Ophthalmological advice on the Internet.
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Humans↗
SEARCH · Search PubMed
Results for “Remote Consultation”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Litigation, legislation, and ethics. The problem, electronic data transmission and the law.
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Humans↗
Quality assurance in radiotherapy.
In 1999, the European Organisation for Research and Treatment of Cancer (EORTC), being a European pioneer in the field of cancer research as well as in quality assurance (QA), launched an Emmanuel van der Schueren fellowship for QA in radiotherapy. In this paper, the work that has been done during the first E. van der Schueren fellowship is reported, focusing on four phase III EORTC clinical trials: 22921 for rectal cancer, 22961 and 22991 for prostate cancer and 22922 for breast cancer. A historical review of the QA programme of the EORTC Radiotherapy group during the past 20 years is included.
Clinical Trials as Topic↗
Developing telemedical facilities for emergency nurse practitioners in nurse-led minor accident treatment services.
In January 1996 a nurse-led Minor Accident Treatment Service (MATS Unit) opened in Wembley Community Hospital London. A telemedical link was implemented, connecting Central Middlesex Hospital (CMH) Accident and Emergency Department of Wembley MATS, to facilitate and support the emergency nurse practitioners (ENPs) working there. Two years on, the unit continues to treat rising numbers of patients while ENPs have become proficient in the application of telemedicine. The telemedical link has enhanced service delivery for the ENP.
Emergency Nursing↗
Remote stereotactic visualization for image-guided surgery: technical innovation.
Additional data from imaging sources using computer navigation assistance enables virtual visualization of anatomical structures in three dimensions for stereotactic navigation during an operation. Recent developments in communication technology enable the broadcasting not only of video data, but also of stereotactic navigation data via the network. By telepresence/teleconsulting, the composite images and overlapping graphics (instrument, target structure, landmark, contour) can be seen in connected clinics, with the possibility of interactive graphic assistance. In cranio-maxillofacial surgery, the first surgical teleconsultation in real time via telecommunication of stereotactic data was performed in August 1996. A patient suffering from a post-traumatic deformity following multiple comminuted midface fractures was re-osteotomized with the aid of image-guided surgery using teleconsultation: the intraoperative position achieved could be discussed with different surgeons with regard to symmetry, hard/soft tissue relationships and occlusal details, with the possibility of on-screen planning interaction and real time evaluation of the results, over a distance of 500 km.
Computer Graphics↗
Telemedicine for cardiac surgery candidates.
BACKGROUND: Cardiac surgery is generally well or over-represented in many Western countries. Since the southern part of Switzerland relies on 300 km distance centers for cardiac surgery, we started a project of telemedicine for the distant evaluation of cardiac surgery candidates. We report our experience of the results of the diagnosis made by telemedicine and by direct scrutiny of coronary angiograms. METHODS: Coronary angiography was performed at the distant hospital by an invasive cardiology team. Teletransmission of images was performed using three Integrated Service Digital Network (ISDN) lines by direct transmission of recent recording. A total of 98 cases were reviewed (87 aorto-coronary bypass candidates, seven valvular and four congenital heart disease). We further performed a prospective blinded comparison of 47 consecutive cases with severe coronary artery disease (CAD) with respect to localization and number of significant coronary lesions, obtained by direct scrutiny of the original angiograms and the evaluation obtained with the teletransmitted images. RESULTS: In 89 cases of the 98 analyzed (91%) correct diagnosis and surgical approach could be established by distant transmission. In nine cases (9%, all aortocoronary bypass candidates) definitive diagnosis and treatment was feasible only by direct scrutiny of the original angiograms. Five critically ill patients were urgently referred to the surgical care center based on the correct distant diagnosis. The blinded comparison of distant diagnosis and direct scrutiny of angiograms in defining 1-2-3 vessel CAD was good: r=0.87, P<0.01. CONCLUSION: Initial experience using non-sophisticated telemedical transmission of angiograms of cardiac surgery candidates seems to be a promising facility for distantly located centers.
Cardiac Surgical Procedures↗
Ready or not, here it comes: the legal, ethical, and clinical implications of E-mail communications.
Electronic mail (E-mail) has the potential to enhance the professional relationship both between physician and patient, and among physicians of the same and different specialties. Despite this promise, E-mail communication in the medical environment raises important questions of legal, ethical, and professional propriety. This article discusses the potential uses of E-mail in medical practice, identifies its benefits, and analyzes the hazards that may be associated with this new and powerful technology. In doing so, the authors hope to foster an approach to E-mail use that takes advantage of its strengths while developing policies and practices that mitigate its weaknesses.
Child↗
Telemedicine and pediatric surgery.
The practice of pediatric surgery has become increasingly demanding, requiring longer working hours with less reimbursement. Although manpower in this field is adequate, there are still areas that are underserved. Advances in technology offer the pediatric surgeon tools to improve efficiency of practice, cover wider areas of practice, and service underserved locations. The purpose of this report is to introduce the pediatric surgeon to telemedicine technology and its potential impact on the practice environment. The history, key components, and current applications of telemedicine are presented. The ability to integrate this technology in pediatric surgical practice holds great potential.
Child↗
A brief, regular, proactive telephone "coaching" intervention for diabetes: rationale, description, and preliminary results.
Telephone-delivered interventions (TDIs) represent a potentially cost-effective method to increase medical adherence. TDIs for diabetes patients have typically been delivered by nurses or computerized telephone messaging. Psychology undergraduates, however, are less costly than nurses, have a strong background in behavioral science, and provide the personal relationship missing with computerized contact. This paper presents the rationale for and description of a brief, regular, proactive telephone intervention designed to be delivered by psychology undergraduates (i.e., paraprofessionals). "Coaches" administer a 15-min telephone intervention weekly for 3 months and biweekly for 3 additional months. Guided by a semistructured protocol that focuses on behavioral goals, coaches provides support, collaborative problem-solving, and apply basic cognitive-behavioral techniques. Results from a pilot study on type 1 diabetes patients are presented. This preliminary evidence suggests that the program is feasible, acceptable to a large majority of patients, and effective in reducing HbA1c levels.
Computer-Assisted Instruction↗
Evaluation of the effectiveness of portable low-bandwidth telemedical applications for postoperative followup: initial results.
BACKGROUND: The idea of using telemedical applications to evaluate patients remotely is several decades old. It has already been established that x-ray images (and magnetic resonance images) can be transferred using a personal computer and a modem, and many other such applications have been implemented. Over the past 50 years the expense and technical demands of the equipment involved in telemedicine have hindered its widespread deployment. The purpose of this study is to evaluate the ability of a mobile, low-bandwidth telemedicine platform to achieve real-time postoperative visits in the home. STUDY DESIGN: This evaluation was designed to evaluate the feasibility of performing a real-time clinical visit with computer and telecommunications hardware and software. A nurse and medical student (for information gathering only) made postoperative visits at patients' homes while the physician stayed at the office. Clinical evaluations were performed by using low-resolution and frame-rate video, high-resolution still images, and simultaneous telephony over a standard telephone line. These remote visits were followed by a standard visit in the office. Eleven patients were included, all of whom had undergone various laparoscopic procedures. They lived 5 to 240 miles from their surgeon. Efficiency was measured by recording the time required to capture and send data required by the physician to make a clinical decision. The time expense was measured at both the patients' and physician's locations. Technical issues were evaluated and patient satisfaction was assessed by standardized objective questionnaires. The accuracy of the evaluation at the remote visit was determined with a standard office visit. RESULTS: No technical problems were observed. The mean total time of the housecall at the remote site was 86 minutes (range 60 to 160 minutes) and at the base station site was 41 minutes (range 21 to 71 minutes). After personnel became familiar with the system, the last three visits averaged 61 and 25 minutes at the two sites, respectively. This corresponds favorablywith current time requirements for visiting nurses and office visits. The patients were highly satisfied with the home visit and, on average, rated the experience as 4.8 out of a maximum of 5. CONCLUSIONS: Followup visits in patients' homes after laparoscopic procedures can be accomplished by transmitting simultaneous voice, low-resolution video, and high-resolution still images to accurately perform postoperative evaluations over standard telephone lines, with time requirements and clinical accuracy similar to those of standard visits.
Adult↗
Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications.
BACKGROUND: Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. STUDY DESIGN: Telemedicine and telementoring were applied using low-bandwidth mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing system, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly, surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. RESULTS: Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps. CONCLUSIONS: Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by limiting travel, expanding services to patients, and increased patient quality assurance.
Ecuador↗
Telemedicine in the care of the end-stage renal disease patient.
Interactive video was used to monitor patients undergoing hemodialysis in a rural community over a 55-mile distance. Between April of 1991 and April 1993, the Texas Telemedicine Project sponsored the contact and record management. During this period, 1,500 patient contacts were documented. After the termination of the Texas Telemedicine Projects, the transmission lines were maintained between the central dialysis center and the satellite facility. Between 1993 and 1996, another 12,000 patient contacts were made. Dialysis monitoring accounted for approximately 80% of contacts, and 20% were nondialysis (primary care) contacts. This report discusses the historical and recent developments of interactive video medical care delivery and technical and medical implications of this emerging medium.
Humans↗
Mobile Breast Care Center: a joint program of the Department of Defense, U.S. Public Health Service's Office on Women's Health, and the National Cancer Institute.
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Female↗
Nursing on the electronic highway.
Notes prepared by Helen Hamilton, Lois Hazelton and Keith O'Brien, from a paper presented by Dr Kathleen McCormick at Royal College of Nursing, Australia's National Forum, Canberra in May 1996. The original paper identified the potential, current trends and applications of electronic technology, and also discussed some of the difficulties and barriers to realising the full potential of this technology in health care, education and research.
Computer Communication Networks↗
Can the Internet be used as a medium to evaluate knee angle?
Telemedicine promises to revolutionize medical care delivery in rural and remote areas. The ability to accurately evaluate physical impairment via the Internet is important to the possible future provision of Internet-based physiotherapy. This study evaluated the reliability and validity of assessing knee range of motion via the Internet. Two therapists evaluated knee angle on a single subject via two methods of assessment: the Internet and the traditional method (face-to-face). Nine random positions of the knee were chosen with the principal examiner performing 20 face-to-face and two sets of 20 Internet measures in each position (n=540). The secondary therapist performed Internet assessments only. The Internet connection was established at a readily available speed of 17 kbit/s. The Internet-based goniometer was found to be a valid tool for measuring both knee flexion and extension angles. It was shown to possess both high intra and inter-rater reliability. Difference average plots of the scores verified the consistency of measurement between both modes of assessment. The successful evaluation of the physical outcome measure of knee range of motion via the Internet assists the further development of Internet-based physiotherapy applications.
Analysis of Variance↗
Design of a PC-based multimedia telemedicine system for brain function teleconsultation.
During time-critical brain surgery, the detection of developing cerebral ischemia is particularly important because early therapeutic intervention may reduce the mortality of the patient. The purpose of this system is to provide an efficient means of remote teleconsultation for the early detection of ischemia, particularly when subspecialists are unavailable. The hardware and software design architecture for the multimedia brain function teleconsultation system including the dedicated brain function monitoring system is described. In order to comprehensively support remote teleconsultation, multi-media resources needed for ischemia interpretation were included: EEG signals, CSA, CD-CSA, radiological images, surgical microscope video images and video conferencing. PC-based system integration with standard interfaces and the operability over the Ethernet meet the cost-effectiveness while the modular software was customized with a diverse range of data manipulations and control functions necessary for shared workspace and standard interfaces.
Brain Ischemia↗
Health care in the information society.
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Computer Systems↗
On fortune telling for health informatics.
This paper examines the paper of Haux et al. in this issue of this journal. It gives some background on specifics of the German health care system, which underlie the theses and prognoses proposed by Haux et al. In analogy to a forecast of the future of health informatics, which is now 10 years old, I then suggest that these attempts meet two types of challenges:that of overestimating the positive effects of recent advances, which later are found not to scale up; and that of blind spots with respect to unforeseen significant advances. The attempt to find indications of such in the projections of Haux et al. leads, among other, to the conclusion that the projections of direct linkages between patients and care providers may be overoptimistic. As to whether the deviating opinions matter in the end, it is concluded that the technology advances may require less attention that the restructuring of the health care system required to take advantage of the advances of technology.
Caregivers↗