Evaluation of a pilot telemedicine network for accident and emergency work

A pilot accident and emergency. teleconsulting service was established in Scotland. It was based at the accident and emergency department of the main hospital in Aberdeen. There were three peripheral sites in rural Grampian (Peterhead, Turriff and Huntly) and one in the Shetland Isles. The videoconferencing equipment used was connected by ISDN at 384 kbit/s. During the 15 months of the study, 1998 videoconference calls were made, of which 402 (20%) calls were made to the accident and emergency department for clinical consultations. The majority of the clinical calls (95%) were made between 09:00 and 17:00, and more than 90% were completed within 20 min. During the majority of calls (87%) one or more X-ray images were transmitted. The majority of patients (89%) received treatment without transportation to the main centre in Aberdeen. The present study demonstrated that accident and emergency teleconsultations can be technically reliable, effective in reducing the number of patient transfers and acceptable to the referring clinicians. As a result, approximately pound1.5 million has been made available by the government to develop a national system for Scotland.

Design and implementation of an automatic message-routing system for low-cost telemedicine

Email has been used for some years as a low-cost telemedicine medium to provide support for developing countries. However, all operations have been relatively small scale and fairly labour intensive to administer. A scalable, automatic message-routing system was constructed which automates many of the tasks. During a four-month study period in 2002, 485 messages were processed automatically. There were 31 referrals from eight hospitals in three countries. These referrals were handled by 25 volunteer specialists from a panel of 42. Two system operators, located 10 time zones apart, managed the system. The median time from receipt of a new referral to its allocation to a specialist was 1.0 days (interquartile range 0.7-2.4). The median interval between allocation and first reply was 0.7 days (interquartile range 0.3-2.3). Automatic message handling solves many of the problems of manual email telemedicine systems and represents a potentially scalable way of doing low-cost telemedicine in the developing world.

The importance of setting and evaluating standards of telemedicine training

The importance of appropriate training in the use of videoconferencing equipment for clinical purposes is often underestimated when telemedicine projects are established. We developed a user training programme which was delivered via videoconferencing to a group of 130 nurses. Training was delivered on a one-to-one basis. A questionnaire was developed to evaluate user satisfaction and the effectiveness of training. One hundred and two fully completed questionnaires were returned (a 79% response rate). High levels of satisfaction were obtained but the level of user competence reached 100% only when training was supported by a training manual and at least weekly practice. Before establishing a telemedicine service, the following steps appear to be important: identify the required training competencies; deliver a 'hands on' training programme based on the required training competencies; back up the training programme with an instruction booklet; ensure that trainees have at least weekly practice; measure the level of user competence.

Effects of viscous dissipation and boundary conditions on forced convection in a channel occupied by a saturated porous medium

Forced convection with viscous dissipation in a parallel plate channel filled by a saturated porous medium is investigated numerically. Three different viscous dissipation models are examined. Two different sets of wall conditions are considered: isothermal and isoflux. Analytical expressions are also presented for the asymptotic temperature profile and the asymptotic Nusselt number. With isothermal walls, the Brinkman number significantly influences the developing Nusselt number but not the asymptotic one. At constant wall heat flux, both the developing and the asymptotic Nusselt numbers are affected by the value of the Brinkman number. The Nusselt number is sensitive to the porous medium shape factor under all conditions considered.

The 23rd October 2002 dust storm in eastern Australia: characteristics and meteorological conditions

The dust storm of 23 October 2002 covered most of eastern Australia and carried one of the largest recorded dust loads in Australia. In the 6 months leading up to the event, severe drought conditions in eastern Australia, plus above average maximum temperatures resulted in high potential evapo-transpiration rates, producing severe soil moisture deficits and reduced vegetation cover. Although increased wind speeds associated with a fast moving cold front were the meteorological driving force, these winds speeds were lower than those for the previously documented large dust storms. The dust storm was 2400 km long, up to 400 km across and 1.5-2.5 km in height. The plume area was estimated at 840,860 km 2 and the dust load at 0900 h was 3.35-4.85 million tones (Mt). These dust load estimates are highly sensitive to assumptions, regarding visibility-dust concentration relationships, vertical dust concentration profiles and dust ceilings. The event is examined using meteorological records, remote sensing and air quality monitoring. (C) 2004 Elsevier Ltd. All rights reserved.