2007 6th International Special Topic Conference on Information Technology Applications in Biomedicine, 2007
... The following medical sensors are used in the VMOTE-II: Digital SP02 Sensor and C02 Sensor, A... more ... The following medical sensors are used in the VMOTE-II: Digital SP02 Sensor and C02 Sensor, Analog Sensors (Skin Temperature and GSR Sensors). ... The regular SP02 and HR values are calculated on a 4 beat average whilst the E-HR and E-SP02 readings are calculated on ...
2007 9th International Conference on e-Health Networking, Application and Services, 2007
A low-power, wireless, wearable physiological monitoring system has been developed and implemente... more A low-power, wireless, wearable physiological monitoring system has been developed and implemented using commercial off-the-shelf components. The non-invasive system supports physiological monitoring of skin temperature, oxygen saturation (SpO2), heart rate (HR), blood volumetric pressure (BVP) and galvanic skin resistance (GSR). The sensors are integrated into a wearable device that can be used to monitor the health and wellness of various
The U.S. Government and other developed nations provide billions of dollars annually in relief as... more The U.S. Government and other developed nations provide billions of dollars annually in relief assistance to countries around the world. The long-term benefits of this aid, however, are often difficult to elucidate. The aim of this article is to present a model of a multipartnership collaboration among U.S. governmental, nongovernmental organizations, and academia to rebuild medical systems using telemedicine as a sustainable model of foreign aid. The International Virtual e-Hospital implemented the ''initiate-build-operatetransfer'' strategy to establish an effective telemedicine system in Albania that includes the National Telemedicine Center and 12 regional telemedicine centers. This nationwide telemedicine network has active clinical programs, virtual educational programs, and an electronic library that has substantially improved the access to care while advancing medical education. We propose that telemedicine is an optimal, sustainable, low-cost model for rebuilding medical systems of developing countries when implemented through a multipartnership approach.
In April 2005, a panel discussion was held at the Med-e-Tel International Trade Event and Confere... more In April 2005, a panel discussion was held at the Med-e-Tel International Trade Event and Conference for eHealth, Telemedicine and Health ICT in Luxembourg. The panel addressed the issue of satellite applications for telehealth in the developing world. There are some 150 ...
Video is a powerful medium and is underused for patient safety in several areas: education, real-... more Video is a powerful medium and is underused for patient safety in several areas: education, real-time consultation, process improvement, research, and workflow coordination. We illustrate this point through an overview of uses of video in health care by the authors and others in several institutions. These uses were in the context of team work training, operating room coordination, technical skills of invasive procedures, process improvement, telementoring, and multimedia video records. Also described are several key issues associated with the use of video, such as ethics and legal concerns. Technology advances and new methods will make video an important tool for improving patient safety.
Background With the use of electronic information distribution and telecommunication technologies... more Background With the use of electronic information distribution and telecommunication technologies, surgical teleconsultation is possible as a vehicle for consulting with experts remotely without their physical presence in the operating room (OR). This study evaluated real-time teleconsultation from the OR to remote consultants in the Russian Research Center of Surgery, Moscow, Russia and the Fundeni Clinical Hospital, Bucharest, Romania. Methods We evaluated the effectiveness of teleconsultation using a secure website interface where consultants could navigate through multimedia-based electronic documentation of a surgical procedure and identify the anatomic landmarks underlying the need for consultation. Additionally, management of a remote camera view by consultants was evaluated. Results Fifteen thyroidectomies and parathyroidectomies were studied to confirm by teleconsultation the identity of 22 recurrent laryngeal nerves (RLNs). There was no Internet connectivity interruption or dropped signal, and the bandwidth was consistently greater than 1 Mbps. Consultants spent an average of 6 min to review an average of 35 min of surgical records to identify the 22 RLNs.
Adherence to the treatment regimen for patients with diabetes is of major concern to healthcare p... more Adherence to the treatment regimen for patients with diabetes is of major concern to healthcare practitioners, particularly when dealing with the high-risk, low-income, Mexican-American population. Assessing the attitudes and beliefs of this group is vital for planning effective and realistic intervention strategies. Therefore, we designed a culturally sensitive instrument to measure health beliefs and attitudes of low-income Mexican Americans with diabetes. The Health Belief Model (HBM) was used as a basis for this study because it is well accepted as a predictor of health-related behaviors. However, we found that the HBM was not an effective tool for assessing the health beliefs or attitudes of this patient population even after rigorous efforts to operationalize the HBM and after conducting extensive statistical analyses. Only two of the five subscales of the traditional HBM, barriers and benefits, were reliable. Scales to measure acculturation and fatalism were added to increase the cultural sensitivity of the tool. These added components were found to be an important variable in interpreting the results for low-income Mexican-American patients.
Long-term cyclosporin A (CsA) administration in dogs was studied with respect to function of the ... more Long-term cyclosporin A (CsA) administration in dogs was studied with respect to function of the islets of Langerhans. After 3 weeks of immunosuppression with therapeutic doses, the islets were isolated and assessed in vitro for insulin release in response to glucose challenge. Islet tissue retrieved from the CsA-treated animals showed a total insulin output significantly lower than that of the control animals (p less than 0.01). The first and second phases of insulin release were both impaired in animals treated with CsA compared with controls (p less than 0.001 and p less than 0.05, respectively). The negative impact of CsA on the beta cells was easily demonstrated in this in vitro study. Similar results are more difficult to achieve with purely in vivo models, probably due to the great redundancy of the islet mass in intact animals. The mechanism of this CsA toxicity remains to be defined.
Background: There clearly must be a surgical capability to support the exploration of the solar s... more Background: There clearly must be a surgical capability to support the exploration of the solar system by humans. We hypothesized that microgravity would impair surgical task performance and sought to measure degree and criticality of task erosion. Methods: Twenty subjects performed basic laparoscopic exercises (grasping, cutting, clipping, and suturing) in an inanimate trainer on the ground and during the microgravity phase of a parabolic flight. Skill assessment involved time, accuracy, and force transfer. Results: A decrease in the total number of on-target task completions was observed in microgravity compared with the ground performance for all tasks. The ratio between the total number of attempts and the number of completions was higher in microgravity. The amount of force introduced into the system was not significantly higher in microgravity.
1University of Miami Miller School of Medicine, Miami, Florida. 2University of WisconsinMadison,... more 1University of Miami Miller School of Medicine, Miami, Florida. 2University of WisconsinMadison, Madison, Wisconsin. 3 CPR Strategic Marketing Communications, Elmwood Park, New Jersey. 4 Advanced Center for Telemedicine and Surgical Innovation, ...
Telemedicine applications can connect surgeons from one operating room (OR) to a distant consulta... more Telemedicine applications can connect surgeons from one operating room (OR) to a distant consultant. The additional capacity of telepresence provides remote consultants the ability to control their own view of the surgical field using robotic management of a network camera. The goal of this study was to compare access to surgical field by robotic camera versus image controlled by the surgeon using a camera mounted to the table. A Stryker laparoscopic camera was attached to the OR table using a Mediflex arm, and video image was transmitted with a Polycom Transfer Control Protocol (TCP)/Internet Protocol (IP) connection. A network Sony camera was mounted on a tripod, connected over the Internet using a parallel TCP/IP connection. A Web interface allowed control of the camera angle and zoom. In 22 consultations effective bandwidth was 800 Kbps for the network camera and 1024 Kbps for the Stryker camera. The operation was thyroidectomy and the consultant was either in Moscow, Russia, or Bucharest, Romania. The quality of the image in both methods was indiscernible. The ability to identify critical surgical anatomy was also indiscernible. No transmission session failed or had an interruption. The robotic camera can be a powerful tool for surgical collaboration.
Establishing sustainable telemedicine has become a goal of many developing countries around the w... more Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.
This report presents a series of recommendations derived from deliberations of the G8 countries S... more This report presents a series of recommendations derived from deliberations of the G8 countries Subproject 4 Group (SP4 Group) of the Global Health Care Applications Project entitled, A Teleconsultation Practice Guideline. The recommendations provide an initial step toward developing a general guideline platform for the practice of telemedicine/teleconsultation.
The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leavi... more The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leaving behind Albanian physicians systematically excluded from advanced medical services for a decade and medical facilities severely damaged in the course of departure in a region with an infrastructure fragmented over the years. The medical system of Kosova can be analyzed for the effectiveness of the many efforts following the disruption of medical care in the 1990s. In this paper, the application of telemedicine and information is recounted. The medical system of Kosova was offered the concept of the International Virtual E-Hospital and this model was used to support, supplement, and guide a massive program development that involved essentially every physician and medical personnel in the region. Currently, the Telemedicine Center of Kosova (TCK) is providing information resources for medical education programs within the Kosova's medical system as well as regional and international consultations and collaboration. Furthermore, it is developing the human resources that will lead and implement telemedicine programs in this region and making serious strides in the redevelopment of medical systems using information technology.
Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, ... more Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, retrieval, and exchange of information for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety. Telemedicine systems consist of collaborative health networks, facilities, and organizations dedicated to these objectives. Over the past several decades, telemedicine systems have demonstrated the capacity to do the following:
To determine applicability of low-cost digital imaging for different radiographic modalities used... more To determine applicability of low-cost digital imaging for different radiographic modalities used in consultations from remote areas of the Ecuadorian rainforest with limited resources, both medical and financial. Low-cost digital imaging, consisting of hand-held digital cameras, was used for image capture at a remote location. Diagnostic radiographic images were captured in Ecuador by digital camera and transmitted to a password-protected File Transfer Protocol (FTP) server at VCU Medical Center in Richmond, Virginia, using standard Internet connectivity with standard security. After capture and subsequent transfer of images via low-bandwidth Internet connections, attending radiologists in the United States compared diagnoses to those from Ecuador to evaluate quality of image transfer. Corroborative diagnoses were obtained with the digital camera images for greater than 90% of the plain film and computed tomography studies. Ultrasound (U/S) studies demonstrated only 56% corroboration. Images of radiographs captured utilizing commercially available digital cameras can provide quality sufficient for expert consultation for many plain film studies for remote, underserved areas without access to advanced modalities.
Advanced laparoscopic procedures require prolonged pneumoperitoneum. Increased intra-abdominal pr... more Advanced laparoscopic procedures require prolonged pneumoperitoneum. Increased intra-abdominal pressure causes a number of hemodynamic changes including a drop in cardiac output, but it is unclear whether there is a direct effect on cardiac contractility. In this experimental study, we sought to determine whether there is a direct impact of pneumoperitoneum on cardiac contractility. We also examined the time-related changes taking place during the insufflation period. Six young pigs were anesthetized and mechanically ventilated. Pneumoperitoneum was established by insufflating carbon dioxide to a pressure of 15 mmHg and maintained for a period of 180 min. Hemodynamic parameters including left ventricular dP/dT were invasively recorded every 15 min. All hemodynamic changes were statistically evaluated, and parameters were correlated with time. Cardiac output decreased with insufflation from a baseline of 3.37 +/- 0.34 lt/min and reached the lowest value at 165 min of pneumoperitoneum (2.86 +/- 0.30 l/min; p = 0.023). Systemic vascular resistance (SVR) significantly increased from 2236 +/- 227 dyne/s/cm(5) to a maximum of 3774 +/- 324 dyne/s/cm(5) (p = 0.005). Left ventricular dP/dT maximum did not change significantly with insufflation. The decrease in cardiac output strongly correlated with the increase in SVR (r = -0.949). Time of insufflation correlated with cardiac output (r = -0.762) and dP/dT maximum (r = -0.727). Pneumoperitoneum at 15 mmHg negatively affects cardiac output without significantly affecting cardiac contractility. A significant increase in SVR appears to be the driving event for the decreased cardiac output. Prolonged pneumoperitoneum may have an additional negative effect on hemodynamic parameters.
Background: Minimally invasive surgical techniques expose surgeons to a variety of occupational h... more Background: Minimally invasive surgical techniques expose surgeons to a variety of occupational hazards that may promote musculoskeletal disorders. Telerobotic systems for minimally invasive surgery may help to reduce these stressors. The objective of this study was to compare manual and telerobotic endoscopic surgery in terms of postural and mental stress. Methods: Thirteen participants with no experience as primary surgeons in endoscopic surgery performed a set of simulated surgical tasks using two different techniques -a telerobotic master -slave system and a manual endoscopic surgery system. The tasks consisted of passing a soft spherical object through a series of parallel rings, suturing along a line 5 -cm long, running a 32-in ribbon, and cannulation. The Job Strain Index (JSI) and Rapid Upper Limb Assessment (RULA) were used to quantify upper extremity exposure to postural and force risk factors. Task duration was quantified in seconds. A questionnaire provided measures of the participants' intuitiveness and mental stress. Results: The JSI and RULA scores for all four tasks were significantly lower for the telerobotic technique than for the manual one. Task duration was significantly longer for telerobotic than for manual tasks. Participants reported that the telerobotic technique was as intuitive as, and no more stressful than, the manual technique. Conclusions: Given identical tasks, the time to completion is longer using the telerobotic technique than its manual counterpart. For the given simulated tasks in the laboratory setting, the better scores for the upper extremity postural analysis indicate that telerobotic surgery provides a more comfortable environment for the surgeon without any additional mental stress.
Background: Telementoring can be an adjunct to surgical training using virtual reality surgical s... more Background: Telementoring can be an adjunct to surgical training using virtual reality surgical simulation.
2007 6th International Special Topic Conference on Information Technology Applications in Biomedicine, 2007
... The following medical sensors are used in the VMOTE-II: Digital SP02 Sensor and C02 Sensor, A... more ... The following medical sensors are used in the VMOTE-II: Digital SP02 Sensor and C02 Sensor, Analog Sensors (Skin Temperature and GSR Sensors). ... The regular SP02 and HR values are calculated on a 4 beat average whilst the E-HR and E-SP02 readings are calculated on ...
2007 9th International Conference on e-Health Networking, Application and Services, 2007
A low-power, wireless, wearable physiological monitoring system has been developed and implemente... more A low-power, wireless, wearable physiological monitoring system has been developed and implemented using commercial off-the-shelf components. The non-invasive system supports physiological monitoring of skin temperature, oxygen saturation (SpO2), heart rate (HR), blood volumetric pressure (BVP) and galvanic skin resistance (GSR). The sensors are integrated into a wearable device that can be used to monitor the health and wellness of various
The U.S. Government and other developed nations provide billions of dollars annually in relief as... more The U.S. Government and other developed nations provide billions of dollars annually in relief assistance to countries around the world. The long-term benefits of this aid, however, are often difficult to elucidate. The aim of this article is to present a model of a multipartnership collaboration among U.S. governmental, nongovernmental organizations, and academia to rebuild medical systems using telemedicine as a sustainable model of foreign aid. The International Virtual e-Hospital implemented the ''initiate-build-operatetransfer'' strategy to establish an effective telemedicine system in Albania that includes the National Telemedicine Center and 12 regional telemedicine centers. This nationwide telemedicine network has active clinical programs, virtual educational programs, and an electronic library that has substantially improved the access to care while advancing medical education. We propose that telemedicine is an optimal, sustainable, low-cost model for rebuilding medical systems of developing countries when implemented through a multipartnership approach.
In April 2005, a panel discussion was held at the Med-e-Tel International Trade Event and Confere... more In April 2005, a panel discussion was held at the Med-e-Tel International Trade Event and Conference for eHealth, Telemedicine and Health ICT in Luxembourg. The panel addressed the issue of satellite applications for telehealth in the developing world. There are some 150 ...
Video is a powerful medium and is underused for patient safety in several areas: education, real-... more Video is a powerful medium and is underused for patient safety in several areas: education, real-time consultation, process improvement, research, and workflow coordination. We illustrate this point through an overview of uses of video in health care by the authors and others in several institutions. These uses were in the context of team work training, operating room coordination, technical skills of invasive procedures, process improvement, telementoring, and multimedia video records. Also described are several key issues associated with the use of video, such as ethics and legal concerns. Technology advances and new methods will make video an important tool for improving patient safety.
Background With the use of electronic information distribution and telecommunication technologies... more Background With the use of electronic information distribution and telecommunication technologies, surgical teleconsultation is possible as a vehicle for consulting with experts remotely without their physical presence in the operating room (OR). This study evaluated real-time teleconsultation from the OR to remote consultants in the Russian Research Center of Surgery, Moscow, Russia and the Fundeni Clinical Hospital, Bucharest, Romania. Methods We evaluated the effectiveness of teleconsultation using a secure website interface where consultants could navigate through multimedia-based electronic documentation of a surgical procedure and identify the anatomic landmarks underlying the need for consultation. Additionally, management of a remote camera view by consultants was evaluated. Results Fifteen thyroidectomies and parathyroidectomies were studied to confirm by teleconsultation the identity of 22 recurrent laryngeal nerves (RLNs). There was no Internet connectivity interruption or dropped signal, and the bandwidth was consistently greater than 1 Mbps. Consultants spent an average of 6 min to review an average of 35 min of surgical records to identify the 22 RLNs.
Adherence to the treatment regimen for patients with diabetes is of major concern to healthcare p... more Adherence to the treatment regimen for patients with diabetes is of major concern to healthcare practitioners, particularly when dealing with the high-risk, low-income, Mexican-American population. Assessing the attitudes and beliefs of this group is vital for planning effective and realistic intervention strategies. Therefore, we designed a culturally sensitive instrument to measure health beliefs and attitudes of low-income Mexican Americans with diabetes. The Health Belief Model (HBM) was used as a basis for this study because it is well accepted as a predictor of health-related behaviors. However, we found that the HBM was not an effective tool for assessing the health beliefs or attitudes of this patient population even after rigorous efforts to operationalize the HBM and after conducting extensive statistical analyses. Only two of the five subscales of the traditional HBM, barriers and benefits, were reliable. Scales to measure acculturation and fatalism were added to increase the cultural sensitivity of the tool. These added components were found to be an important variable in interpreting the results for low-income Mexican-American patients.
Long-term cyclosporin A (CsA) administration in dogs was studied with respect to function of the ... more Long-term cyclosporin A (CsA) administration in dogs was studied with respect to function of the islets of Langerhans. After 3 weeks of immunosuppression with therapeutic doses, the islets were isolated and assessed in vitro for insulin release in response to glucose challenge. Islet tissue retrieved from the CsA-treated animals showed a total insulin output significantly lower than that of the control animals (p less than 0.01). The first and second phases of insulin release were both impaired in animals treated with CsA compared with controls (p less than 0.001 and p less than 0.05, respectively). The negative impact of CsA on the beta cells was easily demonstrated in this in vitro study. Similar results are more difficult to achieve with purely in vivo models, probably due to the great redundancy of the islet mass in intact animals. The mechanism of this CsA toxicity remains to be defined.
Background: There clearly must be a surgical capability to support the exploration of the solar s... more Background: There clearly must be a surgical capability to support the exploration of the solar system by humans. We hypothesized that microgravity would impair surgical task performance and sought to measure degree and criticality of task erosion. Methods: Twenty subjects performed basic laparoscopic exercises (grasping, cutting, clipping, and suturing) in an inanimate trainer on the ground and during the microgravity phase of a parabolic flight. Skill assessment involved time, accuracy, and force transfer. Results: A decrease in the total number of on-target task completions was observed in microgravity compared with the ground performance for all tasks. The ratio between the total number of attempts and the number of completions was higher in microgravity. The amount of force introduced into the system was not significantly higher in microgravity.
1University of Miami Miller School of Medicine, Miami, Florida. 2University of WisconsinMadison,... more 1University of Miami Miller School of Medicine, Miami, Florida. 2University of WisconsinMadison, Madison, Wisconsin. 3 CPR Strategic Marketing Communications, Elmwood Park, New Jersey. 4 Advanced Center for Telemedicine and Surgical Innovation, ...
Telemedicine applications can connect surgeons from one operating room (OR) to a distant consulta... more Telemedicine applications can connect surgeons from one operating room (OR) to a distant consultant. The additional capacity of telepresence provides remote consultants the ability to control their own view of the surgical field using robotic management of a network camera. The goal of this study was to compare access to surgical field by robotic camera versus image controlled by the surgeon using a camera mounted to the table. A Stryker laparoscopic camera was attached to the OR table using a Mediflex arm, and video image was transmitted with a Polycom Transfer Control Protocol (TCP)/Internet Protocol (IP) connection. A network Sony camera was mounted on a tripod, connected over the Internet using a parallel TCP/IP connection. A Web interface allowed control of the camera angle and zoom. In 22 consultations effective bandwidth was 800 Kbps for the network camera and 1024 Kbps for the Stryker camera. The operation was thyroidectomy and the consultant was either in Moscow, Russia, or Bucharest, Romania. The quality of the image in both methods was indiscernible. The ability to identify critical surgical anatomy was also indiscernible. No transmission session failed or had an interruption. The robotic camera can be a powerful tool for surgical collaboration.
Establishing sustainable telemedicine has become a goal of many developing countries around the w... more Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.
This report presents a series of recommendations derived from deliberations of the G8 countries S... more This report presents a series of recommendations derived from deliberations of the G8 countries Subproject 4 Group (SP4 Group) of the Global Health Care Applications Project entitled, A Teleconsultation Practice Guideline. The recommendations provide an initial step toward developing a general guideline platform for the practice of telemedicine/teleconsultation.
The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leavi... more The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leaving behind Albanian physicians systematically excluded from advanced medical services for a decade and medical facilities severely damaged in the course of departure in a region with an infrastructure fragmented over the years. The medical system of Kosova can be analyzed for the effectiveness of the many efforts following the disruption of medical care in the 1990s. In this paper, the application of telemedicine and information is recounted. The medical system of Kosova was offered the concept of the International Virtual E-Hospital and this model was used to support, supplement, and guide a massive program development that involved essentially every physician and medical personnel in the region. Currently, the Telemedicine Center of Kosova (TCK) is providing information resources for medical education programs within the Kosova's medical system as well as regional and international consultations and collaboration. Furthermore, it is developing the human resources that will lead and implement telemedicine programs in this region and making serious strides in the redevelopment of medical systems using information technology.
Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, ... more Telemedicine technology embodies the electronic acquisition, processing, dissemination, storage, retrieval, and exchange of information for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety. Telemedicine systems consist of collaborative health networks, facilities, and organizations dedicated to these objectives. Over the past several decades, telemedicine systems have demonstrated the capacity to do the following:
To determine applicability of low-cost digital imaging for different radiographic modalities used... more To determine applicability of low-cost digital imaging for different radiographic modalities used in consultations from remote areas of the Ecuadorian rainforest with limited resources, both medical and financial. Low-cost digital imaging, consisting of hand-held digital cameras, was used for image capture at a remote location. Diagnostic radiographic images were captured in Ecuador by digital camera and transmitted to a password-protected File Transfer Protocol (FTP) server at VCU Medical Center in Richmond, Virginia, using standard Internet connectivity with standard security. After capture and subsequent transfer of images via low-bandwidth Internet connections, attending radiologists in the United States compared diagnoses to those from Ecuador to evaluate quality of image transfer. Corroborative diagnoses were obtained with the digital camera images for greater than 90% of the plain film and computed tomography studies. Ultrasound (U/S) studies demonstrated only 56% corroboration. Images of radiographs captured utilizing commercially available digital cameras can provide quality sufficient for expert consultation for many plain film studies for remote, underserved areas without access to advanced modalities.
Advanced laparoscopic procedures require prolonged pneumoperitoneum. Increased intra-abdominal pr... more Advanced laparoscopic procedures require prolonged pneumoperitoneum. Increased intra-abdominal pressure causes a number of hemodynamic changes including a drop in cardiac output, but it is unclear whether there is a direct effect on cardiac contractility. In this experimental study, we sought to determine whether there is a direct impact of pneumoperitoneum on cardiac contractility. We also examined the time-related changes taking place during the insufflation period. Six young pigs were anesthetized and mechanically ventilated. Pneumoperitoneum was established by insufflating carbon dioxide to a pressure of 15 mmHg and maintained for a period of 180 min. Hemodynamic parameters including left ventricular dP/dT were invasively recorded every 15 min. All hemodynamic changes were statistically evaluated, and parameters were correlated with time. Cardiac output decreased with insufflation from a baseline of 3.37 +/- 0.34 lt/min and reached the lowest value at 165 min of pneumoperitoneum (2.86 +/- 0.30 l/min; p = 0.023). Systemic vascular resistance (SVR) significantly increased from 2236 +/- 227 dyne/s/cm(5) to a maximum of 3774 +/- 324 dyne/s/cm(5) (p = 0.005). Left ventricular dP/dT maximum did not change significantly with insufflation. The decrease in cardiac output strongly correlated with the increase in SVR (r = -0.949). Time of insufflation correlated with cardiac output (r = -0.762) and dP/dT maximum (r = -0.727). Pneumoperitoneum at 15 mmHg negatively affects cardiac output without significantly affecting cardiac contractility. A significant increase in SVR appears to be the driving event for the decreased cardiac output. Prolonged pneumoperitoneum may have an additional negative effect on hemodynamic parameters.
Background: Minimally invasive surgical techniques expose surgeons to a variety of occupational h... more Background: Minimally invasive surgical techniques expose surgeons to a variety of occupational hazards that may promote musculoskeletal disorders. Telerobotic systems for minimally invasive surgery may help to reduce these stressors. The objective of this study was to compare manual and telerobotic endoscopic surgery in terms of postural and mental stress. Methods: Thirteen participants with no experience as primary surgeons in endoscopic surgery performed a set of simulated surgical tasks using two different techniques -a telerobotic master -slave system and a manual endoscopic surgery system. The tasks consisted of passing a soft spherical object through a series of parallel rings, suturing along a line 5 -cm long, running a 32-in ribbon, and cannulation. The Job Strain Index (JSI) and Rapid Upper Limb Assessment (RULA) were used to quantify upper extremity exposure to postural and force risk factors. Task duration was quantified in seconds. A questionnaire provided measures of the participants' intuitiveness and mental stress. Results: The JSI and RULA scores for all four tasks were significantly lower for the telerobotic technique than for the manual one. Task duration was significantly longer for telerobotic than for manual tasks. Participants reported that the telerobotic technique was as intuitive as, and no more stressful than, the manual technique. Conclusions: Given identical tasks, the time to completion is longer using the telerobotic technique than its manual counterpart. For the given simulated tasks in the laboratory setting, the better scores for the upper extremity postural analysis indicate that telerobotic surgery provides a more comfortable environment for the surgeon without any additional mental stress.
Background: Telementoring can be an adjunct to surgical training using virtual reality surgical s... more Background: Telementoring can be an adjunct to surgical training using virtual reality surgical simulation.
Uploads
Papers by Ronald Merrell