EFFICACY OF TELEMEDICINE COLPOSCOPY

该项目的长期目标是解决 宫颈癌前病变和恶性病变的患病率不成比例 少数民族、农村、贫困妇女的疾病。高流行率可能是 原因是费用和获得护理的问题以及缺乏 受过培训的农村阴道镜专家能够评估患有 巴氏涂片异常这些障碍放大了 服务不足的妇女会患上子宫颈肿瘤。 这个项目 建议使用远程医疗，积极应用 电信和计算机技术到医疗服务， 为农村患者提供阴道镜诊断服务 社区. 知道三分之一的女性有不正常的 巴氏涂片未能完成诊断评估、治疗和 随访中，本研究建议使用远程阴道镜作为一种手段， 减少诊断和管理的地理障碍， 少数农村人群宫颈癌。 远程医疗 被提议作为一种方法来提供护理的质量标准， 社区没有现成的机会获得某些专门知识。 远程医疗的成功取决于是否有足够的 充分的信息传输，以产生临床正确的决策 这最终导致令人满意的患者结果。 远程医疗 必须提供相当于直接的、面对面的传统护理的护理， 被患者接受。 这项研究允许科学 电子阴道镜与现场专家的对比分析 考试 本次调查的具体目标是 确定电视阴道镜检查在以下方面的临床影响：1） 诊断准确性和患者管理决策，2）不同 信息传递的技术方法和3）患者 接受这项技术。 受试者（N = 240）， 巴氏涂片报告或下生殖器疾病将阴道镜检查 由家庭医生或注册护士临床医生检查， 两个农村研究基地。 "真实的时间"和"离线"图像 检查将被传输到三级护理远程医疗 阴道镜专家解读中心。农村 从业者和阴道镜专家将独立识别 病理和活检部位，制定阴道镜印象，和 在咨询前选择适当的患者管理方案。 这些长距离的判断将在三个 个月时间，采用盲法交叉验证阴道镜检查 由另一位专家在各个农村地点对所有主题进行评估 阴道镜医生两种类型的远程医疗，真实的时间或现场视频， 脱机PC调制解调器图像传输，将比较方面 诊断准确性、患者管理决策和图像 分辨率 最后，患者接受度将使用 基于健康信念模型和模拟的满意度问题 在初始和交叉验证后管理的案例情景 阴道镜检查 残疾人获得高质量保健的障碍 癌症的预防、诊断和治疗， 贫穷、农村和少数民族妇女。的 这项研究的力量来自于创新的应用， 程序和技术知情，立即协商， 解决这些难题。 远距离阴道镜检查的有效性将 从这一综合评价和独特的交叉 验证设计

The long term objective of this project is to address the disproportionate prevalence of cervical premalignant and malignant disease in minority, rural, poor women. The high prevalence may be explained by cost and access to care problems as well as a lack of trained expert rural colposcopists able to evaluate women with abnormal Pap smears. These barriers amplify the probability that underserved women will develop cervical neoplasia. This project proposes to use telemedicine, the active application of telecommunications and computer technology to medical services, to provide colposcopic diagnostic services to patients in rural communities. Knowing that one third of women with an abnormal Pap smear fail to complete diagnostic evaluation, treatment and follow-up, this study proposes to use telecolposcopy as a means of reducing the geographic barriers to the diagnosis and management of cervical neoplasia in a minority rural population. Telemedicine has been proposed as a method to provide a quality standard of care to communities without readily available access to certain expertise. The success of telemedicine is contingent upon sufficient and adequate information transfer to generate clinically correct decisions which ultimately lead to satisfactory patient outcomes. Telemedicine must deliver care equivalent to direct, in-person traditional care that is accepted by patients. The proposed study permits a scientific analysis of telecolposcopy in comparison with live expert examination. The specific objectives of this investigation are to determine the clinical impact of telecolposcopy in regard to 1) diagnostic accuracy and patient management decisions, 2) different technological approaches of information transfer and 3) patient acceptance of this technology. Subjects (N=240) with an abnormal Pap smear report or lower genital disease will be colposcopically examined by a family physician or registered nurse clinician at one of two rural study sites. "Real time" and "off-line" images of the examination will be transmitted to a tertiary care Telemedicine Center for interpretation by an expert colposcopist. Rural practitioners and the expert colposcopist will independently identify pathology and biopsy sites, formulate colposcopic impressions, and select appropriate patient management options prior to consultation. These long distance judgements will be compared, within three months time, with blinded cross validation colposcopic examinations of all subjects at the respective rural sites by another expert colposcopist. Two types of telemedicine, real time or live video and "off-line" PC modem image transfer, will be compared with respect to diagnostic accuracy, patient management decisions and image resolution. Finally, patient acceptance will be evaluated using satisfaction questions based on the Health Belief Model and simulated case scenarios administered after the initial and cross validation colposcopy sessions. Barriers to quality health care for the prevention, diagnosis and treatment of cancer continue to exist for women who are poor, rural and of minority populations. The strength of this study evolves from the application of an innovative procedure and technologically informed, immediate consultation to address these difficult problems. The efficacy of telecolposcopy will be determined from this comprehensive evaluation and unique cross validation design.