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Wireless teleradiology and fax using cellular phones and notebook PCs for instant access to consultants.

The feasibility of wireless portable teleradiology and facsimile (fax) transmission using a pocket cellular phone and a notebook computer to obtain immediate access to consultants at any location was studied. Modems specially designed for data and fax communication via cellular systems were employed to provide a data communication interface between the cellular phone and the notebook computer. Computed tomography (CT) scans, X-rays, and electrocardiograms (ECGs) were transmitted to a wireless unit to measure performance characteristics. Data transmission rates ranged from 520 to 1100 bytes per second. Typical image transmission times ranged from 1 to 10 minutes; however, using joint photographic experts group or fractal image compression methods would shorten typical transmission times to less than one minute. This study showed that wireless teleradiology and fax over cellular communication systems are feasible with current technology. Routine immediate cellular faxing of ECGs to cardiologists may expedite thrombolytic therapy decisions in questionable cases. Routine immediate teleradiology of CT scans may reduce operation room preparation times in severe head trauma.

Humans↗

Procedures that assess inconsistency in meta-analyses can assess the likelihood of response bias in multiwave surveys.

BACKGROUND AND OBJECTIVE: Response bias may affect the result of surveys with <100% response rate. We applied methods commonly used in meta-analysis to ascertain the extent to which response bias affects multiwave survey results. METHODS: To test hypotheses of between-wave similarity, we used the Cochran-Armitage test for trends and the Q-test of heterogeneity across waves in a survey of 2,127 North American clinicians using six e-mail waves and one fax wave and achieving a response rate of 22%. We used the I2 statistic To quantify the extent of inconsistency in survey outcomes across waves not due to within-wave random error (i.e., inconsistency due to response bias). RESULTS: With this survey, tests of heterogeneity and trend were not significant and I2 equaled 0%. These results suggest that the underlying responses did not differ across waves and thus strengthened the inference that response bias was not affecting the interpretation of the survey. CONCLUSION: Researchers can use procedures that assess inconsistency in meta-analyses to evaluate the validity of a multiwave survey with a less than optimal response rate.

Bias↗

Communication channels to help build an international community of education and practice.

Two-way communication is required if nurses are to build knowledge networks of international communities of nursing education and practice. Are expensive new technologies feasible or preferred for effective communication and productive outcomes? In this report from a longstanding partnership between schools of nursing at Peking University and the University of Michigan, case study methodology is used to evaluate more than a decade of experience with communication modalities: in person, postal mail, express mail, e-mail, fax, telephone, hand delivery by other travelers, and Web sites. Although each education and practice community develops unique ways to build its shared knowledge, a communications plan is suggested, with use of multiple communication techniques, especially those that are low cost and the most dependable. High-cost technologies are not always feasible or preferred. For the project described, they were not necessary to the major outcome, a nursing education and practice network that resulted in the first nurse-managed community-based clinic in China.

China↗

The use of facsimiles in acute patient transfers: experience with brachial plexus injuries.

In order to optimize the transfer of patients with acute brachial plexus injuries a facsimile proforma was introduced. The transfer of 20 patients prior to its introduction was compared as a retrospective control group with a prospective analysis of 20 patients transferred after the introduction of the facsimiles. There were many fewer missed injuries, the patients were better investigated and it as easier to decide when to delay patient transfer. Subjectively there was a considerably easier passage of both medical and social information about the patients. The cost of the facsimile and its use is more than compensated by the savings in reduced impatient stay, the reduced need for urgent tests upon receipt of the patient, fewer phone calls and considerably reduced administrative workload.

Brachial Plexus↗

Feasibility of keying data from screen-displayed facsimile images in an ongoing trial: the collaborative ocular melanoma study.

As part of an ongoing clinical trial, we conducted an experiment to assess the feasibility and to determine the reliability of data entry from a computer screen display of images of data collection forms transmitted by facsimile (fax) machines directly into a computer for paper forms designed without consideration of fax or image display requirements. Feasibility was assessed on the basis of accuracy and reliability of data entry and on operator satisfaction. During a 2-week period, half of the forms received at the Collaborative Ocular Melanoma Study (COMS) coordinating center were key-entered twice, using the paper forms as the source (paper source entry). The remaining forms were entered once using paper source and were later reentered using the screen display of images of the faxed forms as the source (image source entry). The latter group of forms, or 50% of all forms received, were entered a third time, using the image source entry. Two data entry operators participated in the experiment. Discrepancy rates between and within data entry operators were calculated for both modes of entry. A total of 50,861 keystrokes (28,095 items) across 1122 records were checked for consistency. The overall discrepancy rate associated with double paper source entry was approximately 21 per 10,000 keystrokes (20 per 10,000 items). Discrepancy rates associated with paper source versus image source entry (53 per 10,000 keystrokes [57 per 10,000 items]) and double image source entry (57 per 10,000 keystrokes [47 per 10,000 items]) were similar in magnitude. Image source entry of forms received by facsimile may provide an acceptable alternative to paper entry in ongoing multicenter clinical trials where the costs of converting existing forms and systems to automated data capture may be unacceptable. This experiment confirmed the feasibility of such an alternative and suggested that improved screen displays and changes in equipment to facilitate entry of data from the screen display may enhance accuracy of entries.

Choroid Neoplasms↗

Prehospital ECG transmission: comparison of advanced mobile phone and facsimile devices in an urban Emergency Medical Service System.

OBJECTIVE: To compare the speed and reliability of electrocardiogram (ECG) transmissions from the prehospital setting to a conventional table facsimile device and to an advanced mobile phone in a Helicopter Emergency Medical Service System (HEMS). METHODS: Eighteen authentic ECGs stored in the memory module of a monitor defibrillator were used. The ECGs were (1) sent directly from the monitor defibrillator to a table fax and an advanced mobile phone at the HEMS base; (2) printed out and sent from a mobile fax connected to an ordinary mobile phone to the table fax and the advanced mobile phone at the HEMS base; (3) printed out and sent from an ordinary table fax as well as from a table fax connected to a satellite phone system to the receiving devices at the HEMS base. RESULTS: When the ECGs were sent from the table fax via satellite, the transmission times were longer to the advanced mobile phone than to the table fax at the HEMS base (1 min 54 s+/-0 min 21 s vs. 1 min 37 s+/-0 min 20 s, (mean+/-SD), (P<0.01). Regarding transmission from the other fax devices, there were no differences in transmission times between the two receiving devices. The fastest way to transmit ECGs to the advanced mobile phone was to send it from conventional table fax (1 min 22 s+/-0 min 18 s) and the longest transmission times were with mobile fax connected to mobile phone (5 min 23 s+/-3 min 5 s). In all ECGs transmitted except one the cardiac rhythm and ST-changes could be recognised. CONCLUSION: An advanced mobile phone is as fast and reliable as a conventional table fax in receiving ECGs. A mobile phone with advanced features is a practical tool for HEMS physicians who need to evaluate ECGs in the prehospital setting.

Cell Phone↗

Observer detection performance in radiology using a retransmission-free network communication protocol.

RATIONALE AND OBJECTIVES: We measured the effect of image data loss on diagnostic accuracy to test the possibility of using a retransmission-free network communication protocol for transferring radiologic images. METHODS: Mammograms transferred over a simulated network with 0%, 15%, and 25% transmission packet loss were presented randomly to 10 observers who typically read mammograms. Observers reported on the presence or absence of microcalcification clusters and the number of calcifications per cluster. RESULTS: Performance with 15% loss did not differ from performance with 0% loss. The 25% loss condition resulted in a significant decrease in performance. Accuracy of counting individual microcalcifications was high in all three loss conditions. CONCLUSION: Up to 15% packet loss can be tolerated without affecting diagnostic performance. These data suggest that in some radiologic applications retransmission-free communication protocols may be useful.

Breast Diseases↗

Using facsimile cascade to assist case searching during a Q fever outbreak.

In September 2002, facsimiles were sent to 360 primary-care physicians alerting them to a local outbreak of Q fever. The physicians subsequently submitted serology samples on significantly more patients than in a previously comparable period in 2001. Facsimile cascade assists effective communication with primary-care physicians in an outbreak investigation.

Complement Fixation Tests↗

E-mail: what is e-mail?

This third part of the series explains what e-mail is and why it is the most widely used service on the internet. The principles behind sending and receiving e-mail messages are described. Also the various uses of e-mail are discussed.

Computer Communication Networks↗

Progressive adriamycin nephropathy in mice: sequence of histologic and immunohistochemical events.

BACKGROUND: As an experimental analogue of human focal glomerular sclerosis (FGS), adriamycin (ADR)-induced nephropathy is well-characterized in rats. Previously, this model has not been fully established in mice. The extension of this model to the mouse would be useful in the application of genetic and monoclonal antibody technology to characterize mechanisms of progressive renal disease. Herein, we describe a stable and reproducible murine model of chronic proteinuria induced by ADR. METHODS: Male BALB/c mice were intravenously injected with a single dose of ADR (10 to 11 mg/kg). Seven mice were sacrificed at weeks 1, 2, 4, and 6. Renal function, quantitative morphometric analysis, and electron microscopic studies were performed. Peripheral CD4+ and CD8+ T cells were evaluated using flow cytometric analysis of splenocytes. The leukocytic inflammatory pattern was analyzed by immunohistochemical examination. RESULTS: Overt proteinuria was observed from day 5 and remained significantly elevated throughout the study period. A focal increase in reabsorption droplets in tubular cells appeared at weeks 1 and 2, and numerous intraluminal casts were present after two weeks. Glomerular vacuolation and mild FGS appeared at week 4. At week 6, extensive focal and even global glomerular sclerosis, associated with moderate interstitial expansion and severe inflammation, were observed. A prominent macrophage infiltration appeared within both interstitium and glomeruli at week 2, followed by accumulation of both CD4+ and CD8+ T cells in interstitium but not glomeruli. There were almost no B lymphocytes seen at any time. CONCLUSION: This model should be useful in unraveling the pathogenesis of glomerular and interstitial inflammation and fibrosis in chronic proteinuric renal disease.

Animals↗

The release of unsuitable units through misinterpretation of laboratory results transmitted by facsimile.

BACKGROUND: Preventable errors in transfusion medicine that have a significant risk of adverse outcome include the erroneous administration of blood of the wrong type or blood with unsuitable laboratory test results. Mandatory reports of errors by facilities providing blood services in New York State offer the opportunity for review and analysis of common factors. The state also collects statistics on the collection, laboratory testing, distribution, and disposition of blood in these facilities. CASE REPORTS: Three serious errors in transfusion medicine occurred within 3 months as a result of the misinterpretation of laboratory test results transmitted by facsimile. Two unsuitable units of blood were erroneously released, and a unit mislabeled as to the ABO group was incorporated into the hospital inventory. One of the unsuitable units was repeatedly reactive for HIV (although negative on confirmatory testing), and the other was confirmed positive for HCV. CONCLUSIONS: The vast majority of blood collected in New York State is tested by reference laboratories. Results are often transmitted by facsimile. Facsimile results may be misinterpreted because of distortion during transmission, misreading, or failure to note a separate report of pending results. Such misinterpretation results in an increased risk of adverse outcome for transfusion recipients. Laboratory results to be transmitted by facsimile could readily-and should-be clarified.

Humans↗