http://espace.library.uq.edu.au/ The University of Queensland en Fez http://blogs.law.harvard.edu/tech/rss http://espace.library.uq.edu.au/view/UQ:138224 2008-05-12T00:00:00Z Edirippulige, S. K. og Marasinghe, R. og Smith, A. C. og Fujisawa, Y. og Herath, W. B. og Jiffry, M. T. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:233797 The present study investigates the perceptions and attitudes of medical students in Sri Lanka in regard to e-health, level of their knowledge in e-health and their expectations. We also examined the barriers which impede them to develop knowledge and skills in e-health within their medical curriculum. A questionnaire focusing on the knowledge, attitudes and expectations of medical students towards e-health was distributed to all final year students (n=136) at the Faculty of Medicine, Sri Jayewardenepura University, Sri Lanka. The survey was conducted during their regular lectures and completed questionnaires were collected after their classes. 100 surveys (74%) were completed and returned. 43% of respondents stated that they were familiar with the term e-health. 51% rated their knowledge of e-health applications as minimal. 88% admitted that they had no e-health education or training of any kind. Over 80% of all respondents thought that e-health had an important role to play in the current and future health sector, particularly in developing countries. Our survey revealed that respondents had very poor access to computers and Internet use was rare. 77% of respondents admitted that they were not provided with systematic knowledge and skills in e-health through their medical curriculum and identified the absence of formal education in e-health as a serious shortcoming. Despite the fact that the majority of respondents believe that e-health can be a useful tool, particularly for medical practitioners in developing countries, a lack of systematic courses to provide knowledge and hands-on skills prevent them benefiting from this modality. 2011-03-09T13:47:17Z Edirippulige, Sisira og Marasinghe, Rohana B. og Smith, Anthony C. og Fujisawa, Yoshikazu og Herath, Walisundara B. og Jiffry, Mohamed T. M. og Wootton, Richard http://espace.library.uq.edu.au/view/UQ:9605 Since their introduction more than a decade ago, support vector machines (SVMs) have shown good performance in a number of application areas, including text classification, pattern recognition and bioinformatics. However, the success of SVMs comes at a cost - there is no way to utilise prior knowledge. SVMs are purely inductive learning machines. In this paper, a novel approach for rule initialisation for support vector machines is presented. The application domain is medical diagnosis. The approach presented here uses domain knowledge in the form of propositional rules to create a virtual data set to bias an SVM. The virtual data set is combined with real data for SVM learning. Knowledge initialisation results in better classification accuracy and enhanced rule quality compared with purely inductive learning. 2005-04-11T00:00:00Z Diederich, Joachim og Barakat, Nahla http://espace.library.uq.edu.au/view/UQ:82979 We surveyed all nurses working at a tertiary paediatric hospital (except casual staff and those who were on leave) from 27 hospital departments. A total of 365 questionnaires were distributed. There were 40 questions in six sections: demographic details, knowledge of e-health, relevance of e-health to nursing profession, computing skills, Internet use and access to e-health education. A total of 253 surveys were completed (69%). Most respondents reported that that they had never had e-health education of any sort (87%) and their e-health knowledge and skills were low (71%). However, 11% of nurses reported some exposure to e-health through their work. Over half (56%) of respondents indicated that e-health was important, very important or critical for health professions while 26% were not sure. The lack of education and training was considered by most respondents (71%) to be the main barrier to adopting e-health. While nurses seemed to have moderate awareness of the potential benefits of e-health, their practical skills and knowledge of the topic were very limited. 2007-08-15T00:00:00Z Edirippulige, S. K. og Smith, A. C. og Young, J. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:174673 2009-04-08T00:00:00Z Diederich, J. og Pedersen, M. http://espace.library.uq.edu.au/view/UQ:177186 2009-04-22T00:00:00Z Pedersen, Carol og Diederich, Joachim http://espace.library.uq.edu.au/view/UQ:98104 We carried out a retrospective review of the videoconference activity records in a university-run hospital telemedicine studio. Usage records describing videoconferencing activity in the telemedicine studio were compared with the billing records provided by the telecommunications company. During a seven-month period there were 211 entries in the studio log: 108 calls made from the studio and 103 calls made from a far-end location. We found that 103 calls from a total of 195 calls reported by the telecommunications company were recorded in the usage log. The remaining 92 calls were not recorded, probably for one of several reasons, including: failed calls-a large number of unrecorded calls (57%) lasted for less than 2 min (median 1.6 min); origin of videoconference calls-calls may have been recorded incorrectly in the usage diary (i.e. as being initiated from the far end, when actually initiated from the studio); and human error. Our study showed that manual recording of videoconference activity may not accurately reflect the actual activity taking place. Those responsible for recording and analysing videoconference activity, particularly in large telemedicine networks, should do so with care. 2007-08-24T01:44:17Z Wootton, Richard og Smith, Anthony C. og Gormley, Sinead og Patterson, Jessica http://espace.library.uq.edu.au/view/UQ:115719 We carried out a survey of the site coordinators in a mature telemedicine network of about 200 sites. The site directory contained information about 221 videoconference facilities. There were 191 site coordinators in all (i.e. some coordinators were responsible for more than one site). Of the 221 sites, we were able to contact 87 on first attempt and 155 by the fourth attempt. Thus there were 66 sites (30%) which were not contactable. We asked each site coordinator to describe any videoconference activity that had taken place over the previous five working days. Of the contacted 155 sites, 78 reported some videoconference activity during the period in question. The total reported videoconference activity was 12,800 min during the one-week monitoring period, that is, an estimated 924 h per month. The most common categories of work were education or training (511 h) and management or administration (225 h), which between them accounted for 80% of all reported videoconference activity. Fifty of the 155 sites (32%) reported that the equipment was not located in an area suitable for patient consultations. In addition, 20 sites (13%) volunteered that their videoconferencing facilities were not in working order at the time of the survey. We did not ask this question in the survey, so that this result represents a lower bound for the true number of inoperable systems. 2007-10-17T00:00:00Z Wootton, R og Smith, AC og Gormley, S og Patterson, J http://espace.library.uq.edu.au/view/UQ:77126 2007-08-15T06:54:28Z Swinfen, P. og Swinfen, R. og Youngberry, K. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:63754 2007-08-14T00:00:00Z Yellowlees, P. M. http://espace.library.uq.edu.au/view/UQ:151249 2008-06-06T14:29:59Z Edirippulige, Sisira og Marasinghe, Rohana B. og Smith, Anthony C. og Fujisawa, Yoshikazu og Herath, Walisundara B. og Jiffry, M. T. M. og Wootton, Richard http://espace.library.uq.edu.au/view/UQ:233796 It is believed that the use of information and communication technologies (ICT) can be a potential alternative to address some of the daunting problems in healthcare sector in developing countries. Knowledge, skills and acceptance of e- health by health professionals are essential attributes of a successful integration of this new tool. This study investigates the knowledge of medical students in Sri Lanka in regard to e-health. We also examined the barriers which impede them to develop knowledge and skills in e-health within their medical curriculum. A questionnaire focusing on the knowledge and attitudes of medical students towards e-health was distributed to all final year students (n=136) at the Faculty of Medicine, Sri Jayewardenepura University, Sri Lanka. 100 surveys (74%) were completed and returned. Fifty one per cent rated their knowledge of e-health applications as minimal. The majority (88%) admitted that they had no e-health education or training of any kind. Similar number of respondents (80%) thought that e-health had an important role to play in health sector, particularly in developing countries. We also found that respondents had very poor access to computers and Internet use was rare. A large number of respondents (77%) admitted that their medical curriculum did not provide them knowledge and skills in e-health. 2011-03-09T13:47:13Z Edirippulige, Sisira og Fujisawa, Yoshikazu og Marasinghe, Rohana B. og Jiffry, Mohamed T. M. og Smith, Anthony C. og Wootton, Richard http://espace.library.uq.edu.au/view/UQ:136147 Over a two-year period, eight medical students from four U21 universities spent their electives at hospitals in Pakistan, Papua New Guinea and Sri Lanka. They made a total of 49 e-referrals which resulted in 67 queries in a wide range of specialties. The median response time was 20 h (interquartile range 5–85). Follow-up data were obtained in 14 of the 30 cases from one hospital (47%). The major categories of the 67 queries were internal medicine, paediatrics and surgery, and in very similar proportions to the 785 queries managed by the Swinfen Charitable Trust over the same period. The presence of a medical student facilitated e-referrals by relieving the pressure on the local doctor to undertake the necessary clerical and technical work. The students reported a rewarding elective experience which appears to have the potential to increase the ease with which heavily burdened medical staff in developing countries can make use of e-referrals. 2008-04-23T14:09:16Z Wootton, Richard og Swinfen, Pat og Swinfen, Roger og Warren, Margo-Anne og Wilkinson, David og Brooks, Peter http://espace.library.uq.edu.au/view/UQ:171539 Telemedicine has evolved over the last 14 years, arguably becoming a bit less experimental. A number of experienced telemedicine practitioners were invited to reflect on memorable moments of the last decade or so. The following excerpts represent a selection of the (printable) responses received. 2009-03-24T13:03:13Z Ferguson, James og Hui, Elsie og Kayser, Klaus og Mars, Maurice og Martin-Khan, Melinda og Scalvini, Simonetta og Shumack, Stephen og Smith, Anthony og Soyer, H. Peter og Stachura, Max og Tachakra, Sapal og Van Der Westhuyzen, Jasper http://espace.library.uq.edu.au/view/UQ:114249 2007-10-09T00:00:00Z Diederich, J. og Yellowlees, P. M. http://espace.library.uq.edu.au/view/UQ:60910 If the Internet could be used as a method of transmitting ultrasound images taken in the field quickly and effectively, it would bring tertiary consultation to even extremely remote centres. The aim of the study was to evaluate the maximum degree of compression of fetal ultrasound video-recordings that would not compromise signal quality. A digital fetal ultrasound videorecording of 90 s was produced, resulting in a file size of 512 MByte. The file was compressed to 2, 5 and 10 MByte. The recordings were viewed by a panel of four experienced observers who were blinded to the compression ratio used. Using a simple seven-point scoring system, the observers rated the quality of the clip on 17 items. The maximum compression ratio that was considered clinically acceptable was found to be 1:50-1:100. This produced final file sizes of 5-10 MByte, corresponding to a screen size of 320 x 240 pixels, running at 15 frames/s. This study expands the possibilities for providing tertiary perinatal services to the wider community. 2007-08-14T00:00:00Z Begg, L og Chan, FY og Edie, G og Hockey, R og Wootton, R http://espace.library.uq.edu.au/view/UQ:138063 2008-05-08T17:43:48Z Armfield, N. R. og Bensink, M. og Smith, A. C. og Donovan, T. J. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:103134 2007-08-23T00:00:00Z Nabil Barakat, M. og Barakat, N. og Diederich, J. og Al Lawati, J. http://espace.library.uq.edu.au/view/UQ:142147 2008-06-10T00:00:00Z Wootton, R. og Bloomer, S. E. og Corbett, R. og Eedy, D. J. og Hicks, N. og Lotery, H. E. og Mathews, C. og Paisley, J. og Steele, K. og Loane, M. A. http://espace.library.uq.edu.au/view/UQ:283030 Article first published online: 9 September 2012. 2012-10-09T10:20:49Z Smith, Anthony C. og White, Megan M. og McBride, Craig A. og Kimble, Roy M. og Armfield, Nigel R. og Ware, Robert S. og Coulthard, Mark G. http://espace.library.uq.edu.au/view/UQ:98287 2007-08-24T00:00:00Z Heyer, C. M. og Madden, J. L. og Hollingsworth, K. A. og Heydon, P.A. og Bartlett, K. M. og Diederich, J. http://espace.library.uq.edu.au/view/UQ:195696 2010-02-18T10:18:32Z Armfield N. R. og Bensink, M. og Donovan, T. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:229233 Background: Infant transport can be costly, time consuming and risky for both the infant and transport-team. For some infants, telemedicine may improve care, avoid transport and save money. Methods: We conducted an informal retrospective review of the first 10 telemedicine consultations provided from a tertiary perinatal centre to four referring hospitals. Sessions were recorded to allow evaluation of the content of each consultation. Cases of avoided transport were identified by analysis of the recordings and by interviewing the clinicians involved in the consultations. Potential savings resulting from avoided retrievals was estimated in Australian Dollars (AUD) at 2009 prices (AUD 1GUSD0Æ86). Results: Nine consultations were led by a consultant neonatologist and one by a senior registrar. In all cases a paediatrician attended at the referring sites. During sessions, visual information included radiological images (n = 7); infant observation (n = 7); viewing of the patient monitor (n = 2) and ventilator (n = 2). Telemedicine was used to manage requests for infant retrieval (n = 4) and requests for a second opinion (n = 6). This resulted in transport to the RBWH (n = 2), another intensive care nursery (n = 1) and prevented retrieval (n = 3). The total estimated saving from avoided retrievals was $23 618 (Table 1). Conclusion: These early results suggest that neonatal teleconsultation is effective. Anecdotally, the visual information increased safety and confidence in the formulation of local management plans. An infant may be managed in their own community, avoiding costly and risky transport to a tertiary facility using teleconsultation. Further research will formally assess the clinical and economic benefits over a longer time period. 2011-02-15T15:35:34Z Armfield, N. R. og Bensink, M. E. og Donovan, T. og Smith A. C. http://espace.library.uq.edu.au/view/UQ:220384 2010-11-15T15:15:50Z Armfield, N. R. og Bensink, M. E. og Donovan, T. og Smith, A. C. http://espace.library.uq.edu.au/view/UQ:176791 2009-04-17T00:00:00Z Diederich, Joachim http://espace.library.uq.edu.au/view/UQ:141990 There is little evidence that workshops alone have a lasting impact on the day-to-day practice of participants. The current paper examined a strategy to increase generalization and maintenance of skills in the natural environment using pseudo-patients and immediate performance feedback to reinforce skills acquisition. A random half of pharmacies (N=30) took part in workshop training aimed at optimizing consumers' use of nonprescription analgesic products. Pharmacies in the training group also received performance feedback on their adherence to the recommended protocol. Feedback occurred immediately after a pseudo-patient visit in which confederates posed as purchasers of analgesics, and combined positive and corrective elements. Trained pharmacists were significantly more accurate at identifying people who misused the medication (P<0.001). The trained pharmacists were more likely than controls to use open-ended questions (P<0.001), assess readiness to change problematic use (P <0.001), and to deliver a brief intervention that was tailored to the person's commitment to alter his/her usage (P <0.001). Participants responded to the feedback positively. Results were consistent with the hypothesis that when workshop is combined with on-site performance feedback, it enhances practitioners' adherence to protocols in the natural setting. 2008-06-10T00:00:00Z Neto, ACD og Benrimoj, SI og Kavanagh, DJ og Boakes, RA http://espace.library.uq.edu.au/view/UQ:196324 2010-02-23T00:00:00Z Edirippulige, S og Smith, A.C. og Bensink, M.E. og Armfield, N.R. og Wootton R http://espace.library.uq.edu.au/view/UQ:150953 2008-06-06T00:00:00Z Yellowlees, P. M. http://espace.library.uq.edu.au/view/UQ:67021 Three different, well established systems for e-referral were examined. They ranged from a system in a single country handling a large number of cases (60,000 per year) to a global system covering many countries which handled fewer cases (150 per year). Nonetheless, there appeared to be a number of common features. Whether the purpose is e-transfer or e-consultation, the underlying model of the e-referral process is: the referrer initiates an e-request; the organization managing the process receives it, the organization allocates it for reply; the responder replies to the initiator. Various things can go wrong and the organization managing the e-referral process needs to be able to track requests through the system; this requires various performance metrics. E-referral can be conducted using email, or as messages passed either directly between computer systems or via a Web-link to a server. The experience of the three systems studied shows that significant changes in work practice are needed to launch an e-referral service successfully. The use of e-referral between primary and secondary care improves access to services and can be shown to be cost-effective. 2007-08-15T00:00:00Z Wootton, R og Harno, K og Reponen, J http://espace.library.uq.edu.au/view/UQ:73484 Paediatric outreach services are provided in Australia and overseas to regional and rural communities. More recently telehealth services have been established to support the delivery of paediatric services and clinical management at distant sites. It is suggested that with the large distances separating centres in Australia that a combination of telehealth clinics and outreach visits may provide the most efficient means of delivering paediatric specialty and subspecialty care to these centres. 2007-08-15T04:38:19Z Williams, M. L. og Smith, A. C. http://espace.library.uq.edu.au/view/UQ:73479 Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day-17 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequent elective transfer at the appropriate time for treatment. Only one child (1%) required urgent transfer to the tertiary centre for specialist care and surgery. Telecardiology was effective in accurately identifying congenital heart disease. Paediatric telecardiology is an evolving modality of assessment and communication, and is likely to result in continued improvements in patient care, patient outcomes and parental satisfaction, in provincial centres removed from the tertiary cardiac centre. 2007-08-15T00:00:00Z Justo, Robert og Smith, Anthony C. og Williams, Michael og Van der Westhuyzen, Jasper og Murray, John og Sciuto, Gay og Wootton, Richard http://espace.library.uq.edu.au/view/UQ:268791 2012-03-02T00:00:00Z Bradford, Natalie og Pedersen, Lee-anne og Herbert, Anthony og Irving, Helen http://espace.library.uq.edu.au/view/UQ:236554 2011-03-15T00:00:00Z Gill, F. og Shields, L. og Monterosso, L. og Pascoe, E. og Young, J. og Tanner, A. og Burr, C. http://espace.library.uq.edu.au/view/UQ:138399 Parents whose children are diagnosed in an infant screening program are required to make some difficult choices about the management of the hearing loss at a time when they are emotionally vulnerable. They are required to evaluate information and outcomes regarding issues such as technology for hearing impairment, communication options, education, and rehabilitation. The World Wide Web has become an important resource of health information for both health consumers and practitioners. The ability to obtain accurate health information online quickly, conveniently, and privately provides opportunity to make informed decisions. However, little is known about the level of the use of the Internet to acquire health information, particularly in the case of parents of deaf children seeking information. This study confirms that searches for health information on the Internet are conducted primarily by mothers. In the Australian context, there is minimal online information available to families beyond early intervention. Information on education issues, mental health, and deafness or the day-to-day management of a child or adolescent with a hearing loss are neglected topics on Web sites. This study also revealed that the majority of respondents had never visited HealthInsite or Medline Plus, two gateway sites for reliable consumer health information, although the information on these sites is more generic in nature and unlikely to assist parents to make informed choices on complex issues such as communication options or education. However, the study suggested that half the parents have talked to their doctor or hearing professional about information they found on the Internet, which is an encouraging tendency. 2008-05-14T00:00:00Z Porter, Ann og Edirippulige, Sisira http://espace.library.uq.edu.au/view/UQ:270139 There are many different tools available to the clinician to capture clinical images, the clinicians must familiarize themselves with the particular photographic equipment available to them in order to be able to utilize it effectively. This guide will provide a basic foundation on how a digital camera works to capture an image, as well as fundamental theory and techniques required to take good clinical photographs. 2012-03-16T11:38:06Z Jakowenko, Janelle og Smith, Matthew J. og Smith, Anthony C. http://espace.library.uq.edu.au/view/UQ:63755 2007-08-14T00:00:00Z Yellowlees, P. M. http://espace.library.uq.edu.au/view/UQ:82984 For over five years, post-acute burns care for children in regional areas of Queensland has been provided by videoconference. Some 300 specialist burns consultations are conducted by videoconference annually. To support regional health professionals, particularly occupational therapists who play an integral role in the local management of these children, we have instigated a series of monthly education sessions via videoconference. The sessions have addressed a broad range of topics related to the long-term management of children following a burn injury. During the first six months, up to 22 regional sites participated in multipoint videoconferences. The average number of participants per videoconference was 39 and the average duration of each session was 67 min. Participant satisfaction was measured with a routine survey completed by each site at the conclusion of the videoconference. The survey response rate was 88% (n = 95) and overall feedback was extremely positive. 96% of respondents agreed that the programme provided them with new information and that the content was relevant (95%) and of appropriate depth (84%). The educational programme has provided valuable support to a group of professionals who are taking on greater responsibility for the clinical management of children requiring post-acute burns care. 2007-08-15T00:00:00Z Smith, A. C. og O'Brien, A. og Jakowenko, J. V. http://espace.library.uq.edu.au/view/UQ:96455 2007-08-24T00:00:00Z Mitsdorffer, R. og Diederich, J. og Tan, C. http://espace.library.uq.edu.au/view/UQ:193263 2010-01-20T00:00:00Z Edirippulige, Sisira og Armfielf, Nigel R. og Bensink, Mark E. og Marasinghe, Rohana og Wootton, Richard http://espace.library.uq.edu.au/view/UQ:191342 2010-01-05T00:00:00Z Edirippulige, Sisira og Armfield, Nigel R. og Bensink, Mark E. og Marasinghe, Rohana og Wootton, Richard http://espace.library.uq.edu.au/view/UQ:135574 2008-04-17T00:00:00Z Armfield, N. R. og Bensink, M og Donovan, T. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:67005 We investigated whether allied health assessments carried out via videoconferencing were comparable to assessments carried out face to face. Five allied health therapists (in dietetics, occupational therapy, physiotherapy, podiatry and speech pathology) conducted an assessment of 12 high-dependency residents both face to face and by videoconferencing. On a five-point Likert scale, the therapists' mean ratings for the efficiency and suitability of videoconferencing for assessment were significantly lower than for face to face. Their mean rating for the adequacy of their care plans was also significantly lower for videoconferencing than for face to face. However, in each case the dietician's assessments did not differ significantly between the two modalities. In 35 cases out of 60, two independent raters agreed that the therapists' care plans after the videoconferencing and face-to-face assessments were the same. However, the level of agreement between raters was only moderate (kappa=0.31). Despite the therapists' (natural) preference for face-to-face working, care plans formulated via videoconferencing were reasonably similar to those formulated in face-to-face assessment. Allied health assessments carried out by videoconferencing would therefore seem to be feasible. 2007-08-15T00:00:00Z Guilfoyle, C og Wootton, R og Hassall, S og Offer, J og Warren, M og Smith, D http://espace.library.uq.edu.au/view/UQ:137175 2008-05-02T00:00:00Z Edirippulige, S. og Smith, A. C. og Beattie, H. og Davies, E. og Wootton, R. http://espace.library.uq.edu.au/view/UQ:148926 2008-06-06T00:00:00Z http://espace.library.uq.edu.au/view/UQ:107785 2007-08-27T00:00:00Z http://espace.library.uq.edu.au/view/UQ:148923 2008-06-06T00:00:00Z http://espace.library.uq.edu.au/view/UQ:107786 2007-08-27T00:00:00Z http://espace.library.uq.edu.au/view/UQ:130092 2008-02-18T00:00:00Z Wootton, Richard http://espace.library.uq.edu.au/view/UQ:236543 2011-03-15T00:00:00Z Sidebotham, Peter og Bajanowski, Thomas og Keens, Tom og Kenner, Thomas og Kerbl, Reinhold og Kurz, Ronald og Mitchell, Ed A. og Moon, Rachel og Taylor, Barry og Vennemann, Mechtild og Young, Jeanine og Zotter, Heinz http://espace.library.uq.edu.au/view/UQ:73399 The Swinfen Charitable Trust has managed email consultations for doctors in developing countries since 1999. The process was handled manually for the first three years and then subsequently using an automatic message-handling system. We conducted a prospective review of email consultations between referring doctors and consulting specialists during six months of automatic operation (December 2003 to May 2004). During the study period 125 consultations took place. These concerned a wide range of specialties (e.g. orthopaedics 17%, dermatology 16%, obstetrics and gynaecology 11%, radiology 10%). Of these referrals, 33% (41) were for paediatric cases. Consulting specialists, who were based in five countries, were volunteers. Referring doctors were from 24 hospitals in 12 developing countries. The median time from referral to definitive reply was 1.5 days (interquartile range 0.6-4.9). There was an 85% response rate (n = 106) to a survey concerning the value of the consultation to the referring doctor. All the referring doctors who responded made positive comments about the service and half said that it improved their management of the case. The second-opinion consultation system operated by the Swinfen Charitable Trust represents an example of a global e-health system operated for altruistic, rather than commercial, reasons. 2007-08-15T00:00:00Z Wootton, R og Youngberry, K og Swinfen, P og Swinfen, R