Telemedicine in Micronesia.

Distance and isolation profoundly affect the delivery of health care in the islands of Micronesia. The lack of specialty services on most of the islands has led to a costly off-island referral system that strains health care budgets. Care providers there have incorporated advances in telecommunications to create a telemedicine network amongst themselves and with a tertiary care hospital in Hawaii. They developed an interactive video conferencing system, a still-image transmission network, and a data transfer network for use principally in patient care and continuing education. Patients now receive earlier evaluation by off-island specialists as part of an effort to improve the appropriateness of off-island referrals. Regularly scheduled medical lectures are broadcast from Pohnpei, a main island, to physicians in several more remote locations. Transmission costs are kept low by using, when possible, preexisting public-service satellites, such as the PEACESAT system that serves the entire Pacific basin. The telemedicine system is evolving, and its success depends greatly on the cooperative relationships among the partners.     

Telemedicine in laryngology.

OBJECTIVE: The significance and usefulness of image transmission in laryngology were evaluated retrospectively on the basis of daily clinical practice. MATERIALS AND METHODS: The subjects consisted of 29 patients with laryngeal disease, whose laryngeal findings had been already recorded on videotape. Patient data were sent to a major hospital by Internet e-mail. Two laryngeal images, during breathing at rest and phonation, were transmitted as an attached file. Using a rigid or flexible endoscope coupled with a one-chip CCD camera, laryngeal images were recorded. Pictures of these laryngeal images were printed by a video printer, digitized by a compact print scanner, and saved as JPEG files. RESULTS: The diagnosis made by the three specialists in laryngology (receivers), who referred to the transmitted images and text files of the patient's history, was identical to the diagnosis made by the general otolaryngologist (sender), who referred to the original pictures and patient data. All images were displayed with sufficient quality to evaluate morphologic abnormalities, and the disturbance of cordal movements was detectable by comparing images during breathing at rest with those obtained during phonation. CONCLUSION: The image-transmitting system was a useful tool for consultation between otolaryngologists and for referrals from general practitioners to otolaryngologists.     

远程医学在野战医疗中的应用

在进入信息时代和生命科学世纪的今天,远程医学的发展具有重大而深远的意义.本文主要介绍了远程医学的基本概念、远程医学系统的基本模式、以及远程医学在军队野战医疗中的实际应用情况及发挥的作用等,并提出未来远程医学在部队信息化建设中的发展.     

Telemedicine screening of glaucoma.

OBJECTIVES: Glaucoma is a major cause of blindness. More than 80,000 Americans suffer permanent vision loss from the disease. Widespread screening is fundamental in limiting the incidence of glaucoma-associated blindness. This pilot study explored the use of stereo digital images taken at a primary care center for telemedicine review by an off-site specialist as a means of screening for glaucoma. MATERIALS AND METHODS: Thirty-two diabetic patients were screened at a family medicine clinic. None had previously been diagnosed with glaucoma. A senior optometry student took stereoscopic digital and 35-mm optic disc photographs with a nonmydriatic retinal camera. The digital images were forwarded to a remote ophthalmologist for review. The conventional color stereo slide pairs of the same eyes were subsequently reviewed for comparison. Agreement on signs of glaucomatous disc changes between the two imaging systems was analyzed. RESULTS: Twenty-six of 32 eyes' digital and 35-mm photographs were analyzed. Six of 32 eyes (18.8%) could not be compared due to lack of matching 35-mm slides or digital images. Out of 26 eyes, lamina cribosa visibility was undeterminable in 8 eyes' digital images and 3 other eyes' 35-mm slides. Agreement among digital images and 35-mm slides of the remaining eyes was: 100%-vertical elongation, barring of vessels, bayoneting of vessels, and drance hemorrhage; 96.2%-focus notching of rim and rim pallor; 93.3%-lamina cribosa visability; 92. 3%-overpass cupping; 88.5%-focal enlargement; 84.6%-parapapillary halo; 80%-nerve fiber visibility; 65.4%-parapapillary atrophy. Parapapillary halo (p = 0.046) and nerve fiber layer visibility (p = 0.18) were detected on some 35-mm slides but not seen on matching digital views. CONCLUSION: Evaluations of cup-to-disc ratio (C/D) using both methods were in general agreement. However, some digital images were noted as too dark for assessing fine glaucomatous disc changes. Stereo digital images taken with a nonmydriatic camera by nonophthalmic photographers is a promising alternative for glaucoma screening in primary care settings. Telemedicine offers efficient communications with off-site glaucoma specialists. A larger study population is necessary to determine the overall effectiveness of using stereo digital imagery and teleophthalmology for glaucoma screening.     

Telemedicine for dermatology care in rural patients.

BACKGROUND: Rural patients who develop dermatologic disorders often do not seek specialty care because of multiple logistical and economic factors. OBJECTIVE: To assess the effect of teledermatology consultations on the cost of care for a given episode of illness. METHODS: Telemedicine records were reviewed for 119 visits by 87 patients referred for teledermatology consultation over a 17-month period. RESULTS: Seven patients (8%) required follow-up in the dermatologist office for extended care, while 20 patients (23%) (52 visits) underwent follow-up teledermatology evaluation. The average duration of the dermatologic condition for each patient prior to the telemedical consultation was 17 months. The average of care for the diagnosed dermatologic condition, for all patients during an average period of 8 months prior to teledermatology was $294, compared with $141 for the 6 months after diagnosis by teledermatology. CONCLUSIONS: Telemedicine can be effective for dermatology consultation in new patients referred from rural communities. Our data indicate teledermatology can decrease the cost of care for the diagnosed condition.     

Telemedicine and distributed medical intelligence.

Recent trends in health care informatics and telemedicine indicate that systems are being developed with a primary focus on technology and business, not on the process of medicine itself. The authors present a new model of health care information, distributed medical intelligence, which promotes the development of an integrative medical communication system addressing the process of providing expert medical knowledge to the point of need. The model incorporates audio, video, high-resolution still images, and virtual reality applications into an integrated medical communications network. Three components of the model (care portals, Docking Station, and the bridge) are described. The implementation of this model at the East Carolina University School of Medicine is also outlined.     

发展迅速的远程医疗

远程医疗是医疗保健技术、远程通讯技术和信息科学等学科的结合。远程医疗因其广阔的发展前景 ,而得到广泛的关注。本文就其发展概况、应用等方面作一概述 ,同时也指出了它所带来的一些不容忽视的问题     

远程医疗的发展及应用

始于五十年代末期远程医疗是医学、通讯计算机及多媒体多媒体等技术的相互结合，国外这方面的研究正方兴未艾。远程医疗在我国的研究虽然虽然起步较晚，但近年来也受到了越来越多的关注，本文综述了远程医疗的发展历程、国内外研究的现状及其应用领域，同时也指出了它所带来的一些不容忽视的问题。