A Guide for Intentional Home Telehealth Assessment: Patient and Caregiver Perceptions.

Telehealth can provide expanded access to healthcare. The Comprehensive Patient Assessment for Using Telehealth at Home is a comprehensive approach for an intentional remote patient meeting that provides a high-quality patient encounter when using technology. In this study, we describe the perspectives of seriously ill older adults and their caregivers on the usability of the Comprehensive Patient Assessment for Using Telehealth at Home using technology to meet remotely and assess patients in their own homes. This study used qualitative description with semistructured interviews to explore participants' user experience of the telehealth visit using the Comprehensive Patient Assessment for Using Telehealth at Home. The overarching theme of participants' experiences with the Comprehensive Patient Assessment for Using Telehealth at Home intervention was of a continuum of acceptance of technology use. Participants felt that a combination of in-person and telehealth visits was ideal, and telehealth visits were appropriate for routine visits. In-person assessments would be necessary if the communication was not adequately received through remote technology. Other themes were satisfaction and detractors, usability of the technology, privacy and confidentiality, and timing of the telehealth visit. Telehealth presents new opportunities for patients to engage and connect with providers, allowing them to seek care in the comfort of their own home. In some circumstances, telehealth is appropriate but is not a permanent replacement for in-person visits.

Corrigendum to "Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension" preventive medicine reports 17 (2020): 101,038.

[This corrects the article DOI: 10.1016/j.pmedr.2019.101038.].

Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment.

Background: The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualized care. The videoconferencing camera is a proxy for home visit provider's eyes. However, cameras limit views, thereby reducing environmental cues. The Novice to Expert Theory of skill acquisition supports the use of an intentional viewing guide to assure a comprehensive patient assessment using telehealth in the home (CPATH). This study advances the development of a CPATH framework to guide providers to be intentional when using televideo technology. Methods: A quantitative content validity approach was used to determine the validity of a priori items within domains that were in the original protocol framework. A content validity determination requires 5-10 experts to rate agreement (range 1-5) on items within domains. Our sample was composed of seven expert home health providers. More than five experts had to agree to achieve statistical significance (p < 0.05) for validity. Results: Of the 15 items in the protocol, only 8 items had significant agreement for the sample size. These items were breathing, nonverbal gesturing, positioning, oxygen, safety, and types, dosages, and administration guidance of medication. Other items were added within the existing domains of Patient Characteristics, Treatment and Equipment Functioning, Medications and Environmental Quality, with the exception of Caregivers. Conclusion: The domains triggered considerations for existing or additional items that require assessment, thereby developing the intentional guide framework that permits individualization of a telehealth home-based visit.

Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension.

Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012-16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists' recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p < 0.0001), hemoglobin A1C (p = 0.0082) and systolic blood pressure (p = 0.009) while those with only one condition did not demonstrate significant changes. While the pre/post changes in chronic disease control indicators were statistically significant, the clinical significance was low to moderate. Patients with both comorbid diabetes and hypertension experienced benefit from collaborative, targeted MTM pharmacist-delivered, tertiary prevention interventions in tandem with community-based pharmacy resources. This multi-site MTM program showed promise in increasing patients' use of these services, yet effective strategies are needed to expand recruitment of eligible patients in the future.

Zika Virus: Patient Education Recommendations.

BACKGROUND: A growing threat to maternal-fetal health, the most recent and largest outbreak of the Zika virus disease has introduced the devastating fetal effects of microcephaly and other central nervous system deficits. PURPOSE: This brief outlines a history of Zika virus disease, its known effects, best practice recommendations for providers to educate patients, and information for individuals on how to protect themselves. METHODS/SEARCH STRATEGY: A search of the literature using the databases PubMed, UptoDate, and CINAHL was conducted for articles published between 2009 and 2016. Key informant interviews with clinical genetics and public health professionals were conducted. FINDINGS/RESULTS: The proposed best practice recommendations for education regarding the Zika virus disease and appropriate prevention and treatment methods are outlined. IMPLICATIONS FOR PRACTICE: As the Zika virus continues to spread and further research is conducted regarding its teratogenic effects, the need for concise and effective education is critical to raise awareness, decrease the potential for maternal exposure, and reduce fetal risks. IMPLICATIONS FOR RESEARCH: Therefore, the need for appropriate recognition, treatment, management, and prevention of the Zika virus disease prompts the necessity for further education and high-quality level research to be conducted and utilized.

In vitro antimicrobial efficacy of a silver-containing wound dressing against mycobacteria associated with atypical skin ulcers.

Mycobacterium ulcerans, the etiological agent in Buruli and related ulcers, is a major threat to public health in many tropical countries. Recommended treatment that is accessible and affordable for affected individuals includes surgical debridement and combination antibiotics. The potential benefits in the use of antimicrobial wound dressings has not been demonstrated to date, and consequently the efficacy of a silver-containing absorbent dressing was investigated against a pathogenic wound mycobacterium using stringent in vitro models. The in vitro models were designed to simulate a variety of challenging wound conditions. Mycobacterium fortuitum was used as a fast-growing surrogate for M. ulcerans, a physiologically similar but slower-growing and more significant wound pathogen. Collectively, the studies showed that the silver-containing dressing was bactericidal against M. fortuitum, it maintained killing effect over a prolonged period (7 days) under conditions simulating excessive exudate, and killed an average of 100% of the bacterial population inoculated directly beneath the dressing in a simulated, colonized, shallow wound model. Based on the in vitro data generated in the current research, use of the silver-containing dressing as part of a protocol-of-care in the management of Buruli and related ulcers may help to alleviate wound infection caused by pathogenic mycobacteria, improve quality of life, and provide infection protection in endemic and at-risk regions. .

Multidrug-resistant organisms, wounds and topical antimicrobial protection.

Multidrug-resistant organisms (MDROs) are increasingly implicated in both acute and chronic wound infections. The limited therapeutic options are further compromised by the fact that wound bacteria often co-exist within a biofilm community which enhances bacterial tolerance to antibiotics. As a consequence, topical antiseptics may be an important consideration for minimising the opportunity for wound infections involving MDROs. The objective of this research was to investigate the antimicrobial activity of a silver-containing gelling fibre dressing against a variety of MDROs in free-living and biofilm states, using stringent in vitro models designed to simulate a variety of wound conditions. MDROs included Acinetobacter baumannii, community-associated methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase-producing bacteria. Clostridium difficile was also included in the study because it carries many of the characteristics seen in MDROs and evidence of multidrug resistance is emerging. Sustained in vitro antimicrobial activity of the silver-containing dressing was shown against 10 MDROs in a simulated wound fluid over 7 days, and inhibitory and bactericidal effects against both free-living and biofilm phenotypes were also consistently shown in simulated colonised wound surface models. The in vitro data support consideration of the silver-containing gelling fibre dressing as part of a protocol of care in the management of wounds colonised or infected with MDROs.