A mobile interactive online health system was used to conduct virtual ward rounds at a regional hospital which had no specialist paediatrician. The system was wireless, which allowed telepaediatric services to be delivered direct to the bedside. Between December 2004 and May 2005, 43 virtual ward rounds were coordinated between specialists based in Brisbane and local staff at the Gladstone Hospital. Eighty-six consultations were provided for 64 patients. The most common conditions included asthma (27%), chest infections (12%), gastroenteritis (10%) and urinary tract infections (10%). In the majority of cases, there were partial (67%) or complete changes (11%) in the clinical management of patients. Specialist services were offered by a team of 13 clinicians at the Royal Children's Hospital: 10 general paediatricians, two physiotherapists and one registered nurse. Feedback from all consultants involved in the service and local staff in Gladstone was extremely positive. In 43 videoconference calls there were three technical problems, probably due to an intermittent mains power supply at the regional hospital. There appears to be potential for other rural and regional hospitals to adopt this model of service delivery.

summary We compared the costs incurred by families attending outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane with those incurred by families who had a consultation via videoconference in their regional area. In each category 200 families were interviewed. The median time spent travelling for videoconferences was 30 min compared with 80 min for face-to-face appointments. Families interviewed in the outpatient department had travelled a median distance of 70 km, while those who had a videoconference at the local hospital had travelled only 20 km. It cost these families much more to attend an appointment at the RCH than to attend a videoconference. Ninety-six per cent of families (193) reported at least one of the following types of expense: 150 families had expenses related to parking (median A$10), 156 had fuel expenses (median A$10) and 122 reported costs related to meals purchased at the RCH (median A$10). Only 21 families who had their appointment via local videoconference reported any additional costs. Specialist appointments via videoconference were a more convenient and cheaper option for families living in regional areas of Queensland than the conventional method of attending outpatient appointments at the specialist hospital in Brisbane.

We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two hospitals in Queensland (Mackay and Hervey Bay). We used data from all other hospitals throughout the state as the control group. Although both intervention hospitals were provided with the same service, the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different. There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region. In addition, there was an increase in the number of Mackay patients treated locally (as outpatients). In contrast, little change was observed in Hervey Bay. We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service. These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary centre. We believe that the screening method used for patient referrals was the most important determinant of the use of the telepaediatric service.

Queensland is, in many respects, an ideal place for a conference about telehealth, since the state has a large area and a widely scattered population, and there is a single organization, Queensland Health, providing governmentfunded health services. The delivery of health-care across the state is a challenge because of the distances. Equity of access to specialist medical services and allowing patients to be treated as close to their home as possible are government priorities. As a consequence, health service providers are now looking for alternative methods of delivering specialist services to regional and remote areas to reduce patient travel. Telehealth is an attractive alternative model for service delivery. Although many hospitals in Queensland have telemedicine facilities, the early growth in the use of the telemedicine network appears to have stopped (Fig 1). To date, the telemedicine network in Queensland has been used predominantly for education. Only 8% of network activity has been for clinical purposes (Fig 2). Health service providers need to give careful consideration to identifying and removing the barriers that prevent telehealth from becoming an effective means of delivering clinical services. Research in our district is currently addressing some of these issues. If these impediments can be identified and overcome, the geography of our state is ideally suited to the delivery of health services using the telehealth network. Specialist and some subspecialty services can be made available to remote areas. In many cases, this will prevent the need for the patient to travel to the specialist, which will reduce both the disruption to the patient’s work and family life and the travel costs for both the patient and the health-care system. One key issue that is being slowly addressed by the government is the ability of health-care providers to charge for consultations delivered by telemedicine. This is an essential step if telehealth services are to be sustainable in the long term. Continuing postgraduate education for those in rural and regional areas is an important function of the tertiary hospitals and the telemedicine network is being widely used for this purpose, thus reducing the professional isolation of practitioners in rural and remote areas. This may be a potent way of improving workforce retention in these areas. For teleheath to fulfil its potential, an appropriate funding model must be developed and the barriers to increasing clinical use determined and overcome.

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.

Medical Journal of AustraliaVolume 167, Issue 4 p. 218-223 MJA Practice Essentials Respiratory Medicine 8. Asthma in children Claire Wainwright MB BS, FRACP, Claire Wainwright MB BS, FRACP Royal Children's Hospital Foundation Research Fellow Royal Children's Hospital, Brisbane, QLDSearch for more papers by this authorAlan F Isles MB BS(Hons), FRACP, Alan F Isles MB BS(Hons), FRACP Clinical Associate Professor and Senior Visiting Physician, Department of Respiratory Medicine Royal Children's Hospital, Brisbane, QLDSearch for more papers by this authorPaul W Francis MD, FRACP, Paul W Francis MD, FRACP Director, Department of Respiratory Medicine Royal Children's Hospital, Brisbane, QLDSearch for more papers by this author Claire Wainwright MB BS, FRACP, Claire Wainwright MB BS, FRACP Royal Children's Hospital Foundation Research Fellow Royal Children's Hospital, Brisbane, QLDSearch for more papers by this authorAlan F Isles MB BS(Hons), FRACP, Alan F Isles MB BS(Hons), FRACP Clinical Associate Professor and Senior Visiting Physician, Department of Respiratory Medicine Royal Children's Hospital, Brisbane, QLDSearch for more papers by this authorPaul W Francis MD, FRACP, Paul W Francis MD, FRACP Director, Department of Respiratory Medicine Royal Children's Hospital, Brisbane, QLDSearch for more papers by this author First published: 01 August 1997 https://doi.org/10.5694/j.1326-5377.1997.tb138856.xCitations: 17 Reprints will not be available from the authors. Correspondence: Associate Professor A F Isles, Department of Respiratory Medicine, Royal Children's Hospital, Herston, Brisbane, QLD 4029. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Children may wheeze or cough, but is it asthma and, if it is, are you overtreating, undertreating, or getting it right? Citing Literature Volume167, Issue4August 1997Pages 218-223 RelatedInformation

Medical Journal of AustraliaVolume 162, Issue 8 p. 443-443 Letter Salmeterol xinafoate in children Colin F Robertson, Colin F Robertson Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorCraig Mellis, Craig Mellis Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorRima Staugas, Rima Staugas Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorAlan F Isles, Alan F Isles Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorLouis I Landau, Louis I Landau Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this author Colin F Robertson, Colin F Robertson Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorCraig Mellis, Craig Mellis Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorRima Staugas, Rima Staugas Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorAlan F Isles, Alan F Isles Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this authorLouis I Landau, Louis I Landau Executive Australian Paediatric Respiratory Group Department of Thoracic Medicine, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052Search for more papers by this author First published: 01 April 1995 https://doi.org/10.5694/j.1326-5377.1995.tb139988.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume162, Issue8April 1995Pages 443-443 RelatedInformation

Journal of Paediatrics and Child HealthVolume 29, Issue 2 p. 101-103 Management of acute asthma R. L. HENRY, Corresponding Author R. L. HENRYAssoc. Prof. R. L. Henry, Department of Paediatrics, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW 2310, Australia.Search for more papers by this authorC. F. ROBERTSON, C. F. ROBERTSONSearch for more papers by this authorI. ASHER, I. ASHERSearch for more papers by this authorD. M. COOPER, D. M. COOPERSearch for more papers by this authorP. COOPER, P. COOPERSearch for more papers by this authorK. P. DAWSON, K. P. DAWSONSearch for more papers by this authorP. FRANCIS, P. FRANCISSearch for more papers by this authorG. GEELHOED, G. GEELHOEDSearch for more papers by this authorJ. D. GILLIES, J. D. GILLIESSearch for more papers by this authorA. F. ISLES, A. F. ISLESSearch for more papers by this authorA. KEMP, A. KEMPSearch for more papers by this authorL. I. LANDAU, L. I. LANDAUSearch for more papers by this authorA. J. MARTIN, A. J. MARTINSearch for more papers by this authorB. MASTERS, B. MASTERSSearch for more papers by this authorC. M. MELLIS, C. M. MELLISSearch for more papers by this authorE. A. MITCHELL, E. A. MITCHELLSearch for more papers by this authorJ. MORTON, J. MORTONSearch for more papers by this authorA. OLINSKY, A. OLINSKYSearch for more papers by this authorP. D. PHELAN, P. D. PHELANSearch for more papers by this authorP. D. SLY, P. D. SLYSearch for more papers by this authorP. LE SOUEF, P. LE SOUEFSearch for more papers by this authorR. STAUGAS, R. STAUGASSearch for more papers by this authorP. P. VAN ASPEREN, P. P. VAN ASPERENSearch for more papers by this author R. L. HENRY, Corresponding Author R. L. HENRYAssoc. Prof. R. L. Henry, Department of Paediatrics, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW 2310, Australia.Search for more papers by this authorC. F. ROBERTSON, C. F. ROBERTSONSearch for more papers by this authorI. ASHER, I. ASHERSearch for more papers by this authorD. M. COOPER, D. M. COOPERSearch for more papers by this authorP. COOPER, P. COOPERSearch for more papers by this authorK. P. DAWSON, K. P. DAWSONSearch for more papers by this authorP. FRANCIS, P. FRANCISSearch for more papers by this authorG. GEELHOED, G. GEELHOEDSearch for more papers by this authorJ. D. GILLIES, J. D. GILLIESSearch for more papers by this authorA. F. ISLES, A. F. ISLESSearch for more papers by this authorA. KEMP, A. KEMPSearch for more papers by this authorL. I. LANDAU, L. I. LANDAUSearch for more papers by this authorA. J. MARTIN, A. J. MARTINSearch for more papers by this authorB. MASTERS, B. MASTERSSearch for more papers by this authorC. M. MELLIS, C. M. MELLISSearch for more papers by this authorE. A. MITCHELL, E. A. MITCHELLSearch for more papers by this authorJ. MORTON, J. MORTONSearch for more papers by this authorA. OLINSKY, A. OLINSKYSearch for more papers by this authorP. D. PHELAN, P. D. PHELANSearch for more papers by this authorP. D. SLY, P. D. SLYSearch for more papers by this authorP. LE SOUEF, P. LE SOUEFSearch for more papers by this authorR. STAUGAS, R. STAUGASSearch for more papers by this authorP. P. VAN ASPEREN, P. P. VAN ASPERENSearch for more papers by this author First published: April 1993 https://doi.org/10.1111/j.1440-1754.1993.tb00459.xCitations: 21 Prepared by Australian and New Zealand respiratory paediatricians following a meeting in Perth, Western Australia in May 1991. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume29, Issue2April 1993Pages 101-103 RelatedInformation

Objective: To provide a concise, balanced summary of the principles of management of asthma in children and adolescents.Data sources: Current medical literature and the clinical experience considered during the deliberations of the Australian Paediatric Asthma Special Interest Group.Key Issues: There is evidence of both under-treatment and over-treatment of childhood asthma in Australia. The spectrum of asthma severity is very broad, most children with asthma having mild infrequent episodes that do not require regular preventive therapy. The guidelines presented here provide a framework for accurately assessing the pattern and severity of asthma, Identifying those children who require preventive therapy and making a rational decision about the appropriate preventive agent and delivery device.Conclusions: When prescribing preventive therapy, a careful assessment of the relative risks and benefits should be made in the light of the underlying asthma severity. The level of therapy should be reconsidered regularly to ensure control is maintained with minimum dosages, particularly for inhaled corticosteroids. Recommendations are provided to ensure a normal quality of life for children with asthma, with guidelines to minimise adverse effects of therapy.

Royal Children's Hospital, Herston, Brisbane, Australia, and the Children's Hospital of Los Angeles, Los Angeles, California, USA

A sustained-release theophylline preparation (Theo-Dur Sprinkle) was evaluated in young asthmatic patients aged 1 to 6 years and receiving a daily dose of 23.4 +/- 2.0 mg/kg (mean +/- SD) to determine, on the basis of serial serum concentrations obtained over a 12-hour dosing interval at steady state, the suitability of such a product in patients likely to metabolize the drug very rapidly. Peak theophylline concentrations of 15.1 +/- 4.1 mg/L were achieved 5.5 +/- 1.5 hours after dosing. The mean maximum to minimum concentration difference was 6.9 +/- 2.2 mg/L for the dosing interval studied. Fluctuations in theophylline concentration less than 100% were achieved in nine of the 12 study patients. Use of the "sprinkle-technique" with Theo-Dur Sprinkle appears to be a simple and effective method of maintaining acceptable fluctuations in serum theophylline concentrations in preschool asthmatic children.

Sustained-release theophylline formulations should be most useful in young children who have rapid clearance and long sleep intervals. Somophyllin-12 is a recently introduced, newly designed, bead-filled capsule. We tested its ability to provide adequate serum concentrations at steady state in 16 children ages 0.9 to 5.1 yr. On a 12 hourly dosing schedule, mean dose was 25.9 mg/kg per day, and mean fluctuation was 138%. Seven children (43.8%) had fluctuations less than 100%, whereas four children (25%) had fluctuations more than 200%. Six patients with excessive fluctuation (greater than 100%) were restudied on an eight hourly dosing schedule. Mean dose was 28.7 mg/kg per day, and fluctuation was 59%. Because of the excessive fluctuation (greater than 100%) experienced by half these young children, therapy with this product should be initiated with an eight hourly dosing schedule. However, when dose and dosing interval are subsequently individualized, many young children can be switched to twice daily dosing with its improved compliance and convenience.