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At least 19 recordsLinked to original sources

Comparison of television and telephone for remote medical consultation.

Television and telephone communications were randomly used to compare their effectiveness in allowing consultation between a hospital-based physician and remote nurse practitioners. Visits using television for consultation averaged 50 minutes as compared with 40 minutes for telephone. This difference was caused by longer work-ups before the consultation, longer delays after it was requested, and longer consultations, themselves, on television. However, television consultations resulted in significantly fewer immediate referrals of patients to hospital physicians: 6 plus or minus 1 as compared to 12 plus or minus 1 per cent (mean plus or minus S.E.M) OF ALL TELEPHONE CONSULTATIONS (P SMALLER THAN 0.005). Although no overall difference in satisfaction was documented between the results of television and telephone consultations, participants preferred the former for medical decision making and cited it for allowing more social interaction than telephone. These findings suggest that television may have its greatest value in remote sites where the sense of isolation is great and the need to reduce long-distance referrals offsets the costs of the system.

Community Health Services

Gold award: providing psychiatric care and consultation in remote Indian villages--Department of Psychiatry, University of Toronto, Toronto, Ontario.

Faculty of the University of Toronto department of psychiatry take several trips a year to remote Indian villages in northwestern Ontario to deliver care to the Cree and Ojibway people and to provide consultation and training to the service delivery providers in the area. The program is part of a larger medical program operated by the university and financed by the Canadian government. Psychiatrists face numerous cultural and language obstacles in addition to harsh weather conditions and limited means of communication in the vast Sioux Lookout zone. When they are back in Toronto, they keep in touch via two-way radio with professional staff in the zone for ongoing consultations.

Awards and Prizes

An overview of networking for physicians and problems of network consulting in remote areas.

For computer networking the most suitable operating systems are UNIX or MS-DOS. As networking software UUCP and TCP/IP are most common. Hardware requirements are derived from the operating system and from the networking software. Low-cost solutions, for example, uuPC, a public domain version of UUCP, require only an 8088 processor and a 2400-baud modem. TCP/IP fares better with more powerful processors and requires permanent lines between the connecting computers. In developing countries the introduction of computer networks is hampered by several factors: lack of foreign exchange, price of hardware and software, unreliable electricity and telephone lines, lack of hardware and software support, large distances to the nearest center, and incompatibilities between existing systems and the network. Important aspects for clinical networking in developing countries include appointment scheduling in the referral hospitals, access to laboratory and pathology results from the central laboratory, and primary health care information such as epidemiologic data. Advanced systems, for example, for image processing, are not yet feasible in developing countries.

Computer Communication Networks

Remote expert consultation for MRI procedures by means of teleradiology.

From April 1992 to January 1993, radiology expert opinion for MRI procedures was offered by means of teleradiology. The experiment was carried out in addition to an existing service of a mobile MRI unit. MRI images were sent by means of teleradiology via regular telephone lines from the mobile MRI unit to an academic hospital, which served as expert consultation centre. During this period, 43 requests for expert opinions were performed. This article describes the clinical effects of these expert opinions, and the technical and organisational requirements to perform teleradiology in daily clinical practice.

Humans

[Automatic electrocardiographic diagnosis of the main types of arrhythmia at a remote cardiologic consultation and diagnostic center].

A combination of methods based on hardware, software and mathematical support, was used to filter an ECG signal, transmitted telemetrically to the computer. Clusterization of P-Q and R-R intervals was used as primary informative ECG signs, providing the basis for the diagnosis of the type of heart rhythm disorder. The comparison was made by correlation of ranges. An algorithm, based on unconventional clinical signs, was developed. An analysis of 672 electrocardiograms has demonstrated that mean sensitivity of the proposed automated diagnosis of the basic heart rhythm is 96.9%, and its specificity is 98.0%.

Algorithms

[Distance diagnosis of skin diseases].

During a period of eight weeks in late 1989, doctors in general practice in Kirkenes brought 27 dermatological patients to a studio at the local hospital. Video images were transmitted via a two-way telephone and video network, which enabled the patient and the doctor in Kirkenes to consult a specialist in dermatology in Tromsø. All the patients received written information before the consultation. Anamnestic information and clinical manifestations were presented from the studio at Kirkenes sykehus. The dermatologist diagnosed the disease and prescribed treatment from the studio at the hospital in Tromsø. The technical equipment satisfied our demands for remote diagnostics in dermatology. All the patients were positive to remote consultations.

Computer Communication Networks

Digital and computational morphology in hematology: current platforms, clinical evidence, and future requirements.

INTRODUCTION: Morphologic examination of peripheral blood and bone marrow remains central to the diagnosis and classification of hematologic disorders. Conventional optical microscopy, however, is labor-intensive, dependent on operator expertise, and affected by interobserver variability. Digital morphology has developed from automated image acquisition and cell pre-classification into a broader field that includes whole-slide imaging, remote review, quantitative morphometry, and artificial intelligence-based analysis. CONTENT: This review examines current applications of digital morphology in peripheral blood, bone marrow aspirates, malaria detection, and body-fluid analysis. Commercial platforms are evaluated with particular attention to the distinction between raw automated pre-classification, expert digital post-classification, and comparison with independent optical microscopy. Digital systems generally perform well for common mature leukocyte populations but remain less reliable for rare or diagnostically critical cells, including blasts, abnormal lymphoid cells, plasma cells, and intermediate maturation stages. Research systems increasingly extend analysis from individual-cell classification to whole-slide, specimen-level, and patient-level assessment. SUMMARY: Digital morphology can improve standardization, image traceability, remote consultation, education, proficiency testing, quality assurance, and selected aspects of laboratory workflow. Its clinical value depends on appropriate validation, transparent reporting of reference methods, recognition of algorithm-specific failure modes, and clearly defined criteria for expert review and conventional microscopy. Human expertise remains essential not only for validating results but also for adapting cell taxonomies and interpretive rules to evolving classifications of hematologic diseases. OUTLOOK: Future progress will require representative multicenter datasets, harmonized morphologic terminology, external validation, interoperability with laboratory information systems, and continuous monitoring after software or hardware updates. Integration of morphology with quantitative hematology, flow cytometry, cytogenetics, genomics, and clinical data may support more comprehensive computational diagnosis. Digital platforms may also broaden access to specialist expertise, training, and quality programs in resource-limited institutions and regions, provided that infrastructure, governance, and professional competency are adequately supported.

artificial intelligence

[Work experience of a cardiology center with remote and automatic patient observation].

The author describes the experience of a cardiological remote consultation-diagnostic center which carries out 212 961 consultations with remote ECG recording in 1972--1978. The center is equipped with a telemetric apparatus constructed by the author jointly with engineers, which makes it possible to record the ECG by telephone and radio. The centre also has an automatic system intended for the observation of patients with acute myocardial infarction in intensive therapy wards. The electrocardiographic shifts, skin temperature, myocardial contractility, and arterial pressure of the patients are kept under continuous observation by means of electronic computers.

Cardiac Care Facilities

[Hospital without borders--visions of telemedicine].

Transfer the expertise rather than the patient! With the help of a screen and a videocamera the general practitioner requiring expert help in diagnosis is able to consult the specialists directly via the broadband ISDN (Integrated Services Digital Network), and referrals complemented with audio-visual material can also be transmitted via the network. Modern telemedicine technology enables hospitals to be linked up, advanced information to be transmitted, interpreter services to be enlisted, and continuous postgraduate training to be developed. Thus, time and money can be saved, the patients given better and faster service, and the quality of health care enhanced.

Audiovisual Aids

[Patient consultation via broad-band network--pilot project in hand surgery].

A pilot project launched at Esbjerg was designed to ascertain whether broad-band audiovisual transmission of clinical examination can replace direct contact between patient and physician, and if so to what extent. Provided the technique can be improved and simplified, video consultation is an obvious and economically advantageous alternative to referral to a specialised tertiary clinic. Not only will the technique need to be further tested and improved, however, but doctors will require training in the assessment of moving two-dimensional images and diagnosis via a visual display unit (VDU).

Cost-Benefit Analysis

Radiologic consultation to a remote Canadian hospital using Hermes spacecraft.

Access to medical services in north Canada is limited by geography, climate, communication and transportation. A geostationary spacecraft, Hermes, was used to provide dependable, high-quality communication between a remote nursing station, a base hospital and a health science centre. Teleradiology formed an important component of the telemedicine services. Remote supervision of radiography and fluoroscopy was made possible; consultation services were shown to be 90% effective.

Adult

[Diagnostic image management and communication systems: experience at the University of Pisa].

Our work was aimed at implementing and validating a system for the acquisition, local management and remote transmission of diagnostic images. Integration of imaging equipment was performed in each of the two sites (5 km apart) in which the Department of Radiology of the University of Pisa is divided. Teleradiology was carried out using 64 Kbit/s lines as well as a 140 Mbit/s Metropolitan Area Network compliant with the Distributed Queue Dual Bus standard. Application domains included remote expert consultation and teleprocessing of diagnostic images. Remote expert consultation was performed in particular by using the 34 Mbit/s interconnection with the Metropolitan Area Network of Florence. Remote processing of diagnostic images using the high speed link allowed the cooperative work with scientific institutions in a field often limited by the complexity of image transfer and by the lack of a timely feed-back concerning the clinical value of processed images. Advanced processing of diagnostic images was performed in the field of stereographic display of CT and MR data sets. Moreover, experience was gained in the visualization, on a single composite image, of the multiparametric data obtained by means of different MR sequences (T1, Spin Density, T2), thus allowing to summarize, by using false colors, different tissue contrast information.

Computer Communication Networks

[Automated electrocardiographic diagnosis of ventricular hypertrophy in the system of the cardiologic telemetric consultation-diagnostic center].

A method and algorithm of automated diagnosis of ventricular hypertrophy is described for electrocardiograms, transmitted by telephone to the remote-control consultative diagnostic centre. The validity of computerized ECG diagnosis was assessed in comparison to roentgenologic, echocardiographic and angiographic diagnosis, on the one hand, and a collective ECG diagnosis made by physicians, on the other. Automated electrocardiographic diagnosis is shown to be only slightly less accurate, as compared to physicians' diagnosis. Left ventricular hypertrophy was diagnosed correctly on the basis of ECG findings in 73.01% by a physicians' counsel, and in 69.8% of cases by the computer; in case of right ventricular hypertrophy, the rates were 55.2% and 44.7%, respectively.

Cardiomegaly