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Evaluation of the effectiveness of portable low-bandwidth telemedical applications for postoperative followup: Initial results

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2000年第2期191卷 196-203页

作者： Rosser, JC Prosst, RL Rodas, EB Rosser, LE Murayama, M Brem, H Yale Univ Endolaparoscop Ctr Dept Surg New Haven CT 06510 USA

Background: The idea of using telemedical applications to evaluate patients remotely is several decades old. It has already been established that x-ray images (and magnetic resonance images) can be transferred using a personal computer and a modem, and many other such applications have been implemented. Over the past 50 years the expense and technical demands of the equipment involved in telemedicine have hindered its widespread deployment. The purpose of this study is to evaluate the ability of a mobile, low-bandwidth telemedicine platform to achieve real-time postoperative visits in the home. Study Design: This evaluation was designed to evaluate the feasibility of performing a real-time clinical visit with computer and telecommunications hardware and software. A nurse and medical student (for information gathering only) made postoperative visits at patients' homes while the physician stayed at the office. Clinical evaluations were performed by using low-resolution and frame-rate video, high-resolution still images, and simultaneous telephony over a standard telephone line. These remote visits were followed by a standard visit in the office. Eleven patients were included, all of whom had undergone various laparoscopic procedures. They lived 5 to 240 miles from their surgeon. Efficiency was measured by recording the time required to capture and send data required by the physician to make a clinical decision. The time expense was measured at both the patients' and physician's locations. Technical issues were evaluated and patient satisfaction was assessed by standardized objective questionnaires. The accuracy of the evaluation at the remote visit was determined with a standard office visit. Results: No technical problems were observed. The mean total time of the housecall at the remote site was 86 minutes (range 60 to 160 minutes) and at the base station site was 41 minutes (range 21 to 71 minutes). After personnel became familiar with the system, the last three vis

关键词：决策效率评价研究(主题) 可行性研究随访研究出诊腹腔镜检查微型计算机调制解调器护士诊室就医病人满意度手术后医护远程会诊/仪器和设备远程会诊/方法软件学生医科电话时间因素录像成年人老年人女(雌)性人类男(雄)性中年人

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Three-dimensional ultrasonographic telepresence

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JOURNAL OF TELEMEDICINE AND TELECARE 1998年第4期4卷 224-230页

作者： Macedonia, CR Littlefield, RJ Coleman, J Satava, RM Cramer, T Mogel, C Eglinton, G Georgetown Univ Med Ctr Dept Obstet & Gynecol Washington DC 20007 USA Pacific NW Natl Lab Hanford WA USA Yale Univ Sch Med Dept Surg New Haven CT 06510 USA Telemed Res Lab Ft Detrick MD USA

We have developed a three-dimensional ultrasound telepresence system for remote consultation. Three-dimensional ultrasound data-sets can be acquired by relatively unskilled operators. The data are stored in the remote unit and then transmitted to a consultant equipped with a similar unit. A telepresence pointing device enables the consultant to re-slice that data-set in any plane. During the study period, 72 volumetric scans of male and female volunteers aged 18-45 years were performed in Bosnia. Field users of limited ultrasound experience (most with less than 30 min of training) were able to acquire volumetric scans, send volume data and interact with remote consultants over standard communications lines at distances of up to 20,000 km. Communications links from 9.6 to 1500 kbit/s were used. Technical limitations included lack of motion data, lack of colour data, scan artefacts and increased scan-to-diagnosis time. However, our preliminary experience indicates that this technique may eventually prove to be a useful adjunct to telesonography. Further studies of the technique are needed to determine its value in the broader clinical setting.

关键词：波斯尼亚-黑塞哥维那军事医学/方法远程会诊/仪器和设备遥测术/仪器和设备遥测术/方法超声检查/仪器和设备超声检查/方法青少年成年人女(雌)性人类男(雄)性中年人

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A feasibility study of realtime teledermatology in Finland

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第2期6卷 102-107页

作者： Lamminen, H Tuomi, ML Lamminen, J Uusitalo, H Primary Hlth Care Ctr Ikaalinen Finland Tampere Univ Hosp Dept Dermatol & Venereol Tampere Finland Arcus Software Tampere Finland Tampere Univ Hosp Dept Ophthalmol Tampere Finland

We conducted a feasibility study of teleconsultation in dermatology using low-cost equipment. Patients and their general practitioners took part in consultations from the Primary Health Care Centre in Ikaalinen with a dermatologist 55 km away at the Tampere University Hospital (TAUH). Consultations were performed using standard commercial videoconferencing equipment, a modified document camera and a dermatoscope. A single ISDN line (128 kbit/s) was used for the connection. During the eight months of the study, 25 patients participated in a teledermatology consultation. Their mean age was 45 years (range 4-92). The average time the patient spent in travelling to the videoconsultation (i.e. one way) was 24 min (range 5-65 min). The mean time spent in the teleconsultation was 15 min (range 5-30 min). After the teleconsultation, patients' treatments changed in 19 cases (76%), diagnoses were changed in 13 cases (52%) and 18 patients (72%) did not need to go to the TAUH. The equipment was generally reliable and easy to use. However, the dermatoscope was not very useful and only one of the consultations relied mainly on it. The cost of the teleconsultations for the 18 patients who avoided travel to the TAUH was FM18,627. The total costs for the 18 conventional consultations in the TAUH would have been FM18,034. The main economic benefits of the videoconferencing were attributable to the reduced travelling and hospital costs. The economic benefits of medical education were more difficult to quantify.

关键词：计算机系统成本及成本分析可行性研究芬兰卫生服务易得程度病人满意度远程会诊/经济学远程会诊/仪器和设备远程会诊/方法皮肤疾病/诊断皮肤疾病/治疗遥测术/仪器和设备青少年成年人老年人老年人 80以上儿童儿童学龄前人类中年人

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Realtime remote consultation in the outpatient clinic - experience at a teaching hospital

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第1-Sup期5卷 70-71页

作者： Wan, ACT Gul, Y Darzi, A St Marys Hosp Imperial Coll Sch Med Acad Surg Unit London W2 1NY England

We used an outpatients' telemedicine clinic to evaluate remote consultation in a London hospital practice. Video-images were relayed by ISDN at 384 kbit/s between the main hospital site and the sister hospital. Teleconsultation was evaluated in three different specialties: pain management, orthopaedics and general surgery. Medical personnel involved in the consultation consisted of a resident or senior house officer at the remote site and a senior registrar or consultant at the main hospital. A total of 146 consultations was held over a six-month period in the three clinical specialties involved. Questionnaires were completed by 58% of patients and over 90% of the medical personnel involved. The mean scores ton a five-point Likert scale) for physician satisfaction at the main and distant site were 3.6 and 3.8, respectively. On a scale of 0-10, 92% of patients rated the consultation 8-10 and 90% indicated that they would return for a similar consultation. Seventy-three per cent felt that a similar consultation from their referring doctor would have been appropriate. Confidence in the diagnosis was high among the specialists at the main hospital site.

关键词：计算机系统可行性研究医院教学矫形外科学门诊部医院疼痛/治疗远程会诊/仪器和设备远程会诊/方法外科手术人类

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Videoconferencing: what are the benefits for dental practice?

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BRITISH DENTAL JOURNAL 2000年第2期188卷 67-70页

作者： Cook, J Austen, G Stephens, C Univ Bristol Inst Learning & Res Technol Bristol BS8 1HH Avon England Univ Bristol Sch Dent Bristol BS8 1TH Avon England

For more than 3 years members of the TeleDent team from Bristol University have been looking at the potential of videoconferencing technology for dentistry Here they explain what videocanferencing is and how it can help the GDP. They discuss examples of its most promising uses for the profession, which include professional updating and providing diagnostic support at a distance. They describe the equipment that is needed, the different types of system available and give an indication of costs. A suggested procedure for using the technology for remote referrals is outlined. 'Store and forward' techniques are also discussed. These do not involve a live video but involve the sending of static electronic files. This approach is compared with videoconferencing, and the article looks at the question of which will be best suited to the GDP, and for what purposes.

关键词：计算机系统成本及成本分析开业医生牙科信息存储和检索转诊和会诊远程会诊/分类远程会诊/经济学远程会诊/仪器和设备电信/分类电信/经济学电信/仪器和设备远程医学/分类远程医学/经济学远程医学/仪器和设备录像人类

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A prospective study of teleconferencing for orthopaedic consultations

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第1期5卷 62-66页

作者： Aarnio, P Lamminen, H Lepistö, J Alho, A Satakunta Cent Hosp Dept Surg Pori 28500 Finland Orton Orthopaed Hosp Invalid Fdn Helsinki Finland

We carried out a prospective study of teleconsulting in orthopaedics. A commercial videoconferencing system was connected by three ISDN lines between the Satakunta Central Hospital in Pori and the Orton Orthopaedic Hospital in Helsinki, 240 km away. A document camera was used to transfer radiographic images and paper documents. Twenty-nine patients who needed an orthopaedic consultation were studied over three months. They were examined by a surgeon in Pori with the aid of teleconferencing and again later in a traditional, face-to-face appointment in Helsinki. Patients and doctors completed questionnaires after the consultations. Technically, the videoconferencing system functioned reliably and the quality of the video was judged to be good. Twenty patients (69%) would not have needed to travel for a face-to-face appointment, because the teleconsultation afforded a definite treatment decision. The orthopaedic surgeons considered all the treatment decisions arising from the teleconsultation good, except in one case which was considered satisfactory. The quality of the radiographic images transferred with the document camera was good or very good in 17 cases and satisfactory in three cases. None of the patients had experienced videoconferencing before;87% of them thought that teleconsultation was a good or very good method and the rest felt that it was satisfactory. All patients wanted to participate in teleconsultations again and most would have recommended it to other patients.

关键词：矫形外科学/方法病人满意度前瞻性研究远程会诊/仪器和设备远程会诊/方法青少年成年人女(雌)性人类男(雄)性中年人

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Teleconsultation for cooperative acquisition, analysis and reporting of ultrasound studies

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第1-Sup期5卷 78-80页

作者： Ribeiro, R Conceiçao, R Rafael, JA Pereira, AS Martins, M Lourenço, R Fonseca, L Galvao, F Damas, L Univ Aveiro INESC Dept elect & Telecommun P-3810 Aveiro Portugal CET Portugal Telecom Aveiro Portugal Hosp Dist Aveiro Aveiro Portugal

We have developed a teleconsultation system to support cooperation between doctors at different institutions in the acquisition, analysis and reporting of ultrasound studies. All the relevant activities were supported by the application. The system enabled remote supervision of the ultrasound study as it was being performed, cooperative static image acquisition and analysis, as well as report writing. Cooperative analysis of previously acquired studies was also possible. The system is undergoing evaluation in five hospitals in Portugal.

关键词：计算机系统数据库事实型图像处理计算机辅助葡萄牙远程会诊/仪器和设备远程会诊/方法软件超声检查人类

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Telemedicine and pediatric surgery

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Seminars in Pediatric Surgery 2000年第1期9卷 40-47页

作者： Beals, D.A. Fletcher, J.R. Department of Surgery College of Medicine University of South Alabama Mobile AL 36604 United States

The practice of pediatric surgery has become increasingly demanding, requiring longer working hours with less reimbursement. Although manpower in this field is adequate, there are still areas that are underserved. Advances in technology offer the pediatric surgeon tools to improve efficiency of practice, cover wider areas of practice, and service underserved locations. The purpose of this report is to introduce the pediatric surgeon to telemedicine technology and its potential impact on the practice environment. The history, key components, and current applications of telemedicine are presented. The ability to integrate this technology in pediatric surgical practice holds great potential. (C) 2000 by W.B. Saunders Company.

关键词：计算机系统缺医地区儿科学远程会诊/仪器和设备外科学儿童人类

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Remote-guided surgical navigation in ENT surgery

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Studies in Health Technology and Informatics 1996年 29卷 280-282页

作者： Truppe, M.J. Freysinger, W. Gunkel, A.R. Thumfart, W.F. ARTMA Medizintechnik GmbH Am Kanal 27 A-1110 Wien Austria HNO-Universitaetsklinik Innsbruck Anichstrasse 35 A-6020 Innsbruck Austria

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Teleproctoring laparoscopic operations with off-the-shelf technology

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Studies in Health Technology and Informatics 1996年 29卷 313-318页

作者： Luttmann, Donna R. Jones, Daniel B. Soper, Nathaniel J. Institute for Minimally Invasive Surgery Washington University of Medicine BSRB 4940 Parkview St. Louis MO 63110 United States

Teleproctoring may be a viable approach to training surgeons in the near future. It may also be a superior form of instruction, providing for instantaneous visual and audio feed back to the participant. Conventional proctors are sometimes tempted to reach in and "help", thus infringing on the learning process of the participant. This is a problem that is averted by use of a teleproctoring system. Teleproctoring thereby challenges the proctor to expand the means by which he teaches. As new technologies mature teleproctoring may become the gold standard for teaching new surgical techniques. © The authors 1996.

关键词：计算机系统课程教育医学继续胃底折叠术/仪器和设备腹腔镜远程会诊/仪器和设备机器人外科学/教育外科设备缝合技术录像/仪器和设备人类

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