bluuebunny/crossref_metadata_2025 huggingface dataset:
A Well Woman Clinic in Bangalore: one strategy to attempt to decrease the transmission of HIV infection
Authors: Baksi C M , Harper I , Raj Margaret
Published: October 2002

Samraksha, a non governmental organization NGO in Bangalore, South India, was established in 1993 to take steps to control the spread of HIV infection. As a result of their interactions the Samraksha team recognized the urgent need for management of sexually transmitted diseases STDs as a crucial component of their work. Samraksha approached Action Health, a UK based charity, for assistance. This paper outlines the needs assessment and the process of setting up a Well Woman Clinic for commercial sex workers CSWs and other vulnerable groups in Bangalore. The pilot project has been running for over a year and has gained credibility both with vulnerable women and with professionals. Furthermore it has officially become a government resource centre for the training of doctors and health care staff in the management of STDs, and provides formal training sessions for the staff at each of the primary health care centres in Bangalore. Thus STD management is being integrated with the current primary health care provision for women throughout Bangalore. Factors influencing the successful development of such a service are considered.
HIV testing in Swedish STD clinics 1986-1994
Authors: Anagrius C , Ruden A K , Sandstrom E
Published: October 2002

In 1986 Swedish STD clinicians decided on a national policy of offering HIV tests routinely to all their patients. During the period July 1986 through December 1994, 224,722 tests were performed. HIV tests for one or more specific reasons were carried out on 7 of the patients, and 20 requested the test solely because of anxiety. The remaining 73 , accepted the test as part of the clinical routine without giving any specific reason. Of those offered a test, 54 had been tested at least once before. Twenty three per cent did not accept the test. Among those tested, 373 persons 0.2 were found to have a newly detected HIV infection. Contact tracing was the reason for testing in 11 , whilst 32 were tested for other specific reasons, 29 requested testing for no stated specific reason and 28 had been tested as a routine. Of all the tested men who reported sex with men, 7 proved to be HIV positive. The 373 persons with newly detected HIV infection constituted 14 of the total newly detected cases in Sweden during the period in question.
A Survey of Contact Tracing Practice for Sexually Transmitted Diseases in GUM Clinics in England and Wales
Authors: Stokes Tim , Schober Paul
Published: October 2002

We set out to determine current policy and practice in relation to contact tracing (partner notification) for sexually transmitted diseases (STDs) within genitourinary medicine (GUM) clinics in England and Wales.

A confidential postal questionnaire survey of all GUM clinics in England and Wales was undertaken. Completed questionnaires were returned by 105 GUM clinics (a response rate of 65%).

All respondents undertook routine contact tracing for gonorrhoea and chlamydia. The most popular method of contact tracing used was patient referral. The majority of contact tracing was undertaken by health advisers. Information on the time period over which contact tracing was undertaken showed wide variation. Audit data on the effectiveness of contact tracing in terms of the proportion of sexual contacts seen were available from only a minority of GUM clinics (33/79, 42%). Only chlamydia (24/79, 30%) and gonorrhoea (22/79, 28%) were the subject of any appreciable audit activity.

There is wide variation in contact tracing policy and practice in GUM clinics in England and Wales. Audit of contact tracing effectiveness appears to be a minority activity. Further research is needed before an evidence-based approach to contact tracing can be implemented.
Determinants of Survival in HIV-Positive Patients
Authors: Baillargeon Jacques , Borucki Mike , Black Sandra A , Dunn Kimberly
Published: October 2002

Variation in the clinical stage at which AIDS is diagnosed has hindered the ability of investigators to generate survival estimates which are stable across study cohorts. As a result, little is known about how clinical and sociodemographic factors are associated with survival, independent of AIDS diagnosis stage. By estimating survival following seroconversion while adjusting for baseline CD4 lymphocyte count, the present study generated survival determinants which were unconfounded by time-related changes in AIDS diagnosis. This study's findings indicate that the following factors were associated with significant decreases in HIV-related survival: older age; self-report of no known HIV transmission risk factors; and presence of cytomegalovirus, Mycobacterium avium complex, and Pneumocystis carinii pneumonia. Furthermore, survival decreased in a monotonic fashion with decreases in baseline CD4 count and with increases in calendar period. While this study's findings are consistent with previous investigators’ reports of AIDS survival determinants, it will be important for future investigators to refine and update estimates of HIV-related survival determinants as clinical care for HIV-infected patients continues to improve.
Chlamydia Trachomatis Infection in a Rural Population: The Importance of Screening Men
Authors: Michelson K N , Thomas J C , Boyd C , Janssens A H
Published: October 2002

This prospective observational cohort study describes the demographics, risk of re-infection, and geographical distribution of chlamydia infections in a rural North Carolina county. Data were collected between 1 November 1992 and 21 January 1994 from private physician reports and from screening patients at the county health department STD clinic. The overall chlamydia rate in the county was 563 cases per 100,000 person-years. Rates were highest among women, 15-19-year-olds and non-whites (662, 3982 and 1272 cases per 100,000 person-years, respectively). The 6-month cumulative incidence of re-infection was 10%. Geographic mapping of case rates showed contiguity among high-risk block groups. The rate in men, 449 cases per 100,000 person-years, was higher than expected. Issues concerning the development of screening programmes for men are discussed.
Risk of Cancer in Patients with HIV Disease
Authors: Petruckevitch Ann , Del Amo Julia , Phillips Andrew N , Stephenson Judith M , Johnson Anne M , De Cock Kevin M ,   London African HIV/AIDS Study Group, Theodore C , Evans B , Newell A , Barton S , Mabey D , Low N , Paine K , Pozniak A , Obasi A , Weller I , Hooi A , Medway J , Johnson M , Forster G E , Desmond N , Davidson F , Grifin G , Pym A , Weber J , Hanscheid T , Howitt D , Mortimer J , Nicoll A
Published: October 2002

The aim of this study was to compare cancer incidence in a cohort of HIV-infected patients with the incidence rates in the population of South East England.

Data collected for a retrospective cohort study of 2048 HIV-infected patients were analysed to examine the incidence of cancer. Cases of cancer occurring in South East England from 1985-1995 were obtained from the Thames Cancer Registry. Standardized incidence ratios were calculated by comparison of the observed number of cases for each cancer type in HIV-infected non-Africans with the numbers expected, calculated from the age and sex specific registration rates for the South East England population using person-years of observation. The crude incidence rates of cancer were calculated for HIV-infected Africans.

The incidence of non-AIDS defining cancers such as Hodgkin's disease (standardized incidence ratio 22; 95% CI: 3-80) and anal cancer (standardized incidence ratio 125; 95% CI: 3-697) were significantly increased for non-African males with HIV disease. Anal cancer was also significantly increased for non-African females (standardized incidence ratio 1667; 95% CI: 43-9287). Kaposi's sarcoma (KS) was the commonest cancer among HIV-infected Africans and males had an incidence which was nearly 3 times that of females.

There is evidence to suggest that the risks for other non-AIDS defining cancers were significantly increased in persons with HIV disease which may have implications for HIV/AIDS surveillance.
Antiretroviral Therapy in HIV Infection: Are we using Resources Appropriately and Cost Effectively?
Authors: Horn C K , Dodds R , Scott G R
Published: October 2002

The provision of antiretroviral therapy to HIV-positive patients attending the Department of Genitourinary Medicine at the Royal Infirmary of Edinburgh was assessed, to examine whether clinicians were offering treatment in line with the departmental protocol. A total of 195 patients attended in 1998, of whom 169 ful® lled the protocol criteria for treatment. Although only 115 of these were on therapy, no patient who fulfilled treatment criteria and wished to be treated was denied treatment. Of the 26 patients not fulfilling; lling any treatment criteria, 9 had transferred in from another unit already on treatment. The remaining 17 were not on treatment.
An Outreach Programme for Sexually Transmitted Infection Screening in Street Sex Workers using Self-Administered Samples
Authors: Morton A N , Wakefield T , Tabrizi S N , Garland S M , Fairley C K
Published: October 2002

Street sex workers represent an at-risk group of individuals who find it difficult to access mainstream health services. This was a cross-sectional study of street sex workers in Melbourne, Australia using a self-administered method to detect chlamydial, gonorrhoea and trichomonas infections. Of the 81 individuals approached, 63 (78%) (95% CI: 67–86%) agreed to participate. Overall, 87% of the participants obtained their results. Of the 63 participants, 53 (84%) had a past history of injecting drug use (95% CI: 73–92%), and 21 (33%) had a history of a sexually transmitted infection (STI) (95% CI: 22.0–46.3%). Neisseria gonorrhoeae was identified in 7 (11%) participants, Trichomonas vaginalis in 7 (11%), Chlamydia trachomatis in 1 (1.6%). None of the 19 (30%) participants who had been screened for an STI in the preceding 3 months were infected. Our results demonstrated that this method of testing for STIs was acceptable to the street sex workers, and demonstrated a disturbingly high proportion with infections.
Sexual Behaviour and Sexually Transmitted Infection among African and Caribbean Men in London
Authors: Evans B A , Bond R A , MacRae K D
Published: October 2002

We studied 180 black heterosexual men of whom 133 (74%) were Caribbean and 47 (26%) African. Seventy-three per cent of Caribbeans and 27% of Africans were UK born. We found no difference in age, but more Africans were married (30% cf 10%; P = 0.002) and students (26% cf 10%; P = 0.00008). More Caribbeans smoked 1–10 cigarettes a day (42% cf 22%; P=0.02) and more drank alcohol (89% cf 74%; P = 0.002). Sixty-nine per cent of Caribbeans reported intercourse before the age of 17 compared with 48% of Africans (P=0.004), but there was no difference in the numbers of sexual partners, either in the previous year or in total. Twenty-four (18%) of the 133 Caribbeans had gonorrhoea compared with one (2%) of the 47 Africans (P=0.001). Multivariate analysis showed that coitarche under 16 years of age (odds ratio (OR) 50) and gonococcal and/or chlamydial infection (OR 12.5) were independently associated with Caribbeans. Within this group, gonorrhoea was found more often in teenagers (OR 9.5) who had commenced intercourse before the age of 16 (OR 3.3) and chlamydial infection in those with multiple partners (OR 24). New problem-orientated approaches are needed to eradicate these curable infections which facilitate infection with HIV.
Increased Telomerase Activity and Decreased Telomere Length in Genital Condylomata Acuminata
Authors: Rahat Michal A , Lahat Nitza , Sharon Avishalom , Gazawi Haifa , Abramovici Haim , Bornstein Jacob
Published: October 2002

Our objective was to find a possible correlation between telomerase activity, mean telomere length and human papillomavirus (HPV) presence and type in genital condylomata acuminata.

Fifteen biopsies from women with genital condylomata acuminata and nine control tissue samples were tested for telomerase activity, mean telomere length, and HPV presence and type. All condylomata exhibited telomerase activity, compared to 78% of the control samples. The mean telomere length of condylomata was significantly (P < 0.002) shorter compared to telomere length in control tissue samples. All condylomata lesions were infected with HPV types 6/11, and more than half had additional infection with HPV 16/18. Mixed HPV 6/11 with 16/18 infection correlated with shorter telomeres than presence of HPV 6/11 alone in the lesions (4.68 ± 0.44 kb vs 4.97 ± 0.57 kb). None of the control tissue samples showed presence of HPV DNA.

Telomerase activity may be a marker of proliferation rather than malignancy, whereas the mean telomere length could better serve as a marker for the progression of HPV lesions toward malignancy.
Immunological Markers of Frequently Recurrent Genital Herpes Simplex Virus and Their Response to Hypnotherapy: A Pilot Study
Authors: Fox Paul A , Henderson Donald C , Barton Simon E , Champion Andrew J , Rollin Matthew S H , Catalan Jose , Mccormack Sheena M G , Gruzelier John
Published: October 2002

Patients were recruited for hypnotherapy from a clinic for patients with frequently recurrent genital herpes simplex virus (rgHSV). Psychological and immunological parameters were measured 6 weeks prior to hypnotherapy and 6 weeks afterwards, during which time each patient kept a diary of symptoms of rgHSV. Following hypnotherapy there was a significant overall reduction in the number of reported episodes of rgHSV, accompanied by an increase in the numbers of CD3 and CD8 lymphocytes, which may represent a non specific effect of hypnosis. The improvers showed significant rises in natural killer (NK) cell counts, HSV specific lymphokine activated killer (LAK) activity, and reduced levels of anxiety when compared to non-improvers. NK cell numbers and HSV specific LAK activity may therefore be important in the reduction in rgHSV following hypnotherapy.
The Cellular Immune System in Female Patients with or without Genital Warts: A Study of Peripheral White Blood Cell Components
Authors: Opaneye Abayomi A
Published: October 2002

The immune system plays a vital role in the fight against infections. The commonest viral infections treated in the genitourinary medicine (GUM) departments are genital warts. Knowledge about the status of the immune system in these patients may help in their clinical management.

This study compares the values of various blood cell components in the peripheral blood of 2 groups of female patients—those with genital warts against those without genital warts. The mean monocyte count was lower among patients with genital warts.
Condom Shape: A Neglected Factor Influencing use and Acceptability?
Authors: Garside Ruth ,   UK Family Planning Research Network, Barnett L , Bateman J , Booker D , Brown S , Cooling H , Cox M , Nash K , Oloto E , Richardson S , Saxty P , Taylor A , Tolcher R , Tupper C
Published: October 2002

Improving condom acceptability amongst users is one way to enhance efficacy. This study aimed to test whether or not the shape of a condom influenced users’ perceptions of condom acceptability as measured through their ratings of condom comfort, sensitivity and security. Four types of condoms were tested which had 3 different shapes, and one of which also had a small diameter.

Participants were recruited at 15 UK Family Planning Research Network Clinics and one Student Health Centre in England and Wales in late 1997. A total of 1193 people initially volunteered to take part and of these 204 men and 251 women completed the trial, giving an overall response rate of 38%.

Results suggest that both men and women were able to detect differences in the shapes of the condoms and that differences led to preference for a particular condom type. Similar proportions preferred a straight-sided, a flared and a contoured condom, whilst the smaller, contoured condom was preferred by a minority of respondents.

To optimize consistent condom use, providers should consider encouraging users to try a range of condoms to ensure that they are using the one most suitable for them.
Education attainment as a predictor of HIV risk in rural Uganda: results from a population-based study
Authors: Smith Jennifer , Nalagoda Fred , Wawer Maria J , Serwadda David , Sewankambo Nelson , Konde-Lule Joseph , Lutalo Tom , Li Chuanjun , Gray Ronald H
Published: October 2002

We examined the association between education and prevalent HIV-1 infection in the Rakai district, rural Uganda based on a cross-sectional analysis of a population-based cohort. In 1990, 1397 men and 1705 women aged 13 years and older, were enrolled in 31 randomly selected communities. Strata were comprised of main road trading centres, secondary road trading villages and rural villages. Sociodemographic and behavioural data were obtained by interview and serum for HIV serostatus were obtained in the home. The analysis examines the association between sex-specific prevalent HIV infection and educational attainment, categorized as secondary, primary or none. The odds ratios (ORs) and 95% confidence intervals (95% CIs) of HIV infection were estimated, using no education as the referent group. Higher levels of education were associated with a higher HIV seroprevalence in bivariate analyses (OR 2.7 for primary and 4.1 for secondary education, relative to no education). The strength of the association was diminished but remained statistically significant after multivariate adjustment for sociodemographic and behavioural variables (adjusted OR of HIV infection 1.6 (95% CI: 1.2-2.1)) for primary education and 1.5 (95% CI: 1.0-2.2) for secondary education. Stratified multivariate analyses by place of residence indicated that the association between education and HIV prevalence was statistically significant in the rural villages, but not in the main road trading centres and intermediate trading villages. Educational attainment is a significant predictor of HIV risk in rural Uganda, in part because of risk behaviours and other characteristics among better educated individuals. Preventive interventions need to focus on better educated adults and on school-aged populations.
HIV/AIDS in Bangladesh: a national surveillance
Authors: Islam Manirul , Mitra Amal K , Mian Anwarul Huq , Vermund Sten H
Published: October 2002

Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with sexually transmitted diseases (STDs), pregnant women at antenatal clinics, commercial sex workers (CSWs), patients with tuberculosis, long-distance truck drivers, sailors, and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. The prevalence rate was steady until 1994, and then increased rapidly. The rate among male heterosexuals was significantly higher than that in females (3.40 per 1000 versus 0.29 per 1000; odds ratio (OR) 11.60; 95% confidence intervals (CI) 6.45 to 21.16; P<0.0001). Twelve per cent of patients with STDs had HIV. The HIV cases concentrated in 2 districts, Sylhet (25/72) and Chittagong (20/72), that border India and Myanmar (formerly Burma), respectively. Frequent movement of people of Bangladesh to India, Pakistan, Myanmar and Thailand, where HIV rates are higher, is one of the possible sources of spread of the cases. Bangladesh has the potential to avert epidemic spread of HIV at its early stage.
A one-year survey of gonococcal infection seen in the genitourinary medicine department of a London district general hospital
Authors: Lewis D A , Bond M , Butt K D , Smith C P , Shafi M S , Murphy S M
Published: October 2002

The results of a one-year clinical, epidemiological and microbiological survey of gonococcal infection presenting to the Patrick Clements Clinic (PCC), a London district general hospital (DGH) genitourinary medicine (GUM) clinic, are presented. Clinical and epidemiological patient data were collected by a combination of questionnaire and retrospective case-note review. Microscopy performance within the PCC, outcome of treatment, return for tests of cure and efficacy of contact tracing were assessed. Isolates were tested for susceptibility to penicillin, tetracycline and ciprofloxacin. The study showed the PCC continues to diagnose and treat over 200 cases of gonorrhoea per year. High level resistance to penicillin, tetracycline and ciprofloxacin was documented among the year's isolates and antibiotic resistance was linked to acquisition of gonorrhoea overseas. Despite interviewing 183 patients concerning health advice and contact tracing issues, only 55% of new episodes re-attended for a first test of cure. In addition, only 29% of reported sexual contacts attended GUM clinics for investigation and treatment.
What is the potential for formal patient registration in Canadian primary care? The scale of informal registration' in Manitoba
Authors: Menec Verena , Black Charlyn , Roos Noralou , Bogdanovic Bogdan
Published: October 2002

Objectives: Registration of patients with a physician is increasingly being considered across Canada as part of a reform of the primary health care system. This study aims to determine how much 'informal registration' currently exists; that is, to identify the number/proportion of patients who, given existing utilization patterns, already receive the majority of their care from one practice, in order to assess the potential for formal registration.

Methods: Administrative data were used to classify patients ( n = 528 905) as being informally registered with a clinic if they received the majority of their care (75% or more of their total ambulatory visits) from the same practice over a three-year period (1994-1996). The proportion and number of informally registered patients were examined.

Results: Substantial variability emerged across practices in the proportion of informally registered patients (15-68%) and the number of informally registered patients per physician (544-1378 patients per full-time equivalent physician). Informal registration was higher among rural practices (60%) than among urban practices (38%).

Conclusions: While formal registration of patients with physicians is increasingly being considered in Canada as a means to improve the primary care system, the potential disruption to both patients and physicians in moving towards registration should not be underestimated. The relatively low levels of existing informal registration suggest a need to enhance access by, for example, providing after-hours services.
Identifying barriers to the use of research faced by public health physicians in Norway and developing an intervention to reduce them
Authors: Forsetlund Louise , Bjørndal Arild
Published: October 2002

Objectives: To explore why public health physicians seldom use research-based information and to develop an intervention to remedy this on the basis of this study, other research literature and suitable theories of information-seeking and professional behaviour change.

Methods: A qualitative study was conducted using focus groups, observation of individuals and interviews. The setting was Norwegian public health practice; 52 public health physicians from all over Norway participated in the study.

Results: We identified several barriers to the use of scientific literature that could be categorised as: psychological variables; environmental variables; and source characteristics. We developed an intervention that attempts to address these barriers, informed by previous research on the effectiveness of interventions to change professional practice and incorporating elements from social cognitive theories and the theory of innovation diffusion.

Conclusions: The Norwegian public health physician works in an isolated environment which does not facilitate searching or obtaining scientific information, which does not ask for this information and far less encourages its use as a basis for decision-making. An intervention tailored to reduce some of the barriers to research use may lead to more frequent and extensive use of such information in public health decision-making.
Evaluation of explicit prioritisation for elective surgery: A prospective study
Authors: Derrett Sarah , Paul Charlotte , Herbison Peter , Williams Helen
Published: October 2002

Objectives

To evaluate whether the Clinical Priority Assessment Criteria (CPAC), used to prioritise access to elective surgery, was associated with: (a) patients’ access to surgery in practice; (b) patients’ level of need; and (c) patients’ ability to benefit from surgery. Patients’ perceptions of the ‘booking system’ for surgery were also explored.

Methods

Prospective cohort study in New Zealand. Consecutive patients assessed for cataract (n= 101), prostate (n=103) or hip or knee joint replacement (n=137) surgery were interviewed close to the time of their CPAC prioritisation, and then six and 12 months later.

Results

CPAC scores were associated with access to surgery. There were weak-to-moderate correlations between CPAC scores and disease-specific health status before surgery (need) but almost no correlations with improvement in health status following surgery (ability to benefit). Change in health status was highly correlated with pre-surgery health status. Many patients supported prioritisation according to need, although the impersonal nature of the scoring system and the changing thresholds for surgery distressed some.

Conclusions

While prioritisation systems for surgery have potential value the CPAC criteria investigated need modification. Ability to benefit should receive increased weight. The impact of an explicit prioritisation system upon the doctor-patient relationship needs to be explored as there is some evidence that it may impede the discussion of the risks and benefits of surgery, and of the treatment preferences of patients.
International transmission of tele-ophthalmology images
Authors: Yogesan K , Constable I J , Morgan W , Soebadi D Y
Published: October 2002

Tele-ophthalmic consultations were conducted between a hospital in East Java, Indonesia, and an ophthalmology centre in Perth, Western Australia. Twenty-two eyes of 14 subjects were screened for glaucoma using a hand-held fundus camera. Optic disc images comprised 267 x 234 pixels at 24 bit/pixel (187 kByte). The images were compressed and stored together with patient information on a laptop computer. The images were then transmitted to Perth using either a mobile phone or a satellite phone, taking 170 s or 240 s, respectively. Images were also compressed to five different compression levels before transmission. At a compression ratio of 1 : 5, the images were 36 kByte in size and took 29 s to transmit by mobile phone and 60 s by satellite phone. To measure the loss of quality, the root mean square error was calculated for each colour component, comparing the transmitted and original images. The coefficients of variation were 10% (green), 15% (blue) and 22% (red). The images received in Perth were considered to be of excellent quality and readily interpreted by ophthalmologists in terms of the likely presence of glaucoma.
Evaluating telemedicine for minor injuries units
Authors: Beach Marie , Goodall Ian , Miller Paul
Published: October 2002

Low-cost telemedicine equipment consisting of ISDN videoconferencing units and a store-and-forward system was installed in two minor injuries units (MIUs) and a hospital accident and emergency department in Lincolnshire. Over six months, 45 patients were treated using telemedicine in one MIU and 26 in another. Anecdotally, there were no reported radiograph discrepancies or missed diagnoses. Data collected during teleconsultations by both referring and consulting clinicians suggested that in some cases teleconsultation had helped to avoid transfer or onward referral. There were some changes in diagnosis and treatment after using telemedicine, indicating some decision-making value for the remote practitioners. In the context of minor injuries telemedicine, videoconferencing in realtime may prove to be more valuable than store-and-forward interactions. A cost–benefit analysis is being conducted using a pragmatic prospective case-control study.
The need to ensure that the globalization of information and telematics does not destabilize health-care worldwide
Authors: Rigby Michael , Birch Katherine , Roberts Ruth
Published: October 2002

Modern telecommunication transcends institutional, organizational and cultural boundaries. In the context of health-care, this means that information, enquiries, demands and service provision can be routed anywhere, free of institutional or national control. The Internet makes information available to anyone regardless of its quality, source or intention. Organizationally initiated applications such as telemedicine are usually intended to reinforce local systems, but their very design and intention indicate a potential rapidly to transcend inherited but electronically ineffectual boundaries. The consequences of such uncontrolled globalization of health-care activities will range from beneficial empowerment and quality improvement, to detrimental effects such as overloading of experts, and undermining of stable health-care systems. The major unplanned societal re-engineering effects in a paper-based culture are likely to be significant and global institutions need to respond by creating positive global frameworks and policies.
Partnering through telemedicine to improve the quality of health-care
Authors: Kennedy Richard H
Published: October 2002

In order to assist health-care reform in eastern Slovakia, a partnership was established with health-care institutions in Rhode Island. The aim of the partnership was to improve maternal and child health in Slovakia. Thirty-seven telemedicine sessions were conducted via a satellite link. A number of workshops, case studies, demonstrations and interactive discussions took place between various healthcare professionals. The use of telemedicine accelerated the adoption of new procedures in Slovakia.
A cost–benefit analysis of the effect of shipboard telemedicine in a selected oceanic region
Authors: Patel Toral
Published: October 2002

Data from a selected oceanic region, the UK search and rescue region, were used to establish the average annual number of ship diversions and emergency service call-outs arising from urgent medical problems of passengers or crew. During the period 1997–8 there were 228 medical evacuations. An attempt was made to estimate the extent to which some or all of the diversions and call-outs could have been averted if telemedical facilities had been available on-board the ships. The analysis showed that telemedicine would be an expensive alternative to existing evacuation methods, but did not allow for the fact that helicopter and lifeboat evacuations cannot be carried out in bad weather or at distances over 200 nautical miles (370 km) from land. Taking into consideration the cost of ship diversions in such circumstances produces completely different results. Telemedicine could clearly provide substantial cost-savings for the shipping industry, and a separate analysis focused on the shipowner alone would make an overwhelming economic argument for investment in a telemedicine service simply on the strength of diversion avoidance.
An occupational therapy Internet school
Authors: Six smith Andrew , Beer Martin , Green Sharon
Published: October 2002

Four centres in the UK, Belgium, the Netherlands and Sweden have collaborated to provide Internet-based courses for student and professional occupational therapists. The basis of the Occupational Therapy Internet School (OTIS) is the concept of the ‘virtual college’. This comprises the design and implementation of a sophisticated Internet-based system through which courses can be managed, prepared and delivered on line, and through which students can communicate both with the staff and their peers. The aim is to support and facilitate the whole range of educational activities within a remote electronic environment.
The cost-effectiveness of teleradiology at the Women's and Children's Hospital in Adelaide
Authors: Hayward Tina , Mitchell John
Published: October 2002

The cost-effectiveness of teleradiology was examined in a trial conducted at the Women's and Children's Hospital (WCH) in Adelaide, from February 1998 to February 1999. The trial showed that, with the large distances between remote hospitals and metropolitan hospitals, teleradiology, relative to the transfer of remote patients, could be highly cost-effective, but that a new form of cost justification is required for teleradiology for tertiary hospitals providing second opinions in special cases. A series of compelling case studies proved the economic and social value of teleradiology at the WCH.
An evaluation of an intelligent home monitoring system
Authors: Sixsmith A J
Published: October 2002

A trial was performed of an intelligent monitoring system which used sensors in the home to identify emergencies by detecting deviations from normal activity patterns. The field trial lasted three months. Twentytwo elderly people agreed to participate. Their ages ranged from early 60s to over 85, with two-thirds in the age range 75-84 years. They lived in four different localities within the UK-Ipswich, Northumberland, Merseyside and Nottingham. A total of 61 alerts was recorded, at a mean frequency about one alert per month per client. Of the 61 alerts generated, 46 were classified as false alerts and the other 15 as genuine, although no real emergencies occurred during the study. Many people in the field trial reported enhanced feelings of safety and security, which could help to stimulate independence and help them to remain living in their own homes. The monitoring system increased the care choices available to elderly people and supported and enhanced the carer's role.
Technical evaluation of a low-bandwidth, Internet-based system for teleconsultations
Authors: Lemaire E D , Boudrias Y , Greene G
Published: October 2002

A low-bandwidth telemedicine system was evaluated in eight community hospitals connected to a central hospital via the Internet. PCs were used with videoconferencing software and modem connections to the telephone network. The average data connection rates, still-image transfer times and live-video transmission rates were determined. The time to send 640x480, 320x240 and 160x120 pixel, 24-bit still images ranged from 29 s to 411 s. The average file transfer times for a 10 s MPEG video-clip was 8.6 min. The average live video frame rate was 1 frame/s (at the best image quality), with an average latency of 3 s. The results suggest that Internet-based videoconferencing is acceptable for certain telemedicine applications.
Complex systems in technology and policy: telemedicine and telecare in Japan
Authors: Fujimoto M , Miyazaki K , Von Tunzelmann N
Published: October 2002

We have examined aspects of the development of telemedicine and telecare in Japan. Despite Japan's reputation as an integrated and technocratic country, the diffusion of telemedicine has fallen below expectations, notwithstanding the urgent need to solve the problems of an ageing society. There has been a fragmentation of objectives and perspectives within the corporate (manufacturing) sector and within the policy sector of central and local government. There has also been a broader fragmentation between manufacturers, government and users (doctors and hospitals). As a result, the success or failure of individual projects appears to depend not on the quality of the technology, and often not on the evident importance of the social need, but on the overall coherence of a complex socio-technical system.
The Cave-let: A low-cost projective immersive display
Authors: Green Mark , White Lloyd
Published: October 2002

This paper describes the design and implementation of a low-cost projective immersive display (PID), called the Cave-let. A PID immerses the user in a computer-generated three-dimensional environment that responds to the user's movements. Current devices of this nature are very expensive, so that fewer than 100 units have been installed around the world. A low-cost PID will enable a wide range of applications in areas such as telehealth, visualization, education and collaborative systems. To produce a low-cost PID, we identified the components of the design that represented the major costs. These were then redesigned with the aim of reducing cost as much as possible while preserving most of the functionality. The resulting device is suitable for a wide range of applications and is an order of magnitude less expensive than similar devices.
Is telemedicine a subset of medical informatics?
Authors: Nagendran Shyamala , Moores David , Spooner Rick , Triscott Jean
Published: October 2002

Informatics has a key characteristic of a new discipline in a technically transient environment—there is no universal definition of it. This is not surprising, given its complex and diverse nature. In a broad sense informatics is the interface between developing technologies and the decision sciences, in particular clinical sciences. Telemedicine has no universally accepted definition either. Telemedicine requires the use of electronic communication networks for the transmission of information and data related to the diagnosis and treatment of, as well as education about, medical conditions. The debate ensues over whether it is or is not a subset of medical informatics. The care of the elderly diploma programme is a telemedicine project within the department of family medicine at the University of Alberta; it is a distance learning programme directed towards educating and training physicians in rural Alberta. This project provided us with the practical experience of addressing both informatics and telemedicine issues jointly.
The design and implementation of an off-the-shelf, standards-based tele-ultrasound system
Authors: O'neill Sean K , Allen David , Brockway Pam D
Published: October 2002

We developed an off-the-shelf system to transfer DICOM-compliant ultrasound images from a small rural hospital in northern Alberta to an urban radiology clinic in Calgary. The transfer time was less than 30 s per image. The radiologist could then review the case and release the patient. The radiologist could also switch to realtime videoconferencing mode and direct the rural ultrasound technician to obtain additional images of the patient.
The effect of transmission bandwidth on the quality of ophthalmological still and video images
Authors: Cuzzani Oscar , Bromwich Matthew , Penno Ellen , Gimbel Howard
Published: October 2002

We have examined the minimum realtime transmission speed for video-angiography with the Rodenstock scanning laser ophthalmoscope (SLO) with respect to spatial and contrast resolution. An SLO fluorescein video-angiography sequence was recorded using high-quality media and relayed to a remote site at transmission speeds ranging from T3 (4.5 Mbit/s) to 0.125 T (197 kbit/s). Images were compared with each other subjectively by an ophthalmologist and objectively with image processing software. When compared qualitatively there was little difference between the T3 andT1 images. The T1 images scored well on clarity and contrast, while 0.5 T was satisfactory but inferior to T1. Transmission speeds below 0.5 T were inadequate. The digital analysis showed a slight difference between T3 and T1. We calculated that there was up to a 92% loss of resolution at 0.25T and up to a 98% loss at 0.125 T. Based on our quantitative and qualitative analysis, a T3 line provided the highest bandwidth and best resolution, as expected. However, 0.5T gave satisfactory results for realtime consultations and appears to be the minimum speed required for ophthalmic purposes, producing few motion artefacts and good resolution.
Telemedicine in Armenia
Authors: Istepanian Robert S H , Nikogosian Haik
Published: October 2002

Telemedicine in Armenia began with the US Telemedicine Space Bridge programme, which was introduced following the disastrous earthquake in 1988. More recently educational programmes have been established between the School of Medicine at Boston University and the Emergency Hospital in Yerevan. There are also telemedicine activities involving the Internet, for example at the Diagnostica Medical Centre in Yerevan. The future integration of telemedicine and telehealth services within the health services in Armenia will produce significant benefits. Current telemedicine activities in Armenia represent models for collaborative projects in other former Soviet republics with the aim of providing greater access to health-care at higher quality and lower cost.
A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective
Authors: Loane M A , Bloomer S E , Corbett R , Eedy D J , Evans C , Hicks N , Jacklin P , Lotery H E , Mathews C , Paisley J , Reid P , Steele K , Wootton R
Published: October 2002

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral - 126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was 52.85 for those in urban areas and 59.93 per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was 47.13 for urban patients and 48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.
An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh
Authors: Vassallo D J , Hoque F , Farquharson Roberts M , Patterson V , Swinfen P , Swinfen R
Published: October 2002

In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.
What do radiographers think about teleradiology in Japan?
Authors: Ogasawara K , Endoh A , Sakurai T
Published: October 2002

In order to understand radiographers' views of teleradiology, we sent questionnaires to all radiographers in Hokkaido, Japan. Questions concerned the understanding of, interest in, need for and problems related to teleradiology. A total of 1275 radiographers responded to the survey (a response rate of 65%). Almost all had heard about teleradiology and about 60% of them were interested in it. However, fewer radiographers working in the central region than in other regions expected to be involved in teleradiology. If teleradiology were to be introduced, 60% of the respondents thought that it should be used for interpreting difficult cases and 30% for emergency cases. Half thought that the system should be managed and operated by the radiographer. Thirty-seven per cent of radiographers expected that there would be problems concerning the management of the system within one facility and between facilities, and 34% predicted problems with the installation costs.
A cost-minimization analysis of oncology home care versus hospital care
Authors: Serrate R Subirana , Ferrer-Roca O , González-Dávila E
Published: October 2002

We compared the costs of patient care for two groups of 10 oncology patients. The test group was treated at home and had access to 24 h telephone support, and the control group was treated in hospital, either as inpatients or as outpatients. Direct variable costs were provided by health insurance companies. The time invested by the health-care staff was recorded. The amount of time devoted to patients was more uniform in hospital than in the patients' homes, which suggests that patients at home received a less generic, more specific form of care. The nurses spent four times as long caring for home care patients as for hospital patients. The total cost of home care was 64% of that of hospital care, although this difference was not significant. The mean daily costs were three times lower at home than in hospital. All direct costs, except laboratory tests, were lower at home. Pharmaceutical costs were six times lower at home. Telephone support for home oncology care was cost saving and avoided 27 nursing home visits, which represented 35 working hours and Pta270,000 in savings to the health insurance companies.
Mental health telemedicine programmes in Australia
Authors: Lessing Kate , Blignault Ilse
Published: October 2002

A national survey of mental health telemedicine programmes was conducted and data collected on their catchment areas, organizational structure, equipment, clinical and non-clinical activity, and use by populations who traditionally have been poorly served by mental health services in Australia. Of 25 programmes surveyed, information was obtained for 23. Sixteen programmes had dealt with a total of 526 clients during the preceding three months. Of these, 397 (75%) were resident in rural or remote locations at the time of consultation. Thirty-seven (7%) were Aboriginals or Torres Strait Islanders. Only 19 (4%) were migrants from non-English-speaking backgrounds. The programmes provided both direct clinical and secondary support services. Overall, the number of videoconferencing sessions devoted to clinical activity was low, the average being 123 sessions of direct clinical care per programme per year. Videoconferencing was also used for professional education, peer support, professional supervision, administration and linking families. The results of the study suggest that telehealth can increase access to mental health services for people in rural and remote areas, particularly those who have hitherto been poorly served by mental health services in Australia.