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Biomedical subjects

S Tachakra

Publications and source records attributed to S Tachakra.

At least 19 recordsLinked to original sources
PubMed2002

Are accident and emergency consultants as accurate as consultant radiologists in interpreting plain skeletal radiographs taken at a minor injury unit?

The objective of this study was to compare the accuracy of an accident and emergency (A&E) consultant in interpreting plain skeletal radiographs with that of a consultant radiologist (CR). It took the form of a retrospective study of 2133 radiographs taken in a Minor Injury Unit (MIU). A&E consultant reports on these films were compared with those of a CR and also with a gold standard. The A&E consultant diagnoses achieved an accuracy of 98.5% (CR 97.8%), sensitivity of 97.8% (CR 98.1%), specificity of 98.8% (CR 97.7%), positive predictive value of 97.3% (CR 95.1%) and negative predictive value of 98.97% (CR 99.07%) (gold standard of 100%). In conclusion, the A&E consultant reports of plain skeletal radiographs generated from an MIU were as accurate as those of a consultant radiologist. This could have significant implications for the wet reporting of A&E departmental radiographs.

Accidents↗
PubMed2001

A pilot study of the technical quality of telemedical consultations for remote trauma management.

The technical performance of a telemedical system when used for remote trauma management was compared with face-to-face consultation. Two rooms, 20 yards apart, were linked telemedically in the same Accident & Emergency Department. Two hundred patients, with 'minor' and 'moderate' injuries, underwent the two types of consultation. The Accident & Emergency consultant marked physical parameters using a five-point pre-determined Likert scale. The following parameters were thought to be of excellent quality when compared to face-to-face consultation: overhead fluorescent lighting for the background illumination, video lighting for a close-up view, sound quality after volume adjustment, echo-cancellation after adjustment and lip synchronization. However, the following parameters scored poorly: sound before volume adjustment, echo-cancellation before adjustment, fine and coarse movements. It can be concluded that the quality of lighting and image quality are good in telemedicine. Sound and movement still present some problems. This technology is likely to be used more frequently for remote trauma management.

Humans↗
PubMed2001

Depth perception in telemedical consultations.

This study aimed at quantifying diminished depth perception in telemedicine due to the two-dimensional image and to devise coping strategies for the problem. Two hundred and thirty-five patients in the telemedicine room of a Minor Accident and Treatment Service were studied. The magnitude of impaired depth perception was noted. Seven coping strategies were used and the resolution of the problem was measured. Depth perception was judged to be less than 90% of binocular vision in 235 cases. This improved to more than 90% of binocular vision in 99 of the 234 cases (42.13%) when using of all strategies. Improvement by rotation of the camera 30 degrees at a time in the axial plane was the most useful strategy and it occurred in all 235 (100%) cases. Light adjustment and angulation occurred in 206 of 235 cases (87.66%). Comparison with the opposite side helped in 179 of 235 cases (76.17%), skin color and texture in 139 of 235 cases (59.15%), shutting one eye in 103 of 235 cases (43.83%), enlarging the image in 85 of 235 cases (36.17%), and diminishing depth of field of lens in 77 of 235 cases (32.77%). Other visual cues occurred in 63 of 235 cases (26.81%). Impaired depth perception is a significant problem in telemedicine. It can be improved to make a confident diagnosis in most cases by adopting a variety of strategies that are described in this paper.

Adolescent↗
PubMed2001

Avoiding artificiality in teleconsultations.

The ideal videoconferencing environment would produce the minimum feeling of artificiality for its users. We assessed nurse and patient perceptions of artificiality by varying the technical and operational procedures for telemedicine in a minor injuries unit. Twenty-five patients and eight emergency nurse practitioners (ENPs) participated in simulated teleconsultations under a variety of different conditions and completed a Likert-scale survey. There was a close correlation between the ENPs' ratings and the patients' ratings for the various factors (r > 0.99). In relation to technical factors, a flicker-free television screen and the user being seated close to the screen were preferred. Similarly, in relation to operational procedures, an initial explanation of telemedicine, introductions and adequate preparation were also preferred. The study suggests that careful attention to technical specifications and operational procedures can reduce the perceived artificiality of teleconsultations.

Communication Barriers↗
PubMed2001

Using telemedicine for distance education.

We assessed the use of videoconferencing as an educational tool for students and emergency nurse practitioners based at a minor injuries unit. Nineteen teaching sessions were conducted by videoconferencing, followed by a debriefing session in which the participants made observations about their educational experience. The participants observed that the experience was rewarding. The success of the teaching session depended on group size: an upper limit of six is recommended. The teaching sessions encouraged debate, independent thinking and peer communication.

Education, Distance↗
PubMed2001

Evaluation of telemedical orthopaedic specialty support to a minor accident and treatment service.

Over three and a half years there were 200 teleconsultations between emergency nurse practitioners at a minor accident and treatment service and the orthopaedic service of a main hospital. The main problems were fractures (93% of cases). The reasons for consultation fell almost equally into four groups: request for direct ward admission; discussion and decision about treatment; decision about the disposition of a case; and diagnosis. The technical quality of the majority of teleconsultations was considered satisfactory. Following the teleconsultation, 39% of patients were admitted to hospital, 6% were transferred to the accident and emergency department for a face-to-face consultation, and 56% were discharged and referred to a review clinic. Of the 200 cases, 193 needed teleradiology and the nurse practitioners and the orthopaedic registrars diagnosed all these cases correctly, as judged by the subsequent radiologist's report. Teleconsultations save time and prevent the unnecessary transfer of patients to main hospitals.

Adolescent↗
PubMed2001

Changes in the workplace with telemedicine.

The opinions of 110 emergency nurse practitioners (ENPs) practising telemedicine in 11 British minor injury units were sought using a questionnaire. There were 90 respondents (82%). The respondents thought that, since telemedicine had been introduced, they had become more open to change (96%) and more ready to grasp opportunities (93%). They considered that they were more keen to learn new things (99%) and were better disposed to teaching others (90%). They adopted a more advisory and supportive role (80%), found the work environment more varied (83%) and were well disposed to teamwork (64%). The power balance with doctors had changed (86%) and doctors indulged in dialogue rather than direction (69%). The results suggest that although changes have started in the workplace, they have not been as dramatic as a previous study of patients had predicted.

Attitude of Health Personnel↗
PubMed2000

Long-distance education in radiology via a clinical telemedicine system.

The objectives of the present study are to examine quality of learning, improved comprehension, and the preferred method of learning with teleradiology. Thirteen pairs of medical students transmitted 2,133 radiological series of skeletal injuries telemedically from a community hospital to the main emergency department. Students marked their diagnosis, quality of learning, improvement in comprehension, and preferred method of learning, each marked on a Likert scale. The quality of learning of the 13 sessions marked by the pairs of the students was ranked as excellent = 6, good = 16, fair = 4, unsatisfactory = 0, poor = 0. This was in contrast with the radiological series, which was marked as excellent = 55% or poor or unsatisfactory = 27.5%, most of the poor marks, as explained by the students, being awarded to transmissions in the second half of what had been very long sessions. The pre-tuition comprehension improved from 73 series marked as poor, and 1,037 series marked as unsure. The preferred method of tuition was teleradiology only in 21.8%, teleradiology teaching enhanced by clinical features, lectures and personal study in 62%. Teleradiological sessions needed to be reduced to an hour. Teleradiological teaching is a good method as long as the session lasts no more than 60 minutes, is interrupted by a 10-minute coffee break, and is supplemented by clinical features, lectures, and personal study.

Education, Distance↗
PubMed2000

Supervising trauma life support by telemedicine.

The resuscitation room in a community hospital was linked with a main hospital accident and emergency department using telemedicine equipment working at 384 kbit/s. Fifteen simulated casualties replicated the 'moulage' scenarios in the Advanced Trauma Life Support Course Manual of the American College of Surgeons. Each of the 15 scenarios was broken down into three main parts: the primary survey, resuscitation and the secondary survey. While a physician in the community hospital undertook each task, a senior doctor in the accident and emergency department recorded his degree of confidence in the supervision of the task on a five-point scale. There were features of the management which the supervisor found difficult, mainly related to the camera view and the use of a proxy examiner. However, supervising major trauma management by telemedicine was feasible. The average scores were mostly above 3 and often above 4 in the assessment of the primary survey and the resuscitation. The average scores were mostly above 3 for the secondary survey but were less often above 4 than for the primary survey and the resuscitation. Trials of remote trauma management with real patients appear to be justified.

Feasibility Studies↗
PubMed2000

How do teleconsultations for remote trauma management change over a period of time?

We obtained follow-up information about the new patients seen at a minor accident and treatment service (MATS) staffed by emergency nurse practitioners (ENPs). A previous study, of 150 teleconsultations in a six-month period starting in April 1996, was used for comparison. In the present series, 150 teleconsultations occurring in a four-month period starting in April 1999 were studied; the patients constituted 5.6% of the 2658 new attenders or 3.8% of the 3936 total attenders. In comparison with the study three years before, falling teleconsultation rates were partly offset by increasing numbers of attenders and an extension of the ENPs' roles and skills. Teleconsultation rates rose when the number of consultant-run clinics was curtailed and ENP-run clinics replaced some of them. Eligibility to request and report more radiographs reduced the need for teleconsultations, and subsequently teleconsultations for help with interpretation of radiographs fell as the ENPs became more experienced. Specialty residents trusted ENP judgement and accepted telephoned direct admission of cases to their wards. Fewer teleconsultations were required for soft-tissue injuries. Telemedicine is an excellent educational tool.

Emergency Nursing↗
PubMed2000

A comparison of telemedicine with face-to-face consultations for trauma management.

We compared the accuracy of teleconsultations for minor injuries with face-to-face consultations. Two hundred patients were studied. Colour change, swelling, decreased movement, tenderness, instability, radiological examination, severity of illness, treatment and diagnosis were recorded for both telemedicine and face-to-face consultations. Colour change showed an accuracy of 97%, presence of swelling or deformity of 98%, diminution of joint movement of 95%, presence of tenderness of 97%, weight bearing and gait of 99%, and radiological diagnosis of 98%. The severity of illness or injury was overestimated in one case and underestimated in five cases. Treatment was over-prescribed in one case and under-prescribed in three cases. The final diagnosis was correct in all but the two cases in which mistakes were made in the teleradiology. Overall, there was good accuracy using teleconsultations.

Female↗
PubMed2000

Transfer of telemedical support to Cornwall from a national telemedicine network during a solar eclipse.

During late 1998 and early 1999, planning officers in Cornwall predicted a huge increase in summer visitors to the county to observe the August solar eclipse. There was the possibility that a mass gathering in Cornwall could overload existing arrangements for handling accident and emergency patients. We therefore set up a telemedicine system to support the county's minor injury units (MIUs) from hospitals throughout the UK. Six main hospital accident and emergency departments outside Cornwall with existing links to their own MIUs were twinned with 10 of the 11 MIUs in Cornwall before the expected date of the gathering. The network was live for nine days, starting four days before the eclipse, and 2045 patients were seen in the 10 MIUs. There were 93 telemedicine calls from the 10 MIUs, involving 91 patients. Overall, 4.6% of the patients required a telemedicine consultation. Fifty-seven calls were made during working hours. Thirty-four patients were referred for further management, of whom 18 were referred on the same day. The transfer of telemedical support to a national network was successful.

Emergency Medical Services↗
PubMed2000

The changes patients expect to result from telemedicine.

A focus group of 12 persons who had been the subject of telemedical consultations met four times to discuss what changes to the health service they expected to result from the widespread introduction of telemedicine. There was general agreement about four main themes. First, rationalization of care would occur. For example, health-care spending would have to take into account the need for local care and there would be more primary care, with telemedicine providing easy access to specialists. The implementation of home care would be facilitated. Second, there was an expectation that costs would be controlled, for example by the use of multi-skilled personnel and by having fewer, smaller, newer and different hospitals. Third, quality control would be introduced (e.g. the widespread use of evidence-based medicine). Fourth, it was agreed that a change of professional attitudes would be needed, particularly among doctors (e.g. more openness, less bluster and less hierarchy). Telemedicine is likely to be a great driver of change in the health service. The changes relating to the location and type of work are fairly predictable, but the changes in relationships are likely to be profound.

Attitude to Health↗