The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.

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According to policy makers, telemedicine offers "huge opportunities to improve the quality and accessibility of health services." It is defined as diagnosis, treatment, and monitoring, with doctors and patients separated by space (and usually time) but mediated through information and communication technologies. This mediation is explored through an ethnography of a U.K. teledermatology clinic. Diagnostic image transfer enables medicine at a distance, as patients are removed from knowledge generation by concentrating their identities into images. Yet that form of identity allows images and the expert gaze to be brought into potentially lifesaving proximity. Following Latour's thread, images must be captured and then mobilized to the knowledge base, where they must be stabilized into standard diagnoses, then combined with different images, waiting lists, skin lesions, dermatologists, paper records, and beds, so that ultimately, outcomes are produced. This huge task requires new knowledges and a widening of agency that, if unacknowledged, may see telemedicine projects continue to founder.Systems of observation in medicine have taken a multiplicity of forms, ranging from abstract representations of populations formed through surveillance by epidemiological calculation, through the constitution of individual pathologies, and into the realm of the microscopic and molecular. Diverse technologies and communities of practice operate alongside these, including

In humans, when the medial olivocochlear ͑MOC͒ pathway is activated by noise in the opposite ear, changes in distortion product otoacoustic emission ͑DPOAE͒ level, i.e., the MOC reflex, can be recorded in the test ear. Recent evidence suggests that DPOAE frequency influences the direction ͑suppression/enhancement͒ of the reflex. In this study, DPOAEs were recorded at fine frequency intervals from 500 to 2500 Hz, with and without contralateral acoustic stimulation ͑CAS͒ in a group of 15 adults. The MOC reflex was calculated only at DPOAE frequencies corresponding to peaks in the fine structure. Additionally, inverse fast-Fourier transform was conducted to evaluate MOC effects on individual DPOAE components. Results show the following: ͑1͒ When considering peaks only, the mean MOC reflex was −2.05 dB and 97% of observations reflected suppression, ͑2͒ CAS reduced distortion characteristic frequency component levels more than overlap component levels, and ͑3͒ CAS produced an upward shift in fine structure peak frequency. Results indicate that when the MOC reflex is recorded at DPOAE frequencies corresponding to fine structure maxima ͑i.e., when DPOAE components are constructive and in phase͒, suppression is reliably observed and level enhancement, which probably reflects component mixing in the ear canal rather than strength of the MOC reflex, is eliminated.

Patient acceptance and satisfaction with telemedicine services is complicated by patients' subjective health status. Telehealthcare providers need to recognize that patients with poor quality of life may want and benefit from face-to-face interaction with expert clinicians.