Browsing by Author "Patterson, Victor"
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- ItemA Bayesian tool for epilepsy diagnosis in the resource-poor world: development and early validation.(2014-07-08) Patterson, Victor; Pant, Pankaj; Gautam, Niraj; Bhandari, AnupamThe epilepsy treatment gap in resource poor countries is so large that existing numbers of doctors are unlikely to be able to close it Other health workers are likely to be needed but they will need help The diagnosis of an attack as epileptic or not is an essential step in the management of epilepsy It should be possible to devise a tool to give the probability of episodes being epileptic based on a Bayesian analysis of the results of history taking
- ItemEpilepsy field workers, a smartphone application and telephone telemedicine: Safe and effective epilepsy care in rural Nepal.(0000-00-00) Rajbhandari, Hemav; Joshi, Sweta; Malakar, Shankar; Paudel, Prakash; Jain, Priya; Uppadaya, Kapil; Singh, Mamta; Patterson, VictorPURPOSE Most people with epilepsy live in low or middle income countries LMICs where there are relatively few doctors Over 50 of people with epilepsy in these countries are untreated so other models of care are needed In this report we evaluate a novel model of care METHODS We trained four residents of Myagdi a rural district in Nepal as epilepsy field workers EFWs They provided epilepsy awareness to their communities When they identified someone with possible epilepsy they used a smartphone application app to determine the probability score for an episode being epileptic and contacted an epilepsy specialist by phone If the specialist thought treatment was indicated this was arranged by the EFW We recorded mortality change of diagnosis at face to face consultation and drug related events as measures of safety Seizure frequency and general wellbeing were also recorded and a questionnaire was devised to measure satisfaction RESULTS 112 patients with app scores suggesting epileptic seizures were identified and managed in 18 months of whom 15 had provoked seizures Forty three percent of epilepsy patients were untreated At follow up one had died of a cause other than epilepsy Diagnostic agreement at face to face assessment was 93 Overall 5 had side effects of medication Seizures were stopped in 33 and reduced in 57 Ninety six percent of patients preferred this service to travelling to other doctors CONCLUSION This novel service met all criteria of safety and was effective in reducing frequency of seizures Patients preferred it to conventional services It should be transferable to other LMICs
- ItemGuidelines for filming digital camera video clips for the assessment of gait and movement disorders by teleneurology.(2005-10-21) Schoffer, Kerrie L; Patterson, Victor; Read, Stephen J; Henderson, Robert D; Pandian, Jeyaraj D; O'Sullivan, John DDigital still cameras capable of filming short video clips are readily available but the quality of these recordings for telemedicine has not been reported We performed a blinded study using four commonly available digital cameras A simulated patient with a hemiplegic gait pattern was filmed by the same videographer in an identical brightly lit indoor setting Six neurologists viewed the blinded video clips on their PC and comparisons were made between cameras between video clips recorded with and without a tripod and between video clips filmed on high or low quality settings Use of a tripod had a smaller effect than expected while images taken on a high quality setting were strongly preferred to those taken on a low quality setting Although there was some variability in video quality between selected cameras all were of sufficient quality to identify physical signs such as gait and tremor Adequate quality video clips of movement disorders can be produced with low cost cameras and transmitted by email for teleneurology purposes
- ItemHow can teleneurology improve patient care?(2006-08-25) Patterson, Victor; Wootton, Richard
- ItemIntercontinental telemedicine for acute neurology.(2005-09-19) Patterson, Victor; Conneally, Padhraic
- ItemIntroduction to the practice of telemedicine.(2005-04-14) Craig, John; Patterson, VictorTelemedicine is the delivery of health care and the exchange of health care information across distances It is not a technology or a separate or new branch of medicine Telemedicine episodes may be classified on the basis of 1 the interaction between the client and the expert i e realtime or prerecorded and 2 the type of information being transmitted e g text audio video Much of the telemedicine which is now practised is performed in industrialized countries such as the USA but there is increasing interest in the use of telemedicine in developing countries There are basically two conditions under which telemedicine should be considered 1 when there is no alternative e g in emergencies in remote environments and 2 when it is better than existing conventional services e g teleradiology for rural hospitals For example telemedicine can be expected to improve equity of access to health care the quality of that care and the efficiency by which it is delivered Research in telemedicine increased steadily in the late 1990s although the quality of the research could be improved there have been few randomized controlled trials to date
- ItemMemorable telemedicine experiences.(2008-03-05) Wooton, Richard; Krupinski, Elizabeth; Hailey, David; Patterson, Victor; Scott, Richard; Whited, John; Whitten, Pamela; Yoo, Sun; Hui, Elsie; Ferguson, James; Van Der Westhuyzen, Jasper; Kayser, Klaus; Mars, Maurice; Martin-Khan, Melinda; Tachakra, Sapal; Scalvini, Simonetta; Shumack, Stephen; Smith, Anthony; Soyer, H Peter; Stachura, Max
- ItemReducing your carbon footprint: How telemedicine helps.(2007-11-23) Smith, Anthony C; Patterson, Victor; Scott, Richard E
- ItemSupporting hospital doctors in the Middle East by email telemedicine: something the industrialized world can do to help.(2007-10-22) Patterson, Victor; Swinfen, Pat; Swinfen, Roger; Azzo, Emil; Taha, Husen; Wootton, RichardSince 1999 the Swinfen Charitable Trust has operated an email referral system between doctors in the developing world and specialists in the industrialized world Since 2001 it has expanded its operation into the Middle East in particular Iraq an area of considerable conflict
- ItemTelemedicine for epilepsy support in resource-poor settings.(2014-09-05) Patterson, VictorTHE PROBLEM Epilepsy is a common disease worldwide causing significant physical and social disability It is one of the most treatable neurological diseases Yet in rural poorer countries like much of India and Nepal most people with epilepsy are not undergoing any treatment often because they cannot access doctors Conventional Approaches It is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better Few details however have been put forward about how that might be achieved Thinking Differently Untreated epilepsy should be considered a public health problem like HIV AIDS the various steps needed for treatment identified and solutions found Telemedicine Approaches Telemedicine might contribute to two steps diagnosis and review A tool that enables non doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability sensitivity and specificity for the diagnosis There are a number of ways in which the use of phone review or short messaging service can improve management CONCLUSION Telemedicine as part of a public health program can potentially help the millions of people in the resource poor world with untreated epilepsy
- ItemTelemedicine for epilepsy: a useful contribution.(2005-04-28) Patterson, Victor; Bingham, Ena
- ItemTelemedicine for new neurological outpatients: putting a randomized controlled trial in the context of everyday practice.(2002-10-24) Chua, Richard; Craig, John; Esmonde, Thomas; Wootton, Richard; Patterson, VictorIn a retrospective review the telemedical management of 65 outpatients from a randomized controlled trial RCT of telemedicine for non urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial with that of 150 outpatients seen in the neurology clinics of district general hospitals and with that of 102 neurological outpatients seen by general physicians Outcome measures were the numbers of investigations and of patient reviews The telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of reviews they received Patients from the RCT seen face to face had significantly fewer investigations but a similar number of reviews to the other 150 patients seen face to face by neurologists the disparity in the number of investigations may explain the negative result for telemedicine in that RCT Patients with neurological symptoms assessed by general physicians had significantly more investigations and were reviewed significantly more often than all the other groups Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow ups than those patients managed by general physicians The results suggest that management of new neurological outpatients by neurologists using telemedicine is similar to that by neurologists using a face to face consultation and is more efficient than management by general physicians
- ItemTeleneurology by email.(2004-01-19) Patterson, Victor; Humphreys, Jenny; Chua, RichardWe introduced an email teleneurology service for patients referred to a neurologist by general practitioners Over 14 months 76 referrals of 75 patients were received To determine the sustainability of the service we studied a second cohort of 76 consecutive patients referred after our first study We also followed up the first cohort of patients to get information on longer term safety The second cohort was obtained in one month less than the first and had similar characteristics in terms of age sex and the time taken by the neurologist to reply to the general practitioner It contained fewer patients requiring clinic appointments 34 versus 43 Fewer patients from the second cohort were referred for second opinions 4 versus 10 and there were no resulting changes in diagnosis Follow up of the first cohort from a mean of 6 months to a mean of 23 months led to seven more re referrals and no additional changes in diagnosis We conclude that teleneurology by email is sustainable for this group of patients and confirm that it is safe effective and efficient
- ItemTeleneurology in Northern Ireland: a success.(2003-00-03) Patterson, VictorIn March 1998 two neurologists and a professor of telemedicine met to solve a clinical problem how to get neurological expertise to patients admitted acutely to hospitals which had no resident neurologist Four years later two new consultant neurologists were appointed in Northern Ireland with sessions in telemedicine possibly the first such appointments anywhere in the world This feat was achieved by combining science with politics First we chose the most appropriate telemedicine equipment and bandwidth for our needs Second we altered our neurological consultation to use the technology efficiently Third we were able to show scientifically that teleneurology was reproducible feasible in practice safe acceptable and cost effective This required money to pay for a research fellow and equipment which was obtained initially from some departmental research funds and a local hospital Conventional research funding bodies were on the whole unhelpful It was serendipitous that a review of neurology services in Northern Ireland was set up by the Department of Health This identified our original problem as one that it wanted solved and we were in the fortunate position of being able to offer telemedicine as a tested solution One final political push was required to get the money released The result of this juxtaposition of science and politics should bring benefit to our neurological patients and will perhaps help others trying to establish similar projects elsewhere
- ItemTeleneurology in Northern Ireland: a success.(2003-03-28) Patterson, VictorIn March 1998 two neurologists and a professor of telemedicine met to solve a clinical problem how to get neurological expertise to patients admitted acutely to hospitals which had no resident neurologist Four years later two new consultant neurologists were appointed in Northern Ireland with sessions in telemedicine possibly the first such appointments anywhere in the world This feat was achieved by combining science with politics First we chose the most appropriate telemedicine equipment and bandwidth for our needs Second we altered our neurological consultation to use the technology efficiently Third we were able to show scientifically that teleneurology was reproducible feasible in practice safe acceptable and cost effective This required money to pay for a research fellow and equipment which was obtained initially from some departmental research funds and a local hospital Conventional research funding bodies were on the whole unhelpful It was serendipitous that a review of neurology services in Northern Ireland was set up by the Department of Health This identified our original problem as one that it wanted solved and we were in the fortunate position of being able to offer telemedicine as a tested solution One final political push was required to get the money released The result of this juxtaposition of science and politics should bring benefit to our neurological patients and will perhaps help others trying to establish similar projects elsewhere
- ItemTeleneurology.(2005-04-14) Patterson, VictorTeleneurology enables neurology to be practised when the doctor and patient are not present in the same place and possibly not at the same time The two main techniques are 1 videoconferencing which enables communication between a doctor and a patient who are in different places at the same time often called realtime or synchronous and 2 email where the consultation is carried out without the patient being present at a time convenient to the doctors involved asynchronous or store and forward teleneurology Some problems that can be solved by teleneurology include 1 patients admitted to hospital with acute neurological symptoms rarely see a neurologist 2 delayed treatment for acute stroke 3 non optimum management of epilepsy 4 unproductive travel time for neurologists 5 extremely poor access to a neurologist for doctors in the developing world 6 long waiting times to see a neurologist Neurology is a specialty that because of the emphasis on accurate interpretation of a history does lend itself to telemedicine It has been a late starter in realizing the benefits of telemedicine and most of the publications on teleneurology have been in the last five years Its uptake within the neurological community is low but increasing Telemedicine requires a significant change in how neurologists practise The evidence to date is that teleneurology can narrow the gap between patients with neurological disease and the doctors who are trained to look after them
- ItemTelephone management of severe wasp stings in rural Nepal: a case report.(2011-02-25) Lama, Tshering; Karmacharya, Biraj; Chandler, Colin; Patterson, VictorWe describe a young woman from a rural village in Nepal who suffered multiple wasp and hornet stings She collapsed and was managed by a telephone consultation between a village health worker and a hospital specialist The patient recovered fully Not only was the telephone consultation efficient in terms of cost savings from avoided hospital treatment but it was also effective since with conventional care there was a strong possibility that the patient would have died on her way to hospital This case illustrates the potential for telephone delivered rural care and management in emergency situations
- ItemA web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists.(2013-09-25) Patterson, Victor; Wootton, RichardOne way to tackle health inequalities in resource poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web based telemedicine One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems