Journal of telemedicine and telecare
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Comparative Study
A comparison of teledermatology using store-and-forward methodology alone, and in combination with Web camera videoconferencing.
We compared the diagnostic accuracy of conventional asynchronous teledermatology ('store-and-forward' [SAF]) with a combined technique, in which SAF methodology was used first, followed by a videoconference using low-cost Web cameras. The study involved 228 patients with 242 lesions. For each case, two independent teledermatologists (A and B) evaluated digital images and clinical information by the conventional SAF method and gave a single diagnosis. ⋯ There was no significant difference in the interobserver agreement between the two methods. Use of Web camera videoconferencing improved patient satisfaction with teledermatology. This method of teledermatology may be a useful alternative to the SAF method alone.
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Tele-ophthalmology has been employed mainly for patients in under-served rural areas in need of specialty care, but other applications such as telementoring have also been used. In certain populations, cost containment is a significant issue and telemedicine is a solution. Tele-ophthalmology can be performed in realtime, by store-and-forward mode, or by hybrid techniques. ⋯ Tele-ophthalmology applications include: detecting, screening and diagnosing diabetic retinopathy; anterior segment imaging; glaucoma screening; low vision consultation; telementoring. Tele-ophthalmology shows great promise for improving patient care and increasing access to specialty care not available in under-served areas. In developing countries tele-ophthalmology may be a cost-effective method by which richer countries can assist them.
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Diabetes mellitus is a leading cause of vision loss in industrialized countries. Diabetic retinopathy has features which make it ideal for disease management by telemedicine. The American Telemedicine Association (ATA) has recently established consensus recommendations for ocular telemedicine for diabetic retinopathy, in cooperation with the US National Institute of Standards and Technology. ⋯ To create the practice recommendations, workshops were held to address each of the three components: (1) clinical, (2) technical, and (3) operational and business. Ocular telemedicine programmes will need to demonstrate sustainability and cost-effectiveness, and respect a patient's right to privacy. Nevertheless, ocular telemedicine seems poised to become an integral part of eye health care, as long as programmes meet or exceed present clinical standards of care, and patient and provider expectations are clearly defined.
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In the four-year period from 2000, the Department of Informatics and Telemedicine of the Donetsk R&D Institute of Traumatology and Orthopaedics organized 210 teleconsultations. In 91 cases the Institute was the enquiring party and in 119 the consulting one. Teleconsultations were carried out for 137 male and 73 female patients aged between one month and 85 years. ⋯ We also developed a list of indications for clinical teleconsultation. The optimum equipment for clinical teleconsultations consists of a PC, digital camera, dial-up Internet line and printer. Asynchronous formal and informal Internet-based teleconsultations are most expedient for routine clinical practice, supplemented by realtime teleconsultations where necessary.
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Four specialists (a child psychiatrist, an oncologist, a cardiologist and a rheumatologist) conducted telemedicine clinics using videoconferencing at a bandwidth of 128-384 kbit/s. The consultations were videorecorded. The coded interactions from the first two patients recruited from each of the four telemedicine clinics were analysed. ⋯ In the patient-provider interactions, only 2% of the total utterances related to the technology. The predominance of socio-emotional utterances compared with task-focused utterances for providers was contrary to our expectations. Further studies are required to establish the reliability of the adapted RIAS measure and to increase understanding of telemedicine communication patterns.