of age examined at a remote community clinic and patients assessed in a strabismologist's urban practice. METHODS: Forty-two patients were examined in person by a pediatric ophthalmologist at the remote community and independently by a pediatric ophthalmology fellow by means of TM (TM-standard study). The TM examination was performed with the help of a qualified ophthalmic assistant at the remote telecommunication center using a Power Cam 100 camera, a Picture Tel Concorde 4500 teleconferencing system, and a 224 kilobyte bandwidth. For comparison, independent in person examinations were performed on 43 patients by both examiners (standard-standard study). Agreement was measured using unweighted kappa (k) for categorical data, the intraclass correlation coefficient (ICC) for continuous data, and percent agreement. The odds of disagreement with TM (comparing the TM-standard versus standard-standard studies) was assessed with logistic regression analysis. MAIN OUTCOME MEASURES: Three parameters were assessed: (1) category of strabismus, determined by observation without cover test; (2) angle of deviation at 0.33 and 6.0 m; and (3) ocular muscle action. RESULTS: Agreement on the category of strabismus was good (k > 0.61) other than for vertical deviations. However, there was good to excellent agreement between TM and standard examinations on the vertical (ICC = 0.78) and horizontal (ICC = 0.79) angles of deviation with 6-m fixation with the cover test. Muscle ratings agreed within one point for the lateral, superior, and inferior rectus muscle actions in more than 90% of the eyes examined. Although good agreement was observed in the TM-standard study, it was inferior to the agreement in the standard-standard study. Examination by TM increased the odds of disagreement compared with examination in person by twofold to threefold. CONCLUSIONS: Strabismus examination can be performed with a good level of reliability with the use of medium bandwidth video teleconferencing equipment. However, reduced reliability has been noted in the detection of small vertical deviations by inspection and in evaluating oblique muscle actions.

Adolescent↗
PubMed2003

Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study.

PURPOSE: To evaluate the use of remote reading of digital retinal photographs in the diagnosis of severe (referral-warranted) retinopathy of prematurity (ROP) during longitudinal screening for ROP. STUDY DESIGN: Prospective, longitudinal cohort study. SUBJECTS: Forty-four consecutive premature infants at risk for ROP. METHODS: All infants were examined longitudinally, over a series of examinations, by indirect ophthalmoscopy (gold standard) and digital photography using the RetCam-120 Digital Retinal Camera (Massie Research Laboratories Inc., Dublin, CA) equipped with an ROP lens. Images were stored and read remotely by a masked reader. Referral-warranted ROP was defined as ROP in zone 1, the presence of plus disease or the presence of any stage 3 ROP. We determined whether and when referral-warranted ROP was diagnosed for each eye, of each infant, on each examination, during the course of each of the infant's screening. RESULTS: Severe (referral-warranted) ROP was diagnosed in 23 eyes by indirect ophthalmoscopy during their series of examinations. Digital photography had a sensitivity of 100% and a specificity of 96% in detecting referral-warranted ROP. The positive predictive value of digital photography was 92%, and the negative predictive value was 100%. In 87% of eyes, referral-warranted ROP was diagnosed by digital photography before or at the same time as indirect ophthalmoscopy. CONCLUSIONS: Longitudinal remote reading of digital photographs using the RetCam-120 system has excellent specificity and sensitivity in detecting referral-warranted ROP. This pilot study has shown that remote reading of digital photographs has promise for telemedicine strategies in ROP screening.

Cohort Studies↗
PubMed2000

Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera.

OBJECTIVE: We sought to determine whether retinopathy of prematurity (ROP) can be evaluated and managed telemedically. DESIGN: Multicenter noncomparative case series. PARTICIPANTS: Ten patients (19 eyes) with ROP were evaluated and treated per standard of care and imaged with the RetCam 120 digital fundus camera (Massie Research Laboratories, Inc., Dublin, CA). INTERVENTION: Images were transmitted to a remote site for evaluation and management recommendations. MAIN OUTCOME MEASURES: Telemedical evaluations and management recommendations were compared with traditional on-site standard of care evaluations and treatments. RESULTS: The identification of Plus disease at the remote site was accurately identified in 95% of eyes. Prethreshold, threshold, and stage 4 or 5 ROP were correctly detected in 17 of 19 (89%) eyes. CONCLUSIONS: Results indicate ROP can be evaluated and treatment recommendations made at remote sites with telemedicine strategies.

Diagnostic Techniques, Ophthalmological↗
PubMed1997

Agreement between face-to-face and telephone-administered mood ratings in patients with rapid cycling bipolar disorder.

We examined the reliability and level of agreement between the telephone and face-to-face administration of two mood-rating scales (HIGH-SAD and SIGH-SAD) in patients with rapid cycling bipolar disorder (RCBD). Two clinicians administered the HIGH-SAD and SIGH-SAD to 14 outpatients with RCBD. Patients received consecutive phone and face-to-face mood ratings in a randomized order. Using a paired t-test, no significant differences were found when comparing HIGH-SAD and SIGH-SAD scores administered face-to-face and over the phone. There was a high correlation between the face-to-face and phone administration of both scales as measured by intraclass correlation (r = 0.94 for SIGH-SAD; r = 0.85 for HIGH-SAD). Our results support the use of phone-administered mood ratings as a reliable and convenient method to monitor patients with RCBD.

Adult↗
PubMed2001

The demand for consumer health information.

Using data from an evaluation of a community-wide informational intervention, we modeled the demand for medical reference books, telephone advice nurses, and computers for health information. Data were gathered from random household surveys in Boise, ID (experimental site), Billings, MT, and Eugene, OR (control sites). Conditional difference-in-differences show that the intervention increased the use of medical reference books, advice nurses, and computers for health information by approximately 15, 6, and 4%. respectively. The results also suggest that the intervention was associated with a decreased reliance on health professionals for information.

Adolescent↗