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Biomedical subjects

Victor Patterson

Publications and source records attributed to Victor Patterson.

12 recordsLinked to original sources
PubMed2006

ANG mutations segregate with familial and 'sporadic' amyotrophic lateral sclerosis.

We recently identified angiogenin (ANG) as a candidate susceptibility gene for amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder characterized by adult-onset loss of motor neurons. We now report the finding of seven missense mutations in 15 individuals, of whom four had familial ALS and 11 apparently 'sporadic' ALS. Our findings provide further evidence that variations in hypoxia-inducible genes have an important role in motor neuron degeneration.

Adult↗
PubMed2005

Introduction to the practice of telemedicine.

Telemedicine is the delivery of health care and the exchange of health-care information across distances. It is not a technology or a separate or new branch of medicine. Telemedicine episodes may be classified on the basis of: (1) the interaction between the client and the expert (i.e. realtime or prerecorded), and (2) the type of information being transmitted (e.g. text, audio, video). Much of the telemedicine which is now practised is performed in industrialized countries, such as the USA, but there is increasing interest in the use of telemedicine in developing countries. There are basically two conditions under which telemedicine should be considered: (1) when there is no alternative (e.g. in emergencies in remote environments), and (2) when it is better than existing conventional services (e.g. teleradiology for rural hospitals). For example, telemedicine can be expected to improve equity of access to health care, the quality of that care, and the efficiency by which it is delivered. Research in telemedicine increased steadily in the late 1990s, although the quality of the research could be improved--there have been few randomized controlled trials to date.

Biomedical Research↗
PubMed2005

Teleneurology.

Teleneurology enables neurology to be practised when the doctor and patient are not present in the same place, and possibly not at the same time. The two main techniques are: (1) videoconferencing, which enables communication between a doctor and a patient who are in different places at the same time (often called realtime or synchronous), and (2) email, where the consultation is carried out without the patient being present, at a time convenient to the doctors involved (asynchronous or store-and-forward teleneurology). Some problems that can be solved by teleneurology include: (1) patients admitted to hospital with acute neurological symptoms rarely see a neurologist; (2) delayed treatment for acute stroke; (3) non-optimum management of epilepsy; (4) unproductive travel time for neurologists; (5) extremely poor access to a neurologist for doctors in the developing world; (6) long waiting times to see a neurologist. Neurology is a specialty that, because of the emphasis on accurate interpretation of a history, does lend itself to telemedicine. It has been a late starter in realizing the benefits of telemedicine and most of the publications on teleneurology have been in the last five years. Its uptake within the neurological community is low but increasing. Telemedicine requires a significant change in how neurologists practise. The evidence to date is that teleneurology can narrow the gap between patients with neurological disease and the doctors who are trained to look after them.

Electronic Mail↗
PubMed2005

Guidelines for filming digital camera video clips for the assessment of gait and movement disorders by teleneurology.

Digital still cameras capable of filming short video clips are readily available, but the quality of these recordings for telemedicine has not been reported. We performed a blinded study using four commonly available digital cameras. A simulated patient with a hemiplegic gait pattern was filmed by the same videographer in an identical, brightly lit indoor setting. Six neurologists viewed the blinded video clips on their PC and comparisons were made between cameras, between video clips recorded with and without a tripod, and between video clips filmed on high- or low-quality settings. Use of a tripod had a smaller effect than expected, while images taken on a high-quality setting were strongly preferred to those taken on a low-quality setting. Although there was some variability in video quality between selected cameras, all were of sufficient quality to identify physical signs such as gait and tremor. Adequate-quality video clips of movement disorders can be produced with low-cost cameras and transmitted by email for teleneurology purposes.

Evaluation Studies as Topic↗
PubMed2003

Teleneurology by email.

We introduced an email teleneurology service for patients referred to a neurologist by general practitioners. Over 14 months, 76 referrals (of 75 patients) were received. To determine the sustainability of the service, we studied a second cohort of 76 consecutive patients referred after our first study. We also followed up the first cohort of patients to get information on longer-term safety. The second cohort was obtained in one month less than the first, and had similar characteristics in terms of age, sex and the time taken by the neurologist to reply to the general practitioner. It contained fewer patients requiring clinic appointments (34% versus 43%). Fewer patients from the second cohort were referred for second opinions (4 versus 10) and there were no resulting changes in diagnosis. Follow-up of the first cohort from a mean of 6 months to a mean of 23 months led to seven more re-referrals and no additional changes in diagnosis. We conclude that teleneurology by email is sustainable for this group of patients, and confirm that it is safe, effective and efficient.

Adult↗
PubMed2002

Telemedicine for new neurological outpatients: putting a randomized controlled trial in the context of everyday practice.

In a retrospective review, the telemedical management of 65 outpatients from a randomized controlled trial (RCT) of telemedicine for non-urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial, with that of 150 outpatients seen in the neurology clinics of district general hospitals and with that of 102 neurological outpatients seen by general physicians. Outcome measures were the numbers of investigations and of patient reviews. The telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of reviews they received. Patients from the RCT seen face to face had significantly fewer investigations but a similar number of reviews to the other 150 patients seen face to face by neurologists (the disparity in the number of investigations may explain the negative result for telemedicine in that RCT). Patients with neurological symptoms assessed by general physicians had significantly more investigations and were reviewed significantly more often than all the other groups. Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow-ups than those patients managed by general physicians. The results suggest that management of new neurological outpatients by neurologists using telemedicine is similar to that by neurologists using a face-to-face consultation, and is more efficient than management by general physicians.

Adolescent↗
PubMed2002

Teleneurology in Northern Ireland: a success.

In March 1998 two neurologists and a professor of telemedicine met to solve a clinical problem - how to get neurological expertise to patients admitted acutely to hospitals which had no resident neurologist. Four years later, two new consultant neurologists were appointed in Northern Ireland with sessions in telemedicine, possibly the first such appointments anywhere in the world. This feat was achieved by combining science with politics. First, we chose the most appropriate telemedicine equipment and bandwidth for our needs. Second, we altered our neurological consultation to use the technology efficiently. Third, we were able to show scientifically that teleneurology was reproducible, feasible in practice, safe, acceptable and cost-effective. This required money to pay for a research fellow and equipment, which was obtained initially from some departmental research funds and a local hospital. Conventional research funding bodies were, on the whole, unhelpful. It was serendipitous that a review of neurology services in Northern Ireland was set up by the Department of Health. This identified our original problem as one that it wanted solved and we were in the fortunate position of being able to offer telemedicine as a tested solution. One final political push was required to get the money released. The result of this juxtaposition of science and politics should bring benefit to our neurological patients and will perhaps help others trying to establish similar projects elsewhere.

Journal Article↗
PubMed2002

Teleneurology in Northern Ireland: a success.

In March 1998 two neurologists and a professor of telemedicine met to solve a clinical problem--how to get neurological expertise to patients admitted acutely to hospitals which had no resident neurologist. Four years later, two new consultant neurologists were appointed in Northern Ireland with sessions in telemedicine, possibly the first such appointments anywhere in the world. This feat was achieved by combining science with politics. First, we chose the most appropriate telemedicine equipment and bandwidth for our needs. Second, we altered our neurological consultation to use the technology efficiently. Third, we were able to show scientifically that teleneurology was reproducible, feasible in practice, safe, acceptable and cost-effective. This required money to pay for a research fellow and equipment, which was obtained initially from some departmental research funds and a local hospital. Conventional research funding bodies were, on the whole, unhelpful. It was serendipitous that a review of neurology services in Northern Ireland was set up by the Department of Health. This identified our original problem as one that it wanted solved and we were in the fortunate position of being able to offer telemedicine as a tested solution. One final political push was required to get the money released. The result of this juxtaposition of science and politics should bring benefit to our neurological patients and will perhaps help others trying to establish similar projects elsewhere.

Financial Support↗