Background: During the last century, closure in rural pharmacies has been increasing in Sweden resulting in unequal access to pharmaceutical services among the population. Telepharmacy is a provision of pharmaceutical care to patients at distance thereby increasing access to health care. Previous studies have shown promising results regarding various clinical outcomes, attitudes of patients and pharmacists in addition to high-quality drug counseling. As pharmaceutical care is essential for safe drug utilization, it is of importance to induce new approaches in Sweden to maintain pharmaceutical care in these areas. Aim: This study aimed to evaluate a telepharmacy system named Farmaceut på Distans at a local pharmacy in Sweden concerning; patient's and pharmacists’ attitudes, areas of improvements, and safety of the method. Methods: The study was performed between 26/4,-7/5 2021. The objectives of this study were evaluated through a questionnaire and short semi-structured interviews with patients, a semi-structured observation, a semi-structured interview with the project leader, and a focus group with included pharmacists. Additionally, a medicine dispensing error protocol was established.  Results: Eleven patients, three pharmacists, and the project leader were included in this study. This study shows that patients and pharmacists expressed optimistic attitudes towards Farmaceut på Distans. However, the method requires to be improved regarding technical aspects in advance of implementation. Further, no medicine dispensing errors were obtained.  Conclusions: Due to the small sample size, no conclusions can be drawn regarding the safety of the method. Farmaceut på Distans is a promising approach to maintain safe drug utilization in Sweden. However, further studies require to be performed regarding safety and attitudes among users.

Background: Atrial fibrillation (AF) confers high risk of stroke, but often goes undiagnosed due to difficulties in its diagnosis. AF detection is important in post-stroke populations for secondary prevention and smartwatches have emerged as a promising modality for detecting AF, but little is known about their use in older adults who have experienced a stroke. Methods: This dissertation uses data from the Pulsewatch study, a two-phased trial assessing accuracy, usability, and adherence of smartwatch-based AF detection among older patients after stroke. Analyses performed include: descriptive statistics, linear and logistic regressions, qualitative and mixed-methods analyses, mixed effects modeling, and group-based trajectory modeling. Results: The Pulsewatch system was 91% accurate in detecting AF compared to a clinical gold-standard. Participants found the system easy to use, but indicated that streamlining the smartwatch’s functionalities to focus on passive cardiac monitoring is crucial. Improving battery life to allow for longer wear time would alleviate anxiety in some participants. Participants with previous experience using cardiac rhythm monitors rated the system lower on usability, but overwhelmingly preferred it to previous monitors due to the watch’s comfort, appearance, and convenience. Watch wear decreased over time, and we observed three distinct patterns of decline. No individual-level characteristics were associated with usability or adherence to watch wear. Conclusions: Smartwatches are promising for AF detection in older adults after stroke, though while they offer high accuracy and usability, adherence to wear is low. Strategies to encourage extended watch wear are necessary to realize the potential of smartwatches as a viable cardiac monitoring modality.

This dissertation thesis is focused on the optimization of bandwidth parameters for the transport of medical image data between medical devices and remote data storage. As real and fully functional structure, which will be analyzed in this work. It was selected system MeDiMed (Metropolitan Digital Imaging System in Medicine). The thesis examines the operation of the small health organizations and their modalities, which use this system for remote data archiving. Traffic analysis is then statistically processed. The thesis also deals with the analysis of increasing the security during accessing health system, and assesses its impact on transmitted data. The effect of setting the transmission parameters and the most widely used types of ciphers on the transfer speed is also compared.

L'examen EEG est un examen fonctionnel essentiel de la médecine moderne. Il consiste dans l'acquisition de signaux physiologique d'un patient afin de diagnostiquer ses troubles neurologiques. À cause d'une mauvaise répartition des experts et d'une diversification des spécialités de neurophysiologie, la téléexpertise s'impose comme une solution pour apporter des soins pour tous. Cette thèse aborde la problématique de téléexpertise d'un examen EEG tout en repoussant les limitations des équipements d'EEG actuelle. Ces limitations, observées par les médecins, sont l'imprécision de la synchronisation entre les signaux physiologiques et l'enregistrement vidéo et la faible qualité de cet enregistrement vidéo. La première limitation nous a conduit à développer un mécanisme de synchronisation matérielle déterministe ainsi que de définir un nouveau format de fichier capable de stocker les signaux physiologiques ainsi que la vidéo de manière uniforme. La seconde limitation a mené en la définition d'un nouvel algorithme de compression nommé ROI-Waaves. Cet algorithme, utilisant la transformée en ondelettes et le codeur entropique HENUC, est capable d'encoder des zones de l'image avec une qualité supérieure afin de conserver les détails des mains et du visage du patient. Finalement, nous avons développé deux implémentations mettant en place les solutions proposées et permettant de réaliser un examen EEG synchronisé et compressé. De plus, nous avons proposé une architecture matérielle compressant un flux vidéo à 100 images par seconde en temps réel en utilisant ROI-Waaves. / The EEG exam is an essential functional exam in modern medicine. It involves the acquisition of biological signals of a patient to diagnose his neurological disorders. Because of a poor spread of experts and diversification of neurophysiological specialties, remote expertise imposes itself as a solution to bring health care to most people. The thesis approaches the problematic of remote diagnosis of EEG exams while pushing back the current EEG device limitations. Those limitations, observed by doctors, are the imprecise synchronization between biological signals and the video recording and the low quality of this video recording. The first limitation has led us to develop a hardware determinist synchronization as well as to define a novel file format to store biological signals alongside the video. Thanks to those two mechanisms, we guarantee the correct synchronization when reviewing a EEG file. The second limitation has driven us to define a new compression algorithm named ROI-Waaves. The algorithm uses wavelet transform and the HENUC coding scheme and encodes one or many regions of an image with higher quality to preserve details. Those regions are defined as the hands and head of the patient and help doctors to perform correct diagnoses. Lastly, we have developed two implementations which use the proposed solutions and allowing to carry out a synchronized and compressed EEG exam. The produced exams by these devices are complete and can be used for review or long-time storage. In addition, we have proposed a hardware architecture that compresses 100 frames per second video stream in real time using ROI-Waaves.

Tele-intensive care collaboration in care of critically ill patients improves both the safety and quality of nursing care. However, the full benefits of the telemedicine service may not be realized unless tele-critical care nurses have the ability to communicate clearly with their remote nursing peers. The purpose of this DNP project was to create and validate an acronym style communication tool to assist the tele-critical care nurses with their communication. The relational coordination theory was the primary communication theory utilized for tool development. The tool creation phase of the project included informal observations and discussion with a convenience sample of 11 tele-critical care staff nurses. The formative feedback from this group helped to identify the episode of communication for which the tool was designed and suggested communication elements for inclusion. During the validation phase of this project, 9 volunteer experts evaluated the communication tool with a 5-point Likert scale survey. Descriptive statistics were used to analyze the survey results and provided summative feedback for validation of the tool. Mean scores between 3.44 and 4.44 demonstrated that the experts agreed with the applicability, relevance, and necessity of the tool. Feedback indicated the need for a pilot study implementing the tool to compare it with traditional communication practices and to evaluate its performance in clinical practice. This tool will be useful for future partnerships utilizing telemedicine. The project is socially significant because of its focus on communication and collaboration among healthcare providers in facilitating the patient experience and safety.

Bakgrund: Användningen av digitala videobesök har ökat inom fysioterapin under de senaste åren, särskilt i samband med covid-pandemin. Den nuvarande kunskapen om fysioterapeuters upplevelser och erfarenheter av användandet av digitala videobesök är begränsad.  Syfte: Att undersöka fysioterapeuters upplevelser och erfarenheter av att möta patienter via digitala videobesök. Metod: Studien har en kvalitativ design. Data insamlades genom semistrukturerade intervjuer med fem fysioterapeuter inom primärvården. Datan bearbetades genom kvalitativ innehållsanalys.  Resultat: Insamlad data resulterade i följande huvudkategorier: Begränsningar för användandet av digitala videobesök, fördelar med digitala videobesök samt utveckling av digitala videobesök. Konklusion: Sammanfattningsvis ansåg fysioterapeuterna generellt att digitala videobesök är ett bra verktyg att tillgå. Framförallt genom att det ökar tillgängligheten till fysioterapeuten och att det möjliggör ett mer flexibelt arbete. De beskrev även begränsningar i arbetet med videobesök. Bland annat organisatoriska hinder och frånvaron av fysisk kontakt med patienten. Dessutom framfördes olika tankar om utveckling av videobesök. Exempelvis tekniska förbättringsmöjligheter och möjlighet till mer utbildning på området. / Background: The use of digital video meetings in physiotherapy has increased in recent years, particularly  in conjunction with the covid-pandemic. The current evidence for physiotherapists' experiences and perceptions of using digital video meetings is limited.  Purpose: To investigate physiotherapists experiences and perceptions of meeting patients through digital video meetings.  Method: The study has a qualitative design. Data were collected through semi structured interviews of five physiotherapists in primary care. The data was processed using qualitative content analysis.  Results: Collected data resulted in the following main categories: restrictions in the use of digital video meetings, benefits of digital video meetings and development of digital video meetings.  Conclusion: In summary, physiotherapists generally considered digital video meetings to be a good tool available. Mainly by increasing the accessibility to the physiotherapist and by contributing to  a more flexible job. They also described limitations in their work with video meetings. For instance, organizational obstacles and the absence of physical contact with the patient. Furthermore, different ways of developing the video meetings were presented. For example, technical opportunities for improvement and opportunities for more education in the field.

Quantitative sensory testing (QST) is a useful tool in evaluating patients with neuropathic pain. In light of the COVID-19 pandemic and taking into consideration the transportation barriers that many chronic pain patients face, there is an increasing need for a valid QST protocol that can be completed at home. This study sought to establish and validate an at-home QST protocol for the evaluation of patients with neuropathic pain. A sample of 18 patients with neuropathic pain who had previously completed the validated bedside QST protocol completed the at-home QST assessment and a series of questionnaires. Bivariate correlations between in person and at home QST measures were assessed using Pearson correlations, and Spearman's rho was applied when variables showed non-normal distributions. Results found that comparable at home QST protocols included punctate hyperalgesia, cold allodynia, cold hyperalgesia, and the cold pain tolerance-time measure. At home tests that did not show strong correlations with previously established beside QST included static mechanical allodynia, dynamic mechanical allodynia, temporal summation of mechanical pain, and the cold pain tolerance- pain rating. This research will be instrumental in testing less mobile participants or those who cannot come to a laboratory site for traditional QST testing and future sensory phenotyping of patients that will move the field toward a more individualized medicine approach. / 2024-01-28T00:00:00Z

Sweden's aging population makes the need for a viable health care urgent and telemedicine can be a solution to enable older people to receive or give themselves care in their homes. Furthermore, implementation of telemedicine has the potential to realise profits in society by increasing the accessibility of health care and minimizing travel costs. Sweden’s low population density and geographical configuration makes the advantages of telemedicine even more appealing.   To illustrate the differences between the county councils’ use of telemedicine and thus increasing the possibility for coordinated care between them, the authors have on behalf of the Innovation Centre at the Karolinska University hospital mapped the amount of telemedicine technologies that are available in the Swedish county councils’ today. To collect information an electronic survey and video or telephone interviews were used. This report answers the question of how the use of telemedicine differ between Sweden's county councils in terms of techniques used, how well implemented the technologies are and to what extent the guidelines for development, implementation and use of telemedicine is available. The report also investigated whether the county councils geographic characteristics, in terms of population density and the number of hospitals and health centers, influenced the development of telemedicine.   Of the 21 regional councils information has been collected from 10 counties in seven weeks and the results that were collocated indicated that there are major differences between the county councils' use of telemedicine. It is clear that the northern region and especially Västerbotten and Norrbotten County Council have come a long way in implementing telemedicine technology.   When the results of the electronic survey and interviews were compared with the county councils’ geographical features no correlation could be detected between population density and the use of telemedicine. This can be a result of the low number of participating counties and that we have not examined all departments in health care. The county councils which have university hospitals use multidisciplinary rounds more so than others. In summary, the Swedish county councils are at different stages in the implementation of telemedicine due to several external and internal factors that makes it possible for counties to benefit a lot from collaboration and sharing each other's knowledge. / Sveriges åldrande befolkning gör behovet av en fungerande vård stor och telemedicin kan vara en lösning för att ge äldre möjlighet att få eller ge sig själva vård i hemmet. Genom implementering av telemedicin har Sverige på grund av sin låga befolkningstäthet och geografisk utformning potential att öka tillgängligheten av vård och minska resekostnader.   För att belysa skillnader mellan landstingens användning av telemedicin och på så sätt öka möjligheten för samordnad vård mellan landstingen har författarna på uppdrag av Innovationsplatsen på Karolinska Universitetssjukhuset med hjälp av elektronisk enkät och video- eller telefonintervjuer kartlagt hur mycket telemedicinsk teknik som finns tillgänglig på Sveriges landsting idag. I rapporten besvaras frågeställningen hur användningen av telemedicin skiljer sig mellan Sveriges landsting i avseende på vilka tekniker som används, hur väl implementerade i verksamheten teknikerna är samt i vilken omfattning riktlinjer för utveckling, implementering och användning av telemedicin är tillgängliga. Rapporten har även undersökt om landstingens geografiska egenskaper i form av befolkningstäthet samt antal sjukhus och vårdcentraler påverkat utvecklingen av telemedicin inom landstingen.   Av Sveriges 21 landsting har information samlats in från 10 landsting under sju veckor och resultatet som sammanställdes tydde på att det finns stora skillnader mellan landstingens användning av telemedicin. Det är tydligt att norra regionen och speciellt Västerbottens- och Norrbottens läns landsting har kommit långt i implementering av telemedicinsk teknik.   Då resultaten från den elektroniska enkäten och intervjuerna jämfördes med landstingens geografiska egenskaper drogs slutsatsen att inget tydligt samband kunde upptäckas mellan befolkningstäthet och användandet av telemedicin. Slutsatsen kan bero på för få deltagande landsting och att undersökningen inte utfördes på varje avdelning. En annan slutsats som var tydlig var att landsting som har universitetssjukhus i större utsträckning använder multidisciplinära ronder via videokonferensteknik. Sammanfattningsvis har Sveriges landsting kommit olika långt i utvecklingen av telemedicin på grund av flera yttre och inre faktorer vilket gör det möjligt för landstingen att dra stor nytta av varandras kunskap vid samarbete.

The concept of e-health has been around for decades and has proven to benefit healthcare with improved quality and increased access. In modern days, e-health can often be seen in healthcare technologies connected to networks such as the Internet. Brazil has in recent years made great strides with its expansion of e-health in the country, however, some regions fall behind in this regard. This study has analyzed an exploratory survey conducted in Maranhão, a state in the northeastern region of Brazil, to understand the healthcare problems and use of digital solutions in the sampled municipalities. The survey was analyzed using a mixed approach with the goal of finding out if e-health technologies could alleviate the reported healthcare-related problems. A thematic analysis was performed on parts of the survey to identify the healthcare problems that the municipalities were experiencing. This was then followed up with descriptive statistics on questions that were related to e-health technologies to evaluate their usage level in the municipalities. The results of the study show that there are a wide variety of healthcare problems. Many of these can at least be alleviated by e-health technologies but the result also showed problems that are outside of the scope of e-health. One area of e-health that showed great promise in mitigating the problems was telemedicine. The use of telemedicine could increase access to healthcare for remote areas as well as provide specialist knowledge to healthcare facilities that require that expertise. This study can guide future research into the identified problem areas where in-depth studies are needed to better understand and map out solutions for specific issues.

School-based health clinics are on the rise while telemedicine is increasingly used to provide communities access to health care. Incorporating the two together poses to create healthier school communities. Parker County Hospital District collaborated with Weatherford Independent School District (WISD) to implement the district's first telemedicine school-based health clinic. This project is in partnership with Parker County Hospital District to explore parent perceptions and desires of telemedicine and school-based health clinics to facilitate utilization among the WISD community.