Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2008
Intensive care telemedicine: evaluating a model for proactive remote monitoring and intervention in the critical care setting.
Historically, telemedicine has focused on the application of traditional physician-to-patient (and physician-to-physician) interactions enhanced by two-way video and audio capability. This "one-on-one" interaction via a telemedicine link can dramatically extend a physician's or other caregiver's geographic range and availability. However, this same telemedicine model is most often implemented "on-demand" for a specified time-limited encounter. ⋯ Multiple challenges remain before remote ICU systems become more broadly accepted and applied. These include cost of implementation of the system, resistance to the system by ICU physicians and nurses, and integration of data systems and clinical information into the remote electronic ICU model. In this chapter, we will provide background information on error reduction theory and the role of the remote ICU model, review current data supporting use of the remote ICU system, address the current obstacles to effective implementation, and look to the future of the field for solutions to these challenges.
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Cross-border activities in health care in the European single market are increasing. Many of these cross-border developments are related to e-Health. E-Health describes the application of information and communication technologies across the whole range of functions that affect the health care sector. ⋯ More and clear guidelines on the reimbursement criteria for telemedicine and on liability would also be very useful. Guidance at the European level can be given as to the criteria that (tele-) health sessions will have to comply with for reimbursement purposes, since it is still unclear when e-Health sessions will be reimbursed. It is clear that the existing European legal framework is not finished yet and that more specific European rules are needed.
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Stud Health Technol Inform · Jan 2008
Risser sign: the value of the lateral spinal radiograph to assess the excursion of the iliac apophysis.
The course of the ossification of the iliac apophysis is considered in adolescent patients with idiopathic scoliosis, under the name of the Risser sign, to determine the remaining spinal growth. Although the iliac crest develops in the three-dimensional space as a complex structure, the iliac apophysis ossification has been assessed only on a one plane frontal spinal radiograph. This study points out the usefulness of the lateral radiograph for the visualization of the whole iliac crest, especially the posterior region which otherwise cannot be observed. ⋯ The regions of the maximal thickness corresponded to the earliest appearance of the apophysis ossification (Risser 1), while the thin part of the iliac bone corresponded to late appearance of the apophysis ossification (Risser 3-4). The ossification of the posterior part of the crest was best visualized with the lateral radiograph, which was exclusive in showing the posterior superior iliac spine region. On the frontal spinal radiograph the end of the course of the apophysis (Risser 3-4) is usually searched at the level of the sacroiliac joint, while in reality this point was found to be situated more caudal, and accessible for observation on the lateral radiograph.
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Stud Health Technol Inform · Jan 2008
An artificial neural network derived trauma outcome prediction score as an aid to triage for non-clinicians.
In mass casualty events Emergency Medical Service Providers (EMS) choose treatment at Scene or a "scoop and run" approach. The latter requires clinically trained personnel at the reception site to triage patients. Current methodology based on Revised Trauma Score (tRTS) requires use of Glasgow Coma Scale, a method reliant on experience and clinical knowledge. ⋯ Models performed well in predicting mortality compared to standard outcome predictors. Possible additional variables such as gender or ethnicity might improve the Neural Network predictive ability. Pulse appears an essential variable not recorded by the NTDB.
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Stud Health Technol Inform · Jan 2008
Telemedicine for home health and the new patient: when do we really need to go to the hospital?
This chapter will review the current state-of-the-art of home health services in the telemedicine environment. Two aspects in particular will be discussed that reflect where most of the efforts in home telehealth care are being directed. ⋯ In this application, the users may be patients with chronic conditions such as asthma or diabetes that require regular monitoring to achieve or maintain healthy functioning, but they are typically not in an acute phase. More and more often, however, the users of distance monitoring technologies are relatively healthy people looking to enhance their health awareness and healthy status by monitoring various vital signs to alert them of any potential changes in their health status that would require actual medical attention.