bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term prognosis of patients with myocardial infarction and normal coronary angiography: impact of inherited coagulation disorders
Authors: Tardy Brigitte , Haouchette Kamel , Mismetti Patrick , Cerisier Alexis , Lamaud Michel , Guyotat Denis , Isaaz Karl , Da Costa Antoine 
Published: December 2003

SummaryThe prognosis of patients with myocardial infarction (MI) and normal coronary arteries (NCA) in the presence of an inherited coagulation disorder is unknown. The purpose of this study was to compare the clinical thrombosis outcome of patients with (GpI) or without (GpII), inherited coagulation disorders, who suffered from an acute MI with NCA. Eighty two consecutive patients (mean age 49 ± 15 years; 29 females) with MI, but NCA, were recruited. Twelve patients (15%) had an inherited coagulation disorder. GpI and GpII were statistically similar regarding age (45 ± 11 vs 50 ± 16 years-old), gender (33 vs. 36% female), tobacco consumption (50 vs. 53%), diabetes mellitus (8 vs. 10%), hypertension (25 vs. 17%), obesity (8.3 vs. 14%), family history of coronary heart disease (33 vs. 19%), hypercholesterolemia (50 vs. 21%; p = . 08), left ventricular ejection fraction (58 ± 13 vs. 61 ± 13%) and spasm (8.3% vs. 17%). All patients were initially treated with antiplatelet agents with the exception of one (8%) in GpI, and 6 (9%) in GpII who were taking oral anticoagulant therapy (ns). The mean follow-up was 57 ± 26 (range from 2-91 months). During the outcome, 12/78 (15.4%) thrombosis events occurred, including venous thrombosis or pulmonary embolism (1/12 vs. 1/66), reinfarction (2/12 vs. 4/66), and stroke (2/12 vs. 2/66), with two events in one patient (GpI). Kaplan-Meier event-free survival, with combined end-point, defined as venous thrombo-embolic event, reinfarction, or stroke differed between the two groups: 4/12 (33.3%) in GpI and 7/66 (10.6%) in Gp II (p <. 02). Patients with MI, NCA and congenital coagulation disorder present a high risk of thrombosis recurrence under antiplatelet agent.Presented in part at the 52nd Annual Scientific Session of the American College of Cardiology; March 30-April 2, Chicago USA 2003, Abstract.
The complex between urokinase-type plasminogen activator (uPA) and its type-1 inhibitor (PAI-1) independently predicts response to first-line endocrine therapy in advanced breast cancer
Authors: Tjan-Heijnen Vivianne , Span Paul , Grebenchtchikov Nicolai , Geurts-Moespot Anneke , van Tienoven Doorléne , Beex Louk , Sweep Fred , Manders Peggy 
Published: December 2003

SummaryIt has been shown that urokinase-type plasminogen activator (uPA) and its main inhibitor (PAI-1) have predictive value for therapy success in advanced breast cancer. Levels of the complex between uPA and PAI-1, formed when both molecules are in their active form, might have superior predictive power. Here, we investigate the association between levels of uPA:PAI-1 complex and rate of response to first-line systemic therapy for advanced breast cancer. Tumor tissues of 170 patients with advanced breast cancer were analyzed for uPA:PAI-1 complex concentrations using a quantitative enzyme-linked immunosorbent assay. The patients received either endocrine therapy (n=96) or chemotherapy (n=74) as first-line treatment after diagnosis of advanced disease. Of the endocrine treated patients, those with high levels of uPA:PAI-1 complex showed a shorter progression-free survival (PFS) compared to patients with lower uPA:PAI-1 complex levels (P=0.035). Furthermore, in the multivariate regression analysis a significant lower rate of response to first-line endocrine therapy was found in patients with high uPA:PAI-1 complex levels compared to patients with low uPA:PAI-1 complex levels (odds ratio (OR)=0.27, 95% CI, 0.09–0.59, P=0.018), in addition to the predictive impact of the steroid hormone receptor (ER/PgR) status (OR=2.68, 95% CI, 1.08–6.63, P=0.033). Complex levels did not predict efficacy of chemotherapy in patients with advanced breast cancer. The results show that the plasminogen activation system affects the response to endocrine therapy independent of steroid hormone receptor status and may be of help to further refine the indication for this treatment in individual patients. Further studies are warranted to explain this underlying resistance to endocrine therapy when uPA:PAI-1 levels are high.
Influence of plasma and erythrocyte factors on red blood cell aggregation in survivors of acute myocardial infarction
Authors: Falcó Cristina , Réganon Edelmiro , Vila Virtudes , Martínez-Sales Vicenta , Corella Dolores , Contreras Teresa , Aznar Justo , Vayá Amparo 
Published: December 2003

SummaryIncreased erythrocyte aggregation (EA) has been observed in patients with ischaemic heart disease (IHD), although most of these studies have been performed in the acute phase when reactant proteins may account for this increase. Little is known about the role played by the erythrocyte itself in this aggregation process. To ascertain the contribution of both plasma and erythrocyte factors to EA in IHD, we investigated the following parameters in 78 survivors of acute myocardial infarction (AMI) and in a well-matched control group of 98 subjects: EA, glucose, total cholesterol (T-Chol), low-density lipoprotein-cholesterol (LDL-Chol), high-density lipoprotein–cholesterol (HDL-Chol), triglycerides, apolipoproteins A1 and B, protein and functional fibrinogen, plasma sialic acid, membrane sialic acid, and the cholesterol and phospholipid content of the erythrocyte membrane. AMI survivors showed higher glucose (p<0.001), a borderline increase in triglycerides (p= 0.043), and a statistical decrease in Apo A1 (p= 0.003) relative to controls. EA, functional fibrinogen, and plasma sialic acid were statistically higher in AMI survivors than in controls (p= 0.001; p<0.001; p= 0.011, respectively). Membrane sialic acid content was statistically lower in AMI patients than in controls (p= 0.026). No differences were observed in either membrane cholesterol or phospholipids. Multivariate logistic regression analysis, in which EA was dichotomized as higher or lower than 8.7, demonstrated that triglyceride levels higher than 175 mg/dL (OR= 7.7, p= 0.001) and functional fibrinogen levels higher than 320 mg/dL (OR= 3.7, p= 0.004) were independently associated with a greater risk of erythrocyte hyperaggregability. Our results suggest that plasma lipids, predominantly triglycerides, and fibrinogen may not only enhance the development of ischaemic events by their recognized atherogenic mechanisms, but also by increasing EA.
A clinical and educational telemedicine link between Bulgaria and Greece
Authors: Anogianakis George , Ilonidis George , Anogeianaki Antonia , Milliaras Spyros , Klisarova Anelia , Temelkov Temel , Vlachakis-Milliaras Emmanuel 
Published: December 2003

summary During its transition to a market economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports: an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities; electronic design and publishing activities; Web hosting and mail server activities; and satellite communications. Communications are via ISDN. The main clinical experience has been remote consultations in immunology. This experience (admittedly limited) demonstrates that telemedicine can be used to provide assistance to remote colleagues. In addition, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers in cases where the patient cannot communicate with the attending physician because of a language barrier.
Developing prison telemedicine systems: The Greek experience
Authors: Anogianakis George , Ilonidis George , Milliaras Spyros , Anogeianaki Antonia , Vlachakis-Milliaras Emmanuel 
Published: December 2003

summary Prison telemedicine systems operate in circumstances in which the provision of medical care is very expensive. In 1999 the Greek Ministry of Justice decided to use telemedicine to improve health services in the largest prison in Greece (Korydallos Prison, in Athens). The Nikea Hospital in Piraeus undertook to support the effort in order: to enable prison paramedics and guards to call for remote evaluation of inmates when the prison's doctors were off duty; to provide second opinions; and to allow screening and primary care coverage for inmates through teleconsultations with Nikea Hospital specialists. For 12 months following installation, intensive ‘hands-on’ training on the use of the system was offered to the staff of both the Korydallos Prison and the Nikea Hospital. In all, 400 physicians, nurses and paramedics were trained. Despite all this effort, there were serious operational problems related either to prison bureaucracy or to the inflexibility of the Greek national health system, which annulled the effectiveness of the prison telemedicine system. The experience suggests that prison telemedicine is a viable option if freed from bureaucratic and labour-related obstacles, and can improve the quality of care available to prisoners.
Implementation of videoconferencing to support a managed clinical network in Scotland: Lessons learned during the first 18 months
Authors: Barry N , Campbell P , Reed N , Reid M E , Bower D J , Norrie J , Currie G D 
Published: December 2003

summary Managed clinical networks (MCNs) are usually built on established groups of health professionals from both acute and primary care sectors. We have used videoconferencing to support the gynaecological oncology MCN in the west of Scotland. Videoconferencing was implemented simultaneously at five sites in 2001 and DICOM image-capture software was added in 2003. Videoconferencing and live PC links allowed the multidisciplinary teams to discuss individual cancer diagnoses without the extensive travelling previously required. Our experience of the implementation suggests that local ownership is crucial. In the present project, each of the stakeholders had an important role in the delivery of a successful system. High-quality project management is required during implementation and for some time thereafter to achieve sustainability.
Remote critical care consultation: Telehealth projection of clinical specialty expertise
Authors: Berg Benjamin W , Vincent Dale S , Hudson Donald A 
Published: December 2003

summary Remote critical care consultations have been employed between the Naval Hospital in Guam and the Tripler Army Medical Center in Hawaii, a distance of 5300 km. During a 10-week study period there were physician-physician daily consultation rounds for patients in the intensive care unit at the Naval Hospital. Physiological data, video-images and sound were transmitted via a 768 kbit/s frame relay connection, albeit with a 1–3 s delay. During the study there were 87 consultations concerning 25 patients. Preliminary results showed that a broad range of critical care patients could be managed effectively through daily remote critical care consultation. Broader implementation of this strategy may represent a method of making critical care expertise available to front-line military health-care facilities and to remote civilian facilities with limited critical care expertise.
Fetal endoscopic telesurgery using an Internet Protocol connection: Clinical and technical challenges
Authors: Chan F Y , Soong B , Taylor A , Bornick P , Allen M , Cincotta R , Quintero R 
Published: December 2003

summary Until recently, fetoscopic laser surgery to seal the placental anastomoses that cause severe twin-to-twin transfusion syndrome has been available in only a few centres worldwide. The technique typically takes a long time to learn. We have used a dedicated Internet Protocol (IP) connection for tele-education to assist the introduction of fetoscopic laser surgery to Australia. During the implementation of the international telemedicine link, there were multiple clinical and technical problems, which were eventually overcome. The quality of images and of video-sequences was comparable to that supported by an ISDN connection. Pictures of live surgery performed by an expert in Florida, USA, were transmitted and viewed by a novice team in Brisbane, Australia. The Australian team has performed 19 fetoscopic laser operations to date. Preliminary results are comparable to those from centres that have performed over 100 procedures.
A profile of success and failure in telehealth – evidence and opinion from the Successes and Failures in Telehealth conferences
Authors: Hailey David , Crowe Bernard 
Published: December 2003

summary Papers presented at the three Successes and Failures in Telehealth conferences have made a helpful contribution to what is known about the practicalities of implementing and using telehealth. Ten of the 89 papers covered general concepts, 40 described primary studies and 26 discussed telehealth programmes or networks. Common themes that emerged on determinants of success and failure included the reliability of equipment, the reliability of vendors, political and budgetary issues, the perceived need for telehealth, the involvement of stakeholders, health professionals’ opinions, the stability of management structures, the turnover of personnel and cooperation between organizations. Limitations in some papers included an absence of data, weak study designs, short-term perspectives and lack of information on health outcomes. Despite these limitations, the papers have made a valuable contribution to our knowledge of what has worked and what has failed in the field of telehealth.
A Web-based approach to low-cost telemedicine
Authors: Hersh Dov , Hersch Fred , Mikuletic Lilijana , Neilson Scott 
Published: December 2003

summary We have developed a Web-based application for managing e-consultations. This solves some of the problems inherent in peer-to-peer email communication. Referrals were from three hospitals in Vietnam. Each hospital was provided with Internet access for up to 4 hours a day for an initial 12-month period. In the first six months, six doctors from the Vietnamese hospitals submitted a total of 30 cases. Specialists in Sydney provided their expertise on a voluntary basis. Preliminary data suggest that the Vietnamese doctors found the system benefited their diagnostic and management decision making. Challenges have included equipment failures, language barriers and the difficulty of obtaining feedback. Successes have included the relationship building between doctors in the two countries. Preliminary results were encouraging and most of the Vietnamese doctors (five of the six) reported that they were slowly incorporating use of the system into their daily practice.
A partnership model for the delivery of health education to rural and remote communities using multipoint videoconferencing
Authors: Mcclelland Linda , Faulkner Kathryn , Gale Jennifer , Johnstone Kylie 
Published: December 2003

summary Multipoint videoconferencing has been used by Women's Health Queensland Wide (WHQW) for the delivery of health education to the residents of regional, remote and rural Queensland communities. The educational programme was a partnership between WHQW and health professionals in the participating communities. Telephone interviews with the health professionals were used in a follow-up study. Fifty-one interviews were conducted in October and November 2002; these involved 43 of the 64 participating towns. The results suggested that the project contributed to improved social capital in the participating communities. In addition, it gave rise to unexpected but valuable outcomes for WHQW and, potentially, for the Queensland community. The project demonstrated that success in telehealth can be measured in terms of social and community effects, as well as clinical outcomes and cost-effectiveness.
Can telepharmacy provide pharmacy services in the bush?
Authors: Nissen Lisa , Tett Susan 
Published: December 2003

summary Rural and remote community pharmacies service large areas of rural Queensland, and because of the distances involved often do not meet the patients for whom they provide medication. Telepharmacy would improve the quality of pharmaceutical services provided in rural and remote areas, by allowing community pharmacists to have realtime contact with dispensing doctors, aboriginal health workers and patients via a video-phone. We used commercial (analogue) videophones to connect community pharmacists to dispensing doctors, patients in depot pharmacies (i.e. those with no pharmacist) and aboriginal health workers. However, various problems occurred and only 10 video-phone interactions were recorded during the six-month project. In all of the recorded interactions, the video-phone was actually used as a conventional telephone because a video-connection could not be established at the time of the call. (This may have been due to telephone network problems in the rural areas.) Despite these problems, all project participants showed great enthusiasm for the potential benefits of such a service.
Teleneurology by email
Authors: Patterson Victor , Humphreys Jenny , Chua Richard 
Published: December 2003

summary We introduced an email teleneurology service for patients referred to a neurologist by general practitioners. Over 14 months, 76 referrals (of 75 patients) were received. To determine the sustainability of the service, we studied a second cohort of 76 consecutive patients referred after our first study. We also followed up the first cohort of patients to get information on longer-term safety. The second cohort was obtained in one month less than the first, and had similar characteristics in terms of age, sex and the time taken by the neurologist to reply to the general practitioner. It contained fewer patients requiring clinic appointments (34% versus 43%). Fewer patients from the second cohort were referred for second opinions (4 versus 10) and there were no resulting changes in diagnosis. Follow-up of the first cohort from a mean of 6 months to a mean of 23 months led to seven more re-referrals and no additional changes in diagnosis. We conclude that teleneurology by email is sustainable for this group of patients, and confirm that it is safe, effective and efficient.
Low-bandwidth telerehabilitation for patients who have undergone total knee replacement: Preliminary results
Authors: Russell Trevor G , Buttrum Peter , Wootton Richard , Jull Gwendolen A 
Published: December 2003

summary We have developed a low-bandwidth, Internet-based telerehabilitation system to provide outpatient rehabilitation to patients who have undergone total knee arthroplasty. The preliminary efficacy of this treatment programme in terms of both physical and functional objective outcome measures was assessed on 21 patients. Subjects receiving a six-week rehabilitation programme were randomized to the telerehabilitation system or the usual face-to-face method. The physical and functional improvements in the telerehabilitation group were similar to those in the control group. There was a non-significant trend for greater improvements in the telerehabilitation group for most outcome measurements. The telerehabilitation programme was well received by patients. The results of this study provide evidence for the efficacy of low-bandwidth telerehabilitation consultations.
Video-phone communication with cognitively impaired elderly patients
Authors: Sävenstedt Stefan , Zingmark Karin , Sandman P O 
Published: December 2003

summary We investigated the potential role of remote interactions via video-phone in the care of the elderly. Family members and nursing staff were interviewed about their experiences of communicating with elderly people via video-phone. Seven family members and seven nursing staff participated in the studies. The interviews were analysed using qualitative content analysis. The results showed that it was possible for elderly people with cognitive impairment to engage in remote communication when certain conditions were met. There were also indications that the video-phone interaction sometimes increased the attention and focus of the elderly subjects.
The family costs of attending hospital outpatient appointments via videoconference and in person
Authors: Smith Anthony C , Youngberry Karen , Christie Fiona , Isles Alan , Mccrossin Robert , Williams Michael , Van Der Westhuyzen Jasper , Wootton Richard 
Published: December 2003

summary We compared the costs incurred by families attending outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane with those incurred by families who had a consultation via videoconference in their regional area. In each category 200 families were interviewed. The median time spent travelling for videoconferences was 30 min compared with 80 min for face-to-face appointments. Families interviewed in the outpatient department had travelled a median distance of 70 km, while those who had a videoconference at the local hospital had travelled only 20 km. It cost these families much more to attend an appointment at the RCH than to attend a videoconference. Ninety-six per cent of families (193) reported at least one of the following types of expense: 150 families had expenses related to parking (median A$10), 156 had fuel expenses (median A$10) and 122 reported costs related to meals purchased at the RCH (median A$10). Only 21 families who had their appointment via local videoconference reported any additional costs. Specialist appointments via videoconference were a more convenient and cheaper option for families living in regional areas of Queensland than the conventional method of attending outpatient appointments at the specialist hospital in Brisbane.
Benefit for the patient of a teleradiology process certified to meet an international standard
Authors: Soegner P , Rettenbacher T , Smekal A , Buttinger K , Oefner B , Nedden D Zur 
Published: December 2003

summary To guarantee the quality of teleradiology services in Austria we have developed an easy-to-use and continuously re-evaluated teleradiology workflow model. This is based on the quality management model (ISO 9001:2000) of the International Standardization Organization (ISO) and guarantees the quality of the process. From January 2002 to January 2003 we examined 544 emergency teleradiology computerized tomography studies transmitted to the Department of Radiology 2 in Innsbruck. The patients were from the rural hospital of Reutte. In 450 cases (83%) the sending of the written legal final report took less than 1 h. The numbers of mistakes (mostly minor workflow errors) were reduced from 23 errors per month in January 2002 to 9 errors per month in January 2003. The continuous cross-checking of the workflow and the training of the employees involved guaranteed a better standard of teleradiology in our department. Since December 2002, the whole Tyrolean teleradiology process has been ISO 9001:2000 certified.