bluuebunny/crossref_metadata_2025 huggingface dataset:
Satellite-delivered medical education and training for Central Europe: a TEMPUS project
Authors: Young H L
Published: October 2002

This paper reports the experience gained in delivering continuing and postgraduate medical education by satellite to update medical teachers in Central Europe. An infrastructure of receiving sites was established in the Czech Republic, Slovakia, Poland and Hungary. The sites participated in regular, live interactive broadcasts on a range of medical education topics. Over three years a network of sites was established incrementally and a national coordinator identified for each country, who fed back from national coordinating committees to an overall steering body. In the final year a formal evaluation revealed high satisfaction levels and maintenance of activity during the grant period. The major problems related to a lack of telephone lines to facilitate interactivity, the timing of the programmes, and the need for training in medical English language. Video libraries were established, and the majority continued to be active at the end of the project grant. Material was incorporated into both undergraduate and postgraduate education. It is calculated that continuing professional development can be delivered at less than 18 ECU per participant per country.
Telepathology using Internet multimedia electronic mail: remote consultation on gastrointestinal pathology
Authors: Mea V. Della , Forti S. , Puglisi F. , Bellutta P. , Palma P. Dalla , Mauri F. , Beltrami C. A. , Finato N.
Published: October 2002

The feasibility of using the Internet for remote pathology consultation was examined. We assessed the diagnostic agreement between two groups of pathologists who independently evaluated histopathological cases exchanged by Internet electronic mail. The exchange was between two different workstations using readily available software not specifically developed for telemedicine. Data and images from 76 cases were transmitted to four pathologists. An average of 4.5 images per case were transmitted at compression ratios of between 6:1 and 40:1, corresponding to 250 kByte of data per case. In two cases the remote pathologists could not make a diagnosis. Agreement was reached in 63 of the other 74 (kappa=0.79) =. In 11 cases (15%) there was a misdiagnosis. However, the results are encouraging and suggest that Internet electronic mail can be used successfully for remote consultation in pathology.
Digital transmission of 12-lead electrocardiograms and duplex speech in the telephone bandwidth
Authors: Mckee J J , Evans N E , Owens F J
Published: October 2002

Summary A system was developed which allowed the simultaneous communication of digitized, full duplex speech and electrocardiography ECG signals in realtime. A single band-limited channel was used over a standard telephone line providing 3 kHz bandwidth. The full duplex speech was compressed to 2400 bit s using linear predictive coding, while multiple ECG signals were processed by a novel ECG compression technique. Extensive use of digital signal processing reduced the combined bit rate to less than 9600 bit s, allowing the use of lowcost commercial modems. The ECG communications system was tested in clinical trials. It enabled a hospitalbased clinician to provide diagnostic and treatment advice to a remote location over the standard telephone network.
Organization and activities of the International Radio Medical Centre (CIRM)
Authors: Amenta F , Dauri A , Rizzo N
Published: October 2002

The International Radio Medical Centre CIRM was founded in 1935, to provide free medical assistance by radio to ships with no doctor on board and others who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. The results achieved by the Centre over 61 years include medical assistance to 42,935 patients on board ships as well as on small islands and aircraft , with 375,264 medical messages received and transmitted. CIRM is organized into a medical service, a telecommunications service and a studies section. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case. If necessary the medical service will coordinate the patient's hospitalization at the nearest port with suitable medical facilities or arrange the patient's transfer to another ship with a doctor on board, or an airlift. The telecommunications service receives requests for assistance, locates the ship or whoever made the request, passes the call to the doctor on duty, and relays the doctor's response to those requesting assistance. The studies section, established in 1957-58, researches occupational pathologies of sailors and contributes to their prevention. This provides a scientific basis for improving medical assistance to sailors at sea.
A multiparameter, PC-based for biomedical signals telemetry unit
Authors: Hofmann B
Published: October 2002

A low-cost, general-purpose telemetry system was developed for use in rural health centres, hospitals, ambulances and clinics. It was designed to transmit a range of analogue biomedical signals using various communications media. The system was tested using different telephone systems, including mobile telephony. The results showed a maximum sample rate of 1.6 kHz using the public telephone network. W h three data channels the system produced sample rates of 500 Hz at 8 bit/sample. Typical overall delay times were below 100 ms. Mobile tests showed that the GSM telephone was superior to the Nordic mobile telephone (NMT 900). In field tests, sample rates of 990 Hz were obtained using GSM telephony. Bit error rates were less than 10-7 for all applications and high-fidelity regeneration was obtained at the receiver. The tests showed that the system was well suited for telemetry of analogue biomedical signals in a broad range of telemedicine applications.
A cost analysis of an emergency computerized tomography teleradiology system
Authors: Stoeger A. , Strohmayr W. , Buchberger W. , Jaschke W. , Giacomuzzi S. M. , Dessl A.
Published: October 2002

We carried out a cost analysis of a teleradiology system for emergency computerized tomography CT examinations. Teleradiology was implemented by connecting two spiral CT scanners in the University Hospital in Innsbruck and the Regional Hospital in Zwettl. It enabled the remote hospital in Zwettl to get fast and competent reports of emergency CT examinations when there was no specialist radiologist available. In 13 months use for routine night and weekend service, the system proved fast and reliable. During the study period 121 emergency examinations of 116 patients were transmitted from Zwettl to Innsbruck. The fixed costs of teleradiology were for the ISDN connection and amounted to DM230 plus DM696 year rental. The average cost of one emergency CT examination by teleradiology was DM372 range 308-453 . One possible alternative, transporting the films by taxi for reporting elsewhere, was cheaper estimated cost DM156 , but would have been much slower. Another alternative, transporting the patient to the nearest central hospital for scanning, was much more expensive: DM524 by road or DM4667 by helicopter ambulance.
Use of the new media for medical education
Authors: Tangalos E. G. , Mcgee R. , Bigbee A. W.
Published: October 2002

The use of an advanced communication network for education has been an integral part of practice at the Mayo Clinic since 1986. The network has been used for patient care, research coordination and administrative support, as well as for educational programming. In 1994, 2655 hours were broadcast by satellite. There were 42,292 participants, representing a total of 47,364 contact hours. Over half of this activity was educational. In using the satellite system, a number of background support systems have been found to be essential to effective communication. First, highly trained technical staff are required to support the communication system. Second, presenters require formal training in adapting audiovisual materials, such as slides and transparencies, to broadcast media. Third, as use of the system has grown, scheduling and prioritizing among the many users has become an increasingly time-consuming and challenging task.
A home electrocardiography and blood pressure telemonitoring system
Authors: Bai J , Zhang Y , Zhou X , Dai B , Cui Z , Lin J , Ding C , Zhang P , Yu B , Ye L , Shen D , Zhu Z , Zhang J , Ye D , Zhou L
Published: October 2002

A home electrocardiography (ECG) and blood pressure telemonitoring system for cardiac patients was installed in the Macau region. The monitoring centre was established in the emergency unit at the Government Hospital of Macau. The first users were 10 cardiovascular patients selected by a physician. The average age of these users was 61 years (range 30–78). The results of a three-month trial showed that the system was easy to operate and technically reliable. It was found to be helpful for cardiac patients. The most significant problem during the trial was electrical noise from the ECG electrodes.
Telepsychiatry: ‘tele’ yes, but what about the ‘psychiatry’?
Authors: Baigent Michael F , Lloyd Chris J , Kavanagh Steve J , Ben-Tovim David I , Yellowlees Peter M , Kalucy Ross S , Bond Malcolm J
Published: October 2002

To investigate what is lost or gained in a psychiatric evaluation when it takes place via telepsychiatry we compared the inter-rater reliability between two psychiatrists interviewing 63 subjects in an observer/interviewer split configuration in telepsychiatry and same-room settings. The measures used were the BPRS and interviewer ratings from a semi-structured interview. Patients also rated their experience. There were some clear differences between the telepsychiatry and same-room evaluations. Despite these variations, diagnoses were as reliably made by telepsychiatry. Patient acceptance of telepsychiatry was high.
Home telenursing in Kansas: Patients’ perceptions of uses and benefits
Authors: Whitten Pamela , Mair Frances , Collins Bart
Published: October 2002

Elderly individuals involved in a home telenursing project were studied. The project nurses provided home health services from ‘telenursing cockpits’ located in three separate sites in Kansas. A cable television-based interactive video system was used to transmit video pictures at 30 frames/s, with 288 horizontal lines of resolution. During phase 1 of the study, interview data were collected from 22 subjects(4 men, 18 women). During phase 2, the original participants were contacted but only 9(1 man, 8 women) were still receiving home health services. Contrary to expectations, the technology was not an important issue for the participants. They did not express any particular worry or excitement about it. Nor did they describe difficulties in adapting to its use. Use of telemedicine technology did not appear to have any negative effects on communication. The results suggests that further thought needs to be given to defining clearly the purpose and goals of telemedicine projects.
Use of neural networks in telemedical monitoring of divers
Authors: Istepanian R Habib , Woodward B
Published: October 2002

An artificial neural network (ANN) has been developed to predict and classify the risk of medical disorders for certain dive profiles. The telemedical data applied to the ANN represent different physiological and physical parameters that are transmitted acoustically from a diver to a remote receiver. The telemetered data include dive time, maximum depth and decompression stop times and depths. Preliminary tests demonstrated the successful performance of the ANN where classical mathematical and statistical methods had failed due to the complex nature and variability of the parameters involved.
A pilot study in medical education using interactive television
Authors: Brebner E M , Brebner J A , Norman J N , Brown P A J , Ruddick-Bracken H , Lanphear J H
Published: October 2002

Medical students in the United Arab Emirates do not receive postmortem teaching. This is because postmortems are not normally carried out, for cultural reasons. In order to address this problem a collaborative project was established between the medical schools of Aberdeen University and the United Arab Emirates University to evaluate the feasibility, acceptability and effectiveness of telepathology teaching. A videoconferencing link was established between the UK and the Middle East using ISDN at a transmission speed of 384 kbit/s. Although some technical problems relating to line continuity were encountered, the results relating to feasibility, acceptability and effectiveness were very positive. Although expensive, this form of teaching may still be cost-effective in relation to the benefits.
Effect of camera performance on diagnostic accuracy: preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial
Authors: Loane M A , Gore H E , Corbett R , Steele K , Mathews C , Bloomer S E , Eedy D J , Telford R W , Wootton R
Published: October 2002

The diagnostic accuracy of realtime teledermatology was measured using two different video cameras. One camera was a relatively low-cost, single-chip device camera 1 , while the other was a more expensive, three-chip camera camera 2 . The diagnosis obtained via the videolink was compared with the diagnosis made in person. Sixty-five new patients referred to a dermatology clinic were examined using camera 1 followed by a standard face-to-face consultation on the same day. A further 65 patients were examined using camera 2 and the same procedure implemented. Seventy-six per cent of conditions were correctly diagnosed by telemedicine using camera 2 compared with 62 using camera 1. A working differential diagnosis was obtained in 12 of cases using camera 2 compared with 14 using camera 1. The percentage of `no diagnosis`, wrong and missed diagnoses was halved using camera 2 compared with camera 1. These results suggest that the performance of the more expensive camera was superior for realtime teledermatology.
Telemedicine in Australia. Recent developments
Authors: Crowe B. L. , Mcdonald I. G.
Published: October 2002

There have been a number of important developments in Australia in the area of telemedicine. At the national level, the House of Representatives' Standing Committee on Family and Community Affairs has been conducting the Inquiry into Health Information Management and Telemedicine. The Australian Health Ministers' Advisory Council has supported the establishment of a working party convened by the South Australian Health Commission to prepare a detailed report on issues relating to telemedicine. State governments have begun a number of telemedicine projects, including major initiatives in New South Wales and Victoria and the extensive development of telepsychiatry services in Queensland. Research activities in high-speed image transmission have been undertaken by the Australian Computing and Communications Institute and Telstra, and by the Australian Navy. The matter of the funding of both capital and recurrent costs of telemedicine services has not been resolved, and issues of security and privacy of medical information are subject to discussion. The use of the Internet as a universal communications medium may provide opportunities for the expansion of telemedicine services, particularly in the area of continuing medical education. A need has been recognized for the coordinated evaluation of telemedicine services as cost-benefit considerations are seen to be very important.
Patient satisfaction with multispecialty interactive teleconsultations
Authors: Huston Janis L. , Burton Deborah C.
Published: October 2002

Satisfaction with teleconsulting was evaluated for 96 patients using the Kentucky TeleCare telemedicine network. Consultant specialties included psychiatry 41 , dermatology 24 , clinical nutrition 20 , anaesthesia 3 , infectious diseases 3 , rheumatology 2 , internal medicine 1 , neurology 1 and paediatric pulmonology 1 . The results indicated a high level of patient satisfaction, with a mean score of 6.8 on a 7- point Likert scale with 1 strongly disagree and 7 strongly agree for the question Overall, I was very satisfied with today's consultation'. The results indicated that the majority of patients were satisfied with the telemedicine encounter although a minority, 16 , would have preferred to have seen the specialist in person.
Use of video in the informed consent process
Authors: Burton Deborah C , Huston Janis L
Published: October 2002

We created a video-tape about the concept of telemedicine for informational and educational purposes. Two video-tapes, one with and one without the informed consent segment, were distributed to each of the Kentucky TeleCare sites. On the day of their teleconsultation, patients were asked to watch the video-tape (with the version containing the informed consent segment) before signing the informed consent to participate. Site coordinators then asked patients whether they had any specific questions about telemedicine. To date, patients have reported high levels of satisfaction with this method of consultation, using telecommunications technology to deliver health care.
Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: is clinical management by realtime teledermatology possible?
Authors: Loane M A , Gore H E , Bloomer S E , Corbett R , Eedy D J , Mathews C , Steele K , Wootton R
Published: October 2002

Results from phase 1 of the UK Multicentre Teledermatology Trial demonstrated the diagnostic accuracy of realtime teledermatology using low-cost equipment. Phase 2 of the trial aimed to assess its effectiveness as a management tool for dermatological disease. Teledermatology consultations were organized between two health centres and two hospitals in Northern Ireland using low-cost videoconferencing equipment. For 205 patients seen by a dermatologist over the video-link a diagnosis and management plan were recorded. A subsequent face-to-face consultation was arranged on the same day to confirm the diagnosis and treatment regime. A comparison of these management plans revealed that the same plan was recommended in 64% of cases; the teledermatologist was unable to advocate a suitable management plan in 19% of cases; a suboptimal treatment plan was suggested by the teledermatologist in 6% of cases; and in 11% of cases, the teledermatologist suggested an inappropriate treatment plan. These findings indicate that appropriate clinical management was possible in approximately two-thirds of dermatology consultations via the video-link.
Nurse reactions to a prototype home telemedicine system
Authors: Whitten Pamela , Collins Bart
Published: October 2002

We have studied nurse reactions to a prototype home health telemedicine system. The system used interactive video through the local cable television network. Six nurses were directly involved with telecare video-visits. There were 54 patients. The average age of the patients was 76 years (range 21–101). Thirty-six(67%) patients were female and 18 (33%) were male. The patients had an average of 4.6 different diagnoses (range 1–16). They were also on a very wide range of medications (mean 9.9, range 2–23). Nurses overwhelmingly felt the system was effective for what this particular project was trying to accomplish. They were enthusiastic about the prospects of practising nursing by telemedicine, even though they had reservations about aspects of the particular system being used. Their main complaints were about limitations of the software and limitations of the telecommunication system that linked them to the patients.
A pan-European social alarm system
Authors: Thie Jan
Published: October 2002

SAFE 21 is a pan-European research and development project which will take social alarms into the twenty-first century. It is run by a consortium of eight organizations, with financial support from the European Commission. SAFE 21 will use existing infrastructure to deliver a much broader range of services and extend availability to users who are currently excluded. The project aims: to develop a social alarm that will work from anywhere inside the home, using a neck-worn speech-pendant and outside the home making use of radio cellphone and global positioning technology; to demonstrate how telemedicine can be incorporated at marginal costs, by exploiting the existing social alarm infrastructure; to demonstrate a shared control centre that facilitates emergency services, medical, welfare and social professionals working together to support a broad-based social alarm system; to provide access to social alarms for deaf users, who are currently excluded.
The experience of the Royal Children's Hospital mental health service videoconferencing project
Authors: Gelber Harry
Published: October 2002

In April 1995 the Royal Children's Hospital Mental Health Service in Melbourne piloted the use of videoconferencing in providing access for rural service providers and their clients to specialist child and adolescent psychiatric input. What began as a pilot project has in two years become integrated into the service-delivery system for rural Victoria. The experience of the service in piloting and integrating the use of videoconferencing to rural Victoria has been an important development for child and adolescent mental health services in Australia.
Trans-telephonic electrocardiographic monitoring—experience in India
Authors: Rissam H S , Kishore S , Bhatia M L , Trehan N
Published: October 2002

A centre for trans-telephonic electrocardiographic monitoring (TTEM) was established at the Escorts Heart Institute in May 1996. We have reviewed our experience in the first 398 patients. There were 321 males (81%) and 77 females (19%); their age range was 1 month to 95 years. Sixty-five per cent of patients were from New Delhi, while the remainder were from other cities in India and abroad. As well as follow-up of patients after discharge, the system was used for the evaluation of chest pain, palpitation, chronic angina, arrhythmias, and pacemaker implants. Out of 664 symptomatic transmissions, 510 (77%) were for cardiac symptoms like chest pain (309), palpitation (90), uneasiness (61), dizziness (28) and breathlessness (22); the other 154(23) were for non-cardiac symptoms like stitch pain and backache(51), typical chest pain(39), weakness and fever (45), and sweating(19). The majority of patients with chest pain (84%), palpitation (78%) and dizziness (75%) transmitted their electrocardiograms within one hour of the onset of the symptoms. Out of 664 symptomatic transmissions, 531 required either reassurance or drug-dose adjustment by telephone and 97 were called to the outpatient department on an elective basis. Immediate hospitalization was advised for 36 patients, for acute management of their symptoms. TTEM was useful in avoiding 628 unnecessary visits to the hospital, while 36 patients were immediately hospitalized for acute care.
Cost-effectiveness analysis of telemedicine
Authors: Crowe B L
Published: October 2002

There are a number of different costs associated with the development and operation of telemedicine services. A model is proposed in order to assist in strengthening the evidence base for telemedicine. It includes the following components: project establishment costs; equipment costs; maintenance costs; communication costs; staffing costs. All need to be considered in arriving at an annual cost figure for operating a telemedicine service. The inclusion of all these costs, prepared in the standard manner outlined in the model, will ensure that a realistic cost figure is available when evaluating the cost-effectiveness of a telemedicine service.
Telematic electrodiagnosis from six laboratories in three European countries and one Asian country
Authors: Papakostopoulos D , Ramani V , Papakostopoulos S , Hart J C Dean
Published: October 2002

The results of an electrodiagnostic test, the electro-oculogram, recorded under standardized conditions, were compared. Recordings were obtained from 70 normal subjects in three European countries and 28 subjects in an Asian country. All subjects were 18–34 years old. Equal numbers of male and female patients were tested in each of six laboratories. There were no significant differences between the results of the European laboratories. There were, however, significant differences between the results of the European and the Asian laboratories, and between the results from the male and female subjects in all laboratories. This suggests the need for considering the possibility of male/female as well as local variations in normal control values when telemedicine is applied on a global scale.
A survey of research in telemedicine. 2: Telemedicine services
Authors: Taylor P
Published: October 2002

Summary This article deals with research which attempts to demonstrate the value of health care delivered via telemedicine. A great variety of telemedicine services have been proposed. Much of the published work concentrates on the power of the technology and the content and quality of interaction it supports. There are other parameters to be considered in assessing telemedicine as a component of a health-care system, parameters which in practice determine the nature of the service being provided. Despite the fact that much work in telemedicine is published as short accounts of pilot projects, there is little research that explicitly addresses the difficulties involved in setting up new telemedicine services. Some studies have been performed which attempt to evaluate telemedicine services, but relatively few studies have been able to collect the data required to provide an unambiguous demonstration of their value.
Telecare at home: factors influencing technology choices and user acceptance
Authors: Fisk Malcolm J
Published: October 2002

Summary Acceptance of telecare technologies in the home is strongly influenced by factors that relate to dwelling design and the ways in which independent living is promoted. The experience to date of personal response systems and services provides some indication of the reasons why users may either resist their introduction or not use such technologies after they have been introduced. Telecare systems and services are poised to incorporate medical and other sensors, so that the manner of their provision, installation and control becomes an important consideration for service providers. A clear ethical framework is called for.
Nurse and patient reactions to a developmental home telecare system
Authors: Whitten P. , Collins B. , Mair F.
Published: October 2002

Pilot studies have suggested that telemedicine is a satisfactory means of delivering nursing services into the home. A home telecare programme in Kansas provided nursing services to homes in four towns in Kansas. The present study examined patients' and nurses' perceptions of a variety of issues related to home telecare. Datacollection methods included in-depth interviews, observation and analyses of archival data from patient records. Patients suffered an average of 4.6 concurrent illnesses. On the whole, patients perceived the system as a valuable resource that offered great potential, although many saw no immediate health benefits for themselves. Nurses were enthusiastic about the prospect of practising in this way, although they did have strong opinions about what types of nurses, patients and illnesses were suited to telemedicine.
Telepsychiatry in South Australia
Authors: Hawker Fiona , Kavanagh Steven , Yellowlees Peter , Kalucy Ross S
Published: October 2002

Telemedicine has evolved to become an integral part of the South Australian Rural and Remote Mental Health Service. The resulting telemedicine service is one of only a few telepsychiatry services around the world that is firmly embedded in normal clinical practice and can be regarded as sustainable. The telepsychiatry service has been operational in Adelaide since January 1994 and more than 2000 clinical consultations have been performed since that time. In contrast to other telepsychiatry systems internationally, more than 80 of the usage of the South Australian system has been for clinical purposes. The benefits and limitations of telepsychiatry are reviewed, as are factors that have affected the success of the project.
Digital wireless radiology consultations with a portable computer
Authors: Reponen J , Ilkko E , Jyrkinen L , Karhula V , Tervonen O , Laitinen J , Leisti E-L , Koivula A , Suramo I
Published: October 2002

A wireless system for radiological subspecialist consultation based on a portable personal computer and a GSM cellular phone was tested. A link with secure access to the hospital image network was built. A total of 68 emergency computerized tomography CT examinations were transmitted. Transmission time via GSM for a single CT image was 1 min and for a complete head scan was 18 min. The transmitted images were acceptable for final diagnosis in 72 of the cases, the rest being acceptable for preliminary diagnosis. The diagnosis from the transmitted images did not change after a later review of the original images in 97 of cases. The wireless link saved a hospital visit by the senior radiologist in 24 of cases. The results show that a remote consultation link can be built with readily available technology and that the technique is useful in radiological subspecialist consultations for CT images.
Patient satisfaction with telemedicine in a prison environment
Authors: Mekhjian Hagop , Turner Jeanine Warisse , Gailiun Michelle , Mccain Thomas A.
Published: October 2002

Prison inmates were surveyed about their perceptions of the use of videoconferencing in clinical consultations. A 14-item questionnaire was used to assess satisfaction with the patient-physician clinical interaction. Of the 299 inmates surveyed immediately after their teleconsultations, 221 completed questionnaires that were suitable for analysis 74. Only 9 of patients indicated that they were not satisfied with the teleconsultation. They rated the telemedicine context well above the midpoint of the scale 16 on both an information-exchange and a patient-comfort dimension, with means of 29 and 24, respectively. There was a significant difference P<0.01 in the patient-comfort dimension in terms of the location of the prisoners. No significant differences were found in patient satisfaction related to the specialty of the physician. The results suggest that many contextual factors must be considered to understand the communicative implications of patient satisfaction with telemedicine.
School-based telemedicine: Using technology to bring health care to inner-city children
Authors: Whitten Pamela S , Cook David J
Published: October 2002

In the USA, children in low-income, medically understaffed areas have difficulty accessing health care. A pilot telemedicine service was established in Kansas, linking four elementary schools with a local hospital at 128 kbit/s. PC-based videoconferencing systems, a stethoscope, an otoscope and fax machine were installed for each school's nurse. During the first three months of operation, 187 consultations were conducted by a hospital physician over the video-link. Ear, nose and throat problems were the most common reason for referral (29%), followed by dermatological problems (20%) and mandatory school physicals(20%). Prescriptions were issued in 67% of cases. Eighteen per cent of children required referrals for specialist care. The pilot service successfully enabled medically disadvantaged children to receive health care and prompted four additional schools to join the project.
Telemedicine: Capabilities of telecommunications in clinical practice in Russia
Authors: Buravkov S V
Published: October 2002

Successful implementation of telemedicine services depends on an adequate telecommunications infrastructure. At present the main infrastructure in Russia and the countries of the former Soviet Union consists of analogue telephone lines. These are sufficient for email and access to the World Wide Web but do not provide sufficient bandwidth for the transmission of real time teleconsultations. ISDN lines and fibre optic cables are becoming more widespread in the major cities but have yet to be installed in the regions.
Telemedcine on a small island
Authors: Balestri R , Cavina E , Aliferis A , Goletti O , Rocci R , Lippolis P V , Zocco G , Franceschi M , Cotrozzi A , Economou S , Christofidis E
Published: October 2002

Information on the health status of the population of a small Greek island was collected. The information consisted of personal data, clinical history, physical examination, blood pressure evaluation, electrocardiography, and ultrasound scans of neck, breast and abdomen. Ninety-six per cent of the entire island population (280 inhabitants) participated in the study. Two per cent were at risk of serious complications of pathological disease and were immediately referred to a regional hospital for adequate care while 25% had minor pathological problems. Our on small islands should be trained in the use of technology as a means of communication with ma inland hospitals.
Telemedicine and distance learning—experience in Georgia and future prospects
Authors: Kirtava Z , Paposhvili K , Jorjoliani D , Sheshelidze D
Published: October 2002

Telemedicine and distance learning have a high priority in Georgia owing to the uneven distribution of health-care resources. Outside the country's capital, Tbilisi, resources and manpower are scarce, so telemedicine maybe the best option for health-care delivery in spite of the costs. However, an adequate infrastructure must be in place to make this possible. The National Information Learning Centre(NILC) provides access to the Internet and MEDLINE and is currently assessing the best software for low-bandwidth distance learning and videoconferencing.
Telemedicine in Sweden—a diffusion study
Authors: Sjögren Lotta Holm , Sandberg Carolina , Törnqvist Helene
Published: October 2002

A survey of telemedicine use in Sweden was carried out. The response rate by hospital management was high at almost 90%. Sixty per cent of hospitals were involved in some kind of telemedicine activity in Sweden, with a further 15% planning telemedicine implementation. In rural areas of north Sweden good links exist between primary and secondary care. In the more populated southern region good links exist between the county hospitals and specialist university hospitals. Fifty-four per cent of telemedicine applications were used for specialist consultations, 13% for consultation between paramedics and hospitals and 10% for rounds. Teleradiology was the most frequent service.
A business model for telemedicine
Authors: Navein J , Arose D , Pietermich A
Published: October 2002

The US Military Healthcare System commissioned a clinical and business case study for telemedicine in Europe. The aims of the study were to identify the major cost areas by specialty for each European location, to assess the feasibility of a telemedicine alternative and to carry out a cost–benefit analysis. We also examined 2000 consecutive air referrals to determine whether telemedicine could have avoided evacuation. The study showed that 31, 000 conventional consultations could be replaced by telemedicine in Europe each year. The potential savings amounted to $3.7 million in travel costs and 25, 000 working days. The business and clinical case for telemedicine was strong, thus providing one of the prerequisites for successful telemedicine.
Integrating interactive television-based psychiatric consultation into an urban community mental health service
Authors: Mclaren Paul , Mohammedali Akber , Riley Ann , Gaughran Fiona
Published: October 2002

We conducted a pilot study of urban telepsychiatry employing interactive television (IATV) over ISDN links for psychiatric consultation to support a primary-care mental health team. During the six months of the pilot phase, 30 consultations were arranged by the general practitioners for 14 different patients. Of these, 24 were completed by IATV and one by telephone when the IATV link failed. The system was used to manage patients with complex problems, many of whom were difficult to engage in standard services. The results showed high levels of user acceptance. Various problems for the further implementation of such systems were also identified.
Training for telemedicine
Authors: Blignault Ilse , Kennedy Craig
Published: October 2002

All technology requires training. Simply installing videoconferencing equipment in a hospital or health centre, and leaving the manufacturer's manual nearby, is not sufficient to encourage or maintain its use for telemedicine. Presenting clinicians and other users with thick policy and procedure documents to be read and understood is also not helpful. Following initial awareness raising about telemedicine and its potential, staff must be properly trained: not just in how to turn on the equipment but in how to use it effectively for consultation, education and administrative purposes. Training needs to be continual, especially where staff turnover is high. It should be practical, pitched at different levels, incorporated into mainstream activities such as orientation courses and staff development days wherever possible, and supplemented with clear, straightforward protocols and user-friendly instruction manuals.
MultiMed—remote interactive medical simulation
Authors: Tooley M A , Forrest F C , Mantripp D R
Published: October 2002

MultiMed is a telemedicine and tele-education project to extend access to a sophisticated medical simulation facility in Bristol. It will allow remote users to undertake simulated medical scenarios and to access a reference database, for a comprehensive remote learning experience. The first phase will focus on the area of anaesthesia and all remote users will be based in the UK.
Mobile satellite systems
Authors: Lamminen H
Published: October 2002

Satellite communication is a technique which has been used in telemedicine, often for educational purposes. Almost all of the work has concerned the use of fixed satellite terminals. Mobile satellite services MSS provide two-way voice and data communication from hand-held terminals, where the final link to the subscriber is by satellite. A number of new MSS systems are expected to become operational by 2001, providing either regional or global coverage. The most well developed proposals are Globalstar, ICO, Iridium and Odyssey. All the proposed systems use non-geostationary satellites. The MSS systems will allow international travellers to make and receive calls using a unique telephone number for their handset anywhere in the world where the service has been authorized by the local regulatory authorities. Data and fax services will also be available. By 2002 the proposed MSS systems might serve a million subscribers in Western Europe, although this is less than 1 of the expected number of mobile phone users. To recoup the development costs, the price of MSS airtime is expected to be high compared with existing mobile phones.
Virtual outreach: a telemedicine pilot study using a cluster-randomized controlled design
Authors: Harrison R , Clayton W , Wallace P
Published: October 2002

A pilot study was carried out in preparation for a full-scale randomized controlled trial of teleconsultations versus routine outpatient consultation. The method of study recruited sufficient numbers of patients and avoided selection bias. Over five months, 439 referrals were received, but 297 patients were not eligible to enter the trial because they did not fall within the specialties consultants included in it. Of the 132 referrals entering the trial, 62 were randomized to the intervention group and 70 to the control group. Consent to participate in the experimental arm of the trial was obtained for all but 13 patients. The results also suggested that patient satisfaction with teleconsultation may exceed that with conventional outpatient consultation, with a strong indication of overall time savings for patients.
Information technology and under-served communities
Authors: Swanson Bruce
Published: October 2002

Advances in information technology (IT) and telecommunications offer many potential benefits to Australia's under-served communities. However, there is also a risk that some of these communities will only be further disadvantaged, as IT will not contribute greatly to bringing groups such as the mentally ill and illiterate into the mainstream of the community. However, other under-served groups may experience service improvements. For people who do not have English as their first language, IT developments provide opportunities for cheaper and easier service and information delivery in their own languages. Telemedicine and IT also have the potential to make working in rural areas more attractive. On the other hand, telemedicine may be used as a means to bypass local health service providers, as has happened with other service industries. The health sector, though, is well behind these other industries in adopting IT and telecommunications. The growth of telemedicine projects is one indication that progress is being made, however. Two case studies—of telepsychiatry, and of medical education at Flinders University—provide examples of major Australian successes. The medical workforce implications will involve the overall numbers and mix of practitioners, their geographical distribution, changing professional boundaries and changing skill requirements. The only certain effect is that if IT changes the nature of medical work, large numbers of medical practitioners will need to improve their computer skills and older practitioners will find this most difficult.
A proposed model for telemedicine to supplement the physician workforce in the USA
Authors: Nesbitt Thomas S , Ellis Jeffrey C , Kuenneth Christina A
Published: October 2002

Maldistribution of physicians is the norm in much of the USA. This paper explores the effect that the integration of telemedicine into the health system could have on physician workforce requirements in the USA. The analysis is based on preliminary evidence suggesting that telemedicine is an effective and efficient means of delivering abroad spectrum of health services to medically under-served rural and inner-city communities. While the emphasis here is on interactive, video-based telemedicine services, other telemedicine modalities, such as store-and-forward techniques and remote monitoring, are likely to have a parallel effect. As these new technologies become a normal part of health care, they will reshape the medical workforce and exert a profound influence on physician workforce requirements in the USA. This paper presents a potential model for this reshaped workforce that emphasizes an expanded role for mid-level health-care providers.
Telemedicine in managing demand for secondary-care services
Authors: Harno K S R
Published: October 2002

The sustained growth in demand for hospital services has inspired new ways of managing the demands for secondary care. In Finland, teleconsultations have been used alongside an electronic referral system for hospital outpatient clinics for the management of primary-care patients by specialists. Direct outpatient costs of the internal medicine department of a district general hospital with an electronic referral system and using teleconsultations were compared with those of a similar department at another hospital using a paper referral system. The former were at least 20% lower. Almost every paper referral in the conventional system (over 95%) led to an outpatient visit, whereas only one-third of the teleconsultations resulted in actual outpatient visits. Thus virtual integration of secondary and primary care with an electronic referral system as part of an electronic medical record reduced both the costs of hospital outpatient care and the demand for it.
The ‘Malone Group’ meeting, October 1998
Authors: Benger Jonathan
Published: October 2002

The diverse experiences and activities of seven UK units participating in telemedicine with minor injuries units is described. Not unexpectedly, ‘growing pains’ were experienced and pitfalls in implementation were identified. Difficulties in consensus emerged regarding the minimum equipment required and the most appropriate cases for teleconsultation, but there was general agreement on the need for clear protocols. Decreased utilization of telemedicine links over time proved to be a common trend; it was felt that this resulted from increasing staff experience and confidence at the peripheral sites. Overall, the telemedicine connection was considered successful. It promoted a close working relationship and supervision between units which were linked, although long-distance connection to ‘anonymous’ experts worked less well. With time, certain clinical permutations emerged that were less appropriate for a telemedicine link, such as deep hand and wrist injuries. Radiological interpretation comprised a large proportion of all teleconsultations.
Medical communication from emergency scenes using a notepad computer
Authors: Maghsudi Mohammad , Hente Reiner , Neumann Carsten , Schachinger Ulrich , Nerlich Michael
Published: October 2002

We have developed a communication system in which data are transferred from the scene of an emergency in the form of an electronic record on a notepad computer by means of a satellite link (MODACOM). The data are received at the dispatch centre and transferred to the admitting hospital automatically. In a prospective study of 53 emergencies the technical suitability of the system was investigated. First-sight information could be fed into the computer in 15 s and transmitted within 3 min of arrival on the scene. For 16 patients with life-threatening conditions, the admitting hospital was notified on average after 13.6 min (SD 6.0), whereas by conventional VHF radio it took 35.5 min (SD 8.9). In addition, more precise information about the patient's condition was received at the hospital.
Pneumoconiosis among workers in a Vietnamese refractory brick facility
Authors: Chinh Chien Vien , Kim Chai Sanders , Ngoc Hai Doan , Takaro Tim , Checkoway Harvey , Keifer Matthew , Hong Son Phan , Van Trung Le , Barnhart Scott
Published: October 2002

Background

Vietnam is a rapidly industrializing country with increasing needs for building materials, including refractory bricks. The manufacture of refractory bricks results in high levels of free silica, a recognized occupational hazard.

Methods

A cross‐sectional survey was conducted among 158 employees using a respiratory symptom questionnaire and ILO classification of radiographs for pneumoconiosis.

Results

The prevalence of radiographic silicosis (ILO category 1/0 and greater) was 10% in all workers with evidence of a dose–response gradient. Pneumoconiosis prevalence increased from 0% in workers employed < 10 years at the plant to 18% for workers employed > 20 years (trend test P = 0.01 for each year increment after adjusting for gender and tobacco use).

Conclusions

Workers in this plant demonstrate a consistent pattern of radiographic evidence of pneumoconiosis, which appears to be related to duration of work. Future studies should assess exposure control measures that are appropriate to countries undergoing rapid industrialization such as Vietnam. Am. J. Ind. Med. 42:397–402, 2002. Published 2002 Wiley‐Liss, Inc.