Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
1.
Telemed J E Health ; 20(9): 769-800, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24968105

RESUMO

The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.


Assuntos
Doença Crônica/terapia , Gerenciamento Clínico , Telemedicina , Humanos
2.
Telemed J E Health ; 18(8): 654-60, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23061646

RESUMO

The Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, in conjunction with the American Telemedicine Association's Annual Mid-Year Meeting, conducted a 1-day workshop on how maturing and emerging processes and applications in the field of telemental health (TMH) can be expanded to enhance access to behavioral health services in the Pacific Rim. The purpose of the workshop was to bring together experts in the field of TMH from the military, federal agencies, academia, and regional healthcare organizations serving populations in the Pacific Rim. The workshop reviewed current technologies and systems to better understand their current and potential applications to regional challenges, including the Department of Defense and other federal organizations. The meeting was attended by approximately 100 participants, representing military, government, academia, healthcare centers, and tribal organizations. It was organized into four sessions focusing on the following topic areas: (1) Remote Screening and Assessment; (2) Post-Deployment Adjustment Mental Health Treatment; (3) Suicide Prevention and Management; and (4) Delivery of Training, Education, and Mental Health Work Force Development. The meeting's goal was to discuss challenges, gaps, and collaborative opportunities in this area to enhance existing or create new opportunities for collaborations in the delivery of TMH services to the populations of the Pacific Rim. A set of recommendations for collaboration are presented.


Assuntos
Benchmarking/normas , Psiquiatria Militar/normas , Telemedicina/normas , Benchmarking/métodos , Comportamento Cooperativo , Educação , Humanos , Medicina Militar/métodos , Medicina Militar/normas , Psiquiatria Militar/métodos , Oceano Pacífico , Telemedicina/métodos , Fatores de Tempo , Estados Unidos , Prevenção do Suicídio
3.
J Fam Pract ; 55(11): 946-52, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17090353

RESUMO

Four tympanometers are suitable for outpatient primary care, and each has positive and negative attributes. The Earscan was rated easiest to use and provided the most consistent data.


Assuntos
Testes de Impedância Acústica/instrumentação , Adulto , Criança , Desenho de Equipamento , Ergonomia , Humanos , Atenção Primária à Saúde , Reprodutibilidade dos Testes , Avaliação da Tecnologia Biomédica
4.
Diabetes Care ; 28(6): 1431-7, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15920064

RESUMO

OBJECTIVE: Children who develop type 1 diabetes before age 7 years (early-onset diabetes; EOD) have comparatively poorer cognitive abilities. Whether this relates to psychosocial consequences of chronic illness or organic factors related to diabetes and its complications remains unresolved. We hypothesized that if differences in neuroradiological structure and cognitive ability coexisted in those who had EOD, then an organic component to their etiology was likely. RESEARCH DESIGN AND METHODS: A cohort of 71 young adults with long-duration type 1 diabetes diagnosed during childhood or adolescence participated in a cross-sectional evaluation of cognitive ability (neuropsychological test battery) and brain structure (magnetic resonance imaging). Diabetes onset age, preceding severe hypoglycemia exposure, retinopathy status, and diabetes duration were examined as potential correlates of cognitive and neuroradiological differences. No participants had previous neuropsychological pathology. RESULTS: In EOD participants (n = 26), current intellectual ability (Wechsler Adult Intelligence Scale-Revised performance IQ; P = 0.03) and information processing ability (Choice Reaction Time; P = 0.006) were comparatively poorer than was observed in those with later- onset diabetes (n = 45). Furthermore, lateral ventricular volumes were 37% greater (P = 0.002) and ventricular atrophy was more prevalent (61 vs. 20%; P = 0.01) in the EOD group than in those who had later-onset type 1 diabetes. CONCLUSIONS: An early childhood onset of type 1 diabetes was associated with mild central brain atrophy and significant differences in intellectual performance in adulthood, implying that neurodevelopment may be adversely affected by EOD. The differences observed in brain structure support an organic contribution to their etiology but do not exclude a coexistent contribution of psychosocial factors.


Assuntos
Encéfalo/anatomia & histologia , Cognição , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 1/psicologia , Adulto , Idade de Início , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Retinopatia Diabética/epidemiologia , Escolaridade , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/epidemiologia , Lactente , Imageamento por Ressonância Magnética , Masculino , Leitura , Reprodutibilidade dos Testes
5.
Diabetes ; 52(1): 145-8, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12502505

RESUMO

The epsilon4 allele of the apolipoprotein-E (APOE) gene is associated with poor outcome following various cerebral insults. The relationship between APOE genotype and cognitive function in patients with type 1 diabetes is unknown. In a cross-sectional study of 96 people with type 1 diabetes, subjects were APOE genotyped, previous exposure to severe hypoglycemia was estimated by questionnaire, and cognition was assessed by neuropsychological testing. Cognitive abilities were compared using multivariate general linear modeling (multiple analysis of covariance, MANCOVA) in those with (n = 21) and without (n = 75) the APOE epsilon4 allele. APOE epsilon4 selectively influenced cognitive ability in a sex-specific manner (F = 2.3, P = 0.044, Eta(2) = 0.15); women with APOE epsilon4 performed less well on tests of current, nonverbal intellectual ability (Wechsler Adult Intelligence Scale-Revised performance test score, P = 0.001, Eta(2) 0.26) and frontal lobe and executive function (Borkowski verbal fluency, P = 0.016, Eta(2) = 0.15). Previous exposure to severe hypoglycemia did not interact with APOE epsilon4 to produce cognitive disadvantage. The APOE epsilon4 genotype is associated with specific cognitive disadvantage in young women with type 1 diabetes. APOE epsilon4 is unlikely to mediate susceptibility to hypoglycemia-induced cognitive disadvantage.


Assuntos
Apolipoproteínas E/genética , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/psicologia , Inteligência/fisiologia , Adulto , Alelos , Apolipoproteína E4 , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Feminino , Genótipo , Humanos , Hipoglicemia/etiologia , Hipoglicemia/psicologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Índice de Gravidade de Doença
6.
Diabetes ; 52(1): 149-56, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12502506

RESUMO

Type 1 diabetes is associated with chronic hyperglycemia and exposure to intermittent severe hypoglycemia. The long-term cerebral effects of these consequences of diabetes are ill defined. In this study, the history of preceding severe hypoglycemia and the presence of background retinopathy were examined in relation to cognitive ability (neuropsychological test battery) and brain structure (magnetic resonance imaging) in a cross-sectional evaluation of 74 young people with type 1 diabetes. Participants differed by their severe hypoglycemia exposure and degree of diabetic retinopathy and none had previous neuropsychological pathology. Severe hypoglycemia did not influence cognitive ability or brain structure. Background diabetic retinopathy was associated with small focal white-matter hyperintensities in the basal ganglia (33.3 vs. 4.7%, after correction for age, P = 0.005) and significant cognitive disadvantage, affecting fluid intelligence (P = 0.008, Eta(2) = 0.14), information processing (P = 0.001, Eta(2) = 0.22), and attention and concentration ability (P = 0.03, Eta(2) = 0.09). In conclusion, recurrent exposure to severe hypoglycemia alone in young people with type 1 diabetes had no detrimental impact on brain structure or function over the duration of diabetes examined. Chronic hyperglycemia (inferred by the presence of background diabetic retinopathy) may affect brain structure and function.


Assuntos
Encéfalo/patologia , Cognição , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/psicologia , Hipoglicemia/sangue , Imageamento por Ressonância Magnética , Adulto , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/fisiopatologia , Retinopatia Diabética/etiologia , Feminino , Humanos , Masculino , Prontuários Médicos , Testes Neuropsicológicos , Índice de Gravidade de Doença
7.
Perspect Health Inf Manag ; 8: 1d, 2011 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-21307987

RESUMO

The US Indian health system utilizes a diverse range of health information technology and innovative tools to enhance health service delivery for American Indians and Alaska Natives. This article provides an overview of efforts and experience using such tools to achieve health equity for American Indian and Alaska Native communities. Specific attention is given to the Indian Health Service Electronic Health Record and to two examples of telehealth innovation.


Assuntos
Difusão de Inovações , Disparidades nos Níveis de Saúde , Sistemas de Informação Hospitalar/estatística & dados numéricos , Indígenas Norte-Americanos/estatística & dados numéricos , Telemedicina/organização & administração , Alaska , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , North Carolina , Oftalmologia/organização & administração , Oftalmologia/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Telemedicina/estatística & dados numéricos , Estados Unidos , United States Indian Health Service
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA