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PubMed2005

School nurse, family and provider connectivity in the FITE diabetes project.

The Florida Initiative in Telehealth and Education (FITE) diabetes project includes a system of remote blood glucose monitoring and online education for school personnel, families and providers. Forty-four patients with diabetes (100% of patients), six caregivers, six case managers and 18 school nurses were provided with secure email access, allowing blood glucose and other data transfer. In all, 50% of school nurses and 100% of case managers completed educational modules on the FITE Website. Over 90% of patients and all school nurses received equipment for transmitting blood glucose data to their computers. The data were discussed during clinic appointments. Inclusion of previously unavailable data from school nurses contributed to fine-tuning the diabetes management regimen. Those patients, families and school nurses who chose to transmit blood glucose data and participate in online education expressed satisfaction with the technology, the process and the improved communication.

Blood Glucose↗
PubMed1995

Neurophysiologic assessment in the management of spinal dysraphism.

Neurophysiologic techniques provide a valuable addition to the armamentarium of tools for the evaluation of sensory and motor function in the pediatric spinal cord. These techniques include median, radial, and ulnar nerve evoked potentials from the upper extremity; common peroneal and tibial nerve evoked potentials from the lower extremity; dermatomal potentials; and compound muscle action potentials and compound nerve action potentials. The techniques that evaluate the sensory system have been used extensively and effectively as research tools, as adjuncts to diagnostic evaluation, and for intraoperative monitoring. There is a considerable literature that describes the properties of SEPs in the infant and young child. Techniques for assessing the descending pathways have been developed in the last 10 years. These techniques hold great promise as both diagnostic and intraoperative monitoring tools. Many questions, however, still exist concerning their value and use. The rapidly increasing capability available in computer systems is also providing enhanced capability in the acquisition, display, and analysis of neurophysiologic data. It is now common to acquire multiple responses simultaneously, e.g. tibial SEPs, pudendal SEPs, and motor potentials. It is also possible to apply computationally intensive numerical algorithms in real time to enhance signal quality and reduce the time required to produce an interpretable display. Finally, it is possible to monitor multiple cases simultaneously from remote locations. These enhanced computational capabilities are helping to optimize the contribution of neurophysiologic monitoring to patient care.

Child↗
PubMed1992

Frozen section service via the telenetwork in northern Norway.

We present preliminary results of remote frozen section service for two local hospitals in Northern Norway. The service is arranged by remote controlling microscopes with motorized X, Y and Z stage movements, magnification and illumination located at Kirkenes and Harstad Hospitals at a distance up to 400 km apart from the workstation at the University Hospital in Tromsø. The video-images of the frozen section are transmitted via a two-ways phone and video telenetwork with 2 Mbit/s capacity. The images are displayed on a monitor as both still and live images and diagnosed by pathologists in Tromsø. To data, 50 patients are examined by remote frozen section service. Correct benign versus malignant diagnoses are given in all cases compared with final diagnoses based on formalin fixed and paraffin embedded material except for two false negative malignant cases and two deferred diagnoses. The average time taken for examining each case of frozen section was 13 minutes. For hospitals with limited requirement of local pathology service and for hospitals with deficiency of specialists, remote frozen section service may be a worthwhile substitute.

Diagnosis, Differential↗
PubMed1999

The effectiveness of videophones in home healthcare for the elderly.

OBJECTIVES: This study evaluates the effectiveness of telecare, the use of videophones in healthcare for the elderly in communities, and proposes an effective application of telecare in home healthcare. METHODS: An intervention study design was applied to evaluate the add-on benefits to home healthcare from a videophone system using Integrated Services Digital Network (ISDN) installed in individual homes of clients and service providers. An intervention group of home healthcare cases were provided with videophones (VHHC group), and it was compared to a reference group of regular healthcare cases (HHC group). Persons from the 2 groups were individually matched according to sex, age, and their independence in activities of daily living. The functional independence of the individuals in the 2 groups was assessed before and 3 months after home healthcare was started, with and without videophones. The effectiveness of videophones was assessed by analyzing the improvements in functional independence using a paired t test. RESULTS: Improvements in functional independence of 5 pairs of males and 11 pairs of females were analyzed. Improvements in ADL, communication, and social cognition independence of the VHHC group over the 3-month trial period measured by the Functional Independence Measure were 1.5 points, 0.7 points, and 1.9 points, respectively; statistically, these were significantly greater than those of the HHC group (individually P < 0.05). CONCLUSIONS: The effectiveness of the videophones in home healthcare service was found to be significant. This evidence supports the use of videophones in home healthcare to improve the quality of service.

Activities of Daily Living↗
PubMed2006

Public telesurveillance service for frail elderly living at home, outcomes and cost evolution: a quasi experimental design with two follow-ups.

BACKGROUND: Telesurveillance is a technologically based modality that allows the surveillance of patients in the natural setting, mainly home. It is based on communication technologies to relay information between a patient and a central call center where services are coordinated. Different types of telesurveillance systems have been implemented, some being staffed with non-health professionals and others with health professional, mainly nurses. Up to now, only telesurveillance services staffed with non-health professionals have been shown to be effective and efficient. The objective of this study was to document outcomes and cost evolution of a nurse-staffed telesurveillance system for frail elderly living at home. METHODS: A quasi experimental design over a nine-month period was done. Patients (n = 38) and caregivers (n = 38) were selected by health professionals from two local community health centers. To be eligible, elders had to be over 65, live at home with a permanent physical, slight cognitive or motor disability or both and have a close relative (the caregiver) willing to participate to the study. These disabilities had to hinder the accomplishment of daily life activities deemed essential to continue living at home safely. Three data sources were used: patient files, telesurveillance center's quarterly reports and personal questionnaires (Modified Mini-Mental State, Functional Autonomy Measurement System, Life Event Checklist, SF-12, Life-H, Quebec User Evaluation of Satisfaction with Assistive Technology, Caregiver Burden). The telesurveillance technology permitted, among various functionalities, bi-directional communication (speaker-receiver) between the patient and the response center. RESULTS: A total of 957 calls for 38 registered clients over a 6-month period was recorded. Only 48 (5.0%) of the calls were health-related. No change was reported in the elders' quality of life and daily activity abilities. Satisfaction was very high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months. CONCLUSION: The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient.

Aged↗
PubMed1996

Primary care and hemodialysis monitoring through telemedicine.

Telemedicine offers the primary care physician an opportunity to improve time management while continuing to provide optimal, cost efficient care. The following paper offers a means with which to deliver such care and describes the relationship required between physician and patient to deliver optimal telemedical care. The Texas Telemedicine Project offered an avenue for the physician participants to explore the best delivery system with which to successfully employ telemedicine in the practice of medicine. Patients became comfortable with interactive healthcare delivery quickly, and preferred it as a means of receiving primary care as well as continuous physician monitoring during dialysis treatments. This study leads the authors to the opinion that telematic healthcare delivery will only be successful when the patient/physician relationship most closely mimics that of face-to-face contact.

Attitude to Computers↗
PubMed2003

Patient and nurse-related implications of remote cardiac telemetry.

The purposes of this study were (a) to determine the frequency of rhythm disturbance events among patients on remote cardiac telemetry, (b) to identify how many of these events were detected by the telemetry nurses, and (c) to explore the impact of managing telemetry on nurses' workload This prospective observational study took place in a nine-bed Coronary Respiratory Care Unit (CRCU) in a tertiary Canadian University Hospital. No lethal arrhythmias were detected during 420 hours of observation. There were a high number of remote telemetry warning arrhythmias, the vast majority of which were artifact (80.2%). A warning alarm occurred every 2.1 to 6.2 minutes. Nurses detected between 60% to 100% of valid warning alarms. Remote cardiac telemetry without a dedicated monitor-watcher places unnecessary demand on CRCU nurses' time because the vast majority of arrhythmia alarms are inconsequential. The addition of monitoring remote telemetry to the CRCU nurse's workload has the potential to negatively influence the care provided to CRCU patients.

Arrhythmias, Cardiac↗
PubMed2005

Potential cost savings by telemedicine-assisted long-term care of implantable cardioverter defibrillator recipients.

Home monitoring (HM) of cardioverter defibrillators (ICD) with its automated wireless remote data access, may decrease the rate of patient visits. This study examined the potential cost savings for the long-term care of ICD assisted by HM. A French database including 502 patients from 6 university hospitals was used. Costs of conventional follow-up (FU) of ICD were calculated without, and compared with the expected cost of FU with HM. Calculations included number of visits, including physician's fees, electrocardiograms, and specific ICD surveillance, and transportation costs. The mean distance between home and institutions performing follow-ups was 69 +/- 57 km. For each visit, a mean overall cost of 215 dollars was calculated, including 121 dollars for transportation and 94 dollars for medical services. HM may obviate up to 2 visits per year. Over the 5 years of expected life of the device, the decrease in costs for FU visits was estimated at 2,149 dollars. With an additional cost of 1,200 dollars for the HM system, saving began after a mean FU of 33.5 months. The time to onset of cost saving by HM ranged between 17.4 months for patients living >150 km from the medical facility to 52.2 months for those living <50 km away. It is concluded that the HM may considerably reduce the overall costs of ICD FU by saving on transportation cost, particularly when the distance between home and medical facility is >100 km.

Cost Savings↗
PubMed2002

Validation of a remote monitoring system for the elderly: application to mobility measurements.

The aim of this paper is to introduce a smart tool for the assessment of the mobility of patient with motor disorders and to evaluate its performance through some initial experiments. These experiments are based on a system which is composed of sensors connected to a Personal Computer (PC) using data acquisition cards and a communication network. The PC includes a data acquisition and processing software. This system has been installed in a patient's housing (a bedroom and a washroom) in a long-stay setting. Pre-established travel and activity (going to bed, getting up, visiting the washroom em leader ) patterns of patient in the housing including their duration have been defined by physicians for the experiments. A volunteer participated in the experiments and the results of his mobility obtained by the data processing software were compared with his real mobility. An agreement was found between the proposed assessment system and the experiments, thereby validating functioning of the whole system. Then, the system has been used to monitor a patient over a period of 39 nights. Again there is a good agreement between the characteristics derived from the system and the findings of the caring staff in charge of the patient's routine night monitoring. Data collected during 24 consecutive hours have been used to identify and characterise the patient's whole day mobility. This study paves the way for a new assessment system of the mobility of patient thus allowing the follow up of patients suffering from dementia and to study their significant mobility changes over time by introducing an indicator of mobility which can be used to assess their motor behavioural disorders.

Aged↗
PubMed2006

Monitoring and telemedicine support in remote environments and in human space flight.

The common features of remote environments are geographical separation, logistic problems with health care delivery and with patient retrieval, extreme natural conditions, artificial environment, or combination of all. The exposure can have adverse effects on patients' physiology, on care providers' performance and on hardware functionality. The time to definite treatment may vary between hours as in orbital space flight, days for remote exploratory camp, weeks for polar bases and months to years for interplanetary exploration. The generic system architecture, used in any telematic support, consists of data acquisition, data-processing and storage, telecommunications links, decision-making facilities and the means of command execution. At the present level of technology, a simple data transfer and two-way voice communication could be established from any place on the earth, but the current use of mobile communication technologies for telemedicine applications is still low, either for logistic, economic and political reasons, or because of limited knowledge about the available technology and procedures. Criteria for selection of portable telemedicine terminals in remote terrestrial places, characteristics of currently available mobile telecommunication systems, and the concept of integrated monitoring of physiological and environmental parameters are mentioned in the first section of this paper. The second part describes some aspects of emergency medical support in human orbital spaceflight, the limits of telemedicine support in near-Earth space environment and mentions some open issues related to long-term exploratory missions beyond the low Earth orbit.

Humans↗
PubMed2002

Continuous EEG monitoring in the intensive care unit.

Continuous EEG (CEEG) monitoring allows uninterrupted assessment of cerebral cortical activity with good spatial resolution and excellent temporal resolution. Thus, this procedure provides a means of constantly assessing brain function in critically ill obtunded and comatose patients. Recent advances in digital EEG acquisition, storage, quantitative analysis, and transmission have made CEEG monitoring in the intensive care unit (ICU) technically feasible and useful. This article summarizes the indications and methodology of CEEG monitoring in the ICU, and discusses the role of some quantitative EEG analysis techniques in near real-time remote observation of CEEG recordings. Clinical examples of CEEG use, including monitoring of status epilepticus, assessment of ongoing therapy for treatment of seizures in critically ill patients, and monitoring for cerebral ischemia, are presented. Areas requiring further development of CEEG monitoring techniques and indications are discussed.

Aged↗
PubMed1997

Maritime medicine.

This article reviews the emergency care of sick and injured patients on various seafaring vessels in remote areas of the world. It addresses the characteristic problems encountered by those at sea, the logistical difficulties of assessing and treating these patients on the vessel, and the difficulty in arranging and monitoring definitive care.

Case Management↗
PubMed1993

[Newly occurring stenocardia: the clinical picture, diagnosis, treatment and prognosis].

The article analyses the results of treatment of 77 patients with primarily emerged stenocardia. Three variants of clinical course of illness were distinguished: primarily emerged stenocardia at the state of exertion, primarily emerged progressive stenocardia at the state of exertion, primarily emerged stenocardia at rest state. As for primarily emerged stenocardia at the state of exertion, the changes at the final part of QRS complex were disclosed in 56% of patients, and abnormalities in the mobility of the left ventricle walls in 32%. The contractive function of left ventricle was unchanged. The myocardial infarction developed in 8% of patients in the course of one month, and in 4% in the course of one year. Stenocardia attacks disappeared in 16% of patients. As for primarily emerged progressive stenocardia, the ECG changes were marked in 74% of cases. The whole sphygmic fraction in 65% of patients was 55% lower. The myocardial infarction developed in 12% of patients in the course of one month and in 10.7% in more remote period. 52% of patients with the primarily emerged stenocardia at rest had ECG changes. In ECG daily monitoring 33% of patients had characteristic changes of coronary artery spasm. Myocardial infarction occurred in 8% of patients in the course of the first year. Stenocardia attacks disappeared in 25% of patients.

Adult↗
PubMedDate not supplied

Microcomputer-based coronary care unit central station.

A four-bed central station that can be connected to any commercial intensive-care bedside monitor was developed. The system is based on a personal computer (IBM-AT compatible) as a local unit and on a microcontroller Intel 8031 as a remote unit. Four ECG signals are low-pass filtered, multiplexed, sampled at 256-Hz per channel, 8-bit A/D converted, preprocessed, and converted to a serial format RS-232 by the remote unit. The real-time display of the signals is at the standard speed of 25 and 50 mm/sec. Heartrate, alarms, trend plots, and general patient data are shown on an Olivetti M280 and EGA 13'' color monitor as the local unit. The communication speed was set at 57.6 Kbaud full duplex. Additionally, to reach standard monitoring sweep rates using a 13'' screen with 640 x 350 pixels, an ECG data-compression algorithm was implemented in the remote unit. This unit can support up to eight input channels and can work with any personal computer, via RS-232, with the appropriate software. It also allows other signal preprocessing software that could be developed, such as QRS detection or ST segment quantification, to be loaded into its random access memory and to be run under PC command. The development of this system demonstrated the use of a widespread piece of commercial equipment, the PC, in a very specific application, CCU monitoring, assuring low-cost system implementation. This feature is particularly attractive in upgrading existing CCU units in less developed countries.

Biomedical Engineering↗
PubMedDate not supplied

Beneficial effects of noetic therapies on mood before percutaneous intervention for unstable coronary syndromes.

BACKGROUND: Many common medical, surgical, and diagnostic procedures performed for conscious patients can be accompanied by significant anxiety. Mind-body-spirit interventions could serve as useful adjunctive treatments for the reduction of stress. OBJECTIVE: To evaluate the effects of stress management, imagery, touch therapy, remote intercessory prayer, and standard therapy on mood in patients awaiting percutaneous interventions for unstable coronary syndromes as part of the Monitoring and Actualization of Noetic Training (MANTRA) trial, which explored the feasibility and efficacy of noetic interventions on clinical outcomes in a randomized clinical trial. METHODS: A total of 150 patients were randomized to one of the five treatment conditions. Stress management, imagery, and touch therapy were administered in 30-minute treatment sessions immediately before the cardiac intervention. Intercessory prayer was not necessarily contemporaneous with these treatments. Mood was assessed by a set of visual analog scales before and after treatment for a similar length of time for the standard therapy and prayer groups. RESULTS: Analysis of complete data from 108 patients showed that stress management, imagery, and touch therapy all produced reductions in reported worry, as compared with standard therapy, whereas remote intercessory prayer had no effect on mood. The ratings of other similar moods were not affected, perhaps because of the relatively positive emotional state observed in the participants before treatment. CONCLUSIONS: The results suggest that at least some noetic therapies may have beneficial effects on mood in the course of medical and surgical interventions. Administration of these interventions was feasible even in the hectic environment of the coronary intensive care unit. Given their relatively low cost and limited potential for adverse effects, these interventions merit further study as therapeutic adjuncts.

Affect↗
PubMed1999

Aerosol granulocyte macrophage-colony stimulating factor: a low toxicity, lung-specific biological therapy in patients with lung metastases.

The objective was to study the feasibility of granulocyte macrophage-colony stimulating factor (GM-CSF) delivery to the lung using an aerosol in humans. A Phase I dose escalation study provided GM-CSF at three dose levels as a twice-a-day (BID) x 7 days schedule. Pulmonary functions were monitored using a remote spirometry device. Blood counts were checked at the beginning and end of each week of GM-CSF nebulization. If no toxicity was encountered, patients rested for 7 days and then were treated at the next dose level. Six of seven patients were successfully dose escalated from 60 microg/dose BID x 7 days, to 120 microg/dose BID x 7 days, then 240 microg/dose BID x 7 days. No toxicity was seen. Comparison of day 0 and day 7 blood leukocyte counts showed no significant increases in either leukocyte numbers or percentage of neutrophils. Pulmonary functions test changes were minor. No significant change in forced vital capacity, FEV1, peak flow, or FEF 25-75 related to either time or dose level was observed. One patient's lung metastases progressed. The other five patients received an additional 2-6 months of intermittent aerosol GM-CSF at dose level 3 without side effects. One patient with Ewing's sarcoma has a complete response, and a patient with melanoma had a partial response; the other three had stabilization of pulmonary metastases for 2-6 months. Aerosol delivery of GM-CSF is feasible, safe, and possibly effective. Aerosol cytokine delivery may achieve effective immunological activation against cancer in the lung and is worthy of further study.

Administration, Inhalation↗