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The EUROCAT website www.eurocat-network.eu publishes prenatal detection rates for major congenital anomalies using data from European population-based congenital anomaly registers, covering 28% of the EU population as well as non-EU countries. Data are updated annually. This information can be useful for comparative purposes to clinicians and public health service managers involved in the antenatal care of pregnant women as well as those interested in perinatal epidemiology. more...

We conducted a review to establish the range and scope of current telemedicine guidelines and standards. Published guidelines were identified by searching the Medline and Telemedicine Information Exchange (TIE) databases, and by performing a Google search using the term 'telemedicine guidelines'. Three types of guidelines were identified, namely clinical, operational and technical. Clinical guidelines included those for teleradiology, telepsychiatry, home telenursing, minor injuries telemedicine, surgical telemedicine, teledermatology and telepathology. Operational guidelines included those for email communication, Internet access and videoconferencing. Technical guidelines included those from the American Telemedicine Association and the US Office for the Advancement of Telehealth. The main standards relevant to telemedicine include those of the International Telecommunication Union and the DICOM standard. The scarcity of guidelines and standards suggests that telemedicine is not yet near to routine use. If an international telemedicine organization were to take responsibility for defining guidelines, under the direction of clinicians with appropriate telemedicine experience, this might speed up their development. more...

We developed a general model to assess patient activity within the primary and secondary health-care sectors following a dermatology outpatient consultation. Based on observed variables from the UK teledermatology trial, the model showed that up to 11 doctor-patient interactions occurred before a patient was ultimately discharged from care. In a cohort of 1000 patients, the average number of health-care visits was 2.4 (range 1-11). Simulation analysis suggested that the most important parameter affecting the total number of doctor-patient interactions is patient discharge from care following the initial consultation. This implies that resources should be concentrated in this area. The introduction of teledermatology (either realtime or store and forward) changes the values of the model parameters. The model provides a quantitative tool for planning the future provision of dermatology health-care. more...

There is a surprising lack of published experience on the use of videoconferencing in clinical genetics. Patients were randomly allocated to either a telegenetic (cases) or face-to-face (control) conventional clinic. The telegenetic consultation was done by videoconferencing, using ISDN lines at 384 kbit/s. Evaluation by the doctor and counsellor took place immediately after each appointment. The patient was asked to evaluate the appointment by telephone questionnaire about four weeks after the event. Forty-two patients were invited to participate and 33 (79%) returned their consent forms. Four patients declined to participate and were seen in ordinary face-to-face clinics. Preliminary results showed that the assessment of the telegenetics consultations by doctors, counsellors and patients was very favourable, and they responded positively when asked if they would be happy to use telemedicine in the future. For use in selected consultations, videoconferencing does appear to fulfil a useful role in clinical genetics. more...

The ability of the human eye to perceive depth was measured using a specially designed instrument. Visual acuity and both monocular and binocular stereoacuity were measured when viewing the instrument directly and via a videoconferencing link. Ten subjects with an average age of 32.5 years (range 24-50) took part in the study. The group mean visual acuity using both eyes under normal test conditions was -0.04 logMAR (Snellen 6/5) compared with 0.18 logMAR (Snellen 6/10) for the video-link. The mean stereoacuity using both eyes was 37" (SD 18") under normal test conditions. When a videoconferencing link was used, the mean stereoacuity fell to 1218" (SD 1203") using one eye and to 1651" (SD 1419") using both eyes. The ability to perceive depth remotely via a video-link was significantly decreased compared with normal test conditions. more...

During late 1998 and early 1999, planning officers in Cornwall predicted a huge increase in summer visitors to the county to observe the August solar eclipse. There was the possibility that a mass gathering in Cornwall could overload existing arrangements for handling accident and emergency patients. We therefore set up a telemedicine system to support the county's minor injury units (MIUs) from hospitals throughout the UK. Six main hospital accident and emergency departments outside Cornwall with existing links to their own MIUs were twinned with 10 of the 11 MIUs in Cornwall before the expected date of the gathering. The network was live for nine days, starting four days before the eclipse, and 2045 patients were seen in the 10 MIUs. There were 93 telemedicine calls from the 10 MIUs, involving 91 patients. Overall, 4.6% of the patients required a telemedicine consultation. Fifty-seven calls were made during working hours. Thirty-four patients were referred for further management, of whom 18 were referred on the same day. The transfer of telemedical support to a national network was successful. more...

We conducted a follow-up study of patients who had attended a nurse-led minor accident and treatment service (MATS) and who had participated in a teleconsultation. Over three and a half years, 31,510 patients had attended the MATS unit and 1854 patients (5.9%) of these had participated in a teleconsultation. Of the 1854 telemedicine patients, 1199 had been referred to hospital or clinic and 1153 had actually attended. Retrospective examination of the relevant hospital records showed that in 25 cases (2%) the original telediagnosis was considered incorrect at face-to-face review and that treatment was either begun or changed in 264 cases (23%). All patients, including those discharged home after the teleconsultation, were sent a questionnaire about any changes to their injury. Of the 655 patients discharged home, a questionnaire response was obtained from 598 (91%). Following discharge, 43 of these patients had sought help from another health-care provider (the majority from their general practitioner). Of the 46 patients referred to hospital who did not keep their follow-up appointments, questionnaire results were obtained from 35 (76%). Nine of these patients had sought help from another health-care provider (the majority from their general practitioner) but there had been no change in diagnosis or treatment. Our findings suggest that teleconsultations are an effective means of delivering minor injuries care. more...

We assessed the proportion of home nursing visits that could be replaced by home telenursing in the UK. A retrospective review of nursing notes in the UK was undertaken using an abstraction instrument developed and tested in the US. A total of 1951 episodes of patient care at home were reviewed: 1450 from Liverpool and 501 from Belfast. A total of 1626 (83%) of the episodes involved 'hands-on' interventions. In Belfast two observers estimated that 14% of home nursing visits could be done via telemedicine while in Liverpool two more observers gave an estimate of 16%. Inter-rater agreement was high (kappa = 0.93 for the Belfast observers and 0.79 for the Liverpool observers). Pilot trials of an analogue video-phone in Belfast suggested that even relatively low-quality compressed video might be useful for home nursing. These findings suggest that telemedicine may have a significant role in the delivery of home health care in the UK. more...

Nursing notes for patients nursed at home in the USA and the UK were reviewed using an abstraction instrument developed and tested in the US. More than 1700 episodes of patient care at home were reviewed: 906 in the US and 839 in the UK. Preliminary data suggest that in the US approximately 45% of home nursing visits could be done via telemedicine, while the figure is lower in the UK, less than 15%. Pilot trials of an analogue video-telephone in Kansas City and Belfast suggest that even relatively low-quality compressed video may be useful for home nursing. Clearly, there are differences between the two countries which merit further study, but there is evidence to suggest that telemedicine may have a role in the delivery of home health care. more...