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Accuracy of routine echocardiographic measurements made by an inexperienced examiner through tele-instruction.

https://arctichealth.org/en/permalink/ahliterature68989
Source
J Telemed Telecare. 1996;2(3):148-54
Publication Type
Article
Date
1996
Author
J E Afset
P. Lunde
K. Rasmussen
Author Affiliation
Department of Medicine, Kirkenes Hospital, Norway.
Source
J Telemed Telecare. 1996;2(3):148-54
Date
1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cost-Benefit Analysis
Echocardiography - economics - methods
Female
Humans
Male
Medically underserved area
Middle Aged
Norway
Reproducibility of Results
Research Support, Non-U.S. Gov't
Telemedicine - economics - methods
Video Recording
Abstract
The reproducibility and accuracy of routine echocardiographic measurements made by an inexperienced doctor using tele-instruction were evaluated. Thirty-eight patients were first examined at a local hospital by an inexperienced doctor instructed by a specialist 450 km away at a university hospital. The specialist then examined the patients at the local hospital using the same equipment, after an average of 50 days. The accuracy of M-mode and quantitative Doppler measurements was comparable to that observed in reproducibility studies made under normal examination conditions. There were no systematic measurement errors. No important M-mode information was missed except evidence of left ventricular hypertrophy in six patients. In the two-dimensional examination there were differences of clinical significance in only three patients. There were no clinically important differences in the Doppler quantification of mitral and aortic regurgitation. Tele-instructed echocardiography is also an excellent educational tool, allowing an inexperienced examiner gradually to take responsibility for the local echocardiographic service.
PubMed ID
9375049 View in PubMed
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The added value of thorough economic evaluation of telemedicine networks.

https://arctichealth.org/en/permalink/ahliterature150016
Source
Eur J Health Econ. 2010 Feb;11(1):45-55
Publication Type
Article
Date
Feb-2010
Author
Myriam Le Goff-Pronost
Claude Sicotte
Author Affiliation
Telecom-Bretagne, Ecole Supérieure des Télécommunications de Bretagne, (LUSSI)/MARSOUIN/CREM, Département LUSSI, Logiques des Usages, Sciences Sociales et Sciences de l'Information, GET/ENST-Bretagne, Technopôle de Brest Iroise, CS 83818, 29238, Brest Cedex 3, France. myriam.legoff@telecom-bretagne.eu
Source
Eur J Health Econ. 2010 Feb;11(1):45-55
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Cardiology - economics - organization & administration
Child
Cost-Benefit Analysis
Hospitals, Community - economics
Hospitals, Teaching - economics
Humans
Models, Economic
Pediatrics - economics - organization & administration
Quebec
Retrospective Studies
Social Welfare
Telemedicine - economics - organization & administration
Abstract
This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.
PubMed ID
19562393 View in PubMed
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The application of teleophthalmology in examining patients with glaucoma: a pilot study.

https://arctichealth.org/en/permalink/ahliterature50906
Source
J Glaucoma. 1999 Dec;8(6):367-73
Publication Type
Article
Date
Dec-1999
Author
A. Tuulonen
T. Ohinmaa
H I Alanko
P. Hyytinen
A. Juutinen
E. Toppinen
Author Affiliation
Department of Ophthalmology, University of Oulu, Finland.
Source
J Glaucoma. 1999 Dec;8(6):367-73
Date
Dec-1999
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Female
Glaucoma - diagnosis - economics
Humans
Internship and Residency
Male
Middle Aged
Nerve Fibers - pathology
Ophthalmology - economics - education - methods
Optic Disk - pathology
Optic Nerve - pathology
Patient satisfaction
Pilot Projects
Primary Health Care - economics - methods
Remote Consultation - economics - methods
Retina - pathology
Rural Population
Teaching - methods
Telemedicine - economics - methods
Visual Fields
Abstract
PURPOSE: To test the feasibility of teleophthalmology applications in examining patients with glaucoma, test its use for training purposes in an ophthalmology residency program and as a consultation link between primary healthcare unit and university eye clinic, and to introduce a preliminary model for economic assessment of telemedicine application in ophthalmology. METHODS: A video slit-lamp, an automated perimeter, a nonmydriatic fundus camera and a videoconferencing system were installed in a healthcare center in a rural area. Twenty-nine patients with glaucoma were examined in the rural healthcare center instead of the university eye clinic. A control group consisted of 41 glaucoma patients examined at the eye clinic one year earlier. An ophthalmic resident examined the patients together with the local general practitioner. An interactive video consultation was created with the university glaucoma clinic using ISDN connections and special application software. RESULTS: Both patient groups were equally satisfied with the ophthalmic service. Nearly all patients in the telemedicine group (96%) wanted to have their next visit in their own healthcare center instead of the university clinic. The most important reasons were reduction in traveling (97%), costs (92%), and time (92%). The costs of the telemedicine and conventional visits were equal, but decreased traveling saved $55 per visit. However, the quality of the images obtained in the remote center was poorer than that of the images obtained at the university clinic. CONCLUSION: The results of this pilot study indicate that further research with a larger number of patients is warranted to evaluate both methods, technology, and economics of teleophthalmology.
PubMed ID
10604295 View in PubMed
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Can a telemonitoring system lead to decreased hospitalization in elderly patients?

https://arctichealth.org/en/permalink/ahliterature309373
Source
J Telemed Telecare. 2021 Jan; 27(1):46-53
Publication Type
Journal Article
Date
Jan-2021
Author
Johan Lyth
Leili Lind
Hans L Persson
Ann-Britt Wiréhn
Author Affiliation
Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Sweden.
Source
J Telemed Telecare. 2021 Jan; 27(1):46-53
Date
Jan-2021
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Female
Health Care Costs - statistics & numerical data
Health Resources - statistics & numerical data
Heart Failure - economics - epidemiology - therapy
Home Care Services, Hospital-Based - economics - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Male
Pulmonary Disease, Chronic Obstructive - economics - epidemiology - therapy
Sweden - epidemiology
Telemedicine - economics - statistics & numerical data
Abstract
Growing populations of elderly patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) require more healthcare. A four-year telehealth intervention - the Health Diary system based on digital pen technology - was implemented. We hypothesized that study patients with advanced COPD or HF would have lower rates of hospitalization when using the Health Diary. The aim was to investigate the effects of the intervention on healthcare costs and the number of hospitalizations, as well as other care required in COPD and HF patients.
Patients were introduced to the telemonitoring system which was supervised by a specialized hospital-based home care (HBHC) unit. Staff associated with this unit were responsible for the healthcare provided. The study included patients with COPD or HF, aged = 65 years who were frequently hospitalized due to exacerbations - at least two inpatient episodes within the last 12 months. Observed number of hospitalizations and total healthcare costs were compared with the expected values, which were calculated using the generalized estimating equations (GEE) method.
A total of 36 COPD and 58 HF patients with advanced stages of disease were included. The number of hospitalizations was significantly reduced for both HF and COPD patients participating in telemonitoring. Accordingly, hospitalization costs were significantly reduced for both groups, but the total healthcare cost was not significantly different from the expected costs.
A telemonitoring system, the Health Diary, combined with a specialized HBHC unit significantly decreases the need for hospital care in elderly patients with advanced HF or COPD without increasing total healthcare costs.
PubMed ID
31291794 View in PubMed
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Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector.

https://arctichealth.org/en/permalink/ahliterature262422
Source
PLoS One. 2014;9(9):e105040
Publication Type
Article
Date
2014
Author
Asa Holmner
Kristie L Ebi
Lutfan Lazuardi
Maria Nilsson
Source
PLoS One. 2014;9(9):e105040
Date
2014
Language
English
Publication Type
Article
Keywords
Carbon Footprint - economics - statistics & numerical data
Climate Change - economics
Cost-Benefit Analysis
Delivery of Health Care - economics
Health Care Sector - economics
Hospitals, University
Humans
Sweden
Telemedicine - economics
Travel - economics
Videoconferencing - economics
Abstract
The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers.
To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector.
A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases.
Replacing physical visits with telemedicine appointments resulted in a significant 40-70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car.
Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.
Notes
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Cites: J Telemed Telecare. 2007;13(6):303-917785027
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Cites: J Telemed Telecare. 2009;15(3):137-819364897
Cites: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2009 Mar;52(3):270-819259634
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PubMed ID
25188322 View in PubMed
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Clinical validation of a low-cost telemedicine equipment remote medical diagnostics kit at a tertiary care hospital.

https://arctichealth.org/en/permalink/ahliterature152256
Source
J Assoc Physicians India. 2008 Oct;56:769-76
Publication Type
Article
Date
Oct-2008
Author
R S Math
S. Mishra
K S Kumar
V K Bahl
Author Affiliation
Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Source
J Assoc Physicians India. 2008 Oct;56:769-76
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Costs and Cost Analysis
Diagnostic Techniques, Cardiovascular - economics - instrumentation
Hospitals
Humans
Physical Examination - instrumentation
Reproducibility of Results
Sensitivity and specificity
Telemedicine - economics - instrumentation
Abstract
The Remote Medical Diagnostics kit is an indigenous and low-cost technology that can measure and transmit via the internet 6 clinical parameters viz. Blood pressure (BP), pulse, temperature, oxygen saturation, 12-lead Electrocardiogram (ECG) and heart/breath sounds. Prior to commercial use, it needs clinical validation.
Fifty three patients (including 1 acute myocardial infarction) were evaluated for the above parameters using accepted standard methods and the Remote Medical Diagnostics kit.
The intraclass correlation coefficient (ICC) for systolic BP (SBP), diastolic BP (DBP), saturation pulse, manual pulse and temperature was 0.927, 0.904, 0.989, 0.99 and 0.912 indicating a high degree of agreement between the two methods. For oxygen saturation, the ICC was 0.763 indicating a moderately high agreement. For heart sounds, the kappa coefficient (kappa) for inter-rater reliability was 0.48 (observed agreement of 96.1%). For breath sounds, the 'kappa' value was 0.48 indicating moderate agreement. For the breath sounds, the 'kappa' value was 0.38, indicating fair agreement (the observed agreement of 94.2%). For the ECG, the observed agreement was 94.4% by visual assessment.
At the bedside, the Remote Medical Diagnostics kit was clinically validated for the above 6 parameters.
PubMed ID
19263702 View in PubMed
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Collaborative efforts are needed to ensure proper knowledge dissemination of telemedicine projects.

https://arctichealth.org/en/permalink/ahliterature262976
Source
Dan Med J. 2014 Sep;61(9):A4896
Publication Type
Article
Date
Sep-2014
Author
Neel Kolthoff Jakobsen
Lena Sundby Jensen
Lars Kayser
Source
Dan Med J. 2014 Sep;61(9):A4896
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Denmark
Documentation
Health Communication
Health Services Research - economics - methods - organization & administration
Humans
Information Dissemination
Periodicals as Topic - statistics & numerical data
Research Design
Research Support as Topic - organization & administration
Telemedicine - economics - methods - organization & administration
Abstract
Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were documented and disseminated.
Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted and information about project results and dissemination were obtained.
More than half of all projects were disseminated to professionals as well as to the public and used two-way communication. However, it was generally difficult to obtain an overview of the projects due to dynamic changes in names and scopes.
We propose that the funding authorities require designs comprising proper evaluation models that will subsequently allow the investigators to publish their findings. Furthermore, a dissemination plan comprising both peers and other professions should be made mandatory. The investigators should ensure proper documentation and dissemination of changes both during and after the projects in order to ensure transparency, and national or international organisations should establish a database with relevant data fields.
not relevant.
PubMed ID
25186538 View in PubMed
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78 records – page 1 of 8.