UNESCO CHAIR OF TELEMEDICINE

____________________________________________________________________________________

Report established by: ______Prof.Dr.O.Ferrer-Roca ___

Function / Title: ____Prof. in Pathology ____

To be sent by electronic mail to: m.grosjean@unesco.org

or to UNESCO, Division of Higher Education

7, place Fontenoy – 75352 Paris 07 SP

Fax: 33 1 45 68 56 26/27/28

1. Education/Training/Research
2. Conferences/Meetings
3. Missions/Travels abroad
4. Visiting Professors/Fellowships
5. Information and documentation activities
6. Others

Please specify for each item, when available, total cost and funding sources

1. For the administrative work

2. For the teaching/training/research activities

3. For the information and documentation activities

Please, provide information on items 1 to 7 for each activity, when available, and specify:

• Target groups, in accordance with Annex 1
• Geographical coverage, in accordance with Annex 2
• Funding sources, in accordance with Annex 3.

• Title and expected results for each course, workshop

1. Written agreement with the University of Entre-Rios – Argentina and the University of La Laguna March 2001. Direct consequence is the scholarship for one year extensible to tree years for a Bio-engineering.
2. Written agreement with the Universities of Makerere-Uganda, Regensburg-Germany and La Laguna-Spain through the Unesco Chair of Telemedicine in order to provide trained medical students or already graduate people to train in Telemedicine in the University of Makerere.

Training Books donations

3. Donation of the English version of the Handbook of Telemedicine to the Universities of Panama (1), Entre-Rios (9), Zulia (3), Makerere (4), Kenya (1).
4. Written agreement with the Publisher of the Spanish version of the Textbook of Telemedicine to separate 300 books to be given for free to the Ibero-American Universities.

The relevance of the telemedicine in areas underserved or to people with limited access of difficulties do not require further comments.

One of the principle obstacles in the wide use of Telemedicine is the lack of specific training and qualifications in the health care environment (doctors, nurses, paramedics, managers, NGOs) as well as related areas from which they require support (computer science, telecommunications)

The Unesco chair of Telemedicine is at the present moment an International forum where under-developing countries together with developed countries can exchange knowledge, support and information to implement locally adapted solutions for the underserved areas.

The previous 15 years work carried out in the host institution (Univ..La Laguna) facilitate the proposals acceptance and credibility. Furthermore their location in an archipelago territory, which is the bridge between Europe-America and Africa, also facilitate his tasks.

The International projects most of them with developing countries increase the awareness on the underserved areas of the designed solutions and particularly on the effort to increase the knowledge require to practice telemedicine at distance. Furthermore the Chair acts as a bridge to establish medical support with develop countries. Specifically this year the University of Regensbourg offered to the University of Makere young doctor trained in telemedicine to support the local doctors.

X WINTER COURSE OF THE CATAI - March 2002

X SUMMER COURSE OF THE CATAI- September 2002

SPANISH EDITION OF THE MANUAL OF TELEMEDICINE

GREEK EDITION OF THE MANUAL OF TELEMEDICINE

ITALIAN EDITION OF THE MANUAL OF TELEMEDICINE

FRENCH EDITION OF THE MANUAL OF TELEMEDICINE

GERMAN EDITION OF THE MANUAL OF TELEMEDICINE

STUDENTS EXCHANGE TO USA

STUDENTS EXCHANGE TO TENERIFE

STUDENTS TRAINING IN TENERIFE

DOCTORS EXCHANGE FROM EUROPE TO UGANDA

UGANDA DOCTORS TRAINING IN EUROPE

SCHOLARSHIPS FOR IBEROAMERICAN BIOENGENEERS

EC PROJECT TO EXPAND THE ACTIVITIES TO DEVELOPING MEDITERRANEAN COUNTRIES

The activities of the Chair were settle during 1999 and developed throughout 2000-2001. The development include:

                    Número de Páginas : 13

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Objectives: The 3D-Ultrasound reconstruction, available as a routine exploration since 1994, has brought new technical capabilities such as virtual sonography that can be tele-consulted and which experience is summarized in the present paper.

Methods: During one year 73 3D-US volumetric images coming from 34 patients of the Obstetrics and Gynaecology department were acquired and 68 were consulted at distance. Acquisitions were carried out through an existing 2D device adding a magnetic tracking system on the US-probe. Probe positioning and video output was introduced into a PC running software that allows the generation of 2D-orthogonal and 3D volume images, as well as tele-consultation.

Several image analysis techniques for 3D-reconstruction were evaluated.

Results: Final volumes were small (1.5Mb) and required about 4 minutes, with a SD of 2 minutes, to be transmitted over one ISDN channel (64Kbs). Good correlation (k=0.7) was found between local and distant diagnosis. In 30%, images were considered of low quality and in 29% of good quality; diagnosis could be done with confidence in all except 7 cases. Virtual sonography, by means of oblique cuts in all space directions, improved distant diagnostic confidence. Limitations were linked to: incomplete sampling due to the short acquisition time periods (26 seconds) and difficulties on hand-free probe movement.

3D reconstructions were time consuming (20 min- 4 hours) and of limited indication.

Conclusions: 3D reconstruction could reduce multiple explorations due image constrains such as sub optimal foetal positioning, among others. Virtual sonography was important to reach confidence on distant diagnosis; it was also considered a tool for off- line local review of non-trained sonographer acquisitions.

                    Numero de Páginas: 8

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Background - Advantages provided by phone medicine are still unknown. In spite of health care and user benefits its role in everyday health care provision is neither mentioned nor considered in the medical system organisation schemes. Patient demand in some medical specialities such as oncology advises starting phone-medicine, but manager decisions have been postponed on the basis of the limited available scientific data.

Methods - The present work carries out a comparison before and after the establishment of a 24-hours phone-medicine service attended by the patient’s personal doctor. Service was offered as a patient’s right for 5 months in 1997 and 12 months in 1998. A total of 560 oncology patients with solid tumours were followed during these two years.

Data analysis includes: influence of the service on the number of outreach controls and casualties together with its usage and benefits; the latter were evaluated studying: 1) time variables, 2) patients’ origin and medical data, and 3) objective and subjective phone call classification (identification?).

Results- Phone calls were short (3-5 min); 80% of the were stablished on the patient’s own initiative, 89% came from outreach patients, of whom 66% were under treatment. Half of calls were informative (48%); treatment was indicated in 1/3 of calls and psychological support was needed in 4% of the cases. The pathology causing the calls was solved in 22% of the cases without further medical intervention within ten days, while in 18% an outreach clinical visit was indicated. With a 24% increase in number of controlled patients, the oncology department showed a 53% decrease on casualties and 17% on outreach visits during 1998.

Conclusion.- The introduction of phone medicine in patients’ surveillance was considered the main reason of the decrease in outreach visits and casualties furthermore efficiently handled. Patients’ control improved with quick detection of alarm signs in the course of the treatment. The service has been introduced as the patients’ right has been accepted as a benefit by them.

                    Numero de Páginas : 8

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Se considera que la implantación del servicio de Medicina Telefónica ha sido el responsable de la reducción de la presión asistencial, particularmente en el caso de las urgencias que, por otra parte, se han gestionado de forma mucho más eficiente, mejorando la atención al paciente y detectando precozmente signos de alarma importantes en su evolución.

                    Number of pages : 6

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Purpose/Methods : This paper summarises the testing of the ophtalmological consultations via the spanish web Oftalnet carried during a period of 18 months. Consultations, which are free of charge, are received by the Medical coordinator who submits them to the group of experts that constitute the Scientific Commitee of the web Oftalnet and that are divided into 6 sections : 1) Strabology and Neuroophtalmology ; 2) Orbit, eyelids and appendages ; 3) Anterior Chamber (cornea, conjunctiva, lens and glaucoma) ; 4) Posterior Chamber (vitreous and retina) ; 59 Refractive Surgery and 6) Miscellany.

Results/Conclusions : The 71 consultations attended during this period are grouped into : 1) Informative (75%) ; 2) Diagnostic (13%) ; 3) Trascendental (5%) and 4) Complementary request (7%).

The average number of consultations attended is of 5.5 per month. The designed organisational and working program has proved itself to be efficient and gratifiying both for the users as well as for the Scientifica Committee.

The obtained results confirm in the presents era of Informatics this way of online medical service should be accepted and regulated in order to offer an accurate and responsible advice to the patient.

                    Numero de páginas : 2

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The main concern is related with the regulation requirements in order to facilitate the use and implementation of Telemedicine not only locally but also for the support of third developing countries.

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The information society tools force quick changes and the updating of training programs and laws from which medical practice can not be excluded. This work summarises the norms and laws applied to the practice of telemedicine and home-care. Following the subsidiary principles, the legislative levels applied are: National laws, European Union, laws from the Autonomous Communities, and those from the Medical professional colleges and local medical colleges.

On the results and discussion we will give special mention to those Ethical and Deontological rules that we consider contradictory or not innovative, as well as to the urgent demand to sensitise and habilitate the medical doctors in new technologies that should start with the curriculum renewal. Finally, both the appliance of the existing legislation and the elaboration of an info-ethic code of conduct for the Telemedicine practice, are encouraged.

                    Titulo: AVIATION MEDICINE. CHALLENGES FOR TELEMEDICINE

                    Número de Páginas : 8

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Medical support in the Air is becoming relevant. It started with the law advising to carry on board Medical Decision Support Systems, such as Automatic External Defibrillators, and now a day is linked to the increase awareness of the so-called Economy Class Syndrome and the progressive aging of population. Technology and telecommunication advances allow improving medical support on board by means of telemedicine and telemetry devices . As a result of the better patient care and the coordination with a medical ground station, lives could be saved not only in the aircraft by particulary during patient transfer to the nearest hospital. The present paper brings awareness of the importance of medical support for safety long or transoceanic flights, listing the present situation as well as improvements based on telemedicine. Particulary, regarding technical solutions compatible with existing aircraft technology and specific aero-spatial environment.

                    Número de Páginas: 209

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                    Tipo de Documento/material:

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According to one of the numerous definitions of Telemedicine "providing medicine at a distance", any doctor being trained in the use of some telematic devices could effort that practice. The reality is far from this because to assure a safe practice, people have to learn and bear a minimum understanding of a wide range of topics: from economics to telecommunications and from medicine to legal aspects. Technology learning is not limited to technology itself but linked to its social practical consequences in all their aspects. To guarantee that none of the aspects related with Telemedicine are missed, this minimum knowledge has to be fixed, organised and in some way standardized. The main purpose of this book is to structure the basic knowledge linked to teaching to provide or to practise telemedicine, as well as an overview of the technology developments linked to this new discipline. As expressed in the title (Handbook of Telemedicine), the book is precisely structured as a "handbook" whose main value is the joint opinion of all the participating authors of what are the learning requirements for anyone that would like to practice Telemedicine. It is not a full treatise nor a complete collection of all telemedicine applications or telemedicine basics. It was built with the aim of creating awareness to the academic aspects (technology development, telecommunications approach, law and regulations, medical practice) as well as to the minimum knowledge requirements to guarantee safe and appropiate medical practice. Nowadays this fact is enhanced by the evidence that welfare expenses cannot be endlessly increased, whilst an efficient health provision system in the context of the information society, will mark a new trend to configure health care practice in the next century. If training and teaching schemes are to cope with the demands of society it seems obvious that those carers and professions should consider structured and sufficient training in Telemedicine.

The present CD-ROM contains the Handbook of Telemedicine as a whole, internally structured in 12 Chapters and 13 Annexes (file HANDBOOK.DOC). Some of them are complemented with diverse multimedia material for training and teaching purposes. The handbook is presented in Word and Html formats (directory /html), while the multimedia material is located in the directories /ppt and /mpeg. The former are PowerPoint 97 presentations and the latter are video-clips on Mpeg format.

La web del CATAI tiene como objetivo principal la divulgación de la Telemedicina en España. La actividad científica y humanitaria de la Asociación sin ánimo de lucro CATAI (Centro y de Tecnología Avanzada y Análisis de Imagen), está relacionada con:

Análisis de Imagen

Estadística de la Imagen

Transmisión a Distancia de Imágenes de Alta Resolución

Videoconsultorías

Videoconferencias

Telecuantificación

Dispositivos Multimedia

Y finalmente, Aplicaciones de la Telemedicina en el Mundo Real entre otras actividades.

La web del CATAI ofrece una amplia información sobre bibliografía en Telemedicina, Cursos de Tecnología Avanzados relacionados con Telemedicina, Proyectos de Actividades Internacionales relacionados con la Telemecicina, cursos de enseñanza a distancia así como algunos enlaces interesantes de Telemedicina.

The present activity carries out the diffusion of the structured training skills in the field of TELEMEDICINE. It introduces an innovative professional training by assuming new Information Society skills not only in the Health Care provision but also in the teaching methodology. The co-operation inside of the present CTC consortium will provide and update the contents of those rapidly moving technologies, and will bring innovative approaches in the teaching done at distance with experience of the ODL of APOLLO project as well as the experience on surgical virtual reality simulators provided by the new partners. The training is directed towards trainers to update their knowledge and skills, it means health care professionals (including directors and responsible people) in the European Union. This requires the updating of the Information Society training applied to health care.

The present project will carry out the diffusion activity of the structured training skills in the field of Telemedicine (TM) established in the 1177/95 Leonardo project, expanding the consortium towards complementary activities in Medical Informatics (Apollo pilot from Greece GR/96/1/00022/PI/I.1.1.a/FPI idx: 5107 ODL) and towards distant simulator training in Medicine, particularly in Endoscopes surgery. It will introduce an innovative professional training by assuming new IS technologies skills not only in the Health Care provision but also in the teaching methodology. The training is directed towards:

a) Trainers to update their knowledge and skills, with a side effect on curricula innovation in their own surrounding

b) To students of health care related topics (vocational up to University) that by means of distant teaching, multimedia material and European meetings will experience technologies, otherwise not be available in their own surrounding. A progressive EC demand of trained people in Telemedicine is expected; this multidisciplinary topic is not properly addressed in the curriculae of hospital mantainance people, hospital assitants, nurses, medical doctors, informaticians, telecomunication and biomedical technical and superior engineers, up to emergency related people with navy and air enviroment.

c) developing countries which demands of Telemedicine are very high. The strategy to properly address this demand is by creating a Unesco Chair of Telemedicine that will accomplish that task

CONTENT . Curriculae content have been settle in the Leonardo project CATAI-TELEMED 1177 and consist of 12 topics with theorical and practical teaching material ready to be use in the present action. Furthermore the cooperation inside of the present CTC-consortium will provide and update the contents of those rapidly moving technologies, and will bring innovative approaches in the teaching done at distance with the experience of the ODL of the APOLLO project as well as the experience on surgical virtual reality simulators provided by the new partners.

BENEFITS. It is urgent that Telemedicine reach health professionals (including directors and responsable people) in the EU. This require the updating of the IS technology training applied to health care. A EU coordinated action to teach the structured Telemedicine Body of Knowledge (Leonardo 1177/95) will facilitate cross-border licencing recognition. This pilot also take into consideration the fact that a complete training is not possible in each individual country, due to the irregular Health Care technology developments throughout the EC, being cooperation and distant training the only oportunity to overcome local training deficiencies in Telemedicine which are particularly extreme in developing countries.

IMPACT. The adequate training of health-related profesionals in the field of TM produce active technologies transfer and prepare the people for the acceptance of the new forcoming jobs. The multidisciplinary approach required on Telemedicine training, push new qualifications as well as specializations. This activity is link with the initiative of the UNESCO chair of Telemedicine to apply the consortium experience towards the urgent demand of TM in developing countries, in order to improve their limited health care system into a more efficiency and accessible one.

WORK AND DIFUSSION. The International teaching activities are arranged in intensive Winter and Summer Courses particularly to update trainers’ knowledge and teaching material. The recognition of those courses by the involved Universities may help to renew students´ curriculae and facilitate cross-border recognition of qualifications. The participating countries and Universities had carried out the rest of training locally; they provided presential and distant training including demonstrations with virtual reality simulators. The partners through International organization and Associations actively promoted training recognition; this activity enssured a smooth curriculae renewal and favour technology transfer, preparing the society for the forcoming jobs. In this context the Unesco chair of TM had played a significant role.