Family Medicine

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World Book of Family Medicine – European Edition 2015 interpretation by a specialist. Flexible cameras can capture images from inside the ear, nose, throat and vagina for evaluation by specialists through remote consultation. Teledermatology has been reported as being practised in various settings (4,5). Fundoscopy can now be carried out by professionals who are not expert cardiologists, with the use of an amazing digital ophthalmoscope. Videoconference is now becoming progressively more available with the support of 3D, 4D and Wi-Fi technology . With the widespread use of tablets and smart phones, a team of health professionals including nurses, primary care physicians and specialists can virtually “team up” at any time regardless of distance and with considerable reduction in manpower cost. Inspection is an essential part of physical examination. As a result, videoconference is very important for the remote specialists in order to gain a complete impression of a patient’s condition. With the aid of the visiting health professional’s hands and his or her cooperation, a remote specialist can also recognize abdomen guarding, tenderness, stiffness of joints, tendon reflexes and other signs, which are classified under “palpation”. Percussion sounds can also be heard and evaluated by the remote specialist. We use Ethernet cameras with pan, tilt and zoom functions to achieve 7/24 observation of very ill patients at home. This not only assists in the continuous monitoring of a patients’ breathing and alertness, but also to monitor the carers’ adherence to given instructions. Infusion pumps. In order to guarantee accuracy, safety and nurses’ compliance to regulations, we use multi-functional infusion pumps. Multi-dose function allows administration of medicines in doses, even when a nurse is not present at the time of infusion. Often, a nurse stays with the patient and monitors vital signs, urine output and other parameters. He/she is able to change the pump’s settings, either according to a given protocol, or after a remote specialist’s consultation. A view into the future. Flexible technologies and smart clothing are highlighting a new era in the field of telemonitoring. There is ongoing evolution towards the development of miniature, soft and flexible non-invasive sensors, which are incorporated to clothes (6). Many important parameters regarding metabolism, thermal comfort, skin blood flow, skin hydration, skin thermal conductance, skin infection, muscle activity, autonomic nervous system activity, respiration rate and amplitude, heart rate, blood pressure, position, circadian rhythm, pressure sore detection, heart point detection, etc., can be measured from skin, using non-invasive sensors. A personal area network (7) connects the distributed intelligence of all the items of smart clothing, transmitting data to a computer and a specialist monitoring station, where vital parameters are analysed (8). Conclusion Point of care diagnostic capabilities and telemedicine are essential parameters towards a safe shift of the care of acutely ill patients from hospital to home. Yet the treatment of an acutely ill patient also requires uninterrupted responsibility by a clinical team, regular clinical measurements including vital signs, bio-signals and water intake/output balance, frequent and rapid acquisition of testing results, prompt interpretation of the entire clinical information and decision making and high degree of alertness to effectively react in the case of any unforeseen complication or deterioration. Consequently, safe home care for acutely ill patients, apart from the availability of ambulatory testing equipment and telemedicine, also requires special and smoothly operating organizational structures. Take home messages “Hospital” should not continue to be regarded as a venue, but as an organization, which combines concerted teamwork of health professionals, enhanced patient monitoring and sophisticated treatment. Point-of-care portable diagnostic apparatuses enable most of the frequently required diagnostic tests to be rapidly and reliably performed at the patient’s home. 162
World Book of Family Medicine – European Edition 2015 A team of doctors, nurses and other health professionals can be at any time virtually near the patient regardless of distance barriers, with the support of information and communication technology. Ongoing technological evolution highlights a new era in the field of telemedicine, which promises to allow safer advanced home medical care in the near future. Original abstract http://www.woncaeurope.org/content/4478-home-care-dawn-21st-century-whats-difference-electronic-devices-and-telemedicine References 1. E.Papazissis, Advanced Technology Permits the Provision of Advanced Hospital Care in the Patients' Homes, Studies in Health Technology and Informatics 100 (2004), 190-199. 2. A.Junais, Telemonitoring, COPD and cough counting, Journal of Telemedicine and Telecare 2012; 18: 301-302. 3. S.Martin, J.Augusto, P.McCullagh, W.Carswell, H.Zheng, H.Wang, J.Wallace, M.Mulvenna, Participatory Research to Design a Novel Telehealth System to Support the Night-Time Needs of People with Dementia: NOCTURNAL, Int J Environ Res Public Health. 2013 Dec 4; 10(12):6764-82. doi: 10.3390/ijerph10126764. 4. J.Frühauf, G.Schwantzer, C.Ambros-Rudolph, W.Weger, V.Ahlgrimm-Siess, W.Salmhofer, R.Hofmann-Wellenhof, Pilot study on the acceptance of mobile teledermatology for the home monitoring of high-need patients with psoriasis, Australas J Dermatol. 2012 Feb;53(1):41-6. doi: 10.1111/j.1440-0960.2011.00852.x. Epub 2012 Jan 6. 5. C.Chanussot-Deprez, J.Conteras-Ruiz, Telemedicine in Wound Care: A Review, Adv Skin Wound Care. 2013 Feb;26(2):78-82. doi:10.1097/01. ASW.0000426717.59326.5f. 6. F.Axisa, P.Schmitt. C.Gehin, G.Delhomme, E.McAdams, A.Dittmar, Flexible Technologies and Smart Clothing for Citizen Medicine, Home Healthcare, and Disease Prevention, IEEE Trans Inf Technol Biomed. 2005 Sep; 9(3): 325-36. 7. Yu-Fang Chung, Chia-Hui Liu, Design of a Wireless Sensor Network Platform for Tele-Homecare, Sensors (Basel). 2013 Dec 12;13(12):17156-75. doi: 10.3390/s131217156. 8. Jia-Li Ma, Yuan-Lian Cui, Ming-Chui Dong, An Effective Low-Complexity Multi-Fital-Signs Compression Technique for Embedded-Link e-Home Healthcare, Engineering in Medicine and Biology Society (EMBC), 2013 35th Annual International Conference of the IEEE. doi: 10.1109/EMBC.2013.6609716 163
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