Browsing by Author "Smith, Anthony C"
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- ItemClinicians' perceptions of telemedicine for remote neonatal consultation.(2010-12-30) Armfield, Nigel R; Donovan, Tim; Smith, Anthony CTelemedicine may have a useful role in neonatal care particularly in regionalised health care systems where there may be impediments to access Following the development of a system for neonatal teleconsultation we assessed its efficacy usability and preliminary effectiveness While results were positive uptake in routine clinical use was less than expected The study described in this paper examined aspects of clinicians perceptions of telemedicine in neonatal care Overall clinicians had positive perceptions of telemedicine Further work is required to understand the negative perceived usefulness of telemedicine held by some clinicians and to determine whether this may be overcome
- ItemA comparison of telepaediatric activity at two regional hospitals in Queensland.(2003-03-28) Smith, Anthony C; Williams, Michael; Van Der Westhuyzen, Jasper; McCrossin, Robert; Isles, Alan; Wootton, RichardWe conducted a 15 month feasibility study of telepaediatrics A novel service was offered to two hospitals in Queensland Mackay and Hervey Bay We used data from all other hospitals throughout the state as the control group Although both intervention hospitals were provided with the same service the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region In addition there was an increase in the number of Mackay patients treated locally as outpatients In contrast little change was observed in Hervey Bay We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary centre We believe that the screening method used for patient referrals was the most important determinant of the use of the telepaediatric service
- ItemConcordance between real-time telemedicine assessments and face-to-face consultations in paediatric otolaryngology.(2008-04-23) Smith, Anthony C; Dowthwaite, Samuel; Agnew, Julie; Wootton, RichardTo determine agreement between diagnoses and management plans made during an initial videoconference appointment and subsequent face to face consultations in paediatric ear nose and throat ENT surgery DESIGN AND SETTING AND PARTICIPANTS A paediatric ENT clinic servicing patients from Bundaberg Queensland was conducted through the Centre for Online Health at the Royal Children s Hospital RCH in Brisbane Between January 2004 and February 2006 152 consultations with 97 patients were carried out We retrospectively audited patients charts to compare the diagnosis and management plan formulated at the initial videoconference and the eventual diagnosis and surgical management after face to face consultation The clinical outcomes for children who were not recommended for surgery at the RCH were ascertained by telephone survey
- ItemA cost minimisation analysis of a telepaediatric otolaryngology service.(2008-03-27) Xu, Cathy Q; Smith, Anthony C; Scuffham, Paul A; Wootton, RichardPaediatric ENT services in regional areas can be provided through telemedicine tele ENT using videoconferencing or with a conventional outpatient department ENT service OPD ENT in which patients travel to see the specialist The objective of this study was to identify the least cost approach to providing ENT services for paediatric outpatients
- ItemThe costs and potential savings of a novel telepaediatric service in Queensland.(2007-03-14) Smith, Anthony C; Scuffham, Paul; Wootton, RichardThere are few cost minimisation studies in telemedicine We have compared the actual costs of providing a telepaediatric service to the potential costs if patients had travelled to see the specialist in person
- ItemDiagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients.(2004-07-26) Smith, Anthony C; Kimble, Roy; Mill, Julie; Bailey, Deborah; O'Rourke, Peter; Wootton, RichardVideoconferencing has become a routine technique for the post acute burns care of children in Queensland We compared the agreement between clinical assessments conducted via videoconference and assessments conducted in the conventional face to face manner FTF A total of 35 children with a previous burn injury were studied Twenty five children received three consecutive assessments first FTF by a consultant in the outpatient department then by a second consultant who reviewed the patient via videoconference and then by the second consultant in person The second consultant also reviewed another 10 children twice At each review the following variables were measured scar colour scar thickening contractures range of motion the patient s level of general activity any breakdown of the graft site and adequacy of the consultation Agreement between the two consultants when seeing patients FTF was moderately high with an overall concordance of 85 When videoconferencing was used the level of agreement was almost the same at 84 If one consultant reviewed patients FTF first and then via videoconference the overall concordance was 98 if the process was reversed the overall concordance was 97 This study confirms that the quality of information collected during a videoconference appointment is comparable to that collected during a traditional FTF appointment for a follow up burns consultation
- ItemAn economic analysis of email-based telemedicine: a cost minimisation study of two service models.(2008-06-06) Caffery, Liam; Smith, Anthony C; Scuffham, Paul AEmail based telemedicine has been reported to be an efficient method of delivering online health services to patients at a distance and is often described as a low cost form of telemedicine The service may be low cost if the healthcare organisation utilise their existing email infrastructure to provide their telemedicine service Many healthcare organisations use commercial off the shelf COTS email applications COTS email applications are designed for peer to peer communication hence in situations where multiple clinicians need to be involved COTS applications may be deficient in delivering telemedicine Larger services often rely on different staff disciplines to run their service and telemedicine tools for supervisors clinicians and administrative staff are not available in COTS applications Hence some organisations may choose to develop a purpose written email application to support telemedicine We have conducted a cost minimisation analysis of two different service models for establishing and operating an email service The first service model used a COTS email application and the second used a purpose written telemedicine application
- ItemThe effectiveness of telemedicine for paediatric retrieval consultations: rationale and study design for a pragmatic multicentre randomised controlled trial.(2014-11-10) Armfield, Nigel R; Coulthard, Mark G; Slater, Anthony; McEniery, Julie; Elcock, Mark; Ware, Robert S; Scuffham, Paul A; Bensink, Mark E; Smith, Anthony CBackgroundIn many health systems specialist services for critically ill children are typically regionalised or centralised Studies have shown that high risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality In acute cases where distance and time impede access to specialist care clinical advice may be provided remotely by telephone Emergency retrieval services attended by medical and nursing staff may be used to transport patients to specialist centres Even with the best quality retrieval services stabilisation of the patient and transport logistics may delay evacuation to definitive care Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children However no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval Methods DesignThe study is a pragmatic multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit We aim to recruit 160 children for whom a specialist retrieval consultation is required The primary outcome measure is stabilisation time time spent on site at the referring hospital by the retrieval team adjusted for initial risk Secondary outcome measures are change in patient s physiological status repeated measure two time points scored using the Children s Emergency Warning Tool change in diagnosis repeated measure taken at three time points change in destination of retrieved patients at the tertiary hospital general ward or paediatric intensive care unit retrieval decision and length of stay in the Paediatric Intensive Care Unit for retrieved patients The trial has been approved by the Human Research Ethics Committees of Children s Health Services Queensland and The University of Queensland Australia DiscussionHealth services are adopting telemedicine however formal evidence to support its use in paediatric acute care is limited Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000156886
- ItemThe family costs of attending hospital outpatient appointments via videoconference and in person.(2004-01-19) Smith, Anthony C; Youngberry, Karen; Christie, Fiona; Isles, Alan; McCrossin, Robert; Williams, Michael; Van Der Westhuyzen, Jasper; Wootton, RichardWe compared the costs incurred by families attending outpatient appointments at the Royal Children s Hospital RCH in Brisbane with those incurred by families who had a consultation via videoconference in their regional area In each category 200 families were interviewed The median time spent travelling for videoconferences was 30 min compared with 80 min for face to face appointments Families interviewed in the outpatient department had travelled a median distance of 70 km while those who had a videoconference at the local hospital had travelled only 20 km It cost these families much more to attend an appointment at the RCH than to attend a videoconference Ninety six per cent of families 193 reported at least one of the following types of expense 150 families had expenses related to parking median A 10 dollars 156 had fuel expenses median A 10 dollars and 122 reported costs related to meals purchased at the RCH median A 10 dollars Only 21 families who had their appointment via local videoconference reported any additional costs Specialist appointments via videoconference were a more convenient and cheaper option for families living in regional areas of Queensland than the conventional method of attending outpatient appointments at the specialist hospital in Brisbane
- ItemHome telemedicine for paediatric palliative care.(2010-12-30) Bradford, Natalie; Herbert, Anthony; Walker, Rick; Pedersen, Lee-Anne; Hallahan, Andrew; Irving, Helen; Bensink, Mark E; Armfield, Nigel R; Smith, Anthony CChildren with life limiting conditions require intensive complex management of the physical psychosocial and spiritual issues that evolve for the child and their family as the focus of care moves from curative treatment to palliation Optimal palliative care for children can be limited by the lack of health professionals with the necessary skills and experience to confidently and competently manage the care of both the child and the family The University of Queensland s Centre for Online Health has been working closely with the Paediatric Palliative Care Service PPCS at the Royal Children s Hospital RCH in Brisbane Australia to investigate the potential of telemedicine for the delivery of specialist support in the home or local community Research conducted in Queensland has shown how telemedicine can be effectively used to link the specialist paediatric palliative care team into the home of families caring for a child receiving palliative care regardless of their physical distance from the RCH This qualitative report describes two case studies each illustrating the value of home telemedicine for families at this vulnerable and distressing time This work should provide a useful insight for other specialty disciplines contemplating home telemedicine applications
- ItemHow telehealth facilitates the provision of culturally appropriate healthcare for Indigenous Australians.(0000-00-00) Caffery, Liam J; Bradford, Natalie K; Smith, Anthony C; Langbecker, DanetteIntroduction The aim of this study was to explore how telehealth facilitates or impedes the provision of culturally appropriate healthcare to Indigenous Australians from the perspective of staff at an Aboriginal Community Controlled Health Service ACCHS Methods An exploratory qualitative study was performed Semi structured interviews were conducted with nine ACCHS staff Interview transcripts were analysed using thematic analysis Results One central theme and three sub themes were identified The central theme of Care provided in a supportive environment describes how telehealth enabled specialist consultations to be conducted in the safe environment of an ACCHS instead of a mainstream health service The first sub theme described how telehealth improved affordability and convenience and brought a reduction in the stress of healthcare The second sub theme explained the importance of the presence of an Indigenous health worker to facilitate culturally appropriate healthcare The third sub theme described how telehealth supported a holistic view of health Discussion Our findings show culturally appropriate healthcare may be enhanced by the use of telehealth because it allows care to be provided in the supportive environment of an ACCHS It allows the community member to have the advocacy and assistance of an Indigenous health worker and reduces the burden of travel and dislocation from community and family
- ItemHumour sans frontieres: the feasibility of providing clown care at a distance.(2011-05-26) Armfield, Nigel R; Bradford, Natalie; White, Megan M; Spitzer, Peter; Smith, Anthony CClown care has been shown to have health related benefits and is a well established part of the routine in many children s hospitals However children who have been admitted to general hospitals or who are being cared for at home cannot usually enjoy visits by Clown Doctors Therefore the aim of this work was to investigate whether an existing telemedicine network could be used to improve equity of access to humor for sick children specifically those who are hospitalized away from the nearest clown enabled hospital or who are being cared for at home Using videoconferencing we conducted regular clown outreach links from The Royal Children s Hospital in Brisbane Australia to children in regional hospitals and to sick children in their homes Using a program of performance which was modified for delivery by videoconference teleclowning was found to be feasible Further work is required to determine whether the health related benefits that accrue from in person clowning are successfully translated to the video based modality
- ItemInaugural paediatric telehealth colloquium.(2007-05-23) Parsapour, Kourosh; Smith, Anthony C; Armfield, Nigel; Marcin, James P
- ItemA literature review of email-based telemedicine.(2010-12-30) Caffery, Liam J; Smith, Anthony CA structured analysis of peer reviewed literature about the delivery of health services by email was undertaken for this review A total of 185 articles were included in the analysis These articles were thematically categorised for medical specialty participants sub topic study design and service delivery application It was shown that email based telemedicine can be practiced in a large number of medical specialties and has application in primary consultation second opinion consultation telediagnosis and administrative roles e g e referral Email has niche applications in low bandwidth image based specialties e g dermatology pathology wound care and ophthalmology where attached digital camera images were used for telediagnosis Diagnostic accuracy of these images was the predominant topic of research and results show email as a valid means of delivering these medical services Email is also often used in general practice as an adjunct for face to face consultation Further a number of organisations have significantly improved the efficiency of their outpatient services when using email as a triage or e referral system Email based telemedicine provides specialist medical opinion in the majority of reviewed services and is most likely to be instigated by the patient s primary care giver However email consultations between patient and primary care and patient and secondary care are not uncommon Most email services are implemented using ordinary email However a number of organisations have developed purpose written email applications to support their telemedicine service due to impediments of using ordinary email These impediments include lack of management tools for the allocation and auditing of cases for a timely response and the co ordination of effort in a multi clinician multi disciplinary service The ability to encrypt ordinary email thereby securing patient confidentiality is also regarded as difficult when using ordinary email Hence alternative web based email applications where the encryption can be implemented using the more user friendly HTTPS have become popular Much of the reviewed literature is descriptive or anecdotal and hence suffers from lack of conclusive results regarding positive patient outcomes This may account for email based telemedicine generally being regarded as underutilised However the potential is well recognised
- ItemLogistical aspects of large telemedicine networks. 1: Site directories.(2003-03-28) Wootton, Richard; Smith, Anthony C; Gormley, Sinead; Patterson, JessicaWe carried out a survey of the site coordinators in a mature telemedicine network of about 200 sites The site directory contained information about 221 videoconference facilities There were 191 site coordinators in all i e some coordinators were responsible for more than one site Of the 221 sites we were able to contact 87 on first attempt and 155 by the fourth attempt Thus there were 66 sites 30 which were not contactable We asked each site coordinator to describe any videoconference activity that had taken place over the previous five working days Of the contacted 155 sites 78 reported some videoconference activity during the period in question The total reported videoconference activity was 12 800 min during the one week monitoring period that is an estimated 924 h per month The most common categories of work were education or training 511 h and management or administration 225 h which between them accounted for 80 of all reported videoconference activity Fifty of the 155 sites 32 reported that the equipment was not located in an area suitable for patient consultations In addition 20 sites 13 volunteered that their videoconferencing facilities were not in working order at the time of the survey We did not ask this question in the survey so that this result represents a lower bound for the true number of inoperable systems
- ItemLogistical aspects of large telemedicine networks. 1: Site directories.(2003-00-03) Wootton, Richard; Smith, Anthony C; Gormley, Sinead; Patterson, JessicaWe carried out a survey of the site coordinators in a mature telemedicine network of about 200 sites The site directory contained information about 221 videoconference facilities There were 191 site coordinators in all i e some coordinators were responsible for more than one site Of the 221 sites we were able to contact 87 on first attempt and 155 by the fourth attempt Thus there were 66 sites 30 which were not contactable We asked each site coordinator to describe any videoconference activity that had taken place over the previous five working days Of the contacted 155 sites 78 reported some videoconference activity during the period in question The total reported videoconference activity was 12 800 min during the one week monitoring period that is an estimated 924 h per month The most common categories of work were education or training 511 h and management or administration 225 h which between them accounted for 80 of all reported videoconference activity Fifty of the 155 sites 32 reported that the equipment was not located in an area suitable for patient consultations In addition 20 sites 13 volunteered that their videoconferencing facilities were not in working order at the time of the survey We did not ask this question in the survey so that this result represents a lower bound for the true number of inoperable systems
- ItemLogistical aspects of large telemedicine networks. 2: Measurement of network activity.(2003-03-28) Wootton, Richard; Smith, Anthony C; Gormley, Sinead; Patterson, JessicaWe carried out a retrospective review of the videoconference activity records in a university run hospital telemedicine studio Usage records describing videoconferencing activity in the telemedicine studio were compared with the billing records provided by the telecommunications company During a seven month period there were 211 entries in the studio log 108 calls made from the studio and 103 calls made from a far end location We found that 103 calls from a total of 195 calls reported by the telecommunications company were recorded in the usage log The remaining 92 calls were not recorded probably for one of several reasons including failed calls a large number of unrecorded calls 57 lasted for less than 2 min median 1 6 min origin of videoconference calls calls may have been recorded incorrectly in the usage diary i e as being initiated from the far end when actually initiated from the studio and human error Our study showed that manual recording of videoconference activity may not accurately reflect the actual activity taking place Those responsible for recording and analysing videoconference activity particularly in large telemedicine networks should do so with care
- ItemLogistical aspects of large telemedicine networks. 2: Measurement of network activity.(2003-00-03) Wootton, Richard; Smith, Anthony C; Gormley, Sinead; Patterson, JessicaWe carried out a retrospective review of the videoconference activity records in a university run hospital telemedicine studio Usage records describing videoconferencing activity in the telemedicine studio were compared with the billing records provided by the telecommunications company During a seven month period there were 211 entries in the studio log 108 calls made from the studio and 103 calls made from a far end location We found that 103 calls from a total of 195 calls reported by the telecommunications company were recorded in the usage log The remaining 92 calls were not recorded probably for one of several reasons including failed calls a large number of unrecorded calls 57 lasted for less than 2 min median 1 6 min origin of videoconference calls calls may have been recorded incorrectly in the usage diary i e as being initiated from the far end when actually initiated from the studio and human error Our study showed that manual recording of videoconference activity may not accurately reflect the actual activity taking place Those responsible for recording and analysing videoconference activity particularly in large telemedicine networks should do so with care
- ItemMedical students' knowledge and perceptions of e-health: results of a study in Sri Lanka.(2007-10-03) Edirippulige, Sisira; Marasinghe, Rohana B; Smith, Anthony C; Fujisawa, Yoshikazu; Herath, Walisundara B; Jiffry, M T M; Wootton, RichardThe present study investigates the knowledge perceptions and attitudes of medical students in Sri Lanka in regard to e health We also examined the barriers which impede them to develop knowledge and skills in e health within their medical curriculum A questionnaire focusing on the knowledge attitudes and expectations of medical students towards e health was distributed to all final year students n 136 at the Faculty of Medical Sciences Sri Jayewardenepura University Sri Lanka Response rate was 74 43 of respondents stated that they were familiar with the term e health 51 rated their knowledge of e health applications as minimal 88 admitted that they had no e health education or training of any kind Over 80 of all respondents thought that e health had an important role to play in the current and future health sector particularly in developing countries Our survey revealed that respondents had very poor access to computers and Internet use was rare 77 of respondents admitted that they were not provided with systematic knowledge and skills in e health through their medical curriculum and identified the absence of formal education in e health as a serious shortcoming
- ItemThe multidisciplinary management of a paediatric cardiac emergency.(2002-04-25) Smith, Anthony C; Williams, Michael; Justo, Robert