What is teleconferencing and how is it used as a therapeutic intervention?
Explore the source record for details and available documents.
Adolescent↗
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.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Wireless and satellite transmission of prehospital focused abdominal sonography for trauma.
OBJECTIVE: As military operations become smaller and more remote and as humanitarian missions increase, ultrasound technology is emerging as a valuable asset for defining injuries in austere settings. This study evaluated the feasibility of focused abdominal sonography for trauma (FAST) examinations in a field environment with real-time images sent wireless to an antenna and over satellite. METHODS: Using a 6-lb SonoSite portable ultrasound device with battery pack, FAST examinations were performed on a healthy volunteer, transferred wireless at distances of 1,000 and 1,500 feet from the receiving antenna using a vest-mounted microwave transmitter, and then redirected over satellite (INMARSAT) to a remote hospital for review by emergency physicians, and a radiologist. RESULTS: Real-time wireless transmissions at 1,500 feet reliably yielded images without quality or interpretability drop compared with those recorded digitally at the examination site. A 32% reduction in image quality and interpretability was seen with still images and a 42% reduction was noted with cine loops using INMARSAT. The authors did not find the upper distance limit of the wireless transmitter used. CONCLUSION: This study suggests 1) that remote FAST examinations are plausible for prehospital care and triage using new-generation portable ultrasound units, 2) that line-of-sight transmission of FAST examinations when compared with on-site images results in no degradation in image quality or interpretability at distances used, 3) that ranges greater than 1,500 feet are feasible for interpretable examinations and therefore line-of-site mass casualty or field triage sites, and 4) that real-time INMARSAT transmission of FAST examinations at 64 kbps may serve a limited role for remote clinical interpretation.
Abdominal Injuries↗
Innovation possibilities for prehospital providers.
The national interest in disaster management and a burgeoning technology field are leading to the development of new approaches to emergency evaluation, triage, and treatment in prehospital and all hospital arenas. The ability to bring "hands-on" expertise, both physically and technologically, as quickly as possible to the trauma patient brings the potential for real advancement in the field. This descriptive report presents several such concepts that are moving into reality.
Bioterrorism↗
Training for rural prehospital providers: a retrospective analysis from Montana.
OBJECTIVE: This paper provides a retrospective analysis of training methods used by rural Montana's prehospital care providers. Drawn from both published and unpublished sources and spanning the past 25 years, it examines the origins of training in this vast rural state and aims to shed light on successful, nontraditional training delivery methods currently being used. Because volunteer personnel traditionally provide prehospital emergency care in rural areas, development and implementation of effective training programs are generally considered important to helping these practitioners maintain the knowledge and skills they use in their lifesaving work. METHODS: Five different training programs used in Montana were assessed: Train-the-trainer; Local Cluster with videotape and guided practicals; Circuit Rider training with interactive videodisc; interactive video teleconference; and the TENKIDS statewide electronic infrastructure. Strengths and weaknesses of each training program were analyzed. RESULTS: Traditional train-the-trainer methods make training readily accessible, but it is difficult to ensure consistent, top-quality delivery of the materials. Electronic training is popular and effective but can be expensive and difficult to develop and distribute. Establishing an electronic infrastructure allows for easy delivery of high-quality electronic instruction. However, it remains somewhat expensive to develop. CONCLUSIONS: Efforts to improve capabilities of instructors in Montana have had varied success. Studies illustrate that remote training methods that train the providers directly are effective and popular. The application of electronic media and other distance learning techniques have demonstrated a positive impact on the frequency, quality, and standardization of training for volunteer prehospital EMTs.
Educational Measurement↗
Teleophthalmology link between a primary health care centre and a reference hospital.
We have evaluated a teleophthalmology service linking a primary health care centre and an eye clinic at a reference hospital. General practitioners at the primary care centre serving a population of 15,000 and ophthalmologists at the reference hospital participated in this study. Eye fundus digital images were taken from 278 eye fundi of 139 consecutive patients with clinical conditions that could potentially produce fundus alterations. Fundus images were obtained with a non-mydriatic fundus camera (Canon CR6-45M) and were electronically sent reference hospital where ophthalmologist inspected the images and returned the diagnosis. In 18 patients (13%) the images did not have good enough quality to exclude eye fundus lesions. In 24 patients (17%) clear eye fundus alterations were found in at least one eye. In 14 patients (10%) there were image features suggesting retinal alterations that could not be confirmed by image inspection. Media opacity (13 eyes, 5%, seven patients, 5%) was the most common cause of poor image quality. The most difficult assessment was the evaluation of optic nerve head cupping. Retinal oedema was not observable in the digital images. In our experience teleopthalmology services seem to be an effective alternative for eye fundus diagnosis and patient follow-up.
Computer Communication Networks↗
Motor tele-rehabilitation in post-stroke patients.
PRIMARY OBJECTIVE: The advanced communication technology may allow rehabilitative interventions to patients living at home from a remote provider. We evaluated the effects of a tele-rehabilitation system for the therapy of arm motor impairments due to a stroke. RESEARCH DESIGN: Experimental observational study. METHODS AND PROCEDURES: We selected five patients suffering from mild/intermediate arm motor impairments due to a long-lasting ischaemic stroke. Two workstations were utilized, one in the patient's house and the other in the rehabilitation hospital, connected through the phone lines. A virtual reality based software allowed the patient to perform adequate motor tasks created by the physiotherapist. During performance, the patient could see not only their movement but also the correct trajectory that they had to accomplish. The feedback derived from the patient's action, its outcome, and feedback from the supervision of the physiotherapist may favour the acquisition of new motor abilities. MAIN OUTCOME MEASURES: The arm motor performance and the activities of daily living were evaluated using the Fugl-Meyer and Functional Independence Measure scale, together with the determination of the velocity and duration of 10 representative reaching movements. RESULTS: Subjects underwent the tele-rehabilitation programme for 4 weeks. The therapy significantly improved the Fugl-Meyer mean score, the mean duration and the velocity of the movements, but not the Functional Independence Measure scale score. CONCLUSIONS: These results indicated that this tele-rehabilitation system did not appear to adversely affect rehabilitation; rather it may improve arm motor deficits due to a stroke. If these evidences are further confirmed, tele-rehabilitation may represent a new home-based therapy to treat disabled people.
Activities of Daily Living↗
Influence of the teleradiology technology (N-ISDN and ATM) on the inter-hospital management of neurosurgical patients.
We set out to assess the influence of a teleradiology network on the relations between a general hospital and a 100 km distant university hospital in the context of neurosurgical emergencies, and compared a commercially available technology, N-ISDN (Narrowband Integrated Service/Digital Network), to an emerging technology, ATM (Asynchronous Transfer Mode). The evaluation was conducted using records of advice request calls and patient transfers. Three phases were considered: without teleradiology, with transfer of digitized images over N-ISDN at 64 kbps, and with an experimental ATM network at 10.5 Mbps with DICOM image transfers and videoconferencing. Additionally, staff meetings over ATM videoconferencing were set up. To assess the ATM service, we used log files and questionnaires, 108 advice requests were studied over a 18 month period. The average transmission time for one examination was 38 s with full DICOM image resolution over ATM, versus 150 s with 10:1 JPEG (Joint Photographic Expert Group) compression over N-ISDN. Up to 50% unnecessary patient transfers were avoided. Advice requests increased fourfold, and non-urgent advice requests increased from 0 to 21%. Despite the experimental configuration of the ATM network, the service gave satisfaction to all the physicians. Videoconferencing was unanimously regarded as a prominent tool to improve the quality of interaction. It was particularly useful for non-urgent cases and distant staff meetings. Teleradiology can improve the relations between hospitals through an increase of urgent and non-urgent advice requests. Asynchronous transfer mode is an efficient way for fast transfer of radiological examinations in DICOM format and for discussing them through high-quality videoconferencing.
Brain Neoplasms↗
Video-linked court liaison services: forging new frontiers in psychiatry in Western Australia.
OBJECTIVE: To describe the use of videoconferencing that is providing a specialist forensic service to remote parts of Western Australia. CONCLUSIONS: Court liaison has been shown to be an effective intervention for people with mental illness within the justice system. Most such programmes occur within metropolitan areas in Australia. Videoconferencing facilitates the provision of specialized forensic services to courts in remote parts of Australia.
Commitment of Persons with Psychiatric Disorders↗
Imaging and the Internet.
Internet-based imaging is changing the way urology services are delivered by allowing rapid communication between remote locations. This review focuses on Internet-based imaging modalities, the hardware needed to transmit and view these images, and current applications. With the continuing expansion of Internet-based resources, all physicians must become accustomed to integrating the Internet and Internet-based imaging into their practices.
Diagnostic Techniques, Urological↗
Telemedicine: recent developments and future applications.
Telemedicine, or the delivery of health care from a distance, is an exciting field that has undergone rapid advancements over the past three decades. Previous studies have demonstrated that telemedicine can effectively assist in patient care. However, cost issues and the lack of resources to sustain telemedicine systems have previously limited the use of this technology. Herein, we explore the development, current applications, and future of telemedicine.
Analog-Digital Conversion↗
Is telesurgery a new reality? Our experience with laparoscopic and percutaneous procedures.
BACKGROUND: Minimally invasive surgery offers many advantages, but its correct practice is associated with a steep learning curve. Telesurgery allows a surgeon at a remote site to guide and teach surgeons at a primary site by utilizing robotic devices, telecommunications, and video technology, thereby reducing complications. PATIENTS AND METHODS: From September 1998 to July 2000, 17 procedures were telementored between two sites 9230 km apart: a primary operating room at the Policlinico Casilino "Tor Vergata" University of Rome and a remote site at the Johns Hopkins Medical Institutions in Baltimore. Of these procedures, 14 were laparoscopic cases: 8 spermatic vein ligations, 2 retroperitoneal renal biopsies, 3 simple nephrectomies, and 1 pyeloplasty. Three procedures were carried out to obtain percutaneous renal access. All procedures were performed with the help of two robots: the first robot, AESOP, for the orientation of the laparoscope, and the second one, PAKY, to perform the percutaneous renal access. In addition to the robotic device, the system provided four ISDN lines, a PC with dedicated software to manage the connection, audio and video connections, an external video camera with a panoramic view of the operating room, and remote control of the electrocautery and the Telestrator. RESULTS: All the procedures were accomplished with an uneventful postoperative course. Ten operative cases were telementored successfully. In five cases, it was not possible to establish a connection to the remote site, and two procedures were converted to open surgery because of intraoperative complications. The time delay of the image transmission was <1 second. CONCLUSION: This preliminary experience has demonstrated the feasibility of international telementoring. It could provide education to surgeons and decrease the likelihood of complications attributable to inexperience with new techniques.
Humans↗
Teleradiology at the tertiary-level Women's and Children's Hospital in South Australia.
This article relates to a teleradiology trial undertaken in 1998-1999 at the Women's and Children's Hospital (WCH) in Adelaide, the capital of South Australia. The trial involved linking the hospital to a range of rural and remote sites in South Australia and the Northern Territory. The main aim of the project was to evaluate the advantages, limitations, benefits, and costs of a teleradiology service provided by WCH. The major finding from the study is that for a tertiary hospital providing second opinions in complex medical cases, a new form of business justification is required for teleradiology. The justification would include an emphasis on the range of high-level services that a subspecialist hospital such as the WCH can provide. The justification would also include the range of benefits to different parties, particularly the patient, and the intangible nature of many of the benefits.
Adult↗
Supporting communication in rehabilitation engineering teams.
The objectives of this project were to examine how members of a colocated rehabilitation engineering team communicate during their work and hence deduce the implications of these communications for the design of video-based technologies to support communication among members of a virtual rehabilitation engineering team. Twenty-four assessment clinic sessions conducted by rehabilitation engineering team were recorded on videotape over a period of 3 years. These tapes were analyzed in considerable detail using a schema to identify and classify the talk and actions of the team members. Combining talk and actions with artifacts is a mechanism used by designers to develop ideas and communicate them to others. Speakers rely on actions to support and make their talk lucid. Cooperation based on sharing artifacts is a strength of face-to-face interaction. Participants can experience artifacts and observe others using the artifacts. Tools such as videoconferencing to support virtual rehabilitation teams will have to provide the participants with the ability to see often quite subtle gestures and actions if they are to grasp the meaning of the talk. Increased understanding how a team communicates visually complex data may (1) aid development of next generation videoconferencing equipment to better support distributed designers and rehabilitation engineers and (2) guide development of techniques to enhance the quality of visual data presentation in current videoconferencing systems.
Communication↗
Case-based support in a cooperative medical diagnosis environment.
Many medical services are often not available to people living in remote areas because of the lack of medical specialists. This problem would be alleviated if a suitable environment was designed to allow physicians to collaborate and exchange ideas with centrally located medical specialists. This article describes an ongoing research project to design and implement a collaborative multimedia environment to allow medical specialists to cooperate in diagnosis. The environment will support remote database access for medical images, the retrieval of relevant medical cases to support diagnosis, and communication among participants through telepointers and image annotation by free-hand drawing.
Cervical Vertebrae↗
Multipoint videoconferencing in health: a review of three years' experience in Queensland, Australia.
The objective was to review multipoint videoconferencing in Queensland Health from July 1996 to June 1999. Most videoconferencing has been conducted using desktop systems connected by integrated systems digital network (ISDN) at 128 kbps. Data on utilization and problems were extracted from monthly reports and a survey was conducted. Multipoint videoconferencing increased steadily over the 3 years from just and handful of conferences per month to 101 conferences and 703 hours of bridge use per month. Primary uses were education and administration. Relatively few technical failures and operator errors were recorded. But by 1999, late connection and low attendance were major problems. Survey responses indicated that multipoint videoconferencing met expectations at the great majority of sites. Most respondents were satisfied with the level of administrative and technical support provided. In this large and decentralized state, multipoint videoconferencing has proven a useful and effective means of bringing healthcare workers together for a common purpose, supplementing face-to-face events and other encounters mediated by communications technology such as satellite broadcasts and audioconferences.
Attitude of Health Personnel↗
Live transmission of neonatal echocardiograms from underserved areas: accuracy, patient care, and cost.
OBJECTIVE: Echocardiography is an important tool in the diagnosis and management of critically ill neonates. The authors hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from underserved areas would improve management, prevent unnecessary transports, enhance sonographer proficiency, and result in monetary savings. MATERIALS AND METHODS: Using personal computers capable of real-time transmission of echocardiograms over three integrated services digital network (ISDN) telephone lines, pediatric cardiologists interpreted echocardiograms, suggested views to sonographers, and made recommendations to neonatologists 200 miles away. Analyses of accuracy, management, echocardiogram quality, time, and costs were carried out prospectively. RESULTS: Sixty studies were transmitted over 7 months. Indications for echocardiography were suspected congenital heart disease (n = 29), suspected patent ductus arteriosus (PDA) (n = 27), and hemodynamic instability (n = 4). Diagnoses were critical congenital heart disease (n = 4), noncritical heart disease (n = 8), PDA (n = 21), ventricular dysfunction (n = 5), persistent pulmonary hypertension (n = 3), and normal (n = 19). Videotape review confirmed all telemedicine interpretations. The echocardiogram led to immediate change in management in 25 cases (42%), and echocardiogram quality was improved in 53 studies (88%). Time from request to completion of echocardiography was 43+/-30 min. Monetary savings from five avoided transports exceeded all expenses. CONCLUSION: Live transmission of neonatal echocardiograms over three ISDN lines is diagnostic, improves patient care and echocardiography quality, and is cost effective.
Ductus Arteriosus, Patent↗
Sickle cell telemedicine and standard clinical encounters: a comparison of patient satisfaction.
OBJECTIVES: To determine patient satisfaction with telemedicine encounters among adults with sickle cell disease and compare their scores with SCD patients who have standard medical encounters (as controls). METHODS: Adults patients were recruited from a list of participants in sickle cell telemedicine clinics and prospectively at the time of clinic encounter. Patients were assigned to telemedicine or standard encounter groups. Demographic and pertinent clinical data were obtained for all subjects, and the Client Satisfaction Questionnaire (CSQ-8) was administered. Patients were also asked for open-ended comments regarding their satisfaction with the service. Their responses were recorded verbatim. RESULTS: Patients with telemedicine (n = 60) and standard encounters (n = 60) were comparable in gender, genotype, education, employment, and mean number of sickle cell disease-related complications. Patients in the telemedicine group were younger (p< 0.005), more likely to have Medicaid insurance (p = 0.009), and more likely be taking hydroxyurea (p = 0.003) than patients in the control encounter group. Mean CSQ scores for the telemedicine group were high (total: 28.82+/-3.06), and there was no difference for any item between encounter groups (p = 0.389). Patients in the standard encounter group were more likely to provide positive open-ended comments regarding the encounter (95% vs. 70%; p = 0.001). Negative comments were generally in the area of confidentiality. CONCLUSIONS: While some patients expressed concern about confidentiality with telemedicine, the benefits of improved access and continuity of care were recognized, and overall satisfaction with telemedicine was high. These findings support the use of telemedicine as an acceptable health care delivery option for rural, underserved populations with sickle cell disease.
Adult↗
Telepathology between Richmond and Beckley Veterans Affairs Hospitals: report on the first 1000 cases.
OBJECTIVE: A telepathology connection between Richmond VAMC and Beckley VAMC using dynamic robotic telepathology to provide pathology services remotely was established. MATERIALS AND METHODS: This study reports a 14-month experience using telepathology to diagnose surgical specimens obtained from patients at the Beckley VA Medical Center and viewed in Richmond 250 miles away. Over 14 months, 2325 slides representing 1000 cases were viewed. RESULTS: Discrepancies were observed in 20 of 2325 slides, or 0.86% of the total. None of the patients, where a discrepancy was found, were adversely affected by the preliminary report given. CONCLUSIONS: This study demonstrates that telepathology is a reliable and cost-effective alternative to on-site pathology services and reviews advantages and disadvantages of the system.
Hospital Costs↗