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At least 109 records · Page 6Linked to original sources

A randomized study of a domiciliary antenatal care scheme: the effect on hospital admissions.

A preliminary randomized study has been made of a domiciliary management scheme which incorporates telephonic fetal heart rate monitoring for women with high-risk pregnancies. In this paper we report effects of the scheme on the pattern of hospital admissions. Sixty women were randomized 2:1 for domiciliary surveillance or for conventional hospital care, with 40 and 17 records finally available for analysis. The groups were well matched for maternal, obstetric and socio-economic characteristics. In the domiciliary group, 21 (53%) of the women avoided hospital admission altogether, the admission rate was more than halved, and the mean proportion of the time spent in hospital was reduced from 50% to 16% of the observation period. The women who received domiciliary care were generally satisfied with the scheme. Our study confirms expectations that carefully planned domiciliary surveillance can reduce the number and duration of hospital admissions.

Adolescent

Telematics: a new tool for epidemiological surveillance of diarrhoeal diseases in the Aquitaine sentinel network.

A sentinel health information system using telematics and a network of general practitioners was set up in Aquitaine in south western France in 1986. Among the health problems under surveillance was acute diarrhoea. Data for each patient who fulfilled the usual case definition for acute diarrhoea were reported by general practitioners using home terminals (Minitels) connected to a central computer by telephone. Over one year 2234 cases of diarrhoea were reported, the incidence varying from 0.8 to 1.5 cases per doctor per week. Seasonal variations in incidence were observed, with peaks in the winter and in the summer. Only 379 (17%) episodes of diarrhoea were classified as severe, and these patients consulted their general practitioners earlier than patients whose diarrhoea was less severe. Foreign travel was rarely found in the patients' histories, but clusters of cases were found in communities (4.6%) and in families (22.3%). The advantages of this system were easy reporting and immediate feedback, but it was difficult to extrapolate the data, and the system was inadequate for intervening in outbreaks of diarrhoeal disease. Our knowledge of diarrhoeal diseases in south west France improved.

Acute Disease

Teleradiology: results of a field trial.

A microcomputer-based teleradiology system was tested over a six-month period by linking a medical center with four distant clinics. Data from more than 4,000 diagnostic x-ray examinations were digitized and transmitted from the clinics to the center, where they were displayed on video terminals and interpreted by 30 military and civilian radiologists. The original radiographs were interpreted independently and the video and film reports compared to determine the feasibility of the teleradiology system. Evaluation of the clinical effectiveness of the system indicated that the quality of the video images resulted in diagnostic findings and impressions that were somewhat less accurate than those reported from comparable film images.

Data Display

Computerized telephone assessment of the "concrete" needs of chemotherapy outpatients: a feasibility study.

The feasibility of using a computer-automated telephone outreach system to routinely assess the needs of chemotherapy outpatients was evaluated. The automated intervention was designed as a cost-efficient strategy for assessing patients' needs on a periodic basis so that emerging needs could be identified in a timely way. Ninety-seven chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high-quality, digitally stored voice asking 12 questions regarding the patients' "concrete" needs. Early results of this larger ongoing study, in which patients are scheduled to be called every 4 to 6 weeks for approximately four months, indicated that computer-automated surveys had broad-based acceptance among our outpatients and that patients were able to comply accurately with the survey's instructions. Furthermore, the speech recognition system was found to be reliable, and patients' response patterns to the automated surveys valid. Nonparticipation in this study (28.0%) was not substantially higher than in our previous research within this patient population and neither nonparticipation nor attrition appeared significantly attributable to the automation itself. This method offers the potential for cost-efficient, universal, and ongoing assessment of patient needs, facilitating timely intervention, and efficient use of professional staff.

Ambulatory Care

Electrocardiogram recording by telephone in antiarrhythmic drug trials.

The purpose of this study was to evaluate ECG recording by telephone as a research tool for documenting the cardiac rhythm during symptoms of paroxysmal atrial tachycardia. Eleven patients were enrolled in the study during the first year. They transmitted 34 rhythm strips during symptoms, 17 of which showed paroxysmal atrial tachycardia; only one of the 34 was uninterpretable. Three patients thought they were having paroxysmal atrial tachycardia when their rhythm strips showed that they were having sinus tachycardia. Patient compliance and satisfaction with our follow-up system were high. Our study supports the use of ECG recording by telephone as an excellent tool to document arrhythmias in patients enrolled in clinical trials.

Anti-Arrhythmia Agents

An on-line system for electrocardiogram interpretation using the Bonner program.

An on-line system for electrocardiogram (ECG) interpretation using the Bonner program has been developed. The system consists of a telephone network, a process computer, a host computer, a computer interface and an electrocardiograph equipped with transmitting options. The signal acquisition program offered by IBM was modified so as to be equipped with the following functions: The technician can distinguish whether the process computer is ready or not, even if he is working in an examination room which is distant from the computer room. The data received by the process computer is transferred to the host computer in real time. In cases where the host computer is unable to receive the data, the process computer restarts transmission quickly after the host computer recovers the function of receiving. The host computer interprets transferred data in real-time by the Bonner program. The interpretation report is printed in real time on a remote printer. As the result of these modifications, a series of data processing operations may be executed without intermediary operators. The printed interpretation report begins to appear about ten seconds after completion of transmission.

Electrocardiography

Teleradiology at Gunma University Hospital.

Using NEC MediFile 1000 and the public telephone system, the Department of Radiology of Gunma University Hospital and Saitama Medical School deliver image diagnosis to fellow clinicians and affiliated hospitals. The system consists of digitizing, filing, processing, retrieving and archiving units for radiographs and documents. Images were digitized by CCD and filed in 2 Gbyte double sided optical disk, which can accommodate 500 sheets of 14 x 17 films on 1500 of the smallest size slats without data compression. Image resolution was evaluated by ROC curve using multiple pulmonary nodules. The time taken for image transfer over 24 km was tested with various film sizes, image varieties and data compression rates.

Computer Communication Networks