Telecare at home: factors influencing technology choices and user acceptance.

Acceptance of telecare technologies in the home is strongly influenced by factors that relate to dwelling design and the ways in which independent living is promoted. The experience to date of personal response systems (and services) provides some indication of the reasons why users may either resist their introduction or not use such technologies after they have been introduced. Telecare systems and services are poised to incorporate medical and other sensors, so that the manner of their provision, installation and control becomes an important consideration for service providers. A clear ethical framework is called for.

Telecare equipment in the home. Issues of intrusiveness and control.

Telecare in the home offers substantial benefits to users. However, the manner of its development and technological configuration will determine the extent to which it is acceptable and will meet clinical and social objectives. There are important issues of intrusiveness and control. An ethical framework for telecare is needed.

Silicone oil insertion. A review of 127 consecutive cases.

Silicone oil was used in combination with vitrectomy to treat 127 cases of complicated retinal detachments. An initial anatomic success in 120 cases (94%) was reduced to 68 (54%) after an average follow-up of 32 months and was attributable to ongoing proliferative vitreo-retinopathy (PVR). The indications for the use of silicone oil were: 1. Retinal detachment complicated by PVR (107 cases), 20 of which required multiple operations. Anatomic success was achieved in 59 (55%) and of these 23 (40%) had a visual acuity of 6/60. 2. Giant retinal tears (GRT) (7 cases). Four (57%) of these remained attached, three (75%) having a final vision of 6/36. 3. GRTs complicated by PVR (8 cases). Four (50%) were anatomically successful and two had a final vision of 6/60. 4. Proliferative diabetic retinopathy (5 cases). Two (40%) remained attached and one of these (50%) had hand movements vision. The silicone oil was removed electively in 23 eyes, 16 (70%) of these being anatomically successful. Oil was removed in 43 eyes because of complications, and in 20 (46%) of these, the retina remained attached at the end of follow-up. Complications included cataract in all 14 phakic eyes; rubeosis in 19 eyes (15%); corneal opacification in 52 eyes (41%), there being no clear cut difference between those eyes with an inferior iridectomy (35 of 85 eyes--41%) and those without (12 of 29 eyes--41%); and raised intraocular pressure in 55 eyes (43%). We conclude that although far from being ideal, silicone oil appears to have played some part in achieving the successful results reported in this study.

A comparison of personal response services in Canada and the UK.

Personal response services operating over public telephone networks are now widespread in Western Europe and North America. They serve the needs of a million people in the UK and a further two to three million elsewhere. While most clients are elderly, the scope of such services is extending to people with support needs of all ages, especially where there are medical risks or a likelihood of falls. Such services are, therefore, on a convergent course with those concerned with telemedicine. A study of two personal response services was carried out, one based in Ottawa (Canada) and the other in Oldham (UK). The parallels and contrasts were examined through a survey involving personal interviews with samples of clients. Thirty-eight valid personal interviews were completed, 20 in Ottawa and 18 in Oldham, representing 14% and 53% respectively of all service clients in the survey areas. It is concluded that services established within the health sector (such as many in Canada) are better placed to accommodate change. Convergence with telemedicine will, as a result, be facilitated. In the UK, health authorities and trusts are likely to develop their own telemedicine services in competition with current providers of personal response services, thus delaying convergence.

The quadrate suture. A new technique for temporary intraoperative mydriasis.

A simple, quick, effective, and atraumatic closed suturing technique for producing and maintaining intraoperative pupillary dilation is described. Readily available sutures, needles, and syringes are used in a way that eliminates the need for paracenteses, sclerotomies, and special equipment.