Study design: This study was designed as an international validation study. Objective: The objective of this study was to assess the inter-rater reliability of the International Spinal Cord Injury Bowel Function Basic and Extended Data Sets. Setting: Three European spinal cord injury centers. Methods: In total, 73 subjects with spinal cord injury and a history of bowel dysfunction, out of which 77% were men and median age of the subjects was 49 years (range 20-81), were studied. The inter-rater reliability was estimated by having two raters complete both data sets on the same subject. First and second tests were separated by 14 days. Cohen's kappa was computed as a measure of agreement between raters.

One hundred consecutive patients admitted to the National Spinal Injuries Centre, Stoke Mandeville Hospital, with pressure sores were studied to assess the relative importance of factors known to predispose to the development of sores. Loss of feeling was critical, because patients were unable to appreciate pain when the sore was developing.

We conducted a systematic review of the literature to critically analyse the technical evaluation and assessment frameworks that have been applied to telemedicine systems. A total of 47 articles met the inclusion criteria. Subjective methods were predominantly used for technical evaluation (59%), e.g., Likert scale. Those including objective measurements (41%) were mainly restricted to simple metrics such as network time delays. Only 3 papers included a rigorous standards-based objective approach. Our investigation has been unable to determine a definitive standards-based telemedicine evaluation framework that exists in the literature that may be applied systematically to assess and compare telemedicine systems. We conclude that work needs to be done to address this deficiency.

Results, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).

We conducted a retrospective review of the digital images in the clinical records of 50 patients with pressure ulcers. Ten nurses independently assessed one image from each patient. There was a total of 414 responses from the nurses about the stage and location of the ulcers (83% response rate). The average agreement about the stage and location of the ulcers was 85%. The overall agreement declined as the stage of the ulcer increased. The average agreement regarding the wound descriptors was: necrosis 85%, granulation tissue 81%, ischaemia 83%, cellulitis /infection 69%, erythema 68%. Almost all nurses felt the need to change the current management of the wound (460 responses, or 92%). The nurses judged that most digital images were of good quality (17%) or very good quality (79%). The present study suggests that a high percentage of assessments for patients currently travelling to specialist clinics could be performed in the community using digital images and telemedicine.