Telemedical Centers Research Articles

User-Centered Design of a Dynamic-Autonomy Remote Interaction Concept for Manipulation-Capable Robots to Assist Elderly People in the Home

In this article, we describe the development of a human-robot interaction concept for service robots to assist elderly people in the home with physical tasks. Our approach is based on the insight that robots are not yet able to handle all tasks autonomously with sufficient reliability in the complex and heterogeneous environments of private homes. We therefore employ remote human operators to assist on tasks a robot cannot handle completely autonomously. Our development methodology was user-centric and iterative, with six user studies carried out at various stages involving a total of 241 participants. The concept is under implementation on the Care-O-bot 3 robotic platform. The main contributions of this article are (1) the results of a survey in form of a ranking of the demands of elderly people and informal caregivers for a range of 25 robot services, (2) the results of an ethnography investigating the suitability of emergency teleassistance and telemedical centers for incorporating robotic teleassistance, and (3) a user-validated human-robot interaction concept with three user roles and corresponding three user interfaces designed as a solution to the problem of engineering reliable service robots for home environments.

Deaths on board ships assisted by the Centro Internazionale Radio Medico in the last 25 years

Data on occupational diseases of seafarers and of causes of death during their career are sparse. The causes of deaths on board ships assisted by Centro Internazionale Radio Medico (CIRM), the Italian Telemedical Maritime Assistance Service (TMAS) were reviewed by examining 29,146 files of patients treated from 1986 to 2010. In the 25 years, 383 deaths occurred (1.31%). Diseases of the circulation were the most frequent, followed by external causes such as accidents and violence, infectious and parasitic diseases, alcohol and drug addiction, respiratory system diseases. Cardiovascular and external causes were the principal causes of deaths among seafarers. This investigation is the first study on the causes of death on board ships obtained from data of a maritime telemedical centre, that has assisted seafarers when they were alive or immediately after their death. The fact that diseases of the circulatory system are the first cause of death of sailing seafarers deserves specific initiatives. They should include campaigns for adequate lifestyles and the availability on ships of medical devices useful for diagnostic purposes, resuscitation as well as for verification of death.

Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients With Chronic Heart Failure

Background— This study was designed to determine whether physician-led remote telemedical management (RTM) compared with usual care would result in reduced mortality in ambulatory patients with chronic heart failure (HF). Methods and Results— We enrolled 710 stable chronic HF patients in New York Heart Association functional class II or III with a left ventricular ejection fraction ≤35% and a history of HF decompensation within the previous 2 years or with a left ventricular ejection fraction ≤25%. Patients were randomly assigned (1:1) to RTM or usual care. Remote telemedical management used portable devices for ECG, blood pressure, and body weight measurements connected to a personal digital assistant that sent automated encrypted transmission via cell phones to the telemedical centers. The primary end point was death from any cause. The first secondary end point was a composite of cardiovascular death and hospitalization for HF. Baseline characteristics were similar between the RTM (n=354) and control (n=356) groups. Of the patients assigned to RTM, 287 (81%) were at least 70% compliant with daily data transfers and no break for >30 days (except during hospitalizations). The median follow-up was 26 months (minimum 12), and was 99.9% complete. Compared with usual care, RTM had no significant effect on all-cause mortality (hazard ratio, 0.97; 95% confidence interval, 0.67 to 1.41; P =0.87) or on cardiovascular death or HF hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.67 to 1.19; P =0.44). Conclusions— In ambulatory patients with chronic HF, RTM compared with usual care was not associated with a reduction in all-cause mortality. Clinical Trial Registration:— URL: http://www.ClinicalTrials.gov . Unique identifier: NCT00543881.

Teledental consultations related to trauma in a Swiss telemedical center: a retrospective survey

In addition to medical advice, telemedical centers also provide counseling on the telephone for patients with dental injuries. Data from a Swiss telemedical center during the years 2001-2008 were analyzed retrospectively. A total of 371 988 medical consultations were recorded. Of these, 3430 concerned dental problems, with 672 reports about dental trauma following accidents with 772 injuries. The patients average age was 8.6 years (range 0-73 years). About two-thirds of the cases belonged to the age group 0-6 years, and one-third to the group of 7-80 years. The reasons for calling were dislocations (53%), fractures (31.9%), and avulsions (7.9%). In 76.2% of the cases, the center was contacted on the day of the accident. The majority of the patients (60%) contacted the telemedical center during the so-called 'out of office hours' (Monday to Friday 6 pm to 8 am, and Saturday/Sunday all day). Telemedicial services can be helpful for cases related to dental trauma and may provide valuable support when a dentist is not available.

Systems Development And Key Success Factors In Large Scale Telemedicine Projects: Preliminary Findings Of A Post-Conflict Country Case Study

Information technologies are a form of automation and control system which can provide the basis for important economic activity in unstable regions, such as post-conflict countries. The biggest risk in IT development is failure of the project. From the limited studies that have been conducted it has been found that the success of implementation and continued use of IT in Developing countries is mixed. This paper uses grounded theory method to explore the success factors of a telemedical center in a developing, post war region, and sets out the preliminary findings of open ended and semi-structured interviews. Key factors are placed in categories and discussed and preliminary conclusions drawn.

Architecture of a wireless Personal Assistant for telemedical diabetes care

Purpose Advanced information technologies joined to the increasing use of continuous medical devices for monitoring and treatment, have made possible the definition of a new telemedical diabetes care scenario based on a hand-held Personal Assistant (PA). This paper describes the architecture, functionality and implementation of the PA, which communicates different medical devices in a personal wireless network. Description of the system The PA is a mobile system for patients with diabetes connected to a telemedical center. The software design follows a modular approach to make the integration of medical devices or new functionalities independent from the rest of its components. Physicians can remotely control medical devices from the telemedicine server through the integration of the Common Object Request Broker Architecture (CORBA) and mobile GPRS communications. Data about PA modules’ usage and patients’ behavior evaluation come from a pervasive tracing system implemented into the PA. Results and discussion The PA architecture has been technically validated with commercially available medical devices during a clinical experiment for ambulatory monitoring and expert feedback through telemedicine. The clinical experiment has allowed defining patients’ patterns of usage and preferred scenarios and it has proved the Personal Assistant's feasibility. The patients showed high acceptability and interest in the system as recorded in the usability and utility questionnaires. Future work will be devoted to the validation of the system with automatic control strategies from the telemedical center as well as with closed-loop control algorithms.

Diagnosis at a distance: the invisible work of patients and healthcare professionals in cardiac telemonitoring technology

Although patients are often absent in discourses on telemedicine, many telemonitoring applications constitute a new medical practice in which patients are expected to play an active role. The paper is based on a study of the use of one specific telemonitoring device, an ambulatory ECG recorder introduced to diagnose infrequent irregularities of the heart rhythm. It seeks to examine all the invisible work it takes to produce patients who are active and responsible as participants in the diagnosis of their heart problem. In particular, I address the question of how we can understand that individuals who are anxious about their heart function manage to adopt the role of 'diagnostic agent'. This research shows that, although many patients managed to become competent users of the new technology, there are important patterns of selective use patients invented to integrate the technology in their daily life. In conclusion, the paper suggests that most patients were able to adopt the role of diagnostic agent not only because of their individual motivation but because of their location in the socio-technical network of this technology, in which the invisible work of home-care nurses and physicians at the telemedical centre made all the difference.

Telemedicine for a Children's Field Hospital in Chechnya

In 2001, the Children's Field Hospital in the Gudermes area of the Chechen Republic was connected to a telemedical centre at the Scientific Institute of Pediatrics and Children's Surgery in Moscow, via the Russian SCA HeliosNet satellite system. An asymmetric satellite link, in which there was a high-speed downlink from the satellite to Gudermes and a low-speed uplink from Gudermes to the satellite was used. In total, 179 teleconsultations were carried out from October 2001 until February 2002, when the field hospital was closed. Of the 179 teleconsultations, 26 were real-time, by videoconference and the rest were asynchronous, by email. Almost half of consultations were carried out for emergency or urgent reasons, thus demonstrating the value of providing access to the necessary experts. The use of satellite communication allowed telemedical support for medical decisions in a wide range of disease and trauma in children and teenage in a conflict situation.

P-455 Preservation of pre-hospital time waste in acute myocardial infarction based on a novel telemedical service center concept

P-455 Preservation of pre-hospital time waste in acute myocardial infarction based on a novel telemedical service center concept

P-455 Preservation of pre-hospital time waste in acute myocardial infarction based on a novel telemedical service center concept

P-455 Preservation of pre-hospital time waste in acute myocardial infarction based on a novel telemedical service center concept