Impractical CME programs: Influential parameters in Iran.

Science.gov (United States)

Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Shirazi, Mandana

2017-01-01

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients' care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants' experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians' performance.

The Significance of the Influence of the CME Deflection in Interplanetary Space on the CME Arrival at Earth

Science.gov (United States)

Zhuang, Bin; Wang, Yuming; Shen, Chenglong; Liu, Siqing; Wang, Jingjing; Pan, Zonghao; Li, Huimin; Liu, Rui

2017-08-01

As one of the most violent astrophysical phenomena, coronal mass ejections (CMEs) have strong potential space weather effects. However, not all Earth-directed CMEs encounter the Earth and produce geo-effects. One reason is the deflected propagation of CMEs in interplanetary space. Although there have been several case studies clearly showing such deflections, it has not yet been statistically assessed how significantly the deflected propagation would influence the CME’s arrival at Earth. We develop an integrated CME-arrival forecasting (iCAF) system, assembling the modules of CME detection, three-dimensional (3D) parameter derivation, and trajectory reconstruction to predict whether or not a CME arrives at Earth, and we assess the deflection influence on the CME-arrival forecasting. The performance of iCAF is tested by comparing the two-dimensional (2D) parameters with those in the Coordinated Data Analysis Workshop (CDAW) Data Center catalog, comparing the 3D parameters with those of the gradual cylindrical shell model, and estimating the success rate of the CME Earth-arrival predictions. It is found that the 2D parameters provided by iCAF and the CDAW catalog are consistent with each other, and the 3D parameters derived by the ice cream cone model based on single-view observations are acceptable. The success rate of the CME-arrival predictions by iCAF with deflection considered is about 82%, which is 19% higher than that without deflection, indicating the importance of the CME deflection for providing a reliable forecasting. Furthermore, iCAF is a worthwhile project since it is a completely automatic system with deflection taken into account.

State Policies Influence Medicare Telemedicine Utilization.

Science.gov (United States)

Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem

2016-01-01

Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs

Telemedicine and rural health care applications

Directory of Open Access Journals (Sweden)

Smith Anthony

2005-01-01

Full Text Available Telemedicine has the potential to help facilitate the delivery of health services to rural areas. In the right circumstances, telemedicine may also be useful for the delivery of education and teaching programmes and the facilitation of administrative meetings. In this paper reference is made to a variety of telemedicine applications in Australia and other countries including telepaediatrics, home telehealth, critical care telemedicine for new born babies, telemedicine in developing countries, health screening via e-mail, and teleradiology. These applications represent some of the broad range of telemedicine applications possible. An overriding imperative is to focus on the clinical problem first with careful consideration given to the significant organisational changes which are associated with the introduction of a new service or alternative method of service delivery. For telemedicine to be effective it is also important that all sites involved are adequately resourced in terms of staff, equipment, telecommunications, technical support and training. In addition, there are a number of logistical factors which are important when considering the development of a telemedicine service including site selection, clinician empowerment, telemedicine management, technological requirements, user training, telemedicine evaluation, and information sharing through publication.

Magnetic reconnection processes induced by a CME expansion

Directory of Open Access Journals (Sweden)

A. Bemporad

2008-10-01

Full Text Available On 10–11 December 2005 a slow CME occurred in the Western Hemisphere in between two coronal streamers. SOHO/MDI magnetograms show a multipolar magnetic configuration at the photosphere: a complex of active regions located at the CME source and two bipoles at the base of the lateral coronal streamers. White light observations reveal that the CME expansion affects both of them and induces the release of plasma within or close to the nearby streamers. These transient phenomena are possibly due to magnetic reconnections induced by the CME expansion and occurring inside the streamer current sheet or between the CME flanks and the streamer. These events have been observed by the SOHO/UVCS with the spectrometer slit centered at 1.8 R⊙ over about a full day. In this work we focus on the interaction between the CME and the streamer: the UVCS spectral interval included UV lines from ions at different temperatures of maximum formation such as O VI, Si XIII and Al Xi. These data gave us the opportunity to infer the evolution of plasma temperature and density at the reconnection site and adjacent regions. These are relevant to characterize secondary reconnection processes occurring during a CME development.

American Telemedicine Association: First China (Tianjin International Telemedicine Technology Exhibition

Directory of Open Access Journals (Sweden)

Jordana Bernard

2014-09-01

Full Text Available With the support of Tianjin Municipal People’s Government and the People’s Government of Binhai New Area, the “First China (Tianjin International Telemedicine Technology Exhibition” hosted by the American Telemedicine Association (ATA, will be held October 28- 30, 2014 at the Tianjin Binhai International Convention and Exhibition Center. The three day event will feature keynote sessions, concurrent discussion forums, exhibits (e.g., telemedicine, information technology, mHealth, a venture summit, meet-and-greet sessions for international and domestic companies for potential business collaboration, and policy discussions on China healthcare. For registration information: http://www.atacn.org/en/

Telemedicine in otolaryngology.

Science.gov (United States)

Holtel, Michael R; Burgess, Lawrence P A

2002-12-01

More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious. Examples in otolaryngology might include images of the larynx manipulated to better demonstrate the inflamed tissue of reflux, or images of the tympanic membrane manipulated to better demonstrate early retraction. Despite dramatic and likely continued decreases, equipment cost is still an issue. Current research points to good consumer acceptance, and certainly with each new generation the technology is more readily accepted. As Nesbitt [4] points out, it is certainly not difficult to look to the future and see ubiquitous broadband with video as common as telephone, or even extreme broadband enabling robotics and virtual reality TV with three-dimensional touch. Robotics and genomics will eventually play a greater role in telemedicine and our lives in general. Applications for remote diagnosis in biologic warfare defense and homeland security are currently raising interest in telemedicine. Telemedicine will be combined with new technological advances such as virtual "fly-through" computerized axial tomography examinations. Instead of performing an exploratory tympanotomy, surgeons will use computer programs to "fly through" and examine all aspects of a patient's middle or even inner ear. Spectral imaging of the eardrum, larynx, or oropharynx will immediately identify bacteria without cultures, or gram stain, and potential malignancy without biopsy. By measuring fluorescence emitted from an oropharynx illuminated with a specific

Telemedicine: Pediatric Applications

Science.gov (United States)

Burke, Bryan L.; Hall, R. W.

2017-01-01

Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine’s current use bears testimony to its effectiveness and potential. Telemedicine’s widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits. PMID:26122813

Internet technologies and requirements for telemedicine

Science.gov (United States)

Lamaster, H.; Meylor, J.; Meylor, F.

1997-01-01

Internet technologies are briefly introduced and those applicable for telemedicine are reviewed. Multicast internet technologies are described. The National Aeronautics and Space Administration (NASA) 'Telemedicine Space-bridge to Russia' project is described and used to derive requirements for internet telemedicine. Telemedicine privacy and Quality of Service (QoS) requirements are described.

Patient empowerment and involvement in telemedicine

DEFF Research Database (Denmark)

Konge Nielsen, Marie; Johannessen, Helle

2018-01-01

Basic ideas of empowerment and user involvement in relation to telemedicine are presented, as is a case implying user resistance to telemedicine. Four logics of empowerment are employed to identify the underlying rationale of specific cases of telemedicine. The article concludes, that although...... telemedicine is acknowledged as relevant, the approach to it is often too mechanical to imply empowerment of the patient. Some patient groups may not feel safe by using telemedicine, and user involvement and empowerment will not be possible....

Performance improvement CME for quality: challenges inherent to the process.

Science.gov (United States)

Vakani, Farhan Saeed; O'Beirne, Ronan

2015-01-01

The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively. In this discussion, the challenges associated for adopting the American Medical Association's three-staged PI-CME model are reported. Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits. Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors. Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

Wireless and mobile systems in telemedicine

Directory of Open Access Journals (Sweden)

Reza Safdari

2012-12-01

Full Text Available Background: It is necessary to deploy mobile and wireless systems in healthcare, because they have many benefits for healthcare systems. The objectives of this article were introducing various systems, applications, and standards of the wireless and mobile telemedicine. Material and Methods: This review study was conducted in 2010. To conduct the study, published articles in the years 2005 to 2012, in English with an emphasis on wireless and mobile technologies in health were studied. Search was done with key words include telemedicine, wireless health systems, health and telecommunications technology in databases including Pubmed, Science Direct, Google Scholar, Web of Sciences, Proquest. The collected data were analyzed. Results: Telemedicine system in the ambulance, telemedicine systems in space, telecardiology systems, EEG system, ultrasound system are some types of wireless and mobile systems in telemedicine. PDA-based mobile and wireless telemedicine application, based PDA drug application, and patient tracking application are some of wireless and mobile applications of telemedicine. The most important standards of wireless and mobile telemedicine are HL7, DICOM, SNOMed, and ICD-9-CM. Conclusion: There are many challenges in the wireless and mobile systems in telemedicine, despite the many benefits. Slow speed in sending pictures and video, lack of attention to the privacy in the design of these systems, environmental variables and the number of users during the day are some of these challenges. It is recommended to consider these challenges during the planning and designing of wireless and mobile systems in telemedicine.

Recent VLA Measurements of CME-Induced Faraday Rotation

Science.gov (United States)

Kooi, Jason; Thomas, Najma; Guy, Michael; Spangler, Steven R.

2018-01-01

Observations of Faraday rotation, the change in polarization position angle of linearly polarized radiation as it propagates through a magnetized plasma, have been used for decades to determine the strength and structure of the coronal magnetic field and plasma density. Similarly, observations of Faraday rotation through a coronal mass ejection (CME) have the potential to improve our understanding of the CME’s plasma structure. We report recent results from simultaneous white-light coronagraph and radio observations made of a CME in July 2015. We made radio observations using the Karl G. Jansky Very Large Array (VLA) at 1 - 2 GHz frequencies of a set of cosmic radio sources through the solar corona at heliocentric distances that ranged between 8 - 23 solar radii. A unique aspect of these observations is that the CME occulted several of these radio sources and, therefore, our Faraday rotation measurements provide information on the plasma structure in different regions of the CME. We successfully measured CME-induced Faraday rotation along multiple lines of sight because we made special arrangements with the staff at the National Radio Astronomy Observatory to trigger VLA observations when a candidate CME appeared low in the corona in near real-time images from the Large Angle and Spectrometric Coronagraph (LASCO) C2 instrument.

Development of telemedicine technology in India: ′′Sanjeevani′′-An integrated telemedicine application

Directory of Open Access Journals (Sweden)

Sood S

2005-01-01

Full Text Available Telemedicine has been a technological takeaway for the developed countries. Even in the developing countries, it is increasingly being viewed as a tool for improving care and enhancing access to healthcare. Countries like India where the majority of the population lives in rural areas, where healthcare facilities are inefficient and inadequate, tools like telemedicine can contribute substantially in bridging the gap between the demand and supply. "Sanjeevani"-is an integrated telemedicine application that offers a suite of high utility features as a part of an Indian telemedicine technology. Sanjeevani is based on store and forward as well as real-time models.

The business of telemedicine: strategy primer.

Science.gov (United States)

LeRouge, Cynthia; Tulu, Bengisu; Forducey, Pamela

2010-10-01

There is some tacit understanding that telemedicine can provide cost efficiency along with increased access and equality of care for the geographically disadvantaged. However, concrete strategic guidance for healthcare organizations to attain these benefits is fragmented and limited in existing literature. Telemedicine programs need to move from a grant-funded to a profit-centered status to sustain their existence. This article extends work presented at a recent American Telemedicine Association Business and Finance Special Interest Group course to provide a conceptual framework for strategic planning and for effectively implementing telemedicine programs. An expert panel of telemedicine coordinators provides insight and recommendations.

Artificial Intelligence Base Telemedicine Robotic

OpenAIRE

Hakika, Kisti; TS, Hendra Yunianto; Afriyanti, Liza

2009-01-01

Telemedicine atau pelayanan kesehatan jarak jauh bukan hal yang baru lagi dalam dunia kesehatan.Penggunaan teknologi sangat membantu dalam mengimplementasikan telemedicine. Namun perkembangantelemedicine mengalami kemajuan seiring dengan perkembangan teknologi informasi. Salah satu perkembanganteknologi adalah robot. Secara umum kegunaan robot adalah untuk menggantikan tugas manusia. Padamakalah ini, akan dibuat simulasi telemedicine berupa konsultasi antara dokter dan pasien menggunakansebua...

A Monster CME Obscuring a Demon Star Flare

Science.gov (United States)

Moschou, Sofia-Paraskevi; Drake, Jeremy J.; Cohen, Ofer; Alvarado-Gomez, Julian D.; Garraffo, Cecilia

2017-12-01

We explore the scenario of a coronal mass ejection (CME) being the cause of the observed continuous X-ray absorption of the 1997 August 30 superflare on the eclipsing binary Algol (the Demon Star). The temporal decay of the absorption is consistent with absorption by a CME undergoing self-similar evolution with uniform expansion velocity. We investigate the kinematic and energetic properties of the CME using the ice cream cone model for its three-dimensional structure in combination with the observed profile of the hydrogen column density decline with time. Different physically justified length scales were used that allowed us to estimate lower and upper limits of the possible CME characteristics. Further consideration of the maximum available magnetic energy in starspots leads us to quantify its mass as likely lying in the range 2× {10}21 {--} 2× {10}22 g and kinetic energy in the range 7× {10}35 {--} 3× {10}38 erg. The results are in reasonable agreement with extrapolated relations between flare X-ray fluence and CME mass and kinetic energy derived for solar CMEs.

The Research Agenda in ICU Telemedicine

Science.gov (United States)

Hill, Nicholas S.; Lilly, Craig M.; Angus, Derek C.; Jacobi, Judith; Rubenfeld, Gordon D.; Rothschild, Jeffrey M.; Sales, Anne E.; Scales, Damon C.; Mathers, James A. L.

2011-01-01

ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care. PMID:21729894

Telemedicine: the slow revolution.

Science.gov (United States)

Moncrief, Jack W

2014-01-01

The use of interactive video has been recognized as a means of delivering medical support to isolated areas since the 1950s. The Department of Defense recognized early the capacity of telemedicine to deliver medical care and support to front-line military personnel. In 1989, the Texas Telemedicine Project received grants and support from the then American Telephone and Telegraph Company (now AT&T) and the Meadows Foundation of Dallas, Texas, to establish and evaluate telemedicine delivery in central Texas. That project had 6 connected telemedicine sites: 3 in Austin, Texas, and 3 in Giddings, Texas (a small community 55 miles to the southeast of Austin). The sites in Giddings included a chronic outpatient dialysis facility, an inpatient psychiatric hospital, and the emergency department at Giddings Hospital. Patient contact began in April 1991 and continued through March 1993. During that period, data on the 1500 patient contacts made were recorded. After termination of the Texas Telemedicine Project, AT&T continued to provide the transmission lines, and between 1993 and 1996, another 12,000 patient contacts were made. Approximately 80% were dialysis evaluations and 20% were non-dialysis primary care contacts. The original cost of materials and equipment in the Texas Telemedicine Project exceeded $50,000 per site. Today, a secure Internet connection with full-motion video and wireless data transfer to almost any location in the world is achievable with an iPad. Multiple inexpensive applications with connections for electrocardiogram, otoscope, and stethoscope, among others, make this technology extremely inexpensive and user-friendly. The revolution now is rapidly moving forward, with Medicare reimbursing telemedicine contacts in medically underserved areas. Multiple bills are before Congress to expand Medicare and therefore private insurance payment for this service.

CAT-PUMA: CME Arrival Time Prediction Using Machine learning Algorithms

Science.gov (United States)

Liu, Jiajia; Ye, Yudong; Shen, Chenglong; Wang, Yuming; Erdélyi, Robert

2018-04-01

CAT-PUMA (CME Arrival Time Prediction Using Machine learning Algorithms) quickly and accurately predicts the arrival of Coronal Mass Ejections (CMEs) of CME arrival time. The software was trained via detailed analysis of CME features and solar wind parameters using 182 previously observed geo-effective partial-/full-halo CMEs and uses algorithms of the Support Vector Machine (SVM) to make its predictions, which can be made within minutes of providing the necessary input parameters of a CME.

A review of telemedicine business models.

Science.gov (United States)

Chen, Shengnan; Cheng, Alice; Mehta, Khanjan

2013-04-01

Telemedicine has become an increasingly popular option for long-distance/virtual medical care and education, but many telemedicine ventures fail to grow beyond the initial pilot stage. Studying the business models of successful telemedicine ventures can help develop business strategies for upcoming ventures. This article describes business models of eight telemedicine ventures from different regions of the world using Osterwalder's "Business Model Canvas." The ventures are chosen on the basis of their apparent success and their diverse value chains. The business models are compared to draw inferences and lessons regarding their business strategy and contextual factors that influenced it. Key differences between telemedicine business practices in developing and developed countries are also discussed. The purpose of this article is to inform and inspire the business strategy of the next generation of telemedicine ventures to be economically sustainable and to successfully address local healthcare challenges.

Comparative effectiveness of non-print media and live CME

Directory of Open Access Journals (Sweden)

Kuldeep Singh

2015-01-01

Full Text Available Continuing Medical Education is an integral ingredient of professional development of health care providers. The educational activity can be delivered by different modes. Here we share our experience of using Digital Video Disc (DVD of a CME on Sleep Medicine as an alternative and cost effective mode.Objective: To assess improvement in knowledge and competencies in terms of comparative effectiveness of a model CME program using validated non-print medium for medical education.Methods: Recorded and validated DVD of talks delivered at NAMS-AIIMS Regional Symposium on Sleep Medicine was played to the participants in presence of one of the content experts. Video scripts of talk were also distributed to the participants. The assessment of participants and program evaluation of this CME was compared to the previously held live CME.Results: Eighty nine participants completed both pre and post test. Mean score increased from 9.91± 3.5 to 14.09 ± 2.85. Pass percentage based on an arbitrary cut off of 50%, increased from 8.3 to 43.8 (p< 0.001. Among the live CME group, mean score improved from 12.1±4.6 to 18.3 ± 3.8. Comparative analysis between live and DVD based CME showed improvement in scores of 6.17 and 4.18 respectively while pass percentage of 84.7 and 43.8 post CME among two modes were significant. The program evaluation showed identical level of satisfaction in all parameters except they were less satisfied vis-a-vis 'organizers made use of any critical comments I made' since all locally available resource persons were not present. Activity could be completed at just half the cost of live CME.Conclusions: The educational background and selection process of UG students between two medical institutes were strikingly different. While students at one institute were selected by highly competitive exam at All India level, the students at other institute were selected through state level competitive examination. In spite of that, results showed

THE NATURE OF CME-FLARE-ASSOCIATED CORONAL DIMMING

Energy Technology Data Exchange (ETDEWEB)

Cheng, J. X. [Key Laboratory of Planetary Sciences, Shanghai Astronomical Observatory, Shanghai 200030 (China); Qiu, J., E-mail: chengjx@shao.ac.cn [Department of Physics, Montana State University, Bozeman MT 59717-3840 (United States)

2016-07-01

Coronal mass ejections (CMEs) are often accompanied by coronal dimming that is evident in extreme ultraviolet (EUV) and soft X-ray observations. The locations of dimming are sometimes considered to map footpoints of the erupting flux rope. As the emitting material expands in the corona, the decreased plasma density leads to reduced emission observed in spectral and irradiance measurements. Therefore, signatures of dimming may reflect the properties of CMEs in the early phase of their eruption. In this study, we analyze the event of flare, CME, and coronal dimming on 2011 December 26. We use the data from the Atmospheric Imaging Assembly on the Solar Dynamics Observatory for disk observations of the dimming, and analyze images taken by EUVI, COR1, and COR2 on board the Solar Terrestrial Relations Observatory to obtain the height and velocity of the associated CMEs observed at the limb. We also measure the magnetic reconnection rate from flare observations. Dimming occurs in a few locations next to the flare ribbons, and it is observed in multiple EUV passbands. Rapid dimming starts after the onset of fast reconnection and CME acceleration, and its evolution tracks the CME height and flare reconnection. The spatial distribution of dimming exhibits cores of deep dimming with a rapid growth, and their light curves are approximately linearly scaled with the CME height profile. From the dimming analysis we infer the process of the CME expansion, and estimate properties of the CME.

THE NATURE OF CME-FLARE-ASSOCIATED CORONAL DIMMING

International Nuclear Information System (INIS)

Cheng, J. X.; Qiu, J.

2016-01-01

Coronal mass ejections (CMEs) are often accompanied by coronal dimming that is evident in extreme ultraviolet (EUV) and soft X-ray observations. The locations of dimming are sometimes considered to map footpoints of the erupting flux rope. As the emitting material expands in the corona, the decreased plasma density leads to reduced emission observed in spectral and irradiance measurements. Therefore, signatures of dimming may reflect the properties of CMEs in the early phase of their eruption. In this study, we analyze the event of flare, CME, and coronal dimming on 2011 December 26. We use the data from the Atmospheric Imaging Assembly on the Solar Dynamics Observatory for disk observations of the dimming, and analyze images taken by EUVI, COR1, and COR2 on board the Solar Terrestrial Relations Observatory to obtain the height and velocity of the associated CMEs observed at the limb. We also measure the magnetic reconnection rate from flare observations. Dimming occurs in a few locations next to the flare ribbons, and it is observed in multiple EUV passbands. Rapid dimming starts after the onset of fast reconnection and CME acceleration, and its evolution tracks the CME height and flare reconnection. The spatial distribution of dimming exhibits cores of deep dimming with a rapid growth, and their light curves are approximately linearly scaled with the CME height profile. From the dimming analysis we infer the process of the CME expansion, and estimate properties of the CME.

A Stealth CME Bracketed between Slow and Fast Wind Producing Unexpected Geoeffectiveness

Science.gov (United States)

He, Wen; Liu, Ying D.; Hu, Huidong; Wang, Rui; Zhao, Xiaowei

2018-06-01

We investigate how a weak coronal mass ejection (CME) launched on 2016 October 8 without obvious signatures in the low corona produced a relatively intense geomagnetic storm. Remote sensing observations from SDO, STEREO, and SOHO and in situ measurements from Wind are employed to track the CME from the Sun to the Earth. Using a graduated cylindrical shell model, we estimate the propagation direction and the morphology of the CME near the Sun. CME kinematics are determined from the wide-angle imaging observations of STEREO A and are used to predict the CME arrival time and speed at the Earth. We compare ENLIL MHD simulation results with in situ measurements to illustrate the background solar wind where the CME was propagating. We also apply a Grad–Shafranov technique to reconstruct the flux-rope structure from in situ measurements in order to understand the geoeffectiveness associated with the CME magnetic field structure. Key results are obtained concerning how a weak CME can generate a relatively intense geomagnetic storm: (1) there were coronal holes at low latitudes, which could produce high speed streams (HSSs) to interact with the CME in interplanetary space; (2) the CME was bracketed between a slow wind ahead and an HSS behind, which enhanced the southward magnetic field inside the CME and gave rise to the unexpected geomagnetic storm.

4-D modeling of CME expansion and EUV dimming observed with STEREO/EUVI

Directory of Open Access Journals (Sweden)

M. J. Aschwanden

2009-08-01

Full Text Available This is the first attempt to model the kinematics of a CME launch and the resulting EUV dimming quantitatively with a self-consistent model. Our 4-D-model assumes self-similar expansion of a spherical CME geometry that consists of a CME front with density compression and a cavity with density rarefaction, satisfying mass conservation of the total CME and swept-up corona. The model contains 14 free parameters and is fitted to the 25 March 2008 CME event observed with STEREO/A and B. Our model is able to reproduce the observed CME expansion and related EUV dimming during the initial phase from 18:30 UT to 19:00 UT. The CME kinematics can be characterized by a constant acceleration (i.e., a constant magnetic driving force. While the observations of EUVI/A are consistent with a spherical bubble geometry, we detect significant asymmetries and density inhomogeneities with EUVI/B. This new forward-modeling method demonstrates how the observed EUV dimming can be used to model physical parameters of the CME source region, the CME geometry, and CME kinematics.

Application of Telemedicine in Gansu Province of China

Science.gov (United States)

Cai, Hui; Wang, Hongjing

2016-01-01

Telemedicine has become an increasingly popular option for long-distance health care and continuing education. As information and communication technology is underdeveloped in China, telemedicine develops slowly. At present, telemedicine consultation centers are situated mainly in developed cities, such as Beijing, Shanghai, and Guangzhou. In many less developed regions, such as northwest China, the conditions or related facilities are not available for the application of a better medical service. Accordingly, the aim of this paper was to introduce the construction and application of a telemedicine consultation center in Gansu Province in the northwest of China. In addition, the function of Gansu Provincial Telemedicine Consultation Center on emergency public events was introduced. As a whole, there was a great demand for telemedicine service in the local medical institutions. In the telemedicine consultation center, the telemedicine equipments and regulations were needed to be improved. The function of telemedicine service was not fully used, there was a large space to be applied and the publicity of telemedicine service was important. What is important was that telemedicine played a significance role in promoting the medical policy reform, improving the medical environment and launching the remote rescue in the emergency public events. This paper emphasizes the health care challenges of poor regions, and indicates how to share the high-quality medical service of provincial hospitals effectively and how to help residents in resource-poor environments. PMID:27332894

Telemedicine in a pediatric headache clinic: A prospective survey.

Science.gov (United States)

Qubty, William; Patniyot, Irene; Gelfand, Amy

2018-05-08

The aim of this prospective study was to survey our patients about their experience with our clinic's telemedicine program to better understand telemedicine's utility for families, and to improve patient satisfaction and ultimately patient care. This was a prospective survey study of patients and their families who had a routine telemedicine follow-up visit with the University of California San Francisco Pediatric Headache Program. The survey was administered to patients and a parent(s) following their telemedicine visit. Fifty-one of 69 surveys (74%) were completed. All (51/51) patients and families thought that (1) telemedicine was more convenient compared to a clinic visit, (2) telemedicine caused less disruption of their daily routine, and (3) they would choose to do telemedicine again. The mean round-trip travel time from home to clinic was 6.8 hours (SD ± 8.6 hours). All participants thought telemedicine was more cost-effective than a clinic visit. Parents estimated that participating in a telemedicine visit instead of a clinic appointment saved them on average $486. This prospective, pediatric headache telemedicine study shows that telemedicine is convenient, perceived to be cost-effective, and patient-centered. Providing the option of telemedicine for routine pediatric headache follow-up visits results in high patient and family satisfaction. © 2018 American Academy of Neurology.

PROPAGATION OF THE 2014 JANUARY 7 CME AND RESULTING GEOMAGNETIC NON-EVENT

Energy Technology Data Exchange (ETDEWEB)

Mays, M. L.; Collinson, G.; Taktakishvili, A. [Catholic University of America, Washington, DC (United States); Thompson, B. J.; Jian, L. K.; Savani, N. P.; MacNeice, P. J.; Zheng, Y. [Heliophysics Science Division, NASA Goddard Space Flight Center, Greenbelt, MD (United States); Colaninno, R. C. [Space Science Division, Naval Research Laboratory, Washington, DC (United States); Odstrcil, D. [IGAM-Kanzelhöhe Observatory, Institute of Physics, University of Graz, Graz (Austria); Möstl, C. [George Mason University, Fairfax, VA (United States); Temmer, M., E-mail: m.leila.mays@nasa.gov [Space Research Institute, Austrian Academy of Sciences, Graz (Austria)

2015-10-20

On 2014 January 7 an X1.2 flare and coronal mass ejection (CME) with a radial speed ≈2500 km s{sup −1} was observed from near an active region close to disk center. This led many forecasters to estimate a rapid arrival at Earth (≈36 hr) and predict a strong geomagnetic storm. However, only a glancing CME arrival was observed at Earth with a transit time of ≈49 hr and a K{sub P} geomagnetic index of only 3−. We study the interplanetary propagation of this CME using the ensemble Wang-Sheeley-Arge (WSA)–ENLIL+Cone model, that allows a sampling of CME parameter uncertainties. We explore a series of simulations to isolate the effects of the background solar wind solution, CME shape, tilt, location, size, and speed, and the results are compared with observed in situ arrivals at Venus, Earth, and Mars. Our results show that a tilted ellipsoid CME shape improves the initial real-time prediction to better reflect the observed in situ signatures and the geomagnetic storm strength. CME parameters from the Graduated Cylindrical Shell model used as input to WSA–ENLIL+Cone, along with a tilted ellipsoid cloud shape, improve the arrival-time error by 14.5, 18.7, 23.4 hr for Venus, Earth, and Mars respectively. These results highlight that CME orientation and directionality with respect to observatories play an important role in understanding the propagation of this CME, and for forecasting other glancing CME arrivals. This study also demonstrates the importance of three-dimensional CME fitting made possible by multiple viewpoint imaging.

Adoption of telemedicine: from pilot stage to routine delivery

Directory of Open Access Journals (Sweden)

Zanaboni Paolo

2012-01-01

Full Text Available Abstract Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1 the process of adoption of telemedicine in comparison with other technologies; and 2 the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify

Adoption of telemedicine: from pilot stage to routine delivery

Science.gov (United States)

2012-01-01

Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and

A cost-effectiveness analysis of shipboard telemedicine.

Science.gov (United States)

Stoloff, P H; Garcia, F E; Thomason, J E; Shia, D S

1998-01-01

The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost

International telemedicine consultations for neurodevelopmental disabilities.

Science.gov (United States)

Pearl, Phillip L; Sable, Craig; Evans, Sarah; Knight, Joseph; Cunningham, Parker; Lotrecchiano, Gaetano R; Gropman, Andrea; Stuart, Sheela; Glass, Penny; Conway, Anne; Ramadan, Issam; Paiva, Tania; Batshaw, Mark L; Packer, Roger J

2014-06-01

A telemedicine program was developed between the Children's National Medical Center (CNMC) in Washington, DC, and the Sheikh Khalifa Bin Zayed Foundation in the United Arab Emirates (UAE). A needs assessment and a curriculum of on-site training conferences were devised preparatory to an ongoing telemedicine consultation program for children with neurodevelopmental disabilities in the underserved eastern region of the UAE. Weekly telemedicine consultations are provided by a multidisciplinary faculty. Patients are presented in the UAE with their therapists and families. Real-time (video over Internet protocol; average connection, 768 kilobits/s) telemedicine conferences are held weekly following previews of medical records. A full consultation report follows each telemedicine session. Between February 29, 2012 and June 26, 2013, 48 weekly 1-h live interactive telemedicine consultations were conducted on 48 patients (28 males, 20 females; age range, 8 months-22 years; median age, 5.4 years). The primary diagnoses were cerebral palsy, neurogenetic disorders, autism, neuromuscular disorders, congenital anomalies, global developmental delay, systemic disease, and epilepsy. Common comorbidities were cognitive impairment, communication disorders, and behavioral disorders. Specific recommendations included imaging and DNA studies, antiseizure management, spasticity management including botulinum toxin protocols, and specific therapy modalities including taping techniques, customized body vests, and speech/language and behavioral therapy. Improved outcomes reported were in clinician satisfaction, achievement of therapy goals for patients, and requests for ongoing sessions. Weekly telemedicine sessions coupled with triannual training conferences were successfully implemented in a clinical program dedicated to patients with neurodevelopmental disabilities by the Center for Neuroscience at CNMC and the UAE government. International consultations in neurodevelopmental

Telemedicine in education: bridging the gap.

Science.gov (United States)

O'Shea, Jesse; Berger, Ryan; Samra, Cynthia; Van Durme, Daniel

2015-01-01

The increasing cost and inequitable access to quality healthcare, coupled with the merger of the information technology and health service sectors, has given rise to the modern field of telemedicine. Telemedicine, meaning medicine at a distance, allows us to transcend geographic and socioeconomic boundaries to deliver high quality care to remote and/or in-need patients. As technology becomes more affordable and a physician shortage looms, telemedicine is gaining attention as a possible solution to healthcare delivery. Simultaneously, telemedicine holds great promise with regard to medical education. Several studies integrating telemedicine in medical education have shown positive outcomes, demonstrating similar or greater efficacy compared with traditional educational methods with high student-reported enthusiasm. Other domestic and international telemedicine projects, largely spearheaded by universities, have also achieved great success. In a novel approach, by pairing medical schools with in-need partner communities, utilizing similar faculty resources as traditional learning methods with standardized patients, students can gain valuable experience and skills while serving actual patients. This progressive approach to medical education fosters collaboration, communication, longitudinal care and teaches students needed skills for their future practices as 21 st Century healthcare providers.

Preliminary structural studies of the transcriptional regulator CmeR from Campylobacter jejuni

Energy Technology Data Exchange (ETDEWEB)

Su, Chih-Chia [Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011 (United States); Shi, Feng [Department of Veterinary Microbiology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011 (United States); Gu, Ruoyu; Li, Ming [Department of Physics and Astronomy, Iowa State University, Ames, IA 50011 (United States); McDermott, Gerry [Department of Anatomy, School of Medicine, University of California, San Francisco, CA 94143 (United States); Yu, Edward W., E-mail: ewyu@iastate.edu [Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011 (United States); Department of Physics and Astronomy, Iowa State University, Ames, IA 50011 (United States); Zhang, Qijing [Department of Veterinary Microbiology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011 (United States); Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011 (United States)

2007-01-01

The transcriptional regulator CmeR from C. jejuni has been purified and crystallized and X-ray diffraction data have been collected to a resolution of 2.2 Å. In Campylobacter jejuni, a Gram-negative bacterial pathogen causing gastroenteritis in humans, the CmeR regulatory protein controls transcription of the multidrug transporter gene operon cmeABC. CmeR belongs to the TetR family of transcriptional regulators. The 210-residue CmeR consists of two functional motifs: an N-terminal DNA-binding domain and a C-terminal ligand-binding domain. It is predicted that the DNA-binding domain interacts directly with target promoters, while the C-terminal motif interacts with inducing ligands (such as bile salts). As an initial step towards confirming this structural model, recombinant CmeR protein containing a 6×His tag at the N-terminus was crystallized. Crystals of ligand-free CmeR belonged to space group P2{sub 1}2{sub 1}2, with unit-cell parameters a = 37.4, b = 57.6, c = 93.3 Å. Diffraction was observed to at least 2.2 Å at 100 K. Analysis of the detailed CmeR structure is currently in progress.

Telemedicine expanding the scope of health care information.

Science.gov (United States)

Balch, D C; Tichenor, J M

1997-01-01

The definition of health information is growing to include multimedia audio, video, and high-resolution still images. This article describes the telemedicine program at East Carolina University School of Medicine, including the telemedicine applications presently in use and the virtual reality applications currently under development' Included are the major design criteria that shape the telemedicine network some of the lessons learned in developing the network, and a discussion of the future of telemedicine, including efforts to incorporate telemedicine within a fully integrated health information system.

Towards technical interoperability in telemedicine.

Energy Technology Data Exchange (ETDEWEB)

Craft, Richard Layne, II

2004-05-01

For telemedicine to realize the vision of anywhere, anytime access to care, the question of how to create a fully interoperable technical infrastructure must be addressed. After briefly discussing how 'technical interoperability' compares with other types of interoperability being addressed in the telemedicine community today, this paper describes reasons for pursuing technical interoperability, presents a proposed framework for realizing technical interoperability, identifies key issues that will need to be addressed if technical interoperability is to be achieved, and suggests a course of action that the telemedicine community might follow to accomplish this goal.

Clinicians' Knowledge and Perception of Telemedicine Technology.

Science.gov (United States)

Ayatollahi, Haleh; Sarabi, Fatemeh Zahra Pourfard; Langarizadeh, Mostafa

2015-01-01

Telemedicine is an application of information and communication technology in the healthcare environment. This study aimed to compare knowledge and perceptions of telemedicine technology among different groups of clinicians. This survey study was conducted in 2013. The potential participants included 532 clinicians who worked in two hospitals and three clinics in a northern province of Iran. Data were collected using a five-point Likert-scale questionnaire. The content validity of the questionnaire was checked, and the reliability was calculated using Cronbach's alpha coefficient (α = 0.73). The results showed that most of the clinicians (96.1 percent) had little knowledge about telemedicine. They perceived the advantages of telemedicine at a moderate level and its disadvantages at a low level. The knowledge of dentists about this technology was less than that of other groups, and as a result they were less positive about the advantages of telemedicine compared to nurses, general physicians, and specialists. The limited knowledge of clinicians about telemedicine seems to have influenced their perceptions of the technology. Therefore, providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help to gain a more realistic picture of their perceptions.

Deriving and Constraining 3D CME Kinematic Parameters from Multi-Viewpoint Coronagraph Images

Science.gov (United States)

Thompson, B. J.; Mei, H. F.; Barnes, D.; Colaninno, R. C.; Kwon, R.; Mays, M. L.; Mierla, M.; Moestl, C.; Richardson, I. G.; Verbeke, C.

2017-12-01

Determining the 3D properties of a coronal mass ejection using multi-viewpoint coronagraph observations can be a tremendously complicated process. There are many factors that inhibit the ability to unambiguously identify the speed, direction and shape of a CME. These factors include the need to separate the "true" CME mass from shock-associated brightenings, distinguish between non-radial or deflected trajectories, and identify asymmetric CME structures. Additionally, different measurement methods can produce different results, sometimes with great variations. Part of the reason for the wide range of values that can be reported for a single CME is due to the difficulty in determining the CME's longitude since uncertainty in the angle of the CME relative to the observing image planes results in errors in the speed and topology of the CME. Often the errors quoted in an individual study are remarkably small when compared to the range of values that are reported by different authors for the same CME. For example, two authors may report speeds of 700 +- 50 km/sec and 500+-50 km/sec for the same CME. Clearly a better understanding of the accuracy of CME measurements, and an improved assessment of the limitations of the different methods, would be of benefit. We report on a survey of CME measurements, wherein we compare the values reported by different authors and catalogs. The survey will allow us to establish typical errors for the parameters that are commonly used as inputs for CME propagation models such as ENLIL and EUHFORIA. One way modelers handle inaccuracies in CME parameters is to use an ensemble of CMEs, sampled across ranges of latitude, longitude, speed and width. The CMEs simulated in order to determine the probability of a "direct hit" and, for the cases with a "hit," derive a range of possible arrival times. Our study will provide improved guidelines for generating CME ensembles that more accurately sample across the range of plausible values.

The Impact of Telemedicine on Pediatric Critical Care Triage.

Science.gov (United States)

Harvey, Jillian B; Yeager, Brooke E; Cramer, Christina; Wheeler, David; McSwain, S David

2017-11-01

To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. Retrospective evaluation of consultations occurring between April 2012 and March 2016. Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. Pediatric patients receiving critical care telemedicine or telephone consultations. Telemedicine consultations. Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.

Adoption of routine telemedicine in Norway: the current picture

Science.gov (United States)

Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard

2014-01-01

Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates. PMID:24433942

Mapping telemedicine efforts: surveying regional initiatives in Denmark.

Science.gov (United States)

Kierkegaard, Patrick

2015-05-01

The aim of this study is to survey telemedicine services currently in operation across Denmark. The study specifically seeks to answer the following questions: What initiatives are deployed within the different regions? What are the motivations behind the projects? What technologies are being utilized? What medical disciplines are being supported using telemedicine systems? All data were surveyed from the Telemedicinsk Landkort, a newly created database designed to provide a comprehensive and systematic overview of all telemedicine technologies in Denmark. The results of this study suggest that a growing numbers of telemedicine initiatives are currently in operation across Denmark but that considerable variations exist in terms of regional efforts as the number of operational telemedicine projects varied from region to region. The results of this study provide a timely picture of the factors that are shaping the telemedicine landscape of Denmark and suggest potential strategies to help policymakers increase and improve national telemedicine deployment.

[Telemedicine in dermatological practice: teledermatology].

Science.gov (United States)

Danis, Judit; Forczek, Erzsébet; Bari, Ferenc

2016-03-06

Technological advances in the fields of information and telecommunication technologies have affected the health care system in the last decades, and lead to the emergence of a new discipline: telemedicine. The appearance and rise of internet and smart phones induced a rapid progression in telemedicine. Several new applications and mobile devices are published every hour even for medical purposes. Parallel to these changes in the technical fields, medical literature about telemedicine has grown rapidly. Due to its visual nature, dermatology is ideally suited to benefit from this new technology and teledermatology became one of the most dynamically evolving fields of telemedicine by now. Teledermatology is not routinely practiced in Hungary yet, however, it promises the health care system to become better, cheaper and faster, but we have to take notice on the experience and problems faced in teledermatologic applications so far, summarized in this review.

The Current State of Telemedicine in Urology.

Science.gov (United States)

Miller, Adam; Rhee, Eugene; Gettman, Matthew; Spitz, Aaron

2018-03-01

Telemedicine use in urology is an evolving practice. In this article, the authors review the early experience of telemedicine specifically as it relates to urologic practice and discuss the future implications and the utility of telemedicine as it applies to other fields. Copyright © 2017 Elsevier Inc. All rights reserved.

CME credit systems in three developing countries: China, India and Indonesia

Directory of Open Access Journals (Sweden)

Lewis A. Miller

2015-04-01

Full Text Available Introduction. Two of the largest countries in the world, still developing nations, China and Indonesia, have now created national credit systems for continuing medical education (CME. A third, India, has tried but succeeded only on a state-by-state basis. This study tracks the development of CME/continuing professional development (CPD credit systems in these three major Asian countries, analyses the related administrative backgrounds and points to strengths and weaknesses of each system in terms of serving the goals of CME/CPD in impacting medical care systems. Methods. The authors researched national- and state-level government records to identify legal and regulatory data affecting CME in China, India and Indonesia. Information on current and future activities was gained from media reports. Results. In all three countries, CME/CPD systems evaluate physician continuing competence by counting credits or credit hours. Central health authorities in China and Indonesia have established national systems applying to all health professionals. In Indonesia, CME/CPD is mandatory for re-licensure; in China, it is necessary for career advancement and re-registration. An effort to develop mandatory CME requirements in India, for physicians only, failed because the central agency underwent a major overhaul. Nevertheless, 9 of 28 states in India have developed systems, all tied to re-registration. Discussion. A comparison of systems in the three countries shows that little attention has been paid to physician performance improvement or improved patient health outcomes. Needs assessments and outcomes measures are not regularly carried out. We did not find any evidence of programmes to train administrators or faculty in CME/CPD principles, with the possible exception of Indonesia. Suggestions are offered to CME system leaders and providers to help their counterparts in developing nations.

A Review of Telemedicine Services in Finland

DEFF Research Database (Denmark)

Khatri, Vikramajeet; Peterson, Carrie Beth; Kyriazakos, Sofoklis

2011-01-01

Telemedicine is gaining popularity due to the provision of ubiquitous health care services that is a fundamental need for every socialized society. In this paper, telemedicine services in Finland are discussed, as well as how they came into existence, how they are funded, evaluated, and what...... are their impacts on health care systems and society. Telemedicine services like teleradiology, telelaboratory, telepsychiatry and remote consultations, are being offered in all hospital districts. Primary health care centers in Finland are lacking telemedicine services, and are planning to have them. Electronic...

Feasibility of a Knowledge Translation CME Program: "Courriels Cochrane"

Science.gov (United States)

Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guylene; Fremont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Legare, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

2012-01-01

Introduction: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews ("Courriels Cochrane") were disseminated by e-mail. Program participants…

Expanding CME-flare relations to other stellar systems

Science.gov (United States)

Moschou, Sofia P.; Drake, Jeremy J.; Cohen, Ofer

2017-05-01

Stellar activity is one of the main parameters in exoplanet habitability studies. While the effects of UV to X-ray emission from extreme flares on exoplanets are beginning to be investigated, the impact of coronal mass ejections is currently highly speculative because CMEs and their properties cannot yet be directly observed on other stars. An extreme superflare was observed in X-rays on the Algol binary system on August 30 1997, emitting a total of energy 1.4x 10^{37} erg and making it a great candidate for studying the upper energy limits of stellar superflares in solar-type (GK) stars. A simultaneous increase and subsequent decline in absorption during the flare was also observed and interpretted as being caused by a CME. Here we investigate the dynamic properties of a CME that could explain such time-dependent absorption and appeal to trends revealed from solar flare and CME statistics as a guide. Using the ice-cream cone model that is extensively used in solar physics to describe the three-dimensional CME structure, in combination with the temporal profile of the hydrogen column density evolution, we are able to characterize the CME and estimate its kinetic energy and mass. We examine the mass, kinetic and flare X-ray fluence in the context of solar relations to examine the extent to which such relations can be extrapolated to much more extreme stellar events.

Economic Evaluation of Telemedicine for Patients in ICUs.

Science.gov (United States)

Yoo, Byung-Kwang; Kim, Minchul; Sasaki, Tomoko; Melnikow, Joy; Marcin, James P

2016-02-01

Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. Simulation analyses performed by standard decision models. Hypothetical ICU defined by the U.S. literature. Hypothetical adult patients in ICU defined by the U.S. literature. The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on

Telemedicine for wound management

Directory of Open Access Journals (Sweden)

Ravi K Chittoria

2012-01-01

Full Text Available The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer and real-time transmission (synchronous transfer, e.g. video conference, are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

Integrating telemedicine and telehealth: putting it all together.

Science.gov (United States)

Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail

2008-01-01

Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care

Scaling up Telemedicine

DEFF Research Database (Denmark)

Christensen, Jannie Kristine Bang; Nielsen, Jeppe Agger; Gustafsson, Jeppe

through negotiating, mobilizing coalitions, and legitimacy building. To illustrate and further develop this conceptualization, we build on insights from a longitudinal case study (2008-2014) and provide a rich empirical account of how a Danish telemedicine pilot was transformed into a large......-scale telemedicine project through simultaneous translation and theorization efforts in a cross-sectorial, politicized social context. Although we focus on upscaling as a bottom up process (from pilot to large scale), we argue that translation and theorization, and associated political behavior occurs in a broader...

Physics of Coupled CME and Flare Systems

Science.gov (United States)

2016-12-21

AFRL-RV-PS- AFRL-RV-PS- TR-2016-0162 TR-2016-0162 PHYSICS OF COUPLED CME AND FLARE SYSTEMS K. S. Balasubramaniam, et al. 21 December 2016 Final...30 Sep 2016 4. TITLE AND SUBTITLE Physics of Coupled CME and Flare Systems 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 61102F...objectives for this task were: (i) derive measureable physical properties and discernible structural circumstances in solar active regions that

WAP - based telemedicine applications

International Nuclear Information System (INIS)

Hung, K.; Zhang, Y.T.

2001-01-01

Telemedicine refers to the utilization of telecommunication technology for medical diagnosis, treatment, and patient care. Its aim is to provide expert-based health care to remote sites through telecommunication and information technologies. The significant advances in technologies have enabled the introduction of a broad range of telemedicine applications, which are supported by computer networks, wireless communication, and information superhighway. For example, some hospitals are using tele-radiology for remote consultation. Such a system includes medical imaging devices networked with computers and databases. Another growing area is patient monitoring, in which sensors are used to acquire biomedical signals, such as electrocardiogram (ECG), blood pressure, and body temperature, from a remote patient, who could be in bed or moving freely. The signals are then relayed to remote systems for viewing and analysis. Telemedicine can be divided into two basic modes of operations: real-time mode, in which the patient data can be accessed remotely in real-time, and store-and-forward mode, in which the acquired data does not have to be accessed immediately. In the recent years, many parties have demonstrated various telemedicine applications based on the Internet and cellular phone as these two fields have been developing rapidly. A current, recognizable trend in telecommunication is the convergence of wireless communication and computer network technologies. This has been reflected in recently developed telemedicine systems. For example, in 1998 J. Reponen, et al. have demonstrated transmission and display of computerized tomography (CT) examinations using a remote portable computer wirelessly connected to a computer network through TCP/IP on a GSM cellular phone. Two years later, they carried out the same tests with a GSM-based wireless personal digital assistant (PDA). The WAP (Wireless Application Protocol) Forum was founded in 1997 to create a global protocol

Constraints on particle density evolution within a CME at Mercury

Science.gov (United States)

Exner, W.; Liuzzo, L.; Heyner, D.; Feyerabend, M.; Motschmann, U. M.; Glassmeier, K. H.; Shiota, D.; Kusano, K.

2017-12-01

Mercury (RM=2440) is the closest orbiting planet around the Sun and is embedded in an intensive and highly varying solar wind.Mercury's intrinsic dipole with a southward magnetic moment is aligned with the rotation axis and has a northward offset of 0.2 RM.In-situ data from the MESSENGER spacecraft of the magnetic environment near Mercury indicate that a coronal mass ejection (CME) passed the planet on 8 May 2012. The data constrain the direction and magnitude of the CME magnetic field but no information on its particle density could be determined.We apply the hybrid (kinetic ions, electron fluid) code A.I.K.E.F. to study the interaction of Mercury's magnetosphere with the CME.We use MESSENGER magnetic field observations as well as simulation results to constrain the evolution of the particle density inside the CME.We show that within a 24-hour period the particle density within the CME had to vary between 1-100 cm-3 in order to explain MESSENGER magnetic field observations.

Telemedicine in the Solomon Islands: 2006 to 2009.

Science.gov (United States)

Martiniuk, Alexandra; Negin, Joel; Hersch, Fred; Dalipanda, Tenneth; Jagilli, Rooney; Houasia, Patrick; Gorringe, Lilijana; Christie, Annie

2011-01-01

Telemedicine has been used in the Solomon Islands since 2000. We used quantitative and qualitative methods to examine telemedicine use in the Solomon Islands from January 2006 to June 2009. During the study period 66 telemedicine cases were submitted to the store and forward telemedicine system being used there. These included orthopaedic, oncology, cardiothoracic, infectious, congenital, gastroenterology and dermatology cases. Most cases (52%) were submitted by doctors at the National Referral Hospital (NRH) in Honiara. The majority of responses came from the NRH (27%). A final, firm recommendation regarding patient diagnosis and/or care was given for 46% of the cases. Interviews were conducted with 23 stakeholders in the Solomon Islands and in Australia to better understand the current and future use of telemedicine. The interviews identified the fragility of the Solomon Islands infrastructure, including the lack of training, as the largest barrier to the future use of telemedicine. The best use of telemedicine appears to be case sharing within the Solomon Islands, with connections to clinicians in other countries as a secondary benefit when particular expertise is required.

Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced?

Directory of Open Access Journals (Sweden)

Cynthia LeRouge

2013-11-01

Full Text Available Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks.

Telemedicine and European law.

Science.gov (United States)

Callens, Stefaan

2003-01-01

A Directive of the European Union was first published in 2000, which dealt with telemedicine as part of its provisions. This E-Commerce Directive, as it became known, was subjected to further study which revealed some problems relative to the practice of telemedicine. Among the subjects discussed in this paper are those of privacy, data protection, free movement of services, the impact of electronic communication and ethical issues.

VA Telemedicine: An Analysis of Cost and Time Savings.

Science.gov (United States)

Russo, Jack E; McCool, Ryan R; Davies, Louise

2016-03-01

The Veterans Affairs (VA) healthcare system provides beneficiary travel reimbursement ("travel pay") to qualifying patients for traveling to appointments. Travel pay is a large expense for the VA and hence the U.S. Government, projected to cost nearly $1 billion in 2015. Telemedicine in the VA system has the potential to save money by reducing patient travel and thus the amount of travel pay disbursed. In this study, we quantify this savings and also report trends in VA telemedicine volumes over time. All telemedicine visits based at the VA Hospital in White River Junction, VT between 2005 and 2013 were reviewed (5,695 visits). Travel distance and time saved as a result of telemedicine were calculated. Clinical volume in the mental health department, which has had the longest participation in telemedicine, was analyzed. Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients. Telemedicine at the VA saves travel distance and time, although the reduction in travel payments remains modest at current telemedicine volumes.

Sygeplejerskers arbejde med telemedicin i en tværsektoriel kontekst / Nurses working with Telemedicine in a cross-sectional setting

DEFF Research Database (Denmark)

Lunde, Anita; Drachmann, Astrid Lykke; Christiansen, Karin

2017-01-01

has to be meaningful and a flexible and technically reliable solution. The possession of technical skills and a personal in-terest in telemedicine are advantageous. More important, however, are high clinical skills and competences in caring relationships. Nurses from diverse clinical settings report......The introduction of telemedicine will transform the health care sector and bring changes to the role and function of nurses. In this inquiry we ask, what competences are required in the ‘doing’ of telemedicine? The project is based on interviews with two focus groups involving nurses from...... the primary and secondary sectors, working with telemedicine in a project entitled, Hor-sens på forkant med sundhed (Horsens on the frontiers of Health). The analysis is da-ta-driven and reveals that cultivation of competences is closely associated to structural conditions. Nurses emphasize that telemedicine...

Characterizing New England Emergency Departments by Telemedicine Use.

Science.gov (United States)

Zachrison, Kori S; Hayden, Emily M; Schwamm, Lee H; Espinola, Janice A; Sullivan, Ashley F; Boggs, Krislyn M; Raja, Ali S; Camargo, Carlos A

2017-10-01

Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195) in the six New England states (excluding federal hospitals and college infirmaries). Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Of the 169 responding EDs (87% response rate), 82 (49%) reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); and less likely to have 24/7 access to neurology (ptelemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30-14.86), and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09-0.49]), and annual volume Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.

Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? †

Science.gov (United States)

LeRouge, Cynthia; Garfield, Monica J.

2013-01-01

Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks. PMID:24287864

International Telemedicine/Disaster Medicine Conference: Papers and Presentations

Science.gov (United States)

1991-01-01

The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.

Telemedicine Program

Science.gov (United States)

1996-01-01

Since the 1970s, NASA has been involved in the research and demonstration of telemedicine for its potential in the care of astronauts in flight and Earth-bound applications. A combination of NASA funding, expertise and off-the-shelf computer and networking systems made telemedicine possible for a medically underserved hospital in Texas. Through two-way audio/video relay, the program links pediatric oncology specialists at the University of Texas Health Science Center in San Antonio to South Texas Hospital in Harlingen, providing easier access and better care to children with cancer. Additionally, the hospital is receiving teleclinics on pediatric oncology nursing, family counseling and tuberculosis treatment. VTEL Corporation, Sprint, and the Healthcare Open Systems and Trials Consortium also contributed staff and hardware.

Telemedicine Workplace Environments: Designing for Success

OpenAIRE

Elizabeth A. Krupinski

2014-01-01

When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based practice and centered more in the home than it is now, it is still very important to consider ways to optimize the design of clinic-based telemedicine facilities. This is true on both ends of a consultation?where the patient is and where the consulta...

A Small-Scale Flux Rope and its Associated CME and Shock.

Science.gov (United States)

Feng, L.; Ying, B.; Lu, L.; Zhang, J.

2016-12-01

A magnetic flux rope (MFR) is thought be a key ingredient of a coronal mass ejection (CME). It has been extensively explored after the Solar Dynamics Observatory (SDO) mission was launched. Previous studies are often concentrated on large-scale MFRs whose size are comparable to the active regions they reside. In this paper, we investigate the properties of a small-scale magnetic flux rope (SMFR) of a limb event observed by Atmospheric Imaging Assembly (AIA) . This SMFR originated from a very small and compact region at the edge of the active region and appeared mainly in the AIA 94 Å passband. It drove a coronal mass ejection (CME) and a type II burst was associated with the CME-driven shock. The type II burst started with a very high frequency. We obtain the compression ratio of the shock from the band splitting of the type II emissions and further derive the Alfvénic Mach number and the coronal magnetic field strength. On the other hand,we study the CME structure in LASCO coronagraph images and address its characteristics through measuring its mass and energy. Compared to the nature of the standard model of the CME, this CME triggered by the SMF are found to be different in some aspects.

Navy Telemedicine: Current Research and Future Directions

National Research Council Canada - National Science Library

Reed, Cheryl

2002-01-01

.... This report reviews military and civilian models for evaluating telemedicine systems in order to determine future directions for Navy telemedicine research within the current funding environment...

The Use of Telemedicine in Oral and Maxillofacial Surgery.

Science.gov (United States)

Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K

2016-04-01

To determine the perceived utility and demand for the application of telemedicine for improved patient care between nonsurgical dental practitioners (GPs) and oral and maxillofacial surgeons (OMS). Two distinct questionnaires were made, one for GPs and one for OMSs. The GP questionnaire was sent to practicing Virginia Dental Association members on an e-mail list (approximately 2,200). The OMS questionnaire was sent by the Virginia Society of Oral Maxillofacial Surgery to members on an e-mail list (approximately 213). Questionnaires included questions about access to care, benefits of telemedicine consultations, reliability of telemedicine consultations, and perceived barriers against and opportunities for the implementation of telemedicine. The questionnaire was completed by 226 GP and 41 OMS respondents. There was a significant difference among responses of GPs based on practice location: rural patients had a longer average time from referral to OMS consultation (P = .003), rural patients traveled longer distances (P telemedicine, whereas OMS respondents were more neutral. GPs responded they would refer more patients (4.4) if consultations could be performed by telemedicine. OMSs agreed that more referrals would influence their decision to provide telemedicine consultations (51%). Practitioners had neutral perceptions about the reliability of telemedicine. OMS respondents agreed they would implement telemedicine in their practice if it provided equally good consultations as in-office visits. According to the present findings, telemedicine could be an important step in the right direction for overcoming current issues with patient access to care and increasing health care costs. The benefits of telemedicine technology have been documented and will continue to be seen with wider application of its use in other areas of health care such as oral and maxillofacial surgery. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier

The evolution of telemedicine and nano-technology

Science.gov (United States)

Park, Dong Kyun; Young Jung, Eun; Chan Moon, Byung

2012-10-01

This paper will cover definition and history of telemedicine, changes in medical paradigm and roll of telemedicine and roll of nano-technology for evolution of telemedicine. Hypothetically, telemedicine is distance communication for medical purpose and modern definition explains telemedicine as `a system of health care delivery in which physicians examine distant patients through the use of telecommunications technology. Medical service will change to personalized medicine based on gene information to prevent and manage diseases due to decrease of acute diseases, population aging and increase of prevalence in chronic diseases, which means current medical services based on manualized treatment for diseases will change to personalized medicine based on individual gene information. Also, international healthcare will be activated to provide high quality medical services with low cost using developed transportation. Moreover, hospital centered medical services will change to patients centered medical service due to increase of patient's rights. Development in sensor technology is required for telemedicine to be applied as basic infrastructure for medical services. Various researches in nano-biosensor field are conducted due to introduction of new technologies. However, most researches are in fundamental levels that requires more researches for stability and clinical usefulness. Nano technology is expected to achieve innovative development and define new criteria for disease prevention and management.

Standards and Guidelines in Telemedicine and Telehealth

Science.gov (United States)

Krupinski, Elizabeth A.; Bernard, Jordana

2014-01-01

The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed. PMID:27429261

Characterizing New England Emergency Departments by Telemedicine Use

Directory of Open Access Journals (Sweden)

Kori S. Zachrison

2017-09-01

Full Text Available Introduction: Telemedicine connects emergency departments (ED with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. Methods: We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195 in the six New England states (excluding federal hospitals and college infirmaries. Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Results: Of the 169 responding EDs (87% response rate, 82 (49% reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03; less likely to be academic (1% of users vs. 11% of non-users, p=0.01; and less likely to have 24/7 access to neurology (p<0.001, neurosurgery (p<0.001, orthopedics (p=0.01, plastic surgery (p=0.01, psychiatry (p<0.001, and hand surgery (p<0.001 consultants. Neuro/stroke (68%, pediatrics (11%, psychiatry (11%, and trauma (10% were the most commonly reported applications. On multivariable analysis, telemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30–14.86, and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09–0.49], and annual volume <20,000 (OR 0.24, 95% CI [0.08–0.68]. Conclusion: Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.

Implementation of a Flipped Classroom for Nuclear Medicine Physician CME.

Science.gov (United States)

Komarraju, Aparna; Bartel, Twyla B; Dickinson, Lisa A; Grant, Frederick D; Yarbrough, Tracy L

2018-06-21

Increasingly, emerging technologies are expanding instructional possibilities, with new methods being adopted to improve knowledge acquisition and retention. Within medical education, many new techniques have been employed in the undergraduate setting, with less utilization thus far in the continuing medical education (CME) sphere. This paper discusses the use of a new method for CME-the "flipped classroom," widely used in undergraduate medical education. This method engages learners by providing content before the live ("in class") session that aids in preparation and fosters in-class engagement. A flipped classroom method was employed using an online image-rich case-based module and quiz prior to a live CME session at a national nuclear medicine meeting. The preparatory material provided a springboard for in-depth discussion at the live session-a case-based activity utilizing audience response technology. Study participants completed a survey regarding their initial experience with this new instructional method. In addition, focus group interviews were conducted with session attendees who had or had not completed the presession material; transcripts were qualitatively analyzed. Quantitative survey data (completed by two-thirds of the session attendees) suggested that the flipped method was highly valuable and met attendee educational objectives. Analysis of focus group data yielded six themes broadly related to two categories-benefits of the flipped method for CME and programmatic considerations for successfully implementing the flipped method in CME. Data from this study have proven encouraging and support further investigations around the incorporation of this innovative teaching method into CME for nuclear imaging specialists.

Risk of Telemedicine Infeasibility: An Evidential Reasoning Approach

Directory of Open Access Journals (Sweden)

Sofienne Mansouri

2017-10-01

Full Text Available The viability of a telemedicine system is the strength of its business continuity. Business continuity can only stand if the telemedicine system remains continuously feasible. This article studies telemedicine risk in terms of its feasibility on all its five components: economical, technical, social, operational, and legal/ethical. Any deficiencies in one or more of the feasibility components will affect the system business continuity risk and can lead to infeasibility and possible dissolution. The telemedicine computing environment is full of uncertainties and ambiguities and it just involves too much background knowledge that Bayesian theory cannot accommodate. Decision theory however offers a basic evidence-based multi-criteria decision mechanism that can tackle those decision problems treating both quantitative and qualitative criteria under various uncertainties including ignorance and randomness. We propose an evidential reasoning model to assess a telemedicine business continuity risk based on infeasibility. This business continuity risk is modelled using Dempster and Shafer Theory as the plausibility of infeasibility of the telemedicine system. A numerical example is provided to demonstrate the working of the proposed risk assessment model.

Obstetrician/Gynecologists and Postpartum Mental Health: Differences between CME Course Takers and Nontakers

Science.gov (United States)

Leddy, Meaghan A.; Farrow, Victoria A.; Joseph, Gerald F., Jr.; Schulkin, Jay

2012-01-01

Introduction: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers. Purpose: Obstetrician-gynecologists (OB-GYNs) are health care…

First in-situ observations of exospheric response to CME impact at Mercury

Science.gov (United States)

Raines, J. M.; Wallace, K. L.; Sarantos, M.; Jasinski, J. M.; Tracy, P.; Dewey, R. M.; Weberg, M. J.; Slavin, J. A.

2017-12-01

We present the first in-situ observations of enhancements to Mercury's He exosphere generated by CME impact. We analyzed both plasma and magnetic field measurements from the Mercury Surface Space Environment, Geochemistry and Mapping (MESSENGER) spacecraft over a 60-hour period as a coronal mass ejection (CME) passed by the planet. We identified the shock, magnetic cloud and cavity regions of the moderate intensity CME while MESSENGER was in the solar wind. Inside the magnetosphere just after the CME shock passage, we observed a very active dayside magnetosphere, as evident from the high flux plasma parcels passing through the dayside and a broad northern magnetospheric cusp with exceptionally high planetary ion content. All of these signatures indicate substantial reconnection at the dayside magnetopause, making conditions that were excellent for solar wind access to Mercury's surface. The CME appeared to have been particularly enriched in He2+, causing the observed density of solar wind He2+ in the cusp to rise above 0.1 cm-3 and putting it in the top 1% of the over 3200 cusps analyzed. As the low-density CME cavity passed over the planet on the next orbit, the magnetosphere appeared much quieter, with smoother magnetic fields and a smaller, less intense northern cusp but with greatly enhanced He+ content. The elevated He+ observed density continued to increase on subsequent cusp crossings, peaking at 0.1 cm-3 36 hours after CME impact, the highest observed throughout the entire MESSENGER mission. We suggest that the enhancement in He+ indicates an increase to the neutral He exosphere density from the He-enriched CME, a phenomenon observed at the moon, possibly acting as follows: Increased access to the surface from CME-enhanced reconnection, combined with high He2+ flux, enhanced surface implantation. Neutral He atoms were then liberated at an increased rate by surface processes supplying the exosphere, causing a gradual increase in He exosphere density. This

Telemedicine and anaesthesia.

Science.gov (United States)

Chatrath, Veena; Attri, Joginder Pal; Chatrath, Raman

2010-05-01

Telemedicine is the use of electronic information and communication technology to provide and support healthcare when distance separates the participants. India is characterised by low penetration of healthcare services where primary healthcare facilities for rural population are highly inadequate. The majority of doctors practice in urban and semi-urban areas, whereas the major proportion of population lives in rural areas. This calls for the innovative methods for utilisation of science and technology for the benefit of our society. There are few reports in the literature which support the use of telemedicine technology for pre-operative assessment, intra-operative consultation, monitoring and post-operative follow-up, which is discussed in this article.

Feasibility of AmbulanCe-Based Telemedicine (FACT) Study : Safety, Feasibility and Reliability of Third Generation Ambulance Telemedicine

NARCIS (Netherlands)

Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Espinoza, Alexis Valenzuela; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf

2014-01-01

Background: Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third

Trends in telemedicine utilizing artificial intelligence

Science.gov (United States)

Pacis, Danica Mitch M.; Subido, Edwin D. C.; Bugtai, Nilo T.

2018-02-01

With the growth and popularity of the utilization of artificial intelligence (AI) in several fields and industries, studies in the field of medicine have begun to implement its capabilities in handling and analyzing data to telemedicine. With the challenges in the implementation of telemedicine, there has been a need to expand its capabilities and improve procedures to be specialized to solve specific problems. The versatility and flexibility of both AI and telemedicine gave the endless possibilities for development and these can be seen in the literature reviewed in this paper. The trends in the development of the utilization of this technology can be classified in to four: patient monitoring, healthcare information technology, intelligent assistance diagnosis, and information analysis collaboration. Each trend will be discussed and presented with examples of recent literature and the problems they aim to address. Related references will also be tabulated and categorized to see the future and potential of this current trend in telemedicine.

AplikasiTelemedicine dalam Merujuk Pasien dari Daerah Rural

Directory of Open Access Journals (Sweden)

Lidwina Anissa

2016-03-01

Full Text Available Kusta adalah penyakit menular yang disebabkan oleh basil lepra. Penderita kusta tersebar di seluruh Indonesia. Dalam Standar Kompetensi Dokter Indonesia, penanganan kusta tanpa komplikasi merupakankompetensi tingkat 4A, sedangkan penanganan reaksi kusta merupakan kompetensi tingkat 3A. Penanganankasus reaksi kusta dengan proses rujukan konvensional ke layanan kesehatan yang memilliki tenaga ahliterkendala oleh berbagai macam penyulit. Pemanfaatan teknologi smartphone berupa aplikasi Whatsapp,dengan menerapkan konsep telemedicine, diharapkan dapat menjadi solusi untuk meretas hambatanjarak, waktu dan finansial dalam proses rujukan pasien secara konvensional. Demi memberikan pelayanan kesehatan yang bersifat paripurna, sebaiknya konsep telemedicine dipelajari lebih lanjut dan diterapkan dalam pelayanan kesehatan. Kata Kunci: kusta, reaksi kusta, rujukan, smartphone, telemedicine, Whatsapp   Telemedicine Application for Rural Patients’ Referral Abstract Leprosy is a communicable disease caused by leprosy bacillus. People with leprosy are distributed in all areas of Indonesia. In Indonesian Doctor Competence Standards, leprosy management is at level 4Acompetence; meanwhile leprosy reaction management is at level 3A competence. Management of leprosyreaction that needs a conventional referral to higher level of health centre has faced many obstacles.Smartphone instant messaging application (eg. Whatsapp utilizes the concept of telemedicine, which will bea solution in solving distance, time and financial problems in conventional referral process. In order to provideholistic health service, telemedicine should be learnt further and applied. Keywords: leprosy, leprosy reaction, referral, smartphone, telemedicine, Whatsapp

Changes in the job situation due to telemedicine.

Science.gov (United States)

Aas, I H Monrad

2002-01-01

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.

A model for assessment of telemedicine applications

DEFF Research Database (Denmark)

Kidholm, Kristian; Ekeland, Anne Granstrøm; Jensen, Lise Kvistgaard

2012-01-01

the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study.......Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009...

A qualitative study of the organizational consequences of telemedicine.

Science.gov (United States)

Aas, I H

2001-01-01

The organizational consequences of telemedicine have frequently been mentioned in the telemedicine community, but there are few empirical studies. A study was therefore carried out of what happens in organizations when telemedicine is implemented. Qualitative interviews were undertaken with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. Almost all respondents reported numerous organizational changes, some important. Changes in work processes were the most common. Examples of the organizational consequences of telemedicine were organizational restructuring, new organizational units, changed mechanisms for internal coordination, different flows of patients through the health-care system, improved coordination of care, new job descriptions, relocation of the place of work, employment of personnel living far away from the workplace, effects on employees not directly involved in telemedicine, sharing of experiences, minor staffing changes, clinical teamwork independent of co-location, administrative meetings arranged by telemedicine, merger of organizations independent of location, less travel by staff (and patients), a possible beneficial effect on the quality of care, and limited opposition to the adoption of the technology. Telemedicine may be important in the future organization of the disciplines studied and in health-care generally. The infrastructure of electronic networks may play an important role for organizations as the volume of telemedicine activity increases and economies of scale are realized.

Didactic CME and Practice Change: Don't Throw that Baby out Quite yet

Science.gov (United States)

Olson, Curtis A.; Tooman, Tricia R.

2012-01-01

Skepticism exists regarding the role of continuing medical education (CME) in improving physician performance. The harshest criticism has been reserved for didactic CME. Reviews of the scientific literature on the effectiveness of CME conclude that formal or didactic modes of education have little or no impact on clinical practice. This has led…

The Centralization and Decentralization of Telemedicine Networks in Korea and Japan

Directory of Open Access Journals (Sweden)

Soo-kyung Park

2013-06-01

Full Text Available This study scrutinizes telemedicine networks with regard to regionalization and the propensities and determinants of core telemedicine users (doctors and patients by employing two case areas, Choongbook in Korea and Kagawa in Japan. According to the results, telemedicine networks in Choongbook are dominated by an inter-regional level (in particular, a national level, and most of the telemedicine networks are observed between clinical sites in Choongbook and tertiary care centers in Kyunggi. In contrast, telemedicine networks in Kagawa are dispersed within the diagnostic boundary of Kagawa at a regional level. Interviews with crucial decision-makers revealed the reasons why many patients enjoy health care via telemedicine at an inter-regional level, which include psychological considerations regarding quality and level of health care services, personal stakes in telemedicine service sites, acceptability and credibility of good tertiary care centers, and easy access to and use of medical institutions. In Kagawa, both the existing health care system and the telemedicine system support the maintenance of stable regional health care within Kagawa. Importantly, human relationships based on the regional health care system contribute to creating telemedicine networks within the original purpose of the telemedicine system regarding regionalization. Also, telemedicine’s technological value, convenience, and utility are associated with the regionalization of telemedicine networks within one diagnostic area.

Promoting free online CME for intimate partner violence: what works at what cost?

Science.gov (United States)

Harris, John M; Novalis-Marine, Cheryl; Amend, Robert W; Surprenant, Zita J

2009-01-01

There is a need to provide practicing physicians with training on the recognition and management of intimate partner violence (IPV). Online continuing medical education (CME) could help meet this need, but there is little information on the costs and effectiveness of promoting online CME to physicians. This lack of information may discourage IPV training efforts and the use of online CME in general. We promoted an interactive, multimedia, online IPV CME program, which offered free CME credit, to 92,000 California physicians for 24 months. We collected data on user satisfaction, the costs of different promotional strategies, and self-reported user referral source. We evaluated California physician awareness of the promotion via telephone surveys. Over 2 years, the CME program was used by 1869 California physicians (2% of market), who rated the program's overall quality highly (4.52 on a 1-5 scale; 5 = excellent). The average promotional cost per physician user was $75. Direct mail was the most effective strategy, costing $143 each for 821 users. E-promotion via search engine advertising and e-mail solicitation had less reach, but was more cost efficient ($30-$80 per user). Strategies with no direct cost, such as notices in professional newsletters, accounted for 31% (578) of physician users. Phone surveys found that 24% of California physicians were aware of the online IPV CME program after 18 months of promotion. Promoting online CME, even well-received free CME, to busy community physicians requires resources, in this case at least $75 per physician reached. The effective use of promotional resources needs to be considered when developing social marketing strategies to improve community physician practices. Organizations with an interest in promoting online training might consider the use of e-promotion techniques along with conventional promotion strategies.

Establishment of an effective acute stroke telemedicine program for Australia: protocol for the Victorian Stroke Telemedicine project.

Science.gov (United States)

Cadilhac, Dominique A; Moloczij, Natasha; Denisenko, Sonia; Dewey, Helen; Disler, Peter; Winzar, Bruce; Mosley, Ian; Donnan, Geoffrey A; Bladin, Christopher

2014-02-01

Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase. The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes. This research will provide evidence for an effective telestroke program for use in regional Australian hospitals. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Telemedicine and anaesthesia

Directory of Open Access Journals (Sweden)

Veena Chatrath

2010-01-01

Full Text Available Telemedicine is the use of electronic information and communication technology to provide and support healthcare when distance separates the participants. India is characterised by low penetration of healthcare services where primary healthcare facilities for rural population are highly inadequate. The majority of doctors practice in urban and semi-urban areas, whereas the major proportion of population lives in rural areas. This calls for the innovative methods for utilisation of science and technology for the benefit of our society. There are few reports in the literature which support the use of telemedicine technology for pre-operative assessment, intra-operative consultation, monitoring and post-operative follow-up, which is discussed in this article.

Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit.

Science.gov (United States)

Wu, Tzu-Ching; Parker, Stephanie A; Jagolino, Amanda; Yamal, Jose-Miguel; Bowry, Ritvij; Thomas, Abraham; Yu, Amy; Grotta, James C

2017-02-01

The BEST-MSU study (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) is a comparative effectiveness trial in patients randomized to mobile stroke unit or standard management. A substudy tested interrater agreement for tissue-type plasminogen activator eligibility between a telemedicine vascular neurologist and onboard vascular neurologist. On scene, both the telemedicine vascular neurologist and onboard vascular neurologist independently evaluated the patient, documenting their tissue-type plasminogen activator treatment decision, National Institutes of Health Stroke Scale score, and computed tomographic interpretation. Agreement was determined using Cohen κ statistic. Telemedicine-related technical failures that impeded remote assessment were recorded. Simultaneous and independent telemedicine vascular neurologist and onboard vascular neurologist assessment was attempted in 174 patients. In 4 patients (2%), the telemedicine vascular neurologist could not make a decision because of technical problems. The telemedicine vascular neurologist agreed with the onboard vascular neurologist on 88% of evaluations (κ=0.73). Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500. © 2017 American Heart Association, Inc.

Using Telemedicine to Address Crowding in the ED.

Science.gov (United States)

Guss, Benjamin; Mishkin, David; Sharma, Rahul

2016-11-01

Some health systems are piloting telemedicine solutions in the ED to address crowding and decrease patient wait times. One new program, implemented at the Lisa Perry Emergency Center at New York Presbyterian (NYP) Weill Cornell Medical Center in New York, involves offering low-acuity patients the option of visiting an off-site physician via telemedicine hookup. Administrators note that the approach can get patients in and out of the ED within 30 minutes, and patients have thus far been highly satisfied with the approach. However, an earlier telemedicine program piloted at the University of San Diego Health System’s (UCSD) Hillcrest Hospital in 2013 got bogged down due to administrative and insurance reimbursement hurdles, although the approach showed enough promise that there is interest in restarting the program. In the NYP program, patients are identified as appropriate candidates for the program at triage. They can opt to be seen remotely or through traditional means in the ED’s fast-track section. Administrators note that patients with complex problems requiring extensive workups are not suitable for the telemedicine approach. The most challenging aspect of implementing a successful telemedicine program in the ED is getting the workflows right, according to administrators. An earlier ED-based telemedicine program piloted at UCSD ran into difficulties because the model required the involvement of two physicians, and some insurers did not want to pay for the telemedicine visits. However, patients were receptive.

Telemedicine and advances in urban and rural healthcare delivery in Africa.

Science.gov (United States)

Mars, Maurice

2013-01-01

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine. © 2013.

5G, an approach towards future telemedicine

DEFF Research Database (Denmark)

Anwar, Sadia; Prasad, Ramjee; Kumar, Ambuj

for telemedicine application. Telemedicine’s applications and high data medical information generally require high definition visuals and lower latency connection, in addition mobility and reliability. The next generation of wireless communication standard, known as 5G, will provide data speed in (Gigabit per...... second) Gb/s with lower latency and higher reliability connection, and can be better approach for future telemedicine. In this paper we survey the current state of telemedicine along with examining the characteristics of 5G technology. We also present research challenges concerning 5G and telemedicine.......The use of smartphones has been increasing rapidly and it is expected that in future most people will have a smartphone capable of high speed Internet connection. The capability of smartphones with high definition display, computation power and multitude of sensors made it an excellent candidate...

Narrative review of telemedicine consultation in medical practice

Directory of Open Access Journals (Sweden)

Di Cerbo A

2015-01-01

Full Text Available Alessandro Di Cerbo,1,2 Julio Cesar Morales-Medina,3 Beniamino Palmieri,1,2 Tommaso Iannitti4 1Poliambulatorio del Secondo Parere, 2Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy; 3Centro de Investigación en Reproducción Animal, CINVESTAV, Universidad Autónoma de Tlaxcala, Tlaxcala de Xicohténcatl, Mexico; 4Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN, University of Sheffield, Sheffield, UK Background: The use of telemedicine has grown across several medical fields, due to the increasing number of “e-patients”.Objective: This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care.Methods: A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-­medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty.Results: Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions.Conclusion: Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time. Keywords: telemedicine, health care, patient

Telemedicine and telepharmacy: current status and future implications.

Science.gov (United States)

Angaran, D M

1999-07-15

Uses of telemedicine are described and potential roles for pharmacists are discussed. Telemedicine has been defined as "the use of electronic information and communications technologies to provide and support health care when distance separates the participants." Technologies included in telemedicine are videoconferencing, telephones, computers, the Internet, fax, radio, and television. Telepharmacy has the same basic definition but refers to pharmaceutical care provision. Although the videotelemedicine market is expected to grow considerably, lack of reimbursement and high costs are continuing obstacles. Pharmacy is using video-conferencing for education, training, and management purposes. The telephone has changed from a dial-and-talk instrument to a multimedia access tool. Medical devices are being attached to telephone lines to provide remote monitoring and therapy, and call centers are providing medication counseling, prior authorization, refill authorization, and formulary compliance monitoring. Although the Internet has quickly become a star performer, utilization by health care lags behind that of other industries. The Internet-fueled empowerment of consumers and their expectations for speed, access, and convenience are creating more unmet expectations of the traditional health care system. Pharmacy has both organizational and individual practitioner Web sites, but it is online drugstores that are attracting most attention. Potential benefits of telemedicine include improved access to care, greater efficiency in diagnosis and treatment, higher productivity, and market positioning for the coming century. Telemedicine will tax the economic, regulatory, legal, ethical, and clinical care expertise of the entire health care system. Studies of the effectiveness, cost, and societal implications of telemedicine are needed, along with practice models and standards, training programs, and solutions to regulatory, licensing, and legal questions. Securing reimbursement

Telemedicine for Trauma, Emergencies, and Disaster Management

CERN Document Server

Latifi, Rifat

2010-01-01

Telemedicine has evolved to become an important field of medicine and healthcare, involving everything from simple patient care to actual performance of operations at a distance. This groundbreaking volume addresses the complex technical and clinical development in the management of trauma, disaster, and emergency situations using telemedicine. The book explains how telemedicine and related technologies can be used to effectively handle a wide range of scenarios, from a situation as small as a car crash, to major disasters such as an earthquake. Professionals find critical discussions on the p

Institutionalizing telemedicine applications: the challenge of legitimizing decision-making.

Science.gov (United States)

Zanaboni, Paolo; Lettieri, Emanuele

2011-09-28

During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness. We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale. We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.

Telemedicine for Developing Countries. A Survey and Some Design Issues.

Science.gov (United States)

Combi, Carlo; Pozzani, Gabriele; Pozzi, Giuseppe

2016-11-02

Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries. We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems. We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects. We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area. We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries.

Making medical treatments resilient to technological disruptions in telemedicine systems

NARCIS (Netherlands)

Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.

Telemedicine depends on Information and Communication Technology (ICT) to support remote treatment of patients. This dependency requires the telemedicine system design to be resilient for ICT performance degradation or subsystem failures. Nevertheless, using telemedicine systems create a dependency

Engaging elderly people in telemedicine through gamification

NARCIS (Netherlands)

de Vette, Anna Frederiek Alberdien; Tabak, Monique; van Weering, Marit; Vollenbroek-Hutten, Miriam Marie Rosé

2015-01-01

BACKGROUND: Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the

The Model for Assessment of Telemedicine (MAST)

DEFF Research Database (Denmark)

Kidholm, Kristian; Clemensen, Jane; Caffery, Liam J

2017-01-01

The evaluation of telemedicine can be achieved using different evaluation models or theoretical frameworks. This paper presents a scoping review of published studies which have applied the Model for Assessment of Telemedicine (MAST). MAST includes pre-implementation assessment (e.g. by use...

3D Reconnection and SEP Considerations in the CME-Flare Problem

Science.gov (United States)

Moschou, S. P.; Cohen, O.; Drake, J. J.; Sokolov, I.; Borovikov, D.; Alvarado Gomez, J. D.; Garraffo, C.

2017-12-01

Reconnection is known to play a major role in particle acceleration in both solar and astrophysical regimes, yet little is known about its connection with the global scales and its comparative contribution in the generation of SEPs with respect to other acceleration mechanisms, such as the shock at a fast CME front, in the presence of a global structure such as a CME. Coupling efforts, combining both particle and global scales, are necessary to answer questions about the fundamentals of the energetic processes evolved. We present such a coupling modeling effort that looks into particle acceleration through reconnection in a self-consistent CME-flare model in both particle and fluid regimes. Of special interest is the supra-thermal component of the acceleration due to the reconnection that will at a later time interact colliding with the solar atmospheric material of the more dense chromospheric layer and radiate in hard X- and γ-rays for super-thermal electrons and protons respectively. Two cutting edge computational codes are used to capture the global CME and flare dynamics, specifically a two fluid MHD code and a 3D PIC code for the flare scales. Finally, we are connecting the simulations with current observations in different wavelengths in an effort to shed light to the unified CME-flare picture.

Nursing Roles within a Stroke Telemedicine Network

Directory of Open Access Journals (Sweden)

Terri-Ellen J. Kiernan

2010-01-01

Full Text Available Time sensitive acute stroke treatments and the growing shortage of vascular neurologists compound to create a gap in the delivery of care to meet the American Stroke Association guidelines in underserviced regions. Audio/video consultation (telemedicine, which has been evolving since the late 1990's, is a putative solution. While telemedicine can serve as a valuable facilitative tool, the telestroke consultation is only one piece of a complex collaboration between hub and spoke environments and clinical personnel. The growing use of telemedicine in stroke offers more opportunities for all nurses to participate in the continuum of cerebrovascular disease care. A review of this collaboration will include but will not be limited to: algorithms of the acute stroke evaluation, hub and spoke staff meetings, stroke education for spoke staff, and patient follow–up post acute treatment. Our team's telemedicine experience, utilizing research, education, and clinical practice, will be described.

Telemedicine.

Science.gov (United States)

Dorman, T

2000-09-01

Telemedicine began from the humble beginnings of the first telephone call from Alexander Graham Bell to his associate, Watson. These systems already have been used for educational programs, consultative care, image transfer, second opinions, and direct acute patient care. Most of the original programs failed because of several reasons, primarily because of lack of funding when a grant ended. The major lesson of these programs is that a solid business plan is needed initially for long-term survival. The reliability of telemedical examinations has been demonstrated superficially, but more conclusive work in this area is needed. Studies that evaluate clinical, financial, and satisfaction outcomes are required simultaneously. Further integration of medical informatics into telemedicine systems is needed before these systems can achieve more acceptance. Twenty years ago, few people predicted this technologic revolution. Innovations arise almost daily. The future seems promising for telemedical systems, but much work is required. Partnerships with industry must move beyond niche projects, and regulatory and medicolegal issues must be resolved. Anesthesiologists can expect their practice to be affected directly by technology, and should embrace it, evaluate it, and help lead its use in this millennium.

Determination of CME 3D parameters based on a new full ice-cream cone model

Science.gov (United States)

Na, Hyeonock; Moon, Yong-Jae

2017-08-01

In space weather forecast, it is important to determine three-dimensional properties of CMEs. Using 29 limb CMEs, we examine which cone type is close to a CME three-dimensional structure. We find that most CMEs have near full ice-cream cone structure which is a symmetrical circular cone combined with a hemisphere. We develop a full ice-cream cone model based on a new methodology that the full ice-cream cone consists of many flat cones with different heights and angular widths. By applying this model to 12 SOHO/LASCO halo CMEs, we find that 3D parameters from our method are similar to those from other stereoscopic methods (i.e., a triangulation method and a Graduated Cylindrical Shell model). In addition, we derive CME mean density (ρmean=Mtotal/Vcone) based on the full ice-cream cone structure. For several limb events, we determine CME mass by applying the Solarsoft procedure (e.g., cme_mass.pro) to SOHO/LASCO C3 images. CME volumes are estimated from the full ice-cream cone structure. From the power-law relationship between CME mean density and its height, we estimate CME mean densities at 20 solar radii (Rs). We will compare the CME densities at 20 Rs with their corresponding ICME densities.

Third Intensive Balkan Telemedicine and e-Health Seminar

Science.gov (United States)

2009-03-01

and Cultural Affairs HD High Definition ISDN Integrates Services Digital Network IStTeH International Society for Telemedicine and eHealth IT...Lievens1,2, Marlina Jordanova, MD, PhD3,4 1International Society for Telemedicine & eHealth , Switzerland;2Med-e-Tel, Grimbergen, Belgium; 3Med-e-Tel...Approach F. Lievens 1,2,3, M. Jordanova 4,5 1 Board Member and Secretary, International Society for Telemedicine & eHealth (ISfTeH), Switzerland 2

Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments.

Science.gov (United States)

Yang, Nikki H; Dharmar, Madan; Yoo, Byung-Kwang; Leigh, J Paul; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Marcin, James P

2015-08-01

Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations. © The Author(s) 2015.

Communication network for telemedicine | Debretsion | Zede Journal

African Journals Online (AJOL)

Telemedicine is the most promising one for improving the access to specialized health services to all remote, rural areas in all developing countries. Exploiting the technological advancements in the field of electronics, signal processing and software a communication network for telemedicine is proposedfor the existing ...

Testing a top-down strategy for establishing a sustainable telemedicine program in a developing country: the Arizona telemedicine program-US Army-Republic of Panama Initiative.

Science.gov (United States)

Vega, Silvio; Marciscano, Ivette; Holcomb, Michael; Erps, Kristine A; Major, Janet; Lopez, Ana Maria; Barker, Gail P; Weinstein, Ronald S

2013-10-01

Many developing countries have shown interest in embracing telemedicine and incorporating it into their healthcare systems. In 2000, the U.S. Army Yuma Proving Ground (YPG) initiated a program to assist the Republic of Panama in establishing a demonstration Panamanian rural telemedicine program. YPG engaged the Arizona Telemedicine Program (ATP) to participate in the development and implementation of the program. The ATP recommended adoption of a "top-down" strategy for creating the program. Early buy-in of the Panamanian Ministry of Health and academic leaders was regarded as critical to the achievement of long-term success. High-level meetings with the Minister of Health and the Rectors (i.e., Presidents) of the national universities gained early program support. A telemedicine demonstration project was established on a mountainous Indian reservation 230 miles west of Panama City. Today, three rural telemedicine clinics are linked to a regional Ministry of Health hospital for teleconsultations. Real-time bidirectional videoconferencing utilizes videophones connected over Internet protocol networks at a data rate of 768 kilobits per second to the San Felix Hospital. Telepediatrics, tele-obstetrics, telepulmonology, teledermatology, and tele-emergency medicine services became available. Telemedicine services were provided to the three sites for a total of 1,013 cases, with numbers of cases increasing each year. These three demonstration sites remained in operation after discontinuation of the U.S. involvement in September 2009 and serve as a model program for other telemedicine initiatives in Panama. Access to the assets of a partner-nation was invaluable in the establishment of the first model telemedicine demonstration program in Panama. After 3 years, the Panamanian Telemedicine and Telehealth Program (PTTP) became self-sufficient. The successful achievement of sustainability of the PTTP after disengagement by the United States fits the Latifi-Weinstein model

UH Telemedicine Proposal

National Research Council Canada - National Science Library

Friedman, Richard

2001-01-01

.... To accomplish this task, a clinical telemedicine service was established such that a hub of physician specialists in Honolulu is available to primary care providers and patients in rural and/or remote clinics...

Combining Stereo SECCHI COR2 and HI1 Images for Automatic CME Front Edge Tracking

Science.gov (United States)

Kirnosov, Vladimir; Chang, Lin-Ching; Pulkkinen, Antti

2016-01-01

COR2 coronagraph images are the most commonly used data for coronal mass ejection (CME) analysis among the various types of data provided by the STEREO (Solar Terrestrial Relations Observatory) SECCHI (Sun-Earth Connection Coronal and Heliospheric Investigation) suite of instruments. The field of view (FOV) in COR2 images covers 215 solar radii (Rs) that allow for tracking the front edge of a CME in its initial stage to forecast the lead-time of a CME and its chances of reaching the Earth. However, estimating the lead-time of a CME using COR2 images gives a larger lead-time, which may be associated with greater uncertainty. To reduce this uncertainty, CME front edge tracking should be continued beyond the FOV of COR2 images. Therefore, heliospheric imager (HI1) data that covers 1590 Rs FOV must be included. In this paper, we propose a novel automatic method that takes both COR2 and HI1 images into account and combine the results to track the front edges of a CME continuously. The method consists of two modules: pre-processing and tracking. The pre-processing module produces a set of segmented images, which contain the signature of a CME, for both COR2 and HI1 separately. In addition, the HI1 images are resized and padded, so that the center of the Sun is the central coordinate of the resized HI1 images. The resulting COR2 andHI1 image set is then fed into the tracking module to estimate the position angle (PA) and track the front edge of a CME. The detected front edge is then used to produce a height-time profile that is used to estimate the speed of a CME. The method was validated using 15 CME events observed in the period from January 1, 2008 to August 31, 2009. The results demonstrate that the proposed method is effective for CME front edge tracking in both COR2 and HI1 images. Using this method, the CME front edge can now be tracked automatically and continuously in a much larger range, i.e., from 2 to 90 Rs, for the first time. These improvement scan greatly

[Telecardiology: Tasks and duties of telemedicine].

Science.gov (United States)

Borbás, János; Forczek, Erzsébet; Sepp, Róbert; Bari, Ferenc

2017-11-01

Telemedicine is a young science that integrates innovations of information-technology and telecommunications into medical science. A successful telemedicine procedure should guarantee reduced workload of the healthcare system with well secured and cost-effective processes. Our goal was to collect the development phases of telemedicine projects through existing telecardiology solutions. Subsequent to reviewing international publications we analyzed the past and present situation of blood pressure monitoring, remote diagnostics of electrocardiography, implantable cardioverter defibrillator monitoring and pocket ultrasound devices. In case of new solutions (a) several internationally accepted, confidently reproducible "good practices" are needed for creating (b) guidelines and recommendations of international medical associations. They have to ensure (c) cost-effective work, with well-designed sustainability and (d) patient confidentiality. Improving (e) education for professionals and patients is essential. We recommend to telemedicine developers to use our standards in order to introduce their products more effectively into clinical practice. It is encouraging that current possibilities of telecardiology partly or fully meet the aforementioned criteria. Further development of the topic can contribute to financial sustainability of our healthcare and might be able to resolve limitations of human resources. Orv Hetil. 2017; 158(44): 1741-1746.

CME, Physicians, and Pavlov: Can We Change What Happens When Industry Rings the Bell?

Science.gov (United States)

Lichter, Paul R.

2008-01-01

Purpose To show how physicians’ conditioned response to “keeping up” has helped industry’s opportunistic funding of continuing medical education (CME) and to propose ways to counter the conditioned response to the benefit of patients and the public. Methods Review of the literature and commentary on it. Results The pharmaceutical and device industries (hereafter referred to as industry) have a long history of bribing physicians to prescribe and use their products. Increasing pressure from Congress and the public has been brought to bear on industry gifting. This pressure, coinciding with increasing financial problems for the providers of CME, provided industry with reason and opportunity to expand its role in the financing of CME. Industry’s incentive to make its CME funding appear to be an arm’s-length transaction has spawned medical education service supplier (MESS) companies. Industry makes “unrestricted grants” to the MESS, and the MESS puts on the CME program. Helped by these CME programs, industry is able to subtly “buy” physicians one at a time, so that under the cover of “education” they and their academic institutions and medical organizations lose sight of being CME pawns in industry’s sole objective: profit. Conclusions Despite a vast literature showing how physician integrity is easy prey to industry, the medical profession continues to allow industry to have a detrimental influence on the practice of medicine and on physician respectability. It will take resolute action to change the medical profession’s conditioned response to industry’s CME bell and its negative effect on patients and the public. PMID:19277219

Technology and quality control in telemedicine

International Nuclear Information System (INIS)

Barman, Mallika Roy; Pratik Kumar; Subramaniam, Kailash

2003-01-01

Transferring of medical electronic data from one place to another is known as telemedicine. All relevant medical opinions and investigations, like EGG, x-ray, sonography, GT scan, MRI and angiography can be transferred from one location to another by telemedicine. In developing countries like India where rural population is more and specialized doctors and hospital are few and located more in cities, it should be very useful

Telemedicine - a scientometric and density equalizing analysis.

Science.gov (United States)

Groneberg, David A; Rahimian, Shaghayegh; Bundschuh, Matthias; Schwarzer, Mario; Gerber, Alexander; Kloft, Beatrix

2015-01-01

As a result of the various telemedicine projects in the past years a large number of studies were recently published in this field. However, a precise bibliometric analysis of telemedicine publications does not exist so far. The present study was conducted to establish a data base of the existing approaches. Density-equalizing algorithms were used and data was retrieved from the Thomson Reuters database Web of Science. During the period from 1900 to 2006 a number of 3290 filed items were connected to telemedicine, with the first being published in 1964. The studies originate from 101 countries, with the USA, Great Britain and Canada being the most productive suppliers participating in 56.08 % of all published items. Analyzing the average citation per item for countries with more than 10 publications, Ireland ranked first (10.19/item), New Zealand ranked second (9.5/item) followed by Finland (9.04/item). The citation rate can be assumed as an indicator for research quality. The ten most productive journals include three journals with the main focus telemedicine and another five with the main focus "Information/Informatics". In all subject categories examined for published items related to telemedicine, "Health Care Sciences & Services" ranked first by far. More than 36 % of all publications are assigned to this category, followed by "Medical Informatics" with 9.72 % and "Medicine, General & Internal" with 8.84 % of all publications. In summary it can be concluded that the data shows clearly a strong increase in research productivity. Using science citation analysis it can be assumed that there is a large rise in the interest in telemedicine studies.

QoE for telemedicine: challenges and trends

Science.gov (United States)

Cavaro-Ménard, Christine; Lu, Zhang Ge; Le Callet, Patrick

2013-09-01

Telemedicine that involves sharing of digital data (i.e. physiological signals, 2D/3D images and videos) should meet the same standards of traditional healthcare in terms of usability, accessibility, efficiency, effectiveness and quality of clinical processes. All these requirements can be seen as elementary components that participate to the quality of experience (QoE) in an ad hoc medical application scenario. Although, the quality of service (QoS) in telemedicine has been quite investigated, QoE is still lacking clear definition in this context. This later should not be assimilated to QoS as it refers clearly to the experience by the user while QoS focuses mostly on the system. QoE has a potential relevancy to optimize and understand the technical transmission chain from the final task point viewpoint which one of the most important factor for adoption of telemedicine. Towards this goal, QoE studies should be conducted with an appropriate methodology incorporating user involvement and digital data and their relation with QoS. As one of the first effort in this field, this paper proposes a survey of some key issues and solutions associated to QoE in telemedicine. We first present the services offered by telemedicine and underline the significance of QoE for tele-diagnosis and tele-surgery. Next, we identify and analyze the influencing factors such as application area, application purpose (emergency care, acquisition assistance, second opinion, education...), content type (data specificities depending on acquisition modality), context of use (offline/real time, interactivity...), and user's state (stress, expertise...), that have to be considered for a relevant QoE assessment in telemedicine.

Application of Ethics for Providing Telemedicine Services and Information Technology.

Science.gov (United States)

Langarizadeh, Mostafa; Moghbeli, Fatemeh; Aliabadi, Ali

2017-10-01

Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients' information confidential and secure, controlling a number of therapists' inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients' personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and guidelines to therapists. Due to the advancement in

Towards reinforcing telemedicine adoption amongst clinicians in Nigeria.

Science.gov (United States)

Adenuga, Kayode I; Iahad, Noorminshah A; Miskon, Suraya

2017-08-01

Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (ptelemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians. Copyright © 2017. Published by Elsevier B.V.

The use of telemedicine in Italian Blood Banks: a nationwide survey.

Science.gov (United States)

Berti, Pierluigi; Verlicchi, Franco; Fiorin, Francesco; Guaschino, Roberto; Cangemi, Adelio

2014-01-01

Telemedicine is defined as the use of electronic information and communication technologies to provide health care between distant people. Many activities in transfusion medicine could benefit from the application of telemedicine. To map the spread of the use of telemedicine in transfusion medicine in Italy, the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) performed a nationwide survey: the results are presented in this paper. A survey, dealing with different aspects of the use of telemedicine, was performed by sending a questionnaire to 280 Italian Blood Centres. The survey was designed to evaluate the diffusion of telemedicine and the features of the systems, with special attention to the systems' safety and legal adequacy. One section of the questionnaire was designed to identify the features of the systems considered essential by the respondents. Out of 280 Blood Services contacted, 196 (70%) filled in at least one of the questions of the online questionnaire. Globally the use of some form of telemedicine was reported by 70% of the respondents. Telemedicine is used for remote validation of laboratory tests by 32% of the Centres that responded, for remote biological validation of blood units by 34% and for assignment of blood components by 29%. Less frequently, telemedicine is used to control electronic refrigerators, for electronic blood requests and for bed-side identification of patients. The use of telemedicine is widespread in Italian Blood Services. There appears to be some heterogeneity between structures with regards to the evaluation of the systems' safety and their legal adequacy. No telemedicine system should be introduced into practice until it has proven to have the same standards of safety as the corresponding "on site" activity.

An exploratory survey of the applications of telemedicine in Ghana.

Science.gov (United States)

Darkwa, O

2000-01-01

We examined the use of telemedicine at two major medical institutions in Ghana. Doctors and administrators were surveyed to assess their knowledge of computers and familiarity with telemedicine. The use of modern telecommunications and information technology products within the health service was also examined. Thirty questionnaires were distributed to staff at the two hospitals, one urban and one rural. Twenty were returned (a response rate of 67%). Although most of the respondents were computer literate, they were less familiar with telemedicine applications. Only a minority of the respondents were participating in an information-sharing network, transmitting information by fax or telephone, or had Internet access. Financial constraint appeared to be the major barrier to establishing information-sharing networks. Other constraints were technological and organizational. The respondents expressed an interest in using telemedicine, having access to health-care databases and specific telemedicine applications such as tele-education and videoconferencing. Staff in the urban hospital were more likely to be familiar with telemedicine and more likely to have access to information technology than those in the rural hospital.

PROBABILITY OF CME IMPACT ON EXOPLANETS ORBITING M DWARFS AND SOLAR-LIKE STARS

Energy Technology Data Exchange (ETDEWEB)

Kay, C. [Solar Physics Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD 20771 (United States); Opher, M.; Kornbleuth, M., E-mail: ckay@bu.edu [Astronomy Department, Boston University, Boston, MA 02215 (United States)

2016-08-01

Solar coronal mass ejections (CMEs) produce adverse space weather effects at Earth. Planets in the close habitable zone of magnetically active M dwarfs may experience more extreme space weather than at Earth, including frequent CME impacts leading to atmospheric erosion and leaving the surface exposed to extreme flare activity. Similar erosion may occur for hot Jupiters with close orbits around solar-like stars. We have developed a model, Forecasting a CME's Altered Trajectory (ForeCAT), which predicts a CME's deflection. We adapt ForeCAT to simulate CME deflections for the mid-type M dwarf V374 Peg and hot Jupiters with solar-type hosts. V374 Peg's strong magnetic fields can trap CMEs at the M dwarfs's Astrospheric Current Sheet, that is, the location of the minimum in the background magnetic field. Solar-type CMEs behave similarly, but have much smaller deflections and do not become trapped at the Astrospheric Current Sheet. The probability of planetary impact decreases with increasing inclination of the planetary orbit with respect to the Astrospheric Current Sheet: 0.5–5 CME impacts per day for M dwarf exoplanets, 0.05–0.5 CME impacts per day for solar-type hot Jupiters. We determine the minimum planetary magnetic field necessary to shield a planet's atmosphere from CME impacts. M dwarf exoplanets require values between tens and hundreds of Gauss. Hot Jupiters around a solar-type star, however, require a more reasonable <30 G. These values exceed the magnitude required to shield a planet from the stellar wind, suggesting that CMEs may be the key driver of atmospheric losses.

PROBABILITY OF CME IMPACT ON EXOPLANETS ORBITING M DWARFS AND SOLAR-LIKE STARS

International Nuclear Information System (INIS)

Kay, C.; Opher, M.; Kornbleuth, M.

2016-01-01

Solar coronal mass ejections (CMEs) produce adverse space weather effects at Earth. Planets in the close habitable zone of magnetically active M dwarfs may experience more extreme space weather than at Earth, including frequent CME impacts leading to atmospheric erosion and leaving the surface exposed to extreme flare activity. Similar erosion may occur for hot Jupiters with close orbits around solar-like stars. We have developed a model, Forecasting a CME's Altered Trajectory (ForeCAT), which predicts a CME's deflection. We adapt ForeCAT to simulate CME deflections for the mid-type M dwarf V374 Peg and hot Jupiters with solar-type hosts. V374 Peg's strong magnetic fields can trap CMEs at the M dwarfs's Astrospheric Current Sheet, that is, the location of the minimum in the background magnetic field. Solar-type CMEs behave similarly, but have much smaller deflections and do not become trapped at the Astrospheric Current Sheet. The probability of planetary impact decreases with increasing inclination of the planetary orbit with respect to the Astrospheric Current Sheet: 0.5–5 CME impacts per day for M dwarf exoplanets, 0.05–0.5 CME impacts per day for solar-type hot Jupiters. We determine the minimum planetary magnetic field necessary to shield a planet's atmosphere from CME impacts. M dwarf exoplanets require values between tens and hundreds of Gauss. Hot Jupiters around a solar-type star, however, require a more reasonable <30 G. These values exceed the magnitude required to shield a planet from the stellar wind, suggesting that CMEs may be the key driver of atmospheric losses.

Designing Telemedicine Systems for Geriatric Patients: A Review of the Usability Studies.

Science.gov (United States)

Narasimha, Shraddhaa; Madathil, Kapil Chalil; Agnisarman, Sruthy; Rogers, Hunter; Welch, Brandon; Ashok, Aparna; Nair, Aswathi; McElligott, James

2017-06-01

One area where telemedicine may prove to be highly effective is in providing medical care to the geriatric population, an age group predicted to account for 20% of the population in the near future. However, even though telemedicine has certain advantages, the usability of these systems with this population merits investigation. This article reviews the literature published from 2000 to 2016 with the goal of analyzing the characteristics of usability-related studies conducted using geriatric participants and the subsequent usability challenges identified. Articles were found using Web of Knowledge and PubMed citation indexing portals using the keywords (1) Telemedicine* AND Geriatrics* (2) Telemedicine* AND Usability* (3) Telemedicine* AND Usability* AND Older Adults*. A total of 297 articles were obtained from the initial search. After further detailed screening, 16 articles were selected for review based on the inclusion criteria. Of these, 60% of the studies focused on the overall usability of telemedicine systems; 6.25% focused on the usability of a telepresence robot; 12.5% compared a face-to-face medical consultation with the use of telemedicine systems, and 25% focused on the study of other aspects of telemedicine in addition to its usability. Findings reported in the studies included high patient satisfaction with telemedicine in 31.25%, whereas another 31.25% indicated a high acceptance of this method of medical consultation. Care coordination in 6.25% of the studies; confidence in telemedicine in 6.25%; trust, privacy, and reliability in 6.25%; and increased convenience when compared to personal visits in 18.75% were also reported. This review suggests limited research providing scientifically valid and reproducible usability evaluation at various stages of telemedicine system development. Telemedicine system designers need to consider the age-related issues in cognition, perception, and behavior of geriatric patients while designing telemedicine

The business case for telemedicine.

Science.gov (United States)

Henny, Chris; Hartington, Katharine; Scott, Stuart; Tveiten, Agnar; Canals, Luisa

2013-01-01

Following the coming into force of the International Labour Organisation Maritime Labour Convention (ILO/MLC) and International Maritime Organisation Standards for Training, Certification and Watchkeeping, Manila 2010 (IMO/STCW) amendments, the objective of this article is to provide the shipping community with an initial assessment of the economic reasons and business case, in support of both publicly financed and private telemedicine being implemented on board commercial vessels. It provides the global scale of the requirement, the number of Telemedicine Assistance Services (TMAS) calls handled by participating TMAS, the average direct and indirect costs incurred by both TMAS and ship operators, responding to medical emergencies, and also provides a calculation of the market size of about 760 million Euro/year. It estimates a return on investment per ship, of implementing telemedicine on board to meet the MLC and STCW requirements at less than 1 year. 1. There are both financial and soft benefits, such as crew retention and being perceived as a quality employer offering a telemedicine service on board. 2. It is quite possible to obtain a 20% savings to the industry of perhaps 152 million Euro/year from the deployment of telemedicine on board. 3. The deployment of a telemedical service on ships is an opportunity to encourage further cooperation between TMAS and also with the private TMAS sector. 4. There is clearly a great need, on a global basis, for more cooperation, particularly in standardisation of pre-boarding medical files available, the equipmentrequired on board at a minimum, and level of service quality provided. 5. A collection of a common TMAS annual set of normalised statistics from the stakeholders in the maritime industry is needed. Should someone not be tasked with collecting this? 6. Open registries and countries where the private sector only providestele medicine, should be encouraged to work with the global public TMAS system and contribute to

A new day for CME/CPD in Canada: proceedings from the 1st Canada Regional Conference of the Global Alliance for Medical Education in Montreal, Canada

Directory of Open Access Journals (Sweden)

Suzanne Murray

2015-11-01

Full Text Available The Global Alliance for Medical Education (GAME is a not-for-profit organization founded in 1995, with the aim of advancing innovation in medical education. The 1st GAME Canada regional conference was held in Montreal on May 22, 2015, under the leadership of Suzanne Murray, who acted as programme chair, and GAME president Lisa Sullivan. The conference brought together a broad array of speakers and panellists, including experts from academic centres, health systems, accreditors, private organizations, and industry. Thirty-one key stakeholders participated in the event, demonstrating a strong commitment towards the improvement of best practice in continuing medical education (CME/continuing professional development (CPD. The conference included diverse presentations providing opportunities for reflection and discussion throughout the day. The participants actively took part in stimulating discussions that covered a large range of topics, including the need for enhanced networking and opportunities to learn from others, the challenges of assessment and the potential solutions, interprofessional education and competencies, and, finally, the future of a Canadian CME/CPD organization.

Hageseth's principle of extraterritorial jurisdiction and international telemedicine.

Science.gov (United States)

McLean, Thomas R; McLean, Alexander B

2008-01-01

At what point does an international telemedicine transaction create a sufficient commercial nexus to allow one country the authority to impose its laws on a foreign telemedicine providers? Some light on this matter was shed by the US case of Hageseth versus Superior Court. The authority for extraterritorial jurisdiction is found in the US Constitution, which requires the states to cooperate in matters of law enforcement. Similar cooperation from foreign nations cannot be expected. Unless a defendant is charged with a capital offence, nations are rarely willing to extradite their citizens. As the unlicensed practice of medicine is not a capital offence, it is unlikely that an unlicensed telemedicine provider would be extradited to the US. Because low-volume unlicensed offshore telemedicine providers are unlikely to be extradited or to be subject to trade sanctions, they may be able to operate beyond the law.

Determinants of successful telemedicine implementations: a literature study

NARCIS (Netherlands)

Broens, T.H.F.; Huis in 't Veld, M.H.A.; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.; van Halteren, Aart; Nieuwenhuis, Lambertus Johannes Maria

Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had

The SCEC Community Modeling Environment (SCEC/CME) - An Overview of its Architecture and Current Capabilities

Science.gov (United States)

Maechling, P. J.; Jordan, T. H.; Minster, B.; Moore, R.; Kesselman, C.; SCEC ITR Collaboration

2004-12-01

The Southern California Earthquake Center (SCEC), in collaboration with the San Diego Supercomputer Center, the USC Information Sciences Institute, the Incorporated Research Institutions for Seismology, and the U.S. Geological Survey, is developing the Southern California Earthquake Center Community Modeling Environment (CME) under a five-year grant from the National Science Foundation's Information Technology Research (ITR) Program jointly funded by the Geosciences and Computer and Information Science & Engineering Directorates. The CME system is an integrated geophysical simulation modeling framework that automates the process of selecting, configuring, and executing models of earthquake systems. During the Project's first three years, we have performed fundamental geophysical and information technology research and have also developed substantial system capabilities, software tools, and data collections that can help scientist perform systems-level earthquake science. The CME system provides collaborative tools to facilitate distributed research and development. These collaborative tools are primarily communication tools, providing researchers with access to information in ways that are convenient and useful. The CME system provides collaborators with access to significant computing and storage resources. The computing resources of the Project include in-house servers, Project allocations on USC High Performance Computing Linux Cluster, as well as allocations on NPACI Supercomputers and the TeraGrid. The CME system provides access to SCEC community geophysical models such as the Community Velocity Model, Community Fault Model, Community Crustal Motion Model, and the Community Block Model. The organizations that develop these models often provide access to them so it is not necessary to use the CME system to access these models. However, in some cases, the CME system supplements the SCEC community models with utility codes that make it easier to use or access

Transforming Gastroenterology Care With Telemedicine.

Science.gov (United States)

Siegel, Corey A

2017-04-01

Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Two Distinct Types of CME-flare Relationships Based on SOHO and STEREO Observations

Energy Technology Data Exchange (ETDEWEB)

Jang, Soojeong; Moon, Yong-Jae [School of Space Research, Kyung Hee University, Yongin (Korea, Republic of); Kim, Rok-Soon; Kim, Sujin; Lee, Jae-Ok, E-mail: moonyj@khu.ac.kr [Korea Astronomy and Space Science Institute, Daejeon (Korea, Republic of)

2017-08-20

In this paper, we present two distinct types of coronal mass ejection (CME)-flare relationships according to their observing time differences using 107 events from 2010 to 2013. The observing time difference, Δ T , is defined as flare peak time minus CME first appearance time at Solar Terrestrial Relations Observatory ( STEREO ) COR1 field of view. There are 41 events for group A (Δ T < 0) and 66 events for group B (Δ T ≥ 0). We compare CME 3D parameters (speed and kinetic energy) based on multi-spacecraft data ( SOlar and Heliospheric Observatory ( SOHO ) and STEREO A and B ) and their associated flare properties (peak flux, fluence, and duration). Our main results are as follows. First, there are better relationships between CME and flare parameters for group B than that of group A. In particular, CME 3D kinetic energy for group B is well correlated with flare fluence with the correlation coefficient of 0.67, which is much stronger than that (cc = 0.31) of group A. Second, the events belonging to group A have short flare durations of less than 1 hr (mean = 21 minutes), while the events for group B have longer durations up to 4 hr (mean = 81 minutes). Third, the mean value of height at peak speed for group B is 4.05 Rs, which is noticeably higher than that of group A (1.89 Rs). This is well correlated with the CME acceleration duration (cc = 0.75). A higher height at peak speed and a longer acceleration duration of CME for group B could be explained by the fact that magnetic reconnections for group B continuously occur for a longer time than those for group A.

Need and feasibility of telemedicine in non-urban day care centres.

Science.gov (United States)

Setia, Monika; DelliFraine, Jami L

2010-01-01

There appear to have been no studies of telemedicine in rural day care centres. We have assessed the feasibility of using telemedicine in eight rural day care centres in Pennsylvania, from the day care centres' perspective. The average number of children in these centres was 76 (range 20-150). The centres sent an average of 4.7 children home each month because of illness. Using telephone and face-to-face interviews, we assessed their perceived need for and familiarity with telemedicine, as well as their openness and preparedness for implementing telemedicine. Most day care centres reported a need for telemedicine and were open to learning how to use it. Some centres were concerned about adequate space for the equipment, but overall, the centres felt that their resources were adequate. Telemedicine in rural day care centres appears to be feasible, and would have the potential to save time and money for parents, as well as perhaps improving health care for children in rural areas.

CME Simulations with Boundary Conditions Derived from Multiple Viewpoints of STEREO

Science.gov (United States)

Singh, T.; Yalim, M. S.; Pogorelov, N. V.

2017-12-01

Coronal Mass Ejections (CMEs) are major drivers of extreme space weather conditions, which is a matter of huge concern for our modern technologically dependent society. Development of numerical approaches that would reproduce CME propagation through the interplanetary space is an important step towards our capability to predict CME arrival time at Earth and their geo-effectiveness. It is also important that CMEs are propagating through a realistic, data-driven background solar wind (SW). In this study, we use a version of the flux-rope-driven Gibson-Low (GL) model to simulate CMEs. We derive inner boundary conditions for the GL flux rope model using the Graduate Cylindrical Shell (GCS) method. This method uses viewpoints from STEREO A and B, and SOHO/LASCO coronagraphs to determine the size and orientation of a CME flux rope as it starts to erupt from Sun. A flux rope created this way is inserted into an SDO/HMI vector magnetogram driven SW background obtained with the Multi-Scale Fluid-Kinetic Simulation Suite (MS-FLUKSS). Numerical results are compared with STEREO, SDO/AIA and SOHO/LASCO observations in particular in terms of the CME speed, acceleration and magnetic field structure.

The Promise of Telemedicine for Movement Disorders: an Interdisciplinary Approach.

Science.gov (United States)

Ben-Pazi, H; Browne, P; Chan, P; Cubo, E; Guttman, M; Hassan, A; Hatcher-Martin, J; Mari, Z; Moukheiber, E; Okubadejo, N U; Shalash, A

2018-04-13

Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.

Telemedicine: the invisible legal barriers to the health care of the future.

Science.gov (United States)

Daly, H L

2000-01-01

Telemedicine has the potential to transform the world of health care just as the Internet transformed the world of commerce. Ms. Daly examines two legal obstacles to expanding the use of telemedicine: licensure and liability. She defines telemedicine and discusses its common applications and significant benefits. Licensure laws and liability rules result in formidable barriers to the expanded use of telemedicine, while also failing to provide sufficient protection for consumers. Ms. Daly argues that for the benefits of telemedicine to reach those most in need, mutual recognition of licensing laws coupled with a universal standard of care is necessary.

Use of telemedicine technologies in the management of infectious diseases: a review.

Science.gov (United States)

Parmar, Parmvir; Mackie, David; Varghese, Sunil; Cooper, Curtis

2015-04-01

Telemedicine technologies are rapidly being integrated into infectious diseases programs with the aim of increasing access to infectious diseases specialty care for isolated populations and reducing costs. We summarize the utility and effectiveness of telemedicine in the evaluation and treatment of infectious diseases patients. The use of telemedicine in the management of acute infectious diseases, chronic hepatitis C, human immunodeficiency virus, and active pulmonary tuberculosis is considered. We recapitulate and evaluate the advantages of telemedicine described in other studies, present challenges to adopting telemedicine, and identify future opportunities for the use of telemedicine within the realm of clinical infectious diseases. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Validation of the CME Geomagnetic forecast alerts under COMESEP alert system

Science.gov (United States)

Dumbovic, Mateja; Srivastava, Nandita; Khodia, Yamini; Vršnak, Bojan; Devos, Andy; Rodriguez, Luciano

2017-04-01

An automated space weather alert system has been developed under the EU FP7 project COMESEP (COronal Mass Ejections and Solar Energetic Particles: http://comesep.aeronomy.be) to forecast solar energetic particles (SEP) and coronal mass ejection (CME) risk levels at Earth. COMESEP alert system uses automated detection tool CACTus to detect potentially threatening CMEs, drag-based model (DBM) to predict their arrival and CME geo-effectiveness tool (CGFT) to predict their geomagnetic impact. Whenever CACTus detects a halo or partial halo CME and issues an alert, DBM calculates its arrival time at Earth and CGFT calculates its geomagnetic risk level. Geomagnetic risk level is calculated based on an estimation of the CME arrival probability and its likely geo-effectiveness, as well as an estimate of the geomagnetic-storm duration. We present the evaluation of the CME risk level forecast with COMESEP alert system based on a study of geo-effective CMEs observed during 2014. The validation of the forecast tool is done by comparing the forecasts with observations. In addition, we test the success rate of the automatic forecasts (without human intervention) against the forecasts with human intervention using advanced versions of DBM and CGFT (self standing tools available at Hvar Observatory website: http://oh.geof.unizg.hr). The results implicate that the success rate of the forecast is higher with human intervention and using more advanced tools. This work has received funding from the European Commission FP7 Project COMESEP (263252). We acknowledge the support of Croatian Science Foundation under the project 6212 „Solar and Stellar Variability".

WHY IS A FLARE-RICH ACTIVE REGION CME-POOR?

Energy Technology Data Exchange (ETDEWEB)

Liu, Lijuan; Wang, Yuming; Shen, Chenglong; Ye, Pinzhong; Liu, Rui; Chen, Jun; Zhang, Quanhao; Wang, S. [CAS Key Laboratory of Geospace Environment, Department of Geophysics and Planetary Sciences, University of Science and Technology of China, Hefei, Anhui 230026 (China); Wang, Jingxiu, E-mail: ymwang@ustc.edu.cn, E-mail: ljliu@mail.ustc.edu.cn [National Astronomical Observatories, Chinese Academy of Sciences, Beijing 100012 (China)

2016-08-01

Solar active regions (ARs) are the major sources of two of the most violent solar eruptions, namely flares and coronal mass ejections (CMEs). The largest AR in the past 24 years, NOAA AR 12192, which crossed the visible disk from 2014 October 17 to 30, unusually produced more than one hundred flares, including 32 M-class and 6 X-class ones, but only one small CME. Flares and CMEs are believed to be two phenomena in the same eruptive process. Why is such a flare-rich AR so CME-poor? We compared this AR with other four ARs; two were productive in both and two were inert. The investigation of the photospheric parameters based on the SDO /HMI vector magnetogram reveals that the flare-rich AR 12192, as with the other two productive ARs, has larger magnetic flux, current, and free magnetic energy than the two inert ARs but, in contrast to the two productive ARs, it has no strong, concentrated current helicity along both sides of the flaring neutral line, indicating the absence of a mature magnetic structure consisting of highly sheared or twisted field lines. Furthermore, the decay index above the AR 12192 is relatively low, showing strong constraint. These results suggest that productive ARs are always large and have enough current and free energy to power flares, but whether or not a flare is accompanied by a CME is seemingly related to (1) the presence of a mature sheared or twisted core field serving as the seed of the CME, or (2) a weak enough constraint of the overlying arcades.

Telemedicine in Alentejo

Science.gov (United States)

Bayer, Steffen; Gonçalves, Luís; Barlow, James

2014-01-01

Abstract Alentejo covers a third of Portugal, yet it is home to only 5% of the population. Residents of the region are poorer, older, and less educated than the rest of the country. There is a shortage of physicians in several specialties. The low population density, a concentration of specialized services, and a poor public transportation network all create barriers to access. Telemedicine was introduced in 1998 to help address these challenges. In this article, we provide an overview of the program and its current status, focusing on infrastructure, services, and activity volume. We also discuss the impact the program has had from the perspectives of patients and healthcare professionals. From 1998 to 2011, there were 132,546 episodes of service using telemedicine, including real-time teleconsultations, teleradiology, teleultrasound, and telepathology. At present, the network includes 20 primary care units and five hospitals, covering almost 30,000 km2 and 500,000 people. Units have high-resolution videoconferencing equipment, access to patients' clinical records, an image archive, and peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are available in 15 medical specialties and areas, ranging from neurology to pediatric surgery. In 2008, regional health authorities started a tele-education program, and by the end of 2011, 876 healthcare professionals, across 52 locations, had participated in remote learning sessions. More than a decade since telemedicine was introduced in Alentejo, it is now an integral part of everyday service provision. A comprehensive assessment of the costs and consequences of the program is currently underway. PMID:24180419

Japanese experience of telemedicine in oncology.

Science.gov (United States)

Mizushima, H; Uchiyama, E; Nagata, H; Matsuno, Y; Sekiguchi, R; Ohmatsu, H; Hojo, F; Shimoda, T; Wakao, F; Shinkai, T; Yamaguchi, N; Moriyama, N; Kakizoe, T; Abe, K; Terada, M

2001-05-01

We started telemedicine projects from 1990 with a telepathology system within Tsukiji Campus of National Cancer Center. In 1994, we connected Tsukiji Campus and Kashiwa Campus by 6 Mbps optical fiber leased line using IP protocol for data transmission, for teleconference, telepathology, and teleradiology projects. We also started connection of regional cancer centers and are now forming a cancer center network of 14 cancer centers. We are at present organizing 130 teleconferences per year with an attendance of more than 16000 people as summary. We have also used a high-resolution image transferring system, such as SHD (2000 pixelsx2000 pixels resolution) system on one side, and an economical telemedicine system using JAVA and a WWW browser (NCC_image) on the other side. We think that providing information is another field of telemedicine. We began the experimental gopher and WWW service in 1993. We are now providing official up-to-date cancer information for patients and healthcare professionals. We are getting more than 400000 hits per month. We are also providing a teleconference video session which is held every week on the Internet using a Real Video system with synchronized slide presentation on the WWW browser. We are also organizing a Cancer Image Reference Database System including DICOM images with viewer software. This paper is a summary of the telemedicine projects performed at the National Cancer Center.

Telemedicine in Majuro Hospital, Marshall Islands.

Science.gov (United States)

Gunawardane, K J

2000-09-01

Since March 1998 up to June 2000, telemedicine activities in Marshall Islands have mainly been for Referrals to Tripler Army Medical Center (TAMC) in Hawaii. The activities are based on a computer which has the Internet connection and accessories including a digital camera, flatbed scanner with a transparency adapter, color printer, a video printer, ophthalmoscope, otoscope and a video Lens, all of which were donated by Project Akamai in Hawaii. Two sessions of training were conducted by representatives from Akamai Project and from PBMA at the very beginning of the establishment of the unit, to all levels of Health Care Providers in Ministry of Health in Majuro. The computer and Internet facility is available 24 hours. Since March 1998 to June 2000, there had been 144 telemedicine consultations to TAMC. Out of a total of 326 off-island referrals for the same period, approximately 80 patients have been sent to TAMC using the PIHCP/Telemedicine program. This accounts for approximately 25% of total off-island referrals. This represents a significant reduction in cost. In addition to cost reduction the telemedicine unit most important impact is on the health providers, especially the physicians working at Majuro Hospital. Availability of medical information through internet has helped them to feel less isolated from the constantly changing field of medical science.

Differences in Readiness between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings from a Statewide Telemedicine Survey

Science.gov (United States)

Martin, Amy Brock; Probst, Janice C.; Shah, Kyle; Chen, Zhimin; Garr, David

2012-01-01

Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation…

Telemedicine: history, applications, and impact on librarianship.

OpenAIRE

Zundel, K M

1996-01-01

This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (inclu...

Telemedicine and Palliative Care: an Increasing Role in Supportive Oncology.

Science.gov (United States)

Worster, Brooke; Swartz, Kristine

2017-06-01

With the emergence of telemedicine as a routine form of care in various venues, the opportunities to use technology to care for the most vulnerable, most ill cancer patients are extremely appealing. Increasingly, evidence supports early integration of palliative care with standard oncologic care, supported by recent NCCN guidelines to increase and improve access to palliative care. This review looks at the use of telemedicine to expand access to palliative care as well as provide better care for patients and families where travel is difficult, if not impossible. When telemedicine has been used, often in Europe, for palliative care, the results show improvements in symptom management, comfort with care as well as patient and family satisfaction. One barrier to use of telemedicine is the concerns with technology and technology-related complications in population that is often elderly, frail and not always comfortable with non-face-to-face physician care. There remain significant opportunities to explore this intersection of supportive care and telemedicine.

Online continuing medical education (CME) for GPs: does it work? A systematic review.

Science.gov (United States)

Thepwongsa, Isaraporn; Kirby, Catherine N; Schattner, Peter; Piterman, Leon

2014-10-01

Numerous studies have assessed the effectiveness of online continuing medical education (CME) designed to improve healthcare professionals' care of patients. The effects of online educational interventions targeted at general practitioners (GP), however, have not been systematically reviewed. A computer search was conducted through seven databases for studies assessing changes in GPs' knowledge and practice, or patient outcomes following an online educational intervention. Eleven studies met the eligibility criteria. Most studies (8/11, 72.7%) found a significant improvement in at least one of the following outcomes: satisfaction, knowledge or practice change. There was little evidence for the impact of online CME on patient outcomes. Variability in study design, characteristics of online and outcome measures limited conclusions on the effects of online CME. Online CME could improve GP satisfaction, knowledge and practices but there are very few well-designed studies that focus on this delivery method of GP education.

Evolution of telemedicine from an applied communication perspective in the United States.

Science.gov (United States)

Whitten, Pamela; Sypher, Beverly Davenport

2006-10-01

Telemedicine, the use of telecommunication technologies to provide health services over some distance, has a history that spans more than five decades. Technological development and deployment have been interrelated with shifting paradigmatic views. This paper proposes that telemedicine has evolved through three generations that began with telemedicine as a communication medium to complement traditional services to a technology of automation and decision tools that expands the scope and range of health services and creates a unique health communication context. This paper provides a literature review and overviews three proposed evolutionary stages for telemedicine to date, namely synchronous versus asynchronous modalities, data transfer and storage, and automating decision making and robotics. Finally, we conclude with a discussion of the barriers for telemedicine and a call for engineers to join with social scientists and medical professionals to set an agenda for future telemedicine development.

MED5/355: Using Web-technology for Asynchronous Telemedicine Consulting

OpenAIRE

Reviakin, Y; Sukhanov, A

1999-01-01

Introduction Common telemedicine consultations can be divided in two classes: real-time telemedicine consultations and asynchronous telemedicine consultations. The advantage of real-time consultations is obvious - this is a natural discussion between physicians, which may be realised on the basis of desktop videoconferences. But the problems are also obvious: the necessity of additional hardware and the elevated demands for channel bandwidth. Because of the latter, the use of asynchronous tel...

Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review.

Science.gov (United States)

Mileski, Michael; Kruse, Clemens Scott; Catalani, Justin; Haderer, Tara

2017-10-24

Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of

Selecting a digital camera for telemedicine.

Science.gov (United States)

Patricoski, Chris; Ferguson, A Stewart

2009-06-01

The digital camera is an essential component of store-and-forward telemedicine (electronic consultation). There are numerous makes and models of digital cameras on the market, and selecting a suitable consumer-grade camera can be complicated. Evaluation of digital cameras includes investigating the features and analyzing image quality. Important features include the camera settings, ease of use, macro capabilities, method of image transfer, and power recharging. Consideration needs to be given to image quality, especially as it relates to color (skin tones) and detail. It is important to know the level of the photographer and the intended application. The goal is to match the characteristics of the camera with the telemedicine program requirements. In the end, selecting a digital camera is a combination of qualitative (subjective) and quantitative (objective) analysis. For the telemedicine program in Alaska in 2008, the camera evaluation and decision process resulted in a specific selection based on the criteria developed for our environment.

Portable emergency telemedicine system over wireless broadband and 3G networks.

Science.gov (United States)

Hong, SungHye; Kim, SangYong; Kim, JungChae; Lim, DongKyu; Jung, SeokMyung; Kim, DongKeun; Yoo, Sun K

2009-01-01

The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.

Clinical outcomes resulting from telemedicine interventions: a systematic review

Directory of Open Access Journals (Sweden)

Kraemer Dale

2001-11-01

Full Text Available Abstract Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis. All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

Telemedicine: an enhanced emergency care program for older adults

Directory of Open Access Journals (Sweden)

Takahashi PY

2014-07-01

Full Text Available Paul Y Takahashi,1 Anupam Chandra,1 Frederick North,1 Jennifer L Pecina,2 Benjavan Upatising,3 Gregory J Hanson11Mayo Clinic Division of Primary Care Internal Medicine, 2Mayo Clinic Department of Family Medicine, Rochester, MN, USA; 3Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USAAbstract: Recent changes and consolidations in health care systems have resulted in an increase in new health care delivery models. Telemedicine holds great promise as one of these models. There is a great potential for new patient evaluation and treatment models in emergency care (EC, especially when patients are miles away from a medical team. Evaluations can be performed in a patient's home, a nursing care facility, and in hospitals that focus on advanced subspecialty care. Due to rapid developments in this area, current care models are constantly being evaluated and modified. This review article outlines current telemedicine models for EC and summarizes their potential benefits to patients and the health care system. The review examines the role that the telephone, a fundamental tool of telemedicine, plays in these new models. The review also examines evidence of improved health care outcomes by highlighting the role of telemedicine in reducing hospitalizations. The patient is the primary focus; as a result, this review also examined patient experiences and satisfaction levels regarding telemedicine health care teams. The authors support these technological advances and their potential for information transfer. Health care providers need to continue developing these models by making use of increasing amounts of information. One of the main implementation barriers of these new models in the US and other countries is the issue of payment and reimbursement. Despite this, advancements in EC telemedicine continue.Keywords: telemedicine, emergency care, geriatric, patient evaluation models

Current Landscape of Telemedicine Practice in Inflammatory Bowel Disease.

Science.gov (United States)

Patil, Seema A; Cross, Raymond K

2018-04-28

Inflammatory bowel disease (IBD), comprised of Crohn's disease and ulcerative colitis, affects 1.6 million people in the United States. Although effective medical treatments exist to treat the disease, outcomes are still suboptimal. The reasons for poor outcomes vary but include nonadherence to therapy, inadequate monitoring of patients, limited access to IBD specialty care, concurrent psychiatric disease, limited patient knowledge of the disease and treatments, and patient provider discordance. Telemedicine is a candidate intervention that can be used to improve patient outcomes through more frequent monitoring, patient self-management, delivery of education (patient and provider), and to increase access to multidisciplinary IBD care. Telemedicine includes remote monitoring, telehealth, teleconsultation, and teleconferencing.Telemedicine systems have been used in patients with IBD with widespread patient acceptance of the technology. However, early clinical trials demonstrated high attrition rates among intervention patients. In general, use of telemedicine systems have been associated with improved quality of life, improved patient knowledge, and decreased utilization of health care resources. Early studies evaluating telehealth visits report high patient satisfaction, decreased indirect costs to patients, and no decrease in quality of care delivered.Due to widespread access to computers and smart phones among patients, telemedicine will continue to expand in the care of patients with IBD. To optimize use and effectiveness of telemedicine, barriers for use including concerns over increased liability, need for informed consent, licensure restrictions to providing interstate telehealth visits, and cybersecurity need to be addressed.

A biometric method to secure telemedicine systems.

Science.gov (United States)

Zhang, G H; Poon, Carmen C Y; Li, Ye; Zhang, Y T

2009-01-01

Security and privacy are among the most crucial issues for data transmission in telemedicine systems. This paper proposes a solution for securing wireless data transmission in telemedicine systems, i.e. within a body sensor network (BSN), between the BSN and server as well as between the server and professionals who have assess to the server. A unique feature of this solution is the generation of random keys by physiological data (i.e. a biometric approach) for securing communication at all 3 levels. In the performance analysis, inter-pulse interval of photoplethysmogram is used as an example to generate these biometric keys to protect wireless data transmission. The results of statistical analysis and computational complexity suggest that this type of key is random enough to make telemedicine systems resistant to attacks.

Health information systems to improve health care: A telemedicine case study

Directory of Open Access Journals (Sweden)

Liezel Cilliers

2013-03-01

Full Text Available Background: E-health has been identified as an integral part of the future of South African public healthcare. Telemedicine was first introduced in South Africa in 1997 and since then the cost of running the Telemedicine projects has increased substantially. Despite these efforts to introduce the system, only 34% of the Telemedicine sites in South Africa are functional at present. Objectives: Literature has suggested that one of the barriers to the successful implementation of health information systems is the user acceptance by health care workers of systems such as Telemedicine. This study investigated the user acceptance of Telemedicine in the public health care system in the Eastern Cape Province, making use of the Unified Theory of the Use and Acceptance of Technology. Method: The study employed a quantitative survey approach. A questionnaire was developed making use of existing literature and was distributed to various clinics around the province where Telemedicine has been implemented. Statistics were produced making use of Statistical Package for the Social Sciences (SPSS. Results: In general, the health care workers did understand the value and benefit of health information systems to improve the effectiveness and efficiency of the health care system. The barriers to the effective implementation of a health information system include the lack of knowledge and the lack of awareness regarding the Telemedicine system. This in turn means that the user is apprehensive when making use of the system thus contributing to less frequent usage. Conclusion: Health care workers do acknowledge that information systems can help to increase the effectiveness of the health care system. In general, the acceptance of Telemedicine in the Eastern Cape Department of Health is positive, but in order to integrate it into standard work practices, more must be done with regards to the promotion and education of telemedicine.

The role of telemedicine in obstructive sleep apnea management.

Science.gov (United States)

Lugo, Vera; Villanueva, Jair Asir; Garmendia, Onintza; Montserrat, Josep M

2017-09-01

Obstructive sleep apnea (OSA) is a common disease that leads in notorious symptoms and comorbidities. Although general measures are important, continuous positive airway pressure (CPAP) is the best treatment option. However, compliance can be suboptimal and telemedicine may play a role to improve it. Areas covered: Review authors searched EMBASE, PubMed and Cochrane data bases using the following keywords: continuous positive airway pressure, Obstructive sleep apnea, telemedicine, respiratory telemedicine, information and communication technology. Papers published between 2000 and 2016 in English language were considered. Expert commentary: To improve OSA management, there is a pressing need to develop new cost-effective strategies, particularly those related to OSA treatment, from measures such as lifestyle changes to CPAP use. Two broad strategies should be implemented: 1) adequate pre-, peri-, and post-titration measures to ensure correct diagnosis, adequate training, and appropriate support during follow up; and 2) the use of technological advances including both the optimization of CPAP devices and the use of telemedicine, specially focused on the first days or weeks of treatment. Telemedicine can help with these processes, especially when it is personalized to the needs of each patient group.

Telemedicine Services for the Arctic: A Systematic Review

Science.gov (United States)

Walderhaug, Ståle; Hartvigsen, Gunnar

2017-01-01

Background Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. Objective The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. Methods A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. Results The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated

High-Surety Telemedicine in a Distributed, 'Plug-and-Play' Environment

International Nuclear Information System (INIS)

Craft, Richard L.; Funkhouser, Donald R.; Gallagher, Linda K.; Garcia, Rudy J.; Parks, Raymond C.; Warren, Steve

1999-01-01

Commercial telemedicine systems are increasingly functional, incorporating video-conferencing capabilities, diagnostic peripherals, medication reminders, and patient education services. However, these systems (1) rarely utilize information architectures which allow them to be easily integrated with existing health information networks and (2) do not always protect patient confidentiality with adequate security mechanisms. Using object-oriented methods and software wrappers, we illustrate the transformation of an existing stand-alone telemedicine system into 'plug-and-play' components that function in a distributed medical information environment. We show, through the use of open standards and published component interfaces, that commercial telemedicine offerings which were once incompatible with electronic patient record systems can now share relevant data with clinical information repositories while at the same time hiding the proprietary implementations of the respective systems. Additionally, we illustrate how leading-edge technology can secure this distributed telemedicine environment, maintaining patient confidentiality and the integrity of the associated electronic medical data. Information surety technology also encourages the development of telemedicine systems that have both read and write access to electronic medical records containing patient-identifiable information. The win-win approach to telemedicine information system development preserves investments in legacy software and hardware while promoting security and interoperability in a distributed environment

Telemedicine and burns: an overview.

Science.gov (United States)

Atiyeh, B; Dibo, S A; Janom, H H

2014-06-30

Access to specialized burn care is becoming more difficult and is being restricted by the decreasing number of specialized burn centers. It is also limited by distance and resources for many patients, particularly those living in poverty or in rural medically underserved communities. Telemedicine is a rapidly evolving technology related to the practice of medicine at a distance through rapid access to remote medical expertise by telecommunication and information technologies. Feasibility of telemedicine in burn care has been demonstrated by various centers. Its use facilitates the delivery of care to patients with burn injuries of all sizes. It allows delivery of acute care and can be appropriately used for a substantial portion of the long-term management of patients after a burn by guiding less-experienced surgeons to treat and follow-up patients more appropriately. Most importantly, it allows better effective triage which reduces unnecessary time and resource demanding referrals that might overwhelm system capacities. However, there are still numerous barriers to the implementation of telemedicine, including technical difficulties, legal uncertainties, limited financial support, reimbursement issues, and an inadequate evidence base of its value and efficiency.

Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.

Science.gov (United States)

Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R

2018-05-01

Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.

Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project.

Science.gov (United States)

West, Susan P; Lagua, Carina; Trief, Paula M; Izquierdo, Roberto; Weinstock, Ruth S

2010-05-01

To describe the use of telemedicine for setting goals for behavior change and examine the success in achieving these goals in rural underserved older adults with diabetes. Medicare beneficiaries with diabetes living in rural upstate New York who were enrolled in the telemedicine intervention of the Informatics for Diabetes Education and Telemedicine (IDEATel) project (n = 610) participated in home televisits with nurse and dietitian educators every 4-6 weeks for 2-6 years. Behavior change goals related to nutrition, physical activity, monitoring, diabetes health maintenance, and/or use of the home telemedicine unit were established at the conclusion of each televisit and assessed at the next visit. Collaborative goal setting was employed during 18,355 televisits (mean of 33 goal-setting televisits/participant). The most common goals were related to monitoring, followed by diabetes health maintenance, nutrition, exercise, and use of the telemedicine equipment. Overall, 68% of behavioral goals were rated as "improved" or "met." The greatest success was achieved for goals related to proper insulin injection technique and daily foot care. These elderly participants had the most difficulty achieving goals related to use of the computer. No gender differences in goal achievement were observed. Televisits can be successfully used to collaboratively establish behavior change goals to help improve diabetes self-management in underserved elderly rural adults.

CME 7915 (GUEST ED COMBINED).indd

African Journals Online (AJOL)

deficiencies, including iron, vitamin D and vitamin A, although every vitamin and mineral is critical to good health. It is my pleasure to collate and present the articles in this issue of. CME in the SAMJ. I thank the authors for outstanding contributions and trust that readers will find this issue constructive and educational.

Quality of data computational models and telemedicine treatment effects

NARCIS (Netherlands)

Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.

2014-01-01

Clinical decision-support functions of telemedicine systems use patient's monitored clinical data to support treatment of outpatients. However, the quality of monitored clinical data may vary due to performance variations of technological resources inside a deployed telemedicine system. This paper

Innovation Network Development Model in Telemedicine: A Change in Participation.

Science.gov (United States)

Goodarzi, Maryam; Torabi, Mashallah; Safdari, Reza; Dargahi, Hossein; Naeimi, Sara

2015-10-01

This paper introduces a telemedicine innovation network and reports its implementation in Tehran University of Medical Sciences. The required conditions for the development of future projects in the field of telemedicine are also discussed; such projects should be based on the common needs and opportunities in the areas of healthcare, education, and technology. The development of the telemedicine innovation network in Tehran University of Medical Sciences was carried out in two phases: identifying the beneficiaries of telemedicine, and codification of the innovation network memorandum; and brainstorming of three workgroup members, and completion and clustering ideas. The present study employed a qualitative survey by using brain storming method. Thus, the ideas of the innovation network members were gathered, and by using Freeplane software, all of them were clustered and innovation projects were defined. In the services workgroup, 87 and 25 ideas were confirmed in phase 1 and phase 2, respectively. In the education workgroup, 8 new programs in the areas of telemedicine, tele-education and teleconsultation were codified. In the technology workgroup, 101 and 11 ideas were registered in phase 1 and phase 2, respectively. Today, innovation is considered a major infrastructural element of any change or progress. Thus, the successful implementation of a telemedicine project not only needs funding, human resources, and full equipment. It also requires the use of innovation models to cover several different aspects of change and progress. The results of the study can provide a basis for the implementation of future telemedicine projects using new participatory, creative, and innovative models.

Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients.

Science.gov (United States)

Mohr, Nicholas M; Vakkalanka, J Priyanka; Harland, Karisa K; Bell, Amanda; Skow, Brian; Shane, Dan M; Ward, Marcia M

2018-03-01

Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality. Of the 7,500 North Dakota trauma patients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total trauma patients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14-45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10-21 min), and computed tomography scans (aOR 1.6, 95% CI 1.3-1.9). ED-based telemedicine consultation is requested for the most severely injured rural trauma patients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.

Perceived risks and use of psychotherapy via telemedicine for patients at risk for suicide.

Science.gov (United States)

Gilmore, Amanda K; Ward-Ciesielski, Erin F

2017-01-01

Introduction Suicide is a major public health problem and its human, emotional, and economic costs are significant. Individuals in rural areas are at highest risk for suicide. However, telemedicine services are typically not rendered to individuals who are actively suicidal. The goals of the current study were to identify the risks of using telemedicine for mental healthcare from the perspective of licensed mental health providers and to determine factors associated with the use of telemedicine with patients who are at high risk for suicide. Methods A total of 52 licensed mental health providers were recruited online through several professional organization listservs and targeted emails. Providers completed online questionnaires regarding demographics, caseload of suicidal patients, perceived risks for using telemedicine with patients at risk for suicide, attitudes towards telemedicine, and use of telemedicine with patients at risk for suicide. Results Three key perceived risks associated with using telemedicine were identified, including assessment, lack of control over patient, and difficulties triaging patients if needed. It was also found that individuals who had more positive attitudes towards telemedicine, younger providers, and more experienced providers were more likely to use telemedicine with patients who are at high risk for suicide. Discussion To our knowledge, this is the first study to examine the perceived risks and use of telemedicine with patients at high risk for suicide. It is essential to continue this line of research to develop protocols for the provision of evidence-based therapy via telemedicine for this high-risk group.

Telemedicine on the move: health care heads down the information superhighway.

Science.gov (United States)

Berek, B; Canna, M

1994-01-01

Telemedicine has drawn increasing attention as one of the emerging new service delivery vehicles that will run on the information superhighway. In reality, remote diagnosis and consultation through the application of telecommunications technology have been practiced for many years. But advances in technology and reform imperatives to extend access beyond traditional boundaries are pushing telemedicine into new applications. This is evidenced by the explosion in the number of pilot projects begun within the last 12 months. While demonstrating telemedicine's growing capabilities--for education and administration, as well as medical practice--these projects also raise a number of legal, clinical, and technical questions that must be answered before government and other payers will routinely reimburse for remote services. Academic and industry consortia are springing up to deal with the most compelling issues, including documenting telemedicine's safety and efficacy, developing uniform data and transmission standards, and determining the minimum resolution needed to maintain the integrity of clinical transmissions. Almost every type of medical specialty has proved amenable to performing evaluations via telemedicine links; however, specialties with less direct patient contact, like radiology and pathology, are generally identified as better candidates for telemedicine interactions. The telemedicine equipment required for these consults ranges from the simple to the ultra-sophisticated, depending on the type of system used and its clinical application. The most common system configuration involves a base station in the main facility where specialists and other consultants are housed and a number of remote referral sites. Consults are performed by interactively sharing voice, video, or image data. Increasingly, systems are being introduced that use easy-to-learn, intuitive displays and controls. Systems also require the use of any number of different communication media

State of the art in telemedicine - concepts, management, monitoring and evaluation of the telemedicine programme in Alentejo (Portugal).

Science.gov (United States)

Oliveira, Tiago Cravo; Branquinho, Maria José; Gonçalves, Luís

2012-01-01

Alentejo - one of five Portuguese continental regions - faces major problems impacting the health and social system of the region. Here, the low population density, the low educational and income level as well as an aging population have to be mentioned. Faced with the task of ensuring equal access to healthcare for all its inhabitants, the regional health authorities created the telemedicine program. From 1998 until 2000, the program developed in an experimental fashion, with teleconsultations involving a number of providers: primary health care centers, regional hospitals, and central hospitals. Between 2000 and 2010, there were a total of 135,000 telemedicine acts including teleconsultations, teleradiology (computerised tomography and x-rays), ultrasound telemedicine and telepathology. Presently, the network comprises 20 health centers and 6 hospitals, covering 4 districts. The platform is composed of high resolution videoconferencing equipment, software with patients' clinical records, an image archive, and a number of peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are provided by fifteen medical specialties, across 3 district hospitals, ranging from neurology to pediatric surgery. In 2008, health authorities started the telelearning program, initially using point to point videoconferencing, and by the end of 2010, 848 healthcare professionals, across 52 locations, had participated in remote learning sessions, covering topics from chronic wound treatment, to infection control, to medical error. As of 2011, point to multipoint telelearning is also in operation. This paper provides an overview of the telemedicine program in Alentejo, including both infrastructure and operations. Preliminary results of an ongoing evaluation of the impact of teleconsultations on key indicators of the regional healthcare system are also presented (including current utilization and plans for future expansion). This article builds on the experience

7 CFR 1700.31 - Distance Learning and Telemedicine Loan and Grant Program.

Science.gov (United States)

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Distance Learning and Telemedicine Loan and Grant... § 1700.31 Distance Learning and Telemedicine Loan and Grant Program. RUS, through the Telecommunications Program, makes grants and loans to furnish and improve telemedicine services and distance learning...

Pediatric Critical Care Telemedicine Program: A Single Institution Review.

Science.gov (United States)

Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P

2016-01-01

Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

Telemedicine Consultations in Oral and Maxillofacial Surgery: A Follow-Up Study.

Science.gov (United States)

Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K

2016-02-01

The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at $134,640. This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

77 FR 27015 - Distance Learning and Telemedicine Grant Program

Science.gov (United States)

2012-05-08

... DEPARTMENT OF AGRICULTURE Rural Utilities Service Distance Learning and Telemedicine Grant Program AGENCY: Rural Utilities Service, USDA. ACTION: Notice of Funding for FY 2012 of the Distance Learning and... awards for its Distance Learning and Telemedicine (DLT) Grant Program. For Fiscal Year 2012, $15 million...

Consumer preferences for telemedicine devices and services in South Korea.

Science.gov (United States)

Ahn, Joongha; Shin, Jungwoo; Lee, Jongsu; Shin, Kwangsoo; Park, Hayoung

2014-02-01

The scope of healthcare has been expanding from caring for sick people to keeping people from becoming sick, and telemedicine will play a significant role in this new healthcare paradigm. This study investigated consumer preferences and willingness to pay for attributes of telemedicine services in South Korea. A market simulation was conducted to examine the market shares of alternative services and their relationships to the perceived usefulness of service types and preferred device types. Using a conjoint survey, we collected data on consumer preferences for six telemedicine service attributes. Data analysis used the Bayesian mixed logit model. The market simulation estimated the probabilities of a specific service alternative being chosen using estimated model coefficients. Wearable devices were the most preferred, followed by smart-home and smartphone devices. Consumers perceived managing blood glucose to be the most useful telemedicine service, followed by monitoring oxygen saturation and blood pressure. The market simulation indicated that consumer preferences for device types were associated with the types of chronic diseases for which management through telemedicine services is perceived to be useful. As the focus of healthcare moves from treating patients to keeping individuals healthy, a key factor for the successful deployment of telemedicine services is understanding consumer perceptions and attitudes. The results of this study revealed the dynamics of consumer preferences with regard to service attributes.

Telemedicine in rural areas: general practitioners’ representations and experiences

Science.gov (United States)

Durupt, Maxime; Bouchy, Olivier; Christophe, Sonia; Kivits, Joëlle; Boivin, Jean-Marc

2016-10-19

Introduction: Telemedicine is a rapidly growing new mode of healthcare practice. It is particularly used and needed in remote areas in Lorraine (North East of France) that currently face a shortage of general practitioners and specialists. The objective of this study was to analyse general practitioner’s representations of telemedicine and teleconsultation. The study also identified the advantages and disadvantages of this new mode of medical practice. Methods: A qualitative research was led: 5 focus groups were conducted with 32 doctors in areas faced with the problems of health professional shortages between June 2014 and July 2015. Results: This study reveals a general ignorance of telemedicine. Doctors want to play a central role in this new form of medical practice which must remain optional. Their reluctance essentially concerns financial and legal aspects that constitute obstacles to the development of telemedicine. Finally, this new mode of medical practice must comply with a legal framework regarding medical responsibility and personal data protection. Discussion.More than 100 medical procedures are delivered by telemedicine in Lorraine each month. This new technology is a solution to provide healthcare services in medically underserved areas. However, general practitioners want to preserve the “doctor-patient” relationship and do not wish to change their practice.

Wavelet-based compression of pathological images for telemedicine applications

Science.gov (United States)

Chen, Chang W.; Jiang, Jianfei; Zheng, Zhiyong; Wu, Xue G.; Yu, Lun

2000-05-01

In this paper, we present the performance evaluation of wavelet-based coding techniques as applied to the compression of pathological images for application in an Internet-based telemedicine system. We first study how well suited the wavelet-based coding is as it applies to the compression of pathological images, since these images often contain fine textures that are often critical to the diagnosis of potential diseases. We compare the wavelet-based compression with the DCT-based JPEG compression in the DICOM standard for medical imaging applications. Both objective and subjective measures have been studied in the evaluation of compression performance. These studies are performed in close collaboration with expert pathologists who have conducted the evaluation of the compressed pathological images and communication engineers and information scientists who designed the proposed telemedicine system. These performance evaluations have shown that the wavelet-based coding is suitable for the compression of various pathological images and can be integrated well with the Internet-based telemedicine systems. A prototype of the proposed telemedicine system has been developed in which the wavelet-based coding is adopted for the compression to achieve bandwidth efficient transmission and therefore speed up the communications between the remote terminal and the central server of the telemedicine system.

Using the cloud to provide telemedicine services in a developing country

Directory of Open Access Journals (Sweden)

Liezel Cilliers

2014-11-01

Objectives: The aim of the article is to provide critical success factors (CSF that will enable the deployment of telemedicine in the cloud in order to improve health care services in developing countries. Methods: A thorough literature review was performed of peer reviewed articles in order to identify possible barriers for telemedicine to be deployed in the cloud. Furthermore, the Technology Organization Environmental Model was used in order to group the barriers according to the various factors and, from this process, critical success factors were formulated for consideration. Conclusion: Five critical success factors were formulated in order to implement telemedicine making use of the cloud in developing countries. These include having a national integrated plan for telemedicine; promoting best practices within a legislation framework; involving the end user; providing education to improve levels of telemedicine awareness amongst staff and patients, and addressing technological issues.

Characterizing the Danish telemedicine ecosystem

DEFF Research Database (Denmark)

Manikas, Konstantinos; Hansen, Klaus Marius

2013-01-01

and interoperability issues, silo solutions, and lack of guidelines and standards. In this paper, we characterise the ecosystem evolved around the telemedicine services in Denmark and study the actors involved in this ecosystem. We establish a method for this study, where we define two actor roles and ways...... of characterizing actor contributions, and apply the method to the largest healthcare region of Denmark. Our findings reveal an ecosystem that is relatively closed to new actors, where the actors tend to be related to single telemedicine applications, the applications have low connectivity, and the most influential...... actors of the ecosystem can be characterised as both being beneficial and inhibitory to the ecosystem prosperity....

The SCEC Community Modeling Environment(SCEC/CME): A Collaboratory for Seismic Hazard Analysis

Science.gov (United States)

Maechling, P. J.; Jordan, T. H.; Minster, J. B.; Moore, R.; Kesselman, C.

2005-12-01

The SCEC Community Modeling Environment (SCEC/CME) Project is an NSF-supported Geosciences/IT partnership that is actively developing an advanced information infrastructure for system-level earthquake science in Southern California. This partnership includes SCEC, USC's Information Sciences Institute (ISI), the San Diego Supercomputer Center (SDSC), the Incorporated Institutions for Research in Seismology (IRIS), and the U.S. Geological Survey. The goal of the SCEC/CME is to develop seismological applications and information technology (IT) infrastructure to support the development of Seismic Hazard Analysis (SHA) programs and other geophysical simulations. The SHA application programs developed on the Project include a Probabilistic Seismic Hazard Analysis system called OpenSHA. OpenSHA computational elements that are currently available include a collection of attenuation relationships, and several Earthquake Rupture Forecasts (ERFs). Geophysicists in the collaboration have also developed Anelastic Wave Models (AWMs) using both finite-difference and finite-element approaches. Earthquake simulations using these codes have been run for a variety of earthquake sources. Rupture Dynamic Model (RDM) codes have also been developed that simulate friction-based fault slip. The SCEC/CME collaboration has also developed IT software and hardware infrastructure to support the development, execution, and analysis of these SHA programs. To support computationally expensive simulations, we have constructed a grid-based scientific workflow system. Using the SCEC grid, project collaborators can submit computations from the SCEC/CME servers to High Performance Computers at USC and TeraGrid High Performance Computing Centers. Data generated and archived by the SCEC/CME is stored in a digital library system, the Storage Resource Broker (SRB). This system provides a robust and secure system for maintaining the association between the data seta and their metadata. To provide an easy

Arogyasree: An Enhanced Grid-Based Approach to Mobile Telemedicine

Directory of Open Access Journals (Sweden)

Sriram Kailasam

2010-01-01

Full Text Available A typical telemedicine system involves a small set of hospitals providing remote healthcare services to a small section of the society using dedicated nodal centers. However, in developing nations like India where majority live in rural areas that lack specialist care, we envision the need for much larger Internet-based telemedicine systems that would enable a large pool of doctors and hospitals to collectively provide healthcare services to entire populations. We propose a scalable, Internet-based P2P architecture for telemedicine integrating multiple hospitals, mobile medical specialists, and rural mobile units. This system, based on the store and forward model, features a distributed context-aware scheduler for providing timely and location-aware telemedicine services. Other features like zone-based overlay structure and persistent object space abstraction make the system efficient and easy to use. Lastly, the system uses the existing internet infrastructure and supports mobility at doctor and patient ends.

Telemedicine in dermatology: Evaluation of secondary and tertiary teledermatology

NARCIS (Netherlands)

van der Heijden, J.P.

2013-01-01

The field of dermatology was one of the first adaptors of telemedicine, dating back to 1995, and has one of the highest scientific output in the field of telemedicine. The research described in this thesis expanded on this scientific knowledge base by answering the following research questions: 1.

Telemedicine in Space Flight - Summary of a NASA Workshop

Science.gov (United States)

Barsten, K. N.; Watkins, S. D.; Otto, C.; Baumann, D. K.

2011-01-01

The Exploration Medical Capability Element of the Human Research Program at NASA Johnson Space Center hosted the Telemedicine Workshop in January 2011 to discuss the medical operational concept for a crewed mission to a near-Earth asteroid (NEA) and to identify areas for future work and collaboration. With the increased likelihood of a medical incident on a long duration exploration mission to a near-Earth asteroid, as well as the fact that there will likely be limited medical capabilities and resources available to diagnose and treat medical conditions, it is anticipated that a more structured use of telemedicine will become highly desirable. The workshop was convened to solicit expert opinion on current telemedicine practices and on medical care in remote environments. Workshop Objectives: The workshop brought together leaders in telemedicine and remote medicine from The University of Texas Medical Branch, Henry Ford Hospital, Ontario Telemedicine Network, U.S. Army Institute of Surgical Research, University of Miami, American Telemedicine Association, Doctors Without Borders, and the Pan American Health Organization. The primary objectives of the workshop were to document the medical operations concept for a crewed mission to a NEA, to determine gaps between current capabilities and the capabilities outlined in the operations concept, to identify research required to close these gaps, and to discuss potential collaborations with external-to-NASA organizations with similar challenges. Summary of Discussions and Conclusions: The discussions held during the workshop and the conclusions reached by the workshop participants were grouped into seven categories: Crew Medical Officers, Patient Area in Spacecraft, Training, Electronic Medical Records, Intelligent Care Systems, Consultation Protocols, Prophylactic Surgical Procedures, and Data Prioritization. The key points discussed under each category will be presented.

Licensing telemedicine: the need for a national system.

Science.gov (United States)

Jacobson, P D; Selvin, E

2000-01-01

The expansion of information technology has shattered geographic boundaries, allowing for extraordinarily increased access to health information and expanded opportunities for telemedicine practice across state boundaries. But despite its recent growth, telemedicine technology remains embedded in a state-based licensure system that places severe limits on its expansion. The current system of medical licensure is based primarily on statutes written at the turn of the 20th century. This system is inadequate to address the emerging medical practices and future uses of medical technology in the telecommunications age. To respond to the changes offered by the telecommunications revolution, we need to design a new regulatory structure for the 21st century. The purpose of this article is to propose a policy of national telemedicine licensure. The primary goal here is not to simply develop a policy proposal, but to discuss the rationale for national licensure and place it on the policy agenda. A national licensure system will expand the market for telemedicine, promote both the use and development of new technologies, and simultaneously eliminate many of the legal and regulatory ambiguities that plague and constrain the present system.

Reaching the Unreachable: Novel Approaches to Telemedicine Screening of Underserved Populations for Vitreoretinal Disease.

Science.gov (United States)

Murchison, Ann P; Haller, Julia A; Mayro, Eileen; Hark, Lisa; Gower, Emily; Huisingh, Carrie; Rhodes, Lindsay; Friedman, David S; Lee, David J; Lam, Byron L

2017-07-01

Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.

Telemedicine in the context of different medical specialities. The Polish perspective.

Science.gov (United States)

Rudowski, Robert

2003-01-01

Two types of telemedicine are considered in the paper: pre-recorded and real-time. The advantages and disadvantages of each type are described.The choice of telemedicine type depends on medical speciality. The separate branch of telemedicine--teleprevention of civilization diseases is discussed and examples of relevant WWW services in Poland are given. The own work examples of the Dept. of Medical Informatics, MUW, namely Onco-service of 200 protocols used in hematology and oncology and Cardio.net--a distributed teleinformation system for cardiology, are presented. the barriers of the development of telemedicine in Poland are caused by the organization of health service--Patients Funds using different software, no messaging standards and different reimbursement systems.

Telemedicine in healthcare. 1: Exploring its uses, benefits and disadvantages.

Science.gov (United States)

Sarhan, Firas

This first in a two part series on telemedicine in healthcare outlines the background and context for using this technology. It discusses the levels of telemedicine and its possible applications in healthcare, and examines its advantages and disadvantages.

Telemedicine services in the Republic of Ireland: an evolving policy context.

Science.gov (United States)

MacFarlane, Anne; Murphy, Andrew William; Clerkin, Pauline

2006-05-01

The Republic of Ireland is characterised by few urban conurbations and a high rural population, including significant numbers of island dwellers. Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. As in other countries, the recent National Health Information Strategy is regarded as pivotal to the modernisation of the Irish health care system. There is, however, a dearth of research about telemedicine in Ireland. This paper reports, to the best of our knowledge, the first systematic review of telemedicine in the two regional health boards in the Republic of Ireland. Details of 11 telemedicine services, all initiated by local policy, will be presented. Results of an interview study with service providers about their experiences of the practices and processes involved in telemedicine service delivery are also provided. The focus of our analysis is two-fold. We assess the resonance of these Irish data with the international literature with particular reference to a recently developed model for the normalisation of telemedicine. For the first time, this model which was developed in the United Kingdom is applied to a fresh set of empirical data in a different health care context. We then discuss a number of health information policy issues for Ireland and elsewhere arising from our analysis.

Toward computer-assisted diagnosis and telemedicine in ophthalmology

Czech Academy of Sciences Publication Activity Database

Marrugo, A.; Millán, M. S.; Cristóbal, G.; Gabarda, S.; Šorel, Michal; Šroubek, Filip

2012-01-01

Roč. 2012, č. 6 (2012), s. 1-3 ISSN 1818-2259 R&D Projects: GA MŠk 1M0572 Institutional research plan: CEZ:AV0Z10750506 Institutional support: RVO:67985556 Keywords : computer-aided diagnosis * medical and retinal image * deconvolution * telemedicine Subject RIV: JD - Computer Applications, Robotics http://library.utia.cas.cz/separaty/2012/ZOI/sorel-toward computer-assisted diagnosis and telemedicine in ophthalmology.pdf

Neurosurgery and Telemedicine in the United States: Assessment of the Risks and Opportunities.

Science.gov (United States)

Kahn, Elyne N; La Marca, Frank; Mazzola, Catherine A

2016-05-01

Telemedicine has seen substantial growth in the past 20 years, related to technologic advancements and evolving reimbursement policies. The risks and opportunities of neurosurgical telemedicine are nuanced. We reviewed general and peer-reviewed literature as it relates to telemedicine and neurosurgery, with particular attention to best practices, relevant state and federal policy conditions, economic evaluations, and prospective clinical studies. Despite technologic development, growing interest, and increasing reimbursement opportunities, telemedicine's utilization remains limited because of concerns regarding an apparent lack of need for telemedicine services, lack of widespread reimbursement, lack of interstate licensure reciprocity, lack of universal access to necessary technology, concerns about maintaining patient confidentiality, and concerns and limited precedent regarding liability issues. The Veterans Health Administration, a component of the U.S. Department of Veterans Affairs, represents a setting in which these concerns can be largely obviated and is a model for telemedicine best practices. Results from the VA demonstrate substantial cost savings and patient satisfaction with remote care for chronic neurologic conditions. Overall, the economic and clinical benefits of telemedicine will likely come from 1) diminished travel times and lost work time for patients; 2) remote consultation of subspecialty experts, such as neurosurgeons; and 3) remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and "teletrauma." Telemedicine is effective in many health care scenarios and will become more relevant to neurosurgical patient care. We favor proceeding with legislation to reduce barriers to telemedicine's growth. Copyright © 2016 Elsevier Inc. All rights reserved.

Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation.

Science.gov (United States)

Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo

2007-01-01

The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

Heart failure patients monitored with telemedicine: patient satisfaction, a review of the literature.

Science.gov (United States)

Kraai, I H; Luttik, M L A; de Jong, R M; Jaarsma, T; Hillege, H L

2011-08-01

Remote monitoring of the clinical status of heart failure patients has developed rapidly and is the subject of several trials. Patient satisfaction is an important outcome, as recommended by the U.S. Food and Drug Administration to use in clinical research, and should be included in studies concerning remote monitoring. The objective of this review is to describe the current state of the literature on patient satisfaction with noninvasive telemedicine, regarding definition, measurement, and overall level of patient satisfaction with telemedicine. The Pubmed, Embase, Cochrane, and Cinahl databases were searched using heart failure-, satisfaction-, and telemedicine-related search terms. The literature search identified 193 publications, which were reviewed by 2 independent reviewers. Fourteen articles were included. None of the articles described a clear definition or concept of patient satisfaction with telemedicine. Patient satisfaction with telemedicine was measured with self-developed questionnaires or face-to-face or telephonic interviews. None of the articles used the same questionnaire or telephonic survey to measure patient satisfaction. Only one questionnaire was assessed for validity and reliability. In general, patients seemed to be satisfied or very satisfied with the use of telemedicine. Measurement of patient satisfaction is still underexposed in telemedicine research and the measurement of patient satisfaction with telemedicine underappreciated with poorly constructed questionnaires. Copyright © 2011 Elsevier Inc. All rights reserved.

Editorial Continuing Medical Education (CME) Continuing Medical ...

African Journals Online (AJOL)

System Administrator

developments in the field of medicine. CME has evolved in the last ten years necessitated by the realization that the practice of medicine is constantly changing. New diseases are emerging; diagnostic techniques are being updated and new drugs and therapeutic methods being introduced into the market. Added to this is ...

Tubes, Mono Jets, Squeeze Out and CME

Energy Technology Data Exchange (ETDEWEB)

Longacre, R. [Brookhaven National Lab. (BNL), Upton, NY (United States)

2017-10-23

Glasma Flux Tubes, Mono Jets with squeeze out flow around them plus the Chiral Magnetic Effect(CME) are physical phenomenon that generate two particle correlation with respect to the reaction plane in mid-central 20% to 30% Au-Au collision √sNN = 200.0 GeV measured at RHIC.

Application of International Videoconferences for Continuing Medical Education Programs Related to Laparoscopic Surgery

OpenAIRE

Huang, Ke-Jian; Cen, Gang; Qiu, Zheng-Jun; Jiang, Tao; Cao, Jun; Fu, Chun-Yu

2014-01-01

Background: Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. Materials and Methods: We conducted four CME seminars in 2007–2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-...

Telemedicine in radiotherapy treatment planning: requirements and applications

International Nuclear Information System (INIS)

Olsen, D.R.; Bruland, O.S.; Davis, B.J.

2000-01-01

Telemedicine facilitates decentralized radiotherapy services by allowing remote treatment planning and quality assurance of treatment delivery. A prerequisite is digital storage of relevant data and an efficient and reliable telecommunication system between satellite units and the main radiotherapy clinic. The requirements of a telemedicine system in radiotherapy is influenced by the level of support needed. In this paper we differentiate between three categories of telemedicine support in radiotherapy. Level 1 features video conferencing and display of radiotherapy images and dose plans. Level 2 involves replication of selected data from the radiotherapy database - facilitating remote treatment planning and evaluation. Level 3 includes real-time, remote operations, e.g. target volume delineation and treatment planning performed by the team at the satellite unit under supervision and guidance from more experienced colleagues at the main clinic. (author)

Use of Telemedicine in Addiction Treatment: Current Practices and Organizational Implementation Characteristics

Directory of Open Access Journals (Sweden)

Todd Molfenter

2018-01-01

Full Text Available Telemedicine applications offer innovative approaches for treating and reducing the effects of substance use disorders (SUDs. This analysis assessed the interest in and use of 11 telemedicine applications in a sample of 363 SUD organizations in the United States of America. Fifty percent of the organizations expressed high rates of interest in seven of the telemedicine applications, demonstrating the appeal of telemedicine within this field. The top three self-reported telemedicine applications being used were (1 computerized screening/assessments (44.6%, (2 telephone-based recovery supports (29.5%, and (3 telephone-based therapy (28.37%. The greatest gaps between interest and use were for (1 texting appointment reminders (55.2% differential, (2 mobile apps for posttreatment recovery (46.6% differential, and (3 recovery support chats (46.6% differential. A Latent Class Analysis (LCA of the organizations’ telemedicine use behavior identified three groupings: “Innovators” that were using a range of technologies (n=27, 7.4%; “Technology Traditionalists” that limited their use to telephone, video, and web portal technologies (n=101, 27.8%; and “Low Tech” that had low overall technology use (n=235, 64.7%. Future studies should build on how telemedicine could be applied in SUD settings, organizational behaviors towards its adoption, and telemedicine’s effect on treatment adherence and clinical outcomes.

Proceedings from the second UEMS Conference on CME-CPD in Europe, 28 February 2014, Brussels, Belgium

Directory of Open Access Journals (Sweden)

Julie Simper

2014-09-01

Full Text Available Over a year since the implementation of the new UEMS-EACCME® accreditation criteria for Live Educational Events (LEEs, the second Union Européenne des Médecins Spécialistes (UEMS Conference on continuing medical education and continuing professional development (CME-CPD in Europe was a much anticipated event. The conference, which took place 28 February 2014 in Brussels, Belgium, provided an important opportunity for stakeholders to discuss and debate:• The role of accreditation in CME-CPD, with a focus on EACCME® accreditation as a means of assuring the quality of CME-CPD in Europe.• The UEMS-EACCME®'s accreditation process.• Implementation of the new criteria for the accreditation of LEEs.A key theme of the event was increased collaboration and dialogue amongst the various stakeholders in international CME-CPD. This was exemplified by both the diversity of the faculty members, as well as the full-house audience of approximately 300 international delegates representing accrediting bodies, medical societies and associations, education providers, industry supporters, and European regulators and legislators. In addition to views on CME-CPD from several of the stakeholder groups, sessions provided a glimpse into the European political environment, CME-CPD statistics, and practical discussions on needs assessment, learning objectives, outcomes measurement, and conflicts of interest management. The day's full agenda also included reiteration of the need for self-regulation of European CME-CPD and commitment to the shared goal of improving patient care by providing high-quality, accredited educational initiatives.

Cabo Verde telemedicine program: initial results of nationwide implementation.

Science.gov (United States)

Latifi, Rifat; Dasho, Erion; Merrell, Ronald C; Lopes, Miguel; Azevedo, Vanda; Bekteshi, Flamur; Osmani, Kalterina L; Qesteri, Orland; Kucani, Julian; Lecaj, Ismet

2014-11-01

Telemedicine and e-health have been suggested as one solution for closing the health disparity gap between the developed world and the developing world. Yet evidence is lacking from current successful programs in the developing world and, in particular, from sub-Saharan Africa. The primary objective of our study was to present the preliminary results of our efforts in building the Integrated Telemedicine and e-Health Program for Cabo Verde (ITeHP-CV), with an emphasis on initial utilization and results. This is a prospective study of data collected while we worked to establish a fully functional, integrated national telemedicine network and virtual education network in Cabo Verde. We used the International Virtual e-Hospital Foundation strategic approach known as "initiate-build-operate-transfer" over a 26-month period (November 2011-December 2013). We describe herein the five main pillars of this process that have been implemented: (1) capacity building; (2) network development and deployment of equipment; (3) implementation of clinical telemedicine; (4) implementation of activities related to continuing medical education, delivered from within the country and from abroad; and (5) establishment and use of the electronic virtual library. Based on comprehensive technical and medical assessment of the country's needs, 10 fully functional telemedicine centers in all nine inhabited islands of the Republic of Cabo Verde have been established. RESULTS are presented under the five main pillars of capacity building, network deployment, implementation of clinical telemedicine, implementation of continuing medical education activities, and establishment of the electronic virtual library. The ITeHP-CV has been successfully launched, and the initial results are encouraging. The continuity of the program and sustainability are primary goals once the program is transferred fully to the Ministry of Health of Cabo Verde. A long-term follow-up study is required in order to ensure

Comparing Automatic CME Detections in Multiple LASCO and SECCHI Catalogs

Energy Technology Data Exchange (ETDEWEB)

Hess, Phillip [NRC Research Associate, U.S. Naval Research Laboratory, Washington, DC (United States); Colaninno, Robin C., E-mail: phillip.hess.ctr@nrl.navy.mil, E-mail: robin.colaninno@nrl.navy.mil [U.S. Naval Research Laboratory, Washington, DC (United States)

2017-02-10

With the creation of numerous automatic detection algorithms, a number of different catalogs of coronal mass ejections (CMEs) spanning the entirety of the Solar and Heliospheric Observatory ( SOHO ) Large Angle Spectrometric Coronagraph (LASCO) mission have been created. Some of these catalogs have been further expanded for use on data from the Solar Terrestrial Earth Observatory ( STEREO ) Sun Earth Connection Coronal and Heliospheric Investigation (SECCHI) as well. We compare the results from different automatic detection catalogs (Solar Eruption Event Detection System (SEEDS), Computer Aided CME Tracking (CACTus), and Coronal Image Processing (CORIMP)) to ensure the consistency of detections in each. Over the entire span of the LASCO catalogs, the automatic catalogs are well correlated with one another, to a level greater than 0.88. Focusing on just periods of higher activity, these correlations remain above 0.7. We establish the difficulty in comparing detections over the course of LASCO observations due to the change in the instrument image cadence in 2010. Without adjusting catalogs for the cadence, CME detection rates show a large spike in cycle 24, despite a notable drop in other indices of solar activity. The output from SEEDS, using a consistent image cadence, shows that the CME rate has not significantly changed relative to sunspot number in cycle 24. These data, and mass calculations from CORIMP, lead us to conclude that any apparent increase in CME rate is a result of the change in cadence. We study detection characteristics of CMEs, discussing potential physical changes in events between cycles 23 and 24. We establish that, for detected CMEs, physical parameters can also be sensitive to the cadence.

The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting.

Science.gov (United States)

Eibl, Joseph K; Gauthier, Graham; Pellegrini, David; Daiter, Jeffery; Varenbut, Michael; Hogenbirk, John C; Marsh, David C

2017-07-01

Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (telemedicine), mixed (25-75% by telemedicine), or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records. A total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n=1590; aOR=1.27; 95% CI 1.14-1.41; pTelemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n=418; aOR=1.26; 95% CI 1.08-1.47; p=0.001) and had a retention rate of 47% at one year. Telemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

A call for formal telemedicine training during stroke fellowship

Science.gov (United States)

Jia, Judy; Gildersleeve, Kasey; Ankrom, Christy; Cai, Chunyan; Rahbar, Mohammad; Savitz, Sean I.; Wu, Tzu-Ching

2016-01-01

During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted. Herein, we describe our experiences incorporating telestroke into the vascular neurology fellowship curriculum and propose recommendations on integrating formal telemedicine training into the Accreditation Council for Graduate Medical Education vascular neurology fellowship. PMID:27016522

Fifteen-year Experience with Telemedicine Services in Gangwon Province in Korea

Science.gov (United States)

Kim, Hyung-Gi; Choi, Young-A; Choi, Eun-Hi; Kim, Dong-Won; Shin, Se-Gye; Park, Kyung-Suk; Han, Jae-Hyun

2015-01-01

Objectives This study attempted to identify the factors that contribute to successful telemedicine service. This was done by analyzing the operational state of successful telemedicine services offered in Gangwon Province of Korea and their outcome for the last fifteen years. Methods A comparative analysis was made based on reports and a thesis on the satisfaction rate of patients and providers, patient compliance to treatment, and economic assessment of Gangwon telemedicine service, which were carried out in three periods: the years 2006, 2010, and 2012. Results The satisfaction surveys in all three periods showed similar results for patients (4.46±0.70 point) and healthcare practitioners, including nurses (3.82±0.62 point) and physicians (3.60±0.56 point), in decreasing order from the year 2012. Through the survey of patients' compliance with treatment, it was confirmed that telemedicine services increased patients' compliance with drug administration, facilitated improvement of lifestyle habits, improved glycated hemoglobin for patients with diabetes mellitus, and enhanced the rate of blood pressure control. In the survey conducted on patients' willingness to pay for telemedicine services in 2007, it was found that those patients were willing to pay about $3.5 for services. Conclusions The telemedicine services of Gangwon Province increased patients' compliance with drug administration, improved blood glucose control, enhanced blood pressure control for patients with hypertension, and provided economic advantage. PMID:26618035

Expert advice provided through telemedicine improves healing of chronic wounds: prospective cluster controlled study.

Science.gov (United States)

Zarchi, Kian; Haugaard, Vibeke B; Dufour, Deirdre N; Jemec, Gregor B E

2015-03-01

Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.

Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique.

Science.gov (United States)

Choi, Woo Seok; Park, Joowoong; Choi, Jin Young Brian; Yang, Jae-Suk

2018-01-01

Introduction Sufficient infrastructure for information and communications technology (ICT) and a well-established policy are necessary factors for smooth implementation of telemedicine. However, despite these necessary conditions being met, there are situations where telemedicine still fails to be accepted as a system due to the low receptivity of stakeholders. In this study, we analyse stakeholders' resistance to an organization's implementation of telemedicine. Focusing on the physicians' interests, we propose a strategy to minimize conflicts and improve acceptance. Methods The Delphi study involved 190 telemedicine professionals who were recommended by 485 telemedicine-related personnel in South Korea. Results Out of 190 professionals, 60% of enrolled participants completed the final questionnaires. The stakeholders were categorized into four groups: policy-making officials, physicians, patients, and industrialists. Among these, the physicians were most opposed to the adoption of telemedicine. The main causes of such opposition were found to be the lack of a medical services delivery system and the threat of disruption for primary care clinics. Very little consensus was observed among the stakeholders, except on the following points: the need for expansion of the national health insurance budget by the government, and the need for enhancement of physicians' professional autonomy to facilitate smooth agreements. Discussion Our analysis on the causes of the resistance to telemedicine, carried out with the groups mentioned above, has important implications for policy-makers deriving strategies to achieve an appropriate consensus.

Multistandard Receiver Design for Telemedicine Monitoring System

Directory of Open Access Journals (Sweden)

Hongmei Wang

2018-01-01

Full Text Available In short-distance wireless communications for telemedicine monitoring, different medical data measurement equipment has different wireless transmission modes. A multistandard receiver is designed that can adapt to different medical data measuring equipment. Using a second-order bandpass sampling for the design of antialiasing filters, two aliasing signals can be separated. Simultaneously, constraint conditions for sampling frequency are not as critical. The design is useful for a multistandard receiver in a telemedicine monitoring system and has the advantages such as saving spectrum resources and facilitating spectrum planning.

Development and Parameters of a Non-Self-Similar CME Caused by the Eruption of a Quiescent Prominence

Science.gov (United States)

Kuzmenko, I. V.; Grechnev, V. V.

2017-10-01

The eruption of a large quiescent prominence on 17 August 2013 and an associated coronal mass ejection (CME) were observed from different vantage points by the Solar Dynamics Observatory (SDO), the Solar-Terrestrial Relations Observatory (STEREO), and the Solar and Heliospheric Observatory (SOHO). Screening of the quiet Sun by the prominence produced an isolated negative microwave burst. We estimated the parameters of the erupting prominence from a radio absorption model and measured them from 304 Å images. The variations of the parameters as obtained by these two methods are similar and agree within a factor of two. The CME development was studied from the kinematics of the front and different components of the core and their structural changes. The results were verified using movies in which the CME expansion was compensated for according to the measured kinematics. We found that the CME mass (3.6 × 10^{15} g) was mainly supplied by the prominence (≈ 6 × 10^{15} g), while a considerable part drained back. The mass of the coronal-temperature component did not exceed 10^{15} g. The CME was initiated by the erupting prominence, which constituted its core and remained active. The structural and kinematical changes started in the core and propagated outward. The CME structures continued to form during expansion, which did not become self-similar up to 25 R_{⊙}. The aerodynamic drag was insignificant. The core formed during the CME rise to 4 R_{⊙} and possibly beyond. Some of its components were observed to straighten and stretch outward, indicating the transformation of tangled structures of the core into a simpler flux rope, which grew and filled the cavity as the CME expanded.

Multipurpose Health Care Telemedicine System

National Research Council Canada - National Science Library

Kyriacou, E

2001-01-01

.... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

Arizona TeleMedicine Project.

Science.gov (United States)

Arizona Univ., Tucson. Coll. of Medicine.

Designed to provide health services for American Indians living on rurally isolated reservations, the Arizona TeleMedicine Project proposes to link Phoenix and Tucson medical centers, via a statewide telecommunications system, with the Hopi, San Carlos Apache, Papago, Navajo, and White Mountain Apache reservations. Advisory boards are being…

[The integration of telemedicine concepts in the regional care of rural areas: Possibilities, limitations, perspectives].

Science.gov (United States)

van den Berg, Neeltje; Schmidt, S; Stentzel, U; Mühlan, H; Hoffmann, W

2015-04-01

In rural areas with a low population density and (imminent) gaps in regional health care, telemedicine concepts can be a promising option in supporting the supply of medical care.Telemedicine connections can be established between different health care providers (e.g., hospitals) or directly between health care providers and patients.Different scenarios for the implementation of telemedicine have been developed, from the monitoring of chronically ill patients to the support of acute care. Examples of frequently applied telemedicine concepts are teleradiology, telemedicine stroke networks, and the telemedicine monitoring of patients with heart failure. The development of concepts for other indications and patient groups is apparently difficult in Germany; one reason could be that research institutions are involved in only a small number of projects. However, the participation of research institutes would be of importance in creating more scientific evidence. The development of appropriate evaluation designs for analyzing the effectiveness of telemedicine concepts and economic effects is an important task and challenge for the future. Mandatory evaluation criteria should be developed to provide a basis for the translation of positively evaluated telemedicine concepts into routine care.

Informed consent for telemedicine in South Africa: A survey of ...

African Journals Online (AJOL)

Informed consent for telemedicine in South Africa: A survey of consent practices among healthcare professionals in Durban, KwaZulu-Natal. C Jack, M Mars. Abstract. Background. The Health Professions Council of South Africa is drafting guidelines to regulate the practice of telemedicine. These emphasise the need for ...

Delivering tertiary centre specialty care to ALS patients via telemedicine: a retrospective cohort analysis.

Science.gov (United States)

Selkirk, Stephen M; Washington, Monique O; McClellan, Frances; Flynn, Broderick; Seton, Jacinta M; Strozewski, Richard

2017-08-01

This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters. A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants. There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16-1.59). There was no significant difference in survival time between the two groups (log-rank test χ 2  = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having telemedicine (HR = 0.39, 95% CI = 0.16-0.93). Patients managed by telemedicine received the same quality of care and had similar outcomes to those patients seen via traditional face-to-face encounters. Telemedicine is an effective platform for delivering high quality tertiary ALS care.

High-Surety Telemedicine in a Distributed, 'Plug-andPlan' Environment

Energy Technology Data Exchange (ETDEWEB)

Craft, Richard L.; Funkhouser, Donald R.; Gallagher, Linda K.; Garcia, Rudy J.; Parks, Raymond C.; Warren, Steve

1999-05-17

Commercial telemedicine systems are increasingly functional, incorporating video-conferencing capabilities, diagnostic peripherals, medication reminders, and patient education services. However, these systems (1) rarely utilize information architectures which allow them to be easily integrated with existing health information networks and (2) do not always protect patient confidentiality with adequate security mechanisms. Using object-oriented methods and software wrappers, we illustrate the transformation of an existing stand-alone telemedicine system into `plug-and-play' components that function in a distributed medical information environment. We show, through the use of open standards and published component interfaces, that commercial telemedicine offerings which were once incompatible with electronic patient record systems can now share relevant data with clinical information repositories while at the same time hiding the proprietary implementations of the respective systems. Additionally, we illustrate how leading-edge technology can secure this distributed telemedicine environment, maintaining patient confidentiality and the integrity of the associated electronic medical data. Information surety technology also encourages the development of telemedicine systems that have both read and write access to electronic medical records containing patient-identifiable information. The win-win approach to telemedicine information system development preserves investments in legacy software and hardware while promoting security and interoperability in a distributed environment.

The principles of telemedicine in practice

Directory of Open Access Journals (Sweden)

Ilvana Vučković

2003-11-01

Full Text Available Telemedicine (distance medicine represents a field of medicine that has been in a tremendous expansion over the last couple of years thanks to the fast development of telecommunications and reduction of their costs. It enables a direct communication (visual between the peripheral hospitals and referral facilities in the interior of the country as well as a connection of centres with referral centres abroad in the fields of diagnostics, consultations or education. The main objective is to encourage interest in telemedicine among physicians and other health care experts, initiate an exchange of opinions, and experience about the application of telecommunication technology in medicine, so to reach a common perception of its role in the context of future development of the health care system in Bosnia and Herzegovina. As a standard, current equipment consists of computers, which are equipped with frame grabbers and communication modem for communication through a public telecommunication system. Input data can all be visual data (X-Ray, CT, MRI, ultrasound, ECG, histological finding, cariogram, and of course photos of the patients, of operational/surgical field. The Institute of Pathology of the Sarajevo Medical Faculty has actively participated in the experimental project “SHARED” (1996-2000 together with the Radiology and Ophthalmology Clinic of the Sarajevo Clinical Centre. The past experience in using telemedicine has shown that the introduction of such a telemedicine system in B&H would be of great significance in the future in the context of providing better and more efficient health services to the patients. In practice, that means a more simple approach to some services and data for patients, a better and faster circulation of information and experience of medical experts and health care workers with cost control at the same time. 

Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications.

Science.gov (United States)

Rosser, J C; Bell, R L; Harnett, B; Rodas, E; Murayama, M; Merrell, R

1999-10-01

Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. Telemedicine and telementoring were applied using low-bandwidth mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing system, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly, surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps. Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by

Telemedicine-based system for quality management and peer review in radiology.

Science.gov (United States)

Morozov, Sergey; Guseva, Ekaterina; Ledikhova, Natalya; Vladzymyrskyy, Anton; Safronov, Dmitry

2018-06-01

Quality assurance is the key component of modern radiology. A telemedicine-based quality assurance system helps to overcome the "scoring" approach and makes the quality control more accessible and objective. A concept for quality assurance in radiology is developed. Its realization is a set of strategies, actions, and tools. The latter is based on telemedicine-based peer review of 23,199 computed tomography (CT) and magnetic resonance imaging (MRI) images. The conception of the system for quality management in radiology represents a chain of actions: "discrepancies evaluation - routine support - quality improvement activity - discrepancies evaluation". It is realized by an audit methodology, telemedicine, elearning, and other technologies. After a year of systemic telemedicine-based peer reviews, the authors have estimated that clinically significant discrepancies were detected in 6% of all cases, while clinically insignificant ones were found in 19% of cases. Most often, problems appear in musculoskeletal records; 80% of the examinations have diagnostic or technical imperfections. The presence of routine telemedicine support and personalized elearning allowed improving the diagnostics quality. The level of discrepancies has decreased significantly (p elearning significantly decrease the number of discrepancies. • Teleradiology allows linking all primary-level hospitals to a common peer review network.

Telemedicine and Pediatric Obesity Treatment: Review of the literature and lessons learned

OpenAIRE

Cohen, Gail M.; Irby, Megan B.; Boles, Katie; Jordan, Christine; Skelton, Joseph A.

2012-01-01

Pediatric obesity is more prevalent in rural areas, yet rural families may not have access to pediatric obesity treatment programs. Use of new technologies, particularly telemedicine, has proven effective in other behavioral fields, such as psychiatry. This paper reviews the literature on the use of telemedicine in pediatric obesity treatment, and describes one tertiary-care pediatric obesity telemedicine program. We performed a systematic review of the literature from 1990–2011 using the fol...

An Analysis of Telemedicine in Taiwan: A Business Model Perspective

Directory of Open Access Journals (Sweden)

Tung-Cheng Lin

2011-12-01

Conclusions: The framework we proposed serves as a useful tool to obtain more insights into the future development of telemedicine. The cost of operating a telemedicine service system is currently not low. The practitioner could reduce the cost through modifying value proposition, service process or allying with more experienced partner.

A New Tool for CME Arrival Time Prediction using Machine Learning Algorithms: CAT-PUMA

Science.gov (United States)

Liu, Jiajia; Ye, Yudong; Shen, Chenglong; Wang, Yuming; Erdélyi, Robert

2018-03-01

Coronal mass ejections (CMEs) are arguably the most violent eruptions in the solar system. CMEs can cause severe disturbances in interplanetary space and can even affect human activities in many aspects, causing damage to infrastructure and loss of revenue. Fast and accurate prediction of CME arrival time is vital to minimize the disruption that CMEs may cause when interacting with geospace. In this paper, we propose a new approach for partial-/full halo CME Arrival Time Prediction Using Machine learning Algorithms (CAT-PUMA). Via detailed analysis of the CME features and solar-wind parameters, we build a prediction engine taking advantage of 182 previously observed geo-effective partial-/full halo CMEs and using algorithms of the Support Vector Machine. We demonstrate that CAT-PUMA is accurate and fast. In particular, predictions made after applying CAT-PUMA to a test set unknown to the engine show a mean absolute prediction error of ∼5.9 hr within the CME arrival time, with 54% of the predictions having absolute errors less than 5.9 hr. Comparisons with other models reveal that CAT-PUMA has a more accurate prediction for 77% of the events investigated that can be carried out very quickly, i.e., within minutes of providing the necessary input parameters of a CME. A practical guide containing the CAT-PUMA engine and the source code of two examples are available in the Appendix, allowing the community to perform their own applications for prediction using CAT-PUMA.

Telemedicine in the 'Hood.

Science.gov (United States)

Elgrably, Jordan

1998-01-01

Telemedicine, the ability to examine patients while physically removed from them by using high-tech virtual treatment, is used increasingly to diagnose and prescribe treatment for patients in nontraditional settings. In Los Angeles (California), Charles R. Drew University of Medicine and King-Drew Medical Center communicate in real time with…

Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review

Directory of Open Access Journals (Sweden)

Littauer SL

2017-12-01

Full Text Available Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls and to highlight the main areas of chronic-disease management where these models have been applied. Studies within the areas of hypertension, diabetes, asthma, anticoagulation and depression were identified, but only two randomized controlled trials with adequate sample size demonstrating the positive impact of telemonitoring combined with pharmacist care in hypertension were identified. The evidence for the impact of pharmacist-based telemedicine models is sparse and weak, with the studies conducted presenting serious threats to internal and external validity. Therefore, no definitive conclusions about the impact of pharmacist-led telemedicine models can be made at this time. In the Unites States, the increasing shortage of primary care providers and specialists represents an opportunity for pharmacists to assume a more prominent role managing patients with chronic disease in the ambulatory care setting. However, lack of reimbursement may pose a barrier to the provision of care by pharmacists using telemedicine.

Emergency Telemedicine: Achieving and Maintaining Compliance with the Emergency Medical Treatment and Labor Act.

Science.gov (United States)

Rockwell, Kimberly Lovett; Gilroy, Alexis

2018-03-12

Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. Critical analysis of EMTALA and its attendant regulations. The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.

Evolution of telemedicine in the space program and earth applications

Science.gov (United States)

Nicogossian, A. E.; Pober, D. F.; Roy, S. A.

2001-01-01

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.

State of the Art Telemedicine/Telehealth

National Research Council Canada - National Science Library

Bashshur, Rashid

2001-01-01

.... Reports were derived for the following topics: network organizational models, technology development and application, clinical applications, public health, disease surveillance and personal health, education, and telemedicine diffusion...

Ethical practice in Telehealth and Telemedicine.

Science.gov (United States)

Chaet, Danielle; Clearfield, Ron; Sabin, James E; Skimming, Kathryn

2017-10-01

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

Quality-of-data broker for quality-of-data-aware telemedicine systems

NARCIS (Netherlands)

Larburu Rubio, Nekane; Bults, Richard G.A.; van Sinderen, Marten J.; Widya, I.A.; Hermens, Hermanus J.

2016-01-01

Purpose: Telemedicine systems must provide clinical data of sufficient quality (according to medical standards) to support safe treatment guidance of outpatients. Quality of clinical data (QoD) typically varies due to unstable performance of ICT-components of these telemedicine systems. Therefore,

Virtual Telemedicine Visits in Pediatric Home Parenteral Nutrition Patients: A Quality Improvement Initiative.

Science.gov (United States)

Raphael, Bram P; Schumann, Caitlin; Garrity-Gentille, Sara; McClelland, Jennifer; Rosa, Carolyn; Tascione, Christina; Gallotto, Mary; Takvorian-Bené, Melissa; Carey, Alexandra N; McCarthy, Patrick; Duggan, Christopher; Ozonoff, Al

2018-05-04

Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016. We excluded patients with a history of HPN and strictly palliative care goals. Univariate analysis was performed for primary outcomes: Community-acquired CLABSI and 30-day readmission rate. Twenty-six families participated in the pilot initiative with median (interquartile range) patient age 1.5 (5.7) years old, diagnosis of short bowel syndrome in 16 (62%), and in-state residence in 17 (55%). Ishikawa (fishbone) diagram identified causes of post-discharge HPN complications. Areas of focus during telemedicine visit included central venous catheter care methods, materials, clinical concerns, and equipment. Compared to historical comparison group, the telemedicine group experienced CLABSI rates of 1.0 versus 2.7 per 1,000 line days and readmission rates of 38% versus 17% (p = 0.03, 0.02, respectively). Telemedicine visits identified opportunities for improvement for families newly discharged on HPN. In a small cohort of patients who experienced telemedicine visits, we found lower CLABSI rates alongside higher readmission rates compared with a historical comparison group. Further studies are needed to optimize telemedicine in delivering care to this high-risk population.

Differences in public and private sector adoption of telemedicine: Indian case study for sectoral adoption.

Science.gov (United States)

Sood, Sanjay P; Negash, Solomon; Mbarika, Victor W A; Kifle, Mengistu; Prakash, Nupur

2007-01-01

Telemedicine is the use of communication networks to exchange medical information for providing healthcare services and medical education from one site to another. The application of telemedicine is more promising in economically developing countries with agrarian societies. The American Telemedicine Association (ATA) identifies three healthcare services: clinical medical services, health and medical education, and consumer health information. However, it is not clear how these services can be adopted by different sectors: public and private. This paper looks at four Indian case studies, two each in public and private sectors to understand two research questions: Are there differences in telemedicine adoption between public and private hospitals. If there are differences: What are the differences in telemedicine adoption between public and private sectors? Authors have used the extant literature in telemedicine and healthcare to frame theoretical background, describe the research setting, present the case studies, and provide discussion and conclusions about their findings. Authors believe that as India continues to develop its telemedicine infrastructures, especially with continued government support through subsidies to private telemedicine initiatives, its upward trend in healthcare will continue. This is expected to put India on the path to increase its life expectancy rates, especially for it rural community which constitute over 70% of its populace.

US and territory telemedicine policies: identifying gaps in perinatal care

Science.gov (United States)

Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

2016-01-01

BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

Telemedicine and Diabetic Eye Disease

Centers for Disease Control (CDC) Podcasts

We know that the leading cause of blindness in working-age adults is eye disease related to poorly managed diabetes. In a prevention research study, telemedicine was shown to increase the number of people getting screened for diabetic eye disease.

Designing Home-Based Telemedicine Systems for the Geriatric Population: An Empirical Study.

Science.gov (United States)

Narasimha, Shraddhaa; Agnisarman, Sruthy; Chalil Madathil, Kapil; Gramopadhye, Anand; McElligott, James T

2018-02-01

Background and Introduction: Telemedicine, the process of providing healthcare remotely using communication devices, has the potential to be useful for the geriatric population when specifically designed for this age group. This study explored the design of four video telemedicine systems currently available and outlined issues with these systems that impact usability among the geriatric population. Based on the results, design suggestions were developed to improve telemedicine systems for this population. Using a between-subjects experimental design, the study considered four telemedicine systems used in Medical University of South Carolina. The study was conducted at a local retirement home. The participant pool consisted of 40 adults, 60 years or older. The dependent measures used were the mean times for telemedicine session initiation and video session, mean number of errors, post-test satisfaction ratings, the NASA-Task Load Index (NASA-TLX) workload measures, and the IBM-Computer Systems Usability Questionnaire measures. Statistical significance was found among the telemedicine systems' initiation times. The analysis of the qualitative data revealed several issues, including lengthy e-mail content, icon placement, and chat box design, which affect the usability of these systems for the geriatric population. Human factor-based design modifications, including short, precise e-mail content, appropriately placed icons, and the inclusion of instructions, are recommended to address the issues found in the qualitative study.

Pediatric Diabetes Telemedicine Program Improves Access to Care for Rural Families: Role of APRNs.

Science.gov (United States)

Smith, Nancy Marie; Satyshur, Rosemarie DiMauro

2016-01-01

Type 1 diabetes mellitus has increased in children by 23% from 2001 to 2009. Rural communities additionally have increased disparities related to access barriers and a large minority population with poorer overall health. Research evidence supports telemedicine as an effective alternative to bring preventive diabetes care to remote areas. This article presents an overview of the leadership role of advanced practice registered nurses (APRNs) with the implementation and evaluation of a pediatric diabetes telemedicine program at a rural pediatric outpatient specialty clinic in partnership with a tertiary center telemedicine network. The telemedicine program quality improvement (QI) project explored caregiver satisfaction with a convenience sample of caregivers (N = 14) using a nine-item Telemedicine Diabetes Caregiver Satisfaction Survey (TDCSS), with responses ranging from 1 = strongly disagree to 5 = strongly agree. Findings indicate caregivers were highly satisfied with communication/ privacy (M = 4.8), access to care (M = 4.1), and quality of services (M = 5.0). The multidisciplinary collaborative teamwork, continuous QI, and dependable technology were integral to the quality of the telemedicine clinical initiative. APRNs provided technology expertise, interdisciplinary collaboration leadership, care coordination, and advocacy for policy changes. Results demonstrate that telemedicine and APRN leadership can help implement innovative programs into rural communities to improve access to care, healthcare cost, and outcomes.

Effectiveness and future prospects of telemedicine/remote health care management applications in Pakistan

International Nuclear Information System (INIS)

Iqbal, S.; Khan, N.

2017-01-01

Medical/Health care system is spraining in Pakistan because of innovative technology, activities and services as per their financial cost (position) which is increasing day by day. This research is intended for the assessment of Telemedicine/Remote Health Care Management practices (system), which encompasses usability, acceptance and impact in public/private hospitals. To improve the existing remote health care/telemedicine practices in Pakistan by using EM (Engineering Management) based approach. It has been widely and successfully implemented and is considered as a strategic and operational tool. In the 21st century due to the Technological advancements the mode of operation of service and business sector have been changed drastically. In the same way the health sectors activities also have been altered, new methods and techniques have also been devised for the treatment of the patients that were never even thought before. In the health sector Telemedicine/Remote Health Care Management is one of the development which was experienced lately. Telemedicine/Remote Health Careistaken exactly "medicine at a distance". Therefore, hypothetically, some procedures performed with medication which does not take place "face-to-face"and"in person"which can be considered as Telemedicine/Remote Health Care. In the industrialized world telemedicine is being used in full capacity to provide the health care services to remote and un-accessible areas. But Telemedicine/Remote Health Care Management is not very popular and admired in Pakistan; few applications are being functional presently. (author)

Change in therapeutic apheresis practices: Role of continuing medical education (CME).

Science.gov (United States)

Tiwari, Aseem Kumar; Dara, Ravi C; Pandey, Prashant; Arora, Dinesh; Rawat, Ganesh; Raina, Vimarsh

2016-02-01

American society for apheresis (ASFA) publishes guidelines for therapeutic apheresis (TA) and physicians ordering TA procedures should be aware of the appropriate indications based on scientific evidence. Transfusion Medicine specialists (apheresis physicians) can steer physicians in right direction through CME on right indications, duration of therapy and replacement fluid. Therefore, authors reviewed, collated, and interpreted effect of formal CME interventions. Retrospective study was conducted in a large hospital in India. CME interventions to teach clinical and managerial aspects of TA were conducted in the first quarter of 2012. Sessions involved ASFA guidelines and recommendations for TA. Data was collected and changes in practice related to TA before (March 2010 to December 2011) and after (April 2012 to December 2013) the intervention was analyzed. Seventy-three subjects participated in the interventions. Five hundred and eighty-nine TA procedures were performed during study period; 214 procedures in 49 patients before intervention and 375 procedures in 84 patients after intervention. After intervention there was significant improvement in indications of category I (38.7% vs. 64.3%; P = 0.004), category II (22.5% vs. 16.6%), category III (12.2% vs. 11.9%), and category IV (6.1% vs. 2.4%; P = 0.0001). Significant reduction was seen in procedures not belonging to any category from 20.5% to 4.8% (P = 0.002). Change in practices was also observed in context of duration of therapy and replacement fluid. CME intervention, based on the 2010 edition of ASFA guidelines for therapeutic apheresis appears to have had a positive impact on physicians TA practices. © 2015 Wiley Periodicals, Inc.

Relationship between SEP Peak intensity and CME Acceleration, Speed and Width

Science.gov (United States)

Xie, H.; St Cyr, O. C.; Makela, P. A.; Gopalswamy, N.

2017-12-01

We study the large solar energetic particle (SEP) events that were detected by GOES in the >10 MeV energy channel during December 2006 to January 2016. Data used in this study includes the Solar Electron Proton Telescope (SEPT) and High Energy Telescopes (HET) on STEREO A and B, the Electron, Proton, and Alpha Monitor (EPAM) on ACE, and the Energetic and Relativistic Nuclei and Electron instrument (ERNE) on SOHO. By choosing the smallest connection angles between SEP solar locations and magnetic foot-points of each spacecraft, we divide SEP events as SOHO SEPs or STEREO SEPs. We then compute the SEP peak intensity I0 at the center of the Gausssian using the Gausssian expression from Richardson et al. (2014) and study the relationship between SEP electron and proton peak intensity and CME acceleration, speed and width. By using I0 derived from multi-spacecraft observations we found that the correlations between SEP peak intensity and CME acceleration and speed improved. We also found that this correlation can be further improved by taking into account the effects of CME width and its solar source latitude. The implication for the SEP forecast of our obtained results will be discussed.

The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease.

Science.gov (United States)

Schneider, Ruth B; Biglan, Kevin M

2017-07-01

Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine-defined here as the use of real-time, synchronous videoconferencing to deliver medical care-could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues. Copyright © 2017 Elsevier Ltd. All rights reserved.

Secure Wireless Military Healthcare Telemedicine Enterprise

National Research Council Canada - National Science Library

Lucas, Kenneth W

2005-01-01

The primary objective of this research effort is to integrate ViTel Net's MedVizerTM software and Division Tools with cross platform telemedicine systems, inclusive of computer based systems, handheld...

Evaluation of telemedicine centres in Madhya Pradesh, Central India.

Science.gov (United States)

Bali, Surya; Gupta, Arti; Khan, Asif; Pakhare, Abhijit

2016-04-01

In a developing country such as India, there is substantial inequality in health care distribution. Telemedicine facilities were established in Madhya Pradesh in 2007-2008. The purpose of this study was to evaluate the infrastructure, equipment, manpower, and functional status of Indian Space and Research Organisation (ISRO) telemedicine nodes in Madhya Pradesh. All district hospitals and medical colleges with nodes were visited by a team of three members. The study was conducted from December 2013-January 2014. The team recorded the structural facility situation and physical conditions on a predesigned pro forma. The team also conducted interviews with the nodal officers, data entry operator and other relevant people at these centres. Of the six specialist nodes, four were functional and two were non-functional. Of 10 patient nodes, two nodes were functional, four were semi-functional and four were non-functional. Most of the centres were not working due to a problem with their satellite modem. The overall condition of ISRO run telemedicine centres in Madhya Pradesh was found to be poor. Most of these centres failed to provide telemedicine consultations. We recommend replacing this system with another cost effective system available in the state wide area network (SWAN). We suggest the concept of the virtual out-patient department. © The Author(s) 2015.

Headache patients' satisfaction with telemedicine: a 12-month follow-up randomized non-inferiority trial.

Science.gov (United States)

Müller, K I; Alstadhaug, K B; Bekkelund, S I

2017-06-01

We investigated non-acute headache patients' long-term satisfaction with a telemedicine consultation and consultation preferences in northern Norway. We hypothesized that patients were not less satisfied with telemedicine than traditional consultations. We also examined the influence of gender, age and education on satisfaction. For 2.5 years, patients were consecutively screened, recruited and randomly assigned to telemedicine or traditional visits with a consultation at a neurological outpatient department. The primary endpoint was frequency of satisfied patients at 3 and 12 months. Secondary endpoints were satisfaction with consultation, communication, information, diagnosis, advice and prescriptions, and preferred visit form at 12 months. Of 402 participants, 279 (69.4%) answered questionnaires at both 3 and 12 month, and 291 (72.4%) responded at 12 months. The long-term satisfaction of telemedicine patients was 124/145 (85.5%) compared with 118/134 (88.1%) in the traditional group (P = 0.653). The groups did not differ with respect to secondary endpoints, but females were more satisfied with telemedicine communication (P = 0.027). In the telemedicine group, 99/147 (67.3%) were indifferent to the type of consultation. Age and education did not alter the primary results. At 1 year after a specialist evaluation for headache, telemedicine patients did not express less satisfaction than those with traditional consultation. Telemedicine specialist consultations may be a good alternative for headache patients in secondary care. © 2017 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

Willingness to Adopt Telemedicine in Major Iraqi Hospitals: A Pilot Study

Directory of Open Access Journals (Sweden)

Mohd Khanapi Abd Ghani

2015-01-01

Full Text Available The Iraqi healthcare services are struggling to regain their lost momentum. Many physicians and nurses left Iraq because of the current situation in the country. Despite plans of calling back the skilled health workforce, they are still worried by the disadvantages of their return. Hence, technology plays a central role in taking advantage of their profession through the use of telemedicine. Studying the factors that affect the implementation of telemedicine is necessary. Telemedicine covers network services, policy makers, and patient understanding. A framework that includes the influencing factors in adopting telemedicine in Iraq was developed in this study. A questionnaire was distributed among physicians in Baghdad Medical City to examine the hypothesis on each factor. The Statistical Package for the Social Sciences was utilized to verify the reliability of the questionnaire and Cronbach’s alpha test shows that the factors have values more than 0.7, which are standard.

Expense comparison of a telemedicine practice versus a traditional clinical practice.

Science.gov (United States)

Barker, Gail P; Krupinski, Elizabeth A; Schellenberg, Bonnie; Weinstein, Ronald S

2004-01-01

This paper compares the expenses of a telemedicine program to those of a traditional clinical practice using data from two fiscal years (FY) 1998/1999 and 2000/2001. As part of that evaluation, we compared expenses of the University of Arizona's clinical practice group, the University Physicians Incorporated (UPI), to those of the Arizona Telemedicine Program (ATP) practice. For this study, we used the reporting categories published in the year-end UPI financial statement. These categories included clinical services, administration, equipment depreciation, and overhead. Results showed that clinical service expenses and administrative expenses for FY 2000/2001 were higher in the traditional UPI practice, whereas equipment depreciation and overhead expenses are higher in the telemedicine practice. This differs somewhat from FY 1998/1999, where clinical expenses and overhead were higher in the UPI practice and administration and equipment depreciation were higher in the telemedicine practice. We will discuss the relevance of these results and the critical factors that contribute to these differences.

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support

Directory of Open Access Journals (Sweden)

Karayiannis D

2003-03-01

Full Text Available Abstract The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available or through Plain Old Telephony Systems (POTS where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three

Safety of Medical Abortion Provided Through Telemedicine Compared With In Person.

Science.gov (United States)

Grossman, Daniel; Grindlay, Kate

2017-10-01

To compare the proportion of medical abortions with a clinically significant adverse event among telemedicine and in-person patients at a clinic system in Iowa during the first 7 years of the service. We conducted a retrospective cohort study. We analyzed data on clinically significant adverse events (hospital admission, surgery, blood transfusion, emergency department treatment, and death) for all medical abortions performed by telemedicine or in person at a clinic system in Iowa between July 1, 2008, and June 30, 2015. Data on adverse events came from required reporting forms submitted to the mifepristone distributor. We calculated the prevalence of adverse events and 95% CIs comparing telemedicine with in-person patients. The analysis was designed as a noninferiority study. Assuming the prevalence of adverse events to be 0.3%, telemedicine provision was considered to be inferior to in-person provision if the prevalence were 0.6% or higher. The required sample size was 6,984 in each group (one-sided α=0.025, power 90%). To explore whether patients with adverse events presented to emergency departments and were not reported, we conducted a survey of the 119 emergency departments in Iowa, asking whether they had treated a woman with an adverse event in the prior year. During the study period, 8,765 telemedicine and 10,405 in-person medical abortions were performed. Forty-nine clinically significant adverse events were reported (no deaths or surgery; 0.18% of telemedicine patients with any adverse event [95% CI 0.11-0.29%] and 0.32% of in-person patients [95% CI 0.23-0.45%]). The difference in adverse event prevalence was 0.13% (95% CI -0.01% to 0.28%, P=.07). Forty-two emergency departments responded to the survey (35% response rate); none reported treating a woman with an adverse event after medical abortion. Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant

Feasibility of AmbulanCe-Based Telemedicine (FACT study: safety, feasibility and reliability of third generation in-ambulance telemedicine.

Directory of Open Access Journals (Sweden)

Laetitia Yperzeele

Full Text Available Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation.A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥ 18 years transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis.Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%. The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high.Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high

Telemedicine system interoperability architecture: concept description and architecture overview.

Energy Technology Data Exchange (ETDEWEB)

Craft, Richard Layne, II

2004-05-01

In order for telemedicine to realize the vision of anywhere, anytime access to care, it must address the question of how to create a fully interoperable infrastructure. This paper describes the reasons for pursuing interoperability, outlines operational requirements that any interoperability approach needs to consider, proposes an abstract architecture for meeting these needs, identifies candidate technologies that might be used for rendering this architecture, and suggests a path forward that the telemedicine community might follow.

Adoption of telemedicine in Scottish remote and rural general practices: a qualitative study.

Science.gov (United States)

King, Gerry; Richards, Helen; Godden, David

2007-01-01

We conducted a qualitative interview study to explore the factors that have facilitated and prevented the adoption of telemedicine in general practice in remote and rural Scotland. Face-to-face interviews were carried out with general practitioners (GPs) and practice nurses in 26 of Scotland's most remote practices and five of the seven most rural health boards. The interview study found that GPs were more positive about the use of computers and telemedicine than nurses. Although electronic access to simple data, such as laboratory results, had become widely accepted, most respondents had very little experience of more sophisticated telemedicine applications, such as videoconferencing. There was widespread scepticism about the potential usefulness of clinical applications of telemedicine, although it was perceived to have potential benefit in facilitating access to educational resources. A number of barriers to the adoption of telemedicine were reported, including concerns that videoconferencing could diminish the quality of communication in educational and clinical settings, and that telemedicine would not fit easily with the organizational routines of the practices. Policy-makers should prioritize strategies to develop educational programmes, as these are more likely to succeed than clinical initiatives. It may then follow that clinicians will see opportunities for use in their clinical work.

The Role of Telemedicine in Providing Thoracic Oncology Care to Remote Areas of British Columbia.

Science.gov (United States)

Humer, Michael F; Campling, Barbara G

2017-08-01

The purpose of this study is to review the role of telemedicine in providing oncology care; we describe our long-standing, high-volume telemedicine experience. The Interior Health Thoracic Surgical Group (IHTSG) uses telemedicine, through Virtual Thoracic Surgical Clinics (VTSC), to provide service to remote patients. The IHTSG serves a population of 1.01 million people over an area of 807,538 km 2 (1.3 persons/km 2 ) in the Interior and North of British Columbia, Canada. Between 2003 and 2015, the IHTSG conducted 15,073 telemedicine patient encounters at 63 geographic sites. Telemedicine saved these patients a total travel distance of 11.5 million km-an average of 766 km per patient. VTSC supports and strengthens the Hub and Spoke model of healthcare delivery-patients residing remotely can easily access centrally delivered service. Telemedicine makes specialized care available to all patients by overcoming a major impediment to access, namely distance.

Advances in Telemedicine Using Mobile Communications

National Research Council Canada - National Science Library

Istepanian, Robert S. H

2001-01-01

Future telemedicine systems will exploit mobile communications technology so that patients who are free to move around at home or at work, or in emergency medical situations, can be monitored in a hospital...

Telemedicine vs in-person cancer genetic counseling: measuring satisfaction and conducting economic analysis

Directory of Open Access Journals (Sweden)

Datta SK

2011-05-01

Full Text Available Santanu K Datta1,2, Adam H Buchanan3, Gail P Hollowell4, Henry F Beresford5, Paul K Marcom1,3, Martha B Adams1,61Department of Medicine, Duke University; 2Center for Health Services Research in Primary Care, Durham VA Medical Center; 3Duke Cancer Institute, Duke University; 4Department of Biology, North Carolina Central University; 5School of Nursing, Duke University; 6Department of Community and Family Medicine, Duke University, Durham, NC, USAAbstract: Cancer genetic counseling (CGC provides benefits and is the standard of care for individuals at increased risk of having a hereditary cancer syndrome. CGC services are typically centered in urban medical centers, leading to limited access to counseling in rural communities. Telemedicine has the potential to improve access to CGC, increase efficient use of genetic counselors, and improve patient care in rural communities. For telemedicine CGC to gain wide acceptance and implementation it needs to be shown that individuals who receive telemedicine CGC have high satisfaction levels and that CGC is cost-effective; however little research has been conducted to measure the impact of telemedicine CGC. This paper describes the design and methodology of a randomized controlled trial comparing telemedicine with in-person CGC. Measurement of patient satisfaction and effectiveness outcomes are described, as is measurement of costs that are included in an economic analysis. Study design and methodologies used are presented as a contribution to future comparative effectiveness investigations in the telemedicine genetic counseling field.Keywords: cancer genetics, genetic counseling, rural health services, telemedicine, satisfaction, cost

Feasibility of telemedicine in detecting diabetic retinopathy and age-related macular degeneration.

Science.gov (United States)

Vaziri, Kamyar; Moshfeghi, Darius M; Moshfeghi, Andrew A

2015-03-01

Age-related macular degeneration and diabetic retinopathy are important causes of visual impairment and blindness in the world. Because of recent advances and newly available treatment modalities along with the devastating consequences associated with late stages of these diseases, much attention has been paid to the importance of early detection and improving patient access to specialist care. Telemedicine or, more specifically, digital retinal imaging utilizing telemedical technology has been proposed as an important alternative screening and management strategy to help meet this demand. In this paper, we perform a literature review and analysis that evaluates the validity and feasibility of telemedicine in detecting diabetic retinopathy and age-related macular degeneration. Understanding both the progress and barriers to progress that have been demonstrated in these two areas is important for future telemedicine research projects and innovations in telemedicine technology.

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC from 2010 to 2016

Science.gov (United States)

Wold, Alexandra M.; Mays, M. Leila; Taktakishvili, Aleksandre; Jian, Lan K.; Odstrcil, Dusan; MacNeice, Peter

2018-03-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model coronal mass ejection (CME) propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC space weather team. CCMC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in situ interplanetary coronal mass ejection leading edge measurements at Solar TErrestrial RElations Observatory-Ahead (STEREO-A), Solar TErrestrial RElations Observatory-Behind (STEREO-B), and Earth (Wind and ACE) for simulations completed between March 2010 and December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three locations. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B, and was actually observed (hit event), the mean absolute arrival-time prediction error was 10.4 ± 0.9 h, with a tendency to early prediction error of -4.0 h. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A sidelobe operations (August 2014-December 2015). There is an increase of 1.7 h in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC/SWRC from 2010-2016

Science.gov (United States)

Wold, A. M.; Mays, M. L.; Taktakishvili, A.; Odstrcil, D.; MacNeice, P. J.; Jian, L. K.

2017-12-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model CME propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC/Space Weather Research Center (SWRC). CCMC/SWRC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in-situ ICME leading edge measurements near Earth, STEREO-A and STEREO-B for simulations completed between March 2010-December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B and we observed an arrival (hit), the mean absolute arrival-time prediction error was 10.4 ± 0.9 hours, with a tendency to early prediction error of -4.0 hours. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A side-lobe operations (August 2014-December 2015). There is an increase of 1.7 hours in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Critical to quality in telemedicine service management: application of DFSS (Design for Six Sigma) and SERVQUAL).

Science.gov (United States)

Yun, Eun Kyoung; Chun, Kee Moon

2008-01-01

Telemedicine generally refers to the use of communications and information technologies for the delivery of health care. owever, telemedicine is not merely a simple combination of health care and technology. The researchers propose a systematic approach for assessing needs of telemedicine customers, called critical-to-quality (CTQ) in Six Sigma, with a purpose of continuous quality improvement. The combination approach using DFSS (Design for Six Sigma) and SERVQUAL (Service Quality Framework) was applied to define the critical quality attributes of telemedicine service management and to match them with the current telemedicine process. With a step-by-step procedure, telemedicine service process was reviewed and all the important CTQ candidates identified via a case study. The findings suggest that nurses need further understanding and research methods that will improve and manage the quality of health care service in various medical fields.

Telemedicine and eHealth in Poland from 1995 to 2015.

Science.gov (United States)

Glinkowski, Wojciech M; Karlińska, Maria; Karliński, Michał; Krupiński, Elizabeth A

2018-02-01

The aim of this study is to present a review based on the literature and proceedings from selected telemedicine conferences. The review was developed using the PRISMA framework. The Embase and PubMed (updated until July 13, 2015) literature databases were searched for telemedicine-related terms and Poland. The literature search identified 129 eligible articles in the databases and 85 in conference proceedings until July 2015. Articles measured as a number of contributions per year presented a similar rising, fluctuating and almost parallel pattern. Fifty-nine percent of the reviewed papers were published in impacted journals. Almost half of all publications presented original papers. The published articles concerned mostly cardiology (16%), family medicine (15%) and pathology (11%). Conference proceedings papers concerned orthopedics (29%, significantly more frequent; p < 0.001) and cardiology (14%). Scientific activity of researchers and practitioners in Poland in the field of telemedicine is not high, but it is increasing over time. There is a tendency to present the research rather in high-quality journals instead of conferences before publication. The occurrence of individual medical specialty telemedicine in Poland may reflect country-specific needs.

Telemedicine for children with developmental disabilities: a more effective clinical process than office-based care.

Science.gov (United States)

Langkamp, Diane L; McManus, Mark D; Blakemore, Susan D

2015-02-01

The literature on the use of telemedicine for children with developmental disabilities (DD) is limited and mostly describes telemedicine being used to link patients with distant subspecialty multidisciplinary care. Parents generally have reported satisfaction with such care and have perceived it to be equally effective as in-person care. Here we report on the use of school-based asynchronous telemedicine to connect children with DD with primary care providers. We developed Tele-Health-Kids, a school-based program using asynchronous telemedicine to connect children with DD with their primary care physician for the care of minor illnesses. We surveyed parents at enrollment and after the child's first telemedicine visit to assess satisfaction. We describe 4 cases that illustrate benefits, particularly for children with DD and challenging behaviors, suggesting that asynchronous telemedicine may actually be superior to traditional in-office visits in some circumstances. Most parents expressed a high level of satisfaction with the program. Benefits identified include decreased stress to the child and the parents as well as increasing the likelihood of a successful medical examination due to greater cooperation by the child. Visits using asynchronous or "store and forward" telemedicine technology may be superior in some situations by allowing the visit to be performed at a pace that can be adjusted to the needs of the child with DD. More research in the use of asynchronous telemedicine for children and youth with DD, particularly for children with DD and challenging behaviors, is needed.

Online collaboration environments in telemedicine applications of speech therapy.

Science.gov (United States)

Pierrakeas, C; Georgopoulos, V; Malandraki, G

2005-01-01

The use of telemedicine in speech and language pathology provides patients in rural and remote areas with access to quality rehabilitation services that are sufficient, accessible, and user-friendly leading to new possibilities in comprehensive and long-term, cost-effective diagnosis and therapy. This paper discusses the use of online collaboration environments for various telemedicine applications of speech therapy which include online group speech therapy scenarios, multidisciplinary clinical consulting team, and online mentoring and continuing education.

Participatory design methods in telemedicine research

DEFF Research Database (Denmark)

Danbjørg, Dorthe Boe; Clemensen, Jane; Rothmann, Mette Juel

together with the patients. Participatory design is a research design and methodology that encourages the participation of users in the design process of technological solutions. Therefore, it has a potential for designing technologies that actually reflect the needs of the users, why it is relevant within...... telemedicine. The aim of this presentation is to explain the process and theoretical framework of a PD project; give an example of a project including the applied methods, and to determine its application to telemedicine with focus on the rationale for genuine participation. Theory: Participation implies....... Methods: Key activities of a Participatory Design project comprise methods such as fieldwork; literature reviewing; development and testing, and user activities as workshops. Methods that support telling, making, enacting. For instance telling activities as drivers for participation, where practitioners...

Comparative study of connectivity in telemedicine.

Science.gov (United States)

Singh, Indra Pratap; Kapoor, Lily; Daman, Repu; Mishra, Saroj Kanta

2008-10-01

Communication links are the lifelines for telemedicine practice. Various terrestrial and satellite media can be used; however, each has its own plus and minus side. The current study was designed to evaluate three types of telecommunication media used for telemedical videoconference at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow Telemedicine program over a period of 20 months. The evaluation was based on analysis of technical parameters recorded in a prescribed proforma designed for the study purpose and maintained prospectively after completion of each event. Only technical issues were addressed. At the end of the study period, analysis of data revealed that leased line-based terrestrial Internet Protocol (IP) was better than Sky IP. Integrated Services Digital Network media were found technically less acceptable for telemedical videoconference.

Deriving the radial distances of wide coronal mass ejections from elongation measurements in the heliosphere – application to CME-CME interaction

Directory of Open Access Journals (Sweden)

I. I. Roussev

2009-09-01

Full Text Available We present general considerations regarding the derivation of the radial distances of coronal mass ejections (CMEs from elongation angle measurements such as those provided by SECCHI and SMEI, focusing on measurements in the Heliospheric Imager 2 (HI-2 field of view (i.e. past 0.3 AU. This study is based on a three-dimensional (3-D magneto-hydrodynamics (MHD simulation of two CMEs observed by SECCHI on 24–27 January 2007. Having a 3-D simulation with synthetic HI images, we are able to compare the two basic methods used to derive CME positions from elongation angles, the so-called "Point-P" and "Fixed-φ" approximations. We confirm, following similar works, that both methods, while valid in the most inner heliosphere, yield increasingly large errors in HI-2 field of view for fast and wide CMEs. Using a simple model of a CME as an expanding self-similar sphere, we derive an analytical relationship between elongation angles and radial distances for wide CMEs. This relationship is simply the harmonic mean of the "Point-P" and "Fixed-φ" approximations and it is aimed at complementing 3-D fitting of CMEs by cone models or flux rope shapes. It proves better at getting the kinematics of the simulated CME right when we compare the results of our line-of-sights to the MHD simulation. Based on this approximation, we re-analyze the J-maps (time-elongation maps in 26–27 January 2007 and present the first observational evidence that the merging of CMEs is associated with a momentum exchange from the faster ejection to the slower one due to the propagation of the shock wave associated with the fast eruption through the slow eruption.

Dependence of the Peak Fluxes of Solar Energetic Particles on CME 3D Parameters from STEREO and SOHO

International Nuclear Information System (INIS)

Park, Jinhye; Moon, Y.-J.; Lee, Harim

2017-01-01

We investigate the relationships between the peak fluxes of 18 solar energetic particle (SEP) events and associated coronal mass ejection (CME) 3D parameters (speed, angular width, and separation angle) obtained from SOHO , and STEREO-A / B for the period from 2010 August to 2013 June. We apply the STEREO CME Analysis Tool (StereoCAT) to the SEP-associated CMEs to obtain 3D speeds and 3D angular widths. The separation angles are determined as the longitudinal angles between flaring regions and magnetic footpoints of the spacecraft, which are calculated by the assumption of a Parker spiral field. The main results are as follows. (1) We find that the dependence of the SEP peak fluxes on CME 3D speed from multiple spacecraft is similar to that on CME 2D speed. (2) There is a positive correlation between SEP peak flux and 3D angular width from multiple spacecraft, which is much more evident than the relationship between SEP peak flux and 2D angular width. (3) There is a noticeable anti-correlation ( r = −0.62) between SEP peak flux and separation angle. (4) The multiple-regression method between SEP peak fluxes and CME 3D parameters shows that the longitudinal separation angle is the most important parameter, and the CME 3D speed is secondary on SEP peak flux.

Dependence of the Peak Fluxes of Solar Energetic Particles on CME 3D Parameters from STEREO and SOHO

Energy Technology Data Exchange (ETDEWEB)

Park, Jinhye; Moon, Y.-J. [Department of Astronomy and Space Science, Kyung Hee University, Yongin 17104 (Korea, Republic of); Lee, Harim, E-mail: jinhye@khu.ac.kr [School of Space Research, Kyung Hee University, Yongin 17104 (Korea, Republic of)

2017-07-20

We investigate the relationships between the peak fluxes of 18 solar energetic particle (SEP) events and associated coronal mass ejection (CME) 3D parameters (speed, angular width, and separation angle) obtained from SOHO , and STEREO-A / B for the period from 2010 August to 2013 June. We apply the STEREO CME Analysis Tool (StereoCAT) to the SEP-associated CMEs to obtain 3D speeds and 3D angular widths. The separation angles are determined as the longitudinal angles between flaring regions and magnetic footpoints of the spacecraft, which are calculated by the assumption of a Parker spiral field. The main results are as follows. (1) We find that the dependence of the SEP peak fluxes on CME 3D speed from multiple spacecraft is similar to that on CME 2D speed. (2) There is a positive correlation between SEP peak flux and 3D angular width from multiple spacecraft, which is much more evident than the relationship between SEP peak flux and 2D angular width. (3) There is a noticeable anti-correlation ( r = −0.62) between SEP peak flux and separation angle. (4) The multiple-regression method between SEP peak fluxes and CME 3D parameters shows that the longitudinal separation angle is the most important parameter, and the CME 3D speed is secondary on SEP peak flux.

Shared Care of Childhood Cancer Survivors: A Telemedicine Feasibility Study.

Science.gov (United States)

Costello, Aimee G; Nugent, Bethany D; Conover, Noelle; Moore, Amanda; Dempsey, Kathleen; Tersak, Jean M

2017-12-01

With an increasing number of childhood cancer survivors (CCSs), determining the best model of survivorship transition care is becoming a growing priority. Shared care between pediatric oncology and adult primary care is often necessary, making survivorship a time of transition, but effective standard models are lacking. We sought to provide a more integrated approach to transition using telemedicine. Recruited primary care provider/CCS dyads were instructed to log-in to a password-protected virtual meeting room using telemedicine equipment at the time or a regularly scheduled office visit. Dyads were joined by a pediatric survivorship clinic team member who conducted the telemedicine portion of the transition visit, which consisted of the review of an individualized treatment summary and care plan. Postquestionnaires were developed to evaluate key points such as fund of knowledge, satisfaction with the visit, and effectiveness of this electronic tool. There were 19 transition visits conducted, 13 of which used the telemedicine equipment as planned. Those that did not use the equipment were primarily unable to due to technical difficulties. Postquestionnaires were overall positive, confirming increased knowledge, comfort and abilities, and patient satisfaction in survivorship care. Negative comments were primarily related to equipment difficulties. A gap still remains in helping CCSs transition from oncology to primary care and this pilot study offered insights into how we might better bridge that gap through the use of telemedicine. Further research is needed to refine the transition process for CCSs, including evaluation and testing models for standard of care.

Impact of telemedicine in hospital culture and its consequences on quality of care and safety

Science.gov (United States)

Steinman, Milton; Morbeck, Renata Albaladejo; Pires, Philippe Vieira; Abreu, Carlos Alberto Cordeiro; Andrade, Ana Helena Vicente; Terra, Jose Claudio Cyrineu; Teixeira, José Carlos; Kanamura, Alberto Hideki

2015-01-01

ABSTRACT Objective To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice. Methods The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein. Results Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis. Conclusion The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care. PMID:26676268

Telemedicine Provides Non-Inferior Research Informed Consent for Remote Study Enrollment: A Randomized Controlled Trial

Science.gov (United States)

Bobb, Morgan R.; Van Heukelom, Paul G.; Faine, Brett A.; Ahmed, Azeemuddin; Messerly, Jeffrey T.; Bell, Gregory; Harland, Karisa K.; Simon, Christian; Mohr, Nicholas M.

2016-01-01

Objective Telemedicine networks are beginning to provide an avenue for conducting emergency medicine research, but using telemedicine to recruit participants for clinical trials has not been validated. The goal of this consent study is to determine whether patient comprehension of telemedicine-enabled research informed consent is non-inferior to standard face-to-face research informed consent. Methods A prospective, open-label randomized controlled trial was performed in a 60,000-visit Midwestern academic Emergency Department (ED) to test whether telemedicine-enabled research informed consent provided non-inferior comprehension compared with standard consent. This study was conducted as part of a parent clinical trial evaluating the effectiveness of oral chlorhexidine gluconate 0.12% in preventing hospital-acquired pneumonia among adult ED patients with expected hospital admission. Prior to being recruited into the study, potential participants were randomized in a 1:1 allocation ratio to consent by telemedicine versus standard face-to-face consent. Telemedicine connectivity was provided using a commercially available interface (REACH platform, Vidyo Inc., Hackensack, NJ) to an emergency physician located in another part of the ED. Comprehension of research consent (primary outcome) was measured using the modified Quality of Informed Consent (QuIC) instrument, a validated tool for measuring research informed consent comprehension. Parent trial accrual rate and qualitative survey data were secondary outcomes. Results One-hundred thirty-one patients were randomized (n = 64, telemedicine), and 101 QuIC surveys were completed. Comprehension of research informed consent using telemedicine was not inferior to face-to-face consent (QuIC scores 74.4 ± 8.1 vs. 74.4 ± 6.9 on a 100-point scale, p = 0.999). Subjective understanding of consent (p=0.194) and parent trial study accrual rates (56% vs. 69%, p = 0.142) were similar. Conclusion Telemedicine is non-inferior to face

Urban Telemedicine: The Applicability of Teleburns in the Rehabilitative Phase.

Science.gov (United States)

Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy

Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care

Telemedicine and international disaster response. Medical consultation to Armenia and Russia via a Telemedicine Spacebridge.

Science.gov (United States)

Houtchens, B A; Clemmer, T P; Holloway, H C; Kiselev, A A; Logan, J S; Merrell, R C; Nicogossian, A E; Nikogossian, H A; Rayman, R B; Sarkisian, A E

1993-01-01

The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

Telemedicine and international disaster response: medical consultation to Armenia and Russia via a Telemedicine Spacebridge.

Science.gov (United States)

Houtchens, B A; Clemmer, T P; Holloway, H C; Kiselev, A A; Logan, J S; Merrell, R C; Nicogossian, A E; Nikogossian, H A; Rayman, R B; Sarkisian, A E; Siegel, J H

1993-01-01

The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

A randomized trial of telemedicine efficacy and safety for nonacute headaches.

Science.gov (United States)

Müller, Kai I; Alstadhaug, Karl B; Bekkelund, Svein I

2017-07-11

To evaluate long-term treatment efficacy and safety of one-time telemedicine consultations for nonacute headaches. We randomized, allocated, and consulted nonacute headache patients via telemedicine (n = 200) or in a traditional manner (n = 202) in a noninferiority trial. Efficacy endpoints, assessed by questionnaires at 3 and 12 months, included change from baseline in Headache Impact Test-6 (HIT-6) (primary endpoint) and pain intensity (visual analogue scale [VAS]) (secondary endpoint). The primary safety endpoint, assessed via patient records, was presence of secondary headache within 12 months after consultation. We found no differences between telemedicine and traditional consultations in HIT-6 ( p = 0.84) or VAS ( p = 0.64) over 3 periods. The absolute difference in HIT-6 from baseline was 0.3 (95% confidence interval [CI] -1.26 to 1.82, p = 0.72) at 3 months and 0.2 (95% CI -1.98 to 1.58, p = 0.83) at 12 months. The absolute change in VAS was 0.4 (95% CI -0.93 to 0.22, p = 0.23) after 3 months and 0.3 (95% CI -0.94 to 0.29, p = 0.30) at 12 months. We found one secondary headache in each group at 12 months. The estimated number of consultations needed to miss one secondary headache with the use of telemedicine was 20,200. Telemedicine consultation for nonacute headache is as efficient and safe as a traditional consultation. NCT02270177. This study provides Class III evidence that a one-time telemedicine consultation for nonacute headache is noninferior to a one-time traditional consultation regarding long-term treatment outcome and safety. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

[Telemedicine correlation in retinopathy of prematurity between experts and non-expert observers].

Science.gov (United States)

Ossandón, D; Zanolli, M; López, J P; Stevenson, R; Agurto, R; Cartes, C

2015-01-01

To study the correlation between expert and non-expert observers in the reporting images for the diagnosis of retinopathy of prematurity (ROP) in a telemedicine setting. A cross-sectional, multicenter study, consisting of 25 sets of images of patients screened for ROP. They were evaluated by two experts in ROP and 1 non-expert and classified according to telemedicine classification, zone, stage, plus disease and Ells referral criteria. The telemedicine classification was: no ROP, mild ROP, type 2 ROP, or ROP that requires treatment. Ells referral criteria is defined as the presence at least one of the following: ROP in zone I, Stage 3 in zone I or II, or plus+ For statistical analysis, SPSS 16.0 was used. For correlation, Kappa value was performed. There was a high correlation between observers for the assessment of ROP stage (0.75; 0.54-0.88) plus disease (0.85; 0.71-0.92), and Ells criteria (0.89; 0.83-1.0). However, inter-observer values were low for zone (0.41; 0.27-0.54) and telemedicine classification (0.43; 0.33-0.6). When evaluating telemedicine images by examiners with different levels of expertise in ROP, the Ells criteria gave the best correlation. In addition, stage of disease and plus disease have good correlation among observers. In contrast, the correlation between observers was low for zone and telemedicine classification. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Telemedicine: opportunities and risks

International Nuclear Information System (INIS)

Vogl, R.

2002-01-01

Problem. Due to the rapid progress in the fields of information technology and data networks, telemedicine applications are growing in number. Besides curative telemedicine, the electronic exchange of medical data and the integration of health information systems between health care providers is gaining importance. Through the improved accessibility of electronic patient record information, considerable risks arise.Methods. A project for the interconnection of medical picture archiving and communication systems (PACS) between several hospitals is presented and the possibilities for further developing such networking systems utilizing new software technologies for transparent data access between different locations (GRID) and for decision support (software agents) are considered.Results. The availability of the electronic patient record via the data network and the perspective of semi intelligent software systems automatically preparing the data bears great potential for a boost in treatment quality and efficiency. Systems for unique electronic patient identification and for secure digital signature are a prerequisite, but per se not enough to ensure the protection of data against illegitimate access.Conclusion. Despite quality and efficiency benefits, challenges in the protection of sensible data and in the change of the physicians role result. (orig.) [de

INTEGRATING ARTIFICIAL NEURAL NETWORKS FOR DEVELOPING TELEMEDICINE SOLUTION

Directory of Open Access Journals (Sweden)

Mihaela GHEORGHE

2015-06-01

Full Text Available Artificial intelligence is assuming an increasing important role in the telemedicine field, especially neural networks with their ability to achieve meaning from large sets of data characterized by lacking exactness and accuracy. These can be used for assisting physicians or other clinical staff in the process of taking decisions under uncertainty. Thus, machine learning methods which are specific to this technology are offering an approach for prediction based on pattern classification. This paper aims to present the importance of neural networks in detecting trends and extracting patterns which can be used within telemedicine domains, particularly for taking medical diagnosis decisions.

5G and Telemedicine: A Business Ecosystem Relationship within CONASENSE Paradigm

DEFF Research Database (Denmark)

Anwar, Sadia; Kumar, Ambuj

2018-01-01

Abstract—The use of smartphones has been increasing rapidly and it is expected that in future most people will have a smartphone capable of high speed Internet connection. The capability of smartphones with high definition display, computation power and multitude of sensors made it an excellent...... candidate for telemedicine application. Telemedicine’s applications and high data medical information generally require high definition visuals and lower latency connection, in addition mobility and reliability. The next generation of wireless communication standard, known as 5G, will provide data speed...... a composite business ecosystem. We also discuss the research challenges concerning 5G and telemedicine. Keywords—5G, Telemedicines, Wireless Communications, Business Modeling, Business Ecosystems....

Telemedicine and Plastic Surgery: A Pilot Study

Directory of Open Access Journals (Sweden)

Denis Souto Valente

2015-01-01

Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector.

Science.gov (United States)

Holmner, Asa; Ebi, Kristie L; Lazuardi, Lutfan; Nilsson, Maria

2014-01-01

The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers. To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector. A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases. Replacing physical visits with telemedicine appointments resulted in a significant 40-70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car. Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.

Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

International Nuclear Information System (INIS)

Leong, Cheng Nang; Shakespeare, Thomas Philip; Mukherjee, Rahul K.; Back, Michael F.; Lee, Khai Mun; Lu, Jiade Jay; Wynne, Christopher J.; Lim, Keith; Tang, Johann; Zhang Xiaojian

2006-01-01

Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence

Health in old age, and patients’ approaches to telemedicine in Poland

Directory of Open Access Journals (Sweden)

Leszek Buliński

2017-06-01

In Poland in ageing there still dominates the experience of multiple ailments and polytherapy, something which justifies a search for new, easily accessible, and economically sound solutions for health care. Telemedicine is a promising solution although there is a need for concrete steps to be taken to raise willingness amongst geriatric patients to take advantage of telemedicine.

Measure the Propagation of a Halo CME and Its Driven Shock with the Observations from a Single Perspective at Earth

Energy Technology Data Exchange (ETDEWEB)

Lu, Lei; Feng, Li; Liu, Siming [Key Laboratory of Dark Matter and Space Astronomy, Purple Mountain Observatory, Chinese Academy of Sciences, 210008 Nanjing (China); Inhester, Bernd [Max Planck Institute for Solar System Research, Justus-von-Liebig-Weg 3, D-37077 Göttingen (Germany); Zhao, Xinhua, E-mail: lfeng@pmo.ac.cn, E-mail: inhester@mps.mpg.de [State Key Laboratory of Space Weather, National Space Science Center, Chinese Academy of Sciences, Beijing 100190 (China)

2017-02-01

We present a detailed study of an Earth-directed coronal mass ejection (full-halo CME) event that happened on 2011 February 15, making use of white-light observations by three coronagraphs and radio observations by Wind /WAVES. We applied three different methods to reconstruct the propagation direction and traveling distance of the CME and its driven shock. We measured the kinematics of the CME leading edge from white-light images observed by Solar Terrestrial Relations Observatory ( STEREO ) A and B , tracked the CME-driven shock using the frequency drift observed by Wind /WAVES together with an interplanetary density model, and obtained the equivalent scattering centers of the CME by the polarization ratio (PR) method. For the first time, we applied the PR method to different features distinguished from LASCO/C2 polarimetric observations and calculated their projections onto white-light images observed by STEREO-A and STEREO-B . By combining the graduated cylindrical shell (GCS) forward modeling with the PR method, we proposed a new GCS-PR method to derive 3D parameters of a CME observed from a single perspective at Earth. Comparisons between different methods show a good degree of consistence in the derived 3D results.

Secure Wireless Military Healthcare Telemedicine Enterprise System

National Research Council Canada - National Science Library

Lucas, Kenneth

2003-01-01

...(exp TM) software and Division Tools with cross platform telemedicine systems, inclusive of computer based systems, handheld wireless PDA devices, and miniature computers, to existing DoD legacy...

Secure Wireless Military Healthcare Telemedicine Enterprise System

National Research Council Canada - National Science Library

Lucas, Kenneth

2002-01-01

...) software and Dvision Tools with cross platform telemedicine systems, inclusive of computer based systems, handheld wireless PDA devices, and miniature computers, to existing DoD legacy and developing...

Telemedicine is helping the parents of children with neurodevelopmental disorders living in remote and deprived areas.

Science.gov (United States)

Stuckey, Ruth; Domingues-Montanari, Sophie

2017-08-01

Telecommunication technologies are advancing rapidly with huge investment to improve infrastructure in rural areas. Telemedicine brings the benefits of telecommunication to healthcare, especially in resource-limited and remote communities. The recent literature on telemedicine in paediatrics will be reviewed, with particular focus on its application to help children with neurodevelopmental disorders and their families living in remote regions and/or low-income countries, and gaps identified for future research. Studies show that telemedicine can enable a family's access to appropriately qualified help that physically may only be available hundreds of miles away, helping to overcome geographic barriers. Telemedicine can also train parents and equip them with the knowledge and skills to better care for their children. Despite some technological barriers to implementation, telemedicine can help transform all stages of autism treatment. However, more studies are required in low- and middle-income countries to fully elucidate the benefits offered by telemedicine to autistic children and their families.

7 CFR 1700.57 - Distance Learning and Telemedicine Loan and Grant Program.

Science.gov (United States)

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.57 Section 1700.57 Agriculture Regulations of the Department of Agriculture (Continued... Authorities § 1700.57 Distance Learning and Telemedicine Loan and Grant Program. (a) Administrator: The...

Assessment of Patients’ Perception of Telemedicine Services Using the Service User Technology Acceptability Questionnaire

Directory of Open Access Journals (Sweden)

Claudio Dario

2016-06-01

Full Text Available Introduction: The purpose of this paper is to assess if similar telemedicine services integrated in the management of different chronic diseases are acceptable and well perceived by patients or if there are any negative perceptions. Theory and methods: Participants suffering from different chronic diseases were enrolled in Veneto Region and gathered into clusters. Each cluster received a similar telemedicine service equipped with different disease-specific measuring devices. Participants were patients with diabetes (n = 163, chronic obstructive pulmonary disease (n = 180, congestive heart failure (n = 140 and Cardiac Implantable Electronic Devices (n = 1635. The Service User Technology Acceptability Questionnaire (SUTAQ was initially translated, culturally adapted and pretested and subsequently used to assess patients’ perception of telemedicine. Data were collected after 3 months and after 12 months from the beginning of the intervention. Data for patients with implantable devices was collected only at 12 months. Results: Results at 12 months for all clusters are similar and assessed a positive perception of telemedicine. The SUTAQ results for clusters 2 (diabetes, 5 (COPD and 7 (CHF after 3 months of intervention were confirmed after 12 months. Conclusions: Telemedicine was perceived as a viable addition to usual care. A positive perception for telemedicine services isn’t a transitory effect, but extends over the course of time.

Assessment of Patients' Perception of Telemedicine Services Using the Service User Technology Acceptability Questionnaire.

Science.gov (United States)

Dario, Claudio; Luisotto, Elena; Dal Pozzo, Enrico; Mancin, Silvia; Aletras, Vassilis; Newman, Stanton; Gubian, Lorenzo; Saccavini, Claudio

2016-06-01

The purpose of this paper is to assess if similar telemedicine services integrated in the management of different chronic diseases are acceptable and well perceived by patients or if there are any negative perceptions. Participants suffering from different chronic diseases were enrolled in Veneto Region and gathered into clusters. Each cluster received a similar telemedicine service equipped with different disease-specific measuring devices. Participants were patients with diabetes (n = 163), chronic obstructive pulmonary disease (n = 180), congestive heart failure (n = 140) and Cardiac Implantable Electronic Devices (n = 1635). The Service User Technology Acceptability Questionnaire (SUTAQ) was initially translated, culturally adapted and pretested and subsequently used to assess patients' perception of telemedicine. Data were collected after 3 months and after 12 months from the beginning of the intervention. Data for patients with implantable devices was collected only at 12 months. Results at 12 months for all clusters are similar and assessed a positive perception of telemedicine. The SUTAQ results for clusters 2 (diabetes), 5 (COPD) and 7 (CHF) after 3 months of intervention were confirmed after 12 months. Telemedicine was perceived as a viable addition to usual care. A positive perception for telemedicine services isn't a transitory effect, but extends over the course of time.

Audit with feedback (AWF) as a CME tool for radiation oncologists (ROs): evaluation of efficacy, perception, and cost-effectiveness

International Nuclear Information System (INIS)

Shakespeare, T.P.; Mukherjee, R.K.; Lu, J.J.; Wynne, C.J.; Back, M.F.

2003-01-01

Meta-analyses demonstrate Audit with Feedback (AWF) is effective CME, however educational efficacy for ROs is unknown. We evaluated an AWF CME intervention for ROs, determining efficacy, cost-effectiveness and participant satisfaction. CME program: CME incorporated fortnightly random patient chart audit, scoring management adequacy via checklist. Scores were presented at a same-day institutional meeting, and case management discussed. Senior peers provided educational feedback. RO behavior/performance was evaluated via chart review of new patients seen 2 months before commencement of CME (T0), and after 12 months of CME (T1). A validated instrument scored 19 items as '0' (inadequate/inappropriate) or '1' (adequate/appropriate). Comparisons of mean point-score for 10 behaviour items targeted by the CME AWF checklist, 3 non-targeted behaviour items, and 6 performance items were made; also percent charts achieving a '1' for each item at T0 and T1. A 14-item participant questionnaire measured satisfaction before and after efficacy results were known. Responses scored from 0 (very dissatisfied) to 5 (very satisfied), then averaged. Annual cost and cost-per-point gained incorporated salaries of organizers/ participants, and consumables. 113 and 118 charts were evaluated at T0 and T1. Mean score of targeted behavior improved between T0 and T1 (8.7 to 9.2 out of 10,p=0.0001), with no significant improvement for non-targeted behavior/performance items. Improvement occurred for 'Decision for treatment' (non-targeted; percent charts scoring '1' increased from 84% to 92%,p=0.08), and targeted items 'Letter to referrer' (53% to 66%,p=0.04), 'Treatment intent' (54 to 77%,p=0.0002), 'Laterality doublet' (91 to 98%, p=0.04), and 'Isodose-plan signed' (94 to 100%,p=0.006). Improvements varied between ROs. Participant satisfaction was positive, increasing from 3.2 to 3.7 after efficacy result distribution (p=0.0001). Annual costs and cost-per-point gained were $AUD13,820 and $27

UH-USA Agreement - A Telemedicine Research Proposal

National Research Council Canada - National Science Library

Burgess, Lawrence P; Birkmire-Peters, Deborah P

2004-01-01

The purpose of the University of Hawaii Telemedicine Curriculum Research Project is to develop an effective web-based curriculum for training military healthcare personnel in the use of contemporary...

Identifying Obstacles and Research Gaps of Telemedicine Projects: Approach for a State-of-the-Art Analysis.

Science.gov (United States)

Harst, Lorenz; Timpel, Patrick; Otto, Lena; Wollschlaeger, Bastian; Richter, Peggy; Schlieter, Hannes

2018-01-01

This paper presents an approach for an evaluation of finished telemedicine projects using qualitative methods. Telemedicine applications are said to improve the performance of health care systems. While there are countless telemedicine projects, the vast majority never makes the threshold from testing to implementation and diffusion. Projects were collected from German project databases in the area of telemedicine following systematically developed criteria. In a testing phase, ten projects were subject to a qualitative content analysis to identify limitations, need for further research, and lessons learned. Using Mayring's method of inductive category development, six categories of possible future research were derived. Thus, the proposed method is an important contribution to diffusion and translation research regarding telemedicine, as it is applicable to a systematic research of databases.

Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India

Directory of Open Access Journals (Sweden)

Rajesh V Acharya

2016-01-01

Full Text Available Introduction: Telemedicine incorporates electronic information and medical technology. It connects healthcare through vast distances which would benefit both patients and doctors. The aim of this questionnaire study was to evaluate the effects of telemedicine on patients and medical specialists. Methods: A cross-sectional study was conducted among 122 participants (71 patients and 51 doctors on satisfaction in quality of service, cost-effectiveness, and problems encountered in healthcare provided by the telemedicine in Apollo Tele Health Services, Hyderabad, Telangana, India. The data for each group were calculated and compared. Results: About 80% patients and all the doctors reported their satisfaction on the quality of treatment given through telemedicine. Approximately, 90% of the participants found telemedicine cost-effective and 61% of the doctors found an increase in patient's inflow apart for their regular practice. Problems encountered in telemedicine were 47% in technical issues and 39% in time scheduling by doctors and 31% of patients were uncomfortable to face the camera, and 24% had technical issues. Conclusions: The results of the present study showed that telemedicine in healthcare could prove to be useful to patients in distant regions and to rural doctors in India. In the near future, telemedicine can be considered as an alternate to face to face patient care.

Telemedicine compared with standard care in type 2 diabetes mellitus

DEFF Research Database (Denmark)

Rasmussen, O. W.; Lauszus, Finn F; Loekke, M

2016-01-01

Introduction Good metabolic control is important in type 2 diabetes mellitus to improve quality of life, work ability and life expectancy, and the use of telemedicine has proved efficient as an add-on to the usual treatment. However, few studies in type 2 diabetes patients have directly compared...... telemedicine with conventional outpatient treatment, and we wanted to evaluate whether telemedicine, compared with standard care, provides equivalent clinical outcomes. Methods Forty patients with type 2 diabetes mellitus allocated from October 2011-July 2012 were randomized to either treatment at home...... by video conferences only or standard outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-hour blood pressure, cholesterol levels and albuminuria. The video-telephone was a broadband solution installed and serviced by the Danish Telephone Company (TDC...

Evaluation Framework for Telemedicine Using the Logical Framework Approach and a Fishbone Diagram.

Science.gov (United States)

Chang, Hyejung

2015-10-01

Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited. This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies. This study focused on developing a comprehensive evaluation framework by summarizing themes across the range of evaluation techniques and organized foundational evaluation frameworks generally applicable through studies and cases of diverse telemedicine. Evaluation factors related to aspects of information technology; the evaluation of satisfaction of service providers and consumers, cost, quality, and information security are organized using the fishbone diagram. It was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders. A conceptual framework was developed that incorporates the key dimensions that need to be considered in the evaluation of telehealth implementation for a formal structured approach to the evaluation of a service. The suggested framework consists of six major dimensions and the subsequent branches for each dimension. To implement telemedicine and telehealth services, stakeholders should make decisions based on sufficient evidence in quality and safety measured by the comprehensive evaluation framework. Further work would be valuable in applying more comprehensive evaluations to verify and improve the comprehensive framework across a variety of contexts with more factors and participant group dimensions.

UH - USA Agreement - A Telemedicine Research Proposal

National Research Council Canada - National Science Library

Burgess, Lawrence

2003-01-01

The purpose of the University of Hawaii Telemedicine Curriculum Research Project is to develop an effective web-based curriculum for training military health care personnel in the use of contemporary...

Language cultural brokerage and informed consent will technological terms impede telemedicine use

Directory of Open Access Journals (Sweden)

Caron Jack

2014-04-01

Full Text Available Introduction. Telemedicine provides a solution to treatment of economically and geographically compromised patients and enhances the level of care. However, a problem has arisen in safeguarding patients’ rights to informed consent.Objective. To determine the impact of language, translation and interpretation barriers on gaining legally valid informed consent in telemedicine.Design. Forty-one key words relevant to computer terminology and concepts required to gain informed consent for a telemedicine encounter were selected and sent for translation into isiZulu, the local indigenous language of KwaZulu-Natal, South Africa. A questionnaire with the list of words was developed with three domains covering information communication technology (ICT use, ICT terms and ethics terms. This was administered to patients at four outpatient departments in rural KwaZulu-Natal hospitals.Results. Of the 54 participants, 50 (92.6% did not know or understand the term ‘telemedicine’, 49 (90.7% the term ‘video conference’ and 49 (90.7% the term ‘electronic records’. Words such as ‘consent’ and ‘autonomy’ were understood by less than a third of the participants. Only 19 individuals (35.2% understood the word ‘consent’, and only 4 (7.4% understood both the words ‘consent’ and ‘telemedicine’.Conclusions. The results of this study show that obtaining informed consent for a telemedicine consultation is problematic. Alternative ways of gaining informed consent need to be investigated.

Solar Energy and Telemedicine in West Africa : A strategic solution

OpenAIRE

Ihuoma, Phineese

2011-01-01

It is important to bring medical help to those living in West Africa. A good way to do this is by telemedicine. Telemedicine, although it uses power, can be achieved easily with solar panels, and the best solar panels are monocrystalline and cadmium telluride. Using graphical scenarios, statistical derivations, theoretical ideologies acquired from literature reviews, usability ideas and two personal case scenarios, the objective of this project was achieved. Criteria like cost, temperatur...

A meta-analysis of telemedicine success in Africa

Directory of Open Access Journals (Sweden)

Dan S Wamala

2013-01-01

Full Text Available The use of information and communication technologies (ICT tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa′s socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors′experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality

A meta-analysis of telemedicine success in Africa.

Science.gov (United States)

Wamala, Dan S; Augustine, Kaddu

2013-01-01

The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa's socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors'experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also

Making the business case for telemedicine: an interactive spreadsheet.

Science.gov (United States)

McCue, Michael J; Palsbo, Susan E

2006-04-01

The objective of this study was to demonstrate the business case for telemedicine in nonrural areas. We developed an interactive spreadsheet to conduct multiple financial analyses under different capital investment, revenue, and expense scenarios. We applied the spreadsheet to the specific case of poststroke rehabilitation in urban settings. The setting involved outpatient clinics associated with a freestanding rehabilitation hospital in Oklahoma. Our baseline scenario used historical financial data from face-to-face encounters as the baseline for payer and volume mix. We assumed a cost of capital of 10% to finance the project. The outcome measures were financial breakeven points and internal rate of return. A total of 340 telemedicine visits will generate a positive net cash flow each year. The project is expected to recoup the initial investment by the fourth year, produce a positive present value dollar return of more than $2,000, and earn rate of return of 20%, which exceeds the hospital's cost of capital. The business case is demonstrated for this scenario. Urban telemedicine programs can be financially self-sustaining without accounting for reductions in travel time by providers or patients. Urban telemedicine programs can be a sound business investment and not depend on grants or subsidies for start-up funding. There are several key decision points that affect breakeven points and return on investment. The best business strategy is to approach the decision as whether or not to build a new clinic.

Medical liability, safety and confidentiality in maritime telemedicine--the MERMAID position on issues of importance.

Science.gov (United States)

Ladas, P; Giatagatzidis, P; Anogianakis, G; Maglavera, S

1997-01-01

Telemedicine dates to the days of "wireless telegraphy". As an "extraordinary" arrangement for medical services delivered at time of need, telemedicine has thus far escaped the developments that have taken place over the last 50 years in the areas of medical liability, safety and confidentiality. Today, however, telemedicine is also used to increase quality and cost effectiveness of healthcare provision. This trend is set by the U.S. where the U.S. federal government funds telemedicine at an annual rate of more than $100 million i.e., at a rate 30 times or more than what the EU does while state and local agency support and private business investment in telemedicine is 3 to 4 times larger than that of the U.S. federal government. In this respect it must be stressed that technology tends to satisfy the relevant demand for telecommunications. Telemedicine is used in diverse areas such as pathology, surgery, physical therapy, and psychiatry. It is expected to revolutionise health care in the coming decade and, therefore, it will certainly take into account requirements for medical liability, safety and confidentiality in the same way as traditional "establishment" medicine does.

Telemedicine for Epilepsy Support in Resource-poor Settings

Directory of Open Access Journals (Sweden)

Victor ePatterson

2014-08-01

Full Text Available The ProblemEpilepsy is a common disease worldwide causing significant physical and social. disability. It is one of the most treatable neurological diseases. Yet in rural, poorer countries like much of India and Nepal most people with epilepsy are not on any treatment often because they cannot access doctors. Conventional ApproachesIt is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details however have been put forward about how that might be achieved.Thinking differentlyUntreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found. Telemedicine ApproachesTelemedicine might contribute to two steps - diagnosis and review. A tool which enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity and specificity for the diagnosis. There are a number of ways in which the use of phone review or SMS can improve management.ConclusionsTelemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.

Navy Telemedicine: Current Research and Future Directions

National Research Council Canada - National Science Library

Reed, Cheryl

2002-01-01

.... An assessment of Navy telemedicine as a complex healthcare support system is needed to demonstrate how current practices, training, equipment, and expenditures measure up to the emerging needs of the Fleet...

Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment

DEFF Research Database (Denmark)

Levin, Klaus; Madsen, Jette R; Petersen, Inge

2013-01-01

been offered expert diabetes care using teleconsultations. This article describes the impact of the telemedicine solution on essential diabetes treatment parameters, patient satisfaction, and cost-effectiveness. METHODS: Telemedicine consultations were conducted with the patient and nurse specialist...... in transportation time (7 h). Reductions in traveling costs and saved working days were the most important factors in making the telemedicine set-up economically efficient. CONCLUSION: Telemedicine consultation for remote outpatient diabetes control is feasible, and the interdisciplinary interventions achieved high...... treatment quality results in essential diabetes treatment parameters. In addition, the telemedicine set-up was associated with improved cost-effectiveness and patient satisfaction....

Utilization of the American Telemedicine Association's Clinical Practice Guidelines

Science.gov (United States)

Antoniotti, Nina; Bernard, Jordana

2013-01-01

Abstract Background: The American Telemedicine Association (ATA) Standards and Guidelines Committee develops practice standards and guidelines. Key to the Committee's mission is dissemination so the standards can be used in the practice of telemedicine. Over a 2-year period, when a standards document was accessed from the ATA Web site, a short survey was completed, but it did not assess how the documents were used once downloaded. A more formal survey was conducted to determine the impact ATA standards and guidelines are having on healthcare delivery via telemedicine. Materials and Methods: A survey was developed and distributed via SurveyMonkey to 13,177 ATA members and nonmembers in November 2011. Results were compiled and analyzed after a 90-day open period for responses to be submitted. Results: The majority of respondents (96%) believe the practice of telemedicine/telehealth should have standards and guidelines and that the ATA and other professional societies/associations should be responsible for developing them. The top uses of guidelines include guidance for clinical practice, training, gaining reimbursement, and research. Respondents indicating a need for standards and guidelines said the ATA (78.7%) and other professional societies/associations (74.5%) should be responsible for development. When asked to list specific practice guidelines or standards they are using for telehealth, the majority (21.5%) are using in-house (e.g., hospital, company)-developed guidelines, followed by those from professional associations/societies (20.4%) and those developed by the ATA (18.2%). Conclusions: Overall, the survey results indicate guidelines documents developed by the ATA and other professional societies and those developed in-house are being regularly accessed and used in both public and private sectors. Practitioners of telemedicine believe that standards and guidelines are needed for guidance for clinical practice, training, gaining reimbursement, and research

Telemedicine support to patients with chronic diseases for better long-term control at home

Directory of Open Access Journals (Sweden)

Drago Rudel

2017-02-01

Full Text Available Authors in many scientific publications suggest that the telemonitoring of health parameters is a useful tool for supporting patients with long-term conditions staying at home and their self-management of the disease. Those patients are likely to benefit from timely and adequate response to deteriorated conditions detected by the telemedicine system. Almost all of the studies state that telemedicine provided as telemonitoring can be an effective add-on tool in the hands of patients and medical experts for the self-management of patients with, for example, heart failure or diabetes. In this paper the principles of patient telemonitoring are presented as applied within a telemedicine service provided by the Centre for Telehealth (CEZAR at the General Hospital Slovenj Gradec (Slovenia. The centre supports patients with diabetes mellitus type 2 and/or with chronic congestive heart failure. The service was set-up in 2014 as part of a European project called UNITED4HEALTH. Since then over 550 patients from the Carinthia and Saleška regions (Slovenia have been receiving telemedicine support for more than two years. The clinical outcomes of the telemedicine service published elsewhere prove that the selected telemedicine service model is adequate and the implemented technological solution is acceptable for all service users: the patients and the clinicians.

Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes.

Science.gov (United States)

Chang, Jun-Yih; Chen, Liang-Kung; Chang, Chia-Ching

2009-07-01

This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Statistical significance between the two groups was observed in sex, age, and educational level (all pexpectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples' demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.

An Observational Approach toward Understanding and Prediction of CME Magnetic Ejecta

Science.gov (United States)

Pizzo, V. J.; de Koning, C. A.; Riley, P.

2017-12-01

Quantitative knowledge of the magnetic field inside a coronal mass ejection (CME) is an important contributor to an actionable space weather forecast of geomagnetic storms. However, at present it is not possible to predict the magnetic cloud component of a CME with any accuracy. This has led to the development of increasingly sophisticated physics-based models, each promising a path toward more accurate space weather forecasts. Unfortunately, none of these models can provide meaningful output if they lack for reliable quantitative input. Until we can measure magnetic fields at solar distances where CMEs are launched and over their early-stage evolution, this will remain a fundamental obstacle to successful modeling. Instead of continuing to focus primarily on the modeling approach, we suggest an active investigation of direct, up-stream measurement of the CME internal magnetic field. For current forecasting purposes, or even as a science concept mission, the measurements do not need to be of high accuracy or high cadence. Since previous magnetic cloud analyses have demonstrated that a single spacecraft provides insufficient data to robustly reconstruct the CME internal magnetic field, we suggest deploying a swarm of cube-sats in "quasi-satellite" orbits that are known to be horizontally and vertically stable, even at large (several tenths of an AU) distances from Earth. In this presentation, we describe how simulations of CMEs incorporating magnetic clouds can be used to develop and support this mission concept. By taking simulated cuts through model CMEs with a range of magnetic morphologies and field strengths, we aim to determine the minimum number of spacecraft needed for such a mission and their optimum orbital characteristics. Although a host of challenges remain, especially related to communications and cube-sat telemetry in interplanetary space, we believe that these technological issues can be surmounted once it has been demonstrated that a major leap in

Evaluation of Speakers at a National Continuing Medical Education (CME Course

Directory of Open Access Journals (Sweden)

Jannette Collins, MD, MEd, FCCP

2002-12-01

Full Text Available Purpose: Evaluations of a national radiology continuing medical education (CME course in thoracic imaging were analyzed to determine what constitutes effective and ineffective lecturing. Methods and Materials: Evaluations of sessions and individual speakers participating in a five-day course jointly sponsored by the Society of Thoracic Radiology (STR and the Radiological Society of North America (RSNA were tallied by the RSNA Department of Data Management and three members of the STR Training Committee. Comments were collated and analyzed to determine the number of positive and negative comments and common themes related to ineffective lecturing. Results: Twenty-two sessions were evaluated by 234 (75.7% of 309 professional registrants. Eighty-one speakers were evaluated by an average of 153 registrants (range, 2 – 313. Mean ratings for 10 items evaluating sessions ranged from 1.28 – 2.05 (1=most positive, 4=least positive; SD .451 - .902. The average speaker rating was 5.7 (1=very poor, 7=outstanding; SD 0.94; range 4.3 – 6.4. Total number of comments analyzed was 862, with 505 (58.6% considered positive and 404 (46.9% considered negative (the total number exceeds 862 as a “comment” could consist of both positive and negative statements. Poor content was mentioned most frequently, making up 107 (26.5% of 404 negative comments, and applied to 51 (63% of 81 speakers. Other negative comments, in order of decreasing frequency, were related to delivery, image slides, command of the English language, text slides, and handouts. Conclusions: Individual evaluations of speakers at a national CME course provided information regarding the quality of lectures that was not provided by evaluations of grouped presentations. Systematic review of speaker evaluations provided specific information related to the types and frequency of features related to ineffective lecturing. This information can be used to design CME course evaluations, design future CME

Health in old age, and patients' approaches to telemedicine in Poland.

Science.gov (United States)

Buliński, Leszek; Błachnio, Aleksandra

2017-06-07

Polish ageing society still experiences health-related problems and the increasing difficulties in receiving medical care. The initiation of telemedicine programmes can change this situation for better. The question arises if telemedicine is a solution that the elderly are willing to accept and take advantage of in order to raise their quality of life. Questionnaire based research was conducted in 2015 on a sample group of 312 seniors. The respondents completed the Diener Satisfaction with Life Scale (SWLS) and the subscale of Health States from Fragebogen zur Lebenszufriedenheit (FLZ) by Fahrenberg et al. Each participant gave their consent to take part in the research. SWLS presents a relatively stable value in the subsequent decades of being old (60-69 years M=21.93 SD=6.25; 70-79 years M=21.70 SD=5.52; 80+ M=21.38 SD=5.82). The health related quality of life (the FLZ subscale), varied in the analysed subgroups (F=7.783 p=0.000), and was related to comorbidity and polytherapy. A positive attitude towards telemedicine was expressed by 40% of those surveyed. However the seniors' need for telemedical services was more limited and did not exceed the 10%. In Poland in ageing there still dominates the experience of multiple ailments and polytherapy, something which justifies a search for new, easily accessible, and economically sound solutions for health care. Telemedicine is a promising solution although there is a need for concrete steps to be taken to raise willingness amongst geriatric patients to take advantage of telemedicine.

Does an offer for a free on-line continuing medical education (CME) activity increase physician survey response rate? A randomized trial.

Science.gov (United States)

Viera, Anthony J; Edwards, Teresa

2012-03-07

Achieving a high response rate in a physician survey is challenging. Monetary incentives increase response rates but obviously add cost to a survey project. We wondered whether an offer of a free continuing medical education (CME) activity would be effective in improving survey response rate. As part of a survey of a national sample of physicians, we randomized half to an offer for a free on-line CME activity upon completion of a web-based survey and the other half to no such offer. We compared response rates between the groups. A total of 1214 out of 8477 potentially eligible physicians responded to our survey, for an overall response rate of 14.3%. The response rate among the control group (no offer of CME credit) was 16.6%, while among those offered the CME opportunity, the response rate was 12.0% (p offer for a free on-line CME activity did not improve physician survey response rate. On the contrary, the offer for a free CME activity actually appeared to worsen the response rate. © 2011 Viera et al; licensee BioMed Central Ltd.

American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists.

Science.gov (United States)

Elliott, Tania; Shih, Jennifer; Dinakar, Chitra; Portnoy, Jay; Fineman, Stanley

2017-12-01

The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians. These potential benefits should be weighed against the risks and challenges of using telemedicine. The American College of Allergy, Asthma, and Immunology advocates for incorporation of meaningful and sustained use of telemedicine in allergy and immunology practice. This article serves to offer policy and position statements of the use of telemedicine pertinent to the allergy and immunology subspecialty. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Nine human factors contributing to the user acceptance of telemedicine applications: a cognitive-emotional approach.

Science.gov (United States)

Buck, Susanne

2009-01-01

Much attention is paid to the technical aspects of telemedicine in the development of new applications, but the enthusiasm about what is technically possible very often leads to the user acceptance of such products being neglected. The number of successful and sustainable telemedicine applications would be much higher if developers concentrated more on matters related to the cognitive-emotional situation of the users involved in telemedicine. The users include the care and cure providers, as well as the care and cure receivers. Based on an informal literature search and discussions with telemedicine implementation staff, nine factors have been identified which are essential for the user acceptance of telemedicine applications. All of them are connected more to the cognitive-emotional than to the cognitive-rational side of information processing. This suggests that in the future the cognitive-emotional side will need more attention. This in turn implies that the nine points mentioned above have to find their way into requirements engineering, development processes and product life cycles.

Augmentation of Acute Stroke Management via Telemedicine

National Research Council Canada - National Science Library

Choi, John

2001-01-01

.... 0 Necessary telemedicine study equipment was installed at the study sites. (PictureTel monitors and associated VTC equipment, flat-screen monitors, one PC, and VCR with digital video tape/VHS capabilities were installed...

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

Science.gov (United States)

O'Gorman, Laurel D; Hogenbirk, John C; Warry, Wayne

2016-06-01

Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.

Value-chain analysis of a rural health program: toward understanding the cost benefit of telemedicine applications.

Science.gov (United States)

Gamble, John E; Savage, Grant T; Icenogle, Marjorie L

2004-01-01

While telemedicine's clinical effectiveness and educational benefits are accepted, its cost-effectiveness is controversial. This study focuses on telemedicine's cost-effectiveness from a provider's perspective. Reviews of the cost-effectiveness literature in telemedicine are critical of past studies' (a) methodological and analytical weaknesses; (b) focus on answering "Can we do this?" rather than "Should we do this?"; and (c) emphasis on patient benefits. Value chain analysis examines structural and executional cost drivers; a self-sustaining business model balances the cost and value associated with each telemedicine activity. We illustrate this analysis in a rural health program, examining teleradiography and telerehabilitation.

The added value of thorough economic evaluation of telemedicine networks.

Science.gov (United States)

Le Goff-Pronost, Myriam; Sicotte, Claude

2010-02-01

This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.

COMMUNICA TION NETWORK FOR TELEMEDICINE Debretsion G ...

African Journals Online (AJOL)

(3) continuing medical education and (4) Training the medical ... Telemedicine system consists of at least five major subsystems. [l,4]. ... and wire-line (optical network) telecommunication facilities .... An ATM network needs certain traffic control.

Telemedicine in the acute health setting: A disruptive innovation for specialists (an example from stroke).

Science.gov (United States)

Bagot, Kathleen L; Cadilhac, Dominique A; Vu, Michelle; Moss, Karen; Bladin, Christopher F

2015-12-01

Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine. Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation. Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and >4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine. Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine. © The Author(s) 2015.

Monte Carlo Simulation Modeling of a Regional Stroke Team's Use of Telemedicine.

Science.gov (United States)

Torabi, Elham; Froehle, Craig M; Lindsell, Christopher J; Moomaw, Charles J; Kanter, Daniel; Kleindorfer, Dawn; Adeoye, Opeolu

2016-01-01

The objective of this study was to evaluate operational policies that may improve the proportion of eligible stroke patients within a population who would receive intravenous recombinant tissue plasminogen activator (rt-PA) and minimize time to treatment in eligible patients. In the context of a regional stroke team, the authors examined the effects of staff location and telemedicine deployment policies on the timeliness of thrombolytic treatment, and estimated the efficacy and cost-effectiveness of six different policies. A process map comprising the steps from recognition of stroke symptoms to intravenous administration of rt-PA was constructed using data from published literature combined with expert opinion. Six scenarios were investigated: telemedicine deployment (none, all, or outer-ring hospitals only) and staff location (center of region or anywhere in region). Physician locations were randomly generated based on their zip codes of residence and work. The outcomes of interest were onset-to-treatment (OTT) time, door-to-needle (DTN) time, and the proportion of patients treated within 3 hours. A Monte Carlo simulation of the stroke team care-delivery system was constructed based on a primary data set of 121 ischemic stroke patients who were potentially eligible for treatment with rt-PA. With the physician located randomly in the region, deploying telemedicine at all hospitals in the region (compared with partial or no telemedicine) would result in the highest rates of treatment within 3 hours (80% vs. 75% vs. 70%) and the shortest OTT (148 vs. 164 vs. 176 minutes) and DTN (45 vs. 61 vs. 73 minutes) times. However, locating the on-call physician centrally coupled with partial telemedicine deployment (five of the 17 hospitals) would be most cost-effective with comparable eligibility and treatment times. Given the potential societal benefits, continued efforts to deploy telemedicine appear warranted. Aligning the incentives between those who would have to fund

Comparison of the CME-associated shock arrival times at the earth using the WSA-ENLIL model with three cone models

Science.gov (United States)

Jang, S.; Moon, Y.; Na, H.

2012-12-01

We have made a comparison of CME-associated shock arrival times at the earth based on the WSA-ENLIL model with three cone models using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters from Michalek et al. (2007) as well as their associated interplanetary (IP) shocks. For this study we consider three different cone models (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine CME cone parameters (radial velocity, angular width and source location), which are used for input parameters of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the elliptical cone model is 10 hours, which is about 2 hours smaller than those of the other models. However, this value is still larger than that (8.7 hours) of an empirical model by Kim et al. (2007). We are investigating several possibilities on relatively large errors of the WSA-ENLIL cone model, which may be caused by CME-CME interaction, background solar wind speed, and/or CME density enhancement.

e-health in eating disorders: Virtual Reality and telemedicine in assessment and treatment.

Science.gov (United States)

Riva, Giuseppe; Bacchetta, Monica; Cesa, Gianluca; Conti, Sara; Molinari, Enrico

2002-01-01

e-health, the integration of telehealth technologies with the Internet and shared virtual reality could become a significant enabler of consumer health initiatives. In fact, they provide an increasingly accessible communication channel for a growing part of the population. In the past decade medical applications of virtual reality (VR) and telemedicine have been rapidly developing, and the technology has changed from a research curiosity to a commercially and clinically important area of medical informatics technology. The chapter details the characteristics of the Experiential Cognitive Therapy (ECT), an integrated inpatient/outpatient (4 weeks) and telemedicine approach (24 weeks) that tries to enhance the classical cognitive-behavioral method used in the treatment of eating disorders, through VR sessions and telemedicine support in the follow-up stage. Particularly, using VR and telemedicine, ECT is able to address body experience disturbances, interpersonal relationships, self efficacy and motivation to change, key issues for the development and maintenance of eating disorders that are somehow neglected by actual clinical guidelines.

Semantically based clinical TCM telemedicine systems

CERN Document Server

Wong, Allan K Y; Lin, Wilfred W K; Dillon, Tharam S; Chang, Elizabeth J

2015-01-01

Recent years have seen the development of two significant trends namely: the adoption of some Traditional Chinese Medicine Practices into mainstream Allopathic Western Medicine and the advent of the internet and broad band networks leading to an increased interest in the use of Telemedicine to deliver medical services. In this book, we see the convergence of these two trends leading to a semantically-based TCM Telemedicine system that utilizes an ontology to provide sharable knowledge in the TCM realm to achieve this. The underpinning research required the development of a three-layer architecture and an Ontology of the TCM knowledge. As TCM knowledge like all medical knowledge is not frozen in time it was important to develop an approach that would allow evolution of the Ontology when new evidence became available. In order for the system to be practically grounded it was important to work with an industry partner PuraPharm Group/HerbMiners Informatics Limited. This partnership was initiated through Professo...

Mobile Cloud Computing for Telemedicine Solutions

Directory of Open Access Journals (Sweden)

Mihaela GHEORGHE

2014-01-01

Full Text Available Mobile Cloud Computing is a significant technology which combines emerging domains such as mobile computing and cloud computing which has conducted to the development of one of the most IT industry challenging and innovative trend. This is still at the early stage of devel-opment but its main characteristics, advantages and range of services which are provided by an internet-based cluster system have a strong impact on the process of developing telemedi-cine solutions for overcoming the wide challenges the medical system is confronting with. Mo-bile Cloud integrates cloud computing into the mobile environment and has the advantage of overcoming obstacles related to performance (e.g. battery life, storage, and bandwidth, envi-ronment (e.g. heterogeneity, scalability, availability and security (e.g. reliability and privacy which are commonly present at mobile computing level. In this paper, I will present a compre-hensive overview on mobile cloud computing including definitions, services and the use of this technology for developing telemedicine application.

Telemedicine and EHR Integrated Approach for An Effective E-Governance Healthcare Framework

Directory of Open Access Journals (Sweden)

Alpana Kakkar

2017-05-01

Full Text Available In the recent years, people have been more inclined towards the use of technology to reduce human effort. Telemedicine is one such concept which has gained popularity among the people, providing them easy access to health care. Telemedicine refers to the concept of providing health care from a distance through an integrated approach using information and communication technology (ICT. India, being a geographically wide country has its difficulties when it comes to providing health care facilities to people belonging to the different regions. This is one of the few reasons why India is the best stage to introduce a concept like telemedicine. The use of this technology to counter the various challenges has been highly regarded and termed as something which can revolutionize the medical field. Integrating telemedicine with electronic health record (EHR, which is a digital document of a person’s medical history is said to be a perfect combination which can help improve clinical efficiency. The country has seen initiatives taken up by various organizations, with the main motive of connecting the rural to the urban. Through this paper, we have discussed the potential we have with this technology, and also propose an EHR integrated telemedicine model to make the best use of it in an emergency healthcare situation to help save lives. We have also touched a few factors which can help the government better the current health scenario.

Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants.

Science.gov (United States)

Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P

2017-04-01

The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

"Initiate-build-operate-transfer" - a strategy for establishing sustainable telemedicine programs not only in the developing countries.

Science.gov (United States)

Latifi, Rifat

2011-01-01

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in the Balkans has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in Kosova. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy developed by IVeH "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services not only in developing countries, but in developed countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs is described. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the very core of healthcare infrastructure. The end point is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova and Albania has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program is transitioned to the Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Macedonia, Montenegro and other countries

Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study.

Science.gov (United States)

Meyer, Brett C; Raman, Rema; Hemmen, Thomas; Obler, Richard; Zivin, Justin A; Rao, Ramesh; Thomas, Ronald G; Lyden, Patrick D

2008-09-01

To increase the effective use of thrombolytics for acute stroke, the expertise of vascular neurologists must be disseminated more widely. We prospectively assessed whether telemedicine (real-time, two-way audio and video, and digital imaging and communications in medicine [DICOM] interpretation) or telephone was superior for decision making in acute telemedicine consultations. From January, 2004, to August, 2007, patients older than 18 years who presented with acute stroke symptoms at one of four remote spoke sites were randomly assigned, through a web-based, permuted blocks system, to telemedicine or telephone consultation to assess their suitability for treatment with thrombolytics, on the basis of standard criteria. The primary outcome measure was whether the decision to give thrombolytic treatment was correct, as determined by central adjudication. Secondary outcomes were the rate of thrombolytic use, 90-day functional outcomes (Barthel index [BI] and modified Rankin scale [mRS]), the incidence of intracerebral haemorrhages, and technical observations. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00283868. 234 patients were assessed prospectively. 111 patients were randomised to telemedicine, and 111 patients were randomised to telephone consultation; 207 completed the study. Mean National Institutes of Health stroke scale score at presentation was 9.5 (SD 8.1) points (11.4 [8.7] points in the telemedicine group versus 7.7 [7.0] points in the telephone group; p=0.002). One telemedicine consultation was aborted for technical reasons, although it was included in the analyses. Correct treatment decisions were made more often in the telemedicine group than in the telephone group (108 [98%] vs 91 [82%], odds ratio [OR] 10.9, 95% CI 2.7-44.6; p=0.0009). Intravenous thrombolytics were used at an overall rate of 25% (31 [28%] telemedicine vs 25 [23%] telephone, 1.3, 0.7-2.5; p=0.43). 90-day functional outcomes were not

A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology.

Science.gov (United States)

Vyas, Krishna S; Hambrick, H Rhodes; Shakir, Afaaf; Morrison, Shane D; Tran, Duy C; Pearson, Keon; Vasconez, Henry C; Mardini, Samir; Gosman, Amanda A; Dobke, Marek; Granick, Mark S

2017-06-01

Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field. A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice. A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise. Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use

Effectiveness of Telemedicine for Controlling Asthma Symptoms: A Systematic Review and Meta-analysis.

Science.gov (United States)

Zhao, Jie; Zhai, Yun-Kai; Zhu, Wei-Jun; Sun, Dong-Xu

2015-06-01

The effectiveness of telemedicine for the management of chronic diseases is unclear. This study examined the effectiveness of telemedicine in relieving asthma symptoms. A systematic review of the Medline, Cochrane, EMBASE, and Google Scholar databases was conducted until December 31, 2013 using the following key words: "asthma," "telemedicine," "telehealth," "e-health," "mobile health," "Internet," "telecommunication," "telemanagement," "remote," and "short message service." Inclusion criteria were randomized controlled trial, a diagnosis of asthma, the majority of the patients were ≥18 years of age, and intervention involved any format of telemedicine. A meta-analysis of eligible studies was conducted with the primary outcome being change of asthma symptoms. Of 813 articles identified, 11 were included in the qualitative synthesis, and 6 were included in the meta-analysis. Among the 11 studies, there were 1,460 patients in the intervention groups and 1,349 in the control groups, and the total numbers of participants ranged from 12 to 481 in the intervention groups and from 12 to 487 in the control groups. The mean age of patients ranged in the intervention groups from 34.4 to 54.6 years and in the control groups from 30.7 to 56.4 years. The treatment duration ranged from 0.5 to 12 months. The meta-analysis of six eligible studies revealed no significant difference in asthma symptom score change between the telemedicine and control groups (pooled Hedges's g=0.34, 95% confidence interval=-0.05 to 0.74, Z=1.69, p=0.090). Telemedicine interventions do not appear to improve asthma function scores, but other benefits may be present.

DEVELOPMENT OF A MATURITY MODEL FOR TELEMEDICINE#

Directory of Open Access Journals (Sweden)

L. Van Dyk

2012-01-01

Full Text Available

ENGLISH ABSTRACT: For more than a decade, the South African National Department of Health (DoH has recognised the potential benefit of information and communication technology (ICT in the delivery of health care to rural areas. Despite generous funding and proven technology, not many telemedicine systems have proved sustainable after the pilot phase. The purpose of this paper is to develop a maturity model that can be implemented to measure and manage the capability of a health system, for use in the delivery of sustainable health care after the pilot phase of a telemedicine project. The validity of the telemedicine maturity model (TMMM is tested within the context of the South African public health sector.

AFRIKAANSE OPSOMMING: Die Suid Afrikaanse Nasionale Departement van Gesondheid het reeds meer as ’n dekade gelede die voordeel besef wat inligtings- en kommunikasietegnologie kan bied ten opsigte van die lewering van gesondheidsorg in afgeleë gebiede. Ten spyte van ruim befondsing en bewese tegnologie, is daar egter min volgehoue telegeneeskundedienste in die publieke gesondheidstelsel van Suid Afrika. Die doel van hierdie artikel is om ’n volwassenheids-model te ontwikkel wat gebruik kan word om die vermoë van ’n gesondheidstelsel te bepaal en bestuur, ten einde telegeneeskunde loodsprojekte vol te hou. Die geldigheid van hierdie telegeneeskunde volwassenheidsmodel (TMMM is getoets binne konteks van die publieke gesondheidsektor van Suid Afrika.

Augmented Reality as a Telemedicine Platform for Remote Procedural Training.

Science.gov (United States)

Wang, Shiyao; Parsons, Michael; Stone-McLean, Jordan; Rogers, Peter; Boyd, Sarah; Hoover, Kristopher; Meruvia-Pastor, Oscar; Gong, Minglun; Smith, Andrew

2017-10-10

Traditionally, rural areas in many countries are limited by a lack of access to health care due to the inherent challenges associated with recruitment and retention of healthcare professionals. Telemedicine, which uses communication technology to deliver medical services over distance, is an economical and potentially effective way to address this problem. In this research, we develop a new telepresence application using an Augmented Reality (AR) system. We explore the use of the Microsoft HoloLens to facilitate and enhance remote medical training. Intrinsic advantages of AR systems enable remote learners to perform complex medical procedures such as Point of Care Ultrasound (PoCUS) without visual interference. This research uses the HoloLens to capture the first-person view of a simulated rural emergency room (ER) through mixed reality capture (MRC) and serves as a novel telemedicine platform with remote pointing capabilities. The mentor's hand gestures are captured using a Leap Motion and virtually displayed in the AR space of the HoloLens. To explore the feasibility of the developed platform, twelve novice medical trainees were guided by a mentor through a simulated ultrasound exploration in a trauma scenario, as part of a pilot user study. The study explores the utility of the system from the trainees, mentor, and objective observers' perspectives and compares the findings to that of a more traditional multi-camera telemedicine solution. The results obtained provide valuable insight and guidance for the development of an AR-supported telemedicine platform.

Augmented Reality as a Telemedicine Platform for Remote Procedural Training

Science.gov (United States)

Wang, Shiyao; Parsons, Michael; Stone-McLean, Jordan; Rogers, Peter; Boyd, Sarah; Hoover, Kristopher; Meruvia-Pastor, Oscar; Gong, Minglun; Smith, Andrew

2017-01-01

Traditionally, rural areas in many countries are limited by a lack of access to health care due to the inherent challenges associated with recruitment and retention of healthcare professionals. Telemedicine, which uses communication technology to deliver medical services over distance, is an economical and potentially effective way to address this problem. In this research, we develop a new telepresence application using an Augmented Reality (AR) system. We explore the use of the Microsoft HoloLens to facilitate and enhance remote medical training. Intrinsic advantages of AR systems enable remote learners to perform complex medical procedures such as Point of Care Ultrasound (PoCUS) without visual interference. This research uses the HoloLens to capture the first-person view of a simulated rural emergency room (ER) through mixed reality capture (MRC) and serves as a novel telemedicine platform with remote pointing capabilities. The mentor’s hand gestures are captured using a Leap Motion and virtually displayed in the AR space of the HoloLens. To explore the feasibility of the developed platform, twelve novice medical trainees were guided by a mentor through a simulated ultrasound exploration in a trauma scenario, as part of a pilot user study. The study explores the utility of the system from the trainees, mentor, and objective observers’ perspectives and compares the findings to that of a more traditional multi-camera telemedicine solution. The results obtained provide valuable insight and guidance for the development of an AR-supported telemedicine platform. PMID:28994720

Augmented Reality as a Telemedicine Platform for Remote Procedural Training

Directory of Open Access Journals (Sweden)

Shiyao Wang

2017-10-01

Full Text Available Traditionally, rural areas in many countries are limited by a lack of access to health care due to the inherent challenges associated with recruitment and retention of healthcare professionals. Telemedicine, which uses communication technology to deliver medical services over distance, is an economical and potentially effective way to address this problem. In this research, we develop a new telepresence application using an Augmented Reality (AR system. We explore the use of the Microsoft HoloLens to facilitate and enhance remote medical training. Intrinsic advantages of AR systems enable remote learners to perform complex medical procedures such as Point of Care Ultrasound (PoCUS without visual interference. This research uses the HoloLens to capture the first-person view of a simulated rural emergency room (ER through mixed reality capture (MRC and serves as a novel telemedicine platform with remote pointing capabilities. The mentor’s hand gestures are captured using a Leap Motion and virtually displayed in the AR space of the HoloLens. To explore the feasibility of the developed platform, twelve novice medical trainees were guided by a mentor through a simulated ultrasound exploration in a trauma scenario, as part of a pilot user study. The study explores the utility of the system from the trainees, mentor, and objective observers’ perspectives and compares the findings to that of a more traditional multi-camera telemedicine solution. The results obtained provide valuable insight and guidance for the development of an AR-supported telemedicine platform.

Telemedicine for health issues while abroad: interest and willingness to pay among travellers prior to departure.

Science.gov (United States)

Rochat, Laurence; Genton, Blaise

2018-01-01

Telemedicine is emerging as a useful tool to provide expert medical advice to individuals facing health issues while travelling in remote areas. Before embarking on the development of a telemedicine system, we conducted a survey to assess the needs and expectations of travellers for such a service, and evaluate opinions about the importance of various travel criteria that may determine the contract of such insurance. (i) To assess whether a telemedicine service is considered useful by travellers, (ii) to investigate which telecommunication medium is preferred, (iii) to determine which subgroup of travellers would be most interested in this service and (iv) to estimate the amount of money travellers would be willing to pay for a telemedicine service. Travellers coming to our clinic for pre-travel advice were given a questionnaire to be filled in before consultation. The questionnaire focused on demographics, travel details, health status, interest and willingness to pay for a telemedicine service. Among 307 returned questionnaires, 59% of travellers were interested in a telemedicine service. Email was the preferred communication medium for 63%, mobile phone for 46% and video calls for 31% individuals (multiple answers). Travellers aged ≥60 years and those with an immunocompromising condition tended to be more interested in telemedicine (respectively OR = 1.65; 95% CI: 0.75-3.62 and OR = 3.56; 95% CI: 0.41-30.95). The 99% of travellers were willing to pay for such a service. Median price was 50 USD (IQR: 30-50 USD). There was no correlation between travel duration and amount to be paid. Among individuals consulting for pre-travel advice at a specialized clinic, there is considerable interest in telemedicine, particularly among older and immunocompromised travellers. Based on these data, a pilot system using email communication to help travellers confronted with health issues while abroad was developed and implemented in our travel clinic.

Prediction of SEP Peak Proton Intensity Based on CME Speed, Direction and Observations of Associated Solar Phenomena

Science.gov (United States)

Richardson, I. G.; Mays, M. L.; Thompson, B. J.; Kwon, R.; Frechette, B. P.

2017-12-01

We assess whether a formula obtained by Richardson et al. (Solar Phys., 289, 3059, 2014; DOI 10.1007/s11207-014-0524-8) relating the intensity of 14-24 MeV protons in a solar energetic particle event at 1 AU to the solar event location and the speed of the associated coronal mass ejection (CME), may be used to "predict" the intensity of a solar energetic particle event. Starting with a subset of several hundred CMEs in the CCMC/SWRC DONKI real-time database (http://kauai.ccmc.gsfc.nasa.gov/DONKI/) selected without consideration of whether they were associated with SEP events, we first use the CME speed and direction to predict the proton intensity at Earth or the STEREO spacecraft using this formula. Since most of these CMEs were not in fact associated with SEP events, many "false alarms" result. We then examine whether considering other phenomena which may accompany the CMEs, such as the X-ray flare intensity and the properties of type II and type III radio emissions, may help to reduce the false alarm rate. We also use CME parameters calculated from an ellipsoidal shell fit to multi-spacecraft CME shock observations for a smaller number of events to predict the SEP intensity. We calculate skill scores for each case and assess whether the Richardson et al. (2014) formula, using additional observations to reduce the false alarm rate, has any potential as a SEP prediction tool, assuming that the required observations could be acquired sufficiently rapidly following the onset of the related solar event/CME.

Relationship among knowledge acquisition, motivation to change, and self-efficacy in CME participants.

Science.gov (United States)

Williams, Betsy W; Kessler, Harold A; Williams, Michael V

2015-01-01

The relationship among an individual's sense of self-efficacy, motivation to change, barriers to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and the acquisition of knowledge in a continuing medical education (CME) activity. The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 6-item scale following on the work of Prochaska and colleagues. The knowledge acquisition was measured in a simple post measure. The participants were enrolled in a CME activity focused on HIV.  The CME activities had a significant effect on knowledge. Preliminary analysis demonstrates a relationship among the self-efficacy measure, the motivation to change measure, and global intent to change. Specifically, as reported earlier, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change that, in turn, is predictive of formation of intent to change practice patterns. Interestingly, there were also relationships among the self-efficacy measure, the motivation to change measure, and knowledge acquisition. Finally, as expected, there was a significant relationship between knowledge and intent to change practice.  Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent as well as its effect on knowledge acquisition. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change as well as learning following CME-self-efficacy. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Comparison of the WSA-ENLIL model with three CME cone types

Science.gov (United States)

Jang, Soojeong; Moon, Y.; Na, H.

2013-07-01

We have made a comparison of the CME-associated shock propagation based on the WSA-ENLIL model with three cone types using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters as well as their associated interplanetary (IP) shocks. For this study we consider three different cone types (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine 3-D CME parameters (radial velocity, angular width and source location), which are the input values of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the asymmetric cone model is 10.6 hours, which is about 1 hour smaller than those of the other models. Their ensemble average of MAE is 9.5 hours. However, this value is still larger than that (8.7 hours) of the empirical model of Kim et al. (2007). We will compare their IP shock velocities and densities with those from ACE in-situ measurements and discuss them in terms of the prediction of geomagnetic storms.Abstract (2,250 Maximum Characters): We have made a comparison of the CME-associated shock propagation based on the WSA-ENLIL model with three cone types using 29 halo CMEs from 2001 to 2002. These halo CMEs have cone model parameters as well as their associated interplanetary (IP) shocks. For this study we consider three different cone types (an asymmetric cone model, an ice-cream cone model and an elliptical cone model) to determine 3-D CME parameters (radial velocity, angular width and source location), which are the input values of the WSA-ENLIL model. The mean absolute error (MAE) of the arrival times for the asymmetric cone model is 10.6 hours, which is about 1 hour smaller than those of the other models. Their ensemble average of MAE is 9.5 hours. However, this value is still larger than that (8.7 hours) of the empirical model of Kim et al. (2007). We will compare their IP shock velocities and densities with those from ACE in-situ measurements and discuss them in terms of the

Telemedicine implementation and benefits for quality and patient safety in Pakistan

OpenAIRE

Ijaz A. Qureshi; Hassan Raza; Michael Whitty; Syed Zain Ul Abdin

2015-01-01

Telemedicine is becoming an important aspect in developing countries to provide better health facilities. Rural areas in developing countries suffer due to lack of health facilities and face difficulties like time to reach health facilities at the faraway places, cost of reaching at a health care facility, and transportation needed to move around for the treatment/consulting purpose. Telemedicine could be used for safe and quality health by specialists at low cost in rural areas in Pakistan. ...

[Telemedicine in Bolivia: RAFT-Altiplano project, experiences, future prospects, and recommendations].

Science.gov (United States)

Vargas, Alejandro; Ugalde, Miguel; Vargas, Reynaldo; Narvaez, Ramiro; Geissbuhler, Antoine

2014-01-01

The objective of the RAFT-Altiplano project (RAFT: Réseau en Afrique Francophone pour la Télémédecine, or African Francophone Telemedicine Network) is to evaluate the viability, potential, and risks of implementing and developing a telemedicine network in the context of a developing country-specifically, the Altiplano region of Bolivia-to improve access to medical care and continuing education in a rural area. The activities described in this report took place between 2011 and 2013. Digital telemedicine equipment was donated to the health centers and a Microsoft®-based platform capable of integration with other technologies (using standardized formats) was developed to manage documents and clinical content electronically. Health professionals were trained in teleconsultation and the teleconsultation workflow was designed. The tele-education system used is Dudal, which requires only a small bandwidth. After three years of implementation, an organized working structure of teleconsultation and tele-education tools, adapted to the Latin American context, is now in place and connections have been established with hospitals, institutions, and health centers. The project has improved access to specialized medical care in remote health centers and third-level hospitals in urban areas, and it has become the foundation for development of the national project "TeleSalud for Bolivia" promoted by the Ministry of Health, which involves use of the new Bolivian satellite, Túpac Katari. It is viable to develop and set up telemedicine tools to serve the population in remote regions of Bolivia when they are made available to government and municipal health institutions and communication between them and the health centers takes place in a coordinated manner. The sharing of experiences, challenges, and risks encountered is very useful in designing and implementing the telemedicine project "TeleSalud for Bolivia" on a national scale.

Emerging technologies for telemedicine.

Science.gov (United States)

Cao, Minh Duc; Minh, Cao Duc; Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao

2012-01-01

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.

Emerging Technologies for Telemedicine

Energy Technology Data Exchange (ETDEWEB)

Minh, Cao Duc [National Agency for Science and Technology Information, Hanoi (Viet Nam); Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao [Kyushu University Hospital, Fukuoka (Japan)

2012-02-15

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.

Emerging Technologies for Telemedicine

International Nuclear Information System (INIS)

Minh, Cao Duc; Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao

2012-01-01

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.

Telemedicine as an innovative model for rebuilding medical systems in developing countries through multipartnership collaboration: the case of Albania.

Science.gov (United States)

Latifi, Rifat; Dasho, Erion; Shatri, Zhaneta; Tilley, Elizabeth; Osmani, Kalterina L; Doarn, Charles R; Dogjani, Agron; Olldashi, Fatos; Koçiraj, Agim; Merrell, Ronald C

2015-06-01

The U.S. Government and other developed nations provide billions of dollars annually in relief assistance to countries around the world. The long-term benefits of this aid, however, are often difficult to elucidate. The aim of this article is to present a model of a multipartnership collaboration among U.S. governmental, nongovernmental organizations, and academia to rebuild medical systems using telemedicine as a sustainable model of foreign aid. The International Virtual e-Hospital implemented the "initiate-build-operate-transfer" strategy to establish an effective telemedicine system in Albania that includes the National Telemedicine Center and 12 regional telemedicine centers. This nationwide telemedicine network has active clinical programs, virtual educational programs, and an electronic library that has substantially improved the access to care while advancing medical education. We propose that telemedicine is an optimal, sustainable, low-cost model for rebuilding medical systems of developing countries when implemented through a multipartnership approach.

A FULL STUDY ON THE SUN–EARTH CONNECTION OF AN EARTH-DIRECTED CME MAGNETIC FLUX ROPE

Energy Technology Data Exchange (ETDEWEB)

Vemareddy, Panditi [Indian Institute of Astrophysics, II Block, Koramangala, Bangalore-560 034 (India); Mishra, Wageesh, E-mail: vemareddy@iiap.res.in, E-mail: wageesh@ustc.edu.cn [Department of Geophysics and Planetary Sciences, University of Science and Technology of China, Hefei-230026 (China)

2015-11-20

We present an investigation of an eruption event of a coronal mass ejection (CME) magnetic flux rope (MFR) from the source active region (AR) NOAA 11719 on 2013 April 11 utilizing observations from the Solar Dynamic Observatory, the Solar Terrestrial Relations Observatory, the Solar and Heliospheric Observatory, and the WIND spacecraft. The source AR consists of a pre-existing sigmoidal structure stacked over a filament channel which is regarded as an MFR system. EUV observations of low corona suggest further development of this MFR system by added axial flux through tether-cutting reconnection of loops at the middle of the sigmoid under the influence of continuous slow flux motions for two days. Our study implies that the MFR system in the AR is initiated to upward motion by kink instability and further driven by torus instability. The CME morphology, captured in simultaneous three-point coronagraph observations, is fitted with a Graduated Cylindrical Shell (GCS) model and discerns an MFR topology with its orientation aligning with a magnetic neutral line in the source AR. This MFR expands self-similarly and is found to have source AR twist signatures in the associated near-Earth magnetic cloud (MC). We further derived the kinematics of this CME propagation by employing a plethora of stereoscopic as well as single-spacecraft reconstruction techniques. While stereoscopic methods perform relatively poorly compared to other methods, fitting methods worked best in estimating the arrival time of the CME compared to in situ measurements. Supplied with the values of constrained solar wind velocity, drag parameter, and three-dimensional kinematics from the GCS fit, we construct CME kinematics from the drag-based model consistent with in situ MC arrival.

Decameter Type IV Burst Associated with a Behind-the-limb CME Observed on 7 November 2013

Science.gov (United States)

Melnik, V. N.; Brazhenko, A. I.; Konovalenko, A. A.; Dorovskyy, V. V.; Rucker, H. O.; Panchenko, M.; Frantsuzenko, A. V.; Shevchuk, M. V.

2018-03-01

We report on the results of observations of a type IV burst made by the Ukrainian Radio interferometer of the Academy of Sciences (URAN-2) in the frequency range 22 - 33 MHz. The burst is associated with a coronal mass ejection (CME) initiated by a behind-the-limb active region (N05E151) and was also observed by the Nançay Decameter Array (NDA) radio telescope in the frequency band 30 - 60 MHz. The purpose of the article is the determination of the source of this type IV burst. After analysis of the observational data obtained with the URAN-2, the NDA, the Solar-Terrestrial Relations Observatory (STEREO) A and B spacecraft, and the Solar and Heliospheric Observatory (SOHO) spacecraft, we come to the conclusion that the source of the burst is the core of a behind-the-limb CME. We conclude that the radio emission can escape the center of the CME core at a frequency of 60 MHz and originates from the periphery of the core at a frequency of 30 MHz that is due to occultation by the solar corona at the corresponding frequencies. We find plasma densities in these regions assuming the plasma mechanism of radio emission. We show that the frequency drift of the start of the type IV burst is governed by an expansion of the CME core. The type III bursts that were observed against this type IV burst are shown to be generated by fast electrons propagating through the CME core plasma. A type II burst was registered at frequencies of 44 - 64 MHz and 3 - 16 MHz and was radiated by a shock with velocities of about 1000 km s^{-1} and 800 km s^{-1}, respectively.

A FULL STUDY ON THE SUN–EARTH CONNECTION OF AN EARTH-DIRECTED CME MAGNETIC FLUX ROPE

International Nuclear Information System (INIS)

Vemareddy, Panditi; Mishra, Wageesh

2015-01-01

We present an investigation of an eruption event of a coronal mass ejection (CME) magnetic flux rope (MFR) from the source active region (AR) NOAA 11719 on 2013 April 11 utilizing observations from the Solar Dynamic Observatory, the Solar Terrestrial Relations Observatory, the Solar and Heliospheric Observatory, and the WIND spacecraft. The source AR consists of a pre-existing sigmoidal structure stacked over a filament channel which is regarded as an MFR system. EUV observations of low corona suggest further development of this MFR system by added axial flux through tether-cutting reconnection of loops at the middle of the sigmoid under the influence of continuous slow flux motions for two days. Our study implies that the MFR system in the AR is initiated to upward motion by kink instability and further driven by torus instability. The CME morphology, captured in simultaneous three-point coronagraph observations, is fitted with a Graduated Cylindrical Shell (GCS) model and discerns an MFR topology with its orientation aligning with a magnetic neutral line in the source AR. This MFR expands self-similarly and is found to have source AR twist signatures in the associated near-Earth magnetic cloud (MC). We further derived the kinematics of this CME propagation by employing a plethora of stereoscopic as well as single-spacecraft reconstruction techniques. While stereoscopic methods perform relatively poorly compared to other methods, fitting methods worked best in estimating the arrival time of the CME compared to in situ measurements. Supplied with the values of constrained solar wind velocity, drag parameter, and three-dimensional kinematics from the GCS fit, we construct CME kinematics from the drag-based model consistent with in situ MC arrival

[Implementation of telemedicine programs in Spain: experience of the main actors involved in the decision-making process].

Science.gov (United States)

Mahtani Chugani, Vinita; Martín Fernández, Roberto Luis; Soto Pedre, Enrique; Yanes López, Virginia; Serrano Aguilar, Pedro

2009-01-01

To identify the main benefits and risks related to the implementation of telemedicine programs in Spain, based on the experience of the actors influencing the decision-making process. We performed a qualitative study based on audiotaped semi-structured telephone interviews. Eleven interviews were carried out, and the perspective of four physicians, three administrators, two researchers and two telecommunications industry workers were included. Theoretical sampling was used and thematic inductive analysis was performed. The following factors were identified as necessary to successfully resolve problems by using telemedicine programs: the commitment of the persons involved, technological aspects, economic and institutional support, acceptance by healthcare professionals and patients, the existence of protocols adjusted to the context, the need for information and training prior to the development of telemedicine programs, a forward-looking approach, routine use and full acceptance of telemedicine programs in the organization, and the need to defend equity for professionals and users. Successfully developing a telemedicine program requires a favorable environment in which risk can be foreseen. The main key element seems to be the human factor. The factors identified in this study should be considered when developing strategies to increase the chances of success of telemedicine programs in Spain.

'It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke.

Science.gov (United States)

Gibson, Josephine; Lightbody, Elizabeth; McLoughlin, Alison; McAdam, Joanna; Gibson, Alison; Day, Elaine; Fitzgerald, Jane; May, Carl; Price, Chris; Emsley, Hedley; Ford, Gary A; Watkins, Caroline

2016-02-01

Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients' and carers' views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health-care staff. We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semi-structured interviews were conducted using an interview guide based on normalization process theory (NPT). Thematic analysis was undertaken. We conducted 24 interviews with 29 participants (16 patients; 13 carers). Eleven interviews pertained to 'live' telemedicine assessments (at the time of admission); nine had mock-up telemedicine assessments (within 48 h of admission); four had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sense making) included people's knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Although telemedicine was well accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The 'remote' nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking. © 2015 John Wiley & Sons Ltd.

[Medicine in the digital age : Telemedicine in medical school education].

Science.gov (United States)

Kuhn, S; Jungmann, F

2018-03-01

The increasing digitization of our lives and work has also reached medicine and is changing the profession of medical doctors. The modern forms of communication and cooperation in everyday medical practice demand new skills and qualifications. To enable future doctors to comply with this digitally competent profile, an innovative blended learning curriculum was developed and first implemented at the University Medical Center Mainz in summer semester 2017-Medicine in the Digital Age. The teaching concept encompasses five modules, each consisting of an e‑learning unit and a 3-hour classroom course. This publication presents the teaching concept, the initial implementation and evaluation of the module "Telemedicine". The competency development in the field of telemedicine showed a significant increase for the subcomponents "knowledge" and "skills". The neutral attitude towards telemedicine at the beginning of the module could be changed to a positive opinion after the session. The teaching of digital skills is a relevant component of future curriculum development in medical studies and also a challenge for continuing medical education.

On Flare-CME Characteristics from Sun to Earth Combining Remote-Sensing Image Data with In Situ Measurements Supported by Modeling

Science.gov (United States)

Temmer, Manuela; Thalmann, Julia K.; Dissauer, Karin; Veronig, Astrid M.; Tschernitz, Johannes; Hinterreiter, Jürgen; Rodriguez, Luciano

2017-07-01

We analyze the well-observed flare and coronal mass ejection (CME) from 1 October 2011 (SOL2011-10-01T09:18) covering the complete chain of effects - from Sun to Earth - to better understand the dynamic evolution of the CME and its embedded magnetic field. We study in detail the solar surface and atmosphere associated with the flare and CME using the Solar Dynamics Observatory (SDO) and ground-based instruments. We also track the CME signature off-limb with combined extreme ultraviolet (EUV) and white-light data from the Solar Terrestrial Relations Observatory (STEREO). By applying the graduated cylindrical shell (GCS) reconstruction method and total mass to stereoscopic STEREO-SOHO ( Solar and Heliospheric Observatory) coronagraph data, we track the temporal and spatial evolution of the CME in the interplanetary space and derive its geometry and 3D mass. We combine the GCS and Lundquist model results to derive the axial flux and helicity of the magnetic cloud (MC) from in situ measurements from Wind. This is compared to nonlinear force-free (NLFF) model results, as well as to the reconnected magnetic flux derived from the flare ribbons (flare reconnection flux) and the magnetic flux encompassed by the associated dimming (dimming flux). We find that magnetic reconnection processes were already ongoing before the start of the impulsive flare phase, adding magnetic flux to the flux rope before its final eruption. The dimming flux increases by more than 25% after the end of the flare, indicating that magnetic flux is still added to the flux rope after eruption. Hence, the derived flare reconnection flux is most probably a lower limit for estimating the magnetic flux within the flux rope. We find that the magnetic helicity and axial magnetic flux are lower in the interplanetary space by ˜ 50% and 75%, respectively, possibly indicating an erosion process. A CME mass increase of 10% is observed over a range of {˜} 4 - 20 R_{⊙}. The temporal evolution of the CME

Vascular neurology nurse practitioner provision of telemedicine consultations.

Science.gov (United States)

Demaerschalk, Bart M; Kiernan, Terri-Ellen J; Investigators, Starr

2010-01-01

Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2 +/- 9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0 +/- 9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.

Experience with quality assurance in two store-and-forward telemedicine networks

OpenAIRE

Wootton, Richard; Liu, Joanne; Bonnardot, Laurent; Venugopal, Raghu; Oakley, Amanda

2015-01-01

Published version. Also available at http://dx.doi.org/10.3389/fpubh.2015.00261 Despite the increasing use of telemedicine around the world, little has been done to incorporate quality assurance (QA) into these operations. The purpose of the present study was to examine the feasibility of QA in store-and-forward teleconsulting using a previously published framework. During a 2-year study period, we examined the feasibility of using QA tools in two mature telemedicine networks [Médecins Sa...

Telemedicine in dermatology during external operations.

Science.gov (United States)

Morand, J J

2017-11-01

Telemedicine makes it possible to refer clinical, laboratory, and radiological questions to distant experts, sometimes in real time. This study examines a selection of internet messages sent by physicians carrying out overseas missions or assigned to remote locations and analyzes the interest but also the limitations of teleconsultations in dermatology. The effectiveness of the response depended on the quality of the message, including correct symptom descriptions, thorough history-taking, and the definition of the attached images, as well as the field experience of the specialists receiving the message. Feedback is also of fundamental importance in improving remote expert assessment. The main problem is that conclusive diagnosis is often prevented by the lack of equipment and follow-up available in the field, i.e., inability to perform confirmatory testing or obtain sufficient follow-up information to evaluate the outcome of trial treatments. Training of doctors and nurses in the French Army Medical Service in telemedicine and in clearer better structured messages can contribute to the effectiveness of this mode of communication.

The Principles Of Liability On Telemedicine Practices

Directory of Open Access Journals (Sweden)

Arman Anwar

2016-09-01

Full Text Available This research was aimed at analyzing and finding the principle of liability in telemedicine medical practice proportionally.This research is a legal research with the approach of statute approach, conceptual approach and comparative approach, as well as the approach to the case approach. According to Article 24 paragraph (1 of the 1945 Constitution and Article 5 (1 of Act No. 48 of 2009 on Judicial Authority, determine that the judge shall explore, and understand the legal values and sense of justice in society. Thus Article 1367 paragraph (3 BW and Article 46 of Act No. 44 of 2009 on Hospitals in the application must be in the context of the intended. The principle of liability risk in medical practice telemedicine in proportion refers to professional liability among medical practitioners telemedicine. The theoretical legitimacy is based on professional relationships in the delegation of medical action based on the code of ethics, professional standards, and service standards, and standard operating procedures. Consequences on liability does not necessarily have to be based on errors primary physician (primary care physician / PCP or primary nurse as subordinate as mean vicarious liability doctrine. Nomenclature "proportional" in a significant liability risk as the distribution of rights and obligations of professionals in proportion to each party's fault based on the values of equality (equitability, feasibility and appropriateness (fair and reasionableness. Accountability based on the viewpoint of interactive justice according to the values of professional skill, prudence or accuracy, responsibility, and colleague and the desire to do good for the sake of healing patients (doing good.

First In-Situ Observations of Exospheric Response to CME Impact at Mercury

Science.gov (United States)

Raines, J. M.; Wallace, K. L.; Sarantos, M.; Jasinksi, J. M.; Tracy, P. J.; Dewey, R. M.; Weberg, M. J.; Slavin, J. A.

2018-05-01

We present the first in-situ observations of enhancements to Mercury's He exosphere generated by CME impact. These results have implications for understanding exosphere generation and loss processes, as well space weathering of the planet's surface.

THE 'TWIN-CME' SCENARIO AND LARGE SOLAR ENERGETIC PARTICLE EVENTS IN SOLAR CYCLE 23

International Nuclear Information System (INIS)

Ding, Liuguan; Jiang, Yong; Zhao, Lulu; Li, Gang

2013-01-01

Energetic particles in large solar energetic particle (SEP) events are a major concern for space weather. Recently, Li et al. proposed a 'twin-CME' scenario for ground-level events. Here we extend that study to large SEP events in solar cycle 23. Depending on whether preceding coronal mass ejections (CMEs) within 9 hr exist and whether ions >10 MeV nucleon –1 exceed 10 pfu, we categorize fast CMEs with speed >900 km s –1 and width >60° from the western hemisphere source regions into four groups: groups I and II are 'twin' and single CMEs that lead to large SEPs; groups III and IV are 'twin' and single CMEs that do not lead to large SEPs. The major findings of this paper are: first, large SEP events tend to be 'twin-CME' events. Of 59 western large SEP events in solar cycle 23, 43 are 'twin-CME' (group I) events and 16 are single-CME (group II) events. Second, not all 'twin CMEs' produced large SEPs: 28 twin CMEs did not produce large SEPs (group III events). Some of them produced excesses of particles up to a few MeV nucleon –1 . Third, there were 39 single fast CMEs that did not produce SEPs (group IV events). Some of these also showed an excess of particles up to a few MeV nucleon –1 . For all four groups of events, we perform statistical analyses on properties such as the angular width, the speed, the existence of accompanying metric type II radio bursts, and the associated flare class for the main CMEs and the preceding CMEs.

The Dependence of Characteristic Times of Gradual SEP Events on Their Associated CME Properties

Science.gov (United States)

Pan, Z. H.; Wang, C. B.; Xue, X. H.; Wang, Y. M.

It is generally believed that coronal mass ejections CMEs are the drivers of shocks that accelerate gradual solar energetic particles SEPs One might expect that the characteristics of the SEP intensity time profiles observed at 1 AU are determined by properties of the associated CMEs such as the radial speed and the angular width Recently Kahler statistically investigated the characteristic times of gradual SEP events observed from 1998-2002 and their associated coronal mass ejection properties Astrophys J 628 1014--1022 2005 Three characteristic times of gradual SEP events are determined as functions of solar source longitude 1 T 0 the time from associated CME launch to SEP onset at 1 AU 2 T R the rise time from SEP onset to the time when the SEP intensity is a factor of 2 below peak intensity and 3 T D the duration over which the SEP intensity is within a factor of 2 of the peak intensity However in his study the CME speeds and angular widths are directly taken from the LASCO CME catalog In this study we analyze the radial speeds and the angular widths of CMEs by an ice-cream cone model and re-investigate their correlationships with the characteristic times of the corresponding SEP events We find T R and T D are significantly correlated with radial speed for SEP events in the best-connected longitude range and there is no correlation between T 0 and CME radial speed and angular width which is consistent with Kahler s results On the other hand it s found that T R and T D are also have

Non-adherence to telemedicine interventions for drug users: systematic review

Directory of Open Access Journals (Sweden)

Taís de Campos Moreira

2014-06-01

Full Text Available OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library, Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence.

The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review.

Science.gov (United States)

Bush, Matthew L; Thompson, Robin; Irungu, Catherine; Ayugi, John

2016-12-01

The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation. A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms 1) audiology, otolaryngology, and hearing impairment, 2) rehabilitative methods, and 3) telemedicine. Exclusion criteria were: 1) non-English articles, and 2) non-original research. Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries. This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.

Telemedicine in the management of non-acute headaches: A prospective, open-labelled non-inferiority, randomised clinical trial.

Science.gov (United States)

Müller, Kai I; Alstadhaug, Karl B; Bekkelund, Svein I

2017-08-01

Objectives We determined headache patients' satisfaction with telemedicine and assessed how telemedicine influenced headache burden, compliance with diagnosis and treatment, and need for follow-up consultations. Methods During 2.5 years, patients from Northern Norway referred with non-acute headaches for a specialist consultation at Tromsø University Hospital were consecutively randomised to either telemedicine or traditional visits. Baseline data were recorded and compared to data from a three-month follow-up questionnaire (see Supplementary material). The following were evaluated: (1) satisfaction with the consultation; (2) headache status; subjective improvement, average pain intensity, treatment, headache days per month, and Headache Impact Test (HIT-6); and (3) treatment compliance and follow-up visits. Results Out of 402 consultations, 348 (86.6%) answered the questionnaire. Satisfaction was similar in the telemedicine and the traditional group (88.8% vs. 92.3%; p = 0.35). Subgroup analyses were not prespecified, but there were no differences in satisfaction among females, migraineurs, rural patients and urban patients. Improvement from baseline after three months was reported equally in the telemedicine and the traditional groups. There were also no differences in treatment compliance, but rural telemedicine patients had less-frequent headache visits at three months' follow-up (28.9% vs. 48.7%, p = 0.002). Conclusion Telemedicine is non-inferior to traditional consultations in patient satisfaction, specialist evaluation, and treatment of non-acute headaches. ClinicalTrials.gov ID: NCT02270177.

Diabetes Care and Treatment Project: A Diabetes Institute of Walter Reed Health Care System and Joslin Telemedicine Initiative

Science.gov (United States)

2008-09-01

teleophthalmology system as used by three federal healthcare agencies for detecting proliferative diabetic retinopathy . Telemedicine and e-Health. 2005;11: 641-651...a telemedicine system for comprehensive diabetes management andassessment of diabetic retinopathy that provides increased access for diabetic ...CDMP developed under this collaborative effort. 15. SUBJECT TERMS Joslin Vision Network, telemedicine, diabetes mellitus, diabetic retinopathy

Arizona TeleMedicine Network: System Procurement Specifications.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

Providing general specifications and system descriptions for segments within the Arizona TeleMedicine Project (a telecommunication system designed to deliver health services to rurally isolated American Indians in Arizona), this document, when used with the appropriate route segment document, will completely describe the project's required…

Differences between the CME fronts tracked by an expert, an automated algorithm, and the Solar Stormwatch project

Science.gov (United States)

Barnard, L.; Scott, C. J.; Owens, M.; Lockwood, M.; Crothers, S. R.; Davies, J. A.; Harrison, R. A.

2015-10-01

Observations from the Heliospheric Imager (HI) instruments aboard the twin STEREO spacecraft have enabled the compilation of several catalogues of coronal mass ejections (CMEs), each characterizing the propagation of CMEs through the inner heliosphere. Three such catalogues are the Rutherford Appleton Laboratory (RAL)-HI event list, the Solar Stormwatch CME catalogue, and, presented here, the J-tracker catalogue. Each catalogue uses a different method to characterize the location of CME fronts in the HI images: manual identification by an expert, the statistical reduction of the manual identifications of many citizen scientists, and an automated algorithm. We provide a quantitative comparison of the differences between these catalogues and techniques, using 51 CMEs common to each catalogue. The time-elongation profiles of these CME fronts are compared, as are the estimates of the CME kinematics derived from application of three widely used single-spacecraft-fitting techniques. The J-tracker and RAL-HI profiles are most similar, while the Solar Stormwatch profiles display a small systematic offset. Evidence is presented that these differences arise because the RAL-HI and J-tracker profiles follow the sunward edge of CME density enhancements, while Solar Stormwatch profiles track closer to the antisunward (leading) edge. We demonstrate that the method used to produce the time-elongation profile typically introduces more variability into the kinematic estimates than differences between the various single-spacecraft-fitting techniques. This has implications for the repeatability and robustness of these types of analyses, arguably especially so in the context of space weather forecasting, where it could make the results strongly dependent on the methods used by the forecaster.

Technical Developments and Clinical Use of Telemedicine in Sleep Medicine

Directory of Open Access Journals (Sweden)

Marie Bruyneel

2016-12-01

Full Text Available The use of assistive technology and telemedicine is likely to continue to shape our medical practice in the future, notably in the field of sleep medicine, especially within developed countries. Currently, the number of people suffering from obstructive sleep apnea syndrome (OSAS is increasing. Telemedicine (TM can be used in a variety of ways in sleep medicine: telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with positive pressure devices. In this review, we aim to summarize the recent scientific progresses of these techniques and their potential clinical applications and give consideration to the remaining problems related to TM application.

Collaborative efforts are needed to ensure proper knowledge dissemination of telemedicine projects

DEFF Research Database (Denmark)

Jakobsen, Neel Kolthoff; Jensen, Lena Sundby; Kayser, Lars

2014-01-01

documented and disseminated. MATERIAL AND METHODS: Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted......INTRODUCTION: Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging...... to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were...

Toward a More Usable Home-Based Video Telemedicine System: A Heuristic Evaluation of the Clinician User Interfaces of Home-Based Video Telemedicine Systems.

Science.gov (United States)

Agnisarman, Sruthy; Narasimha, Shraddhaa; Chalil Madathil, Kapil; Welch, Brandon; Brinda, Fnu; Ashok, Aparna; McElligott, James

2017-04-24

Telemedicine is the use of technology to provide and support health care when distance separates the clinical service and the patient. Home-based telemedicine systems involve the use of such technology for medical support and care connecting the patient from the comfort of their homes with the clinician. In order for such a system to be used extensively, it is necessary to understand not only the issues faced by the patients in using them but also the clinician. The aim of this study was to conduct a heuristic evaluation of 4 telemedicine software platforms-Doxy.me, Polycom, Vidyo, and VSee-to assess possible problems and limitations that could affect the usability of the system from the clinician's perspective. It was found that 5 experts individually evaluated all four systems using Nielsen's list of heuristics, classifying the issues based on a severity rating scale. A total of 46 unique problems were identified by the experts. The heuristics most frequently violated were visibility of system status and Error prevention amounting to 24% (11/46 issues) each. Esthetic and minimalist design was second contributing to 13% (6/46 issues) of the total errors. Heuristic evaluation coupled with a severity rating scale was found to be an effective method for identifying problems with the systems. Prioritization of these problems based on the rating provides a good starting point for resolving the issues affecting these platforms. There is a need for better transparency and a more streamlined approach for how physicians use telemedicine systems. Visibility of the system status and speaking the users' language are keys for achieving this. ©Sruthy Agnisarman, Shraddhaa Narasimha, Kapil Chalil Madathil, Brandon Welch, FNU Brinda, Aparna Ashok, James McElligott. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 24.04.2017.

Team medicine in head injury. Usefulness of telemedicine in cooperation with medically depopulated areas

International Nuclear Information System (INIS)

Takazawa, Hiroki; Morita, Takahiro; Narisawa, Ayumi; Saito, Atsushi; Koyama, Shinya; Sasaki, Tatsuya; Nishijima, Michiharu

2011-01-01

Our hospital is located between Tsugaru and Shimokita Peninsulas that are wide medically depopulated areas. The depopulated Tsugaru District has only 2 neurosurgical units, and many patients have to be transferred from the district general hospitals. Since 1989, we have been using an image transfer system that is useful for accurately diagnosing patients with head injury. Between January 2005 and September 2010, 644 patients with head injury were admitted to our hospital. The patients who used and did not use telemedicine were 78 and 566, respectively. In both groups, the background (age, gender, and type of head injury), surgery rate, and time of entry into the operating room were analyzed. There were no significant differences in the age, gender, and type of head injuries between the 2 groups. The surgery rate was 25.6% (28 patients) in the telemedicine group and 12.4% (70 patients) in the direct admission group. The average amount of time between admission and entry into the operating room was 2 h and 13 min in the telemedicine group and 2 h and 57 min in the direct admission group. There were significant differences between the telemedicine and direct admission groups (p<0.05). These results suggest that telemedicine is useful in the treatment of patients with head injuries in a widely depopulated area. (author)

mCME project V.2.0: randomised controlled trial of a revised SMS-based continuing medical education intervention among HIV clinicians in Vietnam.

Science.gov (United States)

Gill, Christopher J; Le, Ngoc Bao; Halim, Nafisa; Chi, Cao Thi Hue; Nguyen, Viet Ha; Bonawitz, Rachael; Hoang, Pham Vu; Nguyen, Hoang Long; Huong, Phan Thi Thu; Larson Williams, Anna; Le, Ngoc Anh; Sabin, Lora

2018-01-01

Continuing medical education (CME) is indispensable, but costs are a barrier. We tested the effectiveness of a novel mHealth intervention (mCME V.2.0) promoting CME among Vietnamese HIV clinicians. We enrolled HIV clinicians from three provinces near Hanoi. The 6-month intervention consisted of (1) daily short message service multiple-choice quiz questions, (2) daily linked readings, (3) links to online CME courses and (4) feedback messages describing the performance of the participant relative to the group. Control participants had equal access to the online CME courses. Our primary endpoint was utilisation of the online CME courses; secondary endpoints were self-study behaviour, performance on a standardised medical exam and job satisfaction. From 121 total HIV clinicians in the three provinces, 106 (87.6%) enrolled, and 48/53 intervention (90%) and 47/53 control (89%) participants completed the endline evaluations. Compared with controls, intervention participants were more likely to use the CME courses (risk ratio (RR) 2.3, 95% CI 1.4 to 3.8, accounting for 83% of course use (P<0.001)). Intervention participants increased self-study behaviours over controls in terms of use of medical textbooks (P<0.01), consulting with colleagues (P<0.01), searching on the internet (P<0.001), using specialist websites (P=0.02), consulting the Vietnam HIV/AIDS treatment guidelines (P=0.02) and searching the scientific literature (P=0.09). Intervention participants outperformed controls on the exam (+23% vs +12% score gains, P=0.05) and had higher job satisfaction. The mCME V.2.0 intervention improved self-study behaviour, medical knowledge and job satisfaction. This approach has potential for expansion in Vietnam and similar settings. NCT02381743.

Telemedicine in wound care.

Science.gov (United States)

Chanussot-Deprez, Caroline; Contreras-Ruiz, José

2008-12-01

Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.

Arizona TeleMedicine Network: Engineering Master Plan.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

As the planning document for establishing a statewide health communications system initially servicing the Papago, San Carlos and White Mountain Apache, Navajo, and Hopi reservations, this document prescribes the communications services to be provided by the Arizona TeleMedicine Network. Specifications include: (1) communications services for each…

Pilot trial of telemedicine as a decision aid for patients with chronic wounds.

Science.gov (United States)

Dobke, Marek K; Bhavsar, Dhaval; Gosman, Amanda; De Neve, Joan; De Neve, Brian

2008-04-01

The study goal was to evaluate the impact of the telemedicine consult on patients with chronic wounds. Thirty patients from long-term care skilled nursing facilities, referred to the ambulatory wound care program for wound assessment and preparation of management plans, were the subject of this prospective, randomized trial. To facilitate communication with a surgical wound care specialist, telemedicine feedback was provided prior to face-to-face consultation to 15 patients. The telemedicine consult included (1) wound assessment, (2) rationale for the suggested wound management with emphasis on wound risk projections, and (3) prevention and benefits of surgical intervention. This was communicated to the patient by the field wound care nurse. The telemedicine impact was measured by assessing the duration of the subsequent face-to-face consultation and patient satisfaction with further care decisions as well as by validation of a decisional conflict scale. The average duration of the face-to-face consultation was 50 +/- 12 minutes versus 35 +/- 6 (p face-to-face evaluation improved patient satisfaction and understanding of their care as well as increased the perception of shared decision making regarding the wound care.

"Initiate-build-operate-transfer"--a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the balkans.

Science.gov (United States)

Latifi, Rifat; Merrell, Ronald C; Doarn, Charles R; Hadeed, George J; Bekteshi, Flamur; Lecaj, Ismet; Boucha, Kathe; Hajdari, Fatmir; Hoxha, Astrit; Koshi, Dashurije; de Leonni Stanonik, Mateja; Berisha, Blerim; Novoberdaliu, Kadri; Imeri, Arben; Weinstein, Ronald S

2009-12-01

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating

Trusting telemedicine: A discussion on risks, safety, legal implications and liability of involved stakeholders.

Science.gov (United States)

Parimbelli, E; Bottalico, B; Losiouk, E; Tomasi, M; Santosuosso, A; Lanzola, G; Quaglini, S; Bellazzi, R

2018-04-01

The main purpose of the article is to raise awareness among all the involved stakeholders about the risks and legal implications connected to the development and use of modern telemedicine systems. Particular focus is given to the class of "active" telemedicine systems, that imply a real-world, non-mediated, interaction with the final user. A secondary objective is to give an overview of the European legal framework that applies to these systems, in the effort to avoid defensive medicine practices and fears, which might be a barrier to their broader adoption. We leverage on the experience gained during two international telemedicine projects, namely MobiGuide (pilot studies conducted in Spain and Italy) and AP@home (clinical trials enrolled patients in Italy, France, the Netherlands, United Kingdom, Austria and Germany), whose development our group has significantly contributed to in the last 4 years, to create a map of the potential criticalities of active telemedicine systems and comment upon the legal framework that applies to them. Two workshops have been organized in December 2015 and March 2016 where the topic has been discussed in round tables with system developers, researchers, physicians, nurses, legal experts, healthcare economists and administrators. We identified 8 features that generate relevant risks from our example use cases. These features generalize to a broad set of telemedicine applications, and suggest insights on possible risk mitigation strategies. We also discuss the relevant European legal framework that regulate this class of systems, providing pointers to specific norms and highlighting possible liability profiles for involved stakeholders. Patients are more and more willing to adopt telemedicine systems to improve home care and day-by-day self-management. An essential step towards a broader adoption of these systems consists in increasing their compliance with existing regulations and better defining responsibilities for all the

Improving Access to Pediatric Cardiology in Cape Verde via a Collaborative International Telemedicine Service.

Science.gov (United States)

Lapão, Luís Velez; Correia, Artur

2015-01-01

This paper addresses the role of international telemedicine services in supporting the evacuation procedures from Cape Verde to Portugal, enabling better quality and cost reductions in the management of the global health system. The Cape Verde, as other African countries, health system lacks many medical specialists, like pediatric cardiologists, neurosurgery, etc. In this study, tele-cardiology shows good results as diagnostic support to the evacuation decision. Telemedicine services show benefits while monitoring patients in post-evacuation, helping to address the lack of responsive care in some specialties whose actual use will help save resources both in provision and in management of the evacuation procedures. Additionally, with tele-cardiology collaborative service many evacuations can be avoided whereas many cases will be treated and followed locally in Cape Verde with remote technical support from Portugal. This international telemedicine service enabled more efficient evacuations, by reducing expenses in travel and housing, and therefore contributed to the health system's improvement. This study provides some evidence of how important telemedicine really is to cope with both the geography and the shortage of physicians.

Telemedicine-Based Burn Research Initiative: Longitudinal Outcomes of Patients

National Research Council Canada - National Science Library

Montalvo, Alfredo

2003-01-01

.... All instruments were professionally printed. The consultant for the project was hired and telemedicine equipment was evaluated by the consultant based on clinical requirements defined by the research team...

Vascular Neurology Nurse Practitioner Provision of Telemedicine Consultations

Directory of Open Access Journals (Sweden)

Bart M. Demaerschalk

2010-01-01

Full Text Available Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2±9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0±9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.

Diabetes Care and Treatment Project: A Diabetes Institute of the Walter Reed Health Care System and Joslin Telemedicine Initiative

Science.gov (United States)

2009-04-09

detecting proliferative diabetic retinopathy . Telemedicine and e-Health. 2005;11: 641-651. MILESTONES AND DELIVERABLES: Completion of data...telemedicine system for comprehensive diabetes management and assessment of diabetic retinopathy that provides increased access for diabetic patients to...CDMP developed under this collaborative effort. 15. SUBJECT TERMS Joslin Vision Network, telemedicine, diabetes mellitus, diabetic retinopathy

Analysis and design of software ecosystem architectures – Towards the 4S telemedicine ecosystem

DEFF Research Database (Denmark)

Christensen, Henrik Bærbak; Hansen, Klaus Marius; Kyng, Morten

2014-01-01

performed a descriptive, revelatory case study of the Danish telemedicine ecosystem and for ii), we experimentally designed, implemented, and evaluated the architecture of 4S. Results We contribute in three areas. First, we define the software ecosystem architecture concept that captures organization......, and application stove-pipes that inhibit the adoption of telemedical solutions. To which extent can a software ecosystem approach to telemedicine alleviate this? Objective In this article, we define the concept of software ecosystem architecture as the structure(s) of a software ecosystem comprising elements...... experience in creating and evolving the 4S telemedicine ecosystem. Conclusion The concept of software ecosystem architecture can be used analytically and constructively in respectively the analysis and design of software ecosystems....

Quality of life in patients receiving telemedicine enhanced chronic heart failure disease management: A meta-analysis.

Science.gov (United States)

Knox, Liam; Rahman, Rachel J; Beedie, Chris

2017-08-01

Background Previous reviews have investigated the effectiveness of telemedicine in the treatment of heart failure (HF). Dependent variables have included hospitalisations, mortality rates, disease knowledge and health costs. Few reviews, however, have examined the variable of health-related quality of life (QoL). Methods Randomised controlled trials comparing the delivery methods of any form of telemedicine with usual care for the provision of HF disease-management were identified via searches of all relevant databases and reference lists. Studies had to report a quantitative measure for mental, physical or overall QoL in order to be included. Results A total of 33 studies were identified. However, poor reporting of data resulted in the exclusion of seven, leaving 26 studies with 7066 participants. Three separate, random effects meta-analyses were conducted for mental, physical and overall QoL. Telemedicine was not significantly more effective than usual care on mental and physical QoL (standardised mean difference (SMD) 0.03, (95% confidence interval (CI) -0.05-0.12), p = 0.45 and SMD 0.24, (95% CI -0.08-0.56), p = 0.14, respectively). However, when compared to usual care, telemedicine was associated with a small significant increase in overall QoL (SMD 0.23, (95% CI 0.09-0.37), p = 0.001). Moderator analyses indicated that telemedicine delivered over a long-duration (≥52 weeks) and via telemonitoring was most beneficial. Conclusion Compared to usual care, telemedicine significantly increases overall QoL in patients receiving HF disease management. Statistically non-significant but nonetheless positive trends were also observed for physical QoL. These findings provide preliminary support for the use of telemedicine in the management of heart failure without jeopardising patient well-being.

Information Retrieval in Telemedicine: a Comparative Study on Bibliographic Databases.

Science.gov (United States)

Ahmadi, Maryam; Sarabi, Roghayeh Ershad; Orak, Roohangiz Jamshidi; Bahaadinbeigy, Kambiz

2015-06-01

The first step in each systematic review is selection of the most valid database that can provide the highest number of relevant references. This study was carried out to determine the most suitable database for information retrieval in telemedicine field. Cinhal, PubMed, Web of Science and Scopus databases were searched for telemedicine matched with Education, cost benefit and patient satisfaction. After analysis of the obtained results, the accuracy coefficient, sensitivity, uniqueness and overlap of databases were calculated. The studied databases differed in the number of retrieved articles. PubMed was identified as the most suitable database for retrieving information on the selected topics with the accuracy and sensitivity ratios of 50.7% and 61.4% respectively. The uniqueness percent of retrieved articles ranged from 38% for Pubmed to 3.0% for Cinhal. The highest overlap rate (18.6%) was found between PubMed and Web of Science. Less than 1% of articles have been indexed in all searched databases. PubMed is suggested as the most suitable database for starting search in telemedicine and after PubMed, Scopus and Web of Science can retrieve about 90% of the relevant articles.

Video-Enhanced Telemedicine Improves the Care of Acutely Injured Burn Patients in a Rural State.

Science.gov (United States)

Wibbenmeyer, Lucy; Kluesner, Karen; Wu, Hongqian; Eid, Anas; Heard, Jason; Mann, Benjamin; Pauley, Alison; Peek-Asa, Corrine

The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P = .030), changes in both transportation mode (P = .042), and disposition decisions (P = .20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 ± 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with

The evolution of publication hotspots in the field of telemedicine from 1962 to 2015 and differences among six countries.

Science.gov (United States)

Wang, Yanjun; Zhao, Ye; Zheng, Jianzhong; Zhang, Ailian; Dong, Haiyuan

2018-04-01

Introduction Telemedicine has been implemented in many countries and has captured the attention of many researchers. Herein, we aim to quantify publication hotspots in the field of telemedicine, analyse their evolution, compare them in different countries, and provide visual representations. Methods We used software tools to process PubMed entries for a 54-year period and identified publication hotspots using keyword frequency analysis. We employed a keyword co-occurrence analysis, principal component analysis, multidimensional scaling analysis, and network visualization technology. Results The number of Medical Subject Heading (MeSH) terms increased with time. The most common subcategories of telemedicine between 1962 and 2015 were Remote Consultation, Teleradiology, and Telepathology. The most popular information communication technologies in telemedicine publications were related to the Internet and cell phones. The topics of Patient Satisfaction, Treatment Outcomes, and Home Care Services associated with telemedicine were highlighted after the 1990s. Use frequency of the terms Cell Phones and Self-Care increased drastically in the past six years, and the publication focus in six countries that had the highest output was different. Knowledge network maps and perceptual maps show the relationship between high-frequency MeSH terms. Discussion The telemedicine field has experienced significant growth and expansion in knowledge and innovation in the last 54 years. Publication hotspots for telemedicine lean towards clinical treatment, home care services, and personal care, and countries emphasize publishing in areas related to their national characteristics. This study quantitatively discusses publication hotspots, provides an objective and systematic understanding of this field, and suggests directions for future telemedicine research.

Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations.

Science.gov (United States)

Müller, Kai Ivar; Alstadhaug, Karl Bjørnar; Bekkelund, Svein Ivar

2016-05-30

The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings. Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches. From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Tromsø University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee's average salary: 3.5 hours spent on travel and consultation=one day's salary. Distance and time spent on travel were estimated by using Google Maps. Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and the investigation, advice, and prescription practices were not statistically

Transaction costs economics as a conceptual framework for the analysis of barriers to the diffusion of telemedicine.

Science.gov (United States)

Pelletier-Fleury, N; Fargeon, V; Lanoé, J L; Fardeau, M

1997-10-01

Telemedecine has been talked about for more than 20 years, without it entering daily use with any success. Based on transaction costs economics, the present analysis of the exchange relationships between health care producers highlights certain characteristics of the current technical and legislative context, which leads to transaction costs. It also demonstrates that the introduction of telemedicine shifts the costs associated with agents' opportunism from patients to health-care producers themselves. All these costs may be considered nowadays to thwart the use of telemedicine. It is argued here that the Public Authorities and professionals of health care could act upon telemedicine in two fields: (1) intervention in the institutional environment aims notably at better defining the property rights of telemedicine, and so constitutes an unavoidable means of encouraging health-care producers to invest in new technology; and (2) implementation of organisational forms and mechanisms susceptible to regulating such telemedical relationships between health care producers-given the present institutional environment-constitutes an essential means for overcoming the immediate barriers blocking the diffusion of telemedicine.

Twenty years of telemedicine in chronic disease management – an evidence synthesis

Science.gov (United States)

Wootton, Richard

2012-01-01

A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory. PMID:22674020

A Correlational Study of the Technology Acceptance Model and Georgia Behavioral Healthcare Provider Telemedicine Adoption

Science.gov (United States)

Yallah, Ali

2014-01-01

The implementation of Telemedicine in behavioral health centers can be expensive if proactive steps were not taken to minimize user perceptions towards the new technology. Despite the significant capital investments on new Telemedicine, no consensus identified and explained what factors determined the acceptance, or rejection, of the technology.…

A systematic review of the methodology of telemedicine evaluation in patients with postural and movement disorders

NARCIS (Netherlands)

Huis in 't Veld, M.H.A.; van Dijk, H; Hermens, Hermanus J.; Vollenbroek-Hutten, Miriam Marie Rosé

2006-01-01

We reviewed the methodology used in telemedicine research concerning patients with postural and movement disorders. Literature searches were performed using various computerized databases through to October 2005. Twenty-two studies met the criteria for review. Two broad models of telemedicine

Outcomes of telemedicine intervention in a regional intensive care unit: a before and after study.

Science.gov (United States)

Panlaqui, O M; Broadfield, E; Champion, R; Edington, J P; Kennedy, S

2017-09-01

Telemedicine consultations in remote intensive care units (ICUs) overseas were found to be effective in reducing mortality and hospital length of stay (LOS). In Australia, there were anecdotal reports of these clinical outcomes. This retrospective before and after study assessed the improvement in patient outcomes with the implementation of a telemedicine program in a regional high dependency unit. Daily virtual consultations were conducted between the rural facility and the intensivists at the regional centre. A total of 525 patients received intensive care support between 2010 and 2015. Hospital and High Dependency Unit mortality showed no evidence of significant differences between the telemedicine group and the baseline (relative risk 1.02, 95% confidence interval [CI] 0.99-1.06, P =0.25 and relative risk 1.00, 95% CI 0.98-1.03, P =0.67 respectively). The hospital LOS was lower in the baseline group by 1.5 days. There was no significant difference in High Dependency Unit LOS. To adjust for the covariates in LOS, log linear regression analysis was performed. The telemedicine intervention, Acute Physiology and Chronic Health Evaluation II scores and inter-hospital transfers were found to contribute significantly to hospital LOS. The most important result of the study was that the proportion of inter-hospital transfers was lower in the telemedicine group (relative risk 0.88, 95% CI 0.80-0.98, P =0.03) compared to baseline. This means that critically ill patients in our regional centre can continue to receive specialist care remotely through tele-ICU consultations thus avoiding the need for patient transport. However, further study is needed to establish the benefits and risks of telemedicine intervention in ICUs in Australia.

["Baltic Declaration"--telemedicine and mHealth as support for clinical processes in cardiology. The opinion of the Committee of Informatics and Telemedicine of the Polish Society of Cardiology and Telemedicine Clinical Sciences Committee of the PAS].

Science.gov (United States)

Piotrowicz, Ryszard; Grabowski, Marcin; Balsam, Paweł; Kołtowski, Łukasz; Kozierkiewicz, Adam; Zajdel, Justyna; Piotrowicz, Ewa; Kowalski, Oskar; Mitkowski, Przemysław; Kaźmierczak, Jarosław; Kalarus, Zbigniew; Opolski, Grzegorz

2015-01-01

For several decades we have observed the development of data transmission technology on an unprecedented scale. With the development of such technology there has also appeared concepts on the use of these solutions in health care systems. Over the last decade telemedicine has been joined by the concept of mHealth, which is based on mobile devices mainly to monitor selected biomedical parameters. On 10 October 2014, during the conference Baltic Electrocardiology Autumn - Telemedicine and Arrhythmia (BEATA), a debate was held with the participation of physicians, politicians, businessmen, and representatives of the Government (Ministry of Health, National Health Fund, Social Insurance Institution) concerning the use of telecardiology services in daily practice. During the meeting issues were discussed such as: telemedicine solutions available throughout the world, analysis of their effectiveness based on clinical trials, funding opportunities, their legal status, and the development perspectives of telecardiology in Poland. The result of the meeting was a document called the "Baltic Declaration". The declaration is a call for proven and profitable technologies to be introduced into clinical practice. The declaration also indicates that the variety of available technological solutions are merely tools, and the utility of such tools stems not only from their modernity, but also primarily from matching their functionality to the features of the health interventions that are to be improved.

Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil.

Science.gov (United States)

de Souza, Carlos Henrique Amaral; Morbeck, Renata Albaladejo; Steinman, Milton; Hors, Cora Pereira; Bracco, Mario Maia; Kozasa, Elisa H; Leão, Eliseth Ribeiro

2017-06-01

In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject. We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described. The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.

Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial

DEFF Research Database (Denmark)

Jacobsen, Anna Svarre; Laursen, Lars C; Østergaard, Birte

2013-01-01

Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable...... phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional...... hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge....

The STARPAHC collection: part of an archive of the history of telemedicine.

Science.gov (United States)

Freiburger, Gary; Holcomb, Mary; Piper, Dave

2007-01-01

An early telemedicine project involving NASA, the Papago Tribe (now the Tohono O'odham Indian Nation), the Lockheed Missile and Space Company, the Indian Health Service and the Department of Health, Education and Welfare explored the possibilities of using technology to provide improved health care to a remote population in southern Arizona. The project, called STARPAHC (Space Technology Applied to Rural Papago Advanced Health Care), took place in the 1970s and demonstrated the feasibility of a consortium of public and private partners working together to provide medical care to remote populations via telecommunication. In 2001 the Arizona Health Sciences Library acquired important archival materials documenting the STARPAHC project and in collaboration with the Arizona Telemedicine Program established the Arizona Archive of Telemedicine. The material is likely to interest those studying early attempts to use technology to deliver health care at a distance, as well as those studying the sociological ramifications of technical and scientific projects among indigenous populations.

Telemedicine + OCT: toward design of optimized algorithms for high-quality compressed images

Science.gov (United States)

Mousavi, Mahta; Lurie, Kristen; Land, Julian; Javidi, Tara; Ellerbee, Audrey K.

2014-03-01

Telemedicine is an emerging technology that aims to provide clinical healthcare at a distance. Among its goals, the transfer of diagnostic images over telecommunication channels has been quite appealing to the medical community. When viewed as an adjunct to biomedical device hardware, one highly important consideration aside from the transfer rate and speed is the accuracy of the reconstructed image at the receiver end. Although optical coherence tomography (OCT) is an established imaging technique that is ripe for telemedicine, the effects of OCT data compression, which may be necessary on certain telemedicine platforms, have not received much attention in the literature. We investigate the performance and efficiency of several lossless and lossy compression techniques for OCT data and characterize their effectiveness with respect to achievable compression ratio, compression rate and preservation of image quality. We examine the effects of compression in the interferogram vs. A-scan domain as assessed with various objective and subjective metrics.

Telemedicine and its potential impacts on reducing inequalities in access to health manpower.

Science.gov (United States)

Nouhi, Mojtaba; Fayaz-Bakhsh, Ahmad; Mohamadi, Efat; Shafii, Milad

2012-10-01

Human resources for health have many diverse aspects that sometimes bring about conflicts in the healthcare market. In recent decades issues such as attrition, migration, and different types of imbalances in health workers were not only considered as international problems, but also took on new particular dimensions and complications. Rapid growth in establishing infrastructure of communications and many diseases such as human immunodeficiency virus/AIDS and malaria, as well as shortages in skilled healthcare providers in developing countries, interested many health economists and health professionals to consider telemedicine as an approach to deliver some healthcare and to pursue its effects on human resources management in healthcare. The objective of this communication is to offer a better understanding of the value of telemedicine in human resources management in healthcare. This article briefly reviews related literature on potential contributions of telemedicine in mitigating four different types of imbalances in health workers and points out some of its capabilities. Although there is a great need for systematic, scientific, and analytical studies in effects of telemedicine on health workers, expansion of communication infrastructure throughout and especially in remote areas, political commitment, and provision of useful information and education to reduce problems of human resources for health are beneficial.

The Efficacy of Telemedicine-Supported Discharge Within an In Home Model of Care.

Science.gov (United States)

Greenup, Edwin P; McCusker, Melissa; Potts, Boyd A; Bryett, Andrew

2017-09-01

To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.

Telemedicine in the management of chronic pain: a cost analysis study.

Science.gov (United States)

Pronovost, Antoine; Peng, Philip; Kern, Ralph

2009-08-01

Telemedicine provides patients with easy and remote access to consultant expertise irrespective of geographic location. In a randomized controlled trial, this study has applied a rigorous costing methodology to the use of telemedicine in chronic pain management. We performed a randomized two-period crossover trial comparing in-person (IP) consultation with telemedicine (TM) consultation in the management of chronic pain. Over an 18-month period, 26 patients each completed two diaries capturing their direct and indirect travel costs, daily pain scores, and satisfaction with physician consultation. Costing models were developed to account for direct, indirect, fixed, and variable costs in order to perform break-even analyses. Sensitivity analysis was performed over a broad range of assumptions. Direct patient costs were significantly lower in the TM group than in the IP group, with median cost and interquartile range 133 dollars (28-377) vs 443 dollars (292-1075), respectively (P = 0.001). More patients were highly satisfied with the TM consultation than with the IP consultation (56 and 24%, respectively; P sensitivity analysis controlling for annual patient volume and round-trip distance indicated that TM remains cost-effective at volumes >50 patients/year or at round-trip distances >200 km. Telemedicine is cost-effective over a broad range of assumptions, including annual patient volumes, travel distance, fuel costs, amortization, and discount rates. This study provides data from a real-world setting to determine relevant thresholds and targets for establishing a TM program for patients who are undergoing chronic pain therapy.

Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

Science.gov (United States)

de la Torre-Díez, Isabel; López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

2015-02-01

A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

The intellectual property cookbook: a guide for the novice health-care telemedicine provider working with industry.

Science.gov (United States)

Beauregard, D; Beauregard, G

2000-01-01

Telemedicine is a new field and many health-care providers are developing their own products with the help of industry. Most practitioners are novices in the legal tools necessary to protect their own work with regard to any future commercialization. To summarize these issues for the telemedicine practitioner, a review of intellectual property protection has been performed. Intellectual property can be protected by tools such as copyrights, patents, non-disclosure and confidentiality agreements, integrated circuit topographies and industrial design. Knowledge of the intellectual property background should allow telemedicine providers to protect their own work when working with industry.

The Responsibility of Telemedicine Focused Organizations in regards to creating Compliant end Users Products and Services

Directory of Open Access Journals (Sweden)

Adrian Dumitru Tanţău

2014-02-01

Full Text Available The main purpose of the present study is to provide a highly comprehensive methodological solution for carrying out products/services which fully comply with customers (i.e. end users functional and performance requirements in Telemedicine field, and furthermore to satisfy multitude end users simultaneously. By bringing into the light Systems Engineering (SE as a multidisciplinary theory used preponderantly in the aero-space segment for realization of complex projects, the paper illustrates the way it can be fulfilled the Functional and Performance Requirements of the end users from Romanian (non emergency medicine services in order to develop an innovative telemedicine product. The case study is based on two sets of qualitative researches as interviews in order to validate the telemedicine triggering idea among users, and to classify them, and secondly, as ample observations in order to gain insights on the users' scenarios and further to elaborate user requirements. Both sets of researches undertaken from users' specific environments were backed up with secondary information gained through document analysis. Relevant for this telemedicine research, it is the fact that the results of this survey have been already successfully used as a baseline to prototype the telemedicine product for Romanian market, in a European Space Agency (ESA Project.

Barriers and challenges in adopting Saudi telemedicine network: The perceptions of decision makers of healthcare facilities in Saudi Arabia

Directory of Open Access Journals (Sweden)

Abdulellah Alaboudi

2016-11-01

Full Text Available Summary: Despite emerging evidence about the benefits of telemedicine, there are still many barriers and challenges to its adoption. Its adoption is often cited as a failed project because 75% of them are abandoned or ‘failed outright’ and this percentage increases to 90% in developing countries. The literature has clarified that there is neither one-size-fit-all framework nor best-practice solution for all ICT innovations or for all countries. Barriers and challenges in adopting and implementing one ICT innovation in a given country/organisation may not be similar – not for the same ICT innovation in another country/organisation nor for another ICT innovation in the same country/organisation.To the best of our knowledge, no comprehensive scientific study has investigated these challenges and barriers in all Healthcare Facilities (HCFs across the Kingdom of Saudi Arabia (KSA. This research, which is undertaken based on the Saudi Telemedicine Network roadmap and in collaboration with the Saudi Ministry of Health (MOH, is aimed at identifying the principle predictive challenges and barriers in the context of the KSA, and understanding the perspective of the decision makers of each HCF type, sector, and location. Three theories are used to underpin this research: the Unified Theory of Acceptance and Use of Technology (UTAUT, the Technology–Organisation–Environment (TOE theoretical framework, and the Evaluating Telemedicine Systems Success Model (ETSSM. This study applies a three-sequential-phase approach by using three mixed methods (i.e., literature review, interviews, and questionnaires in order to utilise the source triangulation and the data comparison analysis technique. The findings of this study show that the top three influential barriers to adopt and implement telemedicine by the HCF decision makers are: (i the availability of adequate sustainable financial support to implement, operate, and maintain the telemedicine system, (ii

Low-cost telemedicine in the developing world.

Science.gov (United States)

Swinfen, R; Swinfen, P

2002-12-01

The Swinfen Charitable Trust uses digital cameras and email to provide specialist advice to doctors in developing countries. The first telemedicine link was set up in July 1999. By the end of a year there were three links to hospitals in Bangladesh, Nepal and the Solomon Islands. Initially the consultants, all of whom give their advice free of charge, were from the UK, but now are worldwide. At present there are 12 links in operation, including one on Tristan da Cunha, and two links approved and awaiting equipment. The advice given by the consultants has been found to be helpful to the referring doctors and to benefit their patients. Failures have been due to the use of obsolescent equipment, computer viruses, lack of communication with the referring hospital before setting up a link, and referring doctors not chasing up their own referrals. Problems yet to be solved include the unreliability of the Internet, certain medicolegal issues and assessing the quality of medical consultants. In future there will be the problem of managing a rapidly growing telemedicine network.

Requirements Elicitation in a Telemedicine Pain-treatment Trial

NARCIS (Netherlands)

Widya, I.A.; Bults, Richard G.A.; van Beijnum, Bernhard J.F.; Sandsjö, L.; Schaake, L.; Huis in 't Veld, M.H.A.; Jones, Valerie M.; Hermens, Hermanus J.; Ryan, K.; Robinson, W.

2009-01-01

This paper presents the early phase requirements elicitation for a work-related neck-shoulder pain teletreatment trial and the assessment of those requirements in respect of their importance to the trial and the feasibility of the needed software adaptations of the telemedicine system within the

Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Ming, Wai-Kit; Mackillop, Lucy H; Farmer, Andrew J; Loerup, Lise; Bartlett, Katy; Levy, Jonathan C; Tarassenko, Lionel; Velardo, Carmelo; Kenworthy, Yvonne; Hirst, Jane E

2016-11-09

Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy. To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy. The review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). A total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of -0.12% (95% CI -0.23% to -0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference -0.14% (95% CI -0.25% to -0.04%). There were no differences in other maternal and neonatal outcomes reported. There is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were

A role for telemedicine in Mali | IDRC - International Development ...

International Development Research Centre (IDRC) Digital Library (Canada)

When Bagayoko chose telemedicine as the focus for his doctoral thesis, he knew it ... and new medical applications for information and communication technologies. While in Switzerland, Bagayoko came across mobile technology used for ski ...

A cohort study following up on a randomised controlled trial of a telemedicine application in COPD patients

DEFF Research Database (Denmark)

Dyrvig, Anne-Kirstine; Gerke, Oke; Kidholm, Kristian

2015-01-01

pulmonary disease (COPD) is no exception. METHODS: In this article, the effects of implementing a telemedicine intervention for COPD patients were analysed using data collected before, during, and after a randomised controlled trial (RCT).More specifically, regression techniques using robust variance...... estimators were used to analyse whether the use of telemedicine, patient age, and gender could explain the risk of readmission, length of hospital admission, and death during a five-year observation period. RESULTS: Increased risk of readmission was significantly related to both use of telemedicine...... and increased age in three sub-periods of the study, whereas women showed a more pronounced risk of readmission than men only during and after the RCT period. The number of days admitted to hospital was higher for patients using telemedicine and being of older age. Risk of death during the observation period...

Flux Cancellation Leading to CME Filament Eruptions

Science.gov (United States)

Popescu, Roxana M.; Panesar, Navdeep K.; Sterling, Alphonse C.; Moore, Ronald L.

2016-01-01

Solar filaments are strands of relatively cool, dense plasma magnetically suspended in the lower density hotter solar corona. They trace magnetic polarity inversion lines (PILs) in the photosphere below, and are supported against gravity at heights of up to approx.100 Mm above the chromosphere by the magnetic field in and around them. This field erupts when it is rendered unstable, often by magnetic flux cancellation or emergence at or near the PIL. We have studied the evolution of photospheric magnetic flux leading to ten observed filament eruptions. Specifically, we look for gradual magnetic changes in the neighborhood of the PIL prior to and during eruption. We use Extreme Ultraviolet (EUV) images from the Atmospheric Imaging Assembly (AIA), and magnetograms from the Helioseismic and Magnetic Imager (HMI), both on board the Solar Dynamics Observatory (SDO), to study filament eruptions and their photospheric magnetic fields. We examine whether flux cancellation or/and emergence leads to filament eruptions. We find that continuous flux cancellation was present at the PIL for many hours prior to each eruption. We present two CME-producing eruptions in detail and find the following: (a) the pre-eruption filament-holding core field is highly sheared and appears in the shape of a sigmoid above the PIL; (b) at the start of the eruption the opposite arms of the sigmoid reconnect in the middle above the site of (tether-cutting) flux cancellation at the PIL; (c) the filaments first show a slow-rise, followed by a fast-rise as they erupt. We conclude that these two filament eruptions result from flux cancellation in the middle of the sheared field, and thereafter evolve in agreement with the standard model for a CME/flare filament eruption from a closed bipolar magnetic field [flux cancellation (van Ballegooijen and Martens 1989 and Moore and Roumelrotis 1992) and runaway tether-cutting (Moore et. al 2001)].

Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial.

Science.gov (United States)

Crowley, Matthew J; Edelman, David; McAndrew, Ann T; Kistler, Susan; Danus, Susanne; Webb, Jason A; Zanga, Joseph; Sanders, Linda L; Coffman, Cynthia J; Jackson, George L; Bosworth, Hayden B

2016-05-01

Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.

Experience with Quality Assurance in Two Store-and-Forward Telemedicine Networks.

Science.gov (United States)

Wootton, Richard; Liu, Joanne; Bonnardot, Laurent; Venugopal, Raghu; Oakley, Amanda

2015-01-01

Despite the increasing use of telemedicine around the world, little has been done to incorporate quality assurance (QA) into these operations. The purpose of the present study was to examine the feasibility of QA in store-and-forward teleconsulting using a previously published framework. During a 2-year study period, we examined the feasibility of using QA tools in two mature telemedicine networks [Médecins Sans Frontières (MSF) and New Zealand Teledermatology (NZT)]. The tools included performance reporting to assess trends, automated follow-up of patients to obtain outcomes data, automated surveying of referrers to obtain user feedback, and retrospective assessment of randomly selected cases to assess quality. In addition, the senior case coordinators in each network were responsible for identifying potential adverse events from email reports received from users. During the study period, there were 149 responses to the patient follow-up questions relating to the 1241 MSF cases (i.e., 12% of cases), and there were 271 responses to the follow-up questions relating to the 639 NZT cases (i.e., 42% of cases). The collection of user feedback reports was combined with the collection of patient follow-up data, thus producing the same response rates. The outcomes data suggested that the telemedicine advice proved useful for the referring doctor in the majority of cases and was likely to benefit the patient. The user feedback was overwhelmingly positive, over 90% of referrers in the two networks finding the advice received to be of educational benefit. The feedback also suggested that the teleconsultation had provided cost savings in about 20% of cases, either to the patient/family, or to the hospital/clinic treating the patient. Various problems were detected by regular monitoring, and certain adverse events were identified from email reports by the users. A single aberrant quality reading was detected by using a process control chart. The present study demonstrates

Cost-Benefit Analysis of Telemedicine Systems/Units in Greek Remote Areas.

Science.gov (United States)

Kouskoukis, Marios-Nikolaos; Botsaris, Charalambos

2017-06-01

Telemedicine units and information technology systems provide special healthcare services to remote populations using telecommunication technology, in order to reduce or even remove the usual and typical face-to-face contact between doctor and patient. This innovative approach to medical care delivery has been expanding for several years and currently covers various medical specialties. To facilitate installation of telemedicine systems/units in Greek remote areas, this article presents results of a cost-benefit analysis for two Greek islands, Patmos and Leros, using specific economic criteria. Net present value (NPV), internal rate of return (IRR), and payback period were calculated, in order to monetize the economic benefits and the costs savings, estimate the depreciation of each project, and highlight the social benefits. Costs were reduced (through saved air medical transportations) by €19,005 for Patmos and €78,225 for Leros each year. NPV and IRR were positive; NPV was €29,608 for Patmos and €293,245 for Leros, and IRR was 21.5% for Patmos and 140.5% for Leros. Each project depreciated faster than the 5-year life-cycle period, and specifically in 3.13 years for Patmos and in 0.70 years for Leros. The establishment of telemedicine systems/units in Patmos and Leros was evaluated and assessed positively, with large savings, economical and social, gained by reducing or even removing the face-to-face contact between doctor and patient. Telemedicine systems/units seem to be a promising solution, especially in Greece, where the problem of primary healthcare services in remote/inaccessible areas is of great concern.

Utilizing patient geographic information system data to plan telemedicine service locations.

Science.gov (United States)

Soares, Neelkamal; Dewalle, Joseph; Marsh, Ben

2017-09-01

To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site. A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient load imbalance between otherwise similar groupings. A majority of the best site groupings used the same small number of sites, and urban sites were heavily used. With EHR geospatial data at an individual patient level, we can model potential telemedicine sites for specialty access in a rural geographic area. Relatively few sites could serve most of the population. Direct access to patient GIS data from an EHR provides direct knowledge of the client base compared to methods that allocate aggregated data. Geospatial data and methods can assist health care location planning, generating data about load, load balance, and spatial accessibility. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

A Web-based Architecture Enabling Multichannel Telemedicine Applications

Directory of Open Access Journals (Sweden)

Fabrizio Lamberti

2003-02-01

Full Text Available Telemedicine scenarios include today in-hospital care management, remote teleconsulting, collaborative diagnosis and emergency situations handling. Different types of information need to be accessed by means of etherogeneous client devices in different communication environments in order to enable high quality continuous sanitary assistance delivery wherever and whenever needed. In this paper, a Web-based telemedicine architecture based on Java, XML and XSL technologies is presented. By providing dynamic content delivery services and Java based client applications for medical data consultation and modification, the system enables effective access to an Electronic Patient Record based standard database by means of any device equipped with a Web browser, such as traditional Personal Computers and workstation as well as modern Personal Digital Assistants. The effectiveness of the proposed architecture has been evaluated in different scenarios, experiencing fixed and mobile clinical data transmissions over Local Area Networks, wireless LANs and wide coverage telecommunication network including GSM and GPRS.

Relation Between the 3D-Geometry of the Coronal Wave and Associated CME During the 26 April 2008 Event

Science.gov (United States)

Temmer, M.; Veronig, A. M.; Gopalswamy, N.; Yashiro, S.

2011-01-01

We study the kinematical characteristics and 3D geometry of a large-scale coronal wave that occurred in association with the 26 April 2008 flare-CME event. The wave was observed with the EUVI instruments aboard both STEREO spacecraft (STEREO-A and STEREO-B) with a mean speed of approx 240 km/s. The wave is more pronounced in the eastern propagation direction, and is thus, better observable in STEREO-B images. From STEREO-B observations we derive two separate initiation centers for the wave, and their locations fit with the coronal dimming regions. Assuming a simple geometry of the wave we reconstruct its 3D nature from combined STEREO-A and STEREO-B observations. We find that the wave structure is asymmetric with an inclination toward East. The associated CME has a deprojected speed of approx 750 +/- 50 km/s, and it shows a non-radial outward motion toward the East with respect to the underlying source region location. Applying the forward fitting model developed by Thernisien, Howard, and Vourlidas we derive the CME flux rope position on the solar surface to be close to the dimming regions. We conclude that the expanding flanks of the CME most likely drive and shape the coronal wave.

Simulation of the 23 July 2012 Extreme Space Weather Event: What if This Extremely Rare CME Was Earth Directed?

Science.gov (United States)

Ngwira, Chigomezyo M.; Pulkkinen, Antti; Mays, M. Leila; Kuznetsova, Maria M.; Galvin, A. B.; Simunac, Kristin; Baker, Daniel N.; Li, Xinlin; Zheng, Yihua; Glocer, Alex

2013-01-01

Extreme space weather events are known to cause adverse impacts on critical modern day technological infrastructure such as high-voltage electric power transmission grids. On 23 July 2012, NASA's Solar Terrestrial Relations Observatory-Ahead (STEREO-A) spacecraft observed in situ an extremely fast coronal mass ejection (CME) that traveled 0.96 astronomical units (approx. 1 AU) in about 19 h. Here we use the SpaceWeather Modeling Framework (SWMF) to perform a simulation of this rare CME.We consider STEREO-A in situ observations to represent the upstream L1 solar wind boundary conditions. The goal of this study is to examine what would have happened if this Rare-type CME was Earth-bound. Global SWMF-generated ground geomagnetic field perturbations are used to compute the simulated induced geoelectric field at specific ground-based active INTERMAGNET magnetometer sites. Simulation results show that while modeled global SYM-H index, a high-resolution equivalent of the Dst index, was comparable to previously observed severe geomagnetic storms such as the Halloween 2003 storm, the 23 July CME would have produced some of the largest geomagnetically induced electric fields, making it very geoeffective. These results have important practical applications for risk management of electrical power grids.

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

Science.gov (United States)

Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision

Telemedicine and robotics: paving the way to the globalization of surgery.

Science.gov (United States)

Senapati, S; Advincula, A P

2005-12-01

The concept of delivering health services at a distance, or telemedicine is becoming an emerging tool for the field of surgery. For the surgical services, telepresence surgery through robotics is gradually being incorporated into health care practices. This article will provide a brief overview of the principles surrounding telemedicine and telepresence surgery as they specifically relate to robotics. Where limitations have been reached in laparoscopy, robotics has allowed further steps forward. The development of robotics in medicine has been a progression from passive to immersive technology. In gynecology, the utilization of robotics has evolved from the use of Aesop, a robotic arm for camera manipulation, to full robotic systems such as Zeus, and the daVinci surgical system. These systems have not only been used directly for a variety of procedures but have also become a useful tool for conferencing and the mentoring of surgeons from afar. As this mode of technology becomes assimilated into the culture of surgery and medicine globally, caution must be taken to carefully navigate the economic, legal and ethical implications of telemedicine. Despite the challenges faced, telepresence surgery holds promise for more widespread applications.

Use of telemedicine to improve burn care in Ukraine.

Science.gov (United States)

Fuzaylov, Gennadiy; Knittel, Justin; Driscoll, Daniel N

2013-01-01

Global burn injuries have been described as the "forgotten public health crises" by the World Health Organization. Nearly 11 million people a year suffer burns severe enough to require medical attention; more people are burned each year than are infected with human immunodeficiency virus/acquired immunodeficiency syndrome and tuberculosis combined. Telemedicine has the potential to link experts in specialized fields, such as burn care, to regions of the world that have limited or no access to such specialized care. A multilevel telemedicine program was developed between Massachusetts General Hospital/Shriners Hospital in Boston, Massachusetts, and City Hospital #8 in Lviv, Ukraine. The program should lead to a sustainable improvement in the care of burn victims in Ukraine. The authors helped establish a Learning Center at City Hospital #8 in Lviv, Ukraine, through which they were able to consult from Shriners Hospital in Boston, on a total of 14 acute burn patients in Ukraine. This article discusses two case reports with the use of telemedicine and how it has allowed the authors to provide not only acute care consultation on an international scale, but also to arrange for direct expert examination and international transport to their specialized burn center in the United States. The authors have established a program through doctors from Massachusetts General Hospital/Shriner's Hospital in Boston, which works with a hospital in Ukraine and has provided acute consultation, as well as patient transportation to the United States for treatment and direct assessment.

[CME-certified online education in Germany - status in ophthalmology 2011].

Science.gov (United States)

Handzel, D M

2012-06-01

The use of the internet is becoming more and more important in every aspect of daily life, also in professional education. Online education and face-to-face learning have proven to be equally efficient. The aim of this study is to evaluate the amount of online education in the German-speaking internet 2011. The terms "ophthalmology", "online-education", "continuing medical education" and "CME" (partly in German language) were searched by an internet-search engine. The first 100 pages were visited. Pages were evaluated in respect of quality and quantity, authorship and possible influence of sponsors. Only 9 of the first 100 hits had an actual offer for ophthalmology. Nearly all of these were websites of ophthalmological scientific journals. The content represented the same educational format (pictures and text) as in the print issue. CME-certified online education can be found in Germany as offspring of print issues only. The content is identical with educational texts in the print issues. An enlargement of the offer, which uses the possibilities of modern internet technology is highly probable. This estimation is supported by the growing use of the internet and developments on English-speaking websites for online-education. © Georg Thieme Verlag KG Stuttgart · New York.

Preparing Student Nurses for the Future of Wound Management: Telemedicine in a Simulated Learning Enviroment

DEFF Research Database (Denmark)

Christiansen, Sytter; Rethmeier, Anita

2015-01-01

Background: The Danish Society for Wound Healing advocates for the use of telemedicine in chronic wound management. It is crucial that student nurses are prepared for the technological demands of the future so that they will be competent to manage chronic wounds. Aim: The aim of this project...... was to integrate the concept of telemedicine for wound care into a simulation-based class for undergraduate student nurses and to evaluate their experiences with this integrated learning method. Methods: Five medium-fidelity mannequins were used in a simulated learning environment consisting of a simulated......, the simulated learning environment seems to be a constructive didactic method. The simulated learning environment should also be tested with postgraduate nurses with less experience in telemedicine....

An 802.11 n wireless local area network transmission scheme for wireless telemedicine applications.

Science.gov (United States)

Lin, C F; Hung, S I; Chiang, I H

2010-10-01

In this paper, an 802.11 n transmission scheme is proposed for wireless telemedicine applications. IEEE 802.11n standards, a power assignment strategy, space-time block coding (STBC), and an object composition Petri net (OCPN) model are adopted. With the proposed wireless system, G.729 audio bit streams, Joint Photographic Experts Group 2000 (JPEG 2000) clinical images, and Moving Picture Experts Group 4 (MPEG-4) video bit streams achieve a transmission bit error rate (BER) of 10-7, 10-4, and 103 simultaneously. The proposed system meets the requirements prescribed for wireless telemedicine applications. An essential feature of this proposed transmission scheme is that clinical information that requires a high quality of service (QoS) is transmitted at a high power transmission rate with significant error protection. For maximizing resource utilization and minimizing the total transmission power, STBC and adaptive modulation techniques are used in the proposed 802.11 n wireless telemedicine system. Further, low power, direct mapping (DM), low-error protection scheme, and high-level modulation are adopted for messages that can tolerate a high BER. With the proposed transmission scheme, the required reliability of communication can be achieved. Our simulation results have shown that the proposed 802.11 n transmission scheme can be used for developing effective wireless telemedicine systems.

Health care for all: effective, community supported, healthcare with innovative use of telemedicine technology.

Science.gov (United States)

Shah, Tariq Kazim; Tariq, Tasneem; Phillips, Roger; Davison, Steve; Hoare, Adam; Hasan, Syed Shahzad; Babar, Zaheer-Ud-Din

2018-01-01

Almost half of the world's total population reside in rural and remote areas and a large number of these people remain deprived of most basic facilities like healthcare and education. It is deemed impossible for government with scarce resources in developing countries to open and run a health facility in every remote community using conventional means. One increasingly popular unconventional mean is the use of existing technology to improve exchange of medical information for the purpose of improving health of underprivileged communities. Telemedicine implies the use of information and communication technology to provide health care remotely from a distance. With the induction of telemedicine, patients who live in rural and remote areas can have increased access to medical services. In many developing countries, use of telemedicine however has been limited mainly to teleconferencing between primary and secondary/tertiary care facilities for diagnosis and management of patients. This system still requires patients from remote communities to travel, often long and arduous journeys to the centre where telecom and medical facilities are available. Health Care 4 All International, a not for profit registered charity is providing primary care to patients by taking telemedicine into their homes in remote communities, thus obviating the need and hardships of travel for patient.

Strategic Analysis and Plan for Implementing Telemedicine at Fort Greely

National Research Council Canada - National Science Library

Bolton, Karl

2003-01-01

.... To best accomplish this, a strategic analysis and business case analysis was conducted. Introspective strategic analysis tools revealed an organization that is capable of supporting a telemedicine program at Fort Greely...

How Do Low-Income Urban African Americans and Latinos Feel about Telemedicine? A Diffusion of Innovation Analysis

Directory of Open Access Journals (Sweden)

Sheba George

2012-01-01

Full Text Available Introduction. Telemedicine is promoted as a means to increase access to specialty medical care among the urban underserved, yet little is known about its acceptability among these populations. We used components of a diffusion of innovation conceptual framework to analyze preexperience perceptions about telemedicine to assess its appeal among urban underserved African Americans and Latinos. Methods. Ten focus groups were conducted with African American (=43 and Latino participants (=44 in both English and Spanish and analyzed for key themes. Results. Both groups perceived increased and immediate access to multiple medical opinions and reduced wait time as relative advantages of telemedicine. However, African Americans expressed more concerns than Latinos about confidentiality, privacy, and the physical absence of the specialist. This difference may reflect lower levels of trust in new health care innovations among African Americans resulting from a legacy of past abuses in the US medical system as compared to immigrant Latinos who do not have this particular historical backdrop. Conclusions. These findings have implications for important issues such as adoption of telemedicine, patient satisfaction, doctor-patient interactions, and the development and tailoring of strategies targeted to each of these populations for the introduction, marketing, and implementation of telemedicine.

Service design attributes affecting diabetic patient preferences of telemedicine in South Korea.

Science.gov (United States)

Park, Hayoung; Chon, Yucheong; Lee, Jongsu; Choi, Ie-Jung; Yoon, Kun-Ho

2011-01-01

Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes. We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey. All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services. The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries.

Supporting the developers of context-aware mobile telemedicine applications

NARCIS (Netherlands)

Broens, T.H.F.

2005-01-01

Telemedicine, which is defined as providing healthcare and sharing of medical knowledge over distance using telecommunication means, is a promising approach to improve and enhance the healthcare provisioning process. However, only recently, technology has evolved (i.e. miniaturization of high power

Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study.

Science.gov (United States)

Bell, Rebecca C; Yager, Phoebe H; Clark, Maureen E; Roumiantsev, Serguei; Venancio, Heather L; Chipman, Daniel W; Kacmarek, Robert M; Noviski, Natan N

2016-02-01

Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine. We conducted a pilot study including 40 assessments by 16 RTs on 11 subjects (5 neonatal ICU; 6 pediatric ICU). Anonymously completed intake forms by 2 different RTs concurrently assessing 14 ventilator-derived and patient-based respiratory variables were used to determine correlations. Forty paired assessments were performed. Median telemedicine assessment time was 8 min. The Pearson correlation coefficient (r) was used to determine agreement between continuous data, and the Cohen kappa statistics were used for binary variables. Pressure control, PEEP, breathing frequency, and FIO2 perfectly correlated (r = 1, all P Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patient-generated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope. Copyright © 2016 by Daedalus Enterprises.

Accepting telemedicine in a circulatory medicine ward in major hospitals in South Korea: patients' and health professionals' perception of real-time electrocardiogram monitoring.

Science.gov (United States)

Lee, Seo-Joon; Jung, Tae-Young; Lee, Tae-Ro; Han, Jae-Hoon

2018-04-20

South Korean government is currently in progress of expanding the coverage of telemedicine projects as part of an attempt to vitalize service industry, but is facing fierce opposition from KMA. Practice of telemedicine requires sufficient discussions among related parties. Although the participation of medical specialists is important, agreement from the public is essential. Three main tertiary care centers in Seoul were selected for data collection. A total of 224 patients (patients n = 180, patient guardian n = 44) and medical professionals (n = 41) were selected using simple random sampling. Mixed method of quantitative survey and qualitative semi-interview was used. This study analyzed patients' and medical professionals' perception about the application of telemedicine in cardiology ward in tertiary care centers to provide baseline data when developing and applying telemedicine services. Results implied high need for encouraging telemedicine projects in order to appeal needs among population by providing experience (p < 0.001) and knowledge (p < 0.001). Other results showed that the need for electrocardiography monitoring was high among not only in remote areas but also in areas close to the capital. 64.52% of all participants thought that telemedicine was needed, and 73.21% of participants were willing to use telemedicine service if provided. Semi-interviews revealed that participants expected more cost and time saving services through remote treatment, by not having to visit long distance hospitals frequently. Research results oppose Korean Medical Association's opinion that the population is against enforcing telemedicine related laws. The findings in this study reflect an up-to-date perception of telemedicine among patients and medical professionals in a tertiary care centers' cardiology ward. Moreover, the study provides a baseline that is needed in order to overcome past failures and to successfully implement telemedicine in South

Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria.

Science.gov (United States)

Alajlani, Mohannad; Clarke, Malcolm

2013-04-01

We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion.

Access and Quality of Care in Direct-to-Consumer Telemedicine.

Science.gov (United States)

Uscher-Pines, Lori; Mulcahy, Andrew; Cowling, David; Hunter, Gerald; Burns, Rachel; Mehrotra, Ateev

2016-04-01

Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided. This study compared the quality of care at Teladoc ( www.teladoc.com ), a large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers. Claims from all enrollees 18-64 years of age in the California Public Employees' Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians. Of enrollees offered Teladoc (n = 233,915), 3,043 adults had a total of 4,657 Teladoc visits. For the pharyngitis performance measure (ordering strep test), Teladoc performed worse than physician offices (3% versus 50%, p located within a healthcare professional shortage area (odds ratio = 1.12, p = 0.10) or rural location (odds ratio = 1.0, p = 0.10). Teladoc providers were less likely to order diagnostic testing and had poorer performance on appropriate antibiotic prescribing for bronchitis. Teladoc users were not preferentially located in underserved communities. Short-term needs include ongoing monitoring of quality and additional marketing and education to increase telemedicine use among underserved patients.

Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

DEFF Research Database (Denmark)

Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

2014-01-01

diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported ... living telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...

Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design.

Science.gov (United States)

Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane

2016-07-08

For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. To identify parental needs when wanting to provide neonatal home care supported by telemedicine. The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.

Impact of Sleep Telemedicine Protocol in Management of Sleep Apnea: A 5-Year VA Experience.

Science.gov (United States)

Baig, Mirza M; Antonescu-Turcu, Andrea; Ratarasarn, Kavita

2016-05-01

There is growing evidence that demonstrates an important role for telemedicine technologies in enhancing healthcare delivery. A comprehensive sleep telemedicine protocol was implemented at the Veterans Administration Medical Center (VAMC), Milwaukee, WI, in 2008 in an effort to improve access to sleep specialty care. The telemedicine protocol relied heavily on sleep specialist interventions based on chart review (electronic consult [e-consult]). This was done in response to long wait time for sleep clinic visits as well as delayed sleep study appointments. Since 2008 all consults are screened by sleep service to determine the next step in intervention. Based on chart review, the following steps are undertaken: (1) eligibility for portable versus in-lab sleep study is determined, and a sleep study order is placed accordingly, (2) positive airway pressure (PAP) therapy is prescribed for confirmed sleep apnea, and (3) need for in-person evaluation in the sleep clinic is determined, and the visit is scheduled. This study summarizes the 5-year trend in various aspects of access to sleep care after implementation of sleep telemedicine protocol at the Milwaukee VAMC. This is a retrospective system efficiency study. The electronic medical record was interrogated 5 years after starting the sleep telemedicine protocol to study annual trends in the following outcomes: (1) interval between sleep consult and prescription of PAP equipment, (2) total sleep consults, and (3) sleep clinic wait time. Two part-time sleep physicians provided sleep-related care at the Milwaukee VAMC between 2008 and 2012. During this period, the interval between sleep consult and PAP prescription decreased from ≥60 days to ≤7 days. This occurred in spite of an increase in total sleep consults and sleep studies. There was also a significant increase in data downloads, indicating overall improved follow-up. There was no change in clinic wait time of ≥60 days. Implementation of a sleep telemedicine

Efficacy and cost effectiveness of telemedicine for improving access to care in the Paris region: study protocols for eight trials.

Science.gov (United States)

Charrier, Nathanael; Zarca, Kevin; Durand-Zaleski, Isabelle; Calinaud, Christine

2016-02-08

With the development of information and communication technologies, telemedicine has been proposed as a way to improve patient management by facilitating access to appropriate diagnosis and treatment. The Paris Ile de France Regional Health Agency is currently funding a comprehensive program of telemedicine experiments. This article describes the protocols for the evaluation of the implementation of telemedicine in the Paris region. Over 2,500 patients have been included in eight studies addressing the use of telemedicine in the context of specific diseases or settings. Two projects are randomized controlled trials, while the six other projects are based on before-after designs (differences in differences studies). Based on the MAST model and the French national framework, we identified endpoints to assess the impact of telemedicine on five dimensions: clinical effectiveness, cost-effectiveness, security of the application, patient satisfaction and quality of life and perception of professionals. Telemedicine encompasses a wide range of services and stakeholders, and thus study protocols must be tailored to the specific constraints and interests of the users. NCT02110433 (03/07/2014), NCT02157740 (05/27/2014), NCT02374697 (02/05/2015), NCT02157727 (05/27/2014), NCT02229279 (08/28/2014), NCT02368769 (02/05/2015), NCT02164747 (NCT02164747), NCT02309905 (11/27/2014).

Tele-education service using telemedicine network in healthcare industry.

Science.gov (United States)

Mahadevan, S; Muralidhar, Kanchi; Shetty, Devi

2012-11-01

We have used a telemedicine facility to conduct academic teaching/training sessions. The objective of this study was to examine the feasibility, advantages, and disadvantages of this method of e-learning sessions. The teaching/learning sessions were organized twice a week between the two teaching hospitals. The success of each academic session was analyzed in terms of satisfaction of the participating candidates, infrastructure difficulties (if any), and the overall outcome of the program. In total, 293 academic sessions were held from 2008 to 2010. Each session's presentation was 45 min long and was made using Microsoft(®) (Redmond, WA) PowerPoint. We have found that telemedicine proved to be effective in establishing communication not only between the patient and the physician, but also between the teacher and the student. Several candidates benefited from the application of this technology. Candidates expressed satisfaction and were content with the teaching methods adapted.

Informed consent for telemedicine in South Africa: A survey of ...

African Journals Online (AJOL)

2013-11-02

Nov 2, 2013 ... 'the use of information communication technology (ICT) for health'. .... Telemedicine serves the ethical principle of beneficence, in that ..... review of the uses, benefits, and limitations of social media for health communication.

THE 'TWIN-CME' SCENARIO AND LARGE SOLAR ENERGETIC PARTICLE EVENTS IN SOLAR CYCLE 23

Energy Technology Data Exchange (ETDEWEB)

Ding, Liuguan; Jiang, Yong [College of Math and Physics, Nanjing University of Information Science and Technology, Nanjing, Jiangsu 210044 (China); Zhao, Lulu; Li, Gang, E-mail: gang.li@uah.edu [Department of Physics and CSPAR, University of Alabama in Huntsville, AL 35899 (United States)

2013-01-20

Energetic particles in large solar energetic particle (SEP) events are a major concern for space weather. Recently, Li et al. proposed a 'twin-CME' scenario for ground-level events. Here we extend that study to large SEP events in solar cycle 23. Depending on whether preceding coronal mass ejections (CMEs) within 9 hr exist and whether ions >10 MeV nucleon{sup -1} exceed 10 pfu, we categorize fast CMEs with speed >900 km s{sup -1} and width >60 Degree-Sign from the western hemisphere source regions into four groups: groups I and II are 'twin' and single CMEs that lead to large SEPs; groups III and IV are 'twin' and single CMEs that do not lead to large SEPs. The major findings of this paper are: first, large SEP events tend to be 'twin-CME' events. Of 59 western large SEP events in solar cycle 23, 43 are 'twin-CME' (group I) events and 16 are single-CME (group II) events. Second, not all 'twin CMEs' produced large SEPs: 28 twin CMEs did not produce large SEPs (group III events). Some of them produced excesses of particles up to a few MeV nucleon{sup -1}. Third, there were 39 single fast CMEs that did not produce SEPs (group IV events). Some of these also showed an excess of particles up to a few MeV nucleon{sup -1}. For all four groups of events, we perform statistical analyses on properties such as the angular width, the speed, the existence of accompanying metric type II radio bursts, and the associated flare class for the main CMEs and the preceding CMEs.

The role of telemedicine and mobile health in the monitoring of sleep-breathing disorders: improving patient outcomes

Directory of Open Access Journals (Sweden)

Villanueva JA

2017-02-01

Full Text Available Jair A Villanueva,1,* Monique C Suarez,2,* Onintza Garmendia,2,3 Vera Lugo,2 Concepción Ruiz,2 Josep M Montserrat,2–5 1Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, 2Sleep Unit, Respiratory Medicine Department, Hospital Clinic, Barcelona, 3Center for Biomedical Research in Respiratory Diseases (CIBERES, Madrid, 4Faculty of Medicine, University of Barcelona, 5August Pi i Sunyer Biomedical Research Institute (IDIBAPS, Barcelona, Spain *These authors contributed equally to this work Abstract: Although the concepts are broad, telemedicine and mobile health (mHealth can be defined as a methodology to provide health care remotely and improve health services and outcomes using telecommunication tools. The widespread adoption of these technologies and current health care challenges, such as the aging population and increasing costs, has encouraged interest in the development of new strategies involving telemedicine. Overall, there is a lack of evidence rigorously assessing the impact of telemedicine and mHealth. Therefore, proper randomized controlled trials, with cost-effectiveness and impact on quality-of-life analysis, are urgently needed. They should also focus on specific populations and their comorbidities, since customizing telemedicine approaches is paramount to ensure success. Obstructive sleep apnea is a highly prevalent chronic condition and the most common of sleep-breathing disorders, and telemedicine and mHealth could play a pivotal role in the different phases of its management. In the future, using new devices capable of signal acquisition and analysis will refine obstructive sleep apnea diagnosis; even smartphones’ built-in sensors could offer improved comfort and the possibility of home sleep monitoring. Continuous positive airway pressure titration could be performed with wireless devices, whose parameters can be changed remotely from sleep centers. Finally, the follow-up phase could be

Engaging Elderly People in Telemedicine Through Gamification.

Science.gov (United States)

de Vette, Frederiek; Tabak, Monique; Dekker-van Weering, Marit; Vollenbroek-Hutten, Miriam

2015-12-18

Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great connectivity between these taxonomies

Change of patients' perceptions of telemedicine after brief use

NARCIS (Netherlands)

Cranen, Karlijn; Cranen, Karlijn; Huis in 't Veld, M.H.A.; IJzerman, Maarten Joost; Vollenbroek-Hutten, Miriam Marie Rosé

Objective: This study aims to investigate whether patients' perceptions regarding a Web-based telemedicine service, for instruction and monitoring of an exercise program, change after brief use. Materials and Methods: Thirty patients were allocated, matched on gender and age, to a control group (10)

Practical Considerations for Optic Nerve Estimation in Telemedicine

Energy Technology Data Exchange (ETDEWEB)

Karnowski, Thomas Paul [ORNL; Aykac, Deniz [ORNL; Chaum, Edward [ORNL; Giancardo, Luca [ORNL; Li, Yaquin [University of Tennessee, Knoxville (UTK); Tobin Jr, Kenneth William [ORNL

2009-01-01

The projected increase in diabetes in the United States and worldwide has created a need for broad-based, inexpensive screening for diabetic retinopathy (DR), an eye disease which can lead to vision impairment. A telemedicine network with retina cameras and automated quality control, physiological feature location, and lesion / anomaly detection is a low-cost way of achieving broad-based screening. In this work we report on the effect of quality estimation on an optic nerve (ON) detection method with a confidence metric. We report on an improvement of the fusion technique using a data set from an ophthalmologists practice then show the results of the method as a function of image quality on a set of images from an on-line telemedicine network collected in Spring 2009 and another broad-based screening program. We show that the fusion method, combined with quality estimation processing, can improve detection performance and also provide a method for utilizing a physician-in-the-loop for images that may exceed the capabilities of automated processing.

High-Intensity Telemedicine Decreases Emergency Department Use by Senior Living Community Residents.

Science.gov (United States)

Shah, Manish N; Wasserman, Erin B; Wang, Hongyue; Gillespie, Suzanne M; Noyes, Katia; Wood, Nancy E; Nelson, Dallas; Dozier, Ann; McConnochie, Kenneth M

2016-03-01

The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents. We performed a prospective cohort study over 3.5 years. Six SLCs cared for by a primary care geriatrics practice were intervention facilities, with the remaining 16 being controls. Consenting patients at intervention facilities could access telemedicine for acute illness care. Patients were provided patient-to-provider, real-time, or store-and-forward high-intensity telemedicine (i.e., technician-assisted with resources beyond simple videoconferencing) to diagnose and treat acute illnesses. The primary outcome was the rate of ED use. We enrolled 494 of 705 (70.1%) subjects/proxies in the intervention group; 1,058 subjects served as controls. Control and intervention subjects visited the ED 2,238 and 725 times, respectively, with 47.3% of control and 43.4% of intervention group visits resulting in discharge home. Among intervention subjects, ED use decreased at an annualized rate of 18% (rate ratio [RR]=0.82; 95% confidence interval [CI], 0.70-0.95), whereas in the control group there was no statistically significant change in ED use (RR=1.01; 95% CI, 0.95-1.07; p=0.009 for group-by-time interaction). Primary care use and mortality were not significantly different. High-intensity telemedicine significantly reduced ED use among SLC residents without increasing other utilization or mortality. This alternative to traditional acute illness care can enhance access to acute illness care and should be integrated into population health programs.

Telemedicine: The Practice of Medicine at a Distance. Resources in Technology.

Science.gov (United States)

Reed, Philip A.

2003-01-01

Reviews developments in telemedicine and a number of related areas (telecommunications, virtual presence, informatics, artificial intelligence, robotics, materials science, and perceptual psychology). Provides learning activities for technology education. (SK)

WhatsApp: a telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations.

Science.gov (United States)

Petruzzi, Massimo; De Benedittis, Michele

2016-03-01

Increased use of smartphone and related software applications has created a new era in clinical data exchange among patients and clinicians. This study describes use of the smartphone-based application WhatsApp to share clinical oral medicine information. Clinical images and related questions were submitted by general dentists, physicians, dental hygienists, and patients to the authors via WhatsApp. For each submission, a clinical impression was made and categorized as traumatic, infective, neoplastic, autoimmune, or unclassified. Submissions were summarized by sender type, number of photographs per sender, and category of question. Patients were invited to undergo a clinical examination with biopsy, when indicated. The telemedicine impression was compared to the clinicopathologic diagnosis. Three hundred and thirty-nine images were received for 96 patients; 92 (95.8%) patients underwent clinicopathologic examination, and 45 (49%) received a biopsy. General dentists (62%) and dental hygienists (26%) were the most frequent senders. The most common question was related to diagnosis (56%). The telemedicine impression agreed with the clinicopathologic assessment for 82% of cases. Telemedicine applications, such as WhatsApp, can support communication about oral conditions among clinicians and patients. Telemedicine consultation reduced geographic barriers to initial clinical consultation and encouraged the significant majority of patients to pursue expert clinical examination. Copyright © 2016 Elsevier Inc. All rights reserved.

Telemedicine: licensing and other legal issues.

Science.gov (United States)

Siegal, Gil

2011-12-01

The growth of information technology and telecommunications has created promising opportunities for better, faster, more accessible, barrier-free health care; telemedicine (TM). The feasibility of many TM projects depends on resolving legal issues. Mastering technical issues or providing training remain important benchmarks for implementation of TM, but legal issues constrain progress. This article identifies the key legal issues, maps current legislation, and offers a forecast of necessary steps to expedite the dissemination of TM. Copyright © 2011 Elsevier Inc. All rights reserved.

Identifying the readiness of patients in implementing telemedicine in northern Louisiana for an oncology practice.

Science.gov (United States)

Gurupur, Varadraj; Shettian, Kruparaj; Xu, Peixin; Hines, Scott; Desselles, Mitzi; Dhawan, Manish; Wan, Thomas Th; Raffenaud, Amanda; Anderson, Lindsey

2017-09-01

This study identified the readiness factors that may create challenges in the use of telemedicine among patients in northern Louisiana with cancer. To identify these readiness factors, the team of investigators developed 19 survey questions that were provided to the patients or to their caregivers. The team collected responses from 147 respondents from rural and urban residential backgrounds. These responses were used to identify the individuals' readiness for utilising telemedicine through factor analysis, Cronbach's alpha reliability test, analysis of variance and ordinary least squares regression. The analysis results indicated that the favourable factor (positive readiness item) had a mean value of 3.47, whereas the unfavourable factor (negative readiness item) had a mean value of 2.76. Cronbach's alpha reliability test provided an alpha value of 0.79. Overall, our study indicated a positive attitude towards the use of telemedicine in northern Louisiana.

Telemedicine and biomedical care in Africa: Prospects and challenges

African Journals Online (AJOL)

2016-01-28

Jan 28, 2016 ... medical education in the absence or limited healthcare ... to medical services is inadequate, holds promise in expanding ... Prospects and challenges of telemedicine in Africa. 2 ... experts' opinions and sharing of knowledge between doctors. .... patients now depend on their pastors or spiritual leaders in.

The added value of telemedicine services for physical rehabilitation

NARCIS (Netherlands)

Kosterink, Stephanie

2014-01-01

Despite the huge potential of telemedicine services (increasing accessibility of care, increasing quality of care and lowering of healthcare costs), its implementation in daily clinical practice is very limited and most services fade away after a project or pilot phase. The aim of this thesis has

Beyond "Initiate-Build-Operate-Transfer" strategy for creating sustainable telemedicine programs: lesson from the first decade.

Science.gov (United States)

Latifi, Rifat; Dasho, Erion; Lecaj, Ismet; Latifi, Kalterina; Bekteshi, Flamur; Hadeed, Molly; Doarn, Charles R; Merrell, Ronald C

2012-06-01

December 10, 2012 will mark the 10th anniversary of the implementation of telemedicine in the Balkans. This first decade of development and function is due to the passion, creativity, experience, and implementation know-how of the award-winning concept of the International Virtual e-Hospital (IVeH) Foundation. The objective of this article is to analyze the results of the IVeH's core strategy, "Initiate-Build-Operate-Transfer" (IBOT), which has been instrumental in establishing telemedicine in the Balkans and has been adopted by many other countries worldwide, and to describe the lessons learned that go beyond IBOT. A retrospective review of the results of IVeH engagement in establishing telemedicine in developing countries was conducted. Using IBOT, the IVeH has successfully established two national programs: one in Kosova and one in Albania. Together, they have connected 16 hospitals. Currently IVeH is in the process of creating such programs in many countries around the world. During the analysis of the first decade, we have identified eight factors that should be considered when establishing telemedicine programs. IBOT has been successful, but further studies are needed to demonstrate its effectiveness in countries beyond the Balkans.

Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes.

Science.gov (United States)

Mathieson, Kathleen; Leafman, Joan S; Horton, Mark B

2017-01-01

Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). Survey data were collected from AI patients with DM during teleophthalmology exams. Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.

An Investigation About Attitude of Clinical Physicians in the Implementation of Telemedicine Technology in TUMS Hospitals 2003-2004

Directory of Open Access Journals (Sweden)

H Dargahi

2005-05-01

Full Text Available Background: This research have presented focuses upon the cultural side of managerial coordination and control as manifested in Telemedicine Technology. Specifically, the research seeks to analyze and determines the attitude of clinical physicians about the role of specific dimensions of organizational culture and organizational structure may have upon effective managerial coordination and control in Telemedicine Technology in TUMS hospitals. Materials and methods: We assessed the attitude of 82 clinical physicians in five randomly selected TUMS teaching hospitals in a mixed method of pooling Quantitative and Qualitative data using unstructured interview technique. Results: For successful telemedicine utilization, most of clinical physicians believed that we need organic organizations that have involved leadership, open and free communication of mistakes and success, desire to experiment with new ideas, support for continuing education, support for new things, clear rules to follow and acknowledge performance goals. Conclusion: The data indicate that organizational is most important to utilize successfur telemedicine technology.

Comparative study on system requirements and success factors of telemedicine solutions in resource-poor settings

OpenAIRE

Dawson, Joanna Adobea

2011-01-01

Rationale: Attempts to successfully develop telemedicine solutions by specifying the require-ments and critical success factors of these solutions are on-going in sub-Saharan Africa (SSA) countries as a means of improving access to high-quality healthcare. European Space Agency (ESA) (Dario et al. 2005) have explored the challenges and benefits of telemedicine solutions in these regions in the domains of eGovernment such as billing and administrative data management to support the healthcare ...

UH-USA Agreement - A Telemedicine Research Proposal

Science.gov (United States)

2004-11-01

institutions in Hawaii and include specialists such as pharmacists to them. Initially, interest was limited in utilizing the technology and nutritionists, as...the physician infections ( UTI ). for inclusion in the telemedicine program. Before Treating patients at home is one alternative that can considering...infection.’ 5 Patients with UTI are excluded if they have uncomplicated pyelonephritis or if they have an obstructed ureter or sepsis syndrome. Patients with

Blended learning in CME: the perception of GP trainers.

Science.gov (United States)

Te Pas, E; Meinema, J G; Visser, M R M; van Dijk, N

2016-05-01

Blended learning (the combination of electronic methods with traditional teaching methods) has the potential to combine the best of traditional education with the best of computer-mediated training. We chose to develop such an intervention for GP trainers who were undertaking a Continuing Medical Education (CME) course in evidence-based medicine (EBM). This study reports on our experience and investigated the factors influencing the perception on usefulness and logistics of blended learning for learners in CME. In total, 170 GP trainers participated in the intervention. We used questionnaires, observations during the four face-to-face meetings and evaluations in the e-course over one year. Additionally we organised focus groups to gain insight in some of the outcomes of the questionnaires and interpretations of the observations. The GP trainers found the design and the educational method (e-course in combination with meetings) attractive, instructive and complementary. Factors influencing their learning were (1) educational design, (2) educational method, (3) topic of the intervention, (4) time (planning), (5) time (intervention), (6) learning style, (7) technical issues, (8) preconditions and (9) level of difficulty. A close link between daily practice and the educational intervention was considered an important precondition for the success of the intervention in this group of learners. GP trainers were positive about blended learning: they found e-learning a useful way to gain knowledge and the meetings a pleasant way of transferring the knowledge into practice. Although some preconditions should be taken into consideration during its development and implementation, they would participate in similarly designed learning in the future.

Access to Specialized Care Through Telemedicine in Limited-Resource Country: Initial 1,065 Teleconsultations in Albania.

Science.gov (United States)

Latifi, Rifat; Gunn, Jayleen K L; Bakiu, Evis; Boci, Arian; Dasho, Erion; Olldashi, Fatos; Pipero, Pellumb; Stroster, John A; Qesteri, Orland; Kucani, Julian; Sulo, Ardi; Oshafi, Manjola; Osmani, Kalterina L; Dogjani, Agron; Doarn, Charles R; Shatri, Zhaneta; Kociraj, Agim; Merrell, Ronald C

2016-12-01

To analyze the initial experience of the nationwide clinical telemedicine program of Albania, as a model of implementation of telemedicine using "Initiate-Build-Operate-Transfer" strategy. This was a retrospective study of prospectively collected data from teleconsultations in Albania between January 1, 2014 and August 26, 2015, delivered synchronously, asynchronously, or a combination of both methods. Patient's demographics, mode of consultation, clinical specialty, hospitals providing referral and consultation, time from initial call to completion of consultation, and patient disposition following teleconsultation were analyzed. Challenges of the newly created program have been identified and analyzed as well. There were 1,065 teleconsultations performed altogether during the study period. Ninety-one patients with autism managed via telemedicine were not included in this analysis and will be reported separately. Of 974 teleconsults, the majority were for radiology, neurotrauma, and stroke (55%, 16%, and 10% respectively). Asynchronous technology accounted for nearly two-thirds of all teleconsultations (63.7%), followed by combined (24.3%), and then synchronous (12.0%). Of 974 cases, only 20.0% of patients in 2014 and 22.72% of patients in 2015 were transferred to a tertiary hospital. A majority (98.5%) of all teleconsultations were conducted within the country itself. The Integrated Telemedicine and e-Health program of Albania has become a useful tool to improve access to high-quality healthcare, particularly in high demanding specialty disciplines. A number of challenges were identified and these should serve as lessons for other countries in their quest to establish nationwide telemedicine programs.

Parent Participation in Pediatric Intensive Care Unit Rounds via Telemedicine: Feasibility and Impact.

Science.gov (United States)

Yager, Phoebe H; Clark, Maureen; Cummings, Brian M; Noviski, Natan

2017-06-01

To evaluate feasibility and impact of telemedicine for remote parent participation in pediatric intensive care unit (PICU) rounds when parents are unable to be present at their child's bedside. Parents of patients admitted to a 14-bed PICU were approached, and those unable to attend rounds were eligible subjects. Nurse and physician caregivers were also surveyed. Parents received an iPad (Apple Inc, Cupertino, California) with an application enabling audio-video connectivity with the care team. At a predetermined time for bedside rounds with the PICU team, parents entered a virtual meeting room to participate. Following each telemedicine encounter, participants (parent, physician, nurse) completed a brief survey rating satisfaction (0?=?not satisfied, 10?=?completely satisfied) and disruption (0?=?no disruption at all, 10?=?very disruptive). A total of 153 surveys were completed following 51 telemedicine encounters involving 13 patients. Parents of enrolled patients cited work demands (62%), care for other dependents (46%), and transportation difficulties (31%) as reasons for study participation. The median levels of satisfaction and disruption were 10 (range 5-10) and 0 (range 0-5), respectively. All parents reported that telemedicine encounters had a positive effect on their level of reassurance regarding their child's care and improved communication with the care team. This proof-of-concept study indicates that remote parent participation in PICU rounds is feasible, enhances parent-provider communication, and offers parents reassurance. Providers reported a high level of satisfaction with minimal disruption. Technological advancements to streamline teleconferencing workflow are needed to ensure program sustainability. Copyright © 2017. Published by Elsevier Inc.

[The Use of Telemedicine Interventions to Improve Hypertension Management Among Racial Ethnic Minorities: A Systematic Review].

Science.gov (United States)

Li, Wen-Wen; Lai, Wei-Shu

2016-08-01

Racial ethnic minorities are one of the fastest growing populations in Taiwan. In recent years, there has been an increase in literature addressing the efficacy of home blood-pressure (BP) management that uses telemedicine interventions in general healthcare and community settings. However, no study or systematic literature review has yet assessed the effectiveness of using telemedicine HTN interventions in Taiwan's indigenous, new-immigrant, and other minority populations. The purpose of the present paper is to review the current literature on the use of telemedicine interventions to assist HTN management among racial ethnic minorities. A comprehensive literature search was conducted for full-text articles that were published between January 2000 and December 2015 using the following databases: PubMed, WEB of Science, CINAHL (Cumulative Index to Nursing & Allied Health Literature), PsycINFO, Science Direct, ProQuest, Medline, Cochrane Library, National Dissertations and Theses, and airiti Library. The search used the following key search terms both alone and in combination: hypertension, blood pressure, management, telemedicine, telehealth, ehealth, and digital health. The studies were thoroughly assessed under the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 6 articles met the criteria for using keywords related to racial ethnic minority populations and were used in the present review. Findings of this systematic review show that telemedicine interventions significantly improve HTN management. The intervention that combined home telemonitoring with culturally competent nurse counseling calls was identified as the best intervention for reducing BP. As the current literature on this topic is limited to African-Americans, more research is necessary to validate our findings. Future studies should target racial ethnic minorities in Taiwan in order to better understand how to provide culturally appropriate

Early phase telemedicine requirements elicitation in collaboration with medical practitioners

NARCIS (Netherlands)

Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.; Napolitano, Carlo

2013-01-01

Ubiquity of Information and Communication Technology enables innovative telemedicine treatment applications for disease management of ambulant patients. Development of new treatment applications must comply with medical protocols and ‘way of working’ to obtain safety and efficacy evidence before

The "Canadian" in Canadian Children's Literature.