SEARCH · PubMed Health

Results for “Digital network”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed2003

Telemedicine for acute stroke: triumphs and pitfalls.

BACKGROUND AND PURPOSE: Telemedicine is emerging as a potential timesaving, efficient means for evaluating patients experiencing acute stroke. In areas where local stroke care specialists are not available, telemedicine can link an emergency department physician with a specialist in a stroke treatment center. This consultation provides an opportunity for administration of thrombolytic drugs within the short therapeutic time window associated with ischemic stroke. Here, we describe our stroke treatment center experiences and report safe administration of recombinant tissue plasminogen activator (rtPA) during telemedicine consultation. METHODS: The University of Maryland Medical Center uses a triplexed integrated services digital network line providing a 30--frames-per-second video link to St Mary's Hospital >100 miles away. The system uses a pan, tilt, and zoom camera with remote site control, allowing 2-way, real-time, audiovisual communication and CT image transfer. We retrospectively reviewed all acute stroke consultations provided to St Mary's Hospital between 1999 and 2001. RESULTS: We reviewed 50 consultations. Of the 50, 23 were attempted through telemedicine linkage, and 27 were by traditional telephone conversation, followed by transfer. Of the 23 telemedicine consultations, 2 were aborted because of technical difficulties. Of the patients evaluated by traditional means, 1 of 27 (3.8%) received intravenous rtPA; 5 of 21 (23.8%) received rtPA after telemedicine consultation. No patients experienced complications. CONCLUSIONS: Telemedicine consultation provided treatment options not previously available at the remote hospital. Administration of rtPA during telemedicine consultation was feasible and safe, and the system was well received. Lack of reimbursement for telemedicine services will hinder widespread adaptation of this promising technology for remote acute stroke treatment.

Academic Medical Centers↗

PubMed1995

Information issues in telemedicine systems.

This paper examines the use of the Integrated Services Digital Network (ISDN) for telemedicine from the computer scientist's point of view. As increased bandwidth becomes available at reasonable cost, it becomes possible to employ graphical user interfaces in telemedicine systems. This means that human-computer interaction (HCI) techniques can be applied to the interface design. This paper describes some of these as applied to telemedicine by other authors. HCI techniques can be considered to be part of the development process of telemedicine systems. An integrated, multimedia-based telemedicine system which emulated the concept of a hospital information system would have many benefits, such as a consistent user interface with appropriate clinical metaphors, integrated patient records with facilities to store graphical information, and remote access. Telemedicine has much to offer in terms of providing higher standards of patient care through improved response times by clinicians who have the required information immediately available. The patient also benefits from convenience factors, such as being able to consult locally a remote specialist.

Computer Communication Networks↗

PubMed2005

Telementoring: an important enabling tool for the community surgeon.

This study evaluated the efficacy of telementoring as an enabling tool for community general surgeons to perform advanced laparoscopic surgical procedures. We present a series of 19 patients who underwent advanced laparoscopic surgical procedures in two community hospitals, between November 2002 and July 2003, by four community surgeons with no formal advanced laparoscopic training. Each surgeon was telementored by an expert surgeon from a tertiary care hospital. Telementoring was achieved with real-time two-way audio-video communications over Internet Protocol or Integrated Services Digital Network lines with bandwidths from 385 kbps to 1.2 mbps. The procedures included 10 bowel resections, 5 Nissen fundoplications, 2 splenectomies, 1 reversal of a Hartmann procedure, and 1 ventral hernia repair. Two of the 19 procedures (11%) were converted to open. There were no intraoperative complications and two postoperative complications (11%). The primary surgeon considered telementoring useful in all cases (median score, 4 of 5). The mentor was also comfortable with the quality of the laparoscopic surgery performed (median score, 4 of 5). Telecommunication bandwidth for audio and video transmission was found to be a critical factor in the quality of telementoring process. Telementoring is safe and feasible. It allows community surgeons with no formal advanced laparoscopic training to benefit from expert intraoperative advice during the performance of advanced laparoscopic procedures. It may also reduce health-care costs by avoiding the need to refer and transfer patients to tertiary care centers.

Adult↗

PubMed2005

Robotic long-distance telementoring in neurosurgery.

OBJECTIVE: To test the feasibility of long-distance telementoring in neurosurgery by providing subspecialized expertise in real time to another neurosurgeon performing a surgical procedure in a remote location. METHODS: A robotic telecollaboration system (Socrates; Computer Motion, Inc., Santa Barbara, CA) capable of controlling the movements of a robotic arm, of handling two-way video, and of audio communication as well as transmission of neuronavigational data from the remote operating room was used for the telementoring procedures. Four integrated services digital network lines with a total speed of transmission of 512 kilobytes per second provided telecommunications between a large academic center (Halifax, Nova Scotia) and a community-based center (Saint John, New Brunswick) located 400 km away. RESULTS: Long-distance telementoring was used in three craniotomies for brain tumors, a craniotomy for an arteriovenous malformation, a carotid endarterectomy, and a lumbar laminectomy. There were no surgical complications during the procedures, and all patients had uneventful outcomes. The neurosurgeons in the remote location believed that the input from the mentors was useful in all of the cases and was crucial in the removal of a mesial temporal lobe glioma and resection of an occipital arteriovenous malformation. CONCLUSION: Our initial experience with long-distance robotic-assisted telementoring in six cases indicates that telementoring is feasible, reliable, and safe. Although still in its infancy, telementoring has the potential to improve surgical care, to enhance neurosurgical training, and to have a major impact on the delivery of neurosurgical services throughout the world.

Academic Medical Centers↗

PubMed1997

Interactive communication in high-technology home care: videophones for pediatric ventilatory care.

OBJECTIVE: To develop and to assess the clinical impact of a near-television quality home digital videophone system (Integrated Services Digital Network [ISDN] 64, 320 x 200 resolutions, 10 to 12 frames per second), which would provide respiratory care specialists' resources to primary care physicians and their pediatric patients receiving home respiratory care. METHOD: A prospective study comparing the preceding 6 months and following 6 months of implementation of a videophone system on seven pediatric home respiratory care patients (group I) and a prospective analytical study of three patients (group II) being introduced to home ventilatory care were carried out. Clinical effectiveness and time-saving benefits were studied. RESULTS: There were large reductions in the number of house calls by the physicians (from 5 to 0), unscheduled hospital visits by patients (from 24 to 5), and hospital admission days (from 22 to 10), with a fivefold increase in phone calls (from 11 to 58) in group I. This reduced the net number of hours spent by both patients and physicians in unscheduled medical care by 95 hours for the patients and 51.2 hours for the physicians. A total of 45 videophone calls, of which 27 were related to mechanical concerns and 18 to medical concerns, were made in group II. There were 7 mechanical and 10 medical problems of clinical significance, but all were directly handled by physicians by videophone. The majority (35 of 45) of videophone calls were made in the first 3-month period, indicating a decrease in nonspecific concerns after this period. The specifications of the system we used were found acceptable by both patients and health care professionals. The system seemed to be useful in effectively using the time of specialists and in relieving the anxieties of families. No deleterious effects were noted. The current initial cost is substantial but rapidly falling. The running cost is similar to a regular telephone bill when one ISDN 64 line is used. CONCLUSIONS: The videophone system using ISDN 64 can now be considered a practical and effective tool to recruit specialist resources into home care and to improve the quality of pediatric home ventilatory care. This study encourages the use of videophones to help establish designated home care support systems that may extend beyond national borders and time zones.

Adolescent↗

PubMed1997

Control of a remote microscope over the Internet.

Globally connected research sites frequently find the need to share information on a timely basis. The sharing of data obtained from microscopy has historically required that the researcher take micrographs of the desired image and send the film to the other site or, more recently, scan the micrographs into a computer and send the micrographs through e-mail. The authors identified the need to control and view, in as close to real time as possible, images being viewed on a remote microscope. The goal was to develop a system that would be versatile, easy to learn and readily adapted from existing materials and that would allow several users to simultaneously view and control the microscope. The use of commercially available materials along with a simple, custom-designed slide holder allowed researchers at remote sites to view one of 15 slides and move the slide as needed. The penalty for use of the Internet vs. dedicated phone lines such as Integrated Services Digital Network (ISDN) is that only 1 frame/7 s can be viewed at video resolution. The advantages of cost and multiple, simultaneous use over a ubiquitous system outweigh the disadvantage for most users.

Computer Communication Networks↗

PubMed1999

Telemedicine in neurosurgery using international digital telephone services between Japan and Malaysia--technical note.

A new image transmission and teleconference system using international digital telephone services was established between Japan and Malaysia. This new system consists of an ordinary personal computer, image scanner, and terminal adapter for digital telephone lines. The quality of images transferred using this system was high enough for diagnosis and discussion except for images such as radiographs requiring huge data transfer. Transmission of one image took approximately 20 seconds. The cost performance was almost equal to the conventional mailing system. The most remarkable advantage of this new system is the high quality of transferred images, the cost and time performance, and security of the medical information. New communication systems using international digital networks including the internet may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery.

Academic Medical Centers↗

PubMed2005

What is eHealth (4): a scoping exercise to map the field.

BACKGROUND: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service. OBJECTIVES: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends. METHODS: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings). We used the search query, "Ehealth OR e-health OR e*health". The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity. RESULTS: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations. CONCLUSIONS: We surmise that the field -- as it stands today -- may be characterized by the global definitions suggested by Eysenbach and Eng.

Delivery of Health Care↗

PubMed2005

Telemedicine in neurology: underutilized potential.

Advances in telecommunication which started with telephone lines, FAX, integrated service digital network (ISDN) lines and now internet have provided an unprecedented opportunity for transfer of knowledge and sharing of information. The information can be used for overlapping applications in patient care, teaching and research. In medicine there is increasing utilization of telemedicine; radiology and pathology being regarded as mature specialties and emergency medicine as maturing specialties compared to other evolving specialties which include psychiatry, dermatology, cardiology and ophthalmology. Of the emergencies, status epilepticus and stroke have high potential for improving patient management. Administration of tPA was more frequent when carried out under telemedicine guidance. Telemedicine has great potential for medical education. The principles of education are in congruence with those of telemedicine and can be closely integrated in the existing medical education system. Our experience of telemedicine as a medical education tool is based on video conferencing with SCB Medical College, Cuttack. We had 30 sessions during 2001 to 2004 in which 2-3 cases were discussed in each session. The patients' details, radiological and neurophysiological findings could be successfully transmitted. These conferences improved the knowledge of participants, provided an opportunity for a second opinion as well as modified the treatment decisions in some cases. The advances in telemedicine should be utilized more extensively in neurology, especially in emergency management, epilepsy and stroke patients as well, as it may have a role in neurophysiology and movement disorders.

Education, Medical↗

PubMed1999

[Consultation per video-conferencing with regional hospitals: the MEDKOM project of the Hannover Medical University].

Consultations between doctors are necessary tools for decisions in diagnosis and treatment of patients. The mainstay is a sound communication between the participants, using verbal and audio-visual means. Usually clinical findings and imaging results are included. Using video technology with ISDN (integrated services digital network), such consulting can be performed across any distance. The department of hematology and oncology of the Medical School Hanover has introduced such a system in 1989 for conferencing with 12 regional hospitals and two private practices. It is now a well recognized and established system being applied for 270 sessions and for 1100 Patients per year. It is an integrated part of the co-operation, also allows medical education and quality improvement.

Computer Systems↗

PubMed1999

[Clinical computer applications in the radiology department].

The information society is currently developing. In the field of radiology, the PACS (picture archiving and communication system) and teleradiology are widely employed in medical practice. The Ministry of Health and Welfare (MHW) reported that physicians should consider some problems in Telemedicine in December 1997. The technology of storage media is improving and we encourage the standardization of data formatting and the transmission protocol to utilize medical electronic information. Several standards exist in the medical imaging field, the DICOM (digital imaging and communications in medicine) standard, the IS&C (image save and carry) standard and the Common Standard that the Medical Information System Development Center (MEDIS-DC) defined for the electronic storage. The PACS requires high transmission speed, integrated services digital network and an asynchronous transfer mode switching system. The MHW needed a technical requirement for the electronic image storage without films in March 1994. The requirement was divided into three parts, (1) security, (2) long-term reproducibility, (3) common usage. The MEDIS-DC published the Common Standards for electronic storage in 1996. When we use the PACS via network, we must consider the security. The present network may have low security, and falsification, such as illegal login may occur. In the future, these problems will be solved, and the network-wide PACS will likely become a commonly used system.

Computer Storage Devices↗

PubMed1998

Features for a B-ISDN telemedicine system and its application.

Telemedicine technology is emerging as a new way of medical practice. It will provide more cooperative activity between departments and more comfortable access for disabled patients home. We developed two types of telemedicine system: a telediagnosis system and a home care system. Our telemedicine application is aimed to be run on the broadband-integrated services digital network (B-ISDN). The legacy network is also considered. The user interface is designed to help doctors to communicate easily. The key elements of telemedicine systems are user friendly interface, medical multimedia database design highly refined display technique.

Computer Communication Networks↗

PubMed1999

Telemedicine technology and applications for home hemodialysis.

Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links. Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment.

Female↗

PubMed1999

An international distance learning nursing course in the U.S. and Japan.

A distance learning nursing course is offered via two-way interactive video and the Internet from the University of North Carolina at Wilmington to nursing students at Mie Prefecture College of Nursing in Japan. The course was designed to teach Japanese students nursing practices and issues in the United States. The classroom environment used a combination of synchronous (two-way interactive video connections over an Integrated Services Digital Network) and asynchronous technologies (electronic mail, Internet-based discussion forums, and World Wide Web pages). Students' course evaluations highlighted areas of success, and pointed out some of the challenges that remain for effective implementation of international education courses.

Curriculum↗

PubMed1999

Saving the cost and energy by an interactive multimedia system with ISDN 128 Kbps for telemedicine.

The telemedicine systems offer many potential advantages for health care delivery. In 1997, we implemented Phoenix, the interactive multimedia system of the Nippon Telegraph and Telephone Corporation (NTT) for clinical application involving teleconsultations over a wide area for delivery of special care in emergency medicine at Tokai University linking with eight hospitals via the Integrated Service Digital Network (ISDN) 128 Kbps. This study was designed to determine the potential saving of the cost and energy through the interactive multimedia network. By using the interactive multimedia system with some modifications, we achieved a satisfactory real-time contact regarding clinical matters. We believe that this network has allowed appropriate transfer of information between medical centers. This system has also significantly reduced the estimated cost for clinical meetings.

Humans↗

PubMed2000

[Telepathology at presence and in the future].

Telepathology is the performance of pathology at distance using available telecommunication links such as optic fiber, communication satellite, and integrated services digitized network (ISDN). The main applications of telepathology are to provide frozen section service, consultation between pathologists at a distance, and conducting conferences using displays. These activities are required due to the shortage and disproportional distribution of pathologists. Telepathology for frozen section service is fairly effective in providing indications for surgical procedures by discriminating malignant tumor from benign tumor, confirming metastasis to distant organs or lymph nodes, and decisions regarding the surgical margin. However, there are several public insurance problems in the spread and practice of telepathology. To solve these problems, not only from a medical approach but also from the development of mechanical engineering, economic and legal issues must be considered.

Diagnosis, Differential↗

PubMed2000

[Telemedicine in neonatal emergencies].

UNLABELLED: Telemedicine is the transmission of medical notices and images among remote sites, that uses adequate audio-video systems. OBJECTIVE: To increase the quality and the amount of medical informations, avoiding unnecessary carriages. Among main fields of interest in Telemedicine, monitoring of cardiovascular parameters and medical emergency represent situations that need to be promptly and appropriately approached. In such a similar conditions, a preliminary transmission to III level Health Institutions of informations as Electrocardiograms or even Echocardiograms may play an essential role in the diagnosis, prognosis and treatment of emergent cardiovascular disease. METHODS: Since March 1998, an Audio-Video PC-based system that uses integrated services digital network (ISDN) at a bandwith of 384 Kbps, was installed at Pediatric Cardiac Surgery Department of Giovanni XXIII Hospital, Bari, Italy. On July 1999, thanks to Research Funds of the Health Ministry of Italy, similar audio-video systems that use ISDN were installed in the main pediatric institutions of provinces of Puglia and linked in a wide area network. RESULTS: We report the experience of Telemedicine of a Department of Pediatric Cardiology and Cardiac Surgery, and we try to analyze its impact on improvement of quality of care, once employed in provincial field.

Emergencies↗

PubMed1992

Experience and present status of telepathology in the National Cancer Center Hospital, Tokyo.

The optical fiber high definition television (HDTV) live image system with a remote control microscope is an ideal telepathology system. Diagnostic accuracy with this system is high enough for pathology consultation. However, it is very expensive to set up. The integrated services digital network (ISDN)-HDTV still image system using public telephone lines presently available in Japan INS 64 (64 kb/s), is not suitable for frozen section diagnosis and diagnosing difficult lesions. However, it functions very well for cytology consultation. When INS 1500 (1.5 Mb/s) becomes available in practice, it can substitute the optical fiber-HDTV live image system in terms of cost and efficacy. Pathologists must become accustomed to making diagnosis from images on the monitor. They must be very careful in making diagnosis, when images are transmitted from institutions without pathologists, since selection error may occur at the time of frozen section and at the time of transmission of images.

Cancer Care Facilities↗