bluuebunny/crossref_metadata_2025 huggingface dataset:
Teleradiology in a military training area
Authors: Brumage M R , Chinn S , Cho K
Published: October 2002

A pilot teleradiology project was established for the medical service providers at the Pohakuloa Training Area (PTA) in Hawaii. It connected them with radiologists at Tripler Army Medical Center (TAMC) on the island of Oahu, approximately 400 km away. This involved changing the standard practice of sending soldiers from the PTA to a civilian hospital in Hilo for radiographs. These emergency trips to Hilo, 55 km away, were expensive, manpower intensive, and dangerous due to road and weather conditions. During 51 days of a training exercise involving 2600 personnel, 29 evacuations were avoided, which would have cost $36,569 in total. The expected savings during one year of training were $176,540. The cost of teleradiology during the first year, including the cost of the equipment, was $167,203. Over five years, the costs and savings were estimated to be $349,940 and $882,700, respectively.
The experience of a rural general practitioner using videoconferencing for telemedicine
Authors: Bowater Max
Published: October 2002

A telemedicine link was installed between a mining town in Western Australia and clinical specialists in Perth, about 1800 km away. Standard commercial videoconferencing units connected by ISDN at 128 kbit/s were used. During a two-year period, 90 teleconsultations were carried out. About one-third of the injuries to mining construction workers were eye problems. In more than 75% of teleconsultations a patient transfer to Perth was avoided.
Telemedicine in Kansas: The successes and the challenges
Authors: Doolittle Gary C
Published: October 2002

Based on our experience of telemedicine in Kansas, we have identified several key factors in the success of a telemedicine practice. Very early in any project, it is important to bring together all participants (especially the physicians who are expected to refer patients) to define the need, outline specific goals, analyse and test the technology, and develop a plan for the implementation. As with traditional health-care, many partners must come together, including primary-care practitioners willing to shoulder day-to-day responsibility for management of complex patients, nurses with special expertise and consultants willing to work with a remote team using telemedicine. These individuals must accept the challenges and appreciate the rewards of working in a different practice model, in which communication and interdependence are critical for success. The telemedicine consultant is only as good as the local health-care team. The technology itself is only a small part of the equation.
Telemedicine in South Africa: Success or failure?
Authors: Gulube S M , Wynchank S
Published: October 2002

A national telemedicine system for South Africa was planned in 1998. In the first phase, starting in 1999, 28 pilot sites were established in six provinces. The initial applications were teleradiology, tele-ultrasound for antenatal services, telepathology and tele-ophthalmology. Telemedicine equipment was connected by ISDN at 256 kbit/s. From January to September 2000, 2663 radiographic studies were performed at the three Northwest Province teleradiology transmission sites, of which 264 studies (10%) were selected for specialist radiologist reporting by teleradiology. From June to August 2000, nine antenatal care tele-ultrasound consultations were performed in the Northern Cape Province and four transfers were avoided through the use of telemedicine. One area of concern is the relatively low usage of the telemedicine system, which raises questions about its cost-effectiveness. The experience of telemedicine in South Africa confirmed, as others have found, that common problems relate to the technical and organizational challenges of introducing telemedicine.
E-health and online teaching: A successful synergy
Authors: Hughes Emma
Published: October 2002

Knowledge of the successes and failures of a variety of e-health applications has contributed to the teaching process as well as the content of an online e-health course. Examining the synergy between e-health and online teaching as forms of technologically mediated communication is useful in developing knowledge about both. Two conclusions may be drawn. The first is that success rests on the ability to make sense of the information that is communicated. The second is that success depends on building social networks. We have developed an online course in e-health in which participants develop an understanding of the domain both through sharing their own experience of online delivery and through course content that illustrates the successes and failures of others.
Effect of teleradiology on the diagnosis, treatment and prognosis of patients in a primary care centre
Authors: Kiuru Martti J , Paakkala Timo A , Kallio Timo T , Aalto Juha , Rajamäki Matti
Published: October 2002

A prospective study was carried out to evaluate the effect of teleradiology on the diagnosis, treatment and prognosis of patients in primary care. A university hospital was sent 685 plain film examinations via an ISDN connection from a primary care centre, for a radiological report. The study was conducted in two phases: during phase 1 (446 cases) general practitioners (GPs) selected the examinations, and during phase 2 (239 cases) all consecutive examinations were transmitted. In phase 1, 40% of the examinations were of the chest and 24% were of the spine; the remaining 36% were mainly bone and sinus examinations. In phase 2, 28% of the examinations were of the chest and 19% were of the spine. The sensitivity and specificity of the GPs' interpretations (compared with the radiologists') were 0.85 and 0.62 respectively in the first phase, and 0.90 and 0.86 in the second. In at least one-third of all cases, teleradiology helped with the diagnosis, although completely new diagnoses were less common. An effect on treatment was noted in 15% of cases and on prognosis in 5%. However, an appropriate consultation level is required for these positive effects. Adequate accuracy and patient safety cannot be achieved if the examinations sent for radiological reporting are preselected by a GP.
User satisfaction with home telecare based on broadband communication
Authors: Guillén S , Arredondo M T , Traver V , Valero M A , Martin S , Traganitis A , Mantzourani E , Totter A , Karefilaki K , Paramythis A , Stephanidis C , Robinson S
Published: October 2002

Home telecare services based on broadband communication were established in five locations in Europe. Two different types of telecare unit were developed: one based on a PC or set-top box containing a videoconferencing codec and another on off-the-shelf videoconferencing units. The participants in the project were 13 medical staff, 135 patients and 88 people informally caring for the patients. Questionnaires were used to evaluate user satisfaction with eight telecare services. Almost all participants rated the usability of the system as good or excellent. A total of 105 telecare sessions were scored by the medical staff. Overall, the quality of audio and video communication was judged satisfactory. For the patients and carers, the perceived quality of communication was also satisfactory and did not vary significantly between sites. The medical staff were reasonably satisfied with how the service supported them in their work. Except for the item about being able to support patients in a critical situation, medical staff agreed that an improved quality of health services was offered through telecare. All participants agreed that personal information was treated confidentially and that there was little risk in using the telecare services. The medical staff trusted the assessments they could make remotely while using the telecare system. Although the findings cannot be generalized due to the small number of telecare sessions and the relatively short duration of the experiment, the results encourage further research.
Client satisfaction in a feasibility study comparing face-to-face interviews with telepsychiatry
Authors: Bishop J E , O'Reilly R L , Maddox K , Hutchinson L J
Published: October 2002

We carried out a pilot study comparing satisfaction levels between psychiatric patients seen face to face (FTF) and those seen via videoconference. Patients who consented were randomly assigned to one of two groups. One group received services in person (FTF from the visiting psychiatrist) while the other was seen using videoconferencing at 128 kbit/s. One psychiatrist provided all the FTF and videoconferencing assessment and follow-up visits. A total of 24 subjects were recruited. Three of the subjects (13%) did not attend their appointments and two subjects in each group were lost to follow-up. Thus there were nine in the FTF group and eight in the videoconferencing group. The two groups were similar in most respects. Patient satisfaction with the services was assessed using the Client Satisfaction Questionnaire (CSQ-8), completed four months after the initial consultation. The mean scores were 25.3 in the FTF group and 21.6 in the videoconferencing group. Although there was a trend in favour of the FTF service, the difference was not significant. Patient satisfaction is only one component of evaluation. The efficacy of telepsychiatry must also be measured relative to that of conventional, FTF care before policy makers can decide how extensively telepsychiatry should be implemented.
Social presence in telemedicine
Authors: Tachakra Sapal , Rajani Rakhi
Published: October 2002

We studied consultations between a doctor, emergency nurse practitioners (ENPs) and their patients in a minor accident and treatment service (MATS). In the conventional consultations, all three people were located at the main hospital. In the teleconsultations, the doctor was located in a hospital 6 km away from the MATS and used a videoconferencing link connected at 384 kbit/s. There were 30 patients in the conventional group and 30 in the telemedical group. The presenting problems were similar in the two groups. The mean duration of teleconsultations was 951 s and the mean duration of face-to-face consultations was 247 s. In doctor-nurse communication there was a higher rate of turn taking in teleconsultations than in face-to-face consultations; there were also more interruptions, more words and more 'backchannels' (e.g. 'mhm', 'uh-huh') per teleconsultation. In doctor-patient communication there was a higher rate of turn taking, more words, more interruptions and more backchannels per teleconsultation. In patient-nurse communication there was relatively little difference between the two modes of consulting the doctor. Telemedicine appeared to empower the patient to ask more questions of the doctor. It also seemed that the doctor took greater care in a teleconsultation to achieve coordination of beliefs with the patient than in a face-to-face consultation.
Telemedicine in Australia. 2: The Health Communication Network
Authors: Alexander M
Published: October 2002

The Health Communication Network HCN in Australia is reviewed. Early interest from both the government and the medical community led to the establishment of a number of pilot services. Because of the community interest in privacy issues, determined efforts to understand and build structures to cope with privacy have been made. The first HCN services began to be tested in 1995, and progressive expansion is planned. The HCN, while supported by the government, is a separate, commercial entity, and much early work has thus focused on corporate governance, so that it will be able to do what it was designed for.
Factors affecting the electronic communication of radiological information to an intensive-care unit
Authors: Shile P E , Kundel H L , Seshadri S B , Carey B , Kishore S , Brikman I , Feingold E , Lanken P N , Purcell J A
Published: October 2002

In order to examine communication of radiological information under circumstances where rapid exchange of information was essential, we studied communication of non-routine portable chest radiographs to an intensive-care unit ICU . Images and reports were available through the usual communication channels and through a PACS workstation in the ICU. Data were obtained to determine how quickly and by what means ICU physicians first viewed images and received radiologists' reports of chest radiographs. Peak information demand occurred within 4 h of the examination. The most rapid means of communication was for the physician to visit the radiology department. Image viewing and report receipt were tightly coupled, usually for images which were first viewed as hard copy. PACS performance suffered from unreliable film digitization and delayed report transcription. Integration of computed radiography and digital dictation into a PACS could markedly reduce the delays in ICU physicians' access to radiological information.
Telemedicine in northern Norway
Authors: Elford D. R.
Published: October 2002

The University Hospital of Tromso has been involved in a variety of telemedicine activities since the late 1980s, including teleradiology, telepathology, teledermatology, remote endoscopy, remote gastroscopy, teleechocardiography, transmission of electrocardiograms, telepsychiatry, electronic delivery of laboratory results and distance learning for health professionals. Since 1993 the department of telemedicine in Tromsl has been designated the national centre of competence in telemedicine. With a wealth of experience to draw from, a critical number of health-care professionals exposed to and using telemedicine routinely, the support of the Norwegian health authorities, a national centre guiding telemedicine research, no licensing barriers within the country, nationwide ISDN and reimbursement for telemedicine services, the future of telemedicine in Norway looks promising.
Intercontinental postmortem studies using interactive television
Authors: Brebner E. M. , Brebner J. A. , Norman J. N. , Brown P. A. J. , Ruddick-Bracken H. , Lanphear J. H.
Published: October 2002

For cultural reasons, medical students in the United Arab Emirates UAE are not offered postmortem studies. In a collaborative project between the medical schools of Aberdeen University and the UAE University the feasibility, acceptability and effectiveness of telepathology teaching were evaluated. The transmission of postmortem video images at a quality high enough for teaching purposes was achieved at a data transmission speed of 384 kbit s. Videoconferencing as a method of presentation was viewed by the students as both interesting and useful. All students participating in the telepathology teaching sessions exceeded the minimum acceptable score of 60 in a multiple-choice examination. Although international videoconferencing at 384 kbit s is expensive, the costs involved in the telepathology project were small in relation to the educational benefits.
Evaluating the alliance in videolink teletherapy
Authors: Ghosh G J , Mclaren P M , Watson J P
Published: October 2002

The use of videoconferencing in psychotherapy remains largely unexplored. Videoconferencing compromises the range and quality of interactional information and thus might be expected to affect the working alliance (WA) between client and therapist, and consequently the process and outcome of therapy. A single case study exploring the effect of videoconferencing on the development of the WA in the psychological treatment of a female–male transsexual is described. The self-rated Working Alliance Inventory (WAI) was used to measure client and therapist perceptions of the WA after each session over 10 sessions of eclectic therapy conducted over a videolink. The serial WAI measurements charting the development of the WA in 4 cases of 10-session, face-to-face therapy by Horvath and Marx1 were used as a quasi-control. Therapist and client impressions of teletherapy are described. WAI scores were essentially similar to the face-to-face control group except for lower client-rated bond subscale scores. It is suggested that client personality factors accounted for this difference and that videoconferencing did not impair the development of an adequate working alliance or successful therapeutic outcome.
Education and training of practice nurses
Authors: Jarrett C , Wainwright P , Lewis L
Published: October 2002

Seventeen nurses in eight rural general practices participated in a distance education project. Low-cost videoconferencing equipment was assessed for its suitability in two training sessions, concerning asthma and travel immunization. The intended learning outcomes were reached and although initially apprehensive, the nurses quickly became accustomed to the medium. Videoconferencing has now become an accepted part of in-service training. Technical reliability remains the most important problem.
Effect size and experimental power analysis in a paediatric cardiology telemedicine system
Authors: Rendina Mark C , Long Walker A , Debliek Ruth
Published: October 2002

A telemedicine system was installed between the University of North Carolina Hospitals and the New Hanover Regional Medical Center. It allowed the transmission of neonatal echocardiograms for immediate reporting. During a six-month study period the system was used for the interpretation of 110 echocardiograms from 48 babies. There were 38 babies studied in a retrospective control period. Hospital length of stay decreased by an average of six days in the telemedicine group, representing an annual saving of some $1.3 million. However, these apparent differences were not significant (P=0.2) and a power analysis suggested that as ample size of some 600 would have been necessary.
Telemedicine in emergency home care—the ‘Shahal’ experience
Authors: Roth Arie , Carthy Ziv , Benedek Michael
Published: October 2002

Shahal serves over 40,000 cardiac, pulmonary and blood pressure subscribers. The system combines emergency home care and telemedicine in a patient-initiated system geared towards the prevention of cardiac and pulmonary complications. About 150,000 calls are received per year. The median time from onset of symptoms to a call for help is 44 min. It is a unique system which has been shown to facilitate improved home health-care control, enabling patients to manage their own health condition and providing them with a higher quality of life and enhanced peace of mind.
Patient satisfaction with realtime teledermatology in Northern Ireland
Authors: Loane M. A. , Bloomer S. E. , Corbett R. , Eedy D. J. , Gore H. E. , Mathews C. , Steele K. , Wootton R.
Published: October 2002

Teledermatology consultations were organized between two health centres and two hospitals in Northern Ireland using low-cost videoconferencing equipment. A prospective study of patient satisfaction was carried out. Following each teleconsultation, patients were asked to complete a questionnaire assessing their satisfaction with the service. Over 22 months, 334 patients were seen by a dermatologist over the video-link, and 292 patients 87 completed the 16-item questionnaire. Patients reported universal satisfaction with the technical aspects of teledermatology. The quality of both the audio and the display was highly acceptable to patients. Personal experiences of the teledermatology consultation were also favourable: 85 felt comfortable using the video-link. The benefits of teledermatology were generally recognized: 88 of patients thought that a teleconsultation could save time. Patients found the teledermatology consultation to be as acceptable as the conventional dermatology consultation. These findings suggest overall patient satisfaction with realtime teledermatology.
The Austrian Academic Computer Network and its usefulness for teleradiology
Authors: Giacomuzzi S M , Springer P , Stöger A , Dessl A , Buchberger W , Bodner G , Bale R , Schreder J G , Gell G , Jaschke W
Published: October 2002

To study the value of the Austrian Academic Computer Network (ACOnet) for teleradiology, 1740 test image data-sets and 620 image data-sets were exchanged between the departments of diagnostic radiology of the Universities of Innsbruck and Graz using the ACOnet service. Data transmission was reliable and fast with an average transfer capacity of 170 kByte/s (range 94–341). During the test phase, no major problems with image transfer occurred. Assuming that problems like security of patient data-sets, data compression and data verification can be solved, the ACOnet service would be a useful additional tool for telemedicine applications throughout Austria and eastern Europe.
Cognitive behaviour therapy via interactive video
Authors: Manchanda M , Mclaren P
Published: October 2002

Interactive video has been identified as a potential delivery medium for psychotherapy. Interactive video may restrict the range of both verbal and non-verbal communication and consequently impede the development of a therapeutic relationship, thus influencing the process and outcome of therapy. A single case study explored the feasibility of the provision of cognitive behaviour therapy using interactive video with a client diagnosed a shaving mixed anxiety and depressive disorder. A range of outcome measures were included together with an independent psychiatric assessment prior to, and on completion of, therapy. Different levels of outcome were also examined: clinical, social, user views and administration. Outcome measures indicated a reduction in psychopathology and some modification of dysfunctional attitudes, with no apparent impairment of the working alliance.
Practical evaluation of telemedicine systems in the real world
Authors: Yellowlees Peter
Published: October 2002

There are six key questions that need to be asked before the evaluation of any telemedicine project. These are: who, why, what, when, where and how? Evaluation, and the subsequent communication of the results, is central to the development and implementation of any telemedicine system. As telemedicine technologies and processes gradually mature the extent and breadth of evaluations relevant to these technologies will undoubtedly improve and it is to be hoped that telemedicine systems will prove themselves as clinical tools.
Cost evaluation of a telepsychiatry service in northern Queensland
Authors: Trott Paul , Blignault Ilse
Published: October 2002

We conducted a simple comparison of the costs associated with delivering a mental health service by telepsychiatry and by conventional methods. The telepsychiatry rural outreach service was delivered to a mining town 900km from the regional hospital in Townsville. When the telemedicine service was well established, 40 cases a month were seen for general adult psychiatry, four for child and adolescent mental health, four for psychology and two for forensic services. Costs and quality-of-life issues were considered. The savings to the health authority were estimated to be $85,380 in the first year and $112,790 in subsequent years, not allowing for maintenance and equipment upgrading. We also estimated a 40%reduction in patient transfers due to the introduction of telemedicine. Based on the previous year's figures of 27 transfers at $8920 each, this would produce an annual saving of $96,336 for the Royal Flying Doctor Service. The results of the study showed considerable savings from reduced travel by patients and health-care workers.
The International Telecommunication Union's Report on Telemedicine and Developing Countries
Authors: Wright David
Published: October 2002

This paper reviews some of the main conclusions and recommendations from the Report on Telemedicine and Developing Countries, which was prepared for the International Telecommunication Union (ITU). The report is the result of three years’ effort by a group of experts in telecommunications and telemedicine from around the world. It provides an extensive survey of the telemedicine experience of various countries. It discusses the different types and applications of telemedicine, the technologies used, costs and benefits, trends, prospects for global standards, and provides guidelines and recommendations to developing countries for implementation of telemedicine services. The ITU study group which prepared the report is expected to begin some new tasks in 1998, including the identification of a set of pilot telemedicine projects for developing countries.
Telemedicine in primary care in Israel
Authors: Itzhak B , Weinberger T , Berkovitch E , Reis S
Published: October 2002

Aprimary-care teleconsulting system was established between an academic family medicine centre and a clinic about 50 km away. The video conferencing units were connected at 384 kbit/s. Seven patients were examined by a physician in the clinic and then examined by a consulting physician using the telemedicine system. Four other patients were examined through the telemedicine system first and by a local physician later. The telemedicine consultation solved five of the patients’ medical problems. The waiting period before receiving expert medical consultation was reduced. There was full patient satisfaction regarding this method of consultation, patient ‘run around’ was avoided and patients felt at ease. The telemedicine consultation process improved the patient-physician bond and the attending physician's level of confidence.
Image selection in static telepathology through the Internet
Authors: Mea V Della , Cataldi P , Boi S , Finato N , Palma P Dalla , Beltrami C A
Published: October 2002

A telepathology study was carried out to examine the differences occurring when the images were selected by an experienced pathologist, a junior pathologist and a first-year resident. One hundred and fifty-five consecutive frozen-section pathology cases were collected and sent for consultation to a remote experienced pathologist using multimedia email. Local diagnoses (as reported in the files of the Institute, not from the image selector) and remote diagnoses (based on the images) were compared with those performed on paraffin-embedded sections. Acquisition time and number of selected images were recorded for each case and used to compare the different behaviour of the three local pathologists. Of the 155 cases sent by telepathology, four were considered insufficient for a diagnosis by the remote pathologist and thus the diagnosis was postponed. In the remaining 151 cases, the overall diagnostic agreement between remote and definitive diagnosis was 96.7%. The results indicate that in the routine diagnostic work of a frozen-section service, an inexperienced pathologist can select images which are sufficiently informative for a remote diagnosis, in a sufficiently short time.
The legal and ethical aspects of telemedicine. 3: Telemedicine and malpractice
Authors: Stanberry Ben
Published: October 2002

Summary This paper reviews the difficulties raised by the need to obtain valid consent from telemedicine patients to the treatment that they receive and evaluates the legal principles that the courts will apply to an allegation of negligence brought against a teleconsultant or telemedicine service by a patient. While many of the processes that take place during a telemedical consultation will be unique, it is suggested that the legal principles that apply to the conventional, face-to-face, doctor-patient relationship are equally as valid in the context of the practice of medicine at a distance.
The use of videoconferencing for telepsychiatry in Finland
Authors: Mielonen Marja-Leena , Ohinmaa Arto , Moring Juha , Isohanni Matti
Published: October 2002

Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours in 1997. During 1997, 45 of the time was used for teaching, 26 for occupational counselling, consultations and therapies, 23 for training and 6 for administration mainly testing the connections . In a survey, 37 participants rated aspects of the quality of the videoconferences on a scale from 4 poor to 10 excellent . The audio quality had a mean value of 8.0 SD0.9 , the picture quality 7.5 SD1.5 , and the general value of the videoconference was rated 7.5 SD1.0 . Preliminary results with telepsychiatry in Finland have been promising. Interactive videoconferencing provides an easy, fast and relatively inexpensive method of providing psychiatric services over long distances.
Planning and cost analysis of digital radiography services for a network of hospitals the Veterans Integrated Service Network
Authors: Duerinckx Andre J. , Kenagy John J. , Grant Edward G.
Published: October 2002

This study analysed the design and cost of a picture archiving and communications system PACS , computerized radiography CR and a wide-area network for teleradiology. The Desert Pacific Healthcare Network comprises 10 facilities, including four tertiary medical centres and one small hospital. Data were collected on radiologists' workloads, and patient and image flow within and between these medical centres. These were used to estimate the size and cash flows associated with a system-wide implementation of PACS, CR and teleradiology services. A cost analysis model was used to estimate the potential cost savings in a filmless radiology environment. ATM technology was selected as the communications medium between the medical centres. A strategic plan and business plan were successfully developed. The cost model predicted the cost-effectiveness of the proposed PACS CR configuration within four to six years, if the base costs were kept low. The experience gained in design and cost analysis of a PACS teleradiology network will serve as a model for similar projects.
Home telecare in the United States
Authors: Kinsella A
Published: October 2002

Telecare has the potential to extend home-care services normally delivered by conventional means. In the USA, government reductions in health-care financing have been matched by a growing interest, on the part of commercial health-care insurers, in cost reductions and cost-effective care planning. This review identifies emerging trends in home care. Several telecare demonstration projects have been undertaken with patients with coronary heart disease and HIV AIDS. These projects have attempted to develop new methods of providing cost-effective care for a growing patient population with chronic disease.
Standardized visual evoked potentials for telematic electrodiagnosis from five laboratories in three European countries
Authors: Papakostopoulos D. , Hart J. C. Dean , Papakostopoulos S. , Dodson K. , Williams A.
Published: October 2002

The pattern-reversal visual evoked potential PR VEP is an electrodiagnostic test which uses an alternating checkerboard pattern as the visual stimulus. To validate the performance of an automated testing system, the equipment was installed in five locations in three countries the UK, Greece and Cyprus . PR VEPs require accurate control of stimulus size, luminance, contrast, timing, multichannel recordings and various modes of signal processing. Recordings were obtained from 70 subjects, 18-34 years old seven male and seven female in each laboratory . The data were transmitted by telephone line to the central station in Bristol. Only in Bristol were the operators experienced. There were no significant differences between laboratories in latency or amplitude of the N70 and P100 components. There were no significant differences between eyes. There were significant differences between the sexes but this was related to head size. Decreased square size used in stimulation produced an increased latency in both components. The amplitude of the N70 component increased while that of the P100 decreased with reduced square size. The results confirmed the ability of the automated system to produce standardized PR VEP recordings comparable to those obtainable in advanced laboratories. The system performed well in different locations using inexperienced operators. The system is suitable for multicentre research studies and telemedicine.
A survey of Norwegian telemedicine
Authors: Uldal S B
Published: October 2002

To get an overview of Norwegian telemedicine, a questionnaire was sent to the contact persons of telemedicine programmes. There was an 83 response rate from 102 telemedicine programmes; there were 66 active research projects. Several larger networks had recently started operation, probably as a result of the Ministry of Health and Social Affairs' plan of action on information and communication technology in health care. Twenty-one programmes involved primary care or home care. Few programmes were using telemedicine to bridge established divisions of service responsibility or to make connections to institutions abroad. There were three large national research programmes in which telemedicine played an important role. Research projects were evaluating the economic, organizational and sociological aspects of telemedicine, as well as the medical. The oldest telemedicine activities were in northern Norway.
The uneven diffusion of telemedicine services in Australia
Authors: Mitchell J G
Published: October 2002

The diffusion of telemedicine services in Australia over the last four years has been uneven. Some of the major barriers to the adoption of telemedicine relate to the nature of the industry, including its immaturity, the limited telecommunications infrastructure, the lack of appropriate dialogue between vendors and buyers about solutions required, and the lack of partnerships in the industry. Remuneration is only one barrier. There are, of course, other substantial organizational, financial and attitudinal barriers to the adoption of telemedicine. Further development of telemedicine in Australia will require detailed assessment of these matters.
Applications of low-cost eye tracking in telemedicine
Authors: Bettley R J
Published: October 2002

A low-cost, high-resolution system for measuring eye position information and eye movement has been developed. The Vision Control System (VCS) equipment can be worn as alight weight headset. The ability to operate equipment via eye movement empowers individuals by keeping hands free to perform other tasks. Potential applications of the VCS equipment include its use in surgical training as a non-screen pointing device to highlight areas of interest, use by paramedics to relay information at the scene of an accident, use to examine a radiologist's visual scanning technique in reading films, and use in ophthalmology to monitor eye behaviour.
The Cornwall dermatology electronic referral and image-transfer project
Authors: White Harold , Gould David , Mills Wayne , Brendish Lawrence
Published: October 2002

An evaluation of a store- and -forward electronic referral system was carried out in Cornwall to gauge its effectiveness in prioritizing dermatological patients needing secondary care. A dermatologist classified patients to be seen according to need based on information on the electronic referral form along with an image of the skin condition. Initial findings indicated that patients were more accurately triaged in at least 50% of cases and that 25% of patients did not require an outpatient dermatological appointment. Dermatologists rated image quality at 7.5 on a 10-point scale. This low-cost system has potential for more appropriate clinical management of dermatological patients in both primary and secondary care.
Tele-otolaryngology consultations between two rural primary-care centres in southern Lapland and the University Hospital of Umeå
Authors: Made Curt , Carle Lars , Söderberg Ove , Hellström Sten
Published: October 2002

In 1996 a telemedicine link was established between two primary-care centres of Västerbotten county and the University Hospital. Specialties involved at the University Hospital were otoloaryngology, orthopaedics and dermatology. Videoconferencing used ISDN at 384 kbit/s. The primary-care centres were equipped with video-endoscopes. During the first 21 months, there were 32 otolaryngology consultations. The average time for each consultation was between 15 and 30 min. Patients, general practitioners and specialists were interviewed using questionnaires with answers on a six-point scale, in which a score of six was best. Patient satisfaction produced a mean score of 5.7. The specialist doctors rated the video-consultation satisfactory for diagnosis. Roughly 40% of the referrals could be avoided by telemedicine. The general practitioners rated the educational effect of the consultation very highly.
The legal and risk management conundrum of telemedicine
Authors: Wallace Simon , Sibson Lynda , Stanberry Ben , Waters David , Goodall Piers , Jones Rupert , Evans Judy , Dunn Rod
Published: October 2002

A store- and -forward teledermatology service was established between two general practices and the department of plastic surgery at Derriford Hospital in Plymouth. An academic lawyer and an expert in risk management made an assessment of the service. They looked at the following issues: medicolegal problems; security; confidentiality; and risk. None of them was considered insoluble and there is no reason why such issues should prevent the National Health Service from developing telemedicine services. All organizations considering telemedicine need to ensure that the proposed telemedicine service satisfies the issues raised in this study.
The sustainability of telemedicine projects
Authors: Wright David
Published: October 2002

Although there are instances where the provision of health care is success fully driven by the profit motive, in most countries it is considered a public service. The provision of telemedicine services assuredly meets an important social need to extend health care to remote and rural areas in developing countries. While there are potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. Telemedicine undoubtedly yields cost savings in certain circumstances, but few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. With their low expenditures per person, developing countries face a daunting challenge in making such public services sustainable. Pilot projects should be a first step in demonstrating the cost-effectiveness and benefits of telemedicine, but such projects should also be sustainable. Sponsors of such pilot projects must have a clear plan from the start about how the project can continue after the sponsorship comes to an end. This paper examines ways in which telemedicine services can be made sustainable.
Twelve months’ experience with telemedicine for the British armed forces
Authors: Vassallo D J
Published: October 2002

In 1998, a low-cost telemedicine system was established for the British armed forces in Bosnia. It involved a digital camera, computer, email and a telephone link between the remote site and the UK. Images were transferred to a PC and forwarded to specialists in the UK, who replied with in 24 hours. In the first 11 months of use, there were 60 referrals from one remote site. Clinical management following specialist advice was significantly altered in a third of these cases, with additional reassurance offered in 13% of cases. When other sites were connected the usage of the service doubled. This inexpensive system provided effective care to our patients, irrespective of location.
The enhancement of audience participation in telemedicine education by the use of electronic voting
Authors: Morris D G , Bakewell M A , Buzila S M , Duyverman H , Mitchell J G , Morris R S , Robinson P J
Published: October 2002

The rotation of trainee registrars in obstetrics and gynaecology to peripheral centres in South Australia was introduced for the first time in January 1998. A pilot study of the use of telemedicine to maintain the trainees’ involvement in the established weekly training sessions conducted at the Women's and Children's Hospital (WCH) was also commenced at the same time. Sessions were problem based and required the trainees to be actively involved throughout. An electronic voting system(EVS) was used by the WCH audience, with the results of all responses being seen at the peripheral centres. Initial evaluation of the EVS as an educational tool was sufficiently positive to justify further studies of its use in this environment. The availability of voting units at the peripheral sites, used in conjunction with the main centre, will provide an exciting opportunity for further research.
A method for identifying comparison counties: application to a rural telemedicine evaluation project
Authors: Hicks L L , Koenig S E , Boles K E , Madsen R W , Kling B W , Mitchell J A , Webb W D , Tracy J A
Published: October 2002

The evaluation of telemedicine activity in rural communities is complicated by the fact that most telemedicine sites are chosen because of their existing telecommunications infrastructure and institutional relationships, not by a random selection process. In addition, it is difficult to draw conclusions about the effects of telemedicine without a careful analysis of parallel changes in communities which do not have access to telemedicine services. We have developed a method of identifying comparable counties based on an aggregate measure of health status. A set of 66 variables was collected in a previous project to develop a model to evaluate the relative health status of the population in Missouri. A stepwise regression was used to identify a subset of 15 variables that had the highest predictive value for the health status of a county. Distance measures were then used to identify six counties which were most similar to three telemedicine counties. The method can be used with any study set chosen non-randomly, to identify similar objects that can be used for comparative purposes.
Factors that may influence the implementation of nurse-centred telemedicine services
Authors: Gerrard Lorraine , Grant Adrian M , Maclean J Ross
Published: October 2002

A qualitative study of four UK telemedicine sites was carried out to explore reactions to nurse-centred telemedicine services and their possible implications. Using semistructured schedules, 36 people directly involved in these services were interviewed - 25 nurses, four general practitioners, two advising medical consultants, three service managers and two researchers. Factors identified which may influence successful implementation included: early involvement of all groups affected, prior consideration of the practical implications, thorough initial equipment testing, good technical support, imaginative training and clarity of the purpose of the service. The study showed that all those involved must be prepared for the rapid learning that is implicit in the implementation of change. The challenge is to maximize the potential for the primary operator to use new techniques. In respect of nurse-centred services, the nurse must not be viewed as a technician, nor should telemedicine be seen as a substitute for an available doctor.
Developmental changes in responsiveness to parents and unfamiliar adults in a monogamous monkey (Callicebus moloch)
Authors: Mayeaux D.J. , Mason W.A. , Mendoza S.P.
Published: October 2002

Titi monkeys (Callicebus moloch) are monogamous New World primates that are characteristically found in family‐type groups consisting of a mated adult pair and one or two young. The factors maintaining the small size of these groups are not known. Based on observations of free‐ranging and captive families, parental aggression toward older offspring seems unlikely to play a significant role. Maturing individuals themselves, however, could undergo behavioral changes that weaken ties to their natal group. These might include waning of affiliative relations with parents, or subtle forms of aversion. Independent of such changes, increasing interest in unfamiliar conspecifics could be a factor. We examined these possibilities in the present study by assessing changes in social behavior and social preferences from initial ambulatory independence (6 months) through reproductive maturity (24 months) in a combined cross‐sectional/longitudinal study of 21 captive titi monkeys living with their parents. Responses to both parents and to an unfamiliar adult heterosexual pair, a single unfamiliar adult male, and a single unfamiliar adult female were observed when subjects were given a choice between parents and strangers presented simultaneously or as the only social incentive. Social stimuli were at opposite ends of a 16.8‐m‐long test corridor. Subjects could move freely about the corridor for 5 min with each configuration of social stimuli. They stayed closer to parents than to strangers at all ages. Responsiveness to strangers increased with age and suggested growing ambivalence, particularly toward the male stranger. As they approached 24 months of age, male subjects showed a dramatic increase in the frequency and intensity of agonistic behaviors toward male strangers, behaviors that were rarely directed toward female strangers or parents. Waning of attraction to parents may be less important in dispersal from the natal group than changing reactions to strangers. Am. J. Primatol. 58:71–89, 2002. © 2002 Wiley‐Liss, Inc.
Toward the engineering of minimal living cells
Authors: Luisi Pier Luigi
Published: October 2002

The article focuses on the notion of a synthetic or semi‐synthetic minimal cell, defined as a system that has the minimal and sufficient structural conditions for cellular life. It is emphasized that two complementary approaches are in principle possible, defined as “bottom‐up” and “top‐down” approaches. The first one aims at the construction of a minimal cell starting from scratch, and it is argued that a very serious bottle‐neck to this pathway lies in the origination of specific macro‐molecular sequences, as in nature those were constructed most likely by a particular contingent set of conditions. The top‐down approaches utilize extant genes and enzymes, and the work in this case is based on the incorporation of the minimal and sufficient amount of such macromolecules into liposomes, as models for the shell of biological cells. The first phase of this ambitious project foresees the study of conditions under which complex molecular biology reactions takes place in the compartments of liposomes. Examples of these reactions are provided, for example, the production of RNA throughout Q‐beta replicase in a self‐reproducing vesicle system; or PC Reaction in phospholipid vesicles; or even the incorporation of ribosomes in liposomes, with the production of polypeptide chains. The use of giant vesicles is also illustrated. These systems, due to their large size, offer the advantage that by way of special micro‐injection techniques, all sort of biochemical agents can be directly introduced in the compartment; and that the reaction can be followed by optical microscopy. In the final part of the article, the outlook of increasing the complexity of these liposome systems so as to arrive at first semi‐synthetic cells is discussed. Anat Rec 268:208–214, 2002. © 2002 Wiley‐Liss, Inc.
Evolution of collagens
Authors: Exposito Jean‐Yves , Cluzel Caroline , Garrone Robert , Lethias Claire
Published: October 2002

The extracellular matrix is often defined as the substance that gives multicellular organisms (from plants to vertebrates) their structural integrity, and is intimately involved in their development. Although the general functions of extracellular matrices are comparable, their compositions are quite distinct. One of the specific components of metazoan extracellular matrices is collagen, which is present in organisms ranging from sponges to humans. By comparing data obtained in diploblastic, protostomic, and deuterostomic animals, we have attempted to trace the evolution of collagens and collagen‐like proteins. Moreover, the collagen story is closely involved with the emergence and evolution of metazoa. The collagen triple helix is one of numerous modules that arose during the metazoan radiation which permit the formation of large multimodular proteins. One of the advantages of this module is its involvement in oligomerization, in which it acts as a structural organizer that is not only relatively resistant to proteases but also permits the creation of multivalent supramolecular networks. Anat Rec 268:302–316, 2002. © 2002 Wiley‐Liss, Inc.