bluuebunny/crossref_metadata_2025 huggingface dataset:
An assessment of care provided by a public sector STD clinic in Cape Town
Authors: Mathews C , Coetzee N , Rensburg A Van , Lombard C J , Ballard R C , Schierhout G , Fehler H G
Published: October 2002

A study was undertaken in a Cape Town public sector STD clinic to evaluate the content and quality of care provided since it has been recognized that appropriate improvements in the management of conventional sexually transmitted diseases (STDs), including provision of correct therapy, health education, condom promotion and partner notification, could result in a reduced incidence of HIV infection. Our objectives were to assess patients' needs for health education and to assess the quality of STD management in terms of health education, condom promotion, partner notification, the validity of the clinical diagnoses and the adequacy of the treatments prescribed. The study subjects were sampled systematically, according to their gender. Patients included in the study were given a standardized interview and their clinical records reviewed. Specimens were collected for laboratory investigations. For each STD detected, the treatment was defined as adequate if drugs currently known to be active against that infection were prescribed. One hundred and seventy men and 161 women were included in the study (median age: females 22 years, males 26 years). While almost all patients believed their STD may have been caused by unprotected sexual intercourse, many also believed it may have been caused by other factors, such as bewitchment with traditional medicine. Only 21% of male and 37% of female patients received any education about STD transmission during the clinic visit, and only 25% of male and 36% of female patients received education about condom use. As a result of the low sensitivity of the clinicians' diagnoses, 16% of men and 61% of women left the clinic with at least one infection inadequately treated. The majority of patients were not receiving education for the prevention of STDs including HIV. Many were not receiving adequate treatment for their infections. The introduction of a syndromic management protocol in this setting would substantially reduce the proportion of inadequately-treated patients. However, syndromic protocols, and the means by which they are implemented, need to take into account problems with the clinical detection of genital ulcerative disease and candidiasis in women.
PCR testing of genital and urine specimens compared with culture for the diagnosis of chlamydial infection in men and women
Authors: Young H , Scott G R , Patrizio C , Moyes A , Horn K , Sutherland S
Published: October 2002

Our aim was to determine the number of chlamydial infections detected by Cobas Amplicor CT/NG multiplex polymerase chain reaction (PCR) testing of genital and first-voided urine (FVU) specimens compared with routine culture. Two hundred and eighty-six female and 276 male patients attending the Genito-Urinary Medicine (GUM) Unit at Edinburgh Royal Infirmary were included in the study. Case notes were analysed retrospectively to determine how many infected patients would not have been treated had diagnosis relied on routine culture. Polymerase chain reaction on FVU from women had a sensitivity, specificity, positive and negative predictive value of 91%, 100%, 100% and 99.1%: corresponding values for genital PCR and culture were 96%, 100%, 100%, 99.6% and 65%, 100%, 100%, 96.7% respectively. PCR on FVU from men had a sensitivity, specificity, positive and negative predictive value of 96%, 99.1%, 92.6% and 99.5%: corresponding values for genital PCR and culture were 89%, 99.5%, 95.8%, 98.6% and 48%, 100%, 100%, 94.3% respectively. In both men and women genital PCR and urine PCR were significantly more sensitive than culture. PCR almost doubled the number of patients detected by culture (49 vs 27). Of the 22 cases detected only by PCR 8 would not have received treatment on the basis of clinic treatment policy.
Mannose-binding protein in HIV-seropositive patients does not contribute to disease progression or bacterial infections
Authors: Mcbride M O , Mcclure M O , Weber J N , Fischer P B , Turner M W , Summerfield J A , Sumiya M , Skinner C J
Published: October 2002

This study set out to investigate whether plasma mannose-binding protein (MBP) deficiency caused by mutations in the MBP gene associates with pyogenic or opportunistic infections in HIV-infected patients. Plasma samples were selected randomly from 131 HIV-infected patients followed prospectively for a period not exceeding 12 months or until death. Plasma MBP concentrations were measured by an ELISA and genotyping was determined by amplification of exon 1 of the MBP gene by polymerase chain reaction (PCR) technology, followed by restriction enzyme analysis and Southern blotting using sequence-specific oligonucleotide probes. Neither MBP concentration nor genotype was found to associate with disease progression or opportunistic infection rate. There was an unexpected increased bacterial infection rate in patients with MBP levels greater than 100 ng/ml and wild type genotype. Thus, MBP does not appear to play a role in HIV infection. MBP is an acute phase reactant and this may explain the higher levels in those with more frequent pyogenic infections.
Anal cytological abnormalities in HIV-infected homosexual men
Authors: Sayers S J , McMillan A , McGoogan E
Published: October 2002

This study aimed to examine the prevalence of anal cytological abnormalities in groups of HIV-infected and non-infected homosexual men, and to monitor changes with time. Dyskaryosis suggestive of anal intraepithelial neoplasia (AIN) was noted in 24 (30%) of the 80 satisfactory anal smears from 66 HIV-seropositive homosexual men; such changes were found in only 7 (4.7%) of the 149 satisfactorysmears from 181 HIV-seronegative homosexual men (P<0.005), and in none of 34 satisfactory preparations from 51 HIV-seronegative heterosexual men. In the follow-up of 20 HIV-seropositive men, the severity of the cytological abnormalities found in 2 men increased, with the most recent smear showing changes suggestive of AIN III; one of these men subsequently developed anal cancer. Smears from 4 men showed apparent regression in the degree of dyskaryosis. Although the numbers of patients studied were small, there appeared to be a trend towards a more severe degree of dyskaryosis in those men with increasing immunodeficiency. There was no significant difference in the detection of human papillomavirus types 6b, 11, 16 and 18 between HIV-infected and non-infected men.
The effect of nonoxynol-9 and chlorhexidine on HIV and sperm in vitro
Authors: Harrison C , Chantler E
Published: October 2002

Summary: The effect of chlorhexidine and nonoxynol-9, either singly or in combination, on the replication and infectivity of HIV and the survival of both lymphocytes (MT2 cells) and human spermatozoa, was studied in vitro . Exposure of MT2 cells to 200 mug/ml nonoxynol-9 or 1 mg/ml chlorhexidine for one minute destroyed their viability. A combination of 60 mug/ml of nonoxynol-9 and chlorhexidine, however, killed MT2 cells under the same conditions. Nonoxynol-9 and chlorhexidine were both spermicidal, 268 mug/ml nonoxynol-9, or 2.063 mg/ml chlorhexidine caused complete immobilization of sperm after one minute. The same effect was achieved by a combination of 200 mug/ml nonoxynol-9 and 1.0 mg/ml chlorhexidine. The effect of chlorhexidine and nonoxynol-9 on the replication of HIV was estimated by the output of p24 (the HIV core protein) and the concentration of virus was determined by titration with MT2 cells. Separately, 300 mug/ml nonoxynol-9 alone completely inactivated HIV, while 1 mg/ml chlorhexidine was 80%-100% effective. Certain combinations of nonoxynol-9 and chlorhexidine were antagonistic in their inactivation of HIV, up to 400 mug/ml chlorhexidine partly neutralized the action of 200-500 mug/ml nonoxynol-9.
Heterosexual behaviour, risk factors and sexually transmitted infections among selfclassified homosexual and bisexual men
Authors: Evans B A , Bond R A , Macrae K D
Published: October 2002

Our study of men presenting at a genitourinary medicine clinic shows that self-classification into homosexual or bisexual does not accurately define behaviour. We found that 8.5% of self-defined homosexual men had had heterosexual intercourse in the past year and that 26% of self-defined bisexual men had not. Overall, 19% of homosexual/bisexual men reported vaginal intercourse in the past year and a further 42% in their lifetime. Compared with heterosexual men attending our clinic, the practising bisexual men were significantly more likely to come from a white ethnic group ( P 0.003) and to use condoms invariably with regular female partners ( P =0.0001). There was no significant difference in consent for HIV testing between homosexual (43%), practising bisexual (49%) and heterosexual (42%) men despite significantly different perceptions of risk. None of the practising bisexual men was seropositive for HIV infection ( P =0.06) or for syphilis ( P =0.02), or had chlamydial infection, which was found infrequently among homosexual men in general ( P =0.00001). HIV infection found in 19.4% of the exclusively homosexual men was associated with more frequent alcohol consumption ( P =0.06). <
The Control and Management of the Sexually Transmitted Diseases: A Comparison of the United Kingdom and the Russian Federation
Authors: Renton A M , Borisenko K K , Tichonova L I , Akovbian V A
Published: October 2002

During the last 20 years, both the United Kingdom and the Russian Federation have seen changes to clinical services for sexually transmitted diseases (STDs) health systems and other mechanisms through which STDs are controlled. In the UK these changes followed the description of the acquired immunodeficiency syndrome (AIDS) and the human immunodeficiency virus (HIV); its causal agent. In Russia, the breakdown of the Soviet Union following glasnost and perestroika, and its associated political, social and economic changes generated substantial developments to the ideological and legislative framework within which STD control is achieved as well as a revolution in the ® nancial base upon which clinical STD services operate. The purpose of this paper is to sketch these developments in STD services within the 2 countries to provide a context for the series of papers presented in this edition.
Relationship between Human Papillomavirus (HPV) Genotyping and Genital Neoplasia in HIV-Positive Patients of Santos City, São Paulo, Brazil
Authors: Gonçalves M A G , Massad E , Burattini M N , Villa L L
Published: October 2002

Among HIV-positive women, infection with multiple human papillomavirus (HPV) types is known to be more frequent and persistent, as well as a greater prevalence of high-grade genital lesions. This study aims to characterize, for the first time in Brazil, HPV presence and types among HIV-positive women of a high-risk population for genital intraepithelial neoplasia (GIN) development. A non-anonymous, voluntary, cross-sectional epidemiological survey was conducted, from June 1996 to April 1997, among 141 HIV-positive women followed at the Center of Reference in AIDS (CRAIDS). They were submitted to gynaecological examination, cytological screening and biopsies whenever necessary, for GIN and HPV DNA detection through polymerase chain reaction (PCR) technique. Positive HPV DNA were found in 80.8% patients. Two or more HPV types were detected in 45% of the samples. The most frequent HPV types detected were 16, 18 (30.5%); 61, 53 (24.4%), and non-identified types (18.7%). According to the oncogenic potential, 34.8% were considered of high-risk types. Among these HIV-positive patients, a great variety of HPV types, including high-risk types, was found in anogenital environment, as well as among young women, a great prevalence of high-grade genital lesions. Thus, it should strengthen the need for a periodical careful gynaecological examination among those women.
A New, Clinically-Based Algorithm for the Diagnosis of HIV in African Tuberculosis Patients: Cross-Sectional Analysis from Mzuzu, Malawi
Authors: Kelly Paul M , Cumming Robert G , Kaldor John M , Irwig Les M
Published: October 2002

We aimed to create an improved, clinically-based algorithm for the diagnosis of HIV in tuberculosis (TB) patients. Cross-sectional analysis was performed on data from adult TB patients consecutively diagnosed at a Malawian district level hospital. Of 225 patients, 187 with valid HIV results were included in the study. Sixty-seven per cent were HIV seropositive. Urban address, history of skin rash and sexually transmitted diseases (STDs) and, on examination, oral candidiasis and lymphadenopathy, were associated with HIV co-infection. Using these clinical characteristics, a case definition for HIV was constructed. The Mzuzu clinical case definition was highly sensitive (86%). The area under the receiver operating characteristic (ROC) curve was 0.81, significantly larger than existing World Health Organization (WHO) clinical case definitions. The Mzuzu definition is proposed for further evaluation in settings where HIV serological testing is not readily available.
Outcome of Contact Tracing for Chlamydia Trachomatis in a District General Hospital
Authors: Jarvis Ranjana Rani , Curless Eric , Considine Kay
Published: October 2002

The outcome of contact tracing (partner notification) for Chlamydia trachomatis in a district general hospital during the 5-year period between 1991-1995 was surveyed. During the 5-year period 1027 cases of C. trachomatis were diagnosed. The health adviser saw 928 (90%) of cases who reported 1132 (1.2) sexual contacts. Out of 682 sexual contacts sought by the health adviser, 472 (69.5%) were seen. Following a consultation with the health adviser, over two-thirds (86%) of index cases chose to inform their contacts themselves. Over two-thirds (71%) of contacts informed by these index cases were seen. A higher proportion of regular and first or most immediate contacts were seen as a result of contact tracing. A significantly higher proportion of partners of index cases who themselves returned for test of cure were seen.

A consultation with the health adviser facilitated uptake of partner notification by the index patients. Patient referral led to a majority of contacts being seen in a genitourinary medicine (GUM) clinic. Follow-up visits by index patients may improve outcome of contact tracing and should continue irrespective of need for test of cure.
Developing a model to enhance the capacity of statutory organisations to engage with lay communities
Authors: Pickin Christine , Popay Jennie , Staley Kristina , Bruce Nigel , Jones Christopher , Gowman Natasha
Published: October 2002

Objective: To understand the processes that constrain the capacity of statutory organisations to work effectively with lay communities and to develop a model to enhance their capacity to do so.

Methods: The research consisted of three elements: a review of relevant literature; in-depth interviews with a purposive sample of people who had recently been involved in community-statutory sector partnership; and a deliberative workshop involving ten expert witnesses, selected to reflect a range of sectors and levels within organisations.

Results: Many factors contribute to a lack of effective strategic partnerships between lay communities and statutory organisations. These factors fall into five domains: the community's capacity to engage; the skills and competencies of organisational staff; the dominant professional service culture; the overall organisational ethos and culture; and the dynamics of the local and national political systems. A model of the relationships and/or interaction between these domains is postulated. There is potential for testing this model with statutory organisations to see whether it concurs with their reality and whether it is enhancing their organisational capacity.

Conclusions: Commonly occurring constraints to effective partnerships between statutory organisations and lay communities need to be identified and addressed by applying a dynamic model of the type presented here.
Are decisions by purchasers in an English health district evidence-based?
Authors: Johnstone Paul , Lacey Prabha
Published: October 2002

Objectives: First, to investigate how many decisions by one commissioning body (district health authority) were based on evidence of effectiveness from randomised controlled trials (RCTs) and systematic reviews of RCTs. Second, to investigate whether other types of quantitative studies and qualitative studies could be used as evidence to support commissioning decisions.

Method: From three planning documents (for 1997-1998), all statements were identified. Effectiveness questions were constructed from each and used to search for evidence from trials and reviews in the Cochrane Library (Issue 4, 1998). Further searches for other studies (all methodologies) were performed on a subset of decisions and appraised by an independent expert panel.

Results: A total of 124 decisions were identified of which two-thirds concerned organisation of care. Evidence existed for less than half (48.4%) the decisions, with 33.9% favouring the decision and 14.5% where evidence was either equivocal or unfavourable. From a random subset of ten decisions, relevant non-randomised quantitative studies and qualitative studies were identified for half the decisions. Evidence from economic evaluations was identified for only one decision.

Conclusions: Large gaps in knowledge exist if health care purchasers are to base their decisions on evidence of effectiveness from RCTs. However, other types of evidence can be used to support such decisions. Summaries of research should be published in a format that is accessible to purchasers.
Extreme honesty may be the best policy
Authors: Kraman Steve S. , Hamm Ginny
Published: October 2002

This paper reviewsa humanisticrisk management policy that includes early injury review, steadfast maintenance of the relationship between the hospital and the patient, proactive full disclosure to patients who have been injured because of accidents or medical negligence, and fair compensation for injuries. The financial consequences of this type of policy are not yet known; however, one Veterans Affairs medical center, which has been using humanistic risk management since 1987, has had encouragingly moderate liability payments. The Department of Veterans Affairs now requires such a policy for all of its facilities; therefore, comprehensive experience may be only a few years away.
Patients' perceptions of a telemedicine specialty clinic
Authors: Mair Frances , Whitten Pamela , May Carl , Doolittle Gary C
Published: October 2002

We studied patients' perceptions of telemedicine interactive video as a means of delivering specialist oncology/haematology care. Semistructured telephone interviews were performed with 22 patients attending a tele-oncology/haematology clinic in Kansas. Interviews were audio-taped and thematic content analysis of the transcripts was done. The response rate was 96%. All participants expressed satisfaction with their teleconsultations. For 50% of respondents, satisfaction with the tele-oncology/haematology clinic was qualified by two factors: participants also saw the specialist in person on occasions and the clinic was perceived as providing mainly a monitoring' function. In addition, 9 of the 22 patients expressed concern about the role of the nurse as a proxy for the doctor in performing certain parts of the physical examination. Overall, participants valued improved access to specialist services but had clear views as to the limitations of such a service. As the use of telecommunications technology grows, patient perspectives merit greater attention.
The AIDMAN project – a telemedicine approach to cardiology investigation, referral and outpatient care
Authors: Jones R W , Clarke M , Kanellopoulos N , Lioupis D , Fowles R
Published: October 2002

The AIDMAN pilot project will connect health clinics on remote Greek islands with a mainland hospital. We have developed a virtual consultation workstation for the project, together with a satellite communication network. A UK pilot site has been used to test the concepts and applications between a surgery in Chorleywood and St Mary's Hospital in London.
Latitude and noise comparisons between digital cameras and a radiographic film scanner
Authors: Whitehouse Richard , Moulding Fenella
Published: October 2002

The test image generated by a radiographic laser printer was used as a test object to measure the latitude and image noise of two digital cameras and a dedicated radiographic film scanner. The film scanner had the widest latitude and least image noise. A Kodak digital camera had a wider latitude but more image noise than an Olympus camera. A blue filter on the Olympus camera increased the latitude without significant increase in image noise.
Postoperative evaluation of patients following ophthalmic surgery
Authors: Murdoch Ian , Bainbridge James , Taylor Paul , Smith Lindsey , Burns Juliat , Rendall Jackie
Published: October 2002

We have used telemedicine to support the postoperative evaluation of patients who have had ophthalmic surgery. Mobile telemedicine workstations connected using three ISDN lines have enabled us to review patients at an outreach clinic on the first postoperative day. Video slit-lamp images of the patient are captured by a trained ophthalmic nurse at the outreach clinic and viewed by surgeons at Moorfields Eye Hospital in central London during live teleconsultations. During the study period, over 80 teleconsultations were carried out on postoperative cataract, trabeculectomy and combined procedures. Preliminary results are very encouraging. Although 8 (33%) of 24 patients were anxious about being involved in the teleconsultation, 20 (83%) had confidence in the system and only one (4%) found the experience unacceptable.
Patient satisfaction with a home televisiting service based on interactive television over a cable network
Authors: Valero M A , Arredondo M T , Del Nogal F , Rodríguez J M , Frías E
Published: October 2002

Experience shows that high-quality audio-visual contact between remote health carers and patients facilitates a telemedicine service. However, the lack of broadband communication to the home usually prevents domestic televisiting. Deployment of cable networks in Spain has allowed the implementation of a home televisiting service designed for patients with chronic diseases. In a trial, 15 patients received televisits by three specialists and three nurses from the Severo Ochoa Hospital in Madrid. Five patients suffered from chronic pain, five were from the nephrology unit and five had been treated at the intensive-care unit after acute myocardial infarction. Each patient participated in three televisiting sessions, two provided by a specialist and the other by a nurse. The average length of a televisit was 12 min (range 5–21 min). The patients expressed their satisfaction with the service.
School-based telemedicine: Teachers’, nurses’ and administrators’ perceptions
Authors: Whitten Pamela , Cook David , Kingsley Charles , Swirczynski Debbi , Doolittle Gary
Published: October 2002

In 1997, a telemedicine project began in Kansas which brought health-care directly into elementary schools using interactive video-links. The project initially involved four schools, but was expanded to cover 10 schools, including two middle and one high school. We examined the organizational issues related to telemedicine links to schools. Specific attention was paid to the perceptions of the nurses, teachers and key administrators. The research involved analysing archive data and interviewing participants in the project from the schools and the medical centre. The results showed the difficulties in delivering health-care, especially by telemedicine, to under-served urban children. However, the data also revealed that these can be overcome. Once they had experienced it at first hand, almost all concerned began to see telemedicine as an effective and important asset to the delivery of health-care.
The design of a practical and reliable fall detector for community and institutional telecare
Authors: Doughty K , Lewis R , Mcintosh A
Published: October 2002

Falls are one of the greatest obstacles to independent living for frail and elderly people. Their early detection is an important step in providing people with the reassurance and confidence necessary to maintain an active lifestyle. We have investigated a worn fall detector linked to a community alarm system. A worn device is the only one which is satisfactory, provided that it generates few false alarms. The fall detector we have developed is the size of a small radio pager. It uses a two-stage detection process which senses shock and the orientation of the wearer. A fall is detected within 20 s and triggers a radio signal to a community alarm system. Tests were devised using a jointed mannequin to simulate five modes of falling to understand the effects of impact at different parts of the body. This allowed us to select the appropriate trigger threshold and wearing positions for the sensor. Prototypes were evaluated with 20 people to observe false alarms. The final design allowed reliable detection in 180 different falling scenarios.
A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing
Authors: Elford R , White H , Bowering R , Ghandi A , Maddiggan B , John K St
Published: October 2002

We used a PC-based videoconferencing system to conduct child psychiatry assessments. The telecommunications link was six digital lines, giving a total bandwidth of 336 kbit s. Twenty-three patients aged 4-16 years, accompanied by their parents, completed two psychiatric assessments, one via videoconferencing and another face to face FTF. The order of assessments was randomized. Questionnaires were used to record the diagnosis, treatment recommendations and the psychiatrists', patients' and their parents' satisfaction with each assessment. An independent evaluator concluded that in 22 cases 96 the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF. The psychiatrists stated that videoconferencing assessments were an adequate alternative to FTF assessments and did not interfere with diagnosis. However, the responses from the psychiatrist satisfaction questionnaire showed that they preferred FTF assessments. No significant difference was found in the patients' or parents' satisfaction responses after the two types of assessment. The majority of children 82 liked' using the telepsychiatry system and six 26 preferred it to a FTF assessment. Most parents 91 indicated that they would prefer to use the videoconferencing system than to travel a long distance to see a psychiatrist in person.
Development of a Web-based picture archiving and communication system using satellite data communication
Authors: Hwang Seoncheol , Lee Jeongwhan , Kim Heejoung , Lee Myoungho
Published: October 2002

Using the JAVA language we have developed a Web-based picture archiving and communication system PACS which allows a remote hospital to access medical images. An asymmetric satellite data communication system ASDCS provided a receive-only link for data delivery and a conventional terrestrial link which could be the conventional telephone network allowed data transmission. The satellite communication link was 10- 30 times faster than the conventional terrestrial link. To increase image transmission speeds over the Internet connection, JPEG and wavelet compression methods were used. The resulting images were evaluated quantitatively by measuring the peak signal:noise ratio and qualitatively by radiologists. Compression ratios of 10:1 or less were deemed acceptable for diagnostic purposes. The system appears to be suitable for teleradiology and telemedicine.
A pilot study of telemedicine for new neurological outpatient referrals
Authors: Craig John , Chua Richard , Wootton Richard , Patterson Victor
Published: October 2002

We investigated whether new patients attending a neurological outpatient clinic could be safely managed by neurologists at a distance, using a video-link. In Northern Ireland, a video-link, transmitting at 384 kbit/s, was set up between a neurological centre and a small rural hospital 140 km away. Twenty-five unselected patients who had been referred by their family doctor were assessed by a neurologist using the telemedicine link and then immediately by another neurologist face to face. Examiners were blinded to the results of each other's assessment. In 24 cases the diagnoses made after the telemedicine and face-to-face examinations were identical. There were minor differences between the type and number of investigations requested, and the requirements for treatment and follow-up between the two groups. Disposal method was the same in 21 of the cases. No major organizational difficulties were encountered during the study. The study showed that neurologists can deliver outpatient neurological care to distant patients using telemedicine. This has the potential to allow access to assessment for the large number of neurological outpatients who might otherwise be denied it.
The reovirus project: An application of distributed visualization
Authors: Green Mark , Bowman Douglas , Goulden David , Rittenhouse Dave , Sun Hanqiu , White Lloyd
Published: October 2002

This paper describes a distributed visualization of the operation of a reovirus. This visualization allows several groups of users at different locations to view how the virus behaves in normal and cancer cells. The users at each location can interact with the visualization and the other users. The techniques used to produce this visualization include the reduction of geometrical complexity, user representation and interaction with the visualization. Future work includes improving the explanations of the reovirus and providing users with different views of the animation highlighting various aspects of the virus's behaviour.
Low-cost video-films in the teaching of undergraduate and postgraduate medical students
Authors: Lewis L , Jones J , Haynes E
Published: October 2002

The high cost of producing good-quality video-films for teaching has hindered the use of this method, which has been shown to improve significantly the efficiency of teaching and the retention of knowledge. During the last five years, a series of short video-films has been produced using inexpensive video-cameras and home video-recording and editing equipment. A variety of techniques were developed to allow recording of lecture presentations, while using the equipment as a teaching aid, without the need for technical staff. The positioning of the camera, the monitor, the slide projector and lighting were critical to the productions. Similar productions at low cost were obtained from recordings of operating theatre sessions, tutorials and clinical ward rounds. A survey of students exposed to teaching with video-film as part of a lecture presentation confirmed that the subject matter being taught was more easily understood and enjoyable and generated more discussions on than other forms of teaching.
Transforming continuing education materials for on-line learning
Authors: Ryan David , Waterston Rosemary
Published: October 2002

Internet-based learning is a growing trend in continuing education for health professionals. We have developed an on-line version of four workshops for practising physicians, tracing a patient's course from the initial diagnosis of dementia to end-of-life care. We have also developed an on-line dementia toolkit that could evolve with changing knowledge. The toolkit consisted of reference material collected from a variety of sources and vetted by our team of experts to address the common complaint that the sources of on-line reference materials are often unauthenticated. The Geriatric Forum provides an array of resources for health professionals.
A telemedicine system for enabling teaching activities
Authors: Masero V , Sanchez F M , Uson J
Published: October 2002

In order to improve the distance teaching of minimally invasive surgery techniques, an integrated system has been developed. It comprises a telecommunications system, a server, a workstation, some medical peripherals and several computer applications developed in the Minimally Invasive Surgery Centre. The latest peripherals, such as robotized tele-operating systems for telesurgery and virtual reality peripherals, have been added. The visualization of the zone to be treated, along with the teacher's explanations, enables the student to understand the procedures of the operation much better.
Remote access to an expert system for infectious diseases
Authors: Tountas Y , Saroglou G , Frissiras S , Vatopoulos A , Salaminios F
Published: October 2002

An expert-system antibiotic information database was developed in order to help non-specialist doctors to choose the appropriate treatment for patients with infectious diseases. Fifty doctors conducted a pilot trial of the database, using modem access and the telephone network. During an eight-month study period, 1053 queries were received. The range of duration of the queries was 130-350s. Of the queries, 473 (45%) were for particular patients with an infectious disease. The response rate to a questionnaire mailed out to the users at the end of the project was 100%. All doctors, even those who had limited experience with computers, found it easy to understand and to use the database.
The use of email by doctors in the West Midlands
Authors: Evans Luc , Nicholas Paul , Hughes-Webb Paul , Fraser Carol-Lynne , Jamalapuram Kasyap , Hughes Ben
Published: October 2002

We surveyed the use of email by doctors in the West Midlands. In addition to 224 questionnaires distributed to doctors at three large hospitals, 300 general practitioners (GPs) selected randomly from a list of 711 were also sent questionnaires. There was a 60% response rate. Overall, 65% of the 314 respondents used email, but 84% of hospital doctors used email compared with 55% of GPs. Email was used mainly for communication with friends and family (92%) and work colleagues (61%), with only 7% using email for transmitting clinical data and 3% to send or receive referrals. Email usage showed a significant trend with respect to age, being highest in the 20-29-year age group and lowest among those aged over 60 years. Over 60% of respondents felt that email was not secure for the transfer of patient data. However, 90% felt that they would be using email in a clinical setting in five years' time. Despite the relatively high use of email for social communication, work-related use by doctors was low.
Factors affecting the use of a telephone-based intervention for caregivers of people with Alzheimer's disease
Authors: Feeney Mahoney D M , Tarlow B , Jones R N , Tennstedt S , Kasten L
Published: October 2002

We investigated the usefulness of a computer-mediated interactive voice response (IVR) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer's disease. The randomization procedure resulted in 49 caregivers being assigned to the intervention group and 51 to the control group. Using their ordinary telephone, the caregivers were linked to the four components of the IVR system: monitoring and counselling, an in-home support group, 'ask the expert', and a respite conversation. During an 18-month study, total system usage amounted to 55 min per user (SD 78, range 1-318). Half the participants used the system for at least 22 min, and 25% for at least 70 min. Participants made between one and 45 calls over the study period, averaging 11 calls (SD 12). Approximately half of the intervention group used the system regularly for two or more months. These 'adopters' were significantly older, more highly educated and reported a greater sense of management of the situation than 'non-adopters'. Adopters were much more likely than non-adopters to have been rated as highly proficient by the trainer following the technology training session. The IVR approach appealed to a subset of users. However, the overall preference was for human interaction.
Videoconferencing in the Queensland health service
Authors: Kennedy Craig , Blignault Ilse , Hornsby Danielle , Yellowlees Peter
Published: October 2002

Videoconferencing was introduced in the Queensland health service in 1995. By the end of 1999, there were more than 150 videoconferencing units in health facilities around the state. Six audits of videoconferencing usage were conducted using similar methodology at six-month intervals from November 1997 to May 2000. Between November 1997 and November 1999, the number of calls more than doubled, from 566 to 1378. Hours of usage almost trebled, from 671 to 1724. The average duration of calls remained similar, at about 1 h 12 min. The proportion of calls involving more than two sites (multipoint videoconferences) increased from 44% to 65%. The majority of the activity was for education (including training). Videoconferencing was also used for administration and clinical care. Mental health staff were the heaviest users, but use by health professionals from other specialty areas increased during the study period. The Queensland health service has realized a number of important benefits from telehealth.
The fall and rise of the South Australian telepsychiatry network
Authors: Kavanagh Steve , Hawker Fiona
Published: October 2002

The Rural and Remote Mental Health Service (RRMHS) has delivered telepsychiatry services through the use of videoconferencing to South Australian communities since May 1994. The survivability of the service results from a combination of factors that have seen the RRMHS expand to 48 centres and deliver an average of 100 clinical sessions a month. The key factors responsible for the success of the service lie in the model of service delivery, management support, and the implementation of a system for the scheduling and reporting of videoconference activity. The current model of service delivery has evolved over the past seven years and is fundamentally different to the infrastructure established at the implementation stage of the project. A retrospective analysis shows the shift in service delivery models necessary for the sustainability of telepsychiatry services in South Australia.
The development of a pilot telemedicine network in Scotland: Lessons learned
Authors: Brebner J A , Brebner E M , Ruddick-Bracken H , Wootton R
Published: October 2002

A pilot telemedicine network was established in 11 sites using funding provided by the Department of Trade and Industry in the UK. The main purpose of the project was to develop and evaluate clinical and educational links between central and peripheral sites in Scotland. The results were very encouraging, and clinical services were established in accident and emergency medicine, tele-ultrasound and clinical psychology. An undergraduate medical teaching service was also successfully established. All of these services are to be continued after the completion of the project. Many lessons were learned during the establishment of this network which will be useful in future projects. These included the importance of training for telemedicine users, the importance of identifying a telemedicine champion, the pitfall of health economics and the fact that services must be needs driven.
Taking telehealth to the bush: Lessons from north Queensland
Authors: Watson Julie , Gasser Lee , Blignault Ilse , Collins Robyn
Published: October 2002

Networking North Queensland (NNQ) was a two-year project to improve access to health services in rural and remote communities. The project involved email and Internet access in 61 communities, in a region almost three times the size of the UK. Videoconferencing equipment was also installed at 21 sites and a total of 197 h of videoconferencing was recorded at 10 of the remote sites over 12 months. As a result of the project, health consumers enjoyed improved access to medical, specialist, allied health and primary health services. In addition, health service providers had better access to reliable, up-to-date health-care information via intranet and Internet services. Consideration of local issues—local needs and existing resources—was vital to the achievements of the project. Community involvement and community access were also important factors in its success.
High-quality television links for home-based support for the elderly
Authors: Erkert Thomas
Published: October 2002

Since 1991, 17 elderly people have been connected via a broadband video communication system to a telecare centre. The new services used videophones based on domestic television sets, including set-top boxes with cameras and a microphone. The services had the overall aim of promoting the ability of elderly and mobility-impaired people to live independently and to reduce the demand on social service resources required to implement this. Service components included: remote response to emergencies; active information and care; information and assistance service; remote care on demand; remote access to expertise (counselling); training and exercise service; and support for carers. Some 14,000 calls have been made. The important qualitative aspects were: clients’ satisfaction; replacement of direct social contacts; privacy and data protection; and improving the effectiveness of social services. For a successful market implementation of video-based social support and telecare services, it is essential to integrate them into existing outpatient services.
Towards a comprehensive telecardiology monitoring centre for community-based services
Authors: Shanit D , Greenbaum R A
Published: October 2002

In a pilot study of primary-care telecardiology, 2563 consultations were carried out over 18 months. Following teleconsultation, 2076 patients (81%) were found to be suitable for management entirely by the general practitioner, without the need for referral to hospital. The system identified 487 patients (19%) with cardiac problems who required either admission to hospital or outpatient assessment. There was a resultant saving of referrals to hospital accident and emergency departments. Extension of the telecardiology service to include tele-echocardiography may result in faster access to diagnosis and better management of patients in heart failure, improving patients’ quality of life and reducing hospitalization.
Urban teleradiology in Hong Kong
Authors: Sheng Olivia R. Liu , Hu Paul Jen-Hwa , Au Grace , Higa Kunihiko , Wei Chih-Ping
Published: October 2002

We investigated four major teleradiology programmes in Hong Kong. We analysed the overall organizational background of each programme, the context of its implementation, the choice of technology and the decision-making process, and the subsequent dissemination of the technology. Our review suggests that the success of a telemedicine programme is contingent not only on good technology but also on effective management of issues pertaining to human and organizational factors. At the departmental level, the context of the implementation of telemedicine is crucial. At the institutional level, success depends on planning and management. At the professional level, continued education, periodic meetings and seminars are all effective means of promoting telemedicine among health-care professionals and administrators. At the national level, the Hong Kong experience suggests that telemedicine can be effectively developed by starting with urbanbased programmes.
Clinical applications of renal telemedicine
Authors: Mitchell J G , Disney A P S
Published: October 2002

In 1994, a telemedicine network was established linking the renal unit at The Queen Elizabeth Hospital to three satellite dialysis centres in South Australia. In the first two and a half years of operation, the telemedicine equipment was used on over 6000 occasions. Interviews were conducted with 18 medical, nursing and allied health staff and dialysis patients. The main finding was that the full range of staff, from surgeons and nephrologists to allied health staff and nurses, were able use the technology successfully for clinical purposes. A second finding was that the technology enabled staff to perform a wide range of clinical procedures, from routine outpatient consultations and monitoring infections to making decisions about retrieval or confirming decisions to operate. A third finding was that telemedicine enabled the renal unit to provide improved services in which teams of staff at the different sites cooperated in ways that were not possible before the telemedicine links became available.
Paediatric echocardiography by telemedicine-nine years' experience
Authors: Finley J. P. , Sharratt G. P. , Nanton M. A. , Chen R. P. , Bryan P. , Wolstenholme J. , Macdonald C.
Published: October 2002

In 1987 we established a realtime echocardiography service by telemedicine from the paediatric cardiology department of a tertiary-care hospital in Halifax. The service was initially provided to a single regional hospital but was expanded to six regional hospitals in the three Canadian Maritime Provinces. The system used a dialup broadband video-transmission service provided by the telephone companies. Records of all transmissions were kept prospectively and reviewed to January 1997. A total of 324 transmissions were made. During 1995- 96 there were 135 studies: 69 51 were urgent examinations of newborn children and 30 22 were urgent examinations of older children; repeat studies and postoperative checks usually for pericardial effusion accounted for the other 36 studies 27 . The images were of broadcast quality except in five cases where problems with transmission or poor sedation occurred. A comparison of 26 transmitted studies with repeat, in person' studies showed no important discrepancies in diagnosis. During the two-year study period, the cost of the network equipment leasing costs and telecommunications costs was C 90,000. Use of the telemedicine network saved unnecessary patient transfer in 31 cases. The cost of the transportation avoided was C 100,000-C 118,000. This review confirms our preliminary findings that broadband echocardiography transmission provides a service comparable in availability and accuracy to that provided in our paediatric cardiology division.
Feasibility of orthopaedic teleconsulting in a geriatric rehabilitation service
Authors: Couturier P , Tyrrell J , Tonetti J , Rhul C , Woodward C , Franco A
Published: October 2002

Fifteen elderly patients participated in a teleconsultation with an orthopaedic surgeon, which was then followed by a conventional, face-to-face consultation. The comparison between the surgeon's ratings for both types of consultation suggested that the telemedicine consultation was satisfactory in terms of the quality of image and sound, the clinical examination and general simplicity. The telemedicine consultations did not generate a need for any additional clinical investigations, although in two cases a face-to-face consultation was necessary to clarify clinical signs (shortening of a limb and scar tissue). The surgeon's rating of his decision level was superior in the face-to-face situation in four cases, and for 11 patients it was equal. Similarly, the surgeon's level of confidence in decision making was superior in the conventional situation for five patients and equal for 10 patients. Patient attitudes towards teleconsulting were favourable. There was a high level of patient satisfaction. Teleconsulting between orthopaedic surgeons and elderly patients therefore appears to be possible, provided that certain technical, clinical and psychological considerations are addressed.
The legal and ethical aspects of telemedicine
Authors: Stanberry B
Published: October 2002

The medical challenge presented by telemedicine is for doctors to find satisfactory ways of doing their jobs from a distance. The legal and ethical challenge presented by telemedicine is to ensure that the very highest standards are met from the outset. This can be achieved only by the legal and medical professions learning to combine their expertise, rather than by the former adopting the adversarial stance that has come to punctuate its relationship with the latter in recent years.