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1

Telemedicine for wound management  

PubMed Central

The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

Chittoria, Ravi K.

2012-01-01

2

A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study  

PubMed Central

Context Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care. Objectives To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older, ethnically diverse, medically underserved patients with diabetes. Design, Setting, and Patients A randomized controlled trial was conducted, comparing telemedicine case management to usual care, with blinded outcome evaluation, in 1,665 Medicare recipients with diabetes, aged ? 55 years, residing in federally designated medically underserved areas of New York State. Interventions Home telemedicine unit with nurse case management versus usual care. Main Outcome Measures The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c (HgbA1c), low density lipoprotein (LDL) cholesterol, and blood pressure levels. Results Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of follow-up in the primary endpoints (HgbA1c, p = 0.001; LDL, p < 0.001; systolic and diastolic blood pressure, p = 0.024; p < 0.001). Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)% for HgbA1c, 3.84 (?0.08, 7.77) mg/dL for LDL cholesterol, and 4.32 (1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3.74) mm Hg for diastolic blood pressure. There were 176 deaths in the intervention group and 169 in the usual care group (hazard ratio 1.01 [0.82, 1.24]). Conclusions Telemedicine case management resulted in net improvements in HgbA1c, LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries. Mortality was not different between the groups, although power was limited. Trial Registration http://clinicaltrials.gov Identifier: NCT00271739.

Shea, Steven; Weinstock, Ruth S.; Teresi, Jeanne A.; Palmas, Walter; Starren, Justin; Cimino, James J.; Lai, Albert M.; Field, Lesley; Morin, Philip C.; Goland, Robin; Izquierdo, Roberto E.; Ebner, Susana; Silver, Stephanie; Petkova, Eva; Kong, Jian; Eimicke, Joseph P.

2009-01-01

3

Telemedicine utilization to support the management of the burns treatment involving patient pathways in both developed and developing countries: a case study.  

PubMed

This case study reports on the utilization of telemedicine to support the management of the burns treatment in the islands of Sao Tome and Principe by Taipei Medical University-affiliated hospital in Taiwan. The authors share experiences about usage of telemedicine to support treatment of the burn victims in a low-income country that receive reconstructive surgery in a developed country. Throughout the entire care process, telemedicine has been used not only to provide an expert advice from distance but also to help establish and maintain the doctor-patient relationship, to keep patients in contact with their families, and to help educate and consult the medical personal physically present in Sao Tome and Principe. This case study presents the details of how this process has been conducted to date, on what were learned from this process, and on issues that should be considered to improve this process in the future. The authors plan to create instructional videos and post them on YouTube to aid clinical workers providing similar treatment during the acute care and rehabilitation process and also to support eLearning in many situations where it otherwise is not possible to use videoconferencing to establish real-time contact between doctors at the local site and remote specialists. PMID:22249104

Syed-Abdul, Shabbir; Scholl, Jeremiah; Chen, Chiehfeng Cliff; Santos, Martinho D P S; Jian, Wen-Shan; Liou, Der-Ming; Li, Yu-Chuan

2012-01-01

4

Telemedicine  

PubMed Central

As the health care industry is facing many challenges and is undergoing extensive change, telemedicine is in the position to address these challenges and be an important part of health care’s development. Telemedicine has been used for approximately a half century, in which researchers have explored the different technologies utilized, clinical outcomes, cost benefits, perceptions, and adoption challenges of its use. This paper reviews and summarizes these findings and presents possible future research endeavors. Examining what is known about telemedicine can aid in the development of innovative, sustainable and beneficial health technologies that could positively impact health care delivery and outcomes.

Whitten, P.; Holtz, B.; LaPlante, C.

2010-01-01

5

Telemedicine and remote management of patients with heart failure.  

PubMed

Advances in telecommunication technologies have created new opportunities to provide telemedical care as an adjunct to medical management of patients with heart failure. Meta-analyses suggest that telemedicine can reduce morbidity and mortality in such patients; however, two prospective clinical trials not included in the analyses do not support these findings. Therefore, the effectiveness of telemedicine in heart failure is not established. Telemedicine approaches range from computer-based support systems to programmes led by nurses and physicians. Standardisation and appropriate classification of telemedical systems are needed to enable accurate interpretation of clinical trials. Here we propose a classification of four generations of telemedicine in heart failure. Not all approaches are the same and not every patient with heart failure will need telemedicine. Crisis prevention and treatment, and stabilisation and self-empowerment of patients are focuses of telemedicine in heart failure. The profile of patients who can potentially benefit from telemedicine is unknown and should be investigated in adequately powered randomised clinical trials. We are optimistic that telemedicine is an efficient approach and will become an important feature of management in heart failure. PMID:21856487

Anker, Stefan D; Koehler, Friedrich; Abraham, William T

2011-08-20

6

An ontology-based telemedicine tasks management system architecture.  

PubMed

The recent developments in ambient intelligence and ubiquitous computing offer new opportunities for the design of advanced Telemedicine systems providing high quality services, anywhere, anytime. In this paper we present an approach for building an ontology-based task-driven telemedicine system. The architecture is composed of a task management server, a communication server and a knowledge base for enabling decision makings taking account of different telemedical concepts such as actors, resources, services and the Electronic Health Record. The final objective is to provide an intelligent management of the different types of available human, material and communication resources. PMID:19162954

Nageba, Ebrahim; Fayn, Jocelyne; Rubel, Paul

2008-01-01

7

The Ontario Telemedicine Network: a case report.  

PubMed

This article describes the evolution, current status, and future prospects of the Ontario Telemedicine Network (OTN). Started in the late 1990s (and formally established in 2006), OTN is a not-for-profit corporation primarily funded by the Government of Ontario, Canada, that aims to improve access to and quality of care throughout the Province. It covers a land mass larger than France and serves a population of just over 13 million, the vast majority of which live in a narrow strip close to the U.S. border. Telemedicine has been effective in reducing travel to usual sources of care, reducing hospital admissions, and improving efficiency and prompt access to care. The diffusion of telemedicine is accelerating in Ontario, and it is becoming an integral part of the health system. PMID:23301768

Brown, Edward M

2013-05-01

8

Telemedicine in a Rural Memory Disorder Clinic--Remote Management of Patients with Dementia  

PubMed Central

Background There are many reasons to develop telemedicine clinics for assessment and management of dementia. Time constraints, location, and poor weather conditions can all impact on the ability of patients and providers to attend rural clinics. The utility of telemedicine in the diagnosis of dementia and subsequent follow-up appears promising in the literature, as it provides a viable means of assessing cognition in patients in remote areas with limited access to medical specialists. Methods & Results This study explored the feasibility of introducing a telemedicine memory disorder follow-up clinic in a rural community. The evaluation of 32 clinic sessions found high levels of satisfaction, with over 90% of physicians and patients indicating that they’d be willing to use video conferencing again. Physicians overwhelmingly felt the sessions provided enough information to assist in clinical decision-making (96%), and patients and CCAC Case Managers/Geriatric Assessors felt able to present the same information by video conferencing as in person (92% for both groups). The telemedicine clinic provided a number of favourable results such as: timely access to specialist care in the patient’s own community; fewer cancelled clinics; enhanced care transitions between the follow-up clinic and primary care with the support of a case manager/geriatric assessor; and enhanced follow-up for a complex patient population. In addition, the telemedicine initiative freed up spaces for “in-person” clinics. This allowed them to focus on new patient assessments. Conclusions The high satisfaction rates amongst all key stakeholders affirm that telemedicine is a viable option and worth continued efforts at shaping and developing, particularly in regions where local physician specialists are a scare resource.

Azad, Nahid; Amos, Stephanie; Milne, Kelly; Power, Barbara

2012-01-01

9

Augmentation of Acute Stroke Management Via Telemedicine.  

National Technical Information Service (NTIS)

Stroke is the leading cause of disability and the third leading cause of death in the United States. Urgent stroke management is constrained by a narrow, 3 hour therapeutic window for treatment with intravenous recombinant tissue plasminogen activator (IV...

J. Y. Choi E. Urban

2002-01-01

10

Impact of Telemedicine in Managing Type 1 Diabetes Among School-age Children and Adolescents: An Integrative Review.  

PubMed

Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents. PMID:24269308

Guljas, Rebecca; Ahmed, Azza; Chang, Karen; Whitlock, Analei

2014-01-01

11

Patient and provider perspectives on using telemedicine for chronic disease management among Native Hawaiian and Alaska Native people  

PubMed Central

Background Among indigenous populations in remote locations who are at increased risk for chronic diseases such as diabetes, telemedicine has the potential to improve access to health care services and thus may reduce adverse health outcomes. Yet few studies are available on how best to use telemedicine technology in reducing ethnic and racial health care disparities. Objective We examined perspectives of patients and providers in 2 indigenous populations in Alaska and Hawai'i about the use of telemedicine in primary care chronic disease management. Design Six focus groups with patients and providers at 2 sites (3 in Alaska and 3 in Hawai'i). Results Three broad themes were common to both sites: (a) benefits and barriers of using telemedicine; (b) building patient–provider relationships; and (c) elements of an acceptable telemedicine primary care encounter. Two key elements were endorsed by both patients and providers as important for an effective telemedicine encounter: (a) the initial patient–provider interaction should be face-to-face; and (b) patients must see the same provider on follow-up visits. Conclusion The use of telemedicine in chronic disease management has potential to improve patient care in remote indigenous populations and may supplement patient–provider relationships.

Hiratsuka, Vanessa; Delafield, Rebecca; Starks, Helene; Ambrose, Adrian Jacques; Mau, Marjorie Mala

2013-01-01

12

A completely decentralized workflow management system for the support of emergency telemedicine and patient monitoring.  

PubMed

In this work we propose a completely decentralized workflow system, based on peer to peer (P2P) computing, in order to support the procedures followed: a) when handling a patient in a hospital emergency health care department: b) telemedicine services needed during emergency cases or during remote patient examination and monitoring. The proposed architecture is an addition to an already existing telemedicine system that enables telediagnosis and long distance support during emergency and monitoring cases. The existing system is based on a client server architecture, which has dependability limitations as it depends on a single centralized machine. Dependability is a critical requirement for such cases; so the new proposed system addresses these limitations by facilitating operation and even when some peers are unavailable for any reason. Concluding, the system design has been completed successfully. PMID:17946322

Kyriacou, E; Fakas, G; Pavlaki, V

2006-01-01

13

Identity-management factors in e-health and telemedicine applications.  

PubMed

Reliable identification is essential in e-health and telemedicine applications. This necessitates a secure and trustworthy method of communication and collaboration between parties, which depends on common acceptance. This in turn is related to privacy and ethical matters. Different technologies, including biometrics and RFID, allow high levels of security and safety in identifying both human beings and goods. However, the diffusion of standards relating to identity management in e-health is far from satisfactory. In order to support standardization in e-health, the European Commission funded the BioHealth project. This project has proved to be useful in promoting standards and creating awareness among the stakeholders. PMID:18852323

Savastano, Mario; Hovsto, Asbjorn; Pharow, Peter; Blobel, Bernd

2008-01-01

14

Management of heart failure patients using telemedicine communication systems  

Microsoft Academic Search

Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital\\u000a admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart\\u000a disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent\\u000a communication is

Abul Kashem; Robert C. Cross; William P. Santamore; Alfred A. Bove

2006-01-01

15

The reality of medical work: The case for a new perspective on telemedicine  

Microsoft Academic Search

This paper considers the nature of medical work and how new telemedicine technologies can be developed to support that work. Telemedicine developers attempt to increase communication and collaboration between medical practitioners and between patients and medics, with the goal being to make medical care and information more easily accessible. However, the focus of telemedicine systems appears to have so far

Rakhi Rajani; Mark Perry

1999-01-01

16

Expanding Technology in the ICU: The Case for the Utilization of Telemedicine.  

PubMed

Abstract Introduction: Telemedicine has been utilized in various healthcare areas to achieve better patient outcomes, lower costs of providing services, and increase patient access to care. Tele-intensive care unit (ICU) technology has been introduced as a way to provide effective ICU services to patients with reduced access, as well as to decrease costs and improve patient care. Materials and Methods: The methodology for this qualitative study was a literature search and review of case studies. The search was limited to sources published in the last 10 years (2003-2013) in the English language. In total, 55 references were used for this research exploration inquiry. Results: Tele-ICU was found to be an effective way to use technology to decrease costs of providing intensive care, while improving patient outcomes such as mortality and length of stay. Several case studies supported the use of telemedicine in ICUs to provide intensive care to patients who lived in rural areas and lacked access to traditional ICUs. Furthermore, it was noted that, although the initial costs for tele-ICU startup were significant, as much as $100,000 per bed, the benefits of the utilization of this technology can offset those costs by reducing costs by 24% via decreased length of stay for patients. Conclusions: The findings of this study have suggested that the implementation of tele-ICU may have been more beneficial than costly, and it may have provided healthcare organizations the opportunity to increase quality of care and decrease mortality, while it might have decreased costs of delivering ICU services in both rural and urban areas. PMID:24621447

Deslich, Stacie; Coustasse, Alberto

2014-05-01

17

Mobile technologies in the management of disasters: the results of a telemedicine solution.  

PubMed Central

Nowadays a great number of applications are used to compile and transmit casualties and disasters information but there are many troubles associated with the technology as can be the communications reliability and the size and weight of the devices medical staff has to carry with. Telecommunication infrastructures support information movement among geographically dispersed locations. Recently a large family of little devices has appeared in the buyer's market. They are called Personal Digital Assistants and because of their physic and technical features, they are very useful in the emergency field. As for the communications reliability, many technologies have been developed in the last years but it is necessary to find a solution that can be used in whatever situation independently of the emergency circumstances. Facing this reality, the Spanish government funded REMAF, an ATYCA (Initiative of Support for the Technology, Security and Quality in the Industry) project. REMAF joined research groups (UPM), phone operators (Fundación Airtel Móvil) and end users (SAMUR) to build a disaster data management system conceived to use modern telemedicine systems to optimize the management in these situations, taking the advantage of the above mentioned mobile communication tools and networks. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5

Cabrera, M. F.; Arredondo, M. T.; Rodriguez, A.; Quiroga, J.

2001-01-01

18

Use of telemedicine to manage severe ischaemic strokes in a rural area with an elderly population.  

PubMed

The rural district of the Meuse (East France) has a high number of elderly patients for whom prognosis of ischaemic strokes is poor with high-haemorrhagic transformation risk of intravenous tissue plasminogen activator (rt-PA). This disadvantage is made worse by the distances a patient has to travel to the nearest stroke unit. We set out to assess the effectiveness of a telestroke system implemented in this area. Between October 2010 and February 2012, data from each "tele-expertised" patient were collected. 53 patients were examined. Diagnosis of ischaemic stroke was confirmed in 43 cases (81 %), and intravenous rt-PA treatment performed in 21 cases (40 %). In the treated patient group, median age was 73 years, with 29 % of octogenarians. Baseline National Institutes of Health Stroke Scale (NIHSS) was 16, with 29 % ? 20. The median onset to needle time was 169 min, and the median door to needle time was 69 min. Intracranial haemorrhage occurred in 3 cases (14 %), and was symptomatic in two (10 %). At 3 months, median NIHSS was 6, 6 patients (29 %) presented a favourable outcome (modified Rankin scale ?1) and 3 (14 %) had died. In rural areas, for elderly patients with severe ischaemic strokes, telemedicine appears to be a way of improving accessibility and benefits of rt-PA treatment. PMID:24277200

Richard, Sébastien; Lavandier, K; Zioueche, Y; Pelletier, S; Vezain, A; Ducrocq, X

2014-05-01

19

Telemedicine Spacebridge  

NASA Technical Reports Server (NTRS)

This video is an overview on NASA's Telemedicine Spacebridge Project, which lets US doctors consult with Russian clinicians thousands of miles away by demonstration of the feasibility of live, two-way, full-bandwidth video as a medical tool.

1994-01-01

20

Case management: managing the nurse case manager.  

PubMed

Nurse executives and nurse managers have become proactive in response to the health care crisis by creating and implementing innovative health care delivery models such as nursing case management. Nursing case management utilizes a nurse as case manager and the unit-based system of managed care to achieve financial and clinical outcomes for target patient groups. Nurse managers can support the nursing case management model best by practicing good managerial skills, developing a participative style of leadership, and empowering the nurse case manager. PMID:10134145

Crawley, W D

1994-06-01

21

Watermarking - a new way to bring evidence in case of telemedicine litigation.  

PubMed

When dealing with medical data sharing, in particular within telemedicine applications, there is a need to ensure information security. Being able to verify that the information belongs to the right patient and is from the right source or that it has been rerouted or modified is a major concern. Watermarking, which is the embedding of security elements, such as a digital signature, within a document, can help to ensure that a digital document is reliable. However, at the same time, questions arise about the validity of watermarking-based proof. In this paper, beyond the technical aspects, we discuss the legal acceptability of watermarking in the context of telemedicine applications. PMID:21893821

Coatrieux, Gouenou; Quantin, Catherine; Allaert, François-André; Auverlot, Bertrand; Roux, Christian

2011-01-01

22

Stretching out and expanding work practices in time and space: The case of telemedicine  

Microsoft Academic Search

The article utilizes the imagery of stretching out and expanding for exploring what happens when medical practices and health working arrangements are temporally and spatially reconfigured. Based on the tenets of contemporary practice theory, and on the back of a three years' longitudinal study of telemedicine in northern Italy, the article investigates some of the practical issues raised by the

Davide Nicolini

2007-01-01

23

The integration of new communication technologies to form virtual organizations: a case study of a prison telemedicine program  

Microsoft Academic Search

Videoconferencing technologies can provide healthcare organizations with innovative ways to deliver clinical consultations. The prison environment is one application where telemedicine can create economic efficiencies, Unfortunately, many relationships cannot be built on a technical infrastructure alone. Effective implementation of telemedicine technologies to create virtual clinics requires attention to the development of relationships among members of the telemedicine network. The paper

Jeanine W. Turner

1998-01-01

24

UH Telemedicine Proposal.  

National Technical Information Service (NTIS)

The purpose of the University of Hawaii Telemedicine Project (UHTP) is to assess and establish an effective telemedicine curriculum uniquely tailored for the training of military healthcare personnel. To accomplish this task, a clinical telemedicine servi...

R. B. Friedman

2001-01-01

25

[Status of telemedicine in Austria].  

PubMed

In an overview the situation of telemedicine in Austria is presented regarding the Austrian health service with the focus on patients. First the term "telemedicine" is defined according to the present definition of the European Union and the situation of the Austrian health service. Afterwards individual success components for the planning of telemedicine projects are presented. These are briefly shown by the "five-column concept" of the Tyrolean Government, which includes the medical, legal, economic, technical and quality management-oriented aspects during the planning and evaluation period of telemedicine projects. The conclusion gives an overview of individual committees and activities of the Austrian medical universities, the federation and states as well as individual Austrian telemedical societies. PMID:15983842

Sögner, P; zur Nedden, D

2005-06-01

26

Stroke Telemedicine  

PubMed Central

Stroke telemedicine is a consultative modality that facilitates care of patients with acute stroke at underserviced hospitals by specialists at stroke centers. The design and implementation of a hub-and-spoke telestroke network are complex. This review describes the technology that makes stroke telemedicine possible, the members that should be included in a telestroke team, the hub-and-spoke characteristics of a telestroke network, and the format of a typical consultation. Common obstacles to the practice of telestroke medicine are explored, such as medicolegal, economic, and market issues. An example of a state-based telestroke network is thoroughly described, and established international telestroke networks are presented and compared. The opportunities for future advances in telestroke practice, research, and education are considered.

Demaerschalk, Bart M.; Miley, Madeline L.; Kiernan, Terri-Ellen J.; Bobrow, Bentley J.; Corday, Doren A.; Wellik, Kay E.; Aguilar, Maria I.; Ingall, Timothy J.; Dodick, David W.; Brazdys, Karina; Koch, Tiffany C.; Ward, Michael P.; Richemont, Phillip C.

2009-01-01

27

Telemedicine Program  

NASA Technical Reports Server (NTRS)

Since the 1970s, NASA has been involved in the research and demonstration of telemedicine for its potential in the care of astronauts in flight and Earth-bound applications. A combination of NASA funding, expertise and off-the-shelf computer and networking systems made telemedicine possible for a medically underserved hospital in Texas. Through two-way audio/video relay, the program links pediatric oncology specialists at the University of Texas Health Science Center in San Antonio to South Texas Hospital in Harlingen, providing easier access and better care to children with cancer. Additionally, the hospital is receiving teleclinics on pediatric oncology nursing, family counseling and tuberculosis treatment. VTEL Corporation, Sprint, and the Healthcare Open Systems and Trials Consortium also contributed staff and hardware.

1996-01-01

28

Telemedicine portal and standardized clinical documents.  

PubMed

The paper describes the experience of creating a flexible telemedicine portal intended to improve a business process of information exchanges needed to manage real-time telemedicine events. The portal structure allows use of digitally-signed standardized clinical documents based on the HL7 Clinical Document Architecture. PMID:17911720

Emelin, Ivan V; Eltchiyan, Radik A

2007-01-01

29

Case management.  

PubMed

Providing cost-effective high quality healthcare services ranks as the number one concern for anyone involved with the healthcare delivery system. While quality of care should always be the number one priority, controlling healthcare costs receives most of the attention. With limited healthcare dollars and providers assuming more of the financial risk for services rendered, a whole assortment of cost-containment strategies are being introduced in an effort to maintain some semblance of financial viability. Healthcare providers can approach cost control from two different angles. On the fixed-cost operational overhead side, traditional cost-containment techniques have focused on downsizing, maximizing productivity, staffing redesign, improved purchasing contracts, standardization, inventory control, and other more individualized restructured service models. On the variable-cost clinical side, cost control has been approached by introducing a variety of cost-containment strategies designed to improve efficiency and effectiveness of provider performance. While many of these strategies, previously discussed in the Journal of Healthcare Resource Management have stressed the importance of education, guidelines, pathways, and other clinical "tools for improvement," the success of many of these tools resides in the ability to provide real-time intervention. Real-time intervention rather than the more passive retrospective variance analysis has the greatest potential for producing cost savings by actually making a recommendation that prevents the unwanted event from occurring. In many institutions, the case manager bears the responsibility for monitoring and managing these programs. This article describes various case management models currently used by different institutions. PMID:10166062

Rosenstein, A H; Propotnik, T

1997-03-01

30

Perceptual Image Compression in Telemedicine  

NASA Technical Reports Server (NTRS)

The next era of space exploration, especially the "Mission to Planet Earth" will generate immense quantities of image data. For example, the Earth Observing System (EOS) is expected to generate in excess of one terabyte/day. NASA confronts a major technical challenge in managing this great flow of imagery: in collection, pre-processing, transmission to earth, archiving, and distribution to scientists at remote locations. Expected requirements in most of these areas clearly exceed current technology. Part of the solution to this problem lies in efficient image compression techniques. For much of this imagery, the ultimate consumer is the human eye. In this case image compression should be designed to match the visual capacities of the human observer. We have developed three techniques for optimizing image compression for the human viewer. The first consists of a formula, developed jointly with IBM and based on psychophysical measurements, that computes a DCT quantization matrix for any specified combination of viewing distance, display resolution, and display brightness. This DCT quantization matrix is used in most recent standards for digital image compression (JPEG, MPEG, CCITT H.261). The second technique optimizes the DCT quantization matrix for each individual image, based on the contents of the image. This is accomplished by means of a model of visual sensitivity to compression artifacts. The third technique extends the first two techniques to the realm of wavelet compression. Together these two techniques will allow systematic perceptual optimization of image compression in NASA imaging systems. Many of the image management challenges faced by NASA are mirrored in the field of telemedicine. Here too there are severe demands for transmission and archiving of large image databases, and the imagery is ultimately used primarily by human observers, such as radiologists. In this presentation I will describe some of our preliminary explorations of the applications of our technology to the special problems of telemedicine.

Watson, Andrew B.; Ahumada, Albert J., Jr.; Eckstein, Miguel; Null, Cynthia H. (Technical Monitor)

1996-01-01

31

Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project  

PubMed Central

The Columbia University Informatics for Diabetes Education and Telemedicine IDEATel) project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine. The focal point of the intervention is the home telemedicine unit (HTU), which provides four functions: synchronous videoconferencing over standard telephone lines, electronic transmission for fingerstick glucose and blood pressure readings, secure Web-based messaging and clinical data review, and access to Web-based educational materials. The HTU must be usable by elderly patients with no prior computer experience. Providing these functions through the HTU requires tight integration of six components: the HTU itself, case management software, a clinical information system, Web-based educational material, data security, and networking and telecommunications. These six components were integrated through a variety of interfaces, providing a system that works well for patients and providers. With more than 400 HTUs installed, IDEATel has demonstrated the feasibility of large-scale home telemedicine.

Starren, Justin; Hripcsak, George; Sengupta, Soumitra; Abbruscato, C.R.; Knudson, Paul E.; Weinstock, Ruth S.; Shea, Steven

2002-01-01

32

Using Telemedicine to Conduct Behavioral Assessments  

PubMed Central

We describe the use of telemedicine by the Biobehavioral Service at the University of Iowa Hospitals and Clinics to conduct brief functional analyses for children with developmental and behavioral disorders who live in rural areas of Iowa. Instead of being served at our outpatient facility, participants received initial behavioral assessments in their local schools or social service agencies via videoconference. Case descriptions for 2 participants whose evaluations were conducted via telemedicine, and a brief summary of all outpatient assessments conducted over a 4-year period by the Biobehavioral Service, are provided. This report extends previous applications of functional analysis procedures by examining brief behavioral assessments conducted via telemedicine.

Barretto, Anjali; Wacker, David P; Harding, Jay; Lee, John; Berg, Wendy K

2006-01-01

33

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support.  

PubMed

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol. PMID:12694629

Kyriacou, E; Pavlopoulos, S; Berler, A; Neophytou, M; Bourka, A; Georgoulas, A; Anagnostaki, A; Karayiannis, D; Schizas, C; Pattichis, C; Andreou, A; Koutsouris, D

2003-03-24

34

Assessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network  

PubMed Central

Store-and-forward telemedicine in resource-limited settings is becoming a relatively mature activity. However, there are few published reports about quality measurement in telemedicine, except in image-based specialties, and they mainly relate to high- and middle-income countries. In 2010, Médecins Sans Frontières (MSF) began to use a store-and-forward telemedicine network to assist its field staff in obtaining specialist advice. To date, more than 1000 cases have been managed with the support of telemedicine, from a total of 40 different countries. We propose a method for assessing the overall quality of the teleconsultations provided in a store-and-forward telemedicine network. The assessment is performed at regular intervals by a panel of observers, who – independently – respond to a questionnaire relating to a randomly chosen past case. The answers to the questionnaire allow two different dimensions of quality to be assessed: the quality of the process itself and the outcome, defined as the value of the response to three of the four parties concerned, i.e., the patient, the referring doctor, and the organization. It is not practicable to estimate the value to society by this technique. The feasibility of the method was demonstrated by using it in the MSF telemedicine network, where process quality scores, and user-value scores, appeared to be stable over a 9-month trial period. This was confirmed by plotting the cusum of a portmanteau statistic (the sum of the four scores) over the study period. The proposed quality-assessment method appears feasible in practice, and will form one element of a quality assurance program for MSF’s telemedicine network in future. The method is a generally applicable one, which can be used in many forms of medical interaction.

Wootton, Richard; Liu, Joanne; Bonnardot, Laurent

2014-01-01

35

Case Management  

Microsoft Academic Search

The Productivity Commission’s inquiry report into ‘Waste Management’ was tabled by Government in December 2006. The Australian Government asked the Commission to identify policies that would enable Australia to address market failures and externalities associated with the generation and disposal of waste, and recommend how resource efficiencies can be optimised to improve economic, environmental and social outcomes. In the final

2009-01-01

36

International telemedicine consultations for neurodevelopmental disabilities.  

PubMed

Abstract Background: A telemedicine program was developed between the Children's National Medical Center (CNMC) in Washington, DC, and the Sheikh Khalifa Bin Zayed Foundation in the United Arab Emirates (UAE). A needs assessment and a curriculum of on-site training conferences were devised preparatory to an ongoing telemedicine consultation program for children with neurodevelopmental disabilities in the underserved eastern region of the UAE. Materials and Methods: Weekly telemedicine consultations are provided by a multidisciplinary faculty. Patients are presented in the UAE with their therapists and families. Real-time (video over Internet protocol; average connection, 768 kilobits/s) telemedicine conferences are held weekly following previews of medical records. A full consultation report follows each telemedicine session. Results: Between February 29, 2012 and June 26, 2013, 48 weekly 1-h live interactive telemedicine consultations were conducted on 48 patients (28 males, 20 females; age range, 8 months-22 years; median age, 5.4 years). The primary diagnoses were cerebral palsy, neurogenetic disorders, autism, neuromuscular disorders, congenital anomalies, global developmental delay, systemic disease, and epilepsy. Common comorbidities were cognitive impairment, communication disorders, and behavioral disorders. Specific recommendations included imaging and DNA studies, antiseizure management, spasticity management including botulinum toxin protocols, and specific therapy modalities including taping techniques, customized body vests, and speech/language and behavioral therapy. Improved outcomes reported were in clinician satisfaction, achievement of therapy goals for patients, and requests for ongoing sessions. Conclusions: Weekly telemedicine sessions coupled with triannual training conferences were successfully implemented in a clinical program dedicated to patients with neurodevelopmental disabilities by the Center for Neuroscience at CNMC and the UAE government. International consultations in neurodevelopmental disabilities utilizing telemedicine services offer a reliable and productive method for joint clinical programs. PMID:24660879

Pearl, Phillip L; Sable, Craig; Evans, Sarah; Knight, Joseph; Cunningham, Parker; Lotrecchiano, Gaetano R; Gropman, Andrea; Stuart, Sheela; Glass, Penny; Conway, Anne; Ramadan, Issam; Paiva, Tania; Batshaw, Mark L; Packer, Roger J

2014-06-01

37

Applications of Telemedicine and Telecommunications to Disaster Medicine : Historical and Future Perspectives  

Microsoft Academic Search

Disaster management utilizes diverse technologies to accomplish a complex set of tasks. Despite a decade of experience, few published reports have reviewed application of telemedicine (clinical care at a distance enabled by telecommunication) in disaster situations. Appropriate new telemedicine applications can improve future disaster medicine outcomes, based on lessons learned from a decade of civilian and military disaster (wide-area) telemedicine

Victoria Garshnek; FREDERICK M. BURKLE

1999-01-01

38

International Telemedicine/Disaster Medicine Conference: Papers and Presentations  

NASA Technical Reports Server (NTRS)

The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.

1991-01-01

39

[Progress in geriatric care through telemedicine].  

PubMed

A constantly aging population leads to an increasing number of elderly patients. As a result, the treatment of chronic illnesses becomes a significant part of daily routine. Today's concepts in social services and healthcare require time consuming and barely cost-effective efforts for the special needs of geriatric care. The use of telemedicine offers a possible solution, because telemedical methods may help to realize improved monitoring systems for optimized and effective patient management. This report provides an overview of the scenarios and advantages of telemedicine in general. In addition, we provide information on practical experiences in a project on telemedical glaucoma management in Mecklenburg-Vorpommern. PMID:16924448

Jürgens, C; Tost, F

2006-09-01

40

Telemedicine Network Expansion.  

National Technical Information Service (NTIS)

Memorial Hermann Hospital's resources of specialty physicians and highly acclaimed Level I trauma center is able to offer comprehensive consultative services to its extensive rural hospital affiliates. Telemedicine may serve as a solution to increase acce...

S. Allen J. Choi

2004-01-01

41

Telemedicine: a cautious welcome.  

PubMed Central

Telemedicine is a major new development. Having become technically and economically feasible, it deserves proper investigation. Rushing into equipment purchase, however, is almost certain to prove counterproductive. Face to face contact is fundamental to health care and enthusiasts of telemedicine should recognise that it is not as good as the real thing (and unlikely ever to be). However, constraints on time and resources will make face to face consultation increasingly expensive, and telemedicine has the potential to produce major efficiencies in the diagnostic process. The goal of current research is therefore to marry medicine with technology, capitalising on the advantages of telemedicine and producing a robust system that delivers an acceptable service at an appropriate price. Images p1375-a p1375-b p1376-a

Wootton, R.

1996-01-01

42

Telemedicine and European law.  

PubMed

A Directive of the European Union was first published in 2000, which dealt with telemedicine as part of its provisions. This E-Commerce Directive, as it became known, was subjected to further study which revealed some problems relative to the practice of telemedicine. Among the subjects discussed in this paper are those of privacy, data protection, free movement of services, the impact of electronic communication and ethical issues. PMID:15074761

Callens, Stefaan

2003-01-01

43

Telemedicine applications in otoloryngology  

Microsoft Academic Search

This article considers both store-and-forward and interactive applications of telemedicine in otolaryngology (the branch of medicine relating to the ears, nose, and throat) and reports on our clinical findings on the accuracy of tele-otolaryngology consults reported from our telemedicine test-bed at The New York Eye and Ear Infirmary. We outline some potential store-and-forward applications in our field and conclude with

Conor Heneghan; A. P. Sclafani; Jordan Stern; Jeffrey Ginsburg

1999-01-01

44

[Telemedicine and wireless devices in heart failure].  

PubMed

Telemedicine has the potential to constitute the central element of the future primary care and become an effective means of prevention and early warning of acute exacerbation of chronic diseases. Up to now, the application of telemedicine has found a variety of difficulties, regarding the types and methods of acquisition and transmission of biological signals, the acceptance and cooperation of the patient, etc. The latest technological developments involve the combined use of wireless technologies and smartphones, for the collection and the transmission of data, and specific softwares for their automatic analysis. This paper examines some of the critical aspects in the application of new technologies for heart failure remote management. PMID:24873944

Billeci, Lucia; Guerriero, Lorenzo; L'Abbate, Antonio; Pioggia, Giovanni; Tartarisco, Gennaro; Trivella, Maria Giovanna

2014-05-01

45

Telemedicine for AIDS patients accommodations.  

PubMed Central

People suffering from AIDS are subject to frequent hospitalisations. In some cases, they cannot go back home after hospitalisations, due to severe illness, family or sociologic problems. This is the reason why some therapeutic flats are at their disposal to make easier their medical follow-up after the hospital's discharge. In these Therapy Accommodation, they are treated by trained GP who often suffer from lack of information and lack of expertise in difficult cases. For this purpose we included these flats in the regional Telemedicine AIDS network to give these physicians free access to the computerised multimedia medical record of their patients and to provide them with synchronous co-operation facilities.

Kulik, J. F.; de la Tribonniere, X.; Bricon-Souf, N.; Beuscart, R. J.; Mouton, Y.

1997-01-01

46

Design of a centralized telemedicine model in Palestine.  

PubMed

To provide patients with easy-access telemedicine services in Palestine, a simple and low-cost telemedicine system has been established. The system is based on a star topology network between local hospitals and a main telemedicine centre. In a pilot trial, a computerized tomography image was transmitted from a local hospital connected to the telemedicine service centre by ISDN (128 kbit/s). A videoconferencing discussion between the two ends was held. The performance of the system was satisfactory. The transmission time for a 1 MByte image was about 60 s. A conference was conducted to discuss this real clinical case by use of interactive sharing of the medical record. The session lasted 20 min. Encouraging results were obtained. The pilot study suggests that telemedicine can overcome existing isolation problems of cities and villages and the difficulties of transferring patients from one location to another. PMID:12217155

Zatari, Daoud I

2002-01-01

47

Diabetes Care and Treatment Program: A Joslin Telemedicine Initiative.  

National Technical Information Service (NTIS)

The major goals of this continuing project are the establishment of a telemedicine system for comprehensive diabetes management and the assessment of diabetic retinopathy that provides increased access for diabetic patients to appropriate care, that centr...

D. Birkmire-Peters D. S. Vincent J. Humphry K. Parisi

2006-01-01

48

Diabetes Care and Treatment Project: A Joslin Telemedicine Initiative.  

National Technical Information Service (NTIS)

The major goals of this continuing project are the establishment of a telemedicine system for comprehensive diabetes management and the assessment of diabetic retinopathy that provides increased access for diabetic patients to appropriate care, that centr...

S. E. Bursell L. M. Aiello

2005-01-01

49

Bringing the Artificial Pancreas Home: Telemedicine Aspects  

PubMed Central

The design and implementation of telemedicine systems able to support the artificial pancreas need careful choices to cope with technological requirements while preserving performance and decision support capabilities. This article addresses the issue of designing a general architecture for the telemedicine components of an artificial pancreas and illustrates a viable solution that is able to deal with different use cases and is amenable to support mobile-health implementations. The goal is to enforce interoperability among the components of the architecture and guarantee maximum flexibility for the ensuing implementations. Thus, the design stresses modularity and separation of concerns along with adoption of clearly defined protocols for interconnecting the necessary components. This accounts for the implementation of integrated telemedicine systems suitable as short-term monitoring devices for supporting validation of closed-loop algorithms as well as devices meant to provide a lifelong tighter control on the patient state once the artificial pancreas has become the preferred treatment for patients with diabetes.

Lanzola, Giordano; Capozzi, Davide; Serina, Nadia; Magni, Lalo; Bellazzi, Riccardo

2011-01-01

50

Telemedicine, virtual reality, and surgery  

NASA Technical Reports Server (NTRS)

Two types of synthetic experience are covered: virtual reality (VR) and surgery, and telemedicine. The topics are presented in viewgraph form and include the following: geometric models; physiological sensors; surgical applications; virtual cadaver; VR surgical simulation; telesurgery; VR Surgical Trainer; abdominal surgery pilot study; advanced abdominal simulator; examples of telemedicine; and telemedicine spacebridge.

Mccormack, Percival D.; Charles, Steve

1994-01-01

51

Evaluation of an off-the-shelf mobile telemedicine model in emergency department wound assessment and management.  

PubMed

We examined the agreement between a videoconference-based evaluation and a bedside evaluation in the management of acute traumatic wounds in an emergency department. Adult and paediatric patients with acute wounds of various severities to the face, trunk and/or extremities presenting to the emergency department within 24 hours of injury were enrolled. Research assistants transmitted video images of the wound to an emergency physician using a laptop computer. The physician completed a standard wound assessment form before conducting a bedside evaluation and then completing a second assessment form. The primary outcome measure was wound length and depth. We also assessed management decision-making. A total of 173 wounds were evaluated. The correlation coefficient between video and bedside assessments was 0.96 for wound length. The mean difference between the lengths was 0.02 cm (SD 0.91). Management of the wound would have been the same in 94% of cases. The agreement on wound characteristics and wound management ranged from 84-100%. The highest correlation was 0.92 in suture material used and the lowest correlation was 0.64 in wound type. The ability of video images to distinguish between a minor and non-minor wound, and predicting the need for hospital management, had high degrees of sensitivity and specificity. The study showed that wound characteristics and management decisions appear to correlate well between video and bedside evaluations. PMID:23470449

Van Dillen, Christine; Silvestri, Salvatore; Haney, Marisa; Ralls, George; Zuver, Christian; Freeman, Dave; Diaz, Lissa; Papa, Linda

2013-02-01

52

"Tuberculosis Case Management" Training.  

ERIC Educational Resources Information Center

The need to isolated health providers with critical knowledge in tuberculosis (TB) case management prompted the development of "Tuberculosis Case Management" CD-ROM. Features include "Learning Center,""Examination Room," and "Library." The combination of audio, video, and graphics allows participants to practice acquired skills in a simulated…

Knebel, Elisa; Kolodner, Jennifer

2001-01-01

53

A knowledge model driven solution for web-based telemedicine applications.  

PubMed

Building knowledge-based telemedicine systems to deliver high quality services is still a challenge. The availability and capability of different human, communication and material resources play an important role in the telemedical task management process especially in emergency scenarios. In this paper we propose a knowledge model enabling intelligent, ubiquitous telemedicine tasks management. The objective of this model is to support the quality of telemedical services delivered by web-based telemedicine applications. The methodology is based on a telemedicine tasks ontology representing the concepts and their interrelations, and on a set of rules that shall be applied by a Reasoner for decision making. This architecture design shall optimize the messages exchange among the different actors in the telemedicine systems, consequently providing more rapid and reliable telemedicine assistance. PMID:19745351

Nageba, Ebrahim; Fayn, Jocelyne; Rubel, Paul

2009-01-01

54

Network basics for telemedicine.  

PubMed

Early telemedicine networks employed dedicated telecommunications circuits (e.g. leased digital lines) in which the sender and receiver were connected by a private circuit. More recently, the Internet has become widely available for general use, including telemedicine. The Internet was engineered to permit network paths to be shared by all users, so data transmission is fundamentally different from traditional, circuit-switched networks. Early telemedicine applications demonstrated the feasibility of Internet Protocol transmission. The basic performance criteria to use in evaluating newer digital communications technologies that carry both voice and data are: (1) bandwidth; (2) packet loss; (3) end-to-end delay; (4) jitter; (5) privacy and security. Network engineering involves performance trade-offs between the hardware, architecture, security and the budget available. A telemedicine application may be running over a network whose design is entirely under the user's control, or the application may employ some part of the Internet whose design is unknown to the user. If an application is not running to satisfaction, then a network engineer should be consulted. PMID:15829050

Gemmill, Jill

2005-01-01

55

Telemedicine in otolaryngology  

Microsoft Academic Search

Background: Telemedicine (TM) is the use of advanced information and communication technology to provide health care services. TM in general, and specifically in the field of otolaryngology, has become a reality. Because of the improvements in telecommunications and computer technology, TM applications are becoming more common in both hospitals and private practice. These applications are altering the manner in which

David Goldenberg; Barry L. Wenig

2002-01-01

56

Integrating telemedicine and telehealth: putting it all together.  

PubMed

Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care organizations. Telemedicine programs should perform ongoing assessments of activities, ranging from service usage to quality of service assessments, to ongoing analyses of financial performance. The financial assessments should include evaluations of costs and benefits, coding issues, reimbursement, account receivables, bad debt and network utilization. Long-range strategic planning for a telemedicine and telehealth program should be carried out on an on-going basis and should include the program's governing board. This planning process should include goal setting and the periodic updating of the program's vision and mission statements. There can be additional special issues for multi-organization telemedicine and telehealth programs. For example, authority management can require the use of innovative approaches tailored to the realities of the organizational structures of the participating members. Inter-institutional relations may introduce additional issues when competing health care organizations are utilizing shared resources. Branding issues are preferably addressed during the initial planning of a multi-organizational telemedicine and telehealth program. Ideally, public policy regarding telemedicine and telehealth within a service region will complement the objectives of telemedicine and telehealth programs within that service area. PMID:18305320

Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail

2008-01-01

57

The evolution of telemedicine and nano-technology  

NASA Astrophysics Data System (ADS)

This paper will cover definition and history of telemedicine, changes in medical paradigm and roll of telemedicine and roll of nano-technology for evolution of telemedicine. Hypothetically, telemedicine is distance communication for medical purpose and modern definition explains telemedicine as `a system of health care delivery in which physicians examine distant patients through the use of telecommunications technology. Medical service will change to personalized medicine based on gene information to prevent and manage diseases due to decrease of acute diseases, population aging and increase of prevalence in chronic diseases, which means current medical services based on manualized treatment for diseases will change to personalized medicine based on individual gene information. Also, international healthcare will be activated to provide high quality medical services with low cost using developed transportation. Moreover, hospital centered medical services will change to patients centered medical service due to increase of patient's rights. Development in sensor technology is required for telemedicine to be applied as basic infrastructure for medical services. Various researches in nano-biosensor field are conducted due to introduction of new technologies. However, most researches are in fundamental levels that requires more researches for stability and clinical usefulness. Nano technology is expected to achieve innovative development and define new criteria for disease prevention and management.

Park, Dong Kyun; Young Jung, Eun; Chan Moon, Byung

2012-10-01

58

Emerging Technologies for Telemedicine  

PubMed Central

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.

Minh, Cao Duc; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao

2012-01-01

59

Telemedicine and telepharmacy: current status and future implications.  

PubMed

Uses of telemedicine are described and potential roles for pharmacists are discussed. Telemedicine has been defined as "the use of electronic information and communications technologies to provide and support health care when distance separates the participants." Technologies included in telemedicine are videoconferencing, telephones, computers, the Internet, fax, radio, and television. Telepharmacy has the same basic definition but refers to pharmaceutical care provision. Although the videotelemedicine market is expected to grow considerably, lack of reimbursement and high costs are continuing obstacles. Pharmacy is using video-conferencing for education, training, and management purposes. The telephone has changed from a dial-and-talk instrument to a multimedia access tool. Medical devices are being attached to telephone lines to provide remote monitoring and therapy, and call centers are providing medication counseling, prior authorization, refill authorization, and formulary compliance monitoring. Although the Internet has quickly become a star performer, utilization by health care lags behind that of other industries. The Internet-fueled empowerment of consumers and their expectations for speed, access, and convenience are creating more unmet expectations of the traditional health care system. Pharmacy has both organizational and individual practitioner Web sites, but it is online drugstores that are attracting most attention. Potential benefits of telemedicine include improved access to care, greater efficiency in diagnosis and treatment, higher productivity, and market positioning for the coming century. Telemedicine will tax the economic, regulatory, legal, ethical, and clinical care expertise of the entire health care system. Studies of the effectiveness, cost, and societal implications of telemedicine are needed, along with practice models and standards, training programs, and solutions to regulatory, licensing, and legal questions. Securing reimbursement for cognitive services remains a problem for telemedicine and telepharmacy. Telemedicine presents profound opportunities and challenges to pharmacy and other health care professions. PMID:10428449

Angaran, D M

1999-07-15

60

Columbia University’s Informatics for Diabetes Education and Telemedicine (IDEATel) Project : Rationale and Design  

Microsoft Academic Search

The Columbia University Informatics for Diabetes Education and Telemedicine (IDEATel) Project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine in the management of older patients with diabetes. The study is designed as a randomized controlled trial and is being conducted

Steven Shea; Justin Starren; Ruth S Weinstock; Paul E Knudson; Jeanne Teresi; Douglas Holmes; Walter Palmas; Lesley Field; Robin Goland; Catherine Tuck; George Hripcsak; Linnea Capps; David Liss

2002-01-01

61

Integrated Telemedicine System in Andalusia  

Microsoft Academic Search

The design of the Andalusian Public Healthcare System fulfils two main objectives: universal cover and quality healthcare. Our aim is to adequately provide for the healthcare needs of all citizens throughout the entire region. Telemedicine plays an important part in achieving these objectives and assures every citizen access to adequate healthcare regardless of geographical location. Our concept of Telemedicine is

C. Gonzalez

2002-01-01

62

Internet technologies and requirements for telemedicine  

NASA Technical Reports Server (NTRS)

Internet technologies are briefly introduced and those applicable for telemedicine are reviewed. Multicast internet technologies are described. The National Aeronautics and Space Administration (NASA) 'Telemedicine Space-bridge to Russia' project is described and used to derive requirements for internet telemedicine. Telemedicine privacy and Quality of Service (QoS) requirements are described.

Lamaster, H.; Meylor, J.; Meylor, F.

1997-01-01

63

Telemedicine in COPD: Time to Pause.  

PubMed

There is increasing interest in the use of telemedicine to assist in the management of chronic diseases. Telemedicine possibilities for patients with COPD include medical consultations, in-home patient monitoring, and remote rehabilitation. Teleconsultations have been used successfully, saving time and travel costs for patients with only a few subsequently requiring face-to-face visits. Despite many reports, the impact of telemonitoring on the detection of exacerbations, reductions in health-care utilization, and cost savings is equivocal. Given the health-care costs and commitment involved in telemonitoring, well-designed longer-term multicenter studies with appropriate follow-up are required prior to its more widespread application. Emerging evidence from preliminary trials of telerehabilitation for the pulmonary patient is encouraging. It may represent a useful tool for increasing access and building capacity, especially in remote areas. PMID:24798834

Goldstein, Roger S; O'Hoski, Sachi

2014-05-01

64

Telemedicine: socio-ethical considerations in the Indian milieu.  

PubMed

Telemedicine is the rapidly developing application of clinical medicine by telephone, the internet or other networks for the purpose of consulting, and on occasions carrying out examinations or medical procedures. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine offers real benefits in a country as vast as India where the majority of the population lives in remote areas with no access to even the most basic healthcare. As the practice of telemedicine spreads, maintaining standards, security and privacy, will be a challenge especially with regard to legal and regulatory measures and who will be held responsible if telemedicine-assisted surgery fails due to failure in connectivity? Is it the surgeon, the satellite provider or the software/hardware engineer? What is the legal status of telemedicine-based diagnosis and treatment? Other legal issues involve conflicting national laws and information piracy, the dangers of prescription drugs that are banned in one country but not in another and quacks who offer medical advice and prescribe drugs over the internet. This paper discusses some of the legal, ethical and social considerations in the Indian context. PMID:19731480

Sharma, Luv K; Rajput, Meena

2009-01-01

65

Comparing Case Management Systems.  

ERIC Educational Resources Information Center

Case management has become a core component in the delivery of long term care services. It is widely viewed as a mechanism for linking and coordinating segments of a service delivery system (within a single agency or involving several providers) to ensure the most comprehensive program for meeting an individual client's needs for care. Although…

Austin, Carol D.; Greenberg, Jay N.

66

Telemedicine in an academic center--the Arizona Telemedicine Program.  

PubMed

This article provides background information on the history of telemedicine in Arizona and the Arizona Telemedicine Program (ATP). Following a brief overview of the growth of the ATP over the past 16 years, special focus is directed toward a description of the ATP business model, sustainability efforts of the Program, and ATP's future directions and goals. The ATP was established by the Arizona State Legislature in 1996 and, today, operates a large university-based statewide telemedicine consortium. It provides a spectrum of telemedicine support services to dozens of independent healthcare organizations throughout Arizona and bordering states. The ATP's backbone is a regional, 160-site dedicated healthcare and education broadband telecommunications network called the Arizona Telemedicine Network (ATN). The ATN is a fixed-cost network operated 24/7 by ATP engineers. In addition to providing access to the ATN, the ATP also provides its member individuals and organizations with benefits including biomedical communications services and expertise, telemedicine training on financial, legal, regulatory, and administrative support aspects, and access to subspecialty telemedicine consultation services. PMID:23343258

Krupinski, Elizabeth A; Weinstein, Ronald S

2013-05-01

67

Case Management: A Resource Manual.  

ERIC Educational Resources Information Center

This resource manual has been developed to assist both case managers and management staff in implementing a case management system as an infrastructure for delivering services that will facilitate the positive growth and development of youth and the achievement of individual and organizational performance goals. (The goal of case managers is to…

Adams, Anne Thomas; Franklin, Sundra; Taylor, Rebecca

68

Determinants of telemedicine acceptance in selected public hospitals in malaysia: clinical perspective.  

PubMed

The purpose of this study is to explore the determinants of telemedicine acceptance in selected public hospitals in Malaysia and to investigate the effect of health culture on the relationship between these determinants and telemedicine acceptance. Data were gathered by means of a survey of physicians and nurses as the main group of users of telemedicine technology from hospitals that are currently using telemedicine technology. The results indicated that government policies, top management support, perception of usefulness and computer self-efficiency have a positive and significant impact on telemedicine acceptance by public hospitals in Malaysia. The results also confirmed the moderating role of health culture on the relationship between government policies as well as perceived usefulness on telemedicine acceptance by Malaysian hospitals. The results are useful for decision-makers as well as managers to recognize the potential role of telemedicine and assist in the process of implementation, adoption and utilization, and, therefore, spread the usage of telemedicine technology in more hospitals in the country. PMID:25038891

Zailani, Suhaiza; Gilani, Mina Sayyah; Nikbin, Davoud; Iranmanesh, Mohammad

2014-09-01

69

International telemedicine in pediatric cardiac critical care: a multicenter experience.  

PubMed

Abstract Objective: To describe our multicenter experience in telemedicine-assisted pediatric cardiac critical care (PCCC) with four hospitals in Latin America from July 2011 to June 2013. Materials and Methods: This was a descriptive study based on telemedicine encounters related to quality of communication, assessed information, activities, and recommendations. Comparison among centers was performed. A postimplementation survey was conducted through a 5-point Likert scale questionnaire investigating acceptance among professionals involved with the telemedicine service through the assessment of general satisfaction, perception about the work system, usefulness, and impact on medical practice. Results: One thousand forty consultations were conducted for 476 patients. Postoperatively, patients were distributed into Risk Adjustment Classification for Congenital Heart Surgery (RACHS-1) categories as follows: 2%, 26%, 36%, 26%, and 10% in categories 1, 2, 3, 4, and 6, respectively. A real-time intervention took place in 23% of encounters. Of the 2,173 recommendations given, 70 were related to extracorporeal membrane oxygenation management. There was a different RACHS-1 distribution and encounter characteristics among centers. From a total of 51 surveys sent, 27 responses were received, and among responders, overall satisfaction was very high (4.27±0.18), as well as work system quality (4.4±0.37). Telemedicine was considered useful in the cardiac intensive care unit (3.86±0.60), for patient outcomes (3.8±0.51), and for education (3.7±0.71). There was a difference in overall satisfaction, perception about telemedicine usefulness in education, and impact on medical practice among centers. Conclusions: An international, multicenter telemedicine program in PCCC is technologically and logistically feasible. Prospective interventions in our international multicenter telemedicine program should consider differences in staff composition, perception of needs, and patient population among centers. PMID:24901442

Otero, Andrea Victoria; Lopez-Magallon, Alejandro Jose; Jaimes, Diana; Motoa, Maria Victoria; Ruz, Miguel; Erdmenger, Julio; Muñoz, Ricardo A

2014-07-01

70

Clinical outcomes resulting from telemedicine interventions: a systematic review  

PubMed Central

Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

2001-01-01

71

Successes and Challenges in the Implementation and Application of Telemedicine in the Eastern Province of Saudi Arabia  

PubMed Central

Telemedicine is the practice of healthcare using audio, video, and data communications. The aim of this study was to determine the perceptions of health professionals at hospitals adopting and not adopting telemedicine on its benefits and challenges, and their willingness to use it. The study was conducted at one hospital not adopting telemedicine and three hospitals adopting telemedicine. It was a cross-sectional descriptive study, and the target population was health professionals. Data collection methods included two paper-based questionnaires. Nonparametric statistical analysis and descriptive statistics were used. The study concluded that although telemedicine is promising and the Ministry of Health in Saudi Arabia has allocated a huge budget for e-health, the telemedicine modalities used were very limited. The percentage of adoption of telemedicine by health professionals was low in comparison to the high interest of nonadopters. Nonadopters’ perception of benefits was higher than that of adopters. The most frequently cited benefits among adopters were improving the quality of care, enhancing access to healthcare, and providing patient care and management. However, adopters’ perceptions were low for other benefits such as easy use of the network, the use of store-and-forward telemedicine, and the ability to follow up after face-to-face contacts. The greatest barrier as perceived by health providers was the lack of knowledge about telemedicine. Dissemination of information about telemedicine and proper training of health professionals on its use are recommended.

El-Mahalli, Azza Ali; El-khafif, Sahar Hafez; Al-Qahtani, Mona Faisal

2012-01-01

72

Barriers, legal issues, limitations and ongoing questions in telemedicine applied to stroke.  

PubMed

The use of telemedicine services, such as telestroke, is still highly fragmented and its deployment in an integrative healthcare system is challenging. Factors impeding the growth of telemedicine include confidence and malpractice issues, technical advances, reimbursement, licensing, credentialing costs, cost effectiveness, and legal issues. These barriers, limitations and requirements in the routine use of telemedicine are reviewed, in addition to medical activities, the objectives of telestroke, technical aspects, funding, legal issues, evaluation and quality management. As telemedicine induces a new form of interrelationship between health care providers, mutual trust and acceptance need to be developed in telemedicine services. Furthermore, education and training will be crucial in order to facilitate the use of telestroke over the next decade. PMID:19546540

de Bustos, Elisabeth Medeiros; Moulin, Thierry; Audebert, Heinrich J

2009-01-01

73

Telemedicine Security: A Systematic Review  

PubMed Central

Telemedicine is a technology-based alternative to traditional health care delivery. However, poor security measures in telemedicine services can have an adverse impact on the quality of care provided, regardless of the chronic condition being studied. We undertook a systematic review of 58 journal articles pertaining to telemedicine security. These articles were selected based on a keyword search on 14 relevant journals. The articles were coded to evaluate the methodology and to identify the key areas of research in security that are being reviewed. Seventy-six percent of the articles defined the security problem they were addressing, and only 47% formulated a research question pertaining to security. Sixty-one percent proposed a solution, and 20% of these tested the security solutions that they proposed. Prior research indicates inadequate reporting of methodology in telemedicine research. We found that to be true for security research as well. We also identified other issues such as using outdated security standards.

Garg, Vaibhav; Brewer, Jeffrey

2011-01-01

74

Telemedicine Health Care Delivery System.  

National Technical Information Service (NTIS)

The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and ...

J. H. Sanders

1991-01-01

75

Telemedicine and Pediatric Obesity Treatment: Review of the literature and lessons learned  

PubMed Central

Pediatric obesity is more prevalent in rural areas, yet rural families may not have access to pediatric obesity treatment programs. Use of new technologies, particularly telemedicine, has proven effective in other behavioral fields, such as psychiatry. This paper reviews the literature on the use of telemedicine in pediatric obesity treatment, and describes one tertiary-care pediatric obesity telemedicine program. We performed a systematic review of the literature from 1990–2011 using the following criteria: pediatric age group, overweight or obesity care or treatment, and use of telemedicine technology. Of 2873 abstracts identified, four studies met all inclusion criteria; all were published after 2008. The limited evidence suggests that telemedicine to be a promising approach to pediatric weight management, particularly for rural families with limited access to treatments. We also provide important lessons learned from one pediatric obesity treatment clinic offering services to rural families via telemedicine. Few studies have examined the use of telemedicine for pediatric obesity treatment, but the available data favor this method for treating rural patients. There are several unique key factors influencing successful delivery of a pediatric obesity telemedicine treatment program. This review identifies a potential avenue for expanded treatment, and highlights the need for further investigation.

Cohen, Gail M.; Irby, Megan B.; Boles, Katie; Jordan, Christine; Skelton, Joseph A.

2012-01-01

76

New technology applied to telemedicine  

NASA Technical Reports Server (NTRS)

Satellite communications technology was used for establishing international telemedicine communications links in a number of instances, (e.g., Telemedicine SpaceBridge between Armenia and the United States in 1989, and the proposed linkages shown, for demonstration during this conference and during 1992 and 1993). In the current example, geostationary satellites are used to provide intercontinental communications links between the two countries and also for distribution within each country.

Miller, Edward F.

1991-01-01

77

Telemedicine in British Airways.  

PubMed

In the year ending March 1994, British Airways (BA) carried in excess of 30 million passengers worldwide. There was a total of 2078 reported in-flight medical incidents, with 18 unscheduled diversions for medical reasons. The commonest reported conditions were faints, diarrhoea and vomiting. The BA aircraft medical kit content exceeds the statutory minimum requirement and all cabin crew undergo training in first aid and life support. There is a BA doctor on 24 h call with whom an aircraft captain may communicate via a high-frequency radio link. This link has limitations and immediate contact is not always possible. BA is installing satellite communication facilities in new aircraft and the application of telemedicine utilizing this facility is being explored. PMID:9375086

Bagshaw, M

1996-01-01

78

Telemedicine in Critical Care  

PubMed Central

Critical care medicine is the specialty that cares for patients with acute life-threatening illnesses where intensivists look after all aspects of patient care. Nevertheless, shortage of physicians and nurses, the relationship between high costs and economic restrictions, and the fact that critical care knowledge is only available at big hospitals puts the system on the edge. In this scenario, telemedicine might provide solutions to improve availability of critical care knowledge where the patient is located, improve relationship between attendants in different institutions and education material for future specialist training. Current information technologies and networking capabilities should be exploited to improve intensivist coverage, advanced alarm systems and to have large critical care databases of critical care signals.

Murias, Gaston; Sales, Bernat; Garcia-Esquirol, Oscar; Blanch, Lluis

2009-01-01

79

[Interdisciplinary surgery and telemedicine].  

PubMed

Surgical therapy is becoming increasingly complex. Besides new surgical techniques, sophisticated diagnostic methods and innovative interventional procedures must be integrated into the therapeutic concept to increase the efficacy of surgery. Accurate application of these techniques requires close cooperation between surgeons, other medical specialists, and technicians. Consequently, there is a significant need for structures promoting efficient communication, organization, and interaction in surgical departments. New techniques developed from telecommunication and information technology enable the transferal of complex medical data at any time to any place and are therefore the basis for telemedical applications. Telemedicine and other new techniques such as virtual operation planning, simulation, and intraoperative navigation promise to increase the efficacy of surgical therapy in the future. This paper provides an overview of the applications of telesurgery and currently available techniques. PMID:15042306

Schlag, P M; Hünerbein, M; Ulmer, C; Graschew, G

2004-04-01

80

[Case management: a concept analysis].  

PubMed

While the case management approach has been increasingly applied to healthcare worldwide in recent years, significant differences in application exist among discrete medical systems. This paper applies a methodology outlined by Walker and Avant to analyze the case management concept. This methodology is designed to assist medical staff to understand a concept in order to better achieve concept goals. The case management approach works to leverage organizational strategies to resolve case-specific circumstances and issues in order to accomplish organizational goals. Defining attributes of case management include: (1) highly complex cases; (2) the use of multidisciplinary professional teams to resolve case problems in the most cost-effective manner; (3) the use of case managers to manage the effective integration and operation of the multidisciplinary team; and (4) helping cases improve and make effective use of medical system resources. PMID:23922096

Yu, Chien-Tai; Feng, Ming-Chu; Ko, Nai-Ying

2013-08-01

81

Changes in provider attitudes toward telemedicine.  

PubMed

A longitudinal study was conducted in which the pre- and post-telemedicine encounter attitudes of healthcare providers were compared in order to ascertain whether and how experience with telemedicine changes their attitudes toward telemedicine. Attitudinal changes of providers who had used telemedicine previously were compared to those experiencing telemedicine for the first time. Data were gathered from the providers in two telemedicine programs located in Georgia and Nebraska. Both used real-time videoconferencing and peripheral devices to conduct telemedicine consultations. A total of 87 providers completed questionnaires just prior to and immediately after each telemedicine encounter in their respective programs. The questions focused on the expected impact of telemedicine on their productivity and ability to prescribe treatment. A 3-point scale was used to measure the responses. More than three quarters (79.3%) of the providers did not change their attitudes subsequent to the use of telemedicine. There was no significant difference between first-time users and those who had experience (p = 0.392). The shift in attitude in the minority (n = 18) of providers who did change their minds after the telemedicine encounter was more positive among those who used telemedicine for the first time as compared to those with experience. Contrariwise, those with experience became more negative (p = 0.025). This finding suggests that experience with telemedicine results in more positive attitudes that may not be realized in subsequent interactions with the technology. PMID:19199846

Hanson, Deborah; Calhoun, Judith; Smith, Dean

2009-01-01

82

Telemedicine and international disaster response: Medical consultation to Armenia and Russia via a telemedicine spacebridge  

NASA Technical Reports Server (NTRS)

The Telemedicine Spacebridge, a satellite mediated audio-video-fax link between four U.S. and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several U.S. medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to onsite physicians and favorably influence clinical decisions in the aftermath of major disasters.

Houtchens, Bruce A.; Clemmer, Terry P.; Holloway, Harry C.; Kiselev, Alexander A.; Logan, James S.; Merrell, Ronald C.; Nicogossian, Arnauld E.; Nikogossian, Haik A.; Rayman, Russell B.; Sarkisian, Ashot E.

1991-01-01

83

Valuation of Online Continuing Medical Education and Telemedicine in Taiwan  

Microsoft Academic Search

Physicians have acknowledged information technology (IT) efficiency and now utilize it in their professional practice and patient management. The benefits of IT within the health care environment has received academic attention, however existing literature currently pertains to limited areas, including the financial effects of telemedicine networks, and both the acceptability of this branch of medical care and the perceptions of

Fuhmei Wang

2008-01-01

84

Rural telemedicine project in northern New Mexico  

SciTech Connect

A virtual electronic medical record system is being deployed over the Internet with security in northern New Mexico using TeleMed, a multimedia medical records management system that uses CORBA-based client-server technology and distributed database architecture. The goal of the NNM Rural Telemedicine Project is to implement TeleMed into fifteen rural clinics and two hospitals within a 25,000 square mile area of northern New Mexico. Evaluation of the project consists of three components: job task analysis, audit of immunized children, and time motion studies. Preliminary results of the evaluation components are presented.

Zink, S.; Hahn, H.; Rudnick, J.; Snell, J.; Forslund, D. [Los Alamos National Lab., NM (United States); Martinez, P. [Northern New Mexico Community Coll., Espanola, NM (United States)

1998-12-31

85

Assessment of Approaches to Evaluating Telemedicine.  

National Technical Information Service (NTIS)

This study had four tasks: (1) creation of an advisory committee, (2) analysis of recent relevant literature and information on HHS-supported telemedicine evaluations, (3) interviews with experts in various aspects of telemedicine, and (4) interviews and ...

2000-01-01

86

A clinical and educational telemedicine link between Bulgaria and Greece.  

PubMed

During its transition to a market economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports: an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities; electronic design and publishing activities; Web hosting and mail server activities; and satellite communications. Communications are via ISDN. The main clinical experience has been remote consultations in immunology. This experience (admittedly limited) demonstrates that telemedicine can be used to provide assistance to remote colleagues. In addition, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers in cases where the patient cannot communicate with the attending physician because of a language barrier. PMID:14728745

Anogianakis, George; Ilonidis, George; Anogeianaki, Antonia; Milliaras, Spyros; Klisarova, Anelia; Temelkov, Temel; Vlachakis-Milliaras, Emmanuel

2003-01-01

87

Population-based case management.  

PubMed

Harris Methodist Health System is an integrated health system that has developed and implemented integrated health management (IHM) as a new care delivery model. IHM provides a focused, differentiated approach to case management based on the concept of population-based care. Unlike traditional case management, IHM goes beyond managing acute care across clinical settings to provide health care across a continuum that includes health promotion and illness prevention. PMID:10163107

Qudah, F J; Brannon, M

1996-01-01

88

Aviation medicine: challenges for telemedicine.  

PubMed

The number and seriousness of medical problems on passenger-carrying aircraft in flight are increasing. Medical incidents occur at a rate of approximately 10-50 per million passengers carried. Medical equipment carried on commercial aircraft is limited to three items: a first-aid kit, an emergency medical kit and sometimes an automatic external defibrillator. Telephone medicine, a lower level of telemedicine support, is well established for commercial air operations. The availability of satellite telecommunications on passenger-carrying aircraft permits more sophisticated forms of telemedicine. Recent telemedicine experiments have involved the transmission of three-lead electrocardiograms (ECGs), heart rate, blood pressure, arterial oxygen saturation, end-tidal CO2, respiratory rate, body temperature and realtime video. The challenge is to demonstrate that such techniques are practicable, improve patient outcomes and are cost-effective. PMID:11809077

Ferrer-Roca, O; Díaz De León, R D; de Latorre, F J; Suárez-Delgado, M; Di Persia, L; Cordo, M

2002-01-01

89

Secure mobile agent for telemedicine based on P2P networks.  

PubMed

Exploring intelligent mobile agent (MA) technology for assisting medical services or transmitting personal patient-health information in telemedicine applications has been widely investigated. Conversely, peer-to-peer (P2P) networking has become one of the most popular applications used in the Internet because of its benefits for easy-to-manage resources and because it balances workloads. Therefore, constructing an agent-based telemedicine platform based on P2P networking architecture is necessary. The main purpose of this paper is to construct a safe agent-based telemedicine that based on P2P networking architecture. Two themes are addressed in this paper: (a) the P2P network architecture for an agent-based telemedicine service, and (b) the security mechanisms for the proposed telemedicine networking architecture. When an MA contains patient information and migrates from one host to another through the Internet, it can be attacked by other software agents or agent platforms that can illegally access patient information. The proposed P2P network architecture is based on the JXTA protocol and provides two types of telemedicine service models: the predictable service model and unpredictable service model. This architecture employs a two-layer safety mechanism for MAs (i.e., time-limited black boxes and RSA undetachable signature technologies), to provide a secure solution for agent-based telemedicine services. PMID:23605144

Hsu, Wen-Shin; Pan, Jiann-I

2013-06-01

90

Telemedicine experience in the Brazilian Amazon  

PubMed Central

Introduction The development of telecommunication technologies and the diffusion of its eHealth applicability have enabled the implementation of a wide range of telemedicine systems, supporting clinical practices in different regions of the world. Distant and poorer areas of the globe, often characterized by difficult access and hazardous environments, are those that can most benefit from availability of remote consultations. This is due to the high costs associated with the transportation of specialized health teams and medical equipment between major cities and small villages, sometimes essential for the provision of adequate health care. Brazil is a country of continental dimensions with socioeconomic inequalities and uneven distribution of specialized health care, making it an ideal environment for establishment of eHealth initiatives. Objective The main objectives were (1) to develop an efficient method for acquiring and delivering patient medical information in remote areas using local Internet and (2) to assist urban and Indian populations in the Brazilian Amazon presenting with skin lesions and cardiovascular diseases. Methodology Ethical approval was granted by the research and Ethics Committees of PUCRS, Porto Alegre, Brazil. The project comprised: (1) triage and patient interview; (2) digital ECG and skin picture acquisition; (3) data management, storage and transmission; (4) delivery of expert second opinion based on development of a secure and confidential communication system between the receiving and delivering sites. Upon internet availability, the system was programmed to connect to the Microgravity Centre’s main server and to synchronise all collected data. Specialist health professionals accessed this server and the electronic patient records via a secure application installed on personal computers. Patient information, images, and exams were analysed by health specialists at the delivering site, and an opinion and treatment suggestion was offered. Cases that proved inconclusive were due to a lack of available information or the need for further laboratory exams. The opinions were secured in an encrypted PDF envelope and returned to the receiving site, where final diagnosis and treatment remained the responsibility of the local health team. Results Telecardiology (n=98): 59 (60.2%) normal ECGs, whilst 39 (39.8%) were altered, showing arrhythmias, conductive alterations and signs of ventricular hypertrophy. No patients presented signs of acute ischemia. In teledermatology (n=110): 57 (51.8%) patients did not present any skin disease. Among the patients with dermatological problems (n=53; 48.2%), the most common diagnoses were eczema, pityriasis versicolor, tinea, onychomycosis, and superficial mycosis. In five patients, the dermatologist suspected a cancerous lesion and recommended further investigation. Conclusion The telemedicine tools and the telecommunication system developed for this project proved to have a great applicability for diagnosis of dermatological skin conditions and for assessment of patient cardiovascular diseases. It was possible to remotely diagnose dermatological and cardiovascular conditions in a short period of time, at low cost and without the need for transportation of patients to other locations. It is believed that the eHealth assistance model applied in this project can be transferred to other places that have access to an Internet connection.

Jones, Christopher Robert; Cardoso, Ricardo Bertoglio; Oliveira, Helena Willhelm; Lopes, Maria Helena Itaqui; Huttner, Edison; Huttner, Eder; Wiehe, Mario; Celia2, Sergio Antonio Curcio; Russomano, Thais

2012-01-01

91

Clinical aspects of telemedicine  

NASA Technical Reports Server (NTRS)

Communication among physicians is an essential in order to combine our experiences for the elucidation and application of new knowledge and for the accurate and uniform application of established medical practice. This communication requires an adequate understanding of the culture of the patient and the social context of disease and indeed the culture of the physician. Malnutrition in Bangladesh means caloric insufficiency, and a program to lower cholesterol would be impertinent, while a program to enhance the nutrition of patients in Texas by an international effort to import more grain would be ludicrous. In the same vein a public health effort to combat alcoholic cirrhosis in Mecca would be as silly as a program to increase fiber in the diet of the Bantu. Clinical communication must acknowledge the culture of the issue at hand and the differences in the experiential base of the physicians. Not only do geography and culture affect the potential differences in the experiential bases, but the world utilizes very different traditions of education and science in training physicians. We are influenced by the diseases we treat, and learn to look for the expected at least as much as we are attentive to the unexpected. A physician in Siberia would be much more likely to recognize frostbite than one from Buenos Aires, and the Argentine doctor would much more likely consider Chaga's Disease to explain abdominal pain than a colleague in Zurich. Beyond these obvious issues in communication among physicians we must deal with the many languages and idioms used in the world. An overview of using Telemedicine SpaceBridge after the earthquake in the Republic of Armenia in 1988 is presented.

Merrell, Ronald C.

1991-01-01

92

Telemedicine in the Federated States of Micronesia.  

PubMed

Telemedicine (other than costly long distance telephone and facsimile messages) in the Federated States of Micronesia (FSM) started approximately 4 years ago with the establishment of Internet access in the State of Yap. A local access, for medical use only, via already established trunk lines maintained by Continental Airlines was established. It provided a connection to CompuServe at a baud rate of 300 bps. FSM TeleCom provided this free service. While this connection was slow, it allowed medical staff at Yap State Hospital to send and receive text based e-mail regarding patient management. By its use interest was generated in both medical and non-medical individuals to develop a commercial full scale Internet service. In March 1996, TeleCom became a full scale commercial Internet Service Provider in Yap. Rates were reasonable and the CompuServe access was phased out. The full scale internet allowed medical personnel to engage in telemedicine activities, including email; email attachments; the search and retrieval of medical literature; transmission to medical specialists of X-rays, ECG's and other images; and real-time teleconferencing over the Internet with both audio and video. In addition, to the improvement of medical care, this allowed for greater efficiency in arranging referral of patients for medical treatment outside of the FSM. PMID:11588919

Rutstein, D

2000-09-01

93

A generic task-driven multi-agent telemedicine system.  

PubMed

Pervasive Telemedicine is an emerging research discipline, which focuses on the development and the application of ubiquitous computing technology for healthcare purposes. However, the current telemedicine systems lack to be self adaptable to handle different types of data such as vital biosignals, images, video and textual data. In addition, they do not use the full capabilities of the computing devices on which they run. Unfortunately, the existing telemedicine systems do not pay enough attention to the quality level of their offered services nor offer adequate resources management for meeting bandwidth and end-to-end communication delays. In this paper we propose an information and communication architecture of a generic telemedicine system based on a knowledge base and intelligent agents interacting each with the other in a synergetic way to perform several medical tasks for a high level of quality of service (QoS). The medical assistance to skiers and high mountains resorts residents will be used in particular as an example of applicability scenario and models personalization. PMID:18002809

Nageba, Ebrahim; Fayn, Jocelyne; Rubel, Paul

2007-01-01

94

A patient-centric approach to telemedicine database development.  

PubMed

Computer and telecommunications technologies have unleashed a wide range of powerful tools for gathering, storing, and distributing patient information. Computerized records enable healthcare providers to rapidly access patient data and to closely monitor patients from a distance. These significant advantages can be further extended by using the technology to more fully involve patients in their own healthcare management. A patient-centric approach to telemedicine means that the patient takes on additional responsibility and control, and the benefits from increased patient involvement will translate into improved compliance, reduced litigation, lower costs, and better outcomes. Furthermore, there are often important ethical questions that are best decided by the informed patient. Patients have a right to know what information is being gathered and who will be authorized to access that information. Current health information systems do not adequately address these issues, and telemedicine applications--particularly home based telemedicine--is forcing everyone to take a closer look at patients' roles in their own healthcare. In this presentation, a patient-centric home telemedicine database is described, the limitations are discussed, and future directions are proposed. PMID:10180588

Peifer, J; Hopper, A; Sudduth, B

1998-01-01

95

Cost Effectiveness of Telemedicine Systems.  

National Technical Information Service (NTIS)

This study, concerned with cost-effectiveness, is an analysis of the uses and impacts of telemedicine systems. Factors affecting cost are investigated for both color and black and white systems. For example, it was found that when these alternative teleme...

B. V. Dean

1978-01-01

96

NASA's telemedicine testbeds: Commercial benefit  

NASA Astrophysics Data System (ADS)

The National Aeronautics and Space Administration (NASA) has been developing and applying telemedicine to support space flight since the Agency's beginning. Telemetry of physiological parameters from spacecraft to ground controllers is critical to assess the health status of humans in extreme and remote environments. Requisite systems to support medical care and maintain readiness will evolve as mission duration and complexity increase. Developing appropriate protocols and procedures to support multinational, multicultural missions is a key objective of this activity. NASA has created an Agency-wide strategic plan that focuses on the development and integration of technology into the health care delivery systems for space flight to meet these challenges. In order to evaluate technology and systems that can enhance inflight medical care and medical education, NASA has established and conducted several testbeds. Additionally, in June of 1997, NASA established a Commercial Space Center (CSC) for Medical Informatics and Technology Applications at Yale University School of Medicine. These testbeds and the CSC foster the leveraging of technology and resources between government, academia and industry to enhance health care. This commercial endeavor will influence both the delivery of health care in space and on the ground. To date, NASA's activities in telemedicine have provided new ideas in the application of telecommunications and information systems to health care. NASA's Spacebridge to Russia, an Internet-based telemedicine testbed, is one example of how telemedicine and medical education can be conducted using the Internet and its associated tools. Other NASA activities, including the development of a portable telemedicine workstation, which has been demonstrated on the Crow Indian Reservation and in the Texas Prison System, show promise in serving as significant adjuncts to the delivery of health care. As NASA continues to meet the challenges of space flight, the technologies adapted to support humans in extreme and remote environments, and the resultant protocols and procedures will further evolve the commercial practice of medicine and thereby enhance life on Earth.

Doarn, Charles R.; Whitten, Raymond

1998-01-01

97

Management Tools Case Study.  

National Technical Information Service (NTIS)

This study investigated documentation and procedures for the NASA Integrated Programs for Aerospace Vehicle Design (IPAD) Program. The purpose was to assess IPAD's value to a proposed R&D program for evaluating the application of management principles and...

J. R. Brown L. S. Hammond

1979-01-01

98

A clinical and educational telemedicine link between Bulgaria and Greece.  

PubMed

During its transition to a free economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports (a) electronic design and publishing activities, (b) web hosting and mail server activities and (c) satellite communications. In addition it supports an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities. Communications are via the ISDN network. In terms of its telemedicine activities, the network provides remote medical assistance to "language handicapped" travellers and to migrant workers in both countries. The main clinical experience is remote consultations in immunology. This admittedly limited experience demonstrates that telemedicine can be used to provide assistance to remote colleagues. In cases where the patient cannot communicate with the attending physician, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers. PMID:15544232

Anogianakis, George; Ilonidis, George; Anogeianaki, Antonia; Milliaras, Spyros; Klisarova, Anelia; Temelkov, Temel; Vlachakis-Milliaras, Emmanuel

2004-01-01

99

Evaluation of a telemedicine system for supporting thyroid disease diagnosis.  

PubMed

A telemedicine system connecting Japan and Belarus via a communication satellite and the international ISDN has been in use since February, 1999. Two relational databases, which are essentially the same, are set respectively at Nagasaki University School of Medicine and Gomel Regional Specialized Dispensary in Belarus for management of patients' data and for research including epidemiologic studies. The thyroid ultrasonographic images, microscopic images of cytological findings and other information on patients are sent from Gomel to Nagasaki once a week with diagnoses and comments by physicians at Gomel Regional Specialized Dispensary for cases whom they found difficult to diagnose. Thyroid specialists at Nagasaki University School of Medicine correct the diagnoses, if necessary, on the basis of information from Gomel and send their comments and instructions to Gomel for improving diagnosis skills of physicians at Gomel. The findings of 330 cases have been sent from Gomel to Nagasaki by September, 2000 since the commencement of the system in February, 1999. Of the 329 cases, thyroid diagnosis was made at Gomel for 261 cases in whom two or more diagnoses were made for 35 cases. As of the end of October, 2000, the Gomel diagnoses have been reviewed for 217 cases and the remaining 112 cases are under review at Gomel. The diagnoses made at Gomel and Nagasaki were in agreement for 110 (50.7%) of 217 cases. Thyroid cancer was diagnosed in 8 cases in whom 6 had been diagnosed at Gomel while the other 2 were diagnosed anew at Nagasaki. The usefulness of the system for improving thyroid diagnosis in Belarus was indicated. PMID:11604859

Yokota, K; Takamura, N; Shibata, Y; Yamashita, S; Mine, M; Tomonaga, M

2001-01-01

100

Telemedicine at the Veterans Health Administration  

Microsoft Academic Search

\\u000a Telemedicine in the Veterans Health Administration (VHA) is a broad concept with extensive possibilities. Telemedicine is\\u000a neither an isolated program, nor a list of projects that will ameliorate this condition or that. In concept and technology,\\u000a telemedicine actually promises a new time-independent geography in which to operate a large, integrated healthcare organization.\\u000a It is a fundamental development that must be

Roger H. Shannon; Daniel L. Maloney

101

The Managerial Nature of Case Management.  

ERIC Educational Resources Information Center

Contends that case managers engage in the practice of management. Employs Mintzberg's seminal research on chief executive behavior to argue that case managers' work is similarly characterized by brevity, variety, and fragmentation. Notes that case managers perform the 10 roles developed by Mintzberg. Describes roles and presents case managers

Wolk, James L.; And Others

1994-01-01

102

Aviation medicine: challenges for telemedicine  

Microsoft Academic Search

The number and seriousness of medical problems on passenger-carrying aircraft in flight are increasing. Medical incidents occur at a rate of approximately 10-50 per million passengers carried. Medical equipment carried on commercial aircraft is limited to three items: a first-aid kit, an emergency medical kit and sometimes an automatic external defibrillator. Telephone medicine, a lower level of telemedicine support, is

O. Ferrer-Roca; R D Díaz de León; F. J. de Latorre; M. Suarez-Delgado; L. Di Persia; M. Cordo

2002-01-01

103

Alaska telemedicine: growth through collaboration.  

PubMed

The last thirty years have brought the introduction and expansion of telecommunications to rural and remote Alaska. The intellectual and financial investment of earlier projects, the more recent AFHCAN Project and the Universal Service Administrative Company Rural Health Care Division (RHCD) has sparked a new era in telemedicine and telecommunication across Alaska. This spark has been flamed by the dedication and collaboration of leaders at he highest levels of organizations such as: AFHCAN member organizations, AFHCAN Office, Alaska Clinical Engineering Services, Alaska Federal Health Care Partnership, Alaska Federal Health Care Partnership Office, Alaska Native health Board, Alaska Native Tribal health Consortium, Alaska Telehealth Advisory Council, AT&T Alascom, GCI Inc., Health care providers throughout the state of Alaska, Indian Health Service, U.S. Department of Health and Human Services, Office of U.S. Senator Ted Steens, State of Alaska, U.S. Department of Homeland Security--United States Coast Guard, United States Department of Agriculture, United States Department of Defense--Air Force and Army, United States Department of Veterans Affairs, University of Alaska, and University of Alaska Anchorage. Alaska now has one of the largest telemedicine programs in the world. As Alaska moves system now in place become self-sustaining, and 2) collaborating with all stakeholders in promoting the growth of an integrated, state-wide telemedicine network. PMID:15709313

Patricoski, Chris

2004-12-01

104

Telemedicine - the future?  

PubMed

New developments in wound management may either come from remarkable progress in science and enhanced understanding of the intimate pathophysiology of wounds, or from improvements in organisation of health care. PMID:24762384

Téot, Luc

2014-04-01

105

CSCW Based Telemedicine on the Internet  

Microsoft Academic Search

This paper proposes a telemedicine system which is a CBM-based real-time interactive telemedicine system using a personal computer on the Internet. This system presents an intelligent remote medical examination system for both online and offline modes to transcend time and space on the Web. It can be used by anybody and is cheaper than existing remote medical examination systems. The

Seok-soo Kim; Dae-joon Hwang

2001-01-01

106

Clinical Decision Support System based Virtual Telemedicine  

Microsoft Academic Search

Telemedicine is a blessing for the people of remote areas because it provides high level medical facilities in an efficient way at low cost. Store-and-Forward method of telemedicine suits more to the progressive countries like Pakistan as not only because it is easy to set up but also due to its cheap operating cost. However, the high response time taken

Shazia Karim; Imran Sarwar Bajwa

2011-01-01

107

Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project  

PubMed Central

The Columbia University Informatics for Diabetes Education and Telemedicine (IDEATel) Project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine in the management of older patients with diabetes. The study is designed as a randomized controlled trial and is being conducted by a state-wide consortium in New York. Eligibility requires that participants have diabetes, are Medicare beneficiaries, and reside in federally designated medically underserved areas. A total of 1,500 participants will be randomized, half in New York City and half in other areas of the state. Intervention participants receive a home telemedicine unit that provides synchronous videoconferencing with a project-based nurse, electronic transmission of home fingerstick glucose and blood pressure data, and Web access to a project Web site. End points include glycosylated hemoglobin, blood pressure, and lipid levels; patient satisfaction; health care service utilization; and costs. The project is intended to provide data to help inform regulatory and reimbursement policies for electronically delivered health care services.

Shea, Steven; Starren, Justin; Weinstock, Ruth S.; Knudson, Paul E.; Teresi, Jeanne; Holmes, Douglas; Palmas, Walter; Field, Lesley; Goland, Robin; Tuck, Catherine; Hripcsak, George; Capps, Linnea; Liss, David

2002-01-01

108

Advanced telemedicine development  

SciTech Connect

This is the final report of a one-year, Laboratory Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). The objective of this project was to develop a Java-based, electronic, medical-record system that can handle multimedia data and work over a wide-area network based on open standards, and that can utilize an existing database back end. The physician is to be totally unaware that there is a database behind the scenes and is only aware that he/she can access and manage the relevant information to treat the patient.

Forslund, D.W.; George, J.E.; Gavrilov, E.M.

1998-12-31

109

Cognitive human factors for telemedicine systems.  

PubMed

The recent integration of telephony systems with information and communication technology (ICT) enables the development of innovative tools for telemedicine. The dissemination and widespread acceptance of telephone-based care monitoring systems challenge the researcher to deal with the cognitive factors involved in the patient-physician interaction, and the way they should be to shape up the technological solutions. This paper proposes a model that describes the impact of socio-cognitive factors in the complex process of health care management. The model has been used to design and develop a telephone system for the management of hypertensive patient within the EU funded Homey project. The knowledge existed in a widely accepted guideline for the care of hypertension has been represented and augmented through the proposed cognitive model. The final product is an intelligent system able to manage an adaptive dialogue. It monitors patients' adherence and increases their involvement by promoting self-care through frequent virtual visits, which is complementary to the traditional face-to-face encounters with their primary care physicians. PMID:15360958

Piazza, Matteo; Giorgino, Toni; Azzini, Ivano; Stefanelli, Mario; Luo, Roger

2004-01-01

110

Telemedicine in the pediatric intensive care unit.  

PubMed

Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedside of any critically ill child. Telemedicine use is increasing and will be a common technology in remote emergency departments, inpatient wards, and pediatric intensive care units. There is mounting data that demonstrate that the use of telemedicine technologies can result in higher quality of care, more efficient resource use and improved cost-effectiveness, and higher satisfaction among patients, parents, and remote providers compared to current models of care. PMID:23639656

Marcin, James P

2013-06-01

111

Telemedicine: legal and licensure issues  

NASA Astrophysics Data System (ADS)

The National Information Infrastructure program offers a great opportunity for the United States to capitalize on remarkable technological advancements over a broad range of applications benefiting society. One such application, telemedicine, has the potential to offer widespread access to sophisticated medical care, curtailed health care delivery costs, and homogeneous health and health-related educational opportunities. However, there are a variety of barriers to widespread application of telemedicine once the technical infrastructure of the information highway is well established and ubiquitous. These barriers include technical limitations, reimbursement issues, equipment and networking costs, and appropriate scientific studies to document efficacy and cost effectiveness. These issues may prove to be only transient disincentives which can be surmounted. Additional barriers exist, however, that may not be as readily resolved by traditional methods of analysis and more widespread practice applications. These political and regulatory obstacles will require clarification of the issues and solutions based on national consensus. It is the purpose of this discussion to amplify on these particular barriers which include licensure and tort jurisdiction.

Wood, Michael B.; Whelan, Leo J.

1995-10-01

112

Telemedicine - is the cart being put before the horse?  

PubMed

A large literature base on telemedicine exists, but the evidence base for telemedicine is very limited. There is little practical or useful information to guide clinicians and health policymakers. Telemedicine is often implemented based on limited or no prior formal analysis of its appropriateness to the circumstances, and adoption of telemedicine by clinicians has been slow and patchy. Formal analysis should be conducted before implementation of telemedicine to identify the patients, conditions and settings that it is likely to benefit. Primary studies of telemedicine tend to be of insufficient quality to enable synthesis of formal evidence. Methods typically used to assess effectiveness in medicine are often difficult, expensive or impractical to apply to telemedicine. Formal studies of telemedicine should examine efficacy, effectiveness, economics and clinician preferences. Successful adoption and sustainable integration of telemedicine into routine care could be improved by evidence-based implementation. PMID:24835716

Armfield, Nigel R; Edirippulige, Sisira K; Bradford, Natalie; Smith, Anthony C

2014-05-19

113

[Cases discussed of crisis management].  

PubMed

Everything undergoes structural shifts from day to day. Any kind of change can become not only a distinguishing feature, but also a source of crisis. The only way to respond to this is to maintain crisis awareness, since crises can develop faster than we imagine. Sound preparation for any manager should therefore involve planning to deal with a crisis that might arise at any time. A crisis could be a turning point for a positive form of change; this will depend on maturity of attitude and sound familiarity with the four stages of crisis management. In each stage, we should consider whether urgent and rapid action might truly create a positive opportunity, or actually make the situation worse. This article discusses the cost of errors in crisis management and the benefits of prompt, positive action in relation to the different examples established by four well-known cases. It is hoped that these will benefit nursing managers by improving crisis management skills in clinical practice. PMID:16475070

Hsieh, Yeu-Shan; Lin, Chun-Mei; Liao, Shu-Chen; Tsai, Chia-Lan

2006-02-01

114

An Albanian open source telemedicine platform.  

PubMed

Abstract Introduction: The use of open source technologies to create collaboration platforms can produce huge advantages with small investment. Materials and Methods: We set up a telemedicine network for a healthcare district with typical centralization issues of developing countries. Our network was built using broadband Internet connection, and the digital divide in rural areas was reduced by means of wireless Internet connection. A software infrastructure was deployed on the network to implement the collaboration platform among different healthcare facilities. Results: We obtained an integrated platform with modest investment in hardware and operating systems and no costs for application software. Messaging, content management, information sharing, and videoconferencing are among the available services of the infrastructure. Furthermore, open source software is managed and continuously updated by active communities, making it possible to obtain systems similar to commercial ones in terms of quality and reliability. Conclusions: As the use of free software in public administration is being widely promoted across the European Union, our experience may provide an example to implement similar infrastructures in the field of healthcare and welfare. PMID:24906118

Zangara, Gianluca; Valentino, Francesca; Spinelli, Gaetano; Valenza, Mario; Marcheggiani, Angelo; Di Blasi, Francesco

2014-07-01

115

Using telemedicine for acute stroke assessment.  

PubMed

In acute stroke care, urgent specialist assessment and treatment are essential to reduce the risk of death and disability. However, many patients do not receive them due to a lack of specialist services. One solution is to use telemedicine. This can give all patients with acute stroke symptoms access to immediate expert assessment and advice, regardless of when and where they present to hospital. This article describes a telemedicine system developed and implemented in Lancashire and Cumbria. In its first year of operation, 319 patients received a telestroke video assessment with a consultant stroke physician; 131 of these patients were given thrombolysis. We discuss how the service was designed, staff training and development, and the implications for nursing practice. The development of a standardised telemedicine toolkit that may facilitate future telemedicine projects is also discussed. PMID:24266238

Gibson, Jo; Fitzgerald, Jane; Gibson, Alison; McAdam, Joanna; Lightbody, Liz; McLoughlin, Alison; Watkins, Caroline; Day, Elaine

116

Evaluation of Telemedicine Satisfaction Among Naval Radiologists.  

National Technical Information Service (NTIS)

The focus of this study was to assess levels of satisfaction and experience among radiologists using teleradiology and other telemedicine technologies at the Naval Medical Center, San Diego (NMCSD). This study was conducted using a survey administered to ...

B. Bohannan C. Strychacz T. Melcer

2003-01-01

117

[Telemedicine: application in the neurological emergencies].  

PubMed

Telemedicine covers different fields going from teleconsultation to tele expertise. Thanks to different national and international studies, telemedicine applied to stroke (telestroke) should be considered as reliable, sure and efficient. Securized specific networks and standardised procedures are required. Telestroke can be used at each stage of stroke and every kind of stroke can benefit this technic. The main limitation is the lack of specific financial retribution. PMID:22425477

Medeiros de Bustos, Elisabeth; Vuillier, Fabrice; Chavot, Didier; Moulin, Thierry

2012-05-01

118

Patient confidentiality, ethics and licensing in telemedicine.  

PubMed

Telemedicine is fast becoming popular in many countries in the world. It has several advantages such as being cost saving and providing better access to health care in the remote areas in many parts of the world. However, it has some disadvantages as well. One of the major problems is the problem of patients' rights and confidentiality in the use of telemedicine. There are no standard guidelines and procedures in the practice of telemedicine as yet. Both the patient and the physician are unsure of the standard of practice and how to maintain confidentiality. The patient is uncertain as to how to protect her/his rights in the use of telemedicine. The issue of litigation is also unclear as to where the physician is practicing when he/she uses telemedicine. Is she/he practicing in the country where the patient is or is the physician practicing in the country of her/his origin? These issues need to be addressed urgently so that telemedicine will have standards of ethical practice and the patient's rights and confidentiality will be protected. PMID:12109246

Yadav, H; Lin, W Y

2001-01-01

119

Wearable devices for telemedicine applications.  

PubMed

Wearable medical devices can provide both continuous monitoring and ubiquitous treatment. Challenges in this area include the need for a low-power/power-saving design to extend battery life and to reduce the size of the battery itself. This is followed by size and weight restrictions to meet patient expectations of what is 'wearable', the biocompatibility of all outer housings and the final assembly concept. Two examples of wearable medical device are described: a wrist-wearable telemedicine monitor for heart patients (AMON) and a generic belt-integrated computing platform for home and hospital use (QBIC). The electrocardiogram (ECG), the blood oxygen saturation (SpO2) sensor and the blood pressure meter of the AMON device were tested with 29 subjects. The sensors were found to be functional, but as expected the data processing algorithms will need some fine-tuning. The prototype QBIC demonstrates a size reduction of 30-50% in relation to comparable devices. PMID:16035978

Scheffler, M; Hirt, E

2005-01-01

120

Evolving telemedicine/ehealth technology.  

PubMed

This paper describes emerging technologies to support a rapidly changing and expanding scope of telemedicine/telehealth applications. Of primary interest here are wireless systems, emerging broadband, nanotechnology, intelligent agent applications, and grid computing. More specifically, the paper describes the changes underway in wireless designs aimed at enhancing security; some of the current work involving the development of nanotechnology applications and research into the use of intelligent agents/artificial intelligence technology to establish what are termed "Knowbots"; and a sampling of the use of Web services, such as grid computing capabilities, to support medical applications. In addition, the expansion of these technologies and the need for cost containment to sustain future health care for an increasingly mobile and aging population is discussed. PMID:16035932

Ferrante, Frank E

2005-06-01

121

San Diego ED leverages telemedicine in a bid to ease crowding, long wait times.  

PubMed

In a study dubbed Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), investigators at the University of California San Diego Health System are gauging whether remote physicians can be quickly and cost-effectively mobilized to evaluate patients when the ED is busy. While there have been administrative hurdles involved with implementing the approach, investigators say the strategy could offer big savings in terms of time and efficiency. Onsite nurses facilitate telemedicine encounters, utilizing technology that enables remote physicians to evaluate patients. While both patients and providers give the telemedicine encounters high marks, managing the workflow is challenging. Investigators say the approach could produce significant gains in efficiency, including the possibility that a single on-call physician could remotely treat patients from multiple ED sites. PMID:23923522

2013-08-01

122

Challenges in telemedicine and eHealth: lessons learned from 20 years with telemedicine in Tromsø.  

PubMed

The Norwegian Centre for Telemedicine (NST) has, over the past two decades, contributed to the development and implementation of telemedicine and ehealth services in Norway. From 2002, NST has been a WHO Collaboration Center for telemedicine. In August 1996, Norway became the first country to implement an official telemedicine fee schedule making telemedicine services reimbursable by the national health insurer. Telemedicine is widely used in Northern Norway. Since the late 1980's, the University Hospital of North-Norway has experience in the following areas: teleradiology, telepathology, teledermatology, teleotorhinolaryngology (remote endoscopy), remote gastroscopy, tele-echocardiography, remote transmission of ECGs, telepsychiatry, teleophthalmology, teledialysis, teleemergency medicine, teleoncology, telecare, telegeriatric, teledentistry, maritime telemedicine, referrals and discharge letters, electronic delivery of laboratory results and distant teaching for healthcare personnel and patients. Based on the result achieved, the health authority in North-Norway plans to implement several large-scale telemedicine services: Teleradiology (incl. solutions for neurosurgery, orthopedic, different kinds of surgery, nuclear medicine, acute traumatic and oncology), digital communication and integration of patient data, and distant education. In addition, the following services will also be considered for large-scale implementation: teledialysis, prehospital thrombolysis, telepsychiatry, teledermatology. Last in line for implementation are: pediatric, district medical center (DMS), teleophthalmology and ear-nose-throat (ENT). PMID:17911683

Hartvigsen, Gunnar; Johansen, Monika A; Hasvold, Per; Bellika, Johan Gustav; Arsand, Eirik; Arild, Eli; Gammon, Deede; Pettersen, Sture; Pedersen, Steinar

2007-01-01

123

A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists  

PubMed Central

Background One way to tackle health inequalities in resource-poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web-based telemedicine. One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems. Objective We wanted to gain some insights into whether and how this system might be improved. Methods We carried out a survey by questionnaire of referrers and specialists over a six months period. Results During the study period, a total of 111 cases were referred from 35 different practitioners, of whom 24% were not doctors. Survey replies were received concerning 67 cases, a response rate of 61 per cent. Eighty-seven per cent of the responding referrers found the telemedicine advice useful, and 78% were able to follow the advice provided. As a result of the advice received, the diagnosis was changed in 22% of all cases and confirmed in a further 18 per cent. Patient management was changed in 33 per cent. There was no substantial difference between doctors and non-doctors. During the study period, the 111 cases were responded to by 148 specialists, from whom 108 replies to the questionnaire were received, a response rate of 73 per cent. About half of the specialists (47%) felt that their advice had improved the management of the patients. There were 62 cases where it was possible to match up the opinions of the referrer and the consultants about the value of a specific teleconsultation. In 34 cases (55%) the referrers and specialists agreed about the value. However, in 28 cases (45%) they did not: specialists markedly underestimated the value of a consultation compared to referrers. Both referrers and specialist were extremely positive about the system which appears to be working well. Minor changes such as a clearer referral template and an improved web interface for specialists may improve it.

Patterson, Victor; Wootton, Richard

2013-01-01

124

Telemedicine  

Microsoft Academic Search

\\u000a On November 21, 2004, eighteen-month-old baby Kate was critically injured in a car accident. She was rushed by paramedics\\u000a to the closest hospital in Douglas AZ, a small rural town. When she arrived at the Douglas emergency room, Kate was in shock\\u000a and minutes away from death, having lost almost two-thirds of her blood from multiple injuries. The doctor saw

William F. Bria; Nancy B. Finn

125

[Concept of the telemedicine system for a Martian mission].  

PubMed

The telemedicine concept for a mission to Mars is presented including the basic operational units and subsystems, and problems of elaboration and creation of the telemedicine system with the use of multilevel structure functional modeling. PMID:16353622

Grigor'ev, A I; Orlov, O I; Potapov, A N

2005-01-01

126

Some virtual reality and telemedicine applications useful for long duration spaceflight from a systems engineering perspective.  

PubMed

This paper presents a review of virtual reality, telemedicine, and systems engineering design concepts that relate to the human performance of mission tasks during long duration spaceflight. A Mini-Case Study of the MIR/Progress collision is discussed and serves to highlight some of the key issues. We review some physiologic changes which occur as a result of long duration spaceflight, discuss issues associated with performing required mission tasks, and integrate concepts from telemedicine and virtual reality as possible methods and technologies to alleviate some of the deleterious effects of extended space missions. PMID:10538344

Holland, D; Barfield, W

1999-01-01

127

Clinical and Educational Support for Space Flight via Telemedicine  

NASA Technical Reports Server (NTRS)

Session MP3 includes short reports on: (1) Telemedicine: A User's Perspective; (2) Health Care in Extreme Environments; (3) Integration of Emerging Technologies in Information and Telecommunications in Health Care Systems for Space; (4) Telemedicine and Environmental Medicine in Russia: A First Step in Basic Medical Education; and (5) Clinical Utility of Internet Telemedicine.

1997-01-01

128

Telemedicine in India: current scenario and the future.  

PubMed

India, with its diverse landmass and huge population, is an ideal setting for telemedicine. Telemedicine activities were started in 1999. The Indian Space Research Organization has been deploying a SATCOM-based telemedicine network across the country since that year. Various government agencies-Department of Information Technology and Ministry of Health & Family Welfare, state governments, premier medical and technical institutions of India-have taken initiatives with the aim to provide quality healthcare facilities to the rural and remote parts of the country. The Government of India has planned and implemented various national-level projects and also extended telemedicine services to South Asian and African countries. Efforts are taking place in the field of medical e-learning by establishing digital medical libraries. Some institutions that are actively involved in telemedicine activities have started curriculum and noncurriculum telemedicine training programs. To support telemedicine activities within the country, the Department of Information Technology has defined the Standards for Telemedicine Systems and the Ministry of Health & Family Welfare has constituted the National Telemedicine Task Force. There are various government and private telemedicine solution providers and a few societies and associations actively engaged to create awareness about telemedicine within the country. With its large medical and IT manpower and expertise in these areas, India holds great promise and has emerged as a leader in the field of telemedicine. PMID:19659413

Mishra, Saroj Kanta; Kapoor, Lily; Singh, Indra Pratap

2009-01-01

129

Adoption of telemedicine: from pilot stage to routine delivery  

PubMed Central

Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and professional incentives for potential telemedicine users and understand their importance for widespread adoption.

2012-01-01

130

Store and Forward Applications in Telemedicine for Wireless IP Based Networks  

Microsoft Academic Search

Telemedicine is the use of telecommunications technology to provide medical information and services. It may be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries, using videoconferencing equipment. The first is used daily by most health professionals, and the

Poondi Srinivasan Pandian; Kadavath Peedikayil Safeer; Doddamallur Thirumala Iyengar Shakunthala; Parvati Gopal; Vinod Chidambar Padaki

2007-01-01

131

Telemedicine can make healthcare greener.  

PubMed

The American healthcare industry is generally lacking environmentally sustainable practices. The environmental impact of healthcare practices in the country has been largely disregarded due to ambivalence, ignorance, and fears of additional costs and regulations. The current practices continue to pollute the environment by requiring large amounts of travel and paperwork by both the patient and the clinician. Telemedicine and health information technology help save time, energy, raw materials (such as paper and plastic), and fuel, thereby lowering the carbon footprint of the health industry. By implementing green practices, for instance, by engaging in carbon credit programs, the health industry could benefit financially as well as reduce its negative impact on the health of our planet. Companies that reduce their carbon emissions by implementing energy-saving practices can sell their carbon credits to companies that emit more carbon than permissible by their legally binding commitment. These carbon profits can then be used for healthcare research or to provide healthcare to the underserved. Alternatively, the savings could be used for green purchasing and to implement other carbon-reducing activities. This report reviews the numerous possible options for the American health industry to become greener and lower its carbon footprint while at the same time becoming more time- and cost efficient. PMID:20156125

Yellowlees, Peter M; Chorba, Kathy; Burke Parish, Michelle; Wynn-Jones, Hannah; Nafiz, Najia

2010-03-01

132

Telemedicine intervention improves ICU outcomes.  

PubMed

Telemedicine for the intensive care unit (Tele-ICU) was founded as a means of delivering the clinical expertise of intensivists located remotely to hospitals with inadequate access to intensive care specialists. This was a retrospective pre- and postintervention study of adult patients admitted to a community hospital ICU. The patients in the preintervention period (n = 630) and during the Tele-ICU period (n = 2193) were controlled for baseline characteristics, acute physiologic scores (APS), and acute physiologic and health evaluation (APACHE IV) scores. Mean APS scores were 37.1 (SD, 22.8) and 37.7 (SD, 19.4) (P = 0.56), and mean APACHE IV scores were 49.7 (SD, 24.8) and 50.4 (SD, 21.0) (P = 0.53), respectively. ICU mortality was 7.9% during the preintervention period compared with 3.8% during the Tele-ICU period (odds ratio (OR) = 0.46, 95% confidence interval (CI), 0.32-0.66, P < 0.0001). ICU LOS in days was 2.7 (SD, 4.1) compared with 2.2 (SD, 3.4), respectively (hazard ratio (HR) = 1.16, 95% CI, 1.00-1.40, P = 0.01). Implementation of Tele-ICU intervention was associated with reduced ICU mortality and ICU LOS. This suggests that there are benefits of a closed Tele-ICU intervention beyond what is provided by daytime bedside physicians. PMID:23365729

Sadaka, Farid; Palagiri, Ashok; Trottier, Steven; Deibert, Wendy; Gudmestad, Donna; Sommer, Steven E; Veremakis, Christopher

2013-01-01

133

Telemedicine Intervention Improves ICU Outcomes  

PubMed Central

Telemedicine for the intensive care unit (Tele-ICU) was founded as a means of delivering the clinical expertise of intensivists located remotely to hospitals with inadequate access to intensive care specialists. This was a retrospective pre- and postintervention study of adult patients admitted to a community hospital ICU. The patients in the preintervention period (n = 630) and during the Tele-ICU period (n = 2193) were controlled for baseline characteristics, acute physiologic scores (APS), and acute physiologic and health evaluation (APACHE IV) scores. Mean APS scores were 37.1 (SD, 22.8) and 37.7 (SD, 19.4) (P = 0.56), and mean APACHE IV scores were 49.7 (SD, 24.8) and 50.4 (SD, 21.0) (P = 0.53), respectively. ICU mortality was 7.9% during the preintervention period compared with 3.8% during the Tele-ICU period (odds ratio (OR) = 0.46, 95% confidence interval (CI), 0.32–0.66, P < 0.0001). ICU LOS in days was 2.7 (SD, 4.1) compared with 2.2 (SD, 3.4), respectively (hazard ratio (HR) = 1.16, 95% CI, 1.00–1.40, P = 0.01). Implementation of Tele-ICU intervention was associated with reduced ICU mortality and ICU LOS. This suggests that there are benefits of a closed Tele-ICU intervention beyond what is provided by daytime bedside physicians.

Sadaka, Farid; Palagiri, Ashok; Trottier, Steven; Deibert, Wendy; Gudmestad, Donna; Sommer, Steven E.; Veremakis, Christopher

2013-01-01

134

[Diabetes mellitus and the era of telemedicine].  

PubMed

Diabetes is one of the chronic diseases targeted by telemedicine applications. The remote monitoring of important physiological values may help lessen health care costs and has the potential for improving care for diabetes patients. A significant decrease in HbA1c levels through the use of telemedicine when compared to standard treatment has previously been postulated. However, the technology's impact on clinical events or cost-effectiveness is not yet clarified. Even though telemedicine harbors the potential of improving care in diabetic patients, some detrimental effects may accompany its implementation. The alteration of the communication between patients and caregivers may adversely affect the therapeutic relationship which is a cornerstone of diabetes treatment. PMID:25004770

Puricel, Serban-George; Ruiz, Juan

2014-06-01

135

The working alliance and consumer case management.  

PubMed

The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment. PMID:10142126

Solomon, P; Draine, J; Delaney, M A

1995-01-01

136

Strategic Procedures and Revisions for implementing Telemedicine and Telecare in Greece  

PubMed Central

The development of telemedicine and telecare has been changed all over the world the recent decades as practitioners and health care managers reached better understanding of the use of information and communication technologies to offer urgent and qualified medical services at a distance. Governments and health care providers have shown a large initial interest in the benefits of telemedicine services to reduce costs mostly for patient’s transfer to tertiary hospitals or for educational purposes but have been slow to provide strategic plans and procedures in order to proceed the projects into practice. The paper identifies the involvement of governments, healthcare management, healthcare professionals and IT suppliers in telemedicine policy development and reviews the experience of Greece in the specific field which seems that despite the enormous scientific interest for both medicine and health informatics, the practice until now has not gained the expected results. Furthermore, the analysis concerns the critical success factors that have to be revised simultaneously with the main managerial principles for the design and implementation of quality telemedicine and telecare services.

Tsirintani, M.

2012-01-01

137

[The case manager, a geriatrics healthcare coordinator].  

PubMed

The case manager mobilises the resources available within a geographic sector determined by the Centre for the autonomy and integration of Alzheimer's patients in order to respond to complex cases of elderly patient care. PMID:23951867

Dauriac, Christine

2013-01-01

138

Telemedicine Can Reduce Correctional Health Care Costs: An Evaluation of a Prison Telemedicine Network.  

National Technical Information Service (NTIS)

Between September 1996 and December 1996, a leased telemedicine network was installed to serve four Federal prisons. One suite, located in the penitentiary, served inmates at both the U.S. Penitentiary and the Federal Correctional Institution in Allenwood...

A. Hassol D. C. McDonald E. Fournier J. McCullough J. Yap K. Carlson

1999-01-01

139

Iowa Case Management for Rural Drug Abuse  

ERIC Educational Resources Information Center

Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…

Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

2009-01-01

140

Evolving medical service in the information age: a legal analysis of applying telemedicine programs in Taiwan.  

PubMed

In the face of the information age, Internet and telecommunication technologies have been widely applied in various settings. These innovational technologies have been used in the areas of e-commerce, long distance learning programs, entertainment, e-government, and so on. In recent years, the evolution of Internet technology is also pervading the health care industry. This dramatic trend may significantly alter traditional medical practice as well as the means of delivery of health care. The idea of telemedicine is to use modern information technology as a means or platform to deliver health care service in remote areas and to manage medical information in digitalized forms. The progress of developing telemedicine, however, is rather slow. The main reason for this slow progress is not technological but rather legal. Health care providers are reluctant to promote this innovation in medical service mainly due to uncertain legal consequences and ethical concerns. Although there are many legal challenges surrounding telemedicine, this note will examine major legal issues including licensure, malpractice liability, and privacy protection. Furthermore, I will discuss the potential of applying telemedicine programs in Taiwan's National Health Insurance Program (hereinafter referred to as NHI). PMID:19202856

Wu, Hsing-Hao

2008-12-01

141

Creating an Ethical Foundation for Home Telemedicine  

Microsoft Academic Search

The entry of telemedicine into the home makes it imperative that home health care professionals prepare to meet the challenge of new ethical issues. Telehome health care accelerates the need for nurse training on a code of ethics, because this new method of health care delivery transforms the patient from the usual object to be acted on into the primary

Linda L. Roman; Scott C. Stockwell; Vicki B. Louvier; Faye Clements

1997-01-01

142

Medical outreach to Armenia by telemedicine linkage  

Microsoft Academic Search

Telemedicine, an electronic mode of transmitting medical information interactively between remote sites, was launched as an educational support for a 3-year-old medical partnership between Boston University School of Medicine and Emergency Hospital, of Yerevan, Armenia. Emergency Hospital is the first site in Armenia to have an audiographic teleconference capability linking it to a major medical center. Emergency Hospital and Boston

Domenic Screnci; Erwin Hirsch; Kirsten Levy; Edward Skawinski; Michael DerBoghosian

1996-01-01

143

42 CFR 440.168 - Primary care case management services.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

2010-10-01

144

42 CFR 440.168 - Primary care case management services.  

Code of Federal Regulations, 2010 CFR

...2009-10-01 2009-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

2009-10-01

145

42 CFR 440.168 - Primary care case management services.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

2013-10-01

146

42 CFR 440.168 - Primary care case management services.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

2012-10-01

147

42 CFR 440.168 - Primary care case management services.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

2011-10-01

148

Adoption of routine telemedicine in Norway: the current picture  

PubMed Central

Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates.

Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard

2014-01-01

149

7 CFR 1700.31 - Distance Learning and Telemedicine Loan and Grant Program.  

...2014-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.31...1700.31 Distance Learning and Telemedicine Loan and Grant Program. RUS...grants and loans to furnish and improve telemedicine services and distance learning...

2014-01-01

150

7 CFR 1700.31 - Distance Learning and Telemedicine Loan and Grant Program.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.31...1700.31 Distance Learning and Telemedicine Loan and Grant Program. RUS...grants and loans to furnish and improve telemedicine services and distance learning...

2011-01-01

151

7 CFR 1700.31 - Distance Learning and Telemedicine Loan and Grant Program.  

Code of Federal Regulations, 2012 CFR

...2012-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.31...1700.31 Distance Learning and Telemedicine Loan and Grant Program. RUS...grants and loans to furnish and improve telemedicine services and distance learning...

2012-01-01

152

High-Performance Telemedicine Information Management  

Microsoft Academic Search

The rapid advances in high performance global communication have accelerated cooperative image-based medical services to a new frontier. Traditional image-based medical services such as radiology and diagnostic consultation can now fully utilize multimedia technologies to provide novel services, including remote cooperative medical triage, distributed virtual simulation of operations, as well as cross-country collaborative medical research and training. Fast (efficient) and

Hong-mei Chen; David Y. Y. Yun

1999-01-01

153

Design and Implementation of Telemedicine based on Java Media Framework  

NASA Astrophysics Data System (ADS)

According to analyze the importance and problem of telemedicine in this paper, a telemedicine system based on JMF is proposed to design and implement capturing, compression, storage, transmission, reception and play of a medical audio and video. The telemedicine system can solve existing problems that medical information is not shared, platform-dependent is high, software is incompatibilities and so on. Experimental data prove that the system has low hardware cost, and is easy to transmission and storage, and is portable and powerful.

Xiong, Fengguang; Jia, Zhiyan

154

Iowa Case Management for Rural Drug Abuse  

PubMed Central

Objective The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. Results Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. Conclusion Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.

Hall, James A.; Sarrazin, Mary S. Vaughan; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

2011-01-01

155

Case Management Services by the Volunteer Elderly.  

National Technical Information Service (NTIS)

The document focuses on the System to Assure Elderly Services (STAES), a program developed to foster social support systems involving elderly volunteers. The program mobilizes and trains elderly persons to become 'volunteer case managers' who serve other ...

M. N. Ozawa

1986-01-01

156

Implementation and performance evaluation of mobile ad hoc network for Emergency Telemedicine System in disaster areas.  

PubMed

So far we have developed Emergency Telemedicine System (ETS) which is a robust system using heterogeneous networks. In disaster areas, however, ETS cannot be used if the primary network channel is disabled due to damages on the network infrastructures. Thus we designed network management software for disaster communication network by combination of Mobile Ad hoc Network (MANET) and Wireless LAN (WLAN). This software maintains routes to a Backbone Gateway Node in dynamic network topologies. In this paper, we introduce the proposed disaster communication network with management software, and evaluate its performance using ETS between Medical Center and simulated disaster areas. We also present the results of network performance analysis which identifies the possibility of actual Telemedicine Service in disaster areas via MANET and mobile network (e.g. HSDPA, WiBro). PMID:19964544

Kim, J C; Kim, D Y; Jung, S M; Lee, M H; Kim, K S; Lee, C K; Nah, J Y; Lee, S H; Kim, J H; Choi, W J; Yoo, S K

2009-01-01

157

Case Studies in Managing Psychological Depth.  

ERIC Educational Resources Information Center

This paper outlines a model for assessing and managing psychological depth in outdoor and experiential group work, and presents two case studies of the complexity of such management in real life. The model contains eight levels of emotional risk and presents four criteria for assessing the level to which a particular event or discussion may lead…

Ringer, Martin; Gillis, H. L.

158

A review of telemedicine in accident and emergency: the story so far  

PubMed Central

Recent developments in information and communications technology have the potential to revolutionise health care. This has been recognised at government level, and plays a significant part in the new information strategy for the NHS "Information For Health". Telemedicine (literally, medicine at a distance) is one of the most successful techniques in this rapidly expanding field, and in preliminary studies has proved to be both successful and popular with patients and health care professionals. In the UK telemedicine has been mainly applied to two major areas of accident and emergency (A&E) practice. These are the transmission of computed tomography scans for urgent neurosurgical opinion and the ongoing support of minor injuries units. The latter also involves transmission and interpretation of radiographs, usually peripheral limb films. Telemedicine is not a medical sub-specialty in itself, but a facilitator of all medical and surgical specialties. While recent modernisation initiatives have permitted A&E departments to purchase a range of telemedical equipment, overall progress is hampered by a lack of large or scientifically rigorous studies, and a complete absence of data on the economic implications of this new technique. This review introduces A&E telemedicine in terms that avoid jargon and complex technical details. After a brief consideration of the origins of the subject, attention is given to recent publications relating to minor injuries support and A&E teleradiology. The technical and clinical feasibility of A&E telemedicine are demonstrated, and a case is made for the transmission and interpretation of minor injuries radiographs using a relatively simple and inexpensive system, supported by timely radiological reporting. After a brief study of various legal and ethical issues, the likely developments of the future are discussed.

Benger, J.

2000-01-01

159

New telemedicine approach to the dynamic ECG and other biological signals ambulatory monitoring  

Microsoft Academic Search

Telemedicine is an emerging field that can potentially affect health management, according to the present technological progress, combining medical expertise and communication technology. In this field, three main trials have been up to now experimented; teleconference, tele-intervention, telemonitoring. Teleconference applications are today a true reality, even in the medical field (i.e. consulting), while tele-intervention (i.e. tele-surgery) and telemonitoring remain at

D. Franchi; A. Belardinelli; G. Palagi; A. Ripoli; R. Bedini

1998-01-01

160

Experimental telemedicine network by extended upstream CATV  

Microsoft Academic Search

A type of tap-off upstream extension system is developed to provide high-speed upstream signal transmission by our experimental telemedicine network, which is composed of a wireless LAN and three CATV networks. Transmission tests conducted with this extension system show that 64QAM signals at the symbol rate of 5 Msymbols\\/sec can be transferred stably in the 260 MHz extended upstream band

Yuying Yang; M. Nakamura; S. Kubota; H. Shimizu

2003-01-01

161

URBAN STORMWATER MANAGEMENT AND TECHNOLOGY: CASE HISTORIES  

EPA Science Inventory

This report is the third in a series on urban stormwater and combined sewer overflow management. It presents 12 case histories representing most promising approaches to stormwater control. The case histories were developed by evaluating completed and operational facilities or ong...

162

Quantitative telemedicine ratings in Batten disease  

PubMed Central

Objective: To determine if remote administration of the Unified Batten Disease Rating Scale (UBDRS) Physical Impairment subscale by telemedicine is reliable and feasible across a broad range of disease severity. Methods: For the majority (n = 10) of subjects, the examination was performed by a nonphysician who had been trained to perform the examination but not to score the subjects. A trained rater scored the subjects via live video; a second trained rater performed a separate examination in person and scored that examination. For 3 telemedicine evaluations, examinations were performed and scored by a trained rater while a second trained rater simultaneously scored the subjects via live video. Reliability was determined by intraclass correlation coefficient (ICC). Results: Subjects (n = 13) represented a wide range of disease severity. Remote administration of the UBDRS Physical Impairment subscale had high interrater reliability across all subjects (ICC = 0.94). When only the subjects (n = 10) who had been examined by the nonphysician and scored remotely were included in the analysis, the reliability was unchanged (ICC = 0.95). Conclusions: The UBDRS Physical Impairment subscale is reliable and feasible for remote administration. Telemedicine has the potential to be a useful tool in rare neurologic disease research and clinical assessment.

Cialone, J.; Augustine, E.F.; Newhouse, N.; Vierhile, A.; Marshall, F.J.

2011-01-01

163

Private payer reimbursement for telemedicine services in the United States.  

PubMed

Telemedicine has garnered significant attention over the past decade as a solution to cost and access challenges facing healthcare. Yet, utilization rates have not reached their full potential. One major barrier to the adoption of telemedicine cited in the literature is the lack of universal reimbursement from private payers. The purpose of this investigation was to capture a current picture of private reimbursement for telemedicine services in the United States. This investigation was a follow-up to a 2003 survey conducted by the American Telemedicine Association (ATA) and AMD Telemedicine. Representatives from 116 telemedicine programs were contacted between September and November 2005 via telephone and/or e-mail to participate in this survey. Of those contacted, we received responses from 64 organizations, a 55% response rate. To provide answers to our research questions, descriptive statistics were used for data analysis. Data indicate that the United States is progressing toward expanded private reimbursement for telemedicine services with 58% of responding organizations who provide potentially billable telemedicine services receiving private reimbursement (up 5% from 2003). In addition, it was found that 81% of those who receive private pay reported no differences between reimbursement for telemedicine services as compared to traditional faceto-face consults. Finally, of those who receive private pay, data indicated that telemedicine programs are submitting on average approximately 40% of consults for private reimbursement. While this investigation does suggest that we are making small improvements in private payer reimbursement, the change appears to lag behind a pace needed to optimize telemedicine deployment. PMID:17309350

Whitten, Pamela; Buis, Lorraine

2007-02-01

164

Development of Telemedicine Capabilities for a Joint US-Russian Space Biomedical Center for Training and Research  

NASA Technical Reports Server (NTRS)

From the perspective of scheduling, some medical consultations can have asynchronous and synchronous components. Consultations frequently involve the compilation of patient data, its analysis, a consultant's report, and a real-time conference between the referring physician and the consultant. The bandwidth of the Internet with Moscow and advances in the hardware and software of personal computing now make possible telemedicine events with store-and-forward components and real-time components. These are hybrid telemedicine and this paper describes such a case.

DeBakey, Michael E.

1998-01-01

165

Mapping the literature of case management nursing  

PubMed Central

Objectives: Nursing case management provides a continuum of health care services for defined groups of patients. Its literature is multidisciplinary, emphasizing clinical specialties, case management methodology, and the health care system. This study is part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association. The study identifies core journals cited in case management literature and indexing services that access those journals. Methods: Three source journals were identified based on established criteria, and cited references from each article published from 1997 to 1999 were analyzed. Results: Nearly two-thirds of the cited references were from journals; others were from books, monographs, reports, government documents, and the Internet. Cited journal references were ranked in descending order, and Bradford's Law of Scattering was applied. The many journals constituting the top two zones reflect the diversity of this field. Zone 1 included journals from nursing administration, case management, general medicine, medical specialties, and social work. Two databases, PubMed/MEDLINE and OCLC ArticleFirst, provided the best indexing coverage. Conclusion: Collections that support case management require a relatively small group of core journals. Students and health care professionals will need to search across disciplines to identify appropriate literature.

White, Pamela; Hall, Marilyn E.

2006-01-01

166

[Telemedicine: Who, what, with what aids, where, why, how, when?].  

PubMed

Telemedicine can be defined as the practice of medicine or surgery via telecommunication interposition using technologies which permit the exchange of medical information and the application of medical care at a distance. Geographic separation, logistical problems which impede the delivery of care, extreme climactic conditions, artificial environments, or a combination of these parameters may all influence the health of patients and the ability of healthcare professionals to do their work effectively. This article reviews the standards of current telemedical and telesurgical systems, defines target groups who may benefit from such care, and details the technologic requirements of telemetry; it uses selected cases and a review the medical literature. The conclusion focuses on future developments and the potential for further improvements through ongoing research. PMID:18955922

Syburra, T; Genoni, M

2008-01-01

167

The Role of Telemedicine in Treating the Critically Ill  

Microsoft Academic Search

Telemedicine use has been increasing exponentially and is expected to become a common tool in remote emergency departments, inpatient wards, and ICUs for acute care. Telemedicine involves real-time, live interactive high-definition video and audio communication that allows critical care physicians to have a virtual presence at the bedside of any critically ill patient. There is increasing data to support new

James P. Marcin; Meghann Marcin; Candace Sadorra; Madan Dharmar

2012-01-01

168

An Interpersonal Examination of Telemedicine: Applying Relevant Communication Theories  

Microsoft Academic Search

The purpose of this analysis is to examine telemedicine's implications in the context of interpersonal communication. As telemedicine is a form of computer-medi ated communication that exchanges and\\/or delivers healthcare information between people - particularly medical practitioners, patients, and general healthcare consumers - it is appropriate to investigate it in terms of its on-line, interpersonal communication conditions and corollaries. In

Gerald-Mark Breen; Jonathan Matusitz

169

Styles of Case Management: The Philosophy and Practice of Case Managers  

Microsoft Academic Search

A great deal of discussion and research has gone into defining and clarifying the role of “case manager” (CM) for persons with severe mental illness. This three state survey examines the philosophy and activities of practicing CMs in an attempt to identify current styles of case management. A cluster analysis based on CM rankings of five CM functions suggested four

Joseph G. Hromco; John S. Lyons; Robert E. Nikkel

1997-01-01

170

Communication action for case managers. Techniques to manage conflict.  

PubMed

The art of communication can facilitate case management in an optimum sense. It can also create conflict issues if handled inappropriately. In this article, the authors explore the basic tenets of the communication process. On this basic foundation, conflict and approaches to conflict resolution are explored. Specifically, Kare Anderson's Triangle Talk model is used in conjunction with a specific case that demonstrates the potential for positive communication outcomes. The model offers three principles, which are discussed individually. Good communication skills are a prime component of therapy and case management. It is important to the case outcome that the communication is done well. However, it is unusual for health care providers to have specialized training in the skills of conflict negotiation. The authors offer the reader an opportunity to apply what is presented in this article in a self-study module at the end. PMID:9526394

Marino, T Y; Kahnoski, B

1998-01-01

171

A Cognitive Framework for Understanding Barriers to the Productive Use of a Diabetes Home Telemedicine System  

PubMed Central

Telemedicine has the potential to transcend geographic and socio-cultural barriers to the delivery of high quality health care to the medically underserved populations. However, there are significant cognitive and usability barriers. This paper presents a multifaceted cognitive evaluation of the IDEATel diabetes education and telemedicine program. The evaluation included a cognitive walkthrough analysis to characterize task complexity and identify potential problems as well as field usability testing in patients’ homes. The study revealed dimensions of the interface that impeded optimal access to system resources. In addition, we found significant obstacles corresponding to perceptual-motoric skills, mental models of the system, and health literacy. The objective of this work is to contribute to a design framework so that participants with a wide range of skills can better manage their chronic illnesses.

Kaufman, David R.; Starren, Justin; Patel, Vimla L.; Morin, Philip C.; Hilliman, Charlyn; Pevzner, Jenia; Weinstock, Ruth S.; Goland, Robin; Shea, Steven

2003-01-01

172

Prevention of Diabetes in Rural India with a Telemedicine Intervention  

PubMed Central

Background Diabetes care is not presently available, accessible, or affordable to people living in rural areas in developing countries, such as India. The Chunampet Rural Diabetes Prevention Project (CRDPP) was conceived with the aim of implementing comprehensive diabetes screening, prevention, and treatment using a combination of telemedicine and personalized care in rural India. Methods This project was undertaken in a cluster of 42 villages in and around the Chunampet village in the state of Tamil Nadu in southern India. A telemedicine van was used to screen for diabetes and its complications using retinal photography, Doppler imaging, biothesiometry, and electrocardiography using standardized techniques. A rural diabetes center was set up to provide basic diabetes care. Results Of the total 27,014 adult population living in 42 villages, 23,380 (86.5%) were screened for diabetes, of which 1138 (4.9%) had diabetes and 3410 (14.6%) had prediabetes. A total of 1001 diabetes subjects were screened for complications (response rate of 88.0%). Diabetic retinopathy was detected in 18.2%, neuropathy in 30.9%, microalbuminuria in 24.3%, peripheral vascular disease in 7.3%, and coronary artery disease in 10.8%. The mean hemoglobin A1c levels among the diabetes subjects in the whole community decreased from 9.3 ± 2.6% to 8.5 ± 2.4% within 1 year. Less than 5% of patients needed referral for further management to the tertiary diabetes hospital in Chennai. Conclusions The Chunampet Rural Diabetes Prevention Project is a successful model for screening and for delivery of diabetes health care and prevention to underserved rural areas in developing countries such as India.

Mohan, Viswanathan; Deepa, Mohan; Pradeepa, Rajendra; Prathiba, Venkat; Datta, Manjula; Sethuraman, Ravikumar; Rakesh, Hari; Sucharita, Yarlagadda; Webster, Premila; Allender, Steven; Kapur, Anil; Anjana, Ranjit Mohan

2012-01-01

173

Navy telemedicine: a review of current and emerging research models.  

PubMed

With extended deployments of military telemedicine to remote, austere, and high-risk settings, there is a danger that implementation will outrun the research designed to assess it. A review of existing research evaluates current assessment models and indicates gaps around which future research may be designed. A review of models for evaluating telemedicine was conducted in September, 2001. Seven areas of assessment recurred that could be subsumed under the framework of "interoperability." A follow-up search was conducted during September, 2003, to ascertain the degree to which assessments of interoperability were being advocated. Although extensive deployments of telemedicine systems in high-risk settings make it imperative to know that human, organizational, and technical components are integrating productively (i.e., interoperating), current research does not evaluate telemedicine as a system. The structure and functioning of telemedicine systems should be assessed empirically and systemically to avoid subjective or limited assessments. PMID:15650529

Reed, Cheryl; Burr, Ralph; Melcer, Ted

2004-01-01

174

Case Management for Traumatic Brain Injury Survivors With Alcohol Problems  

Microsoft Academic Search

Objective: To evaluate a community-based approach to substance abuse using comprehensive case management for persons with traumatic brain injury (TBI). Setting: Two programs that provide case management services (n = 217); a comparison group was recruited that did not receive case management (n = 102). Intervention: Comprehensive case management. Main Outcome Measures: Self-reported substance use, community integration, employment status, health-related

Allen W. Heinemann; John D. Corrigan; Dennis Moore

2004-01-01

175

The Case Management Model: Concept and Process Definition. Volume I.  

ERIC Educational Resources Information Center

This report describes a case management model and was designed to serve as a basic text for training social service workers. Chapter I defines the term case management and discusses the role of case management in the field of social services. Chapter II delineates the main features of the case management model and the activities required of the…

Regional Inst. of Social Welfare Research, Athens, GA.

176

Service Design Attributes Affecting Diabetic Patient Preferences of Telemedicine in South Korea  

PubMed Central

Abstract Objective Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes. Materials and Methods We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey. Results All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services. Conclusions The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries.

Chon, YuCheong; Lee, Jongsu; Choi, Ie-Jung; Yoon, Kun-Ho

2011-01-01

177

The added value of video for consultations in telemedicine for minor injuries work.  

PubMed

We examined the decisions made about transfer of patients with minor injuries, when telemedicine support was provided to the remote nurses in two different ways: the telemedicine doctor either used a video link, or a telephone call with viewing of digital X-ray images (a low resolution version of Picture Archiving and Communications Systems [PACS]). A quasi-randomized study design was used, with a panel of 20 emergency medicine doctors who independently reviewed previously-stored consultations using the two modalities. In total, 60 case reviews were conducted during five sessions, representing 33 different cases from the routine workload of Minor Treatment Centres in Scotland. More experienced doctors transferred fewer patients than less experienced doctors. The proportion of patients transferred was higher when PACS was used than when video was used in most of the cases. A mixed effects logistic regression model was fitted to the data. The estimated odds for patient transfer were 56% lower when video was used instead of PACS (odds ratio 0.44, 95% confidence interval 0.20, 0.93). Although the cost implications are not yet known, video support for local decision-making should remain the preferred method of telemedicine for minor injuries work. PMID:22036927

Mair, Fiona; McClusky, Christine; Wilsgaard, Tom; Wootton, Richard

2011-01-01

178

Screening for Diabetic Retinopathy: The First Telemedicine Approach in a Primary Care Setting in Bahrain  

PubMed Central

Purpose: To develop an integrated diabetic retinopathy screening program that uses telemedicine. Materials and Methods: In this evaluation of diagnostic technology, six telemedical screening units were established to cover all regions of Bahrain. The units were equipped with a digital fundus camera at the primary health care clinic. Fundus photographs were transmitted via the Internet to a centralized reading center. A retinal specialist at the reading center assessed the images. Results: From 2003 to 2009, 17,490 diabetic patients were screened. Of the screened patients, 20% were diagnosed with diabetic retinopathy. Of these cases, 31% required treatment. Conclusion: Telemedicine-based screening program is a feasible and efficient means of detecting diabetic retinopathy and providing treatment.

Al Alawi, Ebtisam; Ahmed, Ahmed Abdulla

2012-01-01

179

Anesthesic Management for Escobar Syndrome: Case Report  

PubMed Central

Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.

Arpaci, Ayse Hande; Bozkirli, Fusun; Konuk, Onur

2011-01-01

180

Case Management of Adolescents with Chronic Disease.  

ERIC Educational Resources Information Center

This training guide presents a model for optimum delivery of the primary duties, tasks, and steps required in the comprehensive case management of adolescents with chronic disease. Using a team approach to coordinated health care, the guide involves the patient and family as key members of the care team along with the physician, nurse, dietitian,…

Lankard, Bettina A.

181

Telemedicine deployments within NATO military forces: a data analysis of current and projected capabilities.  

PubMed

Since the creation of the NATO Telemedicine Expert Panel (now renamed the TMED Expert Team) in 2000, when few nations had deployed telemedicine systems to support military field operations, this group has been encouraging the nations to deploy telemedicine (TMED) in support of their forces, and to write the use of TMED into NATO doctrine. This has been a relatively successful effort, and TMED is increasingly being used within the military medical structures of some NATO and Partnership for Peace nations to provide medical care to deployed military personnel. We report the results of a multinational survey of current and projected availability of various telemedicine modalities within the NATO medical services that are participating in the work of the TMED expert team (ET). Though only a "snapshot in time," and not representing all NATO nations, this is the first attempt to identify both current and planned TMED utilization within the multinational military medical community. Participating nations report that communication systems now in place at the lowest levels of medical support increasingly enable the routine use of Web-based teleconsultation modalities. Teleradiology is now being seen as the de facto standard for imaging support. While a number of nations report they have deployed capabilities for obtaining clinical consultations at a distance, most responding nations do not have a formal organizational structure to control and manage remote consultation and rely on informal clinical relationships (e.g., requesting consults from the deployed clinician's home hospital or from friends). Military electronic health records are in use by only a minority of nations and fewer still are capable of civilian interface. Less common TMED capabilities (e.g., tele-microbiology, tele-pathology, tele-medical maintenance) are being increasingly used, but are still rarely deployed. As a result of the findings of this survey, specific recommendations for expanding the use of TMED in the NATO multinational medical setting have been made to appropriate NATO bodies. PMID:19035805

Lam, David M; Poropatich, Ronald K

2008-11-01

182

OIG offers guidance on the legality of telemedicine arrangements.  

PubMed

Telemedicine increasingly is being used to enable patients in rural areas to gain access to specialists. At the same time, concerns have arisen about the legality of certain telemedicine applications. To date, the HHS Office of Inspector General (OIG) has issued two advisory opinions stating it would not impose sanctions on two specific telemedicine arrangements, where potential violations of the antikickback statute could exist. These opinions, while applying only to the specific arrangements in question, provide physicians with clues to the OIG's thinking on various arrangements they may wish to initiate. PMID:11010186

Stewart, E E

2000-06-01

183

A telemedicine health care delivery system  

NASA Technical Reports Server (NTRS)

The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

Sanders, Jay H.

1991-01-01

184

Supporting Hospital Doctors in the Middle East by Email Telemedicine: Something the Industrialized World Can Do to Help  

PubMed Central

Background Since 1999, the Swinfen Charitable Trust has operated an email referral system between doctors in the developing world and specialists in the industrialized world. Since 2001, it has expanded its operation into the Middle East, in particular Iraq, an area of considerable conflict. Objectives The aim was to compare referral patterns to the Trust from the Middle East with those received from the rest of the developing world and to look for qualitative evidence of health gain. Methods We analyzed referrals to the Swinfen Charitable Trust between July 2004 and June 2007 and compared these by speciality with those received from elsewhere during the same 3-year period. We asked two referring doctors for their views of the process, and we analyzed the total Middle Eastern referrals made to a single specialty (neurology). Results Between July 2004 and June 2007, 283 referrals were received from four countries in the Middle East (Iraq, Afghanistan, Pakistan, Kuwait) and 500 cases were received from 22 other countries. The 283 cases resulted in 522 separate queries to specialists. The median time to specialist reply for the queries relating to the 283 Middle Eastern cases was 24.3 hours (interquartile range 6.1-63.3). There was a significant difference in case mix between the Middle East and the rest of the world (P < .001), with more obstetric referrals and fewer referrals in medical specialties and radiology. The referring doctors were helped greatly by the service. The neurologist was confident of the diagnosis in 20 of 26 referrals received (77%). Both referring doctors and the specialist were able to cite referred cases where management was improved as a result of the service. Conclusions Email telemedicine can be used in areas of conflict such as the Middle East. Perhaps surprisingly, trauma referrals are not increased but obstetric referrals are. Supporting individual doctor-patient encounters in this way is therefore often beneficial and is easily expandable. As well as improving care for individuals, email telemedicine provides effective case-based learning for local doctors, leading to improved care for subsequent similar patients.

Patterson, Victor; Swinfen, Pat; Swinfen, Roger; Azzo, Emil; Taha, Husen

2007-01-01

185

Case management in occupational rehabilitation: Would the real case manager please stand up?  

Microsoft Academic Search

Key stakeholders (injured workers, rehabilitation co-ordinators, rehabilitation providers, treating doctors and insurers ) in the occupa- tional rehabilitation process were interviewed to gain their perspective concerning the degree to which case management was viewed as the organising principle of post-injury management and to whom this role was most frequently assigned. Findings indicated that there were differences in stakeholder perceptions about

Dianna T Kenny

186

Case Management with Displaced Survivors of Hurricane Katrina  

Microsoft Academic Search

Case management is a staple of post-disaster recovery, but there is limited research on this topic. Utilizing in-depth interviews, observations, and document analysis, based on 78 interviews and attendance at approximately 50 public meetings, this longitudinal case study examined case management with displaced hurricane Katrina survivors in one host community between December 2005 and December 2006. Case managers identified, assessed,

Holly Bell

2008-01-01

187

User satisfaction with maritime telemedicine.  

PubMed

We assessed the satisfaction of onboard caregivers with the maritime telehealth service provided by the Centre de Consultations Médicales Maritimes (CCMM). We conducted a survey of captains and caregivers by email. Of the 385 surveys sent out, 165 (43%) were completed. Eighty four percent of responders (n = 110) thought that waiting time was satisfactory or very satisfactory, and 97% (n = 128) were satisfied or very satisfied with their relationship with the remote physician. Thirty eight per cent of participants (n = 50) considered that the physician understood the medical problem very well; understanding was good in 58% of cases (n = 76) and bad in only 4% of cases (n = 5). Sixty two per cent of participants (n = 83) sent pictures before consultation. The respondents were also satisfied with the telephone advice overall, the competence of the physicians providing the advice, the length of time spent waiting, the verbal prescription and the medical advice given. Onboard caregivers were generally well satisfied with the maritime teleconsultations and the advice provided by the CCMM physicians. PMID:22604271

Dehours, Emilie; Vallé, Baptiste; Bounes, Vincent; Girardi, Claire; Tabarly, Julien; Concina, François; Pujos, Michel; Ducassé, Jean-Louis

2012-06-01

188

Implementing DICOM Structured Reporting in a Large-Scale Telemedicine Network  

PubMed Central

Abstract Introduction: Large-scale asynchronous telemedicine networks can offer a unique opportunity for the acquisition of detailed epidemiological information if the data are acquired and handled in an appropriate way. In this work, an approach is presented for the integration of medical reports in the Digital Imaging and Communications in Medicine (DICOM) Structured Reporting standard in telemedicine networks using structured vocabularies. Materials and Methods: The use of these structured vocabularies is extended beyond radiology, and a case study in telecardiology is presented. The approach was applied in the context of a real-world statewide public telemedicine network; nowadays on average 470 written electrocardiographic structured reports daily are being performed. Cardiologists provided more than 220,000 written structured reports, and these reports are stored into a central database. Results: This study was performed during a 12-month period, and it was possible to examine possible associations between a list of co-morbidities and cardiac risk factors with a diagnosis that indicates the presence of cardiac ischemia, cardiac injury, or possible necrosis by using DICOM Structured Reporting. Our application is responsible for coordinating the process of issuance of reports through various technologies and devices. The system works as a library in an HTTP server, which accesses information from studies in DICOM format from the database and from structured vocabularies. Conclusions: Results indicate that traceability of morbidity, diagnoses, and patient clinical information can be achieved, resulting in an efficient data mining–friendly framework. A multidevice application for Web-based and smartphone-based platforms showed that it is a viable solution for applying the DICOM Structured Reporting standard in telemedicine networks.

Barcellos, Cloves Langendorf; Andrade, Rafael; de Carlos Back Giuliano, Isabela; Borgatto, Adriano Ferreti; de Andrade, Dalton Francisco

2013-01-01

189

Telemedicine in Anesthesiology and Reanimatology  

PubMed Central

Review SUMMARY In recent years impressive progress is happening in information and telecommunication technologies. The application of computers in medicine allows permanent data storage, data transfer from one place to another, retrieving and data processing, data availability at all times, monitoring of patients over time, etc. This can significantly improve the medical profession. Medicine is one of the most intensive users of all types of information and telecommunication technology. Quickly and reliably store and transfer data (text, images, sounds, etc.) provides significant assistance and improvement in almost all medical procedures. In addition, data in locations far from medical centers can be of invaluable benefit, especially in emergency cases in which the decisive role has anesthesiologists.

Tafro, Lejla; Masic, Izet

2010-01-01

190

Case management: planning and coordinating strategies.  

PubMed

In summary, planning a case management system involves moving through sequenced stages; namely, (1) a developmental stage; (2) a phase-in stage; and (3) an operational stage. During the developmental stage, before processes have been formalized, attention is given to the political realities, the formation of a representative planning group, formulating goals and objectives, obtaining administrative support, information gathering, assessment of needs, resource procurement, program structure and design, selection of a case management model, participatory decision making, determining organizational fit, and beginning networking. During the phase-in or early implementation state, the formal stage of system introduction, attention is given to the establishment of interorganizational relationships, contracting for services, job descriptions, work assignments, training, problem solving, and conflict resolution. During the operational or full implementation stage, a period when the system should become more stabilized, attention needs to be given to managing movement of the client through the system, the flow of information, program updating, quality assurance, recordkeeping, resource management, evaluating, and system refurbishing. In practice, these stages will interact and overlap. Closure, if the system is to remain viable and open to change, should never occur. PMID:10110505

Walden, T; Hammer, K; Kurland, C H

1990-01-01

191

[Telemedicine and general practice--future or present. Telemedicine, a way to strengthen the gatekeeper role?].  

PubMed

Electronic communication and data-processing are by no means a new phenomenon in general practice. The next logical step might be to include telemedicine, i.e. images, sound, video, and other kinds of medical information in the communication process. The potential for applying telemedicine in the adjoining areas between the general practice and the hospitals and patients is reviewed. We assume that an increase in the use of electronic communication and telemedicine will strengthen the central role of general practice. A representative sample of international literature is reviewed. The findings are that patients have no substantial misgivings against the use of telemedicine, but scientific documentation of the influence on the patient-doctor relationship, on the quality and quantity of the medical work, and on the job satisfaction of general practitioners is still not available. We present a number of suggestions regarding the use of electronic communication between the general practitioner and the patient. The importance of providing clear, in-depth information to the patient about the use of medical IT communication is underlined. The aspect of data-security is evaluated, and for lack of precise guidelines from health officials it is our suggestion that the report from the Danish Ministry of Finance regarding data-security in public administration is consulted. As to data-access, doctors and patients should be placed on two different safety-levels. It's suggested that doctors should be equipped with a digital key, whereas patients should use a pin code and their social security number. The use of traditional e-mail is dissuaded when exchanging sensitive, person-related information. The importance of valid evaluation of new IT functions is underlined. PMID:12451926

Kjaer, Niels Kristian; Karlsen, Kristoffer

2002-11-01

192

Quantitative 3-D Imaging Topogrammetry for Telemedicine Applications.  

National Technical Information Service (NTIS)

The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts ...

B. R. Altschuler

1994-01-01

193

Arogyasree: An Enhanced Grid-Based Approach to Mobile Telemedicine  

PubMed Central

A typical telemedicine system involves a small set of hospitals providing remote healthcare services to a small section of the society using dedicated nodal centers. However, in developing nations like India where majority live in rural areas that lack specialist care, we envision the need for much larger Internet-based telemedicine systems that would enable a large pool of doctors and hospitals to collectively provide healthcare services to entire populations. We propose a scalable, Internet-based P2P architecture for telemedicine integrating multiple hospitals, mobile medical specialists, and rural mobile units. This system, based on the store and forward model, features a distributed context-aware scheduler for providing timely and location-aware telemedicine services. Other features like zone-based overlay structure and persistent object space abstraction make the system efficient and easy to use. Lastly, the system uses the existing internet infrastructure and supports mobility at doctor and patient ends.

Kailasam, Sriram; Kumar, Santosh; Dharanipragada, Janakiram

2010-01-01

194

Arogyasree: an enhanced grid-based approach to mobile telemedicine.  

PubMed

A typical telemedicine system involves a small set of hospitals providing remote healthcare services to a small section of the society using dedicated nodal centers. However, in developing nations like India where majority live in rural areas that lack specialist care, we envision the need for much larger Internet-based telemedicine systems that would enable a large pool of doctors and hospitals to collectively provide healthcare services to entire populations. We propose a scalable, Internet-based P2P architecture for telemedicine integrating multiple hospitals, mobile medical specialists, and rural mobile units. This system, based on the store and forward model, features a distributed context-aware scheduler for providing timely and location-aware telemedicine services. Other features like zone-based overlay structure and persistent object space abstraction make the system efficient and easy to use. Lastly, the system uses the existing internet infrastructure and supports mobility at doctor and patient ends. PMID:20467560

Kailasam, Sriram; Kumar, Santosh; Dharanipragada, Janakiram

2010-01-01

195

Telemedicine in the NHS for the millennium and beyond.  

PubMed Central

This article defines telemedicine, discusses evidence of its effectiveness, looks at its advantages and disadvantages (and barriers to implementation), and considers its role in the NHS for the millennium and beyond.

Wallace, S.; Wyatt, J.; Taylor, P.

1998-01-01

196

10 CFR 2.332 - General case scheduling and management.  

Code of Federal Regulations, 2010 CFR

...2009-01-01 2009-01-01 false General case scheduling and management. 2.332 Section 2.332...Adjudicatory Hearings § 2.332 General case scheduling and management. (a) Scheduling order . The presiding officer shall,...

2009-01-01

197

Telemedicine system interoperability architecture: concept description and architecture overview.  

SciTech Connect

In order for telemedicine to realize the vision of anywhere, anytime access to care, it must address the question of how to create a fully interoperable infrastructure. This paper describes the reasons for pursuing interoperability, outlines operational requirements that any interoperability approach needs to consider, proposes an abstract architecture for meeting these needs, identifies candidate technologies that might be used for rendering this architecture, and suggests a path forward that the telemedicine community might follow.

Craft, Richard Layne, II

2004-05-01

198

Early experience using telemedicine for neonatal surgical consultations  

Microsoft Academic Search

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

Daniel K Robie; Cheryl M Naulty; Robert L Parry; Camille Motta; Bryan Darling; Marshall Micheals; Ronald K Poropatich; Eward R Gomez

1998-01-01

199

WiFi-Based Telemedicine System: Signal Accuracy and Security  

Microsoft Academic Search

Accuracy and security of medical information, when a patient vital sign signal such as respiratory sounds must be transmitted through a communication channel, are two essential important features in design of telemedicine systems and in medical diagnosis. This paper studies medical signal accuracy in WiFi-based telemedicine system. When system resources are limited such as the transmission bandwidth of a WiFi

Huyu Qu; Jie Cheng; Qiang Cheng; Le Yi Wang

2009-01-01

200

Are you tired, overworked? You must be a case manager.  

PubMed

Case managers are being asked to take on more and more tasks, but the caseloads haven't changed, resulting in tired case managers who aren't able to do the job adequately. Make sure the hospital administration understands what case managers do and the value they bring to the organization. Consider developing specialty positions or adding clerical staff to optimize skill sets for staff. Use hard data, not anecdotes, when you make your case to management. PMID:24218691

2013-11-01

201

Telemedicine in Tinnitus: Feasibility, Advantages, Limitations, and Perspectives  

PubMed Central

Given the important patient needs for support and treatment, telemedicine—defined by medical approaches supported by the new technologies of information—could provide interesting alternative in tinnitus treatment. By analyzing the published tools and approaches which could be used in the context of telemedicine for tinnitus by health professionals or self-administrated by patients, this review summarizes, presents, and describes the principal telemedicine approaches available presently or in the near future to help assess or treat tinnitus or to offer support to tinnitus sufferers. Several pieces of evidence strongly support the feasibility of telemedicine approaches for tinnitus. Telemedicine can be used to help tinnitus sufferers at several points in the therapeutic process: for early screening, initial evaluation, and diagnosis; for optimizing therapeutic tools, particularly behavioural therapies and virtual reality-enhanced behavioral therapies; for long-term monitoring of patients and provision of online support. Several limitations are, however, discussed in order to optimize the safe development of such approaches. Cost effective and easy to implement, telemedicine is likely to represent an important part of the future of tinnitus therapies and should be progressively integrated by otolaryngologists.

Guitton, Matthieu J.

2013-01-01

202

Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? †  

PubMed Central

Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks.

LeRouge, Cynthia; Garfield, Monica J.

2013-01-01

203

Telemedicine--contribution of ICT to health.  

PubMed

ICT opens new possibilities to health care and practice of medicine, but carries some inherent risks as well. Based on a study conducted by the CPME representing European doctors current telemedical practices and difficulties encountered by doctors are reported and next important steps are proposed. An European e-Health Highway should be built and obligatory standards for it and for all software used in the health care should be urgently fixed. The medical profession should take care of practical guidelines for doctors, and authorities should agree on international collaboration to supervise the practice of medicine over the net. Telemedicine should be a normal part of the national healthcare systems, and telemedical services should be reimbursed as any other medical services. PMID:15718569

Aärimaa, Markku

2004-01-01

204

Case Managers for Seniors: Educational Needs and Opportunities.  

ERIC Educational Resources Information Center

Several Canadian surveys revealed a need for training of health and social service personnel in long-term case management of elderly clients. Proposed curriculum content areas are understanding case management, special knowledge of older adults, environmental factors, and case management techniques. (SK)

Joshi, Anju; Pedlar, David

1992-01-01

205

Case Management in Community Corrections: Current Status and Future Directions  

ERIC Educational Resources Information Center

Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

2012-01-01

206

Jail Recidivism in a Forensic Case Management Program.  

ERIC Educational Resources Information Center

Explores factors related to jail recidivism among clients receiving case-management services who were seriously mentally ill, homeless, and former inmates in a large urban jail. Results indicate that clients (n=51) whose case managers actively sought legal stipulations to case management as a condition of probation and parole were more likely to…

Solomon, Phyllis; Draine, Jeffrey

1995-01-01

207

Medical outreach to Armenia by telemedicine linkage.  

PubMed

Telemedicine, an electronic mode of transmitting medical information interactively between remote sites, was launched as an educational support for a 3-year-old medical partnership between Boston University School of Medicine and Emergency Hospital, of Yerevan, Armenia. Emergency Hospital is the first site in Armenia to have an audiographic teleconference capability linking it to a major medical center. Emergency Hospital and Boston University School of Medicine share the remote connection in order to allow educational conferences, peer consultations, and distance learning to take place, thus enhancing the partnership's aims to improve the emergency and trauma care system of Yerevan. To date, eight teleconferences have been transmitted linking 100 physicians, nurses and hospital administrators. The teleconference program provides, in effect, a formal continuing medical education program for Emergency Hospital. It is a key tool of low-cost technology transfer with the potential of broadening resources over the wide territory of the 15 republics of the former Soviet Union. The telemedicine system is comprised of Optel Communications' Remote Viewing System computer hardware and software plus two dedicated AT&T telephone lines. The system has been in use at Boston University School of Medicine for live voice and still image transmission between international sites since 1987. This level of technology suited environmental conditions in Armenia, marked by frequent power outages and unreliability of local telephone connections. A protocol for presentations was established governing length of time, number of visuals per session, visual format, compatibility with interpretive services, congruence with project mission, and adaptability to local conditions that was shown to provide clear and concise delivery of the information necessary. This paper reports the process of development, installation, and initial use of the technology in one nation of the post-Soviet world. PMID:8798949

Screnci, D; Hirsch, E; Levy, K; Skawinski, E; DerBoghosian, M

1996-04-01

208

Analysis of the Case Management Process at Walter Reed Army Medical Center: Procedures for Improving Case Management.  

National Technical Information Service (NTIS)

This study analyzed how the case management process has functioned at Walter Reed Army Medical Center in terms of staffing, procedures, and organizational structure. The researcher conducted interviews with case managers from many areas; collected data fr...

K. S. Smith

2006-01-01

209

Lantus overdose: case presentation and management options.  

PubMed

Insulin glargine (Lantus, Aventis Pharmaceuticals, Bridgewater, NJ) is a long-acting once-daily dosed form of insulin intended to maintain a constant baseline insulin level. As a relatively new medication, there is limited experience in overdoses of Lantus. We present a case of a 37-year-old male insulin-dependent diabetic presenting with refractory hypoglycemia secondary to an intentional overdose of Lantus insulin to illustrate the varied management concerns in overdoses of long-acting insulins. The patient was managed with oral intake, intravenous dextrose bolus, peripheral 10% dextrose solution, 25% dextrose sliding scale via central line, and psychiatry evaluation for suicide attempt. Other potential treatments discussed for possible use with long-acting insulin overdoses include incision and drainage of the injection site, glucagon, and octreotide. PMID:17976762

Fuller, Everett T; Miller, Michael A; Kaylor, David W; Janke, Cliff

2009-01-01

210

Quantitative 3-D imaging topogrammetry for telemedicine applications  

NASA Technical Reports Server (NTRS)

The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts may involve, and evolve toward: consultation from remote expert teaching centers; diagnosis; triage; real-time remote advice to the surgeon; and real-time remote surgical instrument manipulation (telerobotics with virtual reality). Further extrapolation leads to teledesign and telereplication of spare surgical parts through quantitative teleimaging of 3-D surfaces tied to CAD/CAM devices and an artificially intelligent archival data base of 'normal' shapes. The ability to generate 'topogrames' or 3-D surface numerical tables of coordinate values capable of creating computer-generated virtual holographic-like displays, machine part replication, and statistical diagnostic shape assessment is critical to the progression of telemedicine. Any virtual reality simulation will remain in 'video-game' realm until realistic dimensional and spatial relational inputs from real measurements in vivo during surgeries are added to an ever-growing statistical data archive. The challenges of managing and interpreting this 3-D data base, which would include radiographic and surface quantitative data, are considerable. As technology drives toward dynamic and continuous 3-D surface measurements, presenting millions of X, Y, Z data points per second of flexing, stretching, moving human organs, the knowledge base and interpretive capabilities of 'brilliant robots' to work as a surgeon's tireless assistants becomes imaginable. The brilliant robot would 'see' what the surgeon sees--and more, for the robot could quantify its 3-D sensing and would 'see' in a wider spectral range than humans, and could zoom its 'eyes' from the macro world to long-distance microscopy. Unerring robot hands could rapidly perform machine-aided suturing with precision micro-sewing machines, splice neural connections with laser welds, micro-bore through constricted vessels, and computer combine ultrasound, microradiography, and 3-D mini-borescopes to quickly assess and trace vascular problems in situ. The spatial relationships between organs, robotic arms, and end-effector diagnostic, manipulative, and surgical instruments would be constantly monitored by the robot 'brain' using inputs from its multiple 3-D quantitative 'eyes' remote sensing, as well as by contact and proximity force measuring devices. Methods to create accurate and quantitative 3-D topograms at continuous video data rates are described.

Altschuler, Bruce R.

1994-01-01

211

Practice Based Versus Telemedicine Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial  

PubMed Central

Objective Practice Based Collaborative Care is a complex evidence-based practice that is difficult to implement in smaller primary care practices lacking on-site mental health staff. Telemedicine Based Collaborative Care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multi-site randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients randomized to Practice Based versus Telemedicine Based Collaborative Care. Method From 2007–2009, patients at Federally Qualified Health Centers serving medically underserved populations were screened for depression, and 364 patients screening positive were enrolled and followed for 18 months. Those randomized to Practice Based Collaborative Care received evidence-based care from an on-site primary care provider and nurse care manager. Those randomized to Telemedicine Based Collaborative Care received evidence-based care from an on-site primary care provider and off-site telephone nurse care manager, telephone pharmacist, tele-psychologist and tele-psychiatrist. The primary clinical outcomes were treatment response, remission and changes in depression severity Results There were significant group main effects for both response (OR=7.74, CI95=3.94–15.20, p<0.0001) and remission (OR=12.69, CI95=4.81–33.46, p<0.0001) and a significant overall group by time interaction effect for Hopkins Symptom Checklist depression severity (?23=40.51, p<0.0001) with greater reductions in depression severity observed over time for those randomized to Telemedicine Based Collaborative Care. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence-base in the Telemedicine Based group. Conclusions Contracting with an off-site Telemedicine Based Collaborative Care team yields better outcomes than implementing Practice Based Collaborative Care with locally available staff.

Fortney, John C.; Pyne, Jeffrey M.; Mouden, Sip B.; Mittal, Dinesh; Hudson, Teresa J.; Schroeder, Gary W.; Williams, David K.; Bynum, Carol A.; Mattox, Rhonda; Rost, Kathryn M

2013-01-01

212

A comparison of assertive community treatment case management and traditional case management on burnout and job satisfaction  

Microsoft Academic Search

Research suggests that burnout and low job satisfaction are significant problems among mental health workers and may be especially so among those working with clients with serious mental illness. This study examined burnout and job satisfaction among case managers working with such clients. It compared 119 case managers from Assertive Community Treatment (ACT) teams with 97 traditional case managers (TCM)

Sara Lynne Boyer

1991-01-01

213

HL7/CDA Framework for the Design and Deployment of Telemedicine Services.  

National Technical Information Service (NTIS)

The advance of regional healthcare networks has created increasing demand for telemedicine services tailored to particular medical specialties and healthcare settings. At the same time, emerging telemedicine protocols and guidelines combined with various ...

C. E. Chronaki P. Lelis C. Demou M. Tsiknakis S. C. Orphanoudakis

2001-01-01

214

7 CFR 1700.57 - Distance Learning and Telemedicine Loan and Grant Program.  

Code of Federal Regulations, 2012 CFR

...2012-01-01 2012-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.57 Section 1700.57...Approval Authorities § 1700.57 Distance Learning and Telemedicine Loan and Grant Program. (a) Administrator:...

2012-01-01

215

7 CFR 1700.57 - Distance Learning and Telemedicine Loan and Grant Program.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 2011-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.57 Section 1700.57...Approval Authorities § 1700.57 Distance Learning and Telemedicine Loan and Grant Program. (a) Administrator:...

2011-01-01

216

7 CFR 1700.57 - Distance Learning and Telemedicine Loan and Grant Program.  

...2014-01-01 2014-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.57 Section 1700.57...Approval Authorities § 1700.57 Distance Learning and Telemedicine Loan and Grant Program. (a) Administrator:...

2014-01-01

217

Telemedicine and advances in urban and rural healthcare delivery in Africa.  

PubMed

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine. PMID:24267440

Mars, Maurice

2013-01-01

218

Application of Telemedicine Technologies to Long Term Spaceflight Support  

NASA Astrophysics Data System (ADS)

Space medicine passed a long way of search for informative methods of medical data collection and analysis and worked out a complex of effective means of countermeasures and medical support. These methods and means aimed at optimization of the habitation conditions and professional activity of space crews enabled space medicine specialists to create a background for the consecutive prolongation of manned space flights and providing their safety and effectiveness. To define support systems perspectives we should consider those projects on which bases the systems are implemented. According to the set opinion manned spaceflights programs will develop in two main directions. The first one is connected with the near space exploration, first of all with the growing interest in scientific-applied and in prospect industrial employment of large size orbit manned complexes, further development of transport systems and in long-run prospect - reclamation of Lunar surface. The second direction is connected with the perspectives of interplanetary missions. There's no doubt that the priority project of the near-earth space exploration in the coming decenaries will be building up of the International Space Station. This trend characteristics prove the necessity to provide crews whose members may differ in health with individual approach to the schedule of work, rest, nutrition and training, to the medical control and therapeutic-prophylactic procedures. In these conditions the importance of remote monitoring and distance support of crew members activities by the earth- based medical control services will increase. The response efficiency in such cases can only be maintained by means of advanced telemedicine systems. The international character of the International Space Station (ISS) gives a special importance to the current activities on integrating medical support systems of the participating countries. Creation of such a system will allow to coordinate international research projects on space biology and medicine at the modern high level. In spite of the ISS international cooperation transparency space research programs require to follow the biomedicine ethics and provide confidentiality of the special medical information exchange. That can be achieved in the telemedicine support system built on the network principle. Presently we have all technical facilities needed to create such a system. In Russia activities on space telemedicicine support improvement are carried out by the State Scientific Center of the Russian Federation - Institute for Biomedical Problems of the Russian Academy of Sciences, Mission Control Center of the Russian Aviation and Space Agency, Space Biomedical Center for Training and Research and Yu. Gagarin Cosmonaut Training Center. Communications development and next generation Internet systems creation almost eliminate differences in the types of information technologies implementation both in the earth-based and near-earth space conditions. In prospect of the information community creation the telecommunication system of the near-earth space objects and its telemedicine element will become a natural part of the Earth unified information field that will open unlimited perspectives for flight support system improvement and space biomedical research conducting. Russia has unique data of numerous investigations on simulation of long, up to a year, effects of space flight factors on the human body. The sphere of situations studied by space medicine specialists embraced orbit manned space flights of the escalating duration (438 days in 1995). However a number of biomedical problems related to space flights didn't face optimal solutions. It's evident that during a space flight to Mars biomedical problems will be much more difficult in comparison with those of the orbit flights of the same duration. The summed up factors of such flights specify a level of the total medical risk that require assessment and application of effective means lowering the risk level. The characteristics of the interplanetary flights projects

Orlov, O. I.; Grigoriev, A. I.

219

Quick management of accidental tritium exposure cases.  

PubMed

Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ?100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies. PMID:22349318

Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R

2012-07-01

220

Use of telemedicine in disaster and remote places.  

PubMed

One of the methods, especially those living in remote areas or have crashed and does not have access to specialists is telemedicine. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients' health status and care. Travel and wait times between the initial consultations with the patient's own general practitioner and referral to specialist can be reduced and specialists have successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consulting if specialists were unable to physically be at the site. In fact, the telemedicine system is providing health care services for individuals who are not available because of geographical and environmental conditions. The aim of this study was to identify telemedicine applications in disaster, and proposed use of this technology in areas where the shortage of specialists in remote areas in disasters. This study was un-systematic (narrative) review. The literature was searched for using of telemedicine in disaster and remote places with the help of libraries, conference proceedings, data bank, and also search engines available at Google, Google scholar. In our searches, we employed the following keywords and their combinations: telemedicine, remote place, earthquake, disaster, war, and telecommunication in the searching areas of title, keyword, abstract, and full text. In this study, more than 85 articles and reports were collected and 26 of them were selected based on their relevancy. This literature review helps define the concept of "components and usages of the Telemedicine in disaster" as the new technology in the present age. PMID:25013819

Ajami, Sima; Lamoochi, Parisa

2014-01-01

221

Use of telemedicine in disaster and remote places  

PubMed Central

One of the methods, especially those living in remote areas or have crashed and does not have access to specialists is telemedicine. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status and care. Travel and wait times between the initial consultations with the patient's own general practitioner and referral to specialist can be reduced and specialists have successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consulting if specialists were unable to physically be at the site. In fact, the telemedicine system is providing health care services for individuals who are not available because of geographical and environmental conditions. The aim of this study was to identify telemedicine applications in disaster, and proposed use of this technology in areas where the shortage of specialists in remote areas in disasters. This study was un-systematic (narrative) review. The literature was searched for using of telemedicine in disaster and remote places with the help of libraries, conference proceedings, data bank, and also search engines available at Google, Google scholar. In our searches, we employed the following keywords and their combinations: telemedicine, remote place, earthquake, disaster, war, and telecommunication in the searching areas of title, keyword, abstract, and full text. In this study, more than 85 articles and reports were collected and 26 of them were selected based on their relevancy. This literature review helps define the concept of “components and usages of the Telemedicine in disaster” as the new technology in the present age.

Ajami, Sima; Lamoochi, Parisa

2014-01-01

222

TELEMEDICINE: THE ADVANCEMENT OF E-HEALTH AND PROBLEMS OF DEVELOPMENT  

Microsoft Academic Search

Telemedicine is changing the way healthcare is provided all around the world. This paper discusses the advancement of telemedicine and problems of its development. Advancements in the field such as personal status monitors and wireless networks and others are covered in this paper. This paper also takes a global view to infer the success factors of telemedicine, which can be

Edward Chen

223

The Use of Telemedicine to Evaluate Competency to Stand Trial: A Preliminary Randomized Controlled Study  

Microsoft Academic Search

To investigate whether forensic evaluations can be performed reliably using telemedicine, we compared the results on a standard competency assessment instrument using telemedicine (TM) and live interviews (LI). Two board- certified forensic psychiatrists used the Georgia Court Competency Test (GCCT) to evaluate 21 forensic psychiatric inpatients. Half of the patients were randomly assigned to a telemedicine interview and half were

Gina M. Manguno-Mire; John W. Thompson; Jay H. Shore; Calvin D. Croy; Jose F. Artecona; John W. Pickering

224

Evolution of telemedicine in the space program and earth applications.  

PubMed

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth. PMID:11321704

Nicogossian, A E; Pober, D F; Roy, S A

2001-01-01

225

[Difficulties of incorporating telemedicine in health organizations: analytical perspectives].  

PubMed

Socioeconomic transformations at the end of the twentieth century and the beginning of the twentyfirst century pose major challenges to health systems, particularly to western societies with high technological systems and an aging population, in a political context of health expense reduction. The incorporation of information and communication technologies to health care systems, which has been called , has created enormous expectations in this context. Telemedicine has been one of pioneer experiences. Despite the early beginnings of telemedicine and the efforts invested, more widespread use of this technology remains difficult and controversial. Most projects last just the feasibility phase and are then forgotten. The traditional model of medical technologies assessment explains this phenomenon, based on the difficulty of obtaining the empirical evidence needed to support widespread adoption of telemedicine, as a consequence of the problems of conducting traditional studies of clinical efficacy and cost-effectiveness. In the last few years, a different analytical approach has emerged. This perspective indicates that the consolidation (or otherwise) of telemedicine projects will depend on the results of interaction between technology and the context where it is applied and not only on clinical results. Better and deeper empirical knowledge of these interaction processes is needed to increase the spread of telemedicine. PMID:19249136

Roig, Francesc; Saigí, Francesc

2009-01-01

226

Evolution of telemedicine in the space program and earth applications  

NASA Technical Reports Server (NTRS)

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.

Nicogossian, A. E.; Pober, D. F.; Roy, S. A.

2001-01-01

227

Case management insider. Back to basics: a day in the life of a hospital case manager--Part 1.  

PubMed

In this month's Case Management Insider we have begun to review the case management process. The process has a total of eight steps, and we have completed our review of six of them. Next month we will continue with the final two steps in the case management process and also discuss best practices for doing an admission assessment. We will also review a case study which should help you in applying the steps we have been reviewing! PMID:23923193

Cesta, Toni

2013-08-01

228

Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury  

Microsoft Academic Search

Aim:Pilot study of the role of RetCam imaging for telemedicine in lieu of availability of ophthalmologist examination for cases of suspected abusive head injury.Design:Cross-sectional observational study.Participants:21 children admitted in the paediatric units of the University Hospital of Strasbourg (France) with suspicion of abusive head trauma were included.Methods:Children were examined by standard ophthalmoscopy. Photographs were taken using the RetCam-120 Digital Retinal

M Saleh; S Schoenlaub; P Desprez; T Bourcier; D Gaucher; D Astruc; C Speeg-Schatz

2009-01-01

229

A pilot trial of telemedicine-assisted, integrated care for patients with advanced amyotrophic lateral sclerosis and their caregivers.  

PubMed

Patients with amyotrophic lateral sclerosis (ALS) need a care programme as the disease progresses. We used telemedicine-assisted integrated care (TAIC) in 40 patients with ALS, for a mean duration of 8.6 months (range 1-12). A nurse-tutor played the key role, supported by respiratory physicians, neurologists and psychologists. Each patient used a portable pulse oximeter during the daily telephone contacts to assess clinical/oxygen variations. Patients also completed a satisfaction questionnaire. During the study period, each patient used TAIC at least five times per month. There were 1907 scheduled telephone calls (86% of the total) and 317 unscheduled calls. Of the unscheduled calls, 84% were managed by the nurse-tutor and only 16% of them required specialist intervention. The most common item was the ALS clinical interview (58%), followed by the description of acute symptoms, cough ability and oxygenation. TAIC staff recommended 4 out of 12 emergency hospital admissions (33%) and 77% of the other hospitalizations. Patients and caregivers were extremely satisfied (79%) with the nurse assistance provided and the patients' confidence in handling their disease improved in 71% of the cases. TAIC provides a nurse-centred, home-monitoring programme that can be a useful way of following up ALS patients. PMID:20139136

Vitacca, Michele; Comini, Laura; Tentorio, Marta; Assoni, Giuliano; Trainini, Debora; Fiorenza, Domenico; Morini, Roberta; Bruletti, Gisella; Scalvini, Simonetta

2010-01-01

230

Communications infrastructure requirements for telemedicine/telehealth in the context of planning for and responding to natural disasters: Considering the need for shared regional networks  

NASA Technical Reports Server (NTRS)

During the course of recent years the frequency and magnitude of major disasters - of natural, technological, or ecological origin - have made the world community dramatically aware of the immense losses of human life and economic resources that are caused regularly by such calamities. Particularly hard hit are developing countries, for whom the magnitude of disasters frequently outstrips the ability of the society to cope with them. In many cases this situation can be prevented, and the recent trend in disaster management has been to emphasize the importance of preparedness and mitigation as a means of prevention. In cases of disaster, a system is needed to respond to relief requirements, particularly the delivery of medical care. There is no generic telecommunications infrastructure appropriate for the variety of applications in medical care and disaster management. The need to integrate telemedicine/telehealth into shared regional disaster management telecommunications networks is discussed. Focus is on the development of infrastructure designed to serve the needs of disaster prone regions of the developing world.

Scott, John Carver

1991-01-01

231

[Telemedicine and hand injuries: a feasibility study].  

PubMed

In France, we count 1,400,000 hand injuries per year. Only 20% are taken care by hand surgeons. In these 20% many of injuries can be healed by non specific centres. Among the 80% remaining injuries, many of complex injuries should be taken care by specialised centres. It is advisable to get a specialised point of view despite the distance. The purpose of this work is to study the feasibility of telediagnosis in hand emergencies. The material contained a computer, a camera and a website which access needed a password. The physician in emergency room built up the e-medical file which can be referred by the expert to give his mind. The agreement of the patients was sought and all the data were unnamed. One hundred and twenty-nine e-medical files were created from a local general hospital. Sixty-six patients had wound injuries and 63 osteo-articular injuries. Sex-ratio was 3.8 and age average was 33 years old. Four hundred and sixty pictures and four movies were stored. The average of duration of tele-expert response was 7 h. Our results underline the great part which can be played by telemedicine in hand emergencies orientations. PMID:19195760

Abou Al Tout, Y; Taleb, C; Kosayer, M; Liverneaux, P

2010-02-01

232

Examining End-of-Life Case Management: Systematic Review  

PubMed Central

Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL) case management identified 17 research articles, with content analysis revealing two themes: (a) seeking to determine or establish the value of EOL case management and (b) identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.

Thomas, Roger E.; Wilson, Donna M.; Birch, Stephen

2014-01-01

233

Case manager alliance with clients in an older cohort.  

PubMed

It was hypothesized that members of an older cohort of seriously mentally ill community mental health clients would develop stronger alliances with intensive case managers. Eighty-six clients participating in a study of case management services completed a measure of working alliance and structured interviews. It was found that older cohort clients, those age 45 or older, showed much stronger alliances with their case managers than younger clients. PMID:8777869

Draine, J; Solomon, P

1996-04-01

234

Community case management -- thinking beyond the hospital walls.  

PubMed

Case managers must approach the case management process as one that focuses across on the continuum of care and addresses inpatient as well as community needs. Case management assessments must go well beyond just the issues of discharge destination, but rather connect the care providers across the continuum in new ways that will improve outcomes for patients and reduce cost for the healthcare industry. PMID:24923073

Cesta, Toni

2014-06-01

235

Telemedicine in Space Flight - Summary of a NASA Workshop  

NASA Technical Reports Server (NTRS)

The Exploration Medical Capability Element of the Human Research Program at NASA Johnson Space Center hosted the Telemedicine Workshop in January 2011 to discuss the medical operational concept for a crewed mission to a near-Earth asteroid (NEA) and to identify areas for future work and collaboration. With the increased likelihood of a medical incident on a long duration exploration mission to a near-Earth asteroid, as well as the fact that there will likely be limited medical capabilities and resources available to diagnose and treat medical conditions, it is anticipated that a more structured use of telemedicine will become highly desirable. The workshop was convened to solicit expert opinion on current telemedicine practices and on medical care in remote environments. Workshop Objectives: The workshop brought together leaders in telemedicine and remote medicine from The University of Texas Medical Branch, Henry Ford Hospital, Ontario Telemedicine Network, U.S. Army Institute of Surgical Research, University of Miami, American Telemedicine Association, Doctors Without Borders, and the Pan American Health Organization. The primary objectives of the workshop were to document the medical operations concept for a crewed mission to a NEA, to determine gaps between current capabilities and the capabilities outlined in the operations concept, to identify research required to close these gaps, and to discuss potential collaborations with external-to-NASA organizations with similar challenges. Summary of Discussions and Conclusions: The discussions held during the workshop and the conclusions reached by the workshop participants were grouped into seven categories: Crew Medical Officers, Patient Area in Spacecraft, Training, Electronic Medical Records, Intelligent Care Systems, Consultation Protocols, Prophylactic Surgical Procedures, and Data Prioritization. The key points discussed under each category will be presented.

Barsten, K. N.; Watkins, S. D.; Otto, C.; Baumann, D. K.

2011-01-01

236

Knowledge Management Analysis: A Case Study  

ERIC Educational Resources Information Center

It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

2009-01-01

237

Survey of case manager training needs in traumatic brain injury.  

PubMed

The results of 138 surveys assessing the training needs of case managers in the area of traumatic brain injury were analysed. Sixty-six per cent of the respondents were case managers working primarily with adults in a variety of work settings. Respondents rated working with families, vocational rehabilitation, and community re-entry as the top three areas for training. Mild traumatic brain injury, paediatric traumatic brain injury, neuropsychological assessment, and medicolegal aspects received the highest rankings by case managers with more than 8 years experience. The need for certification of case managers in specialty areas was supported by 83% of all respondents. PMID:8401487

Goodall, P; Dedrick, D; Zasler, N D; Kreutzer, J S; Riddick, S

1993-01-01

238

A strategy for the development of secure telemedicine applications.  

PubMed Central

Healthcare applications based on computer-supported collaboration technologies have the potential to improve the quality of care delivered to patients. Such applications can help overcome barriers to quality healthcare in the small, scattered populations of rural areas enabling telemedicine to be a part of the practice of medicine. However the growing concern about the potential for abuse through disclosure of personal health information to unauthorized parties has restricted the deployment and adoption of these potentially valuable tools. The authors, who built ARTEMIS--an Intranet healthcare collaboration facility, now describe their approach to develop secure telemedicine applications for rural healthcare practitioners.

Raman, R. S.; Reddy, R.; Jagannathan, V.; Reddy, S.; Cleetus, K. J.; Srinivas, K.

1997-01-01

239

[Telemedicine in your suitcase: useful tools for the traveler].  

PubMed

In our digital age, telemedicine becomes, under various forms, a useful companion for the traveler, providing access to up-to-date information about health and security risks, remote consultation of specialists to ascertain a diagnosis of select an appropriate treatment, connection to similar patients in order to obtain contextualized advice, biomedical sensors and other monitoring and diagnostic portable tools, as well as transportable electronic health records enabling continuity of care and mobility. Commercial telemedicine services are being developed specifically for travelers, most of which are using mobile phones as the main device, which thus becomes a real telestethoscope. PMID:24908747

Geissbuhler, A

2014-05-01

240

The Costs of Critical Care Telemedicine Programs  

PubMed Central

Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identified eight studies reporting tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions: The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology.

Falk, Derik M.; Bonello, Robert S.; Kahn, Jeremy M.; Perencevich, Eli; Cram, Peter

2013-01-01

241

Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study  

PubMed Central

Background This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine. Methods We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time. Results All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions. Conclusions As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine may potentially facilitate a communication-based follow-up and improve safety within the home setting, making it easier to choose and live with home dialysis.

2012-01-01

242

Problems in Office Management: Cases in Practice  

ERIC Educational Resources Information Center

Office managers face an increasing array of job responsibilities in today's business environment. To prepare new office administration employees and managers, educational institutions must maintain a progressive curriculum to meet position demands. Using a population of members of the Association of Professional Office Managers, this study was…

Hemby, K. Virginia; Smith, Vincent W.

2006-01-01

243

Percutaneous Management of High-Output Chylothorax: Case Reviews  

SciTech Connect

Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed using these percutaneous techniques.

Choo, Joseph C., E-mail: joseph_choo@hotmail.com; Foley, Peter T. [Alfred, Department of Radiology (Australia); Lyon, Stuart M. [Alfred, Vascular and Interventional Radiology, Department of Radiology (Australia)

2009-07-15

244

Case Management: Effects of Improved Risk and Value Information  

ERIC Educational Resources Information Center

Purpose: The purpose of this study was to determine the impact on resource use of providing case managers with information on the potential for patients to benefit from home care services. Design and Methods: Twenty-four case managers working in the Arizona Long Term Care System (ALTCS) were randomized into treatment and control groups. Members of…

Weissert, William G.; Hirth, Richard A.; Chernew, Michael E.; Diwan, Sadhna; Kim, Jinkyung

2003-01-01

245

 psychological distress in australian case managers working with the unemployed  

Microsoft Academic Search

This study reports levels of psychological distress found in a sample of Australian case managers who work with the unemployed. Using a longitudinal survey method- ology, 86 case managers employed throughout Australia completed the 12-item General Health Questionnaire (GHQ-12; D. P. Goldberg, 1978) on 2 occasions during 1999. In comparison with other studies investigating psychological well- being of both employed

Richard Goddard; Wendy Patton; Peter Creed

246

42 CFR 441.18 - Case management services.  

Code of Federal Regulations, 2013 CFR

42 Public Health 4 2013-10-01 2013-10-01 false Case management services...Section 441.18 Public Health CENTERS FOR MEDICARE...qualified providers of case management services for...disability or chronic mental illness, in...

2013-10-01

247

[Case management: a new focus on health care].  

PubMed

The study is a literature review and has the goal to present a new modality of health care delivery called case management. Authors emphasize essential aspects related to this modality of care: care methodology, history, goals, practice areas. It is considered the use of case management in the Brazilian reality. PMID:12852301

Gonzales, Roxana Isabel Cardozo; Casarin, Santina Nunes Alves; Caliri, Maria Helena Larcher; Sassaki, Cinthia Midori; Monroe, Aline Aparecida; Villa, Tereza Cristina Scatena

2003-01-01

248

Effective Case Study Methodologies in the Management of IT Courses.  

ERIC Educational Resources Information Center

Many Association to Advance Collegiate Schools of Business (AACSB) accredited schools require undergraduate Management Information Systems (MIS) majors to take a course in the management of information technology. Over half of these schools utilize case studies in the teaching of this course. Case studies are an important vehicle for teaching…

Buffington, James R.; Harper, Jeffrey S.

249

Case management and the new nephrology social worker.  

PubMed

Case management is thought to be an effective way to offer counseling services and integrate the coordination of other services 4 into an efficient care delivery model. Through communication, collaboration and outcome-driven interventions, nephrology social workers can make a difference in health risk behaviors through case management. PMID:24908825

Callahan, Mary Beth

2014-05-01

250

Discursive Hierarchical Patterning in Law and Management Cases  

ERIC Educational Resources Information Center

This paper investigates the differences in the discursive patterning of cases in Law and Management. It examines a corpus of 271 Law and Management cases and discusses the kind of information that these two disciplines call for and how discourses are constructed in discursive hierarchical patterns. A discursive hierarchical pattern is a model…

Lung, Jane

2008-01-01

251

Memorial University of Newfoundland international distance education and telemedicine projects  

Microsoft Academic Search

Several one-way and two-way satellite link audio experiments are described. These include: satellite telemedicine links with offshore oil rigs, a telephony link between Canada, Kenya, Uganda and Jamaica, and the operation of a provincial teleconference network. Possible projects to be included in the Olympus satellite program are outlined.

Max House; Erin Keough

1989-01-01

252

A brief survey of Department of Defense Telemedicine.  

PubMed

This paper describes current telemedical projects sponsored by the Department of Defense (DoD) and provides points of contact for further communication. The scope and scale of these projects demonstrate the DoD commitment to the development and deployment of telemedicine and advanced medical information technologies in health care delivery. PMID:10165547

Zimnik, P R

1996-01-01

253

Heart sound and electrocardiogram recording devices for telemedicine environments  

Microsoft Academic Search

There is currently a worldwide trend to bring healthcare services as close as possible to the patient, either through home healthcare systems, or telemedicine. There is thus a general need for equipment that can capture patient data electronically for automated review or analysis by a medical practitioner. This paper presents prototype systems that were developed with the ultimate aim for

H. L. Koekemoer; C. Scheffer

2008-01-01

254

US-USSR Telemedicine Consultation Spacebridge to Armenia and Ufa.  

National Technical Information Service (NTIS)

The Final Report on the U.S.-U.S.S.R. Telemedicine Consultation Spacebride to Armenia and Ufa is presented. The goal of this activity was to provide expert medical consultation to the Armenian medical personnel in the areas of plastic and reconstructive s...

1991-01-01

255

Development of a Portable Vital Sensing System for Home Telemedicine  

Microsoft Academic Search

For safe and effective home medical care, a network system for observing one's vital signs noninvasively and evaluating one's health conditions is highly desirable. In this paper, we described a portable vital sensing system and a home medical server to establish a home telemedicine system. In order to develop a portable vital sensing system, physiological sensing circuit, digital signal processor

F. Ichihashi; Y. Sankai

2007-01-01

256

Canada produces its first MD specializing in telemedicine  

PubMed Central

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.

Osorio, L

1998-01-01

257

Arizona TeleMedicine Network: System Procurement Specifications.  

ERIC Educational Resources Information Center

Providing general specifications and system descriptions for segments within the Arizona TeleMedicine Project (a telecommunication system designed to deliver health services to rurally isolated American Indians in Arizona), this document, when used with the appropriate route segment document, will completely describe the project's required…

Atlantic Research Corp., Alexandria, VA.

258

STARPAHC space-oriented medical evaluation. [telemedicine system  

NASA Technical Reports Server (NTRS)

Development of the STARPAHC telemedicine system is documented. Using STARPAHC assessment results and monitoring experience, on board and ground based flight medical system monitoring requirements and operational procedures were developed for use with the Space Transportation System during OFT and mature operation phases of the shuttle.

1979-01-01

259

DATA WAREHOUSE MANAGEMENT SYSTEM A CASE STUDY  

Microsoft Academic Search

In the last decade data warehouses have become the basis for support in business decision making. This paper will show our framework for the data warehouse management system as well as advantages and disadvantages of this approach in relation to the other data warehouse management systems. Many approaches to the development of data warehouse emphasize the importance of meta data

DARKO KRULJ; MILUTIN CUPIC; MILAN MARTIC; MILIJA SUKNOVIC

260

The case manager through the eyes of the users: benefits and failures of a French case management experimentation  

PubMed Central

Purpose The PRISMA France project consists in the implementation of a global services integration in which a case management services is dedicated to old people with complex needs. One of the purposes of the research team was to analyze the representations of the users, i.e., the old people and their proxies, of the case management service through their own experience of profane expert. Theory According to the literature that deals with qualitative interviewing, we consider that the users of case management are able to express themselves on the benefit and the failures of the case management services even if some of them suffer from cognitive impairments. Methods In this view, 30 comprehensive and semi-structured talks were done, 19 old people and 11 proxies. All the interviews were face to face interview and were done by an anthropologist. The interviews were transcribed verbatim and analyzed by focusing on the node of sense in the user’s words. Results and conclusions On one side, the proxies describe the case manager as the one who give answers face to the complexity of the system. On the other side, the old people insisted on the relationship established with their case manager. She/he is the one who listens and asks questions in order to help them. Discussion The analysis of the user’s representations raises three main points: Is the main role of the case manager is to bring an answer to the failures of the system? By basing their representation of the case management on relational continuity, the old people reduce the work of the case manager of the work he/she done at home. So, when the presence of the case manager diminished, old people think that his/her work in not efficient. How the policy makers could include the user’s points of view in the implementation of such kind of service?

Balard, Frederic; Somme, Dominique

2012-01-01

261

Three Principles for Determining the Relevancy of Store-and-Forward and Live Interactive Telemedicine: Reinterpreting Two Telemedicine Research Reviews and Other Research  

PubMed Central

Abstract The Agency for Healthcare Research and Quality sponsored two telemedicine research reviews. The latest review concluded that telemedicine is most relevant to specialties, such as psychiatry and neurology, where high levels of patient interaction are crucial to assessment. Telemedicine research studies cited in the reviews having positive findings in the specialties of ophthalmology, otolaryngology, obstetrics and gynecology, gastroenterology, and cardiology and more recent research in these areas are reviewed to identify criteria other than degree of interaction for determining the appropriateness of telemedicine interventions. These criteria include congruity or the extent that procedures used in telemedicine are similar to those of in-person examination, fidelity or the degree to which the information used for assessment in remote examinations is of similar quality to that used in-person, and reliability or the consistency with which information can be gathered and transmitted.

Ackerman, Michael

2013-01-01

262

An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective  

PubMed Central

Telemedicine, the use of advanced communication technologies in the healthcare context, has a rich history and a clear evolutionary course. In this paper, the authors identify telemedicine as operationally defined, the services and technologies it comprises, the direction telemedicine has taken, along with its increased acceptance in the healthcare communities. The authors also describe some of the key pitfalls warred with by researchers and activists to advance telemedicine to its full potential and lead to an unobstructed team of technicians to identify telemedicine’s diverse utilities. A discussion and future directions section is included to provide fresh ideas to health communication and computer-mediated scholars wishing to delve into this area and make a difference to enhance public understanding of this field.

Breen, Gerald-Mark; Matusitz, Jonathan

2009-01-01

263

Telemedicine-based treatment versus hospitalization in patients with severe chronic obstructive pulmonary disease and exacerbation: effect on cognitive function. A randomized clinical trial.  

PubMed

Abstract Objectives: Telemedicine is gaining ground in the treatment of patients with chronic obstructive pulmonary disease (COPD). Because telemedicine often requires both participation and engagement of the patients, it is important to take differences in cognitive ability into account, as there is evidence that cognitive dysfunction may be a limitation in patients with severe COPD. The aim of this study was to investigate whether cognitive performance is better after telemedicine-based treatment than after conventional hospitalization in patients with severe COPD and a mild to moderate exacerbation. Materials and Methods: This randomized study was a substudy of the "Virtual Hospital," a multicenter, randomized controlled trial. The primary outcome in this substudy was cognitive function, evaluated 3 days and 6 weeks after discharge using a neuropsychological test battery comprising four tests and seven variables. Results: We included 44 patients consecutively. Baseline characteristics were as follows: mean age, 70 (standard deviation [SD] 10) years; mean forced expiratory volume in 1?s, 1.0 (SD 0.55) L (42% of predicted); mean hemoglobin oxygen saturation, 95 (SD 2.0) percent; and mean Mini Mental State Examination score, 27.5 (SD 1.6) points. The performance in all seven neuropsychological test variables tended to be better in the group allocated to virtual admission 3 days and 6 weeks after discharge, but the difference was not significant after Bonferroni's correction for multiple comparisons. Conclusions: There were no significant differences in cognitive performance between the telemedicine-based group and the conventional hospital group. Patients with severe COPD suffering from mild to moderate exacerbations were able to manage the telemedicine-based treatment despite the reduced cognitive function often seen in COPD patients. PMID:24820535

Schou, Lone; Ostergaard, Birte; Rasmussen, Lars S; Rydahl-Hansen, Susan; Jakobsen, Anna Svarre; Emme, Christina; Phanareth, Klaus

2014-07-01

264

Efficacy of Case Management in the Military.  

National Technical Information Service (NTIS)

Managed care is a comprehensive approach to the delivery of health care designed to efficiently direct quality health care within a cost-contained environment. The overall goal is to achieve optimal patient outcomes within fiscally responsible time frames...

F. D. Anderson

1997-01-01

265

The case for case studies in management research  

Microsoft Academic Search

It is commonly asserted that qualitative research in the organizational sciences lacks the rigor and objectivity of the quantitative approach. Case studies, while commonly used for educational purposes, have been viewed in a less favorable light in terms of research. This paper suggests that case studies represent an important research track in organizational science, not only as a method of

Eric Patton; Steven H. Appelbaum

2003-01-01

266

Energy and Environmental Quality: Case Histories of Impact Management.  

National Technical Information Service (NTIS)

A discussion of energy source devlopments and environmental protection dealing with impacts, and legal aspects of pollution controls and resource management, and case history studies of major energy projects is presented. (ERA citation 06:035472)

1981-01-01

267

Effectiveness of case management for homeless persons: a systematic review.  

PubMed

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309

de Vet, Renée; van Luijtelaar, Maurice J A; Brilleslijper-Kater, Sonja N; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D; Wolf, Judith R L M

2013-10-01

268

Nurse's Breakout Session Injury/Illness Case Management  

NASA Technical Reports Server (NTRS)

An overview of the work related injury and illness case management model developed at the Johnson Space Center was presented. The major accomplishments and the challenges of implementation were discussed.

Hesselgesser, Connie

2001-01-01

269

Bureau of Justice Assistance Differentiated Case Management. Program Brief.  

National Technical Information Service (NTIS)

Tables of Contents: What is Differentiated Case Management (DCM); The BJA DCM Demonstration Program; Critical elements of a DCM program and performance guidelines; DCM implementation agenda; End Notes; and Sources for additional information and assistance...

1993-01-01

270

Personnel in Transition: The Case of Polish Women Personnel Managers.  

ERIC Educational Resources Information Center

A case study of a Polish company undergoing restructuring demonstrates the influence of political, economic, and social change on postcommunist personnel management. It investigates whether change is providing opportunities to improve the employment status of women. (SK)

Crow, Mary

1998-01-01

271

Time management for case managers--so much work, so little time.  

PubMed

The world of a case manager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned case manager, organizing your workload can always help smooth out the rough edges in anyone's hectic day! PMID:25065103

Cesta, Toni

2014-08-01

272

Case III: Managing Conflict--The Case of the Faculty Stuck in the Middle.  

ERIC Educational Resources Information Center

Explores techniques of conflict management as well as the positive and negative factors that may exert progressive or detrimental influences. Presents a case scenario, drawn from a faculty development workshop, involving a dental school faculty member, and highlights central issues of the case and relevant management concepts. (EV)

Trombly, Robert M.; Comer, Robert W.; Villamil, Juanita E.

2002-01-01

273

[Crisis management in clinical nursing practice: a case analysis].  

PubMed

The clinical medical environment is highly changeable. Hospital administrators must face and resolve various kinds of crisis. Effective crisis management can preempt or reduce negative impacts on an organization, as well as reduce unnecessary costs and bolster an organization's reputation. This article uses actual cases to describe crisis management with reference to four stages of crisis development and 6M models, providing instruction from experience, Educational growth, and enhanced crisis handling and crisis management skills. PMID:16475069

Kuo, Chun-Hua; Yen, Miaofen

2006-02-01

274

Percutaneous Management of High-Output Chylothorax: Case Reviews  

Microsoft Academic Search

Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed\\u000a by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used\\u000a to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed\\u000a using these percutaneous techniques.

Joseph C. Choo; Peter T. Foley; Stuart M. Lyon

2009-01-01

275

Mindfulness: another tool in the case managers' toolbox.  

PubMed

Case managers and their patients/clients may benefit from the practice of mindfulness-based stress reduction. Recently, using MRI technology, science has found that the gray matters in specific areas of the brain increased from premindfulness training to postmindfulness training. The area affected improves regions involved with learning and memory processes, modulation of emotional control, and the process of awareness. This can be another tool in the case management toolbox. PMID:24871432

Powell, Suzanne K

2014-01-01

276

Community case management of pneumonia: at a tipping point?  

Microsoft Academic Search

Pneumonia is the leading cause of child mortality globally. Community case management (CCM) of pneumonia by community health workers is a feasible, effective strategy to complement facility-based management for areas that lack access to facilities. We surveyed experts in the 57 African and Asian countries with the highest levels and rates of childhood mortality to assess current policies, implementation and

David R Marsh; Kate E Gilroy; Renee Van de Weerdt; Emmanuel Wansi; Shamim Qazi

2008-01-01

277

Efficacy of Case Management in a Military Medical Center.  

National Technical Information Service (NTIS)

The purpose of this report is to determine the effects of managed care on a United States Army medical center in Georgia. The sample consisted of the physician staff, nursing staff, ancillary staff, and nurse case managers working with patient populations...

F. D. Anderson

1996-01-01

278

Data management for genomic mapping applications: A case study  

SciTech Connect

In this paper we describe a new approach to the construction of data management systems for genomic mapping applications in molecular biology, genetics, and plant breeding. We discuss the architecture of such systems and propose an incremental approach to the development of such systems. We illustrate the proposed approach and architecture with a case study of a prototype data management system for genomic maps.

Markowitz, V.M.; Lewis, S.; McCarthy, J.; Olken, F.; Zorn, M.

1992-05-01

279

Evaluation of team-based management: a case study  

Microsoft Academic Search

Team-based management systems appear to be a possible avenue for increasing the productivity and effectiveness of organizations. However, there are concerns regarding their true purposes and effects within organizations. There is presently a dearth of literature evaluating the effectiveness of team-based management. To begin filling this void, provides a case study illustrating the process, as well as the findings, from

J. Michael Whitfield; William P. Anthony; K. Michele Kacmar

1995-01-01

280

Essentials of Enrollment Management: Cases in the Field  

ERIC Educational Resources Information Center

In AACRAO's new publication Essentials of Enrollment Management: Cases in the Field experts in enrollment management representing all types of institutions reveal the evolution of the enrollment strategies implemented at their institutions, the results, and the lessons learned. The introductory chapter provides an overview of themes and models…

Black, Jim

2004-01-01

281

Telemedicine for rural and remote child and youth mental health services.  

PubMed

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents. PMID:16375806

Ryan, Ven-nice; Stathis, Stephen; Smith, Anthony C; Best, Denisse; Wootton, Richard

2005-01-01

282

Network design for telemedicine--e-health using satellite technology.  

PubMed

Over the last decade various international Information and Communications Technology networks have been created for a global access to high-level medical care. OP 2000 has designed and validated the high-end interactive video communication system WinVicos especially for telemedical applications, training of the physician in a distributed environment, teleconsultation and second opinion. WinVicos is operated on a workstation (WoTeSa) using standard hardware components and offers a superior image quality at a moderate transmission bandwidth of up to 2 Mbps. WoTeSa / WinVicos have been applied for IP-based communication in different satellite-based telemedical networks. In the DELTASS-project a disaster scenario was analysed and an appropriate telecommunication system for effective rescue measures for the victims was set up and evaluated. In the MEDASHIP project an integrated system for telemedical services (teleconsultation, teleelectro-cardiography, telesonography) on board of cruise ships and ferries has been set up. EMISPHER offers an equal access for most of the countries of the Euro-Mediterranean area to on-line services for health care in the required quality of service. E-learning applications, real-time telemedicine and shared management of medical assistance have been realized. The innovative developments in ICT with the aim of realizing a ubiquitous access to medical resources for everyone at any time and anywhere (u-Health) bear the risk of creating and amplifying a digital divide in the world. Therefore we have analyzed how the objective needs of the heterogeneous partners can be joined with the result that there is a need for real integration of the various platforms and services. A virtual combination of applications serves as the basic idea for the Virtual Hospital. The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms. PMID:18305324

Graschew, Georgi; Roelofs, Theo A; Rakowsky, Stefan; Schlag, Peter M

2008-01-01

283

75 FR 16486 - Proposed Comment Request for Review of ACF Disaster Case Management Implementation Guide; Office...  

Federal Register 2010, 2011, 2012, 2013

...comments on the ACF Disaster Case Management Implementation...December 2009. Disaster case management is the process...disaster-related needs including health care, mental health and human services needs...addressed. Disaster case management...

2010-04-01

284

The importance of setting and evaluating standards of telemedicine training.  

PubMed

The importance of appropriate training in the use of videoconferencing equipment for clinical purposes is often underestimated when telemedicine projects are established. We developed a user training programme which was delivered via videoconferencing to a group of 130 nurses. Training was delivered on a one-to-one basis. A questionnaire was developed to evaluate user satisfaction and the effectiveness of training. One hundred and two fully completed questionnaires were returned (a 79% response rate). High levels of satisfaction were obtained but the level of user competence reached 100% only when training was supported by a training manual and at least weekly practice. Before establishing a telemedicine service, the following steps appear to be important: identify the required training competencies; deliver a 'hands on' training programme based on the required training competencies; back up the training programme with an instruction booklet; ensure that trainees have at least weekly practice; measure the level of user competence. PMID:12952704

Brebner, E M; Brebner, J A; Ruddick-Bracken, H; Wootton, R; Ferguson, J

2003-01-01

285

Using cable television networks for interactive home telemedicine services.  

PubMed

Most recent cable television network infrastructures can be used to deliver broadband interactive telemedicine services to the home. These facilities allow the provision of social and health services like medical televisiting for elderly, disabled and chronically ill patients; health tele-education; and teleconsultation on demand. Large numbers of patients could benefit from these services. There is also the increasing European tendency to offer customized home-care services. These applications are being developed and validated by a pilot project in Madrid as part of the ATTRACT project of the European Commission. The long-term aim is to develop broadband applications on a large scale to support low-cost interactive home telemedicine services for both patients and institutions. PMID:10534858

Valero, M A; Arredondo, M T; del Nogal, F; Rodríguez, J M; Torres, D

1999-01-01

286

Time-management: a case for CSCW  

Microsoft Academic Search

This paper fwuses on time-management as a cooperative task. Based on an analysis of the ctdtnral complexity of the timing of surgery in a large clinic, possibilities of using computersupport for strengthening the sharing of information and resources as well as participation in decision-making rue diwussed.

Edeltraud Egger; Ina Wagner

1992-01-01

287

Case study: Merging technology management methods  

Microsoft Academic Search

Nowadays IT functions are integrated part of organizations' business. One way to manage this integration is to make sure that both parties use similar words with the same meaning to everybody. A way to achieve this common vocabulary is to share methods and measurements to govern the activities. Unfortunately, many of these methods and frameworks are customized for a specific

Pia Narman; Evelina Ericsson

2011-01-01

288

Collaborative telemedicine for interactive multiuser segmentation of volumetric medical images  

Microsoft Academic Search

Telemedicine has evolved rapidly in recent years to enable unprecedented access to digital medical data, such as with networked\\u000a image distribution\\/sharing and online (distant) collaborative diagnosis, largely due to the advances in telecommunication\\u000a and multimedia technologies. However, interactive collaboration systems which control editing of an object among multiple\\u000a users are often limited to a simple “locking” mechanism based on a

Seunghyun Han; Niels A. Nijdam; Jérôme Schmid; Jinman Kim; Nadia Magnenat-Thalmann

2010-01-01

289

Managing Change: A Case Study in Evolving Strategic Management.  

ERIC Educational Resources Information Center

Presents Rio Salado College as a case study of an institution that aligns itself with the needs of learners by altering its organizational values and practices. Emphasizes the need for institutions to embrace change and innovation to accommodate the needs of its learners. Contains 11 references. (YKH)

Thor, Linda; Scarafiotti, Carol; Helminski, Laura

1998-01-01

290

Prioritisation of telemedicine services for large scale implementation in Norway.  

PubMed

In late 2005, the Northern Norway Regional Health Authority requested an evaluation of all tested telemedicine services in northern Norway to clarify which were suitable for large scale implementation. A total of 282 reports from the Norwegian Centre for Telemedicine, the University Hospital of North Norway and the University of Tromsø were included in the study. Projects not focusing on secondary health care were excluded and 46 studies representing 21 topics entered the final analysis. They were analysed with a self-developed scoring tool focusing on five items. Eleven topics were concluded as being candidates for large scale implementation and grouped according to priority. The first priority topics were teleradiology, digital communication/integration of patient records and education. The second priority topics were teledialysis, pre-hospital thrombolysis, telepsychiatry and teledermatology. The third priority topics were paediatrics, district medical centres, tele-ophthalmology and tele-otorhinolaryngology. No priority was suggested for the projects in cardiology, endocrinology, geriatrics, gynaecology/obstetrics, pathology and nursing/care. User support, training, research ability, financial incentives and interaction between clinicians and ICT-personnel were considered as important factors in motivating health-care personnel to use telemedicine. PMID:17565774

Norum, Jan; Pedersen, Steinar; Størmer, Jan; Rumpsfeld, Markus; Stormo, Anders; Jamissen, Nina; Sunde, Harald; Ingebrigtsen, Tor; Larsen, Mai-Liss

2007-01-01

291

Telemedicine in paediatric patients with poorly controlled type 1 diabetes.  

PubMed

We conducted a retrospective study of a telemedicine clinic for paediatric patients with poorly controlled type 1 diabetes. Thirty-one patients (mean age 12 years) were enrolled into the clinic. After an initial visit, a group messaging system was provided to allow communication with the diabetic team which consisted of a diabetic provider, diabetic educator, insulin pump trainer and dietician. Patients and parents were encouraged to make all contacts by electronic means. For urgent matters, direct paging access was provided to the diabetic team. Adjustments in insulin dosing were accomplished via automated web-based communication or email between patient and provider. Compared to baseline, the HbA1c levels were significantly lower at 3 months (9.1% vs. 11.1%, P < 0.05) and 6.5 months (9.5% vs. 11.1%, P < 0.05). There were no significant differences in HbA1c levels for different age categories, insulin delivery methods or number of telemedicine encounters. The study showed that while telemedicine was effective in lowering HbA1c levels, it did not achieve optimum control. PMID:23401606

Choi, Y Sammy; Berry-Cabán, Cristóbal; Nance, Julie

2013-06-01

292

The past, present, and future of telemedicine for Parkinson's disease.  

PubMed

Travel distance, growing disability, and uneven distribution of doctors limit access to care for most Parkinson's disease (PD) patients worldwide. Telemedicine, the use of telecommunications technology to deliver care at a distance, can help overcome these barriers. In this report, we describe the past, present, and likely future applications of telemedicine to PD. Historically, telemedicine has relied on expensive equipment to connect single patients to a specialist in pilot programs in wealthy nations. As the cost of video conferencing has plummeted, these efforts have expanded in scale and scope, now reaching larger parts of the world and extending the focus from care to training of remote providers. Policy, especially limited reimbursement, currently hinders the growth and adoption of these new care models. As these policies change and technology advances and spreads, the following will likely develop: integrated care networks that connect patients to a wide range of providers; education programs that support patients and health care providers; and new research applications that include remote monitoring and remote visits. Together, these developments will enable more individuals with PD to connect to care, increase access to expertise for patients and providers, and allow more-extensive, less-expensive participation in research. © 2014 International Parkinson and Movement Disorder Society. PMID:24838316

Achey, Meredith; Aldred, Jason L; Aljehani, Noha; Bloem, Bastiaan R; Biglan, Kevin M; Chan, Piu; Cubo, Esther; Ray Dorsey, E; Goetz, Christopher G; Guttman, Mark; Hassan, Anhar; Khandhar, Suketu M; Mari, Zoltan; Spindler, Meredith; Tanner, Caroline M; van den Haak, Pieter; Walker, Richard; Wilkinson, Jayne R

2014-06-01

293

Knowledge Management in Ecotourism: A Case Study  

Microsoft Academic Search

\\u000a Ecotourism has been marketed as a form of nature-based tourism, in response to a number of local and regional initiatives\\u000a associated with marketing nature conservation, local traditions and culture, as alternatives to mass tourism and the need\\u000a for businesses that can be managed by people without large amounts of money. In this paper we try to apply the principles\\u000a and

Stefanos Karagiannis; Apostolos Apostolou

2004-01-01

294

Prosthetic management of hypohydrotic ectodermal dysplasia with anodontia. Case report.  

PubMed

The patient in this report is a young boy with hypohydrotic ectodermal dysplasia. His case is exceptional in that anodontia was complete in both deciduous and permanent dentitions. A brief review of this condition is presented along with the prosthetic management of the case which emphasizes the need for regular modification and replacement of dentures worn by growing child. PMID:2346400

Shaw, R M

1990-04-01

295

Knowledge Management in Business Process Development Projects: A Case Study.  

National Technical Information Service (NTIS)

This study is a result from an increasing need to develop processes and improve knowledge management and working methods in business process development projects in a fast growing case company. This study has been done in co-operation of the case company ...

M. Korpi-Filppula

2003-01-01

296

Semantic Business Process Management: An Empirical Case Study  

Microsoft Academic Search

Semantic technologies promise fully leveraging the content of enterprise and business process models by applying reasoning techniques to query the process space or using ontological mappings for bridging the business-IT divide. Such an approach is known as semantic business process management. We conducted an empirical case study to explore semantic business process man- agement. The case study was replicated 13

Sebastian Stein; Christian Stamber; Marwane El Kharbili; Pawel Rubach

2008-01-01

297

A regulated telemedicine system for day to day application in remote areas.  

PubMed

The NIVEMES project creates an international network of Health Service providers which offer Telemedicine-Teleconsultation services to Remote, Isolated places and to ship vessels for both routine and emergency situations. The base of the system is the powerful Multimedia Health Record, with the ability to manage conventional data, images, videos and biosignals, acquired directly from the medical device. National and international medical codification schemata are employed such as ICD-X and WHO standards. Telemedicine and Computing in Health Care are rapidly covering a pending gap, not fulfilled by current bureaucratic and telematic procedures. However even from the first test fields conducted during the past year, it is obvious that a variety of new training needs has arisen. The users of such systems need to be instructed new ways of conducting their business, of taking advantage of the services, even a new way of perceiving health care provision. The user interface of the software is kept simple, thus getting acquainted with it requires minimum effort; however there are other issues on which training is required to best exploit the advantages the system offers. The telemedical networks spawned in each country must be co-ordinated, and the user needs to know where and how he/she will acquire the necessary support. Home-cared patients will have to operate medical devices and telemedical software, a task which although made easy from today's technology, it still requires some basic training, specially as far as elderly users are concerned. The NIVEMES system uncovers a set of new training needs, but it offers at the same time a vehicle for educating the professional health-carers. The Health Record comprises a multimedia, explicit account of the patient history, which can be used for detailed and integrated study from trainee health carers of all levels (as well as from officers on board, people taking care of home-confined patients and others), on real data or in a simulated environment. At the same time the telemedicine facilities may increase the effectiveness of junior doctors working in remote areas and enhance the confidence residents have about their local health centres. Systems like NIVEMES prove that new user needs arise nowadays and employment of modern tools requires training in modern methods and in a new way of thinking. PMID:10947676

Samiotakis, Y; Anagnostopoulou, S; Alexakis, A

2000-01-01

298

Management of dentinogenesis imperfecta: a review of two case reports.  

PubMed

Dentinogenesis imperfecta (DI) is an inherited disorder that affects dentin and often manifests as tooth discoloration; in addition, the dentition is also extremely susceptible to wear. Treatment of DI focuses primarily on protecting affected dentin, reducing sensitivity, and improving esthetics. Routine restorative materials, such as amalgams and composites, may be used. In more severe cases, the treatment of choice is full coverage crowns, while bonding of veneers may be used to improve the esthetics of the anterior teeth. This study presents two cases of Type II DI in the same family and the management of each case. Restorative management included amalgams, composite veneers, crowns, bridges, and overdentures. PMID:23649579

Rafeek, Reisha N; Paryag, Amit; Al-Bayaty, Haytham

2013-01-01

299

A meta-analysis of telemedicine success in Africa.  

PubMed

The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa's socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors'experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also highlights the under-representation of African researchers in the global whelm of information system research. Telemedicine in Africa though has not attracted enough political support is potentially a very useful conduit of health-care given the fact that the continent is resource limited and still enduring the effects of scarce human resource especially in health. PMID:23858382

Wamala, Dan S; Augustine, Kaddu

2013-01-01

300

A CASE STUDY OF ENVIRONMENTAL DATA MANAGEMENT  

EPA Science Inventory

In order to support our ongoing research in watershed ecology and global climate change, we gather and analyze environmental data from several government agencies. This case study demonstrates a researcher’s approach to accessing, organizing, and using intersectoral data. T...

301

Species Conservation and Management: Case Studies  

USGS Publications Warehouse

This edited volume is a collection of population and metapopulation models for a wide variety of species, including plants, invertebrates, fishes, amphibians, reptiles, birds, and mammals. Each chapter of the book describes the application of RAMAS GIS 4.0 to one species, with the aim of demonstrating how various life history characteristics of the species are incorporated into the model, and how the results of the model has been or can be used in conservation and management of the species. The book comes with a CD that includes a demo version of the program, and the data files for each species.

Akcakaya, H. R.; Burgman, M.A.; Kindvall, O.; Wood, C.C.; Sjogren-Gulve, P.; Hatfield, J.S.; McCarthy, M.A.

2004-01-01

302

Weaning from mechanical ventilation followed at home with the aid of a telemedicine program.  

PubMed

We describe the use of telemedicine in support of weaning from invasive mechanical ventilation on a 63-year-old woman of at home by means of a telepneumology program (TPP). Under telephone assistance of a pulmonologist and a TPP nurse tutor, the pulsed arterial saturimetric (pSaT), heart rate (HR), breathing pattern tracing monitoring transmitted via a home telephone line and the aid of the caregiver, the patient was able to maintain diurnal spontaneous breathing after 24 spontaneous breathing trial (SBT) steps twice daily. The duration of each SBT period progressively increased starting from 30 minutes up to 8 hours. This case report shows that many patients at home on ventilators could possibly be weaned through the use of remote monitoring and call center response, with only family/caregivers on-site. PMID:17848112

Vitacca, Michele; Guerra, Alberto; Assoni, Giuliano; Pizzocaro, Piera; Marchina, Lucia; Scalvini, Simonetta; Balbi, Bruno

2007-08-01

303

Case manager as therapy extender for cognitive behavior therapy of serious mental illness: a case report.  

PubMed

Cognitive behavior therapy (CBT) is an evidence-based intervention for individuals with serious mental illness and potentiates standard medication management. Americans receiving publicly funded treatment for serious mental illnesses have limited access to CBT and hence we need to devise innovative ways of providing access to this important intervention. We present a case of a man who had severe disability, was medication resistant, and diagnosed with Obsessive Compulsive Disorder and Major Depressive Disorder. After being home bound for many years he was provided CBT utilizing his existing case manager as a therapy extender. The specific roles of the primary therapist and case manager as well as the improvement in quality of life of the individual are delineated. This case report opens up the possibility of further studying case managers as therapy extenders for treating serious mental illnesses. PMID:23828035

Pinninti, Narsimha R; Schmidt, Lisa T; Snyder, Richard P

2014-05-01

304

Zero Trust Intrusion Containment for Telemedicine.  

National Technical Information Service (NTIS)

Intrusion Management Systems (IMS) serve to protect complex computer systems from unauthorized intrusions. Our objective is the design and analysis of 'zero-trust' Intrusion Tolerant Systems. These are systems built under the extreme assumption that all i...

A. K. Sood Y. Huang R. Simon E. White K. Cleary

2002-01-01

305

The multiple contexts of borders that impact telemedicine as a healthcare delivery solution  

Microsoft Academic Search

For five decades, telemedicine—the use of communication technologies to provide health care at a distance—has improved access to health care for individuals who have previously had limited access. With the increasing number of health challenges across the globe, such as growing costs and limited health resources in rural areas, telemedicine is poised to be a platform to improve these problems.

Pamela Whitten; Jennifer Cornacchione

2010-01-01

306

A prospective evaluation of ENT telemedicine in remote military populations seeking specialty care.  

PubMed

This study evaluated telemedicine use in remote military treatment facilities (MTFs) ashore over a 4-month period to help guide telemedicine applications for shipboard medical departments. A prospective study design was used to evaluate specialty care provided by an ear/nose/throat (ENT) physician via videoconferencing (VC) for patients at remote MTFs in TRICARE Region 9. The study provided a complete and continuous sample of ENT consultations during a planned 4-month period. Data sources included a telemedicine database and telephone interviews to assess attitudes of physician and nonphysician medical personnel. A total of 193 VC consultations (hereafter referred to as teleconsultations) were conducted following referrals from primary providers. Patients were mostly young, male, active-duty personnel. Forty-five percent of the 193 teleconsultations resulted in changed diagnosis by the ENT specialist relative to initial diagnosis by the referring provider. This rate of clinical impact was substantial, and it generalized across various ENT conditions, demographics, and MTFs. Medical personnel reported generally positive attitudes about telemedicine technologies and the telemedicine process in TRICARE Region 9. Nonphysician providers reported slightly more favorable attitudes compared to physicians. These results suggest that ENT telemedicine has substantial clinical impact in the military populations treated at MTFs. A high rate of changed diagnoses (45%) was observed across age, gender, military status, ENT conditions, and treatment facilities. Medical personnel reported positive attitudes about using the telemedicine system. These results support the use of telemedicine in shipboard medical departments. PMID:12419024

Melcer, Ted; Hunsaker, Darrell; Crann, Bobbi; Caola, Lisa; Deniston, William

2002-01-01

307

Six-month programme on lifestyle changes in primary cardiovascular prevention: a telemedicine pilot study  

Microsoft Academic Search

Background: Technology and information systems enabling transmission of patients’ data and ability to provide and exchange professional support remotely to the general practitioners can improve quality and continuity of care.Design: We set up a programme of primary prevention in 27 patients at risk for cardiovascular diseases by using Telemedicine Service for 6 months.Methods: Telemedicine Service enlisted the involvement of physicians

Palmira Bernocchi; Doriana Baratti; Emanuela Zanelli; Silvana Rocchi; Massimo Salvetti; Anna Paini; Simonetta Scalvini

2011-01-01

308

The Incorporation of Telemedicine With Medical Tourism: A Study of Consequences  

Microsoft Academic Search

This article examines the impact of the complementary use of telemedicine before and after a medical tour upon medical tourist satisfaction. It concludes that the integration of telemedicine technologies into the medial tourism system offer a unique opportunity for medical service providers to increase patient satisfaction and loyalty. The research establishes that remote consultations before the medical tour facilitate in

Babu P. George; Tony L. Henthorne

2009-01-01

309

Maternal response to high-risk obstetric telemedicine consults when perinatal prognosis is poor.  

PubMed

This is a qualitative descriptive study evaluating the maternal response after the woman has learned her pregnancy has a poor prognosis via telemedicine rather than in a traditional, face-to-face, consultation method. In general, telemedicine was positively viewed by the participants; however, the experience may be markedly improved by implementing several simple changes in the overall consultative process. PMID:23635010

Wyatt, Stephanie N; Rhoads, Sarah J; Green, Angela L; Ott, Rachel E; Sandlin, Adam T; Magann, Everett F

2013-10-01

310

Telemedicine for mountain climbers with high quality video and stethoscope sound transmission  

Microsoft Academic Search

An experimental telemedicine network is set up to provide telemedicine support to temporary mountain clinic on Japan Alps. The network is composed of long-range wireless LAN's and three CATV networks. It can simultaneously transmit MPEG-2 based video at 2 Mbps and digital stethoscope sound at 192 kbps, which provide enough resolution for doctors to diagnosis.

M. Nakamura; Yuying Yang; Y. Miura; M. Takizawa

2003-01-01

311

Lantus Overdose: Case Presentation and Management Options  

Microsoft Academic Search

Insulin glargine (Lantus, Aventis Pharmaceuticals, Bridgewater, NJ) is a long-acting once-daily dosed form of insulin intended to maintain a constant baseline insulin level. As a relatively new medication, there is limited experience in overdoses of Lantus. We present a case of a 37-year-old male insulin-dependent diabetic presenting with refractory hypoglycemia secondary to an intentional overdose of Lantus insulin to illustrate

Everett T. Fuller; Michael A. Miller; David W. Kaylor; Cliff Janke

2009-01-01

312

Managing Bullying and Managing Difference: A Case Study of One Secondary School  

ERIC Educational Resources Information Center

Much work on school bullying focuses on developing our understanding of the various factors that contribute to bullying and its management. This case study focuses on the possible connections between parts and offers a metaperspective of one mainstream secondary school. Demonstrating that bullying and its management is embedded within the network…

Dixon, Roz; Smith, Peter; Jenks, Chris

2004-01-01

313

An enterprise collaborative management system – a case study of supplier relationship management  

Microsoft Academic Search

In this paper, a server-based enterprise collaborative management system using enterprise application integration technology is developed for trial implementation at Honeywell Consumer Products (Hong Kong) Limited, in the area of supplier relationship management. The system facilitates supplier selection using an integrative case-based supplier selection and help desk approach to select the most appropriate suppliers, based on their past performance records

K. L. Choy; W. B. Lee; Victor Lo

2004-01-01

314

Heavy Metal Risk Management: Case Analysis  

PubMed Central

To prepare measures for practical policy utilization and the control of heavy metals, hazard control related institutions by country, present states of control by country, and present states of control by heavy metals were examined. Hazard control cases by heavy metals in various countries were compared and analyzed. In certain countries (e.g., the U.S., the U.K., and Japan), hazardous substances found in foods (e.g., arsenic, lead, cadmium, and mercury) are controlled. In addition, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) recommends calculating the provisional tolerable weekly intake (PTWI) of individual heavy metals instead of the acceptable daily intake (ADI) to compare their pollution levels considering their toxicity accumulated in the human body. In Korea, exposure assessments have been conducted, and in other countries, hazardous substances are controlled by various governing bodies. As such, in Korea and other countries, diverse food heavy metal monitoring and human body exposure assessments are conducted, and reducing measures are prepared accordingly. To reduce the danger of hazardous substances, many countries provide leaflets and guidelines, develop hazardous heavy metal intake recommendations, and take necessary actions. Hazard control case analyses can assist in securing consumer safety by establishing systematic and reliable hazard control methods.

Kim, Ji Ae; Lee, Seung Ha; Choi, Seung Hyun; Jung, Ki Kyung; Park, Mi Sun; Jeong, Ji Yoon; Hwang, Myung Sil; Yoon, Hae Jung; Choi, Dal Woong

2012-01-01

315

Management of Multiple Impacted Teeth: A Case Report and Review  

PubMed Central

Interdisciplinary care for the management of impacted teeth provides a holistic method of treating patients. Careful planning is necessary to reach the desired treatment goals. This article attempts to highlight the importance of diagnosis and adequate treatment planning for successful eruption of impacted teeth. The concept of forced eruption to improve the bone morphology of the impacted teeth has been used to treat a case of multiple impacted teeth. This paper reviews the diagnosis and management of impacted teeth. A case report of multiple impacted maxillary anterior teeth of a 13-year-old female patient has been presented. How to cite the article: Ajith SD, Shetty S, Hussain H, Nagaraj T, Srinath M. Management of multiple impacted teeth: A case report and review. J Int Oral Health 2014;6(3):93-8.

Ajith, Sreedevi D; Shetty, Smitha; Hussain, Huma; Nagaraj, Tejavathy; Srinath, M

2014-01-01

316

Conservative management of placenta increta: case report and literature review.  

PubMed

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and ?-hCG assessment. Serum ?-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta. PMID:21874645

Yarandi, Fariba; Eftekhar, Zahra; Shojaei, Hadi; Rahimi-Sharbaf, Fatemeh; Baradaran, Fatemeh

2011-01-01

317

Web Service management system for bioinformatics research: a case study  

Microsoft Academic Search

In this paper, we present a case study of the design and development of a Web Service management system for bioinformatics\\u000a research. The described system is a prototype that provides a complete solution to manage the entire life cycle of Web Services\\u000a in bioinformatics domain, which include semantic service description, service discovery, service selection, service composition,\\u000a service execution, and service

Kai Xu; Qi Yu; Qing Liu; Ji Zhang; Athman Bouguettaya

2011-01-01

318

Opportunities for improving disaster management in Chile: a case study  

Microsoft Academic Search

Purpose – This paper seeks to propose measures to improve management of rainfall-related disasters in Chile. Design\\/methodology\\/approach – This research was carried out as a case study in the semi-arid region of Chile where above-normal rainy events occur once or twice during some rainy seasons. Measures to improve management are suggested based on theory, field data, and community participation. The

Paulina Aldunce; Alejandro León

2007-01-01

319

Case management training needs to support vocational rehabilitation for case managers and general practitioners: a survey study  

PubMed Central

Background The use of the biopsychosocial model of health and case management for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR. Methods 80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed. Results In total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training. Conclusions This survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work.

2014-01-01

320

Qualitative case studies in operations management: Trends, research outcomes, and future research implications  

Microsoft Academic Search

Our study examines the state of qualitative case studies in operations management. Five main operations management journals are included for their impact on the field. They are in alphabetical order: Decision Sciences, International Journal of Operations and Production Management, Journal of Operations Management, Management Science, and Production and Operations Management. The qualitative case studies chosen were published between 1992 and

Mark Barratt; Thomas Y. Choi; Mei Li

2011-01-01

321

22 CFR 96.43 - Case tracking, data management, and reporting.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 false Case tracking, data management, and reporting. 96.43 Section 96...Responding to Complaints and Records and Reports Management § 96.43 Case tracking, data management, and reporting. (a) When...

2009-04-01

322

22 CFR 96.43 - Case tracking, data management, and reporting.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 false Case tracking, data management, and reporting. 96.43 Section 96...Responding to Complaints and Records and Reports Management § 96.43 Case tracking, data management, and reporting. (a) When...

2010-04-01

323

Diagnostic ultrasound and telemedicine utilization in the international space station  

NASA Astrophysics Data System (ADS)

Clinical diagnostic ultrasound (US) is experiencing an expanding role that is well suited to application on the International Space Station (ISS). Diagnostic US can be used to reduce the risks associated with long duration human space flight by providing a non-invasive tool with head-to-toe diagnostic capability in both biomedical research and crew health care. General health care of the astronauts will be diagnosed with US, e.g., kidney stones, gall bladder disease, appendicitis, etc. Initial studies will focus on detection of ``ureteral jets'' in the bladder. This is a non-invasive test to rule out obstructive uropathy from kidney stones with minimal requirements for crew training. Biomedical research experiments, focusing on the effects of the microgravity environment, will be performed using both the HHU and the HDI 5000. US will be used to evaluate bone density and muscle mass in this environment. Prolonged or emergency EVAs may occur with the ISS. The hand-held ultrasound unit (HHU) and its telemedicine capability will be used in EVA settings to monitor events such as decompression sickness (DCS) microbubble formation in the cardiovascular system. There will be telemetry links between the HHU and the ATL/Lockheed Martin rack mounted HDI 5000 in the ISS Human Research Facility (HRF), as well as between the HRF and medical expertise on the ground. These links will provide the ISS with both real-time and store-and-forward telemedicine capabilities. The HHU can also be used with the existing telemedicine instrument pack (TIP).

Carter, Stephen J.; Stewart, Brent K.; Kushmerick, Martin J.; Langer, Steve G.; Schmiedl, Udo P.; Winter, Thomas C.; Conley, Kevin E.; Jubrias, Sharon A.

1999-01-01

324

The Portable Dynamic Fundus Instrument: Uses in telemedicine and research  

NASA Technical Reports Server (NTRS)

For years ophthalmic photographs have been used to track the progression of many ocular diseases such as macular degeneration and glaucoma as well as the ocular manifestations of diabetes, hypertension, and hypoxia. In 1987 a project was initiated at the Johnson Space Center (JSC) to develop a means of monitoring retinal vascular caliber and intracranial pressure during space flight. To conduct telemedicine during space flight operations, retinal images would require real-time transmissions from space. Film-based images would not be useful during in-flight operations. Video technology is beneficial in flight because the images may be acquired, recorded, and transmitted to the ground for rapid computer digital image processing and analysis. The computer analysis techniques developed for this project detected vessel caliber changes as small as 3 percent. In the field of telemedicine, the Portable Dynamic Fundus Instrument demonstrates the concept and utility of a small, self-contained video funduscope. It was used to record retinal images during the Gulf War and to transmit retinal images from the Space Shuttle Columbia during STS-50. There are plans to utilize this device to provide a mobile ophthalmic screening service in rural Texas. In the fall of 1993 a medical team in Boulder, Colorado, will transmit real-time images of the retina during remote consultation and diagnosis. The research applications of this device include the capability of operating in remote locations or small, confined test areas. There has been interest shown utilizing retinal imaging during high-G centrifuge tests, high-altitude chamber tests, and aircraft flight tests. A new design plan has been developed to incorporate the video instrumentation into face-mounted goggle. This design would eliminate head restraint devices, thus allowing full maneuverability to the subjects. Further development of software programs will broaden the application of the Portable Dynamic Fundus Instrument in telemedicine and medical research.

Hunter, Norwood; Caputo, Michael; Billica, Roger; Taylor, Gerald; Gibson, C. Robert; Manuel, F. Keith; Mader, Thomas; Meehan, Richard

1994-01-01

325

Management Science in Higher Education Institutions: Case Studies from Greece  

ERIC Educational Resources Information Center

Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…

Saiti, Anna

2010-01-01

326

Assertive Community Treatment and Case Management for Schizophrenia  

Microsoft Academic Search

This review examines the impact of assertive community treatment (ACT) and case management models on the use of inpatient hospitalization and other com- munity mental health services, costs, and other clinical and so- cial outcomes. ACT programs have been found to reduce hos- pitalization and increase use of community mental health serv- ices at an equivalent or reduced cost. Greater

Jack E. Scott; Lisa B. Dixon

1995-01-01

327

Suicide in a community based case management service  

Microsoft Academic Search

Over a 9 year period, 532 people with a long term mental illness received the services of a community based case management program. Of the 532 clients, 13 committed suicide (2%). This group was compared to a control group matched for age, sex and length of stay in the program. No differences were found with regard to most socio-demographic and

Jennifer Pyke; Melanie J. Steers

1992-01-01

328

Orthodontic Management of Silver-Russell Syndrome. A Case Report  

PubMed Central

This case report describes the orthodontic management of a 10-year-old female with Silver-Russell syndrome by means of gradual expansion of the mandibular dental arch using removable appliances and subsequent comprehensive treatment of malocclusion by means of fixed appliances.

Ioannidou-Marathiotou, Ioulia; Sluzker, Ariel; Athanasiou, Athanasios E

2012-01-01

329

Medical Training Skills Curriculum for Case Management Assistants.  

ERIC Educational Resources Information Center

This manual helps service care providers working with HIV-infected people learn how HIV affects the body's major systems, emphasizing the structure and functions of each system and direct and indirect effects of HIV on each system. The curriculum was developed for case management assistants (CMAs) who work in homes of HIV-infected people. Lessons…

Family Planning Council of Southeastern Pennsylvania, Philadelphia.

330

Healthcare supply chain management in Malaysia: a case study  

Microsoft Academic Search

Purpose – The purpose of this paper is to evaluate inventory management in the private healthcare sector in Malaysia, with a particular focus on the distribution of medicines from a wholesaler to clinics. Currently, there are issues with service levels to clinics that need addressing. Design\\/methodology\\/approach – The paper adopts a case study approach, with data collected through process mapping,

Noorfa Haszlinna Mustaffa; Andrew Potter

2009-01-01

331

Customer relationship management: the case of a European bank  

Microsoft Academic Search

Purpose – To convert the principle of customer relationship management (CRM) into practical guidelines for best practice in the implementation of a CRM programme in the real world. Design\\/methodology\\/approach – The findings of an extensive review of the literature provide the foundations for a general CRM paradigm, which is applied to a case study of a large European bank's specification,

Adam Lindgreen; Michael Antioco

2005-01-01

332

The Management of Training in Multinational Corporations: Comparative Case Studies.  

ERIC Educational Resources Information Center

Case studies of British and Australian multinational corporations in the food and drink industry investigated how training and development are managed. Competency-based education and industry boards are important elements in both countries. Lack of a training culture in the industry and little innovation in training were observed. (SK)

Noble, Charles

1997-01-01

333

Magic from Social Networks that Talk to Management: Four Cases  

ERIC Educational Resources Information Center

Purpose: The purpose of this paper is to understand how social networks can help to produce the "magic" of extraordinary results for organizations. Design/methodology/approach: In this exploratory study four cases (from published reports) are compared in order to illustrate different management approaches to utilizing the power of networks.…

Sugarman, Barry

2010-01-01

334

The Affordable Care Act, Medicare spending, and the case manager.  

PubMed

At first blush, it looks like there is welcome relief from the upward growth of Medicare spending. It is important for the case manager to look at the big picture, as there are other reasons for this downward trend, including recovery audit contractor "take backs" and cost shifting to hospitals and Medicare beneficiaries. PMID:23735963

Powell, Suzanne K

2013-01-01

335

Management of Federally Sponsored Libraries: Case Studies and Analysis.  

ERIC Educational Resources Information Center

This book provides insight into how managers of federally sponsored libraries view their roles and carry out their duties. Seven federally supported libraries were selected to serve as case studies. These libraries represent a cross-section of various types, and the nine chapters are written by librarians from these facilities. The discussion…

Missar, Charles D., Ed.

336

Case Studies in Managing School Library Media Centers.  

ERIC Educational Resources Information Center

Thirty-two case studies illustrating problem areas and situations that develop in the modern environment of the electronic school library media program are presented for use by library science students and library/media center managers. Based on input from practicing librarians at the elementary and secondary levels, the studies are designed to…

Callison, Daniel; Morris, Jacqueline

337

Wikis for Knowledge Management: Business Cases, Best Practices, Promises, & Pitfalls  

Microsoft Academic Search

This chapter describes how wikis and related tools can be used for knowledge management (KM), and describes processes and best practices for creating and deploying wiki-based KM systems. In particular, we consider the business cases from multiple perspectives, including: participating in KM systems; initiating KM projects; and developing wiki platforms. Thus, the chapter seeks to help readers understand what KM

Clif Kussmaul; Roger Jack

338

School Asthma Screening and Case Management: Attendance and Learning Outcomes  

ERIC Educational Resources Information Center

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

2013-01-01

339

Successful School Management in India: Case Studies of Navodaya Vidyalayas  

ERIC Educational Resources Information Center

This research explored the management devices followed in successful schools in the Indian context. In-depth case studies of three successful Navodaya schools were carried out. The schools were identified on the basis of the academic performance of students in the last three years in the national examinations and their participation in…

Khaparde, M. S.; Srivastava, Ashok K.; Meganathan, R.

2004-01-01

340

Case-Based Knowledge Management Tools for Software Development  

Microsoft Academic Search

Modern software development is a knowledge-intensive activity. The proliferation of development tools, rapidly changing technology, and increasing complexity and diversity of application domains all increase the cognitive burden placed on software developers. General purpose programming languages and CASE tools offer little relief from these problems. Knowledge management tools are needed that can effectively capture and disseminate software development knowledge that

Scott Henninger

1997-01-01

341

Managing Residual Contaminants – Reuse and Isolation Case Studies  

SciTech Connect

Contaminants remaining on sites after regulatory-approved environmental remediation operations are complete represent continued risk to human health and the environment. Many sites require continued management efforts to: (1) protect the integrity of the engineered remedy/control, (2) limit the exposure of individuals to residual contamination by limiting reuse activities, (3) maintain ready access to accurate records/information, and (4) protect against vulnerabilities from intentional threats/actions. This paper presents performance information from selected case studies to provide insight into various management approaches employed for addressing the risks associated with residual contaminants. The case studies involve sites remediated within the U.S. CERCLA framework, and illustrate two prevailing management approaches for addressing the risks. Sacrifice Zones are sites that are purposefully isolated to prevent human access onto the property. Reuse Sites provide limited access for specific use.

Kevin M. Kostelnik, Ph.D.; James H. Clarke, Ph. D.

2008-03-01

342

Discretionary Use of Involuntary Commitment by Case Managers of Mental Health Clients: A Case Study of Divergent Views  

Microsoft Academic Search

In an exploratory study, case managers held divergent views about their appropriate roles in involuntarily committing clients to psychiatric care. In light of vague organizational guidelines about appropriate use of involuntary commitment, case managers drew on professional social work values to form views about commitment. These values supported client self-determination, but did not clearly delineate ways for case managers' use

John A. Encandela; Wynne Korr; Charles W. Lidz; Edward P. Mulvey; Tonya Slawinski

1999-01-01

343

The clinical application of a PACS-dependent 12-lead ECG and image information system in E-medicine and telemedicine.  

PubMed

This study presents a software technology to transform paper-based 12-lead electrocardiography (ECG) examination into (1) 12-lead ECG electronic diagnoses (e-diagnoses) and (2) mobile diagnoses (m-diagnoses) in emergency telemedicine. While Digital Imaging and Communications in Medicine (DICOM)-based images are commonly used in hospitals, the development of computerized 12-lead ECG is impeded by heterogeneous data formats of clinically used 12-lead ECG instrumentations, such as Standard Communications Protocol (SCP) ECG and Extensible Markup Language (XML) ECG. Additionally, there is no data link between clinically used 12-lead ECG instrumentations and mobile devices. To realize computerized 12-lead ECG examination procedures and ECG telemedicine, this study develops a DICOM-based 12-lead ECG information system capable of providing clinicians with medical images and waveform-based ECG diagnoses via Picture Archiving and Communication System (PACS). First, a waveform-based DICOM-ECG converter transforming clinically used SCP-ECG and XML-ECG to DICOM is applied to PACS for image- and waveform-based DICOM file manipulation. Second, a mobile Structured Query Language database communicating with PACS is installed in physicians' mobile phones so that they can retrieve images and waveform-based ECG ubiquitously. Clinical evaluations of this system indicated the following. First, this developed PACS-dependent 12-lead ECG information system improves 12-lead ECG management and interoperability. Second, this system enables the remote physicians to perform ubiquitous 12-lead ECG and image diagnoses, which enhances the efficiency of emergency telemedicine. These findings prove the effectiveness and usefulness of the PACS-dependent 12-lead ECG information system, which can be easily adopted in telemedicine. PMID:19711129

Hsieh, Jui-Chien; Lo, Hsiu-Chiung

2010-08-01

344

Evaluation method for determining management priorities for special case waste  

SciTech Connect

The U.S. Department of Energy (DOE) Radioactive Waste Technical Support Program (TSP) began the Special Case Waste (SCW) Inventory and Characterization Project in April 1989. The collection of data has been completed and a final draft report, Department of Energy Special Case Radioactive Waste Inventory and Characterization Data Report (DOE/LLW-96), was submitted in May 1990. A second final draft report, Supplemental Data Report to the Department of Energy Special Case Radioactive Waste Inventory and Characterization Data Report (DOE/LLW-95), containing additional and more detailed data and graphical presentations, was completed in July 1990. These two reports contain details on the special case waste categories and summaries of the total volumes and curies associated with each category of waste. It is anticipated that some version or combination of these two reports will be included in the final version of this report, which will describe an evaluation method for determining management priorities for special case waste. Preliminary analysis of the inventory data indicates that approximately 1,000,000 m{sup 3} of special case waste exist in the DOE system with possible insufficient treatment/storage/disposal capability or capacity. To help DOE prioritize the actions required to manage this large volume of special case waste, an evaluation method is required.

Kudera, D.E.; Wickland, C.E.

1990-08-01

345

Provider satisfaction and patient outcomes associated with a statewide prison telemedicine program in Louisiana.  

PubMed

Health information technology including telemedicine offers potential to improve patient care outcomes. As part of the response to Hurricanes Katrina and Rita in 2005, the Louisiana State University Health Care Services Division expanded its statewide telemedicine program. The aim of this study was to evaluate provider satisfaction and patient outcomes associated with telemedicine when used for the administration of prisoner medical care. Providers completed a survey following each patient encounter in real-time; questions were adapted from standard satisfaction indices. Statistical methods included uni-, bi-, and multivariable including ordinal regression methods to characterize unadjusted and adjusted factors associated with telemedicine use and provider satisfaction, and patient outcomes. Data were collected between December 2007 and May 2008 and were analyzed using SAS and Stata. Out of 737 patient visits, the majority of patients were African American (68.6%), men (92.9%), seen for either infectious disease or mental health (46.2% and 50.2%), with most surveys completed by a physician (63.1%). Most telemedicine encounters were completed (92.8%), a treatment plan was established (97.0%), the provider perceived that the technology was adequate to conduct visit (93.4%), and a follow-up telemedicine appointment was requested (90.8%). Most providers were satisfied with telemedicine for the visit overall (87.0%), believed that telemedicine improved patient prognosis (88.2%), and perceived that the patient was satisfied (83.0%). This study suggests that telemedicine was an effective and accepted method of healthcare provision. PMID:20438385

Glaser, Michelle; Winchell, Tom; Plant, Patty; Wilbright, Wayne; Kaiser, Michael; Butler, Michael K; Goldshore, Matthew; Magnus, Manya

2010-05-01

346

Early Recognition and Management of Laryngeal Fracture: A Case Report  

PubMed Central

Background Laryngeal fracture is a rare condition that can lead to significant problems with airway patency, voice production, and swallowing. Conflict in the literature exists regarding the most suitable way to manage this injury. Case Report We present the case of a 29-year-old Caucasian man who sustained a displaced fracture of the thyroid cartilage due to blunt trauma. He reported no swallowing, breathing, or voice problems after 1 year, and his recovery can be attributed to the early recognition and proper management of his condition. Conclusion This case illustrates the importance of ensuring a high level of suspicion for laryngeal fracture in the acute trauma patient. Early identification of this injury allows early intervention that not only protects the airway but also improves long-term voice and airway outcomes.

Schaefer, Nathan; Griffin, Aaron; Gerhardy, Benjamin; Gochee, Peter

2014-01-01

347

[Telemedicine Anáhuac. Educational system and health promotion activities].  

PubMed

Rural telemedicine began in the 1950s in the Papago, Arizona Reservation with the program Starphac. The Anáhuac University began the program in 2002. In the Anáhuac, the project was developed to provide specialty consultations in a virtual way to a highly marginalized population, creating clinical fields of high technology and fulfilling social obligations. The program began in Guerrero and was complemented with video conferences to an open population, courses to general physicians, continuing medical education, activities to promote health, and emergency disaster plans. From May 2002 until the end of 2004, 11,576 general consults have been provided and 2,420 specialty consults. The most frequent diagnoses in surgery were peptic ulcer disease, cholecystitis, diabetic foot and superficial venous insufficiency. The telemedicine program has allowed us to bring high specialty consults with great productivity, efficiency, less wait time and cost-benefit impact, along with a high quality of humane care. Resident physicians do their social service in a positive manner, with a permanent consultation office and a program of continuing medical education. PMID:16454964

Bernal-Sánchez, Gilberto; de la Torre-Rodríguez, Jorge; Restrepo-Arenas, Oscar; Robles-Bonilla, Carlos; Herrera-Bastida, Edgar I; Rodríguez-Macías, Patricia; Torres-Ortiz, Israel

2005-01-01

348

[Telemedicine in pacemaker therapy and follow-up].  

PubMed

Present-day remote systems for cardiovascular implantable electronic devices (CIEDs) provide, in contrast to previous solutions, a broad range of data about the patient and the implanted device ("remote control"). Telemedicine includes remote monitoring as well as remote follow-up: Remote monitoring is the continual interrogation of the device to detect patient- or device-related adverse events earlier than with standard follow-up visits. Remote follow-up aims to replace scheduled and unscheduled face-to-face follow-up visits due to the interrogation of the automatic pacemaker functions. Currently available remote systems, such as Home Monitoring, CareLink, Merlin.net, and Latitude, have in common that they interrogate the device, send these data to a server, and provide the data to the physician on a secured web site. Automatic wireless interrogation of the device is the preferred solution; however, the devices must have been equipped with a micro-antenna, which is usually restricted to more recent pacemaker models. Knowledge about remote control in pacemaker patients is limited, because most remote applications were evaluated in ICD and CRT patients. While the most frequently reported clinical event in pacemaker patients is atrial fibrillation, the impact in routine clinical follow-up still has to be evaluated in detail. Device-related adverse events are rare. Large, long-term, randomized trials are comparing remote and conventional approaches with the aim of demonstrating the benefits of telemedicine in this patient group. PMID:19937330

Schuchert, A

2009-12-01

349

Project RavenCare: global multimedia telemedicine in Alaska  

NASA Astrophysics Data System (ADS)

Project RavenCare is a testbed for assessing the utility of teleradiology, telemedicine and electronic patient records systems for delivering health care to Native Alaskans in remote villages. It is being established as a joint project between the department of radiology at Georgetown University Medical Center and the Southeast Alaska Regional Health Corporation (SEARHC) in Sitka, Alaska. This initiative will establish a sustained routine clinical multimedia telemedicine support for a village clinic in Hoonah, Alaska and a regional hospital in Sitka. It will link the village clinic in Hoonah to Mt. Edgecumbe Hospital in Sitka. This regional hospital will in turn be linked to Georgetown University Hospital through the T1- VSAT (very small aperture terminal) of the NASA-ACTS (Advanced Communication Technology Satellite). Regional physicians in Hoonah lack support in providing relatively routine care in areas such as radiology and pathology. This project is an initial step in a general plan to upgrade telecommunications in the health care system of the Southeast Alaska region and will address aspects of two problems; limited communication between the village health clinics and the hospital and lack of subspecialty support for hospital-based physicians in Sitka.

Tohme, Walid G.; Collmann, Jeff R.; Mun, Seong K.; Vastola, David J.

1995-05-01

350

Telemedicine in Primary Health: The Virtual Doctor Project Zambia  

PubMed Central

This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront.

2011-01-01

351

Open-source telemedicine platform for wireless medical video communication.  

PubMed

An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. PMID:23573082

Panayides, A; Eleftheriou, I; Pantziaris, M

2013-01-01

352

Case series: management of immature permanent teeth with pulpal necrosis: a case series.  

PubMed

The management of immature permanent teeth with necrotic pulps has changed in recent years from apexification techniques to regenerative endodontic procedures, which enable apexogenesis with physiologic maturation of the roots. This regenerative technique lies squarely in the endodontist's scope of practice, but children presenting with necrotic immature incisors may pose behavior management problems that endodontists are untrained and unwilling to handle. Treatment of these immature permanent teeth provides an excellent opportunity for collaboration and shared patient management between pediatric dentists and endodontists that can yield optimal clinical outcomes. The purpose of this paper was to report a series of 32 regenerative endodontic cases in 28 children treated at the Nationwide Children's Hospital, Columbus, Ohio. The report describes procedural and patient management issues and the need for a collaborative relationship between pediatric dentists and endodontists in tackling these challenging cases. PMID:23635900

McTigue, Dennis J; Subramanian, Kumar; Kumar, Ashok

2013-01-01

353

Combining Image and Non-Image Data for Automatic Detection of Retina Disease in a Telemedicine Network  

SciTech Connect

A telemedicine network with retina cameras and automated quality control, physiological feature location, and lesion/anomaly detection is a low-cost way of achieving broad-based screening for diabetic retinopathy (DR) and other eye diseases. In the process of a routine eye-screening examination, other non-image data is often available which may be useful in automated diagnosis of disease. In this work, we report on the results of combining this non-image data with image data, using the protocol and processing steps of a prototype system for automated disease diagnosis of retina examinations from a telemedicine network. The system includes quality assessments, automated physiology detection, and automated lesion detection to create an archive of known cases. Non-image data such as diabetes onset date and hemoglobin A1c (HgA1c) for each patient examination are included as well, and the system is used to create a content-based image retrieval engine capable of automated diagnosis of disease into 'normal' and 'abnormal' categories. The system achieves a sensitivity and specificity of 91.2% and 71.6% using hold-one-out validation testing.

Aykac, Deniz [ORNL; Chaum, Edward [University of Tennessee, Knoxville (UTK); Fox, Karen [Delta Health Alliance; Garg, Seema [University of North Carolina; Giancardo, Luca [ORNL; Karnowski, Thomas Paul [ORNL; Li, Yaquin [University of Tennessee, Knoxville (UTK); Nichols, Trent L [ORNL; Tobin Jr, Kenneth William [ORNL

2011-01-01

354

A case study of holistic wound management in intensive care.  

PubMed

Complex wounds that have become contaminated after abdominal surgery can cause a great deal of distress to patients, and the management of such wounds requires an holistic and humanistic approach (Torrance, 1985). This case study aims to address the issues of wound management, involving some of the underlying and surrounding problems - exudate, malodour, nutrition and wound pain - that may be associated with chronic wounds after surgery. Further discussed will be the treatment and use of vacuum-assisted closure (VAC) therapy which was administered to the patient in this study. The clinical environment is an intensive care unit (ICU) within a district general hospital. The critical care nurse is primarily involved in caring for resuscitation of the critically ill patient and wound care is often a long way down the list of priorities; however, wound management is important and must be addressed at part of holistic nursing care. PMID:12829977

Cardozo, Margaret

2003-06-01

355

Management of Pediatric Traumatic Macular Holes - Case Report  

PubMed Central

Purpose To report and describe the clinical course of four pediatric traumatic macular hole (TMH) cases and respective management. Case Report Four pediatric patients with macular hole following blunt ocular trauma underwent early pars plana vitrectomy, with consecutive hole closure. Initial visual acuity was <20/400 or worse in all patients. After surgery, all patients had visual acuity improvement, with final visual acuity being <20/50 in 2 of the patients by the end of the follow-up. Macular hole closure was achieved in all patients with a single procedure, and anatomical success was confirmed by optical coherence tomography until the end of the follow-up. Conclusions Although spontaneous closure of TMH is not uncommon, especially in pediatric patients, early pars plana vitrectomy seems to be a safe and effective choice in pediatric TMH management. The risk/benefit ratio of surgery seems to be better than observation.

Azevedo, S.; Ferreira, N.; Meireles, A.

2013-01-01

356

An unusual case of intraorbital foreign body and its management.  

PubMed

A 36-year-old aboriginal female presented following an assault with a wooden fence paling. Examination revealed a wooden object protruding lateral to the left eyebrow. CT scan showed a blow-in fracture of lateral orbital wall and a hypodense foreign body causing indentation of the globe and stretching of the optic nerve. The case was managed successfully with complete recovery of the visual acuity on day 1 post-surgery. This case highlights the importance of prompt removal of large lateral wooden intraorbital foreign body to achieve an excellent visual outcome. PMID:23740142

Hamilton, Alexander; Meena, Manju; Lawlor, Mitchell; Kourt, Georgina

2014-04-01

357

The chiropractic management of two cases of cervical spondylotic radiculopathy  

PubMed Central

Cervical spondylotic radiculopathy (CSR) is one of the potential sources of radiculopathy, particularly in patients aged 40 to 60 years. The hallmark sign of cervical-brachial pain presents in the majority of the cases, however a definitive clinical diagnosis is often difficult in the absence of reliable and valid diagnostic tests. Two cases of presumed CSR illustrate the usefulness of applying a comprehensive mechanical assessment that guides the patient's rehabilitation regardless of the traditional anatomical diagnosis. A brief overview of the epidemiology, clinical presentation, and management of CSR is also presented.

Dufton, John A.; Giantomaso, Tony

2003-01-01

358

Postanoxic myoclonus: two case presentations and review of medical management.  

PubMed

Postanoxic myoclonus is a rare manifestation after an anoxic event, with fewer than 150 cases reported in the literature. The condition is characterized by myoclonic jerks, which are worse on action than at rest, and postural lapses, ataxia, and dysarthria. The disability caused by postanoxic myoclonus can be profound, and treatment in the rehabilitation setting is exceptionally challenging. We present 2 patients who suffered from postanoxic myoclonus after an anoxic event, both of whom were successfully treated with a combination of levetiracetam, valproic acid, and clonazepam. These cases act as a framework for discussing the management of postanoxic myoclonus in the clinical setting. PMID:24060492

Budhram, Adrian; Lipson, David; Nesathurai, Shanker; Harvey, David; Rathbone, Michel P

2014-03-01

359

Development of a multimedia CD-ROM on telemedicine and teleradiology  

NASA Astrophysics Data System (ADS)

The Department of Defense Telemedicine Test Bed produced a CD-ROM including information on telemedicine, teleradiology and military medical advanced technology projects. The CD-ROM was produced using media from the Telemedicine Test Bed World Wide Web site and academic papers and presentations. Apple Media Tools software was used to produce the interactive program and the authoring was done on a high speed Apple Macintosh Power PC computer. The process took roughly 100 hours to author 50 Mb of data into 200 frames of interactive material. Future versions of the Telemedicine CD-ROM are in progress which will include much more material to take advantage of the 650 Mb available on a compact disk. This paper graphically depicts and explains the authoring process.

Schnur, Mark T.; Williamson, Morgan P.; Goeringer, Fred; Zimnik, Paul; Linn, Reid; Suitor, Charles T.; Rocca, Mitra A.; Strother, Thomas

1996-04-01

360

Technology assessment for an integrated PC-based platform for three telemedicine applications  

NASA Astrophysics Data System (ADS)

This paper investigates the design and technical efficacy of an integrated PC based platform for three different medical applications. The technical efficacy of such a telemedicine platform has not been evaluated in the literature and optimal technical requirements have not been developed. The first application, with the Department of Surgery, Division of Urology, tests the utility of a telemedicine platform including radiology images for a surgical stone disease consultation service from an off site location in West Virginia. The second application, with the Department of Internal Medicine, Division of Clinical Pharmacology, investigates the usefulness of telemedicine when used for a clinical pharmacology consultation service from an off-site location. The third application, with the Department of Pediatrics, will test telemedicine for trauma care triage service first within an off-site location in Virginia and then from there to Georgetown University Medical Center.

Tohme, Walid G.; Hayes, Wendelin S.; Dai, Hailei L.; Komo, Darmadi; Pahira, John J.; Abernethy, Darrell R.; Rennert, Wolfgang; Kuehl, Karen S.; Hauser, Gabriel J.; Mun, Seong K.

1996-05-01

361

Tele-Medicine Applications of an ISDN-Based Tele-Working Platform.  

National Technical Information Service (NTIS)

The Tele-Medicine sub-services backed up by a novel, open- architecture Tele-Working platform, are evaluated. This multimedia platform, developed over the Hellenic Integrated Services Digital Network (ISDN), is based on user terminals (personal computers)...

G. Economou P. Sotiriades N. Charokopos D. Lymberopoulos

2001-01-01

362

Telemedicine: The Practice of Medicine at a Distance. Resources in Technology.  

ERIC Educational Resources Information Center

Reviews developments in telemedicine and a number of related areas (telecommunications, virtual presence, informatics, artificial intelligence, robotics, materials science, and perceptual psychology). Provides learning activities for technology education. (SK)

Reed, Philip A.

2003-01-01

363

Developing a Measure of Prenatal Case Management Dosage  

Microsoft Academic Search

Recently, federal funding was designated through the Patient Protection and Affordable Care Act giving states the opportunity\\u000a to expand their prenatal case management programs (PCM) through home visitation. Studies evaluating the effect of PCM on birth\\u000a outcomes have shown little or no positive results. One suggested reason for these findings is a lack of attention in the assessment\\u000a of dosage.

Jaime C. SlaughterL; L. Michele Issel

364

Oral bullous lichen planus: Case report and review of management.  

PubMed

A 34-year-old female patient with the chief complaint of burning sensation in the oral cavity associated with generalized pruritis, scalp and skin lesions diagnosed as Bullous lichen planus and treated with systemic prednisolone, levamisole, benzydamine oral rinse. Patient is in follow up since 1 year and free of lesions. Here we report the case and review current modalities in the management of oral lichen planus. PMID:23293497

Patil, Archana; Prasad, Shiva; Ashok, L; Sujatha, G P

2012-07-01

365

TeleMedMail: free software to facilitate telemedicine in developing countries.  

PubMed

Telemedicine offers the potential to alleviate the severe shortage of medical specialists in developing countries. However lack of equipment and poor network connections usually rule out video-conferencing systems. This paper describes a software application to facilitate store-and-forward telemedicine by email of images from digital cameras. TeleMedMail is written in Java and allows structured text entry, image processing, image and data compression, and data encryption. The design, implementation, and initial evaluation are described. PMID:11604848

Fraser, H S; Jazayeri, D; Bannach, L; Szolovits, P; McGrath, S J

2001-01-01

366

Telemedicine in the blood transfusion laboratory: remote interpretation of pre-transfusion tests  

Microsoft Academic Search

We have developed a telemedicine system for blood transfusion work, to supply the local hospital laboratory with an expert opinion from the central reference laboratory. The telemedicine system allows remote inspection and interpretation of pre-transfusion tests, which are performed by ID-cards (micro-tube gel technology). The system was installed at three blood transfusion laboratories in Slovenia, approximately 70 km apart. Validation

Marko Meza; Marko Breskvar; Andrej Kosir; Irena Bricl; Jurij Tasic; Primoz Rozman

2007-01-01

367

Managing knowledge through collaboration: multiple case studies of managing research in university laboratories in Thailand  

Microsoft Academic Search

Universities are widely regarded not only as teaching establishments but also as organizations that create new knowledge and innovation through research. As such, research collaboration has been found to play a significant role in improving and enhancing universities innovation potential of organizations.This paper presents the results from multiple case studies on managing knowledge through collaboration currently in use at three

Somchai Numprasertchai; Barbara Igel

2005-01-01

368

The use of telemedicine to evaluate competency to stand trial: a preliminary randomized controlled study.  

PubMed

To investigate whether forensic evaluations can be performed reliably using telemedicine, we compared the results on a standard competency assessment instrument using telemedicine (TM) and live interviews (LI). Two board-certified forensic psychiatrists used the Georgia Court Competency Test (GCCT) to evaluate 21 forensic psychiatric inpatients. Half of the patients were randomly assigned to a telemedicine interview and half were assigned to a live interview. Total scores on the GCCT were similar for both raters, indicating high levels of agreement between telemedicine and live interviews. Patient and provider satisfaction were measured and indicated that, although patients did not express a preference for a particular interview modality, providers reported greater satisfaction with live interviews. Findings suggest that one aspect of competency to stand trial can be reliably evaluated using telemedicine and that patients perceive telemedicine as an acceptable alternative to a standard live interview. The limited sample size precludes definite conclusions and further studies involving a larger forensic study population are warranted. PMID:18086740

Manguno-Mire, Gina M; Thompson, John W; Shore, Jay H; Croy, Calvin D; Artecona, Jose F; Pickering, John W

2007-01-01

369

Telemedicine system using a high-speed network: past, present, and future.  

PubMed

There is no doubt that telecommunication saves a great deal of time and expense when exchanging information, and recent technological advances have increased its popularity in business and educational applications. Telemedicine is a rapidly developing application of clinical medicine in which medical information is transferred via the Internet or another communication network for the purpose of consultations, and sometimes also for remote medical procedures or examinations. A telemedicine system can also be applied to medical education. Many doctors and medical students could benefit from telementoring and tele-education based on videoconferencing systems. However, telemedicine in general has not yet become popular in clinical practice or medical education. In our university, we have used a telemedicine system to educate doctors and medical students since 2003. Since our first telemedical conference with Kyushu University Hospital on February 12, 2003 when we have regularly performed telemedical conferences. Here we introduce a general methodology for telemedicine, our experiences of medical conferencing using telemedicine, and future possible directions. PMID:20431756

Hahm, Joon Soo; Lee, Hang Lak; Choi, Ho Soon; Shimizu, Shuji

2009-12-01

370

A strategic vision for telemedicine and medical informatics in space flight  

NASA Technical Reports Server (NTRS)

This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond.

Williams, D. R.; Bashshur, R. L.; Pool, S. L.; Doarn, C. R.; Merrell, R. C.; Logan, J. S.

2000-01-01

371

25 CFR 20.318 - What case management responsibilities does the social services worker have?  

Code of Federal Regulations, 2011 CFR

... 1 2011-04-01 2011-04-01 false What case management responsibilities does the social services worker have? ...Assistance Employment Requirements § 20.318 What case management responsibilities does the social services worker...

2011-04-01

372

HIV case manager preparedness for practice in Ryan White CARE Act funded settings.  

PubMed

While current research on the factors affecting the HIV epidemic within the general population has considered the role of HIV case managers, much remains to be known about case management effectiveness and how it might be enhanced. This article presents the data from a statewide survey of case management professionals in Florida. The study focused on case managers' preparation for practice and barriers to successful practice. The study results reflect a very broad educational preparation in multiple disciplines with highly varied means of case manager training and orientation at entry to practice. Further, the results highlighted the existence of multiple barriers that challenge the ability of case managers to cope with the demands of case management practice in sites serving people living with HIV/AIDS who are socially and economically challenged. The article concludes with recommendations for changes in the system that would enhance the preparation of case management professionals for entry to practice. PMID:24117030

Whyte Iv, James; Eccles, David W; Whyte, Maria D; Pappas, Cara; Cesnales, Nicole I

2013-01-01

373

Telemedicine for the Diabetic Foot: A Model for Improving Medical Care, Developing Decision Support Systems, and Reducing Medical Cost  

Microsoft Academic Search

\\u000a The main purpose of this chapter is to discuss the place of telemedicine in the modern medicine, its present and future application\\u000a in the clinical medicine. It covers aspects of clinical telemedicine practice, technical advances, principles and practices,\\u000a health policy and regulation, and health services research dealing with clinical effectiveness, efficacy, and safety of telemedicine\\u000a and its effects on quality,

Adriana Fodor; Eddy Karnieli

374

Research Paper: Development, Validation, and Use of English and Spanish Versions of the Telemedicine Satisfaction and Usefulness Questionnaire  

Microsoft Academic Search

ObjectivesTo describe the development and validation of low literacy English and Spanish versions of the 26-item Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), report telemedicine satisfaction and usefulness ratings of urban and rural participants in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, and explore relationships between utilization and perceptions of satisfaction and usefulness.MethodsData sources included TSUQ, utilization data from

Suzanne Bakken; Lorena Grullon-Figueroa; Roberto E. Izquierdo; Nam-Ju Lee; Philip C. Morin; Walter Palmas; Jeanne A. Teresi; Ruth S. Weinstock; Steven Shea; Justin Starren

2006-01-01

375

Telemedicine via satellite to support offshore oil platforms.  

PubMed

On any one day, approximately 15,000-28,000 oil industry personnel are employed in the North Sea oil and gas industry. First aid in this remote environment is provided by non-medical staff on the rigs. Remote specialist advice via videoconferencing should improve the quality of offshore health care and reduce avoidable medical evacuations. Satellite communications and videoconferencing equipment was installed on the 'Alwyn North' oil platform, with medical advice provided via a call centre in Milan. Over a nine-month period, trial telemedicine links were conducted approximately twice per week. The three onshore physicians were very satisfied on each occasion with communications and diagnostic data image quality, including the ultrasound screening carried out by the rig provider. Remote specialist advice via videoconferencing should reduce unnecessary and/or untimely patient evacuation to hospital or onshore for medical assessment. PMID:18430278

Mair, Fiona; Fraser, Susan; Ferguson, James; Webster, Karyn

2008-01-01

376

Experience in the application of Java Technologies in telemedicine  

PubMed Central

Java language has been demonstrated to be an effective tool in supporting medical image viewing in Russia. This evaluation was completed by obtaining a maximum of 20 images, depending on the client's computer workstation from one patient using a commercially available computer tomography (CT) scanner. The images were compared against standard CT images that were viewed at the site of capture. There was no appreciable difference. The client side is a lightweight component that provides an intuitive interface for end users. Each image is loaded in its own thread and the user can begin work after the first image has been loaded. This feature is especially useful on slow connection speed, 9.6 Kbps for example. The server side, which is implemented by the Java Servlet Engine works more effective than common gateway interface (CGI) programs do. Advantages of the Java Technology place this program on the next level of application development. This paper presents a unique application of Java in telemedicine.

Fedyukin, IV; Reviakin, YG; Orlov, OI; Doarn, CR; Harnett, BM; Merrell, RC

2002-01-01

377

US-USSR telemedicine consultation spacebridge to Armenia and Ufa  

NASA Technical Reports Server (NTRS)

The Final Report on the U.S.-U.S.S.R. Telemedicine Consultation Spacebride to Armenia and Ufa is presented. The goal of this activity was to provide expert medical consultation to the Armenian medical personnel in the areas of plastic and reconstructive surgery, physical and psychological rehabilitation, public health, and epidemiology following the devastating earthquake in Dec. 1988. The U.S. and U.S.S.R. implementation teams developed new standards for medical information transmittal as well as protocols and schedules on how to conduct medical consultations. The consultations were provided to the Republic Diagnostic Center in Yerevan, U.S.S.R. by four U.S. medical centers: University of Utah/LDS Hospital, University of Texas, Maryland Institute for Emergency Medical Service Systems, and Uniformed Services University of the Health Sciences.

1991-01-01

378

Evaluating a Web-Based Interface for Internet Telemedicine  

NASA Technical Reports Server (NTRS)

The objective is to introduce the usability engineering methodology, heuristic evaluation, to the design and development of a web-based telemedicine system. Using a set of usability criteria, or heuristics, one evaluator examined the Spacebridge to Russia web-site for usability problems. Thirty-four usability problems were found in this preliminary study and all were assigned a severity rating. The value of heuristic analysis in the iterative design of a system is shown because the problems can be fixed before deployment of a system and the problems are of a different nature than those found by actual users of the system. It was therefore determined that there is potential value of heuristic evaluation paired with user testing as a strategy for optimal system performance design.

Lathan, Corinna E.; Newman, Dava J.; Sebrechts, Marc M.; Doarn, Charles R.

1997-01-01

379

Network and data security design for telemedicine applications.  

PubMed

The maturing of telecommunication technologies has ushered in a whole new era of applications and services in the health care environment. Teleworking, teleconsultation, mutlimedia conferencing and medical data distribution are rapidly becoming commonplace in clinical practice. As a result, a set of problems arises, concerning data confidentiality and integrity. Public computer networks, such as the emerging ISDN technology, are vulnerable to eavesdropping. Therefore it is important for telemedicine applications to employ end-to-end encryption mechanisms securing the data channel from unauthorized access of modification. We propose a network access and encryption system that is both economical and easily implemented for integration in developing or existing applications, using well-known and thoroughly tested encryption algorithms. Public-key cryptography is used for session-key exchange, while symmetric algorithms are used for bulk encryption. Mechanisms for session-key generation and exchange are also provided. PMID:9304559

Makris, L; Argiriou, N; Strintzis, M G

1997-01-01

380

Remote Measurements of Heart and Respiration Rates for Telemedicine  

PubMed Central

Non-contact and low-cost measurements of heart and respiration rates are highly desirable for telemedicine. Here, we describe a novel technique to extract blood volume pulse and respiratory wave from a single channel images captured by a video camera for both day and night conditions. The principle of our technique is to uncover the temporal dynamics of heart beat and breathing rate through delay-coordinate transformation and independent component analysis-based deconstruction of the single channel images. Our method further achieves robust elimination of false positives via applying ratio-variation probability distributions filtering approaches. Moreover, it enables a much needed low-cost means for preventing sudden infant death syndrome in new born infants and detecting stroke and heart attack in elderly population in home environments. This noncontact-based method can also be applied to a variety of animal model organisms for biomedical research.

Qian, Yi; Tsien, Joe Z.

2013-01-01

381

A novel telemedicine system for monitoring congestive heart failure patients.  

PubMed

Congestive heart failure is a widespread cardiac disease in western countries. At present, the main measure for monitoring the level of pulmonary edema in telemedicine systems is weight, which is not a reliable indicator. The authors propose a novel bioimpedance telemedical system to monitor these patients. The system measures the resistivity of each lung using optimization methods and transmits the measurements via a modem to a call center. Preliminary results show that the measured resistivity values among healthy young patients are consistent and reproducible within 48 hours. The mean resistivity values in patients with pulmonary congestion were lower than those of the healthy patients: 887 [Omega*cm]+/-117 vs 1244 [Omega*cm]+/-87 (P<.01). The system is noninvasive, safe, and portable. It retrieves unique information correlated with the amount of fluid in the lungs and transmits the data to a medical call center in order to improve the diagnostics and treatment of congestive heart failure. PMID:18983286

Radai, Michal M; Arad, Marina; Zlochiver, Sharon; Krief, Haim; Engelman, Tzvika; Abboud, Shimon

2008-01-01

382

Clinical and financial considerations for implementing an ICU telemedicine program.  

PubMed

As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs. PMID:24889437

Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

2014-06-01

383

Chiropractic management of breast-feeding difficulties: a case report  

PubMed Central

Objective The purpose of this study is to discuss a chiropractic case of management and resolution of breast-feeding difficulties. Clinical Features The case involves an 8-day-old baby unable to breast-feed since 4 days old. Initial examination revealed cervical, cranial, and sacral restrictions. She was diagnosed with craniocervical syndrome by a doctor of chiropractic. Intervention and Outcome Following history and examination, the infant received gentle chiropractic manipulation based on clinical findings. Immediate improvement and complete resolution of the nursing problems were observed after 3 treatments over 14 days. Conclusion The results of this case suggest that neuromusculoskeletal dysfunction may influence the ability of an infant to suckle successfully and that intervention via chiropractic adjustments may result in improving the infant's ability to suckle efficiently.

Holleman, Annique C.; Nee, John; Knaap, Simone F.C.

2011-01-01

384

[Telemedicine in acute stroke care--a health economics view].  

PubMed

Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market. PMID:20077382

Günzel, F; Theiss, S; Knüppel, P; Halberstadt, S; Rose, G; Raith, M

2010-05-01

385

A decade of case management: a methodological review of outcome research.  

PubMed

The last decade has witnessed a burgeoning interest in case management services to people with severe mental illness. While the literature on case management is proliferating, there remains a paucity of rigorously designed outcome research. This paper provides a methodological review of that outcome research on case management, which found that the term case management is used to describe a diverse array of interventions that yield differing client outcomes. Suggestions for the direction of future inquiry are described. PMID:2055004

Chamberlain, R; Rapp, C A

1991-06-01

386

From Case Management to Court Clinic: Examining Forensic System Involvement of Persons with Severe Mental Illness  

Microsoft Academic Search

The study examined the flow of a state mental health agency's case-managed clients into its forensic mental health court clinic systems for evaluation of competency to stand trial (CST) for a criminal offense. An analysis of merged encounter data from the case management and court clinic systems revealed that roughly 2% of the case-managed population were referred to court clinics

William H. Fisher; Ira K. Packer; Thomas Grisso; Melissa McDermeit; Julie-Marie Brown

2000-01-01

387

From case management to court clinic: examining forensic system involvement of persons with severe mental illness  

Microsoft Academic Search

The study examined the flow of a state mental health agency's case-managed clients into its forensic mental health court clinic systems for evaluation of competency to stand trial (CST) for a criminal offense. An analysis of merged encounter data from the case management and court clinic systems revealed that roughly 2% of the case-managed population were referred to court clinics

William H. Fisher; Ira K. Packer; Thomas Grisso; Melissa McDermeit; Julie-Marie Brown

2001-01-01

388

Case Managers' Attitudes toward the Use of Homework for People Diagnosed with a Severe Psychiatric Disability  

ERIC Educational Resources Information Center

The study examined mental health case managers' attitudes toward the use of homework and explored the relationship between clinician attitudes and systematic homework administration practices. A survey examining attitudes toward the use of homework was completed by 122 Australian mental health case managers. Case managers who held more positive…

Kelly, Peter J.; Deane, Frank P.; Kazantzis, Nikolaos; Crowe, Trevor P.

2007-01-01

389

Endoscopic surgery and telemedicine in microgravity: developing contingency procedures for exploratory class spaceflight  

NASA Technical Reports Server (NTRS)

OBJECTIVES: The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included. METHODS: A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g). RESULTS: The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission. CONCLUSIONS: In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.

Jones, J. A.; Johnston, S.; Campbell, M.; Miles, B.; Billica, R.

1999-01-01

390

Managing environmental sensitivity: an overview illustrated with a case report  

PubMed Central

While the adverse impact of certain environmental agents is well established and affect individuals in a predictable dose-dependent manner, the validity of some exposure syndromes, such as environmental sensitivity, attributed to the influence of environmental chemicals in low, usually harmless doses, is less certain. Diagnosis of environmental sensitivity is subjective, and both standard medical and complementary and alternative treatment often fails to provide clinically meaningful functional gains. Existing evidence suggests that in many individuals with these syndromes, psychosocial factors play a prominent role. In this article we present an approach to managing patients presenting with sensitivities to environmental agents that includes identifying and managing organic disease, obtaining a thorough biopsychosocial history, confirming a diagnosis, and developing a rehabilitative process that focuses on support and improvements in function. A case of multiple chemical sensitivity illustrates this approach.

Busse, Jason W.; Reid, Steven; Leznoff, Arthur; Barsky, Arthur J.; Qureshi, Roohi; Guyatt, Gordon H.

2008-01-01

391

Pneumatosis Intestinalis: A Case Report and Approach to Management  

PubMed Central

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

Donovan, Sean; Cernigliaro, Joseph; Dawson, Nancy

2011-01-01

392

Telemedicine for the Medicare Population: Pediatric, Obstetric, and Clinician-Indirect Home Interventions. Evidence/Report/Technology Assessment Number 24, Supplement.  

National Technical Information Service (NTIS)

The goal of this report is to extend our original evidence report on the efficacy of telemedicine by extending the assessment to the pediatrics and obstetrics populations along with receiving home telemedicine where the health care provider was involved i...

W. Hersh

2001-01-01

393

Fused upper central incisors: management of two clinical cases  

PubMed Central

Summary This paper reports the management of two clinical cases, in which the upper right central incisor was fused with a supernumerary tooth and the upper left central incisor was macrodontic. A radiographic examination revealed that the fused teeth had two separate roots. Hemisectioning of the fused teeth was performed, the supernumerary portion was extracted and the remaining part was reshaped to remove any sharp margins and to achieve a normal morphology. The macrodontic central incisors were not treated. At 12-months post-surgery there were no periodontal problems and no hypersensitivity. Orthodontic treatment was performed to appropriately align the maxillary teeth and to correct the malocclusion.

Sfasciotti, Gian Luca; Marini, Roberta; Bossu, Maurizio; Ierardo, Gaetano; Annibali, Susanna

2012-01-01

394

Asian management style versus Western management theories – A Singapore case study in construction project management  

Microsoft Academic Search

The Asian financial crisis snowballed in July 1997 following the devaluation of the Thai baht. This triggered off a chain reaction which led to similar crises in many countries in Asia, including Singapore. One of the arguments put forward to explain the financial crisis in Asia relates to the Asian style of management, which purportedly includes kinsmanship and guanxi or

Low Sui Pheng; Christopher H. Y. Leong

2001-01-01

395

Multidisciplinary Management of a Fused Tooth: A Case Report  

PubMed Central

Objective. Fusion is a dental anomaly that arises through the union of two adjacent teeth. The case report presents multidisciplinary management of a fused maxillary anterior tooth. Case Report. A 10-year-old boy was referred to the pediatric dental clinic with the chief complaint of a large upper anterior tooth. Intraoral and radiographic examinations indicated fusion between the permanent maxillary right central incisor and a supernumerary tooth. According to the treatment plan, the fused tooth was sectioned, and the mesial portion was removed. The remaining tooth section was restored with composite resin, and the diastema between the central incisors was closed with orthodontic treatment. After an 18-month followup period, the tooth showed no sign of pathosis. Conclusion. The technique described here offers a simple and effective method for restoring a fused tooth that reestablishes function, shape, and esthetics.

Sen Tunc, Emine; Arici, Nursel; Ozkan, Nilufer

2013-01-01

396

Critical appraisal of published systematic reviews assessing the cost-effectiveness of telemedicine studies.  

PubMed

Abstract Background: Over the last 10 years several systematic reviews have been published on the cost-effectiveness of telemedicine studies. Most reviews have concluded that there is not much difference in the cost-effectiveness when delivering health services via telemedicine or by conventional means. We are not aware of any systematic review looking at the systematic reviews of cost-effectiveness of telemedicine. This study was designed to identify published systematic reviews on the cost-effectiveness of telemedicine studies and to undertake a quality assessment of the identified systematic reviews. Materials and Methods: We searched six electronic databases, including Medline, Embase, and the NHS Economic Evaluation Database, combining "review" terms with "telemedicine" terms to identify systematic reviews. Results: We identified 4,116 potential abstracts. Nine systematic reviews met the inclusion criteria, which looked at the cost-effectiveness of telemedicine in general. All reviews were similar in terms of their stated purpose, and the objectives were clear. Three of the reviews did not use a checklist for the economic evaluation studies included in their review. The quality assessment found that five of the nine reviews had minimal flaws. Conclusions: Even though the general quality of reporting of the reviews was fine, we have found that conclusions cannot be drawn on the cost-effectiveness of telemedicine applications based on the methodological flaws in the economic analysis of the studies included in the reviews. Over time, reporting of cost-effectiveness has generally improved; however, there is still room for improvement, and authors need to use the recommended checklists for economic evaluations. PMID:24820406

Mistry, Hema; Garnvwa, Hyeladzira; Oppong, Raymond

2014-07-01

397

Hospital waste management in Libya: a case study.  

PubMed

In Libya, as in many developing countries, little information is available regarding generation, handling and disposal of hospital waste. This fact hinders the development and implementation of hospital waste management schemes. The specific objective of this study is to present an appraisal of the current situation regarding hospital waste management in Libya. Procedures, techniques, methods of handling, and disposal of waste are presented, as well as the amounts and compositions of hospital waste. This research was conducted in the form of a case study. Fourteen different healthcare facilities in three cities, Tripoli, Misurata, and Sirt, all located in the northwestern part of Libya, were selected for investigation. The investigation showed that the hospitals surveyed had neither guidelines for separated collection and classification, nor methods for storage and disposal of generated waste. This deficiency indicates the need for an adequate hospital waste management strategy to improve and control the existing situation. The average waste generation rate was found to be 1.3 kg/patient/day, comprised of 72% general healthcare waste (non-risk) and 28% hazardous waste. The average general waste composition was: 38% organic, 24% plastics, and 20% paper. Sharps and pathological elements comprised 26% of the hazardous waste component. PMID:19036572

Sawalem, M; Selic, E; Herbell, J-D

2009-04-01

398

A Web-based telemedicine system for diabetic retinopathy screening using digital fundus photography.  

PubMed

The purpose was to design and implement a Web-based telemedicine system for diabetic retinopathy screening using digital fundus cameras and to make the software publicly available through Open Source release. The process of retinal imaging and case reviewing was modeled to optimize workflow and implement use of computer system. The Web-based system was built on Java Servlet and Java Server Pages (JSP) technologies. Apache Tomcat was chosen as the JSP engine, while MySQL was used as the main database and Laboratory of Neuro Imaging (LONI) Image Storage Architecture, from the LONI-UCLA, as the platform for image storage. For security, all data transmissions were carried over encrypted Internet connections such as Secure Socket Layer (SSL) and HyperText Transfer Protocol over SSL (HTTPS). User logins were required and access to patient data was logged for auditing. The system was deployed at Hubert H. Humphrey Comprehensive Health Center and Martin Luther King/Drew Medical Center of Los Angeles County Department of Health Services. Within 4 months, 1500 images of more than 650 patients were taken at Humphrey's Eye Clinic and successfully transferred to King/Drew's Department of Ophthalmology. This study demonstrates an effective architecture for remote diabetic retinopathy screening. PMID:16478413

Wei, Jack C; Valentino, Daniel J; Bell, Douglas S; Baker, Richard S

2006-02-01

399

Telemedicine Diabetes Consultations Are Cost-Effective, and Effects on Essential Diabetes Treatment Parameters Are Similar to Conventional Treatment: 7-Year Results from the Svendborg Telemedicine Diabetes Project  

PubMed Central

Background The increasing number of patients with diabetes poses a major challenge for the health care system. One instrument to meet these challenges could be the use of telemedicine, which, at the same time, may reduce treatment costs. Since 2005, diabetes patients on the island of Aeroe have been offered expert diabetes care using teleconsultations. This article describes the impact of the telemedicine solution on essential diabetes treatment parameters, patient satisfaction, and cost-effectiveness. Methods Telemedicine consultations were conducted with the patient and nurse specialist placed in a consultation room of Aeroe Hospital in audiovisual contact with the physician situated at the hospital on the mainland. Consultations were supported by an electronic patient record and a Web-based quality-monitoring diabetes database. Results Inclusion criteria in this retrospective study were at least 6 months of telemedicine diabetes control with a minimum of two visits and two hemoglobin A1c (HbA1c) values. Results were compared with data from the Danish National Diabetes Registry (DVDD). Data are given in medians. In total, 23 type 1 diabetes mellitus (T1DM) patients, aged 65 (56–74) versus 48 years, diabetes duration 21.0 (10.7–31.3) versus 20.5 years, and 55 type 2 diabetes mellitus (T2DM) patients, aged 67 (64–70) versus 65 years, diabetes duration 14.0 (10.5–17.5) versus 11.7 years, were included. After teleconsultation, HbA1c in T1DM patients was 8.0% (7.4–8.6%) versus 7.9% [64 (57–71) versus 63 mmol/mol], not significant, and in T2DM patients was 7.4% (7.1–7.7%) versus 7.6% [57 (54–61) versus 60 mmol/mol], p <.05. Body mass index, blood pressure, and lipid values were comparable with the DVDD. Patient satisfaction was especially related to the major reduction in transportation time (7 h). Reductions in traveling costs and saved working days were the most important factors in making the telemedicine set-up economically efficient. Conclusion Telemedicine consultation for remote outpatient diabetes control is feasible, and the interdisciplinary interventions achieved high treatment quality results in essential diabetes treatment parameters. In addition, the telemedicine set-up was associated with improved cost-effectiveness and patient satisfaction.

Levin, Klaus; Madsen, Jette R.; Madsen, Jette R.; Petersen, Inge; Wanscher, Christina E.; Hangaard, Joergen

2013-01-01

400

An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative: Economic and Selected Clinical Outcomes  

Microsoft Academic Search

Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected

Jaan Sidorov; Franz Joseph Fisher; Sabrina Girolami; Otto Wolke

2002-01-01

401

Get Them Talking: Managing Change through Case Studies and Case Study Discussion. RUSA Occasional Paper, Number 25.  

ERIC Educational Resources Information Center

Since 1989, the Reference and User Services Association/Management and Operation of User Services Section's Management of Reference Committee has successfully used case studies to foster structured discussions among public service librarians on a wide variety of issues relating to managing change in reference services. The information offered in…

Arthur, Gwen, Ed.

402

Using Telemedicine to Provide Pediatric Subspecialty Care to Children With Special Health Care Needs in an Underserved Rural Community  

Microsoft Academic Search

Objective. For children with special health care needs (CSHCN) that live in rural, medically underserved communities, obtaining subspecialty care is a challenge. Telemedicine is a means of improving access to these children by addressing rural physician shortages and geographic barriers. This article reports a medical- needs assessment of parents\\/guardians with CSHCN and the status of a telemedicine program for CSHCN

James P. Marcin; Jeff Ellis; Roland Mawis; Eule Nagrampa; Thomas S. Nesbitt; Robert J. Dimand

2004-01-01

403

The Use of Telemedicine Technology and Restructured Referral Patterns to Reduce Health Care Costs in a Juvenile Justice System  

Microsoft Academic Search

The study objective was to examine the cost-effectiveness and cost savings of a telemedicine program in four adolescent detention facilities in Tennessee. The facilities, in rural communities with limited access to specialty health care resources, implemented a telemedicine and referral program that obtained care from an academic medical center. The study measured costs for specialty outpatient, emergency department, and inpatient

Karen C. Fox; Grant Somes; Teresa M. Waters

2006-01-01

404

Telemedicine licensure in the United States: the need for a cooperative regional approach.  

PubMed

The extraordinary successes and refinement of modern telemedicine applications in recent years have been diminished somewhat by the anachronistic licensure laws of the 50 state jurisdictions that limit the practice of medicine to specific state geographic boundaries. This approach is deficient when applied to telemedicine because, with the advent of the Internet and modern technological advances, differences in space and time are rendered nearly meaningless. It is recommended in this paper that the practice of telemedicine be handled differently than the practice of face-to-face medicine, as related to licensure. Although it may be argued persuasively that a national licensure model for telemedicine should be advanced, the political and constitutional hurdles may be too great to overcome. It is therefore recommended that a voluntary, regional geographic approach be instituted by jurisdictions already demonstrating a commonality of interests, such as through the Southern Governors' Association or the Western Governors' Association. The benefits to be derived from this approach would include improving access to healthcare and medical specialists, enhancing the quality and timeliness of care, cutting medical costs by moving information instead of people, securing patients' access to medical records and information, and facilitating commercial export of American telemedicine services. PMID:17489700

Cwiek, Mark A; Rafiq, Azhar; Qamar, Aamna; Tobey, Charles; Merrell, Ronald C

2007-04-01

405

A case of normotensive pheochromocytoma with management dilemma  

PubMed Central

Introduction: We report an unusual case of normotensive pheochromocytoma detected incidentally, presenting a pre-operative management problem. Case Note: A 40-year-old lady with vague abdominal symptoms was initially discovered with a left adrenal incidentaloma by ultrasound abdomen, which was also revealed in computed tomography (CT). After exclusion of all the causes with possible necessary investigations, pheochromocytoma was confirmed with elevated 24 hour urinary metanephrine and normetanephrine. Her blood pressure was in low to normotensive range all throughout. She was attempted to be prepared with combined alpha and beta blockade but could not tolerate this regimen due to symptomatic hypotension. Subsequently, surgical preparation was planned cautiously with alpha-adenergic blockade only. With intensive monitoring, she underwent uneventful left adrenalectomy, and surgical pathology was consistent with pheochromocytoma. Conclusion: This case illustrates an unusual presentation of normotensive pheochromocytoma as adrenal incidentaloma. Pre-operative preparation in these patients can be achieved with alpha-adrenergic blockade, adequate hydration, and liberal salt intake.

Roy, Mukut; Sengupta, Nilanjan; Sahana, Pranab Kumar; Giri, Debasis; Das, Chanchal

2012-01-01

406

Water Quality Management in China: The Case of the Huai River Basin  

Microsoft Academic Search

This paper addresses the importance of water quality management and the impacts of water pollution control and water development projects. The case study of the Huai River Basin is an example of the major challenges on water quality management that China is facing, and why water quality management will play a key role on its sustainable use and management. Three

Jun Xia; Yong-Yong Zhang; Chesheng Zhan; Ai Zhong Ye

2011-01-01

407

Multiple-Cases and Bibliometric Research on Management Fashion's Dissemination in China  

Microsoft Academic Search

This paper studies management fashion's dissemination in China by multiple-cases and bibliometric methods. The research shows that management fashion's consumer structure is correlated with its dissemination curve. And the popular curve in recent China is close to a bell shape. Generally, Chinese scholars introduced management techniques into China as triggers and turn them into management fashions, which are characterized by

Yuze Bao; Liwen Tan

2009-01-01

408

Rural telemedicine: lessons from Alaska for developing regions.  

PubMed

Alaska shares many characteristics with other rural and remote regions of the Asia-Pacific, including a small population spread over a large area, lack of roads linking villages to hospitals, a significant indigenous population, and a shortage of doctors in rural areas. Communication with village health aides was originally by high frequency (HF) radio. Satellites brought reliable voice communication in the 1970s. Alaska has now introduced the first permanent upgrade to the voice satellite system, known as the Alaska Federal Health Care Access Network (AFHCAN). This satellite-based system is now the world's most extensive telemedicine network, linking 248 sites, including 158 village health centers. This paper examines the approach used to design the network, and includes preliminary findings on utilization of the network and associated cost-savings. It also discusses the U.S. Universal Service Fund subsidy for rural health care facilities. It concludes with lessons learned that could be applicable for other remote and isolated areas and developing regions. PMID:16149892

Hudson, Heather E

2005-08-01

409

[Health telematics/telemedicine in the republic of Estonia].  

PubMed

The people of Estonia, who until their independence had been systematically deprived of all forms of information, have shown a ready acceptance of the use of information technology in all areas of life. This environment and an excellent IT infrastructure have since the beginning of the new century provided favourable conditions for developing various individual projects in telemedicine. At the core of current telemedical applications in Estonia is the BITNET Project (in neurology, general medicine), built up with Swedish cooperation, and three German-Estonian projects (in telecardiology and telepathology). These projects are accompanied by studies of their cost-effectiveness. They constitute the basis for the plan that routine telemedical services be taken over by the Estonian health insurance. Differing from the situation in the Scandinavian countries, which have had an effective national telemedical service for over ten years, the special feature of telematrics in Estonia is its international networking with foreign centres of excellence. This has its origin in the aim of Estonian health policy to ensure medical services within its own country in all branches of medicine. PMID:15133737

Köhler, F; Fotuhi, P; Schierbaum, C; Dietel, M; Baumann, G; Lange, M; Asser, T

2004-04-30

410

Water resources management: case study of Sharkia governorate, Egypt  

NASA Astrophysics Data System (ADS)

Ministry of water resources and irrigation in Egypt is currently implementing projects that expand new cultivated area, and accordingly the supplies of Nile River to the Nile Delta will be negatively affected. So, Enormous interest toward water resources management has been taken in the Egyptian water sector. Conveyance infrastructure and irrigation technology has been gradually improved to ensure efficient distribution and utilization of scarce water resources. The present study is focused on the optimum utilization of water resources in Sharkia governorate, Egypt. Operational and planning distribution model is implemented on the selected case study (Sharkia governorate) to develop appropriate water plan. The gross revenue of all crops is correlated to surface water discharge, ground water discharge, surface water salinity, and ground water salinity. In addition, the effect of varying both surface and groundwater quantities and qualities on the gross revenue has been investigated. Moreover, the effect of limiting rice production on the gross revenue is allocated.

Mohamed, Y. A.; Rashad, M.

2012-06-01

411

Case manager role. A content analysis of published literature.  

PubMed

The case manager (CM) role is in its third decade of existence. However, there remains a lack of continuity in definition, educational level and qualifications, and the needed experience for role performance. This article presents the results of a content analysis of the published literature, conducted at two points in time, in an attempt to clarify common qualifications and skills needed for role implementation. The results suggest that the CM role requires interpersonal skills, and knowledge of planning, economic and evaluation strategies. Comparison of data for the two measurement times revealed an increased emphasis on the need to work in groups, conduct cost accounting, and facilitate change. Outcome measurement and ongoing evaluation experienced a decline in importance at the time of the second analysis. The ability to critically think, communicate and practice with clinical expertise emerge as inherent qualities of the role. Educational and experiential background remain ill defined in the literature. PMID:11974571

Genrich, S J; Neatherlin, J S

2001-01-01

412

Implementing transnational telemedicine solutions: a connected health project in rural and remote areas of six Northern Periphery countries Series on European collaborative projects.  

PubMed

This is the first article in a Series on collaborative projects between European countries, relevant for general practice/family medicine and primary healthcare. Telemedicine, in particular the use of the Internet, videoconferencing and handheld devices such as smartphones, holds the potential for further strides in the application of technology for the delivery of healthcare, particularly to communities in rural and remote areas within and without the European Union where this study is taking place. The Northern Periphery Programme has funded the 'Implementing Transnational Telemedicine Solutions' (ITTS) project from September 2011 to December 2013, led by the Centre for Rural Health in Inverness, Scotland. Ten sustainable projects based on videoconsultation (speech therapy, renal services, emergency psychiatry, diabetes), mobile patient self-management (physical activity, diabetes, inflammatory bowel disease) and home-based health services (medical and social care emergencies, rehabilitation, multi-morbidity) are being implemented by the six partner countries: Scotland, Finland, Ireland, Northern Ireland, Norway and Sweden. In addition, an International Telemedicine Advisory Service, created for the project, provides business expertise and advice. Community panels contribute feedback on the design and implementation of services and ensure 'user friendliness'. The project goals are to improve accessibility of healthcare in rural and remote communities, reducing unnecessary hospital visits and travel in a sustainable way. Opportunities will be provided for comparative research studies. This article provides an introduction to the ITTS project and how it aims to fulfil these needs. The ITTS team encourage all healthcare providers to at least explore possible technological solutions within their own context. PMID:23432039

Casey, Monica; Hayes, Patrick S; Heaney, David; Dowie, Lee; Ólaighin, Gearoid; Matero, Matti; Hun, Soo; Knarvik, Undine; Alrutz, Käte; Eadie, Leila; Glynn, Liam G

2013-03-01

413

Prune belly syndrome: Early management outcome of nine consecutive cases.  

PubMed

Background: Prune belly syndrome (PBS) is a rare congenital malformation of unclear etiology. The disease progress and outcome in developing countries are not clear as most reports are isolated case reports. Materials and Methods: A review of 9 patients managed for PBS in 5 years. Results: There were 7 males and 2 females, aged 30 min-11 days (median = 5 days) at the time of presentation (a child presented as neonate, defaulted from follow-up and represented at 10 years of life). Their weights on admission were 2.5-4.2 kg (median = 3 kg). Maternal age range was 26-37 years (median = 32 years), with five mothers being above 30 years. Seven mothers had febrile illness in the first trimester and took antimalarial drugs or antibiotics. Intestinal malrotation was the most common associated anomaly. The degree of the anterior abdominal wall and the urinary tract morphology varies from patient to patient. Urinary tract anomalies were initially managed conservatively. Two infants however later had cutaneous ureterostomy due to worsening renal function and recalcitrant urinary tract infection (UTI). Four infants had abdominoplasty at the 2 nd week, 6 th week, 3 rd year and 10 th year of life. Seven orchiopexies were done. Four were done by Fowler-Stephen's method while the rest were via the inguinal route. Of the former, 3 testicles have normal volume 6 months after, whereas one atrophied. Post abdominoplasty, there was a significant reduction in the frequency of respiratory tract infection (RTI), UTI and post void urine volume in three infants. In addition, there was improved peer interaction and academic performance in the 10-year-old child. One infant died of pulmonary hypoplasia and two others from worsening urosepsis and progressive renal failure. Conclusion: PBS presents with a spectrum of features. Initial conservative management of the urinary tract was beneficial. Abdominoplasty and orchiopexy have both physiological and improved quality of life benefits. Early Parental education helped in reducing defaults from follow-up. PMID:24909464

Ekwunife, O H; Ugwu, J O; Modekwe, V

2014-01-01

414

Case Management Reduces Drinking During Pregnancy among High Risk Women  

PubMed Central

Aim Estimate the efficacy of Case Management (CM) for women at high risk for bearing a child with Fetal Alcohol Spectrum Disorders (FASD). Design Women were recruited from antenatal clinics and engaged in 18 months of CM. Setting A South African community with a subculture of heavy, regular, weekend, recreational drinking and high documented rates of FASD. Participants Forty-one women who were high risk for bearing a child with FASD. Measures Statistical analysis of trends in drinking and other risk factors. Findings At intake 87.8% were pregnant, most had previous alcohol-exposed pregnancies, most/all of their friends drink alcohol (67.5%), and 50.0% had stressful lives. CM was particularly valuable for pregnant women, as statistically significant reductions in alcohol risk were obtained for them in multiple variables: total drinks on weekends after six months of CM (p = .026) and estimated peak blood alcohol concentration (BAC) at six (p < .001) and 18 months (p < .001). For participants completing 18 months of CM, AUDIT scores improved significantly by 6-month follow-up (from 19.8 to 9.7, p = .000), and even though rising at 12 and 18 months, AUDIT scores indicate that problematic drinking remained statistically significantly lower than baseline throughout CM. Happiness scale scores correlated significantly with reduced drinking in most time periods. Conclusions An enduring change in drinking behavior is difficult in this social setting. Yet, CM provided by skilled and empathic case managers reduced maternal drinking at critical times, and therefore, alcohol exposure levels to the fetus.

May, Philip A.; Marais, Anna-Susan; Gossage, J. Phillip; Barnard, Ronel; Joubert, Belinda; Cloete, Marise; Hendricks, Natalie; Roux, Sumien; Blom, Annalien; Steenekamp, Jeanetta; Alexander, Theresa; Andreas, Romena; Human, Suzanne; Snell, Cudore; Seedat, Soraya; Parry, Charles C.; Kalberg, Wendy O.; Buckley, David; Blankenship, Jason

2014-01-01

415

The STARPAHC collection: part of an archive of the history of telemedicine.  

PubMed

An early telemedicine project involving NASA, the Papago Tribe (now the Tohono O'odham Indian Nation), the Lockheed Missile and Space Company, the Indian Health Service and the Department of Health, Education and Welfare explored the possibilities of using technology to provide improved health care to a remote population in southern Arizona. The project, called STARPAHC (Space Technology Applied to Rural Papago Advanced Health Care), took place in the 1970s and demonstrated the feasibility of a consortium of public and private partners working together to provide medical care to remote populations via telecommunication. In 2001 the Arizona Health Sciences Library acquired important archival materials documenting the STARPAHC project and in collaboration with the Arizona Telemedicine Program established the Arizona Archive of Telemedicine. The material is likely to interest those studying early attempts to use technology to deliver health care at a distance, as well as those studying the sociological ramifications of technical and scientific projects among indigenous populations. PMID:17697507

Freiburger, Gary; Holcomb, Mary; Piper, Dave

2007-01-01

416

The legal and ethical aspects of telemedicine. 4: Product liability and jurisdictional problems.  

PubMed

The use of telemedicine brings with it the risk that the human factor--the teleconsultant--will fail to reach the standard of care that the law requires of medical professionals. It also brings the risk that the telemedical equipment or system will fail at a crucial moment. Such risks, of course, are inherent in many aspects of medical care but in telemedicine, at the interface between communications technology and health care, one must consider not only who is liable for failure, but under which country's laws will that liability be determined. This final review article describes the challenges facing manufacturers and their customers in providing safe, properly endorsed telemedicine systems. The problem of which country's laws should apply to a cross-border teleconsultation is also reviewed. PMID:10321040

Stanberry, B

1998-01-01

417

A Review on Telemedicine-Based WBAN Framework for Patient Monitoring  

PubMed Central

Abstract Objective: In this article, we describe the important aspects like major characteristics, research issues, and challenges with body area sensor networks in telemedicine systems for patient monitoring in different scenarios. Present and emerging developments in communications integrated with the developments in microelectronics and embedded system technologies will have a dramatic impact on future patient monitoring and health information delivery systems. The important challenges are bandwidth limitations, power consumption, and skin or tissue protection. Materials and Methods: This article presents a detailed survey on wireless body area networks (WBANs). Results and Conclusions: We have designed the framework for integrating body area networks on telemedicine systems. Recent trends, overall WBAN-telemedicine framework, and future research scope have also been addressed in this article.

Gupta, Bharat; Ghosh, Soumya K.

2013-01-01

418

Iowa's National Laboratory for the study of Rural Telemedicine: a description of a work in progress.  

PubMed Central

As the federal administration advances the idea of the "information superhighway," many disciplines are being challenged to find ways to use advanced telecommunications to improve access to information, enhance learning opportunities, and achieve higher levels of international competitiveness. Telemedicine, the use of communications technology in the practice of medicine, may change the way rural health care is provided by improving access to medical information, diagnostic tools, and consultations. The information and health care services required by health care professionals are rapidly changing, and dissemination of this information to isolated practitioners has proven to be difficult. By providing support electronically from a central site, the most current information is more readily available. Using test-bed hospitals in rural and urban settings, the National Library of Medicine-funded National Laboratory for the Study of Rural Telemedicine at the University of Iowa is currently developing the necessary infrastructure to support targeted projects studying how telemedicine applications can be made more effective and readily available.

Kienzle, M; Curry, D; Franken, E A; Galvin, J; Hoffman, E; Holtum, E; Shope, L; Torner, J; Wakefield, D

1995-01-01

419

Dyskeratosis Congenita- Management and Review of Complications: A Case Report  

PubMed Central

Among the inherited bone marrow failure disorders, dyskeratosis congenita is an X-linked inherited disorder arising as a consequence of short telomere and mutations in telomere biology. Production of the altered protein dyskerin, leads to vulnerable skin, nails, and teeth which lead to higher permeability for noxious agents which can induce carcinogenesis accounting for the classical triad of skin pigmentation, nail dystrophy and oral leukoplakia. This condition is fatal and patients succumb to aplastic anemia, malignancy or immunocompromised state. We present a young male with the classic clinical triad and avascular necrosis of both femoral heads, with no evidence of hematologic anomaly or any malignancy. He was managed for osteonecrosis with uncemented total hip arthroplasty for the symptomatic left hip. Our case represents a benign form of such a fatal and rare condition, which if detected and managed early can result in improved quality of life for the patient suffering from this disorder. This patient is under our meticulous follow-up for the last 2 years in order to determine any late development of complications before being labelled as a variant of this syndrome.

Sinha, Shivam; Trivedi, Vikas; Krishna, Arvind; Rao, Nidhi

2013-01-01

420

Environmental management and firm performance: a case study.  

PubMed

This study has as its aim to help to clarify the relationship between environmental management and economic performance by integrating it into a wider framework that includes the relationship between environmental strategy and firm performance, the latter being understood as the combination of environmental performance, competitive advantage and economic performance. A case study of the COATO farming cooperative showed us that its environmental management, focused on prevention logic, has had a positive net effect on its environmental performance. Besides, the order in which these practices were adopted favoured the development of new organisational capabilities that have contributed to the appearance of advantages derived from the greater accumulated experience of employees in creating new projects that are designed to reduce residues and pollution. COATO has also obtained a competitive advantage in differentiation thanks to an improved brand image and to its increased credibility in business relationships. Finally, a positive correlation exists between the pioneering proactive strategy adopted by this cooperative and the improvement of its firm performance with respect to the other firms in its sector. PMID:17141938

Claver, Enrique; López, María D; Molina, José F; Tarí, Juan J

2007-09-01

421

Treating dually diagnosed clients with assertive community treatment and broker case management: A comparative study  

Microsoft Academic Search

This research examined the effectiveness of Assertive Community Treatment (ACT) as a form of therapy for Dually Diagnosed clients by comparing it with the traditional Broker Case Management treatment. The case records of 56 dually diagnosed clients who had been treated by ACT and Broker Case Management were selected and compared for changes in Global Assessment of Functioning scores, frequency

Colin F King

1998-01-01

422

Case Management Models for Persons Who Are Homeless and Mentally Ill: The ACCESS Demonstration Project  

Microsoft Academic Search

Persons who are homeless and mentally illpresent unique challenges to service providers and humanservice systems. In vivo case management approaches suchas assertive community treatment (ACT) have shown promise in engaging this population. This paperexplores case management models employed within theACCESS program, a five year, 18-site demonstrationprogram enriching services for homeless persons with serious mental illness. We describe theimplementation of case

Matthew Johnsen; Laura Samberg; Robert Calsyn; Margaret Blasinsky; Wendy Landow; Howard Goldman

1999-01-01

423

22 CFR 96.43 - Case tracking, data management, and reporting.  

Code of Federal Regulations, 2010 CFR

...tracking, data management, and reporting...AND RELATED SERVICES ACCREDITATION...Standards for Convention Accreditation...and Reports Management § 96.43...provides adoption services in cases not subject to the Convention that...

2013-04-01

424

22 CFR 96.43 - Case tracking, data management, and reporting.  

Code of Federal Regulations, 2010 CFR

...tracking, data management, and reporting...AND RELATED SERVICES ACCREDITATION...Standards for Convention Accreditation...and Reports Management § 96.43...provides adoption services in cases not subject to the Convention that...

2012-04-01

425

Management of a rare case of arrhythmogenic right ventricular dysplasia in pregnancy: a case report  

PubMed Central

Introduction Arrhythmogenic right ventricular dysplasia is a heritable disease of the heart muscle characterized by fibrofatty degeneration of cardiomyocytes. Patients present with ventricular arrhythmias or congestive heart failure, and sometimes sudden cardiac death occurs. Prenatal diagnosis has become possible with the detection of mutations, but, to the best of our knowledge, no case of prenatal diagnosis has been reported previously. There is little information about the management of arrhythmogenic right ventricular dysplasia in pregnancy, and the preferred mode of delivery is not certain; therefore, we present the case of a patient with arrhythmogenic right ventricular dysplasia and discuss the prenatal diagnosis, patient management and prognosis in pregnancy. Case presentation A 26-year-old Caucasian woman who presented to our hospital with heart palpitations was diagnosed with arrhythmogenic right ventricular dysplasia, and, after three years of follow up with anti-arrhythmic drugs, she wanted to conceive. During pregnancy, she ceased taking her medication. She tolerated pregnancy very well but her cardiac symptoms recurred after her 30th week of pregnancy. She delivered a baby via cesarean section under general anesthesia in her 38th week of pregnancy. She was discharged without any medications and continued lactation for six months. Conclusion Patients with mild to moderate arrhythmogenic right ventricular dysplasia tolerate pregnancy and breastfeeding very well, but patients with end-stage arrhythmogenic right ventricular dysplasia should be discouraged from conception.

2011-01-01

426

Case analysis online: a strategic management case model for the health industry.  

PubMed

Despite the plethora of methods and tools available to support strategic management, the challenge for health executives in the next century will relate to their ability to access and interpret data from multiple and intricate communication networks. Integrated digital networks and satellite systems will expand the scope and ease of sharing information between business divisions, and networked systems will facilitate the use of virtual case discussions across universities. While the internet is frequently used to support clinical decisions in the healthcare industry, few executives rely upon the internetfor strategic analysis. Although electronic technologies can easily synthesize data from multiple information channels, research as well as technical issues may deter their application in strategic analysis. As digital models transform access to information, online models may become increasingly relevant in designing strategic solutions. While there are various pedagogical models available to support the strategic management process, this framework was designed to enhance strategic analysis through the application of technology and electronic research. A strategic analysis framework, which incorporated internet research and case analysis in a strategic managementcourse, is described alongwith design and application issues that emerged during the case analysis process. PMID:15129900

Walsh, Anne; Bearden, Eithne

2004-01-01

427

Effect of case management on rehospitalization and utilization of ambulatory care services.  

PubMed

To explore whether intensive case management would reduce discharged psychiatric inpatients' rates of rehospitalization and increase their use of outpatient ambulatory care services, the authors assigned 435 patients discharged from a public general hospital in New York City to three types of postdischarge services: multidisciplinary intensive outreach case management, less intensive Community Support System (CSS) case management services, or routine aftercare but no case management. Patients eligible for CSS were generally more impaired and had more extensive histories of psychiatric hospitalization. At follow-up 18 to 52 months after entering the study, patients who received intensive outreach case management had twice as many psychiatric hospitalizations as the routine aftercare group and had a pattern of utilization of hospital-based ambulatory care services similar to the more impaired CSS group. Intensive outreach case management did not appear to stimulate sufficient use of ambulatory care services to reduce patients' frequency of psychiatric hospitalization. PMID:1330871

Curtis, J L; Millman, E J; Struening, E; D'Ercole, A

1992-09-01

428

Productivity--a key to managing cost-per-case. Part 1.  

PubMed

Productivity and productivity management are critical to effective case-mix management. Case-mix management expands on traditional productivity management to include the relationship between such intermediate products as patient days, tests and meals, and the ultimate end product, the case. As hospitals search to increase the profitability of specific case types, they must focus on two critical productivity control points. First, they must examine length of stay and ancillary utilization as one level of productivity. Then they must turn to more traditional analyses and review departmental productivity in the production of the intermediate products. No case-mix management system is complete unless it focuses on both of these critical relationships. Part two of this article will explore performance reporting and its role in managing both productivity and case mix. PMID:10315375

Orefice, J J; Jennings, M C

1983-08-01

429

Chiropractic management of essential tremor and migraine: a case report  

PubMed Central

Objective The purpose of this case report is to describe the chiropractic management of a 39-year-old woman with essential tremors and migraine headaches. Clinical Features A 39-year-old woman presented with essential tremors and migraine headaches, which occurred 2 to 3 times per week. The essential tremor was diagnosed in 2000, and migraine headaches with aura were diagnosed when she was 10. Both diagnoses were made by her general medical practitioner. Previous treatments for migraine included propranolol, isometheptene, dichloralphenazone, acetaminophen, sumatriptan, and over-the-counter pain relievers. Intervention and Outcome The patient received high-velocity, low-amplitude chiropractic spinal manipulation to her upper cervical spine using the Blair Upper Cervical chiropractic technique protocol. There was improvement in her tremors and migraine headaches following her initial chiropractic treatment, with a sustained improvement after 4 months of care. Conclusion This case study demonstrated improvement in a woman with essential tremors and migraine headaches. This suggests the need for more research to examine how upper cervical specific chiropractic care may help mitigate tremors and migraine headaches.

Hubbard, Todd A.; Kane, Janice D.

2012-01-01

430

Primary umbilical endometriosis. Case report and discussion on management options?  

PubMed Central

INTRODUCTION We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition. PRESENTATION OF CASE A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months. DISCUSSION UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis. CONCLUSION Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

Fancellu, Alessandro; Pinna, Antonio; Manca, Alessandra; Capobianco, Giampiero; Porcu, Alberto

2013-01-01

431

[Therapeutic management of mucous membrane pemphigoid. Report of 11 cases].  

PubMed

In the present study the efficacy of systemic and topical steroid treatment in the management of 11 patients with mucous membrane pemphigoid (MMP) confirmed histologically and immunologically has been evaluated. Eight patients were treated with a topically applied clobetasol in a bioadhesive gel (2-3 times/daily) and with chlorexidine mouth-washes (3 times/daily) and myconazole gel (1 time/daily) as antimycotics. The remaining 3 were treated with systemic prednisone (25 to 100 mg/daily) followed by a topical therapy with clobetasol, chlorexidine and myconazole. In 6 cases (54%), 4 topically treated and 2 systemically plus topically treated, we observed a complete clearance of signs and symptoms of MMP in an average period of 5.7 months. In the remaining 5 cases (46%), 4 topically treated and 1 systemically plus topically treated, we observed partial healing of the oral lesions. One patient treated with a high dose of prednisone (100 mg/daily) showed side-effects (insomnia, fluid retention and gastralgia) whereas other 3 subjects had oral candidiasis. In a mean follow-up time of 13 months (range 6 to 27) 6 patients (54%) were free of disease, 3 (27%) had a marked improvement and 2 (18%) had new active lesions of MMP. These results suggest that often in the treatment of MMP a systemic corticosteroid therapy followed by a treatment with high potency topical steroids is useful to obtain a good control of MMP. PMID:9432562

Carrozzo, M; Carbone, M; Broccoletti, R; Garzino-Demo, P; Gandolfo, S

1997-10-01

432

[Research and development of medical case database: a novel medical case information system integrating with biospecimen management].  

PubMed

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform. PMID:20481307

Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang

2010-04-01

433

The telemedicine spacebridge project: A joint US/Russian venture in long distance medicine via satellite  

NASA Technical Reports Server (NTRS)

The Telemedicine Spacebridge Demonstration Project is a joint U.S./Russian program whose purpose is to further the application of telemedicine both internationally, domestically, and in space. The system has been set up to use a Russian satellite over the Atlantic Ocean and a U.S. domestic satellite to allow physicians a two-way video and audio link between various sites of medical centers in the United States and the Central Hospital in Moscow, Russia. This paper contains a description of the project background, the Spacebridge system, the individual pieces of the system, and the operational experience gained thus far in the project.

Zuzek, John E.; Cauley, Michael A.; Hollansworth, James E.

1994-01-01

434

Non-mydriatic ocular fundus photography and telemedicine: past, present, and future  

PubMed Central

Non-mydriatic ocular fundus photography is a promising alternative to direct ophthalmoscopy, particularly when combined with telemedicine. This review discusses these technologies from a longitudinal perspective: past, present, and future. The focus is directed to the role that non-mydriatic fundus photography and telemedicine have played in medical research and patient care, with emphasis on the major advances to date. Also discussed are the challenges to their widespread application and their substantial promise for revitalizing the importance of the ocular fundus examination in patient care, providing improved access to ophthalmic consultative services, and facilitating clinical and epidemiologic research.

Bruce, Beau B.; Newman, Nancy J.; Perez, Mario A.; Biousse, Valerie

2013-01-01

435

Case management and patient safety: opportunities for process and performance improvement.  

PubMed

Awareness and activities about patient safety and the need for improvement are wide-spread within the health care industry, but the role and the expectation for case management in this area has not yet been well defined. Some case managers voice doubts about the ability to affect safety because they typically are not direct caregivers. Is it realistic to expect case managers and their organizations to influence and improve patient safety? PMID:15999089

Dulworth, Sherrie

2005-01-01

436

Knowledge Management in Preserving Ecosystems: The Case of Seoul  

ERIC Educational Resources Information Center

This study explores the utility of employing knowledge management as a framework for understanding how public managers perform ecosystem management. It applies the grounded theory method to build a model. The model is generated by applying the concept of knowledge process to an investigation of how the urban ecosystem is publicly managed by civil…

Lee, Jeongseok

2009-01-01

437

Management Styles: A Case Study of Women in TAFE.  

ERIC Educational Resources Information Center

Female managers in Australian technical and further education (TAFE) use a predominantly feminine management style in comparison to traditional masculine style. They use a people-oriented style to get tasks done. Managers interviewed felt the climate of TAFE did not support proactive management. (Contains 68 references.)

Rice, Ann

2000-01-01

438

Knowledge Management Challenges in Customer Support: A Case Study  

Microsoft Academic Search

Knowledge management plays an important role in customer support processes such as incident management and problem management. Knowledge-oriented approach on customer support provides an IT organization with several benefits including faster incident resolution times and better identification of systematic incidents. Unfortunately, little attention has focused on examining challenges in customer support from the knowledge management perspective. In this study, the

Marko Jäntti; Kirsi Tanskanen; Jukka Kaukola

2009-01-01

439

Construction waste management based on industrial management models: a Swedish case study.  

PubMed

This paper describes a methodology for estimating the true internal costs of construction waste, aimed at promoting environmentally friendly waste management. The study employs cost-benefit analysis, contribution margin analysis, the polluter-pays principle and a mathematical model: the model for Efficient Use of Resources for Optimal Production Economy (EUROPE), which has been introduced previously by the author for assigning industrial costs to waste. The calculations are performed on construction waste created in a case study of a building project. Moreover, waste is regarded as, in a business sense, having the same basic status as any normal industrial product, namely the 'equality principle'. Application of the methodology is suggested to create incentives for environmental and profitability improvement in construction companies and other types of industrial sectors. The results of the case study show the generation of construction waste to substantially decrease the final operating income, due to the internal shadow price cost it creates. This paper is intended to reduce the gap between the choice of waste management procedures and their economic impact, the overall objective being to accomplish an improved industrial environmental situation. PMID:15751391

Stenis, Jan

2005-02-01

440

Integrated telemedicine applications and services for oncological positron emission tomography.  

PubMed

TENPET (Trans European Network for Positron Emission Tomography) aims to evaluate the provision of integrated teleconsultation and intelligent computer supported cooperative work services for clinical positron emission tomography (PET) in Europe at its current stage, as it is a multi-centre project financially supported by the European Commission (Information Society, eTEN Program). It addresses technological challenges by linking PET centres and developing supporting services that permit remote consultation between professionals in the field. The technological platform (CE-marked) runs on Win2000/NT/XP systems and incorporates advanced techniques for image visualization, analysis and fusion, as well as for interactive communication and message handling for off-line communications. Four PET Centres from Spain, France and Germany participate to the pilot system trials. The performance evaluation of the system is carried out via log files and user-filled questionnaires on the frequency of the teleconsultations, their duration and efficacy, quality of the images received, user satisfaction, as well as on privacy, ethical and security issues. TENPET promotes the co-operation and improved communication between PET practitioners that are miles away from their peers or on mobile units, offering options for second opinion and training and permitting physicians to remotely consult patient data if they are away from their centre. It is expected that TENPET will have a significant impact in the development of new skills by PET professionals and will support the establishment of peripheral PET units. To our knowledge, TENPET is the first telemedicine service specifically designed for oncological PET. This report presents the technical innovations incorporated in the TENPET platform and the initial pilot studies at real and diverse clinical environments in the field of oncology. PMID:16525707

Kontaxakis, George; Visvikis, Dimitris; Ohl, Roland; Sachpazidis, Ilias; Suarez, Juan Pablo; Selby, Peter; Cheze-Le Rest, Catherine; Santos, Andres; Ortega, Fernando; Diaz, Javier; Pan, Leyun; Strauss, Ludwig; Dimitrakopoulou-Strauss, Antonia; Sakas, Georgios; Pozo, Miguel Angel

2006-01-01

441

Applications of telemedicine in the United States space program  

NASA Technical Reports Server (NTRS)

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth.

Doarn, C. R.; Nicogossian, A. E.; Merrell, R. C.

1998-01-01

442

Applications of telemedicine in the United States space program.  

PubMed

Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth. PMID:9599070

Doarn, C R; Nicogossian, A E; Merrell, R C

1998-01-01

443

Multidisciplinary teams of case managers in the implementation of an innovative integrated services delivery for the elderly in France  

PubMed Central

Background The case management process is now well defined, and teams of case managers have been implemented in integrated services delivery. However, little is known about the role played by the team of