Current Issue : October - December Volume : 2018 Issue Number : 4 Articles : 6 Articles
Background: South Korean government is currently in progress of expanding the coverage of telemedicine\nprojects as part of an attempt to vitalize service industry, but is facing fierce opposition from KMA. Practice of\ntelemedicine requires sufficient discussions among related parties. Although the participation of medical specialists\nis important, agreement from the public is essential.\nMethods: Three main tertiary care centers in Seoul were selected for data collection. A total of 224 patients\n(patients n = 180, patient guardian n = 44) and medical professionals (n = 41) were selected using simple random\nsampling. Mixed method of quantitative survey and qualitative semi-interview was used.\nResults: This study analyzed patients� and medical professionals� perception about the application of telemedicine in\ncardiology ward in tertiary care centers to provide baseline data when developing and applying telemedicine services.\nResults implied high need for encouraging telemedicine projects in order to appeal needs among population by\nproviding experience (p < 0.001) and knowledge (p < 0.001). Other results showed that the need for\nelectrocardiography monitoring was high among not only in remote areas but also in areas close to the capital. 64.52%\nof all participants thought that telemedicine was needed, and 73.21% of participants were willing to use telemedicine\nservice if provided. Semi-interviews revealed that participants expected more cost and time saving services through\nremote treatment, by not having to visit long distance hospitals frequently.\nConclusions: Research results oppose Korean Medical Association�s opinion that the population is against enforcing\ntelemedicine related laws. The findings in this study reflect an up-to-date perception of telemedicine among patients\nand medical professionals in a tertiary care centers� cardiology ward. Moreover, the study provides a baseline that is\nneeded in order to overcome past failures and to successfully implement telemedicine in South Korea....
Background: Recent transitions in long-term care in the Netherlands have major consequences for communitydwelling\nolder adults. A new paradigm expects them to manage and arrange their own care and support as much\nas possible. Technology can support this shift. A study has been conducted to explore the needs of communitydwelling\nfrail older adults with regard to an online platform. An existing platform was subsequently modified, based\nupon these needs, resulting in an online community care platform (OCC-platform) comprising of care, health, and\ncommunication functions. The purpose of this platform was to support frail older adults in their independence and\nfunctioning, by stimulating self-care and providing reliable information, products and services.\nMethods: The study used a User-Centred Design. The development processes involved the following steps: Step 1)\nIdentification of the User Requirements. To assess the user requirements, direct observations (N = 3) and interviews (N = 14)\nwere performed. Step 2) Modification of an Existing Online Platform. Based upon Step 1, available online platforms were\nexplored to determine whether an existing useful product was available. Two companies collaborated in\nmodifying such a platform; Step 3) Testing the Modified Platform. A total of 73 older adults were invited to test a\nprototype of the OCC-platform during 6 months, which comprised of two phases: (1) a training phase; and (2) a\ntesting phase.\nResults: An iterative process of modifications resulted in an interactive software concept on a Standard PC,\ncontaining 11 Functions. The Functions of ââ?¬Ë?contactsââ?¬â?¢, ââ?¬Ë?servicesââ?¬â?¢ and ââ?¬Ë?messagingââ?¬â?¢, were by far, the most frequently\nused. The use was at its highest during the first 2 weeks of the testing and then its use steadily declined. The vast\nmajority of the subjects (94%) were positive about the usability of the platform. Only a minority of the subjects\n(27%) indicated that the platform had added value for them.\nConclusion: The overall prospect was that an OCC-platform can contribute to the social participation and the\nself-management competencies of frail older adults, together with their social cohesion in the community. In\norder to validate these prospects, further research is needed on the characteristics and the impact of online\nplatforms....
Background: Osteoarthritis (OA) is the most prevalent chronic joint disease, characterized by joint structural\ndeterioration, pain and loss of function among the elders. It is also associated with several extra-articular symptoms\n(fatigue, sleep disorders, anxiety and depression) and a reduction of life quality. Studies have revealed that patients\nwith OA benefitted from enhanced management via telemedicine. Guangdong Online Hospital (GOH) is the first\nofficially recognized web-based hospital that provides telemedicine service in China. However, the effective\nimplementation of GOH telemedicine (GOHT) to enhance management for patients with OA remains unknown.\nMethods/design: An assessor-blinded, parallel randomized controlled trial will be performed to study the feasibility\nand effectiveness of GOHT in the enhanced management of OA. Forty participants with knee OA will be recruited for a\n6-month study. Patients meeting the inclusion criteria will be randomly allocated to receive conventional therapy (CT)\nor conventional therapy plus a brief GOH-based intervention (CT-GOHT). The primary outcome is the feasibility of a fullscale\nrandomized controlled trial. The secondary outcomes include the self-reported total score of the Western Ontario\nand McMaster Universities Osteoarthritis Index (WOMAC), the Multidimensional Fatigue Inventory (MFI), the Pittsburgh\nSleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS). Assessments will be performed at\nbaseline, 2 weeks, 3 months and 6 months later after the initiation of the study.\nDiscussion: This trial is intended to test the application of GOHT in the chronic management in knee OA. The hypothesis\nis that OA patients may receive disease management via this network platform conveniently and effectively, especially\nthose in the remote areas of our country. GOHT telemedicine would be an attractive alternative to traditional methods\nfor disease management in knee OA. The results could provide preliminary experiences and guidance for an upcoming\nfull-scale randomized controlled trial (RCT) in disease management via telemedicine....
Background: Telemedical programs for patients with chronic heart failure have shown inconsistent effects on\nsurvival and hospitalization. Few studies analyzed effects of telemedical interventions on health costs, although this\noutcome may determine whether or not a successful program will be adopted by health insurance providers. We\nevaluated a large sized telemedicine program provided by a German statutory health insurance, consisting of\nregular telephone contacts and, for a subgroup of the participants, provision of an electronic scale in a routine care\nsetting. We examined the effects of the program on the total healthcare costs after one year compared to a\nmatched control group.\nMethods: The evaluation was based on reimbursement data of the statutory health insurance. Participants of the\nprogram were matched to appropriate controls using a combination of exact (e.g. 5-year age group, gender, NYHA class)\nand propensity score (e.g. medication, psychiatric comorbidity) matching.\nThe total health costs after one year were calculated on the basis of regression analyses in an intention-to-treat-approach.\nIn a sensitivity analysis, the subgroup of patients with a documented beginning of the intervention was examined.\nResults: Two thousand six hundred twenty two patients with chronic heart failure (55% male, mean age: 73.7 years)\nwere included in the intervention program. 1943 participants (74%) could be matched with appropriate control patients.\nThe telemedicine monitoring program for patients with chronic heart failure reduced total health costs after 12 months\nof the intervention: âË?â?? 276ââ??¬ per quarter year in rural regions and âË?â?? 18ââ??¬ in urban regions compared to the control group.\nConclusions: The telemedicine program could reduce total health costs, especially in rural regions in Germany....
Background: The Cochrane review on the effectiveness of speech and language therapy for aphasia following\nstroke suggests intensity of therapy is a key predictor for outcome. Current aphasia services cannot provide\nintervention at the intensity observed within trial contexts because of resource limitations. Telerehabilitation\ncould widen access to speech-language pathologists (SLPs) in geographically remote contexts and reduce the\ntime spent on travel by the therapist and patient. The current academic literature within this field is in its infancy,\nwith few trials of speech and language therapy (SLT) delivered by videoconference. Our pilot randomized controlled\ntrial (RCT) will explore feasibility aspects and effectiveness of telerehabilitation for aphasia in addition to standard SLT.\nMethod/design: Our study is a pragmatic, exploratory, pilot randomized controlled trial, where participants will be\nrandomized to a telerehabilitation group or a control group. Both groups receive standard SLT (usual care) but the\ntelerehabilitation group receives an additional 5 h of telerehabilitation per week over 4 weeks through videoconference.\nThis additional telerehabilitation focuses on spoken language with an emphasis on word naming. We aim to include 40\npatients in each group, with inclusion criteria being aphasia any time post stroke. Participants will be assessed blindly at\npre-randomization (baseline), and 4 weeks and 4 months after randomization. The primary endpoint is naming ability 3\nmonths after the completed intervention, measured by the Norwegian Basic Aphasia Assessment (NGA) naming subtest.\nSecondary endpoints include other subtests of the NGA, the VAST (Verb and Sentence Test) subtest sentence production,\nCommunicative Effectiveness Index (CETI) and the Stroke and Aphasia Quality of Life scale (SAQOL-39). Experiences of\npatients and SLPs with telerehabilitation are assessed using questionnaires and semi-structured interviews. Statistical\nbetween group comparisons will be in line with an intention-to-treat analysis.\nDiscussion: This pilot RCT of intensive language training by videoconference will contribute new scientific evidence to\nthe field of aphasia telerehabilitation. Here, we describe our trial which will explore the feasibility of telerehabilitation for\naphasia as an intervention, our choice of primary and secondary outcome measures and proposed analyses. Our trial will\nprovide information for the development and delivery of future definitive RCTs....
Background: The exponential growth in the reach and development of new technologies over the past decade\nmeans that mobile technologies and social media play an increasingly important role in service delivery models to\nmaximise HIV testing and access to treatment and care. This systematic review examines the impact of electronic\nand mobile technologies in medical care (eHealth) in the linkage to and retention of priority populations in the HIV\ntreatment and care cascade, focussing on the Asia-Pacific region.\nMethods: The review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses\n(PRISMA) statement from the Cochrane Collaboration guidelines. Both grey and published scientific literature from five\ndifferent databases were searched for all original articles in English published from 2010 to 2017. Studies conducted\noutside the Asia-Pacific region or not including HIV priority populations were excluded. The methodological quality of\nstudies included in the review was assessed using the Quality Assessment Tool for Quantitative Studies.\nResults: The database search identified 7309 records. Of the 224 peer-reviewed articles identified for full text review, 16\nstudies from seven countries met inclusion criteria. Six cross sectional studies found evidence to support the use of eHealth,\nvia text messages, instant messaging, social media and health promotion websites, to increase rates of HIV testing and\nre-testing among men who have sex with men (MSM). Evidence regarding the efficacy of eHealth interventions to improve\nantiretroviral treatment (ART) adherence was mixed, where one randomised controlled trial (RCT) showed significant benefit\nof weekly phone call reminders on improving ART adherence. Three further RCTs found that biofeedback eHealth\ninterventions that provided estimated ART plasma concentration levels, showed promising results for ART adherence.\nConclusions: This review found encouraging evidence about how eHealth can be used across the HIV treatment and\ncare cascade in the Asia-Pacific region, including increasing HIV testing and re-testing in priority populations as well as\nART adherence. eHealth interventions have an important role to play in the movement towards the end of AIDS,\nparticularly to target harder-to-reach HIV priority populations, such as MSM....
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