Journal of telemedicine and telecare
-
We conducted a systematic review to identify the extent to which the process of screening for cognitive impairment in older adults has been validated for administration by telephone. A search of electronic databases and a handsearch of relevant journals and reference lists were carried out for studies published between 1966 and 2008. The database search identified 411 studies and handsearching found another seven. ⋯ The limited number of high quality studies with suitable reference standards makes it difficult to recommend a specific tool which should be used to assess the cognition of older adults by telephone. In advance of further studies, the 22-item MMSE is simple to administer and was shown to correlate well with the face-to-face MMSE. It appears to be a useful technique for telephone screening for cognitive impairment or delirium, if used in conjunction with the Delirium Symptom Interview.
-
Comparative Study
Feasibility of dynamic cardiac ultrasound transmission via mobile phone for basic emergency teleconsultation.
We assessed the feasibility of using a camcorder mobile phone for teleconsulting about cardiac echocardiography. The diagnostic performance of evaluating left ventricle (LV) systolic function was measured by three emergency medicine physicians. A total of 138 short echocardiography video sequences (from 70 subjects) was selected from previous emergency room ultrasound examinations. ⋯ There was an improvement in specificity with the observer's increasing experience of cardiac ultrasound. Although the image quality of video on the mobile phone was lower than that of the original, a receiver operating characteristic (ROC) analysis indicated that there was no significant difference in diagnostic performance. Immediate basic teleconsulting of echocardiography movies is possible using current commercially-available mobile phone systems.
-
Patients with amyotrophic lateral sclerosis (ALS) need a care programme as the disease progresses. We used telemedicine-assisted integrated care (TAIC) in 40 patients with ALS, for a mean duration of 8.6 months (range 1-12). A nurse-tutor played the key role, supported by respiratory physicians, neurologists and psychologists. ⋯ TAIC staff recommended 4 out of 12 emergency hospital admissions (33%) and 77% of the other hospitalizations. Patients and caregivers were extremely satisfied (79%) with the nurse assistance provided and the patients' confidence in handling their disease improved in 71% of the cases. TAIC provides a nurse-centred, home-monitoring programme that can be a useful way of following up ALS patients.
-
Adverse events such as deaths following telephone triage calls are rare, suggesting that the process is basically safe. However, if calls tend to concern mostly minor illnesses, then adverse events following calls would be uncommon even if the triage process itself was flawed. We investigated hospitalization rates following triage calls and compared them to hospitalization following two other types of medical access, emergency department (ED) visits and office visits. ⋯ Based on national survey data, hospitalization for adult ED visits concerning the same symptoms were 33% (chest pain) and 19% (abdominal pain). Office visits had hospitalization rates significantly lower than triage calls in all age groups, while ED visits had higher hospitalization rates than triage calls in all age groups. There are both qualitative and quantitative similarities between triage calls and ED visits and, using hospitalization as an indicator, some subgroups of triage calls are nearly as serious as ED visits.
-
We identified the need for a tele-ophthalmology service at the Tywyn hospital in Wales. During a two-year period, 22 emergency patients were managed by telemedicine, thereby reducing the need for ambulance transfer. We expect that there will be increased use of tele-ophthalmology in north Wales as the technology improves and the equipment becomes easier to use.