Health staff priorities for the future development of telehealth in Western Australia.

INTRODUCTION: The views of health managers and physicians working in non-metropolitan areas of Western Australia (WA) were sought about which telehealth services are most needed. METHOD: Chief executives and nurse managers of rural hospitals were sent a simple, open-ended questionnaire and asked to consider the current health situation and problems in their area, and to list the four most-needed telehealth services. In addition, they were asked to hand the questionnaire to one of the GPs or medical officers working with them. A total of 78 questionnaires were sent. RESULTS: The response rate for managers and doctors was 51% and 43%, respectively. The first priority of the managers was wound care (28%). The first priority of the doctors was psychiatry (35%). The collective priorities of the two groups were similar, with managers listing wound care, emergency, psychiatry and ophthalmology; and doctors listing psychiatry, wound care, emergency and ophthalmology. CONCLUSION: Prioritizing potential telemedicine applications is a subject largely absent from the literature. When planning future telehealth applications, the opinion of local health staff who understand the requirements of patients in their region will assist in identifying real needs and lead to the provision of better health services for rural patients.

Comparison of the effect of aminophylline and low PEEP vs. high PEEP on EGF concentration in critically ill patients with ALI/ARDS.

BACKGROUND: Acute respiratory distress syndrome (ARDS) remains a serious, often fatal, condition, despite progress in modern critical care treatment. Cytokines play important roles in the pathogenesis of the syndrome, although their roles in the evaluation and outcome have not been clearly elucidated yet. OBJECTIVES: We tested whether serum concentration of epidermal growth factor (EGF), as one of the important inflammatory mediators, changes with time and administration of mechanical ventilation and aminophylline. PATIENTS AND METHODS: Thirty patients [mean (SD): age = 56.6 (17.4) years] with ARDS were enrolled. After diagnosis based on inclusion and exclusion criteria, the patients were intubated and mechanically ventilated. Two hours after ventilation with definite positive end-expiratory pressure (PEEP), aminophylline with a specific dose was started. Serum samples were obtained at five time points of 0, 2, 2.5, 4 and 8 h post-starting PEEP. RESULTS: Serum EGF concentration decreased after mechanical ventilation with PEEP (P < 0.05). The serum EGF concentrations 8 h after intervention was statistically lower in the low PEEP group than in the high PEEP group. The Acute Physiology and Chronic Health Evaluation (APACHE) Pi score and PaO2/FiO2 improved significantly after 8 h (P < 0.05). CONCLUSION: Beneficial effects of mechanical ventilation and aminophylline on APACHE Pi score and PaO2/FiO2 influence serum EGF levels. These findings may have relevance to the development of multisystem organ failure.