Journal of telemedicine and telecare
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We conducted a retrospective review to assess the potential for Emergency Nurse Practitioners (ENPs) to deliver telemedicine advice for minor injuries. Over a one-year study period, 835 patients from 15 minor injury units in community hospitals presented to the minor injuries telemedicine service and were seen via videoconferencing by a doctor at the Aberdeen emergency department. ⋯ Assessment of all minor injuries via a telemedicine network by medical staff is unnecessary. An ENP-led service offers a realistic and attractive alternative.
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We investigated the diagnostic agreement between teledermatology based on images from a mobile phone camera and face-to-face (FTF) dermatology. Diagnostic agreement was assessed for two teledermatologists (TD) in comparison with FTF consultations in 58 subjects. In almost three-quarters of the cases (TD1: 71%; TD2: 76%), the telediagnosis was fully concordant with the FTF diagnosis. ⋯ Forty-eight subjects responded to a questionnaire, of whom only 10 had any concerns regarding teledermatology. Thirty-one subjects stated that they would be willing to pay to use a similar service in future and suggested an amount ranging from euro5 to euro50 per consultation (mean euro22) (euro = pound0.7, US $1.4). These results are encouraging as patient acceptance and reimbursement represent potential obstacles to the implementation of telemedicine services.
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Multicenter Study
A cohort study of acute plastic surgery trauma and burn referrals using telemedicine.
A store-and-forward telemedicine system was used to supplement normal telephone referrals to the plastic surgery unit at the Queen Victoria Hospital (QVH). During a 12-week prospective study, 11 units (8 hospitals and 3 minor injury units) with the telemedicine system and 10 units (8 hospitals and 2 minor injury units) without it regularly made referrals (at least 10) to the QVH. There were 389 referrals from the telemedicine-equipped units and 607 telephone referrals from the non-telemedicine units. ⋯ There was a significant difference in the management of patients when the telemedicine system was available, with more patients booked directly into day surgery and fewer attending for assessment. The burns unit and the day surgery unit demonstrated a significantly improved accuracy of triage. Telemedicine could have a valuable role to play in the triage and planning of acute plastic surgery referrals.
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We investigated the accuracy and usefulness of teleconsultation using the mobile phone multimedia messaging service (MMS) in emergency orthopaedic patients. Pictures of radiographs were taken using a built-in 1.3 megapixel mobile phone camera from a digital display screen in the emergency room and then transmitted to the camera phones of four assessors. The cases comprised 59 emergency orthopaedic patients diagnosed with non- or minimally displaced fractures and 34 age-matched normal patients visiting the emergency department. ⋯ The consequence of misdiagnosis would have resulted in mismanagement in up to 48% of the cases. No association was found between the experience of the assessors, the region of the fracture or the age group of the patients and the misdiagnosis rate. Teleconsultation via MMS demonstrated good reliability, but poor diagnostic accuracy which could have major consequences in emergency orthopaedic patients.
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In the UK National Health Service (NHS), NHS Direct, the national 24-h telephone helpline, has been available in England and Wales since 2000 and has been termed a 'single gateway' to health care. We conducted a population survey of 15,004 people in areas covered by the service, which included questions about NHS Direct use and socio-economic characteristics. ⋯ Logistic regression showed that those from poorer socioeconomic groups or with communication difficulties were less likely to have used the service than others. Overcoming this apparent bias against those likely to have the greatest need is an unsolved problem not confined to telemedicine.