Telemedicine consultations in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: A Telemedicine project was initiated to evaluate the usefulness of medical teleconsultations in Iceland and to gain experience for further planning of Telemedicine in the country. MATERIAL AND METHODS: The consultations were based on videoconference and store and forward method. Electronic stethoscope, spirometry, otoendoscope and digital pictures were used along with conventional videoconsultations. Doctors in six specialties in Landspitali University Hospital and one in private practice and Primary Care Physicians from five Health Care Centers in Iceland participated in the project. RESULTS: The results show that the Telemedicine consultations is practical and can be very useful. The doctors were content with the use of Telemedicine and the patients were pleased with the technique and the consults in general. All patients for example said that the consultation was just as or even better as if the specialist was in the room in person. The use of Telemedicine was helpful in almost all of the cases. Attention must be paid to organization of the consultations, payment, technical details and knowledge. CONCLUSION: Telemedicine have a role for Icelandic healthcare and may prove to be very useful. There are a number of factors who need preparation before the implementation of a Telemedicine service.Tilgangur: Að meta hvernig nota megi fjarlækningar við samráð (consultation) lækna á Íslandi og safna reynslu fyrir framtíðarskipulagningu fjarlækninga í heilbrigðisþjónustu hér á landi. Efniviður og aðferðir: Samráð voru tvíþætt, annars vegar með fjarfundabúnaði (videoconference) og hins vegar með rafrænum sendingum (store and forward) þar sem notuð voru gögn úr rafrænni hlustpípu, öndunarmæli (spírómetría) og stafrænni myndavél. Auk þess var notuð eyrnaholsjá (otoendóskóp) á fjarfundum. Sérgreinalæknar sex sérgreina, það er í barnalækningum, háls-, nef- og eyrnalækningum, hjartalækningum, húðlækningum, lungnalækningum og skurðlækningum, voru ráðgefandi fyrir heimilislækna á fimm heilsugæslustöðvum víðsvegar um landið. Læknarnir störfuðu á Landspítala, einkarekinni læknamóttöku og heilsugæslustöðvunum á Seyðisfirði, Egilsstöðum, Kópaskeri, Patreksfirði og í Reykjavík. Niðurstöður: Niðurstöður sýna að fjarlækningaþjónusta eins og veitt var í verkefninu gegnir hlutverki sínu ágætlega og getur verið mjög gagnleg. Almenn ánægja var meðal sjúklinga og lækna með fjarlækningarnar. Til dæmis töldu allir sjúklingar sem tóku þátt í fjarlækningum með fjarfundabúnaði að læknisviðtalið gagnaðist svipað og jafnvel betur en ef sérgreinalæknirinn hefði verið til staðar í eigin persónu. Fram kom að til að ná fram hámarks gagnsemi fjarlækninga þarf skipulag samráða að vera gott, greiða þarf fyrir þessa vinnu og einnig þarf tækni og tækniþekking að vera til staðar. Ályktun: Fjarlækningar eiga erindi inn í íslenskt heilbrigðiskerfi og geta verið til mikils gagns. Að mörgum þáttum þarf að huga varðandi uppbyggingu og skipulagningu fjarlækningaþjónustu

Ljósertiexem af völdum sellerís og sólbaðstofugeislunar : tvö sjúkratilfelli á sama vinnustað

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenWe report two patients who were packing celery in the same supermarket. After work they went to a tanning parlour with UVA-sunlamps where they were irradiated for 18-20 minutes without first taking a shower. They had both used UVA-sunlamps before, without any adverse effects. On the following day a bad sunburn was observed on the skin of both patients were the celery had touched the skin. A third employee was known to have had a similar reaction but did not seek medical assistance. Photocontact dermatitis was produced in one of the authors (S.D.) by applying celery extract on the forearm and radiating with UVA-light. Photocontact dermatitis caused by celery and UVA-sunbeds is a well known phenomena but has not been described in Iceland before.Lýst er tveimur sjúkratilfellum á sama vinnustað. Unnið var við snyrtingu og innpökkun á selleríi. Stuttu síðar fóru starfsmenn í sólbaðstofuljós. Slæmur bruni kom fram þar sem sellerí hafði snert húðina. Vitað var um þriðja starfsmanninn á sama vinnustað sem fékk samskonar útbrot. Ljósertiexem var framkallað á höfundi (S.D.) með því að bera safa úr selleríi á húð og lýsa síðan með UVA-ljósi. Ljósertiexem af völdum sellerís og UVA-sólbaðstofuljósa er þekkt fyrirbrigði en því hefur ekki verið lýst hér á landi áður

Cutaneous leishmaniasis. A case report

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCutaneous leishmaniasis is a common infection in South America and the Middle East. A 20 year Icelander was infected with leishmaniasis while travelling in South America. Treatment with the antimonial sodium stibogluconate was successful. With increased travelling to tropical and subtropical countries a rising incidence of tropical infectious diseases can be expected in Iceland.Leishmanssótt (leishmaniasis) í húð er algeng sýking víða um heim sérstaklega í Suður-Ameríku og Mið-Austurlöndum. Hér er lýst sjúkratilfelli þar sem tvítugur Islendingur smitaðist af leishmanssótt á ferðalagi í Suður-Ameríku. Meðferð með kvikasilfurslyfinu natrium stíbóglúkónat var árangursrík. Með auknum ferðalögum Íslendinga til heitari landa má búast við aukinni tíðni ýmissa smitsjúkdóma sem algengir eru þar

Cutaneous leishmaniasis. A case report

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCutaneous leishmaniasis is a common infection in South America and the Middle East. A 20 year Icelander was infected with leishmaniasis while travelling in South America. Treatment with the antimonial sodium stibogluconate was successful. With increased travelling to tropical and subtropical countries a rising incidence of tropical infectious diseases can be expected in Iceland.Leishmanssótt (leishmaniasis) í húð er algeng sýking víða um heim sérstaklega í Suður-Ameríku og Mið-Austurlöndum. Hér er lýst sjúkratilfelli þar sem tvítugur Islendingur smitaðist af leishmanssótt á ferðalagi í Suður-Ameríku. Meðferð með kvikasilfurslyfinu natrium stíbóglúkónat var árangursrík. Með auknum ferðalögum Íslendinga til heitari landa má búast við aukinni tíðni ýmissa smitsjúkdóma sem algengir eru þar

Diagnosis of chlamydia trachomatis infections in women : urinary PCR compared to cervical culture and PCR on cervical swabs in high risk females

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenDiagnosis of Chlamydia trachomatis infections in women has traditionally depended on cell culture or enzyme linked immunoassay. Recently Polymerase Chain Reaction (PCR) has been shown to be more sensitive than these methods when performed on endocervical swabs. A total of 203 high risk females were enrolled in a comparative study of three methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor® PCR on endocervical swabs and urine. Thirty four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor® specimen was retested by Roche with Amplicor® and a primer for the Major Outer Membrane Protein (MOMP) gene. None was false positive in cell culture or in urinary PCR but two were false positive in cervical PCR. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both cul¬ture and urinary PCR but 98% in cervical PCR. The results show that Amplicor® PCR performed on female urine is more sensitive and as specific as cell culture

Prevalence of genital chlamydia trachomatis infections in college students

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSexually transmitted Chlamydia infection is the most common venereal disease in Iceland. Although considerable information is available on the epidemiology of these infections, the true prevalence of C. trachomatis infections in Iceland is unknown because all the studies have been conducted on selected populations. The purpose of the present study was twofold: To investigate the prevalence of Chlamydia infection in an unselected group of people in the age group at high risk, and to investigate the usefulness of collecting urine samples from college students as a screening method for Chlamydia. All students, aged 18-21, in the senior classes in a college in Reykjavik were requested to submit a first void urine (FVU) specimen taken in the morning and asked to fill out a short questionnaire. The urine samples were tested with a polymerase chain reaction assay, the Amplicor® PCR. One hundred eighty three students received urine collection kits. One hundred sixty (87.4%) delivered specimens. Seventy three males and 110 females received the containers. Sixty males (82%) and 100 (91%) females returned the samples. Three samples turned out to be positive (2%), all of them from females. For those who were sexually active (one or more partners for the last six months) the prevalence was 2.6% (117/160). In conclusion: The prevalence of asymptomatic Chlamydia infection in college students in this school was low, probably too low for screening to be cost effective. The procedure was not satisfactory because of the low percentage that enquired about their tests. It is therefore unsuitable in a screening program

Diagnosis of chlamydia trachomatis infections in women : urinary PCR compared to cervical culture and PCR on cervical swabs in high risk females

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenDiagnosis of Chlamydia trachomatis infections in women has traditionally depended on cell culture or enzyme linked immunoassay. Recently Polymerase Chain Reaction (PCR) has been shown to be more sensitive than these methods when performed on endocervical swabs. A total of 203 high risk females were enrolled in a comparative study of three methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor® PCR on endocervical swabs and urine. Thirty four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor® specimen was retested by Roche with Amplicor® and a primer for the Major Outer Membrane Protein (MOMP) gene. None was false positive in cell culture or in urinary PCR but two were false positive in cervical PCR. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both cul¬ture and urinary PCR but 98% in cervical PCR. The results show that Amplicor® PCR performed on female urine is more sensitive and as specific as cell culture

Prevalence of genital chlamydia trachomatis infections in college students

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSexually transmitted Chlamydia infection is the most common venereal disease in Iceland. Although considerable information is available on the epidemiology of these infections, the true prevalence of C. trachomatis infections in Iceland is unknown because all the studies have been conducted on selected populations. The purpose of the present study was twofold: To investigate the prevalence of Chlamydia infection in an unselected group of people in the age group at high risk, and to investigate the usefulness of collecting urine samples from college students as a screening method for Chlamydia. All students, aged 18-21, in the senior classes in a college in Reykjavik were requested to submit a first void urine (FVU) specimen taken in the morning and asked to fill out a short questionnaire. The urine samples were tested with a polymerase chain reaction assay, the Amplicor® PCR. One hundred eighty three students received urine collection kits. One hundred sixty (87.4%) delivered specimens. Seventy three males and 110 females received the containers. Sixty males (82%) and 100 (91%) females returned the samples. Three samples turned out to be positive (2%), all of them from females. For those who were sexually active (one or more partners for the last six months) the prevalence was 2.6% (117/160). In conclusion: The prevalence of asymptomatic Chlamydia infection in college students in this school was low, probably too low for screening to be cost effective. The procedure was not satisfactory because of the low percentage that enquired about their tests. It is therefore unsuitable in a screening program

Clinical evaluation of two immunoassay methods for the rapid detection of chlamydia trachomatis : antigen in endocervical specimens from high risk female patients

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTwo rapid immunoassay methods, QuickVue-Chlamydia (Quidel Corp., San Diego California) and Kodak Surecell (Kodak Corp. Rochester, N.Y.) were evaluated for the detection of Chlamydia trachomatis antigen in endocervical swabs from high risk females attending a sexually transmitted disease clinic. The results were compared to McCoy cell culture and a polymerase chain reaction assay (Amplicor®-PCR, Roche Molecular Systems). Of the 240 females enrolled in the study 45 were considered infected (18.8%). Sensitivity, specificity, predictive value of a positive (PVP) and predictive value of a negative (PVN) of the QuickVue-Chlamydia assay were 96%, 99%, 96% and 99% respectively. Sensitivity, specificity, PVP and PVN of the Surecell assay were 96%, 100%, 100% and 99% respectively. The performance of the two immunoassay methods was similar, the sensitivity was the same and the specificity of the Kodak Surecell was slightly better than that of the QuickVue. On the other hand, the QuickWVL&-Chlamydia assay was considerably simpler to perform (fewer steps) than the Kodak Surecell assay and took significantly less of technologists time

Clinical evaluation of two immunoassay methods for the rapid detection of chlamydia trachomatis : antigen in endocervical specimens from high risk female patients

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTwo rapid immunoassay methods, QuickVue-Chlamydia (Quidel Corp., San Diego California) and Kodak Surecell (Kodak Corp. Rochester, N.Y.) were evaluated for the detection of Chlamydia trachomatis antigen in endocervical swabs from high risk females attending a sexually transmitted disease clinic. The results were compared to McCoy cell culture and a polymerase chain reaction assay (Amplicor®-PCR, Roche Molecular Systems). Of the 240 females enrolled in the study 45 were considered infected (18.8%). Sensitivity, specificity, predictive value of a positive (PVP) and predictive value of a negative (PVN) of the QuickVue-Chlamydia assay were 96%, 99%, 96% and 99% respectively. Sensitivity, specificity, PVP and PVN of the Surecell assay were 96%, 100%, 100% and 99% respectively. The performance of the two immunoassay methods was similar, the sensitivity was the same and the specificity of the Kodak Surecell was slightly better than that of the QuickVue. On the other hand, the QuickWVL&-Chlamydia assay was considerably simpler to perform (fewer steps) than the Kodak Surecell assay and took significantly less of technologists time