Community-wide views. As HIE programs move forward, it's not just data, but diagnostic images, that are being shared among hospitals.
Healthc Inform. 2010 Jan;27(1):30-1
Authors: Hagland M
A small number of HIE organizations have started to go live with diagnostic image sharing. Sharing images electronically is considerably more efficient than distributing them by hand using CD-ROMs. ClOs are implementing solutions that remove them from the loop and enable physicians to access images through RHIOs and HIEs. ClOs need to be active leaders in facilitating the exchange of diagnostic images.
PMID: 20120891 [PubMed - indexed for MEDLINE]
Enhancing the Performance of Medical Implant Communication Systems through Cooperative Diversity.
Int J Telemed Appl. 2010;2010:920704
Authors: Hegyi B, Levendovszky J
Battery-operated medical implants-such as pacemakers or cardioverter-defibrillators-have already been widely used in practical telemedicine and telecare applications. However, no solution has yet been found to mitigate the effect of the fading that the in-body to off-body communication channel is subject to. In this paper, we reveal and assess the potential of cooperative diversity to combat fading-hence to improve system performance-in medical implant communication systems. In the particular cooperative communication scenario we consider, multiple cooperating receiver units are installed across the room accommodating the patient with a medical implant inside his/her body. Our investigations have shown that the application of cooperative diversity is a promising approach to enhance the performance of medical implant communication systems in various aspects such as implant lifetime and communication link reliability.
PMID: 20379346 [PubMed - in process]
Telemedicine for depression: a systematic review.
Perspect Psychiatr Care. 2010 Apr;46(2):119-26
Authors: García-Lizana F, Muñoz-Mayorga I
PURPOSE: More than 14% of the population has a mood disorder, and more than 50% do not receive treatment. Information and communication technology (ICT) could improve health care. A systematic review was considered in order to know the programs that apply ICT in the management of depression and to assess their effectiveness. CONCLUSION: There is insufficient scientific evidence regarding the effectiveness of ICT use in the management of depression. However, there is a well-founded hypothesis that videoconference produces the same results as face-to-face treatment and that self-help Internet programs could improve symptoms. PRACTICE IMPLICATIONS: More research is needed; nevertheless, when traditional care is not possible, telemedicine could be used.
PMID: 20377799 [PubMed - in process]
Guidelines for telematic second opinion consultation on headaches in Europe: on behalf of the European Headache Federation (EHF).
J Headache Pain. 2010 Apr 7;
Authors: Pereira-Monteiro J, Wysocka-Bakowska MM, Katsarava Z, Antonaci F
The seeking of a second opinion is the long-established process whereby a physician or expert from the same or a similar specialty is invited to assess a clinical case in order to confirm or reject a diagnosis or treatment plan. Seeking a second opinion has become more common in recent years, and the trend is associated with significant changes in the patient-doctor relationship. Telemedicine is attractive because it is not only fast but also affordable and thus makes it possible to reach highly qualified centres and experts that would otherwise be inaccessible, being impossible, or too expensive, to reach by any surface transport. In Europe, the European Headache Federation (EHF), being able to draw on a group of headache experts covering all the European languages, is the organisation best placed to provide qualified second-opinion consultation on difficult headache cases and to develop a Headache Medical Opinion Service Centre. The provision of good quality clinical information is crucial to the formulation of a valid, expert second opinion. This preliminary step can be properly accomplished only by the primary health care provider through the furnishing of an appropriate clinical report, together with the results of all available tests, including original films of all imaging studies already performed. On receiving the EHF's proposed standardised data collection form, properly filled in, we may be sure that we have all the relevant data necessary to formulate a valid expert second opinion. This form can be accessed electronically and downloaded from the EHF website. Once finalised, the EHF second opinion project should be treated as a pilot strategy that requires careful monitoring (for the first year at least), so that appropriate changes, as suggested by the retrospective analysis and its quality control, can be implemented.
PMID: 20373124 [PubMed - as supplied by publisher]
Lipid treatment in ethnically diverse underserved older adults with diabetes mellitus: statin use, goal attainment, and health disparities in the informatics for diabetes education and telemedicine project.
J Am Geriatr Soc. 2010 Feb;58(2):401-2
Authors: Weinstock RS, Izquierdo R, Goland R, Palmas W, Teresi JA, Eimicke JP, Shea S,
PMID: 20370876 [PubMed - in process]
The choice of home blood pressure result reporting method is essential: Results mailed to physicians did not improve hypertension control compared with ordinary office-based blood pressure treatment.
Blood Press. 2010 Apr 6;
Authors: Varis J, Kantola I
Abstract Effective antihypertensive care is not possible without regular and reliable blood pressure measurements. The use of blood pressure home measurement has increased a lot during the last years. Various methods have been used in communication between the patients and physicians. In a randomized study we compared traditional office-based hypertension treatment protocol (n=68) to the home-based blood pressure measurement protocol (n=89) in which the patient mailed their home-measured BP diary in a letter to the office of their physician. The studied home-based antihypertensive care system was not more effective than the ordinary office-based treatment. The results highlight the importance of continuous home measurement data interpretation by the physician. The system based on mailing the results to the physician office does not seem to be a suitable method in communication between the patient and the physician. Online or other telemedicine-aided means of communication might yield better antihypertensive control.
PMID: 20367560 [PubMed - as supplied by publisher]
Gender Differences in Cardiovascular Risk Factors and Risk Perception Among Individuals With Diabetes.
Diabetes Educ. 2010 Apr 1;
Authors: Homko CJ, Zamora L, Santamore WP, Kashem A, McConnell T, Bove AA
Purpose The purpose of this study was to examine gender-based differences in cardiovascular risk factors and risk perception among individuals with diabetes. Methods The sample consisted of patients with an established history of diabetes who were enrolled in a telemedicine trial to reduce cardiovascular disease (CVD) risk. All subjects had a 10% or greater risk on the Framingham risk index. Assessments included blood pressure, A1C, lipid profile, medication history, and knowledge and risk perception surveys. Results Data were available for 211 individuals with type 2 diabetes (88 men and 123 women). The women and men did not differ in age, body mass index, or Framingham risk. Only 37.4% of women and 40.9% of men were at an A1C target of <7%. Total cholesterol levels were significantly higher among women, and fewer women were at low-density lipoprotein or blood pressure targets. Knowledge of CVD was similar between the 2 sexes. However, women perceived their risk for CVD to be significantly higher than did men. Conclusion Less favorable cardiovascular risk profiles are observed among women with diabetes as compared with their male counterparts. Multifaceted approaches to both diabetes management and education are needed to target CVD risk reduction among individuals with diabetes.
PMID: 20360597 [PubMed - as supplied by publisher]
Tele-education vs classroom training of neonatal resuscitation: a randomized trial.
J Perinatol. 2010 Apr 1;
Authors: Jain A, Agarwal R, Chawla D, Paul V, Deorari A
Objective:To compare gain in knowledge and skills of neonatal resuscitation using tele-education instruction vs conventional classroom teaching.Study Design:This randomized controlled trial was conducted in the tele-education facility of a tertiary care center. In-service staff nurses were randomized to receive training by tele-education instruction (TI, n=26) or classroom teaching (CT, n=22) method from two neonatology instructors using a standardized teaching module on neonatal resuscitation. Gain in knowledge and skill scores of neonatal resuscitation were measured using objective assessment methods.Result:Age, educational qualification and professional experience of the participants in two groups were comparable. Pre-training mean knowledge scores were higher in TI group (8.3+/-1.7 vs 6.6+/-1.4, P=0.004). However, skill scores were comparable in the two groups (11.7+/-3 vs 10.3+/-2.9, P=0.13). Training resulted in a significant and comparable gain in knowledge scores (4.2+/-2.2 vs 5.3+/-1.7; P=0.06) and skills scores (4.5+/-3.3 vs 5.0+/-3.1, P=0.62) in both the groups. The post-training knowledge scores (TI: 12.5+/-1.7 vs CT: 12.0+/-1.7, P=0.37) and the post-training skill scores (TI: 16.0+/-0.5 vs CT: 15.6+/-2.5, P=0.55) were comparable in the two groups. However, the post-training scores, adjusted for baseline knowledge scores, were statistically higher in the in-person group compared with the telemedicine group (knowledge: 12.46+/-0.03 vs 12.16+/-0.01, P=0.00; skills: 15.6+/-2.5 vs 16.0+/-2.8, P=0.00). The quantum of lower scores in the telemedicine group was only 2% for knowledge and 6% for skills. This difference was felt to be of only marginal importance. Satisfaction scores among trainees and instructors were comparable in the two groups.Conclusion:Tele-education offers a feasible and effective alternative to conventional training in neonatal resuscitation among health-care providers.Journal of Perinatology advance online publication, 1 April 2010; doi:10.1038/jp.2010.42.
PMID: 20357810 [PubMed - as supplied by publisher]
[Medical image, telemedicine and medical teleassistance]
Med Clin (Barc). 2010 Feb;134 Suppl 1:56-62
Authors: Rubies-Feijoo C, Salas-Fernández T, Moya-Olvera F, Guanyabens-Calvet J
The use of Information Communication and Technology (ICT) in medical image and telemedicine, can help improve the quality of life and well-being of citizens (patients and professionals) and overcome the challenges facing the health system, benefiting all parties involved in the health system (patients, professionals, administration, health providers, insurance and industry); ICT will not be the solution by itself, but certainly the solution will pass through ICT. It needs a strong political and clinical directing flexible strategies, aiming to contribute to the realization of care of higher quality and human care leadership.
PMID: 20211355 [PubMed - in process]
[Demographic change : Demands on the health care system and solutions using the example of Mecklenburg-Western Pomerania.]
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Apr 1;
Authors: Fendrich K, van den Berg N, Siewert U, Hoffmann W
The growing absolute number of the elderly causes an increase in the number of patients suffering from not only chronic diseases and multimorbidity, but also higher usage of the health care system. In the German Federal State of Mecklenburg-Western Pomerania (MW), the effects of demographic change will be more pronounced than in other regions. The objective of this article is to show the consequences of the changing population structure for the health care system. Using examples from MW, innovative models to secure high quality health care at the population level are presented. Examples include the establishment of subsidiary practices, multidisciplinary ambulatory health care centers, delegation models, ambulatory health care managers, telemedicine, and intensified and improved interdisciplinary networking. In the context of the demographic change, assisted care, adequate symptom control, maintaining personnel competence, preservation of an independent lifestyle with a high quality of life, and stimulation of social participation become priority objectives of medical care. Besides the effectiveness and the quality of results with regard to these objectives, innovative health care models should be economically evaluated at the population level under real life practice conditions.
PMID: 20354666 [PubMed - as supplied by publisher]
Use of telemedicine will double in next decade, report predicts.
Authors: Zarocostas J
PMID: 20332311 [PubMed - indexed for MEDLINE]
[Blood pressure telemonitoring]
MMW Fortschr Med. 2010 Jan 14;152(1-2):47-9
Authors: Middeke M
PMID: 20302167 [PubMed - indexed for MEDLINE]
Neurology at a distance.
Lancet Neurol. 2010 Apr;9(4):346-7
Authors: Williams R
PMID: 20298960 [PubMed - indexed for MEDLINE]
A telestroke network enhances recruitment into acute stroke clinical trials.
Stroke. 2010 Mar;41(3):566-9
Authors: Switzer JA, Hall CE, Close B, Nichols FT, Gross H, Bruno A, Hess DC
BACKGROUND AND PURPOSE: Acute stroke clinical trials are conducted primarily at academic medical centers. As a result, patients living in rural areas are excluded from participation, results may not be generalizable to nonacademic settings, and studies may be slow to recruit subjects. Telemedicine can provide rural patients with emergency neurovascular consultation. We sought to determine whether telemedicine facilitates enrollment into acute stroke trials. METHODS: We have an established rural "hub and spoke" telestroke network. From 2005 to 2009, we participated in 2 time-sensitive acute stroke trials: Factor Seven for Acute Hemorrhagic Stroke and Minocycline to Improve Neurological Outcome. Candidates for the 2 trials could be identified at either the hub or at the spokes, with patients presenting to the latter transferred to the hub for enrollment. We analyzed the times from symptom onset to consultation via telemedicine, arrival at the hub, and to initiation of a study drug to determine the impact of telemedicine on study enrollment. RESULTS: Nineteen of 28 subjects enrolled in the 2 trials were identified initially at an outside facility via a telemedicine link. An additional 9 candidates identified by telemedicine could not be enrolled because of transportation time. Arrival at the hub was 127 minutes later (median, 207 [95% CI, 145 to 255] versus 80 [95% CI, 55 to 142]; P=0.0002), and study drug was started 74 minutes later (median, 298 [95% CI, 218 to 352] versus 225 [95% CI, 147 to 330]; P=0.05) for subjects who were identified via telemedicine and required transport to the hub compared with local subjects who presented directly to the hub. CONCLUSIONS: Telemedicine can enhance enrollment into time-sensitive acute stroke trials. However, transfer of subjects to the hub results in delays in study initiation for some and precludes enrollment for others similar to the weaknesses of "ship and drip" thrombolytic strategies. To save time, efforts are needed to enroll clinical trial subjects and begin the research drug at the remote site under telemedicine guidance.
PMID: 20056929 [PubMed - indexed for MEDLINE]
Functional compensation in incipient Alzheimer's disease.
Neurobiol Aging. 2010 Mar;31(3):387-97
Authors: Caroli A, Geroldi C, Nobili F, Barnden LR, Guerra UP, Bonetti M, Frisoni GB
Aim of this study was to investigate the functional compensation mechanism in incipient Alzheimer's disease (AD). Seventeen elderly healthy subjects and nine amnestic MCI patients with incipient AD underwent brain MR scan and 99mTc ECD SPECT. We processed all images with SPM2, we created t maps, showing the wholebrain GM atrophy and functional changes, and we properly masked them with each other in order to assess relatively preserved perfusion or depression. Incipient AD showed GM atrophy in the medial temporal and temporoparietal lobes, in the insula and in the retrosplenial cortex, and GM hypoperfusion in the medial temporal and temporoparietal lobes. Relatively preserved perfusion, we could hypothesize to be compensatory in the setting of neuronal loss, was found in the posterior cingulate, in the head of the hippocampus, in the amigdala, and in the insula bilaterally, while functional depression occurred in bilateral parahippocampal gyri. In AD, a perfusional compensatory mechanism takes place in the neocortex, while perfusional depression occurs in the medial temporal lobe. These results help understand the reactive phenomena induced by the brain to try and counteract the pathological changes of AD.
PMID: 18554752 [PubMed - indexed for MEDLINE]