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  • 机译 比较服务不足的黑人和西班牙裔心衰患者的远程医疗自我管理与标准门诊管理的随机对照试验
    摘要:Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days.Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate.Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83–2.27), hospitalization (RR = 0.92, CI = 0.57–1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50–28%; COM = 57–13%; p = 0.05).Conclusions: These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.
  • 机译 远程医疗的质量保证:遵守循证指标
    摘要:Background: Value enhancing telehealth (TH) lacks a robust body of formal clinically focused quality assessment studies. Innovations such as telehealth must always demonstrate that it preserves or hopefully advances quality.Introduction: We sought to determine whether adherence to the evidence-based Choosing Wisely (CW) recommendations (antibiotic stewardship) for acute sinusitis differs for encounters through direct-to-consumer (DTC) telemedicine verses “in-person” care in an emergency department (ED) or an urgent care (UC) center.Materials and Methods: Study design was a retrospective review. Patients with a symptom complex consistent with acute sinusitis treated through DTC were matched with ED and UC patients, based upon time of visit. Charts were reviewed to determine patient characteristics, chief complaint, final diagnosis, presence or absence of criteria within the CW guidelines, and whether or not antibiotics were prescribed. The main outcome was adherence to the CW campaign recommendations.Results: A total of 570 visits were studied: 190 DTC, 190 ED, and 190 UC visits. The predominant chief complaints were upper respiratory infection (36%), sore throat (25%), and sinusitis (18%). Overall, there was a 67% (95% CI 62.3–71.7) adherence rate with the CW guidelines for sinusitis: DTC visits (71%), ED visits (68%), and UC visits (61%). There was a nonsignificant difference (p = 0.29) in adherence to CW guidelines based upon type of visit (DTC, UC, and ED).Discussion: The challenge is to demonstrate whether or not DTC TH compromises quality.Conclusion: In this study, DTC visits were associated with at least as good an adherence to the CW campaign recommendations as emergency medicine (EM) and UC in-person visits.
  • 机译 在城市远眼科计划中,眼科护理人员之间的糖尿病性视网膜病变评估差异
    摘要:Background: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability.Introduction: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program.Methods: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (Ppos) or negative agreement (Pneg) were used to assess variability.Results: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% ± 4.6%, Pneg = 0.91–0.95), presence of moderate nonproliferative or worse retinopathy (87% ± 3.9%, Ppos = 0.67–1.00), and presence of macular edema (99% ± 0.9%, Ppos = 0.67–1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% ± 11%, Ppos = 0.21–0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% ± 8.1%, Ppos = 0.19–0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% ± 5.0%, Ppos = 0.50–0.90).Discussion: Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times.Conclusions: Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.
  • 机译 第三届全国远程医疗与远程医疗服务提供商展示会议:推进远程医疗合作伙伴关系
    摘要:Introduction: As telemedicine and telehealth services are experiencing increasing rates of adoption, industry leaders and healthcare service providers are becoming increasingly focused on human resource issues encountered in the delivery of a broad range of telehealth services. To create a forum for the discussion of many interrelated elements of telehealth service industry, a national conference entitled “Telemedicine & Telehealth Service Provider Showcase” (SPS) Conference was established in 2014, and repeated in 2016 and 2017, in Arizona. These SPS Conferences include thought leaders, telehealth service providers, government administrators, and academicians from leading programs addressing service provider workforce issues.Methods: This report summarizes the content of SPS 2017 conference, held in Phoenix, AZ, October 2–3, 2017. The topics covered at SPS 2017 include using telehealth services as a strategic asset; development of appropriate effective partnerships; direct-to-consumer initiatives; important reimbursement, legislative, and regulatory issues (i.e., Centers for Medicare & Medicaid Services [CMS] approaches, financial models, and return on investment [ROI]); marketing; evaluation and applied metrics; remote monitoring and sensors; integration with electronic health records; and overall lessons learned.Results: The content of SPS 2017 is summarized in the body of this report. The SPS 2017 program evaluators included attendees, speakers, and exhibitors. The knowledge attendees gained at SPS 2017 was characterized, by all three groups, as forward-looking and practical.Conclusion: SPS 2017 succeeded in identifying, and focusing on, solutions for issues, challenges, and barriers impacting the rapidly expanding telehealth service segment of the healthcare industry. The growing interest in this annual SPS Conference series apparently reflects, in part, the program committee's successes in identifying practical issues and their potential solutions.
  • 机译 影响发展中国家农村最终用户接受电子医疗的因素:孟加拉国便携式医疗诊所的研究
    摘要:Background: Existing studies regarding e-health are mostly focused on information technology design and implementation, system architecture and infrastructure, and its importance in public health with ancillaries and barriers to mass adoption. However, not enough studies have been conducted to assess the end-users' reaction and acceptance behavior toward e-health, especially from the perspective of rural communities in developing countries.Objective: The objective of this study is to explore the factors that influence rural end users' acceptance of e-health in Bangladesh.Methods: Data were collected between June and July 2016 through a field survey with structured questionnaire form 292 randomly selected rural respondents from Bheramara subdistrict, Bangladesh. Technology Acceptance Model was adopted as the research framework. Logistic regression analysis was performed to test the theoretical model.Results: The study found social reference as the most significantly influential variable (Coef. = 2.28, odds ratio [OR] = 9.73, p < 0.01) followed by advertisement (Coef. = 1.94, OR = 6.94, p < 0.01); attitude toward the system (Coef. = 1.52, OR = 4.56, p < 0.01); access to cellphone (Coef. = 1.37, OR = 3.92, p < 0.05), and perceived system effectiveness (Coef. = 0.74, OR = 2.10, p < 0.01). Among demographic variables, age, gender, and education were found significant while we did not find any significant impact of respondents' monthly family expenditure on their e-health acceptance behavior. The model explains 54.70% deviance (R2 = 0.5470) in the response variable with its constructs. The “Hosmer-Lemeshow” goodness-of-fit score (0.539) is also above the standard threshold (0.05), which indicates that the data fit well with the model.Conclusion: The study provides guidelines for the successful adoption of e-health among rural communities in developing countries. This also creates an opportunity for e-health technology developers and service providers to have a better understanding of their end users.
  • 机译 糖尿病视网膜病变筛查的临床决策支持系统:创建临床支持应用程序
    摘要:Background: The aim of this study was to build a clinical decision support system (CDSS) in diabetic retinopathy (DR), based on type 2 diabetes mellitus (DM) patients.Method: We built a CDSS from a sample of 2,323 patients, divided into a training set of 1,212 patients, and a testing set of 1,111 patients. The CDSS is based on a fuzzy random forest, which is a set of fuzzy decision trees. A fuzzy decision tree is a hierarchical data structure that classifies a patient into several classes to some level, depending on the values that the patient presents in the attributes related to the DR risk factors. Each node of the tree is an attribute, and each branch of the node is related to a possible value of the attribute. The leaves of the tree link the patient to a particular class (DR, no DR).Results: A CDSS was built with 200 trees in the forest and three variables at each node. Accuracy of the CDSS was 80.76%, sensitivity was 80.67%, and specificity was 85.96%. Applied variables were current age, gender, DM duration and treatment, arterial hypertension, body mass index, HbA1c, estimated glomerular filtration rate, and microalbuminuria.Discussion: Some studies concluded that screening every 3 years was cost effective, but did not personalize risk factors. In this study, the random forest test using fuzzy rules permit us to build a personalized CDSS.Conclusions: We have developed a CDSS that can help in screening diabetic retinopathy programs, despite our results more testing is essential.
  • 机译 评估针对外籍人士的远程医疗咨询计划
    摘要:Background: Health problems for expatriates are common due to their vulnerability to local infectious diseases, psychosocial problems, and chronic diseases, but many problems go largely unmet in this unique population.Introduction: Telehealth counseling was developed and tested for Korean expatriates. We explored the current status of using telehealth counseling systems and showed its feasibility and acceptability in three countries.Materials and Methods: This retrospective study was based on the “Development and demonstration of telehealth counseling program for overseas Koreans” project funded by the Korea Health Industry Development Institute. In this project, we established five Digital Healthcare Centers (DHCs): 3 in Vietnam and 1 each in Uzbekistan and Cambodia. We used data from October 2016 to September 2017; descriptive analysis and one-way ANOVA were used to present detailed information.Results: A total of 442 patients made an appointment for telehealth counseling services. Overall user satisfaction rates were 96.1%. Over two thirds of patients (302/442, 68.3%) completed one-time telehealth counseling. About 13% were referred to primary care, and 17 (3.8%) were referred to specialists or tertiary hospital. The most common diagnostic category was endocrine, nutritional, and metabolic diseases (14%), followed by diseases of the circulatory system (12.3%) for one-time visit patients.Discussion: Our telehealth counseling program for expatriates was feasible and acceptable in three countries. It also has the potential to minimize language barriers and the cost of healthcare usage.Conclusion: Further research for sustainable effective telehealth systems for expatriates will be needed.
  • 机译 影响农村患者电子处方基本依从性的因素:发展中国家的观点
    摘要:Background: The electronic prescription system has emerged to reduce the ambiguity and misunderstanding associated with handwritten prescriptions. The opportunities and challenges of e-prescription system, its impact on reducing medication error, and improving patient's safety have been widely studied. However, not enough studies were conducted to explore and quantify the factors that affect rural patients' compliance with e-prescription, especially from the perspective of Asian developing countries where most of the world's population resides.Objective: The objective of this study is to explore and assess the factors that affect rural patients' primary compliance with e-prescription in Bangladesh.Methods: Data were collected from 95 randomly selected rural patients who received e-prescription through a field survey with a structured questionnaire from Bheramara subdistrict, Bangladesh, during June and July 2016. Logistic regression analysis was performed to test the research hypotheses.Results: The study found patients' gender as the most significantly influential factor (regression coefficient [Coef.] = 2.02, odds ratio [OR] = 7.51, p < 0.05) followed by visiting frequency (Coef. = 0.99, OR = 2.70, p < 0.05); education (Coef. = 0.92, OR = 2.51, p < 0.05); and distance to healthcare facility (Coef. = 0.82, OR = 2.26, p < 0.01). However, patients' age, monthly family expenditure, and use of cell phone were found insignificant. The model explains 59.40% deviance (R2 = 0.5940) in the response variable with its constructs. And the “Hosmer–Lemeshow” goodness-of-fit score (0.99) is also above the standard threshold (0.05), which indicates the data fit well with the model.Conclusions: The findings of this study are expected to be helpful for e-health service providers to gain a better understanding of the factors that influence their patients to comply with e-prescriptions.
  • 机译 WhatsApp:一种实时工具,可减少知识差距并分享牛皮癣的最佳临床实践
    摘要:Background: Psoriasis is a chronic inflammatory disease that affects around 100 million people worldwide. The burden of disease is high, but more recent therapies show promising results. Clinicians need, however, more training in the use of such therapies.Introduction: Project ECHO® (Extension for Community Healthcare Outcomes) is structured around the promise of delivering medical education at a distance, empowering clinicians who operate in remote areas. The use of instant messaging services, such as WhatsApp® Messenger, has the potential to improve on the existing framework and bridge the existing gap of knowledge. This article reports on a study concerning the implementation of a WhatsApp discussion group in Project ECHO Psoriasis in Argentina.Materials and Methods: One hundred thirty-two dermatologists in Argentina were invited to participate in the WhatsApp discussion group. After 1 year of participation, a follow-up questionnaire was used to assess the effectiveness of the project.Results: Eighty dermatologists participated. All questions placed in the discussion were answered by a psoriasis specialist, 79% of which were answered within the first 5 min. Clinicians report significant improvement in diagnosis, comorbidities, and treatment with both conventional and biological therapies.Discussion: Preliminary results are promising. This new cost-effective solution builds on the existing Project ECHO Psoriasis in Argentina and shows potential in bridging the gap of knowledge, promoting better clinical decisions through empowerment of medical doctors operating in remote locations.Conclusions: Further research is needed to increase generalization of the results. Moreover, it would be interesting to match the data from the discussion group with follow-up questionnaires.
  • 机译 创新的在线银屑病管理模型访问皮肤科护理:随机对照试验的结果
    摘要:Background:Many patients with chronic skin diseases lack regular access to dermatologists in the United States and suffer poor clinical outcomes.
  • 机译 移动医疗政策的就绪状态和促成因素:撒哈拉以南非洲与经济合作与发展组织的比较
    摘要:Background: As an innovative solution to poor access to care in low- and middle-income countries (LMICs), m-health has gained wide attention in the past decade.Introduction: Despite enthusiasm from the global health community, LMICs have not demonstrated high uptake of m-health promoting policies or public investment.Materials and Methods: To benchmark the current status, this study compared m-health policy readiness scores between sub-Saharan Africa and high-income Organization for Economic Cooperation and Development (OECD) countries using an independent two-sample t test. In addition, the enabling factors associated with m-health policy readiness were investigated using an ordinal logistic regression model. The study was based on the m-health policy readiness scores of 112 countries obtained from the World Health Organization Third Global Survey on e-Health.Results: The mean m-health policy readiness score for sub-Saharan Africa was statistically significantly lower than that for OECD countries (p = 0.02). The enabling factors significantly associated with m-health policy readiness included information and communication technology development index (odds ratio [OR] 1.57; 95% confidence interval [CI] 1.12–2.2), e-health education for health professionals (OR 4.43; 95% CI 1.60–12.27), and the location in sub-Saharan Africa (OR 3.47; 95% CI 1.06–11.34).Discussion: The findings of our study suggest dual policy goals for m-health in sub-Saharan Africa. First, enhance technological and educational support for m-health. Second, pursue global collaboration for building m-health capacity led by sub-Saharan African countries with hands-on experience and knowledge.Conclusion: Globally, countries should take a systematic and collaborative approach in pursuing m-health policy with the focus on technological and educational support.
  • 机译 使用消费类设备进行的远程医疗体检表明,喉咙痛急诊患者的体格检查与亲自体检的一致性差:一项前瞻性盲研究
    摘要:Background: Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat.Materials and Methods: This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine.Results: Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation.Conclusion: Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of the physical examination in treatment decisions for patients with sore throat and the use of telemedicine in avoiding in-person healthcare visits.
  • 机译 频繁的轮辐联系与改进的医院绩效相关:马萨诸塞州综合医院远程卒中网络的结果
    摘要:Background: For acute ischemic stroke patients, shorter time to thrombolytic (tissue plasminogen activator [tPA]) is associated with improved outcomes.Introduction: Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times for tPA administration is unknown. We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact.Materials and Methods: We identified 375 patients treated with tPA by conventional or telestroke methods in an academic hub-and-spoke telestroke network for whom date and time data were available. Strength of the spoke–hub connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient's presentation. Patient-level regression analyses examined the relationship between DTN time and spoke–hub connection during the year of the patient's presentation, controlling for temporal trends and clustering within hospitals.Results: Sixteen spoke hospitals contributed data on 375 tPA-treated patients from 2006–2015. Hospitals treated a median of 13.5 patients with tPA per year; median hospital-level DTN was 78.8 min (interquartile range [IQR] 71.3–85). Median number of telestroke consults per year was 34 (range 3–137). Among all 375 patients, median DTN was 76 min (IQR 60–97). Strength of spoke–hub connection was significantly associated with faster DTN time for patients (1.3 min gain per 10 additional consults, p = 0.048).Conclusions: More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for secular trends in DTN improvements.
  • 机译 异步远程精神病学:逐步综合护理的组成部分
    摘要:Objective: Integrated behavioral healthcare models typically involve a range of consultation options for mental healthcare. Asynchronous telepsychiatry (ATP) consults may be an additional potential choice, so we are conducting a 5-year clinical trial comparing ATP with synchronous telepsychiatry (STP) consultations.Methods: Patients referred by primary care providers are randomly assigned to one of the two treatment groups, ATP or STP. Clinical outcome, satisfaction, and economic data are being collected from patients for 2 years at 6-month intervals.Results: Baseline characteristics for the first 158 patients and case examples of ATP are presented.Conclusion: Implementing ATP in existing integrated behavioral healthcare models could make mental healthcare more efficient.
  • 机译 手持非散瞳眼底照相机的远程视盘水肿检测的准确性和可靠性
    摘要:Background: Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty.Introduction: The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema.Materials and Methods: Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics.Results: The sensitivity and specificity for detection of optic disc edema were 71.8–92.2% and 81.6–95.2%, respectively. Photos were found to be ungradable in 0–8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52–0.67] to 0.72 (95% CI: 0.66–0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63–0.92) to 0.82 (95% CI: 0.69–0.95).Discussion: Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate–strong and strong within individual providers.Conclusions: Portable photography holds promise for use in remote screening of optic disc edema.
  • 机译 集成的远程医疗和远程护理,可监测患有慢性疾病的衰弱老年人
    摘要:Objective: To investigate the potential of an integrated care system that acquires vital clinical signs and habits data to support independent living for elderly people with chronic disease.Materials and Methods: We developed an IEEE 11073 standards-based telemonitoring platform for monitoring vital signs and activity data of elderly living alone in their home. The platform has important features for monitoring the elderly: unobtrusive, simple, elderly-friendly, plug and play interoperable, and self-integration of sensors. Thirty-six (36) patients in a primary care practice in the United Kingdom (mean [standard deviation] age, 82 [10] years) with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) were provided with clinical sensors to measure the vital signs for their disease (blood pressure [BP] and weight for CHF, and oxygen saturation for COPD) and one passive infrared (PIR) motion sensor and/or a chair/bed sensor were installed in a patient's home to obtain their activity data. The patients were asked to take one measurement each day of their vital signs in the morning before breakfast. All data were automatically transmitted wirelessly to the remote server and displayed on a clinical portal for clinicians to monitor each patient. An alert algorithm detected outliers in the data and indicated alerts on the portal. Patient data have been analyzed retrospectively following hospital admission, emergency room visit or death, to determine whether the data could predict the event.Results: Data of patients who were monitored for a long period and had interventions were analyzed to identify useful parameters and develop algorithms to define alert rules. Twenty of the 36 participants had a clinical referral during the time of monitoring; 16 of them received some type of intervention. The most common reason for intervention was due to low oxygen levels for patients with COPD and high BP levels for CHF. Activity data were found to contain information on the well-being of patients, in particular for those with COPD. During exacerbation the activity level from PIR sensors increased slightly, and there was a decrease in bed occupancy. One subject with CHF who felt unwell spent most of the day in the bedroom.Conclusions: Our results suggest that integrated care monitoring technologies have a potential for providing improved care and can have positive impact on well-being of the elderly by enabling timely intervention. Long-term BP and pulse oximetry data could indicate exacerbation and lead to effective intervention; physical activity data provided important information on the well-being of patients. However, there remains a need for better understanding of long-term variations in vital signs and activity data to establish intervention protocols for improved disease management.
  • 机译 理论应用于低收入和中等收入国家行为改变的移动医疗干预:系统综述
    摘要:Background: Recently there has been dramatic increase in the use of mobile technologies for health (m-Health) in both high and low- and middle-income countries (LMICs). However, little is known whether m-Health interventions in LMICs are based on relevant theories critical for effective implementation of such interventions. This review aimed to systematically identify m-Health studies on health behavioral changes in LMICs and to examine how each study applied behavior change theories.Materials and Methods: A systematic review was conducted using the standard method from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. By searching electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]), we identified eligible studies published in English from inception to June 30, 2017. For the identified m-Health studies in LMICs, we examined their theoretical bases, use of behavior change techniques (BCTs), and modes of delivery.Results: A total of 14 m-Health studies on behavioral changes were identified and, among them, only 5 studies adopted behavior change theory. The most frequently cited theory was the health belief model, which was adopted in three studies. Likewise, studies have applied only a limited number of BCTs. Among the seven BCTs identified, the most frequently used one was the social support (practical) technique for medication reminder and medical appointment. m-Health studies in LMICs most commonly used short messaging services and phone calls as modes of delivery for behavior change interventions.Conclusions: m-Health studies in LMICs are suboptimally based on behavior change theory yet. To maximize effectiveness of m-Health, rigorous delivery methods as well as theory-based intervention designs will be needed.
  • 机译 通过使用脑电图支持的三维音频为盲人轮椅用户提供基于虚拟环境的培训系统
    摘要:People with disabilities encounter many difficulties, especially when a diagnosis of more than one dysfunction is made, as is the case for visually impaired wheelchair users. In fact, this scenario generates a degree of incapacity in terms of the performance of basic activities on the part of the wheelchair user. The treatment of disabled patients is performed in an individualized manner according to their particular clinical aspects. People with visual and motor disabilities are restricted in independent navigation. In this navigation scenario, there is a requirement for interaction that justifies the use of virtual reality (VR). In addition, locomotion needs to be under natural control to be successfully incorporated. Based on such a condition, electroencephalography (EEG) has shown great advances in the area of health by employing spontaneous brain signals. This research demonstrates, through an experiment, the use of a wheelchair adapted to have the support of VR and EEG for training of locomotion and individualized interaction of wheelchair users with visual impairment. The objective was to provide efficient interactions, thus allowing the social inclusion of patients who are considered otherwise incapacitated. This project was based on the following criteria: natural control, feedback, stimuli, and safety. A multilayer computer rehabilitation system was developed that incorporated natural interaction supported by EEG, which activated the movements in the virtual environment and real wheelchair through adequately performed experiments. This research consisted of elaborating a suitable approach for blind wheelchair user patients. The results demonstrated that the use of VR with EEG signals has the potential for improving the quality of life and independence of blind wheelchair users.
  • 机译 远程医疗服务提供者提供护理服务的感觉
    摘要:Background: Nursing homes (NHs) provide care to a complex patient population and face the ongoing challenge of meeting resident needs for specialty care. A NH telemedicine care model could improve access to remote specialty providers.Introduction: Little is known about provider interest in telemedicine for specialty consults in the NH setting. The goal of this study was to survey a national sample of NH physicians and advanced practice providers to document their views on telemedicine for providing specialty consults in the NH.Materials and Methods: We surveyed physician and advanced practice providers who attended the 2016 AMDA—The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their likelihood of referral to and perceptions of a telemedicine program for providing specialty consults in the NH.Results: We received surveys from 524 of the 1,274 conference attendees for a 41.1% response rate. Respondents expressed confidence in the ability of telemedicine to fill existing service gaps and provide appropriate, timelier care. Providers showed the highest level of interest in telemedicine for dermatology, geriatric psychiatry, and infectious disease. Only 13% of respondents indicated that telemedicine was available for use in one of their facilities.Discussion: There appears to be unmet demand for telemedicine in NHs for providing specialty consults to residents.Conclusions: The responses of NH providers suggest support for the concept of telemedicine as a modality of care that can be used to offer specialty consults to NH residents.
  • 机译 制定新生儿复苏远程医疗计划:两种技术的比较
    摘要:Background: Early work has demonstrated the feasibility and acceptance of newborn resuscitation telemedicine programs (NRTPs). The technology requirements for providing this type of emergency telemedicine service are unclear.Introduction: We hypothesized that during NRTP consults, a wired telemedicine cart would provide a more reliable and higher-quality user experience than a consumer-grade wireless tablet.Materials and Methods: In this retrospective observational study, six spoke sites used consumer-grade wireless tablets during preintervention and wired coder/decoder (CODEC)-based telemedicine carts during postintervention. Both technologies used the same videoconferencing software. After the telemedicine consult, providers completed surveys assessing connection reliability, user satisfaction, and audio and video quality using a 1–5 Likert scale.Results: Preintervention, users completed 99 consults and 95 surveys. Postintervention, users completed 73 consults and 192 surveys. Successful connection on first attempt was significantly improved with the wired cart compared with the wireless tablet (82.7% vs. 69.5%, p = 0.01), and the percentage of consults complicated by an unplanned disconnection was reduced (6.4% vs. 14.7%, p = 0.02). User satisfaction and video and audio quality ratings were significantly higher for the wired cart.Discussion: The wired telemedicine cart increased connection reliability, which is important given the critical nature and long duration of NRTP consults. Audio-video quality was also improved, allowing for better visualization of the neonate and communication with the care team.Conclusions: Consumer-grade wireless tablets did not meet the program's technical requirements. Wired telemedicine carts improved reliability, user satisfaction, and audio-video quality. Wired carts may not fully meet NRTP requirements because of cart size and limited mobility.

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