| 1. |
- Biagio, Leigh, et al.
(author)
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Video-otoscopy recordings for diagnosis of childhood ear disease using telehealth at primary health care level
- 2014
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In: Journal of Telemedicine and Telecare. - 1357-633X .- 1758-1109. ; 20:6, s. 300-306
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Journal article (peer-reviewed)abstract
- We studied the diagnoses made by an otologist and general practitioner (GP) from video-otoscopy recordings on children made by a telehealth facilitator. The gold standard was otomicroscopy by an experienced otologist. A total of 140 children (mean age 6.4 years; 44% female) were recruited from a primary health care clinic. Otomicroscopic examination was performed by an otologist. Video-otoscopy recordings were assigned random numbers and stored on a server. Four and eight weeks later, an otologist and a GP independently graded and made a diagnosis from each video recording. The otologist rated the quality of the video-otoscopy recordings as acceptable or better in 87% of cases. A diagnosis could not be made from the video-otoscopy recordings in 18% of ears in which successful onsite otomicroscopy was conducted. There was substantial agreement between diagnoses made from video-otoscopy recordings and those from onsite otomicroscopy (first review: otologist κ = 0.70 and GP κ = 0.68; second review: otologist κ = 0.74 and GP κ = 0.75). There was also substantial inter-rater agreement (κ = 0.74 and 0.74 at the two reviews) and intra-rater agreement (κ = 0.77 and 0.74 for otologist and GP, respectively). A telehealth facilitator, with limited training, can acquire video-otoscopy recordings in children for asynchronous diagnosis. Remote diagnosis was similar to face-to-face diagnosis in inter- and intra-rater variability.
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| 2. |
- Blusi, Madeleine, et al.
(author)
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The benefits of e-health support for older family caregivers in rural areas
- 2014
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In: Journal of Telemedicine and Telecare. - 1357-633X .- 1758-1109. ; 20:2, s. 63-69
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Journal article (peer-reviewed)abstract
- We conducted a pragmatic, mixed methods study comparing rural family caregivers receiving e-health caregiver support (n = 35) with a control group (n = 21) receiving conventional, non-e-health, caregiver support. After 18 months, the benefits of support were evaluated using the Care Effectiveness Scale (40-items exploring the domains of preparedness, enrichment and predictability). In all domains the e-health group scored significantly higher than the control group. The adjusted difference for overall benefits was 3.0 (P = 0.02) on the scale 0-10. In addition, semi structured interviews were conducted with a sub-sample of the caregivers. For the e-health group flexibility, availability and being able to individualise the support were essential factors. All caregivers in the control group found conventional support to be beneficial, but also stressed unmet needs related to the conventional support being standardised and non-flexible. The study suggests that providers of caregiver support should offer e-health support as an alternative to conventional caregiver support, as it can be more beneficial to family caregivers.
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| 3. |
- Boman, Kurt, et al.
(author)
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A pilot test of a new tool for remote blood pressure monitoring
- 2014
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In: Journal of Telemedicine and Telecare. - 1357-633X .- 1758-1109. ; 20:5, s. 239-241
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Journal article (peer-reviewed)abstract
- We conducted a pilot trial of a remote blood pressure (BP) monitoring system, in which subjects measured their own BP at a primary healthcare centre. The data were wirelessly transmitted to the general practitioner. A total of 132 subjects with a new or prior diagnosis of hypertension were enrolled. Their mean age was 61 years and 77 were men (58%). They were followed for an average of 487 days (range 19-1110). The median number of BP measurements made was 6 per patient (range 2-49). The mean blood pressure decreased from 137/85 to 132/78 mmHg (P < 0.001) and the percentage of subjects with adequately controlled BP (defined as < 140/90 mmHg) increased from 47 to 66% (P < 0.01). Randomised trials are now required to confirm these findings.
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| 4. |
- Boman, Kurt, et al.
(author)
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Telemedicine improves the monitoring process in anticoagulant treatment
- 2012
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In: Journal of Telemedicine and Telecare. - : Royal Society of Medicine Press. - 1357-633X .- 1758-1109. ; 18:6, s. 312-316
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Journal article (peer-reviewed)abstract
- We compared the INR (International Normalized Ratio) monitoring process using a telemedicine device with the conventional approach in which blood samples were sent to the hospital for analysis. We conducted a randomized controlled trial. We enrolled 40 patients on chronic warfarin therapy from two primary healthcare centres (PHCs). Half were monitored using the telemedicine device and half were monitored conventionally. Each patient received three INR measurements. The total processing time was measured from blood sampling until warfarin dosing was performed in the anticoagulant clinic. The median total processing time was significantly shorter with telemedicine than usual care (34 vs. 260 min, P andlt; 0.001). This was mainly because sample transport was avoided using the point-of-care device and automatic data transmission. Telemedicine reduced the total processing time for INR monitoring and has the potential to improve the management of patients undergoing anticoagulant treatment at PHCs.
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| 5. |
- Börve, Alexander, et al.
(author)
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Use of the mobile phone multimedia messaging service for teledermatology
- 2012
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In: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 18:5, s. 292-296
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Journal article (peer-reviewed)abstract
- We examined the feasibility of using mobile phone Multimedia Messaging Service (MMS) to send teledermatology referrals from a general practitioner to a dermatologist. Digital photographs of skin conditions in 40 consecutive patients were sent together with relevant clinical information to dermatologists at a university hospital. Two dermatologists separately assessed the MMS referrals. The suspected diagnosis, triage and management decisions were compared to those given after separate face-to-face (FTF) visits, and again after agreeing on a final clinical and/or histopathological diagnosis. Thirty-two patients (80%) were diagnosed with skin tumours and 8 patients (20%) with other skin conditions. Both dermatologists were able to make a correct diagnosis in 31 patients (78%) based solely on the MMS referral. They also provided adequate management recommendations for 98% of the patients. Adequate triage decisions after assessment of the MMS referrals were made for 34 (85%) and 38 (95%) patients by the two dermatologists. There was an inter-observer concordance of 68% for the teledermatology diagnosis, compared to 88% concordance after the separate FTF visits. The diagnostic accuracy and adequacy of the triage and management decisions achieved using MMS referrals were similar to those obtained with other store-and-forward teledermatology methods.
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| 6. |
- Davidson, Thomas, et al.
(author)
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Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study
- 2015
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In: Journal of Telemedicine and Telecare. - : SAGE Publications (UK and US). - 1357-633X .- 1758-1109. ; 21:5, s. 298-301
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Journal article (peer-reviewed)abstract
- The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.
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| 7. |
- Engström, Maria, et al.
(author)
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Relatives’ opinions of IT support, perceptions of irritations and life satisfaction in dementia care
- 2006
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In: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 12:5, s. 246-250
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Journal article (peer-reviewed)abstract
- We studied relatives' opinions of IT support at a residential home for persons with dementia. We also investigated the relatives' perceptions of irritations and life satisfaction before and after increased IT support. This was accomplished using an experimental group (n = 14) and a control group (n = 8) of subjects in dementia care. The design was quasi-experimental with baseline assessments and three follow-ups. Data were collected using two questionnaires measuring opinions of the IT support: irritations in care (the Nursing Home Hassles Scale) and life satisfaction (the Life Satisfaction Questionnaire). Results showed that relatives' opinions of IT support were generally positive. In the experimental group, relatives' perceptions of practical/logistical irritations decreased between baseline and 12-month follow-up. In the control group, there was an increase in the total Nursing Home Hassles score between baseline and three-month follow-up. This difference did not persist at seven- and 12-month follow-ups. No significant differences were found for life satisfaction. We conclude that relatives had positive opinions of IT support, and their perceptions of practical/logistical irritations decreased after implementation of the IT support package.
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| 8. |
- Engström, Maria, et al.
(author)
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Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care
- 2005
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In: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 11:6, s. 304-309
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Journal article (peer-reviewed)abstract
- We measured staff members' satisfaction with their work beforeand after increased information technology (IT) support in dementiacare. Comparisons were also performed of perceived life satisfactionand sense of coherence. Data were collected before, and 6 and12 months after implementation of the first part of an IT supportproject. Instruments used were the Satisfaction with Work Questionnaires,the Life Satisfaction Questionnaire (LSQ) and the Sense of Coherence(SOC) scale. The study was performed in a residential home forpersons with dementia. The participants were 33 staff members.The IT technology included general and individualized passagealarms, sensor-activated night-time illumination, fall detectorsand Internet communication. Results showed that staff members'job satisfaction and perceived quality of care improved in comparisonwith the control group. Personal development, workload, expectationsand demands, internal motivation and documentation, as wellas the total scores for 'psychosocial aspects of job satisfaction'and 'quality of care aspects', increased in the experimentalgroup. There were significant interaction effects for the factorsfamily relation, close friend relation (LSQ), the total SOCscale and the meaningfulness subscale. The study showed thatIT support in dementia care increased staff members' satisfactionwith their work in several ways.
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| 9. |
- Eriksson, Lisbeth, et al.
(author)
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Patients' experiences of telerehabilitation at home after shoulder joint replacement
- 2011
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In: Journal of Telemedicine and Telecare. - : Sage Publications. - 1357-633X .- 1758-1109. ; 17:1, s. 25-30
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Journal article (peer-reviewed)abstract
- We investigated the experience of ten patients who received video-based physiotherapy at home for two months after a shoulder joint replacement. Videoconferencing took place via the patient's home broadband connection at a bandwidth of 256–768 kbit/s. Qualitative interviews were carried out, transcribed and analysed. Through qualitative content analysis six categories were identified: (1) a different reinforced communication; (2) pain-free exercising as an effective routine; (3) from a dependent patient to a strengthened person at home; (4) closeness at a distance; (5) facilitated daily living; and (6) continuous physiotherapy chain. The access to bodily knowledge, continuity, collaboration and being at home were all aspects that contributed to the patients' recovery. The patients described experiences of safety, and strengthening during their daily exercise routine at home. The frequent interplay with the patient during telerehabilitation made it possible for the physiotherapist to make an individual judgement about each patient; this could be one reason for the positive findings. Home video-based physiotherapy may be useful in other kinds of physiotherapy
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| 10. |
- Eriksson, Lisbeth, et al.
(author)
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Physiotherapy at a distance : a controlled study of rehabilitation at home after a shoulder joint operation
- 2009
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In: Journal of Telemedicine and Telecare. - : Sage Publications. - 1357-633X .- 1758-1109. ; 15:5, s. 215-220
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Journal article (peer-reviewed)abstract
- We explored the benefit of video communication in home rehabilitation after shoulder joint replacement and compared it to referral for physiotherapy in the conventional way. A total of 22 patients were included in the study. The intervention group (n = 10) had training at home under the supervision of a physiotherapist at the hospital using videoconferencing. The control group (n = 12) had physiotherapy training in a conventional way in their home town. All patients had the same postoperative, three-phase-programme for two months. The outcome measures were a Visual Analogue Scale (VAS) for pain, range of motion (ROM), shoulder function ability (Constant score and SRQ-S) and health-related quality of life (SF-36). Questions about areas of priority for improvement and general satisfaction with the shoulder were also included. The telemedicine group received a greater number of treatments compared to the control group. After the intervention, there were significant improvements in VAS-pain, Constant score and SRQ-S for both groups. The telemedicine group improved significantly more in all three measurements than the control group (P < 0.001 for all). When changes from baseline to follow-up were compared, the telemedicine group improved significantly more in terms of decrease in pain (P = 0.004) and vitality (P = 0.001) than the control group. Despite some limitations, there seem to be clear benefits from physiotherapy at a distance with a telemedicine technique that allows patients to obtain access to physiotherapy at home.
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