Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 5 Articles
Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective\r\nof psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed\r\nto psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were\r\nconducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was\r\nheld with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo.\r\nFactors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities,\r\nsupportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study�s qualitative\r\nphase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation,\r\nand (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to\r\nprovide consultation services to underresourced communities makes an important contribution to psychiatricworkforce shortages.\r\nUnderstanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies\r\nto telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners....
Background: Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary\r\ndisease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality\r\nof life. However, the studies are few and only involve COPD patients who are in a stable phase or in-patients who\r\nare ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine\r\nsolutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute\r\nexacerbation of COPD at home as compared to conventional hospital treatment measured according to first\r\ntreatment failure, which is defined as readmission due to COPD within 30 days after discharge.\r\nMethods: COPD patients with acute exacerbation who fulfilled the eligibility criteria and were from two university\r\nhospitals in Denmark were randomized (1:1) by computer-generated tables that allocated treatments in blocks of\r\nfour to receive either standard treatment at the hospital or the same standard treatment at home using\r\ntelemedicine technology (that is, a video conference system with a touch screen and webcam and monitoring\r\nequipment (spirometer, thermometer, and pulse oximeter)). Patients treated in the telemedicine group were backed\r\nup by an organizational setting securing 24/7/365 online access to the hospital, as well as access to oxygen,\r\nnebulizer therapy, oral medical therapy and surveillance of vital parameters from home monitoring devices. Patients\r\nin both groups were discharged when clinically stable and when fulfilling five pre-specified discharge criteria.\r\nFollow-up was performed at 1, 3 and 6 months after discharge.\r\nThe primary outcome was treatment failure defined as readmission due to exacerbation in COPD within 30 days.\r\nSecondary outcomes were death from any cause, prescription of additional antibiotics or steroids, need of\r\nintubation or non-invasive ventilation, emergency room visits, visits to the general practitioner, lung function, bed\r\ndays, health-related quality of life, healthcare costs and user satisfaction.\r\nResults: Enrollment of patients started in June 2010 and ended in December 2011. Follow-up ended in May 2012.\r\nResults were analyzed in 2013.\r\nConclusions: The results may have implications on future hospital treatment modalities for patients with severe\r\nexacerbations in COPD where telemedicine may be used as an alternative to conventional admission....
Background: Legal regulations often limit the medical care that paramedics can provide. Telemedical solutions\r\ncould overcome these limitations by remotely providing expert support. Therefore, a mobile telemedicine system to\r\nsupport paramedics was developed. During the implementation phase of this system in four German emergency\r\nmedical services (EMS), the feasibility and possible limitations of this system were evaluated.\r\nMethods: After obtaining ethical approval and providing a structured training program for all medical professionals,\r\nthe system was implemented on three paramedic-staffed ambulances on August 1st, 2012. Two more ambulances\r\nwere included subsequently during this month. The paramedics could initiate a consultation with EMS physicians at\r\na teleconsultation centre. Telemedical functionalities included audio communication, real-time vital data\r\ntransmission, 12-lead electrocardiogram, picture transmission on demand, and video streaming from a camera\r\nembedded into the ceiling of each ambulance. After each consultation, telephone-based debriefings were\r\nconducted. Data were retrieved from the documentation protocols of the teleconsultation centre and the EMS.\r\nResults: During a one month period, teleconsultations were conducted during 35 (11.8%) of 296 emergency\r\nmissions with a mean duration of 24.9 min (SD 12.5). Trauma, acute coronary syndromes, and circulatory\r\nemergencies represented 20 (57%) of the consultation cases. Diagnostic support was provided in 34 (97%) cases,\r\nand the administration of 50 individual medications, including opioids, was delegated by the teleconsultation\r\ncentre to the paramedics in 21 (60%) missions (range: 1ââ?¬â??7 per mission). No medical complications or negative\r\ninterpersonal effects were reported. All applications functioned as expected except in one case in which the\r\nconnection failed due to the lack of a viable mobile network.\r\nConclusion: The feasibility of the telemedical approach was demonstrated. Teleconsultation enabled early initiation\r\nof treatments by paramedics operating under the real-time medical direction. Teleconsultation can be used to\r\nprovide advanced care until the patient is under a physicianââ?¬â?¢s care; moreover, it can be used to support the\r\nparamedics who work alone to provide treatment in non-life-threatening cases. Non-availability of mobile networks\r\nmay be a relevant limitation. A larger prospective controlled trial is needed to evaluate the rate of complications\r\nand outcome effects....
Given the important patient needs for support and treatment, telemedicineââ?¬â?defined by medical approaches supported by the\r\nnew technologies of informationââ?¬â?could provide interesting alternative in tinnitus treatment. By analyzing the published tools and\r\napproaches which could be used in the context of telemedicine for tinnitus by health professionals or self-administrated by patients,\r\nthis review summarizes, presents, and describes the principal telemedicine approaches available presently or in the near future to\r\nhelp assess or treat tinnitus or to offer support to tinnitus sufferers. Several pieces of evidence strongly support the feasibility of\r\ntelemedicine approaches for tinnitus. Telemedicine can be used to help tinnitus sufferers at several points in the therapeutic process:\r\nfor early screening, initial evaluation, and diagnosis; for optimizing therapeutic tools, particularly behavioural therapies and virtual\r\nreality-enhanced behavioral therapies; for long-termmonitoring of patients and provision of online support. Several limitations are,\r\nhowever, discussed in order to optimize the safe development of such approaches.Cost effective and easy to implement, telemedicine\r\nis likely to represent an important part of the future of tinnitus therapies and should be progressively integrated by otolaryngologists....
Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering\r\nand giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies\r\ndescribing the use of ICT in home care for communication between patients, family members, and healthcare professionals.\r\nMethods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted,\r\nwhich finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use\r\nof ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data,\r\nterminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT\r\nwas performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses\r\nin the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools\r\nused that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of\r\ntheir illness that promotes self-care....
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