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Introduction: Tele-intensive care (teleIC) can be used to increase the level of care in the intensive care unit (ICU) with the tele-intensivist being at a remote site. In this study we describe the implementation and outcomes, including patient and family satisfaction, of the first Dutch teleIC., Methods: In a retrospective analysis the patient characteristics are described with a focus on patient outcomes and patient and family satisfaction. The teleIC started on 6 December 2010 in an ICU with three beds. Data for all admitted patients were collected from 1 January 2011 through 31 December 2013 from available systems. Severity of disease (APACHE IV) and standardized mortality ratios (SMR) were available over the complete calendar years 2012 and 2013. A prospective self-made survey of patient and family satisfaction was performed over a 14-month period after the implementation of teleIC., Results: In 2012 and 2013, 556 patients were admitted. The number of operating room recovery patients in the ICU declined over time. One hundred and seven patients were transferred to a higher-level ICU (19%). The SMR for non-transferred patients was 0.73 (95% CI (confidence interval) 0.54-0.98) and 0.66 (95% CI (confidence interval) 0.40-1.02) for transferred patients. These numbers are in line with national data. Thirty-six percent of family and 38% of the patients responded to the survey and showed a positive response concerning communication within the tele IC setting., Conclusion: Implementation of teleIC in a Dutch situation was successful and showed favourable results in patient outcomes and the satisfaction of patients and family members., (© The Author(s) 2015.)

Telemedicine is a way to provide care over a distance. In teleconsultations the intensivist gives advice to his or her colleagues in a remote centre. In tele-intensive care (tele-IC) the intensivist makes medical decisions for the remote patients and is fully responsible for the treatment of the intensive care patients in a remote centre. In the USA, 11% of ICU patients are currently being treated by tele-intensivists. Telemedicine has the potential of increasing the continuity of care and of providing expertise to patients in small ICUs where and when needed. In a pilot setting, the OLVG hospital has implemented a tele-ICU for the 3-bed ICU in the MC Zuiderzee hospital. The tele-ICU was set up on 3 December 2010. Although the tele-ICU performed sufficiently, several aspects, such as cost analysis, need clarification before the system can be widely implemented in the Netherlands.

From Dimmer's original description of 4 cases of keratitis, it would seem that what is now known as a keratitis nummularis (Dimmer), is not one specific corneal disease but a heterogeneous group of diseases. Salzmann demonstrated in certain cases a clear relationship between it and herpetic keratitis and its corneal complications. Later authors have not convincingly differentiated KND from herpetic keratitis, as no tests have been performed to determine corneal sensitivity. Pillat, who did use the criterion of normality of corneal sensitivity for the diagnosis of KND, was unable to differentiate KND adequately from the sequelae of adenovirus keratitis. Nummular keratitis (Dimmer) does not play a diagnostic part in ophthalmology, as we are not dealing with a nosological entity.