Development of a teletechnology protocol for in-home rehabilitation.
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Our ability to provide in-home rehabilitation is limited by distance and available personnel. We may be able to meet some rehabilitation needs with videoconferencing technology. This article describes the feasibility of teletechnology for delivering multifactorial, in-home rehabilitation interventions to community-dwelling adults recently prescribed a mobility aid. We used standard telephone lines to provide two-way video and audio interaction. The interventions included prescription of and/or training in functionally based exercises, home-hazard assessment, assistive technology, environmental modifications, and adaptive strategies. Patients were evaluated in three transfer and three mobility tasks, and appropriate treatment was provided over the course of four visits. To date, 13 of the 14 subjects enrolled in the rehabilitation study have completed all four visits (56 visits total). Equipment-related problems were most common early in the study, particularly on the initial visit to a subject's house. We identified (mean +/- standard deviation [SD]) 13.1 +/- 7.9 mobility/self-care problems per subject and made 12.5 +/- 8.3 recommendations per subject to address those problems. At 6-week follow-up, 60.1 percent of our recommendations had been implemented. The greatest number of problems was identified for tub transfers (mean +/- SD = 3.4 +/- 1.4), the greatest number of recommendations was made for toilet transfers (mean +/- SD = 3.1 +/- 3.4), and the most frequently implemented recommendations were for transition between locations. Overall, our results show promise that both the telerehabilitation technology and intervention procedures are feasible. (+info)
Telemedicine in dermatology: a randomised controlled trial.
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OBJECTIVES: To compare the clinical equivalence, patient and clinician opinion of store-and-forward (SF) teledermatology with conventional face-to-face consultation in setting a management plan for new, adult outpatient referrals. To assess the equivalence of digital photography and dermoscopy with conventional face-to-face consultation in the management of suspected cases of malignant melanoma or squamous cell carcinoma. DESIGN: For the SF teledermatology aspect of the study, a prospective randomised controlled trial was carried out. SETTING: Eight general practices and a hospital dermatology department in Sheffield, England. PARTICIPANTS: For the SF teledermatology part of the study, adults (aged 16 years and over) requiring a new (not seen by a hospital dermatologist within the past year) consultant opinion. For the digital photography element of the study, adults (aged 16 years and over) requiring a consultant opinion due to suspicion of malignant melanoma or squamous cell carcinoma. INTERVENTIONS: Patients in the telemedicine intervention group were referred to the consultant, and managed as far as possible using one or more digital still images and a structured, electronic referral and reply. The control group was managed by conventional hospital outpatient consultation. Patients referred to the 2-week wait clinic were invited to have a series of digital photographs, with and without dermoscopy, immediately before their face-to-face consultation. A second consultant viewed these and outlined a diagnosis and management plan which was compared with the actual management. Both were compared with the definitive diagnosis (either the final clinical or histological diagnosis, where undertaken). MAIN OUTCOME MEASURE: The concordance between the consultant who had managed the case and an independent consultant who gave a second face-to-face opinion. RESULTS: A total of 208 patients were recruited. There was also a greater loss of control cases (26%) than intervention cases (17%). A statistically significant difference in ages between the two groups completing the study (mean age of intervention group 43.6 years, control group 49.7 years, p = 0.039) indicates that this may have introduced a bias between the two groups. A further possible source of bias is the delay (mean difference of 54 days, p = 0.0001) between the SF opinion and the second opinion in the SF group, whereas control patients usually received their second opinion on the same day as their outpatient appointment. In 55% (51/92) of telemedicine cases and 78% (57/73) of control cases, the diagnosis concurred, with the second opinion. In 55% (51/92) of telemedicine cases and 84% (61/73) of control cases, the management plan concurred with the second opinion. Of the 92 telemedicine cases, 53 were judged also to require a face-to-face consultation, mainly to establish a diagnosis and treatment plan. With the digital photography for suspected skin cancer aspect of the study, it was found that an unexpectedly high proportion (33%, 85/256) of referrals proved to have a malignancy or a severely dysplastic lesion, with almost 22% having a malignant melanoma or squamous cell carcinoma, possibly reflecting the rise in incidence of skin cancers reported elsewhere. When both standard and dermoscopic images were employed, diagnostic concordance was modest (68%). The approach was highly sensitive (98%, 95% CI: 92 to 99%), at the expense of specificity (43%, 95% CI: 36 to 51%). Overall, 30% of cases would not have needed to be seen face-to-face, though two squamous cell carcinomas would have been missed (a number-needed-to-harm of 153). If the highest level of clinician confidence had been applied, no cancers would have been missed, but only 20% of patients would have avoided an outpatient appointment. CONCLUSIONS: In view of the difficulties in recruitment and the potential biases introduced by selective loss of patients and the delay in obtaining a valid second opinion in the study group, no valid conclusions can be drawn regarding the clinical performance of this model of SF telemedicine. With regard to digital photography in suspected skin cancer, it is unlikely that this approach can dramatically reduce the need for conventional clinical consultations, whilst still maintaining clinical safety. Additional research on the assessment of diagnostic and management agreement between clinicians would be valuable in this and other fields of research. (+info)
Prof-in-a-Box: using internet-videoconferencing to assist students in the gross anatomy laboratory.
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BACKGROUND: The optimal learning environment for gross anatomy is the dissection laboratory. The Prof-in-a-Box (PiB) system has been developed where an anatomist using distance-learning technologies 'helps' students in a dissection laboratory at a different site. METHODS: The PiB system consists of: (1) an anatomist in his/her office with a computer and video camera; (2) a computer and 2 video cameras in the lab; (3) iChat AV software; (4) a secure server to host the PiB-student 'consultation'. The PiB system allows the students and faculty to interact via audio and video providing an environment where questions can be asked and answered and anatomical structures can be identified 'at a distance' in real-time. The PiB system was set up at a prosected cadaver and made available for student use during 'office hours'. RESULTS: 25-30% of the students used the PiB system. Anatomical structures were identified, questions answered and demonstrations given 'at a distance' using the system. Students completed an optional questionnaire about the PiB system at the end of the semester. Results of the questionnaire indicate that the students were enthusiastic about the PiB system and wanted its use to be expanded in the future. CONCLUSION: Many of the functions of a faculty member in the gross anatomy dissection laboratory can be performed 'at a distance' using the PiB system. This suggests that a geographically dispersed faculty could assist in providing instruction in the dissection labs at multiple medical schools without needing to be physically present. (+info)
Training digital divide seniors to use a telehealth system: a remote training approach.
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As the use of health information technologies continues to proliferate amongst seniors, many of whom lack computer experience, there is a need to develop effective training approaches to foster basic competencies. This paper describes the REmote Patient Education in a Telemedicine Environment (REPETE) system, a component of the IDEATel telemedicine architecture. The REPETE architecture supports simultaneous visual and audio teaching modes over low bandwidth connections. This paper presents an in-depth qualitative analysis of two patients being trained to use the IDEATel patient web portal. The results indicate that this method of instruction was useful in facilitating patients' use of the web application. However, the observations suggest that there is learning curve for the trainer to use the resources effectively to establish common ground and foster competencies in the patient. (+info)
A telehealth case study of videophone use between family members.
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This case study extends beyond the institution-centric provider-patient dyad to examine telehealth communication between a nursing home resident and a geographically distant family member. The participants communicated regularly for three months by videophone. They found technical performance and usability acceptable and were generally satisfied with this application of telehealth technology. They assumed a strong role in self-remedying technical and usability problems they experienced. Potential implications associated with such use of telehealth technology by residence-based patients and their significant others, and the self-directedness displayed by participants in this case study, are discussed. (+info)
Design and evaluation of International Video Teleconference (iVTC) for orthopedic trauma education.
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This poster describes the design and evaluation of an International Video Teleconference (iVTC) system for orthopedic trauma case studies. Three medical facilities in the United States and one in Australia participated in monthly sessions where past and ongoing military and civilian cases were discussed. Participant feedback indicated that iVTC fully met their expectations as an educational tool and that remote participation did not adversely impact their ability to engage in discussion. (+info)
Supporting rural carers through telehealth.
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INTRODUCTION: Videoconferencing is now a firmly established feature of rural health care in Australia. However, the health sector has not used videoconferencing extensively outside the provision of clinical care. This article describes a program of education and support to rural carers via videoconferencing which demonstrates its potential in promoting health. METHODS: Semi-structured interviews were conducted with six service providers, eight carers who participated in sessions and the facilitator of the sessions. Attendance and financial records augmented the interview data. RESULTS: Videoconferencing was well accepted by carers and the facilitator. Carers reported having a positive interaction with the facilitator and other participants despite being at a distance, and the facilitator found the technology offered her more ways to observe non-verbal cues discretely. Carers demonstrated that they had retained information provided and that they had made small behaviour changes. They credited the success to sharing experiences with peers. Local providers of aged care services stressed that the sessions offered a service that they, who were employed to be 'problem-solvers', were not able to perform but that as a result of the sessions they could target services more effectively. Videoconferenced sessions were 16% and 47% of the cost of a face-to-face session. CONCLUSIONS: This study demonstrates that videoconferencing can be used to provide psychosocial support and training to groups of isolated carers. The critical element of this program was that local services were augmented and enhanced through the use of a facilitator who brought skills that were not available locally. (+info)
Store and forward teledermatology.
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Store and forward and real time or videoconferences are the two types of teledermatology services practiced. Dermatology and radio-diagnosis are visual specialties suited for store-and-forward teledermatology (SAFT). Advances in information technology, electronic instruments and biotechnology have revolutionized and brought changes in SAFT. Cellular phone, digital camera, personal digital assistants, Wi-Fi, Wi-Max and computer- aided-design software are incorporated to deliver the quality health care to remote geographic regions. Complete SAFT care equivalent to face-to-face consultation (Gold standard) is essential. Health care providers in rural areas are the 'eyes' for the consultants. Consultants to guide them should have a rapid periodic audit of visual parameters and dimensions of lesions. Given this background, this article reviews advances in 1) capture, store and transfer of images. 2) Computer Aided measurements of generalized and localized lesions and 3) the integration model to meet all the above two requirements in a centralized location. This process enables diagnosis, management, periodic assessment and complete follow-up care to achieve patient and physician satisfaction. Preservation of privacy and confidentiality of digital images is important. Uniform rules and regulations are required. Indian space research organization (ISRO), Government of India has demonstrated telemedicine pilot projects utilizing the satellite communication and mobile telemedicine units to be useful in meeting the health care needs of remote and rural India. we have to join hands with them to meet dermatology problems in rural areas. (+info)