Consent and privacy in telemedicine.

The electronic broadcast of a medical interview, or a video tele-consultation (VTC), challenges many of our traditional concepts of privacy and confidentiality. The nature of a doctor-patient relationship changes dramatically when the open airwaves carry the personal histories, images, and concerns of a patient. Discussions of telemedicine often allude to inherent ethical concerns yet there are no established guidelines for the ethical conduct of a VTC

Tripler pioneers telemedicine across the Pacific.

Between January and August 1993, 59 medical teleconsultations were conducted successfully between the video teleconference center at Tripler Army Medical Center on Oahu and the video teleconference center on Kwajalein Atoll in the Republic of the Marshall Islands. This pioneer effort in the Pacific connected 2 archipeligoes separated by more than 2,200 nautical miles. Diagnostic and therapeutic decisions were made in the specialties of orthopedics, dermatology, radiology, urology, pediatrics, ophthalmology and physical therapy. Geographic isolation no longer means limited medical specialty care

Colonization with Escherichia coli EC 25 protects neonatal rats from necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in premature infants; yet its pathogenesis remains poorly understood. To evaluate the role of intestinal bacteria in protection against NEC, we assessed the ability of naturally occurring intestinal colonizer E. coli EC25 to influence composition of intestinal microbiota and NEC pathology in the neonatal rat model. Experimental NEC was induced in neonatal rats by formula feeding/hypoxia, and graded histologically. Bacterial populations were characterized by plating on blood agar, scoring colony classes, and identifying each class by sequencing 16S rDNA. Binding of bacteria to, and induction of apoptosis in IEC-6 enterocytes were examined by plating on blood agar and fluorescent staining for fragmented DNA. E. coli EC 25, which was originally isolated from healthy rats, efficiently colonized the intestine and protected from NEC following introduction to newborn rats with formula at 106 or 108 cfu. Protection did not depend significantly on EC25 inoculum size or load in the intestine, but positively correlated with the fraction of EC25 in the microbiome. Introduction of EC25 did not prevent colonization with other bacteria and did not significantly alter bacterial diversity. EC25 neither induced cultured enterocyte apoptosis, nor protected from apoptosis induced by an enteropathogenic strain of Cronobacter muytjensii. Our results show that E. coli EC25 is a commensal strain that efficiently colonizes the neonatal intestine and protects from NEC

Interobserver agreement for the ATS/ERS/JRS/ALAT criteria for a UIP pattern on CT

To establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience