bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality and Resource Management in Genitourinary Medicine Service Delivery
Authors: Harry Tubonye C
Published: October 2002

Quality and efficiency are the hallmarks of appropriate resource utilization. Performance indicators in the UK facilitate measurement of efficiency of sexual health services. These parameters include consultant ratio per unit population served, sessional requirement of service providers, duration of wait before an appointment, duration of wait in the clinic setting before being seen and the locality prevalence of gonorrhoea per 100,000 of the catchment population aged 16–64. In a survey of these standards in the Bure Clinic in Great Yarmouth where one consultant physician serves a population of 250,000–320,000, providing 6–7 outpatient sessions a week, with inpatient commitment for HIV/AIDS, 31.4% of patients waited over 2 weeks before being seen in the Genitourinary Medicine (GUM) Clinic. Over 57.5% of the patients surveyed had waited more than one week before their appointment. This had been in an environment of prevailing local high incidence of gonorrhoea — a marker of sexual ill health — from 1996–1998 (>25 per 100,000 in those aged 16–64). This defect in optimum access is inimical to early case detection, contact tracing, and intervention for appropriate behaviour modification and truncation of infectivity.
Type of Partnership and Heterosexual Spread of HIV Infection in Rural Uganda: Results from Simulation Modelling
Authors: Robinson Noah Jamie , Mulder Daan , Auvert Bertran , Whitworth Jimmy , Hayes Richard
Published: October 2002

The objective was to estimate the likely percentage of HIV infections that may be attributable to one-off partnerships (such as those between female sex workers and their clients) and longer-term partnerships in rural Uganda. This was addressed by the application of a microsimulation model (SimulAIDS) of the transmission dynamics of HIV infection, drawing on data from a population cohort of 10,000 in rural Uganda. For a scenario reproducing documented characteristics of the study population in 1990, when adult HIV prevalence was 9%, and during subsequent follow up (1990–1994), when adult HIV incidence was 8 per 1000 person-years, the percentage of HIV infections in men (women) attributed to one-off partnerships decreased from 96% (26%) during 1980 to 67% (8%) in 1989 and 22% (5%) in 1994. Reducing HIV transmission between one-off partners early in an HIV epidemic may substantially limit the potential for the spread of HIV infection. At a later phase, prevention must also focus on control of transmission between longer-term HIV-discordant partners.
Pearly Penile Papules: A Common Cause of Concern
Authors: Sonnex C , Dockerty W G
Published: October 2002

This study of two hundred men attending a department of genitourinary medicine documented a prevalence of pearly penile papules of 48%. Most men with papules had only a few lesions of less than 1 mm in size (73%). Nineteen per cent had papules of less than 1 mm in size extending around the corona and 8% had lesions greater than 1 mm in size extending around the corona. Over one-third of men with papules had previously been concerned or worried by their presence and approximately one-quarter had experienced embarrassment. Fourteen per cent of men with small lesions and 75% with larger lesions wished to have them removed. Two men with large and extensive papules underwent treatment by CO2 laser ablation with excellent cosmetic results.
Neurological manifestations of cytomegalovirus infection in the acquired immunodeficiency syndrome
Authors: Anders H-J , Goebel F D
Published: October 2002

Cytomegalovirus (CMV) infection is one of the most important opportunistic infections in AIDS. The most common manifestation of neurological CMV disease in HIV infection is retinitis followed by encephalitis, polyradiculopathy, and multifocal neuropathy. Untreated necrotizing retinitis proceeds to blindness but can readily be diagnosed by ophthalmological examination. CMV polyradiculopathy presents as subacute leg weakness, paraesthesia, and urinary retention. Untreated patients develop ascending paralysis and die within weeks. Multifocal neuropathy commonly affects the radial, ulnar, and peroneal nerves but cranial nerves may also be involved. Confusion, cranial nerve palsies, and hyperreflexia are signs of ventriculoencephalitis, whereas the presentation of diffuse micronodular encephalitis is often asymptomatic. The diagnostic approach relies on the detection of CMV DNA in the cerebrospinal fluid for polyradiculopathy, encephalitis, and neuropathy. Neuroimaging can exclude other causes of encephalitis and polyradiculopathy. Ganciclovir, foscarnet, and cidofovir monotherapy are current medical treatment options. Intraocular administration can be used for refractory retinitis, but additional systemic prophylaxis is required to suppress extraocular disease. Ganciclovir and foscarnet have improved the prognosis of multifocal neuropathy and polyradiculopathy, but response rates for encephalitis are low. However, despite therapy survival of central nervous CMV disease is still limited to months. Recently highly active antiretroviral therapy (HAART) has decreased the overall incidence of CMV disease in AIDS. Furthermore (HAART) has become a mainstay for CMV therapy by improving the patient's immunocompetence against CMV.
Characterization of an outbreak of tetM-containing Neisseria gonorrhoeae in Argentina
Authors: Cobo M Fernandez , Galarza P , Sparo M , Buscemi L , Pizarro M R , Fiorito S
Published: October 2002

Phenotypic and molecular characterization of an outbreak of 9 Neisseria gonorrhoeae (NG) isolates exhibiting high-level plasmid mediated resistance to penicillin and tetracycline (PP-TRNG) that took place in Tandil, Argentina between February and April 1995. Comparison with the patterns of the 3 PP-TRNG strains previously isolated were made. We determined the following markers for each strain: antimicrobial susceptibility, serogroup, auxotype, plasmid profile, presence of tet M determinant and restriction pattern of the tetM-containing plasmid. Antimicrobial tests values were: tetracycline disk diameter 12-14 mm, minimum inhibitory concentration (MIC) 32 mug/ml; penicillin disk diameter 6 mm, MIC 32 mug/ml and sensitive by both methods to spectinomycin, cefuroxime, ceftriaxone and ciprofloxacin. All isolates were of the same serogroup (WI). Ten of the strains, including the 9 from Tandil outbreak, were arginine-requiring, while the other 2 were methionine and arginine-requiring. All of them demonstrate the same plasmid profile (2.6, 3.2, 25.2 MDa). They were positive for the tetM determinant and the restriction analysis identified it as a Dutch-type plasmid. In spite of the temporal and geographical dispersion, PP-TRNG strains in Argentina seem to be highly homogeneous in terms of antimicrobial susceptibility, serogroup, plasmid profiles and even auxotype.
Trends in HIV-Related Consultation in Dutch General Practice
Authors: Ros C C , Kerssens J J , Foets M , Peters L
Published: October 2002

New medicine against AIDS and a possible changing attitude towards AIDS will affect the role of the general practitioner (GP). We aim to explore and assess the changing role of the GP in preventing and detecting AIDS, which will be done by providing insight into the changing numbers and content of HIV-related consultations in the general practice.

Since 1988 a representative sample of 63 Dutch GPs have participated in a network. They recorded all face-to-face consultations with non HIV-infected patients in which the subject of AIDS was brought up. Timetrend analysis is used to investigate variations over time in the number and content of the consultations, GPs’ actions and patients’ characteristics. The influence of a rural or urban setting and the characteristics of the patients who are involved are also taken into account.

Until 1994 a significant increase was found in the number of consultations. In highly urban areas the number of consultations is higher and still growing, whereas physicians in rural areas see fewer patients every year. The most important topic of conversation was the request for an HIV test (74%). This figure grew over the years, as did the number of tests performed. GPs became less passive and restrictive in advising tests. The group of patients has also changed, e.g. patients do not mostly belong to traditional risk groups anymore, and are significantly younger.

AIDS seems to have become more familiar to patients and doctors. A lot of general information is available from different sources. Because of this change in attitude and knowledge of patients, the GPs’ role as it relates to AIDS is becoming more specific in tracing infected patients and giving customized information to individuals. Patients visit their physicians less often because of concerns about AIDS, but the GP continues to fulfil a very important role in the prevention and detection of AIDS.
Seroprevalence of HIV, HBV and Syphilis and Associated Risk Behaviours in Male Transvestites (Hijras) in Karachi, Pakistan
Authors: Baqi Shehla , Shah Sharaf Ali , Baig Mirza Alim , Mujeeb Syed Abdul , Memon Ashraf
Published: October 2002

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention.
Immunological predictors of HIV-related survival
Authors: Baillargeon Jacques , Grady James , Borucki Michael J
Published: October 2002

While the prognostic role of CD4 lymphocyte count is well established, little is known about how other immunological factors are associated with HIV-related survivorship. CD8 lymphocyte count is reported to inhibit growth of HIV in vitro and to deter the development of cytomeglovirus infections. Scarce information exists, however, on its association with HIV-related survivorship. The objective of the present study therefore was to assess whether survival estimation could be improved by including CD8 lymphocyte count as a prognostic factor. The study sample consisted of 904 adult HIV-infected patients who were treated between 1992 and 1997 at a large southwestern academic medical centre in the US. Survival analysis using proportional hazards modelling showed that baseline CD4 lymphocyte was highly and positively predictive of HIV-related survival. By contrast, baseline CD8 count was not predictive of survival in the study cohort. While the interaction between CD4 and CD8 was not statistically significant in the present study sample, decomposition of this effect indicates that these factors may operate synergistically to predict survival. In conclusion, these findings suggest that clinicians may improve their prognostic accuracy by relying on both CD4 and CD8 lymphocyte counts rather than relying exclusively on CD4 counts.
Does it matter who owns health facilities?
Authors: Duckett Stephen
Published: October 2002

The rhetoric of governments 'steering not rowing' and of purchaser–provider splits is still part of the language of public sector reform throughout the world, despite some retreat in the National Health Service in the UK. Implementation of separation of purchaser and provider roles has often been associated with suggestions that the private sector is better able to manage hospitals. The evidence for this assertion is mixed, especially when possible quality differences are also considered. This essay suggests that the ownership question is a second-order issue and that policy-makers should ensure that existing public hospitals are funded in a way that encourages efficiency.
What is health informatics?
Authors: Sullivan Frank
Published: October 2002

Health informatics is a relatively recent jargon term for a subject that may be of great interest to health services researchers and policy makers. Most countries with highly developed health systems are investing heavily in computer hardware and software in the expectation of higher quality for lower costs. Recent systematic reviews have indeed demonstrated the health benefits of a range of electronic tools, particularly in the areas of prevention and therapeutic monitoring. However, there remains a relative lack of published evaluations of informatics tools and methods. Uncritical adoption of new systems based on the pressures of technological push continue to discredit policy makers who have had to commit significant resources despite inadequate information on what can be realistically expected from a proposed system. There are great opportunities for researchers interested in evaluation to fill the vacuum left by informaticists who are too busy writing their next line of code.
Health system goals: life, death and . . . football
Authors: Appleby John , Street Andrew
Published: October 2002

Objectives: Both the World Health Organization (WHO) and the Fédération Internationale de Football Association (FIFA) have developed sophisticated ways of defining and aggregating performance to produce overall, single-number indices. These are used to illustrate some of the problems of measuring, comparing and improving health system performance.

Methods: Possible associations between FIFA football rankings for international 'A' sides for 176 countries and rankings on the WHO overall health system performance index were explored using econometric techniques.

Results: There is a significant relationship between a country's FIFA ranking and its ranking by the WHO. Taken at face value, the statistical analysis suggests that, if the national football team does well, the WHO score improves.

Conclusions: The relationship between FIFA and WHO ranks is entirely spurious. However, comparison of the two indices illustrates problems with the WHO exercise, including measurement difficulties, how policy-makers may use the information to improve health system performance, what the public are to make of the data and how different dimensions of overall performance may be subject to trade-offs.
Improving the quality of health care in the United States of America: The need for a multi-level approach
Authors: Mechanic David
Published: October 2002

Serious efforts to address quality require coordinated, multi-faceted, multi-level strategies that address the organisational environments and cultures that affect how care is provided. Most efforts over the past 50 years to improve the care provided by physicians and other clinicians have been individually rather than system based. Such individual interventions to modify physician behaviour typically have only modest effects whether considering the recognition and treatment of depression in primary care, following established practice guidelines, carrying out preventive interventions, monitoring and managing chronic illness appropriately, or managing pain and end-of-life care. It is increasingly recognised that quality of care is a property of health systems. Internal efforts to shape clinical routines, such as performance incentives and disease-management approaches, and external inducements and constraints that shape how clinical contexts are organised and function are equally relevant. Internal factors include the skills training of clinical personnel, organisational procedures and mechanisms to coordinate care and prevent errors, implementation of best practices, effective use of informational technologies and appropriate incentives. External factors include broader financial and reimbursement mechanisms, regulatory arrangements that protect access and patient rights in situations of vulnerability and performance-based contracts. The mobilisation of effective advocacy, independent and non-profit statutory watchdog organisations, and good consumer information can facilitate and reinforce quality efforts. System integration is admittedly difficult, and always incomplete, but movement toward this goal is an essential strategic objective.
Systematic review of outreach clinics in primary care in the UK
Authors: Powell John
Published: October 2002

Objectives : To determine the benefits of holding specialist outreach clinics in primary care settings by means of a systematic literature review of UK studies.

Methods: Systematic searches of electronic databases, hand searches of journals, and contact with experts. Application of inclusion criteria. Study findings summarised.

Results: Fifteen studies met the inclusion criteria. Surveys of general practitioners (GPs), specialists and patients identified the perceived advantages of outreach clinics of improving GP-specialist communication and improving patients' experience and access. Reported disadvantages concerned administrative costs, accommodation costs and inefficient use of specialists' time. Comparative studies showed that more patients expressed a preference for outreach clinics than for hospital-based clinics, and measures of patients' satisfaction and convenience generally were higher for outreach clinics. Studies did not show any consistent difference in health outcome between outreach and hospital-based clinics. Outreach clinics had higher direct costs to the health system than hospital-based clinics.

Conclusions: Health care purchasers and providers must decide whether the advantages in terms of patients' experience of outreach clinics are worth the additional costs. They also need to consider issues of equity, which have not been addressed in research to date.
Supervision of thrombolysis of acute myocardial infarction using telemedicine
Authors: Mavrogeni S I , Tsirintani M , Kleanthous C , Vranakis K , Secheta E , Mihelakis D , Sotiriou D , Gatzonis M , Tsolas C , Kontaratos A N , Cokkinos D V
Published: October 2002

The treatment of acute myocardial infarction (MI) constitutes a significant problem in remote geographical areas of Greece. Furthermore, thrombolysis, the treatment of choice in the early phase of acute MI, requires the supervision of an expert. We have used thrombolytic treatment, using telemedicine, in remote medical centres. The Onassis Cardiac Surgery Centre was linked to six remote Aegean islands via telemedicine systems which permitted the transmission of 12-lead electrocardiograms (ECGs). The thrombolytic agent anistreplase was administered to patients with acute MI. Supervision, including consultation for treatment of complications, was achieved using the telemedicine system. One hundred and fifty-two ECGs were transmitted during 24 months, of which 108 (71%) indicated specific treatment of a cardiac condition. Ten cases were diagnosed as having acute MI and eight of these were treated with anistreplase. All patients survived acute MI and complications were treated locally. The application of thrombolytic treatment in acute MI is feasible in remote areas, with the use of a telemedicine system.
The cost-effectiveness of teleneurology consultations for patients admitted to hospitals without neurologists on site. 1: A retrospective comparison of the case-mix and management at two rural hospitals
Authors: Craig John , Chua Richard , Russell Clive , Patterson Victor , Wootton Richard
Published: October 2002

We are currently evaluating the use of telemedicine for improving the care of patients admitted with neurological symptoms to hospitals that do not have specialist neurologists on site. To do this we have been comparing the outcome of patients admitted to two small hospitals. In one hospital all patients with neurological symptoms are seen by a neurologist at a distance using an interactive video-link transmitting at 384 kbit/s; in the other patients with neurological problems are managed as per usual practices. For the results of this study to be valid, it is essential that the case-mix and process of management for neurological patients are similar at the two hospitals. We therefore compared the case-mix, process of management, and outcome for all patients admitted over a four-month period to either hospital who had been coded using ICD-10 as having a final diagnosis of a neurological condition. No appreciable differences were noted between the two hospitals for measures of case-mix or outcome. Likewise, most measures of process were similar, although there was a significant difference for the overall length of hospital episode between the two hospitals. When patients with prolonged hospital episodes were excluded, or only patients with a diagnosis of headache, epilepsy or transient ischaemic attack were considered (who as a group made up the bulk of neurological admissions), the difference in the length of hospital episode was not significant. It should therefore be possible for us to estimate the effect of telemedicine on the management of patients with neurological problems.
Improving quality of life for dialysis patients through telecare
Authors: Stroetmann Karl A , Gruetzmacher Peter , Stroetmann Veli N
Published: October 2002

Home dialysis can improve the care and quality of life for patients with renal failure. We have explored the possibility of extending home care to more patients needing continuous ambulatory peritoneal dialysis (CAPD) using telemedicine. We tested videoconferencing support for five CAPD patients using low-cost ISDN equipment (128 kbit/s). Initial results indicated that it was possible to integrate video-communication into the daily routine of the clinic and the response from patients was surprisingly positive. Selection of appropriate, affordable technology and the ISDN service support by the telecommunications provider proved to be considerably more difficult than anticipated. The first indications also suggest medical advantages for home teledialysis.
The economics of telepathology – a case study
Authors: Mea V Della , Cortolezzis D , Beltrami C A
Published: October 2002

There are several obstacles that slow down the diffusion of telepathology. One is related to uncertainty about the economic consequences of its adoption, possibly more so than in other fields of telemedicine. We have evaluated the economics of telepathology when used to provide a frozen-section service to a mountain hospital, in comparison with three current alternatives. In the specific situations studied, no one model was always less expensive than the others. In particular, owing to the very low cost of the ambulance service provided by the Red Cross, the ambulance model was least expensive when dealing with up to 73 frozen sections a year, while at higher case-loads telepathology was cheaper. If ambulance transfer is neglected, telepathology appears to be the most convenient approach to the remote frozen-section service. Although the consultant pathologist costs more than telemedicine, during free time he/she could perform other (routine) work, thus reducing the real cost of frozen sections.
A pilot study of an educational service for rural mental health practitioners in South Australia using telemedicine
Authors: D'souza Russell
Published: October 2002

Studies have found that rural patients want to be treated in their local hospitals. However, there have been difficulties with recruiting and retaining professionals in rural areas of Australia. Isolation, lack of professional development programmes, lack of academic programmes, lack of peer consultation and the need to travel long distances are some of the reasons identified in the National Rural Health strategy. A pilot service of educational programmes delivered by telemedicine was initiated and then evaluated. Forty-six community mental health workers from nine rural areas and 20 general practitioners from five rural areas participated. High satisfaction with the use of telemedicine was recorded by both groups. Telemedicine reduced the disincentives to rural practice, and also improved the professionals’ competence and confidence in managing patients with psychiatric illness.
Teledermoscopy - results of a multicentre study on 43 pigmented skin lesions
Authors: Piccolo Domenico , Smolle Josef , Argenziano Giuseppe , Wolf Ingrid H , Braun Ralph , Cerroni Lorenzo , Ferrari Angela , Hofmann-Wellenhof Rainer , Kenet Robert O , Magrini Fabio , Mazzocchetti Giampiero , Pizzichetta Maria A , Schaeppi Herwig , Stolz Wilhelm , Tanaka Masaru , Kerl Helmut , Chimenti Sergio , Soyer H Peter
Published: October 2002

We performed a multicentre study to evaluate the agreement between the direct clinical diagnosis and the telediagnosis of 43 cutaneous pigmented lesions. Digital clinical and dermoscopic images of the 43 pigmented skin lesions (11 melanomas, 23 melanocytic naevi, three basal cell carcinomas, three lentigines, two seborrhoeic keratoses and one angiokeratoma) were sent by email to 11 colleagues (six dermatologists, two residents in dermatology, one oncologist, one specialist in internal medicine and one general practitioner) in 10 centres. These 11 colleagues had different degrees of experience in dermoscopy. With histopathology as the gold standard, an average of 85% of the telediagnoses were correct, with results varying from 77% to 95%, whereas face-to-face diagnosis by an expert dermatologist was correct in 91% of cases. The kappa value for all participants ranged from 0.35 to 0.87. The results confirm that teledermoscopy can be a reliable technique for the diagnosis of pigmented skin lesions but one that will depend on the expertise of the observer.
Transportation savings and medical benefits of a teleneuroradiological network
Authors: Maass Marianne , Kosonen Marjatta , Kormano Martti
Published: October 2002

Since 1996, Turku University Central Hospital has offered teleradiology consultations regarding computerized tomography examinations of the brain to three regional hospitals in Finland, in which neurosurgical or neuroradiological specialist services are not available, in order to avoid unnecessary patient transportation. We performed a retrospective survey of the teleconsultations performed in 1998. Medical records and the relevant radiology images were obtained. During the study period, teleconsultations were carried out for a total of 83 patients, of whom 16 were transported to the university hospital (i.e. 81% of these patients had avoided unnecessary transportation). The total savings amounted to 42,100 ECU. Of the 16 transported patients, 12 were immediately operated on in the university hospital. It was judged that, because of the consultation service, the patients undergoing an operation had benefited from a more rapid and a more complete recovery. In 1998 the teleradiology consultation service was established as part of the routine work of the Medical Imaging Centre and a fee for its services was adopted.
Internet-based transfer of cardiac ultrasound images
Authors: Firstenberg Michael S , Greenberg Neil L , Garcia Mario J , Morehead Annitta J , Cardon Lisa A , Klein Allan L , Thomas James D
Published: October 2002

A drawback to large-scale multicentre studies is the time required for the centralized evaluation of diagnostic images. We evaluated the feasibility of digital transfer of echocardiographic images to a central laboratory for rapid and accurate interpretation. Ten patients undergoing trans-oesophageal echocardiographic scanning at three sites had representative single images and multiframe loops stored digitally. The images were analysed in the ordinary way. All images were then transferred via the Internet to a central laboratory and reanalysed by a different observer. The file sizes were 1.5-72 MByte and the transfer rates achieved were 0.6-4.8 Mbit/min. Quantitative measurements were similar between most on-site and central laboratory measurements (all P > 0.25), although measurements differed for left atrial width and pulmonary venous systolic velocities (both P < 0.05). Digital transfer of echocardiographic images and data to a central laboratory may be useful for multicentre trials.
Do community alarm users want telecare?
Authors: Brownsell S J , Bradley D A , Bragg R , Catlin P , Carlier J
Published: October 2002

Previous surveys have suggested that community alarm users are in general satisfied with the service provided. However, there is also evidence that users would like additional options that could be provided by a telecare system. Inner-city users of community alarms were consulted about their current systems and the extension of these to incorporate telecare options. The users lived in 160 homes in three multistorey apartment blocks. The average age of the 176 users surveyed was 76 years. Seventy-seven per cent of users were interested in automatic fall detection, 68% in lifestyle monitoring, 57% in telemedicine and 46% in videoconferencing. Nineteen of those interviewed (11%) did not want any of the suggested enhancements. The survey showed that elderly people are not technophobes, since 58% possessed either a microwave oven or a video-recorder, and also showed that the majority were prepared to accept new technologies that would support their independence.
A telehealth project for supporting an isolated physiotherapist in a rural community of Hokkaido
Authors: Jin C , Ishikawa A , Sengoku Y , Ohyanagi T
Published: October 2002

Almost all towns and villages in the rural areas of Hokkaido suffer shortages of health-care professionals, particularly therapists (e.g. physiotherapists, occupational and speech therapists). A therapist in a rural community must work as a general rehabilitation therapist. This adds to the stress of both the responsibility and the isolation and it seems to be the major reason why therapists do not generally stay in rural communities. A telehealth project to overcome this vicious circle in Hokkaido was started at Sapporo Medical University in 1997, and the town of Betsukai joined the project. This outlines the support given to an isolated physiotherapist working in Betsukai, as part of a larger rehabilitation project. Regular videoconferences helped the physiotherapist gain confidence in her work in the rural community.
Measuring the readership of a health-related Website
Authors: Briggs J S
Published: October 2002

A national database of telemedicine was set up with the sponsorship of the British government to provide a source of information to anyone researching the field or proposing a telemedicine project. To monitor the readership of the database we subscribed to a free Internet service called Extreme Tracking. Since the Website was launched there have been over 9000 visits from over 5000 different Internet addresses. The peak was in the week after launch, when it had 400 visitors in four days. Subsequently, the number of visits tailed off slightly, but nine months later the database was still attracting about 800 visits per month. The majority of visits were via links from other Websites. Of the 288 different Websites identified, the one operated by the UK National Health Service (NHS) Information Authority generated the most visits, suggesting that many readers were from within the NHS. The second most common form of referral was from search engines. Most visits were on weekdays and during normal UK working hours. Taken together with the fact that the Internet domain that generated most visits was the ‘.uk’ one, we concluded that most readers were based in the UK and accessed the site as part of their jobs rather than as a spare-time activity. This is encouraging for the take-up of telemedicine in the UK.
Upgrading rural Japanese nurses’ respiratory rehabilitation skills through videoconferencing
Authors: Sawada I , Sugiyama A , Ishikawa A , Ohyanagi T , Saeki K , Izumi H , Kawase S , Matsukura K
Published: October 2002

We examined the effect of distance learning on nurses’ clinical skills in a rural Japanese hospital. The subject matter was respiratory rehabilitation. After one face-to-face session, two 30min sessions were delivered by videoconferencing to staff nurses working in a 100–bed rural hospital 250 miles (400 km) from Sapporo Medical University. A self-rating questionnaire was distributed before and after the sessions. Responses were collected from 15 out of 32 nurses participating in the face-to-face session (47%). Before the first videoconferencing session, ‘always use’ and ‘sometime use’ the new skills were rated by 67% of nurses, but after the second videoconferencing session ‘always use’ and ‘sometimes use’ were rated by 73% and ‘never use’ at 0%. This implies that there was increased use of new skills after the second session, although the difference was not significant. The nurses’ opinions about the effectiveness for patients increased from 8% to 27% after the second session, which was significant. The pilot project indicated the usefulness of distance learning for upgrading nurses’ clinical practice in one rural Japanese hospital and suggested ways in which videoconferencing can be used in future.
The changes patients expect to result from telemedicine
Authors: Tachakra Sapal
Published: October 2002

A focus group of 12 persons who had been the subject of telemedical consultations met four times to discuss what changes to the health service they expected to result from the widespread introduction of telemedicine. There was general agreement about four main themes. First, rationalization of care would occur. For example, health-care spending would have to take into account the need for local care and there would be more primary care, with telemedicine providing easy access to specialists. The implementation of home care would be facilitated. Second, there was an expectation that costs would be controlled, for example by the use of multi-skilled personnel and by having fewer, smaller, newer and different hospitals. Third, quality control would be introduced (e.g. the widespread use of evidence-based medicine). Fourth, it was agreed that a change of professional attitudes would be needed, particularly among doctors (e.g. more openness, less bluster and less hierarchy). Telemedicine is likely to be a great driver of change in the health service. The changes relating to the location and type of work are fairly predictable, but the changes in relationships are likely to be profound.
Videoconferencing in the provision of psychological services at a distance
Authors: Capner Maxine
Published: October 2002

This paper reviews the literature on the provision of psychological services using videoconferencing. First, mental health assessments are considered in terms of both the initial interview and the use of scales for rating symptoms of mental state dysfunction, including psychosis, depression and anxiety. Ways to increase the reliability of initial assessment data collected by videoconference are provided, and the consumer's experience of receiving this service by videoconference is also considered. Research comparing the administration of psychometric tests in person and by videoconference is then reviewed, as is the client's experience of receiving this service by videoconference. Psychological interventions provided for individuals, families and groups by videoconference are also considered. Positive and negative experiences relate to issues of empathy, working alliance, a sense of control and a sense of presence. The levels of comfort and satisfaction expressed by both counsellors and clients with the use of the medium are discussed. Recommendations for how best to use videoconferencing for psychological interventions are offered and contraindications are reviewed. Videoconferencing for the purposes of supervision is also briefly covered. The legal issues associated with the use of videoconferencing to provide psychological services include consent, reimbursement, professional licensing and liability. It seems that videoconferencing is a new and potentially beneficial means of bringing psychological services to isolated communities. However, it may be necessary to explore the technique cautiously. There is a dearth of evidence regarding the reliability of psychological services provided using videoconferencing and consequently there is vast opportunity for further research.
A follow-up study of remote trauma teleconsultations
Authors: Tachakra Sapal , Loane Maria , Uche Chris Uko
Published: October 2002

We conducted a follow-up study of patients who had attended a nurse-led minor accident and treatment service (MATS) and who had participated in a teleconsultation. Over three and a half years, 31,510 patients had attended the MATS unit and 1854 patients (5.9%) of these had participated in a teleconsultation. Of the 1854 telemedicine patients, 1199 had been referred to hospital or clinic and 1153 had actually attended. Retrospective examination of the relevant hospital records showed that in 25 cases (2%) the original telediagnosis was considered incorrect at face-to-face review and that treatment was either begun or changed in 264 cases (23%). All patients, including those discharged home after the teleconsultation, were sent a questionnaire about any changes to their injury. Of the 655 patients discharged home, a questionnaire response was obtained from 598 (91%). Following discharge, 43 of these patients had sought help from another health-care provider (the majority from their general practitioner). Of the 46 patients referred to hospital who did not keep their follow-up appointments, questionnaire results were obtained from 35 (76%). Nine of these patients had sought help from another health-care provider (the majority from their general practitioner) but there had been no change in diagnosis or treatment. Our findings suggest that teleconsultations are an effective means of delivering minor injuries care.
The diagnostic acceptability of lowbandwidth transmission for tele-ultrasound
Authors: Brebner John A , Ruddick-Bracken Hugh , Brebner Eileen M , Smith A Patricia M , Duncan Karen A , McLeod Andrew J , McClelland Suzanne , Gilbert Fiona J , Thompson Angus , MacLean J Ross , Ritchie Lewis D
Published: October 2002

Ultrasound recordings were made of 100 consecutive patients attending for obstetric examination in Peterhead and 100 patients attending for non-obstetric examination in Aberdeen. Two identical videoconferencing machines were used to transmit and receive the original ultrasound images at data rates of 384 kbit/s and 128 kbit/s, thus producing a total of three tapes for each case. Four experienced observers, who were blinded to the transmission bandwidth, each viewed 300 examinations and decided whether the images were acceptable or not for diagnosis. Almost 100% of the obstetric ultrasound images on the original recordings were considered diagnostically acceptable, compared with 93% of the 384 kbit/s transmissions and 44% of the 128 kbit/s transmissions. Similarly, 99% of the non-obstetric ultrasound images were considered acceptable, compared with 87% of the 384 kbit/s transmissions and 21% of the 128 kbit/s transmissions. For the obstetric ultrasound images the intra-observer diagnostic agreement was 93% (κ = 0.89) between the original and the 384 kbit/s transmissions, and 78% (κ = 0.63) between the original and the 128 kbit/s transmissions. For the non-obstetric ultrasound images the respective intra-observer diagnostic agreements were 77% (κ = 0.62) and 78% (κ = 0.63). The quality of dynamic ultrasound images transmitted at 384 kbit/s was diagnostically acceptable, but was unsatisfactory at 128 kbit/s.
Telemedicine techniques can be used to facilitate the conduct of multicentre trials
Authors: Kennedy Craig , Kirwan James , Cook Colin , Roux Paul , Stulting Andries , Murdoch Ian
Published: October 2002

A multicentre randomized controlled trial was established in Pretoria, Bloemfontein and Edendale in South Africa, and coordinated from London. The purpose of the trial was to determine the efficacy of low-dose beta irradiation of glaucoma. Five communication modalities (telephone, fax, email, videoconferencing and face-to-face meetings) were examined in terms of their benefits in a multicentre trial. The eight stages of the multicentre trial examined were: set-up and training, recruitment, standardization, patient management, data transmission, update and data dissemination, clinical follow-up and monitoring, and publication. On four-point Likert scales for rating the usefulness of the communication modalities at each of the eight stages of the trial (from 0 = not useful to 3 = very useful; maximum score 24) the telephone was given a total score of 10, fax 9, email 13, videoconferencing 15 and face-to-face meetings 9. Telemedicine techniques offer considerable benefits in the coordination of multicentre trials by improving data collection, maintaining the efficacy and monitoring of trials, while potentially offering reduced costs in terms of travel and time. The realtime scrutiny of patient records helps to ensure data uniformity and completeness of data collection. Videoconferencing was most useful when considered as one of several communication tools that can be used to improve the effectiveness of a service or process.
Telemedicine and doctor-patient communication: an analytical survey of the literature
Authors: Miller Edward Alan
Published: October 2002

The literature about the effect of telemedicine on doctor-patient communication was reviewed. A total of 38 studies were identified: six were surveys of provider and community attitudes; 21 were post-encounter surveys of participants in a medical consultation; and 11 were qualitative analyses of behaviour in a medical encounter. Twenty-one of the 38 investigations originated in the USA, six in the UK, four in Australia, three in Norway, two in Canada, one in Finland and one in Sweden. All were relatively recent. The findings from each study were coded according to 23 categories developed from the literature and a positive or negative rating was assigned to each of the 213 communication results. Approximately 80% of abstracted findings favoured telemedicine, with all but two of the 23 categories analysed (non-verbal behaviour and lack of touch) reporting more positive than negative results. Verbal content analysis is important for the development of interventions aimed at facilitating doctor-patient telecommunication. However, further research is necessary if the nature and content of the communication process are to be fully understood.
Evaluation of a routine telepsychiatry service
Authors: Simpson J , Doze S , Urness D , Hailey D , Jacobs P
Published: October 2002

An assessment was undertaken of a routine telepsychiatry service in rural areas of a Canadian province as a follow-up to a pilot telepsychiatry project. Over two years, there were 546 consultations at the five participating general hospitals, although the level of use varied considerably between them. Health professionals expressed high satisfaction with the service. While there were equipment problems in 17% of all consultations in the second year, they did not seem to affect acceptance of the technique. A cost analysis comparing consultations provided by a visiting psychiatrist and telepsychiatry found a break-even point of 348 consultations a year. However, when use of the videoconferencing network for administrative meetings was considered, the break-even point was 224 consultations a year, substantially below the actual utilization of telepsychiatry. Telepsychiatry appeared to result in increased access to community mental health services, suggesting future increased demand for these. From the perspective of health authorities and health professionals, telepsychiatry proved to be a useful and sustainable addition to existing mental health services.
Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population
Authors: Krousel-Wood Marie A , Re Richard N , Abdoh Ahmed , Bradford David , Kleit Andrew , Chambers Richard , Altobello Carolyn , Ginther Barbara , Gomez Natalie
Published: October 2002

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.
Telecar: an Italian telecardiology project
Authors: Bertazzoni G , Genuini I , Aguglia F
Published: October 2002

The Telecar tele-assistance car diology project was an example of tele-assistance between health centres of the Regione Lazio in Italy. The project was approved by the Ministry of Health, financed with 500,000,000 lire and carried out by an operative station within La Sapienza' University (Rome). About 40 of the health centres in Lazio that did not have cardiologists or electrocardiography (ECG) equipment were provided with telematic instruments Cardiophone and fax . With this equipment, they were able to transmit ECG signals and receive copies of ECG reports. The 40 health centres included first-aid clinics, guardia medica' surgeries and community centres. The project was carried out between 1989 and 1992. During these three years the health centres transmitted a total of 4807 ECGs, 2057 (43%) of which were routine, the remaining 2750 (57%) being suspected emergencies. Of the suspected emergencies, 681 cases (25%) had a confirmed abnormality. We can confirm that telematic aids are very important for an operative station, where all kinds of emergencies must be dealt with.
Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: Effect of camera performance on diagnostic accuracy
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. A further 65 patients were examined using camera 2 and the same procedure applied. Seventy-six per cent of conditions were correctly diagnosed by telemedicine using camera 2 compared with 59% using camera 1. A working differential diagnosis was obtained in 12% of cases using camera 2 compared with 17% 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 camera 2 was superior to that of camera 1 for realtime teledermatology.