Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 5 Articles
Background: Management of diabetes through improved glycemic control and risk factor modification can help\nprevent long-term complications. Much diabetes management is self-management, in which healthcare providers\nplay a supporting role. Well-designed e-Health solutions targeting behavior change can improve a range of measures,\nincluding glycemic control, perceived health, and a reduction in hospitalizations.\nMethods: The primary objective of this study is to evaluate if a mobile application designed to improve self-management\namong patients with type 2 diabetes (T2DM) improves glycemic control compared to usual care. The secondary objectives\nare to determine the effects on patient experience and health system costs; evaluate how and why the intervention\nworked as observed; and gain insight into considerations for system-wide scale-up. This pragmatic,\nrandomized, wait-list-control trial will recruit adult participants from three Diabetes Education Programs in\nOntario, Canada. The primary outcome is glycemic control (measured by HbA1c). Secondary outcomes\ninclude patient-reported outcomes and patient-reported experience measures, health system utilization, and\nintervention usability. The primary outcome will be analyzed using an ANCOVA, with continuous secondary\noutcomes analyzed using Poisson regression. Direct observations will be conducted of the implementation\nand application-specific training sessions provided to each site. Semi-structured interviews will be conducted with\nparticipants, healthcare providers, organizational leaders, and system stakeholders as part of the embedded process\nevaluation. Thematic analysis will be applied to the qualitative data in order to describe the relationships between (a)\nkey contextual factors, (b) the mechanisms by which they effect the implementation of the intervention, and (c) the\nimpact on the outcomes of the intervention, according to the principles of Realist Evaluation.\nDiscussion: The use of mobile health and virtual tools is on the rise in health care, but the evidence of their\neffectiveness is mixed and their evaluation is often lacking key contextual data. Results from this study will provide\nmuch needed information about the clinical and cost-effectiveness of a mobile application to improve diabetes\nself-management. The process evaluation will provide valuable insight into the contextual factors that influence the\napplication effectiveness, which will inform the potential for adoption and scale....
Background: This research analyzes teleconsultation from both a mechanistic and complex adaptive system (CAS)\ndominant logic in order to further understand the influence of dominant logic on utilization rates of teleconsultation\nprojects. In both dominant logics, the objective of teleconsultation projects is to increase access to and quality of\nhealthcare delivery in a cost efficient manner. A mechanistic dominant logic perceives teleconsultation as closely\nresembling the traditional service delivery model, while a CAS dominant logic focuses on the system�s emergent\nbehavior of learning resulting from the relationships and interactions of participating healthcare providers.\nMethods: Qualitative case studies of 17 teleconsultation projects that were part of four health sciences center (HSC)\nbased telemedicine networks was utilized. Data were collected at two points in time approximately 10 years apart.\nSemi-structured interviews of 85 key informants (clinicians, administrators, and IT professionals) involved in\nteleconsultation projects were the primary data collection method.\nResults: The findings indicated that the emergent behavior of effective and sustainable teleconsultation projects\ndiffered significantly from what was anticipated in a mechanistic dominant logic. Teleconsultation projects whose\nemergent behavior focused on continuous learning enabled remote site generalists to manage and treat more\ncomplex cases and healthcare problems on their own without having to refer to HSC specialists for assistance. In\nteleconsultation projects that continued to be effectively utilized, participant roles evolved and were expanded.\nFurther, technology requirements for teleconsultation projects whose emergent behavior was learning did not\nneed to be terribly sophisticated.\nConclusions: When a teleconsultation project is designed with a mechanistic dominant logic, it is less likely to be\nsustained, whereas a teleconsultation project designed with a CAS dominant logic is more likely to be sustained.\nConsistent with a CAS dominant logic, teleconsultation projects that continued to be utilized involved participants\ntaking on new roles and continuously learning. This continuous learning enabled remote site generalists to better\nhandle the constantly changing nature of the problems faced. A CAS dominant logic provides a theoretical framework\nwhich explains why the teleconsultation literature about the role of technology, which is based on a mechanistic\ndominate logic, does not have adequate explanatory power....
Mobile phone applications may enhance the delivery of critical health services and the accuracy of health service data. Yet, the\nopinions and experiences of frontline health workers on using mobile apps to track pregnant and recently delivered women are\nunderreported. This evaluation qualitatively assessed the feasibility, usability, and acceptability of a mobile Client Data App for\nmaternal, neonatal, and child client data management by community health nurses (CHNs) in rural Ghana.The mobile app enabled\nCHNs to enter, summarize, and query client data. It also sent visit reminders for clients and provided a mechanism to report level of\ncare to district officers. Fourteen interviews and two focus groupswithCHNs, midwives, and district health officers were conducted,\ncoded, and thematically analyzed. Results indicated that the app was easily integrated into care, improved CHN productivity, and\nwas acceptable due to its capacity to facilitate client follow-up, data reporting, and decision-making. However, the feasibility and\nusability of the app were hindered by high client volumes, staff shortages, and software and device challenges. Successful integration\nof mobile client data apps for frontline health workers in rural and resource-poor settings requires real-time monitoring, program\ninvestments, and targeted changes in human resources....
The use of assistive technology and telemedicine is likely to continue to shape our\nmedical practice in the future, notably in the field of sleep medicine, especially within developed\ncountries. Currently, the number of people suffering from obstructive sleep apnea syndrome (OSAS)\nis increasing. Telemedicine (TM) can be used in a variety of ways in sleep medicine: telediagnostics,\nteleconsultation, teletherapy and telemonitoring of patients being treated with positive pressure\ndevices. In this review, we aim to summarize the recent scientific progresses of these techniques\nand their potential clinical applications and give consideration to the remaining problems related to\nTM application....
Background: According to the World Alzheimer Report (Prince, The Global Impact of Dementia: an Analysis of\nPrevalence, Incidence, Cost and Trends, 2015), 46.8 million people worldwide are nowadays living with dementia.\nAnd this number is estimated to approximate 131.5 million by 2050, with an increasing burden on society and\nfamilies. The lack of medical treatments able to stop or slow down the course of the disease has moved the focus\nof interest toward the nonpharmacological approach and psychosocial therapies for people with/at risk of dementia,\nas in the Mild Cognitive Impairment (MCI) condition. The purpose of the present study is to test an individualized\nhome-based multidimensional program aimed at enhancing the continuum of care for MCI and outpatients with\ndementia in early stage using technology.\nMethods: The proposed study is a single blind randomized controlled trial (RCT) involving 30 subjects with MCI\nand Alzheimerââ?¬â?¢s disease (AD) randomly assigned to the intervention group (Ability group), who will receive the\nââ?¬Å?Ability Programââ?¬Â, or to the active control group (ACG), who will receive ââ?¬Å?Treatment As Usualââ?¬Â (TAU). The protocol\nprovides for three steps of assessment: at the baseline (T_0), after treatment, (T_1) and at follow-up (T_2) with a\nmultidimensional evaluation battery including cognitive functioning, behavioral, functional, and quality of life\nmeasures. The Ability Program lasts 6 weeks, comprises tablet-delivered cognitive (5 days/week) and physical\nactivities (7 days/week) combined with a set of devices for the measurement and monitoring from remote of vital and\nphysical health parameters. The TAU equally lasts 6 weeks and includes paper and pencil cognitive activities (5 days/\nweek), with clinicianââ?¬â?¢s prescription to perform physical exercise every day and to monitor selected vital parameters.\nDiscussion: Results of this study will inform on the efficacy of a technology-enhanced home care service to preserve\ncognitive and motor levels of functioning in MCI and AD, in order to slow down their loss of autonomy in daily life.\nThe expected outcome is to ensure the continuity of care from clinical practice to the patientââ?¬â?¢s home, enabling also\ncost effectiveness and the empowerment of patient and caregiver in the care process, positively impacting on their\nquality of life....
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