bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple sclerosis and quality of life: a qualitative investigation
Authors: Somerset Maggie , Sharp Deborah , Campbell Rona
Published: October 2002

Objectives: Many people who live with long-term illness experience a decline in their quality of life. The primary aim of this qualitative study was to identify aspects of life that contributed to the quality of the lives of people who had one particular chronic illness, namely multiple sclerosis (MS). A secondary aim was to use this information to highlight areas where there was potential for effective intervention by health or social services.

Methods: Sixteen people with MS who lived in a variety of circumstances and had a range of disabilities were interviewed in depth. Views relating to personal experience of chronic illness, diagnosis, living with disability, and conventional and alternative treatments were explored. Transcripts were analysed using a grounded theory approach.

Results: Analysis of the interviews revealed that being subjectively reasonably happy and as socially active as desired was central to an acceptable quality of life. The extent of the personal control that participants were able to exert and their individual illness trajectory were found to be central to whether or not this aim was achieved. In addition, the importance of social comparison was revealed, although its influence upon quality of life was somewhat inconsistent. A number of other factors were found to play an influential role in the quality of people's lives. These are described and plausible links between factors are proposed.

Conclusions: Many aspects of living with chronic illness are unavoidable, but health or social intervention can affect others. Inappropriate personal assistance may result in dependency, which detracts from personal control and worsens quality of life. When appropriate, however, support may have beneficial consequences. By recognising the specific factors that link personal control and the illness trajectory, appropriate and timely support can be negotiated.
'Inappropriate' attendance at an accident and emergency department by adults registered in local general practices: how is it related to their use of primary care?
Authors: Martin Alison , Martin Christopher , Martin Peter B , Martin Peter AB , Green Gill , Eldridge Sandra
Published: October 2002

Objectives: To identify the relationship between 'inappropriate' attendance at an accident and emergency department (AED) by adults registered with local general practices and their use of primary care.

Methods: A case-control study matched for age, sex, distance from the AED, social class and registered general practice and set in a single AED and two health centres in South Essex. The participants were a total of 452 patients over 15 years old from the two health centres classified as having attended the AED 'inappropriately' in 1997 as identified by a modified Sheffield process method, and 452 controls. The predictive variables were measures of utilisation in the year 1997, including number of contacts in primary care, referral and investigation costs. Measures of morbidity were collected as potential confounders. These included a recorded history of anxiety or depression in the year 1997, or being in receipt of repeat prescriptions in that year.

Results: The rate of 'inappropriate' attendance was 16.8% {95% confidence interval (CI): 15.7-18.0}. All measures of utilisation and markers of anxiety and depression were significantly positively associated with 'inappropriate' attendance, but there was no association with markers of chronic morbidity. Only the number of general practitioner (GP) appointments ( P < 0.0001) and out-of-hours advice calls ( P < 0.0001) were independently correlated with 'inappropriate' attendance in a conditional logistic regression. 'Inappropriate' attendees had approximately twice as many GP appointments and 10 times as many out-of-hours telephone contacts with the GP.

Conclusions: GP-registered, 'inappropriate' attendees at AEDs utilise primary care services more than matched controls; this pattern of service utilisation appears to be unrelated to chronic physical illness. Thus, simply providing new, directly accessible primary health care services may not significantly reduce AED use.
What does 'access to health care' mean?
Authors: Gulliford Martin , Figueroa-Munoz Jose , Morgan Myfanwy , Hughes David , Gibson Barry , Beech Roger , Hudson Meryl
Published: October 2002

Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration.
General practitioners' perceptions of store-and-forward teledermatology
Authors: Collins Karen , Nicolson Paula , Bowns Ian , Walters Stephen
Published: October 2002

We studied the views of 26 general practitioners (GPs) towards store-and-forward teledermatology before its introduction into their practices. A postal questionnaire was developed using Likert-type questions with respondents able to explain their answers in free text. Questions related to the GPs' knowledge, perceptions and expectations of teledermatology, as well as their attitudes towards being part of a research trial. Most of the GPs had limited prior knowledge of teledermatology. They perceived its role to relate to quicker access to specialist opinions, decreased referrals, increased convenience for patients, diagnosis, and education and teaching. There was an overwhelming view that any system needed to be quick, easy to use, efficient and reliable. Concerns were expressed about being part of the clinical trial, using new technology and an increased workload. The future of teledermatology was thought to depend on the clinical adequacy of the system.
'Smart' homes and telecare for independent living
Authors: Tang Puay , Venables Tim
Published: October 2002

Telecare services and 'smart' homes share a common technological base in information technology and telecommunications. There is growing interest in both telecare services and smart homes, although they have been studied in isolation. Telecare has been driven largely by perceived cost savings and improved service delivery to the home, leading to improved quality of life and independent living. Smart homes are also expected to provide better and safer living conditions. The integration of the two should produce more secure and autonomous living. There are different forms of telecare services, as there are different types of smart homes, each ranging from basic systems involving the use of alarms and the ordinary telephone to intelligent monitoring with sensors and interactive communication. The introduction of these systems has policy implications, such as the need for coordination between health, social services and housing policy makers, which will reduce duplication and inefficient allocation of resources. Successful delivery of telecare to the home is as much dependent on the construction and condition of the housing stock as it is on the ability of the care provider to meet users' needs. If the UK National Health Service (NHS) could replace a significant proportion of domiciliary nursing visits by telephone calls, then savings of up to 200 million per annum would be possible.
Telemedicine activity at a Canadian university medical school and its teaching hospitals
Authors: Aires L M , Finley J P
Published: October 2002

Dalhousie University Medical School and its teaching hospitals have been providing clinical telemedicine services since 1987. The object of the present study was to assess the extent and growth of telemedicine at the medical school and teaching hospitals, as well as to evaluate the obstacles to its deployment. This was achieved by conducting structured personal interviews with telemedicine providers. Twenty telemedicine programmes were identified, of which 15 were operational and five were being planned. The number of established telemedicine projects had doubled in the six months preceding the study. A wide variety of telemedicine services were provided, ranging from clinical consultations in a number of medical specialties to patient education, grand rounds and continuing medical education. These services were provided to sites in a wide area in the Maritime region and internationally. The three most important obstacles to the implementation of telemedicine were a lack of knowledge about telemedicine (80% of respondents), time constraints (75%) and funding (70%).
Initial experience with a wireless personal digital assistant as a teleradiology terminal for reporting emergency computerized tomography scans
Authors: Reponen J , Ilkko E , Jyrkinen L , Tervonen O , Niinimaki J , Karhula V , Koivula A
Published: October 2002

A new type of terminal device, a wireless personal digital assistant (PDA) based on a GSM digital cellular phone, was used to transmit computerized tomography scans of 21 patients to a neuroradiologist. All transmitted images were suitable for a preliminary consultation and in one case a final report could be made. In 18 cases the findings were compatible with the reference film reading performed later and in three cases there were minor differences of no clinical importance. Transmission of a single image lasted 1 min 30 s and the transmission of a complete brain scan (14 images) took on average 21 min. The total process of transmission and interpretation of a brain examination series took on average 40 min. In this pilot study the neuroradiologist gained essential information in 24% of the cases and beneficial information in 62%. The neuroradiologist considered that the image consultation saved a hospital visit in 15 cases (71%). Although PDA technology is at an early stage of development and has numerous limitations, it is likely that future technical improvements will allow easier clinical consultations for neurosurgeons and neurologists.
Using telemedicine to facilitate training in cardiotocography (CTG) interpretation
Authors: Morris D G
Published: October 2002

Electronic fetal monitoring is a controversial practice in modern obstetric care and is frequently an aspect of medicolegal cases involving the management of labour and delivery. The interpretation of the cardiotocograph (CTG) produced by such monitors is a skill required by those caring for the pregnant woman. Studies have shown that most ‘experts’ do not interpret CTGs in a consistent manner, when compared with either other experts or themselves. However, it has also been shown that consistency can be improved with training. Telemedicine has been used to advantage in the training of obstetrics and gynaecology registrars in CTG interpretation.
Enhancement of an antenatal diagnosis and counselling service (ADACS) through the ready availability of telemedicine services
Authors: Morris D G , Hayward T
Published: October 2002

The early diagnosis of fetal abnormalities and their consequent management comprise a relatively new specialty, which has developed to a large extent from the advances in and availability of ultrasound imaging techniques. The Women's and Children's antenatal diagnosis and counselling service (ADACS) is composed of a multidisciplinary group of health professionals and deals with issues relating to pre-pregnancy counselling, fetal diagnosis of abnormalities and the management of these conditions, including all aspects of pregnancy loss. Detailed minutes are recorded for each case and key information is stored in a relational database. Weekly meetings are held to discuss selected cases and, where possible, are presented to the group by the referring practitioner, either in person or using the telemedicine facilities. Telemedicine has provided a significant enhancement to the ADACS service.
Working with telemedicine: User characteristics and attitudes
Authors: Aas I H Monrad
Published: October 2002

Combined qualitative and quantitative interviews were conducted with 30 persons involved in four telemedicine specialties. The results showed little technology-related anxiety and all viewed the technology as useful. There was a positive general attitude to telemedical work, with a perception of the possibility of job satisfaction being improved and the technology being found to be easy to use. Negative general attitudes to telemedical work were not found. The implementation of telemedicine may therefore have a positive effect within organizations. Such findings may be important for the future widespread adoption of telemedicine.
Cost-effectiveness of home telemedical cardiotocography compared with traditional outpatient monitoring
Authors: Tõrõk Miklós , Kovács Ferenc , Doszpod József
Published: October 2002

We compared the cost of passive sensor telemedical non-stress cardiotocography performed at home and the same test performed by traditional equipment in an outpatient clinic in the Budapest area. The costs were calculated using two years’ registered budget data from the home monitoring service in Budapest and the outpatient clinic of the department of obstetrics and gynaecology at the Haynal Imre University of Health Sciences. The traditional test at the university outpatient clinic cost 3652 forint for the health-care and 1000 forint in additional expenses for the patient (travel and time off work). This means that the total cost for each test in the clinic was 4652 forint. The cost of home telemedical cardiotocography was 1500 forint per test, but each test took 2.1 times as long. For a more realistic comparison between the two methods, we adjusted the cost to take account of the extra length of time that home monitoring required. The adjusted cost for home care was 3150 forint, some 32% lower than in the clinic. Passive sensor telemedical non-stress cardiotocography at home was therefore less expensive than the same test performed in the traditional way in an outpatient clinic.
Application of business case analysis in planning a province-wide telehealth network in Alberta
Authors: Weaver Linda , Spence Dorothy
Published: October 2002

A strategy for implementing telemedicine throughout Alberta was developed. The model was based on a comprehensive evaluation of the four clinical specialties chosen as representative telemedicine services – radiology, psychiatry, emergency services and continuing education. The goals of the telemedicine network were to improve access to health services, provide support for rural health-care providers and increase the efficiency of specialized services. The findings showed that the success factors in a national telemedicine programme depend on a clear organizational structure, with appropriate technical standards and support.
The intellectual property cookbook: A guide for the novice health-care telemedicine provider working with industry
Authors: Beauregard Danielle , Beauregard Gaelle
Published: October 2002

Telemedicine is a new field and many health-care providers are developing their own products with the help of industry. Most practitioners are novices in the legal tools necessary to protect their own work with regard to any future commercialization. To summarize these issues for the telemedicine practitioner, a review of intellectual property protection has been performed. Intellectual property can be protected by tools such as copyrights, patents, non-disclosure and confidentiality agreements, integrated circuit topographies and industrial design. Knowledge of the intellectual property background should allow telemedicine providers to protect their own work when working with industry.
A pilot study of radiotelemetry for continuous cardiopulmonary monitoring of patients at home
Authors: De Lusignan Simon , Althans Anne , Wells Sally , Johnson Paul , Vandenburg Malcolm , Robinson Jan
Published: October 2002

We have conducted a trial of a wireless device for continuous cardiopulmonary monitoring. Its performance, user acceptance and safety were assessed for monitoring in the patient's home. The study included 20 patients: six with chronic obstructive pulmonary disease, six with chronic heart failure, seven with atrial fibrillation and palpitations, and one with a snoring problem. The system recorded the heart rate and respiratory rate, blood pressure, electrocardiogram and body temperature. The results were transmitted automatically to a central monitoring station. The accuracy of the measurements was checked by a comparison system and also by conventional measurements performed by a nurse. The system was acceptable to patients and functioned satisfactorily in the home. An important facet of home telemonitoring may turn out to be its greater reliability in collecting objective data.
Diagnosis of glaucoma using telemedicine – the effect of compression on the evaluation of optic nerve head cup–disc ratio
Authors: Beauregard Danielle , Lewis John , Piccolo Marc , Bedell Harold
Published: October 2002

A photograph of the optic nerve head requires a lot of disk space (over 1 MByte) for storage and may require substantial bandwidth and time for transmission to a remote practitioner for a second opinion. To test whether compression degrades the image quality of the images, 302 slides were digitized at an optical resolution of 2400 pixels/inch (945 pixels/cm) and 30 bit/pixel. The images were saved both in non-compressed TIFF format and in compressed JPEG (compression ratio of 60) format. A blinded observer measured the optic nerve head cup–disc ratio for all three groups: the original slides, uncompressed TIFF and compressed JPEG images. The results showed that digital images were less accurate than slides. However, compression, even up to a ratio of 40, did not make matters worse.
Legal issues relating to telemedicine in Canada's publicly funded health-care system
Authors: Bailey Martha
Published: October 2002

The advent of telemedicine poses new legal challenges for Canada's health-care system. Although telemedicine increases access, it does not fit easily into Canada's traditional one-tier approach to healthcare. Cross-border telemedicine services may inadvertently contribute to a two-tier system. The current legal system will have to be adapted to accommodate changes instigated by cross-border telemedicine.
Increasing the cost-effectiveness of telemedicine by embracing e-health
Authors: Mitchell John
Published: October 2002

In 1999 a national study of telemedicine in Australia led to the promotion of the concept of ‘e-health’, the health sector's equivalent of ‘e-commerce’. A new study explored the view that, with the convergence of technologies and the consequent increase in ability to perform multiple functions with those technologies, it is unwise to promote telemedicine in isolation from other uses of technologies in health-care. The major sources of information for the study were the presentations and discussions at five national workshops held to discuss the findings of the original report on telemedicine. Nineteen case studies were identified. The case studies showed that with the convergence of technologies telehealth is becoming part of e-health. The cost-effectiveness of both telehealth and telemedicine improves considerably when they are part of an integrated use of telecommunications and information technology in the health sector.
Security aspects of teleradiology between the university centre and outlying hospitals in Tyrol
Authors: Sögner Peter , Goidinger Klaus , Reiter Dietmar , Stoeger Alfons , Nedden Dieter Zur
Published: October 2002

We assessed a data security system using biometric fingerprint techniques and smartcards to control access to a teleradiology system. Clinical cases were initially discussed between the referring physician and radiologist in Tyrol using a video-phone. Subsequent correspondence, including the transmission of images between the referring physician and the radiologist, was carried out by email using the security system to prevent unauthorized access to patient information. Seventy-eight teleradiology sessions were conducted using this data security system. Speed and stability of data exchange were unaffected by the additional security feature. The average log-on time to the system was 7.8 s. The average training time on how to use the system was 15 min. The radiologist was able to issue a final patient report using the system within 1.5 of the initial contact. The data security feature was user-friendly and did not hinder the normal teleradiology consultation.
Transfer of telemedical support to Cornwall from a national telemedicine network during a solar eclipse
Authors: Wootton R , Mckelvey A , Mcnicholl B , Loane M , Hore D , Howarth P , Tachakra S , Rocke L , Martin J , Page G , Ferguson J , Chambers D , Hassan H
Published: October 2002

During late 1998 and early 1999, planning officers in Cornwall predicted a huge increase in summer visitors to the county to observe the August solar eclipse. There was the possibility that a mass gathering in Cornwall could overload existing arrangements for handling accident and emergency patients. We therefore set up a telemedicine system to support the county's minor injury units (MIUs) from hospitals throughout the UK. Six main hospital accident and emergency departments outside Cornwall with existing links to their own MIUs were twinned with 10 of the 11 MIUs in Cornwall before the expected date of the gathering. The network was live for nine days, starting four days before the eclipse, and 2045 patients were seen in the 10 MIUs. There were 93 telemedicine calls from the 10 MIUs, involving 91 patients. Overall, 4.6% of the patients required a telemedicine consultation. Fifty-seven calls were made during working hours. Thirty-four patients were referred for further management, of whom 18 were referred on the same day. The transfer of telemedical support to a national network was successful.
Telemedicine for intensive support of psychiatric inpatients admitted to local hospitals
Authors: D'souza Russell
Published: October 2002

A service was developed to treat acute psychiatric inpatients in their local hospitals using telemedicine. This reduced the need for these patients to be transferred to a psychiatric facility in Adelaide. An evaluation of outcomes showed that it was possible to manage acute psychiatric patients in this manner, reducing costs of transport. In addition, patients were treated close to their homes. Patients rated their satisfaction with the service and the use of telemedicine very highly.
Patients' views about information technology in the treatment of hypertension
Authors: Lahdenpera T S , Kyngas H A
Published: October 2002

We assessed patients' attitudes to information technology IT , their experiences of IT, and their attitudes and expectations concerning its use in the treatment of hypertension. Twenty-one patients with high blood pressure were interviewed before they took part in a pilot study of a computer-based intervention to control high blood pressure; they were aged between 32 and 63 years, and had received medication for one year at most, or no medication at all. Content analysis of the interview transcripts revealed six factors that affected the acceptance and use of IT. These were: the patients' general attitude to IT and its use, their experiences of using IT, their perceptions of the barriers to the use of IT, the advantages of using IT in the treatment of hypertension and the usefulness of IT, and their expectations of the computer program. The patients wanted to take part in the intervention and their attitudes were notably positive even when they had little or no experience of using IT.
An experimental teleradiology transmission system using a high-speed ATM backbone network
Authors: Kato Katsuhiko , Shimamoto Kazuhiro , Ishigaki Takeo , Niimi Rie , Ishiguchi Tsuneo , Mimura Takeo
Published: October 2002

We evaluated the performance of an experimental teleradiology system based on a high-speed ATM backbone network. Image acquisition, transmission and the disk-to-display processing times were measured. Computerized tomography CT scans printed on 14inch x 17inch (36cm x 43cm) films were digitized and transferred over the network. The average time for the entire process was 1 min 30 s. Three radiologists interpreted 20 cases. For CT image interpretation, the reading time for one case ranged from 2 to 12 min mean 6 min 46 s on a monitor, and from 1 to 3 min mean 1 min 31 s with the original film. The ATM backbone network operating at 156 Mbit/s provided sufficient speed for remote consultation. However, further improvements in the operability of the system, especially the image viewing station, are necessary before it will be satisfactory for clinical use.
A feasibility study of realtime telemedicine in Croatia using Internet videoconferencing
Authors: Ostojić Vedran , Stipić-Marković Asja , Tudman Zdenko , Zivković Nenad , Cvorišćec Branimir , Trajbar Tomislav , Donnelly Craig L , Grgić Marija , Matek Petar , Lušić Mario , Iskra Marjanca
Published: October 2002

We explored the feasibility of realtime telemedicine in Croatia using Internet videoconferencing. A 33 kbit/s link was established between a team of specialists in the General Hospital 'Sveti Duh' in Zagreb and a general practitioner's clinic in Selca, on the island of Brač. During a two-week study, 16 patients (median age 51 years) were studied. Twenty-one teleconsultations (seven initial and 14 follow-up visits) were conducted, 13 with a specialist in internal medicine, six with a surgeon and two with a neurologist. In 18 cases (86%) telemedicine successfully replaced hands-on examination. The mean duration of the teleconsultations was 7.2 min (initial visits 7.4 min, follow-up visits 7.1 min). Each computer system cost about US$700. The total connection cost for the study was US$4.95. The teleconsultations saved the patients US$272 in travel costs. We suggest forming a permanent on-line specialist service connected to networked clinics via the Internet to improve access to health-care in Croatia.
An exploratory survey of the applications of telemedicine in Ghana
Authors: Darkwa Osei
Published: October 2002

We examined the use of telemedicine at two major medical institutions in Ghana. Doctors and administrators were surveyed to assess their knowledge of computers and familiarity with telemedicine. The use of modern telecommunications and information technology products within the health service was also examined. Thirty questionnaires were distributed to staff at the two hospitals, one urban and one rural. Twenty were returned (a response rate of 67%). Although most of the respondents were computer literate, they were less familiar with telemedicine applications. Only a minority of the respondents were participating in an information-sharing network, transmitting information by fax or telephone, or had Internet access. Financial constraint appeared to be the major barrier to establishing information-sharing networks. Other constraints were technological and organizational. The respondents expressed an interest in using telemedicine, having access to health-care databases and specific telemedicine applications such as tele-education and videoconferencing. Staff in the urban hospital were more likely to be familiar with telemedicine and more likely to have access to information technology than those in the rural hospital.
An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities
Authors: Mitchell J , Robinson P , Seiboth C , Koszegi B
Published: October 2002

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support; improved efficiency and reduced travel costs; and improved efficiency of health services. The problems included: costs; lack of access to technical support; and the need for staff induction and training.
A simple telemedicine system using a digital camera
Authors: Corr Peter , Couper Ian , Beningfield Stephen J , Mars Maurice
Published: October 2002

Radiographs on a viewing box were photographed at a remote hospital in South Africa using a digital camera with a resolution of 1024x768 pixels at 24-bit colour depth. The resultant images were stored in JPEG format and transmitted as email attachments to be read on a PC monitor by radiologists in Durban and Cape Town. Twenty-seven images were received, of which 23 were of diagnostic quality (85%). The mean file size was 120 kByte. For quality control purposes, 100 chest radiographs were photographed at a base hospital and read by a radiologist blinded to the diagnosis. In this study 96 images were of diagnostic quality (96%) and the correct diagnosis was made in 90 cases (94%). Incorrect readings were made in six cases (6%): small pulmonary nodules (less than 1 cm in diameter) were missed in five cases and in one case early apical tuberculosis was missed. Digital camera technology permits simple, inexpensive telemedicine. Limited spatial resolution is a concern when reading chest images with small pulmonary nodules and infiltrates.
The feasibility of telemedicine for orthopaedic outpatient clinicsa randomized controlled trial
Authors: Haukipuro Kari , Ohinmaa Arto , Winblad Ilkka , Linden Teppo , Vuolio Saija
Published: October 2002

We investigated the use of videoconferencing in the examination of orthopaedic outpatients. A consecutive sample of orthopaedic outpatients was randomized to examination either via videoconferencing ( n = 76) while attending a primary-care unit or at a conventional hospital outpatient clinic 160 km away ( n = 69). Videoconferencing was found to be feasible and the equipment functioned well technically. There were somewhat more problems in examining the telemedicine patients than the clinic patients. The two patient groups were equally satisfied with the specialist service. The telemedicine patients were more willing to have their next visit by videoconferencing than the conventional patients. Videoconferencing between primary and secondary care can be used in the examination of orthopaedic patients whenever no demanding imaging technology is needed.
An evaluation of the telepsychiatry programme in Victoria, Australia
Authors: Buist Anne , Coman Greg , Silvas Arlene , Burrows Graham
Published: October 2002

We evaluated the use of telepsychiatry in Victoria, a state of Australia with some five million people. There were 39 sites at the time of the survey, 12 metropolitan and 27 rural. Interviews and postal questionnaires were used. A total of 99 staff were surveyed, 69 by post and 30 during visits. There were 37 participants from metropolitan sites and 62 from rural sites. Rural sites conducted an estimated 137 sessions per month (i.e. an average of 5.1 per month per site). The majority (70%) of the usage in Victoria was for clinical purposes, both primary and secondary consultations.
Remote cardiac rehabilitation
Authors: Henderson Isabel , Vanlohuizen Karen , Fenske Ted
Published: October 2002

The implementation of a remote cardiac rehabilitation service to educate people about heart disease is currently under way in northern Alberta. Twenty per cent of patients in the catchment area live in remote areas outside the regional centre and are faced with the usual difficulties of attending urban health-care programmes. The availability of the remote cardiac rehabilitation service enables patients to receive the same rehabilitation benefits as their urban counterparts.
Optimizing technologies in nurse practitioner education
Authors: Hoxby H
Published: October 2002

A provincial educational programme was launched in 1995 for primary-care nurse practitioners. A consortium of Ontario university schools of nursing joined forces to provide a single, standardized educational programme at all 10 sites in both official languages. This demanding, clinically focused educational initiative required better access, support and efficiencies than could be provided by print copies and videoconferences alone. The development of a password-protected Website allowed equal access for all and maximized the human and financial resources. Optimizing various technologies has enhanced the quality and efficiencies of the nurse practitioner programme.
Telelearning in a partnership between a university faculty and a regional health authority: Benefits, challenges and strategies
Authors: Jennett P , Nijssen-Jordan C , Wiggs B , Gao M , Person V , Andruchuk K , Johnston R
Published: October 2002

The University of Calgary's Faculty of Medicine and the Calgary Regional Health Authority understand that telehealth is an evolving field requiring both academic enquiry and operational readiness. Both parties are committed to quality educational programmes — the Faculty through its commitment to excellence and the Authority with its charge to maintain and enhance such programmes. There are shared applications, multi-learner user groups, shared strategies to overcome distances and shared infrastructure—technologies, communication pathways and resources. Having embarked on a joint telelearning venture, we have learned a number of lessons. Central to progress has been an appreciation and respect for unique mandates, a spirit of trust and flexibility, an agreement on a set of principles, ongoing communication between and participation from the users and, at times, redirection. Questions being answered include the following. How well is this collaborative model working? How functional is it at this time of health reform and restructuring? Can one meet complementary telelearning goals within a faculty–health authority relationship? These all have implications for future success.
Managing pre-examination stress through remote counselling using a session script from a ‘sentinel subject’
Authors: Lewis L , Walters A , Griffith A
Published: October 2002

Twenty-five members of a class of 45 medical students preparing for final examinations were voluntary participants in a pre-examination stress-control exercise conducted four weeks before the start of examinations. The students completed short questionnaires before and after reading the typewritten script of a counselling session of a member of their class (the sentinel subject). In the pre-script questionnaires, 50% of the men and 35% of the women reported a high level of stress. On the post-script questionnaire, 68% identified with the subject being counselled. Only four persons (16%) reported a reduction in stress after reading the script and one person recorded an increase in stress. Seventy-two per cent of respondents (40% of students) indicated that they would use counselling services if they were available. The present study suggests that some form of counselling could be usefully included in distance education modules. The provision of counselling services before examinations may prevent failure. The remote approach by sentinel subject script is an inexpensive method of providing such a service.
Meeting the need for educational standards in the practice of telemedicine and telehealth
Authors: Picot Jocelyne
Published: October 2002

The first telemedicine standard to be developed, documented and adopted widely was the radiology standard, which includes technical and image transmission standards as well as requirements and qualifications needed for teleradiology practice. But many other health professionals engaged either full time or part time in telemedicine and telehealth—for example, telepsychiatry, telepathology, teletriage and tele-ophthalmology — also need and use special skills and knowledge. At present, they acquire these skills on the job and their skills may not be recognized. There should be performance standards and telepractice guidelines for professionals operating in the fields of telemedicine and telehealth. Furthermore, there is a case for the development and implementation of education and training standards, enabling professionals who practise in the field to obtain suitable skills, knowledge and recognition for telepractice.
Using distance training to deliver first aid training
Authors: Reichle Colin W , Cearns Michael
Published: October 2002

The St John Ambulance organization in Alberta issues over 100,000 first aid certificates each year (an 80% market share). The success of the organization is attributed to a province-wide infrastructure of volunteer public first aid providers and over 2000 volunteer instructors in industry and other spheres. In 1998 St John Ambulance piloted the use of CD-ROMs for teaching, producing two courses. One was a first aid course and the other was a babysitter course. The experience of the pilot programmes will allow the digital material to be transferred to our Website. Once this is done people around the world will be able to receive the self-paced learning components. Hands-on evaluation of skills, however, is mandatory to certification. Mass training where certification is required therefore requires a mixture of distance learning and hands-on testing, reinforcing the need for trained evaluators to be available to the population.
Distance education for health centre staff in rural Japan
Authors: Saeki K , Izumi H , Ohyanagi T , Sugiyama A , Sawada I , Suzuki K , Hatazawa M , Ohuch M
Published: October 2002

We have evaluated a course delivered by videoconferencing to rural health centre staff in Hokkaido. The course focused on the planning and evaluation of community health interventions. It included four 90 min sessions and two follow-up sessions. Fourteen professional staff members (public health nurses, nutritionists and dental assistants) attended each class. Knowledge of community health-care planning and evaluation was higher at post-education testing than pre-education testing. Ratings for ‘using a computer’, ‘using some computer software’, ‘using the Internet’ and ‘interest in telehealth’ increased significantly in post-education testing compared with pre-education testing. The course had an additional benefit in increasing the collaboration between community health workers and university staff.
A laboratory for testing the interoperability of telehealth systems
Authors: Sutherland L , Igras E , Ulmer R , Sargious P
Published: October 2002

Interoperability allows telehealth equipment to interact to achieve predictable results. To address the need for telehealth interoperability, the Alberta Research Council has been working with the Alberta Health and Wellness organization in Canada, and others, to create guidelines and a facility for testing telehealth equipment for compliance with technical interoperability standards. The laboratory consists of two rooms (7m x 7 m) in a new building. The rooms are wired with easy-to-configure copper and fibre networks for telephone, Switch-56, ISDN, ATM, wireless and satellite services. One room specializes in teleconsultation and tele-education, while the other has facilities for teleradiology and telemonitoring. The rooms are interconnected in order to perform interoperability tests between realtime and store-and-forward equipment. The laboratory was piloted in the summer of 1999.
A conference support system for telehealth
Authors: Tamai Utako , Nakagawa Kaori , Yokomori Masatoshi , Nishiyama Shigeru
Published: October 2002

We have developed a system that supports presentations in meetings and conferences. Using computers and a network such as an intranet, it enables users to share conference materials effectively, and manages and delivers them easily. If it is used in conjunction with a videoconferencing system, users can hold a teleconference and participate in presentations from various remote sites. From the viewpoint of information transmission, the requirements for a presentation in a teleconference are similar to those for a remote classroom or lecture. We believe that this conference support system is suitable not only for conferences but also for education and telehealth.
Distance learning: Health education for ninth-grade students
Authors: Cox Carol Gordon , White David , Brinson Helen , Ramey Debbie
Published: October 2002

A telehealth programme for schools was established by staff at the East Carolina University schools of nursing, health education, social work, nutrition, education and medicine, in conjunction with the Eastern Area Health Education Center. A health education curriculum was developed for rural high schools using the North Carolina Information Highway for delivery. A Web page provided additional resources for teachers, teenagers and health professionals. Four telehealth sessions were conducted over three years: two with the pilot school and two with a second school on-line simultaneously. A total of 76 ninth-grade students completed the courses. Evaluation indicated successful outcomes in student learning. Respondents to a follow-up survey of members of the first telehealth class had positive comments about the experience. Utilization of the Web page increased steadily from 1997.
The potential of a nursing education support system using videoconferencing
Authors: Fukue Y , Ando N , Mitani M
Published: October 2002

Japan currently employs a total of 400,000 practical nurses, accounting for approximately 40% of the total number of nurses in the country. An education system for improving the skills of practical nurses and encouraging them to obtain certification as registered nurses is due to begin in 2001. In Hokkaido, 90 nursing schools are scheduled to be used as transitional education facilities. These, however, tend to be concentrated in large cities. We have examined the possibilities for an education support system for nurses using videoconferencing. The system will include theoretical lectures using television broadcasts and technical lectures conducted at training facilities. Given Hokkaido's geographical conditions, a support system using telecommunication is considered to be essential for the success of transitional education.
Sickle cell disease telemedicine network for rural outreach
Authors: Woods Kristy F , Johnson Judy A , Kutlar Abdullah , Daitch Lisa , Stachura Max E
Published: October 2002

The Medical College of Georgia (MCG) Sickle Cell Center in Augusta, Georgia, USA, provides consultation and (in some cases) primary-care services to more than 1000 patients with sickle cell disease (SCD). Three SCD telemedicine clinic sites were established in rural areas of middle and southern Georgia, based on clinical need; a fourth site had been proposed. Over a 36-month study period, 77 telemedicine SCD clinics were held. There was a mean of 6.1 (SD 2.5) encounters per clinic and 466 total encounters among 128 SCD patients. By using telemedicine, the productivity of the MCG adult sickle cell clinic increased from 1413 to 1889 encounters a year, with an increase in rural outreach activity from 271 to 745 encounters a year. This was accomplished with the addition of a single physician assistant during the last 12 months of the study period; otherwise provider staffing was unchanged. A formal cost-benefit analysis now needs to be carried out.
Patient referral by telemedicine: effectiveness and cost analysis of an intranet system
Authors: Harno Kari , Paavola Teemu , Carlson Christer , Viikinkoski Pertti
Published: October 2002

The clinical effectiveness and costs of telemedicine in improving the referral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medicine outpatient clinics of two Finnish district hospitals were compared - Peijas Hospital (PH) with telemedicine and Hyvinkää Hospital (HH) without it. The three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/1000) from primary-care centres was twice that to HH (3.8/1000). Thirty-seven per cent of referrals to PH included requests from general practitioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patients receiving a teleconsultation ended up in the outpatient department of PH within one year. These visits were mainly due to progression of chronic disease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic visit in internal medicine (EU211) were seven times greater per patient than for an email consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU7876 in favour of the teleconsultation process. General practitioners sought an outpatient visit for 130 of their patients, and advice only for another 77. On-line advice was nonetheless given in 108 cases, and only 88 patient visits were arranged. Eleven referrals were declined. The cost difference between giving on-line medical advice for the 108 cases and a visit to the outpatient clinic for the other 88 was less costly (by EU4140) than investigating the 124 patients whose original clinic referrals to the PH were not declined. Productivity in the hospital increased over threefold by using email consultations instead of traditional outpatient visits. The wide interactive use of the intranet referral system between secondary and primary care improved clinical effectiveness, lowered direct costs, increased productivity and was cost-effective.
Evaluation of telemedical orthopaedic specialty support to a minor accident and treatment service
Authors: Tachakra Sapal , Hollingdale John , Uche Chris Uko
Published: October 2002

Over three and a half years there were 200 teleconsultations between emergency nurse practitioners at a minor accident and treatment service and the orthopaedic service of a main hospital. The main problems were fractures (93% of cases). The reasons for consultation fell almost equally into four groups: request for direct ward admission; discussion and decision about treatment; decision about the disposition of a case; and diagnosis. The technical quality of the majority of teleconsultations was considered satisfactory. Following the teleconsultation, 39% of patients were admitted to hospital, 6% were transferred to the accident and emergency department for a face-to-face consultation, and 56% were discharged and referred to a review clinic. Of the 200 cases, 193 needed teleradiology and the nurse practitioners and the orthopaedic registrars diagnosed all these cases correctly, as judged by the subsequent radiologist's report. Teleconsultations save time and prevent the unnecessary transfer of patients to main hospitals.