Real-time Videoconferencing Research Articles

Psychotherapy using distance technology: A comparison of face-to-face, video, and audio treatment.

This study compared selected process and outcome variables across 3 modes of psychotherapy: faceto-face, real-time video conference, and 2-way audio (analogous to telephone). Results from 80 randomly assigned clients suggested that differences in process and outcome among the 3 treatments were small and clinically promising in comparison with the untreated control group. Experimental comparisons of process and outcome in distant versus face-to-face conditions may influence the future practice of psychology. Conventional wisdom insists that, for most purposes, the therapist and client must be in the same room. Overall, our training as psychologists has emphasized face-to-face contact as the ideal. It will be interesting to discover whether this is true. Moreover, what conditions are required to establish psychological contact with another person and, in fact, what constitutes psychological contact at all, are salient questions in the age of Internet discourse (e.g., Kraut et al., 1998). These research questions are significant for therapist training, choice of treatment, and application of previous research findings. Our effort to compare face-to-face, video, and audio individual therapy addressed two aspects of substitutability. On the process side, the working alliance was examined in all three conditions. Bordin (1979) conceptualized this alliance as the emotional bond between client and therapist, the quality of client and therapist involvement in the tasks of therapy, and the amount of concordance on goals between therapist and client. Reviewing studies of the predictive validity of the alliance variable, Henry, Strupp, Schacht, and Gaston (1994) found empirical support for alliance– outcome associations no matter how outcome was measured, who measured it, or what psychotherapeutic school of thought was represented. These reviewers entertained “the hypothesis that the alliance is a causal ingredient of change” (p. 485). On the outcome side, several assessments were combined, following the advice of Strupp and Hadley (1977) that evaluation of outcome should include multiple sources of information (therapist and client) and multiple targets for change (symptom change, satisfaction level, problem resolution). As implied above, our research questions were straightforward: Does level of working alliance differ according to mode of delivery (face-to-face, audio, or video)? Does outcome differ according to mode of delivery and in comparison to a no-treatment wait-list control group?

Technical Overview of a Web-based Telemedicine System for Wound Assessment

This report provides a technical overview of a Web-based telemedicine system for monitoring wounds in patients who do not have immediate access to the services of a consulting physician, including patients at home or in long-term-care facilities. Such a system would allow for the easy transmission and access of digital images of a patient's wounds and would allow multiple types of data required for comprehensive management of a patient's condition to be summarized and displayed. A store-and-forward method of data transmission was chosen for this project, rather than real-time videoconferencing, to limit the use of expensive technology and to maximize convenience for both the patient and the consulting physician. Under the store-and-forward technique, a clinician obtains wound data from the patient, then transmits these data to a Web site where the telemedicine physician can view data from multiple patients at his or her convenience.

Telemedicine services for two islands in the Bay of Naples.

In July 1997, telemedicine services were established for two islands, Procida and Ischia, in the Bay of Naples. The telemedicine network allowed a 24 h consultation service to be provided between the islands' health centres and mainland hospitals in the towns of Pozzuoli and Giugliano. Realtime videoconferencing was used, over an ISDN link at 384 kbit/s; radiographs were digitized using a scanner. During 1999 and 2000, there was an average of 46 telemedicine consultations per year from Procida (60% radiology, 30% cardiology, 10% other), 35% of which were emergencies, and 16 training sessions per year; there was an average of 28 telemedicine consultations per year from Ischia (80% radiology, 10% cardiology, 10% other), 10% of which were emergencies, and 12 training sessions per year. The average duration of a telemedicine consultation was 15 min. The total fixed cost of the telemedicine system between the two islands and the two mainland hospitals was approximately Euro 48,000 per year. The total variable costs of the telemedicine service at the observed workload were about Euro 750 per year. The total savings due to telemedicine were approximately Euro 40,000 per year. There was therefore little difference in the overall costs of health-care delivery. The positive consequences of the introduction of the telemedicine service included more rapid diagnosis and treatment, improved quality of service, and the transfer of skills and education. A costs-consequences analysis suggested that the telemedicine service was worthwhile.

Patient-focused urban tele-ophthalmology services.

Since 2000, routine tele-ophthalmology services have been provided by St Erik's Eye Hospital to three large urban primary care centres in Stockholm. Diagnostic support from the specialist eye hospital to primary care centres uses video slit-lamps and realtime videoconferencing. After the initial introduction period at the primary care centres, the number of teleconsultations stabilized at a very low level. Despite this, the general practitioners learned to handle more diagnostic conditions by themselves and to identify what diagnostic situations should be referred to a specialist without having to consult the specialist beforehand via telemedicine. The availability of instant eye expertise via telemedicine therefore proved to be an excellent on-the-job training tool to develop and maintain the diagnostic competence of general practitioners. Patient satisfaction was high.

Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature.

The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.

ACM SIGCOMM computer communication review

At some point in the future, how far out we do not exactly know, wireless access to the Internet will outstrip all other forms of access bringing the freedom of mobility to the way we access the we...

Teledermatology: a review.

Teledermatology holds great potential for revolutionizing the delivery of dermatology services, providing equitable service to remote areas and allowing primary care physicians to refer patients to dermatology centres of excellence at a distance. However, before its routine application as a service tool, its reliability, accuracy and cost-effectiveness need to be verified by rigorous evaluation. Teledermatology can be applied in one of two ways: it may be conducted in real-time, utilizing videoconferencing equipment, or by store-and-forward methods, when transmitted digital images or photographs are submitted with a clinical history. While there is a considerable range of reported accuracy and reliability, evidence suggests that teledermatology will become increasingly utilized and incorporated into more conventional dermatology service delivery systems. Studies to date have generally found that real-time dermatology is likely to allow greater clinical information to be obtained from the patient. This may result in fewer patients requiring conventional consultations, but it is generally more time-consuming and costly to the health service provider. It is often favoured by the patient because of the instantaneous nature of the diagnosis and management regimen for the condition, and it has educational value to the primary care physician. Store-and-forward systems of teledermatology often give high levels of diagnostic accuracy, and are cheaper and more convenient for the health care provider, but lack the immediacy of patient contact with the dermatologist, and involve a delay in obtaining the diagnosis and advice on management. It is increasingly likely that teledermatology will prove to be a significant tool in the provision of dermatology services in the future. These services will probably be provided by store-and-forward digital image systems, with real-time videoconferencing being used for case conferences and education. However, much more research is needed into the outcomes and limitations of such a service and its effect on waiting lists, as well as possible cost benefits for patients, primary health care professionals and dermatology departments.

Can telehealth technology be used for the education of health professionals?

The purpose of this report is to describe the usefulness and desirability of using telehealth technology in the education of health care professionals. The PC-compatible, Windows-based system allowed for both real-time videoconferencing and store-and-forward (sending information from one site and stored at a distant site for access at a later time) functions. Student responses indicated that they thought they would benefit from this type of technology in their clinical education. They were most positive with respect to increasing access to a wider range of clients they may not otherwise access and least positive for the ability to learn from a televideo interaction when compared with a clinic experience. Similarly, faculty were least interested in using videoconferencing for patient rounds and more interested in using telehealth to enhance classroom presentations.

User satisfaction with teleconsultations for surgery.

We carried out a prospective study of realtime videoconferencing in surgical consultations. Videoconferencing equipment at the Satakunta Central Hospital, Pori, was connected by ISDN at 384 kbit/s to two health centres in the cities of Kankaanpää and Huittinen (55 and 60 km from Pori, respectively). A document camera was used to transmit images of radiographs and paper documents. Fifty patients who needed a surgical consultation were examined by a doctor in the health centres, and the surgeon interviewed and observed the physical examination by videoconference. The consultation time ranged from 12 to 23 min (mean 15 min). Technically the equipment functioned reliably and the quality of the video-picture was good. According to the consulting surgeon, the decision made in the videoconference was reliable in 48 cases (96%). According to the doctors in the health centres, the consultation was useful in 49 cases (98%) and was considered satisfactory in one. The doctors thought that the teleconsultation was as reliable as an outpatient appointment in 49 cases (98%). The educational benefit of the consultation was excellent or good in 38 cases (76%). The overall satisfaction of patients was very good or good in 45 cases (96%). All patients, except one, avoided travelling to a face-to-face appointment because they received a definite treatment decision during the teleconsultation.

Development and Use of a Virtual NMR Facility

We have developed a “virtual NMR facility” (VNMRF) to enhance access to the NMR spectrometers in Pacific Northwest National Laboratory's Environmental Molecular Sciences Laboratory (EMSL). We use the term virtual facility to describe a real NMR facility made accessible via the Internet. The VNMRF combines secure remote operation of the EMSL's NMR spectrometers over the Internet with real-time videoconferencing, remotely controlled laboratory cameras, real-time computer display sharing, a Web-based electronic laboratory notebook, and other capabilities. Remote VNMRF users can see and converse with EMSL researchers, directly and securely control the EMSL spectrometers, and collaboratively analyze results. A customized Electronic Laboratory Notebook allows interactive Web-based access to group notes, experimental parameters, proposed molecular structures, and other aspects of a research project. This paper describes our experience developing a VNMRF and details the specific capabilities available through the EMSL VNMRF. We show how the VNMRF has evolved during a test project and present an evaluation of its impact in the EMSL and its potential as a model for other scientific facilities. All Collaboratory software used in the VNMRF is freely available from www.emsl.pnl.gov:2080/docs/collab.

An object-based system for stereoscopic viewpoint synthesis

This paper describes algorithms that were developed for a real-time stereoscopic videoconferencing systems with viewpoint adaptation. The goal is a real telepresence illusion, which is achieved by synthesis of intermediate views from a stereoscopic camera shot with a rather large baseline. The actual viewpoint will be adapted according to the head position of the viewer, such that the impression of motion parallax is produced. The object-based system first identifies foreground and background regions and applies disparity estimation to the foreground object. A hierarchical block matching algorithm is employed for this purpose which takes into account the position of high-activity feature points and the object/background border positions. Using the disparity estimator's output, it is possible to generate arbitrary intermediate views by projections from the left- and right-view images. For this purpose, we have also developed an object-based interpolation algorithm, taking into account a very simple convex-surface model of a person's face and body. Though the algorithms had to be held rather simple under the constraint of hardware feasibility, we obtain a good quality of the intermediate-view images. Finally, we describe the hardware concept for the disparity estimator, which is the most complicated part of the algorithm.

Exploiting locality to provide adaptive routing of real-time flows in global internets (abstract)

This paper addresses the role of routing in supporting real-time applications across large integrated services internetworks. The increasing speed of underlying transmission media is enabling new, and perhaps more importantly, integrated applications. However, because of the size and decentralized nature of the global internet, we cannot assume that the network will be homogeneously capable of all new services. Therefore, routing must identify routes with specific type-of-service (TOS) capabilities. Moreover, we suggest that TOS-routing for performance-sensitive applications (e.g., real-time videoconference, real-time interaction with high-bandwidth sensor or experimental data) should be sensitive to significant load-changes, as well as to topology changes. At the same time, global scale means that we must minimize reliance on global consistency of routing databases and global distribution of dynamic routing information. Today’s internet routing does not adapt to load shifts for two sound reasonsstability and overhead. Loaddependent algorithms can become unstable, simultaneously directing all nodes to respond to load changes in the same way, causing oscillation. Further, distributing fine grain load information throughout the internet (a requirement for loop-free routing in today’s hop-by-hop routed Internet) would introduce excessive overhead. The Internet avoids global distribution of fine grained information by using hierarchical aggregation. If it distributes load information, it does so only within local domains, hiding fine detail between domains. Hierarchical aggregation is one of the most powerful ways of dealing with scaleZ. However, hierarchical aggregation does not provide information about the availability of real time routes across a wide-area, heterogeneous internet. For example, if the internetwork routing updates only contain information about configured, inter-domain, topology, then multiple routes to each destination will be computed and selected based only on the relatively-static information. If at call setup time the selected route is not available, or has insufficient resources to carry the flow, an alternate route will be tried. However, such a trial-and-error approach may introduce intolerable session-startup delays, especially in a high-speed network environment where many data transfers could be completed during the several round-trip times that it might take to discover a route. On the other hand, the overhead of flooding dynamic link or path status information is unacceptable in a large network. Our routing architecture addresses this problem by (a) advertising a different level of detail for those routes that are currently carrying real-time multimedia applications, than for routes that are carrying more generic (less performance sensitive) traffic, and (b) distributing this information to current users of the resource in question, not to the global network. We thereby exploit the route locality of internetwork traffic. Route locality is measured by the mapping of each source to the set of network resources traversed to reach the destinations with which it is communicating. The proposed mechanisms are used to complement, not replace, traditional hierarchical-aggregation techniques (i.e., inter-domain routing). We present what might appear to be an unsupportable requirement, i.e., different levels of routing detail from and to different nodes in the network. However, our proposed solutions can be made to work in the context of source routing. Our source routing uses a link-state style algorithm to compute routes 4. Domain-level,