bluuebunny/crossref_metadata_2025 huggingface dataset:
Symptomatic Anterior Uveitis in HIV-Positive Patients
Authors: Verma Seema , Hughes Judith D , Mabey Denise , Graham Elizabeth M
Published: October 2002

Symptomatic anterior uveitis is rare in HIV-positive patients. The uveitis associated with cytomegalovirus retinitis (CMVR), the commonest ocular manifestation in AIDS patients, is rarely symptomatic and patients do not typically present with a red painful eye in conjunction with blurred vision. In this article we report 12 cases of symptomatic anterior uveitis in HIV-positive patients and discuss the aetiology.

The case notes of all HIV-positive patients presenting to the eye department with symptoms of uveitis over a 4-year period were studied retrospectively. The notes were analysed for age, sex, race, risk factors of HIV, features of the uveitis, concurrent disease and CD4 counts.

Only 12 patients were identified to have symptomatic uveitis out of a total 172 patients. There were 9 males and 3 females with an average age of 35 years. None of these patients were taking either rifabutin, protease inhibitors or cidofovir. Seven out of the 12 patients had granulomatous uveitis. Of these 7 patients, 4 had CD4 counts over 200 and no other concurrent illness whilst 3 patients, with CD4 counts between 130-200, were subsequently found to have an underlying aetiology namely lymphoma, tuberculosis and candida. The remaining 5 patients, all with CD4 counts below 40, had a history of systemic illness with herpes zoster preceding the onset of the uveitis.

HIV-positive patients with symptoms of uveitis do not have active CMVR and the ophthalmologist must search for other causes such as tuberculosis or lymphoma in those with granulomatous uveitis or herpes zoster in those with non-granulomatous uveitis. The CD4 count may be helpful.
Treatment Delay and Reliance on Private Physicians among Patients with Sexually Transmitted Diseases in China
Authors: Choi Kyung-Hee , Zheng Xiwen , Zhou Hua , Chen Weishi , Mandel Jeffrey
Published: October 2002

We examined health-care seeking practices among patients with sexually transmitted diseases (STDs) in south China. In 1995, we recruited a consecutive sample of 939 STD patients attending the STD clinics of the Municipal STD Control Centers of Guangzhou and Shenzhen, ‘special economic zones’ near Hong Kong. Attending physicians interviewed patients face-to-face using a standard survey questionnaire. Twenty-seven per cent of all subjects had sought treatment elsewhere for their presenting complaints, before visiting a study clinic. The main sources of prior treatment were private physicians followed by public clinics and drugstores. Women were more likely than men to delay in presenting their current symptoms to a study clinic (32% vs 25%, P=0.046). Factors associated with treatment delay differed by gender. Among men, seeking prior treatment from private physicians (OR=3.31; 95% CI=1.70, 6.43), having no urethral discharge (OR=4.00; 95% CI=2.33, 6.85), having engaged in sex trade (OR=1.64; 95% CI=1.03, 2.63), or being a resident in Shenzhen (OR=1.80; 95% CI=1.12, 2.89) were more likely to delay seeking treatment. Among women, only living in Shenzhen (OR=2.86; 95% CI=1.56, 5.25) was associated with treatment delay. Promotion of appropriate health-seeking behaviours and better management of STDs must be a top priority to slow a rapid spread of STD/HIV in China. Health education, improvement of STD care in the public and private sectors, and regulations of unauthorized private physicians, may help with STD control and HIV prevention.
The rate of diagnosis and demography of pelvic inflammatory disease in general practice: England and Wales
Authors: Simms I , Rogers P , Charlett A
Published: October 2002

Knowledge of pelvic inflammatory disease (PID) epidemiology is essential to the understanding of reproductive morbidity in women. This paper estimates the rate of PID diagnosis in general practice (GP) and the level of association between PID diagnosis and demographic factors. Diagnoses of PID were made at 1.7% of attendances amongst women aged 16 to 46. Increased risk of PID was associated with smoking (P<0.0001), younger age groups (P,0.0001) and lower socioeconomic groups (P<0.0001). Compared to patients who were married, increased risk was also associated with those patients who were widowed, separated or divorced and not cohabiting (adjusted rate ratio (RR)=1.62; confidence limits (CL) 1.35 to 1.97), and with those who were unmarried but cohabiting (adjusted RR=1.32; 95% CL 1.11 to 1.56). General practice is an important focus for the diagnosis and treatment of PID. If intervention and surveillance are to be undertaken effectively, more has to be known about the epidemiology of this important public health problem.
Survey of risk behaviour and HIV prevalence in an English prison
Authors: Edwards A , Curtis S , Sherrard J
Published: October 2002

An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. Three hundred and seventy-eight (68%) of the inmates participated. The HIV point prevalence was 0.26%. Injecting drug use (IDU) was the most significant HIV risk factor within 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two inmates admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection; hapatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. Injecting drug use and needle sharing represent the greatest risk.
The resurrection of hospital mortality statistics in England
Authors: Street Andrew
Published: October 2002

Mortality statistics for English hospitals were published by the Labour government in 1998, partly in response to the tragedy at the Bristol Royal Infirmary involving the deaths or serious injury of babies and children who had had unsuccessful heart operations. Despite being presented as an important innovation, this publication policy had a number of precedents, most notably the data produced as a result of Florence Nightingale's efforts in the 1860s and the clinical indicators developed by the Scottish Office in the early 1990s. In addition, league tables of death rates for English hospitals were available from 1992 to 1996, although there was widespread ignorance of their existence. This paper examines each of these precedents before discussing events that weakened public trust in the medical profession's ability to regulate itself and led to the Labour government's decision to resurrect the publication of hospital mortality data. It is suggested that these performance indicators may be largely symbolic of the government's broader commitment to performance assessment, but it is also recognised that, if coupled with appropriate incentives, public disclosure of mortality data may foster genuine performance improvements.
The demise of linearity in managing health services: a call for post normal health care
Authors: Kernick David
Published: October 2002

The emerging science of complex adaptive systems offers a complementary perspective on organisational analysis and is already finding an application within health care. The emphasis moves away from the features of normal science (analysis, prediction and control) to focus instead on the configuration of relationships among the system's components and an understanding of what creates patterns of order and behaviour among them. The important features are connectivity, recursive feedback, diversity and the existence of self-ordering rules that give systems the capacity to emerge to new patterns of order. This paper describes some of these complexity insights and their application to health care delivery and development.
Internet-mediated, protocol-driven treatment of psychological dysfunction
Authors: Lange A , Ven J-P Q R van de , Schrieken B A L , Bredeweg B , Emmelkamp P M G
Published: October 2002

An Internet system was developed for assessing psychopathology, for on-line, protocol-driven cognitive-behavioural psychological treatment and for measuring the effects of treatment. The system focused on the treatment of post-traumatic stress. The treatment comprised 10 writing sessions (45 min each) over five weeks. Participants were assessed on-line before treatment, after treatment and after six-week follow-up. After treatment the participants had improved significantly in terms of post-traumatic stress symptoms (P < 0.005) and general psychological functioning (P < 0.005), and this was sustained during the follow-up. Nineteen of the 20 participants were clinically recovered after treatment. Reduction in post-traumatic stress symptoms compared favourably to changes in control and experimental groups in trials of similar but face-to-face treatment.
Using the law to enhance provision of telemedicine
Authors: O'shannessy L
Published: October 2002

Reference is often made to the law as a barrier to the use and development of telemedicine. In New South Wales, however, it has been recognized that some of the principles behind these ‘legal impediments’ can be used to make services better and more cost-effective. The law offers a range of useful tools relating to the emergence of these new techniques. The responsibility of those in a position to regulate is, quite simply, to pick the right tool.
Design and initial implementation of a regional tele-oncology project
Authors: Demichelis F , Berloffa F , Eccher C , Larcher B , Galvagni M , Sboner A , Graiff A , Forti S
Published: October 2002

Two tele-oncology projects have been in progress since 1997 in the Province of Trento in north-east Italy. The common aim of the projects concerns the design and the implementation of a non-surgical tele-oncology system intended to provide a flexible computing environment for the joint management of oncology patients in a wide-area network. The two projects involve both hospital specialists and general practitioners treating oncological patients. The first phase of the project involves the design and implementation of the oncology teleconsultation service.
The potential for telemedicine and telecare in Deptford
Authors: Jardine I , Clough K , Navein J
Published: October 2002

We carried out a study to explore the potential of telemedicine and telecare to improve health-care for the population served by a health centre based in Deptford in south-east London. A wide range of potentially useful telemedicine and telecare applications was identified, nine of which could provide some immediate benefit. Others requiring new approaches to the delivery of care involved some re-engineering of services. Some suggestions focused on the need to integrate information technology with service provision. Other suggestions raised strategic questions, the most important of which concerned the routes of access to health-care.
Five years’ experience with the Telemedicine Information Exchange
Authors: Brown Nancy A
Published: October 2002

The Telemedicine Information Exchange (TIE) has provided comprehensive telemedicine information on the World Wide Web (Web) since early 1995. It received major funding from the National Library of Medicine in 1997. Among other things, the TIE contains six major databases: literature citations; active telemedicine programmes; a ‘what's new in telemedicine’ column; funding opportunities; forthcoming conferences; and a list of vendors of telemedicine equipment and services. Recent additions include a document delivery service, inaugurated in early 1999. More than 1000 other Web sites link to the TIE, and we have 5000 visitors per month from several countries. Given its relative longevity on the Web, TIE researchers have been in a unique position to observe trends in telemedicine.
Telemedicine in the control of intra-ocular pressure
Authors: Michelson G , Striebel W , Prihoda W , Schmidt Volker
Published: October 2002

Glaucoma is one of the most common causes of blindness in the Western world and a major risk factor is increased intra-ocular pressure. We therefore used telemedicine in its control. Patients measured their intra-ocular pressure several times a day with a portable instrument and the values were then entered into a portable digital assistant. These data were transmitted by a modem to a central server. If the intra-ocular pressure was pathologically high, an email message was automatically sent to the ophthalmologist. The pressure curve, including a statistical analysis, was displayed in an easily readable chart format. Ten patients with glaucoma participated in a trial. Self-tonometry with telemedicine enabled continuous evaluation of the patient by the ophthalmologist. This approach offered the advantage of controlling the treatment remotely. Advantages for the patient were that the measurements were easily done at home under normal conditions, and the patient could control when the measurement and data transmission would be performed. Telemedicine is a cost-effective technique enabling the early diagnosis of pathologically increased intra-ocular pressure.
What do we really know about the cost-effectiveness of telemedicine?
Authors: Håkansson Stefan , Gavelin Carin
Published: October 2002

Telemedicine is still in its infancy, but undergoing rapid development. It is very difficult to evaluate telemedicine. We performed a literature survey (Medline). During the period 1990–8, over 1500 articles on telemedicine were published. Of these, 246 mentioned economic aspects in the abstract (16%). We selected 29 studies although few had demonstrated cost-effectiveness. Benefits for the patients in the form of reduced travel and waiting time must often be weighed against increased provider costs. Up to now, telemedicine in general has not had any significant effect on medical practice, or the structure and organization of health-care. In order to utilize the potential of telemedicine, its integration with traditional health-care is very important. There are country-specific variations in the health systems that make it difficult to generalize the results from one country to another.
The current status of medicolegal issues surrounding telepathology and telecytology in Japan
Authors: Tsuchihashi Yasunari , Okada Yoshikazu , Ogushi Yoichi , Mazaki Takeshi , Tsutsumi Yutaka , Sawai Takashi
Published: October 2002

The medicolegal issues surrounding telepathology and telecytology in Japan have been partly resolved since the government declared that telediagnosis in these fields using a microscope is essentially a medical practice between doctors. Thus it does not contravene article 20 of the law pertaining to medical practice in Japan, which states that there must be an actual face-to-face encounter between the doctor performing any diagnostic or treatment episode and the patient. It is, however, only beginning to be recognized that the medicolegal issues surrounding telepathology and telecytology depend on factors such as the type of system used (e.g. active versus passive). In an active diagnostic system, the telepathologist or telecytopathologist can control a robotic microscope at the remote site, while in a passive diagnostic system the telepathologist or telecytopathologist makes the diagnosis based on the microscope images that have been selected, and transmitted, by someone in the remote hospital. In the former case the interpreting telepathologist or telecytopathologist must assume most of the responsibility for the diagnostic process, while in the latter more responsibility must be assumed by those at the remote site. The duties and responsibilities of all participants in the telediagnostic process, whatever the system employed, must be determined. We have established working guidelines for telepathological and telecytological diagnoses to help achieve this and hence ensure safe and effective clinical practice.
Telecardiology: Results and perspectives of an operative experience
Authors: Fogliardi Roberto , Frumento Enrico , Rincón David , Viñas Miguel ángel , Fregonara Mario
Published: October 2002

A telecardiology system has been established between six Italian hospitals. Four of them are connected using three ISDN lines; the remaining two are connected with only a single ISDN line. The telecardiology system was evaluated between two hospitals. Radiographs showing the heart movements of 10 patients were digitized and forwarded to the specialist hospital for expert opinion. The transfer time of a single patient sequence ranged from 6 h 40 min to 22 h 15 min using a single ISDN line at 128 kbit/s. The transfer time decreased considerably using three ISDN lines. Following data transfer, a joint consultation was organized between the cardiologists in realtime. Realtime telecardiology using three ISDN lines was clinically viable and more efficient than the traditional method of delivering this type of specialist care.
Telemedicine and patients’ rights
Authors: Nohr Leif Erik
Published: October 2002

Telemedicine improves access to both health-care and second opinions. However, the potential risks of telemedicine, such as breaches in patient confidentiality and security, need to be addressed in order to ensure that patients’ rights are not violated. Used appropriately, telemedicine has the potential to enhance the rights of patients to high-quality, effective health-care.
The consistency of neuropsychological assessments performed via telecommunication and face to face
Authors: Kirkwood Kim T , Peck David F , Bennie Lindsay
Published: October 2002

Previous studies have suggested that cognitive assessments of adult psychiatric patients can be carried out as reliably via teleconsultation as they can face to face. However, the designs of these studies have often been less than satisfactory. The present study used videoconferencing at 128 kbit/s for the cognitive assessment of individuals with a history of alcohol abuse. Twenty-seven participants were given a range of assessments with two equivalent forms. One of the forms was given via videoconferencing and the other face to face. All participants were assessed using both media and the order of presentation was balanced across participants. Aspects of participant satisfaction with teleconsultations were also assessed, on 10-point scales. The teleconsultations were significantly longer (mean 40.7 min, SD 6.4) than the face-to-face sessions (mean 33.0 min, SD 5.3). For most of the outcome measures, cognitive assessment via teleconsultation produced similar results to face-to-face assessment. Most participants expressed high overall satisfaction with the teleconsultation (mean rating 8.2). The average ratings for the sound quality (mean 7.6) and visual quality of the equipment (mean 7.9) were also high. The findings imply that it is not necessary for patients and neuropsychologists to be present at the same location for cognitive assessments to be carried out.
User satisfaction with teleconsultations for surgery
Authors: Aarnio Pertti , Rudenberg Heikki , Ellonen Markku , Jaatinen Pekka
Published: October 2002

We carried out a prospective study of realtime videoconferencing in surgical consultations. Videoconferencing equipment at the Satakunta Central Hospital, Pori, was connected by ISDN at 384 kbit/s to two health centres in the cities of Kankaanpaa and Huittinen (55 and 60 km from Pori, respectively). A document camera was used to transmit images of radiographs and paper documents. Fifty patients who needed a surgical consultation were examined by a doctor in the health centres, and the surgeon interviewed and observed the physical examination by videoconference. The consultation time ranged from 12 to 23 min (mean 15 min). Technically the equipment functioned reliably and the quality of the video-picture was good. According to the consulting surgeon, the decision made in the videoconference was reliable in 48 cases (96%). According to the doctors in the health centres, the consultation was useful in 49 cases (98%) and was considered satisfactory in one. The doctors thought that the teleconsultation was as reliable as an outpatient appointment in 49 cases (98%). The educational benefit of the consultation was excellent or good in 38 cases (76%). The overall satisfaction of patients was very good or good in 45 cases (96%). All patients, except one, avoided travelling to a face-to-face appointment because they received a definite treatment decision during the teleconsultation.
A low-cost approach to public health education using multimedia packages
Authors: Lewis L , Roach B , Haynes E
Published: October 2002

The effect of health education programmes depends on the number of people exposed to the messages, as well as the method and style in which the information is transmitted. We conducted a pilot project to encourage healthier lifestyles by presenting culturally sensitive information using a variety of media. Material intended to provoke discussion was shared with a range of audiences in Barbados and Montserrat in the West Indies by a series of lecture discussions, which were video-recorded for local television and sound recorded for local radio. The lecture was also disseminated by newspaper articles, a special magazine and by publication on the Internet. The aim of the project was to achieve maximum effect for minimum effort, thus making optimum use of resources. The feedback obtained at the lecture discussions and in response to the radio broadcasts and newspaper articles provided a needs assessment on which to base a definitive programme, and confirmed that radio and television are the most effective media for health education.
Mobile software agents for Web-based medical image retrieval
Authors: Paranjape Raman B , Smith Kevin D
Published: October 2002

Mobile software agents are a new tool which may assist rural and remote physicians to obtain medical data from digital medical libraries on the Internet. Mobile agents are autonomous software objects that can move from digital library to digital library, analysing data to determine their usefulness to the user. A proof-of-concept system applied to mammography is proposed and a simplified prototype for this system is reported. Enhancement and development plans for the complete proof-of-concept system are suggested.
Image processing from computerized tomography images: Virtual reconstruction for telediagnosis
Authors: Masero V , Moreno J , Silva A , Andres F , Chambel J , Uson J
Published: October 2002

We have developed a system for remote three-dimensional reconstruction, which facilitates telediagnosis. The telereconstruction system is based on a computerized tomography (CT) scanner, a workstation connected to the CT scanner, a PC, which can be geographically far away from the workstation, and a computer program that we have developed. The workstation allows CT images to be stored and image processing to be carried out. The PC permits the user to control the workstation in making a three-dimensional reconstruction and allows the remote user to see that reconstruction. From the PC various graphical operations can be performed on the three-dimensional model, such as rotations, translations and cuts through the model. The program therefore allows a remote user to have three-dimensional images and to study them by means of all the options the program provides.
The Centre for Minimal Access Surgery—teaching for tomorrow
Authors: Durst Lianne
Published: October 2002

The Centre for Minimal Access Surgery (CMAS) was established as a state-of-the-art multidisciplinary technological education and research centre for minimal access surgical techniques. Up-to-date training models were obtained to facilitate skill acquisition. Among these were the Minimal Access Therapy trainer and the Body Form Simulator, which provide simulations of the human form on which students can practise operative procedures. The CMAS also acquired the MIST Virtual Reality system, a computer program that facilitates the acquisition of laparoscopy skills. Finally, the CMAS compiled a multimedia library of resources. While many skills can be gained in these synthetic and didactic environments, they cannot provide all the preparation necessary to practise competently. To facilitate the realtime observation of surgical procedures and the telementoring process, the CMAS has commissioned the development of an integrated videoconferencing system that permits the high-quality, rapid transfer of multi-feed video and audio data of surgical procedures from an operating room to the classroom.
A fully automated remote refraction system
Authors: Dyer Alan M , Kirk Angus H
Published: October 2002

Traditional methods of performing refractions depend on a trained refractionist being present with the subject and conducting an interactive form of subjective testing. A fully automated refraction system was installed in 13 optical dispensaries and after 15 months the patient and statistical information was gathered. The data from all operators were consistent and suggested a lack of operator effect on the refraction results. The mean of the SD of subjective sphere measurements was 0.2, or slightly less than a quarter dioptre, which would be an acceptable level of accuracy for ordering corrective lenses. The present study suggests an absence of operator influence on the results of the refractions and a degree of consistency and accuracy compatible with the prescription of lenses.
A questionnaire for the assessment of patients' impressions of the risks and benefits of home telecare
Authors: Demiris George , Speedie Stuart , Finkelstein Stanley
Published: October 2002

Home telecare is a promising method of improving access to care for rural and urban populations. It requires, however, that patients accept the installation and use of equipment in their home. How patients perceive home telecare may influence its acceptability and diffusion. We developed a questionnaire to assess patients' impressions of the risks and benefits of home telecare. A preliminary 20-item questionnaire was developed and tested on 32 subjects. It proved to be of acceptable reliability (Cronbach's alpha of 0.8) and validity, but three items appeared to be redundant. The final 17-item version was tested twice on 10 more subjects and was found to have high test-retest reliability. Most subjects showed an overall positive attitude towards home telecare and agreed it could improve their health. Many were concerned about being able to trust the equipment. The questionnaire can be used to investigate the acceptance of telemedicine and to improve the design of applications.
Telemedical work and cooperation
Authors: Aas I H Monrad
Published: October 2002

In telemedicine, cooperation occurs via telecommunication. This represents a new situation for medical cooperation. Whether such cooperation works poorly or well will be important with an increasing volume of telemedicine. When personnel are involved in external cooperation, as in telemedicine, the question of cooperation within one's own organization also arises. To investigate these matters, qualitative interviews were performed with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. The results showed that cooperating by telecommunication mainly worked well. The cooperation may be influenced by factors such as personality, knowing each other personally, preparation and experience. Telemedical teamwork may be improved by factors like experience and education. Working with telemedicine did not reduce the personnel's cooperation within their own organizations, but rather improved it, although this effect was slight and most commonly involved improved knowledge of others. In general, the findings concerning cooperation and telemedicine were positive.
Telehealth and the diagnosis and management of cardiac disease
Authors: Hooper G S , Yellowlees P , Marwick T H , Currie P J , Bidstrup B P
Published: October 2002

The financial and personal burden of chronic cardiac disease is high. Costs are likely to increase over the next few decades. Promising applications of telehealth have appeared in the diagnosis and management of cardiac disease and there are indications that telehealth services can improve the management of chronic cardiac disease as well as extend services to remote and rural populations. Telehealth has been applied to the capture of symptoms of cardiac disease with electrocardiography and echocardiography, to the management and rehabilitation of recently discharged patients, and in peer-to-peer consultation where remote expertise can facilitate diagnosis. Telehealth promises cost reductions in service delivery, although there is a need for properly controlled cost-effectiveness trials to underpin telehealth with a firm evidence base.
Telenursing for the elderly. The case for care via video-telephony
Authors: Arnaert Antonia , Delesie Lucas
Published: October 2002

As most elderly people prefer home care to residential care, the nursing profession must change its current practice. New models of care are necessary. Information and communications technologies, such as video-telephony (i.e. any form of face-to-face video-communication), allow elderly people to maintain their autonomy by strengthening their emotional, relational and social abilities. Experiments in a variety of settings have tested a range of interventions based on video-telephony, from the simple giving of information to the provision of therapeutic procedures. The elderly have appreciated the opportunity to use video-telephony to communicate with a nurse about their needs, expectations and feelings. After some initial scepticism, nurses have concluded that telenursing complements traditional nursing practice. Although technology is no panacea for the problems of ageing, when applied judiciously it can bolster the position of vulnerable ageing citizens.
A review of the experience with teleradiology in Australia
Authors: Crowe B L
Published: October 2002

Because of the geographical dispersion of the Australian population (25–30% of the total population of 20 million live outside metropolitan areas), there has been considerable interest in the use of teleradiology. In general, the provision of teleradiology by private radiology practices has been successful. However, as regards the provision of publicly funded, statewide teleradiology services, progress has been slower than expected, following enthusiastic support for the technology in the early 1990s. While there have been some notable successes in the implementation of publicly funded teleradiology services, given the delays that have been experienced in Australia, there is a case for a closer connection between the conduct of teleradiology evaluation studies and the incorporation of the results into health policy. This link would ensure that the benefits of technology are made available to the public in as short a time as possible.
Telemedicine and clinical genetics: Establishing a successful service
Authors: Gattas M R , Macmillan J C , Meinecke I , Loane M , Wootton R
Published: October 2002

There is a surprising lack of published experience on the use of videoconferencing in clinical genetics. Patients were randomly allocated to either a telegenetic (cases) or face-to-face (control) conventional clinic. The telegenetic consultation was done by videoconferencing, using ISDN lines at 384 kbit/s. Evaluation by the doctor and counsellor took place immediately after each appointment. The patient was asked to evaluate the appointment by telephone questionnaire about four weeks after the event. Forty-two patients were invited to participate and 33 (79%) returned their consent forms. Four patients declined to participate and were seen in ordinary face-to-face clinics. Preliminary results showed that the assessment of the telegenetics consultations by doctors, counsellors and patients was very favourable, and they responded positively when asked if they would be happy to use telemedicine in the future. For use in selected consultations, videoconferencing does appear to fulfil a useful role in clinical genetics.
What constitutes success in telehealth?
Authors: Wootton R , Hebert M A
Published: October 2002

Before telehealth applications can be judged, there must be some general understanding about what constitutes success. At first sight it seems that defining success in a telehealth application should be relatively easy: a successful application is one that produces high-quality care at low cost. However, the calculation of cost requires some care, since it depends on assuming a particular financial perspective (the patient's, the health-careprovider's, or society's) and is meaningless without a statement of the workload being handled. Other factors include the context in which the service is being delivered. Ultimately, the political imperative may override any rational judgement of success.
Aviation medicine: challenges for telemedicine
Authors: Ferrer-Roca O , Díaz de León R D , de Latorre F J , Suárez-Delgado M , Di Persia L , Cordo M
Published: October 2002

The number and seriousness of medical problems on passenger-carrying aircraft in flight are increasing. Medical incidents occur at a rate of approximately 10–50 per million passengers carried. Medical equipment carried on commercial aircraft is limited to three items: a first-aid kit, an emergency medical kit and sometimes an automatic external defibrillator. Telephone medicine, a lower level of telemedicine support, is well established for commercial air operations. The availability of satellite telecommunications on passenger-carrying aircraft permits more sophisticated forms of telemedicine. Recent telemedicine experiments have involved the transmission of three-lead electrocardiograms (ECGs), heart rate, blood pressure, arterial oxygen saturation, end-tidal CO2, respiratory rate, body temperature and realtime video. The challenge is to demonstrate that such techniques are practicable, improve patient outcomes and are cost-effective.
Nurse–doctor interaction in teleconsultations between a hospital and a geriatric nursing home
Authors: Sävenstedt Stefan , Bucht Gösta , Norberg Lennart , Sandman P O
Published: October 2002

The aim of the present study was to elucidate both the interaction between a doctor and five registered nurses and the problems or tasks dealt with in teleconsultations between a university clinic for geriatric medicine and a nursing home for the elderly in northern Sweden. The interaction and problems or tasks were studied through analyses of video-recorded teleconsultations and through open interviews with the participating staff. The results indicated that teleconsultations between a geriatrician and the nurses at a nursing home for the elderly can be a useful tool for providing medical services. Teleconsultations alter both the 'power-control' and 'practice spheres' for the doctor and the nurses, and must be based on mutual trust. The use of teleconsultations gives the nurse a larger role as the presenter of medical problems, and gives the doctor the role of remote consultant.
Changes in the job situation due to telemedicine
Authors: Aas I H Monrad
Published: October 2002

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.
A review of guidelines and standards for telemedicine
Authors: Loane M , Wootton R
Published: October 2002

We conducted a review to establish the range and scope of current telemedicine guidelines and standards. Published guidelines were identified by searching the Medline and Telemedicine Information Exchange (TIE) databases, and by performing a Google search using the term 'telemedicine guidelines'. Three types of guidelines were identified, namely clinical, operational and technical. Clinical guidelines included those for teleradiology, telepsychiatry, home telenursing, minor injuries telemedicine, surgical telemedicine, teledermatology and telepathology. Operational guidelines included those for email communication, Internet access and videoconferencing. Technical guidelines included those from the American Telemedicine Association and the US Office for the Advancement of Telehealth. The main standards relevant to telemedicine include those of the International Telecommunication Union and the DICOM standard. The scarcity of guidelines and standards suggests that telemedicine is not yet near to routine use. If an international telemedicine organization were to take responsibility for defining guidelines, under the direction of clinicians with appropriate telemedicine experience, this might speed up their development.
Teleconsultation as a replacement for referral to an outpatient clinic
Authors: Jaatinen Pekka T , Aarnio Pertti , Remes Jouko , Hannukainen Jorma , Köymäri-Seilonen Tarja
Published: October 2002

We conducted a randomized case control study of referrals from a primary care centre in Finland. All the consultations and referrals from seven general practitioners (GPs) dealt with by internists and surgeons at Satakunta Central Hospital in Pori and geriatricians at Satalinna Hospital in Harjavalta over five months were included. For patients in the control group, a conventional referral letter was sent to the hospital outpatient clinic. For patients in the intervention group, the GPs had to decide whether they wanted an electronic consultation with the hospital or wanted to refer the patient (i.e. to transfer responsibility for treatment). Communication with the hospital specialist was then via a secure Web-based system. Ninety-three patients consented to participate in the study. None refused, although there were 15 non-attenders. Satisfaction data were collected from questionnaires completed by the patients and doctors. All the patients treated by teleconsultation said that they wanted the same procedure in future and 63% of the control group said they would prefer a teleconsultation next time. The doctors quickly learned to exploit the telemedicine model successfully. The responsibility for treatment was maintained in the health centre in 52% of cases using teleconsultation, without any visit to hospital being required. The GPs and the hospital doctors agreed on the follow-up treatment. Telereferral increased the possibility of the GP maintaining responsibility for the treatment. The reduced number of hospital visits in the telemedicine model should produce significant cost savings.
Assessment of prehospital chest pain using telecardiology
Authors: Scalvini Simonetta , Zanelli Emanuela , Conti Claudia , Volterrani Maurizio , Pollina Riccardo , Giordano Amerigo , Glisenti Fulvio
Published: October 2002

Two hundred general practitioners were equipped with a portable electrocardiograph which could transmit a 12-lead electrocardiogram (ECG) via a telephone line. A cardiologist was available 24 h a day for an interactive teleconsultation. In a 13-month period there were 5073 calls to the telecardiology service and 952 subjects with chest pain were identified. The telecardiology service allowed the general practitioners to manage 700 cases (74%) themselves; further diagnostic tests were requested for 162 patients (17%) and 83 patients (9%) were sent to the hospital emergency department. In the last group a cardiological diagnosis was confirmed in 60 patients and refuted in 23. Seven patients in whom the telecardiology service failed to detect a cardiac problem were hospitalized in the subsequent 48 h. The telecardiology service showed a sensitivity of 97.4%, a specificity of 89.5% and a diagnostic accuracy of 86.9% for chest pain. Telemedicine could be a useful tool in the diagnosis of chest pain in primary care.
Radiological videoconferencing in Sweden
Authors: Kehler M , Bengtsson P O , Freitag M , Lindstrom B , Medin And J
Published: October 2002

For the last four years there has been a videoconferencing link between the Karlskrona hospital and the university hospital of Lund. Because of a need to transmit angiographic films, its use has been gradually expanded to become an everyday routine, used for both elective and emergency examinations. During 1994 and 1995, 1121 cases were examined over the video link. Apart from 156 normal cases all were discussed with surgeons, most at 96 weekly conferences but approximately 50 at conferences taking place as soon as possible after the examination. Assuming that an average of three doctors attended the conferences before the video link was available, this amounts to a saving of 3 8 h in travelling time per videoconference. The average salary was 300 SKr/h and train tickets cost a further 400 SKr per person. The cost of the ISDN connection was approximately 1800 SKr/conference. The net gain was thus about 6500 SKr per videoconference, without taking into account the work that could be done with the doctors still in Karlskrona after the conference.
Low-power radio telemetry: the potential for remote patient monitoring
Authors: Scanlon W G , Evans N E , Crumley G C , Mccreesh Z M
Published: October 2002

Radio-based signalling devices will play an important role in future generations of remote patient monitoring equipment, both at home and in hospital. Ultimately, it will be possible to sample vital signs from patients, whatever their location and without them necessarily being aware that a measurement is being taken. This paper reviews current methods for the transmission by radio of physiological parameters over ranges of 0.3, 3 and 30 m, and describes the radiofrequency hardware required and the carrier frequencies commonly used. Future developments, including full duplex systems and the use of more advanced modulation schemes, are described. The paper concludes with a case study of a human temperature telemeter built to indicate ovulation. Clinical results clearly show the advantage to be had in adopting radio biotelemetry in this instance.
Medical decision support for remote general practitioners using telemedicine
Authors: Armstrong I. J. , Haston W. S.
Published: October 2002

A telemedicine link was set up between the casualty department of a remote community hospital and the accident and emergency department of a large urban hospital. The telemedicine link comprised teleradiology, videoconferencing and telepresence. The system was connected by ISDN 128 kbit/s and also by a satellite link 64 kbit/s . During a one-year clinical trial, 120 teleconsultations took place between the community hospital and the specialist trauma centre, 110 using ISDN and 10 using the satellite link. Teleradiology was used in 116 teleconsultations, videoconferencing in 76, and telepresence in four. Survey results indicated that both the general practitioners running the community hospital and accident and emergency consultants felt that teleconsultation had improved patient care. Communication between clinicians using the telemedicine link avoided the transfer of 70 patients, representing an estimated cost saving of 65,000.
AUDIOMAT: an electronic newspaper for visually impaired people
Authors: Pepino A. , Bracale M. , Liotto D.
Published: October 2002

Electronic newspapers are now becoming available via wide-area computer networks, such as the Internet. Unfortunately, the Windows-based graphical user interface of the client programs makes it difficult for visually impaired people to use such services. Furthermore, few visually impaired people have a PC. The AUDIOMAT project was designed to provide a reading system for the visually impaired, thus giving this community in the Campania region of southern Italy the opportunity to read their local newspaper. In a pilot trial, three blind subjects used the AUDIOMAT system daily for two months. Despite some minor technical problems the system performed well and a wider validation phase is now planned.
Realtime ultrasound diagnosis over a wide-area network (WAN) using off-the-shelf components
Authors: Falconer J , Giles W , Villanueva H
Published: October 2002

A trial system was developed for relaying realtime ultrasound images from an obstetric referral centre, the Maitland Hospital, to a tertiary-care centre, the John Hunter Hospital in Newcastle. The sites were approximately 30 km apart and connected by a microwave link at 2 Mbit/s. The pilot study demonstrated the feasibility of realtime ultrasound transmission using commonly available components.
Telecare equipment in the home. Issues of intrusiveness and control
Authors: Fisk Malcolm J
Published: October 2002

Telecare in the home offers substantial benefits tousers. However, the manner of its development and technological configuration will determine the extent to which it is acceptable and will meet clinical and social objectives. There are important issues of intrusiveness and control. An ethical framework for telecare is needed.
Telemedicine and the New Children's Hospital (Royal Alexandra Hospital for Children)
Authors: Manson Nick
Published: October 2002

Telemedicine is an important factor in the future strategy of the Royal Alexandra Hospital for Children. As a state, national and international centre of excellence, it is the hospital's role to assist in the development of the best child health services. An important aim is to provide easy access to a full range of paediatric services through the provision of a comprehensive telemedicine service, which encompasses videoconferencing and tele-imaging, and positions the child as the centre of service provision. Experience so far suggests that in Australia, as in other countries, the adoption of telemedicine may outstrip the ability of the legislative and administrative frameworks to keep pace. Thus, the enablers appear to be cultural and technological while the obstacles are rooted in the way in which health systems are financed and administered.