Crump W J, Kumar R, Orsak G, Pfeil T
Department of Family Medicine, University of Texas Medical Branch, Galveston 77555-1123, USA.
Arch Fam Med. 1998 Mar-Apr;7(2):174-6. doi: 10.1001/archfami.7.2.174.
Previous reports of telemedicine consultations have demonstrated that the technology is effective but inefficient. Little attention has been directed to the use of telemedicine in a primary care practice, especially the use of the medical peripheral devices. We used a functioning primary care practice as a telemedicine test bed, providing unselected patients in the study group. The goal was to study the performance of a new generation of a compact set of medical peripheral devices specifically designed for telemedicine examinations. In a 3-week field trial, 2 second-generation camera systems were used by physician faculty and residents in family practice to examine the skin, ears, and pharynx of 34 patients, ranging in age from 10 months to 78 years. Evaluations by the clinicians and patients were obtained. The average duration of an examination using these systems was 2 minutes. Patients' response was uniformly positive. A "pistol grip" video otoscope obtained an acceptable image, unless canal debris obscured the view. The system that provided pneumatic otoscopy was preferred, with some modifications necessary to obtain an airtight seal. The preferred skin camera was one that provided an image of a size that clinicians were most accustomed to viewing, although stability of this handheld camera was a problem. This camera also worked well to visualize the pharynx, especially in children with symptoms of pharyngitis. Color was deemed important in all 3 anatomical areas, and using auto-white balance and excluding fluorescent lights were preferred. Thus, the second-generation telemedicine peripheral devices were effective for use in a group of unselected primary care patients. These camera systems can be used by nursing personnel and require a minimum of time per examination.
以往关于远程医疗会诊的报告表明，该技术有效但效率低下。人们很少关注远程医疗在基层医疗实践中的应用，尤其是医疗外围设备的使用。我们将一个正常运作的基层医疗实践作为远程医疗试验平台，为研究组中未经挑选的患者提供服务。目标是研究专门为远程医疗检查设计的新一代紧凑型医疗外围设备的性能。在为期3周的现场试验中，家庭医疗科的医生教员和住院医师使用了2套第二代摄像系统，对34名年龄从10个月到78岁的患者的皮肤、耳朵和咽部进行检查。获得了临床医生和患者的评估结果。使用这些系统进行一次检查的平均时长为2分钟。患者的反应一致为积极。除非耳道内有碎屑遮挡视线，否则“手枪式握把”视频耳镜能获得可接受的图像。提供气压耳镜检查功能的系统更受青睐，但需要进行一些改进以实现气密密封。首选的皮肤相机是能提供临床医生最习惯观看尺寸图像的那种，不过这款手持相机的稳定性是个问题。这款相机在观察咽部方面也表现良好，尤其是对有咽炎症状的儿童。颜色在所有这三个解剖区域都被认为很重要，使用自动白平衡并排除荧光灯照明是更好的选择。因此，第二代远程医疗外围设备在一组未经挑选的基层医疗患者中使用是有效的。这些摄像系统护理人员也可以使用，并且每次检查所需时间最少。
