A cost-effectiveness analysis of shipboard telemedicine.

BACKGROUND: The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. OBJECTIVES: To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. METHODS: A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. RESULTS AND CONCLUSIONS: If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost-effective on carriers only. Telemedicine's bandwidth requirement is small-1% of a month's time. However, if the ships' medical departments need to resort to a commercial satellite, E-mail and Internet would be the only telemedicine modality generating enough monetary benefits to offset the costs.

Hearing screening in Australian aboriginal university students.

Many indigenous peoples have been found to show an increased prevalence of both middle ear disorder and associated conductive hearing loss. Hearing loss may cause educational disadvantage during school years. For many indigenous populations in developed countries there are now increasing opportunities to participate in established formal education. This has led to greater numbers of indigenous students in post-secondary education. This study examined the results of a three-year hearing health programme for Australian Aboriginal students entering university studies. Prevalence rates were compared with those of urban Aboriginal adult non-students and non-indigenous populations. It was found that 15.5% of indigenous university students had a unilateral or bilateral hearing loss. Recommended screening procedures and methods to enhance classroom listening for indigenous hearing impaired students were suggested.

Acoustic neuroma and non-tumour retrocochlear patients: audiological features.

Seventeen surgically confirmed acoustic neuroma subjects and seventeen radiologically confirmed non-tumour subjects with retrocochlear pathology of unknown aetiology were selected to investigate retrospectively the diagnostic yield of basic audiological test procedures. Puretone audiometry, tympanometry, reflexometry and auditory brainstem response audiometry were used in the identification of acoustic neuromas versus non-tumour retrocochlear disorders. All subjects had been referred originally for neuroaudiological assessment because of suspected acoustic neuroma and had been found to have a range of abnormal ABR findings consistent with retrocochlear pathology. Detailed retrospective analysis of audiological results following surgical and radiological classification showed subject similarities for most parameters of the individual audiological tests for both acoustic neuroma and non-tumour groups. A significant difference was noted, however, between the two clinical populations for the ABR Wave V absolute interaural latency difference parameter.

ABR latency-intensity function abnormality in the early detection of a cerebellopontine angle tumour: a case study.

A case is presented of a 27-year-old male subject with a cerebellopontine angle tumour which was provisionally diagnosed on the basis of the ABR latency-intensity function findings and later confirmed by MRI. The patient initially presented with decreased hearing sensitivity, tinnitus and dizziness. The findings of neuroaudiological assessments and radiological examinations are described. The importance of the neuroaudiological test battery, in particular the ABR latency-intensity function, in this case is discussed; and the need for its inclusion for earlier detection and diagnosis of cerebellopontine angle tumours emphasized.