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Biomedical subjects

Joseph C Kvedar

Publications and source records attributed to Joseph C Kvedar.

12 recordsLinked to original sources
PubMed2006

Evaluation of digital skin images submitted by patients who received practical training or an online tutorial.

We evaluated the ability of subjects to capture and submit teledermatology images with a digital camera. We also examined whether participants who received individual training sessions would capture better-quality images than participants who were provided only with self-training. Fifty participants were randomized between in-person training and self-training via an online tutorial. The majority of participants were young, well educated women. Two dermatologists reading the images for quality indicators had high agreement that digital images acquired were of high quality: images were well framed, appropriately bright, in focus and did not have a shadow. There was moderate agreement on diagnosis-related indicators, such as the presence or absence of pustules or papules and acne versus rosacea. There was no difference in the image-quality attributes between participants personally trained and those trained with the online tutorial. Subjects participating in this study were able to acquire images of good quality, irrespective of whether they received practical training or used an online tutorial.

Acne Vulgaris↗
PubMed2005

Clinical outcomes associated with telemedicine/telehealth.

This paper is a comprehensive review and synthesis of the literature concerning clinical outcomes associated with various telemedicine applications. It starts out with a brief description of the findings reported by similar literature reviews already published. Subsequently, it proposes a conceptual model for assessing clinical outcomes based on Donabedian's formulation of the Medical Care Process. Accordingly, research findings are reported in terms of the relevant components of the medical care process, namely, diagnosis, clinical management, and clinical outcomes. Specific findings are organized according to the designated clinical and diagnostic application. This is followed by a general report of studies dealing with patient satisfaction.

Health Services Research↗
PubMed2005

Delivering health care in rural Cambodia via store-and-forward telemedicine: a pilot study.

Since 2001, a monthly telemedicine clinic has helped provide health care to residents in a remote region in Cambodia. Physicians at Massachusetts General Hospital and Brigham and Women's Hospital in Boston, Massachusetts, and Sihanouk Hospital of HOPE in Phnom Penh, Cambodia, provide consultations via e-mail to a mobile nurse in the district of Rovieng, Cambodia. We describe the operations of the monthly clinic and report the results of a retrospective case review of the first 28 months of consultations. We also report the results of a satisfaction and willingness to pay survey. A total of 264 visits were made during the 28 monthly sessions. Mean duration of chief complaint at initial visit declined from 37 months to 8 months during the first and last 6 months of the study period, respectively. Thirty-six percent (n = 76) of new patients complained of abdominal pain. Nine percent (n = 20) of new patients were given an empiric diagnosis of goiter. The percent of patients requiring referral to a hospital outside of the village decreased over time. All patients surveyed were either "very satisfied" or "satisfied" with their care, and most patients were willing to pay for a visit, with a median amount of USD 0.63. We conclude that store-and-forward e-mail consultative support for mobile nonphysician health care workers is a feasible model for delivering care in the developing world. Further research is needed to demonstrate improvement in health status, cost effectiveness, and sustainability.

Cambodia↗
PubMed2005

Telemedicine in the future.

Telemedicine can provide a compelling alternative to conventional acute, chronic and preventive care, and can improve clinical outcomes. In the industrialized world, it is likely that telemedicine will continue to move healthcare delivery from the hospital or clinic into the home. In the developing world or in regions with limited infrastructure, telemedicine will mainly be used in applications that link providers based at health centres, referral hospitals and tertiary centres. The future of telemedicine will depend on: (1) human factors, (2) economics and (3) technology. Behaviours related to technology affect change at the individual, organizational and societal level. Personnel shortages and decreasing third-party reimbursement are significant drivers of technology-enabled health care in the industrialized world, particularly in the areas of home care and self-care. We can safely assume that developments in mobile communications, sensor devices and nanotechnology will alter the way that health care is delivered in the future. The growth and integration of information and communication technologies into health-care delivery holds great potential for patients, providers and payers in health systems of the future. Perhaps the most difficult question to answer, however, is 'When will telemedicine become part of the standard of care?'

Delivery of Health Care, Integrated↗
PubMed2005

Telemedicine by email in remote Cambodia.

An email-based telemedicine service was implemented in two remote village communities in Cambodia. Volunteer physicians at the Brigham and Women's Hospital, Massachusetts General Hospital and the Sihanouk Hospital Center of Hope in Phnom Penh provide monthly consultations to the local clinicians. Between February 2001 and May 2005, there were 469 teleconsultations. The 214 telemedicine cases involving new patients managed in the first 28 months were reviewed. The mean duration of the chief complaint at the initial patient visit was 37 months for the first six months and had dropped to eight months by the end of the study period. Of 63 adult patients surveyed, all were either satisfied (54%, n = 34) or very satisfied (46%, n = 29) with their experience in the telemedicine clinic. About 78% (n = 49) were willing to pay, on average, 0.63 US dollars for their visits. The introduction of basic point-of-care laboratory testing in November 2004 was associated with a reduction in patients requiring off-site referral for completion of laboratory testing (69% before to 35% afterwards, P < 0.001). The success of the pilot telemedicine programme confirms the value of email support for non-physician health-care workers in the developing world.

Adult↗
PubMed2004

Virtual TeleStroke support for the emergency department evaluation of acute stroke.

OBJECTIVES: Telemedicine-enabled acute stroke consultation (TeleStroke) may be useful to determine eligibility for treatment with tissue plasminogen activator (tPA) and provide support to emergency departments without on-site stroke expertise. METHODS: Emergency physicians consulted with stroke neurologists via two-way videoconferencing in the evaluation of patients with possible acute stroke. History, neurologic examination, and computed tomography of the head were reviewed to determine eligibility for treatment with tPA. Interpretations of computed tomography were compared for inter-rater reliability between the neurologist and the neuroradiologist using a conventional workstation. Videotape and written records were analyzed to determine time intervals, patient management, and user satisfaction. RESULTS: The authors reviewed data from 24 patients evaluated over 27 months at an island-based hospital. The mean National Institutes of Health Stroke Scale score was 5.7 (range, 0-22). Fifteen patients arrived at the emergency department less than three hours after symptom onset; 12 were presented for TeleStroke consultation within three hours after symptom onset. Eight of these 12 (75%) had acute ischemic stroke, and six of these eight potentially eligible patients (75%) received intravenous tPA. There was very good agreement among all remote readers for detecting the one case of imaging exclusion (subdural hemorrhage). There were no protocol violations, and a mean (+/- SD) consult-to-needle time of 36 (+/- 15) minutes and door-to-needle time of 106 (+/- 22) minutes was achieved. Transfer was avoided in 11 patients. Physicians believed that TeleStroke consultation improved care in >95% of the cases. CONCLUSIONS: TeleStroke videoconferencing can support emergency department-based evaluation of acute stroke and may facilitate tPA delivery in neurologically underserved facilities. A prospective, randomized trial is needed to determine if these systems are superior to traditional telephone consultation.

Adult↗
PubMed2004

A pilot study of specialized nursing care for home health patients.

We conducted a pilot study to assess the feasibility of remote (Web-based) consultations for leg wounds. The wounds were photographed by a home care nurse using a digital camera and the images were transmitted to a server from the nurses' office, together with patient details. The home care nurse graded the wounds and suggested a treatment plan. Subsequently, a specialist wound-care nurse also graded them and suggested a treatment plan, using the data stored on the Web server. Thirty-four patients were studied. The Web system proved simple to use and staff responses were positive. The agreement between the home care nurses and the specialist nurse in assessing wounds was good (kappa coefficients 0.41 to 0.71). Agreement over the treatment of wounds was more variable (kappa coefficients -0.75 to 0.81). The results of the pilot study are encouraging and suggest that Web-based communication can improve the quality of care for patients with leg wounds and reduce costs.

Aged↗
PubMed2003

Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review.

OBJECTIVE: To assess whether transferring knowledge from specialists at centres of excellence to referring doctors through online consultations can improve the management of patients requiring specialised care. DESIGN: Retrospective case review of the first year of internet based patient initiated consultations between referring doctors and consulting specialists. SETTING: US teaching hospitals affiliated with an organisation providing internet based consultations. PARTICIPANTS: Doctors in various settings around the world engaging in internet based consultations with specialists. MAIN OUTCOME MEASURES: New recommendations for treatment, change in diagnosis, and turnaround time for consultation compared with time to see a specialist. RESULTS: 79 consultations took place. 90% (n=71) of consultations were for services related to oncology. 90% of consultations involved new recommendations for treatment. The most common recommendation was a new chemotherapeutic regimen (68%, n=54). Diagnosis changed in 5% (n=4) of cases. The average turnaround time was 6.8 working days compared with an average of 19 working days to see a comparable specialist. CONCLUSIONS: Internet based consultations between specialists at centres of excellence and referring doctors contribute to patient care through recommendations for new treatment and timely access to specialist knowledge. Although change in diagnosis occurred in only a few cases, the prognostic and therapeutic implications for these patients may be profound.

Adolescent↗
PubMed2003

Patient knowledge and attitude toward information technology and teledermatology: some tentative findings.

A large proportion of Internet users tend to ask health-related questions. There is evidence of growing interest in the use of information technology in health care delivery. Moreover, patient-driven health care is becoming a reality. We hypothesized that dermatology outpatients would be knowledgeable and capable of participating in teledermatology services. Hence, this study was conducted to evaluate knowledge among teledermatology patients. The survey instrument was composed of 16 close-ended questions. The validity and reliability of the questions were tested in a pilot study. Institutional Review Board approval was obtained. Consecutive patients seen at two dermatology clinics at tertiary care hospitals were recruited for a regular survey. A total of 430 questionnaires were completed. About two-thirds of the patients reported having a computer at home, with Internet access, and also using e-mail regularly. Slightly more than one-half of them used the Internet to search for health-related information. One in 5 patients had digital cameras. More than one-half would consider getting an opinion from their physician or send their skin images to their physician via a secure Internet connection. Based on this cross-sectional survey, dermatology outpatients seem to be accepting of and technologically capable of participating in teledermatology.

Adult↗