Practical aspects of telehealth: doctor–patient relationship and communication

The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.     

Medical oncology clinics through videoconferencing: an acceptable telehealth model for rural patients and health workers

Background: Since 2007, Townsville Cancer Centre (Queensland, Australia) has provided routine and urgent medical oncology services to rural and remote communities through videoconferencing. At remote sites, patients were accompanied by doctors and other health workers. The aim of this study was to describe satisfaction of patients and rural health workers with this model of teleoncology. Methods: Between May 2007 and June 2010, 55 videoconferencing patients were invited to participate in a questionnaire‐based telephone survey after informed consent. The survey included responses to 16 satisfaction statements using a 5‐point Likert scale. Perspectives of health workers involved were recorded using open‐ended questions on six themes related to telehealth. Results: Among the 50 participating cancer patients, median age was 56 years (range 28–83). Seventy‐six per cent of patients thought specialist physical examination was important despite local doctors performing it. Seventy‐six per cent of patients felt the presence of accompanying local health workers was not important. Seventy‐eight per cent of patients preferred to be seen in Mt Isa for the first consultation through videoconferencing than travelling to Townsville. More than 80% of patients were in agreement with the rest of the satisfaction statements. Ninety‐six per cent of patients were in agreement with the question relating to overall satisfaction. Eighteen health workers participated and their responses and attitudes were favourable towards telehealth. Conclusion: Satisfaction with this model of care was proven to be high among both patients and health workers. Benefits perceived included effective communication between patients and specialists, reduced travel time and money expenditure, and superior specialist support for rural health workers.     

Relationship between hospital size and teaching status on outcomes for reverse shoulder arthroplasty

MUSCULOSKELETAL SURGERY - The use of reverse shoulder arthroplasty (RSA) continues to grow with expanding indications and increased surgeon awareness. Previous data for other lower extremity joint...     

Homeostasis of Brain Dynamics in Epilepsy: A Feedback Control Systems Perspective of Seizures

In an effort to understand basic functional mechanisms that can produce epileptic seizures, some key features are introduced in coupled lumped-parameter neural population models that produce “seizure”-like events and dynamics similar to the ones during the route of the epileptic brain towards seizures. In these models, modified from existing ones in the literature, internal feedback mechanisms are incorporated to maintain the normal low level of synchronous behavior in the presence of coupling variations. While the internal feedback is developed using basic feedback systems principles, it is also functionally equivalent to actual neurophysiological mechanisms such as homeostasis that act to maintain normal activity in neural systems that are subject to extrinsic and intrinsic perturbations. Here it is hypothesized that a plausible cause of seizures is a pathology in the internal feedback action; normal internal feedback quickly regulates an abnormally high coupling between the neural populations, whereas pathological internal feedback can lead to “seizure”-like high amplitude oscillations. Several external seizure-control paradigms, that act to achieve the operational objective of maintaining normal levels of synchronous behavior, are also developed and tested in this paper. In particular, closed-loop “modulating” control with predefined stimuli, and closed-loop feedback decoupling control are considered. Among these, feedback decoupling control is the consistently successful and robust seizure-control strategy. The proposed model and remedies are consistent with a variety of recent observations in the human and animal epileptic brain, and with theories from nonlinear systems, adaptive systems, optimization, and neurophysiology. The results from the analysis of these models have two key implications, namely, developing a basic theory for epilepsy and other brain disorders, and the development of a robust seizure-control device through electrical stimulation and/or drug intervention modalities.

Spinal Cord Injury Induced by a Cervical Spinal Cord Stimulator

Objective: The use of cervical spinal cord stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of spinal cord stimulators. Methods: Analysis of a patient with a cervical spinal cord stimulator presenting with a spinal cord injury. Patient was followed from presentation in the emergency room until 1‐year follow‐up in the office. Results: The patient in this case presented after a fall and sustained a cervical spinal cord injury induced by the electrodes of her spinal cord stimulator working as a space occupying mass. Conclusion: As more patients are undergoing implantation of spinal cord stimulators we must be aware of the long‐term risks that can be encountered.     

Over-expression of Eph and ephrin genes in advanced ovarian cancer: ephrin gene expression correlates with shortened survival

Background  

Increased expression of Eph receptor tyrosine kinases and their ephrin ligands has been implicated in tumor progression in a number of malignancies. This report describes aberrant expression of these genes in ovarian cancer, the commonest cause of death amongst gynaecological malignancies.     

What should doctors know about cancer? Undergraduate medical education from a societal perspective

Cancer is a major health problem, but medical undergraduate education about cancer leaves many practitioners ill-prepared. All practitioners need some knowledge of cancer. Those practising in rural areas might need more knowledge because of their isolation from tertiary services. We review the need for cancer education from the perspective of patients and clinicians, and examine the cancer-knowledge skills and attitudes of medical undergraduates. Patients with cancer expect their family practitioner to be knowledgeable enough to act as their advocate and to be able to interpret for them the complex array of tests and treatments that they could face. Many oncologists think that they do not have adequate access to students because of entrenched attitudes within universities that aim to protect established teaching programmes and leave little room to adapt teaching to the changing needs of society. Surveys of medical undergraduates have shown that, over the past decade, students have less contact with patients and retain some misconceptions about cancer. To deliver appropriate standards of cancer teaching, an undergraduate programme should incorporate a national or international standard curriculum and a minimum number of essential experiences. Because assessment drives education, students' knowledge, skills, and attitudes relating to cancer should be assessed, and the outcomes of such assessment should inform the curriculum.