Telemedicine

Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed

Current research in capsule endoscopy aims at endowing the capsules with some means of actively propelling themselves inside the gastrointestinal (GO tract, as opposed Advantages of these active capsules are the sipificant potential in the duration of the associated diagnostic procedures. as well as the oossihilitv to direct the line-of-sieht of the oh-hoard cameras towards interesting features of the GI tissue. One such means of active propulsion is by vibratory actuation, employing eccentric-mass micromotors, which is shown to reduce the friction of the capsule with the GI tract. The effect of vibrations on the quality of the acquired images is explored in the present study, which demonstrates that such vibrations do not affect adversely the diagnostic effectiveness of the endoscopic capsules. The parameters of vibratory actuation are evaluated as to the loss bf high-frequency information in the acquired images, due to the induced motion blur, and appropriate design guidelines for...

The Utrecht Diabetes Project (UDP) is a shared-care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist. To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs' motives for enrolling them. Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs. Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out-patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out-patient clinics had more patients with diabetes > 10 years or with complications. UDP patients' records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin. Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care. Diabet. Med. 18, 459-463 (2001)

Jest to jedna z wcześniejszych prac poświęconych telemedycynie jako dziedzinie nauki, techniki i praktyki medycznej. Przedstawiono telemedycynę jako źródło inspirujących problemów naukowych w wielu dyscyplinach badawczych. Wskazano na czynniki stymulujące rozwój telemedycyny oraz na przeszkody, które utrudniają jej rozwój.

The emergence of the new, High Efficiency Video Coding (HEVC) standard, combined with wide deployment of 4G wireless networks, will provide significant support toward the adoption of mobile-health (m-health) medical video communication systems in standard clinical practice. For the first time since the emergence of m-health systems and services, medical video communication systems can be deployed that can rival the standards of in-hospital examinations. In this paper, we provide a thorough overview of today's advancements in the field, discuss existing approaches, and highlight the future trends and objectives.

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.

We introduce a portable biochemical analysis platform for rapid field deployment of nucleic acid-based diagnostics using consumer-class quadcopter drones. This approach exploits the ability to isothermally perform the polymerase chain reaction (PCR) with a single heater, enabling the system to be operated using standard 5 V USB sources that power mobile devices (via battery, solar, or hand crank action). Time-resolved fluorescence detection and quantification is achieved using a smartphone camera and integrated image analysis app. Standard sample preparation is enabled by leveraging the drone's motors as centrifuges via 3D printed snap-on attachments. These advancements make it possible to build a complete DNA/RNA analysis system at a cost of ~ $50 ($US). Our instrument is rugged and versatile, enabling pinpoint deployment of sophisticated diagnostics to distributed field sites. This capability is demonstrated by successful in-flight replication of Staphylococcus aureus and λ-ph...

Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care.Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system’s development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements.The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians’ reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (±13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective.The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.

E-health interventions are of a growing importance for self-management of chronic conditions. This study aimed to describe the process adaptions that are needed in cardiac rehabilitation (CR) to implement a self-management system, called MyCARDSS. We created a generic workflow model based on interviews and observations at three CR clinics. Subsequently, a workflow model of the ideal situation after implementation of MyCARDSS was created. We found that the implementation will increase the complexity of existing working procedures because 1) not all patients will use MyCARDSS, 2) there is a transfer of tasks and responsibilities from professionals to patients, and 3) information in MyCARDSS needs to be synchronized with the EPR system for professionals.

We conducted a feasibility study of an innovative Internet-based system, designed to support collaboration between patients and providers around cancer related symptom management. Our objective was to demonstrate the system&#39;s potential to enhance communication and clinical decision making between patients and their providers. Considering the high prevalence of cancer related symptoms and their impact on patients&#39; quality of life, enhanced collaboration regarding assessment and treatment could significantly reduce illness burden. Twenty-seven patients with known malignancy and twenty-nine oncology clinicians were interviewed to identify functional requirements for the system. Patients reported the ability, willingness and desire to use a computer to help them manage their cancer related symptoms. Physicians recognized the potential of this system to improve communication and collaboration around symptom management, but voiced concern regarding a potential increased workload. ...

This study examined the types of social support messages exchanged between parents and/or caregivers of children with Autism Spectrum Disorders (ASDs) who communicate via Facebook (FB); it studies two autism support groups: Autism Malaysia (AM) and Autism Children Club (ACA). A total of 3637 messages including both postings (381) and comments (3256) were gathered from August to November 2013. The study employed a deductive content-analysis approach. The qualitative data were analyzed for social support themes adapted from the Social Support Behavior Code (SSBC). Before collecting the data, email was sent to the FB groups&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; moderators to gain formal consent from the members. The finding indicated that the highest percentage of messages offered dealt with Informational support (30.7%) followed by Emotional support (27.8%). Network and Esteem support messages were responsible for 20.97% and 20.2%, respectively. Tangible Assistance was the least frequent category (0.4%). A majority of these messages discussed and addressed challenges and difficulties associated with caring and raising ASD children, as well as issues such as children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s social lives and self-care routines. Understandings of how FB is used to seek social support could impact supporting and maintaining effective communication among parents and/or caregivers of children with ASDs. This information could also improve approaches used by health professionals in developing, improving and evaluating social support systems for parents/caregivers.

Objective: To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods: This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients’ average travel distance (ATD) to the closest clinic site. Results: A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient loa...

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.

Mobile phones have been shown effective in several public health domains. However, there are few evaluations of the effectiveness of mobile health in health promotion. Also, although many studies have referenced behavioral theory, none appears to have explicitly tested theoretical assumptions or demonstrated mechanisms of change. More robust evaluation models that incorporate theory and measurement of behavioral mediators are needed. As in all public health programs, mobile health operates within a social ecological context. For example, organizational- and individual-level programs seek to influence health and health care practices and individual health behaviors. New programs such as Text4baby demonstrate how theory and explicit testing of mediators can be incorporated in evaluations. There are challenges and opportunities facing mHealth evaluations given the nature of the mobile channel. Mobile communication is ubiquitous, available at all times and places, and thus experimental control is often difficult. Natural experiments using variation in dosage of mHealth and place- or location-based designs may increase experimental control. Text4baby is a text messaging program that provides prenatal care messages to pregnant women and new mothers. It uses a partnership model with health care facilities often serving as local implementation partners. The authors review a case example of the evaluation of Text4baby at Madigan Army Medical Center. Participants were randomized to usual prenatal care plus text messaging or usual care alone. The evaluation has a theoretical model of behavior change and measures mediators as well as behavioral outcomes. Results will inform how behavioral theory works within mobile health programs.