bluuebunny/crossref_metadata_2025 huggingface dataset:
General practitioner participants in a telemedicine trial: comparisons with their peers
Authors: Snowden S , Harrison R , Wallace P
Published: October 2002

A study was conducted to determine whether general practitioners (GPs) participating in a telemedicine trial were self-selected enthusiasts for information technology compared with GPs in general. We compared two experimental groups of GPs in London and Wales ( n = 126) who had volunteered to participate in a telemedicine trial and two randomly selected groups of GPs from the same areas (total n = 300) who acted as controls. A postal questionnaire was used and achieved a 79% response rate. There were no significant differences in the demographic characteristics of the experimental and control groups in London and Wales, except that the London telemedicine GPs (mean age 41.9 years) were significantly younger than the London controls (mean age 46.6 years). The control GPs were similar to the telemedicine GPs in terms of frequency of computer use and their responses to statements about their attitudes to computers. In the combined telemedicine and control groups, 85% and 77% respectively said that they enjoyed using computers. Telemedicine GPs used computers more frequently for administrative purposes but they shared the same attitudes towards information technology as GPs in general. In all situations where GPs could exercise personal choice, the control and experimental groups were similar.
Improvement in diabetes control with a monitoring system based on a hand-held, touch-screen electronic diary
Authors: Tsang M W , Mok M , Kam G , Jung M , Tang A , Chan U
Published: October 2002

We conducted a six-month prospective interventional crossover study examining a computerized diabetes monitoring system (DMS) that conveyed dietary information. The objectives were to compare glycaemic control between intervention and control periods, and to assess patients' acceptance of the DMS. Nineteen patients were randomized into two groups, each using the DMS for three months and serving as the control group for another three months. The patients recorded information about their meal portions and blood glucose readings in a hand-held electronic diary. After transmitting the data to the DMS through a telephone modem, the patients received immediate feedback about the carbohydrate, protein and fat content of the meal, as well as the calorie content. A significant improvement in glycaemic control was achieved during intervention compared with control periods (mean HbA1C reduction of 0.825%). The DMS was also highly acceptable: 95% patients found it easy to operate while 63% found it useful. The DMS was thus a feasible model of telemedicine in diabetes care and a larger study is warranted to examine its cost-effectiveness.
The effect of videoconferencing on the depth perception of observers
Authors: Wootton Richard , Collins Michael , Loughridge James , Loane Maria
Published: October 2002

The ability of the human eye to perceive depth was measured using a specially designed instrument. Visual acuity and both monocular and binocular stereoacuity were measured when viewing the instrument directly and via a videoconferencing link. Ten subjects with an average age of 32.5 years (range 24-50) took part in the study. The group mean visual acuity using both eyes under normal test conditions was -0.04 logMAR (Snellen 6/5) compared with 0.18 logMAR (Snellen 6/10) for the video-link. The mean stereoacuity using both eyes was 37" (SD 18") under normal test conditions. When a videoconferencing link was used, the mean stereoacuity fell to 1218" (SD 1203") using one eye and to 1651" (SD 1419") using both eyes. The ability to perceive depth remotely via a video-link was significantly decreased compared with normal test conditions.
A cost study of teleconsultation for primary-care ophthalmology and dermatology
Authors: Lamminen Heikki , Lamminen Johanna , Ruohonen Keijo , Uusitalo Hannu
Published: October 2002

Teleconsultations were performed between a health centre in a small Finnish town and a university hospital 55 km away. Telemedicine consultations were carried out with a total of 42 patients suffering from various eye and skin disorders. We evaluated the costs of the teleconsultations in the health centre and the conventional alternative of the patient travelling to the hospital. The cost of conventional consultations, which was not affected by the patient workload, was EU126 per patient for ophthalmology and EU143 per patient for dermatology. The cost of the teleconsultations per patient decreased as the number of patients increased. There were cost savings in relation to teleconsultations when the annual numbers of patients were more than 110 in ophthalmology and 92 in dermatology. Benefits and savings achieved through teleconsultations mainly consisted of reduced transportation costs and reduced paperwork both at the health centre and at the university hospital, as well as time savings for the patient. Another important benefit was improved medical education. The present study shows that teleconsultations can be performed in a cost-effective way in a relatively small health centre.
Telemedicine for the delivery of professional development for health, education and welfare professionals in two remote mining towns
Authors: Mitchell J G , Robinson P J , McEvoy M , Gates J
Published: October 2002

Over a two-year period, telemedicine was used to deliver training and development services for health, education and welfare staff in two remote towns in South Australia - Roxby Downs and Coober Pedy. Both are mining towns but they have different profiles in terms of the community's mental health needs. The services were provided by the Child and Adolescent Mental Health Services (CAMHS) from the Women's and Children's Hospital in Adelaide, South Australia. The media used were videoconferencing, telephone, video-tapes, the Internet and printed material. During 1998-9, professional staff in the two locations participated in structured videoconferencing seminars that addressed important mental health topics, chosen in response to surveys of the needs of the participants. The videoconferencing sessions were sometimes used to discuss specific patient cases. Each remote town was also supported via videoconferencing by a nominated office of the CAMHS: Roxby Downs by the suburban office at Port Adelaide and Coober Pedy by the office in the industrial town of Port Pirie. This customized support was an important factor in the success of the professional development network.
The telemedicine network of the People's Liberation Army
Authors: Lian Ping , Fu Zheng , Ning Yi , Zhai Xinhai
Published: October 2002

In the early 1990s, the People's Liberation Army began to establish a telemedicine network for the non-emergency health-care of the personnel of military units and their families, as well as local civilian patients. All data were transferred over the ordinary telephone network. All the stations were uniformly equipped with PCs containing videoconferencing cards. The network comprised 13 management centres and 208 teleconsultation stations. To evaluate the telemedicine service, we conducted a survey with written questionnaires and telephone interviews. The questionnaire was sent to the person responsible for each telemedicine station. A total of 187 questionnaires were returned, a response rate of 85%. The survey showed that 1503 teleconsultation sessions had been conducted for military as well as civilian patients during the 18-month study period, and 1708 static images had been transferred across the network during these sessions.
A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand
Authors: Loane M A , Oakley A , Rademaker M , Bradford N , Fleischl P , Kerr P , Wootton R
Published: October 2002

A randomized controlled trial was carried out to measure the societal costs of realtime teledermatology compared with those of conventional hospital care in New Zealand. Two rural health centres were linked to a specialist hospital via ISDN at 128 kbit/s. Over 10 months, 203 patients were referred for a specialist dermatological consultation and 26 were followed up, giving a total of 229 consultations. Fifty-four per cent were randomized to the teledermatology consultation and 46% to the conventional hospital consultation. A cost-minimization analysis was used to calculate the total costs of both types of dermatological consultation. The total cost of the 123 teledermatology consultations was NZ$34,346 and the total cost of the 106 conventional hospital consultations was NZ$30,081. The average societal cost of the teledermatology consultation was therefore NZ$279.23 compared with NZ$283.79 for the conventional hospital consultation. The marginal cost of seeing an additional patient was NZ$135 via teledermatology and NZ$284 via conventional hospital appointment. From a societal viewpoint, and assuming an equal outcome, teledermatology was a more cost-efficient use of resources than conventional hospital care.
A comparative study of teleconsultations versus face-to-face consultations
Authors: Nordal E J , Moseng D , Kvammen B , Løchen M-L
Published: October 2002

We compared the diagnoses made by one dermatologist via telemedicine with those of another dermatologist made in a face-to-face consultation. The patients first underwent a teledermatology consultation and then a face-to-face consultation. A general practitioner was present with the patient in the videoconference studio. Videoconferencing equipment connected at 384 kbit/s was used. The doctor-patient relationship and the satisfaction of the patients and dermatologists in the two settings were assessed, as well as technical conditions during the videoconferences. There were 121 patients, with a mean age of 40 years (range 17-82 years). There was a high degree of concordance between the two sets of diagnoses, with 72% complete agreement and 14% partial agreement between the two dermatologists. A total of 116 patients (96% of those included) completed a questionnaire. Both the patients and the dermatologists were in general satisfied with the videoconferences. Videoconferencing with a participating general practitioner may be useful in dermatology, but the technique should be used only for selected patients.
The effect of education on patients' willingness to participate in a telemedicine study
Authors: Krousel-Wood Marie A , Re Richard N , Abdoh Ahmed , Chambers Richard , Altobello Carolyn , Ginther Barbara , Bradford David , Kleit Andrew
Published: October 2002

We assessed the effect of previous education on patients' willingness to participate in a clinical study of telemedicine for hypertensive patients. The design was a cross-sectional study of adult patients arriving for appointments in a hypertension clinic. Of the 259 patients approached, 86% completed a baseline survey and were subsequently asked if they would be willing to participate in a one-year telemedicine study. One hundred and fifty patients (58%) agreed to participate. A stepwise logistic regression analysis was performed to assess the effect of level of education on willingness to participate, while controlling for potentially confounding variables. In the final model, only education remained significant. The odds ratio for non-participation of patients with high-school education or less was 3.6 (95% confidence interval 1.9-7.0). Educational status should be carefully considered when designing, implementing and interpreting telemedicine studies.
Training in cognitive-behavioural therapy for mental health professionals: a pilot study of videoconferencing
Authors: Rees Clare S , Gillam Donelle
Published: October 2002

A foundation course in cognitive-behavioural therapy (CBT) was developed specifically for delivery via videoconferencing at 256 kbit/s. A two-part, 20-week programme was evaluated at seven sites, with a total of 12 participants, in rural and remote Western Australia. Eleven of the participants completed a pre- and post-training knowledge test. There was a significant improvement in their knowledge of CBT after training. Ten participants also completed a satisfaction questionnaire. The majority were satisfied with the training they received and stated that the training had given them greater confidence in their ability to use CBT with their patients. This study lends support to the use of videoconferencing in the training of rural and remote mental health practitioners.
Accuracy of tele-oncology compared with face-to-face consultation in head and neck cancer case conferences
Authors: Stalfors Joacim , Edström Staffan , Björk-Eriksson Thomas , Mercke Claes , Nyman Jan , Westin Thomas
Published: October 2002

Telemedicine was introduced for weekly tumour case conferences between Sahlgrenska University Hospital and two district hospitals in Sweden. The accuracy of tele-oncology was determined using simulated telemedicine consultations, in which all the material relating to each case was presented but without the patient in person. The people attending the conference were asked to determine the tumour ('TNM') classification and treatment. The patient was then presented in person, to give the audience the opportunity to ask questions and perform a physical examination. Then a new discussion regarding the tumour classification and the treatment plan took place, and the consensus was recorded. Of the 98 consecutive patients studied in this way, 80 could be evaluated by both techniques. Of these 80, 73 (91%) had the same classification and treatment plan in the telemedicine simulation as in the subsequent face-to-face consultation. In four cases the TNM classification was changed and for three patients the treatment plan was altered. The specialists also had to state their degree of confidence in the tele-oncology decisions. When they recorded uncertainty about their decision, it was generally because they wanted to palpate the tumour. In five of the seven patients with a different outcome, the clinical evaluation was stated to be dubious or not possible. The results show that telemedicine can be used safely for the management of head and neck cancers.
A preliminary study of the feasibility of wound telecare for the elderly
Authors: Debray M , Couturier P , Greuillet F , Hohn C , Banerjee S , Gavazzi G , Franco A
Published: October 2002

We have developed a method for remote wound assessment in the elderly. Wound images were taken with a digital camera at a resolution of 640×480 pixels. JPEG compression was then used to produce images of about 100 kByte. Selected clinical data were transmitted by email, together with standardized digital images of wounds. The remote physician then read the clinical data and viewed the digital images on a 38 cm colour display monitor, at a resolution of 800×600 pixels, in 16-bit colour, using standard software. Three elderly inpatients with pressure sores or leg ulcers had both bedside and remote examinations, by different physicians. The diagnosis and therapeutic recommendations proposed after each of the two examinations were compared qualitatively. There was reasonable agreement between the two physicians in the assessment of wound size, anatomical classification, wound bed and status of infection. However, the lack of palpation represented a major limitation to remote wound assessment, despite the use of probes to delineate the depth of any opening in the wound bed.
Successes and failures with grand rounds via videoconferencing at the Royal Children's Hospital in Brisbane
Authors: Mccrossin Robert
Published: October 2002

Grand rounds at the Royal Children's Hospital in Brisbane began to be conducted by videoconference in 1997. They were held each week and started at 07:45. A total of 44 multisite videoconferences were held in the year 2000, to an average of 10 sites in Queensland. The remote audience for each conference was about 60 people. The local audience at the Royal Children's Hospital comprised 20–40 people. Many other centres made requests to join the grand rounds, but expansion was not possible because of technical limitations. The lessons learned during four years of close partnership with provincial centres mirror Hippocrates: ‘The need is great, the scope wide, growth inexorable and timing difficult’. Everyone basically wants to do a good job, and most errors can be overcome by good design and dedicated technical support.
The experience in Victoria with telepsychiatry for the child and adolescent mental health service
Authors: Gelber Harry
Published: October 2002

In 1995, the Royal Children's Hospital Mental Health Service in Melbourne developed the first telepsychiatry programme in child and adolescent mental health services (CAMHS) in Australia. A survey of 25 CAMHS clinicians in five rural regions who had used videoconferencing showed that 64% had used the technology for more than 18 months, and 20% had used it for 7–12 months. Also, 60% had used the technology on over 30 occasions, and 24% had used it on 20–29 occasions. Respondents clearly recognized its benefits in terms of their increased knowledge and skills (96%), strengthening of relationships with colleagues (92%) and decreased sense of isolation (92%). To build on the success of telepsychiatry there are a number of challenges that health service managers will need to address. Telepsychiatry works most effectively as a tool to complement face-to-face contact. It cannot be promoted as the total solution to the issue of isolation from mainstream services.
Evaluating satisfaction with a child and adolescent psychological telemedicine outreach service
Authors: Kopel Heidi , Nunn Kenneth , Dossetor David
Published: October 2002

A child and adolescent telepsychiatry service in rural New South Wales was evaluated. Part of the evaluation was to assess whether rural mental health workers and patients were satisfied with the videoconferencing services provided by child psychiatrists from the Children's Hospital at Westmead. During a 12-month study, information was collected using questionnaires on a total of 136 new patients who had been interviewed via videoconferencing. Satisfaction questionnaires were completed by 100 rural mental health workers, and 82 patients and their families/carers. Questionnaires about satisfaction with the technology were completed by 136 child psychiatrists, 101 rural mental health workers and 79 patients. Patients and their families/carers, as well as rural clinicians, expressed high overall satisfaction with the telepsychiatry service. The evaluation suggested that videoconferencing is a good method of providing child and adolescent psychiatry services to remote and rural communities.
The effect of nuclear medicine telediagnosis on diagnostic pathways and management in rural and remote regions of Western Australia
Authors: Tually Peter , Walker John , Cowell Simon
Published: October 2002

Limited accessibility to certain medical imaging services in regional and rural centres has led to the use of alternative modalities, which may not be best practice or which require patients to travel considerable distances for diagnosis. Data collected over three years were examined to determine the clinical effect of nuclear medicine teleradiology (NMT) and its effect on diagnostic patterns for the investigation of cardiovascular disease, radio-occult musculoskeletal injury and oncology. In comparison with two other rural, non-NMT areas of similar demographic profile, there was a significant shift in the delivery of care in terms of diagnostic work-up. NMT input led to the detection of disease and a change to therapeutic management in 122 cases and eliminated the need to transfer patients to another facility for unnecessary and expensive examinations in 38 cases. While NMT is more costly than conventional nuclear medicine services, it permits faster access to specialist consultation, provides for better management and is likely to reduce overall health costs by reducing the volume of inappropriate tests and treatment practice.
Successes and failures in videoconferencing: A community health education programme
Authors: Faulkner Kathryn
Published: October 2002

Women's Health Queensland Wide began delivery of community education programmes for rural women via videoconferencing in the year 2000. A series of three, 90 min videoconference sessions from Brisbane were delivered to 13 sites in northern Queensland. The sessions related to health issues for women at midlife. The sessions were delivered by health experts in Brisbane, who provided a short presentation on their topic; the majority of the videoconference was dedicated to questions from the participants. Each site was supported by a technical coordinator, who ensured that the equipment functioned properly, and a local health worker, who facilitated women's participation in the videoconference as well as providing a local services perspective. Women's Health Queensland Wide was responsible for overall planning and promotion of the sessions. Feedback from these programmes demonstrated women's and health-care professionals’ acceptance of videoconferencing as a mechanism for receiving health information. Sustainability of these programmes depends upon the following issues: cost, delivery model, and the availability of appropriate technology and women-friendly sites.
Connecting the primary and the acute health-care sectors
Authors: Gogler Janette
Published: October 2002

An attempt to implement electronic clinical messaging between general practitioners and a hospital outpatient department was unsuccessful. Nonetheless, the project facilitated the formation of relationships between vendors and hospital departments from which has developed an integrated model of message delivery.
Minimum acceptable standards for digital compression of a fetal ultrasound video-clip
Authors: Begg L , Chan F Y , Edie G , Hockey R , Wootton R
Published: October 2002

If the Internet could be used as a method of transmitting ultrasound images taken in the field quickly and effectively, it would bring tertiary consultation to even extremely remote centres. The aim of the study was to evaluate the maximum degree of compression of fetal ultrasound video-recordings that would not compromise signal quality. A digital fetal ultrasound video-recording of 90 s was produced, resulting in a file size of 512 MByte. The file was compressed to 2, 5 and 10 MByte. The recordings were viewed by a panel of four experienced observers who were blinded to the compression ratio used. Using a simple seven-point scoring system, the observers rated the quality of the clip on 17 items. The maximum compression ratio that was considered clinically acceptable was found to be 1:50–1:100. This produced final file sizes of 5–10 MByte, corresponding to a screen size of 3206240 pixels, running at 15 frames/s. This study expands the possibilities for providing tertiary perinatal services to the wider community.
Clinical call centres: Does low-bandwidth video have a place?
Authors: Howard Andrew
Published: October 2002

Low-bandwidth video has a place in health service delivery. Videoconferencing systems commonly used in telehealth have a high capital cost, take days or weeks to install at specific locations, and have high communications charges. A range of circumstances can be envisaged where video may be of benefit but would not justify the cost of large systems. There are projects in community nursing, home dialysis and post-acute respiratory care where various low-bandwidth video technologies have been added as a supplement to the humble telephone call. It can be expected that at least some of these projects will be able to demonstrate tangible improvements in health outcomes, such as decreased readmission rates, reduced acute episodes of a chronic illness and improved health status from the additional social support.
The role of telemedicine in the assessment of strabismus
Authors: Dawson Emma , Kennedy Craig , Bentley Chris , Lee John , Murdoch Ian
Published: October 2002

Thirty patients with strabismus were seen face to face by an ophthalmologist and an orthoptist. The patients were then presented by the same orthoptist to a second ophthalmologist via a telemedicine link. Twenty-six patients were seen using a bandwidth of 384 kbit/s and four using 128 kbit/s. There was agreement between the two ophthalmologists about diagnosis and management in 24 cases, partial agreement in one and no agreement in five (17%). Manifest strabismus was safely diagnosed and managed using telemedicine at 128 kbit/s, although 384 kbit/s was preferred because it obviated the need for repeated examination. Latent strabismus and micro-movements were difficult to diagnose using telemedicine even at 384 kbit/s. Young patients who are unable to sit still would not be suitable for strabismus assessment via telemedicine.
From operating theatre to operating studio—visualizing surgery in the age of telemedicine
Authors: Aanestad Margunn , Røtnes Jan Sigurd , Edwin Bjørn , Buanes Trond
Published: October 2002

We have conducted a telemedicine project between two of Norway's largest hospitals (Rikshospitalet and Ullevål Hospital) with a focus on image-guided surgical and radiological procedures. Video was broadcast using a 34 Mbit/s ATM network. This resulted in changes in the local work practice to accommodate and facilitate the communication. It also required changes to the surgeon's tasks to improve communication with remote viewers. These changes were not trivial and can be viewed as signs of a shift towards a more public kind of surgery and interventional radiology, brought about by new technology.
An economic analysis of screening for diabetic retinopathy
Authors: Bjørvig Siri , Johansen Monika A , Fossen Kristian
Published: October 2002

The costs of telemedicine screening for diabetic retinopathy were examined in a trial conducted in northern Norway, involving the University Hospital of Tromsø (UHT) and the primary care centre in Alta, approximately 400 km away. In Alta, specially trained nurses examined 42 diabetic patients using a digital camera to obtain images of the retina. The images were then sent by email to an eye specialist at the UHT. A cost-minimization analysis showed that at low workloads, for example 20 patients per annum, telemedicine was more expensive than conventional examination: NKr8555 versus NKr428 per patient. However, at higher workloads, telemedicine was cheaper. For example, at 200 patients per annum, telemedicine cost NKr971 and conventional examination cost NKr1440 per patient. The break-even point occurred at a patient workload of 110 per annum. Given that there are some 250 diabetic patients in Alta, telemedicine screening is the cheaper service for the public sector.
Realtime telemedicine for teaching a first-aid course
Authors: Chi Chih-Hsien , Chang In
Published: October 2002

We evaluated a realtime, distance-learning first-aid course at three schools. From September 1997 to January 1998, 180 students took the course (60 at each of three sites, one of which was the broadcast site). Self-administered questionnaires were distributed to students at the end of the course. The overall response rate was 86%. Sixty-three per cent of students at the remote sites and 83% of students at the broadcast site rated the programme as good or excellent. Students at the broadcast site had a significantly higher degree of satisfaction with the video (79% vs 30%) and audio (83% vs 44%) quality than those at the remote sites. Students at the broadcast site also had a significantly higher degree of satisfaction with slides (75% vs 43%) and transparencies (60% vs 44%) as teaching tools than those at remote sites. The three most important factors affecting the course at the remote sites were teaching aids (video, slides, transparencies), the teacher's body language and self-expression, and equipment stability. Satisfaction at the broadcast site was significantly lower when the course involved demonstrations or practice procedures such as cardiopulmonary resuscitation, dressing, bandaging or splinting. Teaching aids and equipment therefore appear to be important factors at remote sites for a first-aid telemedicine course. Limitations in teachers' movements during demonstration and practice were important at the broadcast site. The evaluation and selection of appropriate teaching models, teaching tools and methods are important when implementing these types of educational programme.
The role of telecardiology in supporting the decision-making process of general practitioners during the management of patients with suspected cardiac events
Authors: Molinari G , Reboa G , Frascio M , Leoncini M , Rolandi A , Balzan C , Barsotti A
Published: October 2002

We studied the role of telecardiology in reducing unnecessary hospital admissions of patients with suspected life-threatening cardiac events (CEs), evaluated by general practitioners (GPs). Over one month, 456 consecutive patients (mean age 65 years, SD 19) complaining of typical (10%) or atypical (42%) chest pain, palpitations (19%), dyspnoea (19%) or syncope (10%) were enrolled. Before teleconsultation, the GPs recorded their own opinion (based on clinical evaluation only) about the presence of a CE. Following transmission of the electrocardiogram (ECG), this opinion was compared with that of the cardiologist. In total there was agreement between the GP and cardiologist about the presence of a CE in 316 of the patients (69%) and disagreement in 140 patients (31%). This represents a specificity and sensitivity of the GPs' diagnosis of 76% and 47%, respectively. For 84 of 134 patients judged as having a CE by the GP, telecardiology avoided hospitalization; on the other hand, telecardiology identified a CE in 56 of 322 patients judged as not having a CE by the GP. Telecardiology is a useful tool with which to reduce unnecessary hospitalizations in patients with suspected life-threatening CEs.
Systematic review of evidence for the benefits of telemedicine
Authors: Hailey David , Roine Risto , Ohinmaa Arto
Published: October 2002

summary

A systematic review of telemedicine assessments based on searches of electronic databases between 1966 and December 2000 identified 66 scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes, or results of economic assessment. Thirty-seven of the studies (56%) suggested that telemedicine had advantages over the alternative approach, 24 (36%) also drew attention to some negative aspects or were unclear whether telemedicine had advantages and five (8%) found that the alternative approach had advantages over telemedicine. The most convincing evidence on the efficacy and effectiveness of telemedicine was given by some of the studies on teleradiology (especially neurosurgical applications), telemental health, transmission of echo-cardiographic images, teledermatology, home telecare and on some medical consultations. However, even in these applications, most of the available literature referred only to pilot projects and to short-term outcomes. Few papers considered the long-term or routine use of telemedicine. For several applications, including teleradiology, savings and sometimes clinical benefit were obtained through avoidance of travel and associated delays. Studies of home care and monitoring applications showed convincing evidence of benefit, while those on teledermatology indicated that there were cost disadvantages to health-care providers, although not to patients. Forty-four of the studies (67%) appeared to have potential to influence future decisions on the telemedicine application under consideration. However, a number of these had methodological limitations. Although useful clinical and economic outcomes data have been obtained for some tele-medicine applications, good-quality studies arestill scarce and thegeneralizability of most assessment findings isratherlimited.
Evaluation of videoconferenced grand rounds
Authors: Allen Michael , Sargeant Joan , MacDougall Eileen , O'Brien Brian
Published: October 2002

We evaluated various aspects of grand rounds videoconferenced from a tertiary care hospital to a regional hospital in Nova Scotia. During a five-month study period, 29 rounds were broadcast (19 in medicine and 10 in cardiology). The total recorded attendance at the remote site was 103, comprising 70 specialists, nine family physicians and 24 other health-care professionals. We received 55 evaluations, a response rate of 53%. On a five-point Likert scale (on which higher scores indicated better quality), mean ratings by remote-site participants of the technical quality of the videoconference were 3.0-3.5, with the lowest ratings being for ability to hear the discussion (3.0) and to see visual aids (3.1). Mean ratings for content, presentation, discussion and educational value were 3.8 or higher. Of the 49 physicians who presented the rounds, we received evaluations from 41, a response rate of 84%. The presenters rated all aspects of the videoconference and interaction with remote sites at 3.8 or lower. The lowest ratings were for ability to see the remote sites (3.0) and the usefulness of the discussion (3.4). We received 278 evaluations from participants at the presenting site, an estimated response rate of about 55%. The results indicated no adverse opinions of the effect of videoconferencing (mean scores 3.1-3.3). The estimated costs of videoconferencing one grand round to one site and four sites were C$723 and C$1515, respectively. The study confirmed that videoconferenced rounds can provide satisfactory continuing medical education to community specialists, which is an especially important consideration as maintenance of certification becomes mandatory.
Hand-held digital video-camera for eye examination and follow-up
Authors: Saari Jukka M , Kerola Markku T , Broas Markku , Saari K Matti
Published: October 2002

We developed a hand-held digital colour video-camera for eye examination in primary care. The device weighed 550 g. It featured a charge-coupled device (CCD) and corrective optics. Both colour video and digital still images could be taken. The video-camera was connected to a PC with software for database storage, image processing and telecommunication. We studied 88 normal subjects (38 male, 50 female), aged 7-62 years. It was not necessary to use mydriatic eye drops for pupillary dilation. Satisfactory digital images of the whole face and the anterior eye were obtained. The optic disc and the central part of the ocular fundus could also be recorded. Image quality of the face and the anterior eye were excellent; image quality of the optic disc and macula were good enough for tele-ophthalmology. Further studies are needed to evaluate the usefulness of the equipment in different clinical conditions.
Subspecialty radiology consultation by interactive telemedicine
Authors: Franken E A , Berbaum K S
Published: October 2002

This investigation tested the hypothesis that interactive, low-resolution telemedicine is an effective method for radiologists' consultations. The case material consisted of radiographs and digital images from patients with 14 paediatric diseases readily diagnosed by imaging, and 10 matched controls. The original images were first evaluated by a general radiologist, who entered a diagnosis. He or she then discussed the case with a paediatric radiologist who had access to the same images via low-resolution interactive video. Following the consultation the general radiologist could change diagnosis. The experimental subjects were three teams of general and paediatric radiologists. Observer-performance and case-comparison methods were used for analysis. The results showed that the general radiologists' diagnostic accuracy improved after telemedicine consultation with the subspecialist, the area under the ROC curve improving from 0.648 to 0.709. The interactive consultation was judged valuable by all participants. We conclude that low-resolution interactive telemedicine is of value for consultation between generalists and subspecialists in radiology.
An economic analysis of teleradiology versus a visiting radiologist service
Authors: Bergmo Trine S
Published: October 2002

An economic analysis of the teleradiology service provided by a university hospital to a local hospital without radiologists was carried out. The average workload at the local hospital was 6000 patients (8000 examinations) per year. In these circumstances teleradiology cost NKr108 per patient, in comparison with NKr178 per patient for the visiting radiologist service which had previously been provided. The total cost of the teleradiology service amounted to NKr646,900 per year; in comparison the visiting radiologist service cost NKr1,069,000 per year. Calculations showed that for teleradiology to be cheaper, the workload had to exceed 1576 patients per year. A sensitivity analysis showed that assuming a shorter equipment lifetime, for instance four years rather than six years, made the threshold value 2320 patients per year instead of 1576.
Accuracy of routine echocardiographic measurements made by an inexperienced examiner through tele-instruction
Authors: Afset J E , Lunde P , Rasmussen K
Published: October 2002

The reproducibility and accuracy of routine echocardiographic measurements made by an inexperienced doctor using tele-instruction were evaluated. Thirty-eight patients were first examined at a local hospital by an inexperienced doctor instructed by a specialist 450 km away at a university hospital. The specialist then examined the patients at the local hospital using the same equipment, after an average of 50 days. The accuracy of M-mode and quantitative Doppler measurements was comparable to that observed in reproducibility studies made under normal examination conditions. There were no systematic measurement errors. No important M-mode information was missed except evidence of left ventricular hypertrophy in six patients. In the two-dimensional examination there were differences of clinical significance in only three patients. There were no clinically important differences in the Doppler quantification of mitral and aortic regurgitation. Tele-instructed echocardiography is also an excellent educational tool, allowing an inexperienced examiner gradually to take responsibility for the local echocardiographic service.
Experimental telemedicine in orthopaedics
Authors: Lamminen H , Nevalainen J , Alho A , Tallroth K , Lepisto J , Lindholm T S
Published: October 2002

There have so far been few telemedical applications in orthopaedics. This experiment involved clinicians in three different locations, two in Helsinki and the third in Tampere, consulting one another simultaneously. We used an ATM network to transfer X-ray pictures, digitized by a 12-bit CCD scanner and archived in a central image server. The consultations between the clinicians and the examination of the patient were transmitted by a videoconferencing system using the ISDN. We found that telemedicine offers new possibilities in orthopaedics, for clinical work, for training and for research.
Telemedicine applications in an integrated mental health service based at a teaching hospital
Authors: Yellowlees Peter , Kennedy Craig
Published: October 2002

Psychiatric applications have predominated in Australian telemedicine in recent years. This paper describes the development of the first telemedicine system for an integrated mental health service based at a teaching hospital. Much effort was devoted to training and education for staff. Within about six weeks of the system being installed, over 80 of all clinical administrative staff, from all the mental health disciplines of the integrated service, had completed a formal training programme. Applications within the service included direct clinical work and the use of videoconferencing in preference to standard telephony over short distances. Applications external to the service, over distances of thousands of kilometres, included clinical supervision and teaching. Evaluation is continuing.
Teleradiology at a children's hospital: a pilot study
Authors: Crowe B. L. , Hailey D. M. , Silva M. De
Published: October 2002

A pilot teleradiology project was conducted between the Royal Alexandra Hospital for Children in Camperdown, central Sydney, and Nepean Hospital in Penrith, about 48 km away. Over three months 575 paediatric radiographs were transmitted at full resolution. The results demonstrated that it was possible to transmit paediatric chest images of diagnostic quality in a reliable and secure manner. Mean transmission time per image was 3.26 min using ISDN, which was considered to be acceptable. Costs were calculated in terms of transmission, equipment, maintenance and staff components. The cost per image transmitted would vary from A 80 for 2500 images per year to A 34 for 10,000 images per year. The experience of the pilot study suggested that more widespread introduction of high-quality paediatric telemedicine in Australia would be feasible. Adoption of the technique would have major implications for paediatric health care, including potential improvements in patient management due to quicker diagnosis and earlier intervention, and potential savings through avoiding transfer of some emergency cases.
The possible use of telemedicine in developing countries
Authors: Wootton R.
Published: October 2002

Telemedicine may be a useful technique for delivering health care in the developing world. However, there is little practical experience to draw on and real concerns that if additional resources were to become available telemedicine might not be the most appropriate use for them. The logical steps to determine the place of telemedicine in the developing world therefore appear to be: 1 to identify potential telemedicine projectsthe Telecommunication Development Bureau of the International Telecommunication Union is trying to do this and has recently sponsored missions to various countries in Africa and Asia; 2 to carry out properly controlled pilot projects in order to demonstrate technical feasibility and to quantify the benefits to the healthcare system; 3 to calculate the costs of large-scale deployment. Assuming that telemedicine is shown to be beneficial, it is only at this final stage that a rational decision can be made about whether telemedicine would be an appropriate use of additional resources in a developing country, as opposed to alternative uses of those resources to solve other important problems of health care.
Continuous automated telecare assessment of the elderly
Authors: Doughty Kevin , Costa Jan
Published: October 2002

An automated scheme is proposed to assess the ability of elderly people to live alone in the community. It employs an Enhanced Activities of Daily Living index based on a computerized questionnaire form. In addition, a number of low-cost sensors have been developed which provide electronic measures of certain activities; these can provide additional inputs to the assessment form using telemetry. The sensors are capable of measuring a wide range of functional performance, thus providing the means of continuously and objectively assessing a patient's condition following hospitalization.
Report of a national neurosurgical teleradiology system
Authors: Gray W P , Somers J , Buckley T F
Published: October 2002

An emergency neurosurgical teleradiology system was initially installed in two referring hospitals in Ireland to transmit images to the neurosurgical department in Cork. It was subsequently expanded to six major referring hospitals transmitting to both neurosurgical departments in Ireland serving the entire population of 3.5 million people, effectively becoming a national teleradiology system. The system was based on PCs interconnected by leased data circuits and ISDN. The network was operational 24 hours a day. Over 750 emergency computerized tomography scans were transmitted and transmission failures occurred in only 6% of cases. We conclude that current PC technology can be used to form a peer-to-peer wide-area network upon which a robust emergency teleradiology system can be based.
Lessons learned during the INSURRECT project (INteractive SURgical Teaching at REmote CeNtres)
Authors: Hobsley M , Mccloy R , Jameson D G , Buckton S , O'hanlon P
Published: October 2002

The INSURRECT project began in 1993 as a collaboration between six UK universities in distance teaching of undergraduate surgery. The first year was spent in testing the network and preparing the course material. This was followed by a two-year pilot teaching course. During this phase, 108 teaching sessions were conducted, involving more than 1300 students in all. It was found that successful teaching depended on increasing the amount of audience interaction as much as possible and transmitting high-quality video pictures. Although the time taken to deliver material by interactive video was greater than for convention al lectures, both students and teachers responded favourably to the project.
Remote consultation for computerized tomography and magnetic resonance studies by means of teleradiology—experience at the Singapore General Hospital
Authors: Png M A , Kaw G J L , Tan K P , Koh B H , Ang L , Filut J
Published: October 2002

A teleradiology link was established between Singapore General Hospital in Singapore and Stanford University in California, USA. Over eight months, a total of 28 cases (involving 27 magnetic resonance investigations and three computerized tomography scans) were transmitted by ISDN to California. Our initial experience with teleradiology for remote consultation was encouraging, although the data transmission cost was higher than we anticipated. However, costs could be reduced by using data compression. Long-distance telecommunication charges continue to fall, so intercontinental teleradiology of this type may be financially viable in future.
Telemedicine applications for home health care
Authors: Warner Ilene
Published: October 2002

Home health care in the USA is one of the most rapidly growing segments of the health-care market. Telehealth seeks to reduce some of the inefficiencies of home health care in various ways, including replacing certain nursing visits with video visits, collecting vital-signs data remotely, improving medication compliance and patient education. The use of telehealth in home health-care settings will provide a means of interacting in a client-centred manner, promoting client autonomy through education and improved communications.
Interpersonal communications and telemedicine: Hypotheses and methods
Authors: Mclaren Paul M , Ball Christopher J
Published: October 2002

Demonstration interviews between a psychiatrist who has used videolinks for a range of clinical interactions and a simulated patient facilitate a better understanding of interpersonal communication, both face to face and mediated. This might allow users to be trained to maximize the use of the available communications technology and provide a source of more rational reassurance for the technophobic professional.
Telemedicine for airline passengers, seafarers and islanders
Authors: Rizzo N , Fulvio S , Camerucci S , Carvalho M , Biagini M , Dauri A
Published: October 2002

Airline passengers, seafarers and islanders are three different examples of people who can benefit from telemedicine. However, the peculiar characteristics of each group require different applications. In 60 years of activity, the CIRM has assisted more than 37,000 patients. In the 10 years from 1986 to 1996 the Centre provided radio medical assistance to 7647 patients, of whom 6981 (91.3%) were sailors, 642(8.4%) were people living in isolated areas (small Italian islands) with few medical facilities, while only 24 patients (0.3%) were airline passengers. In the same period, the telecommunication service received or transmitted almost 80,000 medical messages.