Systematic review of studies of patient satisfaction with telemedicine

ObjectiveTo review research into patient satisfaction with teleconsultation, specifically clinical consultations between healthcare providers and patients involving real time interactive video.DesignSystematic review of telemedicine satisfaction studies. Electronic databases searched include Medline, Embase, Science Citation Index, Social Sciences Citation Index, Arts and Humanities Citation Index, and the TIE (Telemedicine Information Exchange) database.SubjectsStudies conducted worldwide and published between 1966 and 1998.Results32 studies were identified. Study methods used were simple survey instruments (26 studies), exact methods not specified (5), and qualitative methods (1). Study designs were randomised controlled trial (1 trial); random patient selection (2); case-control (1); and selection criteria not specified or participants represented consecutive referrals, convenience samples, or volunteers (28). Sample sizes were ≤20 (10 trials), ≤100 (14), >100 (7), and not specified (1). All studies reported good levels of patient satisfaction. Qualitative analysis revealed methodological problems with all the published work. Even so, important issues were highlighted that merit further investigation. There is a paucity of data examining patients'' perceptions or the effects of this mode of healthcare delivery on the interaction between providers and clients.ConclusionsMethodological deficiencies (low sample sizes, context, and study designs) of the published research limit the generalisability of the findings. The studies suggest that teleconsultation is acceptable to patients in a variety of circumstances, but issues relating to patient satisfaction require further exploration from the perspective of both clients and providers.     

Systematic review of cost effectiveness studies of telemedicine interventions

ObjectivesTo systematically review cost benefit studies of telemedicine.DesignSystematic review of English language, peer reviewed journal articles.Results557 articles without cost data categorised by topic. 55 articles with data initially categorised by cost variables employed in the study and conclusions. Only 24/55 (44%) studies met quality criteria justifying inclusion in a quality review. 20/24 (83%) restricted to simple cost comparisons. No study used cost utility analysis, the conventional means of establishing the “value for money” that a therapeutic intervention represents. Only 7/24 (29%) studies attempted to explore the level of utilisation that would be needed for telemedicine services to compare favourably with traditionally organised health care. None addressed this question in sufficient detail to adequately answer it. 15/24 (62.5%) of articles reviewed here provided no details of sensitivity analysis, a method all economic analyses should incorporate.ConclusionThere is no good evidence that telemedicine is a cost effective means of delivering health care.

What is already known on this topic

The use of telemedicine has garnered much attention in the past decadeHundreds of articles have been published claiming that telemedicine is cost effectiveHowever, missing from the literature is a synthesis or meta-analysis of these publications

What this study adds

A comprehensive literature search of cost related articles on telemedicine identified more than 600 articles, but only 9% contained any cost benefit dataOnly 4% of these articles met quality criteria justifying inclusion in a formalised quality review, and most of these were small scale, short term, pragmatic evaluations with few generalisable conclusionsThere is little published evidence to confirm whether or not telemedicine is a cost effective alternative to standard healthcare delivery     

Peer review of consultations in primary care: the use of audiovisual recordings.

A rating scale was designed to measure performance in interviewing techniques in primary care. Peer review of audiovisual recordings of their consultations showed that a group of experienced general practitioners achieved significantly higher scores on the rating scale compared with a group of similarly experienced general practitioners who did not observe their recordings. The higher scores were obtained at the expense of longer consultations. The traditional five-minute appointment system in general practice needs to be reconsidered if an improved interviewing technique results in a more favourable outcome.     

Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review

ObjectiveTo assess whether transferring knowledge from specialists at centres of excellence to referring doctors through online consultations can improve the management of patients requiring specialised care.DesignRetrospective case review of the first year of internet based patient initiated consultations between referring doctors and consulting specialists.SettingUS teaching hospitals affiliated with an organisation providing internet based consultations.ParticipantsDoctors in various settings around the world engaging in internet based consultations with specialists.Results79 consultations took place. 90% (n=71) of consultations were for services related to oncology. 90% of consultations involved new recommendations for treatment. The most common recommendation was a new chemotherapeutic regimen (68%, n=54). Diagnosis changed in 5% (n=4) of cases. The average turnaround time was 6.8 working days compared with an average of 19 working days to see a comparable specialist.ConclusionsInternet based consultations between specialists at centres of excellence and referring doctors contribute to patient care through recommendations for new treatment and timely access to specialist knowledge. Although change in diagnosis occurred in only a few cases, the prognostic and therapeutic implications for these patients may be profound.

What is already known on this topic

Telemedicine could improve health care by transferring knowledge from centres of excellence to patients'' doctorsFew studies have systematically assessed the value of such internet based specialty consultations

What this study adds

Patients can benefit from internet based consultations between their doctor and consulting specialistsNew recommendations for treatment were discussed in 90% of cases, and change in diagnosis occurred in 5% of casesPatients can access a specialist''s opinion more quickly than waiting to see a specialist     

生物航煤生产技术的发展现状

由于温室气体的大量排放和对化石燃料的高度依赖,航空业的可持续发展得到了全世界的关注。生物航煤被认为是一种有前景的传统航空燃料替代品。本文概述了制备生物航煤的代表性工艺技术路线、发展现状以及生物航煤产业发展所面临的机遇和挑战。迄今为止,已经有多种生物航煤制备工艺得到美国材料实验协会(American Society for Testing and Materials, ASTM)认证。其中,酯和脂肪酸加氢是目前最为成熟、可以实现完全商业化的路径。考虑到技术经济性和成熟度,短期内,费托合成是比较有发展前景的工艺。     

多约束代谢网络模型的研究进展

基于约束的基因组尺度代谢网络模型(genome-scale metabolic models,GEMs)分析已被广泛应用于代谢表型的预测.而实际细胞中代谢速率除计量学约束外,还受到酶资源可用性和反应热力学可行性等其他因素影响,在GEMs中整合酶资源约束或者热力学约束构建多约束代谢网络模型可以进一步缩小优化解空间,提升细...     

Development of a program package for modelling biochemical systems

The development of a program for the identification of a model including up to 15 compartments is presented. The identification of the model parameters with this program package is based upon the improved Gauss Marquardt algorithm. This program, implemented on a microcomputer (Data General) Eclipse 64 K RAM), uses a calculation and automatic generation of a partial derivative routine. Thus, starting from the differential equations of the model correctly written, there is no longer any risk of error.     

Cryo-Electron Microscopy: The field of 1,000+ methods

Cryo-Electron Microscopy (CryoEM) is currently a well-established method to elucidate a biological macromolecule’s three-dimensional (3D) structure. Its success is due to technological and methodological advances in several fronts: sample preparation, electron optics and detection, image acquisition, image processing, and map interpretation. The first methods started in the late 1960s and, since then, new methods on all fronts have continuously been published, maturating the field as we know it now.In terms of publications, we can distinguish several periods, witnessing a substantial acceleration of methodological publications in recent years, pointing out to an increased interest in the domain. On the other hand, this accelerated increase of methods development may confuse practitioners about which method they should be using (and how) and highlight the importance of paying attention to establishing best practices for methods reporting and usage.In this paper, we analyze the trends identified in over 1,000 methodological papers. Our focus is primarily on computational image processing methods. However, our list also covers some aspects of sample preparation and image acquisition.Several interesting ideas stem out from this study: (1) Single Particle Analysis (SPA) has largely accelerated in the last decade and sample preparation methods in the last five years; (2) Electron Tomography is not yet in a rapidly growing phase, but it is foreseeable that it will soon be; (3) the work horses of SPA are 3D classification, 3D reconstruction, and 3D alignment, and there have been many papers on these topics, which are not considered to be solved yet, but ever improving; and (4) since the resolution revolution, atomic modelling has also caught on as a hot topic.     

The relevance to family physicians of core content review: evaluation of a program of continuing education.

The Core Content Review of Family Medicine was assessed for its relevance to family practice. Three sets of questionnaires were completed and assessed by 48 experienced, certificated family physicians, of whom half were faculty members from university departments of family medicine and half were in private practice. The answers to 57% of the questions were correct. In the opinion of the panelists the answers to 62% of the questions permitted discrimination between physicians providing care of good quality and those providing care that was less than adequate. The panelists rated 78% of the questions as being educationally useful. Two thirds of the questions were deemed relevant according to a composite criterion. Examples are given of the questions considered most relevant and of those considered least relevant.     

Development of insects under fluctuating temperature: a review and case study

The relationship between temperature and the developmental rate of organisms is crucial for understanding a variety of biological processes. It is common to use an average‐based index of temperature, for example degree‐days, for examining the relationship; and relatively little attention has been given to the variance of temperature. In this study, we examined the importance of temperature fluctuation on the development of organisms by compiling published studies. Published studies have shown highly variable results where the developmental rate was sometimes higher and sometimes lower under static temperature compared with variable temperature. A laboratory experiment on Megaselia scalaris showed that M. scalaris developed faster under fluctuating temperature than static temperature. We tested an additive model to predict the effect of fluctuating temperature on development and found that the model was inadequate for making quantitative predictions. However, some qualitative predictions, for example temperature fluctuation has a positive or negative effect, can be successfully predicted by the additive model. Our results show that the effect of temperature on developmental rate is not completely additive and average‐based indices such as degree‐days cannot be used when quantitative predictions are required.     

PEDPLO: a pedigree plot program

The program PEDPLO supports the graphical presentation of inheritance. The plot produced is a tree ramifying towards the younger generation. There is only little dependence on the special software and hardware of the plot.     

Invasive growth: a genetic program

Invasive growth is defined as a complex biological program which instructs cells to dissociate, migrate, degrade the surrounding matrix, proliferate and survive. Together, these processes account for tissue morphogenesis, homeostasis and repair, and can be aberrantly implemented for cancer dissemination and metastasis. Individual aspects of this process can be controlled by many cytokines and growth factors. However, coordinated regulation of invasive growth as a whole is specifically accomplished by Hepatocyte Growth Factor, a soluble factor which acts through the tyrosine kinase receptor Met. Here we discuss the different biological facets of invasive growth and analyze the intracellular signals which lead to its execution.