摘要:

BackgroundRoutine surgical pathology review by telepathology could be an important service component of multi-institutional pathology laboratory systems. Such service networks would increase access for rural hospitals without on-site pathologists to a broader range of pathology services on a daily basis.MethodsIn this clinical trial, we analyzed the diagnostic accuracy, deferral rates, and viewing times of two generalist pathologists using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system to render diagnoses in real time on 200 consecutive surgical cases. The objective was to assess the efficacy of TP in providing diagnostic surgical pathology services to a remote hospital without an onsite pathologist. Surgical pathology specimens underwent gross preparation by specially trained personnel. When appropriate, this was done under the video supervision of a telepathologist. For TP, glass slides were placed on the stage of a robotic microscope at the Iron Mountain (MI) Department of Veterans Affairs Medical Center (VAMC) (remote site); control of the motorized microscope was then transferred to a pathologist located 220 miles away at the Milwaukee VAMC (host site). For each case, the telepathologist had the option of rendering a diagnosis or deferring the case for later analysis by conventional light microscopy (LM). After the slides were read by TP and a surgical pathology report had been generated, the slides were transported to Milwaukee, where they were reexamined by the telepathologist using LM and then by the pathology group practice or, when there was no consensus, by an outside consultant to establish a "truth" diagnosis.ResultsCompared with the consensus ("truth") diagnosis, clinically important and overall concordance were 99.0% and 97.4%, respectively, by TP, and clinically important and overall concordance were 100.0% and 98.5%, respectively, by LM. The deferral rate was 2.5%. Examining glass slides by HDSF telepathology took an average of 4.43 minutes per slide and 12.09 minutes per case.ConclusionThe high diagnostic accuracy and low rate of case deferral support the proposal that an offsite pathologist using HDSF telepathology can substitute effectively for an onsite pathologist as a service provider.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.1

年代:1997

数据来源: MAL

摘要:

ObjectiveTo implement a cost/benefit analysis of telemedicine subspecialty care provided between the Powhatan Correctional Center (PCC) of the Virginia Department of Corrections (Corrections) and the Medical College of Virginia campus of Virginia Commonwealth University (MCV/VCU).MethodsWe evaluated the costs and benefits of the implementation of telemedicine for HIV-positive inmates. Benefits included dollar savings in transportation and medical reimbursement. Costs included those of operating the telemedicine system and of medical care. Non-dollar benefits included implementing more consistent and timely treatment of inmates and reducing security risk.ResultsOver the 7-month study period, the total number of HIV consults by telemedicine was 165. The Department of Corrections was able to achieve transportation and medical savings of $35,640 and $21,123, respectively. The operating costs for the telemedicine services totaled $42,277. The net benefit, which is the difference between cost savings and total operating costs, was $14,486.ConclusionTelemedicine increased access to care for HIV-positive inmates and generated cost savings in transportation and care delivery.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.11

年代:1997

数据来源: MAL

摘要:

The Imaging Science and Information Systems (ISIS) Center of the Department of Radiology at Georgetown University Medical Center (GUMC) has been developing technical requirements for different telemedicine applications. This paper details the process through which those technical requirements are determined and shows how they may differ substantially, depending on the clinical need. This information is presented in light of two telemedicine applications being undertaken at GUMC: a urology application for the management of patients with surgical stone disease and a nephrology application for monitoring of renal dialysis patients.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.19

年代:1997

数据来源: MAL

摘要:

ObjectiveTo determine the concordance of dermatopathology diagnosis by still-image telemedicine technology and direct microscopy.Materials and MethodsSkin specimens (N = 79) were examined by a dermatopathologist using a still-image phone system, and the diagnoses were compared with those made by the same dermatopathologist 1 year earlier by direct microscopy. The telemedical diagnoses were reached first without, and then with, patient histories.ResultsWhen the patient history was available, identical diagnoses were made in 66 of the 79 cases (84% concordance rate). Without patient history, the concordance rate was 80%. The diagnostic concordance rate for the diagnosis of benign nevocytic nevi, inflammatory diseases, and benign and malignant non-squamous cell carcinoma neoplasms was statistically significantly greater than the concordance rate for the diagnosis of squamous cell carcinoma and squamous cell carcinomain situ(P = 0.005).ConclusionsThe diagnostic concordance rate achieved by teledermatopathology using a still-image phone system fell short of the 99% intraobserver diagnostic concordance rate using direct microscopy.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.27

年代:1997

数据来源: MAL

摘要:

A multimedia telemedicine network is proposed for a VISN-19 test bed and it will include picture archiving and communication systems (PACS). Initial tests have been performed, and the technical feasibility of the basic plan has been demonstrated.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.33

年代:1997

数据来源: MAL

摘要:

Relatively little information exists concerning the delivery of ophthalmic services via telemedicine, yet ophthalmology is particularly amenable to the utilization of such applications. This paper discusses the technological issues pertinent to the research, development, and assessment of teleophthalmology delivery systems and begins to define the parameters that will determine the sustainability of teleophthalmology. A prototype urban teleophthalmology delivery system is presented in the context of improving access to eye care for an underserved inner-city population. Potential enhancements to the prototype teleophthalmology system are discussed.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.43

年代:1997

数据来源: MAL

摘要:

Complaints of vertigo and imbalance are common presentations to primary care physicians, yet there are few specialists who diagnose and treat these problems as a significant part of their practices. We demonstrated the feasibility of remote consultation for a patient presenting with vertigo using a two-way digital video and audio network. It was possible to take an appropriate history, examine the patient, and provide a diagnosis and treatment. The patient had a common problem that causes dizziness: benign positional vertigo (BPV). An essential component of the examination was the use of a head-mounted display with embedded cameras. The cameras allowed viewing of the patient's eye movements, which were diagnostic.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.53

年代:1997

数据来源: MAL

摘要:

ObjectiveTo assess the level of consensus among the administrative and health care leaders at rural Iowa hospitals regarding service gaps and priorities for developing telemedicine services.MethodsIn the summer of 1994, a survey was conducted of all rural hospital chief executive officers, chiefs of medical staffs, and directors of nursing in Iowa concerning their perceptions of telemedicine services.ResultsWith the exception of teleradiology, few clinical specialties received high ratings as areas of need or priorities for the development of telemedicine. There was a general lack of agreement among respondents from the same hospital on such priorities. In contrast, respondents expressed higher priorities for the development of telemedicine-based educational services.ConclusionsThe interest in teleradiology is consistent with the fact that teleradiology has been more thoroughly tested for medical efficacy than other telemedicine applications. Continuing medical education may represent another potential for widespread successful telemedicine application. Financial issues were reported as the greatest barriers to the development of telemedicine systems.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.59

年代:1997

数据来源: MAL

摘要:

ObjectiveTo determine the feasibility of home monitoring of patients with cardiac disease or hypertension.MethodsAn improved home electrocardiographic and blood pressure telemonitoring system linked to a central workstation was tested in 10 patients in Macau for 3 months.ResultsThe total number of connections was 1377. Of the automatic alarm connections, 32.5% were false positive, with the percentage of false positives ranging from 7.6 to 54.6 for different patients. Both patients and physicians found the system easy to use.ConclusionsFurther investigation is required to match the number of patients with the system capacity. A more robust dysrhythmia detection algorithm is needed to reduce the number of false alarms. Nevertheless, the results were sufficiently good that the trial is being expanded.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.67

年代:1997

数据来源: MAL

ISSN:1078-3024    

DOI:10.1089/tmj.1.1997.3.73

年代:1997

数据来源: MAL