Remote Teleconsultation Research Articles

Ведение пациентов с синдромом дефицита внимания с гиперактивностью с использованием цифровых технологий.

Introduction. Attention deficit hyperactivity disorder (ADHD) is a disease of the group of neuropsychiatric developmental dis- orders, the main symptoms of which are hyperactivity, attention deficit and impulsivity. Behavioral disorders in ADHD, the childhood age of most patients, the need to control the side effects of psychotropic drugs, and limitations in the availability of medical care сan lead to the need for searching for alternative options for the management of patients with this disorder, such as telemedicine and methods of remote monitoring of the disease. The aim of this review is to analyze modern methods of professional medical care for patients with ADHD. Materials and Methods. Literature review was conducted using PubMed, Scopus, and GoogleScholar databases, and the study included literature sources not older than 5 years. Results. We conducted a literature review and analyzed current trends in the management of patients with ADHD using remote technologies. Currently, all these steps can be achieved by using of telemedicine technologies: remote teleconsultations, the use of digitized questionnaires and cognitive tasks, the introduction of psychotherapeutic tools into patients' daily lives through augmented and virtual reality technologies, and the use of apps and wearable devices for symptom tracking. Conclusion. In summary, the analysis has demonstrated the certain aspects of managing patients with attention deficit hy- peractivity disorder using telemedicine technologies. Modern technologies make it possible to achieve control over the course of ADHD, reduce the severity of its symptoms and improve the quality of life of patients with ADHD.

Patient consultations during SARS-CoV-2 pandemic: a mixed-method cross-sectional study in 16 European countries.

Remote consultations help reduce contact between people and prevent cross-contamination. Little is known about the changes in consultation in European rural primary care during the SARS-CoV-2 (COVID-19) pandemic. The purpose of this mixed-methods cross-sectional study was to find out more about the effects of the pandemic on changes in patient consultations in European rural primary care. A key informant survey from 16 member countries of the European Rural and Isolated Practitioners Association (EURIPA) was undertaken using a self-developed questionnaire. The steering committee of this project, called EURIPA Covid-19 study, developed a semi-structured questionnaire with 68 questions, 21 of which included free-text comments. Proportions were calculated for dichotomized or categorized data, and means were calculated for continuous data. Multivariate analysis by logistic regression model was used to assess the association of multiple variables. A total of 406 questionnaires from primary care providers (PCPs) in 16 European countries were collected; 245 respondents (60.5%) were females, 152 PCPs were rural (37.5%), 124 semi-rural (30.5%). Mean age of the respondents was 45.9 years (standard deviation (SD) 11.30) while mean seniority (length of experience) was 18.2 years (SD 11.6). A total of 381 (93.8%) respondents were medical doctors. Significant differences were found between countries in adopting alternative arrangements to face-to-face consultation: remote teleconsultation is well appreciated by both healthcare professionals and patients, but the most common way of remote consultation remains telephone consultation. A factor significantly inversely associated with the adoption of video consultation was the seniority of the PCP (odds ratio 1.19, 95% confidence interval 1.02-1.40, p=0.03). Telephone consultation is the most common form of remote consultation. The adoption of video-consultation is inversely related to the seniority of the informants.

Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19

To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction. The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2). A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication. Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.

Patient Satisfaction with Tele- and Video-Consultation in the COVID-19 Era – A Survey of Vascular Surgical Patients

BackgroundThe COVID 19 pandemic has resulted in the increasing use of telemedicine due to the advantages of avoiding viral transmission. Evidence suggests that telemedicine, for certain conditions, may be as effective as face-to-face consultations; however, there is no research to date regarding vascular patients’ acceptance or satisfaction with telemedicine during and after the COVID-19 pandemic.MethodsA patient satisfaction interview was designed to survey three aspects of the service: patient acceptability of teleconsultations as a replacement to physical clinics; their views of teleconsultation during the pandemic; and the future role of teleconsultations postpandemic. Patients undergoing remote teleconsultation (either by telephone or video software), between April and June 2020 were suitable for inclusion. Patients were contacted by telephone in August 2020 to undertake the survey. Local “Research and Development” approval was obtained.ResultsA total of 333 patients had a consultation with a vascular consultant between April and June 2020, of which 178 were teleconsultations. Successful contact was made with 72 patients, of whom 68 agreed to participate; 10 patients had undergone video consultations, while the remainder had telephone consultations. Teleconsultations were widely viewed as acceptable, and over 90% of patients felt they were beneficial. 91% felt that not needing to travel for appointments was advantageous to them. The option of teleconsultation during the COVID pandemic was valued by 94% of the cohort. While all interviewees felt teleclinics should continue during the pandemic, the majority (74%) also wanted to use teleconsultations for clinic appointments after the pandemic.ConclusionsTelemedicine is viewed by vascular patients as generally acceptable and beneficial for use during the pandemic. The majority of patients wanted future telemedicine appointments postpandemic. Telemedicine services started as a result of the COVID-19 pandemic, which may have been viewed as a temporary measure, should be planned to continue long term.

Development and validation of a new tool to identify factors that influence users’ motivation toward the use of teleconsultation systems: A modified Delphi study

BackgroundHealthcare providers have improved consumer access to healthcare services by the adoption of information communication technology and the use of telemedicine. With the current COVID-19 pandemic, consumers are shifting to remote teleconsultation. There are several studies regarding consumers’ acceptance and satisfaction with telemedicine among healthcare providers and a few among patients at healthcare facilities. However, studies about patients’ motivation toward the use of teleconsultation systems are very few. AimThe aim of this study was to validate an instrument of a newly developed framework to identify factors that motivate patients to use a teleconsultation system. MethodThis study used a modified eDelphi method incorporating content validity index and content validity ratio procedures to validate the instrument among fifteen experts from different disciplines. The eDelphi consisted of three rounds to review each item’s relevance, clarity, importance and the overall validity of the instrument. ResultThe result showed a significant level of agreement among experts for individual items’ relevance, clarity and importance. For relevance, all items had excellent I-CVI above 0.889, except one item with I-CVI = 0.78, which is still acceptable. For clarity, all items had an excellent I-CVI > 0.889, except one with I-CVI = 0.667. For importance, most items had CVR above the threshold value of 0.778, except 5 items. Also, the result showed moderate to high content validity of the overall instrument (S-CVI/UA = 0.694; S-CVI/Ave = 0.996). DiscussionThese findings support the validity and reliability of the developed instrument, which can be used to identify factors that motivated patients to use a teleconsultation system. Future testing of the instrument should be conducted with a larger population that uses a teleconsultation system. ConclusionAn instrument was developed to identify factors that motivated consumers to use teleconsultation, using a modified eDelphi method among experts. The eDelphi method consisted of three rounds and the results showed that the instrument is a valid and reliable tool.

Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area.

IntroductionGreenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations.Materials and methodsProspective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions–total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation.ResultsEighty patients were included. Face-to-face consultations would have resulted in 6699 km (4162 miles) of travel (83.7 km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1 kg CO2e while face-to-face consultation emitted 0.5 kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141 kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112 h (1.4 h/patient).ConclusionsTeleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000 km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener.Level of evidence3.

P0985 - Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area

P0985 - Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area

Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study

BackgroundAn ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change.MethodsSixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes.ResultsVarious uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies.ConclusionsCurrent literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.

Development and Evolution of a Statewide Outpatient Consultation Service: Leveraging Telemedicine to Improve Access to Specialty Care.

Despite a robust health care system in the United States, many Americans experience health care disparities as a result of poor access to medical care. Academic medicine plays an important role in addressing health care disparities by providing primary and specialty care for the poor and uninsured. In South Carolina, 43 of its 46 counties are designated as fully or partially Medically Underserved Areas (MUAs), defined as areas with a shortage of medical providers, high infant mortality, and either high elderly population or high poverty rates. To address these health care disparities, an academic medical center in South Carolina created a hub-and-spoke specialty care model using telemedicine in partnership with primary care providers across community settings. Initial private foundation grant funding enabled the development and dissemination of technology to provide remote teleconsultations by physicians at the academic medical center (hub) to patients in their primary care offices (spoke). This model, now supported by recurring state funding and professional billing, provides much-needed services, including psychiatry, nutrition counseling, and various surgical and medical subspecialties, to rural and underserved populations in the state. This manuscript provides a narrative review of the development of this statewide telemedicine service, with an emphasis on identification of stakeholders, technology issues, barriers to implementation, and future directions.

Delivering Collaborative Care in Rural Settings: Integrating Remote Teleconsultation and Local Supervision in Rural Nepal.

The collaborative care model can deliver high-quality mental health care. In rural regions, clinical supervision is conducted remotely rather than in person. The authors implemented a remote teleconsultation model in rural Nepal, where the consulting psychiatrist is over 30 hours away. This column describes strategies for several challenges: poor mental health competencies and high turnover among primary care providers; need for urgent consultations; psychiatrist discomfort with lack of direct patient contact; unreliable electricity, technological tools, documentation, and delivery of treatment recommendations; on-site clinicians' low motivation to accept psychiatrist recommendations; and mismatch between the psychiatrist's recommendations and the site's capacity to implement them.

The robot will see you now?

Remote medical videoconferencing and teleconsultations are well-established in modern medical practice with good video and audio quality and data security. Extending this practice to ward rounds requires bringing the communication...

Expectations of medical specialists about image-based teleconsultation - A qualitative study on acute burns in South Africa.

BackgroundImage-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care.MethodsIn this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation. Purposive sampling included male and female physicians at different stages of their career, employed at different referral hospitals and all potential future tele-experts in remote teleconsultation using the App. Positioning theory was used to analyse the data.ResultsThe experts are already facing changes in their diagnostic practices due to the informal use of open access applications like WhatsApp. Additional changes are expected when the new App is launched. Four positions of medical experts were identified in situations of diagnostic advice, two related to patient flow–clinical specialist and gatekeeper–and two to point of care staff–educator and mentor. The experts move flexibly between the positions during diagnostic practices with remote colleagues. A new position in relation to previous research on medical roles–the mentor–came to light in this setting. The App is expected to have an important educational impact, streamline the diagnostic process, improve both triage and referrals and be a more secure option for remote diagnosis compared to current practices. Verbal communication is however expected to remain important for certain situations, in particular those related to the mentor position.ConclusionThe quality and security of referrals are expected to be improved through the App but the medical experts see less potential for conveying moral support via the App during remote consultations. Experts’ reflections on remote consultations highlight the embedded social and cultural dimensions of implementing new technology.

Using Teleconsultation to Develop Independent Skills of School-Based Behavior Teams in Functional Behavior Assessment

ABSTRACTThe Iowa Department of Education (DE) has a history of partnering with the Biobehavioral Service (BBS) at the Center for Disabilities and Development to consult with educational teams in Iowa schools regarding students exhibiting challenging behavior. In 2009, the DE requested that BBS consultants improve behavior assessment skills of school-based behavior teams across the state. One aim of the DE was to develop school-based behavior teams who could independently conduct the full range of behavior assessments (i.e., indirect assessment, direct assessment, and experimental analyses). The BBS consultants worked with challenging behavior teams from eight Iowa Area Education Agencies, teaching them to independently design, conduct, and interpret a variety of behavior assessments (e.g., preference assessments, functional analyses). A three-stage teleconsultation model was developed during consultation visits to support and evaluate the independent assessment practice of consultees. The stages included in-person consultation, onsite teleconsultation, and remote teleconsultation. Consultees expressed satisfaction with the use of teleconsultation during the third stage of the model. Additionally, the use of videoconferencing addressed some of the barriers to conducting team-based behavior assessments in the school setting by creating observation and assessment rooms for team members. Consultees continue to use this method as they independently assess the behavior of students.

Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review

Introduction Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care. Methods Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness. Results From 362 potentially relevant papers, we identified five randomised controlled trials (n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials (n = 19; n = 75); two (n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were ‘more likely to continue’ with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective. Discussion The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy.

Mobile gastrointestinal and endoscopic surgery in rural Ecuador: 20years' experience of Cinterandes.

Five billion people worldwide do not have timelyaccess to surgical care. Cinterandes is one of the only mobile surgical units in low- and middle-income countries. This paper examines the methodology that Cinterandes uses to deliver mobile surgery. Founding and core staff were interviewed, four missions were participated in, and internal documents and records were analysed between 1 May and 1 July 2014. Cinterandes performed 7641 operations over the last 20years (60% gastrointestinal/laparoscopic), travelling 300,000km to remote areas of Ecuador. The mobile surgery programme was initiated by a local Ecuadorian surgeon in 1980.Funding was acquired from businesses, private hospitals, and individuals, to fund a low-cost surgical truck, simple equipment, and running costs.The mobile surgical unit is a 24-foot modified Isuzu truck containing a preparation room with general equipment storage and running water, together with an operating room including the operating table, anaesthetic and surgical equipment.Mission structure includes: patient identification by a network of local medical personnel in remote regions; pre-operative assessment at 1 week by core team via teleconsultations; four-day surgical missions; post-operative recovery in tents or a local clinic; post-operative follow-up care by local personnel and remote teleconsultations. The permanent core team includes seven members;lead surgeon, lead anaesthetist, operating-room technician, medical coordinator, driver, general coordinator, and receptionist. Additional support members include seven regular surgeons, residents, medical students, and volunteers. Surgery is a very effective way to gain the trust of the community, due to immediate results. Trust opens doors to other programmes (e.g. family medicine). Surgery can be incorporated with all other aspects of health care, which can in turn be incorporated with all other aspects of human development, education, food production and nutrition, housing, work and productivity, communication, and recreation.

Telemedicine pre-hospital electrocardiogram for acute cardiovascular disease management in detainees: An update

Summary Introduction Medical assistance for detainees is often hampered by logistic and procedural limitations. Telemedicine may represent the solution by which such limitations can be overcome. We therefore report an update on an experience of remote telemedicine support by pre-hospital electrocardiograms and remote tele-consultation with a cardiologist implemented in a group of Italian penitentiaries. Methods Eleven State penitentiaries situated in Apulia (South-Eastern Italy) were provided with a pocket electrocardiogram recorder. The electrocardiograms were interpreted by a remote cardiologist available 24/7, which also gave a brief consultation. Results A total 3213 pre-hospital electrocardiograms were performed from January 2008 to October 2014. In 1.1% of pre-hospital electrocardiograms a supra-ventricular tachycardia was found: pre-hospital electrocardiogram showed in 7.2% anomalies suggestive for acute myocardial ischemia, in 0.8% an ST-elevation requiring immediate transfer for primary PCI. Clinical indications after pre-hospital electrocardiogram were hospitalization in 29 cases, primary PCI in 26; direct cardiologist referral in 162, a cardiac troponin assay in 142; in 252 cases outdoor further medical examinations were suggested. By converse, thanks to pre-hospital telemedicine screening, immediate hospitalization was avoided in 99% of tele-consultations; in 2961 cases with suspected acute cardiovascular disease detainees were examined with an electrocardiogram without leaving the penitentiary. Conclusions Pre-hospital electrocardiogram telemedicine screening strategy in the case of suspected acute cardiovascular disease in detainees is feasible. A single regional telemedicine ‘hub’ may provide support to a region-wide network with 11 penitentiaries and about 3500 detainees.

PDA–Phone-Based Instant Transmission of Radiological Images over a CDMA Network by Combining the PACS Screen with a Bluetooth-Interfaced Local Wireless Link

Remote teleconsultation by specialists is important for timely, correct, and specialized emergency surgical and medical decision making. In this paper, we designed a new personal digital assistant (PDA)-phone-based emergency teleradiology system by combining cellular communication with Bluetooth-interfaced local wireless links. The mobility and portability resulting from the use of PDAs and wireless communication can provide a more effective means of emergency teleconsultation without requiring the user to be limited to a fixed location. Moreover, it enables synchronized radiological image sharing between the attending physician in the emergency room and the remote specialist on picture archiving and communication system terminals without distorted image acquisition. To enable rapid and fine-quality radiological image transmission over a cellular network in a secure manner, progressive compression and security mechanisms have been incorporated. The proposed system is tested over a code division Multiple Access 1x-Evolution Data-Only network to evaluate the performance and to demonstrate the feasibility of this system in a real-world setting.

Telemedicine with the Mobile Camera-phone in Metacarpal and Phalangeal Fracture

The purpose of the present study was to evaluate the feasibility of telemedicine using a mobile camera-phone to transfer radiographic images and on line communication for the diagnosis and treatment recommendations of metacarpal and phalangeal fractures. Teleconsultations were carried out between surgical residents in the emergency room and the consultant surgeon on 49 patients for 60 suspected metacarpal and phalangeal bone fractures by using Panasonic mobile camera-phones, which had a built-in 110,000-pixel digital camera and a 65,536 colors display. Separate fracture identification and treatment recommendations during remote teleconsultation and on-site inspection by the consultant surgeon were performed and compared. Later, a standard questionnaire about the level of satisfaction regarding image resolution and the ability to generate clinical opinions and management recommendations was filled out by three individual plastic surgeons. Of the 60 fractures, 58 fractures (97%) were recognized during the remote teleconsultation and 56 fractures (93%) were managed as per the remote treatment recommendations. Identification of fractures and treatment recommendations of nonoperation or operative fixation made from the remote teleconsultation mostly agreed with evaluations made on-site. In the image analysis conducted by three plastic surgeons, image quality was sufficient for interpretation. The same conclusions were reached in the identification of 56 fractures (93%) and in the treatment planning of 43 (71%) fractures. The results demonstrated that the telemedicine with a mobile camera-phone is feasible and useful for remote metacarpal and phalangeal fracture diagnosis and treatment recommendations. This system has the advantages of ease of use, low cost, and high portability and mobility. There is significant promise in the future for application of telemedicine and telecare with the further advancement of available technology in image media and electronic data transfer.

Teleconsultation with the Mobile Camera-Phone in Digital Soft-Tissue Injury: A Feasibility Study

The purpose of this study was to examine the feasibility of teleconsultation using a mobile camera-phone to evaluate the severity of digital soft-tissue injury and to triage the injury with regard to management recommendations. With a built-in 110,000-pixel digital camera, pictures of the injured digit(s) or radiograph were taken by surgical residents in the emergency room and transmitted to another camera-phone to be viewed by the remote consultant surgeon. A brief medical and trauma history of each patient was relayed also by mobile phone. The consultant surgeon then reviewed all of these patients in the emergency room shortly after the initial telemedicine referral. Separate triaging for each digital injury into three groups was recorded during remote teleconsultation and according to actual treatment by the attending surgeon as follows: group I, the injury could be managed with conservative treatment, such as secondary intention wound healing, or primary closure with or without bone shortening; group II, skin grafting or local flap coverage was required for management of the injury; and group III, microsurgery such as replantation or free flap coverage was necessary to deal with the injury. Later, triaging was also performed individually by three junior plastic residents according to image review and patient referral information. Teleconsultation through a mobile camera-phone was performed for 45 patients with injuries of 81 digits from January to May of 2003. Of these 81 digital injuries, there were 12 cases (15 percent) where disagreement of triaging occurred between the teleconsultation and the actual treatment by the attending surgeon. In image reviewing, there was 79 percent sensitivity and 71 percent specificity in remote diagnosis of the skin defect and 76 percent sensitivity and 75 percent specificity in remote identification of the bone exposure regarding the concordance of opinions of all three surgeons; there was significant discordance in triaging in 20 cases (25 percent), and the difference in triaging was partly attributed to the inability to show instances of tiny exposed digital bone or tendon in some cases under the low-resolution digital image and the situation of a bloody oozing wound. In some cases, the difficulty in evaluating the probability of primary closure of severely avulsed skin edges or the probability of executing replantation for finger amputation also contributed to different triaging outcomes. Two neglected diagnoses of transected digital nerves were found and influenced triaging, highlighting the importance of on-site physical examination during teleconsultation. The telemedicine system using a mobile camera-phone based on the global system for mobile communication is feasible and valuable for early diagnosis and triaging of digital soft-tissue injury in emergency cases, with on-line verbal communication and review of the transmitted captured image. This system has the advantages of ease of use, low cost, high portability, and mobility. With advances in hardware for digital imaging and transmission technology and the development of the third-generation advanced mobile phone system in the foreseeable future, this system has potential for future applications in telemedicine and telecare.

Design of a PC-based multimedia telemedicine system for brain function teleconsultation

During time-critical brain surgery, the detection of developing cerebral ischemia is particularly important because early therapeutic intervention may reduce the mortality of the patient. The purpose of this system is to provide an efficient means of remote teleconsultation for the early detection of ischemia, particularly when subspecialists are unavailable. The hardware and software design architecture for the multimedia brain function teleconsultation system including the dedicated brain function monitoring system is described. In order to comprehensively support remote teleconsultation, multi-media resources needed for ischemia interpretation were included: EEG signals, CSA, CD-CSA, radiological images, surgical microscope video images and video conferencing. PC-based system integration with standard interfaces and the operability over the Ethernet meet the cost-effectiveness while the modular software was customized with a diverse range of data manipulations and control functions necessary for shared workspace and standard interfaces.