ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.1

年代:1998

数据来源: MAL

摘要:

ObjectivesTo determine the reliability of videoconferencing technology in evaluating skin tumors, the impact of the technology on the clinicians' degree of suspicion that a skin tumor is malignant, and the recommendation to do a biopsy.Materials and MethodsFour skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine. A dermatologist saw the patients in person at the local facility, and the same patient was seen by a dermatologist via a T-1 connection to Greenville, North Carolina.ResultsThe two physicians were in absolute agreement on 59% of the 107 skin tumors evaluated. There were five lesions identified by the on-site dermatologist as a probable or definite malignancy. The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different, as shown by kappa analysis.ConclusionThe concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.5

年代:1998

数据来源: MAL

摘要:

BackgroundRural hospitals generally lack staffing with infectious disease specialists or pathologists. Without on-site pathologists, the range of microbiology services offered by clinical laboratories may be limited as well.ObjectiveTo study the feasibility of using static-image telepathology to evaluate Gram stains of microbiologic preparations.Materials and MethodsIn this retrospective feasibility study, three pathologists evaluated Gram stains of slides from 50 cases by two viewing modalities: static-image telepathology and conventional light microscopy. Digital video images of slides were captured at two magnifications (using 40× and 100× objective lenses) at 1024× 768× 24-bit color and transmitted over standard telephone lines at 14,400 kbps. Pathology reports and culture results served as "truth diagnoses." Categories of interpretations were correct, minor discrepancy, or major discrepancy with regard to the implications for patient care.ResultsThe diagnostic accuracy of video image readings and conventional light microscopy readings were nearly identical, with no statistically significant differences in the performances of specialty and nonspecialty pathologists (P>0.05). The mean accuracies of readings of the video images and light microscopy images were 95.3% and 95.4%, respectively. Taking into account the time required by a referring pathologist to capture video digital images, telemicrobiology was somewhat less efficient than conventional light microscopy.ConclusionsPathologists can accurately evaluate digital video images of preselected fields on Gram-stained slides. In clinical practice, however, a limiting factor may be the availability of local personnel qualified to select the microscopic fields for evaluation by telepathologists. The adequacy of the video images suggests that telepathology may also be used for remote supervision of quality assurance programs in microbiology laboratories, as well as for remote proficiency training of laboratory person

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.11

年代:1998

数据来源: MAL

摘要:

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the dawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.19

年代:1998

数据来源: MAL

摘要:

Economic evaluation of telemedicine compares the costs and other consequences of delivering specific services through telemedicine vs. alternative means. Cost-effectiveness analysis, the most common method used for health issues, helps to assess whether the expected health benefits are worth the investment. Telemedicine raises particular challenges for evaluators: a telemedicine system may have multiple uses and joint costs that are difficult to apportion to one service, the existence of a system may lead to expanded indications for use, and technological change may rapidly make an evaluation outdated. Public and private regulation and payment may affect the diffusion of telemedicine. Uncertainty surrounds the policy.of the U.S. Food and Drug Administration, which is still formulating its position. Changes are underway in policies on licensure and credentialing of clinicians, which have traditionally been done by state and by site, to reflect the fact that telemedicine services may cross these regional boundaries. Lack of insurance coverage for telemedicine services has been considered an impediment to adoption with fee-for-service payment. Under capitation payment and fixed budgets, however, providers have financial incentives to use the most efficient method to deliver services, and these arrangements would favor telemedicine if it is the less costly alternative. If telemedicine were most costly and the health benefits worth the cost, monitoring might be needed to ensure the quality of care.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.31

年代:1998

数据来源: MAL

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.39

年代:1998

数据来源: MAL

摘要:

Objective: The Kyushu area of southwestern Japan has several mountains and 157 inhabited islands. We assessed the feasibility of implementing a desktop conference (DTC) system to improve medical care in this area.Telecommunications Technology and Equipment: The Phoenix DTC system (NTT Corporation, Tokyo, Japan) for personal computers includes a microphone, speaker, color CCD camera, and appropriate software. We used a digital camera for still pictures and image-analysis software for radiographs and CT and MRI films. The system was installed on a Pentium 133 MHz computer, which was connected by ISDN line at a 128 kbps data rate to a clinic on a small island where one physician cares for 1000 residents, two small nursing offices where each nurse tends 100 residents, two nursing homes, a hospital in a mountainous area, and the residence of a patient with atopic dermatitis. Connections were made once a week for a period of 6 months.Results: The transmitted still pictures; e.g., senile nevus, atopic dermatitis, chickenpox, and a radiograph of a suspected fracture, were useful for diagnosis and clinical decision making. We received and responded to inquiries from residents of the participating nursing homes on nutrition, senile depression, nevus, decubitus ulcers, urinary tract infection, and protection againstLegionellainfection. We also used the system to deliver lectures on pediatrics to nurses; provided case discussions on diaphragmatic herniation and subtentorial tumor; and had on-line presentation of a patient with beta-thalassemia using presentation software.Conclusion: The DTC system used in the present study seemed technically satisfactory and useful in improving medical care in remote sites of Japan.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.43

年代:1998

数据来源: MAL

摘要:

The Ohio Department of Rehabilitation and Corrections (ODRC) implemented a telemedicine pilot project in March of 1995. The project brought together the Southern Ohio Correctional facility in Lucasville, the Corrections Medical Center in Columbus, and The Ohio State University Medical Center, also located in Columbus. Its purpose was to evaluate the use of two-way interactive video for the delivery of health -services. With two-way interactive video, physicians in one location established audio and video links with inmates hundreds of miles away. Data were collected on the potential savings as a result of telemedicine usage in the Ohio prison system. Costs associated with telemedicine and those incurred without telemedicine were determined on per-consult basis for comparison. The cost for a medical consult to be performed at the Corrections Medical Center averaged $263.51 per inmate. The cost for a medical consult via telemedicine varied from month to month, depending on the utilization volume. The ODRC experienced savings for telemedicine usage when 129 or more consults were performed each quarter. During the third quarter, 145 telemedicine consults were performed. The cost per consult for telemedicine usage during this quarter was $255.19. There was a savings of $8.48 per consult, resulting in a quarterly savings of $1206. As the utilization of telemedicine continued to increase in the fourth quarter, the amount of savings increased.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.49

年代:1998

数据来源: MAL

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.55

年代:1998

数据来源: MAL

ISSN:1078-3024    

DOI:10.1089/tmj.1.1998.4.57

年代:1998

数据来源: MAL