Journal of telemedicine and telecare

Description

Telemedicine' has been defined in general terms to be 'medicine practised at a distance' and as such it encompasses both diagnosis and treatment, as well as medical education. During the last decade certain telemedicine applications, such as videoconsulting and teleradiology, have matured to become essential health care services. Others, such as telepathology, remain the subject of intensive research effort. The Journal of Telemedicine and Telecare publishes peer-reviewed papers on all aspects of both telemedicine and telecare - the latter covering distance nursing and community support. It is relevant to both the primary and secondary medical sectors, as well as having application to the veterinary field, and includes papers on all aspects of these emerging fields. In addition to original articles, the journal publishes preliminary communications, commissioned review articles, case reports, letters to the Editor and book reviews.

Publications in this journal

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    ABSTRACT: We conducted a pilot trial of a remote blood pressure (BP) monitoring system, in which subjects measured their own BP at a primary healthcare centre. The data were wirelessly transmitted to the general practitioner. A total of 132 subjects with a new or prior diagnosis of hypertension were enrolled. Their mean age was 61 years and 77 were men (58%). They were followed for an average of 487 days (range 19-1110). The median number of BP measurements made was 6 per patient (range 2-49). The mean blood pressure decreased from 137/85 to 132/78 mmHg (P < 0.001) and the percentage of subjects with adequately controlled BP (defined as < 140/90 mmHg) increased from 47 to 66% (P < 0.01). Randomised trials are now required to confirm these findings.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: Summary We assessed the accuracy of telephone triage at the 7119 telephone consultation centre in Tokyo. We evaluated walk-in patients at primary care facilities in a clinic or hospital. Nurses asked all patients calling 7119 to join the study and gave them a specific identification number (ID no) at the end of the telephone consultation. The outcome of the consultation was defined as discharge to home (home), admittance to hospital (hospitalization), referral, or transfer to another hospital. After matching consultation records and patient data by ID no, emergency medical physicians reviewed the protocol for problems. During the study, consultation nurses issued an ID no in 17,141 cases, and hospitals and clinics sent back the data on 1205 patients. Among these patients, 1119 cases (93%) were home, 59 cases (5%) were hospitalization, 18 cases (2%) were referral and 9 cases (1%) were transfer. Of the 86 cases which had an outcome of hospitalization, referral or transfer, there were 56 cases with matched patient data. Among these 56 cases, review showed no significant problems with 37 cases. However, there were 11 cases with patient refusal to comply with the triage recommendation, 4 cases with 7119 staff education problems and 4 cases with problems with the protocol itself. We were able to evaluate the 7119 telephone triage system in Tokyo. The study identified three types of problems with the triage process: refusal of telephone triage recommendations, problems with staff education and problems with the protocol itself.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: Summary We studied the effectiveness of a home-based exercise programme with information technology (IT) support in people with metabolic syndrome in India. Ninety-four participants with metabolic syndrome (mean age 50 years) were randomized into two groups. Both groups received a 12-week home exercise programme and Group 2 received additional IT support for health education. Before and after the exercise programme, participants were measured for arterial stiffness using applanation tonometry, exercise capacity using an incremental shuttle walk test and quality of life (QoL) using the SF-36 questionnaire. Sixty-one participants completed the post intervention tests. There was a significant reduction in systolic blood pressure, mean pressure and aortic systolic pressure in both groups. Pulse wave velocity, aortic pulse pressure and aortic diastolic pressure showed significant reductions only in Group 2. There were no significant changes in QoL measures, except vitality in Group 2. There was significant improvement in fasting blood glucose in Group 2, cholesterol in Group 1 and triglycerides in both groups. The participants' exercise capacity did not change significantly, although the mean duration of regular exercise was 7.2 weeks for Group 1 and 10.0 weeks for Group 2 (P = 0.019). Metabolic syndrome was reversed in 16% of the participants in both groups. IT support, through mobile text messages and phone calls, may be helpful in metabolic syndrome. Longer-term studies are now required.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: We assessed an early notification system using smartphones to reduce door-to-balloon times (DTBT) in ST-elevation myocardial infarction (STEMI). Text page alarms were sent to cardiologists for all patients presenting with chest pain or an equivalent in the emergency department before acquisition of an electrocardiogram (ECG). A total of 210 patients (with mean age of 59 years) were investigated (109 in the intervention group and 101 in a control group from the previous two-year period). The primary outcome, the DTBT, was significantly lower in the intervention group compared to the control group (55.0 and 92.5 min, respectively, P < 0.001). In a secondary analysis, the length of hospital stay was also significantly less. However, there was no significant improvement in all-cause one-year mortality. Early text page alarms using smartphones were effective in reducing the DTBT, but had a limited effect on clinical outcome.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: An e-consultation is an asynchronous consultation performed by a specialist without a face-to-face patient visit. E-consultations have been available to primary care providers at the Mayo Clinic for several years. We reviewed e-consultations performed by specialists at the Mayo Clinic for the first six months of 2013. We included only "internal" e-consultations, originating from within the Rochester practice. During the study period a total of 3242 e-consultations were completed at the Mayo Clinic. After excluding those relating to patients who did not give research consent, 3008 e-consultations remained. We categorized our internal e-consultations into eight types. The most frequently used types were the first e-consultation processes to be implemented: the primary care to specialist e-consultation and the specialist to specialist e-consultation, accounting for 74% of the total. As these two types of e-consultation became widely used, the staff discovered that the e-consultation process could be adapted to meet specific practice needs and six more e-consultation types emerged. For example, intra-specialty e-consultations and surgical e-consultations accounted for 16% of the total. E-consultations appear to have improved access to specialists, and they are integrated into care processes when timely expert opinions are needed. As e-consultations evolve, it will be important to develop a standard, well-defined terminology to compare outcomes of these processes across practices.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: We examined the effect of SMS text messages on compliance with iron supplementation among pregnant women. A randomized controlled trial was conducted on 116 pregnant women referred from public health centres in Ahvaz. Their gestational age was 14-16 weeks. The subjects were randomly assigned to a control group who received usual care, or to a 12-week intervention with SMS reminders in addition to usual care. Participants in both groups were provided with iron supplements and taught how to take iron tablets. Most women in the intervention group (94%) had high compliance with iron supplements compared to the control group (66%); this difference was significant (P = 0.003). Although haemoglobin, haematocrit and ferritin decreased significantly in each group, there was no significant difference between them. Using SMS reminders is an efficient way of improving compliance of women with iron supplementation during pregnancy. However, in the present study better compliance did not improve anaemia.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: We conducted a systematic review of the evidence on the costs and cost-effectiveness of telehealth for patients with chronic obstructive pulmonary disease (COPD). A literature search identified six relevant economic evaluations that were assessed according to the Consensus Health Economic Criteria list (CHEC list). Three studies were from North America and three studies were from Europe. All studies reported the use of home monitoring devices that measured and transmitted different physical indicators to nurses who provided personalised feedback to patients during weekdays. The six studies involved a total of 559 COPD patients of whom 281 were randomised to telehealth. The review demonstrated a potential for cost savings. All six studies reported a lower average cost per patient with telehealth plus usual care compared with usual care alone. However, the quality of the economic evidence was poor. Five studies were evaluated as low quality and one study was evaluated as moderate quality, with CHEC list scores of 21-68%. Caution is advised for healthcare decision-makers seeking large-scale implementation of telehealth in routine clinical practice. The clinical effectiveness of such implementations with follow-up exceeding 12 months has not yet been demonstrated.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: We conducted a feasibility study of a home telehealth system that monitored blood pressure and bodyweight. A total of 34 participants with hypertension (10 males and 24 females) had the telemedicine system installed in their homes. Their mean age was 72 years and 94% of them self-identified as Hispanic. The telehealth system transmitted blood pressure and bodyweight data to a server. There was also a messaging function that was used to send a daily reminder to the participants. Participants used the telehealth system for six months. Ten participants were lost to follow up and 24 participants completed the entire study. Participants had strong positive perceptions regarding the usability and usefulness of the telemedicine system. Most of them (92%) found the device easy to use and 96% felt that the training they received prepared them to use the device. The providers indicated that use of the system improved their ability to manage their patients. The results of the study suggest that use of the telehealth system for home monitoring in Hispanic patients with hypertension is feasible.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: A critical review of evidence was carried out to discover whether the actual performance of telemedicine fulfils the expectations of German policy-makers. The analysis was conducted using the example of telemedicine for congestive heart failure (CHF). It was based on both German and international evidence. The PubMed, MEDLINE, Google Scholar and Cochrane Library databases were searched, as well as public sources from the German Federal Ministry of Health. Forty-five studies reporting patient outcomes, costs or acceptance of telemedicine for CHF were included in the review, of which 28 were interventional. The policy expectations of telemedicine generally are: high technology acceptance and improved patient outcomes at lower costs. However, in the field of CHF, policy-makers underestimate the complexity of telemedicine and the technology has not yet lived up to its expectations. Although some studies show improvements in all-cause mortality and CHF-related hospitalisations, there is excessive study heterogeneity and vagueness in the areas of costs and acceptance. Methodological insufficiencies as well as the scarcity of evidence in the German context do not allow definite conclusions to be drawn. Policy-makers and other stakeholders should increase their efforts to consolidate isolated telemedicine projects, establish guidelines for clinical treatment procedures and economic evaluations, and define industry/technical device standards to enhance the comparability of interventions. Imposing the use of telemedicine on patients and physicians is not likely to be fruitful. A successful adaptation requires an analysis of needs and continuous education on both sides.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: Dermatology images can be acquired using a miniature handheld digital microscope at magnifications of 10- to 30-fold. We investigated the contribution of telemicroscopy to the reliability and accuracy of teledermatology for skin tumours. In a retrospective study of the reliability of diagnosis and management plans, two dermatologists compared teledermatology with face-to-face assessment. We also measured the accuracy of diagnosis by comparing teledermatology with histopathological examination. Two dermatologists evaluated the clinical images and information for 120 randomly sorted cases and recorded a diagnosis and a management plan for each case. Two months later, the same dermatologists re-evaluated the cases and suggested a new diagnosis and management plan for each case. The reliability of teledermatology diagnosis was not significantly different from face-to-face examination; it was significantly increased with the addition of microscopic images (P < 0.001). The reliability of teledermatology management plans was not significantly different from face-to-face examination; it was significantly increased with the addition of the microscopic images (P < 0.001). The accuracy of teledermatology was significantly increased with microscopic images (P = 0.05). Telemicroscopy appears to be a useful adjunct to teledermatology with a digital camera. Future studies with different magnifications should be performed to detect the optimum magnification for telemicroscopy.
    Journal of telemedicine and telecare 05/2014;
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    ABSTRACT: We conducted a feasibility study of a web-based intervention, which provided personalized cardiovascular disease (CVD) risk information, behavioural risk reduction strategies and educational resources. Participants were block-randomized to the 3-month intervention (n = 47) or to usual care (n = 49). Participants in the intervention group were presented with their CVD risk based on the Framingham risk score, and in three subsequent online encounters could select two behavioural/lifestyle modules, giving them an opportunity to complete six modules over the course of the study. Because it was self-guided, participants had differing levels of engagement with intervention materials. Most intervention group participants (77%, n = 36) completed all modules. After 3 months there were no significant differences between the intervention and usual care groups for systolic blood pressure, body-mass index, CVD risk, smoking cessation or medication non-adherence. The study suggests that modest clinical improvements can be achieved by interventions that are entirely web-administered. However, web-based interventions do not replace the need for human interaction to communicate CVD risk and assist with decision-making.
    Journal of telemedicine and telecare 03/2014;
  • Journal of telemedicine and telecare 03/2014;
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    ABSTRACT: We evaluated the advice given by a prototype self-assessment triage system in a university student health centre. Students attending the health centre with a new problem used the automated self-assessment system prior to a face-to-face consultation with the general practitioner (GP). The system's rating of urgency was available to the GP, and following the consultation, the GP recorded their own rating of the urgency of the patient's presentation. Full data were available for 154 of the 207 consultations. Perfect agreement, where both the GP and the self-assessment system selected the same category of advice, occurred in 39% of consultations. The association between the GP assessment and the self-assessment rankings of urgency was low but significant (rho = 0.19, P = 0.016). The self-assessment system tended to be risk averse compared to the GP assessments, with advice for more urgent level of care seeking being recommended in 86 consultations (56%) and less urgent advice in only 8 (5%). This difference in assessment of urgency was significant (P < 0.001). The agreement between self-assessed and GP-assessed urgency was not associated with symptom site or socio-demographic characteristics of the user. Although the self-assessment system was more risk averse than the GPs, which resulted in a high proportion of patients being triaged as needing emergency or immediate care, the self-assessment system successfully identified a proportion of patients who were felt by the GP to have a self-limiting condition that did not need a consultation. In its prototype form, the self-assessment system was not a replacement for clinician assessment and further refinement is necessary.
    Journal of telemedicine and telecare 03/2014;
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    ABSTRACT: Telemedicine ("telepractice") allows improved access to specialised early intervention services such as Auditory-Verbal Therapy (AVT) for children with hearing loss. We investigated the effectiveness of a tele-AVT programme (eAVT) in the spoken language development of a group of young children with hearing loss. In a retrospective study we compared the language outcomes of children with bilateral hearing loss receiving eAVT with a control group who received therapy In Person. Seven children in each group (mean age 2.4 years) were matched on pre-amplification hearing level for the better hearing ear, age at optimal amplification and enrolment in the AVT programme. The eAVT sessions were conducted via Skype. Results on the Preschool Language Scale-4 were compared at 2 years post optimal amplification. There were no significant differences in language scores between the two groups. Language scores for the children in the eAVT group were within the normal range for children with normal hearing. The results suggest that early intervention AVT via telepractice may be as effective as delivery In Person for children with hearing loss.
    Journal of telemedicine and telecare 03/2014;
  • Journal of telemedicine and telecare 03/2014;
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    ABSTRACT: We conducted a feasibility study of a mobile phone messaging service for children and adolescents with type 1 diabetes. Two hundred children with type 1 diabetes took part in a six-month trial. The children were provided - through their parents - with daily information messages, with weekly interactive messages, and on request, with multimedia video messages about procedures related to diabetes care. During the study, approximately 30,000 information messages and 2800 interactive messages were sent. One month before the trial, the mean fasting blood glucose level of the children was 150 mg/dl. After the trial, the mean fasting blood glucose level was 133 mg/dl (P < 0.001). There were also significant reductions in post prandial blood glucose level, HbA1c, frequency of simple hypoglycaemic attacks and frequency of blood glucose monitoring. A before and after questionnaire showed that the parents' knowledge of diabetes had improved significantly during the trial. Mobile phone text messaging offers a useful means of contact between clinic visits. The results of the trial suggest that it increases adherence to diabetes therapy and improves clinical outcomes in children and adolescents with type 1 diabetes.
    Journal of telemedicine and telecare 03/2014;
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    ABSTRACT: We conducted a six-month feasibility study of a mobile-phone-based home monitoring system, called M-COPD. Patients with a history of moderate Acute Exacerbation of COPD (AECOPD) were given a mobile phone to record major symptoms (dyspnoea, sputum colour and volume), minor symptoms (cough and wheezing) and vital signs. A care team remotely monitored the recorded data and provided clinical interventions. Eight patients (mean age 65 years) completed the trial. Ten acute exacerbations occurred during the trial and were successfully treated at home. Prior to the AECOPD episode, the combined score of the major symptoms increased significantly (P < 0.05). Following the intervention, it decreased significantly (P < 0.05) within two weeks and returned to the baseline. The score of the minor symptoms also increased significantly (P < 0.05), but the decrease following the intervention was not significant. There were significantly fewer hospital admissions during the trial, fewer ED presentations and fewer GP visits than in a six-month matched period in the preceding year. The results demonstrate the potential of home monitoring for analysing respiratory symptoms for early intervention of AECOPD.
    Journal of telemedicine and telecare 03/2014;
  • Journal of telemedicine and telecare 03/2014;