Governance and management of national telehealth programs in Asia.

UNLABELLED: Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency. OBJECTIVES: enumerate the public funded national telehealth programs in Asia and determine the state of their governance and management. METHOD: Review of literature, review of official program websites and request for information from key informants. CONCLUSIONS: While there are national telehealth programs already in operation in Asia, most experience challenges with governance and subsequently, with management and sustainability of operations. It is important to learn from successful programs that have built and maintained their services over time. An IT governance framework may assist countries to achieve success in offering telehealth and telemedicine to their citizens.

Priorities in urinary diversion following pyeloplasty.

Debate continues regarding optimal drainage following pyeloplasty. We reviewed the method of drainage in 100 consecutive dismembered pyeloplasties performed from 1983 to 1987. Of the children 20 per cent underwent pyeloplasty with placement of a nephrostomy tube and transanastomotic stent (group 1), while 80 per cent underwent pyeloplasty performed in a nonintubated fashion (group 2). A urethral bladder catheter was used in 20 per cent of the patients in group 1 and in 90 per cent in group 2. While the over-all complication rates and long-term results were similar for both groups, the nature of complications for each group differed. The intubated group had a 10.5 per cent incidence of urinary tract infection, while the nonintubated group demonstrated an 8.6 per cent incidence of postoperative anastomotic leakage. A nephrostomy tube and stent appear to be unnecessary in the routine pyeloplasty and may prolong hospitalization. Selective use of upper tract drainage may help to decrease the incidence of postoperative leakage in specific cases.