bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance tests of a satellite-based asymmetric communication network for the `Hyper Hospital`
Authors: Yamaguchi Takami
Published: October 2002

The Hyper Hospital is a prototype networked telemedicine system which uses virtual reality. We measured the performance of a novel multimedia network based on satellite communications. The network was a hybrid system consisting of a satellite channel in one direction and a terrestrial channel in the other. Each user was equipped with a standard satellite communication receiver and a telephone connection. Requests from the users were sent by modemand telephone line and responses were received by satellite. The user requests were initiated by clicking buttons on a World Wide Web browser screen. The transmission rates of satellite and normal telephone-line communications were compared for standardized text data. Satellite communication was three to five times faster. The transmission rate was also measured for standardized graphical data GIF format . With a file size of about 400kByte, satellite-mediated communication was 10 times faster than telephone lines. The effect of simultaneous access on performance was also explored. For simultaneous access of nine users to a single graphics file, 78 of the transmission speed was obtained in comparison with that of a single user. The satellite-based system showed excellent high-speed communication performance, particularly for multimedia data.
Image transfer and computer-supported cooperative diagnosis
Authors: Handels H , Rinast E , Busch Ch , Hahn Ch , Kuhn V , Miehe J , Rossmanith Ch , Seibert F , Will A
Published: October 2002

The KAMEDIN system was designed as a low-cost communication tool as part of a computer-supported cooperative work project that included synchronized user interaction, telepointing and audioconferencing. During a five-month field trial, it was used for medical image transfer and cooperative diagnosis in 14 clinics and medical departments in Germany. During the field test, 297 teleconsultations were performed via ISDN and 875 MByte of data were transferred. An image compression ratio of 2-3 was obtained, so that the total quantity of data transferred corresponded to 14,000-21,000 magnetic resonance images or 3500-5250 computerized tomography images. Furthermore, 694 local sessions were conducted for the preparation of teleconsultations and the review of transferred images. Participants learned to handle the KAMEDIN system in a few hours. This was mainly owing to the design of the user-oriented graphical user interface and the restriction of the system to a set of essential image-processing functions.
The economics of telemedicine
Authors: Lobley D
Published: October 2002

Despite a large number of telemedicine trials, little information has been published on its economic costs and benefits. Most telemedicine initiatives have been funded as special projects which were not subject to normal budgeting procedures. A framework is needed to enable decision makers in health-care delivery to analyse the potential effects of telemedicine applications on the activities, functions and roles of the different parties involved, such as hospitals, consultants, general practitioners, nurses and other health-care workers, and the different costs and benefits for each of these groups. In many countries, telemedicine projects have been introduced within special closed groups, such as in prisons, for military or space operations, or in disaster zones. However, some commercial services providing international telemedicine have also begun. Telemedicine costs are strongly related to patient volumes, but issues such as protocols for reimbursement need to be resolved before large-scale implementation is likely to be achieved.
The tele-assessment of cognitive state: a review
Authors: Ball Chris , Mclaren Paul
Published: October 2002

The telephone is used by all mental health professionals and many of their clients. Despite this, the telephone has been formally evaluated only occasionally. This paper reviews the literature on cognitive testing by telephone and by videoconferencing, and summarizes the different strategies employed to do this task. There remain weaknesses in the use of the telephone for cognitive testing but it could certainly be used more extensively in both clinical work and research, although the choice of test must be made with a clear view of what the assessment is designed to achieve and the limitations of the assessment instrument itself. Assessment by videoconferencing remains at an early stage of development, with much work to be done before it can be routinely employed as a clinical tool. However, videoconferencing shows promise for the future because it allows a much wider range of assessment than the telephone.
A framework for the economic evaluation of telemedicine
Authors: Mcintosh E , Cairns J
Published: October 2002

This paper describes the economic issues associated with the introduction of telemedicine systems and the main challenges to their evaluation. An approach to the economic evaluation of telemedicine is described based on a cost-consequence framework. The paper links these costs and consequences more formally within a set of evaluative questions which in turn forms the basis for an economic model for evaluating telemedicine. By outlining the key questions, a number of issues relevant to the evaluation of telemedicine are identified and considered. The main challenges to the economic evaluation of telemedicine include: constantly changing technology; lack of appropriate study design to manage the frequently inadequate sample sizes; inappropriateness of the conventional techniques of economic evaluation; and the valuation of health and non-health outcomes. The present study addresses these challenges and suggests ways of advancing the techniques for the economic evaluation of telemedicine.
Psychological impact of a remote psychometric consultation with hospitalized elderly people
Authors: Montani C , Billaud N , Tyrrell J , Fluchaire I , Malterre C , Lauvernay N , Couturier P , Franco A
Published: October 2002

Teleconsultation is a potentially useful approach to the psychological assessment of elderly patients. We assessed the psychological impact of a videolinked psychometric consultation in a sample of hospitalized elderly people. The 15 patients, none of whom had a psychiatric history, participated in a video-consultation and a conventional face-to-face consultation. The mean age of the patients was 88 years. Each consultation consisted of a preliminary interview with a psychologist and two psychometric tests which evaluated the patient`s cognitive function the Mini-Mental State Examination and the Clock Face Test . A second psychologist, who acted as an observer, assessed the patients` attitudes to the two types of consultation. Although most patients 11 of the 15 expressed a preference for the face-to-face consultation, the videoconsultations were judged to be acceptable by the patients and the psychologists. The experience of teleconsultation could be improved by practice on the consultant`s part and by some technical modifications. Finally, some differences in test scores were observed and further work is required to evaluate the reliability of different psychometric tests when used by videolink.
An economic analysis of teleconsultation in otorhinolaryngology
Authors: Bergmo T S
Published: October 2002

A cost comparison of three different methods of providing consultations for ear, nose and throat ENT problems was carried out. The study was based on the delivery of ENT examination and treatment to a small primary-care centre without an ENT specialist in northern Norway. The three alternatives evaluated were teleconsultation, a visiting specialist and patient travel to the nearest secondary-care centre. Patient travel was cheaper for patient workloads below 56 per year. For patient workloads above 56 and below 325 patients per year teleconsultation was the cheapest alternative. Above 325 patients per year, the visiting specialist service cost less than either teleconsultation or patient travel. Transfer of medical skills from the specialist to the general practitioner was also accounted for, separately from the main cost calculation. Teleconsultation then became cost-effective for patient workloads above 52 patients per year.
The effect of transmission bandwidth on diagnostic accuracy in remote fetal ultrasound scanning
Authors: Wootton R. , Dornan J. , Fisk N. M. , Harper A. , Barry-Kinsella C. , Kyle P. , Smith P. , Yates R.
Published: October 2002

Six subspecialists with considerable experience in fetal ultrasound viewed a selection of pre-recorded ultrasound scans. Scans from 18 patients recorded on VHS video-tape were supplied from five centres in the UK and Ireland, each made on a high-resolution ultrasound machine by an experienced sonologist at a referral centre. Each observer viewed the scans on a large display monitor in an individual viewing booth. The scans were viewed in random order, at randomly selected bandwidths. Observers, who were blinded to both recording and bandwidth, assessed the technical quality on a five-point Likert scale. They also recorded their diagnosis. The six observers each carried out 32 viewing sessions, which gave a total of 192 viewings. There was no significant difference in the perceived technical quality of the scans between the two bandwidths used P 0.09 . Of the 84 recordings transmitted at 1920 kbit s, 71 85 were diagnosed correctly or half correctly' and 13 15 were misdiagnosed. Of the 95 recordings transmitted at 384 kbit s, 66 69 were diagnosed correctly or half correctly' and 29 31 were misdiagnosed. This difference was significant P 0.03. The results indicate that although there were no perceived differences in technical quality between recordings transmitted at 384 or 1920 kbit s, diagnostic accuracy was marginally worse at the lower bandwidth. This suggests that the higher bandwidth conveys more detail and information to the observer, which in turn enables more accurate diagnosis. However, further work is required before a definitive choice can be made about the optimum transmission bandwidth for remote fetal ultrasound studies.
Successful development of telemedicine systems-seven core principles
Authors: Yellowlees Peter
Published: October 2002

This article discusses seven core principles that underlie the development of successful telemedicine systems. These principles have been formulated from evidence in the literature and from the personal experience of setting up three telemedicine systems in Australia. Of particular importance has been the observation of failed telemedicine systems, of which there are many examples in the world literature. It is important to learn from history by studying both the successful and the unsuccessful components of these programmes. Telemedicine is still a relatively new area of interest, and while the technology is rapidly evolving, changing and fascinating, it is still the human factors that tend to determine the success or failure of telemedicine projects. These cannot be ignored.
Planning criteria for multicentre, multilingual telemedicine conferences
Authors: Hjelm N. Magnus , Lee Joseph C. K. , Li Albert K. K. , Hazlett Clarke B.
Published: October 2002

The international telemedicine conference Chinese TeleMed 96 was held in November 1996. This three-way teleconference included delegates in London where the international telemedicine conference TeleMed 96 was taking place and medical staff from one Beijing hospital and one Hong Kong medical faculty. In total, over 1000 health-care personnel across eight time zones participated. The event demonstrated that the quality of teleconferencing technology was suitable for medical teaching, for providing medical consultations to remote locations and for stimulating medical exchanges. In general, planning a telemedicine conference requires a longer lead time, a wider representation of expertise in the organizing committee and more financial resources than conventional conferences. It is recommended that the aim and format of a telemedicine conference be determined at least one year before the target date. Criteria for improving the preparation of such conferences have been identified and a set of guidelines for future conference organizers has been drawn up.
The assessment of cognitive function in the elderly using videoconferencing
Authors: Ball Chris , Puffett Alison
Published: October 2002

People over the age of 65 were recruited from an inner-city old-age psychiatry service. Subjects had a structured interview (the CAMCOG test) by videoconferencing, and also face to face, by an investigator blind to the results of the test in the other mode. Reassessments were carried out within one week of the initial assessment. Eleven subjects were initially enrolled in the study and eight completed both modes. The number of patients in this study is very small but the results suggest that the CAMCOG test can be used reliably over a videoconferencing system without major modification.
Telemedicine and medical care to ships without a doctor on board
Authors: Amenta F , Dauri A , Rizzo N
Published: October 2002

Providing medical assistance to ships at sea was probably one of the first practical applications of telemedicine. At present, about 200 different organizations worldwide give medical assistance to ships without a doctor on board. The activity of the Foundation Centro Internazionale Radio Medico (CIRM), which probably has the largest experience in the world of telemedicine applied to seafarers, is reviewed. Medical assistance to seafarers has not improved in parallel with advances in medicine and telecommunications. Possible initiatives for improving teledelivery of medical assistance to seafarers are discussed.
Telepsychiatry: an island pilot project
Authors: Mannion L , Fahy T J , Duffy C , Broderick M , Gethins E
Published: October 2002

A telemedicine link was established in 1996 between the island of Inishmore and the department of psychiatry in University College Hospital, Galway. The link was mainly used to facilitate emergency consultations between patients on the island and the duty psychiatrist, always at the request of the island's general practitioner. Nine patients were referred for assessment in this manner over eight months. Three patients had their first psychiatric contact and assessment through the video-link, and were followed up as outpatients via the link to eventual resolution of the episode of illness and discharge at the outpatient clinic. Our experience has been that videoconferencing systems are acceptable and satisfactory for patients and staff alike.
Easy Medic: an Internet application for the general practitioner
Authors: Arnone G , Bianchi A , Pietra B Della , Sernicola R , Sparacino E , Vitolo R
Published: October 2002

A research project has been carried out to develop a client server application which supplies the general practitioner (GP) with a ‘personal digital assistant’ (hand-held mobile computer)to connect to Web servers at a hospital site through the Internet. This allows the doctor to book medical examinations, hospital admissions and manage patient data. The application used advanced object-oriented techniques, on both the client and the server side. The connection to a Web server was achieved through GSM wireless cellular telephones using standard Internet protocols (HTTP, TCP/IP and CGI). Conventional telephone lines can be used as well. Other application modules on the client side provided patient medical record supervision, GP schedule management, general information about hospitals and clinics, and pharmacy consultation. These services should help GPs in their daily work. Moreover, the quality of health-care resource management and cost supervision should improve, since each GP ‘transaction’ is automatically entered in realtime into a database at the server. The services are under test in the health-care system of an urban area in southern Italy.
A survey of physicians’ acceptance of telemedicine
Authors: Sheng Olivia R Liu , Hu Paul Jen-Hwa , Chau Patrick Y K , Hjelm N M , Tam Kar Yan , Wei Chih-Ping , Tse John
Published: October 2002

Physicians’ acceptance of telemedicine is an important managerial issue facing health-care organizations that have adopted, or are about to adopt, telemedicine. Most previous investigations of the acceptance of telemedicine have lacked theoretical foundation and been of limited scope. We examined technology acceptance and usage among physicians and specialists from 49 clinical departments at eight public tertiary hospitals in Hong Kong. Out of the 1021 questionnaires distributed, 310 were completed and returned, a 30% response rate. The preliminary findings suggested that use of telemedicine among clinicians in Hong Kong was moderate. While 18% of the respondents were using some form of telemedicine for patient care and management, it accounted for only 6.3% of the services provided. The intensity of their technology usage was also low, accounting for only 6.8% of a typical telemedicine-assisted service. These preliminary findings have managerial implications.
Telemedicine conference on a 13-year-old Chinese girl with an unusual skeletal condition
Authors: Yeung W L , Wong G , Fok T F , Griffith J , Cheng J C Y , Hjelm M , Hall C , Shaw D
Published: October 2002

Departments of Paediatrics, Diagnostic Radiology, Orthopaedics and Traumatology and Chemical Pathology, Prince of Wales Hospital, Shatin, Hong Kong, China; Department of Paediatric Radiology, Hospital for Sick Children, Great Ormond Street Hospital, London, UK
A remote collaboration system for telemedicine using the Internet
Authors: Nagata Hiroshi , Mizushima Hiroshi
Published: October 2002

We have developed a still-image telemedicine system for the Internet. It was implemented with the Java programming language and enables remote collaboration between two or more client computers located anywhere on the Internet. Each client requires only a PC or workstation and a popular Internet browser- no special hardware or software is required. We carried out both local-area and wide-area tests of the system. On a local network, JPEG images at a resolution of 640 480 pixels took 2-5 s to display on four different clients PCs or workstations ; at 1000 1000 pixels, the images took 10-65 s. We also tested the system between two universities in Japan, one in Italy and one in the USA, using the Internet for communications. Images required 4-20 s for display. The exchange of remote collaboration commands between the four locations was good and the maximum lag in mouse pointer movement was less than 1 s. The system has the potential to solve three problems of conventional telemedicine systems: their cost, the need for high-bandwidth telecommunication and the low compatibility between them.
Staff perceptions of emergency and home-care telemedicine
Authors: Hayes Risa P , Duffey Erin B , Dunbar Jeffrey , Wages John W , Holbrook Stephen E
Published: October 2002

The utilization of a low-bandwidth telemedicine system for emergency and for home-care patients was studied in a pilot trial. The emergency setting was the emergency department of a small urban hospital and its emergency medical service EMS ; the home-care setting was the home-health agency affiliated to the hospital. Utilization data were obtained through baseline and follow-up interviews with EMS technicians, emergency department and home-health nurses, and the project coordinator. The results indicated that initial enthusiasm for the use of the telemedicine system was not followed by a commitment to the system's utilization during the trial by the relevant administrations. Barriers to optimum utilization were identified, but the actual value of the system to patient care could not be determined. We conclude that the value of a telemedicine system to patient care cannot be realized unless there is an organizational commitment from the top to system utilization.
The environment for telemedicine in the Canary Islands
Authors: Ferrer-Roca O. , Estevez M. , Gomez E.
Published: October 2002

We studied the environment for telemedicine in the Canary Islands. The population's attitude to telemedicine was surveyed in 503 questionnaire interviews with doctors, nurses, paramedical staff and patients on the seven islands. Almost half the respondents 46-50 across groups had a positive opinion of telemedicine. We also collected data about telephone medicine. A total of 479 medical-support telephone calls were made to four doctors, in psychiatry, ophthalmology and paediatrics. The telephone calls resolved the problem in 73 of cases and 86 would have come to the doctor if not made. Therapy was prescribed in 11 and 10 were just for information. The number of telephone calls per day was highest in psychiatry. Finally, we carried out a detailed analysis of the number of transfers between the islands 14,942 people in 1995 and 22,418 in 1996 . According to the number of transfers and location of the referral hospital, oncology, psychiatry, dermatology and traumatology were the specialties that would be most likely to benefit from telemedicine.
A feasibility study of video-based home telecare for clients with spinal cord injuries
Authors: Phillips V L , Temkin A J , Vesmarovich S H , Burns R
Published: October 2002

We carried out a feasibility study of the use of a home telecare intervention to promote skin and other self-care activities for clients with spinal cord injuries SCIs following their discharge from a rehabilitation facility. Eleven clients mean age 38 years participated in at least three video-sessions over a minimum of six weeks. The equipment used was a video-phone which could transmit both audio and still images over an ordinary telephone line. Video-sessions were followed by, or interspersed with, telephone calls. There was an average of 10 video-calls range 3-25 and an average of six telephone calls range 0-22 per client. The average length of the consultations was 23 min range 15-34 min . The overall impressions of the 11 clients were very positive. Weekly telecare sessions for four to six weeks, followed by telephone counselling alone every other week for another four weeks, appears to be the appropriate sequence for most SCI clients.
Three-dimensional ultrasonographic telepresence
Authors: Macedonia Christian R , Littlefield Richard J , Coleman John , Satava Richard M , Cramer Timothy , Mogel Greg , Eglinton Gary
Published: October 2002

We have developed a three-dimensional ultrasound telepresence system for remote consultation. Threedimensional ultrasound data-sets can be acquired by relatively unskilled operators. The data are stored in the remote unit and then transmitted to a consultant equipped with a similar unit. A telepresence pointing device enables the consultant to re-slice that data-set in any plane. During the study period, 72 volumetric scans of male and female volunteers aged 18-45 years were performed in Bosnia. Field users of limited ultrasound experience most with less than 30 min of training were able to acquire volumetric scans, send volume data and interact with remote consultants over standard communications lines at distances of up to 20,000 km. Communications links from 9.6 to 1500 kbit s were used. Technical limitations included lack of motion data, lack of colour data, scan artefacts and increased scan-to-diagnosis time. However, our preliminary experience indicates that this technique may eventually prove to be a useful adjunct to telesonography. Further studies of the technique are needed to determine its value in the broader clinical setting.
The Lancashire telemedicine ambulance
Authors: Curry Graham R , Harrop Nicholas
Published: October 2002

An emergency ambulance was equipped with three video-cameras and a system for transmitting slow-scan video-pictures through a cellular telephone link to a hospital accident and emergency department. Videopictures were transmitted at a resolution of 320 240 pixels and a frame rate of 15 pictures min. In addition, a helmet-mounted camera was used with a wireless transmission link to the ambulance and thence the hospital. Speech was transmitted by a second hand-held cellular telephone. The equipment was installed in 1996-7 and video-recordings of actual ambulance journeys were made in July 1997. The technical feasibility of the telemedicine ambulance has been demonstrated and further clinical assessment is now in progress.
Telemedicine in the emergency department: a randomized controlled trial
Authors: Brennan J A , Kealy J A , Gerardi L H , Shih R , Allegra J , Sannipoli L , Lutz D
Published: October 2002

Emergency physicians and nurses were trained in telemedicine techniques in two emergency departments, one rural low volume and one suburban high volume . Fifteen patient complaints were selected as appropriate for the study. Of 122 patients who met the inclusion criteria, 104 85 consented to participate. They were randomized to control and experimental groups. The suburban emergency physician diagnosed and treated the control patients. Experimental patients presenting to the high-volume emergency department were evaluated and treated by the telemedicine nurse in person and the rural emergency physician via the telemedicine link. Immediately before discharge all telemedicine patients were re-evaluated by the suburban emergency physician. Data collected on each patient included: diagnosis; treatment; 72 h return visits; need for additional care; and satisfaction of patient, physicians and nurses. There were no significant differences P 0.05 for occurrence of 72 h return visits, need for additional care or overall patient satisfaction. The average patient throughput time from admission to discharge was 106 min for the telemedicine group and 117 min for the control group. Telemedicine was a satisfactory technique for the chosen group of patients in the emergency department and was acceptable to the participants.
A study of rural women's satisfaction with a breast cancer self-help network
Authors: Curran Vernon R , Church Jon G
Published: October 2002

The impact of breast cancer on the emotional and social health of women and their families is an important issue for the cancer field. Nevertheless, many patients do not avail themselves of support programmes. In rural communities there is often a lack of services, which, for many, leads to a perception of being alone' in the struggle to become better. This paper reports an evaluation of a pilot project to facilitate a self-help peer support group network: an extensive provincial audio teleconferencing network for rural breast cancer survivors, established by the Telemedicine Centre of the Memorial University of Newfoundland. A satisfaction questionnaire was distributed to participants in the pilot programme. Responses suggested that they were very satisfied with the use of audio teleconferencing for the facilitation of a social support programme. The programme appeared to help bridge the isolation gap that rural women with breast cancer often experience. The results have implications for the provision of self-help social support services through audio teleconferencing, as well as for the quality of life and wellbeing of rural women.
Patient cost–benefit analysis of teledermatology measured in a randomized control trial
Authors: Loane M A , Bloomer S E , Corbett R , Eedy D J , Core H E , Hicks N , Mathews C , Paisley J , Steele K , Wootton R
Published: October 2002

A randomized controlled trial of the costs and benefits of teledermatology consultations compared with traditional hospital consultations was carried out. Over a nine-month period, 197 patients were referred from general practice for a dermatological opinion, 98 for a teledermatology consultation and 99 for a hospital consultation. Eighty patients required an additional subsequent hospital appointment. Patients were asked to complete an economic questionnaire after each consultation, and 164 questionnaires were returned: 62% of those randomized to the teledermatology consultation responded compared with 58% of those randomized to the hospital consultation. Patients seen by teledermatology at their own health centre had shorter distances to travel and spent less time overall attending the appointment compared with those seen at the hospital. However, the teledermatology consultations were more time-consuming for the general practitioner and dermatologist. These findings indicate that teledermatology has more benefits for the patient than for the health-care delivery team.
A three-year review of telemedicine at the community level —clinical and fiscal results
Authors: Chodroff Paul H
Published: October 2002

The Telemedical Emergency Neurosurgical Network (TENN) was developed to establish community-level access to neurosurgical critical care services for an under served urban population. Since October 1994, the system has provided round-the-clock connectivity between a single peripheral hospital and a 10-station receiving network which includes physicians’ homes and offices. Data from the first 35 months of operation confirm clinical efficacy and cost-effectiveness. The primary benefit was in providing rapid access to care for an ‘at-risk’ under served population in emergencies. This undoubtedly resulted in the actual saving of life and prevention of permanent disability. The total costs over the 35 months were calculated as $64, 375 and the total savings (mainly in avoided air transport) were $626, 149, a net saving of $561, 774.
Burns follow-up: An innovative application of telemedicine
Authors: Massman N J , Dodge J D , Fortman K K , Schwartz K J , Solem L D
Published: October 2002

We assessed the efficiency and effectiveness of burn consultations via telemedicine. The Regions Hospital Burn Center completed 87 follow-up visits with 40 patients via telemedicine from March 1997 to August 1998. These consultations involved burn physicians, occupational therapists and a clinical psychologist. Patients were seen at 15 telemedicine sites in six states (Minnesota, Iowa, Montana, North and South Dakota, and Wisconsin). Telemedicine burn consultations were cost-effective for the patient, but were more time consuming for the physician and therapist. As remote sites become more familiar with preparing patients for teleconsultations, telemedicine will become more efficient for the physician while remaining cost-effective for the patient.
Dynamic robotic telepathology: A preliminary evaluation on frozen sections, histology and cytology
Authors: Mea Vincenzo Della , Cataldi Palmina , Pertoldi Barbara , Beltrami Carlo A
Published: October 2002

We evaluated the diagnostic efficacy of a dynamic robotic telepathology system for the delivery of pathology services to distant hospitals. The system provided static/dynamic features and the remote control of a robotic microscope using four ISDN lines. For evaluation purposes, 184 consecutive cases were diagnosed at distance using the system. The cases were 60 frozen sections, 64 cases of gastrointestinal pathology and 60 cases of urinary cytology. The telemedicine diagnoses obtained in this way were compared with traditional microscopic diagnosis. Diagnostic agreement ranged from 90% in urinary cytology to 100% in frozen sections. The results suggest that a dynamic robotic telepathology system can be a useful tool for supporting the pathology practice of isolated hospitals.
Clinical outcomes in telepsychiatry
Authors: Zaylor Charles
Published: October 2002

A retrospective review of patient records comparing clinical outcomes of patients seen by interactive television (IATV) and those seen in person was carried out to determine whether IATV reduced the quality of psychiatric care. A Global Assessment of Functioning(GAF) score was determined for each patient in both the study and control groups at the initial visit, and at subsequent visits. Forty-nine patients with either major depression or schizoaffective disorder were studied. No significant difference was found in the percentage change in GAF scores between the two groups, which suggests that clinical outcomes were not affected by the use of IATV. Patients seen by IATV had a greater attendance rate and follow-up visits took less than half the time compared with in-person visits, indicating that IATV was an acceptable and efficient method of providing psychiatric services.
Realtime remote consultation in the outpatient clinic—experience at a teaching hospital
Authors: Wan A C T , Gul Y , Darzi A
Published: October 2002

We used an outpatients’ telemedicine clinic to evaluate remote consultation in a London hospital practice. Video-images were relayed by ISDN at 384 kbit/s between the main hospital site and the sister hospital. Teleconsultation was evaluated in three different specialties: pa in management, orthopaedics and general surgery. Medical personnel involved in the consultation consisted of aresident or senior house officer at the remote site and a senior registrar or consultant at the ma in hospital. A total of 146 consultations was held over a six-month period in the three clinical specialties involved. Questionnaires were completed by 58% of patients and over 90% of the medical personnel involved. The mean scores (on a five-point Likert scale) for physician satisfaction at the ma in and distant site were 3.6 and 3.8, respectively. On a scale of 0–10, 92% of patients rated the consultation 8–10 and 90% indicated that they would return for a similar consultation. Seventy-three per cent felt that a similar consultation from their referring doctor would have been appropriate. Confidence in the diagnosis was high among the specialists at the main hospital site.
Telemedical record documentation: A preliminary survey
Authors: Huston Janis L
Published: October 2002

Telemedical records are the weak link in telemedicine. With a number of medicolegal and reimbursement issues still unresolved, telemedical record documentation will be a critical piece of the puzzle when the patient's original legal medical record must be produced. A questionnaire was distributed to active telemedicine programmes in the USA to determine how interactive teleconsultations were being documented. Forty programmes completed the questionnaire. The responses indicated a lack of consistency and a need for documentation guidelines for telemedical records.
Teleconsultation for cooperative acquisition, analysis and reporting of ultrasound studies
Authors: Ribeiro R , Conceição R , Rafael J A , Pereira A Sousa , Martins M , Lourenço R , Fonseca L , Galvão F , Damas L
Published: October 2002

We have developed a teleconsultation system to support cooperation between doctors at different institutions in the acquisition, analysis and reporting of ultrasound studies. All the relevant activities were supported by the application. The system enabled remote supervision of the ultrasound study as it was being performed, cooperative static image acquisition and analysis, as well as report writing. Cooperative analysis of previously acquired studies was also possible. The system is undergoing evaluation in five hospitals in Portugal.
Using cable television networks for interactive home telemedicine services
Authors: Valero M A , Arredondo M T , Nogal F Del , Rodríguez J M , Torres D
Published: October 2002

Most recent cable television network infrastructures can be used to deliver broadband interactive telemedicine services to the home. These facilities allow the provision of social and health services like medical televisiting for elderly, disabled and chronically ill patients; health tele-education; and teleconsultation on demand. Large numbers of patients could benefit from these services. There is also the increasing European tendency to offer customized home-care services. These applications are being developed and validated by a pilot project in Madrid as part of the ATTRACT project of the European Commission. The long-term aim is to develop broadband applications on a large scale to support low-cost interactive home telemedicine services for both patients and institutions.
A review of telemedicine
Authors: Al-Kassab Mohammed Hameed Ahmed , Lu Dong Ming , Pan Yun He
Published: October 2002

Moving the information instead of the patient is often sufficient and telemedicine is a useful and potentially powerful tool which fulfils this idea. It has changed the classical form of health-care delivery by providing those people living in rural and remote areas with comparable services to those in urban areas. Equally, remote hospitals can obtain specialist consultations and diagnosis without the need for the patient to travel. We have reviewed the present status of telemedicine and its future possibilities.
Business risks in telemedicine
Authors: Dennis Terry
Published: October 2002

There is a wide range of potential risks associated with telemedicine. Medical professionals and managers who are contemplating the use of telemedicine are strongly advised to undertake a full risk analysis before, not after, implementation.
Ten years’ clinical experience with telemedicine in prenatal care in Hungary
Authors: Tõrõk Miklós , Turi Zsuzsa , Kovács Ferenc
Published: October 2002

A multicentre randomized clinical trial of prenatal home care of pregnant women was carried out in Hungary. Pregnant women registered contraction activity of the uterus daily using a portable contraction monitor. The data were transmitted directly to the physician's PC for analysis. Of 748 women who entered the study, only 263 fulfilled all the requirements of randomization, monitoring and treatment. The preterm birth rate in the study group was half that of the control group. Telemedical prenatal monitoring improves perinatal results by providing more intensive and better observation of pregnant women.
Preliminary results from the Mexican national telemedicine network
Authors: Coutin-O Javier Castellanos , Vivian Manuel Gonzalez , Hernandez Luis Amaro , Gonzalez Amanda O. Gomez
Published: October 2002

A national telemedicine network was established in Mexico, based on satellite transmission. Six remote hospitals were connected during the first phase in 1997. The network applications included distance learning and administration. In addition, 476 clinical consultations were carried out in the first six months to March 1998 . Clinical problems were solved in the teleconsultation in 159 cases 33 . The patient was transferred in 217 cases 46 . The 16 most common specialties at the six remote sites accounted for 274 teleconsultations, and cardiology and orthopaedics accounted for just over half of all teleconsultations. One of the six remote sites accounted for 41 of the teleconsultations.
The comparative performance of mobile telemedical systems based on the IS-54 and GSM cellular telephone standards
Authors: Istepanian Robert H , Woodward B , Balos P A , Chen S
Published: October 2002

The performance of mobile telemedical communications links based on the IS-54 and GSM cellular telephone standards the most widely used commercial systems in North America and Europe, respectively was studied by computer simulations. A photoplethysmography signal was used to investigate the transmission of medical data over simulated mobile phone channels. Various conditions were simulated in the communications path between a mobile transmitter and receiver, from perfect to distorted conditions. The results showed successful transmission, with bit error rates of better than 10-7 at the receiver for the IS-54 standard. The performance of the IS-54 standard was superior to that of GSM in terms of minimum path delay variations, especially in builtup urban areas.
Teleconsultations between general practitioners and ophthalmologists in Finland
Authors: Lamminen Heikki , Salminen Lotta , Uusitalo Hannu
Published: October 2002

We carried out a study of the value of videoconferencing in consultations between general practitioners GPs and ophthalmologists in Finland. We used ISDN lines 128 kbit s between the Primary Health Care Centre in Ikaalinen and the ophthalmology clinic at the Tampere University Hospital TAUH. Questionnaires covering both clinical and technical matters were given to patients and doctors after the consultation. During the 10-month study, consultations were carried out successfully for 23 of 24 patients 96 . Most consultations 84 took less than 15 min. If we had not had this system, the GP would have made 21 referrals to an ophthalmologist. After teleconsultation, six patients were sent to the TAUH, so the system saved 15 referrals. Twenty-two patients 92 thought that videoconferencing was a reliable tool for GPs. Our system proved to be a valuable and reliable tool for the GPs in ophthalmology consultations and continuing education.
The effect of information technology on the physician workforce and health care in isolated communities: The Canadian picture
Authors: Watanabe Mamoru , Jennett Penny , Watson Margaret
Published: October 2002

The ratio of physicians to population in Canada peaked in the mid-1990s and is now falling. The decrease in the number of family physicians has had a disproportionate effect on rural and remote communities, and surveys have indicated that the availability of physicians and services is likely to deteriorate in rural and remote communities. Telemedicine is increasingly evident in every Canadian province and territory, and it could assist in more effective use of workforce resources by linking appropriate experts at central sites to patients and practitioners at remote sites. Positive effects on recruitment and retention of health providers and morale of the local workforce can be expected. In spite of national interest, evidence for the effect of telemedicine on staff distribution, roles and recruitment, use of health resources, health management and system integration is very limited. Telephone interviews were therefore conducted to collect information from 12 telehealth projects in Canada, one from each province or territory. The responses confirmed observations in the literature that telemedicine has positive outcomes for the workforce.
Future systems for remote health care
Authors: Brownsell S J , Williams G , Bradley D A , Bragg R , Catlin P , Carlier J
Published: October 2002

As the number of elderly people in society increases, the use of technology to support the care system is being examined. However, there is no agreed model of a technology-based health-care system that fully integrates the technical and social aspects to meet the needs of both clients and care providers. This paper examines a possible model from the perspective of both the client and the service provider, and estimates the costs, and hence the potential savings, associated with the introduction of a health-care system based on this model. Cost data are presented in the context of an installation as might be anticipated within a city such as Birmingham, UK. Installation costs of an advanced telecare system would be higher than the set-up costs of conventional systems. Expected savings in control centre costs and emergency services costs would be small. However, a reduction in the average annual length of hospital stay by one day and a reduction in the proportion of elderly people being treated in hospital from 32.4% to 32.0%, directly as a result of the use of advanced telecare, would produce significant savings. A financing scheme with a 5-year or 10-year repayment period would then be financially viable for a 10,000-home advanced telecare system.
Guidelines for multipoint videoconferencing using low-cost, PC-based equipment
Authors: Klutke P J , Baruffaldi F , Mattioli P , Toni A , Englmeier K-H
Published: October 2002

We have compiled a set of guidelines for effective multipoint videoconferencing carried out with low-cost, PC-based systems. The guidelines are based on experience gained during multipoint videoconferences in epidemiology and orthopaedics/radiology. Joint data inspection and manipulation were carried out by application sharing between the PCs. The guidelines are categorized by the time of their application and also by their content. For effective multipoint videoconferences, preparation of the agenda and of digital documents is mandatory. The prevention of echo effects and half-duplex audio connections are of special importance. A protocol to optimize the order of speakers increases the efficient use of conference time. The guidelines worked well when used in a multisite research project and addressed the most important weak points of multipoint videoconferences using low-cost equipment.
Telemedicine in north-west Russia
Authors: Sorensen T , Rundhovde A , Kozlov V D
Published: October 2002

During the last few years, telemedicine based on simple, low-cost technology has increased significantly in the Arkhangelsk region of north-west Russia. Specialists at the regional hospital of Arkhangelsk are diagnosing patients from local hospitals 600-700 km from the capital. A still-image system is used for emergency cases. The same technology, along with telephones with loudspeakers, is also used to provide distance learning at the regional hospitals of Arkhangelsk and Tromso. This article describes the results from the telemedicine collaboration between the University Hospital of Tromso and health-care institutions in Arkhangelsk, and discusses the experience gained.
Telemedicine for clinical psychology in the Highlands of Scotland
Authors: Freir V , Kirkwood K , Peck D , Robertson S , Scott-Lodge L , Zeffert S
Published: October 2002

Telemedicine may be useful in the delivery of clinical psychology services in the Highlands of Scotland, where geographical size and sociodemographic factors can hinder service delivery. The Highlands have a population of 210,000 at a density of approximately 8 people/km2, one of the lowest in the European Union. Despite a general lack of formal evaluation of telemedicine, especially in mental health, descriptive studies and patient satisfaction reports give grounds for optimism. There are several current applications of telemedicine in the Highlands, including cognitive-behavioural therapy, a comparative evaluation of neuropsychological assessments, and the treatment of children and their families. The projects are being formally evaluated and early results are encouraging.
Neurological examination is possible using telemedicine
Authors: Craig J J , Mcconville J P , Patterson V H , Wootton R
Published: October 2002

To compare the reliability of neurological examination performed by telemedicine and face to face, a junior doctor examined 23 patients face to face, these examinations being witnessed either by one or by two telemedicine observers using a telemedicine video-link at 384 kbit/s. The gold standard was a face-to-face examination from a panel of six consultant neurologists. Power, deep tendon reflexes, plantar responses, coordination, sensation, eye movements, facial strength, tongue movements, sitting balance and gait were studied. Seventeen patients satisfied the inclusion criteria, and a total of 1084 matched pairs of observations were made. The reliability of the telemedicine examination ranged from fair to moderate for deep tendon reflexes, coordination and eye movement, to near perfect for plantar responses. Overall, examination by telemedicine compared favourably with face-to-face examination. Telemedicine examination was more sensitive in detecting abnormalities than face-to-face examination for all the neurological tests studied and more specific for all but one (plantar responses). The study showed that neurological examination using telemedicine is at least as good as face-to-face examination performed by a junior doctor.