Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 71
Filtrar
Más filtros

Tipo del documento
Intervalo de año de publicación
1.
Haemophilia ; 30(4): 1025-1031, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38825768

RESUMEN

INTRODUCTION/AIM: To evaluate whether patients with haemophilia (PwH) can be enabled to perform ultrasonography (US) of their knees without supervision according to the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) protocol and whether they would be able to recognize pathologies. METHODS: Five PwH (mean age 29.6 years, range 20-48 years) were taught the use of a portable US device and the HEAD-US protocol. Subsequently, the patients performed US unsupervised at home three times a week for a total of 6 weeks with a reteaching after 2 weeks. All images were checked for mapping of the landmarks defined in the HEAD-US protocol by a radiologist. In a final test after the completion of the self-sonography period, participants were asked to identify scanning plane and potential pathology from US images of other PwH. RESULTS: On the images of the self-performed scans, 82.7% of the possible anatomic landmarks could be identified and 67.5% of the requested images were unobjectionable, depicting 100% of the required landmarks. There was a highly significant improvement in image quality following reteaching after 2 weeks (74.80 ± 36.88% vs. 88.31 ± 19.87%, p < .001). In the final test, the participants identified the right scanning plane in 85.0% and they correctly identified pathology in 90.0% of images. CONCLUSION: Appropriately trained PwH can perform the HEAD-US protocol of their knee with high quality and are capable to identify pathologic findings on these standardized images. Asynchronous tele-sonography could enable early therapy adjustment and thereby possibly reduce costs.


Asunto(s)
Estudios de Factibilidad , Hemofilia A , Ultrasonografía , Humanos , Hemofilia A/complicaciones , Hemofilia A/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Persona de Mediana Edad , Masculino , Adulto Joven , Articulación de la Rodilla/diagnóstico por imagen , Rodilla/diagnóstico por imagen
2.
Int J Audiol ; : 1-11, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38696614

RESUMEN

OBJECTIVES: To develop and evaluate Cochlear™ Remote Assist (RA), a smartphone-based cochlear implant (CI) teleaudiology solution. The development phase aimed to identify the minimum features needed to remotely address most issues typically experienced by CI recipients. The clinical evaluation phase assessed ease of use, call clarity, system latency, and CI recipient feedback. DESIGN: The development phase involved mixed methods research with experienced CI clinicians. The clinical evaluation phase involved a prospective single-site clinical study and real-world use across 16 clinics. STUDY SAMPLE: CI clinicians (N = 23), CI recipients in a clinical study (N = 15 adults) and real-world data (N = 57 CI recipients). RESULTS: The minimum feature set required for remote programming in RA, combined with sending replacements by post, should enable the clinician to address 80% of the issues typically seen in CI follow-up sessions. Most recipients completed the RA primary tasks without prior training and gave positive ratings for usefulness, ease of use, effectiveness, reliability, and satisfaction on the Telehealth Usability Questionnaire. System latency was reported to be acceptable. CONCLUSION: RA is designed to help clinicians address a significant proportion of issues typically encountered by CI recipients. Clinical study and real-world evaluation confirm RA's ease of use, call quality, and responsiveness.

3.
Int J Qual Health Care ; 35(3)2023 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-37405853

RESUMEN

Patient safety is a major concern in medicine. Approximately, 4 million infants die each year worldwide and 23% of these deaths are caused by perinatal asphyxia. To prevent the long-term damage of asphyxia, the resuscitation flowchart must be perfectly and promptly performed. However, high effectiveness in performing resuscitation can only be achieved and maintained if the algorithm is frequently executed. Therefore, maintaining a high level of patient care is difficult in some remote centres. The aim of this study was to evaluate the effectiveness of a new organizational model of care-network between Hub & Spoke hospitals to improve both the safety of the newborns in hospitals with a low number of births and the well-being of operators. Our project, NEO-SAFE (NEOnatal SAFety and training Elba), began in 2017 and involved the neonatal intensive care unit and the NINA Center of the Pisa University Hospital (hub) and the Hospital of Elba Island (spoke). It consisted of a continuous training program, both with 'classic' training course and 'on-job tutoring' (on side and remotely), of the health workers at spoke (i.e. nurses, midwives, and paediatricians). All four milestones of the study design were achieved. During the project, NINA Center instructors organized training courses for the staff in Portoferraio. These courses were based on learning technical and non-technical skills in a training course of increasing difficulty. Staff training needs were also monitored during the project by means of periodic questionnaires, sentinel events, and specific requests. The curve described by the rate of newborns transfer to the Pisa neonatal intensive care unit (hub) shows a monotonous decreasing trend line. On the other hand, this project allowed operators to develop greater self-confidence and greater safety in managing emergency situations, reducing stress for them and improving patient safety. The project allowed the creation of a safe, effective, low-cost, and reproducible organizational model for centres with a low number of births. Moreover, the tele-medicine approach is an important improvement in the assistance and is a window on the future.


Asunto(s)
Asfixia , Partería , Femenino , Embarazo , Humanos , Recién Nacido , Personal de Salud/educación , Hospitales , Partería/educación , Atención a la Salud
4.
J Med Syst ; 47(1): 123, 2023 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-37987870

RESUMEN

BACKGROUND: Paediatric emergencies are challenging for healthcare workers, first aiders, and parents waiting for emergency medical services to arrive. With the expected rise of virtual assistants, people will likely seek help from such digital AI tools, especially in regions lacking emergency medical services. Large Language Models like ChatGPT proved effective in providing health-related information and are competent in medical exams but are questioned regarding patient safety. Currently, there is no information on ChatGPT's performance in supporting parents in paediatric emergencies requiring help from emergency medical services. This study aimed to test 20 paediatric and two basic life support case vignettes for ChatGPT and GPT-4 performance and safety in children. METHODS: We provided the cases three times each to two models, ChatGPT and GPT-4, and assessed the diagnostic accuracy, emergency call advice, and the validity of advice given to parents. RESULTS: Both models recognized the emergency in the cases, except for septic shock and pulmonary embolism, and identified the correct diagnosis in 94%. However, ChatGPT/GPT-4 reliably advised to call emergency services only in 12 of 22 cases (54%), gave correct first aid instructions in 9 cases (45%) and incorrectly advised advanced life support techniques to parents in 3 of 22 cases (13.6%). CONCLUSION: Considering these results of the recent ChatGPT versions, the validity, reliability and thus safety of ChatGPT/GPT-4 as an emergency support tool is questionable. However, whether humans would perform better in the same situation is uncertain. Moreover, other studies have shown that human emergency call operators are also inaccurate, partly with worse performance than ChatGPT/GPT-4 in our study. However, one of the main limitations of the study is that we used prototypical cases, and the management may differ from urban to rural areas and between different countries, indicating the need for further evaluation of the context sensitivity and adaptability of the model. Nevertheless, ChatGPT and the new versions under development may be promising tools for assisting lay first responders, operators, and professionals in diagnosing a paediatric emergency. TRIAL REGISTRATION: Not applicable.


Asunto(s)
Urgencias Médicas , Servicios Médicos de Urgencia , Humanos , Niño , Reproducibilidad de los Resultados , Personal de Salud , Lenguaje
5.
Epilepsy Behav ; 128: 108569, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35104733

RESUMEN

BACKGROUND: Effectiveness of different tele-medicine strategies varies in different medical conditions. Use of basic tele-medicine strategy like mobile health (m-health) can be an effective option in different medical conditions in a resource-poor setting. AIMS: To study effectiveness and satisfaction of tele-medicine among persons with epilepsy (PWE) in a developing nation during COVID-19 pandemic. METHODS: Persons with epilepsy aged 18 years or more who have attended epilepsy clinic at least once physically and were asked for regular follow-up were included. A cross-sectional telephonic survey was conducted to assess effectiveness of tele-medicine over past 1 year. Satisfaction was assessed by tele-medicine satisfaction questionnaire. RESULT: 31.9% of PWE have used tele-medicine facility in last 1 year and 58.2% were unaware of the availability of such a facility. Among those who utilized tele-medicine, 95.3% were able to explain their concerns satisfactorily during tele-consultation and change in prescription was done in 42.8%. None experienced any new adverse event. Overall, more than 95% were satisfied with tele-consultation and more than 80% wanted to use it again. CONCLUSION: Even basic tele-medicine strategies can be a very effective and satisfactory mode of follow-up for PWE in resource-poor settings. Steps should be undertaken to make people aware of the availability of such a facility.


Asunto(s)
COVID-19 , Epilepsia , Telemedicina , Adolescente , Estudios Transversales , Epilepsia/epidemiología , Epilepsia/terapia , Estudios de Seguimiento , Humanos , Pandemias , Satisfacción Personal , SARS-CoV-2
6.
Sensors (Basel) ; 22(9)2022 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-35590854

RESUMEN

The COVID-19 pandemic accelerated the assimilation of telemedicine platforms into medical practice. Nevertheless, research-based evidence in this field is still accumulating. This was a prospective, cross-sectional comparative assessment of a remote physical examination device used mainly for heart and lung digital auscultation. We analyzed usage patterns, user (physician) subjective appreciation and compared it to legacy measures. Eighteen physicians (median age 36 years (IQR 32-45): two interns, seven residents and nine senior physicians; eleven internists, five geriatricians and two pediatricians) executed over 250 remote physical examinations. Their median work duration with quarantined patients was 60 days (IQR 45-60). The median number of patients examined by a single physician was 17 (IQR 10-34). Regarding overall estimation, all participants tended to prefer the remote examination in the setting of quarantined patients (median 6, IQR 3.75-8), while no statistically significant difference was demonstrated compared to the indifference value (p = 0.122). Internists preferred tele-medical examination over non-internists, with significant differences between groups regarding heart auscultation, (median 7, (IQR 3-7) vs. median 2, (IQR 1-5, respectively)), p = 0.044. In the setting of quarantined patients, from the physicians' perspective, a digital platform for remote auscultation of heart and lungs was considered as an acceptable alternative to legacy measures.


Asunto(s)
COVID-19 , Adulto , Auscultación , COVID-19/diagnóstico , Estudios Transversales , Humanos , Pulmón , Pandemias
7.
Curr Rheumatol Rep ; 23(1): 5, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33403528

RESUMEN

PURPOSE OF REVIEW: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) emerged in December 2019, rapidly reaching global pandemic proportions. Coronavirus disease 2019 (COVID-19) has presented unique challenges to the rheumatology community. It is known that many individuals with rheumatic disease are at increased risk of severe disease from other infections, sparking a similar fear for COVID-19. In addition, medications routinely used in rheumatology practice are being trialled as treatments, with the potential for drug shortages for rheumatology patients. RECENT FINDINGS: Underlying comorbidities and active disease are associated with worse COVID-19 outcomes in patients with rheumatic disease. Tocilizumab and hydroxychloroquine have not proven to be effective treatments in the management of COVID-19. Telehealth has become an essential tool for the rheumatology community to monitor patients during the pandemic. In this article, we summarise the available COVID-19 evidence that is of relevance to the rheumatology community. We discuss the risk of contracting COVID-19 in individuals with rheumatic disease, along with presenting features and clinical outcomes. We provide an overview of the treatments for COVID-19 which have significance for rheumatology. We highlight published recommendations which can guide our management of rheumatic disease populations during this pandemic. Finally, we discuss the challenges in delivering effective care virtually and present methods and tools which could be adapted for use.


Asunto(s)
COVID-19/complicaciones , COVID-19/terapia , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/terapia , Reumatología , Antirreumáticos/uso terapéutico , Humanos , Telemedicina
8.
Clin Gastroenterol Hepatol ; 18(8): 1822-1830.e4, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-31887445

RESUMEN

BACKGROUND & AIMS: Liver transplantation is the only treatment that increases survival times of patients with decompensated cirrhosis. Patients who live farther away from a transplant center are disadvantaged. Health care delivery via telehealth is an effective way to manage patients with decompensated cirrhosis remotely. We investigated the effects of telehealth on the liver transplant evaluation process. METHODS: We performed a retrospective study of 465 patients who underwent evaluation for liver transplantation at the Richmond Veterans Affairs Medical Center from 2005 through 2017. Of these, 232 patients were evaluated via telehealth, and 233 via in-person evaluation. Using regression models, we evaluated the differential effects of telehealth vs usual care on placement on the liver transplant waitlist. We also investigated the effects of telehealth on time from referral to initial evaluation by a transplant hepatologist, liver transplantation, and mortality. RESULTS: Patients in the telehealth group were evaluated significantly faster than patients evaluated in person, without or with adjustment for potential confounders (21.7 vs 79.5 d; P < .01). Telehealth also was associated with a significantly shorter time on the liver transplant waitlist (138.8 vs 249 d; P < .01). After propensity-matched analysis, telehealth was associated with a reduction in the time from referral to evaluation (hazard ratio, 0.15; 95% CI, 0.09-0.21; P < .01) and listing (hazard ratio, 0.26; 95% CI, 0.12-0.40; P < .01), but not to transplantation. In the intent-to-treat analysis of all referred patients, we found no significant difference in pretransplant mortality between patients evaluated via telehealth vs in-person. There was statistically significant interaction between model for end-stage liver disease (MELD)-Na scores and time to evaluation (P = .009) and placement on the transplant waitlist (P = .002), with telehealth offering greater benefits to patients with low MELD-Na scores. CONCLUSIONS: Use of telehealth is associated with a substantial reduction in time from referral to initial evaluation by a hepatologist and placement on the liver transplant waitlist, especially for patients with low MELD scores, with no changes in time to transplantation or pretransplant mortality. More studies are needed, particularly outside of the Veterans Administration Health System, to confirm that telehealth is a safe and effective way to expand access for patients undergoing evaluation for liver transplantation.


Asunto(s)
Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Telemedicina , Humanos , Derivación y Consulta , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Listas de Espera
9.
Neurol Sci ; 41(6): 1369-1371, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32440979

RESUMEN

BACKGROUND: As a consequence of the coronavirus disease 2019 (COVID-19) pandemic, a large amount of consultations will be delivered through tele-medicine, especially for diseases causing chronic disability and requiring immunomodulatory treatments, such as multiple sclerosis (MS). METHODS: We have hereby reviewed available tools for tele-neurology examination in MS, including components of neurological examination that can be assessed through video, patient-reported outcome measures (PROMs), and digital technology. RESULTS: Overall, we have suggested a battery for assessing MS disability and relapses on tele-medicine, which brings together conventional examination, PROMs (e.g., Patient Determined Disease Steps, MS Impact Scale), and cognitive tests (Symbol Digit Modalities Test) that can be delivered remotely and in multiple languages. DISCUSSION: The use of common tools for neurological examination could improve tele-neurology practice for both general neurologists and MS specialists, and quality of care for people with MS.


Asunto(s)
Evaluación de la Discapacidad , Esclerosis Múltiple Recurrente-Remitente/epidemiología , Esclerosis Múltiple Recurrente-Remitente/terapia , Neurología/métodos , Telemedicina/métodos , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Humanos , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/terapia , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Neurología/tendencias , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , SARS-CoV-2 , Telemedicina/tendencias
10.
Curr Diab Rep ; 19(9): 72, 2019 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-31367962

RESUMEN

PURPOSE OF REVIEW: This paper systematically reviews the recent progress in diabetic retinopathy screening. It provides an integrated overview of the current state of knowledge of emerging techniques using artificial intelligence integration in national screening programs around the world. Existing methodological approaches and research insights are evaluated. An understanding of existing gaps and future directions is created. RECENT FINDINGS: Over the past decades, artificial intelligence has emerged into the scientific consciousness with breakthroughs that are sparking increasing interest among computer science and medical communities. Specifically, machine learning and deep learning (a subtype of machine learning) applications of artificial intelligence are spreading into areas that previously were thought to be only the purview of humans, and a number of applications in ophthalmology field have been explored. Multiple studies all around the world have demonstrated that such systems can behave on par with clinical experts with robust diagnostic performance in diabetic retinopathy diagnosis. However, only few tools have been evaluated in clinical prospective studies. Given the rapid and impressive progress of artificial intelligence technologies, the implementation of deep learning systems into routinely practiced diabetic retinopathy screening could represent a cost-effective alternative to help reduce the incidence of preventable blindness around the world.


Asunto(s)
Retinopatía Diabética/diagnóstico , Tamizaje Masivo/métodos , Inteligencia Artificial , Salud Global , Humanos , Aprendizaje Automático , Oftalmología/métodos , Oftalmología/tendencias
11.
BMC Public Health ; 19(1): 562, 2019 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-31088411

RESUMEN

BACKGROUND: The prevalence of stroke in Uganda is increasing. In stroke rehabilitation, information and communication technology has been shown to have potential in improving service delivery in high-income countries but there is limited knowledge of its use and impact in low-income countries. The aim of the study was to evaluate the implementation process of a mobile phone-supported family-centred rehabilitation intervention and to gain knowledge on the mechanisms of impact as well as the contextual factors that might have affected the implementation process and its outcome. METHOD: This was a single-case study design using the integrated Promoting Action on Research Implementation in Health Services framework and the Medical Research Council guidance as frameworks. Quantitative process data was derived from 14 log books used by occupational therapists during the implementation. Qualitative semi-structured interviews were conducted with 12 implementers in different professions, 12 months into the implementation, in order to obtain the primary data. Secondary data was derived from six semi-structured interviews conducted directly after pre-intervention workshops and 6 months later. The framework method was used in the data analysis. RESULTS: In 11 out of 14 cases, the clients were compliant with the intervention. Yet, challenges such as technical problems were reported. The target of conducting 16 phone calls for each client was achieved to 74%. Eight categories emerged from the qualitative analysis of the interviews including: 1) perceptions on facilitation, 2) using scientific and experience-based knowledge, 3) tailoring the intervention, 4) supportive working culture, 5) barriers to the service delivery, 6) implementers' interaction with the intervention, 7) perceptions on motivations and values, and 8) improving the model and enabling sustainability. Mechanisms contributing to the implementation of the intervention included engaged facilitators and motivated participants. Challenges in the client recruitment and poor information dissemination were some of the mechanisms impeding the implementation. CONCLUSIONS: The intervention was partially delivered in accordance with the logic model for the project, where the implementation process was influenced by several barriers in the context such as technical setbacks. However, there were also several mediators in the process driving the project forward, including strong facilitation and motivated participants.


Asunto(s)
Implementación de Plan de Salud/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Evaluación de Procesos, Atención de Salud/estadística & datos numéricos , Rehabilitación de Accidente Cerebrovascular/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , Anciano , Teléfono Celular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Cooperación del Paciente/psicología , Investigación Cualitativa , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/métodos , Telemedicina/métodos , Uganda
12.
J Med Internet Res ; 21(3): e12143, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30821691

RESUMEN

BACKGROUND: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary. OBJECTIVE: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). METHODS: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements, and to wear the smartwatch daily. RESULTS: Up to July 2017, we enrolled 790 eFHS participants, representing 76% (790/1044) of potentially eligible FHS participants. eFHS participants were, on average, 53±8 years of age and 57% were women. A total of 85% (675/790) of eFHS participants completed all of the baseline survey and 59% (470/790) completed the 3-month survey. A total of 42% (241/573) and 76% (306/405) of eFHS participants adhered to weekly digital BP and heart rate (HR) uploads, respectively, over 12 weeks. CONCLUSIONS: We have designed an e-cohort focused on identifying novel cardiovascular disease risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable.


Asunto(s)
Teléfono Celular/normas , Electrónica/métodos , Estudios Longitudinales , Teléfono Inteligente/normas , Telemedicina/métodos , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
13.
Wiad Lek ; 72(12 cz 2): 2558-2562, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-32124785

RESUMEN

OBJECTIVE: Introduction: The right to health is one of the fundamental human rights. Due to the fact that older persons are requiring special treatment in medical care international law pays particular attention to the issue of securing their specified right. Nowadays new forms of health-care are being established, in particular, by using the latest technologies that facilitate access to healthcare services. However, there is a number of barriers related to the implementation of these rules. In view of this, the practical implementation of the international agreement's provisions in this field into national legal system is obviously important. The aim: of the article is to study the organizational and legal aspects of the provision of medical services to older persons through the use of information and communication technology; to create recommendations aimed at improving the health-care system with regard to older persons. PATIENTS AND METHODS: Materials and methods: The following research is based on the analysis of the international legal acts and scientific researches in this field. The methodological basis of the study is a set of general and special methods of scientific knowledge. CONCLUSION: Conclusions: Smart technologies are becoming an important tool in health-care system. The introduction of digital health solutions can increase the quality of life for older persons who may need medical care for aging. Important when using ICT is: keeping patients' confidential medical information; training of medical staff; ensuring transparent legal support at all stages of implementation. Given the fact that the problem of aging is a common problem for modern states of the world, it is important to share the latest developments in the field of healthcare.


Asunto(s)
Derecho a la Salud , Anciano , Anciano de 80 o más Años , Atención a la Salud , Derechos Humanos , Humanos , Derecho Internacional , Calidad de Vida
14.
Global Health ; 14(1): 82, 2018 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-30111333

RESUMEN

BACKGROUND: There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce™), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. METHODS: The study comprised a pre-post design with an intervention group (IG) receiving the F@ce™ and a control group (CG). The inclusion criteria's were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aim of the F@ceTM was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce™ was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants' home environment at baseline and after eight weeks. Data on acceptability of the F@ce™ and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. RESULTS: The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce™. Overall with minor modifications the intervention and the study design were feasible for all participants involved. CONCLUSION: The results support the need for further research to rigorously evaluate the effects of F@ce™ since the intervention appears to be feasible for persons with stroke and their family members.


Asunto(s)
Actividades Cotidianas/psicología , Teléfono Celular , Familia/psicología , Rehabilitación de Accidente Cerebrovascular/métodos , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoeficacia , Resultado del Tratamiento , Uganda
15.
Occup Med (Lond) ; 67(9): 718-721, 2017 12 30.
Artículo en Inglés | MEDLINE | ID: mdl-29155960

RESUMEN

Background: Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM). Aims: To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training. Methods: Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed. Results: 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers. Conclusions: The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners.


Asunto(s)
Medicina del Trabajo/métodos , Pautas de la Práctica en Medicina/tendencias , Derivación y Consulta/tendencias , Telemedicina/métodos , Adulto , Femenino , Humanos , Masculino , Enfermeras Practicantes/estadística & datos numéricos , Medicina del Trabajo/estadística & datos numéricos , Medicina del Trabajo/tendencias , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Investigación Cualitativa , Reproducibilidad de los Resultados , Especialización/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Estados Unidos , United States Department of Veterans Affairs/organización & administración , United States Department of Veterans Affairs/estadística & datos numéricos
16.
Australas Psychiatry ; 23(6 Suppl): 48-51, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26634671

RESUMEN

OBJECTIVE: The paper reports on the establishment of Papua New Guinea's first ever health call centre. METHOD: Details of the phone calls received during the first nine weeks of the call centre's operation are presented. RESULTS: The data on phone call rates and types indicate a slight increase in utilisation of the service over the initial period. A total of 113 health-related phone calls were received during the first nine weeks of the call centre's operation. Most of these calls were from the public, while a small number were from rural health workers. Prank calls and calls enquiring about the service were also received. During establishment, mental health was not considered and calls that may fall into this category have not been logged separately. CONCLUSIONS: Further analysis would need to be undertaken to determine the effectiveness of the health call centre model in the Papua New Guinea context. Scripts, protocols and analysis regarding mental health may need to be developed.


Asunto(s)
Líneas Directas/estadística & datos numéricos , Desarrollo de Programa , Femenino , Humanos , Masculino , Papúa Nueva Guinea
17.
Mult Scler Relat Disord ; 90: 105766, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39094448

RESUMEN

BACKGROUND: To investigate the reliability of balance tests administered using a tele-assessment method in patients with multiple sclerosis (MS). METHODS: The participants were assessed both online and face-to-face. The assessments were performed synchronously by two physiotherapists. The first method to used to evaluate the participants was determined through randomization. The Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Timed Up and Go (TUG) were used in the evaluations. Three days were left between the assessment methods. Online platforms were used for tele-assessment. The agreement between and correlation of face-to-face and tele-assessments was analyzed by applying intra-class correlation coefficients (ICC), limits of agreement, and Pearson's correlation coefficient. RESULTS: This study included 39 individuals with MS with an EDSS score of 3.03 ± 1.41. Intra-rater reliability of the tele-assessment was excellent (ICCBBS = 0.96; ICCDGI = 0.97; ICCTUG = 0.97). Very high correlations were observed in all BBS, DGI, and TUG measurements between face-to-face and tele-assessment methods according to the first and second assessors (rBBS1 = 0.92; rBBS2 = 0.93; rDGI1 = 0.94; rDGI2 = 0.95; rTUG1 = 0.94; rTUG2 = 0.95, respectively). The inter-rater reliability of tele-assessments (ICCBBS = 0.97; ICCDGI = 0.97; ICCTUG = 1.00) achieved excellent reliability. CONCLUSION: BBS, DGI, and TUG are reliable and agreed tests that can be used with tele-assessments, offering similar data to face-to-face methods.


Asunto(s)
Esclerosis Múltiple , Equilibrio Postural , Humanos , Equilibrio Postural/fisiología , Femenino , Masculino , Adulto , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/diagnóstico , Reproducibilidad de los Resultados , Persona de Mediana Edad , Telemedicina , Evaluación de la Discapacidad
18.
Digit Health ; 10: 20552076241228416, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38269369

RESUMEN

Background: Digital cognitive assessment is becoming increasingly widespread in ageing research and care, especially since the COVID-19 pandemic. Remote online collection provides opportunities for ageing and dementia professionals to collect larger datasets, increase the diversity of research participants and patients and offer cost-effective screening and monitoring methods for clinical practice and trials. However, the reliability of self-administered at-home tests compared to their lab-based counterparts often goes unexamined, compromising the validity of adopting such measures. Objective: Our aim is to validate a self-administered web-based version of the visual short-term memory binding task (VSTMBT), a potential digital biomarker sensitive to Alzheimer's disease processes, suitable for use on personal devices. Methods: A final cross-sectional sample of 37 older-adult (51-77 years) participants without dementia completed our novel self-administered version of the VSTMBT, both at home on a personal device and in the lab, under researcher-controlled conditions. Results: ANOVA and Bayesian t-test found no significant differences between the task when it was remotely self-administered by participants at home compared to when it was taken under controlled lab conditions. Conclusions: These results indicate the VSTMBT can provide reliable data when self-administered at-home using an online version of the task and on a personal device. This finding has important implications for remote screening and monitoring practices of older adults, as well as supporting clinical practices serving diverse patient communities. Future work will assess remote administration in older adults with cognitive impairment and diverse socio-economic and ethno-cultural backgrounds as well as a bench-to-bedside application.

19.
JMIR Form Res ; 8: e58503, 2024 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-38935428

RESUMEN

BACKGROUND: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. OBJECTIVE: In this study, we aimed to understand the experience of the telehealth SICP from the clinician's perspective. METHODS: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. RESULTS: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients' values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. CONCLUSIONS: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. TRIAL REGISTRATION: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676.

20.
Cureus ; 16(5): e59657, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38707751

RESUMEN

MediaPipe Hand (MediaPipe) is an artificial intelligence (AI)-based pose estimation library. In this study, MediaPipe was combined with four machine learning (ML) models to estimate the rotation angle of the thumb. Videos of the right hands of 15 healthy volunteers were recorded and processed into 9000 images. The rotation angle of the thumb (defined as angle θ from the palmar plane, which is defined as 0°) was measured using an angle measuring device, expressed in a radian system. Angle θ was then estimated by the ML model by using parameters calculated from the hand coordinates detected by MediaPipe. The linear regression model showed a root mean square error (RMSE) of 12.23, a mean absolute error (MAE) of 9.9, and a correlation coefficient of 0.91. The ElasticNet model showed an RMSE of 12.23, an MAE of 9.95, and a correlation coefficient of 0.91; the support vector machine (SVM) model showed an RMSE of 4.7, an MAE of 2.5, and a correlation coefficient of 0.99. The LightGBM model achieved high values: an RMSE of 4.58, an MAE of 2.62, and a correlation coefficient of 0.99. Based on these findings, we concluded that the thumb rotation angle can be estimated with high accuracy by combining MediaPipe and ML.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA