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Biodegradable nanoparticles for drug delivery prepared by a new spray-drying process. Journal of Magnetic Resonance, in press. Modeling dispersion in arterial spin labeling: Validation using dynamic angiographic measurements. A fast analysis method for non-invasive imaging of blood flow in individual cerebral arteries using vessel-encoded arterial spin labelling angiography. A kinetic model for vessel-encoded dynamic angiography with arterial spin labeling.
Magnetic resonance in medicine: Critical Reflections, Future Directions. American Journal of Neuroradiology, Modelling Inception and Enlargement, GA. Multiscale Modelling of Vascular Disease: Abdominal Aortic Aneurysm Evolution, In: Multiscale modelling of intracranial aneurysms: An aortic model for the physiological assessment of endovascular stent-grafts. Annals of Vascular Surgery, Multiscale Modelling of Intracranial Aneurysms: Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs , and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing.
Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities. The term can also refer to the use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely.
Teleneuropsychology Cullum et al. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected brain disorders and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings that are similar to traditional in-person evaluations, thereby establishing the basis for the reliability and validity of teleneuropsychological assessment.
Telerehabilitation or e-rehabilitation [36] [37] is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: Some fields of rehabilitation practice that have explored telerehabilitation are: Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance. Most telerehabilitation is highly visual. As of , the most commonly used mediums are webcams , videoconferencing , phone lines , videophones and webpages containing rich Internet applications.
The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation ; fitting of rehabilitation equipment such as wheelchairs , braces or artificial limbs ; and in speech-language pathology.
Rich internet applications for neuropsychological rehabilitation aka cognitive rehabilitation of cognitive impairment from many etiologies were first introduced in This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology hearing assessments is a growing application. Currently, telerehabilitation in the practice of occupational therapy and physical therapy is limited, perhaps because these two disciplines are more "hands on".
Two important areas of telerehabilitation research are 1 demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and 2 building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics the sense of touch and virtual reality may broaden the scope of telerehabilitation practice, in the future.
Only a few health insurers in the United States, and about half of Medicaid programs, [40] reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services. Telemedicine can be utilized to improve the efficiency and effectiveness of the delivery of care in a trauma environment.
Telemedicine for trauma triage: They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient. Telemedicine for intensive care unit ICU rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people to include attending physicians, fellows, residents and other clinicians.
This group usually moves from bed to bed in a unit discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift, but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside.
Video-conferencing allows the remote viewers two-way communication with clinicians at the bedside. Telemedicine for trauma education: Each lecture provides fundamental principles, firsthand knowledge and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources. Telemedicine in the trauma operating room: This capability allows the attending to view the residents in real time.
The remote surgeon has the capability to control the camera pan, tilt and zoom to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient. Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C. ECGs, or electrocardiographs , can be transmitted using telephone and wireless.
This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In Einthoven came up with a way to transmit the data from the hospital directly to his lab. Remotely treating ventricular fibrillation Medphone Corporation, Mantri using an indigenous technique for the first time in India. Transmission using wireless was done using frequency modulation which eliminated noise.
Transmission was also done through telephone lines. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas. In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology.
There are many examples of successful telecardiology services worldwide. Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. Three hubs were established: These 12 remote sites were connected and on average of 1, patients being treated per month per hub.
The project was still running smoothly after two years. Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings.
As of , the following are some of the model programs and projects which are deploying telepsychiatry in rural areas in the United States:. There is an independent comparison site of current technologies. Links for several sites related to telemedicine, telepsychiatry policy, guidelines, and networking are available at the website for the American Psychiatric Association. In April , a Manchester-based Video CBT pilot project was launched to provide live video therapy sessions for those with depression, anxiety, and stress related conditions called InstantCBT [56] The site supported at launch a variety of video platforms including Skype, GChat, Yahoo, MSN as well as bespoke [57] and was aimed at lowering the waiting times for mental health patients.
This is a Commercial, For-Profit business. In the United States, the American Telemedicine Association and the Center of Telehealth and eHealth are the most respectable places to go for information about telemedicine. For this reason, most companies provide their own specialized videotelephony services.
The momentum of telemental health and telepsychiatry is growing. In June the U. Veterans Administration announced expansion of the successful telemental health pilot. Their target was for , cases in There is an independent comparison site that provides a criteria-based comparison of telemental health technologies. The most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes.
Sometimes the receiving computer will have a printer so that images can be printed for convenience. The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.
Today's high-speed broadband based Internet enables the use of new technologies for teleradiology: Therefore, they do not need particular workstations to view the images; a standard personal computer PC and digital subscriber line DSL connection is enough to reach keosys central server. No particular software is necessary on the PC and the images can be reached from wherever in the world. Telepathology is the practice of pathology at a distance.
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It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis , education , and research. The use of " television microscopy ", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement is the selection of microscopic fields-of-view for analysis and diagnosis.
A pathologist, Ronald S. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia. Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses, at a distance, for education, and for research.
Although digital pathology imaging, including virtual microscopy , is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries. Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency.
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In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists. Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine. Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology.
Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6—12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally.
There were huge cost savings in travel etc. Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions varying from state to state that may release an out-of-state practitioner from the additional burden of obtaining such a license.
A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.
If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. In , the U. State medical licensing boards have sometimes opposed telemedicine; for example, in electronic consultations were illegal in Idaho, and an Idaho-licensed general practitioner was punished by the board for prescribing an antibiotic, triggering reviews of her licensure and board certifications across the country.
In , Teladoc filed suit against the Texas Medical Board over a rule that required in-person consultations initially; the judge refused to dismiss the case, noting that antitrust laws apply to state medical boards. In the United States, the major companies offering primary care for non-acute illnesses include Teladoc , American Well , and PlushCare. In this PrEP initiative, PlushCare does not require an initial check-up and provides consistent online doctor visits, regular local laboratory testing and prescriptions filled at partner pharmacies. Remote surgery also known as telesurgery is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location.
It is a form of telepresence. Remote surgery combines elements of robotics , cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital. Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user.
Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated. Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time.