Telemedicine
Twinning initiative shows promise in paediatric neuro-oncology



In industrialised countries, paediatric oncology has witnessed path-breaking strides in survival rates over the last several decades. But developing countries, where nearly 80% of childhood malignancies occur, still have a long way to go before they catch up. Patients in the developing world often fight against disadvantages including late detection, a lack of subspecialists, distrust of doctors and scarce medical resources.

Bridging the gap

As described in a recent issue of Pediatric Blood and Cancer*, a continuing cooperative effort has brought together experts from The Hospital for Sick Children (SickKids) in Toronto, Canada and King Hussein Cancer Centre (KHCC) in Amman, Jordan via video link to discuss how to help with the care of neurooncology patients at KHCC. “This experience has given Jordanian patients and their families the opportunity to get an expert second opinion without having to travel,” said Dr Eric Bouffet, neuro-oncologist and director of the Paediatric Brain Tumour Programme at SickKids.

The meetings began in 2004 as consultations between the article’s primary author, Dr Ibrahim Qaddoumi, who heads KHCC’s paediatric neurooncology service, Dr Bouffet and Dr James Drake, chief neurosurgeon at SickKids. The meetings have grown to include up to nine brain tumour physicians from KHCC and eight in Toronto. The group has discussed their most difficult decisions for 64 patients, and in 23 cases the team in Jordan changed their plan for treating the patient. The most common suggestion from the SickKids team was a review of pathology results. In six cases, reviewing the pathology led the doctors to change their treatment plan for the child, choosing observation instead of radiation treatment. In five cases, SickKids staff suggested a second surgery. Telemedicine facilitated technical discussions concerning surgical approaches and optimal surgical options.

Multidisciplinary approach

Although the discussion in the teleconference meetings was focused on the care of individual patients, Dr Qaddoumi said that the Jordanian team came to appreciate the multidisciplinary approach at SickKids, in which doctors from different specialisations work together to decide on the best treatment for a child. The right decisions are most likely when oncologists, medical imaging specialists, surgeons, radiation oncologists and pathologists all co-operate.

Parents around the world want their child to get the best possible care for a brain tumour.

The main treatments for brain tumours are surgery, radiation therapy, or treatment with powerful drugs, all of which can be physically and emotionally difficult for parents as well as children. Parents were often reassured to learn that doctors thousands of miles away had been consulted and agreed with their oncologist’s treatment decisions. Patients and families considered the conferences a formal second opinion. This deepened their trust in the medical team and strengthened their resolve to stick with treatments.

In developing countries, where the lack of subspecialists can pose great challenges, telemedicine can play an important role in providing the best care possible, said Dr Qaddoumi.

“This telemedicine twinning project provided a speed track for our service at KHCC to develop and excel. Without it, we would have needed at least double the time to get to where we are now,” Dr Qaddoumi said. “Also, our co-operation created a real culture of twinning and telemedicine at KHCC, where many services are working to follow our path. In fact, there is now an official telemedicine committee at KHCC to promote the culture of telemedicine.”

While the reduction of childhood mortality in developing countries relies primarily on relatively inexpensive strategies for improving access to clean water and combating infectious diseases, support is needed to ensure a wider access to appropriate cancer treatments. Twinning between centres is an approach that seems to provide the best opportunity for achieving this goal. While previous twinning experiences involved costly exchanges and timeconsuming travel between institutions, telemedicine offers many advantages and appears to be a promising tool for such co-operation.

*Impact of telemedicine on pediatric neuro-oncology in a developing country: The Jordanian-Canadian experience. Qaddoumi I, Mansour A, Musharbash A, Drake J, Swaidan M, Tihan T, Bouffet E. Pediatric Blood & Cancer 2007 Jan; 48(1):39-43.


Interactive TV designed to help patients at home

Telecommunications engineer at the Public University of Navarre, Spain, Alejandro Fanjul Fernández, has designed a pioneering system of telemedicine for interactive digital television. This system enables the monitoring and treatment of and support for both patients and elderly people, from the comfort and convenience of their homes, by means of the television.

Fernández worked on this project for his graduate thesis.

This designed tele-assistance system, known as ATSInteractiva, focuses its services on the monitoring and treatment of and support for patients by means of television. To this end, every so often, a series of check-ups and medication reminders are carried out, which at the same time enable a channel of communication to be opened up between the healthcare professional and the patient.

Monitoring

Through a complex system of data, treatment and interactivity with the patient, the ATS-Interactiva system enables doctors to have a complete system of monitoring of patients at all times, enabling them to assess patients’ progress through the observation of their vital signs: weight, pulse, blood pressure, glucose level and so on.

This application could be particularly useful for the monitoring of patients who are convalescing following surgery but who can carry out basic tasks independently. It is also of great interest to those elderly persons who require a minimum of control and monitoring of their state of health on a daily basis. The progress of these persons may be followed without them having to be transferred to a health clinic or hospital – the monitoring being undertaken simply from their sitting-room sofa using the TV remote control.

The system also has an application known as an “interactive dosifier” that provides a personalised reminder for the administration of medicines. In this way, when the patient is due to take medication, the system emits a sound signal and a nurse appears on the TV screen to remind the patient of what has to be taken and a complete description or written recommendation from the doctor on how it should be taken.

The system also enables communication between the patient and the doctor through interactive messages or by email via the TV.

The application of teleassistance does not interfere with TV viewing, as the screen can be minimised or left in the background in such a way that, while the system is operating, TV programmes continue to be seen, the system information appears in the foreground only when the patient has to be reminded or requests information.

Personalised system

The ATS-Interactiva identifies the patient by means of an intelligent card. This enables the patient to move from one location to another where they can simply connect the intelligent card to a receptor where the ATSInteractiva application is available. Fanjul is considering the possibility of adapting the system to function using mobile phones.

                                  
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