Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy.
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BACKGROUND: Previous short-term work reported fewer suicides among elderly users of a telephone helpline and emergency response service (the TeleHelp-TeleCheck Service). AIMS: To examine long-term effects of the service on suicide in an elderly population of northern Italy. METHOD: The service provided twice-weekly support and needs assessment telephone calls and a 24h emergency alarm service. Data from 1988 to 1998 allowed comparison of 18 641 service users with a comparable general population group of the Veneto region in Italy. RESULTS: Significantly fewer suicide deaths (n(OBSERVED)=6) occurred among elderly service users (standardised mortality ratio (SMR) 28.8%) than expected (n(EXPECTED)=20.86; chi(2)=10.58, d.f.=1, P<0.001) despite an assumed overrepresentation of persons at increased risk. The service performed well for elderly females (n(OBSERVED)=2, SMR=16.6%, n(EXPECTED)=12.03; chi(2)=8.36, d.f.=1, P<0.001). CONCLUSIONS: The study confirms the initial promise of the TeleHelp-TeleCheck service over a much longer time period. Further research will clarify the apparent lack of benefit for elderly males. (+info)
Self-help for bulimic disorders: a randomised controlled trial comparing minimal guidance with face-to-face or telephone guidance.
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BACKGROUND: There is great potential demand for treatment of bulimia nervosa and binge eating disorder. Skilled therapists are in short supply. Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases. AIMS: To investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service. METHOD: A randomised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption over the subsequent 8 months. RESULTS: Self-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months. There is also some evidence to support the use of telephone guidance. A minority of participants achieved lasting remission of their disorder in relation to self-help, but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme. Patients initially offered guided self-help had a lower long-term drop-out rate. CONCLUSIONS: Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder. It is a treatment that could be delivered in primary care and in other non-specialist settings. (+info)
Robot-assisted surgical systems: a new era in laparoscopic surgery.
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The introduction of laparoscopic surgery offers clear advantages to patients; to surgeons, it presents the challenge of learning new remote operating techniques quite different from traditional operating. Telemanipulation, introduced in the late 1990s, was a major advance in overcoming the reduced dexterity introduced by laparoscopic techniques. This paper reviews the development of robotic systems in surgery and their role in the operating room of the future. (+info)
Effects of current and future information technologies on the health care workforce.
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Information technologies have the potential to affect the types and distribution of jobs in the health care workforce. Against a background of an explosively growing body of knowledge in the health sciences, current models of clinical decision making by autonomous practitioners, relying upon their memory and personal experience, will be inadequate for effective twenty-first-century health care delivery. The growth of consumerism and the proliferation of Internet-accessible sources of health-related information will modify the traditional roles of provider and patient and will provide opportunities for new kinds of employment in health-related professions. (+info)
Doctors in a wired world: can professionalism survive connectivity?
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The information revolution has the potential to reduce the asymmetry of information between patients and doctors and thereby to undermine a central pillar of physicians' claim to professional status: the possession of distinctive competence based on technical know-how selflessly applied and collectively monitored. A close analysis of the information revolution's likely effects suggests that for some patients with some conditions, their access to more and better information will indeed reduce the magic, mystery, and power of the medical profession. However, the information revolution also offers opportunities for physicians to bolster the cognitive and moral bases of professionalism. To seize those opportunities, physicians must master new roles and skills and avoid unacceptable conflicts of interest. (+info)
Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment.
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BACKGROUND: Heart murmurs are common in children, and they are often referred to a specialist for examination. A clinically innocent murmur does not need further investigation. The referral area of the University Hospital is large and sparsely populated. A new service for remote auscultation (telemedicine) of heart murmurs in children was established where heart sounds and short texts were sent as an attachment to e-mails. AIM: To assess the clinical quality of this method. METHODS: Heart sounds from 47 patients with no murmur (n = 7), with innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor based stethoscope and e-mailed to a remote computer. The sounds were repeated, giving 100 cases that were randomly distributed on a compact disc. Four cardiologists assessed and categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded the assessment time per case, their degree of certainty, and whether they recommended referral. RESULTS: On average, 2.1 minutes were spent on each case. The mean sensitivity and specificity were 89.7% and 98.2% respectively, and the inter-observer and intra-observer variabilities were low (kappa 0.81 and 0.87), respectively. A total of 93.4% of cases with a pathological murmur and 12.6% of cases with an innocent murmur were recommended for referral. CONCLUSION: Telemedical referral of patients with heart murmurs for remote assessment by a cardiologist is safe and saves time. Skilled auscultation is adequate to detect patients with innocent murmurs. (+info)
Operative fetoscopy via telesurgery.
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We describe a case in which telesurgical consultation from Tampa, Florida, USA was used to accomplish operative fetoscopy in Santiago, Chile for the treatment of a twin pregnancy involving an acardiac twin. The procedure was successful and a healthy infant was delivered at 37.5 weeks. Operative fetoscopy, a surgical approach to correct birth defects in utero via combined ultrasound and endoscopy, is only available in a handful of centers worldwide. Telesurgery makes use of telecommunication to allow a surgeon at a primary operating site to consult with another experienced surgeon for complex surgical cases. This case illustrates the potential for ultrasound and telesurgery to expand the horizons of operative fetoscopy. (+info)
Interpretation and reporting of myocardial perfusion SPECT: a summary for technologists.
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Interpretation of cardiac perfusion SPECT images, and the subsequent reporting of results to referring physicians, are sometimes taken to be outside the sphere of the nuclear medicine technologist. However, all personnel involved with nuclear medicine procedures contribute to the timeliness and usefulness of the final report. The goal of this article is to review the principles of scan interpretation and reporting, from the standpoint of what technologists need to understand about these processes. In addition, software tools to aid these processes will be discussed, including quantitative image analysis, telemedicine, computer-aided scan interpretation, databases, computer-aided reporting, and Internet-based reporting. Finally, the accuracy of the scan report will be related to the tasks normally performed by technologists, such as the acquisition and processing of images and the entry, transfer, and networking of data. After reading this article, the reader will be able to describe the principles of scan interpretation and reporting, the software tools for telemedicine and computer-aided interpretation, and the role of the technologist in this process. (+info)