EFFICACY OF TELEMEDICINE COLPOSCOPY

该项目的长期目标是解决 宫颈癌前病变和癌前病变的比例不成比例 疾病在少数民族、农村、贫困妇女中流行。高患病率可能是 由费用和获得护理的问题以及缺乏 训练有素的农村镜专家能够用 异常巴氏涂片。这些障碍放大了这样的可能性 服务不足的妇女会患上宫颈肿瘤。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，到 为农村患者提供镜诊断服务 社区。我知道有三分之一的女性有异常 巴氏涂片未能完成诊断评估、治疗和 后续，本研究建议使用远程阴道镜检查作为一种手段 减少诊断和管理的地理障碍 少数农村人口中的宫颈肿瘤。远程医疗已经 作为一种提供护理质量标准的方法被提出 一些社区没有现成的获得某些专门知识的机会。 远程医疗的成功取决于足够的和 充分的信息传输以产生临床上正确的决定 最终会带来令人满意的患者结果。远程医疗 必须提供与直接、面对面的传统护理相同的护理 是被患者接受的。拟议的研究允许一项科学的 电视阴道镜检查与现场专家对照分析 考试。这项调查的具体目标是 确定远程阴道镜检查在以下方面的临床影响 诊断准确性和患者管理决策，2)不同 信息传递的技术途径和3)患者 接受这项技术。受试者(N=240)有异常 巴氏涂片报告或下生殖器疾病将通过镜检查 由家庭医生或注册护士临床医生在1点检查 两个乡村研究地点。实时的和离线的图像 检查将被传输到三级医疗远程医疗 由镜专家提供的口译中心。农村 从业者和镜专家将独立识别 病理和活检部位，形成镜下的印记，以及 在会诊前选择适当的患者管理选项。 这些远距离判断将在三年内进行比较 几个月，盲法交叉验证镜检查 由另一位专家在各自的农村地点对所有受试者进行 镜医生。两种类型的远程医疗，实时或实时视频和 离线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 决议。最后，将使用以下方法评估患者的接受度 基于健康信念模型的满意度问题及其模拟 在初始验证和交叉验证之后管理的案例方案 阴道镜检查。阻碍老年人获得优质医疗保健的障碍 癌症的预防、诊断和治疗继续存在于 贫穷、农村和少数民族人口的妇女。这个 本研究的优势来自于一种创新的应用 程序和技术知识，立即进行咨询，以 解决这些难题。远程阴道镜检查的疗效将 从这个全面的评价和独特的交叉点上确定 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.