Video analysis tool system: implementation and evaluation of use with clinical nursing assessments of older adults.

The purpose of this project was to implement and evaluate the Video Analysis Tool (VAT) system, a tool for capturing and analyzing video evidence of students' clinical performance. Through the VAT system, nursing student dyads from 4 universities used a video camera, a computer, and a tripod in the residences of older adults to record interactions and psychosocial assessments of older adult clients. Using their recordings to compare their clinical activities with predefined clinical objectives derived from gerontological nursing standards, they made video clips of their assessments to demonstrate the required outcomes. Use of the VAT system received positive evaluations from students, faculty, and residents in multiple clinical sites. The process has significant implications for assessing clients and health care providers in their interactions in a variety of settings, including on home visits. It has additional applications for documenting performance measures of nurses and team members as they provide client care.

CSII and MDII for intensive diabetes management: impact perceptions of older adult patients and their significant others.

PURPOSE: To investigate impacts of multiple daily insulin injections (MDII) and continuous subcutaneous insulin infusion (CSII) on disease management and patient lifestyle by patients and significant others (SOs). HYPOTHESES: Older patients (>50 years) and their SOs will perceive differences in satisfaction between CSII and MDII impact on diabetes management and lifestyle. METHODS: Patient and paired SO completed parallel instruments framed by sociotechnical systems theory and the life patterns model. Alpha = .901-.940. RESULTS: Whites reported greater satisfaction with CSII and non-Whites with MDII. Both reported increased independence. CSII scored significantly higher than MDII. Age did not reduce positive impacts. CSII enhanced independence of SOs but 38.6% of SOs did not know how to suspend CSII for hypoglycemia; 47.3% of patients believed SOs would not know. CONCLUSIONS: Neither age nor diabetes type contraindicate using CSII in older patients. CSII is perceived more impactful on disease management and lifestyle. Education of SOs needs emphasis.

An analysis of business issues in a telestroke project.

A telehealth network based at the Medical College of Georgia was established in 2003 to treat stroke patients in remote hospitals. In the first three years, more than 400 patients were evaluated at nine rural hospitals. A total of 65 patients (16%) were treated with tissue plasminogen activator (approximately half of them in less than 2 h). Although clinically successful, the system reached the point at which it would either further diffuse or die out. We examined the roles played by internal and external factors in the development of the system. We interviewed 25 individuals in five hospitals (the hub hospital and four rural hospitals). Important business issues were identified that would need to be addressed in order to expand the project and make it self-sustaining. The external factors were economic, legal and market issues. The internal factors were organizational, technical and educational issues. Early identification and negotiation of business issues related to project implementation are likely to be important in diffusion and sustainability.

Assessment of Insulin Administration Methods: Perceptions by Patients and Significant Others Instrument Development.

BACKGROUND AND PURPOSE: To develop, test, and establish the validity and reliability of 4 instruments to evaluate perceptions of paired patients and patient-identified significant others to assess the impact of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDII) on diabetes management and lifestyle. METHODS: Sociotechnical systems theory and the life patterns model framed the study. Four parallel survey instruments (patient CSII and MDII and significant other CSII and MDII) were developed to elicit demographic information and perceptions concerning CSII and MDII. RESULTS: Validity and reliability were established. CONCLUSIONS: The instruments developed for this study could be adapted or used as templates in management approach impact studies of other chronic diseases. The study should be replicated with a different geographic sample.

Sustainable rural telehealth innovation: a public health case study.

OBJECTIVE: To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable. STUDY SETTING: Longitudinal, qualitative study (1988-2008) of the largest public health district in Georgia. STUDY DESIGN: Case study design provided deep insights into the innovation's social dynamics. Punctuated equilibrium theory helped present and make sense of the process. We identified antecedent conditions and outcomes, and we distinguished between episodes and encounters based on the disruptive effects of events. DATA COLLECTION: Twenty-five semistructured interviews with 19 decision makers and professionals, direct observations, published papers, grant proposals, technical specifications, and other written materials. PRINCIPAL FINDINGS: Strong collaboration within the district, with local community, and with external partners energized the process. Well-functioning outreach clinics made telehealth desirable. Local champions cultivated participation and generative capability, and overcame barriers through opportunistic exploitation of technological and financial options. Telehealth usage fluctuated between medical and administrative operations in response to internal needs and contextual dynamics. External agencies provided initial funding and supported later expansion. CONCLUSIONS: Extensive internal and external collaboration, and a combination of technology push and opportunistic exploitation, can enable sustainable rural telehealth innovation.

Delivering Diagnostic Quality Video over Mobile Wireless Networks for Telemedicine.

In real-time remote diagnosis of emergency medical events, mobility can be enabled by wireless video communications. However, clinical use of this potential advance will depend on definitive and compelling demonstrations of the reliability of diagnostic quality video. Because the medical domain has its own fidelity criteria, it is important to incorporate diagnostic video quality criteria into any video compression system design. To this end, we used flexible algorithms for region-of-interest (ROI) video compression and obtained feedback from medical experts to develop criteria for diagnostically lossless (DL) quality. The design of the system occurred in three steps-measurement of bit rate at which DL quality is achieved through evaluation of videos by medical experts, incorporation of that information into a flexible video encoder through the notion of encoder states, and an encoder state update option based on a built-in quality criterion. Medical experts then evaluated our system for the diagnostic quality of the video, allowing us to verify that it is possible to realize DL quality in the ROI at practical communication data transfer rates, enabling mobile medical assessment over bit-rate limited wireless channels. This work lays the scientific foundation for additional validation through prototyped technology, field testing, and clinical trials.

Counseling center-based tele-mental health for students at a rural university.

Students attending rural academic institutions often have no immediate access to psychiatrists to supplement on-site Counseling Center (CC) services. Because the Medical College of Georgia (MCG) could not cost-effectively provide on-site psychiatry services to Georgia Southern University (GSU) students, the two institutions explored telehealth services delivered by supervised Psychiatry residents using Web-based videoconferencing on MCGs virtual private network. GSU counselors completed client severity rating forms. CC clients in ongoing therapy who were judged to be in need of psychiatric services were referred to the Tele-clinic (TC). CC counselors referred the most challenged students to TC according to total distress score on intake, clinician intake assessment of client difficulty, and client need for medications. After seeing the clients in TC, MCG residents also completed GSU CC client severity rating forms. Post-intake and satisfaction surveys already in use at the GSU CC were completed both by CC clients not in TC and by CC clients jointly enrolled in TC. TC and CC populations were compared by gender, race, past mental health treatment, past psychiatric hospitalization, and past and current use of psychotropic drugs. Telepsychiatry conducted using low bandwidth videoconferencing successfully supplemented GSU CC mental healthcare, especially for clients with the most serious problems, and did so without travel from campus and within the milieu of daily student life. Cost-effective telepsychiatry services can successfully supplement management of students with mental health issues who attend rural, smaller, and/or resource-challenged academic institutions.