The clinical effectiveness and costs of videoconferencing in orthopaedics between primary and secondary care were examined in an eight-month prospective, comparative study. The general surgery outpatient clinics of two Finnish district hospitals were compared: Peijas Hospital, with telemedicine, and Hyvinkää Hospital, without it. The three study primary-care centres referred a total of 419 adult patients to the outpatient clinics. The population-based number of referrals to Peijas Hospital was similar to that to Hyvinkää Hospital after adjusting for the proportion of older people living in the Hyvinkää Hospital municipalities. Of the 225 patients referred to Peijas Hospital, 168 (75%) were given appointments at the outpatient clinic of surgery and the rest of the referred patients received a teleconsultation. All patients referred to Hyvinkää Hospital were given appointments at the outpatient clinic. The direct costs of an outpatient visit were 45% greater per patient than for a teleconsultation, with a marginal cost decrease of EU48 for every new teleconsultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU2500 in favour of teleconsultations. The use of videoconferencing between primary and secondary care was modest in orthopaedics, although the use of this telemedicine method was shown to reduce direct costs and be cost-effective.

The clinical effectiveness and costs of telemedicine in improving the referral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medicine outpatient clinics of two Finnish district hospitals were compared--Peijas Hospital (PH) with telemedicine and Hyvinkää Hospital (HH) without it. The three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/1000) from primary-care centres was twice that to HH (3.8/1000). Thirty-seven per cent of referrals to PH included requests from general practitioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patients receiving a teleconsultation ended up in the outpatient department of PH within one year. These visits were mainly due to progression of chronic disease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic visit in internal medicine (EU211) were seven times greater per patient than for an e-mail consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU7876 in favour of the teleconsultation process. General practitioners sought an outpatient visit for 130 of their patients, and advice only for another 77. On-line advice was nonetheless given in 108 cases, and only 88 patient visits were arranged. Eleven referrals were declined. The cost difference between giving on-line medical advice for the 108 cases and a visit to the outpatient clinic for the other 88 was less costly (by EU4140) than investigating the 124 patients whose original clinic referrals to the PH were not declined. Productivity in the hospital increased over threefold by using e-mail consultations instead of traditional outpatient visits. The wide interactive use of the intranet referral system between secondary and primary care improved clinical effectiveness, lowered direct costs, increased productivity and was cost-effective.

We evaluated the outcome of both realtime teleconsultations and face-to-face consultations in dermatology. Forty-six patients were enrolled in an open controlled study. Twenty-nine patients (60%) answered the questionnaire sent to them after six months. Over the six-month follow-up, similar proportions of the two patient groups had visited a general practitioner or a specialist in the consulting hospital. At follow-up, overall patient satisfaction with the consultation, measured on a linear analogue scale (0-10), had fallen only slightly and to the same extent after both types of consultation, that is by 1.2 (SD 3.7) after realtime teleconsultations and by 1.4 (SD 4.5) after face-to-face consultations. The proportions of patients who would prefer the same mode of consultation for their next appointment had decreased from 83% to 50% in the realtime teleconsultation group and from 83% to 62% in the face-to-face consultation group. However, in neither group was the change significant. The study suggests that patient satisfaction with teleconsultation is well preserved after six months.

Twenty patients with severe or medium severe asthma were given atenolol (Atenol ICI-Pharma) and/or metoprolol (Seloken Hässle) for tachycardia, hyperkinetic tremor, arterial hypertension or symptoms of angina pectoris. These cardioselective beta-blocking drugs caused only a very slight decrease in PF values. There was no difference between atenolol and metoprolol as regards the PF values. A 24 hourly dose of 100 mg atenolol caused a distinct fall in diastolic fall in diastolic pressure as compared with the same amount of metoprolol. Both these two beta1-blockers moderated the tachycardia which occurs in asthma; atenolol in this dose had a slightly stronger action. The subjective condition of five patients with severe or medium severe asthma was considerably relieved by atenolol and/or metoprolol. The relief manifested as a lessening of dyspnoea and improvement of the general status. No essential change was observed in the PF values despite the subjective effects. The most noteworthy change was the amelioration of tachycardia which had continued longer than expected in these patients. The heart rate dropped from 140-120/min to 90-70/min and dyspnoea was relieved at the same time.

A multicentre, group comparative open study was carried out on 68 patients to compare the effects of 2% sodium cromoglycate eyedrops and an oral antihistamine, terfenadine, on acute symptoms of seasonal allergic conjunctivitis. The study was continued for one week after the onset of acute symptoms. Both medications were equally efficient in reducing symptoms during the first hour of observation. During the one-week follow-up both medications reduced symptoms to a low level, and both medications were equally effective for allergic symptoms, except that terfenadine was more effective in reducing the watering of eyes.

Purpose: Prompt treatment of acute coronary syndromes (ACS) was shown to reduce morbidity and mortality. Gender differences in ACS symptoms are well documented, but the findings regarding how differently men and women may respond to ACS symptoms are less consistent; such responses influence health seeking behavior and subsequent outcomes. The purpose of this study was to explore gender differences in the cognitive, emotional and behavioral responses to ACS symptoms in Lebanese adults. Methods: A convenience sample of 149 men and 63 women diagnosed with unstable angina or acute myocardial infarction (MI) were interviewed within 72 h of admission to coronary care in a tertiary center in Beirut. The instrument used was the Response to Symptoms Questionnaire. Data was also extracted from the medical records about demographic and clinical variables. Results: Women were older (p < 0.01), less educated (p < 0.001), and more often widowed (p < 0.001) than men, but did not differ in their medical diagnosis. In terms of cardiovascular risk factors, women were more likely to be hypertensive (p < 0.05), but less likely to be current smokers (p < 0.01) than men. Women also had higher HDL (48.02T 10.50 vs. 40.87 T 13.36, p < 0.001), lower triglycerides level (172.88 T 91.30 vs. 217.22 T 141.15, p <0.05), and fewer diseased vessels (1.57 T 1.13 vs. 2.00T 1.10, p <0.05) than men. Women were more likely to have shoulder pain (OR = 2.01, CI = 1.03-3.93), dyspnea (OR = 1.92, CI = 1.06-3.49), nausea and vomiting (OR = 2.32, CI = 1.2-4.49), and palpitations (OR = 4.15, CI = 1.6-10.73) than men, and rated the symptoms as more severe (8.5 T 1.88 vs. 6.22 T 2.29, p = 0.01). Women experienced the symptoms more often at home (p < 0.01) and in the company of family members (p < 0.001) compared to men. Knowledge of MI symptoms was lower in women than men (p = 0.034). Women also showed a trend of feeling more fear, more embarrassment to seek help, less willingness to trouble others, and longer delay in coming to the hospital compared to men (0.05 < p < 0.1). Conclusion: The different clinical representations and responses to cardiac events between men and women suggest the need for carefully tailored interventions to each gender when attempting to educate the public on cardiac disease, with the aim of reducing delays in seeking treatment.