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Also, the telemedicine communication link usually involves standard telephone service through high speed, wide bandwidth transmission of digital signals in conjunction with computer enhancement. Evolving alternative communication links for telemedicine include fiber optics, satellite connections, and other sophisticated peripheral equipment and software. Telemedicine can be divided into three areas: decision-making aids, remote sensing, and collaborative arrangements for real-time management of patients at a distance.
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Telemedicine for Pediatric Patients
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I think that telemedicine should develop as fast as possible within pediatric subspecialties. I believe it is crucial to our children that medical expertise be available as much as possible. In our small town and many small towns, specialized pediatric care is available at great distances. This means that families must drive great distances, ambulances must travel many miles, and medical air transport systems must be used in many emergencies.
We see pediatric specialist leaving our small town as the economy worsens here. Years ago, they were coming to our town as recruiting efforts were great. Other types of specialists besides pediatricians were also arriving to our town years ago. But this is not the case now. Telemedicine is a viable means to fill the voids.
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The speed and outer boundries of healthcare informatics resources used in the case of Osama bin Laden has to be mind blowing!
I imagine that the USA armed service personnel had pictures and documentation stored on electronic devices to identify Osama bin Laden on the spot. These items had to include markings, scars, and maybe birthmarks. The same things we identify patients by in the hospital and other settings.
There also may have been a small portable lab setup present to quickly identify blood type. This does not identify a specific person. But it allows the personnel to quickly keep searching if the wrong blood type is shown. Again, this blood typing is used in the USA for quick close identification.
Telemedicine had to be in place also. It may or may not have been used during the raid. If the armed service personnel needed an answer or needed to send data, then Telemedicine or some form of it had to be quickly accessible.
I will let other healthcare informatics professionals discuss the aspect of rapid DNA analysis.
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May 11, 2011
President Obama will not release public pictures of the dead Osama bin Laden, comment
I wished I were part of the team that performed an autopsy on Osama bin Laden. There were more than the usual number of personnel for a single autopsy and/or there were several shortcuts to accomplish such an autopsy in a very short time. An autopsy will continue weeks, months, and sometimes years after a person is dissected and buried. Looking at television videos, I will guess that Osama bin Laden may have arthritis. This will show up in the forensic investigation of his death especially if it is chronic.
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May 5, 2011
President Obama will not release public pictures of the dead Osama bin Laden
Is President Barack Obama correct on this decision not to release disfigured photos of the dead Osama Bin Laden? Yes, he is.
The spirit of international and US laws prohibit the public release of photos of the deceased. Note that the US is unhappy when pictures of dead Americans are broadcasted publicly.
Morally speaking, most Americans would not want pictures of their disfigured passed away loved one broadcasted publicly. The moral, social and spiritual beliefs of a victim and family members should be taken into account. Also the moral, social, and spiritual belief of the country in possession of the pictures should be taken into account.
Ethically speaking, members of the Forensic Medical and Nursing profession are not permitted to show public pictures of the deceased. This brings me to another point. Forensic physicians, nurses, and personnel should be involved with the handling of Osama bin Laden and others. Forensic healthcare personnel are trained to be objective. They will confirm the cause of death, the time of death, the identification, and identify extra factors. The forensic healthcare personnel are removed from political and military biases. Their training includes caring for victims of war on both sides and innocent bystanders.
ICU nursing frequently involves caring for the patient who is artificially ventilated. This could be for numerous reasons: i.e. failure to wear off ventilator following surgery, respiratory failure, PE, pneumonia, etc. Without advances in informatics, care of this difficult patient would be made even more difficult. Assist controlled ventilation is the most often used. In this mode, tidal volume and rate are pre-set. In other words the ventilator is taking over the work of breathing, filling the lungs with air and enabling gas exchange to occur so the patient remains well-oxygenated. If the patient does indicate respiratory effort, the ventilator is programmed to respond though it still delivers the preset tidal volume. Nurses must be attentive to the patient’s respiratory rate and the ventilator’s assistance in order to avoid hyperventilation and subsequent respiratory alkalosis. Generally, the nurse checks and records ventilator settings and respiratory effort frequently throughout the shift. The patient will be monitored with vital signs, cardiac rate and rhythm, respiratory rate and pulse oximetry, via electronic monitors which transmit information directly to nurses in preset intervals (often as frequently as 2-5 minutes) and alarm when abnormals occur. Without this form of monitoring, care of this patient would be much more difficult. If the ventilator is alarming, the nurse attends to the patient first, then, if all is well, attends to the alarms which may indicate water in the tubing or a loose connection. The patient should be assessed for skin color (nail beds and lips particularly), lung sounds, bilateral chest expansion, need for suctioning and respiratory effort. The physician may order labs, arterial blood gases, chest x-ray or alteration of settings. Again, thanks to computerized information retrieval continuity of care on a multi-disciplinary level is more accessible than in the past. In most ICUs, physicians, nurses and respiratory therapists have access to electronic bedside charting to allow for continuous monitoring. This form of charting makes the work of documentation and information retrieval safer for the patient. Simply put, breathing supplies the human anatomy with life-giving oxygen a necessity for every cell in the human body; thus the “A” in ABCs. Nurses always must attend to airway first, for without a patent airway, no other intervention could help the patient achieve homeostasis.
In an era with a shortage of nurses and primary care providers in rural areas, telemedicine is a innovative way to reach out to and underserved population. Within the umbrella of telemedicine, we also have telecardiology specifically, which is a new concept for most. However, the first major use of telecardiolgy was in 1975 in India where EKG’s were sent via phone lines for evaluation. In North Carolina many patients must travel hours to reach a city equipped to manage their cardiac disease. This creates physical and often times financial strain on the patients resulting in lack of follow up care.
This is where modern health care and brilliantly engineered cardiac devices come into play. Patients can now send information via their pacemakers or internal cardiac defibrillators (ICD) directly to their physician for evaluation, all of which is done over phone or internet. The physician can monitor heart rate, rhythm changes, or see if their ICD has implemented a shock. The physician can then change settings on their pacemaker or ICD from a computer that will better help the patient’s cardiac arrhyhmias. Medications can also be prescribed or changed based the transmitted data. This is a major benefit for patients who live far from their physician’s hospital or office.
I get excited to think how modern medicine will continue to grow and how it will continue to benefit disadvantaged patients.
There are several patients that live rural and live far from a hospital as well as many elderly that may lack transportation or it is difficult for them to get to the office. There are many patients that would benefit from the Vigilence 2 and the Vigileo monitoring systems. Monitoring a patient from a distance can also help with unnecessary visits to an ER. Sometimes the solution may be as simple such as a medication adjustment, and other times hospitalization may be required. This also can give some piece of mind to the individual as well as preserving their independence.
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