Telehealth: experience of the first 120 consultations delivered from a new refugee telehealth clinic.

BACKGROUND: In 2011, the Australian Government introduced Medicare item numbers for telehealth consultations. This is a rapidly expanding method of healthcare provision. AIMS: We assessed the demographic and disease profile of refugee patients attending a new telehealth clinic, and calculated the patient travel avoided. We examined technical challenges and assessed the performance of two videoconferencing solutions using different bandwidth and latencies. METHODS: We audited the first 120 patients attending the telehealth clinic. During consultations, the patient was with the general practitioner (GP) and linked by internet videoconference using VIDYO, GoToMeeting or Skype, to the specialist at a tertiary referral hospital. Travel avoided was calculated and technical problems were assessed by the participating specialist. Bandwidth and latency variations were examined within a university broadband testing facility. RESULTS: The two most frequently managed conditions were hepatitis C and latent tuberculosis. Twenty-nine different GP were included and 42 consultations required an interpreter. Nearly 500 km of travel and 127 kg of CO(2) production was avoided per consultation. Technical issues were faced in 25% of consultations, most frequently sound problems and connections dropping out. A bandwidth of at least 512 kbps and latency of no more than 300 ms was necessary to conduct an adequate multipoint videoconference. CONCLUSIONS: Telehealth using videoconferencing adds a new component to care of refugee and immigrant patients settling in regional areas. Telehealth will be improved by changes to improve simplicity and standardisation of videoconferencing, but requires ongoing Medicare funding to allow sufficient administrative support.

Facilitation of memory performance through induced semantic processing in survivors of severe closed-head injury.

This study examined whether survivors of severe closed-head injury (CHI) show a relative benefit in memory for words that are processed semantically versus words that are processed physically or acoustically. Sixteen long-term CHI patients and 14 demographically matched controls were administered a Levels of Processing paradigm involving detection of semantic (categorical), physical (letter), or acoustic (rhyme) features of to-be-remembered words. Semantic processing enhanced recognition memory and cued recall in the CHI patients, but the degree of facilitation was reduced relative to controls. The results indicate that attention to semantic features facilitates memory performance in survivors but may require greater cognitive effort. Implications for the remediation of memory impairments following CHI are discussed.