The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process. PMID:23162242
Context Telemedicine is a promising but largely unproven technology for providing casemanagement services to patients with chronic conditions and lower access to care. Objectives To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older, ethnically diverse, medically underserved patients with diabetes. Design, Setting, and Patients A randomized controlled trial was conducted, comparing telemedicinecasemanagement to usual care, with blinded outcome evaluation, in 1,665 Medicare recipients with diabetes, aged ? 55 years, residing in federally designated medically underserved areas of New York State. Interventions Home telemedicine unit with nurse casemanagement versus usual care. Main Outcome Measures The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c (HgbA1c), low density lipoprotein (LDL) cholesterol, and blood pressure levels. Results Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of follow-up in the primary endpoints (HgbA1c, p = 0.001; LDL, p < 0.001; systolic and diastolic blood pressure, p = 0.024; p < 0.001). Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)% for HgbA1c, 3.84 (?0.08, 7.77) mg/dL for LDL cholesterol, and 4.32 (1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3.74) mm Hg for diastolic blood pressure. There were 176 deaths in the intervention group and 169 in the usual care group (hazard ratio 1.01 [0.82, 1.24]). Conclusions Telemedicinecasemanagement resulted in net improvements in HgbA1c, LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries. Mortality was not different between the groups, although power was limited. Trial Registration http://clinicaltrials.gov Identifier: NCT00271739. PMID:19390093
Shea, Steven; Weinstock, Ruth S.; Teresi, Jeanne A.; Palmas, Walter; Starren, Justin; Cimino, James J.; Lai, Albert M.; Field, Lesley; Morin, Philip C.; Goland, Robin; Izquierdo, Roberto E.; Ebner, Susana; Silver, Stephanie; Petkova, Eva; Kong, Jian; Eimicke, Joseph P.
Background: Telemedicine is a promising but largely unproven technology for providing casemanagement services to patients with chronic conditions who experience barriers to access to care or a high burden of illness. Methods: The authors conducted a randomized, controlled trial comparing telemedicinecasemanagement to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Results: In the intervention group (n = 844), mean HgbA1c improved over one year from 7.35% to 6.97% and from 8.35% to 7.42% in the subgroup with baseline HgbA1c ?7% (n = 353). In the usual care group (n = 821) mean HgbA1c improved over one year from 7.42% to 7.17%. Adjusted net reductions (one-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mm Hg (p < 0.001), and LDL cholesterol, 9.5 mg/dL (p < 0.001). In the subgroup with baseline HgbA1c ?7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York. Conclusion: Telemedicinecasemanagement improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up. PMID:16221935
Any telemedicine application should be viewed in terms of its health-care context, the clinical process it is enabling, and whether it is appropriate to apply telemedicine to that process. Telemedicine should be used as a tool to enable the transfer of clinical information which, by being transferred, will reduce clinical risks. Because managing clinical services involves knowing where clinical decisions are being made, it is important to ensure that telemedicine activity is recorded as part of the routine clinical and investigative data sets that will be kept for clinical audit and health-service costing purposes. There may be areas of health-care delivery where the telemedicine solution becomes the treatment of choice. In this event, not to provide telemedicine may be unethical and may expose a service to high clinical risk. If a service is based on the use of telemedicine, it is important to ensure that the technical specifications are adequate, that the system is sufficiently reliable, and that there are adequate back-up provisions in the case of system failure. PMID:9375056
As the health care industry is facing many challenges and is undergoing extensive change, telemedicine is in the position to address these challenges and be an important part of health care’s development. Telemedicine has been used for approximately a half century, in which researchers have explored the different technologies utilized, clinical outcomes, cost benefits, perceptions, and adoption challenges of its use. This paper reviews and summarizes these findings and presents possible future research endeavors. Examining what is known about telemedicine can aid in the development of innovative, sustainable and beneficial health technologies that could positively impact health care delivery and outcomes. PMID:23616832
Telemedicine (health-care delivery where physicians examine distant patients using telecommunications technologies) has been heralded as one of several possible solutions to some of the medical dilemmas that face many developing countries. In this study, we examine the current state of telemedicine in a developing country, India. Telemedicine has brought a plethora of benefits to the populace of India, especially those living in rural and remote areas (constituting about 70% of India's population). We discuss three Indian telemedicine implementation cases, consolidate lessons learned from the cases, and culminate with potential researchable critical success factors that account for the growth and modest successes of telemedicine in India. ?? 2005 IEEE.
Pal, A.; Mbarika, V. W. A.; Cobb-Payton, F.; Datta, P.; McCoy, S.
Veterinary surgeons have a long tradition of consulting one another about problem cases and many have unwittingly practised telemedicine when discussing cases by telephone or by sending laboratory reports by telefax. Specific veterinary telemedicine applications have been in use since the early 1980s, but little research has been undertaken in this field. The Pubmed and CAB International databases were searched for the following Boolean logic-linked keywords; veterinary and telemedicine, veterinary and telecare, animal and telemedicine, animal and telecare and veterinary and e-mail and an additional search was made of the worldwide web, using Google Scholar. This returned 25 papers which were reviewed. Of these only 2 report research. Sixteen papers had no references and 1 author was associated with 13 papers. Several themes emerge in the papers reviewed. These include remarks about the use of telemedicine, the benefits that can and are derived from the use of telemedicine, areas of practice in which telemedicine is being used, ethical and legal issues around the practice of telemedicine, image standards required for telemedicine, the equipment that is required for the practice of telemedicine, advice on ways in which digital images can be obtained and educational aspects of telemedicine. These are discussed. Veterinary practice has lagged behind its human counterpart in producing research on the validity and efficacy of telemedicine. This is an important field which requires further research. PMID:17120623
Abstract Objectives: To offer a systematic review of the body of literature in the emerging field of telemedicine in the management of acute-phase injuries. Materials and Methods: We conducted a literature review. Results: Telemedicine has only recently been applied to the specialties of trauma, emergency care, and surgery. The potential benefits of telemedicine include a decrease in travel expenses, enhanced continuity of care, and increased access to specialized consultants in medically underserved and rural areas. Conclusions: There still exist barriers to the use of teletechnologies in medicine that limit their wider adoption. Poor infrastructure, limited equipment availability, and insufficient access to training and education for medical personnel have prevented wider use. PMID:22694296
Lewis, Erin R.; Thomas, Carlos A.; Mbarika, Victor W.A.
Background Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management. Objective The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients’ CPAP follow-up and training. Methods We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement. Results More than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups. Conclusions OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients’ CPAP training and clinical follow-up. PMID:24554392
Leon, Carmen; Torres, Marta; Embid, Cristina; Roca, Josep; Navajas, Daniel; Farre, Ramon; Montserrat, Josep M
Rural residents report lower likelihood of exercising, and higher rates of obesity, heart disease, and diabetes compared to their urban counterparts. Our goals were to (1) investigate the outcomes of telemedicine consultations for pediatric obesity on changes/additions to diagnoses, diagnostic evaluation or treatment, and (2) determine whether changes in diagnostic and management recommendations made by the consultant were associated with improvements in patient nutrition, activity level, and weight. We conducted a retrospective medical record review of patients referred to a University-affiliated Children's Hospital Pediatric Telemedicine Weight Management Clinic for a diagnosis of obesity. Of the 139 children and adolescents who received pediatric weight management consultations during the study period, 99 patients met inclusion criteria. Weight management consultations resulted in changes/additions to diagnoses in 77.8% of patients and changes/additions to diagnostic evaluation in 79.8% of patients. Of patients seen more than once, 80.7% showed improvement in clinical outcomes. Of patients seen more than once, 80.6% improved their diet, 69.4% increased activity levels, 21.0% showed slowing of weight gain or weight maintenance, and 22.6% showed weight reduction. Improvements in clinical outcomes were not associated with changes/additions to diagnoses (Odds Ratio [OR] = 0.98; 95% Confidence Interval [CI] = 0.25-3.98) and were weakly associated with changes/additions to diagnostic evaluations (OR = 2.23; 95% CI = 0.58-8.73). However, changes/additions to treatment were associated with improvement in weight status (OR = 9.0; 95% CI = 1.34-76.21). Obesity consultations were associated with changes/additions to diagnoses, diagnostic evaluation, and treatment. Treatment changes were associated with improvement in weight status. Telemedicine weight management consultations have the potential to result in modifications in patient care plans and outcomes. PMID:18578677
Shaikh, Ulfat; Cole, Stacey L; Marcin, James P; Nesbitt, Thomas S
The opportunity to treat neurotologic patients when the patient and physician are in separate locations is an important clinical delivery mechanism. The authors developed their applications of neurotologic telemedicine in the aftermath of Hurricane Katrina and found this to be an effective way to deliver clinical care, develop a clinical neurotology practice, and train residents and fellows and to manage a growing neurotologic clinical practice remotely. This article outlines the technical requirements, current uses, clinical applicability, and implementation details of the Our Lady of the Lake - LSU neurotology telemedicine program; administrative issues surrounding telemedicine; and future considerations. PMID:22032478
Congestive heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension are common causes of hospitalization in the elderly. Short-term postdischarge clinical outcomes regarding compliance, symptom control, readmission, functional status, and mortality rates are in need of improvement. This observational study documents the results of a home-based case-managedtelemedicine (CMTM) program delivered over a 2-month period postdischarge. A population of 851, predominantly elderly (over age 60), recently discharged patients were enrolled in the program. They received a nurse visit up to 3 times/week and home telemedicine monitoring (weight, blood pressure, pulse rate, blood glucose, and oximeter recordings) on a daily basis. Patient education was provided by the nurse and reinforced through telemedicine. Compliance rates, quality of life parameters, patient satisfaction with telemedicine, and data regarding nine quality of care measures (QCM), hospital readmission, and mortality rates were documented. Patient demographics and outcomes of care were analyzed. There were 68% females and 56% African Americans. The readmission rate was 13% and mortality 2%. Treatment goals were met in 67%, patient compliance rate was 77%, and the average improvement in the nine QCM indicators was 66%. A majority of patients showed improved quality of health perception, better disease understanding, and high satisfaction rates with telemedicine. This is one of the larger observational studies in a predominantly elderly patient population enrolled in a CMTM program, to date. This model of care was well accepted by the elderly and produced excellent short-term clinical outcomes. PMID:20064067
There is a gradual decline in concern of specialists who follow up the care of pregnant women with diabetes. In addition, due to the dwindling economic resources allocated to health services, access to specialized healthcare facilities is becoming more difficult. Telemedicine, or medicine practiced at a distance, is inserted in this context with applications differing for type of interaction (real-time or deferred, i.e., videoconferencing versus store-and-forward data transmission), type of monitoring (automatic versus requesting cooperation from the patient), and type of devices used (web connections and use of mobile phones or smartphones). Telemedicine can cope with the current lack of ability to ensure these patients frequent direct contact with their caregivers. This approach may have an impact not only on the classical maternal-fetal outcome, but also on some underestimated aspects of patients with diabetes in pregnancy, in this case their quality of life, the perception of “diabetes self-efficacy,” and the glycemic variability. In this paper, we will analyze the current evidence regarding the use of telemedicine in pregnancies complicated by diabetes, trying to highlight the main limitations of these studies and possible strategies to overcome them in order to improve the effectiveness of future clinical interventions with these medical applications.
Chilelli, Nino Cristiano; Dalfra, Maria Grazia; Lapolla, Annunziata
There is a gradual decline in concern of specialists who follow up the care of pregnant women with diabetes. In addition, due to the dwindling economic resources allocated to health services, access to specialized healthcare facilities is becoming more difficult. Telemedicine, or medicine practiced at a distance, is inserted in this context with applications differing for type of interaction (real-time or deferred, i.e., videoconferencing versus store-and-forward data transmission), type of monitoring (automatic versus requesting cooperation from the patient), and type of devices used (web connections and use of mobile phones or smartphones). Telemedicine can cope with the current lack of ability to ensure these patients frequent direct contact with their caregivers. This approach may have an impact not only on the classical maternal-fetal outcome, but also on some underestimated aspects of patients with diabetes in pregnancy, in this case their quality of life, the perception of "diabetes self-efficacy," and the glycemic variability. In this paper, we will analyze the current evidence regarding the use of telemedicine in pregnancies complicated by diabetes, trying to highlight the main limitations of these studies and possible strategies to overcome them in order to improve the effectiveness of future clinical interventions with these medical applications. PMID:25295059
Chilelli, Nino Cristiano; Dalfrà, Maria Grazia; Lapolla, Annunziata
With continuing advances in information technology, the applications of computers in medicine are increasing rapidly. Modern information technology not only affects the delivery of health care, but also significantly influences the doctor-patient relationship. Since the 1990s, technologic developments in high-bandwidth telecommunications systems and digitizing devices have led to a surge of interest in telemedicine. In recent years, the Internet, with its powerful penetration and scalability, has become an increasingly popular medical information resource and a new platform for telemedicine. The impact of modern technology on the advancement of telemedicine in Taiwan started with the 1995 National Information Infrastructure project, which uses networks of different bandwidths for teleconsultation and distance education programs. In 1998, National Taiwan University and Taipei Medical College in Taiwan, and the University of Pittsburgh and the University of Iowa in the USA, began cooperation on a new Cyber Medical Center (CMC) project that integrates the technologies of multimedia, database management, a multiple-site videoconferencing system, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the Web. In the future, telemedicine systems in Taiwan are expected to combine the Internet and cable television to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend health services to every household. PMID:10705694
Chen, H S; Guo, F R; Lee, R G; Lin, C C; Chen, J H; Chen, C Y; Kuo, T S; Hou, S M
We created a Web catalogue of approved telemedicine systems that authoritative Italian research bodies had made available for more general use. The evaluation process was divided into two stages: (1) classification of the telemedicine systems and rough preliminary evaluation; (2) assessment of the telemedicine products and services. The scoring method was applied to four well-known telemedicine systems that had been tested in health-care settings: an echocardiology teleconsulting and analysis system; a ward nursing management system; a virtual cooperative system for the management of oncology patients and a telepathology system based on remotely controlled microscopy. After technical revision during the standardization/qualification process, the applications were transferred successfully to eight new health-care facilities. The methodology achieved the main goal of providing effective tools, such as a set of quality control procedures for telemedicine and telehealth projects and a Web catalogue of telemedicine applications with a standardized level of quality, available to all interested parties. PMID:16774700
After the creation of the european institute of telemedicine on 10 July 1989 at Paul Sabatier university in Toulouse, it became clear that legislation was needed to provide a solid framework for this new medical practice. The French government's decision in 1993 to create an experimental telemedicine network in the Midi-Pyrenees region, bringing together all public and private healthcare establishments, led us to managetelemedicine in much the same way as a hospital department. This resulted in the creation of institutional systems suited to multicenter networking and requiring particular regulations to govern healthcare professionals' responsibilities, financing, data security, and the use of new communication and information technologies. Articles specific to telemedicine were integrated into the law of 13 August 2004 relating to the reorganisation of French healthcare insurance. PMID:17001862
Since the 1970s, NASA has been involved in the research and demonstration of telemedicine for its potential in the care of astronauts in flight and Earth-bound applications. A combination of NASA funding, expertise and off-the-shelf computer and networking systems made telemedicine possible for a medically underserved hospital in Texas. Through two-way audio/video relay, the program links pediatric oncology specialists at the University of Texas Health Science Center in San Antonio to South Texas Hospital in Harlingen, providing easier access and better care to children with cancer. Additionally, the hospital is receiving teleclinics on pediatric oncology nursing, family counseling and tuberculosis treatment. VTEL Corporation, Sprint, and the Healthcare Open Systems and Trials Consortium also contributed staff and hardware.
Telemedicine is advocated for its potential to improve the accessibility and quality of health care delivery while lowering costs (1). Although the potential benefits of telemedicine have long been a subject of research and intense discussion, the results of actual implementations have been far from conclusive. Most current research, which views telemedicine as a substitute for travel and a basis
We describe the use of telemedicine by the Biobehavioral Service at the University of Iowa Hospitals and Clinics to conduct brief functional analyses for children with developmental and behavioral disorders who live in rural areas of Iowa. Instead of being served at our outpatient facility, participants received initial behavioral assessments in their local schools or social service agencies via videoconference. Case descriptions for 2 participants whose evaluations were conducted via telemedicine, and a brief summary of all outpatient assessments conducted over a 4-year period by the Biobehavioral Service, are provided. This report extends previous applications of functional analysis procedures by examining brief behavioral assessments conducted via telemedicine. PMID:17020213
Barretto, Anjali; Wacker, David P; Harding, Jay; Lee, John; Berg, Wendy K
The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol. PMID:12694629
Seven long-running telemedicine networks were surveyed. The networks provided humanitarian services (clinical and educational) in developing countries, and had been in operation for periods of 5-15 years. The number of experts serving each network ranged from 15 to 513. The smallest network had a total of 10 requesters and the largest one had more than 500 requesters. The networks operated in nearly 60 countries. The seven networks managed a total of 1857 cases in 2011, i.e. an average of 265 cases per year per network. There was a significant growth in total activity, amounting to 100.3 cases per year during the 15 year study period. In 2011, network activity was 50-700 teleconsultations per network. There were clear differences in the patterns of activity, with some networks managing an increasing caseload, and others managing a slowly reducing caseload. The seven networks had published a total of 44 papers listed in Medline which summarized the evidence resulting from the delivery of services by telemedicine. There was a dearth of information about clinical and cost-effectiveness. Nevertheless, the services were widely appreciated by referring doctors, considered to be clinically useful, and there were indications that clinical outcomes for telemedicine patients were often improved. Despite a lack of formal evidence, the present study suggests that telemedicine can provide clinically useful services in developing countries. PMID:22869822
Wootton, Richard; Geissbuhler, Antoine; Jethwani, Kamal; Kovarik, Carrie; Person, Donald A; Vladzymyrskyy, Anton; Zanaboni, Paolo; Zolfo, Maria
TELEMEDICINE TO ASSIST PATIENT UNDERSTANDING OF ATMOSPHERIC INFLUENCE ON LUNG FUNCTION AND IMPROVE-time generic telemedicine system is presented. It is discussed in the context of self- management for people as influencing lung function, we have used data collected during a feasibility study of the telemedicine system
Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized. PMID:17697506
Purpose – The purpose of this paper is to provide a conceptual framework along with underlying propositions for the design and deployment of telemedicine projects which provide healthcare organizations with strategic benefits. Design\\/methodology\\/approach – Field research conducted at four healthcare organizations along with academic literature in the areas of telemedicine and process management form the basis for the conceptual framework
The aim of this work is to establish some basic methodological aspects that should not be ignored in the arduous task of the development of telemedical platforms for the efficient control and management of chronic elderly patients. Among the main methodological proposed concepts should be: an integrated market-oriented approach, a user-centered design, an evaluation-driven development and a work plan organization.
L. F. Crespo Foix; D. Sanchez Morillo; M. Crespo; N. Gross; C. Kunze; K. Giokas; J. A. Jimenez
The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.
We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210-1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant's opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists. PMID:24218349
Fatehi, Farhad; Gray, Leonard C; Russell, Anthony W
Telemedicine is defined as the "delivery of health care and sharing of medical knowledge over a distance using telecommunication systems." The concept of telemedicine is not new. Beyond the use of the telephone, there were numerous attempts to develop telemedicine programs in the 1960s mostly based on interactive television. The early experience was conceptionally encouraging but suffered inadequate technology. With a few notable exceptions such as the telemetry of medical data in the space program, there was very little advancement of telemedicine in the 1970s and 1980s. Interest in telemedicine has exploded in the 1990s with the development of medical devices suited to capturing images and other data in digital electronic form and the development and installation of high speed, high bandwidth telecommunication systems around the world. Clinical applications of telemedicine are now found in virtually every specialty. Teleradiology is the most common application followed by cardiology, dermatology, psychiatry, emergency medicine, home health care, pathology, and oncology. The technological basis and the practical issues are highly variable from one clinical application to another. Teleradiology, including telenuclear medicine, is one of the more well-defined telemedicine services. Techniques have been developed for the acquisition and digitization of images, image compression, image transmission, and image interpretation. The American College of Radiology has promulgated standards for teleradiology, including the requirement for the use of high resolution 2000 x 2000 pixel workstations for the interpretation of plain films. Other elements of the standard address image annotation, patient confidentiality, workstation functionality, cathode ray tube brightness, and image compression. Teleradiology systems are now widely deployed in clinical practice. Applications include providing service from larger to smaller institutions, coverage of outpatient clinics, imaging centers, and nursing homes. Teleradiology is also being used in international applications. Unresolved issues in telemedicine include licensure, the development of standards, reimbursement for services, patient confidentiality, and telecommunications infrastructure and cost. A number of states and medical boards have instituted policies and regulations to prevent physicians who are not licensed in the respective state to provide telemedicine services. This is a major impediment to the delivery of telemedicine between states. Telemedicine, including teleradiology, is here to stay and is changing the practice of medicine dramatically. National and international communications networks are being created that enable the sharing of information and knowledge at a distance. Technological barriers are being overcome leaving organizational, legal, financial, and special interest issues as the major impediments to the further development of telemedicine and realization of its benefits. PMID:9579416
Technological innovations in medical care have led to the development of telemedicine programs in both rural and urban environments. The necessity for telemedicine has increased immensely as more cost-effective treatment options have become available for both patients and physicians through the addition of telecommunication technologies to medical practice. The development of telemedicine systems began as a means of providing access to health care resources for individuals living in isolated rural areas, grew into advanced medical intervention techniques for soldiers on the battlefield, and have become prevalent in urban medical centers both as a resource to the underserved populations and as a platform for physicians off-site to conduct patient consults remotely. Urban telemedicine systems, as monitored in the Mercy Health System (Philadelphia, Pennsylvania) and AtlantiCare Regional Medical Center (Atlantic City, New Jersey), display the enormous benefits of telemedicine as a form of preliminary analysis of patients for the treatment of various medical conditions including chronic disease, mental health disorders and stroke. However, the initiation of telemedicine programs requires new protocols and safeguards to be initiated to protect patient confidentiality/privacy, ensure the appropriate licensure of physicians practicing across state borders, and educate patients on the use of new technological systems. Telemedicine represents the progression of medicine in the presence of improving communication technologies and should be instituted in all urban medical centers. This conclusion is based upon the ethical responsibility to treat all persons with dignity and respect, which in this case, mandates the provision of the most cost-effective, beneficial medical care for all populations. PMID:21119593
... week. Apple’s New Health Products are Major Disruptive Innovations in Healthcare Sep 09, 2014 The American Telemedicine ... app, HealthKit and Apple Watch as major disruptive innovations in healthcare. The new products demonstrate how advanced ...
Telemedicine itself is not the medical profession, it is not a medical specialty, but the way in which the medical profession conduct its activity. Therefore we are talking about tele otorhinolaryngology, tele cardiology or tele pathology. In the definition of a multitude of telemedicine that can be found in the literature is the following: Telemedicine is a system that supports the process of health care by providing ways and means for more efficient exchange of information that allows multitude of activities related to health care, including health care and health personnel, including education, administration and treatment. Telemedicine applications include tele diagnosis, tele consultation, tele monitoring, tele-care, tele consultations and remote access to information contained in one or more databases. It turned out that telemedicine is an important factor in technological, professional, financial and organizational uniformity of development of the health system. Telemedicine, although a new area, to a large extent already changed the ways of providing health care, and even more influence on the ways of designing the future of medicine. PMID:25395732
Telemedicine itself is not the medical profession, it is not a medical specialty, but the way in which the medical profession conduct its activity. Therefore we are talking about tele otorhinolaryngology, tele cardiology or tele pathology. In the definition of a multitude of telemedicine that can be found in the literature is the following: Telemedicine is a system that supports the process of health care by providing ways and means for more efficient exchange of information that allows multitude of activities related to health care, including health care and health personnel, including education, administration and treatment. Telemedicine applications include tele diagnosis, tele consultation, tele monitoring, tele-care, tele consultations and remote access to information contained in one or more databases. It turned out that telemedicine is an important factor in technological, professional, financial and organizational uniformity of development of the health system. Telemedicine, although a new area, to a large extent already changed the ways of providing health care, and even more influence on the ways of designing the future of medicine.
We have previously proposed a method for assessing the quality of individual teleconsultation cases; this paper proposes an additional step to allow the long-term monitoring of quality. The basic scenario is a teleconsultation system (aka an e-referral system or a tele-expertise system) where the referrer posts a question about a clinical case, the question is relayed to an appropriate expert, and the chosen expert provides an answer. The people running this system want assurances that it is stable, i.e., they want routine quality assurance information about the “output” from the “process.” This requires two things. It needs a method of assessing the quality of individual patient consultations. And it needs a method for taking into account differences between patients, so that these quality assessments can be compared longitudinally. Building on the previously proposed methodology, the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation. The first is an indirect method, similar to a willingness to pay economic estimation. The second is a direct method. Using these two methods with real data from a telemedicine network showed that the first method was feasible, but did not produce useful results in a pilot trial. The second method, while more laborious, was also feasible and did produce useful results. Thus, when output quality is measured, an allowance can be made for the characteristics of the case submitted. This means that fluctuations in output quality can be attributed to variations in the process (network) or to variations in the raw materials (queries submitted to the network). Long-term quality assurance should assist those providing telemedicine services in low-resource settings to ensure that the services are operated effectively and efficiently, despite the constraints and complexities of the environment.
The study of the adoption of information technology (IT) by individuals has taken two approaches, one emphasizing rationalistic goal-oriented behavior and the other focusing on poignant forces that influence an individual's reaction to a new IT. These approaches are not necessarily mutually exclusive. Individuals' acceptance and subsequent usage of a new IT is predicated on both. Additionally, the tendency in past studies has been to examine either the rational or the poignant factors in the context of a "resource-rich" environment-one in which there is an abundance of IT, adequate infrastructure, and a high level of acculturation to technology solutions. Consequently, there is a clear need for the examination of these factors in resource-poor environments, where assumptions on technology abundance and technology culturation do not hold. We empirically test a model that explains the intention of physicians in a resource-poor environment (epitomized by rural Ethiopia) to adopt telemedicine systems. This model integrates the rational factors driving goal-oriented behavior with the poignant/emotive factors that are an innate part of each adopter's reaction to the new technology. We use the model to expose salient contextual factors that explain the acceptance behavior of individuals toward complex information and communications technology (ICT) solutions and implications of these on the management of technology transfer initiatives in a resource-poor environment. The model is parsimonious, yet explains 28% of the variance in the intention to adopt telemedicine systems and 58% in perceived ease of use. The theoretical and practical implications of this model are discussed. Namely, Sub-Saharan African, in general, and Ethiopian culture, in particular, plays an integral role in the adoption of ICT solutions. Organizational positions and roles among physicians, clinical professionals, and superiors stand to impact the adoption of telemedicine and other healthcare applications. Last, the degree to which users perceive that ICT is easy to use (i.e., ease of use) can be a function of technology experience and can influence perceived usefulness on behalf of users and healthcare organizations. PMID:20406120
Kifle, Mengistu; Payton, Fay Cobb; Mbarika, Victor; Meso, Peter
Telemedicine involves the use of advanced and reliable communication techniques to deliver biomedical signals over long distances. In such systems, biomedical information is transmitted using wireline or wireless communication systems. Mobile telemedicine is an improved form of telemedicine, in which advanced wireless communication systems are used to deliver the biomedical signals of patients at any place and any time. Mobile telemedicine employs advanced concepts and techniques from the fields of electrical engineering, computer science, biomedical engineering, and medicine to overcome the restrictions involved in conventional telemedicine and realize an improvement in the quality of service of medicine. In this paper, we study several mobile telemedicine systems, and it is important to gain a good understanding of mobile telemedicine systems because in the further, such systems are expected to become ubiquitous for the delivery of biomedical signals for medicine. PMID:20703699
Similar to virtual reality (VR), telemedicine became a concept so broad that it literally lost its meaning. In VR we have virtual offices that are nothing more than word processing, spreadsheets, graphics, or other forms of software available to the employees working away from their offices. There is nothing virtual about it other than substitution of one environment (office) for
Dag K. J. E. von Lubitza; Benjamin Carrasco; Timothy Pletcher; Caleb Poirier
Early telemedicine networks employed dedicated telecommunications circuits (e.g. leased digital lines) in which the sender and receiver were connected by a private circuit. More recently, the Internet has become widely available for general use, including telemedicine. The Internet was engineered to permit network paths to be shared by all users, so data transmission is fundamentally different from traditional, circuit-switched networks. Early telemedicine applications demonstrated the feasibility of Internet Protocol transmission. The basic performance criteria to use in evaluating newer digital communications technologies that carry both voice and data are: (1) bandwidth; (2) packet loss; (3) end-to-end delay; (4) jitter; (5) privacy and security. Network engineering involves performance trade-offs between the hardware, architecture, security and the budget available. A telemedicine application may be running over a network whose design is entirely under the user's control, or the application may employ some part of the Internet whose design is unknown to the user. If an application is not running to satisfaction, then a network engineer should be consulted. PMID:15829050
Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care organizations. Telemedicine programs should perform ongoing assessments of activities, ranging from service usage to quality of service assessments, to ongoing analyses of financial performance. The financial assessments should include evaluations of costs and benefits, coding issues, reimbursement, account receivables, bad debt and network utilization. Long-range strategic planning for a telemedicine and telehealth program should be carried out on an on-going basis and should include the program's governing board. This planning process should include goal setting and the periodic updating of the program's vision and mission statements. There can be additional special issues for multi-organization telemedicine and telehealth programs. For example, authority management can require the use of innovative approaches tailored to the realities of the organizational structures of the participating members. Inter-institutional relations may introduce additional issues when competing health care organizations are utilizing shared resources. Branding issues are preferably addressed during the initial planning of a multi-organizational telemedicine and telehealth program. Ideally, public policy regarding telemedicine and telehealth within a service region will complement the objectives of telemedicine and telehealth programs within that service area. PMID:18305320
Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail
Requirement volatility is an issue in software engineering in general, and in Web-based clinical applications in particular, which often originates from an incomplete knowledge of the domain of interest. With advances in the health science, many features and functionalities need to be added to, or removed from, existing software applications in the biomedical domain. At the same time, the increasing complexity of biomedical systems makes them more difficult to understand, and consequently it is more difficult to define their requirements, which contributes considerably to their volatility. In this paper, we present a novel agent-based approach for analyzing and managing volatile and dynamic requirements in an ontology-driven laboratory information management system (LIMS) designed for Web-based case reporting in medical mycology. The proposed framework is empowered with ontologies and formalized using category theory to provide a deep and common understanding of the functional and nonfunctional requirement hi...
Telemedicine is used more and more frequently worldwide. It is increasingly popular in North America, Australia, South Africa, as well as the Scandinavian countries. However, it is not commonly used in Hungary despite various attempts, which is presumably due to earlier dismissive governmental attitude. In this paper the authors analyze ethical, legal and financial aspects of telemedicine from the viewpoints of physicians and patients, too. The results indicate that it cannot be clearly decided whether telemedicine is worth to apply at present. Further, introduction of telemedicine should be based on experience gained in local application. PMID:23876613
Daragó, László; Jung, Zsófia; Ispán, Fanni; Bendes, Rita; Dinya, Elek
At what point does an international telemedicine transaction create a sufficient commercial nexus to allow one country the authority to impose its laws on a foreign telemedicine providers? Some light on this matter was shed by the US case of Hageseth versus Superior Court. The authority for extraterritorial jurisdiction is found in the US Constitution, which requires the states to cooperate in matters of law enforcement. Similar cooperation from foreign nations cannot be expected. Unless a defendant is charged with a capital offence, nations are rarely willing to extradite their citizens. As the unlicensed practice of medicine is not a capital offence, it is unlikely that an unlicensed telemedicine provider would be extradited to the US. Because low-volume unlicensed offshore telemedicine providers are unlikely to be extradited or to be subject to trade sanctions, they may be able to operate beyond the law. PMID:18776071
The transmission of moving pictures to remote locations is an important part of telemedicine. Although the first videoconferencing demonstrations were performed in the 1930s, the technology is still fragmented and its quality is sometimes too poor for it to be useful. Conventional television technology is analogue (the fundamental television standards were developed before the Second World War) and does not 'fit' the digital world very well. This paper reviews video transmission and videoconferencing technologies and the results that can be expected. While trained professionals may be able to make use of poor-quality video systems, real advances in telemedicine require studio-quality video, which is possible only with high-bandwidth technology. PMID:10505363
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions. PMID:22563284
Telemedicine is the rapidly developing application of clinical medicine by telephone, the internet or other networks for the purpose of consulting, and on occasions carrying out examinations or medical procedures. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine offers real benefits in a country as vast as India where the majority of the population lives in remote areas with no access to even the most basic healthcare. As the practice of telemedicine spreads, maintaining standards, security and privacy, will be a challenge especially with regard to legal and regulatory measures and who will be held responsible if telemedicine-assisted surgery fails due to failure in connectivity? Is it the surgeon, the satellite provider or the software/hardware engineer? What is the legal status of telemedicine-based diagnosis and treatment? Other legal issues involve conflicting national laws and information piracy, the dangers of prescription drugs that are banned in one country but not in another and quacks who offer medical advice and prescribe drugs over the internet. This paper discusses some of the legal, ethical and social considerations in the Indian context. PMID:19731480
Internet technologies are briefly introduced and those applicable for telemedicine are reviewed. Multicast internet technologies are described. The National Aeronautics and Space Administration (NASA) 'Telemedicine Space-bridge to Russia' project is described and used to derive requirements for internet telemedicine. Telemedicine privacy and Quality of Service (QoS) requirements are described.
Although wound care has been practiced for centuries, telewound care is a relatively new concept. Currently, only a few pilot programs are in existence. Telewound care has yet to achieve the popularity and recognition of its other telemedicine predecessors amongst members of the health care industry and public alike. The tremendous potential of incorporating the technology of telemedicine into wound care needs to be realized. Wound care is a representation of the care of chronic and debilitating conditions that require long-term specialized care. We have seen the positive effects of improved living conditions and advances in health care globally. The result: people are now living longer. Every day a small piece is added to the pie: the percentage of world's elderly and those with chronic medical conditions that would require medical attention is rising. With the escalating costs of health care, and the push of the industry towards outpatient care, this is a part of the health care crisis that is demanding our immediate attention. We have seen positive outcomes in the care of other chronic medial conditions using telemedicine such as home telecare programs. In addition, the effectiveness of several programs using available advances in technology such as the field of radiology has been established. Wound care can build on success created in these fields to create an effective and useful method of care. The aim of this chapter is to recognize the impact of this problem, to introduce several pilot programs in several different aspects of wound care and to build on current resources in order to achieve a novel method of wound care. The goal would be to create a technologically advanced, cost-effective and user-friendly program, and be able to bridge the gap between the sick and available specialized care. Both store-and-forward technology and televideo have a role to play in telewound care, the latter greater in the role of home telecare and teleconsultation, and the former in post-operative patients and the follow-up of chronic wounds. Either way, both have been underutilized and underdeveloped. With the advances in the field of telecommunications in connecting people across distances at a fraction of the time and costs, improved outcomes reported in other fields of telemedicine and positive legislative changes, there is an enormous potential in this field. We now have the ability, knowledge and resources to develop telewound care programs, which can provide high quality patient care in a more concise and cost-effective way. It is certainly a welcoming relief to a field that has traditionally been known to pose an emotional, physical and financial drain to all those involved. PMID:18305332
Objectives. We examined the social impact of the telemedicine intervention effects in lower– and higher–socioeconomic status (SES) participants in the Informatics for Diabetes Education and Telemedicine (IDEATel) study. Methods. We conducted a randomized controlled trial comparing telemedicinecasemanagement with usual care, with blinded outcome evaluation, in 1665 Medicare recipients with diabetes, aged 55 years or older, residing in federally designated medically underserved areas of New York State. The primary trial endpoints were hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and systolic blood pressure levels. Results. HbA1c was higher in lower-income participants at the baseline examination. However, we found no evidence that the intervention increased disparities. A significant moderator effect was seen for HbA1c (P?=?.004) and systolic blood pressure (P?=?.023), with the lowest-income group showing greater intervention effects. Conclusions. Lower-SES participants in the IDEATel study benefited at least as much as higher-SES participants from telemedicine nurse casemanagement for diabetes. Tailoring the intensity of the intervention based on clinical need may have led to greater improvements among those not at goal for diabetes control, a group that also had lower income, thereby avoiding the potential for an innovative intervention to widen socioeconomic disparities. PMID:23488491
Kothari, Dhruva; Teresi, Jeanne A.; Kong, Jian; Eimicke, Joseph P.; Lantigua, Rafael A.; Palmas, Walter; Weinstock, Ruth S.
Telemedicine is the practice of healthcare using audio, video, and data communications. The aim of this study was to determine the perceptions of health professionals at hospitals adopting and not adopting telemedicine on its benefits and challenges, and their willingness to use it. The study was conducted at one hospital not adopting telemedicine and three hospitals adopting telemedicine. It was a cross-sectional descriptive study, and the target population was health professionals. Data collection methods included two paper-based questionnaires. Nonparametric statistical analysis and descriptive statistics were used. The study concluded that although telemedicine is promising and the Ministry of Health in Saudi Arabia has allocated a huge budget for e-health, the telemedicine modalities used were very limited. The percentage of adoption of telemedicine by health professionals was low in comparison to the high interest of nonadopters. Nonadopters’ perception of benefits was higher than that of adopters. The most frequently cited benefits among adopters were improving the quality of care, enhancing access to healthcare, and providing patient care and management. However, adopters’ perceptions were low for other benefits such as easy use of the network, the use of store-and-forward telemedicine, and the ability to follow up after face-to-face contacts. The greatest barrier as perceived by health providers was the lack of knowledge about telemedicine. Dissemination of information about telemedicine and proper training of health professionals on its use are recommended. PMID:23209455
The use of telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Consequently, the development of a strategy for coverage, payment, and utilization policy has been hindered. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal budget cuts and major changes in health service financing. This article reviews the literature on the effects and medical effectiveness of telemedicine. It concludes with several recommendations for research, followed by a discussion of several specific questions, the answers to which might have a bearing on policy development. PMID:10153466
Grigsby, Jim; Kaehny, Margaret M.; Sandberg, Elliot J.; Schlenker, Robert E.; Shaughnessy, Peter W.
DIABETES O. J. Gibson1 , L. Tarassenko1 , P. E. McSharry1 , P. M. Hayton1 , A. J. Farmer2 , H. A. W. Neil2 and Primary Health Care, University of Oxford, Oxford, UK 3 Oxford Centre for Diabetes Endocrinology- management of Type 1 diabetes was tested in a clinical randomized controlled trial. Both intervention
To prepare for the case study, lecture material on coastal landforms and processes is presented. Particular attention is paid to barrier islands, such as the Outer Banks. During the lecture, typical coastal engineering structures, such as groins, breakwaters, and jetties, are introduced. The case study is introduced with a brief overview of North Carolina's coastal management laws, Figure Eight Island's geography, and the current controversy over whether to build a terminal groin. Students are then broken down into small groups and presented with two opposing editorials. The groups are instructed to try to come to consensus as to whether the terminal groin should be allowed or disallowed or to suggest a third alternative. After approximately 25 minutes, each group informally reports out to the rest of the class.
The Telemedicine Spacebridge, a satellite mediated audio-video-fax link between four U.S. and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several U.S. medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to onsite physicians and favorably influence clinical decisions in the aftermath of major disasters.
Houtchens, Bruce A.; Clemmer, Terry P.; Holloway, Harry C.; Kiselev, Alexander A.; Logan, James S.; Merrell, Ronald C.; Nicogossian, Arnauld E.; Nikogossian, Haik A.; Rayman, Russell B.; Sarkisian, Ashot E.
A regional telemedicine hub, providing linkage of a telemedicine command center with an extended network of clinical experts in the setting of a natural or intentional disaster, may facilitate future disaster response and improve patient outcomes. However, the health benefits derived from the use of telemedicine in disaster response have not been quantitatively analyzed. In this paper, we present a general model of the application of telemedicine to disaster response and evaluate a concept of operations for a regional telemedicine hub, which would create distributed surge capacity using regional telemedicine networks connecting available healthcare and telemedicine infrastructures to external expertise. Specifically, we investigate (1) the scope of potential use of telemedicine in disaster response; (2) the operational characteristics of a regional telemedicine hub using a new discrete-event simulation model of an earthquake scenario; and (3) the benefit that the affected population may gain from a coordinated regional telemedicine network. PMID:21161569
A virtual electronic medical record system is being deployed over the Internet with security in northern New Mexico using TeleMed, a multimedia medical records management system that uses CORBA-based client-server technology and distributed database architecture. The goal of the NNM Rural Telemedicine Project is to implement TeleMed into fifteen rural clinics and two hospitals within a 25,000 square mile area of northern New Mexico. Evaluation of the project consists of three components: job task analysis, audit of immunized children, and time motion studies. Preliminary results of the evaluation components are presented.
Zink, S.; Hahn, H.; Rudnick, J.; Snell, J.; Forslund, D. [Los Alamos National Lab., NM (United States); Martinez, P. [Northern New Mexico Community Coll., Espanola, NM (United States)
1 Chapter 1 Introduction 1.1 Telemedicine The trend in medical imaging is increasing toward direct that telemedicine and digital image processing will eventually completely replace conventional film (hard copy) imaging in medicine. Telemedicine is the provision of health care services via electronic transmission
The article presents the results of the survey of the dermatovenereologists and patients to explore their attitude to the telemedicine consultations. It is found that most of the dermatovenereologists have the positive attitude towards telemedicine consultations. From the perspective of patients using telemedicine technology is likely to breach the protection of personal privacy. PMID:21938895
In the 21st century, telemedicine has become daily business. Nevertheless, they are still a lack of precise definitions of telemedicine. Legal and financial implications of telemedical applications are complex, with lots of local restrictions, far beyond global technological aspects. In the United States, telemedicine is a reality since decades, and is basically defined as the provision of health care when distance separates the participants. Technology and networks for telemedicine are universally globalized, but the legal and financial implications are diametrically more local based. Any CT-scan made at midnight in Switzerland can be accurately assessed within minutes by any Australian radiologist, for whom it will be the morning, and so far around the globe at any time of the day or the night. But how will the billing work intercontinentally? And what about legal implications of this telemedical service? In this paper, we review the actual definitions of telemedicine, check our local legal responsibilities, and present the Tarmed financial positions for billing. PMID:19160998
A multimedia telemedicine system (MTS) using Transfer Control Protocol and Internet Protocol (TCP/IP) over the Internet is developed. Doctor with patient and doctor can communicate each other using this system. Real-time data, including audio, video and instant message (IM), and non-real-time data, including vital sign signals, radiological images with DICOM 3.0, file, bio-signal, bio-data and so on, can be exchanged on the system. This system's architecture is client/server mode. All data are encoded/compressed before transferring through Internet/Intranet. The real-time audio is encoded and decoded by MPEG (Moving Picture Experts Group) audio layer 3 algorithm and real-time video is encoded and decoded by MPEG-4. The software implementation of needed functionality without any externally attached hardware CODEC (Coder/Decoder) units enables the compact design with low cost. The real-time video has 25 frames per second at Local Area Network (LAN) and more than 20 frames per second at ADSL. PMID:17281043
Ling, Li; Dezhong, Yao; Jianqing, Li; Bin, Li; Ling, Wang
Telemedicine is rapidly developing telecommunication technology to provide medical information and services. The importance of telemedicine for neurosurgical emergencies was established with the fact that majority of the neurosurgical specialists are practicing in urban settings and in most of the rural areas, neurosurgical care is far off or non-existing. Countries with inadequate health care must incorporate telemedicine in their health care system. Telemedicine offers real benefits in a country as vast as India, where the majority of the population lives in remote areas with no access to even the most basic healthcare. Issues pertaining security, privacy, maintaining standards, and legal aspects are relevant. A recommended set of standards and guidelines for telemedicine needs to be set in place and constantly refined to promote the integrated growth of telemedicine in the country. The paper discusses various issues, shortcomings, and utility of telemedicine in India. PMID:22870155
Exploring intelligent mobile agent (MA) technology for assisting medical services or transmitting personal patient-health information in telemedicine applications has been widely investigated. Conversely, peer-to-peer (P2P) networking has become one of the most popular applications used in the Internet because of its benefits for easy-to-manage resources and because it balances workloads. Therefore, constructing an agent-based telemedicine platform based on P2P networking architecture is necessary. The main purpose of this paper is to construct a safe agent-based telemedicine that based on P2P networking architecture. Two themes are addressed in this paper: (a) the P2P network architecture for an agent-based telemedicine service, and (b) the security mechanisms for the proposed telemedicine networking architecture. When an MA contains patient information and migrates from one host to another through the Internet, it can be attacked by other software agents or agent platforms that can illegally access patient information. The proposed P2P network architecture is based on the JXTA protocol and provides two types of telemedicine service models: the predictable service model and unpredictable service model. This architecture employs a two-layer safety mechanism for MAs (i.e., time-limited black boxes and RSA undetachable signature technologies), to provide a secure solution for agent-based telemedicine services. PMID:23605144
Introduction The development of telecommunication technologies and the diffusion of its eHealth applicability have enabled the implementation of a wide range of telemedicine systems, supporting clinical practices in different regions of the world. Distant and poorer areas of the globe, often characterized by difficult access and hazardous environments, are those that can most benefit from availability of remote consultations. This is due to the high costs associated with the transportation of specialized health teams and medical equipment between major cities and small villages, sometimes essential for the provision of adequate health care. Brazil is a country of continental dimensions with socioeconomic inequalities and uneven distribution of specialized health care, making it an ideal environment for establishment of eHealth initiatives. Objective The main objectives were (1) to develop an efficient method for acquiring and delivering patient medical information in remote areas using local Internet and (2) to assist urban and Indian populations in the Brazilian Amazon presenting with skin lesions and cardiovascular diseases. Methodology Ethical approval was granted by the research and Ethics Committees of PUCRS, Porto Alegre, Brazil. The project comprised: (1) triage and patient interview; (2) digital ECG and skin picture acquisition; (3) data management, storage and transmission; (4) delivery of expert second opinion based on development of a secure and confidential communication system between the receiving and delivering sites. Upon internet availability, the system was programmed to connect to the Microgravity Centre’s main server and to synchronise all collected data. Specialist health professionals accessed this server and the electronic patient records via a secure application installed on personal computers. Patient information, images, and exams were analysed by health specialists at the delivering site, and an opinion and treatment suggestion was offered. Cases that proved inconclusive were due to a lack of available information or the need for further laboratory exams. The opinions were secured in an encrypted PDF envelope and returned to the receiving site, where final diagnosis and treatment remained the responsibility of the local health team. Results Telecardiology (n=98): 59 (60.2%) normal ECGs, whilst 39 (39.8%) were altered, showing arrhythmias, conductive alterations and signs of ventricular hypertrophy. No patients presented signs of acute ischemia. In teledermatology (n=110): 57 (51.8%) patients did not present any skin disease. Among the patients with dermatological problems (n=53; 48.2%), the most common diagnoses were eczema, pityriasis versicolor, tinea, onychomycosis, and superficial mycosis. In five patients, the dermatologist suspected a cancerous lesion and recommended further investigation. Conclusion The telemedicine tools and the telecommunication system developed for this project proved to have a great applicability for diagnosis of dermatological skin conditions and for assessment of patient cardiovascular diseases. It was possible to remotely diagnose dermatological and cardiovascular conditions in a short period of time, at low cost and without the need for transportation of patients to other locations. It is believed that the eHealth assistance model applied in this project can be transferred to other places that have access to an Internet connection.
Jones, Christopher Robert; Cardoso, Ricardo Bertoglio; Oliveira, Helena Willhelm; Lopes, Maria Helena Itaqui; Huttner, Edison; Huttner, Eder; Wiehe, Mario; Celia2, Sergio Antonio Curcio; Russomano, Thais
Communication among physicians is an essential in order to combine our experiences for the elucidation and application of new knowledge and for the accurate and uniform application of established medical practice. This communication requires an adequate understanding of the culture of the patient and the social context of disease and indeed the culture of the physician. Malnutrition in Bangladesh means caloric insufficiency, and a program to lower cholesterol would be impertinent, while a program to enhance the nutrition of patients in Texas by an international effort to import more grain would be ludicrous. In the same vein a public health effort to combat alcoholic cirrhosis in Mecca would be as silly as a program to increase fiber in the diet of the Bantu. Clinical communication must acknowledge the culture of the issue at hand and the differences in the experiential base of the physicians. Not only do geography and culture affect the potential differences in the experiential bases, but the world utilizes very different traditions of education and science in training physicians. We are influenced by the diseases we treat, and learn to look for the expected at least as much as we are attentive to the unexpected. A physician in Siberia would be much more likely to recognize frostbite than one from Buenos Aires, and the Argentine doctor would much more likely consider Chaga's Disease to explain abdominal pain than a colleague in Zurich. Beyond these obvious issues in communication among physicians we must deal with the many languages and idioms used in the world. An overview of using Telemedicine SpaceBridge after the earthquake in the Republic of Armenia in 1988 is presented.
Although Botswana has recently been categorised as an upper middle income country, it is burdened by a scarcity of resources, both human and technological. There are barriers to patients' access to specialized care and healthcare providers' access to medical knowledge. Over the past three years, the Botswana-University of Pennsylvania Partnership (BUP) has piloted four mobile telemedicine projects in the specialties of women's health (cervical cancer screening utilizing visual inspection with acetic acid), radiology, oral medicine and dermatology. Mobile telemedicine has been used in 11 locations in Botswana, training a total of 24 clinicians and successfully contributing to the management of 643 cases. In addition to mobile telemedicine, BUP has initiated an m-learning programme with the University of Botswana School of Medicine. While successfully providing patients and providers with improved access to healthcare resources, the m-health projects have faced numerous technical and social challenges. These include malfunctioning mobile devices, unreliable IT infrastructure, accidental damage to mobile devices, and cultural misalignment between IT and healthcare providers. BUP has worked with its local partners to develop solutions to these problems. To ensure sustainability, m-health programmes must have strategic goals that are aligned with those of the national health and education system, and the initiatives must be owned and led by local stakeholders. Whenever possible, open source technology and local IT expertise and infrastructure should be employed. PMID:23454821
Managed care and capitation will become increasingly familiar in the Central Valley of California as managed care arrangements capture more of the marketshare. This type of healthcare environment presents a myriad of opportunities for casemanagement to affect quality and cost outcomes within healthcare organizations. Assessment skills (clinical outcomes), client-provider relationship (member satisfaction), and resource coordination (cost containment) are three key elements underlying the role of the casemanager, making the role components congruent with the needs of a managed care population. As payers continue to mandate outcomes measurement, casemanagement beyond the walls or outside the inpatient setting is a technique that will increasingly be used to document that the diverse needs of high-risk patients are met. PMID:10167585
Background: Volunteer ophthalmologists can achieve success with teaching and service programs working with high intensity over a short term. Continuation of initially successful programs may be limited by lack of timely, effective communication and follow-up. In an attempt to overcome these limitations, a total of 6 telemedicine programs were established after a successful trial program at the Ramon Pando Ferrer
Eugene M. Helveston; Faruk H. Orge; Rosa Naranjo; Lourdes Hernandez
Virtual Reality (VR) can be considered as the leading edge of a general evolution of present communication interfaces involving the television, computer and telephone. Main characteristic of this evolution is the full immersion of the human sensorimotor channels into a vivid and global communication experience. Since telemedicine is principally focusing on transmitting medical information, VR has the potential to enhance
Computer and telecommunications technologies have unleashed a wide range of powerful tools for gathering, storing, and distributing patient information. Computerized records enable healthcare providers to rapidly access patient data and to closely monitor patients from a distance. These significant advantages can be further extended by using the technology to more fully involve patients in their own healthcare management. A patient-centric approach to telemedicine means that the patient takes on additional responsibility and control, and the benefits from increased patient involvement will translate into improved compliance, reduced litigation, lower costs, and better outcomes. Furthermore, there are often important ethical questions that are best decided by the informed patient. Patients have a right to know what information is being gathered and who will be authorized to access that information. Current health information systems do not adequately address these issues, and telemedicine applications--particularly home based telemedicine--is forcing everyone to take a closer look at patients' roles in their own healthcare. In this presentation, a patient-centric home telemedicine database is described, the limitations are discussed, and future directions are proposed. PMID:10180588
The National Aeronautics and Space Administration (NASA) has been developing and applying telemedicine to support space flight since the Agency's beginning. Telemetry of physiological parameters from spacecraft to ground controllers is critical to assess the health status of humans in extreme and remote environments. Requisite systems to support medical care and maintain readiness will evolve as mission duration and complexity increase. Developing appropriate protocols and procedures to support multinational, multicultural missions is a key objective of this activity. NASA has created an Agency-wide strategic plan that focuses on the development and integration of technology into the health care delivery systems for space flight to meet these challenges. In order to evaluate technology and systems that can enhance inflight medical care and medical education, NASA has established and conducted several testbeds. Additionally, in June of 1997, NASA established a Commercial Space Center (CSC) for Medical Informatics and Technology Applications at Yale University School of Medicine. These testbeds and the CSC foster the leveraging of technology and resources between government, academia and industry to enhance health care. This commercial endeavor will influence both the delivery of health care in space and on the ground. To date, NASA's activities in telemedicine have provided new ideas in the application of telecommunications and information systems to health care. NASA's Spacebridge to Russia, an Internet-based telemedicine testbed, is one example of how telemedicine and medical education can be conducted using the Internet and its associated tools. Other NASA activities, including the development of a portable telemedicine workstation, which has been demonstrated on the Crow Indian Reservation and in the Texas Prison System, show promise in serving as significant adjuncts to the delivery of health care. As NASA continues to meet the challenges of space flight, the technologies adapted to support humans in extreme and remote environments, and the resultant protocols and procedures will further evolve the commercial practice of medicine and thereby enhance life on Earth.
Telemedicine has become an increasingly popular option for long-distance/virtual medical care and education, but many telemedicine ventures fail to grow beyond the initial pilot stage. Studying the business models of successful telemedicine ventures can help develop business strategies for upcoming ventures. This article describes business models of eight telemedicine ventures from different regions of the world using Osterwalder's "Business Model Canvas." The ventures are chosen on the basis of their apparent success and their diverse value chains. The business models are compared to draw inferences and lessons regarding their business strategy and contextual factors that influenced it. Key differences between telemedicine business practices in developing and developed countries are also discussed. The purpose of this article is to inform and inspire the business strategy of the next generation of telemedicine ventures to be economically sustainable and to successfully address local healthcare challenges. PMID:23540278
ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care. PMID:21729894
Hill, Nicholas S.; Lilly, Craig M.; Angus, Derek C.; Jacobi, Judith; Rubenfeld, Gordon D.; Rothschild, Jeffrey M.; Sales, Anne E.; Scales, Damon C.; Mathers, James A. L.
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development. PMID:16388175
Many aspects of medical care can now be delivered at a distance using telemedicine technology. Rapid video and computer-based communication of medical information makes it possible for a physician to "examine" a patient located in another city, to view highly detailed medical images, to consult with distant subspecialists, or to supervise complex medical procedures. This same technology can bring scattered health-care workers together for joint teaching conferences. The Yale Telemedicine Center has initiated a number of such programs ranging from providing consultations in real time to physicians in Saudi Arabia, to interpreting medical images across town or across the state. Telemedicine will become a powerful tool for managed health-care organizations which are responsible for the medical needs of widely distributed patients in a vertically integrated health-care delivery system. This paper reviews the evolution of telemedicine, its technical fundamentals, specific medical applications, and the activities of the Yale Telemedicine Center. Evolving uses for telemedicine in Connecticut are described. PMID:7587175
Swett, H A; Holaday, L; Leffell, D; Merrell, R C; Morrow, J S; Rosser, J C; Warshaw, J
Humor is an effective tool to prevent and resolve burnout, a common problem associated with the practice of casemanagement. Easily accessed by almost everyone, humor has many physiological and psychological benefits. The conscious use of humor in an organization requires a commitment at all levels in order for the organization to benefit as a whole. Offering formal seminars, using humor in company newsletters, and encouraging cartoon or joke sharing impacts on the physical and mental health of the employees. Techniques for bringing laughter to the workplace are outlined, as well as examples from the practice of casemanagement. PMID:9335722
Objectives: the evaluation of the feasibility, potential, problems and risks of an Internet-based telemedicine network in developing countries of Western Africa. Methods: a project for the development of a national telemedicine network in Mali was initiated in 2001, in Mauritania in 2002, Morocco in 2003 using Internet-based technologies for distance learning and teleconsultations. Several other countries are currently in the
Cheick Oumar Bagayoko; Henning Müller; Antoine Geissbuhler
This paper proposes a telemedicine system which is a CBM-based real-time interactive telemedicine system using a personal computer on the Internet. This system presents an intelligent remote medical examination system for both online and offline modes to transcend time and space on the Web. It can be used by anybody and is cheaper than existing remote medical examination systems. The
This article analyzes telemedicine, the use of distant communication technologies within the context of clinical health care, and the effects it has on health communication. The main effect is that telemedicine has the capacity to substantially transform health care in both positive and negative ways and to radically modify personal face-to-face communication (Turner, 2003). This has tremendous implications for health
This collection of case studies, based on factual situations which have challenged broadcast managers in recent years, is designed to stimulate thinking about and solving of "real world" problems in commercial radio and television operations. Topics of a serious, long-run nature include enlarging the radio audience; station revenue and economy;…
The Problem: Epilepsy is a common disease worldwide causing significant physical and social disability. It is one of the most treatable neurological diseases. Yet, in rural, poorer countries like much of India and Nepal, most people with epilepsy are not undergoing any treatment often because they cannot access doctors. Conventional Approaches: It is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details, however, have been put forward about how that might be achieved. Thinking Differently: Untreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found. Telemedicine Approaches: Telemedicine might contribute to two steps – diagnosis and review. A tool that enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity, and specificity for the diagnosis. There are a number of ways in which the use of phone review or short messaging service can improve management. Conclusion: Telemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.
Global burn injuries have been described as the "forgotten public health crises" by the World Health Organization. Nearly 11 million people a year suffer burns severe enough to require medical attention; more people are burned each year than are infected with human immunodeficiency virus/acquired immunodeficiency syndrome and tuberculosis combined. Telemedicine has the potential to link experts in specialized fields, such as burn care, to regions of the world that have limited or no access to such specialized care. A multilevel telemedicine program was developed between Massachusetts General Hospital/Shriners Hospital in Boston, Massachusetts, and City Hospital #8 in Lviv, Ukraine. The program should lead to a sustainable improvement in the care of burn victims in Ukraine. The authors helped establish a Learning Center at City Hospital #8 in Lviv, Ukraine, through which they were able to consult from Shriners Hospital in Boston, on a total of 14 acute burn patients in Ukraine. This article discusses two case reports with the use of telemedicine and how it has allowed the authors to provide not only acute care consultation on an international scale, but also to arrange for direct expert examination and international transport to their specialized burn center in the United States. The authors have established a program through doctors from Massachusetts General Hospital/Shriner's Hospital in Boston, which works with a hospital in Ukraine and has provided acute consultation, as well as patient transportation to the United States for treatment and direct assessment. PMID:23702854
Fuzaylov, Gennadiy; Knittel, Justin; Driscoll, Daniel N
Background Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation. Methods A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ?18 years) transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis. Results Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%). The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high. Conclusions Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high speed broadband access, is needed before this approach can be implemented in daily practice. PMID:25343246
Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Valenzuela Espinoza, Alexis; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf
Telemedicine services are very relevant tools to train local physicians and to improve diagnosis by exchanging medical data. Telemedicine networks allow these exchanges but the set-up of multipoint dynamic telemedicine requires moving towards GRID technologies. A healthgrid is an environment where data of medical interest can be stored and is easily available between the different actors of healthcare. Two telemedicine applications were developed to link physicians from Burkina Faso and France with the perspective of setting up a grid infrastructure between the participating medical sites. A web site to exchange diagnosis on diabetic retinopathy was developed in PHP and another application using web services was developed to exchange patient information between two databases.
delivery services that are two-way telecommunications using a File Transfer Protocol over an Ethernet connection. The system is used to demonstrate effective telemedicine delivery to enable tele-consultation. Virtual instruments are developed for both ends...
Background: Using telemedicine to provide health services for seafarers represents a special case of intersectoral co-operation. Since 2006, several North Sea drilling platforms and internationally operating Norwegian merchant ships have used onboard telemedicine equipment continuously. Experience gained through this new technology has improved intersectoral co-operation regarding seafarers' health care. Aim: This study aimed to analyze the need for intersectoral co-operation
This review is describing different models of casemanagement, showing their similarities and differences with regards to the way they operate. Good relationship between patient and casemanager, application of the biopsychosocial model, availability of psychosocial treatment methods and rehabilitation programs, and individual treatment plan are all important factors in casemanagement's success. Large number of studies supports the application of casemanagement in practice as effective treatment method in treating people with severe mental disorder, particularly those, who are less co-operative. Therefore, the implementation of casemanagement into psychiatric practice should be supported. PMID:20305587
Low-cost telemedicine is a viable and secure tool for preoperative evaluation of surgical mission patients. It increases efficiency and optimizes the use of existing resources. More specifically, it helps ensure an accurate assessment of patients before the surgical team arrives, reduces on-site prescreening time, and decreases the number of surgical candidates on the waiting list. Routine use of telemedicine in surgical missions most likely would reduce preoperative times and the number of operations canceled at the last minute. Moreover, it may be effectively used for long-term follow-up care, including the management of any postoperative complications. PMID:24552027
Latifi, Rifat; Mora, Francisco; Bekteshi, Flamur; Rivera, Renato
In a study dubbed Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), investigators at the University of California San Diego Health System are gauging whether remote physicians can be quickly and cost-effectively mobilized to evaluate patients when the ED is busy. While there have been administrative hurdles involved with implementing the approach, investigators say the strategy could offer big savings in terms of time and efficiency. Onsite nurses facilitate telemedicine encounters, utilizing technology that enables remote physicians to evaluate patients. While both patients and providers give the telemedicine encounters high marks, managing the workflow is challenging. Investigators say the approach could produce significant gains in efficiency, including the possibility that a single on-call physician could remotely treat patients from multiple ED sites. PMID:23923522
Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems Dimitrios I. Kosmopoulos dkosmo Force Hospital 11525 Athens, Greece Abstract The timely diagnosis and treatment of pressure ulcers for automated pressure ulcer stage classification can be integrated into an asynchronous telemedicine system
The telemedicine concept for a mission to Mars is presented including the basic operational units and subsystems, and problems of elaboration and creation of the telemedicine system with the use of multilevel structure functional modeling. PMID:16353622
Explores the healthcare information technology context as a backdrop for viewing the legal issues that accompany telemedicine and teleradiology. In this age of managed care, healthcare informatics has become a burgeoning field. Computer-based technologies help automate processes such as patient data collection. As patient records become increasingly digitized, they are more easily transmitted between various healthcare sites and personnel. The
Casemanagers have been viewed as engaging in direct practice, community practice, or both. This article offers a third view: Casemanagers also engage in the practice of management. Employing Mintzberg's seminal research on chief executive behavior, the authors argue that casemanagers' work is similarly characterized by brevity, variety, and fragmentation. Casemanagers perform the 10 roles developed in Mintzberg's original study. These roles are divided into three groups: interpersonal, including figurehead, leader, and liaison; informational, including monitor, disseminator, and spokesperson; and decision-making, including entrepreneur, disturbance handler, resource allocator, and negotiator. Casemanagers' tasks associated with each role are presented. Considering their work as managerial in nature will help casemanagers more effectively assist clients in goal achievement. PMID:8153757
Telemedicine has always developed in close relation with communication technology. When only aural telephones were used, several experiments of telemedicine were carried out by utilizing telephone lines. When INS64 (ISDN with 64 kbits) and telecommunication satellites came onto the scene, experiments for telemedicine began to be conducted accordingly using the cutting-edge technology of the time. In this paper, one of
Telemedicine in the context of the National Broadband Network June 2010 Report by NICTA for Department of Broadband, Communications and the Digital Economy #12;Australian telemedicine opportunities://creativecommons.org/licenses/by/2.5/au/legalcode). The document should be attributed as `Telemedicine in the context of the National
Session MP3 includes short reports on: (1) Telemedicine: A User's Perspective; (2) Health Care in Extreme Environments; (3) Integration of Emerging Technologies in Information and Telecommunications in Health Care Systems for Space; (4) Telemedicine and Environmental Medicine in Russia: A First Step in Basic Medical Education; and (5) Clinical Utility of Internet Telemedicine.
Telemedicine is gaining popularity due to its high potential for cost savings and increased efficiency in healthcare delivery. However, most telemedicine systems available in the markets are limited to particular applications and lack interoperability with other information systems and measurement devices. In this paper, we present a generic service platform, which is applicable in a wide range of telemedicine applications
Jaakko Lähteenmäki; Juha Leppänen; Hannu Kaijanranta; Kjell Nikus; Teppo Veijonen; Timo Laakko; Antti Nummiaho
CaseManagement At JDH, CaseManagers are Registered Nurses who have a strong clinical background. They are assigned to the inpatient units as well as the Emergency Department. CaseManagers the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness
The challenges faced and the methods implemented by the Apollo Hospitals Group in introducing telemedicine in the Indian setting are discussed in this article. Using Information and Communication Technology (ICT) to make available secondary and tertiary medical expertise to suburban and rural India was thought of as early as 1997. In March 2000, the world's first Very Small Aperture Terminal (VSAT)-enabled village hospital was commissioned. Today, with 115 centers including 9 overseas, the Apollo Telemedicine Networking Foundation (ATNF) is the oldest and largest multispecialty telemedicine network. More than 57,000 teleconsultations in various disciplines, ranging from sexual medicine to neurosurgery, have been provided. Patients have been evaluated from distances ranging from 120 to 4,500 miles. A majority (85%) of these teleconsults were reviews. The successful proof of concept validation studies, carried out from 2000 to 2001 by Apollo, were instrumental in the Indian Space Research Organization (ISRO) including telemedicine as a major thrust area. The pioneering role played by Apollo is also discussed in using VSAT-enabled Hospitals on Wheels. The paper reviews the significant role played by ATNF in the growth and development of telemedicine in South Asia. Academic activities are also highlighted. The pioneering efforts in the field of m-health, home telecare, the Pan African e-Network Project, starting the first formal educational course in telehealth and various other e-initiatives are elaborated. PMID:19659414
In recent years, financial risk management has received increasing attention from managers in both private and public enterprises, regulatory agencies, and elected officials. The purpose of this research is to prepare a case study of a firm that seeks to ...
In this article the adoption of casemanagement processes in US hospitals is discussed. While such process change is prevalent, there is a paucity of systematic empirical evidence that hospital casemanagement improves efficiency or effectiveness. Using an institutional theoretical framework, motivations other than improved efficiency and effectiveness are proposed that may drive hospitals to adopt change to their technical core processes, in the form of casemanagement. Further research using these propositions as an adjunct to cost-benefit analyses would be important to validate the rationale behind the widespread adoption of hospital casemanagement processes. PMID:11556775
The digital camera is an essential component of store-and-forward telemedicine (electronic consultation). There are numerous makes and models of digital cameras on the market, and selecting a suitable consumer-grade camera can be complicated. Evaluation of digital cameras includes investigating the features and analyzing image quality. Important features include the camera settings, ease of use, macro capabilities, method of image transfer, and power recharging. Consideration needs to be given to image quality, especially as it relates to color (skin tones) and detail. It is important to know the level of the photographer and the intended application. The goal is to match the characteristics of the camera with the telemedicine program requirements. In the end, selecting a digital camera is a combination of qualitative (subjective) and quantitative (objective) analysis. For the telemedicine program in Alaska in 2008, the camera evaluation and decision process resulted in a specific selection based on the criteria developed for our environment. PMID:19519277
Recent Federal and state legislation and new payment opportunities from Medicare, Medicaid, and private payers may make it possible to offer telemedicine as a viable, cost-effective alternative to traditional care delivery in communities where access to health care is limited. Originally, nonexistent payment and expensive technology held back telemedicine but, these barriers are giving way to specific applications that can yield dramatic cost savings for group practices in the delivery of medical care while adding features and benefits not typically available in traditional delivery settings. Before joining a telemedicine network, group practices need to negotiate a variety of legal issues related to the corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, Medicare and Medicaid payment, fraud and abuse, medical device regulation, and antitrust. PMID:11066698
This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (including examples of patient education, home monitoring, and continuing education). The concluding section highlights how telemedicine affects health sciences librarianship, beginning with the development of online computerized literature searching. This section also discusses the medical resources available to health sciences librarians as a result of the Internet. PMID:8938332
Telemedicine refers to the use of information and communication technology to provide and support health care mainly for the purpose of providing consultation. It is also a way to provide medical procedures or examinations to remote locations. It has the potential to improve both the quality and the access to health care services delivery while lowering costs even in the scarcity of resources. Understanding the potentiality of telemedicine, many developing countries are implementing telemedicine to provide health care facility to remote area where health care facilities are deficient. Bangladesh is not an exception to this either. In this paper we mention the reasons why Bangladesh has to move for telemedicine. We also present the past and on-going telemedicine activities and projects in Bangladesh. Analyzing these projects we have found out some factors which should be assessed carefully for successful implementation of telemedicine application. Finally we propose a prototype telemedicine network for Banglad...
The Knitting, Lace, and Net Industry Training Board in Great Britain is beginning to work with management training, using three firms for experimental pilot projects. The Board plans to introduce this management system throughout the industry. (MF)
This chapter presents a series of supervision-related case studies of situations that midlevel managers might face. Individuals enrolled in a midlevel management professional development course recommended the topics selected for this chapter. Drawing upon her experience teaching the course, the author selected four case studies that individuals…
Job Title Veteran Services CaseManager Employer/ Agency ASSET BUILDING NETWORK, INC. Job To post a job opportunity or if your response to this job posting results in successful employment, please Description Weekly casemanagement meetings with the veterans, development services plans, connect and link
In 1987 we established a realtime echocardiography service by telemedicine from the paediatric cardiology department of a tertiary-care hospital in Halifax. The service was initially provided to single regional hospital but was expanded to six regional hospitals in the three Canadian Maritime Provinces. The system used a dial-up broadband video-transmission service provided by the telephone companies. Records of all transmissions were kept prospectively and reviewed to January 1997. A total of 324 transmissions were made. During 1995-96 there were 135 studies: 69 (51%) were urgent examinations of newborn children and 30 (22%) were urgent examinations of older children; repeat studies and postoperative checks (usually for pericardial effusion) accounted for the other 36 studies (27%). The images were of broadcast quality except in five cases where problems with transmission or poor sedation occurred. A comparison of 26 transmitted studies with repeat, 'in person' studies showed no important discrepancies in diagnosis. During the two-year study period, the cost of the network (equipment leasing costs and telecommunications costs) was C$90,000. Use of the telemedicine network saved unnecessary patient transfer in 31 cases. The cost of the transportation avoided was C$100,000-C$118,000. This review confirms our preliminary findings that broadband echocardiography transmission provides a service comparable in availability and accuracy to that provided in our paediatric cardiology division. PMID:9614734
Finley, J P; Sharratt, G P; Nanton, M A; Chen, R P; Bryan, P; Wolstenholme, J; MacDonald, C
...management services means casemanagement services furnished without...comparability). Targeted casemanagement services may be offered...goals. (iii) Identifies a course of action to respond to the...with providers. (e) Casemanagement may include contacts...
Purpose – The purpose of this paper is to explore the interconnections between management development and change management within the context of an industry case study. To develop strategies for how management development practices might better support the management of change. Design\\/methodology\\/approach – Using a constructivist methodology, one-to-one interviews were conducted with two groups: a randomly chosen cross-section of middle
Health authorities currently have high expectations for telemedicine (TM), as it addresses several major challenges: to improve access to healthcare (especially for patients in underserved or remote areas); to overcome the scarcity of specialists faced with epidemic disease; and to reduce the costs of healthcare while improving quality. The aims of TM in the field of diabetes differ according to
S. Franc; A. Daoudi; S. Mounier; B. Boucherie; D. Dardari; H. Laroye; B. Neraud; E. Requeda; L. Canipel; G. Charpentier
This paper summarizes the main topics of discussion at a workshop hosted by the Centre for Law Ethics and Risk in Telemedicine at the 2nd International Conference on Advances in the Delivery of Care, held at the Institute of Health Sciences, City University, London from Wednesday 24 to Friday 26 March 1999. The workshop offered a unique opportunity for practitioners
The role of medical informatics in telemedicine is dependent on using the power of the computerized database to not only feed patient specific information to the health care providers, but to use the epidemiological and statistical information in the data base to improve decision making and ultimately care. The computer is also a powerful tool to facilitate standardizing and monitoring
The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good blood sugar control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers.
Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates. PMID:24433942
Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard
Many software organizations face serious problems in their attempts to make expectations and realities meet in introduction of CASE technology. One promising and substantial approach to understand CASE introduction better and to provide guidelines for how to manage it more effectively has been developed by Watts S. Humphrey, Bill Curtis, and others. By relating CASE introduction to software process maturity
This paper outlines a model for assessing and managing psychological depth in outdoor and experiential group work, and presents two case studies of the complexity of such management in real life. The model contains eight levels of emotional risk and presents four criteria for assessing the level to which a particular event or discussion may lead…
Background The purpose of this study was to evaluate the efficacy and safety of implementation of telemedicine and the Thammasat Stroke\\u000a Network model in treating acute ischemic stroke patients with intravenous thrombolysis.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Telemedicine (telephone consultation and tele-radiology) has been used in acute ischemic stroke management since June, 2007.\\u000a The Thammasat Stroke Network (TSN) was effectively organized in March, 2008. Thammasat Hospital
Pornpatr A. Dharmasaroja; Sombat Muengtaweepongsa; Urai Kommarkg
Differential measurements selection for evaluation of telemedicine applications Shuai Zhang, Sally measurements for better economic analysis. Methods Results We use Chi-square tests and Fisher's exact tests
So far we have developed Emergency Telemedicine System (ETS) which is a robust system using heterogeneous networks. In disaster areas, however, ETS cannot be used if the primary network channel is disabled due to damages on the network infrastructures. Thus we designed network management software for disaster communication network by combination of Mobile Ad hoc Network (MANET) and Wireless LAN (WLAN). This software maintains routes to a Backbone Gateway Node in dynamic network topologies. In this paper, we introduce the proposed disaster communication network with management software, and evaluate its performance using ETS between Medical Center and simulated disaster areas. We also present the results of network performance analysis which identifies the possibility of actual Telemedicine Service in disaster areas via MANET and mobile network (e.g. HSDPA, WiBro). PMID:19964544
Kim, J C; Kim, D Y; Jung, S M; Lee, M H; Kim, K S; Lee, C K; Nah, J Y; Lee, S H; Kim, J H; Choi, W J; Yoo, S K
Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission's (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study.
Haber, S.B.; Barriere, M.T. (Brookhaven National Lab., Upton, NY (United States)); Roberts, K.H. (California Univ., Berkeley, CA (United States). Walter A. Haas School of Business)
Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission`s (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study.
Haber, S.B.; Barriere, M.T. [Brookhaven National Lab., Upton, NY (United States); Roberts, K.H. [California Univ., Berkeley, CA (United States). Walter A. Haas School of Business
Health authorities currently have high expectations for telemedicine (TM), as it addresses several major challenges: to improve access to healthcare (especially for patients in underserved or remote areas); to overcome the scarcity of specialists faced with epidemic disease; and to reduce the costs of healthcare while improving quality. The aims of TM in the field of diabetes differ according to the type of diabetes. In type 1 diabetes (T1DM) associated with complex insulin regimens, the goal of TM is to help patients achieve better control of their blood glucose levels through accurate adjustment of insulin doses. In type 2 diabetes (T2DM), while therapeutic adjustments may be necessary, improvement in blood glucose control is based primarily on behavioural changes (reduced calorie and carbohydrate intakes, increased physical activity). Many TM studies focusing on management of blood glucose levels have been published, but most failed to demonstrate any superiority of TM vs traditional care. While previously published meta-analyses have shown a slight advantage at best for TM, these meta-analyses included a mix of studies of varying durations and different populations (both T1DM and T2DM patients, adults and children), and tested systems of inconsistent quality. Studies published to date on TM suggest two currently promising approaches. First, handheld communicating devices, such as smartphones, loaded with software to apply physicians' prescriptions, have been shown to improve glycaemic control. These systems provide immediate assistance to the patient (such as insulin-dose calculation and food choice optimization at meals), and all data stored in the smartphone can be transmitted to authorized caregivers, enabling remote monitoring and even teleconsultation. These systems, initially developed for T1DM, appear to offer many possibilities for T2DM, too. Second, systems combining an interactive Internet system (or a mobile phone coupled to a remote server) with a system of communication between the healthcare provider and the patient by e-mail, texting or phone calls have also shown certain benefits for glycaemic control. These systems, primarily aimed at T2DM patients, generally provide motivational support as well. Although the individual benefits of these systems for glycaemic control are fewer than with smartphones, their widespread use should be of particular value for overcoming the relative shortage of doctors and reducing the health costs associated with a disease of such epidemic proportions. PMID:21889388
The Commission for CaseManager Certification (CCMC) conducted its third casemanagers' role and functions study in 2004. The purpose of this research was to validate the currency and relevancy of the certified casemanager examination. The results of this study are shared in 2 parts of an article. Part I discusses the process the CCMC used for the development of the CaseManager's Role and Functions Survey Instrument (CMRFSI). The research leads to the identification of 6 new essential functions and 6 new knowledge areas, which describe casemanagement practice. These findings were based on the survey of a large national sample of practicing casemanagers. Part II continues the analysis of the survey results and focuses on identifying the empirical activity and knowledge domains of casemanagement practice, using factor analysis. It also discusses the similarities and differences found among various subgroups of casemanagers who were compared on the basis of certain demographic variables. In addition, it summarizes future changes in the field of casemanagement as perceived by those who participated in the study. PMID:16444117
Tahan, Hussein A; Huber, Diane L; Downey, William T
Telemedicine is an emerging field that can potentially affect health management, according to the present technological progress, combining medical expertise and communication technology. In this field, three main trials have been up to now experimented; teleconference, tele-intervention, telemonitoring. Teleconference applications are today a true reality, even in the medical field (i.e. consulting), while tele-intervention (i.e. tele-surgery) and telemonitoring remain at
D. Franchi; A. Belardinelli; G. Palagi; A. Ripoli; R. Bedini
From the perspective of scheduling, some medical consultations can have asynchronous and synchronous components. Consultations frequently involve the compilation of patient data, its analysis, a consultant's report, and a real-time conference between the referring physician and the consultant. The bandwidth of the Internet with Moscow and advances in the hardware and software of personal computing now make possible telemedicine events with store-and-forward components and real-time components. These are hybrid telemedicine and this paper describes such a case.
The project Mobimed started in 1988. The purpose of the project was to develop a telemedicine system where patient information text as well as data reflecting the status of various physiological parameters could be transmitted from a mobile terminal to a resident terminal at a hospital or similar place. The information transmitted was to be so comprehensive that a physician at the hospital together with the personnel attending the patient could make a diagnosis and suggest therapy. At the hospital all transmitted data should be stored automatically. Since September 1989 a prototype system is running in Sweden with one ambulance connected to two hospitals. This system is using the Mobitex* and speech transmission system for data transmission. As a first step the project is oriented towards ECG-monitoring. Mobimed has also been developed for laptop computers using the ordinary telephone network. In this case Mobimed can be used at home or anyplace where wireless transmission is not required. 1.
Telemedicine is a broad term and has recently become a household term in the medical field. However, there are many interpretations as to what the term "telemedicine" means. There are many facets to telemedicine and here we describe all of the elements of telemedicine, a glossary of terms, and how they relate to pediatric surgery. PMID:25111277
Nalugo, Margaret; Craner, Domenic R; Schwachter, Marc; Ponsky, Todd A
The purpose of this project was to test the efficacy of behavioral telemedicine interventions designed to teach self-regulation skills to chronic pain patients who had not previously been treated. The study sought to determine whether there were differences in outcome and consumer satisfaction with the pain management intervention when delivered by conventional face-to-face methods, by telephone only, and by closed circuit TV (CCTV). We found that self-regulation techniques can be readily taught via behavioral telemedicine interventions. The primary methodologic weakness of the study is that a single experienced clinician provided all of the interventions. Thus, it is not known at this time how well the intervention can be generalized to other clinicians. In addition, there was no control on the administration of the protocols across conditions. PMID:12626105
Telemedicine has the potential to transcend geographic and socio-cultural barriers to the delivery of high quality health care to the medically underserved populations. However, there are significant cognitive and usability barriers. This paper presents a multifaceted cognitive evaluation of the IDEATel diabetes education and telemedicine program. The evaluation included a cognitive walkthrough analysis to characterize task complexity and identify potential problems as well as field usability testing in patients’ homes. The study revealed dimensions of the interface that impeded optimal access to system resources. In addition, we found significant obstacles corresponding to perceptual-motoric skills, mental models of the system, and health literacy. The objective of this work is to contribute to a design framework so that participants with a wide range of skills can better manage their chronic illnesses. PMID:14728194
Kaufman, David R.; Starren, Justin; Patel, Vimla L.; Morin, Philip C.; Hilliman, Charlyn; Pevzner, Jenia; Weinstock, Ruth S.; Goland, Robin; Shea, Steven
This survey collected extensive data from 770 county casemanagers, casemanager supervisors, consumers, and service providers in Minnesota in order to provide a comprehensive description of casemanagement practices serving individuals with developmental disabilities. The survey report describes current casemanagement practices, identifies…
Médecins Sans Frontières (MSF) began a pilot trial of store-and-forward telemedicine in 2010, initially operating separate networks in English, French, and Spanish; these were merged into a single, multilingual platform in 2013. We reviewed the pattern of teleradiology usage on the MSF telemedicine platform in the 4-year period from April 2010. In total, 564 teleradiology cases were submitted from 22 different countries. A total of 1114 files were uploaded with the 564 cases, the majority being of type JPEG (n?=?1081, 97%). The median file size was 938?kb (interquartile range, IQR 163-1659). A panel of 14 radiologists was available to report cases, but most (90%) were reported by only 4 radiologists. The median radiologist response time was 6.1?h (IQR 3.0-20). A user satisfaction survey was sent to 29 users in the last 6?months of the study. There was a 28% response rate. Most respondents found the radiologist's advice helpful and all of them stated that the advice assisted in clarification of a diagnosis. Although some MSF sites made substantial use of the system for teleradiology, there is considerable potential for expansion. More promotion of telemedicine may be needed at different levels of the organization to increase engagement of staff. PMID:25389524
Halton, Jarred; Kosack, Cara; Spijker, Saskia; Joekes, Elizabeth; Andronikou, Savvas; Chetcuti, Karen; Brant, William E; Bonnardot, Laurent; Wootton, Richard
Casemanagement, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The casemanagement role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While casemanagers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between casemanagers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people. PMID:17194052
Austin, Carol D; McClelland, Robert W; Gursansky, Di
The article conceptualizes casemanagement in the context of the health service delivery system as a set of goal-oriented activities which organize, coordinate, and monitor service delivery based on measurable objectives intended to meet the needs of chronically ill children and their families. The functions, objectives, and procedures associated…
Abstract Intraoperative neurophysiological monitoring (IONM) is used as an adjunct for surgeries that pose risk to nervous system structures. IONM is performed by a technologist in the operating room and is overseen by a highly trained fellowship-trained physician clinical neurophysiologist. Telemedicine has allowed the professional oversight component to be done remotely, with reimbursement for multiple simultaneous cases. Recent changes to Current Procedure Terminology coding and Medicare reimbursement policies provide options only for exclusive 1:1 technologist:oversight physician billing. This policy change may create profound repercussions in the practice of telemedicine by actively discouraging the leveraging of highly specialized and scarce expertise through on-site physician extenders. PMID:23952785
During late 1998 and early 1999, planning officers in Cornwall predicted a huge increase in summer visitors to the county to observe the August solar eclipse. There was the possibility that a mass gathering in Cornwall could overload existing arrangements for handling accident and emergency patients. We therefore set up a telemedicine system to support the county's minor injury units (MIUs) from hospitals throughout the UK. Six main hospital accident and emergency departments outside Cornwall with existing links to their own MIUs were twinned with 10 of the 11 MIUs in Cornwall before the expected date of the gathering. The network was live for nine days, starting four days before the eclipse, and 2045 patients were seen in the 10 MIUs. There were 93 telemedicine calls from the 10 MIUs, involving 91 patients. Overall, 4.6% of the patients required a telemedicine consultation. Fifty-seven calls were made during working hours. Thirty-four patients were referred for further management, of whom 18 were referred on the same day. The transfer of telemedical support to a national network was successful. PMID:10794014
Since the creation of the NATO Telemedicine Expert Panel (now renamed the TMED Expert Team) in 2000, when few nations had deployed telemedicine systems to support military field operations, this group has been encouraging the nations to deploy telemedicine (TMED) in support of their forces, and to write the use of TMED into NATO doctrine. This has been a relatively successful effort, and TMED is increasingly being used within the military medical structures of some NATO and Partnership for Peace nations to provide medical care to deployed military personnel. We report the results of a multinational survey of current and projected availability of various telemedicine modalities within the NATO medical services that are participating in the work of the TMED expert team (ET). Though only a "snapshot in time," and not representing all NATO nations, this is the first attempt to identify both current and planned TMED utilization within the multinational military medical community. Participating nations report that communication systems now in place at the lowest levels of medical support increasingly enable the routine use of Web-based teleconsultation modalities. Teleradiology is now being seen as the de facto standard for imaging support. While a number of nations report they have deployed capabilities for obtaining clinical consultations at a distance, most responding nations do not have a formal organizational structure to control and manage remote consultation and rely on informal clinical relationships (e.g., requesting consults from the deployed clinician's home hospital or from friends). Military electronic health records are in use by only a minority of nations and fewer still are capable of civilian interface. Less common TMED capabilities (e.g., tele-microbiology, tele-pathology, tele-medical maintenance) are being increasingly used, but are still rarely deployed. As a result of the findings of this survey, specific recommendations for expanding the use of TMED in the NATO multinational medical setting have been made to appropriate NATO bodies. PMID:19035805
Telemedicine is by no means a new technology, given that audio-video telecommunication links have been utilized for the provision of medical services since the 1950s. Nonetheless, telemedicine is currently in a phase of rapid growth and evolution. The combination of increasingly affordable and powerful networking, computing, and communication technology, along with the continued nationwide crisis in health care access and costs, has created a "tipping point," whereby telemedicine has progressed from a novel means of practicing medicine to practical tool to help address our nation's health care needs. Telemedicine has also evolved beyond a means of providing care to remote communities to becoming a versatile tool in the delivery of health care in a variety of non-rural settings. Although no one can be everywhere at once, telemedicine allows us to be in more places at once than we've ever been before. The problems of disparities and access to care are even more evident in pediatrics, where subspecialists are fewer in number and more regionalized than adult providers. Numerous successful telemedicine programs across the country have demonstrated the impact that these technologies can have in pediatrics, with many more programs in development. As a versatile means of delivering care, telemedicine can be used at any point during the course of a health care encounter as not only a means of expanding our reach, but also as a means of increasing efficiency. Using telemedicine to provide consultations to community hospitals has been shown to improve quality of care, strengthen the referral base for the consulting facilities, facilitate cost savings, and improve the financial bottom line for both referring and consulting facilities. This review highlights some of the ways in which telemedicine is being used to facilitate timely and effective pediatric care in a variety of hospital settings. PMID:24512161
Telemedicine has developed around certain assumptions about connectivity and format. From the pioneer work of Kenneth Bird in the 1970's medical events separated by distance were connected for videoconference interaction . The connection implied well developed telecommunications tools at both ends of the interaction. Telemedicine in its most common manifestations relies upon electronic and professional familiarity plus training with proper technical support. This is true even with Internet telemedicine at the low end of bandwidth. A workable Internet service provider and intact telecommunication services are required at both ends. The assumption of intact, robust telecommunications fails when there is any significant disruption of services, power, or trained people to initiate a telemedicine request. The very nature of disasters whether made by nature, made by fellow humans or in war declarations implies a rupture of the social fabric, a failure of infrastructure. This loss of infrastructure and connection happens at a cruel time when the need for services in health matters is generally very much exacerbated. Extreme remote sites have never had infrastructure and therefore fit into this chapter. Is telemedicine incompatible with support and relief in disasters of remote places? Certainly not. However, telemedicine must adapt to the situation in ways not generally associated with standard telemedicine. New solutions can meet the expectation of being wherever services are need whenever the need arises. This chapter looks at the experiences, successes and failures of telemedicine in natural disaster, war, and extreme remote sites. The presentation is concluded with recommendations to make telemedicine integral to any disaster response and a natural tool for any human endeavor that requires sending people to remote and hostile environments. PMID:18305326
How can we meet the many ethical challenges we face every day in our practice settings? When health care values and services were strong, no one questioned the motivation behind a referral or lack of a referral. Financial decisions and knowledge of health care costs were left to accountants and the bookkeeping departments in hospitals. When payers ran out of dollars to support the growing numbers of ill people, money managers moved in. The challenge we face now is to strike a balance between acceptable levels of profit and socially responsible care. Ethical casemanagement (CM) is an important part of the solution. PMID:11094957
This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.
Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.; Vallario, Robert W.
Abstract Introduction: Large-scale asynchronous telemedicine networks can offer a unique opportunity for the acquisition of detailed epidemiological information if the data are acquired and handled in an appropriate way. In this work, an approach is presented for the integration of medical reports in the Digital Imaging and Communications in Medicine (DICOM) Structured Reporting standard in telemedicine networks using structured vocabularies. Materials and Methods: The use of these structured vocabularies is extended beyond radiology, and a case study in telecardiology is presented. The approach was applied in the context of a real-world statewide public telemedicine network; nowadays on average 470 written electrocardiographic structured reports daily are being performed. Cardiologists provided more than 220,000 written structured reports, and these reports are stored into a central database. Results: This study was performed during a 12-month period, and it was possible to examine possible associations between a list of co-morbidities and cardiac risk factors with a diagnosis that indicates the presence of cardiac ischemia, cardiac injury, or possible necrosis by using DICOM Structured Reporting. Our application is responsible for coordinating the process of issuance of reports through various technologies and devices. The system works as a library in an HTTP server, which accesses information from studies in DICOM format from the database and from structured vocabularies. Conclusions: Results indicate that traceability of morbidity, diagnoses, and patient clinical information can be achieved, resulting in an efficient data mining–friendly framework. A multidevice application for Web-based and smartphone-based platforms showed that it is a viable solution for applying the DICOM Structured Reporting standard in telemedicine networks. PMID:23837517
Barcellos, Cloves Langendorf; Andrade, Rafael; de Carlos Back Giuliano, Isabela; Borgatto, Adriano Ferreti; de Andrade, Dalton Francisco
Those medical providers deployed to remote countries and tasked with caring for military personnel must diagnose and treat diseases and nonbattle injuries that result from exposures rarely seen in developed countries. Military providers must also function with limited resources and a lack of access to physician specialists, to include medical toxicologists. There have been limited published approaches to addressing this clinical gap for medical toxicology. To address this void, the US Army Medical Department deployed an electronic mail telemedicine system to provide teleconsultations for remote health-care providers worldwide, including Iraq and Afghanistan. This study aimed to describe the types and the frequency of toxicology teleconsultation and consultant responses using electronic mail to assist physicians serving in resource-limited locations. This was a retrospective observational study in which an unblinded data extractor independently reviewed all medical toxicology email consultations. Using a previously developed data collection worksheet, the extractor recorded the type of question asked by the consultant (overdose case, envenomation, occupational exposure, etc.) and the duration of time from when the teleconsultation was placed until the consultant replied. The extractor also recorded if the patient was adult or pediatric and if the patient was US military, US contractor, or local national. The extractor also recorded how often the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. In addition, for clinical teleconsultations, the extractor documented the frequency that the consulted toxicologist (i) provided a differential diagnosis or specific diagnosis, (ii) provided specific management guidelines for a patient, and (iii) recommended to evacuate or not evacuate a patient. The results were analyzed using descriptive statistics. Of the 99 consultations evaluated, the most common consultation was for snake envenomation and antivenom recommendations (n?=?23, 23 %) followed by accidental chemical exposures (n?=?14, 14 %), drug testing (n?=?13, 13 %), and substance abuse (n?=?10, 10 %). In 41 % of consults, the toxicologist provided a differential diagnosis or specific diagnosis, and in 60 % of cases, the toxicologist provided specific management or evaluation guidelines. In 11 % of cases, the toxicologist recommended for or against evacuation of the patient. In 25 % of consults, the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. The most frequent consultations for the military telemedicine consultation service were for direct patient cases, specifically snake envenomation management and accidental chemical exposures. Our results may be used to educate physicians prior to military deployment or international humanitarian efforts and to create toxicology clinical guidelines for remote locations. Expansion of the current military teleconsultation program capabilities to include video teleconsultation may improve the effectiveness of military medical toxicology teleconsultation. PMID:24752493
Maddry, Joseph K; Sessions, Daniel; Heard, Kennon; Lappan, Charles; McManus, John; Bebarta, Vikhyat S
??Telemedicine has been identified as a tool to distnllUte medical expertise to medically underserved rural community. However, due to the underdeveloped or non-existent telecommunication infrastructure,… (more)
Tavarua is a platform designed to support mobile telemedicine systems over wireless wide area networks, WWANs. It utilizes network striping and other complementary techniques to send uni-directional near real time video ...
Researchers at Osaka and Kyoto University hospital performed three experiments, beginning in 1995, which looked at high quality-oriented telemedicine. This paper describes the system design for the three projects. Experiment 1 applied high-definition TV images and B-ISDN for distance learning and medical information exchange. Experiment 2 developed a super high-definition medical image filing system and the images were transmitted via B-ISDN for teleconferences and experiment 3 utilized digital, high-definition, TV images and communication satellites for teleconferences. Multimedia and communication technologies were considered to be fundamental components of telemedicine. The three projects were evaluated initially for quality of images, operability and utility. The experimental design and its implementation showed that it was possible to provide high quality image-oriented telemedicine in the health care environment. Obstacles to establishing practical telemedicine are also discussed. PMID:10471238
The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts ...
This article defines telemedicine, discusses evidence of its effectiveness, looks at its advantages and disadvantages (and barriers to implementation), and considers its role in the NHS for the millennium and beyond. PMID:10320886
This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology\\u000a was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest\\u000a adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology\\u000a with a longitudinal and
The movement of telemedicine from desktop platforms to wireless and mobile configurations may have a significant impact on future health care. This paper reviews some of the latest technologies in wireless communication and their application in health care. The new technologies can make the remote medical monitoring, consulting, and health care more flexible and convenient. But, there are challenges for successful wireless telemedicine, which are addressed in this paper. PMID:14611692
Tachakra, Sapal; Wang, X H; Istepanian, Robert S H; Song, Y H
In order for telemedicine to realize the vision of anywhere, anytime access to care, it must address the question of how to create a fully interoperable infrastructure. This paper describes the reasons for pursuing interoperability, outlines operational requirements that any interoperability approach needs to consider, proposes an abstract architecture for meeting these needs, identifies candidate technologies that might be used for rendering this architecture, and suggests a path forward that the telemedicine community might follow.
Casemanagers are being asked to take on more and more tasks, but the caseloads haven't changed, resulting in tired casemanagers who aren't able to do the job adequately. Make sure the hospital administration understands what casemanagers do and the value they bring to the organization. Consider developing specialty positions or adding clerical staff to optimize skill sets for staff. Use hard data, not anecdotes, when you make your case to management. PMID:24218691
The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS). PMID:19767156
McCormick, Cynthia G; Henningfield, Jack E; Haddox, J David; Varughese, Sajan; Lindholm, Anders; Rosen, Susan; Wissel, Janne; Waxman, Deborah; Carter, Lawrence P; Seeger, Vickie; Johnson, Rolley E
Background The telemedicine services in Korea are expected to rapidly expand its use to the general population due to the development of digital networking, and its recent revision of related law and regulations. The purpose of this study was to investigate the knowledge and attitude of telemedicine in primary care patients. Methods We enrolled a total 243 participants, visited Family Medicine clinics and health promotion centers of university hospital in Seoul metrocity and Chungju city from April 1, 2010 to May 31, 2010. Data was collected by questionnaire, including demographic variables, knowledge and attitude of telemedicine. Results Among the total of 243 participants, 117 (49.8%) respondents were aware of telemedicine, and 178 (73.3%) respondents preferred telemedicine. The awareness showed differences according to the residence (P = 0.007), education (P = 0.03), and occupation (P = 0.02) of the respondents. The patient preference showed the differences at 50 years of age (P = 0.01) and in income of the participants (P = 0.005). Conclusion Awareness of telemedicine in primary care patients was low. As for the patients more than 50 years of age who will be having difficulty manipulating the instruments, more education is crucial. Establishment of appropriate plans to increase patient preference is needed, especially for patients with low-incomes. PMID:22745885
Jung, Sung-Gwon; Kim, Eun-Tae; Kim, Seun-Ah; Choi, Jae-Kyung; Cho, Dong-Yung
We examined the use of telemedicine at two major medical institutions in Ghana. Doctors and administrators were surveyed to assess their knowledge of computers and familiarity with telemedicine. The use of modern telecommunications and information technology products within the health service was also examined. Thirty questionnaires were distributed to staff at the two hospitals, one urban and one rural. Twenty were returned (a response rate of 67%). Although most of the respondents were computer literate, they were less familiar with telemedicine applications. Only a minority of the respondents were participating in an information-sharing network, transmitting information by fax or telephone, or had Internet access. Financial constraint appeared to be the major barrier to establishing information-sharing networks. Other constraints were technological and organizational. The respondents expressed an interest in using telemedicine, having access to health-care databases and specific telemedicine applications such as tele-education and videoconferencing. Staff in the urban hospital were more likely to be familiar with telemedicine and more likely to have access to information technology than those in the rural hospital. PMID:10912338
Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks. PMID:24287864
MBA Supply Chain Case Competition Center for Supply Chain Management February 1, 2013 1:00 Â 4:00 p their skills in analyzing a real-world supply chain managementcase. Provide a chance for sponsoring companies of the Rutgers Center for Supply Chain Management to get to know top talent from RBS. The Schedule The case
The application and form of electronically stored medical knowledge has a direct impact on the design of any healthcare delivery system. For those who plan for remote medical care or who work at the disaster relief level, there are specific requirements which will dictate the type of knowledge required and the vehicle best suited to deliver that information. The PC based multimedia biomedical library developed for NASA was originally intended for long-term space missions where complete isolation from each support was a distinct possibility. The library is a combination of traditional references and secondary databases structured within a primary care physician's workstation. The integration of the library and a point-of-care system allows optimal use of both resources and provides a basic building block for telemedicine networking. PMID:7602248
Grams, R; Morgan, G; Yu, F S; Zhang, D; Zhang, G J; Iddings, E; Fiorentino, R; Broughton, H
This is a retrospective study about the treatment of spontaneous muscle haematomas (SMH) that are an uncommon disease that occurs especially in elderly patients with acquired coagulopathy. We report the management of 10 cases admitted to our Emergency Surgical Unit (ESU) between March 2011 and October 2012. For this analysis we have considered some parameters such as age, drug history, current symptoms, location of the haematoma, cause, and imaging examination. Our attention focused on: clinical presentation, differential diagnosis, diagnostic imaging techniques and treatments. PMID:25147761
Objective Practice Based Collaborative Care is a complex evidence-based practice that is difficult to implement in smaller primary care practices lacking on-site mental health staff. Telemedicine Based Collaborative Care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multi-site randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients randomized to Practice Based versus Telemedicine Based Collaborative Care. Method From 2007–2009, patients at Federally Qualified Health Centers serving medically underserved populations were screened for depression, and 364 patients screening positive were enrolled and followed for 18 months. Those randomized to Practice Based Collaborative Care received evidence-based care from an on-site primary care provider and nurse care manager. Those randomized to Telemedicine Based Collaborative Care received evidence-based care from an on-site primary care provider and off-site telephone nurse care manager, telephone pharmacist, tele-psychologist and tele-psychiatrist. The primary clinical outcomes were treatment response, remission and changes in depression severity Results There were significant group main effects for both response (OR=7.74, CI95=3.94–15.20, p<0.0001) and remission (OR=12.69, CI95=4.81–33.46, p<0.0001) and a significant overall group by time interaction effect for Hopkins Symptom Checklist depression severity (?23=40.51, p<0.0001) with greater reductions in depression severity observed over time for those randomized to Telemedicine Based Collaborative Care. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence-base in the Telemedicine Based group. Conclusions Contracting with an off-site Telemedicine Based Collaborative Care team yields better outcomes than implementing Practice Based Collaborative Care with locally available staff. PMID:23429924
Fortney, John C.; Pyne, Jeffrey M.; Mouden, Sip B.; Mittal, Dinesh; Hudson, Teresa J.; Schroeder, Gary W.; Williams, David K.; Bynum, Carol A.; Mattox, Rhonda; Rost, Kathryn M
Presents a series of analyses of a case involving implementing a new voice-mail system, noting a newly appointed manager's failure to obtain feedback about the planned transition and evaluate user needs; successful introduction of any new technology is variable and suggests a degree of incrementalism; and four major issues arising in similar cases…
Fin, T. Andrew; Rogers, Priscilla S.; Taylor, James R.
Rural areas in developing countries are characterized by lack of resources, low population density, and scarcity of communications infrastructure. These circumstances make it difficult to provide appropriate health-care services. This paper explains research results achieved by Enlace Hispano Americano de Salud – Hispano American Health Link (EHAS) and how they have contributed to improve healthcare in isolated areas of developing countries through the use of information and communication technologies (ICT). As the first step, EHAS always collaborates with public health systems to identify its communication and information needs. Based on the analysis of needs, EHAS does research on appropriate technologies to provide communication in each context and on information systems suited to needs of health personnel. In parallel, EHAS has worked to provide applications that, making use of the communications services installed, could improve the health-care services in these remote areas. In this line, solutions to improve epidemiological surveillance or to provide telemedicine services (like a digital stethoscope or a tele-microscopy system) have been developed. EHAS has also performed several researches trying to ensure the sustainability of their solutions and has summarized them in a Management Framework for Sustainable e-Healthcare Provision. Finally, the effort to spread acquired knowledge has crystallized in a book that details all the technologies and procedures previously mentioned. PMID:25360436
Rural areas in developing countries are characterized by lack of resources, low population density, and scarcity of communications infrastructure. These circumstances make it difficult to provide appropriate health-care services. This paper explains research results achieved by Enlace Hispano Americano de Salud - Hispano American Health Link (EHAS) and how they have contributed to improve healthcare in isolated areas of developing countries through the use of information and communication technologies (ICT). As the first step, EHAS always collaborates with public health systems to identify its communication and information needs. Based on the analysis of needs, EHAS does research on appropriate technologies to provide communication in each context and on information systems suited to needs of health personnel. In parallel, EHAS has worked to provide applications that, making use of the communications services installed, could improve the health-care services in these remote areas. In this line, solutions to improve epidemiological surveillance or to provide telemedicine services (like a digital stethoscope or a tele-microscopy system) have been developed. EHAS has also performed several researches trying to ensure the sustainability of their solutions and has summarized them in a Management Framework for Sustainable e-Healthcare Provision. Finally, the effort to spread acquired knowledge has crystallized in a book that details all the technologies and procedures previously mentioned. PMID:25360436
Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine. PMID:24267440
Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ?100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies. PMID:22349318
Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R
Space medicine passed a long way of search for informative methods of medical data collection and analysis and worked out a complex of effective means of countermeasures and medical support. These methods and means aimed at optimization of the habitation conditions and professional activity of space crews enabled space medicine specialists to create a background for the consecutive prolongation of manned space flights and providing their safety and effectiveness. To define support systems perspectives we should consider those projects on which bases the systems are implemented. According to the set opinion manned spaceflights programs will develop in two main directions. The first one is connected with the near space exploration, first of all with the growing interest in scientific-applied and in prospect industrial employment of large size orbit manned complexes, further development of transport systems and in long-run prospect - reclamation of Lunar surface. The second direction is connected with the perspectives of interplanetary missions. There's no doubt that the priority project of the near-earth space exploration in the coming decenaries will be building up of the International Space Station. This trend characteristics prove the necessity to provide crews whose members may differ in health with individual approach to the schedule of work, rest, nutrition and training, to the medical control and therapeutic-prophylactic procedures. In these conditions the importance of remote monitoring and distance support of crew members activities by the earth- based medical control services will increase. The response efficiency in such cases can only be maintained by means of advanced telemedicine systems. The international character of the International Space Station (ISS) gives a special importance to the current activities on integrating medical support systems of the participating countries. Creation of such a system will allow to coordinate international research projects on space biology and medicine at the modern high level. In spite of the ISS international cooperation transparency space research programs require to follow the biomedicine ethics and provide confidentiality of the special medical information exchange. That can be achieved in the telemedicine support system built on the network principle. Presently we have all technical facilities needed to create such a system. In Russia activities on space telemedicicine support improvement are carried out by the State Scientific Center of the Russian Federation - Institute for Biomedical Problems of the Russian Academy of Sciences, Mission Control Center of the Russian Aviation and Space Agency, Space Biomedical Center for Training and Research and Yu. Gagarin Cosmonaut Training Center. Communications development and next generation Internet systems creation almost eliminate differences in the types of information technologies implementation both in the earth-based and near-earth space conditions. In prospect of the information community creation the telecommunication system of the near-earth space objects and its telemedicine element will become a natural part of the Earth unified information field that will open unlimited perspectives for flight support system improvement and space biomedical research conducting. Russia has unique data of numerous investigations on simulation of long, up to a year, effects of space flight factors on the human body. The sphere of situations studied by space medicine specialists embraced orbit manned space flights of the escalating duration (438 days in 1995). However a number of biomedical problems related to space flights didn't face optimal solutions. It's evident that during a space flight to Mars biomedical problems will be much more difficult in comparison with those of the orbit flights of the same duration. The summed up factors of such flights specify a level of the total medical risk that require assessment and application of effective means lowering the risk level. The characteristics of the interplanetary flights projects
The healthcare industry is only beginning to understand e-health. E-health can be defined as the use of technology to directly improve healthcare delivery-affording patients the opportunity to participate in their own healthcare management, provider, and institution. The market is changing rapidly, and innovations, partnerships, and mergers are taking place daily. For healthcare institutions, setting a long-term, yet adaptable e-health strategy is of vital importance for the continued success of the organization. For clinicians, an understanding of and familiarity with technologies can significantly improve workflow, organization, and patient interaction. For the patient, technology can be leveraged as a means to take initiative and responsibility for his/her own health. This article defines e-health and explains the implications and benefits of e-health to nurses and their patients. The article also identifies unique opportunities e-health/e-commerce can provide casemanagers in promoting patient connectivity, care management, and economy in cost of care. PMID:16397993
Background Intensive CaseManagement (ICM) is a community based package of care, aiming to provide long term care for severely mentally ill people who do not require immediate admission. ICM evolved from two original community models of care, Assertive Community Treatment (ACT) and CaseManagement (CM), where ICM emphasises the importance of small caseload (less than 20) and high intensity input. Objectives To assess the effects of Intensive CaseManagement (caseload <20) in comparison with non-Intensive CaseManagement (caseload > 20) and with standard community care in people with severe mental illness. To evaluate whether the effect of ICM on hospitalisation depends on its fidelity to the ACT model and on the setting. Search methods For the current update of this review we searched the Cochrane Schizophrenia Group Trials Register (February 2009), which is compiled by systematic searches of major databases, hand searches and conference proceedings. Selection criteria All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community-care setting, where Intensive CaseManagement, non-Intensive CaseManagement or standard care were compared. Outcomes such as service use, adverse effects, global state, social functioning, mental state, behaviour, quality of life, satisfaction and costs were sought. Data collection and analysis We extracted data independently. For binary outcomes we calculated relative risk (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% confidence interval (CI). We employed a random-effects model for analyses. We performed a random-effects meta-regression analysis to examine the association of the intervention’s fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. Main results We included 38 trials (7328 participants) in this review. The trials provided data for two comparisons: 1. ICM versus standard care, 2. ICM versus non-ICM. 1. ICM versus standard care Twenty-four trials provided data on length of hospitalisation, and results favoured Intensive CaseManagement (n=3595, 24 RCTs, MD ?0.86 CI ?1.37 to ?0.34). There was a high level of heterogeneity, but this significance still remained when the outlier studies were excluded from the analysis (n=3143, 20 RCTs, MD ?0.62 CI ?1.00 to ?0.23). Nine studies found participants in the ICM group were less likely to be lost to psychiatric services (n=1633, 9 RCTs, RR 0.43 CI 0.30 to 0.61, I2=49%, p=0.05). One global state scale did show an Improvement in global state for those receiving ICM, the GAF scale (n=818, 5 RCTs, MD 3.41 CI 1.66 to 5.16). Results for mental state as measured through various rating scales, however, were equivocal, with no compelling evidence that ICM was really any better than standard care in improving mental state. No differences in mortality between ICM and standard care groups occurred, either due to ’all causes’ (n=1456, 9 RCTs, RR 0.84 CI 0.48 to 1.47) or to ’suicide’ (n=1456, 9 RCTs, RR 0.68 CI 0.31 to 1.51). Social functioning results varied, no differences were found in terms of contact with the legal system and with employment status, whereas significant improvement in accommodation status was found, as was the incidence of not living independently, which was lower in the ICM group (n=1185, 4 RCTs, RR 0.65 CI 0.49 to 0.88). Quality of life data found no significant difference between groups, but data were weak. CSQ scores showed a greater participant satisfaction in the ICM group (n=423, 2 RCTs, MD 3.23 CI 2.31 to 4.14). 2. ICM versus non-ICM The included studies failed to show a significant advantage of ICM in reducing the average length of hospitalisation (n=2220, 21 RCTs, MD ?0.08 CI ?0.37 to 0.21). They did find ICM to be more advantageous than non-ICM in reducing rate of lost to follo
Dieterich, Marina; Irving, Claire B; Park, Bert; Marshall, Max
1 TELEMEDICINE IN PRACTICE From operating theatre to operating studio Â visualising surgery in the age of telemedicine Margunn Aanestad1 , Jan Sigurd RÃ¸tnes1 , BjÃ¸rn Edwin1 and Trond Buanes2 1 a telemedicine project between two of Norway's largest hospitals (Rikshospitalet and Ullevaal hospital
Telemedicine using VoIP combined with a Store and Forward Approach M Chetty, W Tucker, Prof E Blake developed a telemedicine application for a rural village in the Eastern Cape. This paper describes how weIP) combined with a store and forward approach to achieve our telemedicine goals. We present an overview
Mobile Telemedicine Sensor Networks with Low-Energy Data Query and Network Lifetime Considerations admission control scheme in terms of meeting the multimedia telemedicine QoS requirements. Index Terms-- Mobile telemedicine, ad hoc networks, sensor networks, 3G wireless cellular networks. Ã¦ 1 INTRODUCTION
Models to Extend the Scope of Usability Testing for Telemedicine Systems [Extended Abstract.Stevens@ed.ac.uk ABSTRACT Some of the changes brought about by the introduction of telemedicine into healthcare organisations can be partly ad- dressed by a better consideration of usability in telemedicine system design
Quality of Service consideration for the wireless telemedicine and e-health services PhD Anna the application of IEEE 802.11 wireless standard to QoS (Quality of Service) support within wireless e-health/telemedicine-health technologies and wireless telemedicine systems are presented and some open research problems are identified
Survey of Current Efforts and Potentials in Application of Telemedicine in Ethiopia Fikreyohannes. Telemedicine Â delivery of health services through the use of ICT Â that has met wide success in alleviating. To study the past and current effort on the application of telemedicine in Ethiopia, a survey of government
Telemedicine and Dialysis Pierre-Yves Durand*, Jacques Chanliau*, Agnes Mariot*, MichÃ¨le Kessler in the literature presents only marginal experiences concerning telemedicine in regards to peritoneal dialysis (PD. This article presents a new and innovative application of telemedicine in the field of PD and describes its
The Role of Outcome Mapping in Developing a Rural Telemedicine System William D. TUCKER1 , Edwin H@cs.uct.ac.za Abstract: We describe the use of Outcome Mapping to guide the design of a rural telemedicine consultation Technology for Development project. Keywords: ICT design methodology, telemedicine, telehealth, Outcome
Telemedicine, the use of advanced communication technologies in the health care context, has a rich history and a clear evolutionary course. In this paper, the authors identify telemedicine as operationally defined, the services and technologies it comprises, the direction telemedicine has taken, along with its increased acceptance in the health care communities. The authors also describe some of the key
As a casemanager or casemanagement leader, it is important for you to stay in touch with how CMS continues to roll out the two-midnight rules as well as the manner of auditing on a go-forward basis. It is also important that your department continue to have a close working relationship with the billing department in your hospital to ensure that the hospital remains compliant with this new rule. Finally, it is also critical that your emergency department and its physicians are kept up to date on the rule and its implications for hospital admissions. Having a casemanagement presence in the emergency department will help to ensure a sound review process at this important route of entry to the hospital. A working team should be created to review the cases that fall outside of the rule, and these cases should also be presented to the utilization review committee so that the hospital can continue to learn and move forward. Finally, listen to the CMS National Provider Calls (www.cms. gov/NPC) to gain additional and updated information as it becomes available! For additional information on the two-midnight rule go to www.cms.gov and search for CMS-1599-F. PMID:24697139
Background: The objectives of this paper are to (i) provide an overview of the educational and clinical experiences of the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network, (ii) analyze key challenges and lessons learnt throughout a decade of activity, and (iii) draw a vision and perspectives of its sustainability. Methods: The study was carried out following three main stages: (i) a literature review, (ii) the analysis of key documents, and (iii) discussions with key collaborators of the RAFT. Results: Réseau en Afrique Francophone pour la Télémédecine has been offering an important quantity of educational, clinical, and public health activities during the last decade. The educational activities include the weekly delivery of video-lectures for continuing and post-graduate medical education, the use of virtual patients for training in clinical decision making, research training activities using ICTs and other e-learning activities. The clinical and public health activities include tele-expertise to support health professionals in the management of difficult clinical cases, the implementation of clinical information systems in African hospitals, the deployment of mHealth projects, etc. Since 2010, the RAFT has been extended to the Altiplano in Bolivia and Nepal (in progress). Lessons Learnt and Perspectives: Important lessons have been learnt from the accumulated experiences throughout these years. These lessons concern: social and organization, human resources, technologies and data security, policy and legislation, and economy and financing. Also, given the increase of the activities and the integration of eHealth and telemedicine in the health system of most of the countries, the RAFT network faces many other challenges and perspectives such as learning throughout life, recognition, and valorization of teaching or learning activities, the impact evaluation of interventions, and the scaling up and transferability out of Africa of RAFT activities. Based on the RAFT experience, effective integration and optimum use of eHealth and telemedicine in low- and middle-income countries (LMICs) health systems should take into account the context (resources, infrastructure, and funding), the needs of key stakeholders, and the results derived from theoretical and practical experience. The relevant items highlighted to illustrate the sustainability of the RAFT network and the analyses performed in this study, should serve as discussion basis for the development of eHealth and telemedicine in LMICs. PMID:25340048
Bediang, Georges; Perrin, Caroline; Ruiz de Castaneda, Rafael; Kamga, Yannick; Sawadogo, Alexandre; Bagayoko, Cheick Oumar; Geissbuhler, Antoine
Delphi and focus group methods were used to identify nurse casemanagers' (NCMs') opinions regarding their professional role. This study convened 15 NCMs from a regional medical center in the southeastern United States. Findings present the highest-rated items influencing the NCM role, as well as a definition and model depicting the role's essential elements. In study questionnaires, participants were asked to identify and subsequently rate items in seven categories. The overall highest-rated item was the personal attribute of critical thinking and prioritizing. The second highest-rated response was the critical function of coordinating a multidisciplinary plan of care. Interdisciplinary support and participative decision making were consistently ranked as important organizational factors. In the category of impact on health care outcomes, identifying patient needs and services was highly rated. Participants suggested that NCM assignments should be based on clinical knowledge and expertise, with a focus on prevention. Practice implications, based on the findings, are emphasized. PMID:9934114
Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth. PMID:11321704
These 15 case studies developed by faculty at institutions in Bangladesh are appropriate for use in a course in management development. The typical case describes a real business situation in which a real manager had to reach a decision. The case gives quantitative and qualitative information that is, or may be, relevant to that decision.…
Médecins Sans Frontières (MSF) began a pilot trial of store-and-forward telemedicine in 2010, initially operating separate networks in English, French, and Spanish; these were merged into a single, multilingual platform in 2013. We reviewed the pattern of teleradiology usage on the MSF telemedicine platform in the 4-year period from April 2010. In total, 564 teleradiology cases were submitted from 22 different countries. A total of 1114 files were uploaded with the 564 cases, the majority being of type JPEG (n?=?1081, 97%). The median file size was 938?kb (interquartile range, IQR 163–1659). A panel of 14 radiologists was available to report cases, but most (90%) were reported by only 4 radiologists. The median radiologist response time was 6.1?h (IQR 3.0–20). A user satisfaction survey was sent to 29 users in the last 6?months of the study. There was a 28% response rate. Most respondents found the radiologist’s advice helpful and all of them stated that the advice assisted in clarification of a diagnosis. Although some MSF sites made substantial use of the system for teleradiology, there is considerable potential for expansion. More promotion of telemedicine may be needed at different levels of the organization to increase engagement of staff. PMID:25389524
Halton, Jarred; Kosack, Cara; Spijker, Saskia; Joekes, Elizabeth; Andronikou, Savvas; Chetcuti, Karen; Brant, William E.; Bonnardot, Laurent; Wootton, Richard
In France, we count 1,400,000 hand injuries per year. Only 20% are taken care by hand surgeons. In these 20% many of injuries can be healed by non specific centres. Among the 80% remaining injuries, many of complex injuries should be taken care by specialised centres. It is advisable to get a specialised point of view despite the distance. The purpose of this work is to study the feasibility of telediagnosis in hand emergencies. The material contained a computer, a camera and a website which access needed a password. The physician in emergency room built up the e-medical file which can be referred by the expert to give his mind. The agreement of the patients was sought and all the data were unnamed. One hundred and twenty-nine e-medical files were created from a local general hospital. Sixty-six patients had wound injuries and 63 osteo-articular injuries. Sex-ratio was 3.8 and age average was 33 years old. Four hundred and sixty pictures and four movies were stored. The average of duration of tele-expert response was 7 h. Our results underline the great part which can be played by telemedicine in hand emergencies orientations. PMID:19195760
Abou Al Tout, Y; Taleb, C; Kosayer, M; Liverneaux, P
During the course of recent years the frequency and magnitude of major disasters - of natural, technological, or ecological origin - have made the world community dramatically aware of the immense losses of human life and economic resources that are caused regularly by such calamities. Particularly hard hit are developing countries, for whom the magnitude of disasters frequently outstrips the ability of the society to cope with them. In many cases this situation can be prevented, and the recent trend in disaster management has been to emphasize the importance of preparedness and mitigation as a means of prevention. In cases of disaster, a system is needed to respond to relief requirements, particularly the delivery of medical care. There is no generic telecommunications infrastructure appropriate for the variety of applications in medical care and disaster management. The need to integrate telemedicine/telehealth into shared regional disaster management telecommunications networks is discussed. Focus is on the development of infrastructure designed to serve the needs of disaster prone regions of the developing world.
Telemedicine in India is spearheaded by the Indian Space Research Organization (ISRO) and has matured beyond technology demonstration to enter an operational phase in its history. This article attempts to bring out the evolution and development of telemedicine in India: the genesis, the approach followed, the stakeholders involved, and the results so far, with an outline for the future. ISRO has coupled its prowess in satellite communication technology with medical science and information technology to project specialty healthcare to the doorsteps of the rural, remote, and distant populace across the country. Having set the telemedicine program as a model for benefiting society with advances in modern technology, India is advancing to international dimensions the proven domestic program to people in other parts of the globe. More specifically, the article attempts to bring out the role played by ISRO, its vision, goals, and partners in the program along with the technology and observed impact. PMID:19659415
Bhaskaranarayana, A; Satyamurthy, L S; Remilla, Murthy L N
In this article, the authors report the methods for obtaining subsidies for overseas telemedicine projects from Japanese sources based on their own personal experiences. The Japanese Government is already subsidizing such specialized NGOs (Non-Governmental Organizations) as the Telemedicine Society of Japan and Basic Human Needs and, Japanese trading companies are also hiring telemedicine experts. Prospective methods for obtaining subsidies are outlined as under the following headings: Assistance without compensation, Technology transfer, Grass-roots grant assistance, the Telecommunications Advancement Organization, Postal Savings for International Voluntary Aid, Venture business development funds provided by the Ministry of International Trade and Industry, Mission demonstration satellites by the National Space Development Agency of Japan, the Sasakawa Pacific Island Nations Fund, and International Communications Foundation. Key points of the applications are noted under (1) Degree of contribution to local residents, (2) Significance of project continuation and (3) Novelty and economic impact. PMID:10733158
Nakajima, I; Tsurumi, T; Sawada, Y; Juzoji, H; Ogushi, Y
Application of Management Frameworks: A Case Study on Managing Workflow related Systems Srinath management of a system involves much more complexities than just closing the control loop by implementing management usecase for managing workflow related systems using Hasthi, a ro- bust, scalable, and distributed
It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…
Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.
In order to determine whether a super high definition (SHD) image running at a series of 2048 resolution x 2048 line x 60 frame/sec was capable of telemedicine, we established a filing system for medical images and two experiments for transmission of high quality images were performed. All images of various types, produced from one case of ischemic heart disease were digitized and registered into the filing system. Images consisted of plain chest x-ray, electrocardiogram, ultrasound cardiogram, cardiac scintigram, coronary angiogram, left ventriculogram and so on. All images were animated and totaled a number of 243. We prepared a graphic user interface (GUI) for image retrieval based on the medical events and modalities. Twenty one cardiac specialists evaluated quality of the SHD images to be somewhat poor compared to the original pictures but sufficient for making diagnoses, and effective as a tool for teaching and case study purposes. The system capability of simultaneously displaying several animated images was especially deemed effective in grasping comprehension of diagnosis. Efficient input methods and creating capacity of filing all produced images are future issue. Using B-ISDN network, the SHD file was prefetched to the servers at Kyoto University Hospital and BBCC (Bradband ISDN Business chance & Culture Creation) laboratory as an telemedicine experiment. Simultaneous video conference system, the control of image retrieval and pointing function made the teleconference successful in terms of high quality of medical images, quick response time and interactive data exchange. PMID:10384469
Takeda, H; Matsumura, Y; Okada, T; Kuwata, S; Komori, M; Takahashi, T; Minatom, K; Hashimoto, T; Wada, M; Fujio, Y
High increases in media advertising costs have caused a shift away from generic advertising to other promotional activities. A relatively new retail-level promotional activity is the Dairy CaseManagement Program aimed at improving the management, appearance, and operation of the dairy case. An evaluation of the Northwestern Hudson Valley Market program demonstrated increases in sales volume for both supermarkets\\/mass merchants
Purpose: The purpose of this study was to determine the impact on resource use of providing casemanagers with information on the potential for patients to benefit from home care services. Design and Methods: Twenty-four casemanagers working in the Arizona Long Term Care System (ALTCS) were randomized into treatment and control groups. Members of…
Weissert, William G.; Hirth, Richard A.; Chernew, Michael E.; Diwan, Sadhna; Kim, Jinkyung
Examines the nature of management training in Poland, which has been largely technical and production oriented with little emphasis on strategic or behavioural aspects. Presents case studies of two companies in Poland which are typical of management development in general. Concludes that although there is a need for more professional and entrepreneurial managers at all levels, the economic, political and
Power management has traditionally focused on portable and handheld devices. This paper breaks with tradition and presents a case for managing power con- sumption in web servers. Web servers experience large periods of low utiliza- tion, presenting an opportunity for using power management to reduce energy consumption with minimal performance impact. We measured the energy con- sumption of a \\
Pat Bohrer; Elmootazbellah N. Elnozahy; Tom Keller; Michael Kistler; Charles Lefurgy; Chandler McDowell; Ram Rajamony
What makes a knowledge management system work: a case study Thomas Martine Tech-CICO, University why a knowledge management system, if conceived strictly from the point of view of organizational, an engineer, a product, a procedure) . Doing knowledge management, then, consists in identifying
A Knowledge Management Framework to Morph Clinical Cases with Clinical Practice Guidelines Fehmida University, Halifax, Nova Scotia, Canada Abstract In this paper we present a knowledge management framework to automate the captured knowledge through knowledge management systems. We note with interest
the general goals of the City of Orlando Urban Stormwater Management Manual (OUSWMM). CDM, workingA-1 Appendix Innovative Stormwater Management in New Development: Planning Case Study1 Brian W International Airport as shown in Figure A-1. Outlined in the Growth Management Plan Southeast Annexation Study
Groundwater Management Tools: Analytical Procedure and Case Studies MAF Technical Paper No: 2003 and Forestry #12;i Contents Page Executive Summary v Introduction 1 Section A Â Groundwater Management: Best Practice Guideline 2 1. The Management Objective 2 2. Concepts of Sustainable Yield 2 2.1. A Misconception
This report represents a summary of the International Virtual e- Hospital's effort in coordinating and conducting the Third Intensive Balkan Telemedicine and e-Health Seminar on February 6-7, 2009 in Skopje, Macedonia. The seminar, which was cosponsored b...
Presents a new method for obtaining blood pressure readings noninvasively with telemedicine application. Through the pulse transit time technique, the systolic, diastolic, and mean blood pressures can be predicted using the time interval between the electrocardiogram (ECG) and photoplethysmography (PPG). The data can then be relayed to the Internet for analysis and viewing. The wireless application protocol (WAP) is used
According to a survey by Indian Council of Medical Research, an abysmally low number of people living in rural India have access to specialist care and advice. The telemedicine grid aims to fill up this gap by integrating multiple hospitals to form a large-scale enterprise collaboration to deliver services to all those areas which lack specialist care. We present a
This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into 'info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician-patient relationships and against complacency regarding the risks and responsibilities - many of which are as yet unknown - that distant medical intervention, consultation and diagnosis carry. PMID:10886483
As the planning document for establishing a statewide health communications system initially servicing the Papago, San Carlos and White Mountain Apache, Navajo, and Hopi reservations, this document prescribes the communications services to be provided by the Arizona TeleMedicine Network. Specifications include: (1) communications services for each…
Intensive care unit telemedicine involves nurses and physicians located at a remote command center providing care to patients in multiple, scattered intensive care units via computer and telecommuni- cation technology. The command center is equipped with a workstation that has multiple monitors dis- playing real-time patient vital signs, a complete elec- tronic medical record, a clinical decision support tool, a
Joseph Cummings; Cathleen Krsek; SM Karl Matuszewski
Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems. PMID:10311923
The Sun Network Software Environment (NSE) is a network-based object manager for software development. The NSE supports parallel development through an optimistic concurrency control mechanism, in which developers do not acquire locks before modifying objects. Instead, developers copy objects, modify the copies, and merge the modified objects with the originals. Objects managed by the NSE are typed, and the set
Theatre provides a unique set of conditions for the management of emotions. Drawing on participant observation from one repertory theater, three university productions, and interviews with stage actors, directors, and acting instructors, I conceptualize actors as privileged emotion managers. Actors access structural resources that enable their…
In a graduate course on the Public Management of Science each student undertook to prepare a descriptive monograph on the management of science in a Federal agency. The objective was to provide a self-learning experience and a useful exchange of findings ...
D, 1997) and 00-56 (MoD, 1996)). A safety case concerned with the avionics of a complex military aircraftManaging Complex Safety Cases T P Kelly Department of Computer Science University of York, York, YO10 5DD, UK. email@example.com Abstract Safety case reports are often complex documents
Abstract The Agency for Healthcare Research and Quality sponsored two telemedicine research reviews. The latest review concluded that telemedicine is most relevant to specialties, such as psychiatry and neurology, where high levels of patient interaction are crucial to assessment. Telemedicine research studies cited in the reviews having positive findings in the specialties of ophthalmology, otolaryngology, obstetrics and gynecology, gastroenterology, and cardiology and more recent research in these areas are reviewed to identify criteria other than degree of interaction for determining the appropriateness of telemedicine interventions. These criteria include congruity or the extent that procedures used in telemedicine are similar to those of in-person examination, fidelity or the degree to which the information used for assessment in remote examinations is of similar quality to that used in-person, and reliability or the consistency with which information can be gathered and transmitted. PMID:23186085
Building on redesign efforts that created casemanagement, clinical care technicians, support service hosts, and pharmacy technician roles, this redesign focused on integrating casemanagement, utilization management, and discharge planning functions into a new outcomes manager role. The authors describe the process of developing and implementing the new role and outline specific actions that eliminated redundancy and inefficiency. Results of the evaluation of the project are reviewed, including full-time equivalent and salary savings and employee and physician satisfaction improvements. PMID:9031661
This paper gives an overview of core factors mitigating effective transfer of TeleMedicine to Sub-Saharan Africa (SSA) as a capability for improving the extremely poor state of healthcare delivery systems in that region of the world. Using specific examples of TeleMedicine applications, such as in TeleRadiology and health education, the paper highlights the importance of TeleMedicine in SSA. It then presents the salient factors that influence TeleMedicine technology transfer in the form of a conceptual framework. In explaining the framework, the paper offers opinions and supportive arguments on the importance and significance of the identified factors in effective TeleMedicine "uptake" within the SSA. We believe the framework provides a grounded theoretical basis that information and communications technologies (ICT) or technology transfer researchers can use for empirical investigation in order to understand the efficacy of TeleMedicine adoption within developing countries at large. PMID:19273036
Meso, Peter; Mbarika, Victor W A; Sood, Sanjay Prakash
The purpose of this study was to examine comprehensive prenatal casemanagement programs in terms of organizational, program, and process characteristics. Data from 66 program surveys of government agencies were used. Organizational capacity was measured as extent of organizational change and extent of interagency agreements. Program data included age and size of the program, reasons for having casemanagement, and funding diversity. Process data were eight types of interventions. The most highly rated reason for having casemanagement was to improve client outcomes. The greatest organizational change was in the area of the organizational structure, followed by financial status and types of services provided. Contracts with other agencies were rare. Agencies with more interagency contacts reported higher levels of change in the casemanagement department and turnover among mid-level managers. Older programs had fewer employees. Approximately 49% of client contacts were not billed to Medicaid. Larger programs had significantly less time allocated to emotional support and coaching. Data on organizational characteristics, program, and process variables provide insights into comprehensive casemanagement. Relationships among these variables underscore the importance of studying client outcomes within the context of program and organizational idiosyncrasies. Future studies of comprehensive prenatal casemanagement should focus on cross-level questions. PMID:12930459
Case Based Reasoning (CBR) is an intelligent systems methodology that enables information managers to increase efficiency and reduce cost by substantially automating processes (i.e., diagnosis, scheduling, or design). By identifying and ranking the relevance between a new case and previously encountered cases (i.e., stored in the case base), CBR systems can capture and share all of an organizationÕs related knowledge
An overview of the work related injury and illness casemanagement model developed at the Johnson Space Center was presented. The major accomplishments and the challenges of implementation were discussed.
The search for means to contain rising health care costs has increasingly focused on the physician's key role in resource consumption decisions. A particularly explicit example of this is the new wave of interest in public and non-public programs which designate a primary care physician to be a 'physician casemanager'. This title seems to reflect an attempt to assign and impute to the physician functions and responsibilities significantly beyond traditional clinical duties. This paper explores the multiple functions of the physician to develop a behavioral model of the physician casemanager. This model is employed to identify a series of practice style orientations (PSOs) which represent differing emphases given to the core functions physicians are required to perform. Strong physician casemanagement is characterized as those PSOs in which the rationer/resource allocator function is emphasized. The paper concludes by suggesting what types of external pressures and incentives may be useful in fostering strong casemanagement. PMID:3749966
Blake is sick. With his background in the sciences and a little help from the Internet, he should be able to do a self-diagnosis. Or can he? As this case study unfolds, we follow the course of Blake’s illness and the eventual diagnosis of his disorder. The case works well as an interrupted case that can be assigned to individual students or student teams. It was written for a School of Pharmacy microbiology course, but could easily be used in a medical microbiology or infectious diseases course.
In this paper we describe a new approach to the construction of data management systems for genomic mapping applications in molecular biology, genetics, and plant breeding. We discuss the architecture of such systems and propose an incremental approach to the development of such systems. We illustrate the proposed approach and architecture with a case study of a prototype data management system for genomic maps.
Markowitz, V.M.; Lewis, S.; McCarthy, J.; Olken, F.; Zorn, M.
Focuses on how behaviour changes in an organization should be evaluated following management development. Describes the evaluation strategy, the rationale for this, and problems associated with such a strategy, following a team-building programme of integrated modules in a community-based unit of a district health authority.
For some years now, organizations and countries have been concerned with waste management. This has resulted in laws that held producers responsible for the recovery of the products that they produce when these reach the end of their lifetime. Although the existing legislation does not include all types of wastes, some producers have been making efforts in adapting the supply
V. H. Machado; A. P. Barroso; C. S. Santos; V. Cruz Machado
Construction and demolition activities generate a large portion of the total solid waste stream in the United States and have a significant impact on the environment. To reduce this environmental impact, some contractors have implemented construction waste management plans on their projects in order to divert construction and demolition debris from landfill disposal. Yet there are still many contractors who
The world of a casemanager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned casemanager, organizing your workload can always help smooth out the rough edges in anyone's hectic day! PMID:25065103
...What are the requirements for casing pressure management? 250.518 Section...Well-Completion Operations Casing Pressure Management § 250.518 What are the requirements for casing pressure management? Once you install...
...What are the requirements for casing pressure management? 250.518 Section...Well-Completion Operations Casing Pressure Management § 250.518 What are the requirements for casing pressure management? Once you install...
Over the last decade various international Information and Communications Technology networks have been created for a global access to high-level medical care. OP 2000 has designed and validated the high-end interactive video communication system WinVicos especially for telemedical applications, training of the physician in a distributed environment, teleconsultation and second opinion. WinVicos is operated on a workstation (WoTeSa) using standard hardware components and offers a superior image quality at a moderate transmission bandwidth of up to 2 Mbps. WoTeSa / WinVicos have been applied for IP-based communication in different satellite-based telemedical networks. In the DELTASS-project a disaster scenario was analysed and an appropriate telecommunication system for effective rescue measures for the victims was set up and evaluated. In the MEDASHIP project an integrated system for telemedical services (teleconsultation, teleelectro-cardiography, telesonography) on board of cruise ships and ferries has been set up. EMISPHER offers an equal access for most of the countries of the Euro-Mediterranean area to on-line services for health care in the required quality of service. E-learning applications, real-time telemedicine and shared management of medical assistance have been realized. The innovative developments in ICT with the aim of realizing a ubiquitous access to medical resources for everyone at any time and anywhere (u-Health) bear the risk of creating and amplifying a digital divide in the world. Therefore we have analyzed how the objective needs of the heterogeneous partners can be joined with the result that there is a need for real integration of the various platforms and services. A virtual combination of applications serves as the basic idea for the Virtual Hospital. The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms. PMID:18305324
Graschew, Georgi; Roelofs, Theo A; Rakowsky, Stefan; Schlag, Peter M
Abstract-- Compression of biomedical signals is of great interest in telemedicine applications in telemedicine applications [1-4]. These studies were mainly focused on the applications of wavelet transforms
Telemedicine has had a positive impact on some aspects of patient care. However, existing telemedicine systems that use high-quality video are inflexible, requiring investment in fixed infrastructure. We have overcome a ...
The revolution in digital technology is rapidly changing the world of telecommunications. Its applications to Medicine, and in particular to Cardiology, offer enormous benefits since communication is an essential part of medical practice. The need to improve the management of medical information is critical because of the explosion of medical knowledge, and the need to provide comprehensive documentation on patient care. The availability of a network offers many possibilities for clinical, research and teaching activities. Relevant, up-to-date scientific information is instantly available for analysis and interaction. The authors review the issue of digital communications as well as its potential application to Telemedicine, and present their preliminary experience with digital analysis and storage of echocardiographic images. PMID:9138462
The authors have designed and developed a telemedicine-based service for the follow-up and monitoring of patients on oral anticoagulant therapy (OAT) that consists of two phases; the first involving self-testing and the second involving guided self-management. To evaluate the first phase of the protocol, a project was conducted with 108 patients, with a mean age of 72.7 years and a
Carlos Hernández Salvador; Antonio Ruiz-sanchez; M. A. González De Mingo; Montserrat Carmona Rodriguez; M. Pascual Carrasco; Pilar G. Sagredo; Juan A. Fragua; Fernando Caballero-martinez; Fernando Garcia-lopez; J. Marquez-Montes; Jose Luis Monteagudo
Successful implementation of telemedicine services depends on an adequate telecommunications infrastructure. At present the main infrastructure in Russia and the countries of the former Soviet Union consists of analogue telephone lines. These are sufficient for e-mail and access to the World Wide Web but do not provide sufficient bandwidth for the transmission of realtime teleconsultations. ISDN lines and fibre optic cables are becoming more widespread in the major cities but have yet to be installed in the regions. PMID:10534833
Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Casemanagers' interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver's management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed. PMID:25189535
Davis, Linda Lindsey; Chestnutt, Deborah; Molloy, Margory; Deshefy-Longhi, Tess; Shim, Bomin; Gilliss, Catherine L
The self-management of thoughts and mental images was used in a series of empirical case studies to influence behavior changes. The target behaviors in the cases reported were smoking, overeating, fingernail biting, thinking self-depreciative thoughts, and responding assertively. Self-monitoring, covert positive reinforcement, covert…
Lymphangiomas are lymphatic malformations commonly seen around the neck, axillary region and the mediastinum. Perirenal lymphangiomatosis is very rare with only a few cases being reported in literature. We present a case of symptomatic perirenal lymphangiomatosis in a female of childbearing age, managed laparoscopically by deroofing and marsupialization. PMID:23671373
Job Title Bilingual CaseManager Employer/ Agency VisionQuest Job Description VisionQuest, a behavioral organization working with at-risk teens and families is seeking a Case Manger for their Parenting factors with the family - working with advocates and/or other organizations to provide needed services
In this study, the author compared the effectiveness of two different strategic management course designs: one centered on case discussions and the other combining a computer-based simulation with some cases. In addition to evaluation of the research literature, the study involved experiments with six course sections composed of 130 students, Both…
The case shares the turn-around story in leveraging Knowledge Management (KM) at Enterprise Application Services (EAS), a major business unit (BU) in Wipro Technologies. The case depicts the approach taken in enrolling the employees onto the KM systems and practices. The turnaround was the result of a project that ran for 6 months, and the comparisons are drawn based on
Telemedicine systems are seen as a possible solution for the remote monitoring of physiological parameters and can be particularly useful for chronic patients treated at home. Implementing those systems however has always required spending a great effort on the underlying infrastructure instead of focusing on the application cores as perceived by their users. This paper proposes an abstract unifying infrastructure for telemedicine services which is loosely based on the multi-agent paradigm. It provides the capability of transferring to the clinic any remotely acquired information, and possibly sending back updates to the patient. The infrastructure is a layered one, with the bottom layer acting at the data level and implemented in terms of a software library targeting a wide set of hardware devices. On top of this infrastructure several services can be written shaping the functionality of the telemedicine application while at the highest level, adhering to a simple agent model, it is possible to reuse those functional components porting the application to different platforms. The infrastructure has been successfully used for implementing a telemonitoring service for a randomized controlled study aimed at testing the effectiveness of the artificial pancreas as a treatment within the AP@home project funded by the European Union. PMID:23415079
In order to support our ongoing research in watershed ecology and global climate change, we gather and analyze environmental data from several government agencies. This case study demonstrates a researcher’s approach to accessing, organizing, and using intersectoral data. T...
Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months. PMID:18797673
Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura
Treating injured workers can be a time-consuming task for the physician. These patients bring with them a host of issues and needs that influence their response to treatment. The physician must be aware of the numerous nonmedical issues that can influence the patient's recovery and ability to return to work. The physician is the key player in managing these patients and the physician's approach to the injured worker is paramount to the successful outcome of the treatment plan. Communication is the critical component in managing these patients. The physician must be willing to work cooperatively with the casemanager toward the goal of facilitating a safe return to work for the worker. The casemanager can function as an extension of the physician and can be of benefit to the physician and the worker during the recovery process. The needs of the injured worker, the provider, and the insurer all receive attention with the casemanagement approach. This approach can help minimize fragmentation of care and maximize the coordination and delivery of quality services. Injured workers are in need of physicians who are willing to provide quality care and who will be sensitive to their often complex needs. The physician who will work in conjunction with an experienced casemanager can realize the reward of witnessing the patient's recovery in an appropriate time frame. The casemanager can assist the physician by acting as the liaison among parties, which allows the physician to do what he or she does best--practice medicine. The casemanagement approach can be a win-win situation for all involved. PMID:8823400
Tampa Bay, Florida,USA, is a shallow,subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of sea grasses and other selected habitat types, to support estuarine-dependent faunal guilds.
Background The combination of telemedicine systems integrating mobile technologies with the use of continuous glucose monitors improves patients’ glycemic control but demands a higher interaction with information technology tools that must be assessed. In this article, we analyze patients’ behavior from the use-of-the-system point of view, identifying how continuous monitoring may change the interaction of patients with the mobile telemedicine system. Methods Patients’ behavior were evaluated in a clinical experiment consisting of a 2-month crossover randomized study with 10 type 1 diabetes patients. During the entire experiment, patients used the DIABTel telemedicine system, and during the intervention phase, they wore a continuous glucose monitor. Throughout the experiment, all user actions were automatically registered. This article analyzes the occurrence of events and the behavior patterns in blood glucose (BG) self-monitoring and insulin adjustments. A subjective evaluation was also performed based on the answers of the patients to a questionnaire delivered at the end of the study. Results The number of sessions established with the mobile Smart Assistant was considerably higher during the intervention period than in the control period (29.0 versus 18.8, p < .05), and it was also higher than the number of Web sessions (29.0 versus 22.2, p < .01). The number of daily boluses was higher during the intervention period than in the control period (5.27 versus 4.40, p < .01). The number of daily BG measurements was also higher during the intervention period (4.68 versus 4.05, p < .05) and, in percentage, patients increased the BG measurements not associated to meals while decreasing the percentage of preprandial measurements. The subjective evaluation shows that patients would recommend the use of DIABTel in routine care. Conclusions The use of a continuous glucose monitor changes the way patients manage their diabetes, as observed in the increased number of daily insulin bolus, the increased number of daily BG measurements, and the differences in the distribution of BG measurements throughout the day. Continuous monitoring also increases the interaction of patients with the information system and modifies their patterns of use. We can conclude that mobile technologies are especially useful in scenarios of tight monitoring in diabetes, and they are well accepted by patients. PMID:21303619
Martinez-Sarriegui, Inaki; Garcia-Saez, Gema; Rigla, Mercedes; Brugues, Eulalia; de Leiva, Alberto; Gomez, Enrique J.; Hernando, M. Elena
The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa's socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors'experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also highlights the under-representation of African researchers in the global whelm of information system research. Telemedicine in Africa though has not attracted enough political support is potentially a very useful conduit of health-care given the fact that the continent is resource limited and still enduring the effects of scarce human resource especially in health. PMID:23858382
The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa’s socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors’experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also highlights the under-representation of African researchers in the global whelm of information system research. Telemedicine in Africa though has not attracted enough political support is potentially a very useful conduit of health-care given the fact that the continent is resource limited and still enduring the effects of scarce human resource especially in health. PMID:23858382
A new telemedicine service, called the Hellenic Telecommunication Organization Telemedicine Service (OTE-TS), which addresses an open multidisciplinary group of medical care providers (users), is presented in this paper. OTE-TS is supported by the Hellenic Telecommunication Organization (OTE) and is the result of the close collaboration of engineers, medical doctors and market analysts. Its architecture provides the user with an integrated
Evy I. Karavatselou; George-peter K. Economou; Constantine A. Chassomeris; Vassiliki Danelli-mylonas; Dimitris K. Lymberopoulos
A Cost-Effective Portable Telemedicine Kit for Use in Developing Countries by Ari T. Adler B Telemedicine Kit for Use in Developing Countries by Ari T. Adler Submitted to the Department of Mechanical patients in remote areas and medical specialists around the world. Developing countries have had little
Telemedicine applications using cellular phones and the Internet have already been demonstrated. A recognizable trend in telecommunication is the convergence of cellular phone and computer network technologies. A WAP (wireless application protocol) phone is capable of not only voice and data transmission, but also wireless Internet connectivity. The paper discusses the methods and feasibility of several WAP-based telemedicine applications. A
Background: Technology and information systems enabling transmission of patients’ data and ability to provide and exchange professional support remotely to the general practitioners can improve quality and continuity of care.Design: We set up a programme of primary prevention in 27 patients at risk for cardiovascular diseases by using Telemedicine Service for 6 months.Methods: Telemedicine Service enlisted the involvement of physicians
The rapid development of information and communication technology has brought about new ways of diagnosis and treatment. The growing impact on health care practices of the combination between medical sciences and telematic computers materialized in an incredibly wide range of new applications called telemedicine. The great variety of opportunities provided by this new field defines telemedicine set against a historical
Current funding mechanisms can impede the efficient use and integration of telemedicine services. Telemedicine has developed in Australia against a background of complex funding arrangements and interwoven health-care responsibilities. These impediments are not unique to telemedicine but are accentuated by its ability to cover different locations, clinical areas and purposes. There is also a link between economic evaluation and funding mechanisms for telemedicine. While economic evaluations provide important information for the efficient allocation of resources, the funding environment in which telemedicine is established is also crucial in ensuring that services are efficient. Given these complexities, should telemedicine be funded? We conclude that this will depend on: the objectives and priorities of the health system; the efficiency of telemedicine relative to that of other forms of health-care delivery; and the funding environment. In terms of resource allocation processes, the optimum scenario is likely to be where the decision to invest in telemedicine services is made taking local needs into account, but where considerations such as market structure and network compatibility are examined on a broader scale and balanced against the principles of efficiency and equity. PMID:12396851
To prepare measures for practical policy utilization and the control of heavy metals, hazard control related institutions by country, present states of control by country, and present states of control by heavy metals were examined. Hazard control cases by heavy metals in various countries were compared and analyzed. In certain countries (e.g., the U.S., the U.K., and Japan), hazardous substances found in foods (e.g., arsenic, lead, cadmium, and mercury) are controlled. In addition, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) recommends calculating the provisional tolerable weekly intake (PTWI) of individual heavy metals instead of the acceptable daily intake (ADI) to compare their pollution levels considering their toxicity accumulated in the human body. In Korea, exposure assessments have been conducted, and in other countries, hazardous substances are controlled by various governing bodies. As such, in Korea and other countries, diverse food heavy metal monitoring and human body exposure assessments are conducted, and reducing measures are prepared accordingly. To reduce the danger of hazardous substances, many countries provide leaflets and guidelines, develop hazardous heavy metal intake recommendations, and take necessary actions. Hazard control case analyses can assist in securing consumer safety by establishing systematic and reliable hazard control methods. PMID:24278603
Kim, Ji Ae; Lee, Seung Ha; Choi, Seung Hyun; Jung, Ki Kyung; Park, Mi Sun; Jeong, Ji Yoon; Hwang, Myung Sil; Yoon, Hae Jung; Choi, Dal Woong
The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive casemanagement programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and casemanagers of the eight casemanagement programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of casemanagers, casemanagement process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the casemanagers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of casemanagers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and providers. PMID:19694030
Minkman, Mirella M N; Ligthart, Suzanne A; Huijsman, Robbert
Telemedicine activities in underserved communities were reviewed as part of the Universitas 21 (U21) e-health project. A SWOT analysis (strengths, weaknesses, opportunities, threats) was conducted on 12 articles identified in a literature review, supplemented by expertise from U21 members. The analysis showed that threats include the reluctance of populations to use telemedicine services, and a general absence of infrastructure and resources to sustain them. Opportunities centre around potential research, including cost-effectiveness analyses and quantitative assessments of existing telemedicine services. The great strength of telemedicine is that it can improve access to health services among those most in need. However, its greatest weakness is the lack of evidence supporting its clinical and cost advantages relative to traditional services. This represents an important opportunity for research on telemedicine initiatives among underserved populations. PMID:16035962
Wootton, Richard; Jebamani, Laurel S; Dow, Shannon A
The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system. PMID:19964507
Hong, SungHye; Kim, SangYong; Kim, JungChae; Lim, DongKyu; Jung, SeokMyung; Kim, DongKeun; Yoo, Sun K
In this paper, we present a case study of the design and development of a Web Service management system for bioinformatics\\u000a research. The described system is a prototype that provides a complete solution to manage the entire life cycle of Web Services\\u000a in bioinformatics domain, which include semantic service description, service discovery, service selection, service composition,\\u000a service execution, and service
Kai Xu; Qi Yu; Qing Liu; Ji Zhang; Athman Bouguettaya
Background The use of the biopsychosocial model of health and casemanagement for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR. Methods 80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed. Results In total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training. Conclusions This survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work. PMID:24884477
Accessing timely acute medical care is a challenge for older adults. This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community (SLC) residences. This program, based in a primary care geriatrics practice that cares for SLC residents, is designed to offer acute care through telemedicine for complaints that are felt to need attention before the next available outpatient visit but not to require emergency department (ED) resources. This option gives residents access to care in their residence. Measures used to evaluate the program include successful completion of telemedicine visits, satisfaction of residents and caregivers with telemedicine care, and site of care that would have been recommended had telemedicine been unavailable. During the first 2 years of the program's operation, 281 of 301 requested telemedicine visits were completed successfully. Twelve residents were sent to an ED for care after the telemedicine visit. Ninety-four percent of residents reported being satisfied or very satisfied with telemedicine care. Had telemedicine not been available, residents would have been sent to an ED (48.1%) or urgent care center (27.0%) or been scheduled for an outpatient visit (24.4%). The project demonstrated that high-intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without requiring ED or urgent care use. Continuation of the program will require evaluation demonstrating equal or better resident-level outcomes and the development of sustainable business models. PMID:24164485
Shah, Manish N; Gillespie, Suzanne M; Wood, Nancy; Wasserman, Erin B; Nelson, Dallas L; Dozier, Ann; McConnochie, Kenneth M
Much work on school bullying focuses on developing our understanding of the various factors that contribute to bullying and its management. This case study focuses on the possible connections between parts and offers a metaperspective of one mainstream secondary school. Demonstrating that bullying and its management is embedded within the network…
This is a case study of a failed Department of Defense (DOD) project, even though it was fully justified and badly needed. Project management within the DOD is a complicated process. Projects are beset by the agenda of various stakeholders within the DOD organizational structure. When this occurs, strong project management leadership is necessary for success. This paper analyzes the
J. Scott Sutterfield; Shawnta S. Friday-Stroud; Sheryl L. Shivers-Blackwell
The term fetus papyraceus is used to describe a mummified fetus associated with multiple gestations where one fetus dies and is flattened between the membranes of living fetus and uterine wall. Though the maternal and fetal complications in affected cases can be severe, we report of two cases of fetus papyraceus managed conservatively without any complications. Successful outcome is related to careful monitoring during pregnancy. PMID:24715942
...Case tracking, data management, and reporting. ...ACT OF 2000 (IAA) Standards for Convention Accreditation...Responding to Complaints and Records and Reports Management § 96.43 Case tracking, data management, and...
Clinical diagnostic ultrasound (US) is experiencing an expanding role that is well suited to application on the International Space Station (ISS). Diagnostic US can be used to reduce the risks associated with long duration human space flight by providing a non-invasive tool with head-to-toe diagnostic capability in both biomedical research and crew health care. General health care of the astronauts will be diagnosed with US, e.g., kidney stones, gall bladder disease, appendicitis, etc. Initial studies will focus on detection of ``ureteral jets'' in the bladder. This is a non-invasive test to rule out obstructive uropathy from kidney stones with minimal requirements for crew training. Biomedical research experiments, focusing on the effects of the microgravity environment, will be performed using both the HHU and the HDI 5000. US will be used to evaluate bone density and muscle mass in this environment. Prolonged or emergency EVAs may occur with the ISS. The hand-held ultrasound unit (HHU) and its telemedicine capability will be used in EVA settings to monitor events such as decompression sickness (DCS) microbubble formation in the cardiovascular system. There will be telemetry links between the HHU and the ATL/Lockheed Martin rack mounted HDI 5000 in the ISS Human Research Facility (HRF), as well as between the HRF and medical expertise on the ground. These links will provide the ISS with both real-time and store-and-forward telemedicine capabilities. The HHU can also be used with the existing telemedicine instrument pack (TIP).
Carter, Stephen J.; Stewart, Brent K.; Kushmerick, Martin J.; Langer, Steve G.; Schmiedl, Udo P.; Winter, Thomas C.; Conley, Kevin E.; Jubrias, Sharon A.
For years ophthalmic photographs have been used to track the progression of many ocular diseases such as macular degeneration and glaucoma as well as the ocular manifestations of diabetes, hypertension, and hypoxia. In 1987 a project was initiated at the Johnson Space Center (JSC) to develop a means of monitoring retinal vascular caliber and intracranial pressure during space flight. To conduct telemedicine during space flight operations, retinal images would require real-time transmissions from space. Film-based images would not be useful during in-flight operations. Video technology is beneficial in flight because the images may be acquired, recorded, and transmitted to the ground for rapid computer digital image processing and analysis. The computer analysis techniques developed for this project detected vessel caliber changes as small as 3 percent. In the field of telemedicine, the Portable Dynamic Fundus Instrument demonstrates the concept and utility of a small, self-contained video funduscope. It was used to record retinal images during the Gulf War and to transmit retinal images from the Space Shuttle Columbia during STS-50. There are plans to utilize this device to provide a mobile ophthalmic screening service in rural Texas. In the fall of 1993 a medical team in Boulder, Colorado, will transmit real-time images of the retina during remote consultation and diagnosis. The research applications of this device include the capability of operating in remote locations or small, confined test areas. There has been interest shown utilizing retinal imaging during high-G centrifuge tests, high-altitude chamber tests, and aircraft flight tests. A new design plan has been developed to incorporate the video instrumentation into face-mounted goggle. This design would eliminate head restraint devices, thus allowing full maneuverability to the subjects. Further development of software programs will broaden the application of the Portable Dynamic Fundus Instrument in telemedicine and medical research.
Hunter, Norwood; Caputo, Michael; Billica, Roger; Taylor, Gerald; Gibson, C. Robert; Manuel, F. Keith; Mader, Thomas; Meehan, Richard
This quantitative research study assesses the organizational characteristics, market factors, and profitability of U.S. hospitals operating with a casemanagement model. These results have managerial implications associated with individual hospital performance, implications for nursing leadership, and policy implications on resource allocation. PMID:15108474
This book provides insight into how managers of federally sponsored libraries view their roles and carry out their duties. Seven federally supported libraries were selected to serve as case studies. These libraries represent a cross-section of various types, and the nine chapters are written by librarians from these facilities. The discussion…
This manual helps service care providers working with HIV-infected people learn how HIV affects the body's major systems, emphasizing the structure and functions of each system and direct and indirect effects of HIV on each system. The curriculum was developed for casemanagement assistants (CMAs) who work in homes of HIV-infected people. Lessons…
Family Planning Council of Southeastern Pennsylvania, Philadelphia.
Several strategic, organizational, and operational variables drive successful casemanagement programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the casemanager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a casemanagement program to higher level of performance. While many organizations have employees called "casemanagers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance. PMID:14618974
The National Center for Children in Poverty has recently conducted research on casemanagement in service integration projects, with the core information coming from 16 projects around the country from many service domains. Six programs specifically target very young children living in poverty, and six provide services to very young children…
Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…
Purpose – The purpose of this paper is to examine the key issues involved in situations within the workplace when an employee goes through gender reassignment, in order to consider how such situations might be managed more effectively. Design\\/methodology\\/approach – It analyses a case study from a national public sector organisation in the UK where a transsexual person went through
This study presents an analysis of the allocative efficiency of casemanagers for the community-based elderly in an environment in which casemanagement and a range of home and community-based services were available and directly linked to a mandatory preadmission screening program for nursing home applicants. We collected data for a one-year follow-up period on client placement, health and functional status, informal support, and use of health and social services for clients in two urban and two rural counties that participated in the Minnesota Pre-Admission Screening/Alternative Care Grants Program (PAS/ACG). We found that among those receiving ACG-supported services, the relationship between variation in the level of support for home and community-based services and the length of time elderly clients remained in the community suggested that casemanagers were allocating home and community-based services in a reasonably efficient manner. This finding offers support for using casemanagers to target services to the elderly. PMID:2681082
Four general medicine units were divided into two "firms" to improve patient outcomes and ensure continuity of care. All members remain part of their firm for as long as they are employed. The nurse casemanagers remain constant in both inpatient and outpatient settings and coordinate discharge planning. PMID:7478362
Schurdell, S; Pendleton, E; Tate, L; Trice, R; Steward, P
“Intensive casemanagement” (ICM) programs for people with serious mental illness are found widely throughout the United States. However, there is no standard definition or conceptualization of ICM. Despite these differences, ICM aspires to a set of common principles and core functions derived from the concept of continuity of care. This study attempted to identify the elements of ICM program
Objective: In 1997, Michigan's Family Independence Agency piloted casemanagement procedures designed to expedite permanency and improve services to children in foster care. Method: A 3-year evaluation examined outcomes in nine pilot and nine comparison counties to determine if children in the pilot counties achieved permanency, either returned…
The purpose of this study was to identify how effective teachers manage productive groups in elementary grade classrooms. Multiple instrumental case study methods were used to document the managerial actions of selected teachers who made extensive use of cooperative learning (CL) activities. Four teachers in three elementary grade classrooms (two…
This article presents a case study reporting the methodology and experiences of using Web 2.0 social media tools through Facebook to facilitate a graduate-level course in nursing informatics. Using Facebook as the sole classroom management software program permitted the class to become a synergetic learning team. The reader will benefit by learning how the instructor became the facilitator and a
This paper looks at terms and definitions associated with external debt management.It analyses the Balance of Payments Crisis in Mexico in late 1994-1995.Then it looks at the External Debt situation in India as a case study and draws possible inferences about it's present state.
The CaseManaged Residential Care (CMRC) program, a social rehabilitation model, was implemented in a traditional medical environment as a response to the needs of homeless chem-cally dependent veterans, many of whom were also mentally ill. These veterans were resistant to traditional interventions and were frequently rejected or discharged prematurely by many community resources due to the facilities' inability to
Annie R. Pope; Kendon J. Conrad; William Baxter; Phillip Elbaum; Joseph Lisiecki; Amin Daghestani; Cheryl Hultman; John Lyons
Case studies of British and Australian multinational corporations in the food and drink industry investigated how training and development are managed. Competency-based education and industry boards are important elements in both countries. Lack of a training culture in the industry and little innovation in training were observed. (SK)
In 2011, revised international guidelines were issued jointly by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, which provide a valuable framework for the diagnosis and management of idiopathic pulmonary fibrosis (IPF). However, due to the complexity of IPF, these guidelines may not comprehensively account for the management of individual IPF patients in clinical practice. We describe three patient cases that were presented and discussed during the 2013 AIR: Advancing IPF Research meeting in Nice, France. These cases highlight the heterogeneity in the presentation, history and clinical course of IPF, together with expert insights regarding the diagnosis and management of IPF in the real-life setting. PMID:24881079
Kreuter, Michael; Kardos, Peter; Hoffstein, Victor
Objectives This report describes the case of a patient with chronic idiopathic meralgia paresthetica associated with bilateral sacroiliac joint dysfunction who was managed with chiropractic care. Clinical Features A 35-year-old white woman presented to a private chiropractic clinic with a complaint of numbness in the right anterolateral thigh region. Neurological assessment revealed a diminution of sensibility and discrimination on the right lateral femoral cutaneous nerve territory. Pain was rated as 8.5 on a numeric pain scale of 0 to 10. Musculoskeletal examination of the pelvic region disclosed bilateral sacroiliac joint dysfunction. Intervention and Outcomes Chiropractic management included pelvic mobilizations, myofascial therapy, transverse friction massage, and stretching exercises. After 3 visits (2 weeks later), result of neurological evaluation was normal, with no residual numbness over the lateral thigh. Conclusion In the present case, chiropractic management with standard and applied kinesiology techniques resulted in recovery of meralgia paresthetica symptoms for this patient. PMID:22942840
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront. PMID:21569490
Project RavenCare is a testbed for assessing the utility of teleradiology, telemedicine and electronic patient records systems for delivering health care to Native Alaskans in remote villages. It is being established as a joint project between the department of radiology at Georgetown University Medical Center and the Southeast Alaska Regional Health Corporation (SEARHC) in Sitka, Alaska. This initiative will establish a sustained routine clinical multimedia telemedicine support for a village clinic in Hoonah, Alaska and a regional hospital in Sitka. It will link the village clinic in Hoonah to Mt. Edgecumbe Hospital in Sitka. This regional hospital will in turn be linked to Georgetown University Hospital through the T1- VSAT (very small aperture terminal) of the NASA-ACTS (Advanced Communication Technology Satellite). Regional physicians in Hoonah lack support in providing relatively routine care in areas such as radiology and pathology. This project is an initial step in a general plan to upgrade telecommunications in the health care system of the Southeast Alaska region and will address aspects of two problems; limited communication between the village health clinics and the hospital and lack of subspecialty support for hospital-based physicians in Sitka.
Tohme, Walid G.; Collmann, Jeff R.; Mun, Seong K.; Vastola, David J.
With advances and availability of information and communication technology infrastructures in some nations and institutions, patients are now able to receive healthcare services from doctors and healthcare centers even when they are physically separated. The availability and transfer of patient data which often include medical images for specialist opinion is invaluable both to the patient and the medical practitioner in a telemedicine session. Two existing approaches to telemedicine are real-time and stored-and-forward. The real-time requires the availability or development of video-conferencing infrastructures which are expensive especially for most developing nations of the world while stored-and-forward could allow data transmission between any hospital with computer and telephone by landline link which is less expensive but with delays. We therefore propose a hybrid design of applications using hypermedia database capable of harnessing the features of real-time and stored-and-forward deployed over a wireless Virtual Private Network for the participating centers and healthcare providers.
Ikhu-Omoregbe, N. A.; Atayero, A. A.; Ayo, C. K.; Olugbara, O. O.
With advances and availability of information and communication technology infrastructures in some nations and institutions, patients are now able to receive healthcare services from doctors and healthcare centers even when they are physically separated. The availability and transfer of patient data which often include medical images for specialist opinion is invaluable both to the patient and the medical practitioner in a telemedicine session. Two existing approaches to telemedicine are real-time and stored-and-forward. The real-time requires the availability or development of video-conferencing infrastructures which are expensive especially for most developing nations of the world while stored-and-forward could allow data transmission between any hospital with computer and telephone by landline link which is less expensive but with delays. We therefore propose a hybrid design of applications using hypermedia database capable of harnessing the features of real-time and stored-and-forward deployed over a wireless Virtual Private Network for the participating centers and healthcare providers.
Ikhu-Omoregbe, N. A.; Atayero, A. A.; Ayo, C. K.; Olugbara, O. O.
An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. PMID:23573082
The integration of telecommunications and information systems into health care delivery in human space flight operations is not new. It has been an integral tool for over 45 years. During these past decades, numerous efforts have been conducted to further develop and promulgate telemedicine. The National Aeronautics and Space Administration (NASA) established a commercial space center in 1997, known as the Medical Informatics and Technology Applications Consortium (MITAC). MITAC has developed and conducted a variety of test beds in several international settings, including Russia, Ecuador and other extreme and remote environments. These test beds have been designed to evaluate and validate technologies and techniques that have application in the delivery and support of health care in unique environments. The characteristics of these test beds are analogous to what might be observed or experienced in low earth orbit or on space-based platform. These include intermittent communications, low bandwidth, level of competency of the front line health worker, etc. These test beds have led to new approaches for the delivery of health care as well as enhanced education. These experiences have been beneficial in the promulgation of telemedicine as an effective tool and have provided new ideals for space exploration as well terrestrial medicine. This paper will highlight MITAC's test beds and their relationship to space exploration. PMID:15537228
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront. PMID:21569490
Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim of this review was to identify all published cases of the most severe condition, placenta percreta in order to describe complications associated with the three commonly used surgical strategies: local resection, hysterectomy or leaving the placenta in situ, and to describe the outcome, with respect to blood loss and transfusion requirements, with the different endovascular interventions that may be used as adjuncts in the management of the conditions. A PubMed search was performed in April 2013 and the final review included 119 published placenta percreta cases. Conservative management, where the placenta is left in situ for resorption, seems to be associated with severe long-term complications of hemorrhage and infections, including a 58% risk that a hysterectomy will eventually be needed up till nine months after the delivery. Local resection seems to be associated with fewer complications within 24 h postoperatively compared with hysterectomy or leaving the placenta in situ. A selection bias in the direction of less severe cases for the local resection technique might in part explain the lower complication rates with that approach. Future prospective data collection activities should include intended as well as actual management, and long-term follow-up of all cases is of vital importance. PMID:24266548
Objective: Our goal was to reduce the prevalence of antipsychotic medication side-effects by providing a short-term training program on the assessment and management of side-effects to casemanagers.Method: Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in which they resided.
Paul Morrison; Tom Meehan; Deanne Gaskill; Paul Lunney; Paul Collings
Objective: Our goal was to reduce the prevalence of antipsychotic medication side- effects by providing a short-term training program on the assessment and manage- ment of side-effects to casemanagers. Method: Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in
Paul Morrison; Tom Meehan; Deanne Gaskill; Paul Lunney; Paul Collings
Background Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical Pharmacy Specialist (CPS), telephone administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk. Methods Randomized controlled trial including patients with hypertension (blood pressure (BP) > 150/100 mmHg) or elevated low density liporotein (LDL) (> 130 mg/dl). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined. Conclusion Given the national prevalence of CVD and the dismal rates of risk factor control; intensive, but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans. PMID:23537965
Melnyk, S. Dee; Zullig, Leah L.; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Stechuchak, Karen M.; Edelman, David; Rakley, Susan; Morey, Miriam; Bosworth, Hayden B
A telemedicine network with retina cameras and automated quality control, physiological feature location, and lesion/anomaly detection is a low-cost way of achieving broad-based screening for diabetic retinopathy (DR) and other eye diseases. In the process of a routine eye-screening examination, other non-image data is often available which may be useful in automated diagnosis of disease. In this work, we report on the results of combining this non-image data with image data, using the protocol and processing steps of a prototype system for automated disease diagnosis of retina examinations from a telemedicine network. The system includes quality assessments, automated physiology detection, and automated lesion detection to create an archive of known cases. Non-image data such as diabetes onset date and hemoglobin A1c (HgA1c) for each patient examination are included as well, and the system is used to create a content-based image retrieval engine capable of automated diagnosis of disease into 'normal' and 'abnormal' categories. The system achieves a sensitivity and specificity of 91.2% and 71.6% using hold-one-out validation testing.
Aykac, Deniz [ORNL; Chaum, Edward [University of Tennessee, Knoxville (UTK); Fox, Karen [Delta Health Alliance; Garg, Seema [University of North Carolina; Giancardo, Luca [ORNL; Karnowski, Thomas Paul [ORNL; Li, Yaquin [University of Tennessee, Knoxville (UTK); Nichols, Trent L [ORNL; Tobin Jr, Kenneth William [ORNL
Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links. Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment. PMID:10585132
In the post-asylum era, casemanagers perform much of the face-to-face work of pharmaceutical compliance for people with severe and persistent mental illness. Their work demands careful orchestration of the assemblage of compliance, including the actual medications, the ideology of biopsychiatry, the division of professional labor, and certain mundane tools. Ethnographic vignettes from an Assertive Community Treatment (ACT) team show
This article describes one agency's model of delivering casemanagement services to an adult population of seriously and persistently mentally ill persons. It was developed following improvements in psychotropic medications that have resulted in considerable symptom relief for many clients. The treatment program, both medical and psychosocial aspects, is focused on recovery rather than maintenance. Outcome measures of treatment and rehabilitation objectives demonstrated that the program has been successful. PMID:15112374
Despite its development and suitability to many specialties of medicine for the past forty years and the driving demands of an aging population, telemedicine has not made significant progress in deployment or commercialization. ...
This paper investigates the design and technical efficacy of an integrated PC based platform for three different medical applications. The technical efficacy of such a telemedicine platform has not been evaluated in the literature and optimal technical requirements have not been developed. The first application, with the Department of Surgery, Division of Urology, tests the utility of a telemedicine platform including radiology images for a surgical stone disease consultation service from an off site location in West Virginia. The second application, with the Department of Internal Medicine, Division of Clinical Pharmacology, investigates the usefulness of telemedicine when used for a clinical pharmacology consultation service from an off-site location. The third application, with the Department of Pediatrics, will test telemedicine for trauma care triage service first within an off-site location in Virginia and then from there to Georgetown University Medical Center.
Tohme, Walid G.; Hayes, Wendelin S.; Dai, Hailei L.; Komo, Darmadi; Pahira, John J.; Abernethy, Darrell R.; Rennert, Wolfgang; Kuehl, Karen S.; Hauser, Gabriel J.; Mun, Seong K.
Broadly stated, this dissertation focuses on how practitioners and provider organizations integrate the computer and web into healthcare delivery. The opportunity that afforded this research was a Telemedicine Needs ...
and implementation stage. Looking forward, however, we argue that telemedicine should play a more prominent role is a preferred model due to its ease of expandability and improved fault isolation characteristics. The WAN
Telemedicine concept originated from attempts to deliver healthcare services to patients located some distance from providers.\\u000a Consecutive inventions brought by technological progress like the telephone and telegraph were early adapted in the healthcare\\u000a domain. First examples of such applications come from the 1920s. In subsequent decades, more advanced systems were developed\\u000a and first definitions of telemedicine were shaped in the
OBJECTIVES:Patients with inflammatory bowel disease (IBD) often experience barriers to subspecialty access. We applied telemedicine, using a new computerized system called Collaborative Imaging, to resolve these barriers. We studied patients’ experience and satisfaction, and clinic throughput.METHODS:We performed a prospective randomized controlled pilot study at a Veterans Affairs hospital, assigning patients into two groups: telemedicine encounter, with the IBD specialist remotely
Michael Krier; Tonya Kaltenbach; Kenneth McQuaid; Roy Soetikno
We compared the records of paediatric palliative consultations undertaken face-to-face, with telemedicine consultations undertaken in patients' homes. A convenience sample of consecutive paediatric palliative care patients was identified from the hospital's palliative care database. A total of 100 consultations was reviewed (50 telemedicine consultations during home visits and 50 face-to-face consultations) according to 14 established principles and components of a paediatric palliative care consultation. In the telemedicine group there was a higher proportion of patients in a stable condition (58% vs 7%), and a lower proportion of patients in terminal phase (2% vs 17%). Discussion about pain and anorexia were significantly more common in the telemedicine group. Discussion about follow up was significantly more common in the telemedicine group (86% vs 56%), whilst resuscitation planning was more common in deteriorating patients receiving inpatient care. All other components and principles of a palliative care consultation were documented equally regardless of method of consultation. The findings confirm that palliative consultations via telemedicine are just as effective as face-to-face consultations in terms of the documented components of the consultation. PMID:25399995
Bradford, Natalie K; Armfield, Nigel R; Young, Jeanine; Herbert, Anthony; Mott, Christine; Smith, Anthony C
There is a growing body of experience and research suggesting that telemedicine (video conferencing, smart phones and online patient portals) could be the solution to addressing gaps in the provision of specialised healthcare in rural areas. The proposed role of telemedicine in providing needed services in hard to reach areas is not new. The United States Telecommunication Act of 1996 provided the initial traction for telemedicine by removing important economic and legal obstacles regarding the use of technology in healthcare delivery. This initial ruling has been supplemented by the availability of federal funding to support efforts aimed at developing telemedicine in underserved areas. In this paper, we explore one aspect of disease disparity pertinent to rural Illinois (kidney cancer incidence and mortality) and describe how we are planning to use an existing telemedicine program at Southern Illinois University School of Medicine (SIUSOM) to improve kidney cancer (Kca) care in rural Illinois. This represents an example of the possible role of telemedicine in addressing healthcare disparities in rural areas/communities and provides a description of general challenges and barriers to the implementation and maintenance of such systems. PMID:25286964
Alanee, S; Dynda, D; LeVault, K; Mueller, G; Sadowski, D; Wilber, A; Jenkins, W D; Dynda, M
Commercial telemedicine systems are increasingly functional, incorporating video-conferencing capabilities, diagnostic peripherals, medication reminders, and patient education services. However, these systems (1) rarely utilize information architectures which allow them to be easily integrated with existing health information networks and (2) do not always protect patient confidentiality with adequate security mechanisms. Using object-oriented methods and software wrappers, we illustrate the transformation of an existing stand-alone telemedicine system into `plug-and-play' components that function in a distributed medical information environment. We show, through the use of open standards and published component interfaces, that commercial telemedicine offerings which were once incompatible with electronic patient record systems can now share relevant data with clinical information repositories while at the same time hiding the proprietary implementations of the respective systems. Additionally, we illustrate how leading-edge technology can secure this distributed telemedicine environment, maintaining patient confidentiality and the integrity of the associated electronic medical data. Information surety technology also encourages the development of telemedicine systems that have both read and write access to electronic medical records containing patient-identifiable information. The win-win approach to telemedicine information system development preserves investments in legacy software and hardware while promoting security and interoperability in a distributed environment.
Craft, Richard L.; Funkhouser, Donald R.; Gallagher, Linda K.; Garcia, Rudy J.; Parks, Raymond C.; Warren, Steve
This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond. PMID:11242553
Williams, D R; Bashshur, R L; Pool, S L; Doarn, C R; Merrell, R C; Logan, J S
While current research on the factors affecting the HIV epidemic within the general population has considered the role of HIV casemanagers, much remains to be known about casemanagement effectiveness and how it might be enhanced. This article presents the data from a statewide survey of casemanagement professionals in Florida. The study focused on casemanagers' preparation for practice and barriers to successful practice. The study results reflect a very broad educational preparation in multiple disciplines with highly varied means of casemanager training and orientation at entry to practice. Further, the results highlighted the existence of multiple barriers that challenge the ability of casemanagers to cope with the demands of casemanagement practice in sites serving people living with HIV/AIDS who are socially and economically challenged. The article concludes with recommendations for changes in the system that would enhance the preparation of casemanagement professionals for entry to practice. PMID:24117030
Whyte Iv, James; Eccles, David W; Whyte, Maria D; Pappas, Cara; Cesnales, Nicole I
resources. The purpose of this study was to evaluate stress levels of the disaster casemanagers employed through the ten smaller faith-based organizations that make up one of the larger recipient organizations providing casemanagement services to victims...
The nurse casemanager role is continually evolving. Casemanagers are being challenged to perform new functions. There are few articles concerning orientation programs for casemanagers. This article provides a successful orientation program and clinical orientation schedule for a unique unit-based nurse casemanager/educator role. The orientation program is outlined based on the four competency domains of the nurse casemanager/educator clinical expertise, resource management, staff education, and patient/family education. Program topics and an orientation schedule are provided. PMID:9155342
Positioning the performance of public service. When management tools are in conflict : the case performed in the field of urban water management, we report the conflict occurring between a new management the conflict between new and existing performance management tools in a large urban public service3 . We use
On any one day, approximately 15,000-28,000 oil industry personnel are employed in the North Sea oil and gas industry. First aid in this remote environment is provided by non-medical staff on the rigs. Remote specialist advice via videoconferencing should improve the quality of offshore health care and reduce avoidable medical evacuations. Satellite communications and videoconferencing equipment was installed on the 'Alwyn North' oil platform, with medical advice provided via a call centre in Milan. Over a nine-month period, trial telemedicine links were conducted approximately twice per week. The three onshore physicians were very satisfied on each occasion with communications and diagnostic data image quality, including the ultrasound screening carried out by the rig provider. Remote specialist advice via videoconferencing should reduce unnecessary and/or untimely patient evacuation to hospital or onshore for medical assessment. PMID:18430278
The Final Report on the U.S.-U.S.S.R. Telemedicine Consultation Spacebride to Armenia and Ufa is presented. The goal of this activity was to provide expert medical consultation to the Armenian medical personnel in the areas of plastic and reconstructive surgery, physical and psychological rehabilitation, public health, and epidemiology following the devastating earthquake in Dec. 1988. The U.S. and U.S.S.R. implementation teams developed new standards for medical information transmittal as well as protocols and schedules on how to conduct medical consultations. The consultations were provided to the Republic Diagnostic Center in Yerevan, U.S.S.R. by four U.S. medical centers: University of Utah/LDS Hospital, University of Texas, Maryland Institute for Emergency Medical Service Systems, and Uniformed Services University of the Health Sciences.
Sustainable Waste Management; Case study of Nagpur INDIA Dr. Vivek S. Agrawal cdcindia waste management is far from being satisfactory. The environmental and health hazards caused Municipal Solid Waste (Management and Handling) Rules 2000, under the Environmental Protection Act, 1986
Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market. PMID:20077382
Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma casemanagement by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse casemanagement in a local community coalition. Evidence suggests the common factor for success involves casemanagers spending time contacting and patiently
Amanda Schulte; Jeanne Musolf; John R Meurer; Jennifer H Cohn; Kevin J Kelly
Job Title Homeless Prevention CaseManager Employer/ Agency Humble Area Assistance Ministries Job Description The Homeless Prevention CaseManager will be responsible for casemanagement as it relates to the agency's homeless prevention programs funded through ESG, United Way- Basic Needs and other sources
It is sometimes difficult to illustrate the cost benefits of providing casemanagement services on the local level. The City of Manchester Department of Health in New Hampshire has identified the cost benefits associated with providing comprehensive casemanagement services to lead-burdened children. Comprehensive casemanagement involves collaborating with primary care providers and health department staff to coordinate appropriate medical
There has been a growth in managerialism of professionals in the Public Sector. This paper contributes to this debate by examining perceptions of senior managers in mental health services within Health Authorities, NHS Trusts and Local Authorities' Social Services departments in Wales. The paper explores how different professions responded differently to the growth of managerialism. The results suggest important differences and similarities between management in health and social services settings. PMID:12908995
Laryngomalacia is a dynamic airway condition characterised by inward collapse of flaccid supraglottic structures during inspiration. Although the most common cause of stridor in the paediatric population, adult-onset laryngomalacia remains a rare entity and its management, challenging. Two cases of adult-onset laryngomalacia are reported. A review of the English literature is performed and additional publications identified by hand-searching relevant papers; 13 case reports/series comprising 28 cases of adult-onset laryngomalacia were identified, divided into two main groups: idiopathic (6/28) and acquired (22/28). The aetiology of the acquired form includes neurological, traumatic and iatrogenic. Reported therapeutic measures used are laser supraglottoplasty, epiglottopexy, partial epiglottidectomy, defunctioning tracheostomy and intubation whilst correcting the underlying cause. The majority of patients only required one therapeutic procedure (follow-up of 2-24 months). A strong index of suspicion is required to diagnose adult-onset laryngomalacia aided by in-office laryngoscopy. The rarity of this condition prevents management-based randomised controlled trials. PMID:24615649
Hey, Shi Ying; Oozeer, Nashreen Banon; Robertson, Stuart; MacKenzie, Kenneth
An evaluation of an internal laboratory decision to implement a protocol for limiting drug testing based on ethanol concentration in laboratory analysis for driving under the influence (DUI) cases is presented. The described casemanagement strategy is supported by known impairment of ethanol at relatively high concentrations, difficulty assigning a level of contributing impairment from drugs in the presence of high ethanol levels and the likelihood that the drug results may be suppressed at trial. Although the results of this study reinforce the assertion that such protocols lead to the under reporting of drugs in DUI cases, for the majority of cases, 95% in this study, the drug analysis results were not significant and did not warrant the time and resources needed for the additional blood drug testing. Furthermore, the study demonstrated that a high drug positivity rate does not necessarily mean that those drug results are legally or pharmacologically meaningful. Additional research should be conducted with quantitative drug results and casework impact of blood drug screen protocols as previous studies only report drug positivity rates and not whether the drug results would be meaningful to the case. PMID:25217546
Tiscione, Nicholas B; Shan, Xiaoqin; Yeatman, Dustin Tate
Eosinophilic gastroenteropathies, such as eosinophilic esophagitis and eosinophilic colitis, have classically been treated with swallowed inhaled corticosteroids or oral corticosteroids. More recent studies have found elimination and elemental diets to be effective treatment alternatives to steroids. In this case series we describe the treatment of three children using nutritional management in a community setting. Elimination diets and elemental diets based on patch testing and skin prick tests reduced the eosinophil counts to normal levels in all three children. Food items which tested positive were then reintroduced while symptoms and eosinophil counts were monitored. Nutritional management of eosinophilic esophagitis and eosinophilic colitis was found to be effective in reducing symptoms. However, obstacles facing patients who choose this type of therapy include limitations due to the cost of repeated endoscopies, palatability of elimination/elemental diets and the availability of subspecialists trained in management (e.g. Allergy, Gastroenterology, and Pathology). It may be a worthwhile endeavour to overcome these obstacles as nutritional management minimizes the potential long-term effects of chronic steroid therapy. PMID:21619708
Crouzon Syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. Once the sutures become closed, growth potential to those sutures is restricted. However, multiple sutural synostoses frequently extend to premature fusion of skull base causing midfacial hypoplasia, shallow orbit, maxillary hypoplasia and occasional upper airway obstruction.The case of a 7-year-old South African black boy with Crouzon Syndrome is presented. He presented with characteristic triad of cranial deformity, maxillary hypoplasia and exophthalmos. The clinical, cephalometric features and initial orthodontic management of this patient are discussed as part of multidisciplinary management. PMID:23139476
Pineal cyst apoplexy is a very rare entity with previously reported symptoms of severe frontal or occipital headache, gaze paresis and visual field defects, nausea or vomiting, syncope, ataxia, hearing loss and sudden death. The treatment options for symptomatic pineal cysts are observation, shunting, aspiration via stereotactic guidance or endoscopy, third ventriculostomy, ventriculocysternostomy, and/or surgical resection by craniotomy and microsurgery. Here, the authors report an unusual case of a 28-year-old male patient with pineal cyst apoplexy, presenting with headache, insomnia, and sexual dysfunction symptoms who is being managed conservatively and observed for two years by an academic tertiary care unit. PMID:22212992
To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios’s theoretical frame of Communication Privacy Management (CPM). Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient’s family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors. Significance for public health Much of the mission central to public health sits squarely on the ability to communicate effectively. This case analysis offers an in-depth assessment of how error disclosure is complicated by misunderstandings, assuming ownership and control over information, unwittingly following conversational scripts that convey misleading messages, and the difficulty in regulating privacy boundaries in the stressful circumstances that occur with error disclosures. As a consequence, the potential contribution to public health is the ability to more clearly see the significance of the disclosure process that has implications for many public health issues.
Petronio, Sandra; Helft, Paul R.; Child, Jeffrey T.
Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula.
OBJECTIVES: The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included. METHODS: A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g). RESULTS: The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission. CONCLUSIONS: In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.
Jones, J. A.; Johnston, S.; Campbell, M.; Miles, B.; Billica, R.
Case studies about managing evaluation are examined for perspectives on expertise in managing evaluation. There are lessons on a geography of managing, managing as organizational work, the notions of "competency" and "expertise," and managing evaluation as professional work. Dreyfus and Dreyfus (2004) offer a framework for an introductory…
System design is an iterative, creative, and cooperative process where informal ideas are transformed into a detailed definition of how a system can be implemented. Design rationale aims at capturing and preserving the why underlying the what, the argument behind the artifact in the design process. Recording deliberations of the design process therefore promises benefits for the overall system engineering life cycle. Providing adequate computer support for design rationale is an interesting issue and a real need for effective application. A design rationale management system (DRMS) supports the capturing, storing and retrieval of interaction rationale in a shared corporate knowledge base and allows organizational learning through long-term and inter-project reuse. The intent of meta-CASE systems is to capture the specification of a required CASE tool and then generate the tool for actual production from the specification. In this paper we identify the requirements for a DRMS and investigate the applicability of meta-CASE tools for the implementation of DRMS`s. Furthermore we describe the experiences gained in the development of two DRMS`s adopting the meta CASE tools MaestroII GED/TCI and Hardy.
Project management education programmes are often proposed in higher education to give students competences in project planning (Gantt's chart), project organizing, human and technical resource management, quality control and also social competences (collaboration, communication), emotional ones (empathy, consideration of the other, humour, ethics), and organizational ones (leadership, political vision, and so on). This training is often given according a training-by-project type of learning with case studies. This article presents one course characterized by a pedagogical organization based upon Knowledge Management (KM) concepts: knowledge transfer and construction throughout a learning circle and social interactions. The course is supported by a rich and complex tutor organization. We have observed this course by using another KM method inspired from KADS with various return of experience formalized into cards and charts. Our intention is, according to the model of Argyris and Sch\\"on (Smith, 2001), to gai...
Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent. PMID:25311458
We studied maritime telemedicine and its potential for improvement. Twenty-four people representing 13 different shipping companies and maritime public authorities were interviewed. They covered all areas of the Norwegian maritime sector except for offshore installations. The morbidity pattern reported differed between the groups: on cruise liners and ferries the major problems were due to coronary heart disease, while on merchant ships, navy vessels and in the fishing fleet the major problems were accidents. Voice and fax systems were available in all cases. However, the Emergency Medical Dispatch Centres did not offer an email service and did not use faxes in the maritime setting. Radio Medico Norway was the only assistance provider offering two-way transfer of digital pictures. The interviewees suggested a number of areas for improvement; these included having a single emergency telephone number to call for help, email systems with the possibility of digital picture attachments, wireless communication systems on board and a standard CD-ROM reference work for medical guidance/education. PMID:12396854
A primary goal of casemanagement is to coordinate services across treatment settings and to integrate substance abuse services\\u000a with other types of services offered in the community, including housing, mental health, medical, and social services. However,\\u000a casemanagement is a global construct that consists of several key dimensions, which include extent of casemanagement coverage,\\u000a the degree of management
Jeffrey A. Alexander; Harold Pollack; Tammie Nahra; Rebecca Wells; Christy Harris Lemak
Objective: To examine the costs and benefits of a case-management program for an elderly, function- ally impaired population in a managed care setting. Study Design: A post hoc, cost-effectiveness study of casemanagement. Subjects and Methods: As part of a larger study, 317 elderly, functionally impaired clients were ran- domly assigned to a case-managed or regular-care group. During the 2-year
Background The increasing number of patients with diabetes poses a major challenge for the health care system. One instrument to meet these challenges could be the use of telemedicine, which, at the same time, may reduce treatment costs. Since 2005, diabetes patients on the island of Aeroe have been offered expert diabetes care using teleconsultations. This article describes the impact of the telemedicine solution on essential diabetes treatment parameters, patient satisfaction, and cost-effectiveness. Methods Telemedicine consultations were conducted with the patient and nurse specialist placed in a consultation room of Aeroe Hospital in audiovisual contact with the physician situated at the hospital on the mainland. Consultations were supported by an electronic patient record and a Web-based quality-monitoring diabetes database. Results Inclusion criteria in this retrospective study were at least 6 months of telemedicine diabetes control with a minimum of two visits and two hemoglobin A1c (HbA1c) values. Results were compared with data from the Danish National Diabetes Registry (DVDD). Data are given in medians. In total, 23 type 1 diabetes mellitus (T1DM) patients, aged 65 (56–74) versus 48 years, diabetes duration 21.0 (10.7–31.3) versus 20.5 years, and 55 type 2 diabetes mellitus (T2DM) patients, aged 67 (64–70) versus 65 years, diabetes duration 14.0 (10.5–17.5) versus 11.7 years, were included. After teleconsultation, HbA1c in T1DM patients was 8.0% (7.4–8.6%) versus 7.9% [64 (57–71) versus 63 mmol/mol], not significant, and in T2DM patients was 7.4% (7.1–7.7%) versus 7.6% [57 (54–61) versus 60 mmol/mol], p <.05. Body mass index, blood pressure, and lipid values were comparable with the DVDD. Patient satisfaction was especially related to the major reduction in transportation time (7 h). Reductions in traveling costs and saved working days were the most important factors in making the telemedicine set-up economically efficient. Conclusion Telemedicine consultation for remote outpatient diabetes control is feasible, and the interdisciplinary interventions achieved high treatment quality results in essential diabetes treatment parameters. In addition, the telemedicine set-up was associated with improved cost-effectiveness and patient satisfaction. PMID:23759390
All the health care facilities examined in the case studies addressed several important organizational issues before and during the installation of their systems. All the facilities examined employee commitment. The prudent managers considered how easily their employees adapt to changes in their jobs and work environment. They considered how enthusiastic cooperation can be fostered in the creation of a liberated and reengineered office. This was determined not only by each individual's reaction to change, but also by the health care facility's track record with other system installations. For example, document image, diagnostic image, and coded data processing systems allow the integration of divergent health care information systems within complex institutions. Unfortunately, many institutions are currently struggling with how to create an information management architecture that will integrate their mature systems, such as their patient care and financial systems. Information managers must realize that if optical storage technology-based systems are used in a strategic and planned fashion, these systems can act as focal points for systems integration, not as promises to further confuse the issue. Another issue that needed attention in all the examples was the work environment. The managers considered how the work environment was going to affect the ability to integrate optical image and data systems into the institution. For example, many of these medical centers have created alliances with clinics, HMOs, and large corporate users of medical services. This created a demand for all or part of the health information outside the confines of the original institution. Since the work environment is composed of a handful of factors such as merged medical services, as many work environment factors as possible were addressed before application of the optical storage technology solution in the institutions. And finally, the third critical issue was the organization of work. "Organizations that understand their business processes are having no trouble whatsoever justifying the cost of optical storage-based information management systems," said Thornton May, director of imaging research at Nolan Norton Institute. "It is only confusing to organizations that do not have a feel for what is happening in the flow of work in the company. If an organization has on-line performance measurements with regard to time, cost, quality, error rates, and customer service, the move to optical image and data management technology is a no-brainer."(ABSTRACT TRUNCATED AT 400 WORDS) PMID:10119028
Since 1989, the Reference and User Services Association/Management and Operation of User Services Section's Management of Reference Committee has successfully used case studies to foster structured discussions among public service librarians on a wide variety of issues relating to managing change in reference services. The information offered in…
The study objective was to examine the cost-effectiveness and cost savings of a telemedicine program in four adolescent detention facilities in Tennessee. The facilities, in rural communities with limited access to specialty health care resources, implemented a telemedicine and referral program that obtained care from an academic medical center. The study measured costs for specialty outpatient, emergency department, and inpatient
The Telemedicine Program at the State University of New York at Buffalo, School of Medicine, and the Erie County Medical Center (UB/ECMC) represents a "quiet success story" for telemedicine development. Though a relatively young program starting in 1992, it demonstrates steady and consistent progress in the areas of clinical services, education and research as it continues to develop as a comprehensive university telemedicine program. The Emergency Telemedicine program provided 2,294 consultations in 2001. Other services included clinics in Gastroenterology, Infectious Disease (HIV/AIDS), Psychiatry, Orthopedic Hand Surgery, Dermatology, and Neurology. The UB/ECMC program has sponsored regular education activities with a focus on internet protocol (IP) videoconferencing for grand rounds in emergency medicine and traffic injury research, nursing education, distance precepting of nurse practitioner students on clinical rotations, Megaconference I and II presentations, and the continuing exploration of advanced tools for educational presentation over the internet. The program's research activities have focused on portable, roll-about telemedicine systems and virtual palpation using a data glove. PMID:12699610
Introduction Neuromuscular diseases cause a number of limitations which may be improved by using a telemedicine system. These include functional impairment and dependence associated with muscle weakness, the insidious development of respiratory failure and episodes of exacerbation. Material and methods The present study involved three patients with severe neuromuscular disease, chronic respiratory failure and long-term mechanical ventilation, who were followed up using a telemedicine platform. The telemedicine system is based on videoconferencing and telemonitoring of cardiorespiratory variables (oxygen saturation, heart rate, blood pressure and electrocardiogram). Two different protocols were followed depending on whether the patient condition was stable or unstable. Results Over a period of 5 years, we analyzed a series of variables including use of the system, patient satisfaction and clinical impact. Overall we performed 290 videoconference sessions, 269 short monitoring oximetry measurements and 110 blood pressure measurements. With respect to the clinical impact, after enrolment in the telemedicine program, the total number of hospital admissions fell from 18 to 3. Conclusions Our findings indicate that the system was user friendly for patients and care givers. Patient satisfaction scores were acceptable. The telemedicine system was effective for the home treatment of three patients with severe neuromuscular diseases and reduced the need for hospital admissions. PMID:25395959
Governing and managing water resources under changing hydro-climatic contexts: The case Water governance Water management Rhone basin Switzerland a b s t r a c t Climate change represents., Governing and managing water resources under changing hydro-climatic contexts: The case of the upper Rhone
The nonrenewable-with-backstop model of resource management is extended to cover renewables and applied to the case of coastal groundwater. In the optimal management trajectory, efficiency price exceeds extraction cost by the sum of scarcity rent and “drawdown” cost, the latter remaining large even after the backstop price is reached. In the case of rising demand, optimal management may call for
BACKGROUND: Tomorrow's physicians must learn to access, retrieve, integrate and apply current information into ambulatory patient encounters, yet few medical schools teach 'real time' information management. METHODS: We compared two groups of clerkship students' information management skills using a standardized patient case. The intervention group participated in case-based discussions including exercises that required them to manage new information. The control
Heidi S Chumley; Alison E Dobbie; John E Delzell Jr
Introduction: Citrullinemia is a defect in the urea cycle that causes ammonia to accumulate in the blood. We describe the anesthetic management of a patient with citrullinemia, who experienced an unexpected 10 day hospital admission. Case Presentation: We anesthetized a 3.5 year-old boy with citrullinemia who was scheduled for a dentistry procedure. Perioperative precautions included minimizing fasting period, hypothermia prevention, relieving anxiety and pain, perioperative infusion of D10W and benzoate sodium, as well as a pediatric endocrinology consultation. The operation lasted 4 hours and its course was uneventful. He had a delayed recovery from anesthesia and was discharged from hospital after 10 days. Conclusions: General anesthesia and surgery can be a risk factor for exacerbating the course of the disease in patients with citrullinemia. It appears that administering short acting sedatives and analgesics in these patients would be of more benefit. Further studies are required to identify a safe method for anesthesia in citrullinemia. PMID:25289380
An extensive list of side effects and problems are associated with the administration of l-dopa (l-3, 4-dihydroxyphenylalanine) during treatment of Parkinson’s disease. These problems can preclude achieving an optimal response with l-dopa treatment. Purpose: To present a case study outlining a novel approach for the treatment of Parkinson’s disease that allows for management of problems associated with l-dopa administration and discusses the scientific basis for this treatment. Patients and methods: The case study was selected from a database containing 254 Parkinson’s patients treated in developing and refining this novel approach to its current state. The spectrum of patients comprising this database range from newly diagnosed, with no previous treatment, to those who were diagnosed more than 20 years before and had virtually exhausted all medical treatment options. Parkinson’s disease is associated with depletion of tyrosine hydroxylase, dopamine, serotonin, and norepinephrine. Exacerbating this is the fact that administration of l-dopa may deplete l-tyrosine, l-tryptophan, 5-hydroxytryptophan (5-HTP), serotonin, and sulfur amino acids. The properly balanced administration of l-dopa in conjunction with 5-HTP, l-tyrosine, l-cysteine, and cofactors under the guidance of organic cation transporter functional status determination (herein referred to as “OCT assay interpretation”) of urinary serotonin and dopamine, is at the heart of this novel treatment protocol. Results: When 5-HTP and l-dopa are administered in proper balance along with l-tyrosine, l-cysteine, and cofactors under the guidance of OCT assay interpretation, the long list of problems that can interfere with optimum administration of l-dopa becomes controllable and manageable or does not occur at all. Patient treatment then becomes more effective by allowing the implementation of the optimal dosing levels of l-dopa needed for the relief of symptoms without the dosing value barriers imposed by side effects and adverse reactions seen in the past. PMID:21475622
Aim Estimate the efficacy of CaseManagement (CM) for women at high risk for bearing a child with Fetal Alcohol Spectrum Disorders (FASD). Design Women were recruited from antenatal clinics and engaged in 18 months of CM. Setting A South African community with a subculture of heavy, regular, weekend, recreational drinking and high documented rates of FASD. Participants Forty-one women who were high risk for bearing a child with FASD. Measures Statistical analysis of trends in drinking and other risk factors. Findings At intake 87.8% were pregnant, most had previous alcohol-exposed pregnancies, most/all of their friends drink alcohol (67.5%), and 50.0% had stressful lives. CM was particularly valuable for pregnant women, as statistically significant reductions in alcohol risk were obtained for them in multiple variables: total drinks on weekends after six months of CM (p = .026) and estimated peak blood alcohol concentration (BAC) at six (p < .001) and 18 months (p < .001). For participants completing 18 months of CM, AUDIT scores improved significantly by 6-month follow-up (from 19.8 to 9.7, p = .000), and even though rising at 12 and 18 months, AUDIT scores indicate that problematic drinking remained statistically significantly lower than baseline throughout CM. Happiness scale scores correlated significantly with reduced drinking in most time periods. Conclusions An enduring change in drinking behavior is difficult in this social setting. Yet, CM provided by skilled and empathic casemanagers reduced maternal drinking at critical times, and therefore, alcohol exposure levels to the fetus. PMID:24729823
May, Philip A.; Marais, Anna-Susan; Gossage, J. Phillip; Barnard, Ronel; Joubert, Belinda; Cloete, Marise; Hendricks, Natalie; Roux, Sumien; Blom, Annalien; Steenekamp, Jeanetta; Alexander, Theresa; Andreas, Romena; Human, Suzanne; Snell, Cudore; Seedat, Soraya; Parry, Charles C.; Kalberg, Wendy O.; Buckley, David; Blankenship, Jason
Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated casemanagement by a professional, colocation of services, and integrated medical and addiction care—elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective. PMID:19809579
Saitz, Richard; Larson, Mary Jo; LaBelle, Colleen; Richardson, Jessica; Samet, Jeffrey H.
This paper described a 3D image based collaboration system for telemedicine. This system enables doctor to observe 3D images transferred from image database through network, and also has collaboration function which operate 3D position of viewing of each doctor by 3D image displaying and data transferring through network. It is constructed based on server client style, and the server has the function of transferring data from a 3D image database and a collaboration record database, and also has control unit of transferring data between doctors during operating the system. The client has a user interface including operation part for parameter selection of viewing and sending comments, and display part for displaying 3D image based on volume rendering and 3D position and direction of observer by suing avatar. Doctors can use this system to do collaboration work by sending comments with viewing 3D image each other. We implement this system in different platforms including UNIX workstation and PC, and also supply Web browser based user interface for considering various user environments. We applied the 3D images of MRI in head for examining the structure of soft tissues and tumor in detail. We also evaluated the performance of the system through network including LAN and Internet, and experimental result shows that this system is useful.
The people of Estonia, who until their independence had been systematically deprived of all forms of information, have shown a ready acceptance of the use of information technology in all areas of life. This environment and an excellent IT infrastructure have since the beginning of the new century provided favourable conditions for developing various individual projects in telemedicine. At the core of current telemedical applications in Estonia is the BITNET Project (in neurology, general medicine), built up with Swedish cooperation, and three German-Estonian projects (in telecardiology and telepathology). These projects are accompanied by studies of their cost-effectiveness. They constitute the basis for the plan that routine telemedical services be taken over by the Estonian health insurance. Differing from the situation in the Scandinavian countries, which have had an effective national telemedical service for over ten years, the special feature of telematrics in Estonia is its international networking with foreign centres of excellence. This has its origin in the aim of Estonian health policy to ensure medical services within its own country in all branches of medicine. PMID:15133737
Köhler, F; Fotuhi, P; Schierbaum, C; Dietel, M; Baumann, G; Lange, M; Asser, T
BACKGROUND: There is interest as to whether casemanagement reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are. DESIGN: Qualitative study embedded in a wider evaluation. SETTING: Primary health care. METHOD: Analysis of casemanagercase reports in a service innovation evaluation study. RESULTS:
G. Elwyn; M. Williams; C. Roberts; R. G. Newcombe; J. Vincent
Persons who are homeless and mentally illpresent unique challenges to service providers and humanservice systems. In vivo casemanagement approaches suchas assertive community treatment (ACT) have shown promise in engaging this population. This paperexplores casemanagement models employed within theACCESS program, a five year, 18-site demonstrationprogram enriching services for homeless persons with serious mental illness. We describe theimplementation of case
Matthew Johnsen; Laura Samberg; Robert Calsyn; Margaret Blasinsky; Wendy Landow; Howard Goldman
Telemedicine has had a positive impact on some aspects of patient care. However, existing telemedicine systems that use high-quality video are inflexible, requiring investment in fixed infrastructure. We have overcome a number of technical challenges to build a mobile telemedicine system that can reliably deliver high-quality video from both stationary sites and moving vehicles. Our system is constructed using custom software and off-the-shelf hardware, and opportunistically aggregates wireless data connections from different providers. We have evaluated the communication capabilities of our system in a number of realistic experiments. We are about to launch an evaluation of the clinical utility of our system. The system will be used to allow neonatal specialists to participate in the care of critically ill infants at remote sites and during transport. PMID:21347061
Abstract Objective: In this article, we describe the important aspects like major characteristics, research issues, and challenges with body area sensor networks in telemedicine systems for patient monitoring in different scenarios. Present and emerging developments in communications integrated with the developments in microelectronics and embedded system technologies will have a dramatic impact on future patient monitoring and health information delivery systems. The important challenges are bandwidth limitations, power consumption, and skin or tissue protection. Materials and Methods: This article presents a detailed survey on wireless body area networks (WBANs). Results and Conclusions: We have designed the framework for integrating body area networks on telemedicine systems. Recent trends, overall WBAN-telemedicine framework, and future research scope have also been addressed in this article. PMID:23841489
Proposes a perspective of sociotechnical theory relevant to knowledge management within organizations. Finds that management and leadership plays a critical role in establishing the multilevel context for the effective assimilation of knowledge management practice. (Author/CCM)
INTRODUCTION We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition. PRESENTATION OF CASE A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months. DISCUSSION UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis. CONCLUSION Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions. PMID:24291679
Fancellu, Alessandro; Pinna, Antonio; Manca, Alessandra; Capobianco, Giampiero; Porcu, Alberto
Background Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine. Methods A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured. Results This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis. Conclusion As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results. PMID:19852828
Following a randomized trial of casemanager delivered HIV prevention intervention to persons with severe mental illness (SMI), this study sought to document changes within the service environment and with casemanagers themselves as a result of their experience and skills training. Utilizing qualitative methods, researchers conducted focus groups and in-depth interviews with 22 casemanagers and 3 administrators at an urban community mental health center. Beyond confirming previously established barriers to casemanager delivery of HIV prevention interventions for persons with SMI, most noteworthy was the finding that casemanagers were generally unskilled in conducting assessments and tended to focus on “spoiled identity” and illness parts of their consumers. Experimental casemanagers revealed that they had been transformed by the training experience in a manner permitting them to both understand and work from a recovery model. Implications and directions for further study are discussed. PMID:20549558
The Information Age has made profound\\u000a changes in society and is slowly entering the healthcare field. Some of\\u000a the most important areas are telemedicine, the Internet, and the world\\u000a wide web (www). Millions of physicians, healthcare providers, and\\u000a patients are accessing the web daily for patient information,\\u000a consultation, and distant learning. Telemedicine is beginning to\\u000a enter the mainstream of health
The Telemedicine Spacebridge Demonstration Project is a joint U.S./Russian program whose purpose is to further the application of telemedicine both internationally, domestically, and in space. The system has been set up to use a Russian satellite over the Atlantic Ocean and a U.S. domestic satellite to allow physicians a two-way video and audio link between various sites of medical centers in the United States and the Central Hospital in Moscow, Russia. This paper contains a description of the project background, the Spacebridge system, the individual pieces of the system, and the operational experience gained thus far in the project.
Zuzek, John E.; Cauley, Michael A.; Hollansworth, James E.
IMPLEMENTING AN ISO 14001 ENVIRONMENTAL MANAGEMENT SYSTEM A Case Study of Environmental Training an ISO 14001 environmental management system: A case study of environmental training and awareness of limiting environmental damage. Environmental management systems (EMSs), such as ISO 14001, provide
This paper describes a methodology for estimating the true internal costs of construction waste, aimed at promoting environmentally friendly waste management. The study employs cost-benefit analysis, contribution margin analysis, the polluter-pays principle and a mathematical model: the model for Efficient Use of Resources for Optimal Production Economy (EUROPE), which has been introduced previously by the author for assigning industrial costs to waste. The calculations are performed on construction waste created in a case study of a building project. Moreover, waste is regarded as, in a business sense, having the same basic status as any normal industrial product, namely the 'equality principle'. Application of the methodology is suggested to create incentives for environmental and profitability improvement in construction companies and other types of industrial sectors. The results of the case study show the generation of construction waste to substantially decrease the final operating income, due to the internal shadow price cost it creates. This paper is intended to reduce the gap between the choice of waste management procedures and their economic impact, the overall objective being to accomplish an improved industrial environmental situation. PMID:15751391
This study was planned in an experimental manner to use the "casemanagement model" for the care of patients with acute myocardial infarction (MI), and to determine the effect of this method on the quality of care, patient and nurse satisfaction, and the patient's inpatient duration at the hospital. Data for the study were obtained using the Patient Information Form, Acute MI Care Protocol (Clinical Pathway), Care Monitoring Scale and Scoring Form, Acute MI Nursing Care Plan, Patient Education Booklet, and a Patient and Nurse Satisfaction Evaluation Survey. Evaluation results showed that the patient group where the casemanagement model was used had increased quality of care, decreased inpatient stay, and increased satisfaction of the patient and the nurse. Therefore, it was suggested that the casemanagement model be used in healthcare institutions in Turkey, care protocols for various diagnoses be developed, and nurses should be trained as casemanagers to increase the quality of care at healthcare institutions. PMID:16926693
Abstract Background: Although effective psychotherapies for posttraumatic stress disorder (PTSD) exist, high percentages of Veterans in need of services are unable to access them. One particular challenge to providing cost-effective psychological treatments to Veterans with PTSD involves the difficulty and high cost of delivering in-person, specialized psychotherapy to Veterans residing in geographically remote locations. The delivery of these services via clinical videoteleconferencing (CVT) has been presented as a potential solution to this access to care problem. Materials and Methods: This study is a retrospective cost analysis of a randomized controlled trial investigating telemedicine service delivery of an anger management therapy for Veterans with PTSD. The parent trial found that the CVT condition provided clinical results that were comparable to the in-person condition. Several cost outcomes were calculated in order to investigate the clinical and cost outcomes associated with the CVT delivery modality relative to in-person delivery. Results: The CVT condition was significantly associated with lower total costs compared with the in-person delivery condition. The delivery of mental health services via CVT enables Veterans who would not normally receive these services access to empirically based treatments. Additional studies addressing long-term healthcare system costs, indirect cost factors at the patient and societal levels, and the use of CVT in other geographic regions of the United States are needed. Conclusions: The results of this study provide evidence that CVT is a cost-reducing mode of service delivery to Veterans with PTSD relative to in-person delivery. PMID:23931729
Raab, Michelle; Mackintosh, Margaret-Anne; Rosen, Craig S.; Dismuke, Clara E.; Greene, Carolyn J.; Frueh, B. Christopher
Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments. There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity. Because astronauts are selected for their health, among other factors, disease and illness are minimized. However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur. With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth. At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars. These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks. Crews of long-duration missions must become more independent from ground controllers. New systems, protocols, and procedures are currently being perfected. Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care. Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments. These technologies will also serve as a basis to enhance training and medical education. The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth. PMID:9599070
CaseManagers are in the middle of the upcoming HIPAA regulation changes, with the issuance of the Final Privacy Rule. Every case obliges casemanagers to work with Individually Identifiable Health Information (IIHI) and Protected Health Information (PHI). The purpose of this article is to provide casemanagers in all practice settings with a clear understanding of a "Business Associate," of a "Covered Entity," and of the specifics of a Business Associate Contract. This information will demonstrate how casemanagers can benefit from the use of these contracts in their business life. As an essential component of an organization's compliance plan, Business Associate Contracts can become a sword or a shield. This article is particularly helpful to casemanagers in independent practice, as well as those who work for Covered Entities. PMID:12555038
This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of casemanagement with the severely and persistently mentally ill. Summative findings were: (1) Overall, casemanagement interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense casemanagement service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various casemanagement practice models did not differ significantly on estimated effectiveness. Important questions concerning the differential effectiveness of casemanagement by specific program, worker, client, and client-worker relationship characteristics remain to be answered. PMID:9607161
Gorey, K M; Leslie, D R; Morris, T; Carruthers, W V; John, L; Chacko, J
Merkel cell carcinoma is a rare, highly malignant skin tumor with a predisposition for local, nodal and distant recurrence which should be managed in a multimodal approach. Here, we performed a retrospective analysis of 36 patients, treated from 1984 to 1994. In patients with stage I disease, locoregional recurrence after surgery alone occurred in 65% compared to 43% after excision and adjuvant radiotherapy. Although the difference in disease-specific survival was not significant (67% versus 52% at 5 years), combination therapy conferred a benefit for locoregional control and relapse-free survival (88 versus 58 months). The majority of failures (54%) occurred within the draining lymph nodes that were not treated in the initial approach and locoregional recurrence was strongly associated with a later systemic relapse (50% versus 0%). Salvage after localized recurrence was achieved in 67% of resectable cases. The high rate of nodal recurrence after surgery alone warrants the use of elective nodal treatment in patients with stage I disease. Surgical resection of the primary tumor should be followed by postoperative radiotherapy to the primary site and draining lymph nodes. Even after locoregional recurrence, a substantial proportion of patients is able to achieve long-term disease-free survival, particularly after complete resection and adjuvant irradiation. PMID:12684627
Müller, Anja; Keus, Ronald; Neumann, Norbert; Lammering, Guido; Schnabel, Thomas
The Theater Battle Management Core System (TBMCS) is an integrated air command and control (C2) system that performs standardized, secure, automated air battle planning and execution management for Air Force, multi-service, and allied commanders in theate...
Feral cat management is a highly debated topic. Trap, Neuter, and Return (TNR) programs have become increasingly popular as an alternative to eradication. Public preference about how to manage feral cats has been explored by previous authors, but no consensus has been reached. Public policy and best management practices depend in part upon public opinion on this topic. Wording of
This study looks at two regional New South Wales tourism organisations heavily dependant on volunteers in order to analyse whether managers understand what motivates their volunteers and whether, as a result, they have any management strategies in place to retain current volunteers and to attract new ones. The Volunteer Function Inventory (VFI) was used to measure both management and volunteer
Human resources (HR) represent a key resource for the health care system in any coun try. Its development and management are considered vital for establishing a sustain able health system infrastructure. A human resources management information system (MIS) is essential for sound planning and management of a health system. This paper briefly discusses the conceptual development of health care human
Whilst the extant diversity management literature has provided a comprehensive array of theoretical frameworks and empirical studies on how organizations can and have approached the management of a diverse workforce, the same cannot be said about the literature on diversity in an international setting. Indeed, from a diversity management perspective we know surprisingly little about how multinational firms are responding
...production casing annulus (A annulus). (3) hybrid* wells,............ the...day for the production casing. (c) hybrid wells,............. continuously...measured at the subsea wellhead. (3) hybrid...
Airsickness is the most significant medical condition affecting naval aviation training. A 2001 study showed that airsickness was reported in 81% of naval aviation students and was associated with 82% of below average flight scores. The cost to a single training air-wing was over $150,000 annually for fuel and maintenance costs alone. Resistent cases are sent to the Naval Aerospace Medical Institute (NAMI) for evaluation and desensitization in the self-paced airsickness desensitization (SPAD) program. This approach is 75% successful, but can take up to 8 weeks at a significant travel cost. NASA Ames Research Center's Autogenic Feedback Training Exercises (AFTE) uses physiological and biofeedback training for motion sickness prevention. It has a remote capability that has been used from Moffett Field, CA to Atlanta, GA . AFTE is administered in twelve (30-minute) training sessions. The success rate for the NASA AFTE program has been over 85%. Methods: Implementation Phases: Phase I: Transfer NASA AFTE to NAMI; NASA will remotely train aviation students at NAMI. Phase II: NAMI-centered AFTE application with NASA oversight. Phase III: NAMI-centered AFTE to remotely train at various Navy sites. Phase IV: NAMI to offer Tri-service application and examine research opportunities. Results: 1. Use available telemedicine connectivity between NAMI and NASA. 2. Save over $2,000 per student trained. 3. Reduce aviation training attrition. 4. Provide standardization of multi-location motion sickness training. 5. Future tri-service initiatives. 6. Data to NASA and Navy for QA and research opportunities.
Acromite, Michael T.; Cowings, Patricia; Toscano, William; Davis, Carl; Porter, Henry O.
In this paper we propose a novel telemedicine system capable of medical data acquisition, transmission, integration and analysis. In detail, the proposed system consists of: 1) a wearable acquisition system for ECG (electrocardiogram), EEG (electroencephalogram), body temperature and blood pressure, 2) a storage\\/analysis center where the acquired medical data are integrated into a Personal Health Record (PHR) system that also
Alberto Faro; Daniela Giordano; Isaak Kavasidis; Concetto Spampinato
Objective: To evaluate differences between rural older adults with diabetes reporting the presence or absence of food insecurity with respect to meal planning, preparation, shopping, obesity, and glycemic control after receiving nutrition counseling through telemedicine. Methods: Food insecurity data were obtained by telephone survey (n = 74).…
Homenko, Daria R.; Morin, Philip C.; Eimicke, Joseph P.; Teresi, Jeanne A.; Weinstock, Ruth S.
Telemedicine and e-health is the use of electronic information and advanced telecommunication technologies to support long distance clinical health care,patient's health records, patients and professional health related education, public health and health administration. As Nigeria enters the world of telehealth, there are concerns about the level of information and knowledge of health care providers who are to operate the programme.
In this contribution, a new concept for interfacing sensor network nodes (motes) and smartphones is presented for the first time. In the last years, a variety of telemedicine applications on smartphones for data reception, display and transmission have been developed. However, it is not always practical or possible to have a smartphone application running continuously to accomplish these tasks. The
Lorenzo T. D'Angelo; Michael Schneider; Paul Neugebauer; Tim C. Lueth
The purpose of this study was to evaluate the outcomes of group speech therapy for individuals with Parkinson Disease (IWPD) in general and to compare outcomes of group treatment delivered face-to-face (FtF) versus delivery via telemedicine (TM...
The practice of medicine, with its wide range of environmental conditions and complex dependencies, has long been used as a testbed for various advanced technologies. Telemedicine as conceptualised within the Multimedia Super Corridor (MSC) context is seen as the application of several relatively mature technologies— artificial intelligence (AI), multimedia communication and information systems (IS) amongst others. We will discuss in
DEVELOPING LOCALLY RELEVANT APPLICATIONS FOR RURAL SOUTH AFRICA: A TELEMEDICINE EXAMPLE on the local culture and traditions of the Eastern Cape. Â· Chris Morris of the Council for Scientific, there is a digital divide between rural and urban areas. In order to overcome this division, we need to provide
This brief report discusses the use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy (PCIT). PCIT is an empirically supported behavioral parent training program for reducing disruptive behavior in young children and for reducing future rates of child physical abuse. The positive impact PCIT has demonstrated in reducing child maltreatment has galvanized interest in widespread dissemination
Beverly W. Funderburk; Lisa M. Ware; Elizabeth Altshuler; Mark Chaffin
The current medical system provides medical services to patients who visit hospitals. However, medical services can be provided at or close to the home of the patient using fully-equipped mobile telemedicine systems. Such a system can identify diseases at an early stage, improve the patient's quality of life and prognosis through early diagnosis and treatment, and reduce the cost of
Despite the opportunities the health sector will offer as a result of the design and development of a technology infrastructure, the fact is that hospitals have been slow to adopt telemedicine technologies, largely because very few organisations are prepared to face this challenge. A possible explanation for the efficiency and effectiveness gaps of services provided by Hospital-in-the-Home Units (HHUs) may
Juan-Gabriel Cegarra-Navarro; Gabriel Cepeda Carrión
The Strengths model of team casemanagement was assessed relative to an existing high quality psychosocial rehabilitation program that informally provided many services typical of casemanagement (e.g., service linkage, monitoring, and consumer advocacy). The experimental evaluation triangulated consumer and family member responses with mental health professional reports and consumer records of hospitalization and crisis center contacts. An analysis of
Cathaleene Macias; Ronald Kinney; O. William Farley; Robert Jackson; Betty Vos
Case-based reasoning (CBR) is a problem solving technique that reuses past cases. It guarantees its ability of reasoning to continuously enhance with a self-learning function. Meanwhile, it is an important means for enterprises to deal with similar competitive intelligence. This paper will introduce CBR technology into the field of stakeholders management and build a knowledge model of stakeholder management strategy
Casemanagement is a component of school nurse practice that provides an opportunity to demonstrate the contribution that school nurses make to the health and academic success of children, particularly children with chronic health conditions. However, casemanagement programs vary in their mission and scope, leading to confusion about what it…
Engelke, Martha Keehner; Guttu, Martha; Warren, Michelle B.
An HIV knowledge survey and qualitative interview were administered to 20 casemanagers in community-based programs for troubled youth to assess HIV knowledge and their perception of client HIV risk behaviors. Participants had good HIV knowledge. Casemanagers perceived client youth to be at high risk for HIV infection due to unsafe sexual…
Smith, Michael D.; Seal, David Wyatt; Hartley, Shannon
Job Title Housing CaseManager (Texas City Location) Employer/ Agency Goodwill Industries of Houston Job Description Provides direct support services and casemanagement to help veteran families who a job opportunity or if your response to this job posting results in successful employment, please email
Job Title CaseManager/Veterans Employer/ Agency Neighborhood Centers, Inc Job Description Summary or if your response to this job posting results in successful employment, please email the GCSW Office: The CaseManager/ Veterans assesses the needs of Veterans household to develop and implement a service plan
This TIP contains information on the best practice guidelines on casemanagement for substance abuse treatment providers. It serves to educate program coordinators and facilitators about the factors to consider as they decide to modify or implement casemanagement activities. Many substance abuse clients arrive for treatment with a number of other…
Cook, Paddy; Dogoloff, Mary Lou; Harteker, Linda; Nelson, Anne E.; Paul, Michelle M.; Shuman, Deborah J.; Mjoseth, Marcia; Vitzthum, Virginia; Hayes, Elizabeth; Gilbert, Max; Smith, Cara; Nguyen, Y-Lang
This article explains how individual academic casemanager intervention programs were implemented in three urban middle schools. Academic casemanagers helped students integrate their personal lives with academic expectations by helping students learn to cope with their own personal challenges with the goal of improving their academic performance.…
Van Kannel-Ray, Nancy; Zeller, Pamela J.; Lacefield, Warren E.
In Sweden, as in many other countries, paramedics or nurses constitute the majority of prehospital personnel. If tasks usually performed by doctors are to be performed by these personnel, there is a need for guidelines and triage in the handling of medical emergencies. We describe an information management system used in ambulances for data communication, documentation, triaging and presentation of checklists. In most cases, data are input while the patient is being cared for. The information is collected and stored together with data automatically received from the dispatch centre. The latter date are transferred by a mobile radio network to the ambulance. Medical date (e.g. electrocardiograms) are transferred from the ambulance over the data network to the receiving medical facility. All transferred data are finally collected in a database for statistical analysis and follow-up. PMID:10824383
The British National Health Service (NHS) has experienced a number of changes in management over the last 20 years resulting in management development becoming a greater priority. Consequently, hospitals and other NHS organisations have rapidly introduced competence-based management development programmes for their staff. This paper reports in depth on a case study of a partnership between a hospital trust and
Purpose – This paper aims to examine how Chinese apparel retailers manage their production outsourcing risks and why they elect to manage those risks in a particular manner. Design\\/methodology\\/approach – The investigation used the case study approach to explore factors driving two Chinese apparel retailers operating in different market environments to manage their production outsourcing risks. Findings – The selection
The term computer managed instruction (CMI) often refers to a set of functionalities which allow learning objects to be launched in the learning management system and to exchange data with it. A framework for the support of CMI functionalities in learning management systems, named CMIFramework, has been developed at the University of Salerno. In this paper, we present two case
ICT Driven Knowledge Management in Developing Countries: A Case Study in a Chinese Organisation Jin.firstname.lastname@example.org Abstract. Current research of knowledge management (KM) is mostly based on experience in developed developing countries context than just China. Keywords: Knowledge Management, ICT adoption, Chinese
Managing Performance to Align the Participants of Collaborative Networks: Case Studies Results.email@example.com Abstract. The paper underlines the interest of using a performance management system applied to monitor with this study is to verify if a performance management system helps decision- makers reach the alignment among
9-1 Chapter 9 Urban Stormwater and Watershed Management: A Case Study James P. Heaney, Len Wright, and David Sample Overview Interest in watershed management has waxed and waned over the past century. The concept of integrated water and land management was first articulated in the western U.S. by John Wesley
Classroom management is a concern for preservice teachers (Charles, 2008). Teacher educators struggle to find the most effective ways to teach preservice teachers classroom management. Role-playing, combined with classroom management content, may offer a productive approach. As such, this study focused on the use of role-play with case studies to…
In 1991, the School of Nursing at San Francisco State University initiated a master's degree program in casemanagement/long-term care. It was one of the first programs in the country to take a broad view of long-term care to include client populations from infancy through old age and to prepare nurses at the graduate level in the casemanagement role. This article describes the methods for developing the program, identifies major areas of professional competence in casemanagement, describes the program and major teaching approaches, and presents preliminary evaluation findings. The experience at San Francisco State may provide other nursing faculty, staff educators, and casemanagement trainers with helpful information for developing educational programs and continuing education courses in casemanagement. PMID:7580954
A substantial body of literature has examined the importance of the working alliance in psychotherapy; few works have examined it in the context of casemanagement Qualitative methods were used to examine how 26 persons with substance abuse problems perceived the working alliance with casemanagers who practice from the strengths perspective. Clients' narratives emphasized the personal qualities of the casemanager and the nature of the client-casemanager relationship. Their narratives also reflected two guiding principles of strengths-based casemanagement: personal control over goal-setting, and an emphasis on strengths. Most clients concluded that a positive working alliance helped them to build trust, self-worth, and self-esteem. PMID:18159777
Redko, Cristina; Rapp, Richard C; Elms, Cindy; Snyder, Mindy; Carlson, Robert G
Examines the factors which underpin the success of industry-academic partnerships in management development. Uses data drawn from an in-depth case study of Cummins Engine Company Limited. Reviews the literature on company-university partnerships and work-based learning in management development and provides information on the background of the case-study organization. Reports on the experience of developing management training programmes for supervisors and
Background Casemanagement programmes for home-dwelling people with dementia and their informal carers exist in multiple forms and shapes. The aim of this research was to identify the essential components of casemanagement for people with dementia as well as the preconditions for an effective delivery of casemanagement services. Method The method used to carry out the research was a modified four-phase Delphi design. First, a list of potentially essential components and preconditions for the provision of casemanagement was drawn up on the basis of a literature review and a subsequent focus group interview. The list was then validated by experts in a first Delphi survey round, following which the researchers translated the list items into 75 statements. In the second Delphi survey, the experts rated the statements; in the third Delphi round, they rated 18 statements on which no consensus had been reached in the second round. Results The experts were able to build consensus on 61 of the 75 statements. Essential components of casemanagement for people with dementia are: information, support and counselling, coordination of the care provided and, to a lesser extent, practical help. A patient-centred approach was found to be one of the key aspects of providing casemanagement services. Essential preconditions are: vision, care relationship, structured methodology, integration of casemanagement into the health care chain, and the casemanager's level of training and expertise. Conclusions We recommend that, based on the essential components and preconditions referred to above, quality criteria be developed for the provision of casemanagement for people with dementia. Furthermore, we suggest the conduct of additional research to assess the effectiveness of casemanagement in people with dementia. PMID:20696035
A prototype project management system was developed for the Level III Project Office for the Space Station Freedom. The main goal was to establish a framework for the Space Station Project Office whereby Project and Office Managers can jointly establish and review scheduled milestones and activities. The objective was to assist office managers in communicating their objectives, milestones, schedules, and other project information more effectively and efficiently. Consideration of sophisticated project management systems was included, but each of the systems had limitations in meeting the stated objectives.
Bishop, Peter C.; Learned, David B.; Yoes, Cissy A.
Rhinoscleroma is a rare entity encountered in anesthesia practice. We discuss the management of a patient after its recurrence, involving the upper respiratory tract i.e. nasopharynx and oropharynx, which compromised the airway. The pateint was referred for anesthesia on three different occasions with different presentations owing to the recurrence of symptoms.The presence of an oropharyngeal membrane with a small opening made airway management a challenge. The patient was successfully managed on all three occasions. Imaging facilitated assessment and subsequent airway management. PMID:21897516
Ultrasound was used as adjunct to radiographic imaging in the assessment and management of metallic fragments in five cases encountered in forward-deployed military facilities. Although metallic fragments are usually seen well on radiographs, ultrasound can add details of the surrounding soft-tissue structures and clarify location. Portable handheld units are well suited for studies when probe selection and equipment adjustments are correct. In selected cases, ultrasound information can favorably influence casemanagement. PMID:22934382
The helping relationship or alliance is theorized to be an important process variable in casemanagement services for people\\u000a with serious mental illness. Previous studies of the casemanagement relationship borrow concepts and measures from psychotherapy\\u000a research and therefore may overlook important differences in tasks, settings, and clinical roles across settings. A study\\u000a of client–provider relationships as perceived by case
Load management programs have become increasingly valuable in recent times as a result of electricity deregulation and volatile energy prices. The ability to manage loads by load reduction or load shifting quickly and effectively with minimal interference to a company's operations can be very valuable to the energy user. This article discusses a general approach and methodology toward effective load
The introduction of an online learning management system (LMS) raises a number of complex issues involving institutional responses at various levels to the adoption and diffusion of technological change. Issues include those related to governance, management and technical support, as well as to core learning and teaching matters associated with…
The effective and efficient implementation of change is often required for both successful performance and management survival across a host of contemporary domains. However, although of major theoretical and practical significance, research to date has overlooked the application of change management (hereafter CM) knowledge to the elite sport performance team environment. Considering that the success of ‘off-field’ sports businesses are
Traditional Chinese governance based on “information islands” has negatively affected e-government evolution. E-government has been a mostly debated concept in the domain of public management in recent years just as what has happened to lean supply chain in the field of business management. Yet, there has been few discussion of the relationship between the two in the past. This paper
Management education is truly at crossroads especially after scandals like Enron, which have put corporate reputation at great stake. Are Business Schools failing in training the future managers in their legal and ethical responsibilities to society? Can teaching Corporate Governance (CG) to business students help to develop a CG culture in business organizations. Taking up this issue, the study investigates
Post-modern theorists have challenged the totalizing and unifying ambitions of change management practices. This paper explores how a narrative action research approach may be used to combine our modernist commitment to facilitate change and collaboration in the land management context with a post-modern sensitivity to complexity and difference.…
BACKGROUND: The Ministry of Health and Medical Education in the Islamic Republic of Iran has undertaken a reform of its health system, in which-lower level managers are given new roles and responsibilities in a decentralized system. To support these efforts, a United Kingdom-based university was contracted by the World Health Organization to design a series of courses for health managers
Maye Omar; Nancy Gerein; Ehsanullah Tarin; Christopher Butcher; Stephen Pearson; Gholamreza Heidari
Performance indicators for locally managedirrigation systems in the Gediz Basin,Turkey, show that during the first fouryears after management transfer there wasbeen a continued improvement in irrigationperformance. While the area cropped usingsurface water has only marginally improved,yields and water productivity have shownsignificant increases. These benefits canbe attributed in part to favorable marketconditions for cotton and grapes, but alsoto a management system
Purpose – It is argued that ethical ideology espoused by an individual provides the framework within which individuals contemplate the issues and determine the right way to behave. This paper aims to report the findings of a study designed to examine the ethical orientations of managers. Design\\/methodology\\/approach – This study was conducted on a sample of 175 managers and was
A postal questionnaire survey about the forest situation and management in urban woodland was carried out around the three largest urban agglomerations in each of the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden. Twenty estate managements responded, giving a respondent rate of 54%. Our material from 13 cities includes 108,888ha productive forests, representing approximately 13% of all urban
Vegard Gundersen; Lars Helge Frivold; Irja Löfström; Bruno Bilde Jørgensen; Jan Falck; Bernt-Håvard Øyen
In Fall 2003, Randolph-Macon Woman's College rolled out Claroline, an Open Source course management system for all the classes on campus. This document will cover some background on both Open Source in general and course management systems in specific, discuss technical challenges in the introduction and integration of the system and give some…
In the process of China's agricultural modernization, especially agricultural machinery modernization, in terms of equipment, we've chose the way that foreign imports (and domestic research) with the combination of self-developed, in the software, it is difficult to fully apply this approach, the specific reasons are: the modernization of China's agriculture development model is diversified, it is difficult to find a unified management model, even in the scale of operations of the representative state-owned farms and the abroad farms are also very different management models. Due to various types of growth models of biological complexity, diverse climatic and geographical environment factors, coupled with the characteristics such as long cycle of agricultural production, high input, high-risk, and decentralized management, industrial management mode it is very difficult to apply. Moreover, the application of modern management tools is also difficult to quantify the benefits, leading to the current research and application are in a state of comparatively dropped behind.
Background A community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. Objective Assess the long-term effects of a community-based casemanagement program for providing rehabilitations services to individuals with schizophrenia. Methods A total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the casemanagement group and 350 in the control group from two districts in Shanghai. Casemanagement involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as ‘self-determined medication discontinuation’. Results Compared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the casemanagement program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort. Conclusions Casemanagement is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients’ medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects. PMID:25114486
Casemanagement has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of casemanagement among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of casemanagement compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of casemanagement, some evidence is available about the (differential) effectiveness of intensive casemanagement and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist casemanagement have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and casemanagement. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes. PMID:17523588
Vanderplasschen, Wouter; Wolf, Judith; Rapp, Richard C.; Broekaert, Eric
Background Eighty-five per cent of the Ethiopian population lives in remote areas, without access to modern health services. The limited health care budget, chronic shortage of health care workers and lack of incentives to retain those in remote areas further jeopardize the national health care delivery system. Recently, the application of information communication technology (ICT) to health care delivery and the use of telemedicine have raised hopes. Objective This paper analyzes the challenges, failures and successes encountered in setting-up and implementing a telemedicine program in Ethiopia and provides possible recommendations for developing telemedicine strategies in countries with limited resources. Design Ten sites in Ethiopia were selected to participate in this pilot between 2004 and 2006 and twenty physicians, two per site, were trained in the use of a store and forward telemedicine system, using a dial-up internet connection. Teledermatology, teleradiology and telepathology were the chosen disciplines for the electronic referrals, across the selected ten sites. Results Telemedicine implementation does not depend only on technological factors, rather on e-government readiness, enabling policies, multisectoral involvement and capacity building processes. There is no perfect ‘one size fits all’ technology and the use of combined interoperable applications, according to the local context, is highly recommended. Conclusions Telemedicine is still in a premature phase of development in Ethiopia and other sub-Saharan African countries, and it remains difficult to talk objectively about measurable impact of its use, even though it has demonstrated practical applicability beyond reasonable doubts. PMID:22479235
The CMS efficiency measure has once again raised the issues of length of stay management and cost reduction. These have always been a component of the role of the hospital-based casemanager. In today's best practice models, these interventions must be correlated with the roles of coordination and facilitation of care, discharge planning and utilization management. The casemanager's roles and functions, as well as staffing ratios, must be designed in such a way as to allow for this integration of roles. Be sure that your department is focusing on how to embed this important function in your everyday practice! PMID:25420300
Given the demand for authentic personal interactions over social media, it is unclear how much firms should actively manage their social media presence. We study this question empirically in a health care setting. We show ...
Are watershed processes controlling the yield, transport, and transformation of carbon, nitrogen, and phosphorous scientifically understood and amenable to man's control in an ecological management framework? or many large estuarine ecosystems such as the Hudson, Chesapeake Bay, ...
ObjectiveThe aim of this study is to describe the clinical management of a young male patient with sciatica symptoms that developed after an avulsion of the ischial tuberosity. This is a rare injury, but complications may occur.
Nancy Mayrand; Joel Fortin; Martin Descarreaux; Martin C. Normand
Purpose – The objective of this paper is to develop a model for planning and establishment of knowledge management (KM) strategy in one of the Iranian Sub-stream Aerospace Industries Organization to improve company's performance. Design\\/methodology\\/approach – This research tries to use multi-method approach by integrating balanced score card, which is a renowned strategic management approach, and Nonaka and colleagues' knowledge
Mostafa Jafari; Jalal Rezaeenour; Peyman Akhavan; Mehdi N. Fesharaki
ABSTRACT Reputation management,is by,no,means restricted to companies and other organizational entities. In fact, nations today are increasingly concerned with their reputation relative to other nations and turn to actively measuring and managing that reputation. This paper draws on findings from an extensive study of the reputa- tion and identity of the Principality of Liechten- stein, conducted from April to December
We describe a case of uterine necrosis, following Gelitaspon(®) embolization for postpartum hemorrhage resulting from vaginal laceration. Previous cases published help to improve the safety of this effective method by showing the risk factors, as particles sizes, ultraselective embolization, prevention of infection. Controlling bleeding by surgery is the priority when hemorragy is due to laceration without uterin atony. In case of failure, embolization is an option which should be proposed without delay. Uterine necrosis should be suspected in case of postembolization septic syndrome. PMID:23706157
Gitz, L; Picone, O; Mas, A-E; Dagher, L; Deffieux, X
This article examines the environment and habitat management experiences of Ethiopia and Ghana in the postindependence period (1960-2000). Based on extensive archival research, semistructured focused interviews of environment and habitat officers of the World Bank, the United Nations System and the International Union for the Conservation of Nature (IUCN) and personal professional field experiences, the paper argues that the uncritical adoption of externally generated discourses, narratives, policy guidelines, and strategies of environmental and habitat management has structured thought and action in both countries. The experience of both countries in defining and responding to environmental and human settlement management is explored from a political ecology perspective. The analysis indicates that both countries have essentially adopted a technocratic, state-centered, and unsustainable management strategy framework based on population control, poverty reduction, sustainable development, and capacity-building. It also suggests that international organizations such as the World Bank, INCN, and the United Nations system have been important sources of thought and action in both countries. Conversely, regional international organizations such as the Economic Commission for Africa, the Organization of African Unity and the African Development Bank have largely served as conduits for the diffusion of global discourses, narratives, policies and strategies. The need for adopting management policies and strategies that are based on principles of multiple engagement, decentralization, incentives, public education, and participation is underscored. PMID:12592447
Cancer pain management is a crucial aspect of patients' quality of life. During the course of the disease, patients with cancer may develop difficult pain management problems that do not respond to interventions that use the basic principles of pain management. Ongoing assessment, multiple approaches, and excellent communication among all care management team members are critical. Pain management goals must be continually evaluated, reestablished if necessary, and negotiated by patients and the team. Difficult pain managementcases demand the involvement of all team members, especially patients, to assist in determining acceptable approaches. Nurses must recognize the challenge, advocate for better management, and provide ongoing assessment. Ultimately, pain management outcomes are determined by nursing advocacy. Through nurse leadership, suffering is minimized and quality of life is improved for this patient population. PMID:16482727
Because of the multifaceted, chronic, and relapsing nature of substance use disorders, casemanagement has been adapted to work with persons who have these disorders. Deliberate implementation has been identified as a powerful determinant of successful casemanagement. This article focuses on six key questions about implementation of casemanagement services on the basis of a comparison of experiences from the United States, the Netherlands, and Belgium. It was found that casemanagement has been applied in various populations with substance use disorders, and distinct models have been associated with positive effects, such as increased treatment participation and retention, greater use of services, and beneficial drug-related outcomes. Program fidelity, robust implementation, extensive training and supervision, administrative support, a team approach, integration in a comprehensive network of services, and minimal continuity have all been linked to successful implementation. PMID:15292541
Vanderplasschen, Wouter; Rapp, Richard C.; Wolf, Judith R.; Broekaert, Eric
Based on availability of casemanagement services, drug-involved women offenders entered either a probation casemanagement (PCM) intervention (n = 65) or standard probation (n = 44). Participants were placed in the casemanagement condition until all slots were filled, then placed in standard probation until casemanagement slots opened. Participants were interviewed at program entry and at 6 and 12 month follow-up using measures of substance abuse, psychiatric symptoms, and social support. Results showed modest change over time in both conditions, but PCM did not result in more services or treatment, or in better outcomes, than standard probation. These findings are discussed in the context of study limitations, and in the context of state initiatives like those in Arizona and California designed to apply treatment as an alternative to incarceration. PMID:22719108
... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.515 What is required for casemanagement? Social services workers must document...specific program requirements. The social services agency is...
... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.515 What is required for casemanagement? Social services workers must document...specific program requirements. The social services agency is...
... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.515 What is required for casemanagement? Social services workers must document...specific program requirements. The social services agency is...
... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.515 What is required for casemanagement? Social services workers must document...specific program requirements. The social services agency is...
... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.515 What is required for casemanagement? Social services workers must document...specific program requirements. The social services agency is...
As surgeons, we are often faced with treating many dermatologic and facial lesions. We present a case ofrhinophyma as well as review the medical and surgical management of such a condition. PMID:24772833
Ferneini, Elie M; Banki, Mohammad; Paletta, Frank; Ferneini, Christina M
This case study presents some of the internal human relations problems that do or could exist in a project management office. The major issues presented are focused on the interpersonal relations between the military officer and his civilian counterpart i...
The Environmental Protection Agency (EPA) Office of Water has released a publication concerning the quality of drinking water in America that supplements the recent 1997 National Public Water System Annual Compliance Report (discussed in the April 28, 1999 Scout Report for Science & Engineering). This report documents the experiences of seventeen drinking water suppliers who draw from lakes, reservoirs, and rivers in their efforts to manage and protect their sources. The report covers topics such as creating partnerships, watershed assessment, land use in watersheds, and wastewater management.