Darbo tikslas – įvertinti KMUK padalinių vadovų nuomonę apie telemediciną bei jos taikymo galimybes Lietuvoje. Tyrimo metodika: KMUK vadovaujamą darbą dirbančių gydytojų (klinikų, skyrių, sektorių vadovų) anoniminė anketinė apklausa vyko 2008 metų sausio –vasario mėnesiais. Anketos buvo išdalintos visiems 128 respondentams. Statistinėje analizėje naudota 101 teisingai užpildyta anketa. Atsako dažnis 78,9 proc.. Rezultatai. Geriausiai su telemedicinos taikymo galimybėmis susipažinę klinikų vadovai. Respondentų nuomone, radiologija, oftalmologija ir kardiologija – sritys, kuriose telemedicina galėtų būti plėtojama labiausiai. 23,8 proc. respondentų telemedicinos plėtros galimybes KMUK įvertintos palankiai. Galimybės plėtoti telemediciną Lietuvos mastu buvo vertinamos atsargiau: dauguma (39,6 proc.) apklaustųjų manė, jog kol kas tam nėra pakankamų galimybių. Svarbiausi veiksniai, skatinantys sėkmingą telemedicinos diegimą Lietuvoje: gydytojų specialistų noras ir pastangos dirbti novatoriškai, telemedicinos metodų ir priemonių kūrimas bei taikymas praktikoje, teisinės bazės, susijusios su šia sritimi, tobulinimas. Pagrindinės kliūtys, trukdančios sėkmingai plėtoti telemedicinos paslaugas - kompiuterinio raštingumo stoka vyresnio amžiaus respondentų tarpe, nepakankami užsienio kalbų įgūdžiai, darbo aplinkoje esančios nepalankios techninės galimybės naudoti telemediciną bei informacijos apie informacines bei telekomunikacines technologijas bendrai ir informacijos apie... [toliau žr. visą tekstą] / Aim of the aim. To evaluate the opinion of the heads of the departments of Kaunas University Hospital on telemedicine and the possibilities of its application in Lithuania. Methods. Anonymous survey of the heads of the departments of Kaunas University Hospital was carried out in January and February, 2008. 128 heads of the department were distributed. 101 questionnaires were filled in correctly and were used for a statistical data analysis. The frequency response 78.9%. Results. The heads of different clinics of Kaunas University Hospital knew the possibilities of using telemedicine. The primary fields of medicine where the potential use of telemedicine could be developed include radiology, ophthalmology and cardiology. 23.8% of respondents thought that there were enough options to develop telemedicine in Kaunas University Hospital, whereas the options to develop it in Lithuania were assessed moderately. Many respondents (39.6 %) thought that there was not enough potential to do that. The most important factors in developing telemedicine in Lithuania were: wishes and efforts of doctors to work in a different way, the establishment and use of telemedicine’s methods and devices in practice and the improvement of telemedicine law. The main barriers to the development of telemedicine in Lithuania are: insufficient computer and foreign languages skills, inadequate technologies and the lack of knowledge about information and telecommunications technologies and the shortage of... [to full text]

Text in English / Telehealth makes healthcare services accessible by underserved and resource-constrained rural communities of developing countries such as Ethiopia. However, the limitation of frameworks on telemedicine-based healthcare inequality reduction is a challenge for developing countries. In Ethiopia there are four telemedicine projects; however, there is no evidence that any of these projects have been evaluated by considering contextual issues. This academic research explored telehealth practices in Ethiopia with the aim of developing a comprehensive telehealth evaluation framework for developing countries. Such a conceptual framework could be used to inform health institutes and governmental policy makers and in so doing create a vehicle for the implementation of improved health practices in Ethiopia. A grounded theory approach is used to qualitatively explore the usefulness of telemedicine practices in Ethiopia, in mitigating healthcare inequality. Grounded theory makes use of emerging insights in order to contribute to new knowledge. From the inductive analysis of the study, themes such as barrier removal, service quality, synergetic effect, localization, technical setup, resource utilization and managerial readiness emerged to formulate a framework for evaluating telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia. This study contributes to the understanding of the question of how telemedicine practices can be evaluated, to support the healthcare service and reduce the healthcare inequalities in resource constrained communities in Ethiopia. Moreover, the framework could be used during evaluation of telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia. / School of Computing / Ph.D. (Information Systems)

The implementation of telehealth applications is resource intensive and fraught with challenges unique to the people and places involved. The use of telehealth to provide clinical care to patients, educate patients and providers, and conduct research studies to advance medical science has been shown to positively affect issues of access and the quality of care. Previous research has focused on the use of specific technologies, known barriers to adoption and diffusion, and the general efficacy of these applications. Few studies have researched the role champions play in the deployment and operation of telehealth networks. The researcher proposed conducting an interpretative phenomenological analysis (IPA) of clinicians, educators and technical professionals within a successful telehealth network to determine the lived experiences that identify them as champions in the field. Three research questions were studied: 1) What do telehealth champions believe to be the human elements necessary to advance telehealth systems?; 2) How do these telehealth champions explain their empowerment during the creation and use of telehealth networks?; and 3) How do these champions use shared processes and experiences to help spur engagement? Semi-structured interviews with 16 champions from the three disciplines were conducted to explore their lived experiences as part of a telehealth network. Seven champion themes - modern pioneers; champion teams; agents of change; knowledge brokers; supported by management; advocates, not champions; and well-prepared visionaries - emerged from the iterative review and analysis of data. Findings suggest that telehealth champions are not born but instead created. They are modern pioneers who function as part of innovative telehealth teams. Champions also serve as agents of change who utilize their knowledge of disruptive technologies to advocate for improvement in established healthcare systems. They are problem solvers who serve as resources for their colleagues, organizations and collaborative networks. Telehealth champions channel the universal goals of improving patient care and expanding healthcare access to overcome adoption barriers. Applying the ideals of what it means to be champions and how they overcome barriers to new telehealth applications could prove to be very beneficial for those tasked with developing new networks.

Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients' goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers. This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences. This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention.

Yip Mei Po. / "April 2002." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 170-197). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Ο αριθμός των ατόμων με χρόνιες ασθένειες αυξάνει καθώς ο πληθυσμός γερνάει όλο και περισσότερο. Οι χρόνιες ασθένειες δεν εμφανίζονται μόνο σε ασθενείς μεγάλης ηλικίας(αν και εκει είναι όμως είναι συχνότερες). Το Εθνικό Σύστημα Υγείας δεν περιλαμβάνει δομές Πρωτοβάθμιας Περίθαλψης, όμως με την βοήθεια της Τηλεϊατρικής μεμονωμένα κέντρα ή νοσοκομεία προσπαθούν να καλύψουν ασθενείς με χρόνιες παθήσεις δίνοντας τους την δυνατότητα να ζήσουν καλύτερα με την ασθένεια, να μειώσουν τις επισκέψεις στο Νοσοκομείο και το κυριότερο να έχουν ενεργό ρόλο στη διαχείριση της ασθένειάς τους. Στο πρόβλημα των χρόνιων ασθενειών η Τηλεϊατρική αποτελεί την βασική λύση, όμως για την ολοκληρωμένη διαχείριση των χρόνιων ασθενών χρειάζονται και επιμέρους υπηρεσίες που θα πρέπει να προέρχονται από το κράτος πρόνοιας. Η παρούσα εργασία αναλύει το πρόβλημα των χρόνιων παθήσεων και των ασθενών στην Ελλάδα, αναφέρει τις επιμέρους προσπάθειες που γίνονται, με όποια προβλήματα και ελλείψεις υπάρχουν καθώς επίσης και τα κέρδη (ποσοτικά και ποιοτικά) από την χρήση τέτοιων δομών. / The number of people with chronic diseases is increasing as the population ages more and more.Chronic diseases do not only occur in older patients but is more frequent. The National Health System does not include structures for Primary Care, but with the help of Telemedicine individual centers or hospitals try to provide patients with chronic diseases by giving them the opportunity to live better with illness, reduce hospital visits and most importantly be actively role in managing the disease problem safeguarded. In the era of chronic diseases that / where Telemedicine is the basic solution, but for the integrated management of chronic patients need and individual services should come from the welfare state. This paper analyzes the problem of chronic diseases and patients in Greece, reports on various efforts made, whatever the problems and deficiencies exist and to report its earnings (quantitatively and qualitatively) the use of such structures.

Telemedicine systems represent significant achievements in the provision of clinical medicine and health care service using telecommunication and information technologies for the purpose of remote monitoring. Almost all telemedicine systems require a network-enabled device, ranging from server machine to smart phone, which delivers the data as a transmission gateway. The research in this thesis introduces the hardware and software design of a novel Internet-based real time DSP system in the application of telemedicine. Before this work, it was not previously achievable or economically feasible to develop a telemedicine system with a truly embedded measurement platform for real-time monitoring of clinical information on a global scale. The novelty of this design consists in embedding the Internet-based monitoring into the real-time signal processing system, as well as incorporating the merits of wireless communication and global distributed measurement. To demonstrate this concept, a prototype of a truly embedded device incorporating either a browser-based application or a LabVIEW software application has been designed and developed, which is able to provide real-time biomedical signal acquisition, processing, wired/wireless transmission, visualisation, storage and retrieval via the Internet. The concept-to-prototype manipulates multiple biomedical signals from multi-sensors during studies and distributes them to the Internet. The prototype was evaluated on volunteers in vivo under ethical approval. The designed system was also tested under various physiological conditions and different Internet speeds. It manifests desirable performance regarding multi-functionality, ubiquitous accessibility, robustness, and adaptability. The full functionality of this innovative system successfully enables clinicians to remotely monitor a patient's physical condition in real-time globally. The experimental results obtained from the host are in close agreement with the expected performance of the designed system, which proffers evidence that this system represents a true innovation in the realm of telemedicine.

Objective: Evaluate The Ottawa Hospital Viral Hepatitis Program (TOHVHP) telemedicine (TM) program for patient retention, treatment initiation and sustained virologic response (SVR) rates. Methods: Retrospective analysis of TOHVHP cohort data for patients entering HCV care between 2012 and 2016. Logistic regression modeling was used to assess characteristics associated with patient retention, treatment initiation, and achieving SVR. TM outcomes were compared to the standard outpatient clinic and mixed delivery outcomes. Results: Treatment initiation rates were comparable between TM and the outpatient clinic. TM delivered Direct Acting Antiviral treatments achieved high SVR outcomes across all patient populations. Patient retention was lower among TM patients. Conclusion: TOHVHP TM program engaged patients facing barriers to traditional HCV care models. Efforts to improve TM retention are needed.

The present health, care and support mechanisms are unable to truly meet the demands made upon it. Between 1992 and 1996 the total number of home care hours increased by 50% while the number of households receiving the service declined by around 7%. A more intensive service is being delivered to a minority of people yet at the same time the number of people who may need support is increasing. Health spending on people aged 75 and over is 6 times that of the average for the rest of the population but between 1995 and 2025 the UK will see a 43.6% increase in the 60 and over age range. A similar trend is apparent across much of the developed world. In order to meet this new demand the use of technology has been suggested, yet a review of the literature indicates that little evidence exists to indicate if users would welcome technology and whether it would be effective. This research therefore seeks to answer the question ‘Are assistive technologies an enhancement to the present health, care and support mechanisms?’ The NHS and Community Care Act 1990 suggests that resources should move from hospitals and institutions to the community and therefore since 80% of older people want to stay in their own homes it would seem appropriate that assistance is provided to people in these locations. The literature review has also highlighted 4 key areas, which are addressed in this thesis, namely: user requirements, system modelling, cost analysis and service delivery. Currently relatively simple technology, refereed to as the community alarm system is used to assist, predominately older people, in the community. Using these people and the technology as a base level this research indicates that such users would welcome more advanced technology. Indeed, in a survey of 176 users, 77% welcomed automatic fall detection, 68% welcomed lifestyle monitoring where changes in the pattern of behaviour generates an automatic alarm, 57% welcomed telemedicine where medical parameters are measured in the users home and the doctor is contacted if necessary, and 46% welcomed videoconferencing. To assist people in their own homes telecare has been defined as an appropriate model with the community alarm system being defined as the 1st generation system. Several authors have attempted to define subsequent generations of telecare in generalities with no one defining the actual system and data flows. To address this insufficiency, and provide a structure to developments, based on the availability of technology and the views of users, a target system has been defined which could be available within 15 years. In order to move from the present 1st generation system to this 4th generation, 2 stepping stone systems have been defined and it is hoped that subsequent work will use these system definitions and create and trial the technology and systems suggested. Telecare is an emerging area of research and therefore little attention has been given to costeffectiveness, in order to address this area a financial model has been created using Excel worksheets. The results indicate that, in comparison to the present system a 2nd generation telecare system could potentially save £8.3m over the 10-year system life cycle. Various sensitivity analyses are performed and in each and every constraint the 2nd generation telecare system is more profitable than the present community alarm system. Extrapolating the results to represent the whole of the UK indicates that there is the potential to save £832m over the 10-year system life cycle. As with any system the introduction of a 2nd generation telecare system will inevitably change the way people work. In order to discover the impact that the introduction of such a system may have a model has been created to estimate the impact at the community alarm control centre, currently the centre of activity in the present system. The net result is that the number of calls increases by 321%, however many of these calls regard data that do not require human attention. When analysing the impact on service delivery the actual amount of time required speaking to people in need of assistance reduce by 55%. This is predominantly achieved by reducing the number of calls activated by mistake through the greater use of effective technology. Overall it could be argued that this research has added considerably to the knowledge base and the results indicate that telecare has tremendous potential to address the ageing population difficulties that the UK and other developed countries face.

NHS Direct Wales (NHSDW) is a nurse-led 24-hour health advice and information line. This study estimated the effect of deprivation on the demand for, and outcome of, direct calls to NHSDW after controlling for potentially confounding factors. The author analysed anonymous data from NHSDW on 410,000 calls over 2.5 years, including patient characteristics (age, gender, relationship to caller, ward of residence) and call characteristics (whether for triage or information, day of call). To each call she added ward data including: the corresponding Welsh Index of Multiple Deprivation score; population density; and distance from nearest Emergency Department (ED). She used multiple linear regression to model the relationship between deprivation and demand and binary logistic regression to model the relationship between deprivation and outcome. Confounding variables explained 33.0% of variation in advice call rates; and 27.5% of that in information call rates (both significant at 0.1% level). Deprivation was not a statistically significant predictor of these rates (significance levels 0.158 and 0.244 respectively). Deprivation had more effect on outcomes: an increase in deprivation from one fifth to the next fifth increased by 13% the probability of receiving advice to call 999 emergency care within triage calls [Odds ratio (OR) 1.127; 95% confidence interval (Cl) from 1.113 to 1.143]; and that of receiving advice to seek care face to face rather than self care by 5% (OR 1.049; Cl from 1.041 to 1.058) for triage calls and by 3% (OR 1.034; Cl from 1.022 to 1.047) for information calls. In short, deprivation had no detectable effect on demand for calls, but a positive effect on the outcome of the call. While it is possible that the data underestimated the ‘need’ of deprived patients for healthcare, they yield no evidence that NHSDW should seek to improve access from those patients.