Journal of telemedicine and telecare
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A systematic review of accident and emergency teleconsultation services was carried out. Studies (English language only) conducted worldwide and published between 1996 and 2003 were included. Evidence relating to technical feasibility, clinical effectiveness, cost effectiveness and level of local management was used as the main outcome measure. ⋯ The range for local management was 35-100% with a mean of 76%. Only 23% of the studies provided evidence to suggest that the service was cost effective. The case for cost-effectiveness is far from proven and this area of research requires immediate attention if potential users are to be convinced of the value of telemedicine.
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A 12-lead electrocardiogram (ECG) recorded in patients with acute coronary syndrome (ACS) was transmitted to a call centre via telephone (tele-ECG). In 120 patients (mean age 64 years) referred to hospitals because of ACS, a standard 12-lead ECG and a tele-ECG recorded at the same time were compared by two cardiologists and one internist independently and blindly. Conduction times exhibited very good agreement between standard and tele-ECG with reliability coefficients (R) of 0.91, 0.86 and 0.89 for the PQ-, QRS- and QT interval, respectively. ⋯ Negative T waves, ST-segment elevation and depression were detected with very high agreement in the tele-ECG exhibiting kappa (kappa) coefficients between 0.75 and 0.96. The correct ECG diagnosis of ST-elevation myocardial infarction (STEMI) was possible with excellent agreement between standard and tele-ECG, showing kappa coefficients of 0.96, 0.99 and 0.99, respectively, for three investigators. The 12-lead tele-ECG recorder proved accurate for the detection of acute STEMI.
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There are many issues of concern regarding the legal and ethical aspects of telemedicine. These include the responsibilities and potential liabilities of the health professional, the duty to maintain the confidentiality and privacy of patient records, and the jurisdictional problems associated with cross-border consultations. ⋯ Cross-border telemedicine services have begun, particularly in specialties such as teleradiology, but questions of jurisdiction and registration have yet to be answered definitively. While this may be true of many of the legal and ethical aspects of telemedicine generally, it is also the case that health-care professionals who undertake telemedicine in a prudent manner will minimize the possibility of medicolegal complications.
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At present, mobile phones are not a useful tool for medical control during a disaster. We have estimated the number of satellite channels that would be needed for telemedicine in a major disaster using the Erlang B equation. This indicated that 29 satellite channels would be sufficient for the operation of a telemedicine system for hospital-to-hospital communications during a major disaster in Japan. Governments at local and national levels in Japan, as well as private organizations, require an independent satellite telecommunication infrastructure to deal with the aftermath of disasters.
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We have used telemedicine at the Seattle Veterans Administration Medical Center to deliver follow-up care to patients with Parkinson's disease (PD). Patients were located at eight facilities which were 67-2400 km from the medical centre. Each facility had videoconferencing equipment (connected by Internet Protocol at 384 kbit/s), and computer terminals that could access the patient's electronic medical record. ⋯ For the first 82 telemedicine visits, the video quality was inadequate for scoring all components of the motor Unified Parkinson Disease Rating Scale (UPDRS). For the last 18 visits, a different videoconferencing unit produced better video quality, which was satisfactory for motor UPDRS measurements, except for components that required physical contact with the patient (rigidity and retropulsion testing). Our experience shows that telemedicine can be used effectively for follow-up visits with selected PD patients who are unable to travel.