International telemedicine

The following is a consensus statement from the Heart Editors Action Round Table Group concerning its policy on redundant publication. This statement is being published in journals represented on the panel beginning in July, 1997.     

Principles of orthotic treatment in neuromuscular diseases

Multiple mitochondrial DNA (mtDNA) deletions have been associated with aging in humans and monkeys. Since the inbred mouse strain, C57BL/6, has been extensively studied gerontologically, we sought to investigate its utility as a model for examining the importance of mtDNA deletions in aging. Using the polymerase chain reaction (PCR), we analyzed hind limb skeletal muscle from mice of three age groups (5, 16 and 25 months) for the presence of age-associated mtDNA deletions. We observed multiple mtDNA deletions in all three age groups. Further, the number of deletions detected per mouse increased greatly with advancing age.     

Early experience using telemedicine for neonatal surgical consultations

BACKGROUND/PURPOSE: Telemedicine affords the opportunity to extend the presence of surgical evaluation to centers without an on-site pediatric surgeon. However, concern for cost, accuracy of diagnosis, and physician acceptance have limited its use. METHODS: Using a low-cost, desktop computer-based system, this study was designed to test the effectiveness of telemedicine in neonatal surgical consultation. RESULTS: Early experience with six video-teleconference (VTC) and six store-and-forward consultations are presented. Diagnosis was established accurately in all cases. With the three intestinal cases (jejunal atresia, duplication cyst, and r/o malrotation), diagnostic studies were guided by the images transmitted with the consult. Earlier care could be implemented in other cases. Technical problems were encountered primarily with the VTC modality, which also proved more consuming of physician time. CONCLUSIONS: Telemedicine was used successfully in each case and proved accurate in diagnosis and guiding further evaluation. This is the first report of the use of telemedicine for surgical consultation in the intensive care nursery.     

Planning criteria for multicentre, multilingual telemedicine conferences

The international telemedicine conference Chinese TeleMed 96 was held in November 1996. This three-way teleconference included delegates in London (where the international telemedicine conference TeleMed 96 was taking place) and medical staff from one Beijing hospital and one Hong Kong medical faculty. In total, over 1000 health-care personnel across eight time-zones participated. The event demonstrated that the quality of teleconferencing technology was suitable for medical teaching, for providing medical consultations to remote locations and for stimulating medical exchanges. In general, planning a telemedicine conference requires a longer lead time, a wider representation of expertise in the organizing committee and more financial resources than conventional conferences. It is recommended that the aim and format of a telemedicine conference be determined at least one year before the target date. Criteria for improving the preparation of such conferences have been identified and a set of guidelines for future conference organizers has been drawn up.     

A framework for the economic evaluation of telemedicine

Alongitudinal study was conducted in four indicator villages of PHC Shankargarh, District Allahabad, U.P. from July 1991 to June 1992 to have information on seasonality of indoor resting anopheline species in silica sand/hard stone quarry area. Fourteen anopheline species namely, An. aconitus (0.35%), An. annularis (17.03%), An. barbirostris (0.09%), An. culicifacies (36.74%), An. fluviatilis (0.13%), An. nigerrimus (0.01%), An. pallidus (4.40%), An. splendidus (0.02%), An. stephensi (0.01%), An. subpictus (40.84%), An. tessellatus (0.15%), An. turkhudi (0.004%), An. vagus (0.20%) and An. varuna (0.02%) were collected. An. culicifacies, An. subpictus and An. annularis were found throughout the year. An. fluviatilis, An. pallidus, An. vagus and An. aconitus were also observed in all the seasons except extreme summer. However, An. barbirostris and An. splendidus were collected only in monsoon/post-monsoon and winter seasons. An. tessellatus and An. stephensi were recorded in winter and spring seasons. An. nigerrimus and An. varuna were recorded in winter, while An. turkhudi in spring. Prolonged high vector density may be attributed to the extended malaria transmission in this area.     

Experimental telemedicine in orthopaedics

An accurate technique that simplifies measurements of two- and three-dimensional specimens is presented. Photomicrographs of a microruler and of the specimens of a research project were made at the same magnification. A ruler with the exact dimensions of the photographic prints of the microruler was generated through computer graphics and printed as a transparency. After verification, the ruler was used to measure specimens directly on the photomicrographs.     

Ankle weight effect on gait: orthotic implications

Oxygen consumption during ambulation was measured in 10 normal subjects wearing ankle weights of 0.91 kg, 1.82 kg, and 2.73 kg, either on the right ankle or bilaterally. Subjects walked at self-selected speeds and oxygen consumption was measured over 1-minute intervals during steady-state walking. Oxygen consumption per unit distance and oxygen consumption rate demonstrated significant positive linear correlations with added weight (P = .001, P = 0.007, respectively). Velocity demonstrated a significant decrease when correlated with added weight (P = 0.03). Multiple regression analysis was used to relate these measures of oxygen consumption rates to velocity, age, and added weight, yielding predictive relationships. Based on these results, the weight of orthoses should be minimized in order to maximize walking velocity and minimize oxygen consumption per unit distance. The advantage of a light-weight, molded plastic ankle-foot orthosis (AFO) over heavier AFO designs is demonstrated by this study.     

Design and development of a multimedia database for emergency telemedicine

Recent studies conclude that early and specialised pre-hospital patient management contributes to emergency cases survival. Recent developments in telecommunication and medical informatics by means of telemedicine can be extremely useful to accomplish such tasks in a cost-effective manner. Along that direction, we have designed a portable device for emergency telemedicine. This device is able to telematically "bring" the expert doctor at the emergency site, have him perform an accurate diagnosis, and subsequently direct the Emergency Medical Technicians on how to treat the patient until he arrives to the hospital. The need for storing and archiving all data being interchanged during the telemedicine sessions is very crucial for clinical, legal and administrative purposes. For this, we have developed a multimedia database able to store and manage the data collected by the AMBULANCE system. The database was equipped with a user-friendly graphical interface to enable use from computer naive users. Furthermore, the database has the possibility to display, in an standard way, ECG's, X-ray, CT and MRI images. The application is password protected with a three-level hierarchy access for users with different privileges. The scope of this application is to enhance the capabilities of the doctor on duty for a more precise and prompt diagnosis. The application has the ability to store audio files related to each emergency case and still images of the scene. Finally, this database can become a useful multimedia tool which will work together with the AMBULANCE portable device, the HIS and the PACS of the hospital. The system has been validated in selected non-critical cases and proved to be functional and successful in enhancing the ability of the doctor's on duty for prompt and accurate diagnosis and specialised pre-hospital treatment.     

"Telestroke" : the application of telemedicine for stroke

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.     

Cost issues surrounding the use of computerized telemedicine for obstetric ultrasonography

Whole-body plethysmography is not included in guidelines from regulatory authorities for the development of treatments or delivery devices for lung disease, despite its potential advantages compared to spirometry. Two separate studies were undertaken to assess the use of specific airway conductance (sGaw) as a pharmacodynamic endpoint for the comparison of two bronchodilator delivery systems (a novel dry powder inhaler and a standard metered dose inhaler). The first pilot study involved delivery of a single dose of salbutamol (200 micrograms) to 12 healthy volunteers and determination of sGaw up to 120 min after treatment. The second study involved delivery of cumulative doses of salbutamol (100, 200 and 400 micrograms) to 19 healthy volunteers with demonstrated reversibility of sGaw to the bronchodilator and measurement of sGaw up to 240 min after treatment. In both studies, increases in sGaw after treatment were significant compared to placebo and larger than the recorded increases in FEV1. Increases in sGaw were similar for both delivery devices and support the therapeutic equivalence of the two products. Power calculations indicated that the second study had appropriate statistical power to discriminate between treatments. It is concluded that the assessment of sGaw in healthy volunteers may be a useful and sensitive pharmacodynamic endpoint for use in the development of bronchodilators and their delivery devices.     

Successful development of telemedicine systems--seven core principles

This article discusses seven core principles that underlie the development of successful telemedicine systems. These principles have been formulated from evidence in the literature and from the personal experience of setting up three telemedicine systems in Australia. Of particular importance has been the observation of failed telemedicine systems, of which there are many examples in the world literature. It is important to learn from history by studying both the successful and the unsuccessful components of these programmes. Telemedicine is still a relatively new area of interest, and while the technology is rapidly evolving, changing and fascinating, it is still the human factors that tend to determine the success or failure of telemedicine projects. These cannot be ignored.     

Performance improvement in telemedicine: the essential elements

Performance improvement activities in telemedicine may be placed into five categories. (1) Licensing and credentialing. Telemedicine overcomes geographical boundaries, but its reach is constrained by state laws on licensing. Some states require a state license, whereas others grant "consultation exemptions" for out-of-state physicians. Simple renewable licenses do not guarantee quality. Potential solutions include a national telemedicine license or license reciprocity laws for telemedicine. (2) Data security and privacy. Telemedicine technology raises some security concerns. Differences in reporting requirements among states complicate the issue of privacy. Storage of telemedicine consultation records may help physicians document care decisions for risk management, but conventional long-term storage may not be feasible because of cost constraints and may not be required to document the encounter appropriately. (3) Informed consent. Potential failures in security and transmission are new, and should be communicated to the patient. (4) Peer review. Peer review findings encourage thorough, accurate, and legible documentation. Results should be recorded by provider and must be available during the recredentialing process. (5) Tailored performance improvement initiatives. By using established principles and techniques, performance improvement initiatives can gather, analyze, and communicate information about the cost-effectiveness of telemedicine. These performance improvement efforts are the heart of quality management and are critical to the justification of telemedicine. Walter Reed Telemedicine has put into effect a performance improvement plan in accordance with this outline. This article describes the plan and suggests it as a model for other telemedicine programs.     

Device for remote control of equipment

Novolipetsk Metallurgical Combine. Translated from Metallurg, No. 1, pp. 33–34, January, 1990.     

Canada produces its first MD specializing in telemedicine

Originally Dr. Rod Elford had planned to pursue a career in sports medicine. An introduction to space medicine and the possibilities inherent in telemedicine changed all that, and last year he became the first Canadian physician to complete a clinical fellowship in this emerging field. Observers think he is likely to be the first of many.     

远程银行智能信息安全模型

对银行的三种营业模型进行分析后指出,现代“机—机”模型是未来银行的必然经营方式,而其关键技术是储户的身份甄别和确保交互信息在网路中的安全。提出了两种安全性控制策略,即双密钥(伴随密钥)与语音智能识别,前者绕过了身份直接甄别,后者则是用动态语音代替动态图像来甄别身份。最后对问题求解策略及算法给出了框架性描述。