Evaluation of tele-ultrasound as a tool in remote diagnosis and clinical management at the Amundsen-Scott South Pole Station and the McMurdo Research Station.

UNLABELLED: Abstract Background: A large number of Antarctic stations do not utilize ultrasound for medical care. Regular use of ultrasound imaging at South Pole and McMurdo Stations first began in October 2002. To date, there has been no evaluation of medical events requiring ultrasound examination from this remote environment. Additionally, the importance of tele-ultrasound for clinical management in Antarctica has not yet been assessed. We therefore conducted a retrospective analysis of all ultrasound exams performed at South Pole and McMurdo Stations between October 2002 and October 2003. SUBJECTS AND METHODS: Radiology reports and patient charts were reviewed for pre- and post-ultrasound diagnosis and treatment. RESULTS: Sixty-six ultrasound exams were conducted on 49 patients. Of the exams, 94.0% were interpreted by the store-and-forward method, whereas 6.0% were interpreted in "real-time" format. Abdominal, genitourinary, and gynecology ultrasound exams accounted for 63.6% of exams. Ultrasound examination prevented an intercontinental aeromedical evacuation in 25.8% of cases, and had a significant effect on the diagnosis and management of illness in patients at South Pole and McMurdo research stations. CONCLUSIONS: These findings indicate that diagnostic ultrasound has significant benefits for medical care at Antarctic stations and that tele-ultrasound is a valuable addition to remote medical care for isolated populations with limited access to tertiary-healthcare facilities.

Postictal psychosis: implications for nursing.

Postictal psychosis (PIP) is a serious outcome of epilepsy, which may be preventable. Once the symptoms are identified, rapid diagnosis and treatment will prevent further deterioration in the patient's condition. The nurse plays a critical role in this process. The specific presentation of PIP, along with clarification of potential causes and strategies to prevent the occurrence of this complication, will be discussed. Through a case study format and emphasis on the role of the nurse, the specifics of case finding and rapid intervention will be described.

Telepsychiatry program for rural victims of domestic violence.

Domestic violence is a significant public health problem and is correlated with serious mental and physical disorders. Victims' fear and isolation seriously limit access to psychiatric evaluation and treatment. Telemedicine provides a means to overcome these obstacles. This article describes a telemedicine program that provides psychiatric screening, evaluation, treatment, and referral for ongoing care to clients of a rural women's crisis center. Psychiatric evaluation and treatment were provided to a rural women's shelter program using telepsychiatry. The shelter program had difficulty accessing traditional mental health service. All new clients entering the program were screened for mental health problems. Those requiring further evaluation received a physical examination with medical history and initial psychological interview on site, followed by psychiatric evaluation by videoconference. Appropriate treatment was initiated, and referral for ongoing psychiatric care through the local community mental health clinic was arranged. Of the 38 women referred for mental health services by clinic staff, 35 completed a psychiatric evaluation using telepsychiatry and 31 entered treatment. The most commonly identified disorders were anxiety and major affective disorders, followed by substance use disorders. Telepsychiatry can provide rapid crisis intervention and effective mental health services to victims of domestic violence in a rural setting.

A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic.

PURPOSE: This article compares a traditional ambulatory clinic in an academic medical center with a telemedicine clinic. The telemedicine clinic is a joint project of the UTMB Telehealth Center and the Epilepsy Foundation of Southeast Texas, with partial funding for clinical operations provided by the Texas Department of Health. METHODS: Data were collected on all the patients (n = 155) in both clinics for 3 months in 2004. In addition to demographic information, outcome data (number of seizures, hospitalizations, and emergency room visits) were gathered. Medication compliance also was collected by using self-report and medication levels. RESULTS: Outcome variables were subjected to t test and chi(2) analysis. No significant differences were found in any of the demographic data or outcome measures between the two groups. CONCLUSIONS: Telemedicine is an acceptable alternative to in-person clinics for the provision of care to adults with epilepsy. Because telemedicine programs are designed to bring medical care closer to where patients live, these clinics provide an excellent alternative to provide consistent care in rural and geographically isolated areas. Additional studies are needed to investigate the potential costs associated with telemedicine as well as the potential for cost savings over time as patients are more able to access care and therefore may be more likely to seek the needed routine care and follow-up.