Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 6 Articles
Background: Telemedicine has been advocated as an effective means to provide health care\r\nservices over a distance. Systematic information on costs and consequences has been called for to\r\nsupport decision-making in this field. This paper provides a review of the quality, validity and\r\ngeneralisability of economic evaluations in telemedicine.\r\nMethods: A systematic literature search in all relevant databases was conducted and forms the\r\nbasis for addressing these issues. Only articles published in peer-reviewed journals and written in\r\nEnglish in the period from 1990 to 2007 were analysed. The literature search identified 33\r\neconomic evaluations where both costs (resource use) and outcomes (non-resource\r\nconsequences) were measured.\r\nResults: This review shows that economic evaluations in telemedicine are highly diverse in terms\r\nof both the study context and the methods applied. The articles covered several medical specialities\r\nranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home\r\ncare, and in primary and secondary care settings using a variety of different technologies including\r\nvideoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies\r\nused multiple outcome measures and analysed the effects using disaggregated cost-consequence\r\nframeworks. Objectives, study design, and choice of comparators were mostly well reported. The\r\nmajority of the studies lacked information on perspective and costing method, few used general\r\nstatistics and sensitivity analysis to assess validity, and even fewer used marginal analysis.\r\nConclusion: As this paper demonstrates, the majority of the economic evaluations reviewed were\r\nnot in accordance with standard evaluation techniques. Further research is needed to explore the\r\nreasons for this and to address how economic evaluation in telemedicine best can take advantage\r\nof local constraints and at the same time produce valid and generalisable results....
Advances in information and communication technologies are changing the delivery of trauma care and\r\neducation. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the\r\nworld. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through\r\nvideoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars,\r\nconferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as\r\nenhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine\r\nfor trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across\r\nthe world....
performance can be optimised. In the context of a formative evaluation referring clinician and patient satisfaction\r\nwith a teleneurophysiology service was examined during a 20 week pilot period.\r\nMethods: Questionnaire surveys of referring clinicians and patients were conducted.\r\nResults: Fifteen (58%) clinicians responded to the first part of a postal survey which examined their satisfaction\r\nwith traditional clinical neurophysiology services. Nine (35%) responded to a second part which assessed their\r\nexperience with the teleneurophysiology service. Teleneurophysiology improved satisfaction with waiting times,\r\navailability of results and impact on patient management. There was unanimous support from the clinicians for the\r\npermanent development of a teleneurophysiology service, although 2 cautioned this could delay establishing a\r\nneurology service in their region.\r\nEighty-two percent (116/142) of patients responded to a survey of their satisfaction with teleneurophysiology. This\r\nwas compared to a previous report of 322 patients� experience with traditional CN services in Ireland. Waiting\r\ntimes for appointment were shorter for the former group who supported the telemedicine model recognising that\r\nit reduced the travel burden and need for overnight journeys. The two groups were equally anxious about the\r\ninvestigation although the teleneurophysiology patients received more prior information.\r\nConclusion: This study illustrates that teleneurophysiology is an acceptable model of service delivery for its\r\nprimary customers. Their feedback is important in informing appropriate design and governance of such innovative\r\nmodels of health service provisio....
Biomedical sensors, called invivo sensors, are implanted in human bodies, and cause some harmful effects on surrounding body\r\ntissues. Particularly, temperature rise of the invivo sensors is dangerous for surrounding tissues, and a high temperature may\r\ndamage them from a long term monitoring. In this paper, we propose a thermal-aware routing algorithm, called least total-routetemperature\r\n(LTRT) protocol, in which nodes temperatures are converted into graph weights, and minimum temperature routes\r\nare obtained. Furthermore, we provide an extensive simulation evaluation for comparing several other related schemes. Simulation\r\nresults show the advantages of the proposed scheme....
Introduction: Telemedicine extends intensivists� reach to critically ill patients cared for by other physicians. Our\r\nobjective was to evaluate the impact of telemedicine on patients� outcomes.\r\nMethods: We searched electronic databases through April 2012, bibliographies of included trials, and indexes and\r\nconference proceedings in two journals (2001 to 2012). We selected controlled trials or observational studies of\r\ncritically ill adults or children, examining the effects of telemedicine on mortality. Two authors independently\r\nselected studies and extracted data on outcomes (mortality and length of stay in the intensive care unit (ICU) and\r\nhospital) and methodologic quality. We used random-effects meta-analytic models unadjusted for case mix or\r\ncluster effects and quantified between-study heterogeneity by using I2 (the percentage of total variability across\r\nstudies attributable to heterogeneity rather than to chance).\r\nResults: Of 865 citations, 11 observational studies met selection criteria. Overall quality was moderate (mean score on\r\nNewcastle-Ottawa scale, 5.1/9; range, 3 to 9). Meta-analyses showed that telemedicine, compared with standard care, is\r\nassociated with lower ICU mortality (risk ratio (RR) 0.79; 95% confidence interval (CI), 0.65 to 0.96; nine studies, n = 23,526;\r\nI2 = 70%) and hospital mortality (RR, 0.83; 95% CI, 0.73 to 0.94; nine studies, n = 47,943; I2 = 72%). Interventions with\r\ncontinuous patient-data monitoring, with or without alerts, reduced ICU mortality (RR, 0.78; 95% CI, 0.64 to 0.95; six\r\nstudies, n = 21,384; I2 = 74%) versus those with remote intensivist consultation only (RR, 0.64; 95% CI, 0.20 to 2.07; three\r\nstudies, n = 2,142; I2 = 71%), but effects were statistically similar (interaction P = 0.74). Effects were also similar in higher\r\n(RR, 0.83; 95% CI, 0.68 to 1.02) versus lower (RR, 0.69; 95% CI, 0.40 to 1.19; interaction, P = 0.53) quality studies. Reductions\r\nin ICU and hospital length of stay were statistically significant (weighted mean difference (telemedicine-control), -0.62\r\ndays; 95% CI, -1.21 to -0.04 days and -1.26 days; 95% CI, -2.49 to -0.03 days, respectively; I2 > 90% for both).\r\nConclusions: Telemedicine was associated with lower ICU and hospital mortality among critically ill patients,\r\nalthough effects varied among studies and may be overestimated in nonrandomized designs. The optimal\r\ntelemedicine technology configuration and dose tailored to ICU organization and case mix remain unclear....
Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular followup\r\neven after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing online\r\nspecialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been introduced in the\r\nregional healthcare network in order to make it compliant with current legal regulations on data protection, including smartcard\r\nauthentication. Although a number of training courses have been made to introduce SCI persons to portal use (up to 50 users),\r\nthe number of accesses remained very low. Reasons for that have been investigated by means of a questionnaire submitted to the\r\ninitial feasibility study subjects and included the still easier use of telephone versus our web-based smartcard-authenticated portal,\r\nin particular, because online communications are still perceived as an unusual way of interacting with the doctor. To summarize,\r\nthe overall project has been appreciated by the users, but when it is time to ask for help to, the specialist, it is still much easier to\r\nmake a phone call....
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