bluuebunny/crossref_metadata_2025 huggingface dataset:
A community-based approach to evaluation of health outcomes and costs for telepsychiatry in a rural population: Preliminary results
Authors: Kennedy Craig , Yellowlees Peter
Published: October 2002

A pilot trial was established to support visiting psychiatric services and local public and private practitioners through the use of videoconferencing. The purpose of the trial was to determine whether people in the community received better health-care with telemedicine. A community-based approach was used to evaluate health outcomes, costs, utilization, accessibility, quality and needs for such services in a rural community in Queensland. Over a two-year period data were collected from 124 subjects who met the criteria of having a mental health problem or mental disorder. Nine further subjects refused to participate in the study. Only 32 subjects used videoconferencing to receive mental health services. Preliminary results did not show any significant improvements in wellbeing or quality of life, although the time span was relatively short. However, the results confirmed that the people were no worse off from a consumer or a practitioner perspective from using videoconferencing. Most consumers found that videoconferencing with a psychiatrist moderately or greatly helped them in managing their treatment, with 98% of them preferring to be offered videoconferencing in combination with local services. Overall, videoconferencing is a crucial part of enhancing psychiatry services in rural areas. However, it is not necessarily cost-effective for all consumers, general practitioners, psychiatrists, or the public mental health service.
Telemedicine in Greenland – from the early beginnings to the making of a business plan
Authors: Stensgaard Thomas
Published: October 2002

Greenland has a geography and demography that make telemedicine a logical choice when planning a future public health service. Telemedicine was introduced in 1994. Although everybody considered it to be a good idea, it took five years to move from initial enthusiasm to politicians and officials committing the necessary resources. Over such a long period, there is a risk that good ideas will become neglected, although, where resources are limited, it is useful as a time in which to select the best of the new ideas. We have certainly gained a great deal of experience which we will use if and when, over the next two years, we have to argue for an extension of our business plan.
A comparison of telemedicine with face-to-face consultations for trauma management
Authors: Tachakra Sapal , Lynch Maria , Newson Roger , Stinson Alistair , Sivakumar Alganandan , Hayes Jesus , Bak Julie
Published: October 2002

We compared the accuracy of teleconsultations for minor injuries with face-to-face consultations. Two hundred patients were studied. Colour change, swelling, decreased movement, tenderness, instability, radiological examination, severity of illness, treatment and diagnosis were recorded for both telemedicine and face-to-face consultations. Colour change showed an accuracy of 97%, presence of swelling or deformity of 98%, diminution of joint movement of 95%, presence of tenderness of 97%, weight bearing and gait of 99%, and radiological diagnosis of 98%. The severity of illness or injury was overestimated in one case and underestimated in five cases. Treatment was over-prescribed in one case and under-prescribed in three cases. The final diagnosis was correct in all but the two cases in which mistakes were made in the teleradiology. Overall, there was good accuracy using teleconsultations.
The reliability and acceptability of telemedicine for patients with schizophrenia in Korea
Authors: Chae Young Moon , Park Hyun Joo , Cho Joong Geun , Hong Geum Duk , Cheon Keun-Ah
Published: October 2002

We conducted a pilot study to evaluate telemedicine for patients with schizophrenia. The telemedicine system was connected over the ordinary telephone network at 33 kbit s. A computer-based patient record was used to view patient summaries and to allow nursing notes to be entered at the patient's home. Fifteen patients with schizophrenia were assessed over the telemedicine system and 15 patients were assessed face to face, using the Brief Psychiatric Rating Scale BPRS . Our low-bandwidth telemedicine system appeared to be as reliable as higher-bandwidth ISDN systems. In addition, the patients' acceptance of the telemedicine interview, in terms of comfort, ease of self-expression, quality of interpersonal relationship and usefulness, was good in most cases. The only factors significantly affecting the patients' level of acceptance of their particular type of interview were the assessment type i.e. whether the patient had had a telemedicine assessment or not and their BPRS score. Since the system was of low cost and was easy to interface with a notebook computer, it could be used support other home-health nursing services.
Psychiatric inpatient care planning via telemedicine
Authors: Mielonen Marja-Leena , Ohinmaa Arto , Moring Juha , Isohanni Matti
Published: October 2002

We assessed the costs of psychiatric inpatient care-planning consultations to remote areas using videoconferencing, instead of the conventional face-to-face consultations at a hospital. The data were collected from all wards at the department of psychiatry of Oulu University Hospital over 11 months. A total of 14 videoconferences were conducted with two primary-care centres located 220 km and 160 km from Oulu. During the same period, 20 conventional consultations at the Oulu University Hospital were also assessed. A questionnaire was completed by a total of 124 patients, relatives and health-care personnel; the response rate was about 90%. Of the respondents, 90% were satisfied with the quality of communication afforded by videoconferencing. At a workload of 20 patients per year, the cost of the videoconferences was FM2510 per patient; the cost of the conventional alternative was FM4750 per patient. At 50 care consultations per year, a remote municipality would save about FM117,000.
An evaluation of satisfaction with telemedicine among health-care professionals
Authors: Hicks L L , Boles K E , Hudson S T , Koenig S , Madsen R , Kling B , Tracy J , Mitchell J , Webb W
Published: October 2002

A survey was conducted among non-doctor health-care professionals in six rural counties in Missouri. The purpose of the survey was to establish baseline data to evaluate the effect of changes in the health-care sector, especially technology changes, on the job satisfaction, career satisfaction, relationships and communication activities of health professionals. The survey included three rural counties in which integrated telecommunication and interactive video telemedicine services were being installed, but before significant activities had begun, and three comparator counties without substantial integrated telecommunications infrastructure and telemedicine services. During a one-month study period, 1108 questionnaires were distributed. The total response rate was 50.1% ( n = 555). Of the respondents, 30.3% indicated that technology in health-care was having a large effect on their work, although only 18.2% indicated that telemedicine and telecommunications were having a large effect. No systematic differences were found among the health professionals in the two communities at the time telemedicine equipment was being installed.
Improving user acceptance of health-care telematics
Authors: Kolitsi Zoi , Iakovidis Ilias
Published: October 2002

Telehealth represents a new approach to health-care with the potential for improving accessibility and reducing costs. Over the years, technology has become increasingly interactive, cheaper and standardized. Despite this, the uptake of technology has been low. One of the main reasons is that the introduction of telematics in health-care requires more than technology and software—organizational and cultural change is required as well. A suggested approach is based on the principles of service quality and quality management, to produce a partnership between the users and the developers of new technologies. This will in turn make it possible to bring user-validated requirements into the design of the system and create feelings of ownership and motivation on the part of users, in order to prepare their environment for the change. The methodology has been effectively used in various projects of the Telematics Application Programme of the European Commission.
Instructional technology in medical education: Lessons learnt
Authors: Pereira Jose , Peden Jacqui , Campbell Katy
Published: October 2002

New instructional technologies, especially Web-based applications, may play an increasing role in medical education, particularly for distance and distributed learning. As medical educators turn to this medium, numerous benefits and opportunities, but also challenges and pitfalls, will arise. The successful development and implementation of instructional technologies in medicine require an appreciation of the medium's heterogeneous nature, its strengths, weaknesses and limitations. These in turn rely on partnerships with various experts and the early adoption of evaluation. We have summarized the lessons learnt from developing Web-based courses on palliative care in a framework for adopting instructional technologies. This framework incorporates development, implementation and evaluation.
Web-based education and support for patients on the cardiac surgery waiting list
Authors: Scherrer-Bannerman A , Fofonoff D , Minshall D , Downie S , Brown M , Leslie F , Mcgowan P
Published: October 2002

We assessed the effectiveness of two methods of patient education, a printed manual and a Website, provided to patients waiting for cardiac surgery. The four-phase study was conducted over two and a half years, and included urban and rural subjects in Vancouver and the interior of British Columbia. The Website was based on the specially developed patient education manual. A pilot evaluation study was carried out to assess the features of the Website and to ensure it was ‘user-friendly’, after which it was revised. The two education methods were evaluated using both qualitative and quantitative studies. Findings supported the feasibility and viability of both formats. The Web-based format demonstrated two additional benefits over the print-based format, namely increased social support and decreased anxiety. Other findings included the perception of increased support, lifestyle changes and more positive attitudes towards the impending surgery.
Community computing: Perceptions of technology access, use and policies in urban Ontario
Authors: Valaitis Ruta
Published: October 2002

The perceptions of community service providers about access to public technology and uses of technology to support population health were investigated. Perceptions about policies regarding access to technology for the public were also pursued. Qualitative semistructured interviews with service providers in the community were used. One-hour semistructured interviews were conducted with representatives from five community organizations and one business in an urban centre with a population of 400,000. Respondents believed that computers are here to stay, that that they can provide a valuable means for information access and that they have the potential to support communication in local communities. Perceived barriers were also identified.
Telereconstruction from computerized tomography images for the distance teaching of medicine
Authors: Masero V , Moreno J , Andres F , Silva A , Chambel J , Uson J
Published: October 2002

A system for making remote two- and three-dimensional reconstructions from computerized tomography images has been developed in order to improve medical teleteaching. It allows the automatic two- and three-dimensional remote visualization of the anatomical structure of interest. As a part of this system, software has been developed which allows many visual operations or transformations on a remote three-dimensional model. It permits the remote workstation and the local workstation to visualize every transformation simultaneously. It allows a doctor to interact virtually and remotely with the anatomical structure. The software enables examination of the anatomical model from all angles, even from inside (including planar and three-dimensional presentations).
Safety and risk issues in using telecare
Authors: Williams G , Doughty K , Bradley D A
Published: October 2002

The increasing adoption of technology to support independent living at home through the extended use of community alarms and, ultimately, second-generation telecare systems poses some safety problems. The implications of any failure of the technology must be addressed in order to provide a safe and reliable care service. The risks of using home-based technology can be assessed by standard techniques under three categories: environmental factors; human factors; and technological factors. A safety classification system for telecare devices is proposed leading to a range of design guidelines which represent good practice. An example of the use of these design principles is a prototype second-generation telecare system, MIDAS, which is currently undergoing trials. In order to reduce the risks associated with device failure, the system incorporates distributed intelligence, built-in self-testing and redundancy. Potentially hazardous situations can therefore be controlled.
The role of telenursing in the provision of geriatric outreach services to residential homes in Hong Kong
Authors: Chan W M , Hjelm N M
Published: October 2002

A residential nursing home in Hong Kong was linked to the community geriatric assessment team based in a regional hospital using videoconferencing equipment operating at 384 kbit/s. The feasibility of providing nursing services and their acceptability to users were evaluated over 12 months. There were 198 occupants of the nursing home and their mean age was 82 years (range 60-101). Services included patient education regarding the use of a metered dose inhaler, wound management and a falls prevention programme, together with assessment of clients' need for infirmary care and the risk of aspiration. The acceptability of the system to the clients and nursing home staff was also assessed. It was found that 89% of such services could be carried out via telemedicine, and only 11% required on-site visits. There was an increase in the proportion of patients correctly using inhalers as well as a reduction in the number of falls. More consultations were conducted by the nurse (an increase of 76% per month) and an additional 8.4 patients per month could be attended to by the nurse compared with 5 patients when on-site visits were used. Acceptability to clients and nursing home staff was good. The problem of lack of resources to support elderly residential care institutions makes service delivery via telemedicine appear economically attractive, as well as facilitating improvements in the quality of long-term care.
Low-bandwidth, Internet-based videoconferencing for physical rehabilitation consultations
Authors: Lemaire Edward D , Boudrias Yvon , Greene Gayle
Published: October 2002

Low-bandwidth, Internet-based videoconferencing was used to provide physical rehabilitation consultation services for eight community hospitals. Videoconferencing and file transmission used a PC and modem. A separate telephone line was used for voice. Over 21 months, 47 physical rehabilitation consultations were completed for communication disorders, foot care, gait problems, orthotics, prosthetics, arm weakness and wheelchair prescription. Consultations were approximately 40 min long. Clinician questionnaires were completed by 47 individuals. While more than 80% of the questionnaire responses supported the telemedicine approach, remote clinicians rated their satisfaction higher than did the specialists. Client questionnaires were completed by 24 individuals (a response rate of 51%). All clients were comfortable with and had confidence in the teleconsultations.
Telepsychiatry as a routine service - the perspective of the patient
Authors: Simpson J , Doze S , Urness D , Hailey D , Jacobs P
Published: October 2002

Patient perspectives were examined as part of an assessment of a routine telepsychiatry service in rural Alberta. Information was gathered through self-report questionnaires and telephone interviews. Of 379 questionnaires distributed to patients, 230 (61%) were returned. Of the patients who completed questionnaires, 89% reported being satisfied with the service and 96-99% were satisfied with the equipment and the room. Twenty-nine of 31 patients who were interviewed by telephone preferred telepsychiatry to waiting for a consultation, were willing to use the service again and would recommend telepsychiatry to a friend. While 25 of these 31 patients preferred telepsychiatry to travelling to a consultation, 15 indicated that they would prefer a face-to-face interview to telepsychiatry and a further seven were unsure. Twenty-three of the 31 patients interviewed would have had to miss time from work or pay for child care in order to travel to a conventional psychiatric consultation. The availability of telepsychiatry led to an estimated cost saving of $210 per consultation for patients who would otherwise have had to travel. From the patient's perspective, telepsychiatry was an acceptable technique in the management of mental health difficulties that both increased access to services and produced cost savings.
Teledermatology as a tool for communication between general practitioners and dermatologists
Authors: van den Akker Th W , Reker C H M , Knol A , Post J , Wilbrink J , van der Veen J P W
Published: October 2002

A feasibility study of teledermatology was undertaken in Groningen. Six general practitioners (GPs) sent digital images by email, along with relevant patient information, to dermatologists at the Martini Ziekenhuis Groningen, a general non-academic hospital. The dermatologists returned their responses by email. A total of 89 cases were dealt with in this way. On average, the GPs took three photographs per patient. The time taken by the GP to produce and transmit the images, and to implement the telemedicine advice received from the dermatologist, was 9 min and 3 min, respectively. The time spent on diagnosis, provision of advice and response by email amounted to 10 min for the dermatologist. It was concluded that teleconsultations by email are feasible in the daily practice of GPs and dermatologists in a general non-academic hospital. Generally, GPs, dermatologists and patients were satisfied with teleconsultations. Furthermore, GPs reported that 63% of the teleconsultations were of educational value.
Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics
Authors: Harno Kari , Arajärvi Eero , Paavola Teemu , Carlson Christer , Viikinkoski Pertti
Published: October 2002

The clinical effectiveness and costs of videoconferencing in orthopaedics between primary and secondary care were examined in an eight-month prospective, comparative study. The general surgery outpatient clinics of two Finnish district hospitals were compared: Peijas Hospital, with telemedicine, and Hyvinkää Hospital, without it. The three study primary-care centres referred a total of 419 adult patients to the outpatient clinics. The population-based number of referrals to Peijas Hospital was similar to that to Hyvinkää Hospital after adjusting for the proportion of older people living in the Hyvinkää Hospital municipalities. Of the 225 patients referred to Peijas Hospital, 168 (75%) were given appointments at the outpatient clinic of surgery and the rest of the referred patients received a teleconsultation. All patients referred to Hyvinkää Hospital were given appointments at the outpatient clinic. The direct costs of an outpatient visit were 45% greater per patient than for a teleconsultation, with a marginal cost decrease of EU48 for every new teleconsultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU2500 in favour of teleconsultations. The use of videoconferencing between primary and secondary care was modest in orthopaedics, although the use of this telemedicine method was shown to reduce direct costs and be cost-effective.
Telepathology
Authors: Faoagali Joan , Coles Wendy , Price Lee , Siebert David
Published: October 2002

The development of a Queensland-wide videoconferencing network provided an opportunity to develop telepathology. In 1999, weekly videoconferences began with remote laboratories and clinical staff in four peripheral hospitals and the Royal Brisbane Hospital and in 2000 biweekly videoconference pathology grand rounds started across Queensland with up to six sites, from Cairns to the Gold Coast, joining in or presenting. The average number of sites connected was 3.0 in 1998, 3.5 in 1999, 4.4 in 2000 and 4.5 in 2001. Problems included the complexity of the system, timing and need for bookings, coordination of presenters and presentations, and the time needed to organize sessions, set up linkages, advertise sessions and attend the telepathology conference. Successful meetings have been associated with well prepared cases, time for discussion, attendance by all sites, timeliness of cases and responses, and the presence of experts to respond to questions, as well as effective linkages and trouble-free hardware. Future needs include better infrastructure and trained staff to coordinate the linkages and presentations. Telepathology has an important part to play in the provision of cost-effective medical care in Queensland.
Telemedicine services for two islands in the Bay of Naples
Authors: Bracale Marcello , Cesarelli Mario , Bifulco Paolo
Published: October 2002

In July 1997, telemedicine services were established for two islands, Procida and Ischia, in the Bay of Naples. The telemedicine network allowed a 24 h consultation service to be provided between the islands' health centres and mainland hospitals in the towns of Pozzuoli and Giugliano. Realtime videoconferencing was used, over an ISDN link at 384 kbit/s; radiographs were digitized using a scanner. During 1999 and 2000, there was an average of 46 telemedicine consultations per year from Procida (60% radiology, 30% cardiology, 10% other), 35% of which were emergencies, and 16 training sessions per year; there was an average of 28 telemedicine consultations per year from Ischia (80% radiology, 10% cardiology, 10% other), 10% of which were emergencies, and 12 training sessions per year. The average duration of a telemedicine consultation was 15 min. The total fixed cost of the telemedicine system between the two islands and the two mainland hospitals was approximately €48,000 per year. The total variable costs of the telemedicine service at the observed workload were about €750 per year. The total savings due to telemedicine were approximately €40,000 per year. There was therefore little difference in the overall costs of health-care delivery. The positive consequences of the introduction of the telemedicine service included more rapid diagnosis and treatment, improved quality of service, and the transfer of skills and education. A costs-consequences analysis suggested that the telemedicine service was worthwhile.
The Italian national telemedicine programme
Authors: Ricci Fabrizio L
Published: October 2002

The Italian national telemedicine programme included a broad range of research projects, but they all served the common purpose of bringing about improvements in health-care management and performance. The programme consisted of seven projects, each of which had specific research and training objectives, and a three-year duration. The systems developed in the course of the programme were not experimental prototypes: they were intended to be pre-commercial systems. The functional and clinical merits of the products and systems developed were evaluated, and their costs and benefits measured with reference to those already in use. The seven projects were completed in 1999. The Italian Ministry of Universities, Research and Technology granted research funds totalling €50,000,000 for the whole programme. While the results of the research were promising, successful projects alone are not sufficient to reduce costs in health-care. Indeed, far more money can be saved simply by encouraging the uptake on a larger scale of many technologies and practices that already exist.
A systematic review of the efficacy of telemedicine for making diagnostic and management decisions
Authors: Hersh William , Helfand Mark , Wallace James , Kraemer Dale , Patterson Patricia , Shapiro Susan , Greenlick Merwyn
Published: October 2002

We conducted a systematic review of the literature to evaluate the efficacy of telemedicine for making diagnostic and management decisions in three classes of application: office/hospital-based, store-and-forward, and home-based telemedicine. We searched the MEDLINE, EMBASE, CINAHL and HealthSTAR databases and printed resources, and interviewed investigators in the field. We excluded studies where the service did not historically require face-to-face encounters (e.g. radiology or pathology diagnosis). A total of 58 articles met the inclusion criteria. The articles were summarized and graded for the quality and direction of the evidence. There were very few high-quality studies. The strongest evidence for the efficacy of telemedicine for diagnostic and management decisions came from the specialties of psychiatry and dermatology. There was also reasonable evidence that general medical history and physical examinations performed via telemedicine had relatively good sensitivity and specificity. Other specialties in which some evidence for efficacy existed were cardiology and certain areas of ophthalmology. Despite the widespread use of telemedicine in most major medical specialties, there is strong evidence in only a few of them that the diagnostic and management decisions provided by telemedicine are comparable to face-to-face care.
Telecardiology: supporting the decision making process in general practice
Authors: Shanit D , Cheng A , Greenbaum R A
Published: October 2002

To assess the initial phase of a telecardiology diagnostic service for general practitioners GPs , we provided 93 GPs in 26 health centres with direct telephone access to a cardiologist, and equipped them with hand-held, automatic standard 12-lead electrocardiogram ECG transmitters for on-line cardiac consultations and ECG interpretation in their daily practice. Clinical details, reason for consultation and the ECG signal were transmitted from the GPs' practices or the patients' homes. A consultation followed and a full report, including ECG print-out, was then sent to the GP. During an 18-month study period, 2563 consultations were carried out. The system allowed the identification of 479 patients 19 with urgent cardiac problems and the remaining 2084 81 in whom admission or outpatient investigation was unnecessary. Following the study, we distributed a questionnaire asking the GPs to rate the quality, define the use and consider the benefit of the service to their daily practice. We conclude that a telecardiology diagnosis and ECG interpretation service is simple, reliable and efficacious in routine primary care. It offers instant access to cardiac assessment and supports the decision-making process of GPs. A preliminary cost comparison with a conventional referral indicated that a teleconsultation was substantially cheaper. We expect that the future incorporation of teleechocardiography would expand the scope of telecardiology even further and allow comprehensive cardiology consultations.
Diagnosis of neonatal congenital heart defects by remote consultation using a low-cost telemedicine link
Authors: Casey F , Brown D , Craig B G , Rogers J , Mulholland H C
Published: October 2002

To determine whether telemedicine could assist in the earlier diagnosis of neonates with congenital heart disease (CHD) in an area hospital remote from a paediatric cardiologist, we established a low-cost telemedicine link between the neonatal unit of a district general hospital and the regional paediatric cardiology unit. Realtime ultrasound images of babies suspected of having CHD were obtained by a paediatrician and transmitted for realtime interpretation by a paediatric cardiologist. In a four-month pilot study, 10 neonates were studied in this way. In eight of the ten cases, the diagnosis made over the telemedicine link was confirmed subsequently in a direct examination at the regional unit. In one case the patient died before the direct examination was possible. In one case two small muscular ventricular septal defects were missed on the remote examination. Our early experience suggests that, with realtime guidance by a paediatric cardiologist, transmitted images of sufficient quality to allow confirmation or exclusion of major cardiac defects can be obtained. This form of remote consultation should improve morbidity and mortality rates by reducing the waiting time for specialist diagnosis and treatment.
Telemedicine demonstration projects in the Western Pacific
Authors: Malani Joji , Dever Gregory J
Published: October 2002

Telemedicine demonstration projects in the Western Pacific are attempting to provide distance medical consulting and distance medical education for the isolated health-care workforce of the region. The Picasso Phone system is a low-cost telemedicine system which requires only the standard telephone network for its operation, needs little additional equipment and is user-friendly. The demonstration projects have shown the utility of the system in both international, inter-island and on-island communications. All demonstration activities used the various existing island telephone systems. With the adaptation of such a user-friendly telemedicine systemas the Picasso Phone system to the Peacesat public-interest education al network, the capacity of the telemedicine network will expand to include isolated islands with Peacesat capacity which do not have access to the commercial island telephone systems.
Comprehensive standardized ophthalmic telemedicine
Authors: Papakostopoulos D , Everingham M , Gogolitsyn Y , Dodson K , Papakostopoulos S , Dean-Hart J C
Published: October 2002

The Electrodiagnostic Neurophysiological Automated Analysis (ENAA) telematic system was developed in the EU EUREKA project. To validate the system 2500 electrodiagnostic tests were administered in a standardized manner during a three-year period. The tests were performed on 70 normal subjects and 500 patients in five laboratories in three European countries. The data were transmitted to the Bristol Telematic Electrodiagnostic Centre in the Bristol Eye Hospital. Data from normal subjects were not significantly different between laboratories. Data from patients were reported upon and the conclusions transmitted to the place of origin. The system provided the remote consultant with multimedia data, including medical images such as colour fundus photography and angiography, video and sound.
Telemedicine delivery to developing countries
Authors: Wright David
Published: October 2002

This paper highlights current activities with regard to telemedicine activities in and for developing countries. The paper reviews: the preparation of a telemedicine report by a study group of the International Telecommunication Union (ITU), the aim of which is to provide recommendations and guidelines for developing countries; the formation of the European Telemedicine Collaboration Group (ETCG), which is undertaking telemedicine pilot projects in developing countries; and telemedicine delivery via Inmarsat, which is coordinating production of the ITU report and is a participant in the ETCG.
A telemedical record model
Authors: Huston Janis L
Published: October 2002

Medical record issues appear to be the weak link in telemedicine. A telemedical record model is proposed which would fit both a managed-care and fee-for-service health-care environment. In this model, the originator of the teleconsultation referral is the party responsible for creation of the record, since that is the initial point of patient contact. The telemedical record model prevents duplication of information gathering and provides a consistent way to document teleconsultations. Telemedical record policies and procedures should be in place before starting a telemedicine programme, to ensure consistency in the documentation of doctor–patient encounters.
A referrer and patient evaluation of a telepsychiatry consultation–liaison service in South Australia
Authors: Clarke P H J
Published: October 2002

A study was carried out to describe the patient population assessed by a telepsychiatry consultation-liaison service in rural South Australia, and to assess the referrers’ and patients’ satisfaction rating with this service. The study was performed in two parts, with retrospective and prospective components. The author completed a semi-structured interview for each patient (n=75) with a Brief Psychiatric Rating Scale (BPRS) for the prospective group (n=32). A questionnaire was also sent to all referrers seeking an evaluation of the usefulness of the telepsychiatry interview in terms of assessment and management recommendations and outcome. Patients from the prospective group were sent a questionnaire examining their evaluation of the usefulness of the interview in terms of assessment and management recommendations, and difficulties with the technology. The patient population was characterized by high rates of affective disorder and personality disorder, and high indices of developmental disturbance. Referrers reported high rates of satisfaction with the service. Nursing staff rated the service more positively than general practitioners. The usefulness for assessment was rated more highly than for management.
Expert pathology consultation through the Internet: Melanoma versus benign melanocytic tumours
Authors: Mea V Della , Puglisi F , Forti S , Delendi M , Boi S , Mauri F , Palma P Dalla , Beltrami C A
Published: October 2002

Twenty consecutive cases of melanocytic lesions were chosen from the archives of the Institute of Anatomic Pathology at Santa Chiara Hospital, Trento. Representative images were acquired at a spatial resolution of 512×512 pixels, saved in JPEG format and delivered to the remote pathologist by multimedia Internet electronic mail. Six cases were diagnosed as benign melanocytic lesions by the local pathologist. Of the 20 cases transmitted, each with an average of 5.3 images, the remote pathologist suggested a diagnosis of malignancy in nine cases while 10 cases were thought to be benign. In one case the images were not considered sufficient for diagnosis. Overall, the diagnostic agreement between local and remote pathologist was 79%(κ=0.58, P=0.002). This preliminary study suggest that telepathology by Internet electronic mail can be a valuable tool for remote consultation in dermatopathology, as well as for other diagnostic fields where expert consultation is necessary.
The legal situation of telemedicine in Austria
Authors: Mairinger T , Netzer T , Gschwendtner A , Markl Ch
Published: October 2002

Searches were conducted of two legal databases dealing with civil law in Austria. The searches produced 12 references relevant to telemedicine, which were obtained from a university legal library. From the literature, it can be concluded that Austrian civil regulations are sufficient to clarify the questions of liability arising in connection with the practice of telemedicine. Although no specific legislation has been enacted as yet, we would not expect such legislation to produce different results in the legal assessment of the case patterns discussed in this paper.
A protocol for telemedical consultation
Authors: Tachakra S , Sivakumar A , Hayes J , Dawood M
Published: October 2002

We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384kbit s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 . The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.
What do students think about telemedicine?
Authors: Gschwendtner A , Netzer T , Mairinger B , Mairinger T
Published: October 2002

A questionnaire was distributed to 300 medical students attending a conference in 1996. The return rate was 32 . The majority of students believed that telemedicine will become very important in future. About a quarter of students had had practical experience of telemedicine in a hospital. More than 75 of the respondents said that they would attend telemedicine lectures if they were offered by their university. There were no major concerns among medical students about telematics and its applications in medicine. There was a clear need for more information, which suggests that universities should offer special lectures and practical courses in telemedicine. The interest of students in tele-learning was very high. This interest would justify more attempts to introduce tele-learning by the universities.
A pilot study of tele-ophthalmology outreach services to primary care
Authors: Shanit Dan , Lifshitz Tova , Giladi Ran , Peterburg Yitzhak
Published: October 2002

We have begun a randomized study of tele-ophthalmology. General practitioners in two participating health centres in the Negev region of Israel, serving a local population of 40,000, were invited to participate. The study group consisted of 50 consecutive patients attending the general eye outpatient clinic and 50 consecutive patients suffering from various retinal diseases attending a hospital outpatient clinic. The initial assessment was carried out via the tele-ophthalmology system. There was then a face-to-face re-examination of the same patients, in randomized order, by the same ophthalmologist on the same day, at an outpatient ophthalmology clinic.
Broadband multimedia for education
Authors: Mackinnon Malcolm
Published: October 2002

Over the next five to ten years the accelerating development of computing and broadband networks will lead to a revolution in the ways in which healthcare is delivered. Patients will spend less time in the great institutions of the tertiary hospitals and the illnesses taking them there will assume a different pattern. The new information technologies will foster the emergence of general practices with a new emphasis on keeping patients in their communities for medical management. Knowledge exchange and delivery—to both patient and practitioner—will therefore become an increasingly important component of the health-care system in the next millennium.
Telemedicine applications in otolaryngology
Authors: Stern Jordan , Heneghan Conor , Sclafani Anthony P , Ginsburg Jeffrey , Sabini Paul , Dolitsky Jay N
Published: October 2002

A prospective study of the use of realtime and store-and-forward teleconsulting was carried out in patients who presented to the New York Eye and Ear Infirmary for otolaryngology care. Forty-five patients were seen in the study. There were no significant differences between local and remote otolaryngologists when interpreting the examinations, indicating that transmission did not affect the ability of a qualified physician to make an accurate diagnosis. In the store-and-forward examinations only 62% of the electronic records provided sufficient information for a confident diagnosis. Records were judged inadequate primarily due to poor selection, or an insufficient number of stored images. The study demonstrates that both interactive and store-and-forward techniques can be used to provide accurate clinical consultations in nasopharyngolaryngoscopic examinations. However, since store-and-forward consultations include less information and do not provide immediate feedback, a well defined clinical protocol for assembling the electronic consultation is needed.
Benefits of using telemedicine and first results in Bosnia and Herzegovina
Authors: Bilalović Nurija , Paties Carlo , Mason Andreas
Published: October 2002

In October 1996 the Institute of Pathology with the Radiology and Ophthalmology Clinic of the university hospital of Sarajevo joined the experimental telemedicine project SHARED. Two months after the project began, dermatology, paediatrics and haematology were also included. During the first phase we had 40 teleconsultations that showed us the benefits of using telemedicine. Our opinions and the opinions of the pathologist in Milan were similar for most of the biopsies (78%). The total time required for the consultation for the first 40 cases was 372 min, or 9.3 min each, on average. The longest consultation time was 25 min. The largest number of images was 44 per case, the smallest four. Because of problems of infrastructure and lack of experts, telemedicine will be important to a small country like Bosnia and Herzegovina.
The legal and ethical aspects of telemedicine. 4: Product liability and jurisdictional problems
Authors: Stanberry Ben
Published: October 2002

The use of telemedicine brings with it the risk that the human factor-the teleconsultant-will fail to reach the standard of care that the law requires of medical professionals. It also brings the risk that the telemedical equipment or system will fail at a crucial moment. Such risks, of course, are inherent in many aspects of medical care but in telemedicine, at the interface between communications technology and health care, one must consider not only who is liable for failure, but under which country's laws will that liability be determined. This final review article describes the challenges facing manufacturers and their customers in providing safe, properly endorsed telemedicine systems. The problem of which country's laws should apply to a cross-border teleconsultation is also reviewed.
Patient reactions to specialist telemedicine consultations-a sociological approach
Authors: Holtan Amy
Published: October 2002

A sociological study was made of patient experiences of telemedical specialist consultations in northern Norway. The study made use of a qualitative methodological approach. The data were collected through unstructured in-depth interviews of patients or the parents of very young patients. The patients were referred for a telemedical otolaryngology consultation in a randomly selected period of three months. Of a total of 35 patients, 15 refused to participate in the study. Of the 20 remaining, three were excluded for practical and financial reasons. The telemedicine consultation consisted of a general practitioner examining patients endoscopically and realtime transmission of the examination to a specialist by means of a videoconferencing system. Video-communication seemed to restrict personal contact with the specialist. In spite of that, it was not the video-communication itself but the social situation that mattered to the patients. Compared with an ordinary medical consultation, a telemedical consultation represented a wider interaction system, with more channels for access, inspection and information, which gave the patients different options for participation in the consultation.
Home telecare
Authors: Ruggiero C , Sacile R , Giacomini M
Published: October 2002

Technology can be used to help the care of people at home in many ways and home health care is one of the fastest growing areas of health-care provision. Home-based technology has two main facets: passive monitoring and active measurement. Technical solutions must be acceptable to both the health-care staff and the assisted person, and should supplement not replace human carers. Other important aspects of technical solutions are: simplicity of operation and management, availability, reliability and affordability. The introduction of a home telecare system always requires changes in organization, since it is not enough simply to transmit data. The data must be received and interpreted, and advice for care must be provided. The most important aspects of home telecare are: organization and training; improving the quality of care; improving the quality of life; economy; and technology.
The basic diagnostic approaches used in robotic still-image telepathology
Authors: Tsuchihashi Y , Mazaki T , Nakasato K , Morishima M , Nagata H , Tofukuji I , Shirakata H , Naito K , Akasaka Y
Published: October 2002

We investigated the basic diagnostic processes used in telepathology with our robotic still-image system, OLMICOS, by analysing the steps and patterns used in 20 consecutive tissue section diagnoses. Three basic approaches were recognized. One was magnifying a suspect finding in a low-powered microscopic image. This approach was used mostly for confirming or characterizing a tumour. The second approach was scanning over a low-powered image by magnifying square images to form a mesh. This was found to be useful to confirm the presence or absence of signs and was mostly used as the initial step in judging the surgical margin of malignant cases or diagnosing lesions. The third approach was a combination of these two and was used for delineating the surgical margin, confirming the absence of metastases or diagnosing difficult lesions. Recognition of these three basic diagnostic approaches is important in making a rapid and correct remote diagnosis.
An evaluation of an Australian videoconferencing project for child and adolescent telepsychiatry
Authors: Gelber Harry , Alexander Max
Published: October 2002

A user satisfaction survey of videoconferencing services for child and adolescent mental health was carried out over a two-year period in Victoria, Australia. The aims of the survey were to evaluate key utilization areas, effect on professional practice, and advantages and disadvantages of the videoconferencing service. Eighty questionnaires were sent out and 58(73%) were returned. Consultations were reported as the most frequent use of videoconferencing equipment (62%), followed by clinical use (59%), supervision(36%), teaching(19%) and administration(14%). Fifty-seven percent of respondents reported that videoconferencing had affected professional practice. Advantages of the services included cost savings (52%) while disadvantages included technological problems (40%). The findings show the benefits of videoconferencing for improving the delivery of mental health care in rural Australia.
Internet electronic mail: a tool for low-cost telemedicine
Authors: Mea Vincenzo Della
Published: October 2002

Electronic mail, in addition to the sending of text messages, may be used to transfer multimedia and privacyenhanced messages. Email can be used for so-called store-and-forward telemedicine, which can be particularly useful for remote consultations. This paper reviews the standards used in Internet email, from communication protocols to the message formats, and pays special attention to multimedia and confidential messages; it then describes some email-based telemedicine applications. The problems of the Internet are principally the lack of any guarantee of quality of service and the low bandwidth; intranets can guarantee appropriate performance.