The impact of telemedicine on quality of life in rural areas: the Extremadura model of specialized care delivery.

BACKGROUND: Referrals from rural health centers to urban hospitals join waiting lists as outpatients for hospital admission and hospital treatment. This influences quality of life (QoL) of the rural population and retired people who require medical attention without traveling, provided no risks are involved. For this reason, a rural region of Spain has adopted a strategy to deliver telemedicine (TM) specialized care (Extremadura model) as a political decision. OBJECTIVES: The present study aimed at objectively assessing QoL on aspects of health and well-being for citizens benefiting from this system. METHODS: We performed a randomized study of 800 primary care patients referred for specialized care: 420 regular face-to-face hospital referrals and 380 referred to a hospital specialist at a distance by TM. The study used two questionnaires: a modified version of the classical SF-12v2 short form questionnaire for health and well-being and a specific author-elaborated questionnaire. The latter focused on major patient concerns such as (1) discomfort and pain relief, (2) swift diagnosis, (3) swift treatment, (4) swift decision on hospital admission or not, (5) avoidance of traveling, (6) avoidance of red tape, and (7) personal attention. QoL was assessed twice: before referral to a hospital specialist and 6 months after referral to the same. The results were statistically compared. RESULTS: Both groups showed comparable health status with added advantages for TM referrals such as (1) less traveling (p = 0.0001) and (2) faster diagnosis, health examination, and treatment (p = 0.0001). CONCLUSION: Telemedicine care by a hospital specialist through videoconferencing was comparable to hospital referral for face-to-face medicine. Teleconsultations managed by nurses had a positive impact on the QoL of rural patients. They did not have to travel and thus diagnoses and examinations to start treatment were initiated faster.

Endomicroscopía en Anatomía Patológica. Biopsia óptica / Endomicroscopy, new surgical pathology. Optical biopsy

Los avances tecnológicos en el campo de la visiónmicroscópica de las imágenes o la capacidad diagnostica deuna gran variedad de técnicas ópticas, obligan a analizar y reubicarel papel del anatomopatólogo en la medicina. Ni losmicroscopios, ni la tinción, ni el procesado de tejidos son hoyen día imprescindibles para diagnosticar una lesión en aquelloscampos en los que se esta implantado la biopsia óptica.Se hace necesario contar con publicaciones morfológicas quepermitan aprender el estándar-oro de acuerdo con la técnicaempleada de estas biopsias in vivo o biopsias ópticas no disruptivas.Este cometido ha de estar en manos del patólogo.El artículo introduce en las técnicas de diagnostico ópticoy en las técnicas de visión microscópica no invasiva mostrandolos niveles diagnósticos de cada una(AU)

Technological advances in optical microscopy and thediagnostic capacity of a wide variety of optical techniquescall for a reappraisal of the role of the pathologist. Today,neither microscopes nor tissue staining and processing areessential for diagnosis. However, in order to set the goldstandard for these techniques, more publications on themorphology of in vivo biopsies and noninvasive opticalbiopsies are needed. This should be the responsibility ofpathologists. The present article introduces the techniquesof optical microscopy and non invasive microscopy anddemonstrates their diagnostic capacity(AU)

Anatomía patológica digital. Control de calidady pato-informática / Digital pathology. Quality control and information technology for pathology

Al igual que el resto de los servicios hospitalarios, el deanatomía patológica requiere un control de calidad y unagestión automatizada. Lo habitual es que dentro del PIS(pathology information system) se automaticen las muestras,imágenes e informes y que se incorpore la PI (patoinformática),D-AP (anatomía patológica digital), la e-AP(anatomía patológica electrónica), TP (tele-patología) , la FAPo fármaco-patología, la autopsia virtual y todo tipo deinvestigación translacional dentro del PMIS (pathologymanagement information system).Al no tener un estándar especifico de calidad, estaqueda a cargo de la ISO-13485:2003 para servicios y dispositivosmédicos y la ISO 17025:2005 en los aspectostécnicos; mientras que en los procesos automatizados ycuantificables, la normativa aplicable seria la UNE: ISO-15198:2003 ligada al PIS y a los dispositivos con software,que se ve directamente afectado por la nueva directivacomunitaria.En los procedimientos no estandarizados, el criterio delos usuarios sobre su finalidad es el que prevalece. Segúnnuestro criterio, los requerimientos de control de calidad deuna preparación virtual no se cumplen en la mayoría de lossistemas comerciales.Las innovaciones que se avecinan auguran la «anatomíapatológica en solitario» (solo-patología) en un entornorobotizado bajo un estricto control de calidad que incluya elsoporte diagnostico a distancia para minimizar el grado deerror diagnostico (AU)

As in other hospital departments, histopathology andmorbid anatomy require automation and quality control.Usually the PIS (Pathology information system) automatessamples, images and reports and progressively incorporatesPI (Pathology informatics), D-PATH (digital pathology), e-PATH (electronic pathology), PPH (Patho-pharmacology),virtual autopsy and in general all types of translational researchin the PMIS (pathology management informationsystem).Not subject to a specific standard, quality controlfollows ISO-13485:2003 on services and medical devices,ISO 17025:2005 on technical aspects and ISO-15198:2003for automatic and quantifiable procedures that, as medicalsoftware, is regulated by the new European directive onmedical devices.For non-standardized procedures, users’ requirementsfor testing and calibration are essential. In our opinion, qualitycontrol requirements for virtual slides are not fulfilledin the majority of commercial systems.Future innovations in «solo-pathology» should see automatedpathology laboratories, regulated by strict qualitycontrol, which include a telepathology backup to minimizediagnostic errors (AU)

Telepathology and optical biopsy.

The ability to obtain information about the structure of tissue without taking a sample for pathology has opened the way for new diagnostic techniques. The present paper reviews all currently available techniques capable of producing an optical biopsy, with or without morphological images. Most of these techniques are carried out by physicians who are not specialized in pathology and therefore not trained to interpret the results as a pathologist would. In these cases, the use of telepathology or distant consultation techniques is essential.

Firma electrónica y manejo de privilegios en sanidad / Electronic signature and handling of privileges in health work

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