Participatory design methods for the development of a clinical telehealth service for neonatal homecare

DEFF Research Database (Denmark)

Garne Holm, Kristina; Brødsgaard, Anne; Zachariassen, Gitte

2017-01-01

. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical...... on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information...... regarding infant growth and well-being. CONCLUSION: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design...

Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians.

Science.gov (United States)

Jetty, Anuradha; Moore, Miranda A; Coffman, Megan; Petterson, Stephen; Bazemore, Andrew

2018-04-01

Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. Nationally representative randomly sampled survey of 5,000 FPs. Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.

Personalized telehealth in the future

DEFF Research Database (Denmark)

Dinesen, B.; Nonnecke, B.; Lindeman, David

2016-01-01

of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide...... research agenda for future telehealth applications within chronic disease management....

Extent of telehealth use in rural and urban hospitals.

Science.gov (United States)

Ward, Marcia M; Ullrich, Fred; Mueller, Keith

2014-01-01

Key Findings. Data from 4,727 hospitals in the 2013 HIMSS Analytics database yielded these findings: (1) Two-thirds (66.0% of rural defined as nonmetropolitan and 68.0% of urban) had no telehealth services or were only in the process of implementing a telehealth application. One-third (34.0%rural and 32.0% urban) had at least one telehealth application currently in use. (2) Among hospitals with "live and operational" telehealth services, 61.4% indicated only a single department/program with an operational telehealth service, and 38.6% indicated two or more departments/programs with operational telehealth services. Rural hospitals were significantly less likely to have multiple services (35.2%) than were urban hospitals (42.1%) (3) Hospitals that were more likely to have implemented at least one telehealth service were academic medical centers, not-for-profit institutions, hospitals belonging to integrated delivery systems, and larger institutions (in terms of FTEs but not licensed beds). Rural and urban hospitals did not differ significantly in overall telehealth implementation rates. (4) Urban and rural hospitals did differ in the department where telehealth was implemented. Urban hospitals were more likely than rural hospitals to have operational telehealth implementations in cardiology/stroke/heart attack programs (7.4% vs. 6.2%), neurology (4.4% vs. 2.1%), and obstetrics/gynecology/NICU/pediatrics (3.8% vs. 2.5%). In contrast, rural hospitals were more likely than urban hospital to have operational telehealth implementations in radiology departments (17.7% vs. 13.9%) and in emergency/trauma care (8.8% vs. 6.3%).

2014 Mid-Atlantic Telehealth Resource Center Annual Summit

Directory of Open Access Journals (Sweden)

Katharine Hsu Wibberly

2013-12-01

Full Text Available The Mid-Atlantic Resource Center (MATRC; http://www.matrc.org/ advances the adoption and utilization of telehealth within the MATRC region and works collaboratively with the other federally funded Telehealth Resource Centers to accomplish the same nationally. MATRC offers technical assistance and other resources within the following mid-Atlantic states: Delaware, District of Columbia, Kentucky, Maryland, North Carolina, Pennsylvania, Virginia and West Virginia.   The 2014 MATRC Summit “Adding Value through Sustainable Telehealth” will be held March 30-April 1, 2014, at the Fredericksburg Expo & Conference Center, Fredericksburg, VA. The Summit will explore how telehealth adds value to patients, practitioners, hospitals, health systems, and other facilities. Participants will experience a highly interactive program built around the case history of “Mr. Doe” as he progresses through the primary care, inpatient hospitalization, and post-discharge environments. The Summit will conclude with a session on financial and business models for providing sustainable telehealth services.   For further information and registration, visit: http://matrc.org/component/content/article/2-uncategorised/80-mid-atlantic-telehealth-resource-summit-2014    

A framework for telehealth program evaluation.

Science.gov (United States)

Nepal, Surya; Li, Jane; Jang-Jaccard, Julian; Alem, Leila

2014-04-01

Evaluating telehealth programs is a challenging task, yet it is the most sensible first step when embarking on a telehealth study. How can we frame and report on telehealth studies? What are the health services elements to select based on the application needs? What are the appropriate terms to use to refer to such elements? Various frameworks have been proposed in the literature to answer these questions, and each framework is defined by a set of properties covering different aspects of telehealth systems. The most common properties include application, technology, and functionality. With the proliferation of telehealth, it is important not only to understand these properties, but also to define new properties to account for a wider range of context of use and evaluation outcomes. This article presents a comprehensive framework for delivery design, implementation, and evaluation of telehealth services. We first survey existing frameworks proposed in the literature and then present our proposed comprehensive multidimensional framework for telehealth. Six key dimensions of the proposed framework include health domains, health services, delivery technologies, communication infrastructure, environment setting, and socioeconomic analysis. We define a set of example properties for each dimension. We then demonstrate how we have used our framework to evaluate telehealth programs in rural and remote Australia. A few major international studies have been also mapped to demonstrate the feasibility of the framework. The key characteristics of the framework are as follows: (a) loosely coupled and hence easy to use, (b) provides a basis for describing a wide range of telehealth programs, and (c) extensible to future developments and needs.

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

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Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

2016-11-01

Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

Directory of Open Access Journals (Sweden)

James Robert Langabeer

2016-11-01

Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

Availability, spatial accessibility, utilisation and the role of telehealth for multi-disciplinary paediatric cerebral palsy services in Queensland.

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Edirippulige, Sisira; Reyno, John; Armfield, Nigel R; Bambling, Matthew; Lloyd, Owen; McNevin, Elizabeth

2016-10-01

The purpose of this study was to understand the methods of current delivery of health care services to cerebral palsy (CP) patients in Queensland, Australia. The study also examines the current use of telehealth by clinicians and their perceptions about telehealth use. Patient records during July 2013-July 2014 were accessed from the Queensland Paediatric Rehabilitation Service (QPRS) to collect information relating to the service delivery for CP patients. Analysis was carried out to examine the patient locations and travel distances using ArcMap geoprocessing software. In addition, 13 face-to-face semi structured interviews were conducted with clinicians from the QPRS and the Cerebral Palsy Health Service (CPHS) to understand the perceptions of clinicians relating to the current level of health care delivery. We also examined the clinicians' current use of telehealth and their opinions about this method. Records of 329 paediatric CP patients were accessed and reviewed. The majority of patients (96%, n = 307) who attended the clinics at the Royal Children's Hospital (RCH), Brisbane, were from remote, rural or regional areas of Queensland. Only 4% of patients (n = 13) were from major cities. During 12 months, patients had attended nine outreach programmes that were conducted by the QPRS and CPHS. The study found that non-local patients were required to travel an average distance of 836 km to access QPRS and CPHS services in Brisbane. The average distance for receiving a consultation at an outreach clinic was 173 km. Clinicians perceived that access to health care services to CP patients in Queensland is inadequate. Nearly all clinicians interviewed had some experience in using telehealth. They had high satisfaction levels with the method. Traditional methods of delivering services to CP patients do not meet their needs. Clinicians have found telehealth is a feasible and satisfactory delivery method. However, the use of telehealth is still limited. © The

Telehealth

Science.gov (United States)

... role of telehealth in an evolving health care environment. Washington DC: The National Academies Press; 2012. Review ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

Audit of primary care electrocardiograms sent as emergency to a telehealth service - the Telehealth Network of Minas Gerais, Brazil.

Science.gov (United States)

Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M

2015-01-01

The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.

Steps to Offering Low Vision Rehabilitation Services through Clinical Video Telehealth

Science.gov (United States)

Ihirig, Carolyn

2016-01-01

Telehealth clinical applications, which allow medical professionals to use telecommunications technologies to provide services to individuals remotely, continue to expand in areas such as low vision rehabilitation, where evaluations are provided to patients who live in rural areas. As with face-to-face low vision rehabilitation, the goal of…

Service providers' experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service.

Science.gov (United States)

Newman, Lareen; Bidargaddi, Niranjan; Schrader, Geoffrey

2016-10-01

Despite evidence of benefits of telehealth networks in increasing access to, or providing, previously unavailable mental health services, care providers still prefer traditional approaches. For psychiatric assessment, digital technology can offer improvements over analog systems for the technical and, subsequently, the social quality of provider-client interaction. This is in turn expected to support greater provider uptake and enhanced patient benefits. Within the framework of Innovation Diffusion Theory, to study service providers' experiences of an existing regional telehealth network for mental health care practice twelve months after digitisation in order to identify the benefits of digital telehealth over an analog system for mental health care purposes in rural Australia. Qualitative interviews and focus groups were conducted with over 40 service providers from June to September 2013 in South Australia, ranging from the metropolitan central operations to health providers located up to 600km away in rural and remote areas of the same state. Participants included rural mental health teams, directors of nursing at rural hospitals, metropolitan-based psychiatrists and registrars, the metropolitan-based mental health team dedicated to rural provider support, rural GPs, administrative staff, and the executive group of the state rural health department. Fieldwork was conducted 12 months after the analog system was digitised. The interview and focus group data were analysed using thematic analysis, focusing on three key areas of innovation diffusion theory: relative advantage, technical complexity and technical compatibility. Five themes with 11 sub-themes were identified: (1) "Existing Uses", with three sub-themes: current mental health use, use by GPs, and use for staff support; (2) "Relative Advantage", with four sub-themes: improved technical quality, improved clinical practice, time and cost benefits for providers, and improved patient care; (3) "Technical

Telehealth and Medicare - Payment Policy, Current Use...

Data.gov (United States)

U.S. Department of Health & Human Services — Despite legislative changes from 2001 to 2008 that increased Medicare payment rates for telehealth and decreased regulatory burdens, the study Telehealth and...

WTP (willingness to pay) for tele-health consultation service in Hokkaido, Japan.

Science.gov (United States)

Ogasawara, Katsuhiko; Abe, Tamotsu

2013-01-01

We developed a tele-health consultation system that combines a sphygmomanometer with a tele-conference system. These were placed in pharmacies and the University. We selected five pharmacies to set up a consultation room; one in a local area, two in a suburban area, and the remaining two in an urban area. Nurses with more than 5 years of clinical experience were assigned as consultants. These consultants offer health consultation but do not practice medicine. Some researchers have indicated the economic viability of at-home health management systems, but nothing has been researched on the economic viability of tele-health consultation. The objective of present study was estimated Willingness to Payment (WTP) of Tele-health consultation service. The WTP was estimated by Double-Bounded Dichotomous-Choice model. We performed logistic-regression analysis to confirm factors to affect WTP. The number of the respondent was 480. Mean WTP was calculated 495 yen and the median was 367 yen. There was significant difference for factor of "annual income", "have a willingness to use this system", and "have a child/children".

Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

Directory of Open Access Journals (Sweden)

Mountain Gail A

2011-01-01

Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a Tele-health supported Community COPD Service; or (b Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a

Patient Centric Ontology for Telehealth Domain

DEFF Research Database (Denmark)

Jørgensen, Daniel Bjerring; Hallenborg, Kasper; Demazeau, Yves

2015-01-01

This paper presents an ontology for the telehealth domain, a domain that concerns the use of telecommunication to support and deliver health related services e.g. patient monitoring and rehabilitative training. Our vision for the future of telehealth solutions is that they adapt their behavior to...

Integrating telemedicine and telehealth: putting it all together.

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Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail

2008-01-01

Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care

Providing Telehealth Services to a Public Primary Care Network: The Experience of RedeNUTES in Pernambuco, Brazil.

Science.gov (United States)

Diniz, Paula Rejane Beserra; Ribeiro Sales, Fernando José; de Araújo Novaes, Magdala

2016-08-01

Information technologies have been applied in primary care domains to improve the delivery of health services. This article reports the telehealth network experience in Pernambuco, Brazil. Five different data sets were used, one by each service and the structural aspects of the network, collected from 2008 until August 2015. The data include solicited themes for educational activities, users' evaluation of services, numbers of sites, municipalities participating, participants in tele-education activities, teleconsultations, telediagnosis, and remote screenings. The analysis was done in absolute and percentage values using Microsoft Excel (version 2007). The indicators show high utilization of tele-education resources, followed by the teleconsultation service. The synchronous modality was the most used and the general clinical question was the most frequent type of question. Nurses are the professional category that most used the teleconsultation services (36%). Telediagnosis of electrocardiography has growth utilization, overcoming teleconsulting more recently. The satisfaction rate was 89%, and 68.5% of professionals changed their planning to patients' referrals to specialists. Telehealth has been considered effective since it avoids inappropriate referrals of the patient and provides continuous actualization to health professionals. Our results provide evidence of the feasibility and importance of using telehealth as a tool to ensure the universality, equality, and completeness in the health system.

The relationship between telehealth and information technology ranges from that of uneasy bedfellows to creative partnerships.

Science.gov (United States)

Wade, Victoria A; Hamlyn, Jeremy S

2013-10-01

The relationship between the clinical and technical aspects of a telehealth operation is frequently problematic, and technically-driven projects often fail to achieve sustainability. Qualitative data from a study of 37 Australian telehealth services were analysed to understand how the relationship between telehealth providers and information technology (IT) departments helps or hinders the development of telehealth. The most frequent difficulties reported were between telehealth services and the internal IT departments of health services, rather than with external vendors. The difficulties included barriers to installing telehealth over IT networks, a lack of priority given to telehealth services, and IT departments insisting on standardised approach. Alternatively, when IT staff were assigned to supporting clinical staff and had a close working relationship with them, they were major enablers of telehealth services. Authorising dedicated IT support and encouraging joint problem solving should provide a strong foundation for a healthy relationship which contributes to the growth and sustainability of telehealth.

Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.

Science.gov (United States)

Ackerman, Michael J; Filart, Rosemarie; Burgess, Lawrence P; Lee, Insup; Poropatich, Ronald K

2010-01-01

The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth?

End-to-End Security for Personal Telehealth

NARCIS (Netherlands)

Koster, R.P.; Asim, M.; Petkovic, M.

2011-01-01

Personal telehealth is in rapid development with innovative emerging applications like disease management. With personal telehealth people participate in their own care supported by an open distributed system with health services. This poses new end-to-end security and privacy challenges. In this

The Role of School Nursing in Telehealth. Position Statement

Science.gov (United States)

Haynie, Kathey M.; Mauter, Elaine; Lindahl, Brenda; Simons-Major, Keisha; Meadows, Lynne; Maughan, Erin D.

2017-01-01

It is the position of the National Association of School Nurses (NASN) that utilization of telehealth technology may be a valuable tool to assist registered professional school nurses (herein referred to as a school nurse) to provide school health services. The health of many students is impacted by lack of access to primary care and specialty…

Personalized Telehealth in the Future: A Global Research Agenda.

Science.gov (United States)

Dinesen, Birthe; Nonnecke, Brandie; Lindeman, David; Toft, Egon; Kidholm, Kristian; Jethwani, Kamal; Young, Heather M; Spindler, Helle; Oestergaard, Claus Ugilt; Southard, Jeffrey A; Gutierrez, Mario; Anderson, Nick; Albert, Nancy M; Han, Jay J; Nesbitt, Thomas

2016-03-01

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Elton

2004-01-01

The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Elton

2003-01-01

The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Jr, Elton L

2007-01-01

The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...

Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial.

Science.gov (United States)

Myers, Kathleen; Vander Stoep, Ann; Zhou, Chuan; McCarty, Carolyn A; Katon, Wayne

2015-04-01

To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. The Children's ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ(2)[4] = 19.47, p ADHD (χ(2)[4] = 14.90, p = .005), ODD (χ(2)[4] = 10.05, p = .04), and VADRS-Caregiver role performance (χ(2) [4] = 12.40, p = .01) and CIS-P impairment (χ(2)[4] = 20.52, p ADHD (χ(2)[4] = 9.72, p = .045). The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to specialty mental health services. Clinical trial registration information-Children's Attention Deficit Disorder With Hyperactivity (ADHD) Telemental Health Treatment Study; http://clinicaltrials.gov; NCT00830700. Copyright © 2015 American

World Federation of Occupational Therapists' Position Statement on Telehealth

Directory of Open Access Journals (Sweden)

World Federation of Occupational Therapists

2014-09-01

Full Text Available The purpose of this document is to state the World Federation of Occupational Therapists’ (WFOT position on the use of telehealth for the delivery of occupational therapy services. Telehealth is the use of information and communication technologies (ICT to deliver health-related services when the provider and client are in different physical locations. Additional terms used to describe this service delivery model include: tele-occupational therapy, telerehabilitation, teletherapy, telecare, telemedicine, and telepractice, among other terms. Telehealth may be used by occupational therapy practitioners for evaluation, intervention, monitoring, supervision, and consultation (between remote therapist, client, and/or local health-care provider as permitted by jurisdictional, institutional, and professional regulations and policies governing the practice of occupational therapy.Occupational therapy services via telehealth should be appropriate to the individuals, groups and cultures served,and contextualized to the occupations and interests of clients. Important considerations related to licensure/registration, collaboration with local occupational therapists, client selection, consent to treat, professional liability insurance, confidentiality, personal and cultural attributes, provider competence/standards of care, reimbursement/payer guidelines, and authentic occupational therapy practice are discussed.

Mixed methods for telehealth research.

Science.gov (United States)

Caffery, Liam J; Martin-Khan, Melinda; Wade, Victoria

2017-10-01

Mixed methods research is important to health services research because the integrated qualitative and quantitative investigation can give a more comprehensive understanding of complex interventions such as telehealth than can a single-method study. Further, mixed methods research is applicable to translational research and program evaluation. Study designs relevant to telehealth research are described and supported by examples. Quality assessment tools, frameworks to assist in the reporting and review of mixed methods research, and related methodologies are also discussed.

Visioning technology for the future of telehealth.

Science.gov (United States)

Brennan, David M; Holtz, Bree E; Chumbler, Neale R; Kobb, Rita; Rabinowitz, Terry

2008-11-01

By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.

Telehealth at the US Department of Veterans Affairs after Hurricane Sandy.

Science.gov (United States)

Der-Martirosian, Claudia; Griffin, Anne R; Chu, Karen; Dobalian, Aram

2018-01-01

Background Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. Methods This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. Results During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. Conclusion Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and

Discovering untapped relationship potential with patients in telehealth: a qualitative interview study.

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Heckemann, Birgit; Wolf, Axel; Ali, Lilas; Sonntag, Steffen Mark; Ekman, Inger

2016-03-02

To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional's perspective. 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds. 20 telehealth professionals. A telehealth service centre in the south of Germany that provided care for 12,000 patients with chronic heart failure across Germany. Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skillful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as 'experts on their own illness' to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training. Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Service provider perceptions of transitioning from audio to video capability in a telehealth system: a qualitative evaluation

OpenAIRE

Clay-Williams, Robyn; Baysari, Melissa; Taylor, Natalie; Zalitis, Dianne; Georgiou, Andrew; Robinson, Maureen; Braithwaite, Jeffrey; Westbrook, Johanna

2017-01-01

Background Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology. Methods Using a mixed-method, qualitative approach, w...

Proposal for a telehealth concept in the translational research model.

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Silva, Angélica Baptista; Morel, Carlos Médicis; Moraes, Ilara Hämmerli Sozzi de

2014-04-01

To review the conceptual relationship between telehealth and translational research. Bibliographical search on telehealth was conducted in the Scopus, Cochrane BVS, LILACS and MEDLINE databases to find experiences of telehealth in conjunction with discussion of translational research in health. The search retrieved eight studies based on analysis of models of the five stages of translational research and the multiple strands of public health policy in the context of telehealth in Brazil. The models were applied to telehealth activities concerning the Network of Human Milk Banks, in the Telemedicine University Network. The translational research cycle of human milk collected, stored and distributed presents several integrated telehealth initiatives, such as video conferencing, and software and portals for synthesizing knowledge, composing elements of an information ecosystem, mediated by information and communication technologies in the health system. Telehealth should be composed of a set of activities in a computer mediated network promoting the translation of knowledge between research and health services.

Telehealth and Autism: Treating Challenging Behavior at Lower Cost.

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Lindgren, Scott; Wacker, David; Suess, Alyssa; Schieltz, Kelly; Pelzel, Kelly; Kopelman, Todd; Lee, John; Romani, Patrick; Waldron, Debra

2016-02-01

To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet. Copyright © 2016 by the American Academy of Pediatrics.

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

OpenAIRE

Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

2016-01-01

Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

Environment for Telehealth Applications on Top of BDI4JADE

DEFF Research Database (Denmark)

Jørgensen, Daniel Bjerring; Hallenborg, Kasper; Demazeau, Yves

2015-01-01

Patients using telehealth systems have different needs and hence their treatments must differ accordingly. Different compositions of smart home sensors, telehealth devices, and services are used depending on the needs of the individual. This paper presents an open and flexible infrastructure...

Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland.

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Keogh, Kandice; Clark, Paul; Valery, Patricia C; McPhail, Steven M; Bradshaw, Candise; Day, Melany; Smith, Anthony C

2016-12-01

For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders. © The Author(s) 2016.

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

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Gagnon, Marie-Pierre; Duplantie, Julie; Fortin, Jean-Paul; Landry, Réjean

2006-08-24

Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

Directory of Open Access Journals (Sweden)

Duplantie Julie

2006-08-01

Full Text Available Abstract Background Telehealth, as other information and communication technologies (ICTs introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. Methods A qualitative field study was conducted in four remote regions of Quebec (Canada to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. Results According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and

Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

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Schwamm, Lee H

2014-02-01

"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

Cost-benefit analysis of telehealth in pre-hospital care.

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Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

2017-09-01

Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

Occupational Therapy Home Safety Intervention via Telehealth

OpenAIRE

Lori E. Breeden

2016-01-01

Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist.  In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety.  After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each.  Sessions were recorded and transcribed.  Data were examined using content ...

Success factors for telehealth--a case study.

Science.gov (United States)

Moehr, J R; Schaafsma, J; Anglin, C; Pantazi, S V; Grimm, N A; Anglin, S

2006-01-01

To present the lessons learned from an evaluation of a comprehensive telehealth project regarding success factors and evaluation methodology for such projects. A recent experience with the evaluation of new telehealth services in BC, Canada, is summarized. Two domains of clinical applications, as well as educational and administrative uses, and the project environment were evaluated. In order to contribute to the success of the project, the evaluation included formative and summative approaches employing qualitative and quantitative methods with data collection from telehealth events, participants and existing databases. The evaluation had to be carried out under severe budgetary and time constraints. We therefore deliberately chose a broad ranging exploratory approach within a framework provided, and generated questions to be answered on the basis of initial observations and participant driven interviews with progressively more focused and detailed data gathering, including perusal of a variety of existing data sources. A unique feature was an economic evaluation using static simulation models. The evaluation yielded rich and detailed data, which were able to explain a number of unanticipated findings. One clinical application domain was cancelled after 6 months, the other continues. The factors contributing to success include: Focus on chronic conditions which require visual information for proper management. Involvement of established teams in regular scheduled visits or in sessions scheduled well in advance. Problems arose with: Ad hoc applications, in particular under emergency conditions. Applications that disregard established referral patterns. Applications that support only part of a unit's services. The latter leads to the service mismatch dilemma (SMMD) with the end result that even those e-health services provided are not used. The problems encountered were compounded by issues arising from the manner in which the telehealth services had been introduced

Towards Patient-Centric Telehealth: a Journey into ICT Infrastructures and User Modeling

DEFF Research Database (Denmark)

Jørgensen, Daniel Bjerring

Problem setting: The problem setting for this thesis is the telehealth domain. Telehealth is addressed from two perspectives: ICT infrastructures and personalized telehealth. ICT infrastructures are addressed on both the local level concerning the systems that are deployed in patients’ homes......, and on the national level concerning the transmission of data in end-to-end infrastructural scenarios. Personalized telehealth concerns the design of telehealth systems that are able to fit the everyday life of their patients. Problem and Research questions: The problem setting was formalized in a principal research...... events in the CASAS datasets. New ideas for research directions have been spawned by the ICT infrastructure: tools to strengthen and supporting telehealth patients’ motivation and identification of patterns, if such exist, indicating correlations between changes to a telehealth patient’s behavioral...

A case study detailing key considerations for implementing a telehealth approach to office ergonomics.

Science.gov (United States)

Ritchie, Catherine L W; Miller, Linda L; Antle, David M

2017-01-01

Telehealth approaches to delivering ergonomics assessment hold great potential to improve service delivery in rural and remote settings. This case study describes a telehealth-based ergonomics service delivery process, and compares in-person and telehealth-based ergonomics approaches at an Alberta-based non-profit advocacy group. This project demonstrates that telehealth approaches to ergonomics do not lead to significantly different scoring outcomes for assessment of ergonomics issues, when compared to in-person assessments. This project also outlines the importance of live real-time video conferencing to improving communication, attaining key assessment information, and demonstrating ergonomic adjustments. However, some key considerations of bandwidth and hardware capabilities need to be taken into account. Key communication strategies are outlined to improve rapport, maintain employee confidentiality, and reduce client anxiety around telehealth ergonomics assessments. This project provides further support for telehealth approaches to office ergonomics, and outlines some key implementation strategies and barriers that should be considered.

Caring in telehealth.

Science.gov (United States)

Varghese, Shainy B; Phillips, Carolyn A

2009-12-01

The overall goal of this study was to explore and describe the perceptions of advanced practice nurses (APNs) about caring while providing primary care using telehealth technology. This study used naturalistic inquiry methodology to elicit the subjective perceptions and reflections of a sample of APNs about how they convey caring in the context of telehealth. Thirteen APNs, selected by purposive and snowball sampling, participated in the study. The data for the study consisted of interviews conducted by e-mail using a semistructured interview guide. Data analysis used the constant comparison method; rigor and trustworthiness of the study procedures were established using the criteria of credibility, confirmability, dependability, and transferability. The findings of this study revealed that the APNs conveyed caring to their telehealth patients by (1) being with them, (2) personifying the images, and (3) possessing certain attributes. The major constructs that emerged from the data together formed a model of how APNs conveyed caring in telehealth. The findings provide insights and increase the understanding of how caring in telehealth was perceived by APNs. The findings of the study can make important contributions in improving our profession's preparation of future telehealth APNs. The study findings also can lend themselves to developing an instrument to measure caring in telehealth. The study findings also contribute to the nursing literature in a number of ways.

The use of telehealth in early autism training for parents: a scoping review

Directory of Open Access Journals (Sweden)

Boisvert M

2014-03-01

Full Text Available Michelle Boisvert,1 Nerissa Hall2 1WorldTide, Inc., Williamsburg, MA, USA; 2Communicare, LLC, Ludlow, MA, USA Abstract: Telehealth involves the application of technology to deliver services over a geographical distance. Studies in which telehealth procedures were used in the training or coaching of parents with young children (aged 6 years and under who were diagnosed with autism were reviewed. Scoping searches identified two studies that met the inclusion criteria. These studies were evaluated in terms of the: 1 characteristics of the participants; 2 technology utilized; 3 services delivered via telehealth; 4 research methodology; and 5 results and conclusions of the study. Telehealth was used by speech–language pathologists and university researchers to provide training to parents on specific intervention approaches to facilitate targeted communication initiations and responses by gestures, picture pointing, or verbalizations, as well as the delivery and evaluation of the Early Start Denver Model. While the available literature is limited on this topic, this review suggests that the use of telehealth is a viable means to provide training to parents with young children diagnosed with autism. Keywords: autism spectrum disorder, telehealth, training, education, caregivers, parents

Telehealth: current practices and future directions

Science.gov (United States)

David, Yadin B.

1996-02-01

When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.

Occupational Therapy Home Safety Intervention via Telehealth

Science.gov (United States)

BREEDEN, LORI E.

2016-01-01

Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions. Sessions were recorded and transcribed. Data were examined using content analysis. The content analysis identified the following themes: the value of photos to support learning; the value of narrative learning related to home safety education; and abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention. PMID:27563389

Effect of telehealth-to-home interventions on quality of life for individuals with depressive and anxiety disorders

Directory of Open Access Journals (Sweden)

Durl

2014-11-01

Full Text Available Logan Durland,1 Alejandro Interian,1,2 Ingrid Pretzer-Aboff,3 Roseanne D Dobkin11Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, 2The New Jersey Healthcare System, Veteran Affairs Medical Center, Lyons, NJ, 3University of Delaware, School of Nursing and Biomechanics and Movement Sciences Program, Newark, DE, USAAbstract: Although millions of individuals suffer from mental health problems worldwide, only a small fraction receives adequate treatment. The high prevalence of depression and anxiety observed worldwide, in conjunction with very low rates of treatment utilization, are of great clinical significance, as these psychiatric conditions are two of the most important determinants of quality of life (QoL. Telehealth interventions have been touted as potential solutions to these mental health care disparities, with great interest and utility demonstrated across a diverse array of medical and psychiatric populations. Telehealth interventions may be clinic-based or home-based. The primary objective of this paper is to highlight the extent to which telehealth-to-home interventions positively impact multiple facets of QoL for individuals with depression and anxiety disorders, including those with comorbid medical conditions. While QoL outcomes are important to consider in any assessment of treatment effectiveness, QoL enhancement has received limited attention in the telemental health literature to date. All studies included in the present review evaluate telehealth-to-home treatments, assess QoL outcomes, and incorporate some degree of live, synchronous therapist-patient contact. Recommendations to advance the application of telehealth-to-home approaches are proposed and include: additional research on video-to-home telehealth platforms, strategies to increase the adoption of telehealth-to-home interventions amongst mental health treatment providers, national legislative

Nurses' and community support workers' experience of telehealth: a longitudinal case study.

Science.gov (United States)

Sharma, Urvashi; Clarke, Malcolm

2014-04-10

Introduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced. In a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation. Users experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise. Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients.

The Ottawa telehealth project.

Science.gov (United States)

Cheung, S T; Davies, R F; Smith, K; Marsh, R; Sherrard, H; Keon, W J

1998-01-01

To examine the telehealth system as a means of improving access to cardiac consultations and specialized health services in remote areas of Ontario. The University of Ottawa Heart Institute has set up a telehealth test program, Healthcare and Education Access for Remote Residents by Telecommunications (HEARRT), in collaboration with industry and the provincial and federal government, as well as several remote clinical test sites. The program makes off-site cardiology consultations possible. History taking and physical examinations are conducted by video and electronic stethoscope. Laboratory results and echocardiograms are transmitted by document camera and VCR. The technology is being tested in both stable outpatient and emergency situations. Various telecommunications bandwidths and encoding systems are being evaluated, including satellite and terrestrial-based asynchronous transfer-mode circuits. Patient satisfaction and cost-effectiveness are also being assessed. Bandwidths from as low as 384 kbps using H.320 encoders to 40 Mbps using digital transport of NTSC video signals have been evaluated. Although lower bandwidths are sufficient for sending echocardiographic and electrocardiogram data, bandwidths with transport speeds of 4 to 6 Mbps appear necessary to capture the nuances of the cardiac physical examination. A preliminary satisfaction survey of 19 patients noted that all felt that they could communicate effectively with the cardiologist by video, and each had confidence in the advice offered. None reported that he or she would rather have traveled to the doctor in person. Initial and projected examination of the costs suggested that telehealth will effectively reduce overall health care spending while decreasing travel expenses for rural patients. Telehealth technology is sufficiently sophisticated to allow off-site cardiology assessments. Preliminary results suggest there is a sound business case for the implementation of telehealth technology to meet

Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review.

Science.gov (United States)

Fraser, Sarah; Mackean, Tamara; Grant, Julian; Hunter, Kate; Towers, Kurt; Ivers, Rebecca

2017-01-01

Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.

What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services.

Science.gov (United States)

Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Hinder, Sue; Rouncefield, Mark

2015-04-23

We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability. This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants' lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services. Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning. Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and

Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study.

Science.gov (United States)

Bashir, Ayisha; Bastola, Dhundy R

2018-05-25

Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. The responses to the interview questions and data gathered

Interpersonal Communication in Behavioral Telehealth: What Can We Learn from Other Fields?

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Collie, Katharine R.

In this paper, research about mediated communication is used to shed light on questions that have arisen in relation to behavioral telehealth about the relative merits of different modes of distance communication for the transaction of behavioral telehealth services. The paper is in two parts. The first part contains a presentation of questions…

Occupational Therapy Home Safety Intervention via Telehealth

Directory of Open Access Journals (Sweden)

Lori E. Breeden

2016-07-01

Full Text Available Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist.  In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety.  After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each.  Sessions were recorded and transcribed.  Data were examined using content analysis.  A content analysis identified the following themes as well as an understanding of the learning process.  Analyses yielded themes of: the value of photos to support learning, the value of narrative learning related to home safety education, abstract versus concrete learners.  Procedural findings are included to support future endeavors.  Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention.

Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis

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Renee Speyer

2017-12-01

Full Text Available Objective: To describe telehealth interventions delivered by allied health professionals and nurses in rural and remote areas, and to compare the effects of telehealth interventions with standard face-to-face interventions. Data sources: CINAHL, Embase, PsycINFO and PubMed databases were searched. The content of relevant journals and published articles were also searched. Study selection: Studies examining the effectiveness of allied health and nursing telehealth interventions for rural and remote populations were included in descriptive analyses. Studies comparing telehealth intervention with standard face-to-face interventions grouped by type of intervention approach were used to examine between-groups effect sizes. Data extraction: Methodological quality of studies was rated using the QualSyst critical appraisal tool and the National Health and Medical Research Council (NHMRC Evidence Hierarchy levels. Data synthesis: After quality ratings, 43 studies were included. A majority of studies had strong methodological quality. The disciplines of psychology and nursing were represented most frequently, as were studies using a cognitive intervention approach. Meta-analysis results slightly favoured telehealth interventions compared with face-to-face interventions, but did not show significant differences. Interventions using a combined physical and cognitive approach appeared to be more effective. Conclusion: Telehealth services may be as effective as face-to-face interventions, which is encouraging given the potential benefits of telehealth in rural and remote areas with regards to healthcare access and time and cost savings.

An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal

OpenAIRE

Clarke, M; Mars, M

2014-01-01

This article has been made available through the Brunel Open Access Publishing Fund. Abstract Background: We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. Materials and Methods: We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access...

Increasing Access to an ASD Imitation Intervention via a Telehealth Parent Training Program

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Wainer, Allison L.; Ingersoll, Brooke R.

2015-01-01

Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed…

Personalized telehealth in the future

DEFF Research Database (Denmark)

Dinesen, Birthe Irene; Nonnecke, Brandie; Lindeman, David

2016-01-01

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the c...

Telehealth in the developing world: current status and future prospects

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Scott RE

2015-02-01

Full Text Available Richard E Scott,1,2 Maurice Mars11Department of TeleHealth, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 2NT Consulting - Global e-Health Inc., Calgary, AB, CanadaAbstract: In a setting of constant change and confusing terminology, telehealth continues to gain ground in both developed and developing countries within the overarching milieu of e-health. Evidence shows telehealth has been used in essentially all countries of the world, but is embedded in few. Uses and needs of telehealth vary between the developed and developing world; the latter struggles with both communicable diseases and noncommunicable diseases, and with very few resources. Common clinical applications include teleconsultation, telecardiology (transmission of ECGs, teleradiology, and teledermatology. Many telehealth projects exist throughout Latin America and the Caribbean, Asia, and Africa, but there is little published evidence and only isolated examples of sustained programs, although several sustained humanitarian networks exist. Application of mobile solutions (m-health is on the rise in many developing countries. Telehealth is still not integrated into existing health care systems globally. Reasons vary: lack of proven large-scale operations, poor evidence base, inadequate implementation, lack of attention to the “soft side” of implementation (readiness, change management, and many others. For the developing world, reasons can be more pragmatic, including limited resources, unreliable power, poor connectivity, and high cost for the poverty stricken – those most in need. Telehealth is poised to improve health and health care in the developing world, driven by both altruistic and profit motives. But to have the desired effect, telehealth must address very specific and evidence-based health “needs” of each facility, region, or country; the shortage of health workers and specialist services; and the required skills upgrading and training

The Impact of Telehealth and Care Coordination on the Number and Type of Clinical Visits for Children With Medical Complexity.

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McKissick, Holly D; Cady, Rhonda G; Looman, Wendy S; Finkelstein, Stanley M

The purpose of this analysis was to evaluate the effects of an advanced practice nurse-delivered telehealth intervention on health care use by children with medical complexity (CMC). Because CMC account for a large share of health care use costs, finding effective ways to care for them is an important challenge requiring exploration. This was a secondary analysis of data from a randomized clinical trial with a control group and two intervention groups. The focus of the analysis was planned and unplanned clinical and therapy visits by CMC over a 30-month data collection period. Nonparametric tests were used to compare visit counts among and within the three groups. The number of unplanned visits decreased over time across all groups, with the greatest decrease in the video telehealth intervention group. Planned visits were higher in the video telehealth group across all time periods. Advanced practice registered nurse-delivered telehealth care coordination may support a shift from unplanned to planned health care service use among CMC. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Participatory design methods for the development of a clinical telehealth service for neonatal homecare

DEFF Research Database (Denmark)

Holm, Kristina Garne; Brødsgaard, Anne; Zachariassen, Gitte

2017-01-01

on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information...... regarding infant growth and well-being. Conclusion: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design...

The organising vision for telehealth and telecare: discourse analysis.

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Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara

2012-01-01

To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Discourse analysis. 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for

A cross-sectional survey and service evaluation of simple telehealth in primary care: what do patients think?

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Cottrell, Elizabeth; McMillan, Kate; Chambers, Ruth

2012-01-01

To determine the patient experience of using a simple telehealth strategy to manage hypertension in adults. As part of a pragmatic service evaluation, the acceptability of, satisfaction with and ease of use of a simple telehealth strategy was determined via text, cross-sectional questionnaire survey administered by telephone, case studies, discussion groups and informal feedback from practices. This simple telehealth approach required patients to take home blood pressure (BP) readings and text them to a secure server ('Florence') for immediate automatic analysis and individual healthcare professional review. 124 intervention patients who used the Florence system. 10 volunteer general practitioner's (GP) practices in Stoke on Trent, UK, with poor health and high levels of material deprivation took part. Patient satisfaction was high. In particular, patients found the system easy to use, were very satisfied about the feedback from their GP regarding their BP readings, found the advice sent via Florence useful and preferred to send BP readings using Florence rather than having to go to the practice monthly to get BP checked. Overall satisfaction with the system was 4.81/5.00 at week 13 of the programme. Other advantages of being enrolled with Florence were improved education about hypertension, a greater feeling of support and companionship and flexibility which allowed self-care to occur at a time that suited the patient rather than their practice. This simple telehealth strategy for managing hypertension in the community was met with high levels of patient satisfaction and feelings of control and support. This management approach should thus be considered for widespread implementation for clinical management of hypertension and other long-term conditions involving monitoring of patients' bodily measurements and symptoms as a large number of meaningful readings can be obtained from many patients in a prompt, efficient, interactive and acceptable way.

A Pilot Investigation of Speech Sound Disorder Intervention Delivered by Telehealth to School-Age Children

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Sue Grogan-Johnson

2011-05-01

Full Text Available This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth, or conventional side-by-side intervention.  Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002. Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting. Keywords:  Telehealth, telerehabilitation, videoconferencing, speech sound disorder, speech therapy, speech-language pathology; E-Helper

Exploring telehealth opportunities in domestic violence shelters.

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Mattson, Susan; Shearer, Nelma; Long, Carol

2002-10-01

To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention. Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews. Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs. Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.

Business models for telehealth in the US: analyses and insights

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Pereira F

2017-02-01

Full Text Available Francis Pereira Data Sciences and Operations, Marshall School of Business, University of Southern, Los Angeles, CA, USAAbstract: A growing shortage of medical doctors and nurses, globally, coupled with increasing life expectancy, is generating greater cost pressures on health care, in the US and globally. In this respect, telehealth can help alleviate these pressures, as well as extend medical services to underserved or unserved areas. However, its relatively slow adoption in the US, as well as in other markets, suggests the presence of barriers and challenges. The use of a business model framework helps identify the value proposition of telehealth as well as these challenges, which include identifying the right revenue model, organizational structure, and, perhaps more importantly, the stakeholders in the telehealth ecosystem. Successful and cost-effective deployment of telehealth require a redefinition of the ecosystem and a comprehensive review of all benefits and beneficiaries of such a system; hence a reassessment of all the stakeholders that could benefit from such a system, beyond the traditional patient–health provider–insurer model, and thus “who should pay” for such a system, and the driving efforts of a “keystone” player in developing this initiative would help. Keywords: telehealth, business model framework, stakeholders, ecosystem, VISOR business Model

Designing clinically valuable telehealth resources: processes to develop a community-based palliative care prototype.

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Tieman, Jennifer Joy; Morgan, Deidre Diane; Swetenham, Kate; To, Timothy Hong Man; Currow, David Christopher

2014-09-04

Changing population demography and patterns of disease are increasing demands on the health system. Telehealth is seen as providing a mechanism to support community-based care, thus reducing pressure on hospital services and supporting consumer preferences for care in the home. This study examined the processes involved in developing a prototype telehealth intervention to support palliative care patients involved with a palliative care service living in the community. The challenges and considerations in developing the palliative care telehealth prototype were reviewed against the Center for eHealth Research (CeHRes) framework, a telehealth development model. The project activities to develop the prototype were specifically mapped against the model's first four phases: multidisciplinary project management, contextual inquiry, value specification, and design. This project has been developed as part of the Telehealth in the Home: Aged and Palliative Care in South Australia initiative. Significant issues were identified and subsequently addressed during concept and prototype development. The CeHRes approach highlighted the implicit diversity in views and opinions among participants and stakeholders and enabled issues to be considered, resolved, and incorporated during design through continuous engagement. The CeHRes model provided a mechanism that facilitated "better" solutions in the development of the palliative care prototype by addressing the inherent but potentially unrecognized differences in values and beliefs of participants. This collaboration enabled greater interaction and exchange among participants resulting in a more useful and clinically valuable telehealth prototype.

Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis.

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Rawstorn, Jonathan C; Gant, Nicholas; Direito, Artur; Beckmann, Christina; Maddison, Ralph

2016-08-01

Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD). CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence. 11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors. Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Speech-language pathology telehealth in rural and remote schools: the experience of school executive and therapy assistants.

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Fairweather, Glenn C; Lincoln, Michelle A; Ramsden, Robyn

2017-01-01

Difficulties in accessing allied health services, especially in rural and remote areas, appear to be driving the use of telehealth services to children in schools. The objectives of this study were to investigate the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia. The program, called Come N See, provided therapy interventions remotely via low-bandwidth videoconferencing, with email follow-up. Over a 12-week period, children were offered therapy blocks of six fortnightly sessions, each lasting a maximum of 30 minutes. School executives (n=5) and therapy assistants (n=6) described factors that promoted or threatened the program's feasibility and acceptability, during semistructured interviews. Thematic content analysis with constant comparison was applied to the transcribed interviews to identify relationships in the data. Emergent themes related to (a) unmet speech pathology needs, (b) building relationships, (c) telehealth's advantages, (d) telehealth's disadvantages, (e) anxiety replaced by joy and confidence in growing skills, and (f) supports. School executive staff and therapy assistants verified that the delivery of the school-based telehealth service was feasible and acceptable. However, the participants saw significant opportunities to enhance this acceptability through building into the program stronger working relationships and supports for stakeholders. These findings are important for the future development of allied health telehealth programs that are sustainable as well as effective and fit the needs of all crucial stakeholders. The results have significant implications for speech pathology clinical practice relating to technology, program planning and teamwork within telehealth programs.

Practical aspects of telehealth: financial considerations.

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Loh, P K; Sabesan, S; Allen, D; Caldwell, P; Mozer, R; Komesaroff, P A; Talman, P; Williams, M; Shaheen, N; Grabinski, O; Withnall, D

2013-07-01

The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Telehealth language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated.

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Sutherland, Rebecca; Trembath, David; Hodge, Antoinette; Drevensek, Suzi; Lee, Sabrena; Silove, Natalie; Roberts, Jacqueline

2017-01-01

Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children's needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children's reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8-12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child's point of view. Parent feedback about their child's experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96-1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The

Telehealth for Hepatitis C Care in the DAA Era; Ensuring Everyone Can Access a Cure

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Schulz, Thomas Ray; Kanhutu, Kudzai; Sasadeusz, Joe; Watkinson, Sally; Biggs, Beverley Ann

2017-01-01

Abstract Background The Victorian Infectious Diseases Service currently provides telehealth care for rural and regional patients with hepatitis C. From March 2016 direct acting antiviral therapy (DAA) for Hepatitis C has been subsidised for all Australian adults with Hepatitis C. The wide geographic distribution of Australia’s population means patients have to travel considerable distances to access specialist care. The increasing availability of web-based videoconferencing platforms have provided unprecedented capacity to manage patients remotely. The primary aim of this study is to determine whether telehealth delivered hepatitis C management achieves virological outcomes comparable to that achieved in randomised clinical trials. Methods The study is part of a quality audit of the hepatitis and outreach service. Measured outcomes were; (i) proportion of patients achieving a sustained virological response (SVR); (ii) failure to attend rate (FTA); (iii) frequency of technical difficulties; (iv) patient travel kilometres saved through not attending clinic in person; (v) Reduced carbon production due to reduced travel; and (vi) Consultation duration time. Results In 1 year from March 1, 2016, 58 patients have been commenced on Hepatitis C treatment and managed either partially or completely via telehealth. Of those who have so far completed therapy (29 patients) an SVR rate of 97% has been achieved. Expected SVR genotype 1 (>95%); genotype 3 (>85%). The average travel avoided for each telehealth consultation was 616km and each patient had a 
median of two telehealth consultations. Technical difficulties occurred in less than 10% of consultations with FTA of 17%. Consult duration averaged 15 minutes or less. Conclusion Our completed patient cohort results demonstrate comparable virological outcomes for telehealth managed patients as compared with onsite management, even when adjusted for age, gender and hepatic fibrosis status. This suggests efforts to

[Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program].

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Prado, Cláudia; Silva, Isília Aparecida; Soares, Alda Valéria Neves; Aragaki, Ilva Marico Mizumoto; Shimoda, Gilcéria Tochika; Zaniboni, Vanessa Forte; Padula, Camila Brolezzi; Muller, Fabiana Swain; Salve, Jeanine Maria; Daré, Sergio Junior; Wen, Chao Lung; Peres, Heloísa Helena Ciqueto; Leite, Maria Madalena Januário

2013-08-01

The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.

An evaluation of the telehealth facilitation of diabetes and cardiovascular care in remote Australian Indigenous communities: - protocol for the telehealth eye and associated medical services network [TEAMSnet] project, a pre-post study design.

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Brazionis, Laima; Jenkins, Alicia; Keech, Anthony; Ryan, Chris; Bursell, Sven-Erik

2017-01-05

Despite substantial investment in detection, early intervention and evidence-based treatments, current management strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time and face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore, we aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk vulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia. Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from three primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will be four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and telehealth screening strategy]. 2. A lifestyle survey tool administered at ≈ 6-months. 3. At ≈ 6- and 18-months, an electronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard Treatment Manual of the Central Australian Rural Practitioner's Association to generate clinical recommendations. 4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will include: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and survey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence to clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed. Remoteness is a major barrier to provision and uptake of best-practice chronic disease management. Telehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and cardiovascular disease in Indigenous Australians and serve as a model for other conditions. Australia

Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.

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Tuot, Delphine S; Boulware, L Ebony

2017-01-01

CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Conceptualizing Telehealth in Nursing Practice: Advancing a Conceptual Model to Fill a Virtual Gap.

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Nagel, Daniel A; Penner, Jamie L

2016-03-01

Increasingly nurses use various telehealth technologies to deliver health care services; however, there has been a lag in research and generation of empirical knowledge to support nursing practice in this expanding field. One challenge to generating knowledge is a gap in development of a comprehensive conceptual model or theoretical framework to illustrate relationships of concepts and phenomena inherent to adoption of a broad range of telehealth technologies to holistic nursing practice. A review of the literature revealed eight published conceptual models, theoretical frameworks, or similar entities applicable to nursing practice. Many of these models focus exclusively on use of telephones and four were generated from qualitative studies, but none comprehensively reflect complexities of bridging nursing process and elements of nursing practice into use of telehealth. The purpose of this article is to present a review of existing conceptual models and frameworks, discuss predominant themes and features of these models, and present a comprehensive conceptual model for telehealth nursing practice synthesized from this literature for consideration and further development. This conceptual model illustrates characteristics of, and relationships between, dimensions of telehealth practice to guide research and knowledge development in provision of holistic person-centered care delivery to individuals by nurses through telehealth technologies. © The Author(s) 2015.

The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights.

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Mohan, Jai; Razali Raja Yaacob, Raja

2004-03-31

Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.

Attitudes to telehealth use among rural residents

DEFF Research Database (Denmark)

Sørensen, Jens Fyhn Lykke

2008-01-01

. One prerequisite for successful delivery of health care by means of telehealth is the existence of positive attitudes toward telehealth solutions among the potential end beneficiaries. Purpose: The purpose of this study was to examine the attitudes toward telehealth use among residents in a Danish...... rural area. Method: A representative sample from the island of Ærø (n=1000) was selected and attitudes toward two telehealth applications were examined by structured telephone interviews regarding: 1) video consultation between patient and specialist, and 2) transfer of work tasks from local hospital...

The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis.

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Brunton, Lisa; Bower, Peter; Sanders, Caroline

2015-01-01

As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake. Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. 705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or empowerment). Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at

The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD: A Qualitative Meta-Synthesis.

Directory of Open Access Journals (Sweden)

Lisa Brunton

Full Text Available As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake.Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool.705 references (after duplicates removed were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care; transforming interactions (increases risk or reassurance and reconfiguration of 'work' practices (causes burden or empowerment.Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include

Being Spontaneous: The Future of Telehealth Implementation?

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Mars, Maurice; Scott, Richard E

2017-09-01

The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity. Much has been written about the steps that need to be followed to implement and establish a successful telemedicine service that is integrated into everyday clinical practice. A traditional and systematic approach has evolved incorporating activities such as strategy development, needs assessment, business cases and plans, readiness assessment, implementation plans, change management interventions, and ongoing monitoring and evaluation. This "best practice" has been promoted in the telehealth literature for many years. In contrast, several recent initiatives have arisen without any such formal undertakings. This article describes the strengths and weaknesses of two "spontaneous" telemedicine services in dermatology and burn management that have evolved in South Africa. Two spontaneous services were identified and reviewed. In one unsolicited service, doctors at rural referring hospitals have been taking photographs of skin lesions and sending them with a brief text message history to dermatologists using the instant messaging smartphone app, WhatsApp. In the other, burns service, admissions to the burns unit or the clinic were triaged by telephonic description of the case and completion of a preadmission questionnaire. More recently, management and referral decisions are made only after completion of the questionnaire and subsequent submission of photographs of the burn sent by WhatsApp, with the decision transmitted by text message. Although efficient and effective, potential legal and ethical shortcomings have been identified. These "spontaneous" telehealth services challenge traditional best practice, yet appear to lead to truly integrated practice and, therefore, are successful and warrant further study.

Telehealth for diabetes self-management education and support in an underserved, free clinic population: A pilot study.

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Threatt, Tiffaney B; Ward, Eileen D

Primary study objectives were to (1) describe mean change in A1c from baseline of a free clinic population enrolled in telehealth diabetes self-management education and support (DSME/S) services and (2) to compare change in A1C and other clinical outcomes measures with free clinic patients enrolled in a traditional face-to-face DSME/S program. An exploratory study design and comparative evaluation of telehealth DSME/S services in a free clinic population was used. Baseline clinical measures were collected upon referral. Diabetes educators met with patients individually over 2-3 months. Clinical outcomes measures were collected within 6 months of program completion. Data from the telehealth group was assessed individually and compared to a free clinic traditional DSME/S program population. Twelve patients completed a telehealth free clinic DSME/S pilot program with a mean ± SD change in A1C from baseline of -1.03 ± 1.53% (P = 0.050). Mean ± SD change in A1C from baseline in the free clinic population participating in traditional face-to-face DSME/S services was -1.42 ± 1.80% (P = 0.001). No significant differences in secondary outcomes measures, including body mass index and blood pressure, were revealed among the study populations. Expanding access to care in populations faced with challenges of socioeconomics, limited education, and lower health literacy is a step toward reducing health disparities and positively affecting care. Mean A1C can be improved with telehealth DSME/S services in an underserved, free clinic population. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic.

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Beard, Matthew; Orlando, Joseph F; Kumar, Saravana

2017-09-01

Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with

Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis

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Lucas, Grace; Marcu, Afrodita; Piano, Marianne; Grosvenor, Wendy; Mold, Freda; Maguire, Roma; Ream, Emma

2017-01-01

Background Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes

The diffusion of telehealth in rural American Indian communities: a retrospective survey of key stakeholders.

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Brooks, Elizabeth; Manson, Spero M; Bair, Byron; Dailey, Nancy; Shore, Jay H

2012-01-01

Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.

Telehealth for Expanding the Reach of Early Autism Training to Parents

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Laurie A. Vismara

2012-01-01

Full Text Available Although there is consensus that parents should be involved in interventions designed for young children with autism spectrum disorder (ASD, parent participation alone does not ensure consistent, generalized gains in children’s development. Barriers such as costly intervention, time-intensive sessions, and family life may prevent parents from using the intervention at home. Telehealth integrates communication technologies to provide health-related services at a distance. A 12 one-hour per week parent intervention program was tested using telehealth delivery with nine families with ASD. The goal was to examine its feasibility and acceptance for promoting child learning throughout families’ daily play and caretaking interactions at home. Parents became skilled at using teachable moments to promote children’s spontaneous language and imitation skills and were pleased with the support and ease of telehealth learning. Preliminary results suggest the potential of technology for helping parents understand and use early intervention practices more often in their daily interactions with children.

Video-conferencing Telehealth Linkage attempts to Schools to Facilitate Mental Health Consultation.

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McLennan, John D

2018-04-01

Telehealth to schools may be a strategic approach to expand child mental health service delivery, however, there are only a few published examples. This report describes video-conferencing telehealth linkage attempts to schools to facilitate mental health consultation. A series of synchronous video-conferencing linkage strategies were attempted to connect a mental health consultation service to multiple schools in a Canadian setting. Consultation to support the implementation of the Daily Report Card, for students with attentional and behavioural problems, was the core content of this pilot linkage attempt. Synchronous video conference consultations were successfully delivered to six elementary schools across three school districts. Two of three linkage strategies were functional. One used existing health centre-based telehealth units to connect to school-based dedicated tablets with a video collaboration app and reliance on existing school Wi-Fi. A second used existing laptops in both the health and school system linked through a communication platform. A third connection, using 3G/4G hotspots to obviate the need to access school Wi-Fi, was deemed too expensive in this setting. The potential to use existing computer hardware to connect mental health providers and schools could facilitate scale-up. However, it is unknown whether mental health systems and school sectors will invest in such linkages and reorganize core mental health services to be delivered in this way.

A Pilot Study to Improve Access to Eye Care Services for Patients in Rural India by Implementing Community Ophthalmology through Innovative Telehealth Technology.

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John, Sheila; Premila, M; Javed, Mohd; Vikas, G; Wagholikar, Amol

2015-01-01

To inform about a very unique and first of its kind telehealth pilot study in India that has provided virtual telehealth consultation to eye care patients in low resource at remote villages. Provision of Access to eye care services in remote population is always challenging due to pragmatic reasons. Advances in Telehealth technologies have provided an opportunity to improve access to remote population. However, current Telehealth technologies are limited to face-to-face video consultation only. We inform about a pilot study that illustrates real-time imaging access to ophthalmologists. Our innovative software led technology solution allowed screening of patients with varying ocular conditions. Eye camps were conducted in 2 districts in South India over a 12-month period in 2014. Total of 196 eye camps were conducted. Total of 19,634 patients attended the eye camps. Innovative software was used to conduct consultation with the ophthalmologist located in the city hospital. The software enabled virtual visit and allowed instant sharing of fundus camera images for assessment and diagnosis. About 71% of the patients were found to have Refractive Error problems, 15% of them were found to have cataract, 7% of the patients were diagnosed to have Retina problems and 7% of the patients were found to have other ocular diseases. The patients requiring cataract surgery were immediately transferred to city hospital for treatment. Software led assessment of fundus camera images assisted in identifying retinal eye diseases. Our real-time virtual visit software assisted in specialist care provision and illustrated a novel tele health solution for low resource population.

Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health.

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Silva, Andressa Sharllene Carneiro da; Rizzante, Fabio Antonio Piola; Picolini, Mirela Machado; Campos, Karis de; Corrêa, Camila de Castro; Franco, Elen Caroline; Pardo-Fanton, Cássia de Souza; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

2011-01-01

Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. The results showed that the TLFOB-USP members, adjoining to the professor's participants, develop projects

Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health

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Andressa Sharllene Carneiro da Silva

2011-12-01

Full Text Available Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL, in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. Objective: The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. Material and Methods: The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%, and by the performance of tests and paperwork about the theoretical content provided. Results: In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%, an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. Conclusions: The results showed that the TLFOB

An Exploration of Intent to Use Telehealth at Home for Patients with Chronic Diseases

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Shu-Lin Uei

2017-12-01

Full Text Available Telecare is defined as care practiced at a distance. It is an effective strategy for improving the self-health care management of home-patients with chronic diseases. The purpose of this study was to explore the intent to use of telehealth patients. The correlation between the self-care behaviors, the intent to use of telehealth, and the effects on physiological indicators of patients with chronic disease at home were studied. A cross-sectional study design employing purposive sampling was selected. The structured questionnaire ‘Telecare Usage Intention Scale and Self-Care Behavior Scale’ were used, ‘HbA1c, glucose levels and monthly blood pressure measurements’ were analyzed in this thirteen month study. The self-care behaviors of the participants were positively correlated with their intent to use telehealth (p < 0.01. The results also indicated that HbA1c, glucose levels and frequency BP measurement of the participants improved significantly after using telecare (p < 0.005. The results indicated a strong intent to use telehealth and positive perception of telecare services by in-home patients with a chronic disease. Telehealth improves the self-care behavior of in-home chronic disease patients and enhances medical professionals’ ability to deliver quality and effective healthcare.

Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.

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Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R

2018-05-01

Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.

The use of telehealth for diabetes management: a qualitative study of telehealth provider perceptions

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Woodbridge Peter A

2007-05-01

Full Text Available Abstract Background Monitoring and Messaging Devices (MMDs are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use. Methods We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States. Results Findings suggest that MMD program enrollment is limited by both clinical and non-clinical factors, and that patients have varying levels of program participation and system use. Telehealth providers see MMDs as a useful tool for monitoring patients who are interested in working on management of their disease, but are concerned with technical challenges and the time commitment required to use MMDs. Conclusion Telehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation.

Transforming home health nursing with telehealth technology.

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Farrar, Francisca Cisneros

2015-06-01

Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care. Copyright © 2015 Elsevier Inc. All rights reserved.

Competencies required for nursing telehealth activities: A Delphi-study.

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van Houwelingen, Cornelis T M; Moerman, Anna H; Ettema, Roelof G A; Kort, Helianthe S M; Ten Cate, Olle

2016-04-01

Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding

Telehealth and eHealth in nurse practitioner training: current perspectives

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Rutledge CM

2017-06-01

Full Text Available Carolyn M Rutledge,1 Karen Kott,2 Patty A Schweickert,3 Rebecca Poston,1 Christianne Fowler,1 Tina S Haney1 1College of Health Sciences, School of Nursing, 2College of Health Sciences, School of Physical Therapy, Old Dominion University, Norfolk, 3Department of Neuroradiology, University of Virginia, Charlottesville, VA, USA Abstract: Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1 defining telehealth, 2 telehealth etiquette, 3 interprofessional collaboration, 4 regulations, 5 reimbursement, 6 security/Health Insurance Portability and Accountability Act (HIPAA, 7 ethical practice in telehealth, and 8 satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1 didactics, 2 simulations including standardized patient encounters, 3 practice immersions, and 4 telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care. Keywords: telehealth, nurse practitioner education, telemedicine, simulation, health care

An evaluation of telehealth websites for design, literacy, information and content.

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Whitten, Pamela; Holtz, Bree; Cornacchione, Jennifer; Wirth, Christina

2011-01-01

We examined 62 telehealth websites using four assessment criteria: design, literacy, information and telehealth content. The websites came from the member list of the American Telemedicine Association and the Office for the Advancement of Telehealth and partner sites, and were included if they were currently active and at least three clicks deep. Approximately 130 variables were examined for each website by two independent researchers. The websites reviewed contained most of the design variables (mean 74%, SD 6), but fewer of those relating to literacy (mean 26%, SD 6), website information (mean 35%, SD 16) and telehealth content (mean 37%, SD 18). Only 29% of websites encouraged users to ask about telehealth, and 19% contained information on overcoming telehealth barriers. Nonetheless, 84% promoted awareness of telehealth. All evaluation assessments were significantly correlated with each other except for literacy and information. The present study identified various matters that should be addressed when developing telehealth websites. Although much of this represents simple common sense in website design, our evaluation demonstrates that there is still much room for improvement.

The Telehealth Satisfaction Scale (TeSS): Reliability, validity, and satisfaction with telehealth in a rural memory clinic population

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Morgan, Debra G; Kosteniuk, Julie; Stewart, Norma; O’Connell, Megan E; Karunanyake, Chandima; Beever, Rob

2015-01-01

Introduction Patient satisfaction is a key aspect of quality of care and can inform continuous quality improvement. Of the few studies that have reported on patient satisfaction with telehealth in programs aimed at individuals with memory problems, none has reported on the psychometric properties of the user satisfaction scales employed. Methods We evaluated the construct validity and internal consistency reliability of the Telehealth Satisfaction Scale (TeSS), a 10-item scale adapted for use in a Rural and Remote Memory Clinic (RRMC). The RRMC is a one-stop interprofessional clinic for rural and remote seniors with suspected dementia, located in a tertiary care hospital. Telehealth videoconferencing is used for pre-clinic assessment and for follow-up. Patients and caregivers completed the TeSS after each telehealth appointment. With data from 223 patients, exploratory factor analysis was conducted using the principal components analysis extraction method. Results The eigenvalue for the first factor (5.2) was greater than 1 and much larger than the second eigenvalue (.92), supporting a one-factor solution that was confirmed by the scree plot. The total variance explained by factor 1 was 52.1%. Factor loadings (range 0.54 – 0.84) were above recommended cutoffs. The TeSS items demonstrated high internal consistency reliability (Cronbach’s alpha = 0.90). Satisfaction scores on the TeSS items ranged from 3.43 to 3.72 on a 4-point Likert scale, indicating high satisfaction with telehealth. Conclusions The study findings demonstrate high user satisfaction with telehealth in a rural memory clinic, and sound psychometric properties of the TeSS in this population. PMID:25272141

User Authentication in Smartphones for Telehealth

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Katherine A. Smith

2017-11-01

Full Text Available Many functions previously conducted on desktop computers are now performed on smartphones. Smartphones provide convenience, portability, and connectivity.  When smartphones are used in the conduct of telehealth, sensitive data is invariably accessed, rendering the devices in need of user authentication to ensure data protection. User authentication of smartphones can help mitigate potential Health Insurance Portability and Accountability Act (HIPAA breaches and keep sensitive patient information protected, while also facilitating the convenience of smartphones within everyday life and healthcare. This paper presents and examines several types of authentication methods available to smartphone users to help ensure security of sensitive data from attackers. The applications of these authentication methods in telehealth are discussed.  Keywords: Authentication, Biometrics, HIPAA, Mobile security, Telehealth

Towards Resilient Telehealth Support for Clinical Psychiatry and Psychology: A Strategic Review.

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Fiorini, Rodolfo A; De Giacomo, Piero; L'Abate, Luciano

2015-01-01

Human beings have increasingly shown a willingness to adopt Internet, mHealth and telehealth applications as a part of managing their health. Recent technological advances in the use of the Internet and video technologies has greatly impacted the provision of psychotherapy and other clinical services as well as how the training of psychotherapists may be conducted. When utilized appropriately these technologies may provide greater access to needed services to include treatment, consultation, supervision, and training. The major issue in such a development is whether online interventions will be structured or unstructured. The proper use of technology is fundamental to create and boost outstanding results. We present a strategic review and, as an example, the main steps to develop and achieve application resilience and antifragility at system level, for diagnostic and therapeutic telepractice and telehealth support. This article presents a number of innovations that can take psychotherapy treatment, supervision, training, and research forward, towards increased effectiveness application.

Health care on demand: four telehealth priorities for 2016.

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Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason

2016-01-01

Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term.

Delivering scalable Telehealth: ‘What is Scale?’ with case studies from NHS providers, a perspective on the challenges, constraints and issues associated with ‘scalability’

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Sonia Jane Milburn; Adrian Flowerday

2012-01-01

Introduction With local and national evidence highlighting and confirming numerous benefits gained from implementing telehealth, why is it so hard to roll out the technology at scale? Solent NHS Trust has worked alongside Docobo Limited, since 2005, to successfully introduce telehealth to its patients and clinical staff. Our Chronic Obstructive Pulmonary Disease, Chronic Heart Failure and Community Matron teams have utilised Telehealth tools into their normal practice and have delivered signi...

Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: a systematic review.

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du Toit, Marie; Malau-Aduli, Bunmi; Vangaveti, Venkat; Sabesan, Sabe; Ray, Robin A

2017-01-01

Background Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. Conclusion The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Elton

2003-01-01

.... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Jr, Elton L

2007-01-01

.... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Elton

2004-01-01

.... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...

For telehealth to succeed, privacy and security risks must be identified and addressed.

Science.gov (United States)

Hall, Joseph L; McGraw, Deven

2014-02-01

The success of telehealth could be undermined if serious privacy and security risks are not addressed. For example, sensors that are located in a patient's home or that interface with the patient's body to detect safety issues or medical emergencies may inadvertently transmit sensitive information about household activities. Similarly, routine data transmissions from an app or medical device, such as an insulin pump, may be shared with third-party advertisers. Without adequate security and privacy protections for underlying telehealth data and systems, providers and patients will lack trust in the use of telehealth solutions. Although some federal and state guidelines for telehealth security and privacy have been established, many gaps remain. No federal agency currently has authority to enact privacy and security requirements to cover the telehealth ecosystem. This article examines privacy risks and security threats to telehealth applications and summarizes the extent to which technical controls and federal law adequately address these risks. We argue for a comprehensive federal regulatory framework for telehealth, developed and enforced by a single federal entity, the Federal Trade Commission, to bolster trust and fully realize the benefits of telehealth.

Testing telehealth using technology-enhanced nurse monitoring.

Science.gov (United States)

Grant, Leslie A; Rockwood, Todd; Stennes, Leif

2014-10-01

Technology-enhanced nurse monitoring is a telehealth solution that helps nurses with assessment, diagnosis, and triage of older adults living in community-based settings. This technology links biometric and nonbiometric sensors to a data management system that is monitored remotely by RNs and unlicensed support staff. Nurses faced a number of challenges related to data interpretation, including making clinical inferences from nonbiometric data, integrating data generated by three different telehealth applications into a clinically meaningful cognitive framework, and figuring out how best to use nursing judgment to make valid inferences from online reporting systems. Nurses developed expertise over the course of the current study. The sponsoring organization achieved a high degree of organizational knowledge about how to use these systems more effectively. Nurses saw tremendous value in the telehealth applications. The challenges, learning curve, and organizational improvements are described. Copyright 2014, SLACK Incorporated.

Competencies required for nursing telehealth activities: A Delphi-study

NARCIS (Netherlands)

Dr. H.S.M. Kort; Olle ten Cate; Thijs van Houwelingen; Anna H. Moerman; Roelof G.A. Ettema

2016-01-01

Background: Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach

Competencies required for nursing telehealth activities: a Delphi-study

NARCIS (Netherlands)

van Houwelingen, C.T.M.; Moerman, A.H.; Ettema, R.G.A.; Kort, H.S.M.; ten Cate, O.

2016-01-01

Background: Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach

Telehealth, Mobile Applications, and Wearable Devices are Expanding Cancer Care Beyond Walls.

Science.gov (United States)

Cannon, Carol

2018-05-01

To review telehealth solutions, mobile applications, and wearable devices that are currently impacting patients, caregivers, and providers who work in the oncology setting. A literature search was conducted using the terms (Telehealth, Mobile Health, mHealth, Wearable Devices) + (Oncology, Cancer Care). There are many current applications of telehealth and mobile health in the oncology setting. Nurses who care for patients with cancer should be aware of the pervasiveness and impact of telehealth and mobile health to this unique population. Copyright © 2018 Elsevier Inc. All rights reserved.

Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey.

Science.gov (United States)

Edwards, Louisa; Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris

2014-05-08

There is growing interest in telehealth-the use of technology to support the remote delivery of health care and promote self-management-as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology

Environmental aspects of health care in the Grampian NHS region and the place of telehealth

Science.gov (United States)

Wootton, Richard; Tait, Alex; Croft, Amanda

2010-01-01

Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

Telehealth in the Developing World | CRDI - Centre de recherches ...

International Development Research Centre (IDRC) Digital Library (Canada)

Telehealth in the Developing World. Couverture du livre Telehealth in the Developing World. Directeur(s) : Richard Wootton, Nivritti G. Patil, Richard E. Scott, et Kendall Ho. Maison(s) d'édition : Royal Society of Medicine Press, CRDI. 24 février 2009. ISBN : 9781853157844. 324 pages. e-ISBN : 9781552503966.

Telehealth innovations in health education and training.

Science.gov (United States)

Conde, José G; De, Suvranu; Hall, Richard W; Johansen, Edward; Meglan, Dwight; Peng, Grace C Y

2010-01-01

Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences.

Exploring the factors that influence the decision to adopt and engage with an integrated assistive telehealth and telecare service in Cambridgeshire, UK: a nested qualitative study of patient 'users' and 'non-users'.

Science.gov (United States)

Cook, Erica J; Randhawa, Gurch; Sharp, Chloe; Ali, Nasreen; Guppy, Andy; Barton, Garry; Bateman, Andrew; Crawford-White, Jane

2016-04-19

There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare. Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method. This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'. The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more

Locating of Rural Health Centers Equipped with Telehealth using GIS: A Case Study on Khorramabad City, Iran

Directory of Open Access Journals (Sweden)

Safdari Reza

2016-10-01

Full Text Available Residents of the rural and remote area always having limitations on accessing properly required service providers. In such condition, the establishment of rural health centers equipped with telehealth, and also the use of GIS for optimal site selection to the centers, would play an important role in facilitating the achievement of quality health services in desired time factor. This study intended to find the optimal sites for building the Rural Health Centers Equipped with remote health facilities in, Khorramabad City, using GIS. During the pilot study, we identified few effective locating criteria and sub-criteria for rural health centers equipped with telehealth, the priorities was also determined in that descriptive study. Further, we prepared a special layer for each criterion on the site selection, and by integrating such layers based on specified rules and patterns, about the spatial analysis , (like distance and density analysis were done. For such methods, we used Arc Map, Arc Catalog and Arc toolbox environments of Arc GIS (version 9.3. Finally, a map was prepared that indicated the possibility of appropriateness for establishing the centers in the study area. Considering a large number of areas, the research team selected the areas which were the appropriate location for build rural health centers which could be equipped with Telehealth.

Contributors to Frequent Telehealth Alerts Including False Alerts for Patients with Heart Failure: A Mixed Methods Exploration

Science.gov (United States)

Radhakrishna, K.; Bowles, K.; Zettek-Sumner, A.

2013-01-01

Summary Background Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients. Objective To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency. Materials and Methods A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency. Results Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (ppatient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management. PMID:24454576

Are People With Chronic Diseases Interested in Using Telehealth? A Cross-Sectional Postal Survey

Science.gov (United States)

Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris

2014-01-01

Background There is growing interest in telehealth—the use of technology to support the remote delivery of health care and promote self-management—as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. Objective This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Methods Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Results Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs

Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease

DEFF Research Database (Denmark)

Jakobsen, Anna Svarre; Laursen, Lars C; Rydahl-Hansen, Susan

2015-01-01

Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study...... was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD. Materials and Methods: A two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD...... admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge...

Telehealth in the Developing World | CRDI - Centre de recherches ...

International Development Research Centre (IDRC) Digital Library (Canada)

Telehealth in the Developing World. Book cover Telehealth in the Developing World. Directeur(s) : Richard Wootton, Nivritti G. Patil, Richard E. Scott, and Kendall Ho. Maison(s) d'édition : Royal Society of Medicine Press, IDRC. 24 février 2009. ISBN : 9781853157844. 324 pages. e-ISBN : 9781552503966. Téléchargez le ...

Extending Agent Based Telehealth Platform with Activities of Daily Living Reasoning Capabilities

DEFF Research Database (Denmark)

Jørgensen, Daniel Bjerring; Hallenborg, Kasper; Demazeau, Yves

2016-01-01

it will influence his or her everyday live. Therefore we believe that a telehealth system shall adapt its behavior so that it will not be a burden for the patient/resident to use. To this aim we have extended an existing telehealth platform to reason about activities of daily living in a smart home scenario......In the future patients will have a more active role in strengthening and maintaining their own health. Telehealth can empower and motivate patients by giving them the chance to stay in their own homes instead of going to the hospital. A telehealth system is deployed in a patient’s home hence...

Roles and identities in transition: boundaries of work and inter-professional relationships at the interface between telehealth and primary care.

Science.gov (United States)

Segar, Julia; Rogers, Anne; Salisbury, Chris; Thomas, Clare

2013-11-01

complex and multi-faceted roles within primary care is likely to prepare and facilitate the introduction and integration of telehealth innovations into existing patient services. © 2013 John Wiley & Sons Ltd.

Nursing Telehealth Applications Initiative

Science.gov (United States)

2011-01-01

promotion, diagnosis, consultation, education, and/or therapy " (5). Telehealth encompasses videoconferencing, transmission of still images, e-health, remote...one 16 ounce chocolate milkshake at McDonalds has 580 calories and 102 grams of carbohydrate, one Minute Maid apple juice box has 90 calories and

User Authentication in Smartphones for Telehealth.

Science.gov (United States)

Smith, Katherine A; Zhou, Leming; Watzlaf, Valerie J M

2017-01-01

Many functions previously conducted on desktop computers are now performed on smartphones. Smartphones provide convenience, portability, and connectivity. When smartphones are used in the conduct of telehealth, sensitive data is invariably accessed, rendering the devices in need of user authentication to ensure data protection. User authentication of smartphones can help mitigate potential Health Insurance Portability and Accountability Act (HIPAA) breaches and keep sensitive patient information protected, while also facilitating the convenience of smartphones within everyday life and healthcare. This paper presents and examines several types of authentication methods available to smartphone users to help ensure security of sensitive data from attackers. The applications of these authentication methods in telehealth are discussed.

Task-technology fit of video telehealth for nurses in an outpatient clinic setting.

Science.gov (United States)

Cady, Rhonda G; Finkelstein, Stanley M

2014-07-01

Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task-technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task-technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes. The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time-motion study. Qualitative and quantitative results were merged and analyzed within the task-technology fit framework to determine the workflow fit of video telehealth for APRN care coordination. Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task-technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN. Telehealth must provide the right information to the right clinician at the right time. Evaluating task-technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology.

Telehealth on advanced networks.

Science.gov (United States)

Wilson, Laurence S; Stevenson, Duncan R; Cregan, Patrick

2010-01-01

We address advanced Internet for complex telehealth applications by reviewing four hospital-based broadband telehealth projects and identifying common threads. These projects were conducted in Australia under a 6-year research project on broadband Internet applications. Each project addressed specific clinical needs and its development was guided by the clinicians involved. Each project was trialed in the field and evaluated against the initial requirements. The four projects covered remote management of a resuscitation team in a district hospital, remote guidance and interpretation of echocardiography, virtual-reality-based instructor-student surgical training, and postoperative outpatient consultations following pediatric surgery. Each was characterized by a high level of interpersonal communication, a high level of clinical expertise, and multiple participants. Each made use of multiple high-quality video and audio links and shared real-time access to clinical data. Four common threads were observed. Each application provided a high level of usability and task focus because the design and use of broadband capability was aimed directly to meet the clinicians' needs. Each used the media quality available over broadband to convey words, gestures, body movements, and facial expressions to support communication and a sense of presence among the participants. Each required a complex information space shared among the participants, including real-time access to stored patient data and real-time interactive access to the patients themselves. Finally, each application supported the social and organizational aspects of their healthcare focus, creating and maintaining relationships between the various participants, and this was done by placing the telehealth application into a wider functioning clinical context. These findings provide evidence for a significantly enhanced role for appropriate telemedicine systems running on advanced networks, in a wider range of clinical

Designing human centered GeoVisualization application--the SanaViz--for telehealth users: a case study.

Science.gov (United States)

Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E

2012-01-01

Public health data is typically organized by geospatial unit. GeoVisualization (GeoVis) allows users to see information visually on a map. Examine telehealth users' perceptions towards existing public health GeoVis applications and obtains users' feedback about features important for the design and development of Human Centered GeoVis application "the SanaViz". We employed a cross sectional study design using mixed methods approach for this pilot study. Twenty users involved with the NUTES telehealth center at Federal University of Pernambuco (UFPE), Recife, Brazil were enrolled. Open and closed ended questionnaires were used to gather data. We performed audio recording for the interviews. Information gathered included socio-demographics, prior spatial skills and perception towards use of GeoVis to evaluate telehealth services. Card sorting and sketching methods were employed. Univariate analysis was performed for the continuous and categorical variables. Qualitative analysis was performed for open ended questions. Existing Public Health GeoVis applications were difficult to use. Results found interaction features zooming, linking and brushing and representation features Google maps, tables and bar chart as most preferred GeoVis features. Early involvement of users is essential to identify features necessary to be part of the human centered GeoVis application "the SanaViz".

The Process for the Formulation of the International Telehealth Position Statement for Occupational Therapy

Science.gov (United States)

JACOBS, KAREN; CASON, JANA; MCCULLOUGH, ANN

2015-01-01

The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations’ telehealth position statements and data collected from a survey sent to member organizations’ delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations. PMID:27563380

Social acceptance and population confidence in telehealth in Quebec.

Science.gov (United States)

Poder, Thomas G; Bellemare, Christian A; Bédard, Suzanne K; Lemieux, Renald

2015-02-21

Access to healthcare in remote areas is difficult and telehealth could be a promising avenue if accepted by the population. The aim of this study is to assess social acceptance and population confidence in telehealth in the Province of Quebec. We conducted a survey using a questionnaire assessing the social acceptance of and confidence level in telehealth. Two strategies were used: 1) paper questionnaires were sent to two hospitals in Quebec; and 2) online questionnaires were randomly sent by a firm specialized in online survey to a representative sample of the population of the Province of Quebec. Respondents were all residents of the Province of Quebec and 18 years and older. Questions were scored with a four-level Likert scale. A total of 1816 questionnaires were analyzed (229 written and 1,587 online questionnaires). The socio-demographic variables in our samples, especially the online questionnaires, were fairly representative of Quebec's population. Overall, social acceptance scored at 77.71% and confidence level at 65.76%. Both scores were higher in the case of treatment (3 scenarios were proposed) vs. diagnosis (p < 0.05). No difference was found when respondents were asked to respond for themselves and for a member of their family, which demonstrates a true interest in telehealth in Quebec. In addition, we found a significant difference (p < 0.05) between written and online questionnaires regarding social acceptance (80.75% vs. 77.33%) and confidence level (74.84% vs. 64.55%). These differences may be due to social desirability or avidity bias in the written questionnaires. Our results suggest that the population in Quebec encourages the development of telehealth for real time diagnosis and long distance treatment for regions deprived of healthcare professionals.

Growing up with confidence: using telehealth to support continence self-care deficits amongst young people with complex needs

Directory of Open Access Journals (Sweden)

Sharon Levy

2014-05-01

Full Text Available Background Many young people with chronic ill health use technology for selfcare activities, but little is known about the use of telehealth amongst those with spina bifida. The limited availability of specialist continence nurses in primary care settings, for this client group in the UK, exacerbates their reliance on parents or carers.Objectives1. Exploring the way in which home-based and technology-enabled clinical interventions affect young people’s engagement in continence self-care.2. Articulating the way in which telehealth impacts on nursing practice and the conduct of remote clinical encounters.Methods A virtual nurse-led clinic was established to support a small cohort of service users and their parents from home. Data from participants were collected and analysed alongside a narrative record of a reflective diary, used by the continence specialist nurse.Results Participants reported increased level of self-confidence, which was attributed to interacting remotely with the specialist nurse. The virtual clinic assisted users to attain some self-care goals as well as assert their role as partners in care planning. The specialist nurse gained new valuable skills in mastering telehealth technology and managing remote clinical provision.Conclusions Using Skype™ to support young people with complex needs is an effective intervention to support continence care at home. Dedicated technical support during the initial set-up phase and on-going clinical mentorship are needed to ensure that telehealth is successfully embedded within health care practice.

Education and training to support the use of clinical telehealth: A review of the literature.

Science.gov (United States)

Edirippulige, S; Armfield, N R

2017-02-01

Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

78 FR 53506 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

Science.gov (United States)

2013-08-29

... Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481); Activity: Comment Request... required to obtain patient perspective on satisfaction with the CCHT program and messaging devices. DATES.... Titles: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481. OMB...

78 FR 76193 - Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

Science.gov (United States)

2013-12-16

... Coordination Home Telehealth (CCHT) Patient Satisfaction Survey) Activities Under OMB Review AGENCY: Veterans... patient perspective on satisfaction with the CCHT program and messaging devices. DATES: Comments must be...: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481. Type of Review...

Carers' perceptions of the impact of home telehealth monitoring on the provision of care and sustainability of use.

Science.gov (United States)

Wade, Rachael; Cartwright, Colleen; Shaw, Kelly

2015-06-01

This paper aims to report carers' perceptions of the impact of home telehealth on the provision of care and the sustainability of home telehealth use. This paper is reporting on a sample of 15 carers who were involved in the telehealth arm of a larger controlled trial. Carers primarily believed that telehealth helped to provide better care. None of the carers had organised, or planned to organise, ongoing telehealth monitoring beyond the study. The main reason given for non-sustained usage was the belief that the person they cared for no longer required, or would benefit from, the monitoring. As the person being cared for was a frail older person with multiple chronic diseases and a history of recent hospitalisation, the non-sustained usage of home telehealth by carers raises questions about what is needed to ensure sustainability of use; this requires further investigation. © 2014 AJA Inc.

Electrocardiogram signal quality measures for unsupervised telehealth environments

International Nuclear Information System (INIS)

Redmond, S J; Xie, Y; Chang, D; Lovell, N H; Basilakis, J

2012-01-01

The use of telehealth paradigms for the remote management of patients suffering from chronic conditions has become more commonplace with the advancement of Internet connectivity and enterprise software systems. To facilitate clinicians in managing large numbers of telehealth patients, and in digesting the vast array of data returned from the remote monitoring environment, decision support systems in various guises are often utilized. The success of decision support systems in interpreting patient conditions from physiological data is dependent largely on the quality of these recorded data. This paper outlines an algorithm to determine the quality of single-lead electrocardiogram (ECG) recordings obtained from telehealth patients. Three hundred short ECG recordings were manually annotated to identify movement artifact, QRS locations and signal quality (discrete quality levels) by a panel of three experts, who then reconciled the annotation as a group to resolve any discrepancies. After applying a published algorithm to remove gross movement artifact, the proposed method was then applied to estimate the remaining ECG signal quality, using a Parzen window supervised statistical classifier model. The three-class classifier model, using a number of time-domain features and evaluated using cross validation, gave an accuracy in classifying signal quality of 78.7% (κ = 0.67) when using fully automated preprocessing algorithms to remove gross motion artifact and detect QRS locations. This is a similar level of accuracy to the reported human inter-scorer agreement when generating the gold standard annotation (accuracy = 70–89.3%, κ = 0.54–0.84). These results indicate that the assessment of the quality of single-lead ECG recordings, acquired in unsupervised telehealth environments, is entirely feasible and may help to promote the acceptance and utility of future decision support systems for remotely managing chronic disease conditions. (paper)

Telehealth technology: consequences for structure through use.

Science.gov (United States)

Cornford, T; Klecun-Dabrowska, E

2001-01-01

In recent years the focus of ICTs in healthcare has changed from the â back office' to the front end of patient care. These changes have been brought about by a number of factors including the potential of technologies, pressures for modernisation and administrative reforms, including blurring of the boundaries between different organisations (within and beyond the health sector), and which break down traditional barriers between administration of health services and the practice of medicine In this paper we explore in particular how technology is implicated in such changes, focussing on the consequences of the use of the new telehealth technologies, as seen in a set of linked case studies from an inner city borough in London. The paper addresses the way these technologies, through routine use, become (or not) resources and rules that embody new structures for health care.

Being Human: A Qualitative Interview Study Exploring Why a Telehealth Intervention for Management of Chronic Conditions Had a Modest Effect.

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O'Cathain, Alicia; Drabble, Sarah J; Foster, Alexis; Horspool, Kimberley; Edwards, Louisa; Thomas, Clare; Salisbury, Chris

2016-06-30

Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients' lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients' lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients' motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address

Telehealth Stroke Dysphagia Evaluation Is Safe and Effective.

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Morrell, Kate; Hyers, Megan; Stuchiner, Tamela; Lucas, Lindsay; Schwartz, Karissa; Mako, Jenniffer; Spinelli, Kateri J; Yanase, Lisa

2017-01-01

Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP. Inter-rater reliability was analyzed using percent agreement, Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank tests. Logistic regression models accounting for age and gender were used to test the impact of stroke severity and stroke location on agreement. We found excellent agreement for both liquid (91% agreement; kappa = 0.808; Kendall's tau-b = 0.813, p Dysphagia evaluation by a remote SLP via telehealth is safe and effective following stroke. We plan to implement teleswallow across our multistate telestroke network as standard practice for poststroke dysphagia evaluation. © 2017 S. Karger AG, Basel.

Telehealth--an effective delivery method for diabetes self-management education?

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Fitzner, Karen; Moss, Gail

2013-06-01

Diabetes is a chronic disease that is often comorbid with cardiovascular disease, hypertension, kidney disease, and neuropathy. Its management is complex, requiring ongoing clinical management, lifestyle changes, and self-care. This article examines recent literature on telehealth and emerging technological tools for supporting self-management of diabetes and identifies best practices. The authors conducted a PubMed search (January 2008-2012) that was supplemented by review of meeting materials and a scan of the Internet to identify emerging technologies. Fifty-eight papers were reviewed; 12 were selected for greater analysis. This review supports earlier findings that the delivery of diabetes self-management and training (DSME/T) via telehealth is useful, appropriate, and acceptable to patients and providers. Best practices are emerging; not all technology is appropriate for all populations--interactive technology needs to be appropriate to the patient's age, abilities, and sensitivities. Telehealth is scalable and sustainable provided that it adds value, does not add to the provider's workload, and is fairly reimbursed. However, there are multiple barriers (patient, provider, health system) to remotely provided DSME/T. DSME/T delivered via telehealth offers effective, efficient, and affordable ways to reach and support underserved minorities and other people with diabetes and related comorbidities. The new generation of smartphones, apps, and other technologies increase access, and the newest interventions are designed to meet patient needs, do not increase workloads, are highly appropriate, enhance self-management, and are desired by patients.

Experiences with tele-health follow-up in patients with rheumatoid arthritis: a qualitative interview study

DEFF Research Database (Denmark)

Raunsbæk Knudsen, Line; Thurah, Annette De; Lomborg, Kirsten

2017-01-01

the patients' different needs, wishes and abilities to take part in tele-health follow-up. Our findings reveal a need for more insight into how tele-health follow-up could be integrated in routine clinical practice, paying special attention to how reluctant patients may be supported.......: Adopting a strategy of interpretive description, we conducted individual, semi-structured interviews with 15 RA patients participating in a tele-health follow-up. Participants were selected purposively and consecutive from both genders and with various ages, disease durations and disease severity....... The analysis was inductive with a constant comparative approach. First, we identified the main themes conveying the participants' experiences. Then, we constructed patient typologies to explain different perspectives on the tele-health follow-up. RESULTS: Five themes covered the participants' experiences: 'A...

Telehealth application on the rehabilitation of children and adolescents

Directory of Open Access Journals (Sweden)

Maria Tereza N. dos Santos

2014-03-01

Full Text Available Objective: To systematically review the literature on the telehealth initiatives in telerehabilitation practices in children and adolescents from zero to 18 years old. Data sources: Randomized and controlled clinical trials published in the past ten years (January 2002 to February 2012 in Medline/PubMed, Medline/BVS, PEDro and Cochrane Library databases. The descriptors "telemedicine", "rehabilitation" and "telehealth" were used in three different languages (English, Portuguese and Spanish. Data synthesis: From the 20 studies found in the literature, nine were included in this review. Most of the studies showed that telerehabilitation is able to produce better results in the treatment when compared to the traditional methods, providing less frequency of symptoms, better disease control, better quality of life and greater adherence to treatment. Conclusions: Telerehabilitation is a viable and effective strategy in the treatment of common diseases in children and adolescents. However, there are few studies on the subject in this age group. Although telehealth is already consolidated worldwide, there are no studies in Brazil that used the telerehabilitation in children and adolescents, which reinforces the need for more research and investments.

Telehealth Cognitive Behavior Therapy for Co-Occurring Insomnia and Depression Symptoms in Older Adults

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Lichstein, Kenneth L.; Scogin, Forrest; Thomas, S. Justin; DiNapoli, Elizabeth A.; Dillon, Haley R.; McFadden, Anna

2015-01-01

Objective Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. Method Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician’s office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. Results Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. Conclusions These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations. PMID:24014056

Telehealth ICT Infrastructures in the Nordic Countries

DEFF Research Database (Denmark)

Jørgensen, Daniel Bjerring; Hallenborg, Kasper

2015-01-01

This paper presents an overview and recommendations of ICT infrastructures and reference architectures for telehealth in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). This study shows that so far only Denmark has designed a complete reference architecture, and by the end...

Resilient Systemics to Telehealth Support for Clinical Psychiatry and Psychology.

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Fiorini, Rodolfo A; De Giacomo, Piero; L'Abate, Luciano

2015-01-01

Reliably expanding our clinical practice and lowering our overhead with telepsychiatry, telepsychology, distance counseling and online therapy, requires resilient and antifragile system and tools. When utilized appropriately these technologies may provide greater access to needed services to include more reliable treatment, consultation, supervision, and training. The wise and proper use of technology is fundamental to create and boost outstanding social results. We present, as an example, the main steps to achieve application resilience and antifragility at system level, for diagnostic and therapeutic telepractice and telehealth support, devoted to psychiatry and psychology application. This article presents a number of innovations that can take psychotherapy treatment, supervision, training, and research forward, towards increased effectiveness application.

An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal.

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Clarke, Malcolm; Mars, Maurice

2015-02-01

We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access to manage chronic disease, local support and management of patients (to reduce unnecessary travel to the hospital), emergency care (up to 8 h for an ambulance to arrive), e-mail, access to up-to-date information (Web), and teleclinics. We made site measurements at a representative set of health clinics to determine the type of coverage (general packet radio service [GPRS]/3G), its capabilities to support videoconferencing (H323 and Skype™ [Microsoft, Redmond, WA]) and audio (Skype), and throughput for transmission control protocol (TCP) to gain a measure of application performance. We found that none of the remote health clinics had 3G service. The GPRS service provided typical upload speed of 44 kilobits per second (Kbps) and download speed of 64 Kbps. This was not sufficient to support any form of videoconferencing. We also observed that GPRS had significant round trip time (RTT), in some cases in excess of 750 ms, and this led to slow start-up for TCP applications. We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT. We found some health clinics were so remote that they had no mobile service. 3G, where available, had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites, but we frequently experienced 3G changing to GPRS. We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable

Balancing Health Information Exchange and Privacy Governance from a Patient-Centred Connected Health and Telehealth Perspective.

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Kuziemsky, Craig E; Gogia, Shashi B; Househ, Mowafa; Petersen, Carolyn; Basu, Arindam

2018-04-22

 Connected healthcare is an essential part of patient-centred care delivery. Technology such as telehealth is a critical part of connected healthcare. However, exchanging health information brings the risk of privacy issues. To better manage privacy risks we first need to understand the different patterns of patient-centred care in order to tailor solutions to address privacy risks.  Drawing upon published literature, we develop a business model to enable patient-centred care via telehealth. The model identifies three patient-centred connected health patterns. We then use the patterns to analyse potential privacy risks and possible solutions from different types of telehealth delivery.  Connected healthcare raises the risk of unwarranted access to health data and related invasion of privacy. However, the risk and extent of privacy issues differ according to the pattern of patient-centred care delivery and the type of particular challenge as they enable the highest degree of connectivity and thus the greatest potential for privacy breaches.  Privacy issues are a major concern in telehealth systems and patients, providers, and administrators need to be aware of these privacy issues and have guidance on how to manage them. This paper integrates patient-centred connected health care, telehealth, and privacy risks to provide an understanding of how risks vary across different patterns of patient-centred connected health and different types of telehealth delivery. Georg Thieme Verlag KG Stuttgart.

Hype, harmony and human factors: applying user-centered design to achieve sustainable telehealth program adoption and growth.

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Rossos, P G; St-Cyr, O; Purdy, B; Toenjes, C; Masino, C; Chmelnitsky, D

2015-01-01

Despite decades of international experience with the use of information and communication technologies in healthcare delivery, widespread telehealth adoption remains limited and progress slow. Escalating health system challenges related to access, cost and quality currently coincide with rapid advancement of affordable and reliable internet based communication technologies creating unprecedented opportunities and incentives for telehealth. In this paper, we will describe how Human Factors Engineering (HFE) and user-centric elements have been incorporated into the establishment of telehealth within a large academic medical center to increase acceptance and sustainability. Through examples and lessons learned we wish to increase awareness of HFE and its importance in the successful implementation, innovation and growth of telehealth programs.

The Use of Telehealth to Teach Reproductive Health to Female Rural High School Students.

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Yoost, Jennie Lee; Starcher, Rachael Whitley; King-Mallory, Rebecca Ann; Hussain, Nafeeza; Hensley, Christina Ann; Gress, Todd William

2017-04-01

To evaluate the use of telehealth to teach reproductive health to rural areas with high rates of teen pregnancy. Prospective cohort study. Two high schools in rural West Virginia. High school female students who attended telehealth sessions. Teleconferencing equipment connected rural high schools to a distal academic institution. Telehealth sessions included reproductive health and life skills topics. Demographic information, session pre- and post-tests, and 6- month assessment was obtained. Reproductive health knowledge, behavior, and self-efficacy were assessed at intervention and at 6 months, along with Likert scale evaluation of telehealth as an educational tool. Fifty-five students participated in the program with an average age of 16.14 (SD 1.24) years. Only 20% (10/50) of subjects' mothers and 12% (6/50) of subjects' fathers had achieved education beyond high school, and 20% (10/50) of subject's mothers had experienced teen pregnancies (age 18 or younger). Sexual activity was reported among 52% (26/50) of subjects, 4/50 (8%) reported desire to become pregnant within the next year, and 4/50 (8%) reported already pregnant. Thirty-seven students completed the 6-month follow-up survey. Reported condom use increased from 20% (10/50) at baseline to 40% (15/37) at 6 months (P = .04) and hormonal contraception use increased from 22% (11/50) to 38% (14/37) (P = .12). Report of human papillomavirus vaccination increased from 38% (10/26) to 70% (26/37) (P = .001) among all subjects. At 6 months, 91.8% (34/37) reported the use of telehealth was "very effective" as a means to teach the material. Telehealth is an effective tool to teach reproductive health to rural areas. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions

Directory of Open Access Journals (Sweden)

Duplantie Julie

2007-01-01

Full Text Available Abstract Background The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. Methods A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. Results Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. Conclusion Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice.

Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia.

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Morony, Suzanne; Weir, Kristie; Duncan, Gregory; Biggs, Janice; Nutbeam, Don; Mccaffery, Kirsten J

2018-03-07

Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back. We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a "communication skills" study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses' experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016. In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues

A Mixed-Method Evaluation of the Feasibility and Acceptability of a Telehealth-Based Parent-Mediated Intervention for Children with Autism Spectrum Disorder

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Pickard, Katherine E.; Wainer, Allison L.; Bailey, Kathryn M.; Ingersoll, Brooke R.

2016-01-01

Research within the autism spectrum disorder field has called for the use of service delivery models that are able to more efficiently disseminate evidence-based practices into community settings. This study employed telehealth methods in order to deliver an Internet-based, parent training intervention for autism spectrum disorder, ImPACT Online.…

Rehabilitation and Prosthetic Services

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... Review Resources AT Education Blind Rehab Chiropractic Service Polytrauma/TBI Prosthetics & Sensory Aids Recreation Therapy More Health ... Military Sexual Trauma PTSD Research (MIRECC) Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues ...

The influence of a telehealth project on healthcare professional recruitment and retention in remote areas in Mali: A longitudinal study

Directory of Open Access Journals (Sweden)

Gisèle Irène Claudine Mbemba

2016-05-01

Full Text Available Objectives: The telehealth project EQUI-ResHuS (in French, Les TIC pour un accès Équitable aux Ressources Humaines en Santé aimed to contribute to more equitable access to care and support practice in remote regions in Mali. This study explored the evolution of perceptions concerning telehealth among healthcare professionals in the four district health centres that participated in the EQUI-ResHus project and identified variables influencing their perceptions of telehealth impact on recruitment and retention of health professionals. Methods: One year after a first survey (T1, a second data collection (T2 was carried out among healthcare professionals using a 91-item questionnaire. Questions assessing telehealth use and perceptions and perceived impact on recruitment and retention of healthcare professionals were rated on a 5-point Likert scale. A total of 10 independent variables were considered for the analyses. A Wilcoxon signed-rank test was performed to detect differences between T1 and T2, and a bivariate linear regression model for repeated measures was carried out to assess the impact of independent variables on dependent variables. Results: There were no noticeable changes in perceptions related to telehealth influence on recruitment and retention. Only access to information and communication technology significantly differed between T1 and T2 according the Wilcoxon rank test (p = 0.001. Perceived influence of telehealth on recruitment and retention was mostly explained by attitude towards telehealth, perceived effect on recruitment and retention and barriers to recruitment and retention. Conclusion: Based on our results, telehealth was perceived as having a positive influence but mostly indirect influence on healthcare professional recruitment and retention. Also, there were no major changes after 1 year of telehealth use.

A Systematic Review of Research Studies Examining Telehealth Privacy and Security Practices Used By Healthcare Providers

Directory of Open Access Journals (Sweden)

Valerie J.M. Watzlaf

2017-11-01

Full Text Available The objective of this systematic review was to systematically review papers in the United States that examine current practices in privacy and security when telehealth technologies are used by healthcare providers. A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P. PubMed, CINAHL and INSPEC from 2003 – 2016 were searched and returned 25,404 papers (after duplications were removed. Inclusion and exclusion criteria were strictly followed to examine title, abstract, and full text for 21 published papers which reported on privacy and security practices used by healthcare providers using telehealth.  Data on confidentiality, integrity, privacy, informed consent, access control, availability, retention, encryption, and authentication were all searched and retrieved from the papers examined. Papers were selected by two independent reviewers, first per inclusion/exclusion criteria and, where there was disagreement, a third reviewer was consulted. The percentage of agreement and Cohen’s kappa was 99.04% and 0.7331 respectively. The papers reviewed ranged from 2004 to 2016 and included several types of telehealth specialties. Sixty-seven percent were policy type studies, and 14 percent were survey/interview studies. There were no randomized controlled trials. Based upon the results, we conclude that it is necessary to have more studies with specific information about the use of privacy and security practices when using telehealth technologies as well as studies that examine patient and provider preferences on how data is kept private and secure during and after telehealth sessions. Keywords: Computer security, Health personnel, Privacy, Systematic review, Telehealth

Home telehealth in older patients with heart failure – costs, adherence, and outcomes

Directory of Open Access Journals (Sweden)

Spinsante S

2014-09-01

Full Text Available Susanna Spinsante Dipartimento di Ingegneria dell'Informazione, Università Politecnica delle Marche, Ancona, Italy Abstract: This short review discusses the role of telehealth technologies in the management of older patients with heart failure, from different perspectives. Instead of providing a systematic overview of existing literature in the field, this paper provides evidence for a simple, but effective, paradigm upon which a telehealth system may be built, and highlights how such a model may successfully apply to heart failure management, to improve patients' quality of life after discharge, increase independency, and reduce readmissions and costs for the public health institutions. A few examples are discussed, to show the real applicability of the proposed model and further confirm the effectiveness of telehealth, when properly designed and tailored to users' needs. Keywords: remote health care, workflow, requirements

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

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Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

2017-06-01

Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

Mixed Methods Approach for Measuring the Impact of Video Telehealth on Outpatient Clinic Triage Nurse Workflow

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Cady, Rhonda G.; Finkelstein, Stanley M.

2015-01-01

Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

A Modeled Analysis of Telehealth Methods for Treating Pressure Ulcers after Spinal Cord Injury

Directory of Open Access Journals (Sweden)

Mark W. Smith

2012-01-01

Full Text Available Home telehealth can improve clinical outcomes for conditions that are common among patients with spinal cord injury (SCI. However, little is known about the costs and potential savings associated with its use. We developed clinical scenarios that describe common situations in treatment or prevention of pressure ulcers. We calculated the cost implications of using telehealth for each scenario and under a range of reasonable assumptions. Data were gathered primarily from US Department of Veterans Affairs (VA administrative records. For each scenario and treatment method, we multiplied probabilities, frequencies, and costs to determine the expected cost over the entire treatment period. We generated low-, medium-, and high-cost estimates based on reasonable ranges of costs and probabilities. Telehealth care was less expensive than standard care when low-cost technology was used but often more expensive when high-cost, interactive devices were installed in the patient’s home. Increased utilization of telehealth technology (particularly among rural veterans with SCI could reduce the incidence of stage III and stage IV ulcers, thereby improving veterans' health and quality of care without increasing costs. Future prospective studies of our present scenarios using patients with various healthcare challenges are recommended.

77 FR 54783 - Improving Access to Mental Health Services for Veterans, Service Members, and Military Families

Science.gov (United States)

2012-09-05

... develops formal arrangements with community-based providers, such as community mental health clinics... effectiveness of community partnerships in helping to meet the mental health needs of veterans in a timely way... networks that supports the use of community mental health services, including telehealth services and...

Telehealth Business: Boom Times, but Profits May Wait.

Science.gov (United States)

Calandra, Robert

2017-04-01

What we have here is irrational telehealth exuberance. Investors are plowing millions into startups. And even though millennials could be eager adopters, these are still early days for the industry. It may take years-and some regulatory changes-for profits to materialize.

Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

Science.gov (United States)

Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

2011-01-01

Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

eConsent management and enforcement in personal telehealth

NARCIS (Netherlands)

Asim, M.; Koster, R.P.; Petkovic, M.; Rosner, M.; Reimer, H.; Pohlmann, N.; Schneider, W.

2013-01-01

Advances in information and communication technologies are expected to bring large benefits in the healthcare domain. Personal telehealth is one such example that has the potential to address some of the important challenges currently faced by healthcare such as improvement in the quality of

Telehealth Technologies and Applications for Terrorism Response: A Report of the 2002 Coastal North Carolina Domestic Preparedness Training Exercise

Science.gov (United States)

Simmons, Scott C.; Murphy, Timothy A.; Blanarovich, Adrian; Workman, Florence T.; Rosenthal, David A.; Carbone, Matthew

2003-01-01

Effective response to natural or man-made disasters (i.e., terrorism) is predicated on the ability to communicate among the many organizations involved. Disaster response exercises enable disaster planners and responders to test procedures and technologies and incorporate the lessons learned from past disasters or exercises. On May 31 and June 1, 2002, one such exercise event took place at the Camp Lejeune Marine Corps Base in Jacksonville, North Carolina. During the exercise, East Carolina University tested: (1) in-place Telehealth networks and (2) rapidly deployable communications, networking, and data collection technologies such as satellite communications, local wireless networking, on-scene video, and clinical and environmental data acquisition and telemetry. Exercise participants included local, county, state, and military emergency medical services (EMS), emergency management, specialized response units, and local fire and police units. The technologies and operations concepts tested at the exercise and recommendations for using telehealth to improve disaster response are described. PMID:12595406

Integrated Personal Health and Care Services deployment: Experiences in eight European countries

DEFF Research Database (Denmark)

Villalba, Elena; Casas, Isabel; Abadie, Fabienne

2013-01-01

conditions for mainstreaming these services into care provision. Methods: We conducted a qualitative analysis of 27 Telehealth, Telecare and Integrated Personal Health System projects, implemented across 20 regions in eight European countries. The analysis was based on Suter’s ten key principles...... mechanisms, interoperable information systems, policy commitment, engaged professionals, national investments and funding programmes, and incentives and financing. Conclusion: In those cases which provided evidence of success beyond the pilot stage, we observed a promising trend: awareness and introduction...

Ethical practice in Telehealth and Telemedicine.

Science.gov (United States)

Chaet, Danielle; Clearfield, Ron; Sabin, James E; Skimming, Kathryn

2017-10-01

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial.

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Bohingamu Mudiyanselage, Shalika; Stevens, Jo; Watts, Jennifer J; Toscano, Julian; Kotowicz, Mark A; Steinfort, Christopher L; Bell, Jennifer; Byrnes, Janette; Bruce, Stephanie; Carter, Sarah; Hunter, Claire; Barrand, Chris; Hayles, Robyn

2018-01-01

Introduction The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. Methods This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. Results A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. Discussion The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.

The Church as a Bridge to Deliver Health Resources Via Telehealth

Science.gov (United States)

2017-10-25

Obesity; Diet, Food, and Nutrition; Church; Healthcare Disparities; Minority Health; Mobile Health; Telehealth; Community-based Participatory Research; Primary Health Care; Weight Loss Programs; Health Behavior

Diagnosis of hearing loss using automated audiometry in an asynchronous telehealth model: A pilot accuracy study.

Science.gov (United States)

Brennan-Jones, Christopher G; Eikelboom, Robert H; Swanepoel, De Wet

2017-02-01

Introduction Standard criteria exist for diagnosing different types of hearing loss, yet audiologists interpret audiograms manually. This pilot study examined the feasibility of standardised interpretations of audiometry in a telehealth model of care. The aim of this study was to examine diagnostic accuracy of automated audiometry in adults with hearing loss in an asynchronous telehealth model using pre-defined diagnostic protocols. Materials and methods We recruited 42 study participants from a public audiology and otolaryngology clinic in Perth, Western Australia. Manual audiometry was performed by an audiologist either before or after automated audiometry. Diagnostic protocols were applied asynchronously for normal hearing, disabling hearing loss, conductive hearing loss and unilateral hearing loss. Sensitivity and specificity analyses were conducted using a two-by-two matrix and Cohen's kappa was used to measure agreement. Results The overall sensitivity for the diagnostic criteria was 0.88 (range: 0.86-1) and overall specificity was 0.93 (range: 0.86-0.97). Overall kappa ( k) agreement was 'substantial' k = 0.80 (95% confidence interval (CI) 0.70-0.89) and significant at p loss. This method has the potential to improve synchronous and asynchronous tele-audiology service delivery.

Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease.

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Ho, Yi-Lwun; Yu, Jiun-Yu; Lin, Yen-Hung; Chen, Ying-Hsien; Huang, Ching-Chang; Hsu, Tse-Pin; Chuang, Pao-Yu; Hung, Chi-Sheng; Chen, Ming-Fong

2014-06-10

Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases. We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases. We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital's database and were adjusted to the follow-up months. The mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost

Tablet PC Enabled Body Sensor System for Rural Telehealth Applications

Directory of Open Access Journals (Sweden)

Nitha V. Panicker

2016-01-01

Full Text Available Telehealth systems benefit from the rapid growth of mobile communication technology for measuring physiological signals. Development and validation of a tablet PC enabled noninvasive body sensor system for rural telehealth application are discussed in this paper. This system includes real time continuous collection of physiological parameters (blood pressure, pulse rate, and temperature and fall detection of a patient with the help of a body sensor unit and wireless transmission of the acquired information to a tablet PC handled by the medical staff in a Primary Health Center (PHC. Abnormal conditions are automatically identified and alert messages are given to the medical officer in real time. Clinical validation is performed in a real environment and found to be successful. Bland-Altman analysis is carried out to validate the wrist blood pressure sensor used. The system works well for all measurements.

Evaluation of a telehealth training package to remotely train staff to conduct a preference assessment.

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Higgins, William J; Luczynski, Kevin C; Carroll, Regina A; Fisher, Wayne W; Mudford, Oliver C

2017-04-01

Recent advancements in telecommunication technologies make it possible to conduct a variety of healthcare services remotely (e.g., behavioral-analytic intervention services), thereby bridging the gap between qualified providers and consumers in isolated locations. In this study, web-based telehealth technologies were used to remotely train direct-care staff to conduct a multiple-stimulus-without-replacement preference assessment. The training package included three components: (a) a multimedia presentation; (b) descriptive feedback from previously recorded baseline sessions; and (c) scripted role-play with immediate feedback. A nonconcurrent, multiple-baseline-across-participants design was used to demonstrate experimental control. Training resulted in robust and immediate improvements, and these effects maintained during 1- to 2-month follow-up observations. In addition, participants expressed high satisfaction with the web-based materials and the overall remote-training experience. © 2017 Society for the Experimental Analysis of Behavior.

Implementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.

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Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, Andrew

2009-01-01

Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients. Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally. The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse. Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.

Exploring challenges to telehealth communication by specialists in poison information.

Science.gov (United States)

Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara

2012-01-01

The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.

Nursing care by telehealth: what is the influence of distance on communication?

Science.gov (United States)

Barbosa, Ingrid de Almeida; Silva, Maria Júlia Paes da

2017-01-01

Evaluate the perception of nurses regarding interpersonal communication while providing care via telehealth. Qualitative research realized with seven nurses working in telehealth in Brazil, the sample was determined by data saturation. A questionnaire with open questions was applied and then content analysis of the dialogues was conducted, focusing on thematic analysis. Four categories emerged from the dialogues: Understanding the importance of communication; the interpersonal relationship interfering with communication; Communicating via technology; and Learning the communication process. The perception of nurses working in telehealth in Brazil is that technology has facilitated their professional practice; however, in relation to the communication process, they believe it is harder to communicate by telehealth, mainly due to difficulty in perceiving nonverbal signals. To overcome these difficulties, they agreed that interpersonal communication is a skill that must be acquired during their professional training. Avaliar a percepção do enfermeiro referente à Comunicação interpessoal no cuidado por telessaúde. Pesquisa qualitativa, realizada com sete enfermeiros que atuam em telessaúde no Brasil, com amostra determinada pela saturação de dados. Aplicou-se um questionário com perguntas abertas e foi realizada análise de conteúdo dos discursos, com enfoque na análise temática. Dos discursos emergiram quatro categorias: Entendendo a importância da comunicação; O relacionamento interpessoal interferindo na comunicação; Comunicando-se por meio da tecnologia; e Aprendendo o processo de comunicação. A percepção dos enfermeiros que atuam em telessaúde no Brasil é de que a tecnologia tem facilitado sua prática profissional; porém, em relação ao processo de comunicação, creem que seja mais difícil se comunicar pela telessaúde, principalmente devido à dificuldade de percepção de sinais não verbais. Para superar essas dificuldades, concordam

The application of telemedicine in orthopedic surgery in singapore: a pilot study on a secure, mobile telehealth application and messaging platform.

Science.gov (United States)

Daruwalla, Zubin Jimmy; Wong, Keng Lin; Thambiah, Joseph

2014-06-05

The application of telemedicine has been described for its use in medical training and education, management of stroke patients, urologic surgeries, pediatric laparoscopic surgeries, clinical outreach, and the field of orthopedics. However, the usefulness of a secure, mobile telehealth application, and messaging platform has not been well described. A pilot study was conducted to implement a health insurance portability and accountability act (HIPAA) compliant form of communication between doctors in an orthopedic clinical setting and determine their reactions to MyDoc, a secure, mobile telehealth application, and messaging platform. By replacing current methods of communication through various mobile applications and text messaging services with MyDoc over a six week period, we gained feedback and determined user satisfaction with this innovative system from questionnaires handed to the program director, program coordinator, one trauma consultant, all orthopedic residents, and six non-orthopedic residents at the National University Hospital in Singapore. Almost everyone who completed the questionnaire strongly agreed that MyDoc should replace current systems of peer to peer communication in the hospital. The majority also felt that the quality of images, videos, and sound were excellent. Almost everyone agreed that they could communicate easily with each other and would feel comfortable doing so routinely. The majority felt that virtual consults through MyDoc should be made available to inpatients as well as outpatients to potentially lessen clinic loads and provide a secure manner in which patients can communicate with their primary teams any time convenient to both. It was also agreed by most that the potential of telerounding had advantages, especially on weekends as a supplement to normal rounds. Potential uses of MyDoc in an orthopedic clinical setting include HIPAA-compliant peer to peer communication, clinical outreach in the setting of trauma, supervision

Developing telepsychiatry services in KwaZulu-Natal – an action ...

African Journals Online (AJOL)

Objective: In 2009, the Departments of Psychiatry and Telehealth of the University of KwaZulu-Natal (UKZN) initiated a three year project to develop telepsychiatry services in KwaZulu-Natal. This paper describes the challenges and opportunities of this project. Method: This was a collaborative, in situ health service project ...

History of the National Weather Service - Public Affairs - NOAA's National

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enter or select the go button to submit request City, St Go About NWS -Mission -Strategic Plan -History and local government web resources and services. Home >> History History of the National Weather Service The National Weather Service has its beginnings in the early history of the United States. Weather

The TiM system: developing a novel telehealth service to improve access to specialist care in motor neurone disease using user-centered design.

Science.gov (United States)

Hobson, Esther V; Baird, Wendy O; Partridge, Rebecca; Cooper, Cindy L; Mawson, Susan; Quinn, Ann; Shaw, Pamela J; Walsh, Theresa; Wolstenholme, Daniel; Mcdermott, Christopher J

2018-08-01

Attendance at a specialist multidisciplinary motor neurone disease (MND) clinic is associated with improved survival and may also improve quality of life and reduce hospital admissions. However, patients struggle to travel to clinic and may experience difficulties between clinic visits that may not be addressed in a timely manner. We wanted to explore how we could improve access to specialist MND care. We adopted an iterative, user-centered co-design approach, collaborating with those with experience of providing and receiving MND care including patients, carers, clinicians, and technology developers. We explored the unmet needs of those living with MND, how they might be met through service redesign and through the use of digital technologies. We developed a new digital solution and performed initial testing with potential users including clinicians, patients, and carers. We used these findings to develop a telehealth system (TiM) using an Android app into which patients and carers answer a series of questions about their condition on a weekly basis. The questions aim to capture all the physical, emotional, and social difficulties associated with MND. This information is immediately uploaded to the internet for review by the MND team. The data undergoes analysis in order to alert clinicians to any changes in a patient or carer's condition. We describe the benefits of developing a novel digitally enabled service underpinned by participatory design. Future trials must evaluate the feasibility and acceptability of the TiM system within a clinical environment.

Role of telehealth in renal replacement therapy education.

Science.gov (United States)

Malkina, Anna; Tuot, Delphine S

2018-03-01

The prevalence of end-stage renal disease is rising in the United States, which bears high financial and public health burden. The most common modality of renal replacement therapy (RRT) in the United States is in-center hemodialysis. Many patients report lack of comprehensive and timely education about their treatment options, which may preclude them from participating in home-based dialysis therapies and kidney transplantation evaluation. While RRT education has traditionally been provided in-person, the rise of telehealth has afforded new opportunities to improve upon the status quo. For example, technology-augmented RRT education has recently been implemented into telehealth nephrology clinics, informational websites and mobile applications maintained by professional organizations, patient-driven forums on social media, and multimodality programs. The benefits of technology in RRT education are increased access for geographically isolated and/or medically frail patients, versatility of content delivery, information repetition to enhance knowledge retention, and interpersonal connection for educational content and emotional support. Challenges center around privacy and accuracy of information sharing, in addition to differential access to technology due to age and socioeconomic status. A review of available scholarly and social media resources suggests that technology-aided delivery of education about treatment options for end-stage renal disease provides an important alternative and/or supplemental resource for patients and families. © 2018 Wiley Periodicals, Inc.

Do we need new personalized emergency telehealth solutions? A survey of 100 emergency department patients and a first report of the swiss limmex emergency wristwatch: an original study.

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Tabbara, Malek; Hodel, Thomas; Müller, Urs; Briner, Gabi; Zimmermann, Heinz; Exadaktylos, Aristomenis K

2012-01-01

Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces "Limmex" a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.

PLANNING NATIONAL RADIOTHERAPY SERVICES

Directory of Open Access Journals (Sweden)

Eduardo eRosenblatt

2014-11-01

Full Text Available Countries, states and island nations often need forward planning of their radiotherapy services driven by different motives. Countries without radiotherapy services sponsor patients to receive radiotherapy abroad. They often engage professionals for a feasibility study in order to establish whether it would be more cost-beneficial to establish a radiotherapy facility. Countries where radiotherapy services have developed without any central planning, find themselves in situations where many of the available centres are private and thus inaccessible for a majority of patients with limited resources. Government may decide to plan ahead when a significant exodus of cancer patients travel to another country for treatment, thus exposing the failure of the country to provide this medical service for its citizens. In developed countries the trigger has been the existence of highly visible waiting lists for radiotherapy revealing a shortage of radiotherapy equipment.This paper suggests that there should be a systematic and comprehensive process of long-term planning of radiotherapy services at the national level, taking into account the regulatory infrastructure for radiation protection, planning of centres, equipment, staff, education pr

Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.

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Theodore, Brian R; Whittington, Jan; Towle, Cara; Tauben, David J; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z

2015-06-01

With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. Wiley Periodicals, Inc.

A human centered GeoVisualization framework to facilitate visual exploration of telehealth data: a case study.

Science.gov (United States)

Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E

2012-01-01

Public health data is typically organized by geospatial units. Routine geographic monitoring of health data enables an understanding of the spatial patterns of events in terms of causes and controls. GeoVisualization (GeoVis) allows users to see information hidden both visually and explicitly on a map. Despite the applicability of GeoVis in public health, it is still underused for visualizing public health data. The objective of this study is to examine the perception of telehealth users' to utilize GeoVis as a proof of concept to facilitate visual exploration of telehealth data in Brazil using principles of human centered approach and cognitive fit theory. A mixed methods approach combining qualitative and quantitative assessments was utilized in this cross sectional study conducted at the Telehealth Center of the Federal University of Pernambuco (NUTE-UFPE), Recife, Brazil. A convenient sample of 20 participants currently involved in NUTES was drawn during a period of Sep-Oct 2011. Data was gathered using previously tested questionnaire surveys and in-person interviews. Socio-demographic Information such as age, gender, prior education, familiarity with the use of computer and GeoVis was gathered. Other information gathered included participants' prior spatial analysis skills, level of motivation and use of GeoVis in telehealth. Audio recording was done for all interviews conducted in both English and Portuguese, and transcription of the audio content to English was done by a certified translator. Univariate analysis was performed and means and standard deviations were reported for the continuous variables and frequency distributions for the categorical variables. For the open-ended questions, we utilized a grounded theory to identify themes and their relationship as they emerge from the data. Analysis of the quantitative data was performed using SAS V9.1 and qualitative data was performed using NVivo9. The average age of participants was 28 years (SD=7), a

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer.

Science.gov (United States)

Hanlon, Peter; Daines, Luke; Campbell, Christine; McKinstry, Brian; Weller, David; Pinnock, Hilary

2017-05-17

Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful

A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes.

Science.gov (United States)

Carlisle, Karen; Warren, Robin

2013-10-01

The present study formed part of a randomised controlled trial of telehealth for in-home monitoring to support people with poorly controlled type 2 diabetes. We explored the experiences of patients and healthcare practitioners, and their perceptions of the telehealth model of care used in the trial. In addition to their usual diabetes care, participants receive diabetes care from a diabetes educator nurse via an in-home broadband communication device. On average, each patient participated in 14 videoconferences with a diabetes care coordinator during the 12-month trial period. Qualitative data was collected from two general practices and included semi-structured interviews and document review of patient clinical notes. A total of 12 people were interviewed: 8 health practitioners and 4 patients. Patients and health practitioners expressed a high level of satisfaction with the model of care provided. Patients also reported positive health and social outcomes as a result of being involved in the trial and indicated that in the main they had achieved their goals and were happy with their progress over the 12-month period. Analysis of interviews revealed three broad elements associated with the implementation of telehealth: interpersonal factors, operational problems and the wider health system context within which the general practices and trial team were operating. The findings suggest that adopting telehealth in the management of type 2 diabetes can lead to improved diabetes control, but more support is required to ensure sustainability and widespread implementation.

Dutch nurses' willingness to use home telehealth : implications for practice and education

NARCIS (Netherlands)

van Houwelingen, C.T.M.; Barakat, A.; Best, R.; Boot, W.R.; Charness, N.; Kort, H.S.M.

Home telehealth (HT) refers to the use of videoconferencing to provide care to patients remotely and can help older adults age in place. However, these technologies are unlikely to impact care unless health care providers are motivated to use them. Education may play a key role in increasing

Do We Need New Personalized Emergency Telehealth Solutions? A Survey of 100 Emergency Department Patients and a First Report of the Swiss Limmex Emergency Wristwatch: An Original Study

Directory of Open Access Journals (Sweden)

Malek Tabbara

2012-01-01

Full Text Available Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces “Limmex” a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.

The potential of telehealth for 'business as usual' in outpatient clinics.

Science.gov (United States)

Day, Karen; Kerr, Patricia

2012-04-01

A six-month pilot study was conducted to ascertain the value of using high-definition videoconferencing equipment in an outpatients' setting. The videoconferencing equipment, which included digital biometric equipment, was installed in the outpatient clinics of a remote health service in New Zealand. Use of the equipment was evaluated using action research techniques. Clinicians were interviewed about their assessment of the equipment's usefulness. Patients and their carers completed questionnaires about their clinic experience. During the pilot trial, 109 patients were seen in 25 clinics of six different specialities. Questionnaire results showed that patients and their companions had a good user experience, similar to a face-to-face appointment. Clinicians found that the large screen, sense of proximity, video clarity and definition, and lack of sound/picture lag worked well for certain types of outpatients' clinics, e.g. methadone maintenance clinics. The need for process changes made it difficult to turn telehealth into business as usual in an environment built for face-to-face appointments. We conclude that videoconference equipment has potential to become integral to outpatients' clinics.

Terminology Management at the National Language Service

African Journals Online (AJOL)

The National Terminology Services (NTS) and State Language Services (SLS) of .... as CD-ROM and online (i.e. the National Termbank and, in future, the Inter- ... cal Engineering, Education, Olympic Games, Mammals, Dietetics, Frail Care,.

Health Insurance Portability and Accountability Act-Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy

Energy Technology Data Exchange (ETDEWEB)

Li, Yaquin [University of Tennessee, Knoxville (UTK); Karnowski, Thomas Paul [ORNL; Tobin Jr, Kenneth William [ORNL; Giancardo, Luca [ORNL; Garg, Seema [University of North Carolina; Fox, Karen [Delta Health Alliance; Chaum, Edward [University of Tennessee, Knoxville (UTK)

2011-01-01

In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.

Psychosocial health coaching for chronically ill in a telehealth context: a pilot study

Directory of Open Access Journals (Sweden)

Lenneke Van Genugten

2015-10-01

The results show that the structured, partly automated approach can be used in a telehealth context by means of health coaches. MAY appeared to be a suitable tool for providing input for psychosocial care. HCs attitudes towards the structured approach were positive, which is crucial to the success of the implementation of MAY. Based on these results, we recommend to continue this approach as it may strengthen the wellbeing of patients (to be evaluated in future work. However, improvements are necessary. The tool should get a better fit in the current working procedures, and support the translation from recommendations to action. Further automation may facilitate this. In conclusion, this study shows that it is possible for HCs to implement structured psychosocial care in a telehealth program but that combining digitalized and human efforts in one structure is a challenge. The appreciation of the health coaches is an important first step in this process.

A randomized controlled trial of a telehealth parenting intervention: A mixed-disability trial.

Science.gov (United States)

Hinton, Sharon; Sheffield, Jeanie; Sanders, Matthew R; Sofronoff, Kate

2017-06-01

The quality of parenting a child receives has a major impact on development, wellbeing and future life opportunities. This study examined the efficacy of Triple P Online - Disability (TPOL-D) a telehealth intervention for parents of children with a disability. Ninety-eight parents and carers of children aged 2-12 years diagnosed with a range of developmental, intellectual and physical disabilities were randomly assigned to either the intervention (51) or treatment-as-usual (47) control group. At post-intervention parents receiving the TPOL-D intervention demonstrated significant improvements in parenting practices and parenting self-efficacy, however a significant change in parent-reported child behavioral and emotional problems was not detected. At 3-month follow up intervention gains were maintained and/or enhanced. A significant decrease in parent-reported child behavioral and emotional problems was also detected at this time. The results indicate that TPOL-D is a promising telehealth intervention for a mixed-disability group. Copyright © 2017 Elsevier Ltd. All rights reserved.

Educational actions in human communication health: telehealth contributions in primary care

Directory of Open Access Journals (Sweden)

Gabriela Guedes de Sá Leitão

Full Text Available ABSTRACT Objective: to characterize educational actions related to human communication health produced at the Tele-Health Center for health professionals in primary care. Methods: a cross-sectional study was conducted at the Tele-Health Center at the Federal University of Pernambuco Clinical Hospital. Educational actions produced by tele-consultants between 2008 and 2014 linked to the health of human communication were considered. Data collection was conducted in two phases. In the first phase, the data were explored and educational actions were selected based on the title and the relationship with human communication. In the second phase, each action was observed and evaluated for content. The data were analyzed using descriptive statistics. Results: a few educational actions related to human communication health were concentrated in 2014. Throughout the period analyzed, the actions were restricted to the field of language and concentrated on the education issue as well as the strategic area of child and adolescent health. The most frequent occupational category among the tele-consultants was nursing. Conclusion: a small number of educational actions addressing the health of human communication was produced and the participation of speech therapists remains incipient.

Comparing Web, Group and Telehealth Formats of a Military Parenting Program

Science.gov (United States)

2016-06-01

materials are available upon request: • Online questionnaire for baseline data collection (9 pages) • Online parent survey for time point 1 (69 pages...web-based parenting intervention for military families with school-aged children, we expect to strengthen parenting practices in families and...AWARD NUMBER: W81XWH-14-1-0143 TITLE: Comparing Web, Group and Telehealth Formats of a Military Parenting Program PRINCIPAL INVESTIGATOR

A point-to-point simple telehealth application for cardiovascular prevention: the ESINO LARIO experience. Cardiovascular prevention at point of care.

Science.gov (United States)

Malacarne, Mara; Gobbi, Giorgio; Pizzinelli, Paolo; Lesma, Alessandro; Castelli, Alberto; Lucini, Daniela; Pagani, Massimo

2009-01-01

Recent epidemiological evidence indicates that chronic degenerative diseases, notably cardiovascular, represent the major toll in terms of death and of impaired quality of life. Recent estimates indicate that a small increase in financial resources in a number of clinical cases may be sufficient to minimize the consequences of elevated cardiovascular risk per individual. The observation that lifestyle choices, and in particular increased physical exercise, might strongly impact cardiovascular risk, suggests a redesign of preventive strategies, based on the combination of pharmacological and behavioral interventions. Following our recent experience with the INteractive teleConsultation network for worldwide healthcAre Services (INCAS) system, we designed a simpler point-to-point telehealth infrastructure, to be employed in cardiovascular risk reduction programs, predicting a high level of acceptance from the population, at the cost of very limited investment. This model was tested on 181 subjects (ages 18-80 years) in the Italian mountain village of Esino Lario. These subjects underwent a screening test to evaluate arrhythmia and cardiometabolic risks (arrhythmias were found in 14% of subjects, systolic arterial pressure was observed in 43% of subjects above 140 mm Hg, diastolic arterial pressure in 31% above 90 mm Hg). This study demonstrates the feasibility of a scaled-down telehealth application particularly suited to cardiovascular prevention in remote areas, such as in mountain villages.

76 FR 7807 - National Wildlife Services Advisory Committee; Reestablishment

Science.gov (United States)

2011-02-11

... Inspection Service [Docket No. APHIS-2009-0057] National Wildlife Services Advisory Committee.... SUMMARY: We are giving notice that the Secretary of Agriculture will reestablish the National Wildlife.... SUPPLEMENTARY INFORMATION: The purpose of the National Wildlife Services Advisory Committee (the Committee) is...

Telehealth clinics increase access to care for adults with cystic fibrosis living in rural and remote Western Australia.

Science.gov (United States)

Wood, Jamie; Mulrennan, Siobhain; Hill, Kylie; Cecins, Nola; Morey, Sue; Jenkins, Sue

2017-08-01

Introduction A significant proportion (15%, n = 28) of the adults with cystic fibrosis (CF) in Western Australia (WA) live in rural and remote areas and have difficulty accessing specialist care at the state adult CF centre, located in Perth. We aimed to increase access by offering telehealth clinics, and evaluate the impact on health outcomes. Methods Telehealth clinics were offered via videoconference over a 12-month period, with uptake and satisfaction measured at the end of the intervention. Participants could still attend in person clinics at the CF centre if requested. Other outcomes comprised healthcare utilisation (HCU), spirometry, weight and health-related quality of life. Results In 21 participants, total clinic visits increased from 46 (median (range) per participant 2 (0-6)) in the 12-month period preceding the study to 100 (5 (2-8), p vitality domain of the Cystic Fibrosis Questionnaire - Revised ( p < 0.05). Discussion Telehealth had good uptake and increased clinic attendance in adults with CF living in rural and remote WA, and had high satisfaction amongst participants. The increase in HCU, resulting from increased detection and treatment of exacerbations, may improve long-term outcomes in this population.

Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study.

Science.gov (United States)

Hung, Chi-Sheng; Lee, Jenkuang; Chen, Ying-Hsien; Huang, Ching-Chang; Wu, Vin-Cent; Wu, Hui-Wen; Chuang, Pao-Yu; Ho, Yi-Lwun

2018-01-24

Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95% CI 0.837-0.896). This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD. We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates. The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD. Our study showed that there was a triphasic relationship between contract compliance rate to the

Developing an Employee Counselling Service within the British National Health Service.

Science.gov (United States)

Whelan, Linda; Robson, Maggie; Cook, Peter

1999-01-01

Evaluation of an employee counseling service in Britain's National Health Service by 26 staff participants found the service was valued by employees. Designed to meet the objectives of a "healthy workplace" initiative, the service appeared to be addressing staff support needs. (SK)

The Perceived Stigma of Mental Health Services Among Rural Parents of Children With Psychosocial Concerns

OpenAIRE

Polaha, Jodi; Williams, Stacey L.; Heflinger, Craig Anne; Studts, Christina R.

2015-01-01

Objective To examine parents’ perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. Methods 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. Results Parents endorsed low levels of s...

National Oceanic and Atmospheric Administration: National Weather Service Modernization and Weather Satellite Program

National Research Council Canada - National Science Library

Willemssen, Joel

2000-01-01

...). At your request, we will discuss the status of the National Weather Service (NWS) systems modernization and the National Environmental Satellite, Data, and Information Service's Geostationary Operational Environmental Satellite (GOES) program...

75 FR 36427 - National Advisory Council on the National Health Service Corps; Notice of Meeting

Science.gov (United States)

2010-06-25

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2... of Clinician Recruitment and Service, Health Resources and Services Administration, Parklawn Building...

76 FR 29769 - National Advisory Council on the National Health Service Corps; Notice of Meeting

Science.gov (United States)

2011-05-23

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2..., Bureau of Clinician Recruitment and Service, Health Resources and Services Administration, Parklawn...

78 FR 55264 - National Advisory Council on the National Health Service Corps; Notice of Meeting

Science.gov (United States)

2013-09-10

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2... Recruitment and Service, Health Resources and Services Administration, Parklawn Building, Room 13-64, 5600...

At-Home Transcranial Direct Current Stimulation (tDCS With Telehealth Support for Symptom Control in Chronically-Ill Patients With Multiple Symptoms

Directory of Open Access Journals (Sweden)

Alexa Riggs

2018-05-01

Full Text Available Transcranial direct current stimulation (tDCS delivered in multiple sessions can reduce symptom burden, but access of chronically ill patients to tDCS studies is constrained by the burden of office-based tDCS administration. Expanded access to this therapy can be accomplished through the development of interventions that allow at-home tDCS applications.Objective: We describe the development and initial feasibility assessment of a novel intervention for the chronically ill that combines at-home tDCS with telehealth support.Methods: In the developmental phase, the tDCS procedure was adjusted for easy application by patients or their informal caregivers at home, and a tDCS protocol with specific elements for enhanced safety and remote adherence monitoring was created. Lay language instructional materials were written and revised based on expert feedback. The materials were loaded onto a tablet allowing for secure video-conferencing. The telehealth tablet was paired with an at-home tDCS device that allowed for remote dose control via electronic codes dispensed to patients prior to each session. tDCS was delivered in two phases: once daily on 10 consecutive days, followed by an as needed regimen for 20 days. Initial feasibility of this tDCS-telehealth system was evaluated in four patients with advanced chronic illness and multiple symptoms. Change in symptom burden and patient satisfaction were assessed with the Condensed Memorial Symptom Assessment Scale (CMSAS and a tDCS user survey.Results: The telehealth-tDCS protocol includes one home visit and has seven patient-tailored elements and six elements enhancing safety monitoring. Replicable electrode placement at home without 10–20 EEG measurement is achieved via a headband that holds electrodes in a pre-determined position. There were no difficulties with patients’ training, protocol adherence, or tolerability. A total of 60 tDCS sessions were applied. No session required discontinuation, and

At-Home Transcranial Direct Current Stimulation (tDCS) With Telehealth Support for Symptom Control in Chronically-Ill Patients With Multiple Symptoms.

Science.gov (United States)

Riggs, Alexa; Patel, Vaishali; Paneri, Bhaskar; Portenoy, Russell K; Bikson, Marom; Knotkova, Helena

2018-01-01

Transcranial direct current stimulation (tDCS) delivered in multiple sessions can reduce symptom burden, but access of chronically ill patients to tDCS studies is constrained by the burden of office-based tDCS administration. Expanded access to this therapy can be accomplished through the development of interventions that allow at-home tDCS applications. Objective: We describe the development and initial feasibility assessment of a novel intervention for the chronically ill that combines at-home tDCS with telehealth support. Methods: In the developmental phase, the tDCS procedure was adjusted for easy application by patients or their informal caregivers at home, and a tDCS protocol with specific elements for enhanced safety and remote adherence monitoring was created. Lay language instructional materials were written and revised based on expert feedback. The materials were loaded onto a tablet allowing for secure video-conferencing. The telehealth tablet was paired with an at-home tDCS device that allowed for remote dose control via electronic codes dispensed to patients prior to each session. tDCS was delivered in two phases: once daily on 10 consecutive days, followed by an as needed regimen for 20 days. Initial feasibility of this tDCS-telehealth system was evaluated in four patients with advanced chronic illness and multiple symptoms. Change in symptom burden and patient satisfaction were assessed with the Condensed Memorial Symptom Assessment Scale (CMSAS) and a tDCS user survey. Results: The telehealth-tDCS protocol includes one home visit and has seven patient-tailored elements and six elements enhancing safety monitoring. Replicable electrode placement at home without 10-20 EEG measurement is achieved via a headband that holds electrodes in a pre-determined position. There were no difficulties with patients' training, protocol adherence, or tolerability. A total of 60 tDCS sessions were applied. No session required discontinuation, and there were no adverse

A mixed methods systematic review of success factors of mhealth and telehealth for maternal health in Sub-Saharan Africa.

Science.gov (United States)

Ag Ahmed, Mohamed Ali; Gagnon, Marie-Pierre; Hamelin-Brabant, Louise; Mbemba, Gisele Irène Claudine; Alami, Hassane

2017-01-01

Access to health care is still limited for many women in sub-Saharan Africa (SSA), while it remains an important determinant of maternal mortality and morbidity. Information and communication technologies (ICTs), such as mhealth and telehealth, can help to facilitate this access by acting on the various obstacles encountered by women, be they socio-cultural, economic, geographical or organizational. However, various factors contribute to the success of mhealth and telehealth implementation and use, and must be considered for these technologies to go beyond the pilot project stage. The objective of this systematic literature review is to synthesize the empirical knowledge on the success factors of the implementation and use of telehealth and mhealth to facilitate access to maternal care in SSA. The methodology used is based on that of the Cochrane Collaboration, including a documentary search using standardized language in six databases, selection of studies corresponding to the inclusion criteria, data extraction, evaluation of study quality, and synthesis of the results. A total of 93 articles were identified, which allowed the inclusion of seven studies, six of which were on mhealth. Based on the framework proposed by Broens et al ., we synthesized success factors into five categories: (I) technology, such as technical support to maintain, troubleshoot and train users, good network coverage, existence of a source of energy and user friendliness; (II) user acceptance, which is facilitated by factors such as unrestricted use of the device, perceived usefulness to the worker, adequate literacy, or previous experience of use ; (III) short- and long-term funding; (IV) organizational factors, such as the existence of a well-organized health system and effective coordination of interventions; and (V) political or legislative aspects, in this case strong government support to deploy technology on a large scale. Telehealth and mhealth are promising solutions to reduce

Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study

Science.gov (United States)

Chen, Ying-Hsien; Hung, Chi-Sheng; Huang, Ching-Chang; Hung, Yu-Chien

2017-01-01

Background Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. PMID:28951384

77 FR 50549 - Agency Information Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's...

Science.gov (United States)

2012-08-21

... Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's Disease Research, Education... needed to improve the care and clinical outcomes of patients with Parkinson's disease. DATES: Comments... Parkinson's Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered...

Ostomy telehealth for cancer survivors: Design of the Ostomy Self-management Training (OSMT) randomized trial.

Science.gov (United States)

Sun, Virginia; Ercolano, Elizabeth; McCorkle, Ruth; Grant, Marcia; Wendel, Christopher S; Tallman, Nancy J; Passero, Frank; Raza, Sabreen; Cidav, Zuleyha; Holcomb, Michael; Weinstein, Ronald S; Hornbrook, Mark C; Krouse, Robert S

2018-01-01

An ostomy adversely affects health-related quality of life (HRQOL) in a diverse population of cancer survivors and their caregivers. Hit-or-miss ostomy care, nurse counseling, and community referral have been the primary modes of self-management education and support in the peri-operative setting. Few evidence-based, systematic ostomy self-management programs are available to ensure optimal post-operative care. This paper describes the study design of a telehealth-based Ostomy Self-management Training (OSMT) program for cancer survivors and their caregivers. The study is a three-year, randomized trial that tests the effectiveness of the OSMT program on survivor activation, self-efficacy, and HRQOL. The intervention integrates goal setting and problem-solving approaches to enhance survivor activation and self-efficacy to carry out ostomy care. The curriculum is delivered via four group sessions administered by trained ostomy certified nurses (WOCNs) and peer ostomates. An additional session is offered to caregivers to address their needs in relation to ostomy care. Telehealth approaches through videoconferencing are used to enhance program delivery to participants in three different geographic areas across two time zones. Participants join sessions via real-time videoconferencing from their homes. The OSMT program has high potential to make a positive impact on the unique physical, psychological, social, and spiritual needs of cancer survivors living with a permanent ostomy. The study design, process, and telehealth approach contributes to the success of future dissemination efforts of the intervention into diverse clinical and community settings. Copyright © 2017 Elsevier Inc. All rights reserved.

CE: Telehealth: a case study in disruptive innovation.

Science.gov (United States)

Grady, Janet

2014-04-01

Technologic advances in health care have often outpaced our ability to integrate the technology efficiently, establish best practices for its use, and develop policies to regulate and evaluate its effectiveness. However, these may be insufficient reasons to put the brakes on innovation-particularly those "disruptive innovations" that challenge the status quo and have the potential to produce better outcomes in a number of important areas. This article discusses the concept of disruptive innovation and highlights data supporting its necessity within health care in general and nursing in particular. Focusing on telehealth as a case study in disruptive innovation, the author provides examples of its application and reviews literature that examines its effectiveness in both nursing practice and education.

The Role of Telehealth to Assist In-Home tDCS: Opportunities, Promising Results and Acceptability

Directory of Open Access Journals (Sweden)

Brenton Hordacre

2018-06-01

Full Text Available Transcranial direct current stimulation (tDCS has shown great promise as a neuromodulatory intervention capable of improving behavioral outcomes in a range of neurological and psychiatric populations. Evidence indicates that the neuromodulatory effect of stimulation may be cumulative, with greater improvements in behavior observed following multiple treatment sessions. However, the requirement to attend clinical or research departments for multiple treatment sessions may present a barrier for many people, particularly those with greater disability or living remotely. The portability of tDCS suggests that in-home stimulation may become an avenue for further investigation. However, safe and effective use of tDCS by a participant within their home requires a form of monitoring. This review discusses how telehealth may provide real-time visual monitoring to ensure correct tDCS set-up and adherence to stimulation protocols, manage technical issues and monitor adverse events. The combination of telehealth to supplement in-home tDCS use has potential to transform the way tDCS is delivered.

Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study.

Science.gov (United States)

Chen, Ying-Hsien; Hung, Chi-Sheng; Huang, Ching-Chang; Hung, Yu-Chien; Hwang, Juey-Jen; Ho, Yi-Lwun

2017-09-26

Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician's ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. ©Ying-Hsien Chen, Chi-Sheng Hung, Ching-Chang Huang, Yu-Chien Hung, Juey-Jen Hwang, Yi-Lwun Ho. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 26.09.2017.

Gateway National Weather Service (NWS) Service Records and Retention System (SRRS)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Service Records Retention System (SRRS) was developed to store weather observations, summaries, forecasts, warnings, and advisories provided by the U.S. National...

Automation of Field Operations and Services (AFOS) National Weather Service (NWS) Service Records and Retention System (SRRS) Data

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Service Records and Retention System (SRRS) is historical digital data set DSI-9949, a collection of products created by the U.S. National Weather Service (NWS) and...

Refocusing and Evolving Subseasonal-to-Seasonal Services in NOAA's National Weather Service

Science.gov (United States)

Timofeyeva-Livezey, M. M.; Horsfall, F. M. C.; Silva, V.; Mangan, M. R.; Meyers, J. C.; Zdrojewski, J.

2017-12-01

NOAA's National Weather Service (NWS) recently completed a reorganization to better support its goal to build a Weather-Ready Nation. As part of the reorganization, NWS streamlined its 11 national service programs, including climate services, to provide a more structured approach to supporting service delivery needs. As the American public increasingly requests information at sub-seasonal and seasonal time scales for decision making, the NWS Climate Services Program is striving to meet those needs by accelerating transition of research to operations, improving delivery of products and services, and enhancing partnerships to facilitate provision of seamless weather, water, and climate products and services at regional and local scales. Additionally, NWS forecasters are requesting more tools to be able to put severe weather and water events into a climate context to provide more effective impact-based decision support services (IDSS). This paper will describe the activities to more effectively integrate climate services into the NWS suite of environmental information, the roles of the NWS offices supporting or delivering sub-seasonal and seasonal information to the US public, and engaging NWS core and deep-core partners in provision of information on climatological risks and preparedness as a part of IDSS. We will discuss the process by which we collect user requests and/or needs and the NWS process that allows us to move these requests and needs through a formal requirements validation process and thus place the requirement on a path to identify a potential solution for implementation. The validation of a NWS climate-related requirement is also key to identify research, development, and transition mission delivery needs that are supported through the Office of Oceanic and Atmospheric Research (OAR) Climate Program Office (CPO). In addition, we will present the outcomes of key actions of the first ever NWS National Climate Services Meeting (NCSM) that was held in May

Design and Implementation of an Interactive Website for Pediatric Voice Therapy-The Concept of In-Between Care: A Telehealth Model.

Science.gov (United States)

Doarn, Charles R; Zacharias, Stephanie; Keck, Casey Stewart; Tabangin, Meredith; DeAlarcon, Alessandro; Kelchner, Lisa

2018-06-05

This article describes the design and implementation of a web-based portal developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. This in-between care consisted of supported home practice that was remotely monitored by speech-language pathologists (SLPs). A web-based voice therapy portal (VTP) was developed as a platform so participants could complete voice therapy home practice by an interdisciplinary team of SLPs (specialized in pediatric voice therapy), telehealth specialists, biomedical informaticians, and interface designers. The VTP was subsequently field tested in a group of children with voice disorders, participating in a larger telehealth study. Building the VTP for supported home practice for pediatric voice therapy was challenging, but successful. Key interactive features of the final site included 11 vocal hygiene questions, traditional voice therapy exercises grouped into levels, audio/visual voice therapy demonstrations, a store-and-retrieval system for voice samples, message/chat function, written guidelines for weekly therapy exercises, and questionnaires for parents to complete after each therapy session. Ten participants (9-14 years of age) diagnosed with a voice disorder were enrolled for eight weekly telehealth voice therapy sessions with follow-up in-between care provided using the VTP. The development and implementation of the VTP as a novel platform for the delivery of voice therapy home practice sessions were effective. We found that a versatile individual, who can work with all project staff (speak the language of both SLPs and information technologists), is essential to the development process. Once the website was established, participants and SLPs effectively utilized the web-based VTP. They found it feasible and useful for needed in-between care and reinforcement of therapeutic exercises.

Integrating social capital theory, social cognitive theory, and the technology acceptance model to explore a behavioral model of telehealth systems.

Science.gov (United States)

Tsai, Chung-Hung

2014-05-07

Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities.

Integrating Social Capital Theory, Social Cognitive Theory, and the Technology Acceptance Model to Explore a Behavioral Model of Telehealth Systems

Directory of Open Access Journals (Sweden)

Chung-Hung Tsai

2014-05-01

Full Text Available Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory, technological factors (TAM, and system self-efficacy (social cognitive theory in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively, which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities.

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator.

Science.gov (United States)

Hendy, Jane; Chrysanthaki, Theopisti; Barlow, James; Knapp, Martin; Rogers, Anne; Sanders, Caroline; Bower, Peter; Bowen, Robert; Fitzpatrick, Ray; Bardsley, Martin; Newman, Stanton

2012-11-15

To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.

Building National Infrastructures for Patient-Centred Digital Services

DEFF Research Database (Denmark)

Thorseng, Anne; Jensen, Tina Blegind

2015-01-01

Patient-centred digital services are increasingly gaining impact in the healthcare sector. The premise is that patients will be better equipped for taking care of their own health through instant access to relevant information and by enhanced electronic communication with healthcare providers. One...... infrastructure theory, we highlight the enabling and constraining dynamics when designing and building a national infrastructure for patient-centred digital services. Furthermore, we discuss how such infrastructures can accommodate further development of services. The findings show that the Danish national e...

Integrating ecosystem services into national Forest Service policy and operations

Science.gov (United States)

Robert Deal; Lisa Fong; Erin Phelps; Emily Weidner; Jonas Epstein; Tommie Herbert; Mary Snieckus; Nikola Smith; Tania Ellersick; Greg Arthaud

2017-01-01

The ecosystem services concept describes the many benefits people receive from nature. It highlights the importance of managing public and private lands sustainably to ensure these benefits continue into the future, and it closely aligns with the U.S. Forest Service (USFS) mission to “sustain the health, diversity, and productivity of the Nation’s forests and...

Telehealth Delivery of Cognitive-Behavioral Intervention to Youth with Autism Spectrum Disorder and Anxiety: A Pilot Study

Science.gov (United States)

Hepburn, Susan L.; Blakeley-Smith, Audrey; Wolff, Brian; Reaven, Judy A.

2016-01-01

Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or…

36 CFR 6.8 - National Park Service solid waste responsibilities.

Science.gov (United States)

2010-07-01

..., DEPARTMENT OF THE INTERIOR SOLID WASTE DISPOSAL SITES IN UNITS OF THE NATIONAL PARK SYSTEM § 6.8 National Park Service solid waste responsibilities. (a) Beginning one year after January 23, 1995, a Superintendent will not permit or allow a person to dispose of solid waste at a National Park Service operated...

NURE and the National Park Service

International Nuclear Information System (INIS)

Weaver, T.A.

1979-01-01

Under the National Resource Evaluation (NURE), massive amounts of geological, geochemical, and geophysical data, covering the entire conterminous 48 states and Alaska, are being collected and made public. In addition to NURE goals, these data are applicable to various other researches on and in the vicinity of lands controlled by the National Park Service. Airborne geophysical and hydrogeochemical survey NURE data have been made public for the majority of the area in the combined Mt. McKinley National Park and Denali National Monument. Besides indicating potential raw material deposits, these data are also useful for geologic mapping, water quality, pollution and othe geological, biological, and environmental studies in the park

Embedded DSP-based telehealth radar system for remote in-door fall detection.

Science.gov (United States)

Garripoli, Carmine; Mercuri, Marco; Karsmakers, Peter; Jack Soh, Ping; Crupi, Giovanni; Vandenbosch, Guy A E; Pace, Calogero; Leroux, Paul; Schreurs, Dominique

2015-01-01

Telehealth systems and applications are extensively investigated nowadays to enhance the quality-of-care and, in particular, to detect emergency situations and to monitor the well-being of elderly people, allowing them to stay at home independently as long as possible. In this paper, an embedded telehealth system for continuous, automatic, and remote monitoring of real-time fall emergencies is presented and discussed. The system, consisting of a radar sensor and base station, represents a cost-effective and efficient healthcare solution. The implementation of the fall detection data processing technique, based on the least-square support vector machines, through a digital signal processor and the management of the communication between radar sensor and base station are detailed. Experimental tests, for a total of 65 mimicked fall incidents, recorded with 16 human subjects (14 men and two women) that have been monitored for 320 min, have been used to validate the proposed system under real circumstances. The subjects' weight is between 55 and 90 kg with heights between 1.65 and 1.82 m, while their age is between 25 and 39 years. The experimental results have shown a sensitivity to detect the fall events in real time of 100% without reporting false positives. The tests have been performed in an area where the radar's operation was not limited by practical situations, namely, signal power, coverage of the antennas, and presence of obstacles between the subject and the antennas.

National Mental Health Services Survey (N-MHSS-2010)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Mental Health Services Survey (N-MHSS) is an annual survey designed to collect statistical information on the numbers and characteristics of all known...

Evaluating the Treatment Fidelity of Parents Who Conduct In-Home Functional Communication Training with Coaching via Telehealth

Science.gov (United States)

Suess, Alyssa N.; Romani, Patrick W.; Wacker, David P.; Dyson, Shannon M.; Kuhle, Jennifer L.; Lee, John F.; Lindgren, Scott D.; Kopelman, Todd G.; Pelzel, Kelly E.; Waldron, Debra B.

2014-01-01

We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the…

Rhetoric and Reality in the English National Health Service; Comment on “Who Killed the English National Health Service?”

Directory of Open Access Journals (Sweden)

Rudolf Klein

2015-09-01

Full Text Available Despite fiscal stress, public confidence in the National Health Service (NHS remains strong; privatisation has not hollowed out the service. But if long term challenges are to be overcome, pragmatism not rhetoric should be the guide.

36 CFR 1501.1 - Cross reference to National Park Service regulations.

Science.gov (United States)

2010-07-01

... NATIONAL MEMORIAL TRUST GENERAL PROVISIONS § 1501.1 Cross reference to National Park Service regulations... (the Trust) adopts by cross reference the provisions of the National Park Service in 36 CFR chapter I... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Cross reference to National...

A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy.

Science.gov (United States)

Kantarcigil, Cagla; Sheppard, Justine Joan; Gordon, Andrew M; Friel, Kathleen M; Malandraki, Georgia A

2016-08-01

Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated. To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment. Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity. Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, KW=0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, KW=0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW=1); interrater agreement was substantial (85%; KW=0.76). Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care. Copyright © 2016 Elsevier Ltd. All rights reserved.

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator

Science.gov (United States)

2012-01-01

Background To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Methods Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. Results The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. Conclusions The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised. PMID:23153014

45 CFR 2515.10 - What are the service-learning programs of the Corporation for National and Community Service?

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false What are the service-learning programs of the... Public Welfare (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE SERVICE-LEARNING PROGRAM PURPOSES § 2515.10 What are the service-learning programs of the Corporation for National and Community...

77 FR 23810 - Advisory Committee on Prosthetics and Special-Disabilities Programs, Notice of Meeting

Science.gov (United States)

2012-04-20

...; Director of National Veterans Sports Programs and Special Events; Chief Procurement and Logistics Officer... Consultant for Telehealth Services. No time will be allocated for receiving oral presentations from the... Drake, Committee Management Officer. [FR Doc. 2012-9498 Filed 4-19-12; 8:45 am] BILLING CODE 8320-01-P ...

76 FR 41032 - Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and...

Science.gov (United States)

2011-07-12

... documentation must also describe how the health status of the recipient at the time of the face-to-face... [CMS 2348-P] RIN 0938-AQ36 Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy... document the existence of a face-to-face encounter (including through the use of telehealth) with the...

The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study.

Science.gov (United States)

Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador

2018-04-25

To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Forging University-Community Collaboration: The Agency Perspective on National Service.

Science.gov (United States)

Tice, Carol H.

1994-01-01

With passage of the National and Community Service Trust Act of 1993, national service volunteers will be joining forces with community-based organizations to work with underserved populations, creating many challenges. The community agency perspective on some anticipated challenges, possible responses, and application of principles of good…

A mobile network-based multimedia teleconference system for homecare services.

Science.gov (United States)

Zhang, Zhaomin; He, Aiguo; Wei, Daming

2008-03-01

Because most research and development for homecare services have focused on providing connections between home and service centers, the goal of the present work is to develop techniques and create realtime communications to connect service centers and homecare workers in mobile environments. A key technical issue for this research is how to overcome the limitation of bandwidth in mobile media and networks. An effort has been made to balance performance of communication and basic demands in telehealth through optimized system design and technical implementation. Implementations using third generation (3G) Freedom Of Mobile multimedia Access (FOMA) and Personal Handyphone System (PHS) were developed and evaluated. We conclude that the system we developed based on 3G FOMA provides sufficient and satisfactory functions for use in homecare services.

Telehealth in older adults with cancer in the United States: The emerging use of wearable sensors.

Science.gov (United States)

Shen, John; Naeim, Arash

2017-11-01

As the aging and cancer populations in the world continue to increase, the need for complements to traditional geriatric assessments and the logical incorporation of fast and reliable telehealth tools have become interlinked. In the United States, studies examining the use of telehealth for chronic disease management have shown promising results in small groups. The implementation of health technology on a broader scale requires older adults to both accept and adapt such innovation into routine medical care. Though the commercial and recreational use of new technology has increased in older individuals, the transition into creating a smart and connected home that can interface with both patients and healthcare professionals is in its early phases. Current limitations include an inherent digital divide, as well as concerns regarding privacy, data volume, rapid change, cost and reimbursement. The emergence of low-cost, high-fidelity wearable sensors with a spectrum of clinical utility may be the key to increased use and adaptation by older adults. An opportunity to utilize wearable sensors for objective and real-time assessment of older patients with cancer for baseline functional status and treatment toxicity may be on the horizon. Copyright © 2017 Elsevier Inc. All rights reserved.

Planning National Radiotherapy Services: A Practical Tool (Russian Edition)

International Nuclear Information System (INIS)

2015-01-01

The current and future burden of cancer incidence in developing countries requires the planning, establishment and upgrading of radiotherapy services at the national level. This publication is a practical guide outlining the main issues at stake when planning national radiotherapy services. It provides an assessment of the cancer burden, evaluates the existing resources, and determines what is needed and how to cover the gap in a resource oriented rational way. The publication will be of practical value to decision makers and programme managers in public health facing the organization or reorganization of radiotherapy services in their countries.

50 CFR 86.102 - How did the Service design the National Framework?

Science.gov (United States)

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How did the Service design the National Framework? 86.102 Section 86.102 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT... INFRASTRUCTURE GRANT (BIG) PROGRAM Service Completion of the National Framework § 86.102 How did the Service...

The National Health Services of Brazil and Northern Europe

DEFF Research Database (Denmark)

Gurgel Jr., Garibaldi D.; Carvalho de Sousa, Islâandia M.; de Araujo Oliveira, Sydia Rosana

2017-01-01

In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles......, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having...... chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population...

76 FR 81515 - National Advisory Council on the National Health Service Corps; Notice of Meeting

Science.gov (United States)

2011-12-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National..., to hear updates from the Health Resources and Services Administration and the NHSC program, as well... comments and questions. FOR FURTHER INFORMATION CONTACT: Njeri Jones, Bureau of Clinician Recruitment and...

78 FR 39738 - National Advisory Council on the National Health Service Corps; Notice of Meeting

Science.gov (United States)

2013-07-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National... Affordable Care Act, NHSC retention resources, and partnerships. The public can join the meeting via audio... the call. FOR FURTHER INFORMATION CONTACT: Njeri Jones, Bureau of Clinician Recruitment and Service...

Climate Prediction - NOAA's National Weather Service

Science.gov (United States)

Statistical Models... MOS Prod GFS-LAMP Prod Climate Past Weather Predictions Weather Safety Weather Radio National Weather Service on FaceBook NWS on Facebook NWS Director Home > Climate > Predictions Climate Prediction Long range forecasts across the U.S. Climate Prediction Web Sites Climate Prediction

HUMANICS 1. A feasibility study to create a home internet based telehealth product to supplement acquired brain injury therapy

DEFF Research Database (Denmark)

Brooks, Tony

2005-01-01

The goal of the project was to produce a unique, cost effective, and user-friendly computer based telehealth system product which had longevity and the ability to be integrated modularly into a future internet-based health care communication provision. This was conceptualised as an aid to home-ba...

24-Hour Forecast of Air Temperatures from the National Weather Service's National Digital Forecast Database (NDFD)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The National Digital Forecast Database (NDFD) contains a seamless mosaic of the National Weather Service's (NWS) digital forecasts of air temperature. In...

72-Hour Forecast of Air Temperatures from the National Weather Service's National Digital Forecast Database (NDFD)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The National Digital Forecast Database (NDFD) contains a seamless mosaic of the National Weather Service's (NWS) digital forecasts of air temperature. In...

48-Hour Forecast of Air Temperatures from the National Weather Service's National Digital Forecast Database (NDFD)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The National Digital Forecast Database (NDFD) contains a seamless mosaic of the National Weather Service's (NWS) digital forecasts of air temperature. In...

The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network.

Science.gov (United States)

Alami, Hassane; Fortin, Jean-Paul; Gagnon, Marie-Pierre; Pollender, Hugo; Têtu, Bernard; Tanguay, France

2017-09-13

The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological

NNDC [National Nuclear Data Center] on-line services documentation

International Nuclear Information System (INIS)

Dunford, C.L.; Burrows, T.W.; Tuli, J.K.

1987-01-01

This document summarizes and describes how to access the on-line services available from the National Nuclear Data Center (NNDC) located at Brookhaven National Laboratory. The services are available free of cost to US Department of Energy, its contractors and others who support the NNDC or supply data to the NNDC. Four of the center's data bases are now accessible to non-NNDC scientists via remote connection to the center's VAX 11/780. To use this service, you must have a terminal with access by either a telephone line or the PHYSNET network. A VT100 terminal or a terminal with VT-100 emulation is recommended but not required

Co-production in practice: how people with assisted living needs can help design and evolve technologies and services.

Science.gov (United States)

Wherton, Joseph; Sugarhood, Paul; Procter, Rob; Hinder, Sue; Greenhalgh, Trisha

2015-05-26

The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of 'care closer to home' is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants' perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual's wider social support network. Finally, the service must support a high degree of information sharing and coordination. The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use.

USGS NAIPPlus Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS NAIP Plus service from The National Map consists of National Agriculture Imagery Program (NAIP) and high resolution orthoimagery (HRO) that combine the...

USGS Hydrography (NHD) Overlay Map Service from The National Map - National Geospatial Data Asset (NGDA) National Hydrography Dataset (NHD)

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS National Hydrography Dataset (NHD) service from The National Map (TNM) is a comprehensive set of digital spatial data that encodes information about...

USGS Transportation Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS Transportation service from The National Map (TNM) is based on TIGER/Line data provided through U.S. Census Bureau and road data from U.S. Forest Service....

Integrating Information and Communication Technology for Health Information System Strengthening: A Policy Analysis.

Science.gov (United States)

Marzuki, Nuraidah; Ismail, Saimy; Al-Sadat, Nabilla; Ehsan, Fauziah Z; Chan, Chee-Khoon; Ng, Chiu-Wan

2015-11-01

Despite the high costs involved and the lack of definitive evidence of sustained effectiveness, many low- and middle-income countries had begun to strengthen their health information system using information and communication technology in the past few decades. Following this international trend, the Malaysian Ministry of Health had been incorporating Telehealth (National Telehealth initiatives) into national health policies since the 1990s. Employing qualitative approaches, including key informant interviews and document review, this study examines the agenda-setting processes of the Telehealth policy using Kingdon's framework. The findings suggested that Telehealth policies emerged through actions of policy entrepreneurs within the Ministry of Health, who took advantage of several simultaneously occurring opportunities--official recognition of problems within the existing health information system, availability of information and communication technology to strengthen health information system and political interests surrounding the national Multimedia Super Corridor initiative being developed at the time. The last was achieved by the inclusion of Telehealth as a component of the Multimedia Super Corridor. © 2015 APJPH.

Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study.

Science.gov (United States)

van Houwelingen, Cornelis Tm; Ettema, Roelof Ga; Antonietti, Michelangelo Gef; Kort, Helianthe Sm

2018-04-06

The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people's intention to use technology. The objective of this study was to understand community-dwelling older people's readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators. A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people's intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people's actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2). In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people's perception of videoconferencing. Older people's (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9

The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: a quasi-experimental study.

Science.gov (United States)

Chiang, Li-Chi; Chen, Wan-Chou; Dai, Yu-Tzu; Ho, Yi-Lwun

2012-10-01

Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home. To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only. This is a quasi-experimental study design. Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients' health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group×time interaction were analysed using Mixed Model in SPSS (17.0). Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function

Rural Trends in Diagnosis and Services for Autism Spectrum Disorder

Directory of Open Access Journals (Sweden)

Ligia Antezana

2017-04-01

Full Text Available Rural communities face significant challenges regarding the adequate availability of diagnostic-, treatment-, and support-services for individuals with autism spectrum disorder (ASD. Specifically, a variety of factors, including geographic distance between families and service providers, low reliance on health care professionals, and cultural characteristics, contribute to the diminished availability and utilization of services. Together, these factors lead to risks for delayed ASD screening and diagnosis, yielding lower educational and functional outcomes. The purpose of this review is to outline the specific diagnosis and treatment barriers that affect individuals with ASD and their families in rural settings. Telehealth feasibility and efficacy research is also reviewed, suggesting that telecommunication services may offer an inroad for addressing the specific service barriers faced by rural communities. Together, the current review identifies specific needs for both research and support services that address the specific access barriers characteristic of rural settings.

Spectrum Management Guidelines for National and Service Test and Training Ranges

Science.gov (United States)

2017-07-12

Frequency Management Group RCC 700-17 SPECTRUM MANAGEMENT GUIDELINES FOR NATIONAL AND SERVICE TEST AND TRAINING RANGES DISTRIBUTION...left blank. DOCUMENT 700-01 SPECTRUM MANAGEMENT GUIDELINES FOR NATIONAL AND SERVICE TEST AND TRAINING RANGES July 2017...Prepared by RANGE COMMANDERS COUNCIL FREQUENCY MANAGEMENT GROUP Published by Secretariat Range Commanders Council U.S. Army White

5 CFR 831.306 - Service as a National Guard technician before January 1, 1969.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Service as a National Guard technician... National Guard technician before January 1, 1969. (a) Definitions. In this section—(1) Service as a National Guard technician is service performed under section 709 of title 32, United States Code (or under...

National Survey of Substance Abuse Treatment Services (N-SSATS-2007)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2004)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2013)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2010)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2014)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2012)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2003)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2006)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2000)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2002)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2008)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2009)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

National Survey of Substance Abuse Treatment Services (N-SSATS-2005)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

Technical Service Agreement (TSA) | Frederick National Laboratory for Cancer Research

Science.gov (United States)

Frederick National Laboratory for Cancer Research (FNLCR) scientists provide services and solutions to collaborators through the Technical Services Program, whose portfolio includes more than 200 collaborations with more than 80 partners. The Frederi

National Survey of Substance Abuse Treatment Services (N-SSATS-2011)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

A national survey of radiodiagnostic services in Ecuador

International Nuclear Information System (INIS)

Penaherrera S, P.; Echeverria T, F.; Buitron S, S.; Yela de Chacon, L.

1979-11-01

The Ecuadorian Atomic Energy Commission elaborated a Radiation Protection Regulation for Ecuador. In order to implement it, a national survey of radiodiagnostic services was implemented with the following objectives: a) Statistics of Radiodiagnostic services related to geography and population ulation density, b) To establish general patterns for X-Ray control and calibration, c) Evaluation of the professional and technical work in this field. (Author)

National Weather Service (NWS) Station Information System (SIS), Version 2

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — National Weather Service (NWS) Station Information System (SIS) contains observing station metadata from November 2016 to present. These are renditions are used for...

75 FR 31745 - Notice of Request for Approval of an Information Collection; National Veterinary Services...

Science.gov (United States)

2010-06-04

...] Notice of Request for Approval of an Information Collection; National Veterinary Services Laboratories... collection associated with the National Veterinary Services Laboratories animal health diagnostic system...: For information on request forms associated with the National Veterinary Services Laboratories animal...

NATIONAL WEATHER SERVICE MARINE PRODUCTS VIA INTERNET

Science.gov (United States)

the search's key words. Tide Predictions, Observations and Storm Surge Forecasts Near real-time Water , Extratropical Water Level Forecasts are available from the National Weather Service's Meteorological Development Laboratory. Status maps are provided to give the user a quick overview of a region. Forecasts of storm surge

National All-Age Career Guidance Services: Evidence and Issues

Science.gov (United States)

Watts, A. G.

2010-01-01

The three major national all-age career guidance services--in New Zealand, Scotland and Wales--have been reviewed using an adaptation of the methodology adopted in the OECD Career Guidance Policy Review. The main features of the three services are summarised, and some key differences and distinctive strengths are outlined. The alternative approach…

77 FR 13625 - Notice of Inventory Completion: USDA Forest Service, Daniel Boone National Forest, Winchester, KY

Science.gov (United States)

2012-03-07

... Forest Service, Daniel Boone National Forest, Winchester, KY AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The U.S. Department of Agriculture, Forest Service, Daniel Boone National Forest... culturally affiliated with the human remains may contact the Daniel Boone National Forest, Winchester, KY...

External Service Providers to the National Security Technology Incubator: Formalization of Relationships

Energy Technology Data Exchange (ETDEWEB)

None

2008-04-30

This report documents the formalization of relationships with external service providers in the development of the National Security Technology Incubator (NSTI). The technology incubator is being developed as part of the National Security Preparedness Project (NSPP), funded by a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. This report summarizes the process in developing and formalizing relationships with those service providers and includes a sample letter of cooperation executed with each provider.

Information technology for competitive advantage: the case of learning and innovation in behavioural healthcare service.

Science.gov (United States)

Hsieh, Chang-tseh; Lin, Binshan

2011-01-01

The utilisation of IS/IT could offer a substantial competitive advantage to healthcare service providers through the realisation of improved clinical, financial, and administrative outcomes. In this study, 42 journal articles were reviewed and summarised with respect to identified benefits and challenges of the development and implementation of electronic medical records, tele-health, and electronic appointment reminders. Results of this study help pave the knowledge foundation for management of the behavioural healthcare to learn how to apply state-of-the-art information technology to offer higher quality, clinically proven effective services at lower costs than those of their competitors.

Volunteer Service and Service Learning: Opportunities, Partnerships, and United Nations Millennium Development Goals.

Science.gov (United States)

Dalmida, Safiya George; Amerson, Roxanne; Foster, Jennifer; McWhinney-Dehaney, Leila; Magowe, Mabel; Nicholas, Patrice K; Pehrson, Karen; Leffers, Jeanne

2016-09-01

This article explores approaches to service involvement and provides direction to nurse leaders and others who wish to begin or further develop global (local and international) service or service learning projects. We review types of service involvement, analyze service-related data from a recent survey of nearly 500 chapters of the Honor Society of Nursing, Sigma Theta Tau International (STTI), make recommendations to guide collaborative partnerships and to model engagement in global and local service and service learning. This article offers a literature review and describes results of a survey conducted by the STTI International Service Learning Task Force. Results describe the types of service currently conducted by STTI nursing members and chapters, including disaster response, service learning, and service-related responses relative to the Millennium Development Goals (MDGs). The needs of chapter members for information about international service are explored and recommendations for promoting global service and sustainability goals for STTI chapters are examined. Before engaging in service, volunteers should consider the types of service engagement, as well as the design of projects to include collaboration, bidirectionality, sustainability, equitable partnerships, and inclusion of the United Nations Sustainable Development Goals. STTI supports the learning, knowledge, and professional development of nurses worldwide. International service and collaboration are key to the advancement of the nursing profession. Culturally relevant approaches to international service and service learning are essential to our global organization, as it aims to impact the health status of people globally. © 2016 Sigma Theta Tau International.

Queensland Youth Cancer Service: A Partnership Model to Facilitate Access to Quality Care for Young People Diagnosed with Cancer.

Science.gov (United States)

Bradford, Natalie K; Henney, Roslyn; Walker, Rick; Walpole, Euan; Kennedy, Glen; Nicholls, Wayne; Pinkerton, Ross

2018-06-01

Global recognition of the need to improve outcomes for adolescents and young adults (AYA) with cancer has led to the development of specific oncology programs and services. In Australia, Youth Cancer Services (YCS) are now established across the country. While each service has been shaped by nationally agreed principles, program development has been influenced by local policy and geographic differences. Queensland is a vast state with a widely dispersed population; coordination of cancer services for young people across this landscape presents unique challenges. The Queensland YCS (QYCS) work in a consultative partnership model with primary treating teams, across both pediatric and adult tertiary cancer services. Understanding how cancer services approach challenges and service development can provide guidance for other developing services. In this article, we describe the goals and development of QYCS and review the outcomes achieved in the service to date. We reviewed referral data and retrieved statewide clinical activity from the web-based data system. We compared these data with cancer registry data to identify disparities and areas for service development. While the service has achieved notable outcomes, challenges remain. These include recruitment of appropriately skilled and trained health professionals for this newly developing area of oncology. In addition, there is an ongoing need to advocate for this relatively small patient group, and to promote awareness and understanding of the need for AYA-specific services. With the dispersed population and concentration of services in metropolitan Brisbane, identifying and testing new innovative models, including telehealth, to reach all AYA diagnosed with cancer regardless of location of care are priorities.

Who Killed the English National Health Service?

Directory of Open Access Journals (Sweden)

Martin Powell

2015-05-01

Full Text Available The death of the English National Health Service (NHS has been pronounced many times over the years, but the time and cause of death and the murder weapon remains to be fully established. This article reviews some of these claims, and asks for clearer criteria and evidence to be presented.

Randomized Controlled Trial of Nurse-Delivered Cognitive Behavioral Therapy Versus Supportive Psychotherapy Telehealth Interventions for Chronic Back Pain.

Science.gov (United States)

Rutledge, Thomas; Atkinson, J Hampton; Holloway, Rachael; Chircop-Rollick, Tatiana; D'Andrea, John; Garfin, Steven R; Patel, Shetal; Penzien, Donald B; Wallace, Mark; Weickgenant, Anne L; Slater, Mark

2018-04-16

This study evaluated a nurse-delivered, telehealth intervention of cognitive behavioral therapy versus supportive psychotherapy for chronic back pain. Participants (N=61) had chronic back pain (pain "daily" ≥ 6 months at an intensity ≥4/10 scale) and were randomized to an 8-week, 12-session, Cognitive Behavioral Therapy (CBT) or to Supportive Care (SC) matched for frequency, format, and time, with each treatment delivered by a primary care nurse. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included the Numerical Rating Scale (NRS) and the Patient Global Impressions Scale (CGI). CBT participants (n=30) showed significant improvements on the RMDQ (means=11.4[5.9] vs. 9.4[6.1] at baseline and post-treatment, respectively, p.10). The results suggest that telehealth, nurse-delivered CBT and SC treatments for chronic back pain can offer significant and relatively comparable benefits. ClinicalTrials.gov: NCT00608530. This article describes the benefits of training primary care nurses to deliver evidence-based behavioral therapies for low back pain. Due to the high prevalence of chronic pain and the growing emphasis on non-opioid therapies, training nurses to provide behavior therapies could be a cost-effective way to improve pain management. Copyright © 2018. Published by Elsevier Inc.

A web application to support telemedicine services in Brazil.

Science.gov (United States)

Barbosa, Ana Karina P; de A Novaes, Magdala; de Vasconcelos, Alexandre M L

2003-01-01

This paper describes a system that has been developed to support Telemedicine activities in Brazil, a country that has serious problems in the delivery of health services. The system is a part of the broader Tele-health Project that has been developed to make health services more accessible to the low-income population in the northeast region. The HealthNet system is based upon a pilot area that uses fetal and pediatric cardiology. This article describes both the system's conceptual model, including the tele-diagnosis and second medical opinion services, as well as its architecture and development stages. The system model describes both collaborating tools used asynchronously, such as discussion forums, and synchronous tools, such as videoconference services. Web and free-of-charge tools are utilized for implementation, such as Java and MySQL database. Furthermore, an interface with Electronic Patient Record (EPR) systems using Extended Markup Language (XML) technology is also proposed. Finally, considerations concerning the development and implementation process are presented.

Challenges for developing national climate services – Poland and Norway

Directory of Open Access Journals (Sweden)

Zbigniew W. Kundzewicz

2017-12-01

Full Text Available This contribution discusses the challenges for developing national climate services in two countries with high fossil fuel production – Poland (coal and Norway (oil and gas. Both countries, Poland and Norway, have highly developed weather services, but largely differ on climate services. Since empirical and dynamical downscaling of climate models started in Norway over 20 years ago and meteorological and hydrological institutions in Oslo and Bergen have been collaborating on tailoring and disseminating downscaled climate projections to the Norwegian society, climate services are now well developed in Norway. The Norwegian Centre for Climate Services (NCCS was established in 2011. In contrast, climate services in Poland, in the international understanding, do not exist. Actually, Poland is not an exception, as compared to other Central and Eastern European countries, many of which neither have their national climate services, nor are really interested in European climate services disseminated via common EU initiatives. It is worth posing a question – can Poland learn from Norway as regards climate services? This contribution is based on results of the CHASE-PL (Climate change impact assessment for selected sectors in Poland project, carried out in the framework of the Polish – Norwegian Research Programme. The information generated within the Polish-Norwegian CHASE-PL project that is being broadly disseminated in Poland can be considered as a substitute for information delivered in other countries by climate services.

On-site customer analytics and reporting (OSCAR) : a portable clinical data warehouse for the in-house linking of hospital and telehealth data

NARCIS (Netherlands)

Thomaidis, P.

2014-01-01

This document conveys the results of the On-Site Customer Analytics and Reporting (OSCAR) project. This nine-month project started on January 2014 and was conducted at Philips Research in the Chronic Disease Management group as part of the H2H Analytics Project. Philips has access to telehealth data

77 FR 68851 - Sunshine Act Meeting of the National Museum and Library Services Board

Science.gov (United States)

2012-11-16

... Coordinator for Special Events and Board Liaison, Institute of Museum and Library Services, 1800 M Street NW... NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES Institute of Museum and Library Services Sunshine Act Meeting of the National Museum and Library Services Board AGENCY: Institute of Museum and...

National Survey of Substance Abuse Treatment Services (N-SSATS-1997-2011)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and...

Evaluating the Implementation of Home-Based Videoconferencing for Providing Mental Health Services.

Science.gov (United States)

Interian, Alejandro; King, Arlene R; St Hill, Lauren M; Robinson, Claire H; Damschroder, Laura J

2018-01-01

The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.

USGS Governmental Unit Boundaries Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS Governmental Unit Boundaries service from The National Map (TNM) represents major civil areas for the Nation, including States or Territories, counties (or...

50 CFR 86.101 - What is the Service schedule to adopt the National Framework?

Science.gov (United States)

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false What is the Service schedule to adopt the National Framework? 86.101 Section 86.101 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE... schedule to adopt the National Framework? The Secretary of the Interior adopted the National Framework on...

75 FR 57737 - Notice of Request for Approval of an Information Collection; National Veterinary Services...

Science.gov (United States)

2010-09-22

...] Notice of Request for Approval of an Information Collection; National Veterinary Services Laboratories... Service's intention to request approval of an information collection associated with National Veterinary...' Information Collection Coordinator, at (301) 851-2908. SUPPLEMENTARY INFORMATION: Title: National Veterinary...

31 CFR 500.575 - Certain services to Vietnamese nationals authorized.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Certain services to Vietnamese... Vietnamese nationals authorized. (a) Specific licenses may be issued on a case-by-case basis for the provision in the United States or a third country of business orientation or training services to Vietnamese...

78 FR 1824 - Notice of Request for Approval of an Information Collection; National Veterinary Services...

Science.gov (United States)

2013-01-09

...; National Veterinary Services Laboratories; Bovine Spongiform Encephalopathy Surveillance Program Documents... associated with National Veterinary Services Laboratories diagnostic support for the bovine spongiform..., Veterinary Services, APHIS, 4700 River Road Unit 43, Riverdale, MD 20737; (301) 851-3511. For copies of more...

Next-generation services for e-traceability to ionizing radiation national standards

International Nuclear Information System (INIS)

Desrosiers, M.F.; Klemick, Mark; Puhl, J.M.; Uchida, David; Mallis, Steven

2004-01-01

An Internet-based system for fast, remote certification of high-dose radiation sources against the US national standard is being constructed at the National Institute of Standards and Technology (NIST). The new service will establish traceability (through transfer dosimetry) in real time at a lower cost by using automated routines and the Internet. A prototype of this service was successfully demonstrated in 2000 at the American Society for Testing and Materials (ASTM) Dosimetry Workshop in San Diego. Despite this impressive accomplishment, new developments demanded that several aspects of the service be modified. The new service has been completely redesigned to address these new demands and ensure greater accessibility. A description of the hardware and software configurations of this service as well as the communication and information management aspects will be presented. The Internet-based transfer certification program will provide industry with 24-h, 7-day-per-week, on-demand certifications, immediate turnaround times, and lower cost, ultimately improving the quality of the manufacturing process

Next-generation services for e-traceability to ionizing radiation national standards

Science.gov (United States)

Desrosiers, Marc F.; Klemick, Mark; Puhl, James M.; Uchida, David; Mallis, Steven

2004-09-01

An Internet-based system for fast, remote certification of high-dose radiation sources against the US national standard is being constructed at the National Institute of Standards and Technology (NIST). The new service will establish traceability (through transfer dosimetry) in real time at a lower cost by using automated routines and the Internet. A prototype of this service was successfully demonstrated in 2000 at the American Society for Testing and Materials (ASTM) Dosimetry Workshop in San Diego. Despite this impressive accomplishment, new developments demanded that several aspects of the service be modified. The new service has been completely redesigned to address these new demands and ensure greater accessibility. A description of the hardware and software configurations of this service as well as the communication and information management aspects will be presented. The Internet-based transfer certification program will provide industry with 24-h, 7-day-per-week, on-demand certifications, immediate turnaround times, and lower cost, ultimately improving the quality of the manufacturing process.

PTSD: National Center for PTSD

Medline Plus

Full Text Available ... Military Exposures Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations ...

Terminology management at the national language service | Alberts ...

African Journals Online (AJOL)

Through the use of correct, standardised terminology, effective scientific and technical communication skills are developed. A brief overview is given of terminology development in South Africa, with special emphasis on the work of the Terminology Division of the National Language Service. Aspects of present terminology ...

Strengthening Climate Services Capabilities and Regional Engagement at NOAA's National Climatic Data Center

Science.gov (United States)

Shea, E.

2008-12-01

The demand for sector-based climate information is rapidly expanding. In order to support this demand, it is crucial that climate information is managed in an effective, efficient, and user-conscious manner. NOAA's National Climatic Data Center is working closely with numerous partners to develop a comprehensive interface that is authoritative, accessible, and responsive to a variety of sectors, stakeholders, and other users. This talk will explore these dynamics and activities, with additional perspectives on climate services derived from the regional and global experiences of the NOAA Integrated Data and Environmental Applications (IDEA) Center in the Pacific. The author will explore the importance of engaging partners and customers in the development, implementation and emergence of a national climate service program. The presentation will draw on the author's experience in climate science and risk management programs in the Pacific, development of regional and national climate services programs and insights emerging from climate services development efforts in NCDC. In this context, the author will briefly discuss some of guiding principles for effective climate services and applications including: - Early and continuous dialogue, partnership and collaboration with users/customers; - Establishing and sustaining trust and credibility through a program of shared learning and joint problem- solving; - Understanding the societal context for climate risk management and using a problem-focused approach to the development of products and services; - Addressing information needs along a continuum of timescales from extreme events to long-term change; and - Embedding education, outreach and communications activities as critical program elements in effective climate services. By way of examples, the author will reference lessons learned from: early Pacific Island climate forecast applications and climate assessment activities; the implementation of the Pacific Climate

78 FR 63518 - Uranium Enrichment Fuel Cycle Inspection Reports Regarding Louisiana Energy Services, National...

Science.gov (United States)

2013-10-24

... NUCLEAR REGULATORY COMMISSION [Docket No. 70-3103; NRC-2010-0264] Uranium Enrichment Fuel Cycle Inspection Reports Regarding Louisiana Energy Services, National Enrichment Facility, Eunice, New Mexico... Louisiana Energy Services (LES), LLC, National Enrichment Facility in Eunice, New Mexico, and has authorized...

National Youth Service Day: A Youth Development Strategy

Directory of Open Access Journals (Sweden)

Silvia Blitzer Golombek

2006-06-01

Full Text Available A growing number of studies show connections between youth participation in service and service-learning opportunities and positive behavior outcomes. Building on this data, the article presents National Youth Service Day (NYSD as a program that can be incorporated into ongoing activities to enhance youth development goals. The paper describes the program’s components– building a network of support organizations, offering project planning grants, providing service-learning materials, and developing a media and advocacy campaign. Examples of NYSD projects show how project planners are using the program to learn and practice academic and non-academic skills. A review of evaluations to date indicates the program is annually increasing its output measures. Participants’ responses show that the program is also contributing to positive behavioral changes, in particular related to young people’s increasing awareness about specific community issues and their own competency in addressing them.

The National Library Service (SBN towards digital

Directory of Open Access Journals (Sweden)

Giuliana Sgambati

2003-12-01

Full Text Available In the sector of technologies for the Information Society, the General Direction for Library Heritage and Cultural Institutes has promoted two programs: · SBN: The National Library Service (Servizio Bibliotecario Nazionale · BDI: The Italian Digital Library (Biblioteca Digitale Italiana and another project, which was approved on March 18, 2003: · BDI&NTC: The Italian Digital Library and Cultural Tourist Network

Customer service model for waste tracking at Los Alamos National Laboratory

International Nuclear Information System (INIS)

Dorries, Alison M.; Montoya, Andrew J.; Ashbaugh, Andrew E.

2010-01-01

The deployment of any new software system in a production facility will always face multiple hurtles in reaching a successful acceptance. However, a new waste tracking system was required at the plutonium processing facility at Los Alamos National Laboratory (LANL) where waste processing must be integrated to handle Special Nuclear Materials tracking requirements. Waste tracking systems can enhance the processing of waste in production facilities when the system is developed with a focus on customer service throughout the project life cycle. In March 2010 Los Alamos National Laboratory Waste Technical Services (WTS) replaced the aging systems and infrastructure that were being used to support the plutonium processing facility. The Waste Technical Services (WTS) Waste Compliance and Tracking System (WCATS) Project Team, using the following customer service model, succeeded in its goal to meet all operational and regulatory requirements, making waste processing in the facility more efficient while partnering with the customer.

76 FR 44323 - National Grid Transmission Services Corporation; Bangor Hydro Electric Company; Notice of...

Science.gov (United States)

2011-07-25

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL11-49-000] National Grid Transmission Services Corporation; Bangor Hydro Electric Company; Notice of Petition for Declaratory Order Take..., 18 CFR 385.207, National Grid Transmission Services Corporation and Bangor Hydro Electric Company...

Strengthening health-related rehabilitation services at national levels.

Science.gov (United States)

Gutenbrunner, Christoph; Bickenbach, Jerome; Melvin, John; Lains, Jorge; Nugraha, Boya

2018-04-18

One of the aims of the World Health Organization's Global Disability Action Plan is to strengthen rehabilitation services. Some countries have requested support to develop (scale-up) rehabilitation services. This paper describes the measures required and how (advisory) missions can support this purpose, with the aim of developing National Disability, Health and Rehabilitation Plans. It is important to clarify the involvement of governments in the mission, to define clear terms of reference, and to use a systematic pathway for situation assessment. Information must be collected regarding policies, health, disability, rehabilitation, social security systems, the need for rehabilitation, and the existing rehabilitation services and workforce. Site visits and stakeholder dialogues must be done. In order to develop a Rehabilitation Service Implementation Framework, existing rehabilitation services, workforce, and models for service implementation and development of rehabilitation professions are described. Governance, political will and a common understanding of disability and rehabilitation are crucial for implementation of the process. The recommendations of the World Report on Disability are used for reporting purposes. This concept is feasible, and leads to concrete recommendations and proposals for projects and a high level of consensus stakeholders.

Strengthening health-related rehabilitation services at national levels

Directory of Open Access Journals (Sweden)

Christoph Gutenbrunner

2017-04-01

Full Text Available Objective: One of the aims of the World Health Organization’s Global Disability Action Plan is to strengthen rehabilitation services. Some countries have requested support to develop (scale-up rehabilitation services. This paper describes the measures required and how (advisory missions can support this purpose, with the aim of developing National Disability, Health and Rehabilitation Plans. Recommendations: It is important to clarify the involvement of governments in the mission, to define clear terms of reference, and to use a systematic pathway for situation assessment. Information must be collected regarding policies, health, disability, rehabilitation, social security systems, the need for rehabilitation, and the existing rehabilitation services and workforce. Site visits and stakeholder dialogues must be done. In order to develop a Rehabilitation Service Implementation Framework, existing rehabilitation services, workforce, and models for service implementation and development of rehabilitation professions are described. Governance, political will and a common understanding of disability and rehabilitation are crucial for implementation of the process. The recommendations of the World Report on Disability are used for reporting purposes. Conclusion: This concept is feasible, and leads to concrete recommendations and proposals for projects and a high level of consensus stakeholders.

Privatization of Electricity Service Delivery in Developing Nations: Issues and Challenges

Directory of Open Access Journals (Sweden)

Olamide Eniola Victor

2015-09-01

Full Text Available The provision of public utilities and infrastructures particularly electricity by the public sector (Government especially in the Developing Nations has been heavily criticized. This has been attributed to many reasons including poor electricity supply, poor distribution of service delivery of electricity due to the absence of spatial planning, insufficient government investment into the power industry, ineptitude operation on the part of the technicians, poor administration and managerial control. However, efforts to move away from government ownership, control or participation in this sector of economy towards free enterprise and increased inclusive private sector participation known as privatization, has been adopted as one of the solutions. This paper presents a critical review of privatization practices of alternative Service Delivery approach of selected Asian and African nations. The paper would elicit the common variants of privatization models adopted by these nations and the different implementation strategies which resulted in divergence in effectiveness and efficiency in the service delivery of electricity. The selected Asian countries are; Malaysia, India, and China, while the selected African nations are Nigeria, Cameroun and South Africa. The paper will draw from the literatures the various approaches, concepts adopted, practices, issues and challenges faced by these countries.

Policy implementation in practice: the case of national service frameworks in general practice.

Science.gov (United States)

Checkland, Kath; Harrison, Stephen

2004-10-01

National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

The National Library of Medicine Programs and Services, Fiscal Year 1974.

Science.gov (United States)

National Library of Medicine (DHEW), Bethesda, MD.

The activities and projects of the National Library of Medicine are described. New and continuing programs in library services and operations, on-line computer retrieval services, grants for library assistance, audiovisual programs, and health communications research are included. International activities of the Library are outlined. Summary…

76 FR 6827 - Public Availability of the National Aeronautic and Space Administration FY 2010 Service Contract...

Science.gov (United States)

2011-02-08

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION Public Availability of the National Aeronautic and Space Administration FY 2010 Service Contract Inventory AGENCY: National Aeronautic and Space Administration. ACTION: Notice of public availability of FY 2010 Service Contract Inventories. [[Page 6828...

USGS Imagery Topo Large-scale Base Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS Imagery Topo Large service from The National Map (TNM) is a dynamic topographic base map service that combines the best available data (Boundaries,...

78 FR 23311 - Sunshine Act Meeting of the National Museum and Library Services Board

Science.gov (United States)

2013-04-18

... policies with respect to the duties, powers, and authority of the Institute relating to museum, library and... NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES Institute of Museum and Library Services Sunshine Act Meeting of the National Museum and Library Services Board AGENCY: Institute of Museum and...

Ten years of a National Service of Dosimetric calibration at radiation protection

International Nuclear Information System (INIS)

Morales, J.A.; Jova, L.; Hernandez, E.; Campa, R.; Walwyn, G.

1996-01-01

Since 1986, the CPHR has offered a national service of calibration of dosimetric instruments at levels of radiation protection. The history of such a service is the chronology of efforts to reduce the uncertainties of the calibration process, expand the ranges of useful dose rates, and enhance the radiological safety when using the sources. The crowning of those efforts is the complement and start-up of the secondary la laboratory of dosimetric calibration (SLDC), which is currently a member of the IAEA/WHO. SLDC international network. As a result of this service, 256 instruments have been calibration and 867 personal dosimeters film badges and TLD and 72 environmental TLD dosimeters have been irradiated at known doses. The service rendered has benefited 62 national institutions which are users of ionizing radiations

Geo-spatial Service and Application based on National E-government Network Platform and Cloud

Science.gov (United States)

Meng, X.; Deng, Y.; Li, H.; Yao, L.; Shi, J.

2014-04-01

With the acceleration of China's informatization process, our party and government take a substantive stride in advancing development and application of digital technology, which promotes the evolution of e-government and its informatization. Meanwhile, as a service mode based on innovative resources, cloud computing may connect huge pools together to provide a variety of IT services, and has become one relatively mature technical pattern with further studies and massive practical applications. Based on cloud computing technology and national e-government network platform, "National Natural Resources and Geospatial Database (NRGD)" project integrated and transformed natural resources and geospatial information dispersed in various sectors and regions, established logically unified and physically dispersed fundamental database and developed national integrated information database system supporting main e-government applications. Cross-sector e-government applications and services are realized to provide long-term, stable and standardized natural resources and geospatial fundamental information products and services for national egovernment and public users.

Current National Weather Service Watches, Warnings, or Advisories for the United States

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The National Weather Service (NWS) Storm Prediction Center uses RSS feeds to disseminate all watches, warnings and advisories for the United States that are...

78 FR 13383 - Public Availability of the National Aeronautics and Space Administration FY 2012 Service Contract...

Science.gov (United States)

2013-02-27

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION Public Availability of the National Aeronautics and Space Administration FY 2012 Service Contract Inventory (SCI) AGENCY: Office of Procurement, National Aeronautics and Space Administration. ACTION: Notice of Public Availability of the FY 2012 Service Contract...

77 FR 7183 - Public Availability of the National Aeronautics and Space Administration FY 2011 Service Contract...

Science.gov (United States)

2012-02-10

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION Public Availability of the National Aeronautics and Space Administration FY 2011 Service Contract Inventory AGENCY: National Aeronautics and Space Administration. ACTION: Notice of Public Availability of Analysis of the FY 2010 Service Contract Inventories and...

Chronic illness, self-management and technology: type 1 diabetes patients’ views of the use of technology to communicate with health professionals about their disease

Directory of Open Access Journals (Sweden)

Fernando B

2012-11-01

Full Text Available Annmarie Ruston,1 Alison Smith,1 Bernard Fernando21Centre for Health and Social Care Research, Faculty of Health and Social Care, Canterbury Christ Church University, Chatham Maritime, United Kingdom; 2Thames Avenue Surgery, Rainham, United KingdomPurpose: Diabetes represents one of the greatest health challenges facing the UK. Telehealth is seen to have the potential to revolutionize health care provision by improving access for patients with chronic disease, reducing health care costs, and improving efficiency. There have been many trials of telehealth in the UK but these have typically failed to become part of routine health care, particularly for diabetics. Program design and implementation has not been grounded in an understanding about the ways in which patients manage their disease and perceive these new technologies. This study addresses this gap by gaining an understanding of the perceptions of patients with type 1 diabetes about how telehealth could be used as part of their health care.Patients and methods: Thirty-two people with type 1 diabetes were recruited from a database of insulin pump users, and in-depth telephone interviews were undertaken, tape recorded, and transcribed. Analysis was conducted using a constant comparative approach.Results: Although respondents used technology as part of their diabetes self-management, they considered that the use of telehealth, as part of their health care, was potentially of limited value. Three themes emerged from their discourses: (1 a need to be in control of their disease themselves and a lack of trust of health care professionals in this process; (2 the belief that the National Health Service routine IT systems were unable to support telehealth; and (3 the belief that face-to-face communication was vital in providing them with high-quality care.Conclusion: Telehealth is considered to be revolutionizing health care and shifting power between patients and health professionals; however

National Marine Fisheries Service Grain Size Data from the Baltimore Canyon Trough

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Grain size analyses produced by Robert Reid of the NOAA National Marine Fisheries Service for the NOAA/BLM Outer Continental Shelf Mid-Atlantic Project, Baltimore...

The National Terminology Services: a new paradigm | Jordaan ...

African Journals Online (AJOL)

The new dispensation in South Africa necessitated a paradigm shift at the National Terminology Services (NTS). Being part of the Central Government, the NTS has to implement policy as laid down by the government of the day. Former policy, processes and products are described as well as the vision and objectives for the ...

Evolving National Strategy Driving Nursing Informatics in New Zealand.

Science.gov (United States)

Honey, Michelle; Westbrooke, Lucy

2016-01-01

An update to the New Zealand Health Strategy identifying direction and priorities for health services is underway. Three specific areas have implications for nursing informatics and link to education and practice: best use of technology and information, fostering and spreading innovation and quality improvements, and building leaders and capability for the future. An emphasis on prevention and wellness means nursing needs to focus on health promotion and the role of consumers is changing with access to their on-line information a major focus. As the modes of delivery for services such as telehealth and telenursing changes, nurses are increasingly working independently and utilizing information and communication technologies to collaborate with the health team. New Zealand, and other countries, need strong nursing leadership to sustain the nursing voice in policy and planning and ensure nurses develop the required informatics skills.

78 FR 72703 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service...

Science.gov (United States)

2013-12-03

... of an inventory of human remains and associated funerary objects under the control of Canyonlands....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service.... Department of the Interior, National Park Service, Canyonlands National Park, has completed an inventory of...

76 FR 7232 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Dinosaur...

Science.gov (United States)

2011-02-09

.... Department of the Interior, National Park Service, Dinosaur National Monument, Dinosaur, CO AGENCY: National... Service, Dinosaur National Monument, Dinosaur, CO, has completed an inventory of human remains and... Indian tribe that believes itself to be culturally affiliated with the human remains may contact Dinosaur...

Relative risk of home hemodialysis attrition in patients using a telehealth platform.

Science.gov (United States)

Weinhandl, Eric D; Collins, Allan J

2017-12-06

Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. We identified 606 Nx2me users; 49.5% initiated use of Nx2me in NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls. Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden. © 2017 The Authors

Food Service Perspectives on National School Lunch Program Implementation.

Science.gov (United States)

Tabak, Rachel G; Moreland-Russell, Sarah

2015-09-01

Explore barriers and facilitators to implementation of the new National School Lunch Program (NSLP) policy guidelines. Interviews with eight food service directors using an interview guide informed by the Consolidated Framework for Implementation Research. Food service personnel; parents, teachers, school staff; and students were important stakeholders. Characteristics of the new NSLP policy guidelines were reported to create increased demands; resources alleviated some barriers. Directors reported increased food and labor costs, food sourcing challenges, decreased student participation, and organizational constraints as barriers to implementation. Creativity in menu planning facilitated success. Factors within the food service department, characteristics of implementing individuals and the new NSLP policy guidelines, and stakeholder involvement in the implementation process relate to successful implementation.

National Plant Germplasm System: Critical Role of Customer Service

Science.gov (United States)

The National Plant Germplasm System (NPGS) conserves plant genetic resources, not only for use by future generations, but for immediate use by scientists and educators around the world. With a great deal of interaction between genebank curators and users of plant genetic resources, customer service...

The intelligence-security services and national security

OpenAIRE

Mijalković, Saša

2011-01-01

Since their inception, states have been trying to protect their vital interests and values more effectively, in which they are often impeded by other countries. At the same time, they seek to protect the internal order and security against the so-called internal enemy. Therefore, the states organize (national) security systems within their (state) systems, in which they form some specialized security entities. Among them, however, intelligence and security services are the ones that stand out...

A national survey of services for the prevention and management of falls in the UK

Directory of Open Access Journals (Sweden)

Potter Rachel

2008-11-01

Full Text Available Abstract Background The National Health Service (NHS was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. Methods Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE. Results We identified 303 clinics across the UK. 231 (76% were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health. Conclusion The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance.

Collaborative Practice Improvement for Childhood Obesity in Rural Clinics: The Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP)

OpenAIRE

Shaikh, U; Nettiksimmons, J; Joseph, JG; Tancredi, D; Romano, PS

2014-01-01

© 2013 by the American College of Medical Quality. This study assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. A total of 7 primary care clinics in rural California included in the Healthy Eating Active Living TeleHealth Community of Practice and 288 children seen in these clinics for well-child care participated in this prospective observational pre-post study. Cl...

Problem Gambling Treatment within the British National Health Service

Science.gov (United States)

Rigbye, Jane; Griffiths, Mark D.

2011-01-01

According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study…

The Perceived Stigma of Mental Health Services Among Rural Parents of Children With Psychosocial Concerns.

Science.gov (United States)

Polaha, Jodi; Williams, Stacey L; Heflinger, Craig Anne; Studts, Christina R

2015-01-01

To examine parents' perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. Parents endorsed low levels of stigma around services. Greater perceived stigma was related to less willingness to seek services in a mental/behavioral health center or schools but not in other settings, even when other barriers were considered. Having a younger child and a history of prior services was associated with greater willingness to seek services. Stigma does appear to present as a barrier, but only for some parents. Providing mental health services to young children and their parents in some nontraditional settings may increase access. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

USGS Elevation Availability (NED) Overlay Map Service from The National Map - National Geospatial Data Asset (NGDA) National Elevation Data Set (NED)

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS Elevation Availability service from The National Map (TNM) shows the best available resolution of downloadable elevation data, and is updated approximately...

USGS Elevation Contours Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS Elevation Contours service from The National Map (TNM) consists of contours generated for the conterminous United States from 1- and 1/3 arc-second...

USGS NAIP Imagery Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS NAIP Imagery service from The National Map (TNM) consists of high resolution images that combine the visual attributes of an aerial photograph with the...

Inconsistencies Exist in National Estimates of Eye Care Services Utilization in the United States

Directory of Open Access Journals (Sweden)

Fernando A. Wilson

2015-01-01

Full Text Available Background. There are limited research and substantial uncertainty about the level of eye care utilization in the United States. Objectives. Our study estimated eye care utilization using, to our knowledge, every known nationally representative, publicly available database with information on office-based optometry or ophthalmology services. Research Design. We analyzed the following national databases to estimate eye care utilization: the Medical Expenditure Panel Survey (MEPS, National Health Interview Survey (NHIS, Joint Canada/US Survey of Health (JCUSH, Behavioral Risk Factor Surveillance System (BRFSS, and the National Ambulatory Medical Care Survey (NAMCS. Subjects. US adults aged 18 and older. Measures. Self-reported utilization of eye care services. Results. The weighted number of adults seeing or talking with any eye doctor ranges from 87.9 million to 99.5 million, and the number of visits annually ranges from 72.9 million to 142.6 million. There were an estimated 17.2 million optometry visits and 55.8 million ophthalmology visits. Conclusions. The definitions and estimates of eye care services vary widely across national databases, leading to substantial differences in national estimates of eye care utilization.

The Modernization and Associated Restructuring of the National Weather Service: An Overview.

Science.gov (United States)

Friday, Elbert W., Jr.

1994-01-01

The scientific understanding of the atmosphere and the ability to forecast large-and small-scale hydrometeorological phenomena have increased dramatically over the last two decades. As a result, the National Oceanic and Atmospheric Administration has set an ambitious goal: to modernize the National Weather Service (NWS)through the deployment of proven observational, information processing, and communications technologies, and to establish an associated cost-effective operational structure. The modernization and associated restructuring of the NWS will assure that the major advances that have been made in our ability to observe and understand the atmosphere are applied to the practical problems of providing atmospheric and hydrologic services to the nation. Implementation and practice of the new science will improve forecasts, provide more reliable detection of and warnings for severe weather and flooding, achieve more uniform hydrometeorological services across the nation, permit a more cost-effective NWS, and increase productivity among NWS employees. The changes proposed by the NWS will allow increased productivity and efficiency for any entity dependent on weather information, including local, state, and federal government agencies; researchers; private-sector meteorologists; private industry; and resource management organizations. This is the first in a series of articles intended to highlight these changes.

78 FR 43745 - Expanding National Service Through Partnerships to Advance Government Priorities

Science.gov (United States)

2013-07-19

... CNCS and the Director of the Domestic Policy Council, which shall include representatives from agencies... Affairs; (m) the Department of Homeland Security; (n) the Peace Corps; (o) the National Science Foundation...- effectiveness of national service and volunteering interventions in achieving agency priorities, and aggregate...

A way to motivate Danish GPs to implement a new national service.

Science.gov (United States)

Kristensen, Alice; Wengler, Bente

2012-01-01

The Common Medicine card (CMC) is a new national service in Denmark which aim is to ensure better patient care and minimize medication errors. All health professionals as well as authorities have to use this system. CMC requires changing the organization of work for both physicians and clinical staff in General Practice (GP). Commissioning of CMC in GP requires a significant effort beyond the technical installation of the solution. Finding the right way to implement a new service in a busy GP has been the main focus of the national project organization MedCom. MedCom has in collaboration with the five regions in Denmark, established a joint plan and has created an implementation model contraining various initiatives including "after hours" meetings for each service provider of EMR (Electronic Medicine Records) in order to disseminate and support the new CMC service. This paper shows the status of the "after hours" meetings effect in dissemination of CMC from August to November 2011.

Questioning the Role of the Indian Administrative Service in National Integration

Directory of Open Access Journals (Sweden)

Dalal Benbabaali

2008-09-01

Full Text Available After Independence, the Indian Administrative Service was expected to promote national integration, from a social as well as a spatial point of view. Yet, despite the reservation policy, this elite body lacks representativeness. The partisanship of IAS officers along caste, religious and ethnic lines has further reduced their efficiency as a binding force of the nation. Being an All-India Service, the IAS encourages the spatial mobility of its members, which is not always welcome by officers posted in far-off states or in disturbed areas. In these places, the vacancy of postings in the higher administration is a sign of desertion that is contrary to the IAS mission of territorial integration.

Service-Learning. National Dropout Prevention Center/Network Newsletter. Volume 22, Number 4

Science.gov (United States)

Duckenfield, Marty, Ed.

2011-01-01

The "National Dropout Prevention Newsletter" is published quarterly by the National Dropout Prevention Center/Network. This issue contains the following articles: (1) Dropouts and Democracy (Robert Shumer); (2) 2011 NDPN Crystal Star Winners; (3) Service-Learning as Dropout Intervention and More (Michael VanKeulen); and (4) Teacher…

76 FR 344 - Office of Special Education and Rehabilitative Services; Overview Information; National Institute...

Science.gov (United States)

2011-01-04

... DEPARTMENT OF EDUCATION Office of Special Education and Rehabilitative Services; Overview... Special Education and Rehabilitative Services establishes a priority for the funding of a National SCI... Special Education and Rehabilitative Services may change the maximum amount through a notice published in...

A security framework for nationwide health information exchange based on telehealth strategy.

Science.gov (United States)

Zaidan, B B; Haiqi, Ahmed; Zaidan, A A; Abdulnabi, Mohamed; Kiah, M L Mat; Muzamel, Hussaen

2015-05-01

This study focuses on the situation of health information exchange (HIE) in the context of a nationwide network. It aims to create a security framework that can be implemented to ensure the safe transmission of health information across the boundaries of care providers in Malaysia and other countries. First, a critique of the major elements of nationwide health information networks is presented from the perspective of security, along with such topics as the importance of HIE, issues, and main approaches. Second, a systematic evaluation is conducted on the security solutions that can be utilized in the proposed nationwide network. Finally, a secure framework for health information transmission is proposed within a central cloud-based model, which is compatible with the Malaysian telehealth strategy. The outcome of this analysis indicates that a complete security framework for a global structure of HIE is yet to be defined and implemented. Our proposed framework represents such an endeavor and suggests specific techniques to achieve this goal.

Services of the CDRH X-ray calibration laboratory and their traceability to National Standards

Energy Technology Data Exchange (ETDEWEB)

Cerra, F.; Heaton, H.T. [Center for Devices and Radiological Health, Rockville, MD (United States)

1993-12-31

The X-ray Calibration Laboratory (XCL) of the Center for Devices and Radiological Health (CDRH) provides calibration services for the Food and Drug Administration (FDA). The instruments calibrated are used by FDA and contract state inspectors to verify compliance with federal x-ray performance standards and for national surveys of x-ray trends. In order to provide traceability of measurements, the CDRH XCL is accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) for reference, diagnostic, and x-ray survey instrument calibrations. In addition to these accredited services, the CDRH XCL also calibrates non-invasive kVp meters in single- and three-phase x-ray beams, and thermoluminescent dosimeter (TLD) chips used to measure CT beam profiles. The poster illustrates these services and shows the traceability links back to the National Standards.

Services of the CDRH X-ray calibration laboratory and their traceability to National Standards

International Nuclear Information System (INIS)

Cerra, F.; Heaton, H.T.

1993-01-01

The X-ray Calibration Laboratory (XCL) of the Center for Devices and Radiological Health (CDRH) provides calibration services for the Food and Drug Administration (FDA). The instruments calibrated are used by FDA and contract state inspectors to verify compliance with federal x-ray performance standards and for national surveys of x-ray trends. In order to provide traceability of measurements, the CDRH XCL is accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) for reference, diagnostic, and x-ray survey instrument calibrations. In addition to these accredited services, the CDRH XCL also calibrates non-invasive kVp meters in single- and three-phase x-ray beams, and thermoluminescent dosimeter (TLD) chips used to measure CT beam profiles. The poster illustrates these services and shows the traceability links back to the National Standards

77 FR 58141 - Public Buildings Service; Information Collection; Art-in-Architecture Program National Artist...

Science.gov (United States)

2012-09-19

... Buildings Service; Information Collection; Art-in- Architecture Program National Artist Registry (GSA Form... Information Collection 3090- 0274, Art-in-Architecture Program National Artist Registry (GSA Form 7437), by... corresponds with ``Information Collection 3090-0274, Art-in- Architecture Program National Artist Registry...

PTSD: National Center for PTSD

Medline Plus

Full Text Available ... Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations Flu Vaccination Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen ...

78 FR 1832 - National Wildlife Services Advisory Committee; Notice of Solicitation for Membership

Science.gov (United States)

2013-01-09

...., Washington, DC 20250, Attn: Secretary's National Wildlife Services Advisory Committee. Nomination packages... demonstrated ability to represent minorities, women, and persons with disabilities. Done in Washington, DC... Services Advisory Committee. DATES: Consideration will be given to nominations received on or before March...

Developing a Service Improvement System for the National Dutch Railways

NARCIS (Netherlands)

Verhoef, Peter C.; Heijnsbroek, Martin; Bosma, Joost

2017-01-01

Customer satisfaction is essential for public and railway services, because firms in these industries have contracts with governments requiring them to achieve specific customer satisfaction targets. In this paper, we describe a National Dutch Railways project in which we identify the major

76 FR 43718 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Gila National...

Science.gov (United States)

2011-07-21

... Reservation, New Mexico (hereinafter referred to as ``The Tribes''). History and Description of the Remains... History, Chicago, IL AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The U.S. Department of Agriculture, Forest Service, Gila National Forest and the Field Museum of Natural History have...

PTSD: National Center for PTSD

Medline Plus

Full Text Available ... Innovation (VACI) Agency Financial Report (AFR) Budget Submission Recovery Act Resources Business Congressional Affairs Jobs Benefits Booklet ... Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations Flu Vaccination Prevention / Wellness ...

PTSD: National Center for PTSD

Medline Plus

Full Text Available ... Website Site Map Content Inventory Accessibility Privacy and Security Updating of Web Site Web Site Policies Important ... Polytrauma Rehabilitation Spinal Cord Injury Telehealth Womens Health Issues Wellness Programs MyHealtheVet Nutrition Quitting Smoking Vaccines & Immunizations ...

Hardwoods for timber bridges : a national program emphasis by the USDA Forest Service

Science.gov (United States)

James P. Wacker; Ed Cesa

2005-01-01

This paper describes the joint efforts of the Forest Service and the FHWA to administer national programs including research, demonstration bridges, and technology transfer components. Summary information on a number of Forest Service-WIT demonstration bridges constructed with hardwoods is also provided.

The Cuban National Healthcare System: Characterization of primary healthcare services.

Directory of Open Access Journals (Sweden)

Keli Regina DAL PRÁ

2015-10-01

Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

Designing and implementing E-health Applications in the UK's National Health Service.

Science.gov (United States)

Bower, D Jane; Barry, Nessa; Reid, Margaret; Norrie, John

2005-12-01

Telemedicine/e-health applications have the potential to play an important role in Britain's National Health Service (NHS), including the NHS in Scotland. The Scottish Telemedicine Action Forum (STAF) was established by the Scottish Executive Department of Health in 1999 to take a range of applications, targeted on national priorities, into routine service. In the process it has provided insights into how advanced information and communication technologies (ICTs) can be moved from the research stage into routine service. In this article four of the projects are described and analysed focusing on the key issues that have emerged as critical for carrying projects successfully through to implementation in service as follows: 1. A multisite videoconferencing network linking 15 minor injury units to the main accident and emergency (A&E) centre. 2. A single-site neonatal intensive care "cotside" laptop system to assist communication between parents and clinical staff. 3. A single-site outpatient chronic disease management system. 4. A multisite software audit tool to support the care of cleft lip and palate patients from birth onward.

76 FR 40937 - Public Availability of National Labor Relations Board's FY 2010 Service Contract Inventory

Science.gov (United States)

2011-07-12

... NATIONAL LABOR RELATIONS BOARD Public Availability of National Labor Relations Board's FY 2010 Service Contract Inventory AGENCY: National Labor Relations Board. ACTION: Notice of public availability... Consolidated Appropriations Act of 2010 (Pub. L. 111-117), the National Labor Relations Board (NLRB) is...

77 FR 5062 - Public Availability of National Labor Relations Board's FY 2011 Service Contract Inventory

Science.gov (United States)

2012-02-01

... NATIONAL LABOR RELATIONS BOARD Public Availability of National Labor Relations Board's FY 2011 Service Contract Inventory AGENCY: National Labor Relations Board. ACTION: Notice of public availability... Consolidated Appropriations Act of 2010 (Pub. L. 111-117), the National Labor Relations Board (NLRB) is...

USGS Map Indices Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS Map Indices service from The National Map (TNM) consists of 1x1 Degree, 30x60 Minute (100K), 15 Minute (63K), 7.5 Minute (24K), and 3.75 Minute grid...

National Health Insurance, Profitability, and Service Quality: Case Study at the Private Hospital in West Java

Directory of Open Access Journals (Sweden)

Andriyani Rahmah Fahriati

2018-02-01

Full Text Available National health insurance is one of the government programs to facilitate health services for the people. The purpose of this research to determine whether there are effects of National Health Insurance program (JKN on profitability and service quality at Juanda Kuningan Hospital, of West Java. The method using the paired-t-test to analyze the difference between before and after the National Health Insurance program. The result showed that there is a difference in profitability and service quality between pre and post the implementation of national health insurance program. Gross profit margin measured the profitability, net profit margin, return on total assets, and return on equity. This result means that the value of the company's profitability is better when the program JKN yet takes place in the Juanda hospital. While on the service quality variable it is found that the mean value is higher when the JKN program has conducted at the hospital.DOI: 10.15408/etk.v17i1.7064

Democratic candidates call for change in the health care system: wider use of home and community-based care, chronic disease management, universal coverage, and greater use of telehealth.

Science.gov (United States)

Marsh, Aaron G

2008-10-01

Senator Barack Obama, the Democratic candidate for president, and Senator Joe Biden, the party's candidate for vice president, have made health care reform a central pillar of their campaign. The Democrats want to target the 12 percent of Americans who are responsible for 69 percent of health care costs. Such individuals generally have multiple and complex health care problems, which if left untreated, require them to seek care in hospital emergency rooms which are vastly overcrowded. In order to solve the problem, they believe first that universal coverage along the lines of the Federal Government Employees' health plan is necessary, followed by a shift away from institutionally-based care, making home and community-based care, which integrates telehealth and other technologies, the norm. The party's platform includes this committment to help solve the problem of long-term care, which affects not only the nation's 35 million elderly, but increasingly will affect the 78 million baby boomers who are entering their retirement years.

75 FR 32818 - Institute of Museum and Library Services; Sunshine Act Meeting of the National Museum and Library...

Science.gov (United States)

2010-06-09

... NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES Institute of Museum and Library Services; Sunshine Act Meeting of the National Museum and Library Services Board AGENCY: Institute of Museum and Library Services (IMLS), NFAH. ACTION: Notice of Meeting. SUMMARY: This notice sets forth the agenda of...

75 FR 8139 - Institute of Museum and Library Services; Sunshine Act Meeting of the National Museum and Library...

Science.gov (United States)

2010-02-23

... policies with respect to the duties, powers, and authorities related to Museum and Library Services. If you... NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES Institute of Museum and Library Services; Sunshine Act Meeting of the National Museum and Library Services Board AGENCY: Institute of Museum and...

USGS US Topo Availability Overlay Map Service from The National Map

Data.gov (United States)

U.S. Geological Survey, Department of the Interior — The USGS US Topo Availability service from The National Map consists of footprints where US Topo products are currently available. Various green tints are used to...

Impact of national cultures on automotive after sales services perception

Directory of Open Access Journals (Sweden)

Jose Albors-Garrigos

2017-09-01

Full Text Available This article clarifies the impact of national culture in the after sales service in the automotive sector. Introduction and objectives: After-sales services have become paramount in the automobile industry. However, they are not sufficiently researched, particularly in emerging markets. Here an academic gap exists because, within the automotive research literature, culture is a widely neglected issue. Thus no explicit knowledge can be applied regarding emerging markets service demand behaviour, which might be a crucial point, as some of these countries culture is different to the western culture. Methods: The research is based in a survey carried out among Chinese premium brand automotive customers. Results: It shows which individual level values are causal and positively contribute to the perception of service quality and loyalty behaviour by customers. Conclusion: The article providing a guideline how the entire process chain of after-sales services could be researched and applies successfully the individual level value theory by Schwartz. Implications and research limitation: Brand loyalty is well explained by perceived service quality significantly leads to after-sales service satisfaction, which itself is a strong predictor of workshop loyalty. Moreover, workshop loyal customers are likewise significantly brand loyal. Finally, the influence of culture is empirically verified with the one exception of after-sales service satisfaction.

U.S. Public Health Service Commissioned Corps pharmacists: making a difference in advancing the nation's health.

Science.gov (United States)

Flowers, Louis; Wick, Jeannette; Figg, William Douglas; McClelland, Robert H; Shiber, Michael; Britton, James E; Ngo, Diem-Kieu H; Borders-Hemphill, Vicky; Mead, Christina; Zee, Jerry; Huntzinger, Paul

2009-01-01

To describe how U.S. Public Health Service (PHS) pharmacists serving in jobs that are normal for them, but considerably different than those found in the private sector, are making a difference in advancing the nation's health. Pharmacists who serve in the Commissioned Corps of PHS fill roles that are considerably different than their counterparts in the private sector. Their work takes them out from behind the counter and into the world. Pharmacy officers advance the health and safety of the nation by their involvement in the delivery of direct patient care to medically underserved people, national security, drug vigilance, research, and policy-making endeavors. PHS pharmacists fill essential public health leadership and service roles throughout the U.S. Department of Health and Human Services (HHS) and certain non-HHS federal agencies and programs. The Health Resources and Services Administration, National Institutes of Health, Federal Bureau of Prisons, Indian Health Service, Food and Drug Administration, and U.S. Coast Guard are among the many federal agencies in which pharmacy officers are assigned. In each setting, PHS pharmacists find traditional roles augmented with assignments and challenges that broaden the scope of their practice.

32 CFR 1630.48 - Class 4-A-A: Registrant who has performed military service for a foreign nation.

Science.gov (United States)

2010-07-01

... military service for a foreign nation. 1630.48 Section 1630.48 National Defense Other Regulations Relating... who has performed military service for a foreign nation. In Class 4-A-A shall be placed any registrant... be written in the English language. [52 FR 24456, July 1, 1987] ...

Medical Tourism and the Libyan National Health Services

Directory of Open Access Journals (Sweden)

El Taguri A

2007-01-01

recognized location of choice for quality healthcare and an integrated centre of excellence for clinical and wellness services, medical education and research [2]. An international medical travel conference (IMTC was held in December 2006 and some web sites such as ArabMedicare.com were established to accompany the needs of this growing market.In spite of the aforementioned rewards, medical tourism is not without risks [3]. Medical tourism can do harm to national health services of the host as well as the country of origin. Besides cultural and language issues, there are risks inherent in traveling as accidents, exposure to different infectious diseases, risks from traveling soon after surgery, impossibility of treating chronic disease after a single consultation, the non familiarity of how a certain specialty applies to other communities, the on-off consultations, the limited possibility for follow up, the absence of record of the consultation [3], and most importantly fraud and abuse.The total amount of money spent by Libyans on both forms of medical tourism is difficult to estimate. It ranges between $100-200 millions per year for treatment abroad, but the accurate figures are not available. The form of medical tourism where doctors rather than patients travel, gained a momentum with the increased role of private practice in health service delivery. There is a real threat from the growing market of medical tourism in the region on the public health oriented national health system in Libya. The two neighboring countries that are mostly visited by Libyans have a lower performance of National Health Service in comparison to Libyan National Health services with an objective assessment as revealed by infant mortality rate, life expectancy at birth, maternal mortality ratio and proportion of low birth weight [7]. Giving the non-popularity of tourism among the Libyan population, traveling in itself is an important event in one’s life. We should not deny that in many cases

The National Security Education Program and Its Service Requirement: An Exploratory Study of What Areas of Government and for What Duration National Security Education Program Recipients Have Worked

Science.gov (United States)

Comp, David J.

2013-01-01

The National Security Education Program, established under the National Security Education Act of 1991, has had a post-funding service requirement in the Federal Government for undergraduate scholarship and graduate fellowship recipients since its inception. The service requirement, along with the concern that the National Security Education…

75 FR 20893 - National Day of Service and Remembrance for Victims and Survivors of Terrorism, 2010

Science.gov (United States)

2010-04-21

... National Day of Service and Remembrance for Victims and Survivors of Terrorism, 2010 By the President of... innocents. On this National Day of Service and Remembrance for Victims and Survivors of Terrorism, we pause to remember victims of terrorism at home and abroad, we honor the heroes who have supported them, and...

Study protocol: home-based telehealth stroke care: a randomized trial for veterans

Directory of Open Access Journals (Sweden)

McGee-Hernandez Nancy

2010-06-01

Full Text Available Abstract Background Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. Methods We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a TR; or (b Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. Discussion For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and

National Coal Board Medical Service annual report 1981-82

Energy Technology Data Exchange (ETDEWEB)

1983-01-01

Sections report on: medical examinations and consultations; protection from health hazards, such as pneumoconiosis and other prescribed diseases; problems such as vitamin D in miners' blood, Legionnaires' disease, rehabilitation and physiotherapy, high pressure injection injuries, pump packing; National Coal Board (Coal Products) Ltd.; injuries and treatment; and nursing service. A list of staff and their publications and a supplement on occupational toxicology are included.

The National Oceanic and Atmospheric Administration (NOAA) Climate Services Portal: A New Centralized Resource for Distributed Climate Information

Science.gov (United States)

Burroughs, J.; Baldwin, R.; Herring, D.; Lott, N.; Boyd, J.; Handel, S.; Niepold, F.; Shea, E.

2010-09-01

With the rapid rise in the development of Web technologies and climate services across NOAA, there has been an increasing need for greater collaboration regarding NOAA's online climate services. The drivers include the need to enhance NOAA's Web presence in response to customer requirements, emerging needs for improved decision-making capabilities across all sectors of society facing impacts from climate variability and change, and the importance of leveraging climate data and services to support research and public education. To address these needs, NOAA (during fiscal year 2009) embarked upon an ambitious program to develop a NOAA Climate Services Portal (NCS Portal). Four NOAA offices are leading the effort: 1) the NOAA Climate Program Office (CPO), 2) the National Ocean Service's Coastal Services Center (CSC), 3) the National Weather Service's Climate Prediction Center (CPC), and 4) the National Environmental Satellite, Data, and Information Service's (NESDIS) National Climatic Data Center (NCDC). Other offices and programs are also contributing in many ways to the effort. A prototype NCS Portal is being placed online for public access in January 2010, http://www.climate.gov. This website only scratches the surface of the many climate services across NOAA, but this effort, via direct user engagement, will gradually expand the scope and breadth of the NCS Portal to greatly enhance the accessibility and usefulness of NOAA's climate data and services.

Engaging and Empowering the National Park Service to apply Earth Observations to Management Decisions

Science.gov (United States)

Clayton, A.; Ross, K. W.; Crepps, G.; Childs-Gleason, L. M.; Ruiz, M. L.; Rogers, L.; Allsbrook, K. N.

2017-12-01

Since 2015, the NASA DEVELOP National Program has partnered with the National Park Service (NPS) engaging more than 120 program participants, working on over 22 projects across approximately 27 unique park units. These projects examined a variety of cultural and environmental concerns facing the NPS including landscape disturbance, invasive species mapping, archaeological site preservation, and water resources monitoring. DEVELOP, part of NASA's Applied Sciences' Capacity Building program, conducts 10-week feasibility projects which demonstrate the utility of NASA's Earth observations as an additional tool for decision-making processes. This presentation will highlight several of these projects and discuss the progress of capacity building working with individual, regional, and institutional elements within the National Park Service.

Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

Science.gov (United States)

Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

2018-03-23

To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

The application of epidemiology in national veterinary services: Challenges and threats in Brazil.

Science.gov (United States)

Gonçalves, Vitor Salvador Picão; de Moraes, Geraldo Marcos

2017-02-01

The application of epidemiology in national veterinary services must take place at the interface between science and politics. Animal health policy development and implementation require attention to macro-epidemiology, the study of economic, social and policy inputs that affect the distribution and impact of animal or human disease at the national level. The world has changed fast over the last three decades including the delivery of veterinary services, their remit and the challenges addressed by public and animal health policies. Rethinking the role of public services and how to make public programs more efficient has been at the heart of the political discussion. The WTO through its SPS Agreement has changed the way in which national veterinary services operate and how trade decisions are made. Most low and middle income countries are still struggling to keep up with the new international scene. Some of these countries, such as Brazil, have very important livestock industries and are key to the global food systems. Over the last two decades, Brazil became a leading player in exports of livestock products, including poultry, and this created a strong pressure on the national veterinary services to respond to trade demands, leading to focus animal health policies on the export-driven sector. During the same period, Brazil has gone a long way in the direction of integrating epidemiology with veterinary services. Epidemiology groups grew at main universities and have been working with government to provide support to animal health policy. The scope and quality of the applied epidemiological work improved and focused on complex data analysis and development of technologies and tools to solve specific disease problems. Many public veterinary officers were trained in modern epidemiological methods. However, there are important institutional bottlenecks that limit the impact of epidemiology in evidence-based decision making. More complex challenges require high levels

22 CFR 228.37 - Nationality of employees under contracts or subcontracts for services.

Science.gov (United States)

2010-04-01

... the Nationality of Suppliers of Services for USAID Financing § 228.37 Nationality of employees under... the United States. (b) When the contractor on a USAID-financed construction project is a United States firm, at least half of the supervisors and other specified key personnel working at the project site...

Training for Effective National Weather Service (NWS) Communication in Chat and Conference Calls

Science.gov (United States)

Pearce, Vanessa

2012-01-01

Staff of the National Weather Service Offices should be able to understand interpersonal communication and public relations in order to better serve their mission to "protect lives and property" as well as work with their internal and external partners (NWS Internet Services Team). Two technologies have been developed to assist the integration of…

NNDC Stand: Activities and Services of the National Nuclear Data Center

International Nuclear Information System (INIS)

Pritychenko, B.; Arcilla, R.; Burrows, T.W.; Dunford, C.L.; Herman, M.W.; McLane, V.; Oblozinsky, P.; Sonzogni, A.A.; Tuli, J.K.; Winchell, D.F.

2005-01-01

The National Nuclear Data Center (NNDC) collects, evaluates, and disseminates nuclear physics data for basic nuclear research, applied nuclear technologies including energy, shielding, medical and homeland security. In 2004, to answer the needs of nuclear data users community, NNDC completed a project to modernize data storage and management of its databases and began offering new nuclear data Web services. The principles of database and Web application development as well as related nuclear reaction and structure database services are briefly described

Differential Impact and Use of a Telehealth Intervention by Persons with MS or SCI.

Science.gov (United States)

Mercier, Hannah W; Ni, Pensheng; Houlihan, Bethlyn V; Jette, Alan M

2015-11-01

The objective of this study was to compare outcomes and patterns of engaging with a telehealth intervention (CareCall) by adult wheelchair users with severe mobility limitations with a diagnosis of multiple sclerosis (MS) or spinal cord injury (SCI). The design of this study is a secondary analysis from a pilot randomized controlled trial with 106 participants with SCI and 36 participants with MS. General linear model results showed that an interaction between baseline depression score and study group significantly predicted reduced depression at 6 mos for subjects with both diagnoses (P = 0.01). For those with MS, CareCall increased participants' physical independence (P SCI (P = 0.005). Those with SCI missed more calls (P SCI, and in increasing health care access and physical independence for those with a diagnosis of MS. Future research should aim to enhance the efficacy of such an intervention for participants with SCI.

A national survey of cardiac rehabilitation services in New Zealand: 2015.

Science.gov (United States)

Kira, Geoff; Doolan-Noble, Fiona; Humphreys, Grace; Williams, Gina; O'Shaughnessy, Helen; Devlin, Gerry

2016-05-27

Guidelines for cardiac rehabilitation (CR) programmes inform best practice. In Aotearoa NewZealand, little information exists about the structure and services provided by CR programmes and there is a poor understanding of how existing CR programmes are delivered with respect to evidence-based national guidelines. All 46 CR providers in New Zealand were invited to participate in a national survey in 2015. The survey sought information on the following: unit structure; referral processes; patient assessment; audit (including quality assurance activity); Phase 2 CR content; and support for special populations. Simple descriptive analysis of the responses was conducted, involving forming counts and percentages. Thirty-six distinct units completed the survey and 94% provided Phase 2. Assessment tools, Phase 2 educational components, and the methods of providing the exercise component varied. Most units audited their services, 25% audited their programme six-monthly or more frequently. Just over half of the units (56%) reported key performance indicators. The survey identified variations in delivery and content of CR in New Zealand, with poor understanding of the impact on patient outcomes. This is likely due to the absence of standardised audit practices and routine collection of key performance indicators on a national basis.

78 FR 23312 - Uranium Enrichment Fuel Cycle Inspection Reports Regarding Louisiana Energy Services, National...

Science.gov (United States)

2013-04-18

... NUCLEAR REGULATORY COMMISSION [Docket No. 70-3103; NRC-2010-0264] Uranium Enrichment Fuel Cycle Inspection Reports Regarding Louisiana Energy Services, National Enrichment Facility, Eunice, New Mexico..., National Enrichment Facility in Eunice, New Mexico, and has authorized the introduction of uranium...

A case for increased private sector involvement in Ireland's national animal health services.

Science.gov (United States)

More, Simon J

2008-02-01

Non-regulatory animal health issues, such as Johne's disease, infectious bovine rhinotracheitis (IBR) and mastitis will become increasing important, with ongoing globalisation of markets in animals and animal products. In response, Ireland may need to broaden the scope of its national animal health services. However, there have been concerns about the respective roles and responsibilities (both financial and otherwise) of government and industry in any such moves. This paper argues the case for increased private sector involvement in Ireland's national animal health services, based both on theoretical considerations and country case studies (the Netherlands and Australia). The Dutch and Australian case studies present examples of successful partnerships between government and industry, including systems and processes to address non-regulatory animal health issues. In each case, the roles and responsibilities of government are clear, as are the principles underpinning government involvement. Furthermore, the roles and responsibilities (financial and otherwise) of the Dutch and Australian industry are determined through enabling legislation, providing both legitimacy and accountability. There are constraints on the use of EU and national government funds to support non-regulatory animal health services in EU member states (such as Ireland and the Netherlands).

A case for increased private sector involvement in ireland's national animal health services

Directory of Open Access Journals (Sweden)

More Simon J

2008-02-01

Full Text Available Abstract Non-regulatory animal health issues, such as Johne's disease, infectious bovine rhinotracheitis (IBR and mastitis will become increasing important, with ongoing globalisation of markets in animals and animal products. In response, Ireland may need to broaden the scope of its national animal health services. However, there have been concerns about the respective roles and responsibilities (both financial and otherwise of government and industry in any such moves. This paper argues the case for increased private sector involvement in Ireland's national animal health services, based both on theoretical considerations and country case studies (the Netherlands and Australia. The Dutch and Australian case studies present examples of successful partnerships between government and industry, including systems and processes to address non-regulatory animal health issues. In each case, the roles and responsibilities of government are clear, as are the principles underpinning government involvement. Furthermore, the roles and responsibilities (financial and otherwise of the Dutch and Australian industry are determined through enabling legislation, providing both legitimacy and accountability. There are constraints on the use of EU and national government funds to support non-regulatory animal health services in EU member states (such as Ireland and the Netherlands.

Computerization of the Botswana National Library Service. Restricted Technical Report.

Science.gov (United States)

Underwood, Peter C.

This report discusses the scope for and feasibility of introducing automated systems into the Botswana National Library Service (BNLS). The study was undertaken at the request of BNLS and was conducted by an outside consultant who interviewed staff, read internal documents and reports, and studied patterns of work. Topics of the report include:…

Tackling Work Related Stress in a National Health Service Trust

Science.gov (United States)

Vick, Donna; Whyatt, Hilary

2004-01-01

The challenge of tackling the problem of coping with work related stress in a National Health Service (NHS) Trust was undertaken. Ideas were developed within the context of two different action learning sets and led to actions resulting in a large therapy Taster Session event and the establishment of a centre offering alternative therapies and…

Strengthening systems for integrated early childhood development services: a cross-national analysis of governance.

Science.gov (United States)

Britto, Pia Rebello; Yoshikawa, Hirokazu; van Ravens, Jan; Ponguta, Liliana Angelica; Reyes, Maria; Oh, Soojin; Dimaya, Roland; Nieto, Ana María; Seder, Richard

2014-01-01

While there has been substantial growth in early childhood development (ECD) services in low- and middle-income countries (LMICs), there is considerable inequity in their distribution and quality. Evidence-based governance strategies are necessary, but currently they are insufficient for widespread, quality implementation. In particular, there is a limited understanding of the use of systems approaches for the analysis of ECD services as they go to scale. The aim of this paper is to present findings from four countries, using a cross-national case study approach to explore governance mechanisms required to strengthen national systems of ECD services. While different sets of governance strategies and challenges were identified in each country, overarching themes also emerged with implications for systems strengthening. Study results focus on local, mid-level and central governance, with recommendations for effective coordination and the integration of ECD services in LMICs. © 2014 New York Academy of Sciences.

Remote access to information sources in National and university library: development of service

Directory of Open Access Journals (Sweden)

Gorazd Vodeb

2006-01-01

Full Text Available National and University Library established remote access to information sources in september 2004. The article describes implementation and development of the service. Library wanted to offer information sources to users wherever and whenever they would need them. First main evaluation criteria for software selection were integration with existing authentication system and second no need for intervention user side. The EZproxy software from Useful Utilities was chosen. Key step to implementation was establishing communication between software applications EZproxy and COBISS library automation system. Library needed to obtain licence agreements from publishers. Promotion campaign aimed to notify large number of users. Only users of National & University Library were able to use the service. Other users and libraries of Ljubljana University requested to authenticate by credentials of their library. Remote access service was developed further in order to enable authentication for other libraries. We needed to establish authentication and authorisation system and also upgrade and install the communication command procedure on different servers. The data about service usage are presented.

POLLUTION PREVENTION OPPORTUNITY ASSESSMENT - U.S. POSTAL INSPECTION SERVICE FORENSIC & TECHNICAL SERVICES DIVISION - NATIONAL FORENSIC LABORATORY, DULLES, VIRGINIA

Science.gov (United States)

The United States Postal Service (USPS) in cooperation with EPA's National Risk Management Research Laboratory (NRMRL) is engaged in an effort to integrate waste prevention and recycling activities into the waste management programs at Postal facilities. This report describes the...

The challenge of implementing peer-led interventions in a professionalized health service: a case study of the national health trainers service in England.

Science.gov (United States)

Mathers, Jonathan; Taylor, Rebecca; Parry, Jayne

2014-12-01

Policy Points: In 2004, England's National Health Service introduced health trainer services to help individuals adopt healthier lifestyles and to redress national health inequalities. Over time these anticipated community-focused services became more NHS-focused, delivering "downstream" lifestyle interventions. At the same time, individuals' lifestyle choices were abstracted from the wider social determinants of health and the potential to address inequalities was diminished. While different service models are needed to engage hard-to-reach populations, the long-term sustainability of any new service model depends on its aligning with the established medical system's characteristics. In 2004, the English Public Health White Paper Choosing Health introduced "health trainers" as new members of the National Health Service (NHS) workforce. Health trainers would offer one-to-one peer-support to anyone who wished to adopt and maintain a healthier lifestyle. Choosing Health implicitly envisaged health trainers working in community settings in order to engage "hard-to-reach" individuals and other groups who often have the poorest health but who engage the least with traditional health promotion and other NHS services. During longitudinal case studies of 6 local health trainer services, we conducted in-depth interviews with key stakeholders and analyzed service activity data. Rather than an unproblematic and stable implementation of community-focused services according to the vision in Choosing Health, we observed substantial shifts in the case studies' configuration and delivery as the services embedded themselves in the local NHS systems. To explain these observations, we drew on a recently proposed conceptual framework to examine and understand the adoption and diffusion of innovations in health care systems. The health trainer services have become more "medicalized" over time, and in doing so, the original theory underpinning the program has been threatened. The

Denial of service to same-sex and interracial couples: Evidence from a national survey experiment.

Science.gov (United States)

Powell, Brian; Schnabel, Landon; Apgar, Lauren

2017-12-01

Legislatures and courts are debating whether businesses can deny services to same-sex couples for religious reasons. Yet, little is known about public views on this issue. In a national survey experiment, Americans ( n = 2035) responded to an experimental vignette describing a gay or interracial couple refused service. Vignettes varied the reason for refusal (religion/nonreligious) and by business type (individual/corporation). Results confirm greater support of service refusal by the self-employed than by corporations and to gay couples than to interracial couples. However, religious reasons for refusal to gay couples elicit no more support than do nonreligious reasons. In the first national study to experimentally analyze views on service refusal to sexual minorities, we demonstrate that views vary by several factors but not by whether the refusal was for religious reasons.

[The strategic purchasing of health services: a big opportunity for the National Universal Health System].

Science.gov (United States)

González-Block, Miguel Ángel; Alarcón Irigoyen, José; Figueroa Lara, Alejandro; Ibarra Espinosa, Ignacio; Cortés Llamas, Noemí

2015-01-01

proposed to establish a service packages, whether through a single obligatory list or through the definition of a flexible, high priority set to be offered to specific populations according to their economic possibilities. For the strategic purchasing of services, two alternatives are proposed: to assign the fund either to a single national manager or to each of the existing public provider institutions, with the expectation that they would contract across each other and with private providers to fulfill their complementary needs.The proposal does not consider the risks and alternatives to a single tax contribution fund, which could have been suggested given that it is not an essential part of a National Universal Health System. However, it is necessary to discuss in more detail the roles and strategies for a national single-payer, especially for the strategic purchasing of high-cost and specialized interventions in the context of public and private providers. The alternative of allocating funds directly to providers would undermine the incentives for competition and collaboration and the capacity to steer providers towards the provision of high quality health services.It is proposed to focus the discussion of the reform of the national health system around strategic purchasing and the functions and structure of a single-payer as well as of agencies to articulate integrated health service networks as tools to promote quality and efficiency of the National Universal Health System. The inclusion of economic incentives to providers will be vital for competition, but also for the cooperation of providers within integrated, multi-institutional health service networks.Health professionals and sector policy specialists coordinated by the Centro de Estudios Espinosa Yglesi as in Mexico propose a policy to anchor the health system in primary care centered on the individual. The vision includes effective stewardship,solid financing, and the provision of services by a

National Service Frameworks and UK general practitioners: street-level bureaucrats at work?

Science.gov (United States)

Checkland, Kath

2004-11-01

This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well-established sociological perspectives of deprofessionalisation and proletarianisation, this paper takes a view of general practice as work, and uses the ideas of Lipsky to analyse practice-level responses to some of these changes. In addition to evidence-based clinical guidelines, National Service Frameworks, introduced by the UK government in 1997, also specify detailed models of service provision that health care providers are expected to follow. As part of a larger study examining the impact of National Service Frameworks in general practice, the response of three practices to the first four NSFs were explored. The failure of NSFs to make a significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as 'street-level bureaucrats' is discussed and used as a framework within which to view these findings.

Offer patterns of nationally placed livers by donation service area.

Science.gov (United States)

Lai, Jennifer C; Feng, Sandy; Vittinghoff, Eric; Roberts, John P

2013-04-01

We previously reported that national liver distribution is highly concentrated in 6 US centers, and this raises the possibility of expedited placement. Therefore, we evaluated all national offers of nationally placed livers (n=1625) to adult wait-list candidates from February 2005 to January 2010. We developed a model to predict national utilization pathways; pathways exceeding the best-fit linear unbiased predictions by ≥3 standard errors were defined as preferred. All 51 donation service areas (DSAs) placed 1 or more livers nationally, but the percentage per DSA ranged from 1% to 36%. Of 2830 possible national DSA-center pathways, 87% were used. Five hundred eighty livers (36%) were accepted on the first national offer. Four DSAs accounted for 47% of first-national-offer livers, and 44% of these were accepted by a single center. In comparison with first-offer livers using nonpreferred pathways, first offers along a preferred pathway were offered to fewer status 1 candidates (19% versus 61%) and had lower median model for end-stage liver disease (MELD) scores (22 versus 36, Poffer to non-status 1 candidates with MELD scores less than their local transplant MELD scores. Although this practice may facilitate liver placement, it raises the possibility of expedience trumping patient need. Here we propose changes to the national liver distribution system that will help to balance equity, efficiency, and transparency. Copyright © 2013 American Association for the Study of Liver Diseases.

77 FR 7184 - Public Availability of the National Archives and Records Administration FY 2011 Service Contract...

Science.gov (United States)

2012-02-10

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Public Availability of the National Archives and... Administration. ACTION: Notice of public availability of FY 2011 Service Contract Inventory. SUMMARY: In...), the National Archives and Records Administration (NARA) is publishing this notice to advise the public...

American Akicita: Indigenous American warriors and military service.

Science.gov (United States)

McDonald, J Douglas

2017-08-01

Indigenous Americans (i.e., Native/American Indians, AK natives, Pacific Islanders) have consistently volunteered for military service at greater rates than any other ethnic group, including the majority culture, since the early days of the country. This article is an introduction to the special section which includes a number of outstanding papers that provide an innovative and compelling effort to overcome the challenges of casualties from war and render effective and culturally informed care. These manuscripts describe culturally appropriate considerations of suicide (O'Keefe), family involvement and access to care (Whealin), and telehealth for treatment of rural Native veterans (Goss). Challenging and complex treatment needs call for equally mindful and competent approaches. These authors and providers present compelling examples of addressing these needs in working with our Wounded Warriors. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

75 FR 57978 - Notice of Intent; Request for Comments on Adoption of the National Park Service's Wetland and...

Science.gov (United States)

2010-09-23

... Code: 7B] Notice of Intent; Request for Comments on Adoption of the National Park Service's Wetland and... adopt the National Park Service's (NPS) existing final environmental impact statement/environmental... (CSCC) to assist with implementing restoration activities that have been identified and reviewed under...

A Case Study - On Patient Empowerment and Integration of Telemedicine to National Healthcare Services

DEFF Research Database (Denmark)

Urazimbetova, Surayya

Patient empowerment in the digitalized healthcare can be supported by means of telemedicine. As opposed to Electronic Patient Records developed by a few large business suppliers for healthcare professionals, telemedical applications include innovative solutions of small-medium size suppliers...... and are targeted at specific groups of patients (e.g., hip operated or dermatology patients) and their care network. Based on an integration experiment we argue that in order to support the national visions for patient empowerment and connectedness of healthcare at the same time, it is necessary to achieve...... the integration of telemedicine to the national healthcare services on a business logic (functional) integration level. In this paper, (1) we identify the lack of business logic (functional) level integration opportunities for patient oriented telemedical applications with national healthcare services; (2) we...

75 FR 2144 - Public Buildings Service; Submission for OMB Review; Art-in-Architecture Program National Artist...

Science.gov (United States)

2010-01-14

... GENERAL SERVICES ADMINISTRATION [OMB Control No. 3090-0274] Public Buildings Service; Submission for OMB Review; Art-in- Architecture Program National Artist Registry AGENCY: Public Buildings Service... in 2000 when a renewed focus on commissioning works of art that are an integral part of the building...

SWOT analysis on National Common Geospatial Information Service Platform of China

Science.gov (United States)

Zheng, Xinyan; He, Biao

2010-11-01

Currently, the trend of International Surveying and Mapping is shifting from map production to integrated service of geospatial information, such as GOS of U.S. etc. Under this circumstance, the Surveying and Mapping of China is inevitably shifting from 4D product service to NCGISPC (National Common Geospatial Information Service Platform of China)-centered service. Although State Bureau of Surveying and Mapping of China has already provided a great quantity of geospatial information service to various lines of business, such as emergency and disaster management, transportation, water resource, agriculture etc. The shortcomings of the traditional service mode are more and more obvious, due to the highly emerging requirement of e-government construction, the remarkable development of IT technology and emerging online geospatial service demands of various lines of business. NCGISPC, which aimed to provide multiple authoritative online one-stop geospatial information service and API for further development to government, business and public, is now the strategic core of SBSM (State Bureau of Surveying and Mapping of China). This paper focuses on the paradigm shift that NCGISPC brings up by using SWOT (Strength, Weakness, Opportunity and Threat) analysis, compared to the service mode that based on 4D product. Though NCGISPC is still at its early stage, it represents the future service mode of geospatial information of China, and surely will have great impact not only on the construction of digital China, but also on the way that everyone uses geospatial information service.

How is feedback from national clinical audits used? Views from English National Health Service trust audit leads.

Science.gov (United States)

Taylor, Angelina; Neuburger, Jenny; Walker, Kate; Cromwell, David; Groene, Oliver

2016-04-01

To explore how the output of national clinical audits in England is used by professionals and whether and how their impact could be enhanced. A mixed-methods study with the primary recipients of four national clinical audits of cancer care of 607 local audit leads, 274 (45%) completed a questionnaire and 32 participated in an interview. Our questions focused on how the audits were used and whether barriers existed to using the audits for local service improvement. We described variation in questionnaire responses between the audits using chi-squared tests. Results are reported as percentages with their 95% confidence intervals. Qualitative data were analysed using Framework analysis. More than 90% of survey respondents believed that the audit findings were relevant to their clinical work, and interviewees described how they used the audits for a range of purposes. Forty-two percent of survey respondents said they had changed their clinical practice, and 56% had implemented service improvements in response to the audits. The degree of change differed between the four audits, evident in both the questionnaire and the interview data. In the interviews, two recurring barriers emerged: (1) the importance of data quality, which, in turn, influenced the perceived relevance and validity of the audit data and therefore the ability to make changes based on it and (2) the need for clear presentation of benchmarked local performance data. The perceived authority and credibility of the professional bodies supporting the audits was a key factor underpinning the use of the audit findings. National cancer audit and feedback is used to improve services, but their impact could be enhanced by improving the data quality and relevance of feedback. © The Author(s) 2016.

Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation

Directory of Open Access Journals (Sweden)

Carlos Fernández-Llatas

2013-10-01

Full Text Available Born in the early nineteen nineties, evidence-based medicine (EBM is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized.

The National Workforce Assistance Collaborative: A New Institution with Plans To Improve Workforce Services.

Science.gov (United States)

Bergman, Terri

The National Workforce Assistance Collaborative (NWAC) was established by the National Alliance of Business to provide assistance to community colleges and other organizations that offer programs to increase business productivity. The NWAC is charged with building the capacity of service providers that work with small and mid-sized companies in…

Conversations on telemental health: listening to remote and rural First Nations communities.

Science.gov (United States)

Gibson, Kerri L; Coulson, Heather; Miles, Roseanne; Kakekakekung, Christal; Daniels, Elizabeth; O'Donnell, Susan

2011-01-01

Telemental health involves technologies such as videoconferencing to deliver mental health services and education, and to connect individuals and communities for healing and health. In remote and rural First Nations communities there are often challenges to obtaining mental healthcare in the community and to working with external mental health workers. Telemental health is a service approach and tool that can address some of these challenges and potentially support First Nations communities in their goal of improving mental health and wellbeing. Community members' perspectives on the usefulness and appropriateness of telemental health can greatly influence the level of engagement with the service. It appears that no research or literature exists on First Nations community members' perspectives on telemental health, or even on community perspectives on the broader area of technologies for mental health services. Therefore, this article explores the perspectives on telemental health of community members living in two rural and remote First Nations communities in Ontario, Canada. METHODS; This study was part of the VideoCom project, a collaborative research project exploring how remote and rural First Nations communities are using ICTs. This current exploration was conducted with the support of Keewaytinook Okimakanak (KO), our partner in Northwestern Ontario. With the full collaboration of the communities' leadership, a team involving KO staff and VideoCom researchers visited the two communities in the spring of 2010. Using a participatory research design, we interviewed 59 community members, asking about their experiences with and thoughts on using technologies and their attitudes toward telemental health, specifically. A thematic analysis of this qualitative data and a descriptive quantitative analysis of the information revealed the diversity of attitudes among community members. Finally, based on a discussion with the community telehealth staff, a 'ways forward

USDA Forest Service National Woodland Owner Survey, 2011-2013: design, implementation, and estimation methods

Science.gov (United States)

Brett J. Butler; Brenton J. Dickinson; Jaketon H. Hewes; Sarah M. Butler; Kyle Andrejczyk; Marla. Markowski-Lindsay

2016-01-01

The National Woodland Owner Survey (NWOS) is conducted by the U.S. Forest Service, Forest Inventory and Analysis program to increase the understanding of the attitudes, behaviors, and demographics of private forest and woodland ownerships across the United States. The information is intended to help policy makers, resource managers, educators, service providers, and...

77 FR 19525 - National School Lunch Program: School Food Service Account Revenue Amendments Related to the...

Science.gov (United States)

2012-04-02

... National School Lunch Program: School Food Service Account Revenue Amendments Related to the Healthy... Food Service Account Revenue Amendments Related to the Healthy, Hunger-Free Kids Act of 2010'' on June... sold in a school and purchased with funds from the nonprofit school food service account, other than...

12 CFR 7.4003 - Establishment and operation of a remote service unit by a national bank.

Science.gov (United States)

2010-01-01

...(Seventh). An RSU includes an automated teller machine, automated loan machine, and automated device for... a remote service unit by a national bank. A remote service unit (RSU) is an automated facility...

Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms.

Science.gov (United States)

Haux, Reinhold; Howe, Jurgen; Marschollek, Michael; Plischke, Maik; Wolf, Klaus-Hendrik

2008-06-01

Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Summarizing outcomes of literature analyses and results from own research projects in this field. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

75 FR 17763 - National Park Service Benefits-Sharing Final Environmental Impact Statement Record of Decision

Science.gov (United States)

2010-04-07

... management in connection with the allocation of benefits from valuable discoveries, inventions, and other... share the benefits with the National Park Service. Another alternative prohibits scientific research... Service and researchers who study material associated with a Scientific Research and Collecting Permit to...

Quality control and quality assurance philosophy introduced in national personnel dosimetry service

International Nuclear Information System (INIS)

Trousil, J.; Zelenka, Z.; Kvasnicka, O.

2008-01-01

There in National Personnel Dosimetry Service (NPDS) the implementation of the control system to guarantee the credibility of the measured personal dose equivalents results was given on the basis of the international recommendations published by the European Commission and the IAEA and in particular of the decree of the SUJB No. 132/2008 Coll. The quality control and the quality assurance are carried out in all three personal dosimetry services introduced in NPDS: in the film badge, thermoluminescent (TL) and neutron dosimetry. (authors)

Quality Control in the Dosimetric System of the Personnel Dosimetry Service of the Spanish National Health Service

Energy Technology Data Exchange (ETDEWEB)

Casal, E.; Gil, J.A.; Roig, F.; Soriano, A. [Valencia (Spain)

1999-07-01

The main operating and quality control procedures implemented at the Centro Nacional de Dosimetria (CND) of the Spanish National Health Service to ensure the acceptance of the dosimetry service are described. The operating procedures are routinely performed at every step, since the dosemeters are received from the manufacturer until the doses are assigned to the dosimetric history and their main aim is to ensure the traceability of the doses. They make use of control and background dosemeters and frequent cross reference (automatic and manual) of different sources of data. The control procedures are performed at the end of each monthly process to detect possible errors or systematic bias in the dosimetry service and include analysis of the measurements of quality control dosemeters irradiated at the CND's laboratory and randomly read. The results of this analysis since 1996 are presented. (author)

Quality Control in the Dosimetric System of the Personnel Dosimetry Service of the Spanish National Health Service

International Nuclear Information System (INIS)

Casal, E.; Gil, J.A.; Roig, F.; Soriano, A.

1999-01-01

The main operating and quality control procedures implemented at the Centro Nacional de Dosimetria (CND) of the Spanish National Health Service to ensure the acceptance of the dosimetry service are described. The operating procedures are routinely performed at every step, since the dosemeters are received from the manufacturer until the doses are assigned to the dosimetric history and their main aim is to ensure the traceability of the doses. They make use of control and background dosemeters and frequent cross reference (automatic and manual) of different sources of data. The control procedures are performed at the end of each monthly process to detect possible errors or systematic bias in the dosimetry service and include analysis of the measurements of quality control dosemeters irradiated at the CND's laboratory and randomly read. The results of this analysis since 1996 are presented. (author)

Why some countries have national health insurance, others have national health services, and the U.S. has neither.

Science.gov (United States)

Navarro, V

1989-01-01

This article presents a discussion of why some capitalist developed countries have national health insurance schemes, others have national health services, and the U.S. has neither. The first section provides a critical analysis of some of the major answers given to these questions by authors belonging to the schools of thought defined as 'public choice', 'power group pluralism' and 'post-industrial convergence'. The second section puts forward an alternative explanation rooted in an historical analysis of the correlation of class forces in each country. The different forms of funding and organization of health services, structured according to the corporate model or to the liberal-welfare market capitalism model, have appeared historically in societies with different correlations of class forces. In all these societies the major social force behind the establishment of a national health program has been the labor movement (and its political instruments--the socialist parties) in its pursuit of the welfare state. In the final section the developments in the health sector after World War II are explained. It is postulated that the growth of public expenditures in the health sector and the growth of universalism and coverage of health benefits that have occurred during this period are related to the strength of the labor movement in these countries.

Meeting the Oral Health Needs of Immigrants: National Public Health Services Vs. Charitable Volunteer Services In Rome, Italy

Directory of Open Access Journals (Sweden)

Denise Corridore

2012-03-01

Full Text Available

Abstract:
Background: oral health is an important aspect of well-being. In Italy immigrants can have different access to health care services, and can opt for the national Health Service (nHS and/ or private non- profit health care organizations. The purpose of this study was to develop an instrument to evaluate oral health in the immigrant population of rome and to investigate the differences between two different types of ser- vices: the First observation unit at the department of oral and Maxillo Facial Sciences, at the "Sapienza" university of rome (a nHS affiliate, and a charitable organization, the caritas dental center (cdc.
Methods: a multiple-choice questionnaire was administered between the last trimester of 2006 and the first trimester of 2007. a chi square analysis was performed and the level of significance was set at p<0.05. reSulTS: The sample was composed of 250 people, of which 100 were patients of the cdc and 150 were patients of the nHS. The percentage of non-Italians was 80% (n=80 in the cdc sample, and only 16% (n=25 in the nHS sample. In the cdc, definitive resolving therapies, such as tooth extractions, prevailed (60% v’s 47% nHS; p=0.033. In addition, the frequency of consumption of sugary foods and drinks was significantly higher among cdc patients (31% reported to consume these over 9 times a day compared to nHS patients (11% reporting this consumption.
Discussion: the study shows a substantial under using of the national Health Service for oral health care needs by the immigrant population. The particular composition of the sample, with a high prevalence being of romanian nationality, might reflect specific conditions of this nationality. The results showed that immigrants were satisfied with the health care even though they encountered difficulties in terms of level of communication.

Laboratory services series: the utilization of scientific glassblowing in a national research and development laboratory

International Nuclear Information System (INIS)

Farnham, R.M.; Poole, R.W.

1976-04-01

Glassblowing services at a national research and development laboratory provide unique equipment tailored for specific research efforts, small-scale process items for flowsheet demonstrations, and solutions for unusual technical problems such as glass-ceramic unions. Facilities, equipment, and personnel necessary for such services are described

Facilitating a teleconference-delivered fatigue management program: perspectives of occupational therapists.

Science.gov (United States)

Dunleavy, Leah; Preissner, Katharine L; Finlayson, Marcia L

2013-12-01

Telehealth refers to the provision of health information and services across a geographical distance. Little is known about the experiences of occupational therapists using this method of service delivery. The study explored the process of facilitating a telehealth intervention from the perspective of occupational therapists. Occupational therapists completed SOAP (Subjective, Objective, Assessment, and Plan) notes after facilitating group-based, teleconference-delivered fatigue management groups to people with multiple sclerosis. Notes were also documented after therapist team meetings. All SOAP notes and field notes were subjected to thematic analysis. Five major themes were identified. "Managing time" was the central theme and was facilitated by professional foundation and challenged by logistics. Managing time contributed to challenging work, which led to the realization that it can work! Based on study findings, the theory and research on clinical reasoning, professional development, and adult learning are relevant to developing curricula that prepare occupational therapists for using telehealth approaches in practice.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

LENUS (Irish Health Repository)

Fennelly, Orna

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

Logistics of national radioimmunoassay services and radioimmunoassay trouble shooting in developing countries

International Nuclear Information System (INIS)

Hazra, D.K.; Shukla, A.K.; Arvind, B.; Khandelwal, S.; Singh, R.; Lahiri, V.L.

1986-01-01

The logistics of national radioimmunoassay services are analysed in regard to: applications of immunoassays in developing countries; provision of matched reagents; collection, storage and transport of patient samples, particularly from rural areas; development of robust new immunoassay systems, especially those using non-isotopic labels; quality control; and interrelation with international agencies and commercial suppliers. The effect of using different methods and temperatures of sample storage on representative glycoprotein, steroid, thyroid and communicable disease analytes is examined. The need for stratification of assay services (district, state and national/regional levels) for various tests is discussed in relation to their clinical urgency. A trouble shooting guide suited to developing countries has been written. Starting from various symptoms of assay failure, it describes the differential diagnosis of likely causes, lists appropriate tests to confirm the diagnosis and finally suggests remedial action to prevent future similar mishaps or to salvage the assay. (author)

Emergency recompression: clinical audit of service delivery at a national level.

Science.gov (United States)

Ross, John As; Sayer, Martin Dj

2009-03-01

Clinical audit is an essential element to the maintenance or improvement of delivery of any medical service. During the development phase of a National Recompression Registration Service for Scotland, clinical audit was initiated to provide a standardised tool to monitor the quality of outcome with respect to the severity of presentation. A functional audit process was an essential consideration for planned future measurement of treatment efficacy at local (single hyperbaric unit) and national (multiple hyperbaric units) scales. The audit process was designed to be undemanding, robust and informative, irrespective of the experience of treatment centre and of the clinician in charge of treatment. The clinical records from 104 cases of divers with decompression illness were used to derive and evaluate measures of severity and clinical outcome that could be used for audit and quality assurance. The various measures of disease severity were examined against clinical outcome and days spent in care after admission to a hyperbaric unit. An initial version of the clinical audit format that was developed from this process is presented.

[The Technology Acceptance Model and Its Application in a Telehealth Program for the Elderly With Chronic Illnesses].

Science.gov (United States)

Chang, Chi-Ping

2015-06-01

Many technology developments hold the potential to improve the quality of life of people and make life easier and more comfortable. New technologies have been well accepted by most people. Information sharing in particular is a major catalyst of change in our current technology-based society. Technology has widely innovated life and drastically changed lifestyles. The Technology Acceptance Model (TAM), a model developed to address the rapid advances in computer technology, is used to explain and predict user acceptance of new information technology. In the past, businesses have used the TAM as an assessment tool to predict user acceptance when introducing new technology products. They have also used external factors in the model to influence user perceptions and beliefs and to ensure the successful spread of new technologies. Informatization plays a critical role in healthcare services. Due to the rapid aging of populations and upward trends in the incidence of chronic illness, requirements for long-term care have increased in both quality and quantity. Therefore, there has been an increased emphasis on integrating healthcare and information technology. However, most elderly are significantly less adept at technology use than the general population. Therefore, we reexamined the effect that the essential concepts in a TAM exerted on technology acceptance. In the present study, the technology acceptance experience with regard to telehealth of the elderly was used as an example to explain how the revised technology acceptance model (TAM 2) may be effectively applied to enhance the understanding of technology care among nurses. The results may serve as a reference for future research on healthcare-technology use in long-term care or in elderly populations.

Environmental accounting of natural capital and ecosystem services for the US National Forest System

Science.gov (United States)

Elliot T. Campbell; Mark T. Brown; NO-VALUE

2012-01-01

The National Forests of the United States encompass 192.7 million acres (78 million hectares) of land, which is nearly five percent of the total land area of the nation. These lands are managed by the US Forest Service (USFS) for multiple uses, including extraction of timber, production of fossil fuels and minerals, public recreation, and the preservation of...

Implementing SLMTA in the Kenya National Blood Transfusion Service: lessons learned

Directory of Open Access Journals (Sweden)

Eric N. Wakaria

2017-04-01

Full Text Available Background: The Kenya National Blood Transfusion Service (KNBTS is mandated to provide safe and sufficient blood and blood components for the country. In 2013, the KNBTS National Testing Laboratory and the six regional blood transfusion centres were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA programme. The process was supported by Global Communities with funding from the United States Centers for Disease Control and Prevention. Methods: The SLMTA implementation at KNBTS followed the standard three-workshop series, on-site mentorships and audits. Baseline, midterm and exit audits were conducted at the seven facilities, using a standard checklist to measure progress. Given that SLMTA was designed for clinical and public health laboratories, key stakeholders, guided by Global Communities, tailored SLMTA materials to address blood transfusion services, and oriented trainers, auditors and mentors on the same. Results: The seven facilities moved from an average of zero stars at baseline to an average of three stars at the exit audit. The average baseline audit score was 38% (97 points, midterm 71% (183 points and exit audit 79% (205 points. The Occurrence Management and Process Improvement quality system essential had the largest improvement (at 67 percentage points, from baseline to exit, whereas Facilities and Safety had the smallest improvement (at 31 percentage points. Conclusion: SLMTA can be an effective tool for preparing a blood transfusion service for accreditation. Key success factors included customising SLMTA to blood transfusion activities; sensitising trainers, mentors and auditors on operations of blood transfusion service; creating SLMTA champions in key departments; and integrating other blood transfusion-specific accreditation standards into SLMTA.

77 FR 58868 - Teleconference for the National Park Service Alaska Region's Subsistence Resource Commission Program

Science.gov (United States)

2012-09-24

... Wildlife Updates 8. NPS Staff Reports 9. New Business 10. Public and other Agency Comments 11. Select Time... Subsistence Collections Environmental Assessment Update b. SRC Letters 10. New Business a. Susitna-Watana...: National Park Service, Interior. ACTION: Notice of open public meetings. SUMMARY: The Lake Clark National...

75 FR 63516 - Institute of Museum and Library Services; Sunshine Act Meeting of the National Museum and Library...

Science.gov (United States)

2010-10-15

...: Elizabeth Lyons, Director of Special Events and Board Liaison, Institute of Museum and Library Services... and Library Services, related to museum and library services. If you need special accommodations due... NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES Institute of Museum and Library Services...

Preliminary results of a national quality audit programme in radiotherapy services in Cuba

International Nuclear Information System (INIS)

Dominguez Hung, L.; Larrinaga Cortina, E.F.; Campa Menendez, R.; Morales Lopez, J.L.; Garcia Yip, A.F.

2001-01-01

The current state of radiotherapy in Cuba has allowed to pass to a superior stage in the process of quality assurance, the establishment of a National Quality Audit Program (PNAC). The National Control Center for Medical Devices, as national regulator entity for the control and supervision of the medical devices of the National Health System, is responsible for the implementation of this program. This paper presents the preliminary results of the execution of the PNAC in teletherapy services with isotopic units of 60 Co. The audits were carried out according to the methodology settled down in the normalized procedure of operation of the PNAC. The physical aspects related with the treatment were audited, such as: the installation and unit's safety, mechanical and dosimetric aspects of the treatment unit and organizational aspects of the institution quality assurance program. Also carried out, in the clinical aspect, verifications of cases type planned by the qualified personnel of the service. The results corresponding to the determination of the reference dose for each institution were compared with those obtained in a postal audit with the International Atomic Energy Agency. These first audits allowed to evaluate the performance of the institutions' program of quality assurance and a feedback for the setting about to the PNAC. (author)