Practical evaluation of standard-based low-cost video conferencing in telemedicine and epidemiological applications.

The results of the evaluation of use of low-cost video conferencing systems (VCSs) in telemedicine is presented. Applications sharing, a new feature of these systems, recently has allowed high-quality computer-supported collaborative work (CSCW). The video conferencing (VCing) equipment used was Intel ProShare 200 v2.0a. It is representative of other low-cost VCSs. The areas of application are epidemiology and telemedicine (orthopaedics and radiology). Potential end users filled out 58 evaluation questionnaires concerning user profiles, contents and benefits of the sessions, organizational aspects, user friendliness, user acceptance, cost effectiveness, technical and multipoint related aspects. Although the end users had a lot of computer experience, their knowledge in VCSs was rather limited. The users assessed the system capable of being integrated into routine work, despite a high organizational impact. The VCS is user friendly, application sharing being used in almost every session. Audio quality was not always sufficient. The remote video was sufficient, as was the quality of medical images such as CT, MRI or X-ray. The user acceptance of the system was high. Multipoint sessions require a structured protocol to be effective. Some technical problems with MCUs (Multipoint Control Units) occurred. The use of low-cost standard VCSs in telemedicine is advisable and is a good substitute for real meetings.

[Survival time of AIDS patients resident in Bologna city and county. Recommendations for care planning]. / Tempo di sopravvivenza dei malati di AIDS residenti a Bologna e Provincia. Indicazioni per una programmazione dell'assistenza.

The authors have analyzed the survival time of AIDS patients (resident in Bologna) in the period from 1984 to 1995. The study can allow accurate predictions to be made as to the likely volume of admissions to in-patients wards and Day Hospital, as well as helping Home Care planning for patients with serious social problems. The case histories studied were of 752 adult AIDS patients and 13 children. The adult AIDS patients had a mean survival time of 10.4 months (range 9.6-11.8). By breaking down the case histories into those notified between 1984 and 1987, 1988 and 1991 and 1992 and 1995, the greatest increase of survival time (mean) with respect to the previous four years period was achieved in the period covering 1988-1991: 5.23 months against 10.53 months (p<0.05). The life expectancy of persons above 40 years of age is lower than in the case of younger patients: 7.7 months against 11.37 months in the age bracket 26-39 years (P<0.05). The child cases of AIDS showed a survival time of 31.4 months (range 11.1-55.9).

[Pharmaco economics aspects of antibiotic therapy for AIDS patients in department of infectious disease]. / La spesa per la terapia antibiotica e chemioterapica in un reparto di malattie infettive per i malati con infezione HIV.

The financial budget for public health care in Italy has been more and more restricted in the last few years, but, on the other hand, the care of AIDS patients is still very expensive and antibiotic therapy plays an important role in the management and cost of these patients. The antibiotic therapies and related costs have been evaluated in 99 patients affected by AIDS (59 pts), ARC (28 pts) or HIV serum positive (12 pts), all hospitalized or treated in Day Hospital for different bacterial infections in 1995 at the Department of Infectious Diseases, Ospedale Maggiore, Bologna, for a total of 7733 days of antibiotic therapy. The average cost for antibiotic therapy was about 400,000 Italian Lira, with no significant difference depending on the stage of HIV related disease. The crude cost for antibiotic treatment was not particularly high, but the high frequency of adverse events, registered in these patients, required additional medical support and/or a prolonged hospital stay, which increased substantially the total cost of management of bacterial infections.

[Home care service: a need for AIDS patients. Epidemiological and economical data]. / Necessità dell'assistenza domiciliare per i malati di AIDS. Dati epidemiologici ed economici.

The Authors present epidemiological and economic data, to demonstrate that in Bologna and in Emilia Romagna region the home care service is an important instrument to treat AIDS patients and in particular those who have psychological and social problems as the drug abusers. There are human, social, sanitary and economic reasons to realize an integrate home care assistance according to the law 135/1990. The serious epidemiological situation of Emilia Romagna strongly induces to apply the guidelines for the home care service in the city where they haven't been realized and to extend the program where it's inadequate.

[Analysis of operating costs during a year in an infectious diseases department (April '94-March '95)]. / Analisi dei costi di ricovero durante un anno di attivita in un reparto di malattie infettive (Aprile '94-Marzo '95).

The Authors have analytically worked out the operating costs on the different pathologies for all the patients admitted at the Infectious Diseases department (USL Bologna City) from April 1994 to March 1995. The economic costs for one-year treatment of AIDS patients were very expensive for the community. In fact, for each patient, the average hospital admissions were 2.2 for year, and the average duration of hospitalization was 24 days each time. The Day Hospital had an important role for the majority of the patients with pathologies correlated with HIV infection (AIDS and ARC). The 75% of hospitalization days were spent by patients with HIV correlated pathologies. This group of patients caused 71% of diagnostic-therapeutic procedures. The number of admissions to hospital for patients with a pathology not correlated with HIV was lower than statistical expectations, probably because these patients preferred other medical services to avoid contacts with AIDS patients. The Authors have got the conviction that the existence of other kind of territorial assistance services such as House Care and Domiciliary Therapy Care would determine a great decrease of the operating costs.

[Mortality rate correlated to AIDS and to other causes in i.v. drug addicts]. / Tasso di mortalita correlato all'AIDS e ad altre cause nei tossicodipendenti.

The authors observed over time a sample of 1212 drug addicts in the city of Bologna and pointed out that AIDS-related deaths are constantly increasing while deaths due to overdose, although high in the Emilia-Romagna region, are still steady since 1984. The mortality rate AIDS-related is higher in female drug users than in males, whereas males are more prone to die for overdose. HIV positivity is not a relevant factor associated to deaths for overdose and subjects aged between 25 and 44 years show the highest mortality rate. During the period 1984 to 1995, 126 drug addicts died (10.4% of the observed population) and the highest mortality rate was registered after 1989. No death was reported between 1977 and 1983.