bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic immunosuppression by HIV infection influences HPV transcription and thus local immune responses in condyloma acuminatum
Authors: Arany I , Tyring S K
Published: October 2002

Summary: Human immunodeficiency virus (HIV) infection is considered to influence the pathogenesis of human papillomavirus (HPV)-associated diseases. It is not clear whether this occurs directly through molecular interactions between viral genes and/or indirectly through effects on the immune functions. In the present study we compared molecular characteristics of penile condylomas from immunocompetent and HIV-positive individuals. Using polymerase chain reaction (PCR) and reverse transcriptase (RT)-PCR techniques we determined some characteristics of local immune responses and transcriptional activity of both viruses. Our findings revealed that HIV-seropositivity was accompanied by multiple HPV infection and a CD4-count-dependent appearance of oncogenic HPV-types. HIV infection also changed the patterns of HPV transcription favouring transcription of early genes such as E7. Apparently, HIV infection influences local immunity by altering HPV transcription and by systemic immunodeficiency.
Acceptability of female condom use among women exchanging street sex in New York City
Authors: Witte Susan S , El-Bassel Nabila , Wada Takeshi , Gray Omi , Wallace Joyce
Published: October 2002

Greater access to alternative female-initiated barrier methods, such as the female condom, is needed among women exchanging street sex. This study describes knowledge of and experience with the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV/ STD prevention among this population. Female condom use among this sample of sex workers was found to be related to having a regular sexual partner, living with someone who is a drug or alcohol abuser, not being homeless, using alcohol or intravenous heroin, having heard of the device, and having discussed the device with other women or with a regular sexual partner. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.
Brief behavioural skills building intervention for female controlled methods of STD-HIV prevention: outcomes of a randomized clinical field trial
Authors: Kalichman Seth C , Williams Ernestine , Nachimson Dena
Published: October 2002

The need for female controlled methods for preventing HIV infection is well recognized and women have been found to accept the female condom for these purposes. Women (n=105) were randomly assigned to receive either (a) a 3-h behavioural skills building intervention that concentrated on educating women about the female condom, motivating female condom use, and building behavioural skills relevant to using the female condom, or (b) a time-matched broadly defined women's health education intervention. Women who received the female controlled skills building intervention used the female condom to a greater extent than did women in the health education condition. Importantly, the effects of the behavioural skills intervention were most pronounced for women who reported only one male sex partner in the previous 6 months compared to women with multiple sex partners. However, female condom use was modest, with only one in 5 vaginal intercourse acts being protected by female condoms among women with one partner who received skills training. Interventions are needed to further enhance use of the female condom and new female controlled methods are needed for the majority of women at risk who did not adopt the female condom.
Factors Affecting Men's Liking of Condoms they have Used
Authors: Smith Anthony M A , Jolley Damien , Hocking Jane , Benton Kim , Gerofi John
Published: October 2002

The objective of this study was to assess the impact on men's liking for the condoms they use of a range of factors including demographic variables and variables that describe men's experience of using particular condoms. One hundred and ninety-four men used 3765 condoms for which they provided a liking rating. The condoms were manufactured to one of 2 published standards and the study employed a double-blind crossover design. Sixty-one per cent of condoms were rated favourably, 31% were rated neutrally and the remainder (8%) unfavourably. Men rated condoms less favourably if they were experienced as too loose, too tight, too short, if difficulty was experienced applying the condom, if the condom slipped partially or completely down the penis or if the condom broke. Men rated more highly condoms which were experienced as well lubricated throughout use. Men with larger penises rated condoms less favourably and, of all the variables considered, ejaculating in the condom was the variable which had the largest positive impact. Men's liking for the condoms they use is influenced by a range of factors. However, given that most of the factors associated with men liking condoms less are those that can be addressed through better condom design and manufacture, the opportunity exists to enhance men's experience of condom use and hence help reduce resistance to the adoption of consistent condom use.
Neisseria Gonorrhoeae in Newcastle upon Tyne 1995-1997: Increase in Ciprofloxacin Resistance
Authors: Tayal S C , Sankar K N , Pattman R S , Watson P G , Galloway A
Published: October 2002

Fluoroquinolones and third generation cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhoea. However, clinically significant resistance to fluoroquinolones in Neisseria gonorrhoeae has been reported worldwide including Britain. The aim of this analysis was to study the factors relating to ciprofloxacin resistance and treatment failure. A total of 201 patients attending the Newcastle Genitourinary Medicine (GUM) clinic from 1995-1997 who were diagnosed with culture positive gonorrhoea was analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) was measured for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant range (<0.05 μg/ml) were reviewed to determine the clinical outcome. The ciprofloxacin resistance with treatment failure was seen in 5% (8/160). All the 8 cases of treatment failure were heterosexual and had isolates resistant to penicillin and 4 cases (50%) were also resistant to tetracycline. All were sensitive to spectinomycin and ceftriaxone. Most of the cases probably acquired their infection from the Far East. As ciprofloxacin resistance seems to be associated with overseas exposure, changes in the standard treatment of gonorrhoea are not justified but consideration should be given to appropriate alternatives when the infection may have arisen from where such resistant strains are endemic. Monitoring fluoroquinolone resistance is now essential for ensuring adequate treatment of infections with resistant strains and for maximizing the time of usage of fluoroquinolones to treat gonorrhoea.
Sexually transmitted infections in young pregnant women in Bangui, Central African Republic
Authors: Blankhart David , Muller Olaf , Gresenguet Gerard , Weis Peter
Published: October 2002

In early 1996, 481 women visiting the antenatal services of the 3 major governmental health centres in the capital city of the Central African Republic (CAR) were included in the study. All study participants underwent the health centre's routine gynaecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhoea, syphilis and bacterial vaginosis. Cervical secretions and blood samples from study participants were sent to the National STD Reference Centre for diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Treponema pallidum, and HIV. Overall, 34% of the study women were diagnosed with at least one sexually transmitted infection (STI) (3.1% N. gonorrhoeae, 6.2% C. trachomatis, 9.9% T. vaginalis, 6.7% T. pallidum, 12.2% HIV-1). In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. Only a small proportion of these women had sought treatment during the weeks before, despite the recognition of genital symptoms. Self-reported and health worker recognized symptoms, signs and laboratory results exhibited only low sensitivities, specificities, and positive predictive values in the diagnosis of STIs. These findings confirm the high vulnerability of young African women to STIs and emphasize the need for specific control interventions which should include affordable and user friendly services. Moreover, these results call for more effective quality control in case of laboratory-based STI control strategies and question the validity of syndromic STI management strategies in women attending antenatal care services in Africa.
Implementation of evidence-based medicine: evaluation of the Promoting Action on Clinical Effectiveness programme
Authors: Dopson Sue , Locock Louise , Chambers David , Gabbay John
Published: October 2002

Objectives: To evaluate the Promoting Action on Clinical Effectiveness (PACE) programme, which sought to implement clinically effective practice in 16 local sites.

Methods: 182 semi-structured interviews, usually by telephone, with project team members, clinicians, and senior managers and representatives from the Department of Health and the King's Fund.

Results: The most influential factors were strong evidence, supportive opinion leaders and integration within a committed organization; without these factors, projects had little chance of success. Other factors (context analysis, professional involvement and good project management) emerged as important, supporting processes; their presence might be an additional help, but on their own they would not be enough to initiate change. A serious problem with any of them could have a strong adverse impact.

Conclusions: Although there is no simple formula for the factors that ensure successful implementation of research-based improvements to clinical practice, certain principles do seem to help. Time and resource need to be devoted to a period of local negotiation and adaptation of good research evidence based on a careful understanding of the local context, in which opinion leader influence is an important component of a well managed and preferably well integrated process of change.
Developing appropriate measures of the benefits of complementary and alternative medicine
Authors: Meenan Richard
Published: October 2002

Complementary and alternative medicine (CAM) is growing in popularity and consumes increasing amounts of resources. Economic evaluations such as cost-effectiveness analyses (CEAs) are intended to inform decision-makers about the relative efficiency of different interventions, including CAM. To be generalizable, economic evaluations should use the same metric to assess health benefits – e.g. quality-adjusted life years (QALYs). However, the recurrent conditions for which CAM is typically used suggest that the health benefits of CAM will manifest themselves primarily as quality-of-life improvements that appear in CEA as 'utilities' attached to health states. Therefore, appropriate utility measures will be critical to the production of valid CEAs of CAM therapies. Some economists assert that the process of health care, as well as its outcome, can contribute to patient utility. This essay argues that process utility is especially relevant to CAM; accurate assessment of process utility will be important to valid economic evaluations of CAM; existing utility assessment methods do not directly account for process utility; and, therefore, techniques such as qualitative analysis that can inform more appropriate and complete assessments of the benefits of CAM should be explored. The heterogeneity of CAM modalities suggests that the arguments made in this essay will apply with similar force to economic evaluation of conventional therapies with which CAM is likely to be compared.
If changing skill mix is the answer, what is the question?
Authors: Buchan James , Ball Jane , O'May Fiona
Published: October 2002

Changing skill mix is often identified as a potential solution to health services staffing and resourcing problems, or is related to health sector reform. This paper discusses what is meant by skill mix, provides a typology of the different approaches to assessing skill mix and examines, by means of case studies, the contextual, political, social and economic factors that play a part in determining skill mix. These factors are examined in relation to three factors: the reasons (or drivers) for examining skill mix; the impact of contextual constraints; and the effect of varying spans of managerial control. Case studies conducted in Costa Rica, Finland, Mexico, the UK and the USA are used to explore the reality of assessing skill in different contexts and health care settings. We argue that, although skill mix may be a universal challenge, it is not a challenge that all managers or health professionals can meet in the same way, or with the same resources. Context can have a significant effect on the ability of health service managers to assess and change skill mix. The key determinant is the extent to which these factors are in the locus of control of management nationally, regionally, or locally, within different countries. We emphasise the need to evaluate the problem and examine the context, before deciding if a change in skill mix is the answer. The local managerial span of control and degree of organisational flexibility will be major factors in determining the likely impact of any attempts to change skill mix. Before embarking on a skill mix review, any organisation should ask itself the question: 'If changing skill mix is the answer, what is the question?'
Does waiting for total hip replacement matter? Prospective cohort study
Authors: Hajat Shakoor , Fitzpatrick Ray , Morris Richard , Reeves Barnaby , Rigge Marianne , Williams Olwen , Murray David , Gregg Paul
Published: October 2002

Objectives: To assess the impact on the outcome of total hip replacement of the length of timing spent waiting for surgery.

Methods: One hundred and forty-three orthopaedic and general hospitals provided information about aspects of surgical practice for each total hip replacement conducted between September 1996 and October 1997 for publicly and privately funded operations in five English health regions. These data were linked to patient information about hip-related pain and disability status (measured using the Oxford Hip Score) before operation and at 3 and 12 months after. Data were analysed using multiple regression analysis.

Results: Questionnaires were completed by surgeons for 10 410 (78%) patients treated during the recruitment period and by 7151 (54%) patients. Twelve months after total hip replacement, the majority of patients experienced substantial improvements in hip-related pain and disability (as measured by the Oxford Hip Score). Those patients who started with a worse Oxford Hip Score before the operation tended to remain worse after the operation. Worse pre-operative score was associated with an increased length of either outpatient or inpatient wait, and this trend remained after the operation. The relationship between waiting time and outcome remained after adjustment for possible confounding variables. A consistently worse score was observed in public compared with private patients at all three time-points. In addition, in both sectors, those patients who were socially disadvantaged had a worse score than more socially advantaged patients both before and after the operation.

Conclusions: Waiting for surgery is associated with worse outcomes 12 months later. Longer-term outcome needs to be considered to see if this association persists.
Salaried contracts in UK general practice: a study of job satisfaction and stress
Authors: Gosden Toby , Williams Jacky , Petchey Roland , Leese Brenda , Sibbald Bonnie
Published: October 2002

Objectives: To compare job satisfaction and stress levels of general practitioners (GPs) employed on salaried contracts with GPs on a 'standard' performance-related contract paid by fee-for-service and capitation.

Methods: Job satisfaction and stress levels were assessed using data from two postal surveys of GPs: a national survey of 'standard' contract GPs carried out in 1998; and a survey of salaried GPs and their non-salaried GP employers in 1999. Differences in satisfaction and stress scores were assessed by t-tests; regression analysis was used to control for confounding factors and possible selection bias.

Results: We achieved a response rate of 77% in the 1999 survey of salaried and non-salaried GPs; 48% of 'standard' contract GPs responded in the 1998 survey. We found that salaried GPs were as satisfied overall as both non-salaried GP employers and GPs on the 'standard' contract, even after controlling for confounding factors and selection bias. Salaried GPs were more satisfied with their remuneration, working hours and the recognition they got for their work. They experienced more stress with two factors but less stress with 19 factors compared with the 'standard' contract GPs.

Conclusions: Overall job satisfaction levels among salaried doctors were similar to those of doctors on contracts paid by mixed fee-for-service and capitation. Future studies of job satisfaction levels under different doctor payment systems need to take account of the extent to which doctors have preferences for different types of contract if they are to derive unbiased results.
Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness
Authors: Wilton Paula , Smith Richard , Coast Joanna , Millar Michael
Published: October 2002

Objectives: To conduct a systematic review of the literature to describe and critically appraise studies reporting on the cost and/or effectiveness of interventions proposed to control the emergence of antimicrobial resistance (AMR).

Methods: The search for relevant studies encompassed consultation with world experts in AMR, and electronic bibliographic database search of: Medline (1960-2000); ISI (1981-2000); EMBASE (1988-2000); Grey Literature (1999-2000); Database of Reviews of Effectiveness (DARE) and the NHS Health Economic Evaluation Database (HEED) at York University's Centre for Reviews and Dissemination (CRD) (numerous years); OPAC (1975-2000); and the Cochrane Library Online (1990-2000). Only studies that concerned the effectiveness or cost-effectiveness of measures specifically designed to contain the emergence of AMR were reviewed. Standardised data extraction sheets, based on existing checklists for effectiveness and cost-effectiveness, were used to assess the validity of each study using the 'risk of bias criteria' suggested in the Cochrane Handbook. Only studies categorised as being at low or moderate risk of bias were reported fully. The reliability of the data review process was monitored by comparison of several, random, independent assessments by all authors. The mix of study methods (i.e. including studies based on non-randomised controlled trials) meant that formal meta-analysis was not possible, and thus a qualitative review was performed.

Results: In total, 43 studies were reviewed, with 21 classed as being at moderate or low risk of bias and therefore reported in the paper. These studies covered policies on: restricting the use of antimicrobials (five studies, suggesting that restriction policies can alter prescriber behaviour, although with limited evidence of subsequent effect on AMR); prescriber education, feedback and use of guidelines (six studies, with no clear conclusion); combination therapies (seven studies, showing the potential to lower drug-specific resistance, although for an indeterminate time period); vaccination (three studies showing cost/effectiveness). Most of these studies were: from the developed world, principally the USA; hospital-based, with few community level interventions; and concerned with effectiveness, not cost-effectiveness.

Conclusions: Overall, there is an absence of good evidence concerning what is effective, and especially cost-effective, in reducing the emergence of AMR. However, in addition to more research concerning these forms of intervention, the paper highlights four specific areas for further investigation: validating intermediate or surrogate outcome measures to enable better use to be made of the literature on intermediate measures; development and evaluation of 'macro' strategies; research into specific aspects of AMR in developing countries; and empirical and methodological research concerning the economic evaluation of interventions.
Diagnosis and prognosis of Australia&s health information for evidence-based policy
Authors: Gool Kees Van , Lancsar Emily , Viney Rosalie , Hall Jane , Haywood Philip
Published: October 2002

Without adequate information it is difficult to determine the success or failure of health policies. This paper assesses the adequacy of Australia&s health information for evidence-based policy. Three policy areas are analysed: the impact of changing the public and private health financing mix; waiting lists and waiting times; and pooling of funds. In each, the issue is analysed to identify the key policy questions, the available data and existing analyses are examined, and gaps in data availability and analysis are assessed.

There is variability in the extent and usefulness of current health information. In terms of the impact of changing the financing mix, there is good information on the distribution of finance, but much less available on comparative use or efficiency of public and private hospitals. There is comprehensive information available on waiting lists and waiting times but little analysis of the implications of this for equity of access or the costs and benefits of reducing waiting times. There is insufficient information for the development of the capitation based formulae required for the introduction of the pooling of funds, nor enough information to assess the extent and impact of current cost-shifting which might be addressed by pooling funds. While the concept of evidence-based medicine has been embraced with regard to specific treatment decisions, there has not been a parallel investment in the use of evidence to drive policy decisions.
Self-treatment of obsessive-compulsive disorder guided by manual and computer-conducted telephone interview
Authors: Nakagawa Akiko , Marks Isaac M , Park Je-Min , Bachofen Martin , Baer Lee , Dottl Susan L , Greist John H
Published: October 2002

While on a waiting list for treatment by therapist-guided exposure and ritual prevention (ERP), patients with obsessive-compulsive disorder (OCD) did self-treatment at home guided by a manual plus a computer-driven telephone interview system (BT STEPS). Of 21 patients who used the system for at least three weeks while on the waiting list, one improved so much that subsequent therapist-guided ERP was unnecessary. Progress of the rest with the system predicted later progress with therapist-guided ERP. Improvement after using the system was similar to that of 20 matched historical controls who had had therapist-guided ERP without the prior use of BT STEPS. Outpatient users of BT STEPS needed less subsequent clinician-guided time than did their matched controls. In this pilot study, patients with OCD improved nearly as much with home self-treatment guided by a manual plus computer, as with treatment guided by a behaviour therapist.
The value of the World Wide Web for tele-education in radiology
Authors: Gotwald T F , Daniaux M , Stoeger A , Knapp R , Nedden D zur
Published: October 2002

We assessed Websites for radiological education. Of several hundred sites identified, 30 were randomly selected for evaluation by two groups of observers. All Web pages were rated with respect to time required to access the information; structure and organization of the site; image quality; and information content and relevancy. Rapid access was gained to many educational radiology Websites, which contained large numbers of interesting radiological images of good quality. A weak point was the structure and organization of the sites. The greatest variability in ratings was found in the information content and relevancy of the Websites.
Smart care technologies: Meeting whose needs?
Authors: Six smith Andrew , Six smith Judith
Published: October 2002

Recent funding programmes supporting research and development in telecare have argued for a shift in perspective from a technology-driven approach to one that is needs-led. While this is in the interests of both users and technologists, achieving this goal is not straightforward. This paper outlines some of the conceptual, methodological and practical problems that potentially constrain a needs-led approach and illustrates the emergent issues with a case study of the development of an intelligent home monitoring system to support the independent living of older people. The research indicates clear differences between users and technologists in the way problems, needs and requirements are understood and defined. This in turn has consequences for the way assistive technologies are developed and implemented.
A cost measurement study for a home-based telehospice service
Authors: Doolittle Gary C
Published: October 2002

A telehospice service is one in which telemedicine is used to provide hospice care in the home. To date, there have been few studies addressing the cost of home-based telemedical care, and none that specifically addresses cost-effectiveness for telehospice recipients. We measured costs for traditional hospice care as well as those associated with launching and operating a telehospice service. The costs were tallied over two separate three-month periods. For the first study period, costs were measured for traditional hospice home visits. During the second, expenses were monitored for traditional (in-person) and telehospice visits. For traditional care, the cost per visit was $126 and $141, for the first and second time periods, respectively. The average telehospice visit cost was $29.
A feasibility study of realtime teledermatology in Finland
Authors: Lamminen H , Tuomi M-L , Lamminen J , Uusitalo H
Published: October 2002

We conducted a feasibility study of teleconsultation in dermatology using low-cost equipment. Patients and their general practitioners took part in consultations from the Primary Health Care Centre in Ikaalinen with a dermatologist 55 km away at the Tampere University Hospital TAUH . Consultations were performed using standard commercial videoconferencing equipment, a modified document camera and a dermatoscope. A single ISDN line 128 kbit s was used for the connection. During the eight months of the study, 25 patients participated in a teledermatology consultation. Their mean age was 45 years range 4-92 . The average time the patient spent in travelling to the videoconsultation i.e. one way was 24 min range 5-65 min . The mean time spent in the teleconsultation was 15 min range 5-30 min . After the teleconsultation, patients' treatments changed in 19 cases 76 , diagnoses were changed in 13 cases 52 and 18 patients 72 did not need to go to the TAUH. The equipment was generally reliable and easy to use. However, the dermatoscope was not very useful and only one of the consultations relied mainly on it. The cost of the teleconsultations for the 18 patients who avoided travel to the TAUH was FM18,627. The total costs for the 18 conventional consultations in the TAUH would have been FM18,034. The main economic benefits of the videoconferencing were attributable to the reduced travelling and hospital costs. The economic benefits of medical education were more difficult to quantify.
Knowledge and acceptance of telemedicine in surgery: a survey
Authors: Demartines Nicolas , Freiermuth Oliver , Mutter Didier , Heberer Michael , Harder Felix
Published: October 2002

A questionnaire was sent to the chief surgeons at 141 Swiss hospitals to evaluate their knowledge and acceptance of telemedicine in surgery. The response rate was 69%. Ninety-three per cent of all surgical departments used computer technology, 85% regularly used the Web and 88% had an internal hospital network. ISDN lines were used in 58% of the participants' hospitals. While 35% of respondents had participated at least once in networking, only 8% regularly used telemedicine. The opinion was that access to therapeutic advice (87%) was a better use of telemedicine than was obtaining a primary diagnosis (24%), although the majority accepted the principle of making (91%) and receiving (94%) a remote diagnosis. The survey suggested that surgeons are interested in telemedicine and open to its development, although their experience and knowledge are limited. Therefore, telemedicine in surgery may be advanced by creating surgical networks for teleconsultation and tele-education.
An integrated system of telemedicine for minimally invasive surgery
Authors: Masero V , Sanchez F M , Uson J
Published: October 2002

We have developed a telemedicine project called Telesurgex, which is an integrated information system designed for several hospitals as well as the Minimally Invasive Surgery Centre. The project researches and develops telemedicine systems (both hardware and software) and their contents, ensuring that they are really useful and not just a videoconference with medical topics. Another aim of the project is the improvement of teleteaching systems as applied to medicine, mainly teleteaching of minimally invasive surgical techniques.
A study of Internet use by doctors and patients in Poland
Authors: Rzymski P
Published: October 2002

We evaluated Internet use in Poland in the field of obstetrics and gynaecology. Questionnaires were sent to 33 hospital departments of obstetrics and gynaecology; 25 replied (76%). The 25 departments contained a total of 275 doctors, 70% of whom ( n=193) returned the questionnaire. We also invited 3054 people visiting a gynaecological Website for patients to complete an online form; 161 replied, a response rate of 5.3%. While 84% of the 102 doctors using the Internet were satisfied with Internet medical resources, only 24% of patients were. Patients searched for medical information less frequently than professionals and were younger. About half of the doctors and patients had only modem access to the Internet. The most popular services for professionals were databases and information services; patients were most interested in information on pregnancy, contraceptives, physiology and general female health. Most of the 45% of patients who said that they did not receive sufficient information from doctors could not usually find it on the Internet either.
Patient satisfaction with telediabetes education in Hong Kong
Authors: Yip Mei Po , Mackenzie Ann , Chan Juliana
Published: October 2002

Forty-one patients suffering from type 2 diabetes mellitus were selected to receive diabetes education at a local health centre via low-cost videoconferencing equipment. The educational material was transmitted from the diabetic centre of a district hospital. Four educational sessions were carried out over 4.5 months. Satisfaction was measured using a self-administered questionnaire on the completion of the programme. Of the 41 subjects who participated in the study, 36 (88%) completed the questionnaire. Patients reported a high level of satisfaction with most aspects of the education process. The mean total score on the questionnaire was 61.9 (SD 9.4); the highest possible total score was 75. There was a significant positive correlation between age and satisfaction level ( r=0.39). The results showed that diabetes education conducted via telemedicine was highly acceptable to diabetic patients.
Research into telehealth applications in speech-language pathology
Authors: Hill Anne , Theodoros Deborah
Published: October 2002

A literature review was conducted to investigate the extent to which telehealth has been researched within the domain of speech-language pathology and the outcomes of this research. A total of 13 studies were identified. Three early studies demonstrated that telehealth was feasible, although there was no discussion of the cost-effectiveness of this process in terms of patient outcomes. The majority of the subsequent studies indicated positive or encouraging outcomes resulting from telehealth. However, there were a number of shortcomings in the research, including a lack of cost benefit information, failure to evaluate the technology itself, an absence of studies of the educational and informational aspects of telehealth in relation to speech-language pathology, and the use of telehealth in a limited range of communication disorders. Future research into the application of telehealth to speech-language pathology services must adopt a scientific approach, and have a well defined development and evaluation framework that addresses the effectiveness of the technique, patient outcomes and satisfaction, and the cost benefit relationship.
An eight-year study of Internet-based remote medical counselling
Authors: Labiris G , Coertzen I , Katsikas A , Karydis A , Petounis A
Published: October 2002

We carried out a prospective study of an Internet-based remote counselling service. A total of 15,456 Internet users visited the Website over eight years. From these, 1500 users were randomly selected for analysis. Medical counselling had been granted to 901 of the people requesting it (60%). One hundred and sixty-four physicians formed project groups to process the requests and responded using email. The distribution of patients using the service was similar to the availability of the Internet: 78% were from the European Union, North America and Australia. Sixty-seven per cent of the patients lived in urban areas and the remainder were residents of remote rural areas with limited local medical coverage. Sixty-five per cent of the requests were about problems of internal medicine and 30% of the requests concerned surgical issues. The remaining 5% of the patients sought information about recent developments, such molecular medicine or aviation medicine. During the project, our portal became inaccessible five times, and counselling was not possible on 44 days. There was no hacking of the Website. Internet-based medical counselling is a helpful addition to conventional practice.
The Telemedicine Information Exchange (TIE)
Authors: Hayes Tamara , Kinsella Audrey , Brown Nancy A , Perednia Douglas A
Published: October 2002

An on-line information service, the Telemedicine Information Exchange TIE , was established to provide a comprehensive source of telemedicine information. The TIE comprised a number of frequently updated, searchable, linked databases, each dealing with an important aspect of telemedicine. These included an extensive bibliography on telemedicine consisting of more than 2000 citations, many with abstracts. There was also a series of topical sections describing current telemedicine projects, products and services, legislation, funding, research activities, and news in the field. The TIE was designed to exploit the features of electronic information storage: hypertext linking between related pieces of information; specialized views technical, legal, and business of the bibliographic database; and usage monitoring to determine which data were most frequently accessed and therefore where any enhancement should be done. The TIE was made available via the World Wide Web, by remote telnet access over the Internet, and via modem. The rapid increase in the usage of the TIE since its introduction in April 1995 indicated that the TIE satisfied a need in the telemedicine community.
The management of clinical risk in telemedicine applications
Authors: Darkins Adam
Published: October 2002

Any telemedicine application should be viewed in terms of its health-care context, the clinical process it is enabling, and whether it is appropriate to apply telemedicine to that process. Telemedicine should be used as a tool to enable the transfer of clinical information which, by being transferred, will reduce clinical risks. Because managing clinical services involves knowing where clinical decisions are being made, it is important to ensure that telemedicine activity is recorded as part of the routine clinical and investigative data sets that will be kept for clinical audit and health-service costing purposes. There may be areas of health-care delivery where the telemedicine solution becomes the treatment of choice. In this event, not to provide telemedicine may be unethical and may expose a service to high clinical risk. If a service is based on the use of telemedicine, it is important to ensure that the technical specifications are adequate, that the system is sufficiently reliable, and that there are adequate back-up provisions in the case of system failure.
Videoconferencing in psychiatry : a survey of use in northern Norway
Authors: Gammon D , Bergvik S , Bergmo T , Pedersen S
Published: October 2002

A survey of the use of videoconferencing in mental health care was carried out in northern Norway. A questionnaire was distributed to all user institutions in northern Norway at the same time that ISDN became available, in mid-1995. The questionnaire completion rate for locations recorded as participants in videoconferencing sessions was 62%. Within six months, a total of 1028 persons had participated in 140 videoconferencing sessions from 35 institutions. The purposes of videoconferencing included meetings (50%), supervision, training and teaching (31%), clinical consultations (14%) and tests or demonstrations (5%). The alternative forms of contact which videoconferencing replaced included travel (59%), no contact (25%), telephone (14%), and mail or fax (2%). No problems were reported in 55% of the sessions; in 19% there were audio problems, in 14% there were picture problems, in 5% attempts to connect failed and in 5% disconnection occurred. The majority of users (87%) reported that they were satisfied or very satisfied with the facility; 8% were uncertain and 5% were less satisfied or totally dissatisfied. Continued surveying will provide longitudinal data on the diffusion of telepsychiatry in northern Norway.
Teledentistry: protocols for the transmission of digitized radiographs of the temporomandibular joint
Authors: Eraso Francisco Eduardo , Scarfe William C. , Hayakawa Yoshihiko , Goldsmith Jane , Farman Allan G.
Published: October 2002

Tomograms of the temporomandibular joint were digitized in three different formats using a PC-based system. The image resolution for various projections was determined at different camera-film distances. Three series of images were transmitted by telephone, and transmission times were measured. The original radiographs, the digitized images, the transmitted images and the transmitted-and-printed images were presented to 10 observers, who were asked to rate image quality. No difference in image quality was found between the initial digitized and the transmitted images. However, transmitted and transmitted-and-printed images were of significantly lower quality than the original radiographs or the digitized images viewed on a computer monitor. Transmission time was reduced significantly 50 by cropping the images before transmission. The image quality of individual radiographs was better than radiographs formatted as a series.
The contribution of telemedicine to cardiology
Authors: Tsagaris M J , Papavassiliou M V , Chatzipantazi P D , Danis N D , Dendrinou M S , Tsantoulas D J , Ioannidis P G
Published: October 2002

The Telemedicine Centre at Sismanoglion Hospital of Athens is connected to seven primary-care units (HCCs) on the mainland and six HCCs on Aegean islands. Telemedicine activity from 1992 to 1995 was reviewed. During the study period, the data relating to 1947 cardiac patients were transmitted through the telemedicine network: 681 (35%) of the patients presented with cardiological problems and 333 (17%) of them had an urgent cardiac event. The telemedicine network brought a number of benefits, including better access to cardiology specialists, improved decisions about patient transportation, a reduction in isolation and continuing professional education.
Remote, mobile telemedicine: The satellite transmission of medical data from Mount Logan
Authors: Otto Christian , Pipe Andrew
Published: October 2002

The purpose of this investigation was to demonstrate the potential of remote, mobile telemedicine during a four-week, high-altitude mountaineering expedition to Mount Logan, Canada's highest summit. Using a mobile satellite terminal and a laptop computer (both powered by a photovoltaic solar panel), ECG tracings and blood pressure measurements, in addition to colour images, short-segment video and audio clips were transmitted during the course of the ascent. The data were transmitted via a mobile communications satellite to a ground station in Ottawa, a distance of over 4000 km. The data were then transferred to the publics witched data network and delivered to the University of Ottawa Heart Institute for analysis. Similarly, data were transmitted from the ground station to the expedition team on Mount Logan throughout the ascent. Using this technique, medical diagnosis and emergency care can be facilitated in extreme and isolated locations lacking a telecommunications infrastructure. Such technology has applications in developing countries, disaster response efforts, remote civilian and military operations, and in space operations.
A survey of research in telemedicine. 1: Telemedicine systems
Authors: Taylor P
Published: October 2002

Published work in telemedicine has been surveyed in order to consider the range of current research, highlight some pitfalls and point out areas where it seems that more work is required. This article deals with tests of the safety and efficacy of telemedicine systems. This work can be seen as moving through three phases: first, identify the technical specification of equipment required for the particular telemedicine application; second, test that this is appropriate in particular settings; third, establish a set of standards and guidelines to ensure that the telemedicine system is used to the best advantage. Work in teleradiology seems to be in the second phase. Work in teledermatology, for example, is still in the first phase. Telemedicine is an important and growing area of academic research. The quality of the research ought also to be increasing. While there have been a number of well designed, robust studies with clear conclusions that show the value of telemedicine in certain settings, much more remains to be done.
Transmission of electrocardiograms from a moving ambulance
Authors: Giovas P , Papadoyannis D , Thomakos D , Papazachos G , Rallidis M , Soulis D , Stamatopoulos C , Mavrogeni S , Katsilambros N
Published: October 2002

Delay is the enemy for patients with acute myocardial infarction. It would be helpful for the hospital cardiologist to interpret the patient's electrocardiogram(ECG) before the arrival of the ambulance. The aim of our study was to determine whether ECG transmission from an ambulance is feasible and to assess the time savings. An ambulance was equipped with an ECG recorder, which was connected to a notebook computer and coupled to acellular telephone for transmission to a hospital-based station. Paramedics needed 2 min (SD 0.5) to record the ECG on the move and 34 s(SD 14) to transmit it. The ambulance arrived 15.5 min (SD 6.5) after reception. The time between arrival and ECG diagnosis, for a control group patient, was approximately 9.5 min (SD 3.5). Therefore, pre-hospital ECG diagnosis took place 25 min (SD 7.5) before in hospital diagnosis. We conclude that ECG transmission from a moving ambulance is feasible, reduces in-hospital delays and allows faster triage in critical cardiac cases.
Design of mobile telemedicine systems using GSM and IS-54 cellular telephone standards
Authors: Istepanian Robert H , Woodward B , Gorilas E , Balos P A
Published: October 2002

This paper presents an overview of the design of mobile telemedical systems using cellular telephone channels. A mobile telemedicine communication system was studied using both the GSM and the IS-54 standards, which are the most widely used commercial cellular telephone systems in Europe and North America, respectively. A simulation using a photoplethesmography signal showed successful transmssion of data with bit error rates of less than 10-7 at the receiver for the IS-54 standard and less than 10-5 for the GSM standard, depending on the mobile channel conditions used.
A randomized controlled trial of telemedicine in an emergency department
Authors: Brennan John A , Kealy John A , Gerardi Lisa H , Shih Richard , Allegra John , Sannipoli Laurene , Lutz Don
Published: October 2002

A prospective study of emergency department telemedicine was carried out at two hospitals in northern New Jersey. One hundred and twenty-two patients met the inclusion criteria. One hundred and four (85%) consented to participate, with 54 being randomized to the telemedicine group and 50 to the control group. Four patients did not complete the protocol. No significant differences were seen between the groups for: occurrence of 72 h emergency department return visits (0% vs 0%); need for additional care (2.3% vs 2.4%); positive patient–physician interaction (98% vs 100%); positive patient–nurse interaction (98% vs 98%); positive overall patient satisfaction (98% vs 95%). The average patient throughput time (time from admission to discharge) for the telemedicine group was 106 min; the average for the control group was 117 min. Telemedicine was found to be a satisfactory technique for pre-selected emergency department patients and was viewed by the physicians as an acceptable method of complementary care.
Video transmission for telemedicine
Authors: Squibb N J
Published: October 2002

The transmission of moving pictures to remote locations is an important part of telemedicine. Although the first videoconferencing demonstrations were performed in the 1930s, the technology is still fragmented and its quality is sometimes too poor for it to be useful. Conventional television technology is analogue the fundamental television standards were developed before the Second World War and does not fit' the digital world very well. This paper reviews video transmission and videoconferencing technologies and the results that can be expected. While trained professionals may be able to make use of poor-quality video systems, real advances in telemedicine require studio-quality video, which is possible only with high-bandwidth technology.
Evaluation of a telepsychiatry pilot project
Authors: Doze S , Simpson J , Hailey D , Jacobs P
Published: October 2002

We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist C 610 per consultation ; with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.