A feasibility study of an Internet-based telemedicine system for consultation in an ophthalmic emergency room

We examined the feasibility of a low-bandwidth, Internet-based tele-ophthalmology system for consultation in an ophthalmic emergency room. Forty-nine patients (98 eyes) with complicated cases were seen during night shifts in the ophthalmic emergency room. Ocular images were taken using a slit-lamp connected to a video camera, processed and transmitted to a senior physician by email. A telephone was used for real-time audio communication. Each case was re-examined by the same senior physician the following day. The time needed to capture and to process the images was 5 min (SD 2). Each case was given a feasibility score (0-100%), which was defined as the contribution made by the transmitted images in presenting clinical details which could not have been described verbally. High feasibility scores (mean scores ranging from 85 to 90) were found for the following images: ocular surface, anterior chamber, anterior chamber angle, pupils, lens, optic nerve and macula. In contrast, images of vitreous and peripheral retina received low feasibility scores (mean score 65). There was 100% agreement between the diagnosis made during consultation and the on-site examination made by the senior ophthalmologist later on. Ninety-eight percent of the patients stated that they would prefer being examined under the telemedicine system on their next emergency room visit, rather than the traditional resident on-site examination.     

Infectious urgencies in an emergency medical service

The aim of this study is to evaluate the frequency of infectious urgencies and the quality of their management in an emergency medical service. During the period of study, 21737 consultants are recorded, from which 2011 for an infectious urgency (9,25%), pharyngitis with rhinitis excluded. 692 patients are hospitalized and 1074 receive ambulatory antibiotics. Therapeutic urgencies are the most frequent infectious urgencies (48,4%), followed by protection urgencies (46,3%), urgencies due to antibiotics (5,2%) and prevention urgencies (0,1%). The conduct is considered correct for 1379 cases (68,5%) and incorrect for 500 cases (25%). Main incorrect conducts are the absence of follow-up (81,6%) and the maladjusted antibiotherapy (11,8%). These results incite, mainly, to the improvement of the professional training of emergency physicians and their communication with their colleagues of the other sanitary structures.     

Performance of a wireless telemedicine system in a hospital accident and emergency department

We developed a mobile, wireless videoconferencing system suitable for use in a hospital accident and emergency (A&E) department. Four consultants, eight junior doctors and 11 nurses working in the A&E department tested the system. Transmission of three types of data (audio, still images and video) was tested. The audio for the breath and heart sounds was judged to have some disturbance. One consultant rated the diagnostic quality as good and one rated it as fair. The quality of the still images was judged to be from fair to excellent. The quality of the video was rated as good. Possible interference between the wireless local-area network and various medical devices in the A&E department were examined, but none was detected. The four consultants who tested the system were very positive in their initial comments. Eight of the 11 nurses remained sceptical about its use. Of a total of 20 patients who answered a survey, 13 were slightly anxious about the use of the system to transmit their data to a distant point. Overall, the performance of the system was satisfactory for use in the A&E role.     

Explaining the adoption of telemedicine services: an analysis of a paediatric telemedicine service

Since 1998, over 1300 telemedicine consultations have been provided to 12 schools in Kansas City. Despite the success of the programme, effective utilization of services has not occurred at all sites. We used a focus group and survey methods to investigate barriers to and catalysts for service adoption. The results showed that the school nurses strongly supported the programme. They valued its ability to provide health-care for the children and they welcomed their enhanced role. However, technical complexities and difficulties in obtaining parental consent were found to impede adoption. The nurses also expressed frustration with school personnel who had a poor understanding of their role in general as well as that of the telemedicine service. A new state reimbursement policy may promote greater understanding and provide a financial incentive for schools to adopt the telemedicine service.     

Preliminary evaluation of the use of a CDMA-based emergency telemedicine system

We have conducted a preliminary evaluation of the use of a code division multiple access (CDMA)-based emergency telemedicine system to be used by emergency rescuers providing first-aid treatment for patients. The prototype system included five instrumentation modules for measuring non-invasive arterial blood pressure (NIBP), arterial oxygen saturation (SpO(2)), six-channel electrocardiogram (ECG), blood glucose concentration and body temperature. The patient data were transferred to a doctor's PC through CDMA and TCP/IP networks using an embedded personal digital assistant (PDA) phone. Performance tests in the laboratory showed that the system provided reliable values with error ranges within +/-1% for heart rate, +/-5 mmHg for NIBP, +/-2% for SpO(2) and +/-1% for glucose. The feasibility of the prototype system was then evaluated with 15 real emergency patients on Jeju Island over a two-month period. Measured data were transmitted from a moving ambulance to the emergency medical centre without significant CDMA connection loss or transmission errors. The average transfer time was 8 min. Four emergency doctors and 11 rescuers completed a questionnaire. There were favourable reviews from the users.     

Measuring procedures and circuits within a multifunctional medical system

New methods of obtaining the measurements information, which ensure higher reliability and reproducibility of sought data, were suggested for a new-generation diagnostic system. A computer-aided diagnostic scheme for evaluating the patient's condition by the parameter of integument's biologically active points of the patients is described; the results of the first experimental studies are presented.     

Examining empathy in medical encounters: an observational study using the empathic communication coding system

Educators, researchers, clinicians, and patients often advocate empathy in the physician-patient relationship. However, little research has systematically examined how patients present opportunities for physicians to communicate empathically and how physicians respond to such opportunities. The Empathic Communication Coding System was used to investigate empathic opportunity-response sequences during initial visits in a general internal medicine clinic. This study focuses on 100 visits during which patients created at least 1 explicit empathic opportunity. Overall, patients presented 249 empathic opportunities in these 100 visits; physicians most often responded by acknowledging, pursuing, or confirming the patient's statement. The mean length of empathic opportunity-response sequences was 25.8 sec; sequences tended to be longer in duration when the physician used a more empathic response. Positively valenced empathic opportunities generated a more empathic response than did negatively valenced empathic opportunities. However, there was no relation between the emotional intensity of empathic opportunities and the level of empathy in subsequent physician responses. Further research should examine patient preferences and outcomes associated with varying levels of empathic responses.     

医疗服务预付费体系研究概述

目的 推荐北京市有条件采用的相对最佳的医疗服务预付费支付方式,为建立适合北京市情况的医疗费用支付体系提供科学依据.方法 剖析北京市医疗费用支付方式的现状及存在的问题;对439名利益相关者进行问卷调查,了解其对现行支付方式的看法及进行支付方式改革的需求;深入研究国内13个城市及国外部分国家医疗费用支付方式的现状及改革经验,并根据课题组制定的6项评价指标,对19位专家开展问卷调查,最终对各种支付方式进行了整体优劣排序.结果 北京市目前的医疗费用支付方式存在各种问题,需要进行制度性调整;各利益相关者对支付方式改革的必要性和迫切性已基本达成共识,北京市存在支付方式改革的社会需求;各种支付方式均有其优缺点,专家咨询结果显示得分最高的是按DRGs付费方式.结论 北京市进行支付方式改革具有迫切性和必要性;北京市对住院病人应实行以DRGs-PPS为主的支付方式;需开展以费用为基础的DRGs-PPS支付方式逐步转换为以成本为基础的DRGs-PPS支付方式的后续研究.     

A feasibility study of realtime telemedicine in Croatia using Internet videoconferencing

We explored the feasibility of realtime telemedicine in Croatia using Internet videoconferencing. A 33 kbit/s link was established between a team of specialists in the General Hospital 'Sveti Duh' in Zagreb and a general practitioner's clinic in Selca, on the island of Brac. During a two-week study, 16 patients (median age 51 years) were studied. Twenty-one teleconsultations (seven initial and 14 follow-up visits) were conducted, 13 with a specialist in internal medicine, six with a surgeon and two with a neurologist. In 18 cases (86%) telemedicine successfully replaced hands-on examination. The mean duration of the teleconsultations was 7.2 min (initial visits 7.4 min, follow-up visits 7.1 min). Each computer system cost about US$700. The total connection cost for the study was US$4.95. The teleconsultations saved the patients US$272 in travel costs. We suggest forming a permanent on-line specialist service connected to networked clinics via the Internet to improve access to health-care in Croatia.     

Use of emergency medical service and sociodemographic factors

Objectives: Health resources utilization is related to health conditions and to the population's sociodemographic characteristics. Low socioeconomic groups show increased utilization of certain resources. Emergency department utilization could also be affected by socioeconomic factors. The aim of this study was to identify differences in emergency department utilization among different socioeconomic groups.Material and methods: A population-based study was performed. Census sections of the city of Santander in Spain were grouped according to sociodemographic variables (age, educational and professional attinment). Areas of the city with similar socioeconomic characteristics were established by cluster analysis. The place of residence of patients visiting the emergency department of th Hospital Marqués de Valdecilla was identified and the utilization rate was calculated for each cluster.Results: Cluster analysis was able to identify four different groups, each with different socioeconomic characteristics, which were closely related to the districts of Santander. Comparison of clusters 1 and 4 showed that increased emergency department utilization was found amongst groups with lowest socioeconomic status and higher mean age, with an odds ratio of 1.91 (95% CI: 1.73-2.1). Patients from higher socioeconomic groups were more likely to be admitted to hospital while those from lower socioeconomic groups made more repeat visits to the emergency department.Conclusion: Emergency department utilization is affected by the sociodemographic characteristics of patients' area of residence. Patients with lower socioeconomic status show greater use of the emergency department.     

Use of emergency medical service in acute myocardial infarction in an Italian Northeastern region

Journal of Public Health - This study aimed at assessing emergency medical service (EMS) use by patients with acute myocardial infarction (AMI), factors associated with EMS use, and outcomes in the...     

Characterization of the care profile of adult patients of an emergency medical service

It was developed an exploratory study, having as a method the study of case which aimed to characterize the profile of adult patients admitted at the emergency medical service in a general public hospital in S?o Paulo as subsidy for the nursing personal downsizing. Subjects were the patients admitted during the period of thirty days. Data was obtained through application of a patient classification instrument by Fugulin. This study showed patients in the category of intensive care, semi-intensive, high dependence, intermediate and minimal and occupation rate above official prediction making physical space inappropriate to the patients and professionals, reflex of the lack of control service.     

User's demands to an emergency service and their welcoming in the health system

This study aims to identify and analyze users' demands to emergency services, as well as to examine the work organization to welcome them in the health system. We carried out a case study with a qualitative approach. Data were collected through free observation by time sampling. Observation focused on the organization of the work process and on the care given to users who received some kind of care at the emergency service, highlighting their demands and their acceptance in the system. Users who demanded health services displayed different needs, ranging from the simple to the more complexes level. The work process was organized to meet some of these needs, aiming, within certain limits, to treat the main complaint and follow the health system hierarchy. Healthcare users were responsible for obtaining integral care. They journeyed alone, at their own risk, through different services, with no guidance or help from the healthcare system, as would be expected.     

Telecolposcopy - a feasibility study in primary care

Organized cervical screening has reduced the incidence of invasive cervical cancer, but this has resulted in large numbers of women requiring investigation. We have investigated the negative predictive value of colposcopy and used telemedicine to develop a secondary screening technique for use in primary care. A video-colposcope was used to record video-clips, which were subsequently transmitted to a specialist for interpretation. The gold standard for the comparison was the opinion of the colposcopist who examined the women in the hospital colposcopy clinic. Eighty-one out of 97 women were studied by both techniques. Using a diagnosis of normal or abnormal, telecolposcopy had a sensitivity of 88.9% and a specificity of 93.3%. There was very good agreement between the telecolposcopy screener and the colposcopist (Cohen s kappa statistic = 0.70). Furthermore, telecolposcopy screening did not grade any cases of colposcopic high-grade cervical intraepithelial neoplasia as normal. The pilot study has established the validity of diagnosing from transmitted computerized video-clips.     

Problems and solutions arising during a study in visual semantics of the medical emergency team system

A study of the medical emergency team (MET) to explore communication within the team, leadership, handover, and MET resuscitation practice was performed using audiovisual recording in hospitals of Sydney South West Area Health Service, Sydney, Australia. In this article, we report on the process of data collection: the completion of 25 video recordings of MET calls across three of the six study hospitals. We describe how we gained entry into hospital environments to film events characterized by the unpredictability and uncertainties associated with resuscitating a patient and the strategies that we implemented during the fieldwork to develop and maintain rapport with both clinicians and managers. We describe how we addressed some of the practical constraints related to collecting audiovisual data at the point of acute care as well as their implications for the theoretical and methodological aspects of the study.