Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

Introduction and purpose: The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa’s regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. Methodology: A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. Results and Conclusions: The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a “big win” (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model.  Few studies were conducted in LMICs, indicating a gap in such research. &nbsp

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems

Personalized Service Creation by Non-technical Users in the Homecare Domain

AbstractOne of the conditions for the successful introduction of ICT-based homecare services is to allow non-technical persons such as home nurses to personalize these services. We refer to this process of homecare service personalization as service tailoring. Service tailoring can be done by configuring and composing previously developed and deployed service building blocks. In this paper, we describe an approach that employs predefined information of care-receivers, called user profile, to hide most of the technical details from care-givers who do the service tailoring. First, we define the information to be included in a user profile and patterns that represent composition structures corresponding to common homecare tasks experienced in homecare. Then, we define how the service tailoring process can exploit information contained in the predefined user profiles. After that, we illustrate the approach with a tailoring scenario

Introducing Telehealth to Nursing Students in a Pre-Licensure Program

Telehealth has emerged as an enhancement to health care, giving clients greater access to care providers than ever before. It has benefited persons living in remote areas who cannot readily access health services and it has helped clients who have chronic disease conditions that require frequent monitoring, saving themselves and hospitals thousands of dollars. Nurses are an important part of delivering telehealth, yet it is not currently being taught in many nursing courses. The purpose of this project is to introduce telehealth into a pre-licensure nursing program via a learning module and to assess the students\u27 understanding of the material before and after the module has been presented. A two-tailed t test was given before and after the module was presented with p.05, which upheld the null hypothesis that demographic variables would not influence the outcome of either test. The learning module proved to be effective and could have further applications in pre-licensure nursing programs

First steps of asthma management with a personalized ontology model

Asthma is a chronic respiratory disease characterized by severe inflammation of the bronchial mucosa. Allergic asthma is the most common form of this health issue. Asthma is classified into allergic and non-allergic asthma, and it can be triggered by several factors such as indoor and outdoor allergens, air pollution, weather conditions, tobacco smoke, and food allergens, as well as other factors. Asthma symptoms differ in their frequency and severity since each patient reacts differently to these triggers. Formal knowledge is selected as one of the most promising solutions to deal with these challenges. This paper presents a new personalized approach to manage asthma. An ontology-driven model supported by Semantic Web Rule Language (SWRL) medical rules is proposed to provide personalized care for an asthma patient by identifying the risk factors and the development of possible exacerbations

Modèle ontologique contextuel pour les patients atteints de la maladie pulmonaire obstructive chronique

L'informatique ubiquitaire est considérée comme l'une des réalisations scientifiques les plus marquantes de la dernière décennie. Cette vision a créé une révolution dans les interactions des utilisateurs finaux à partir le concept de sensibilité au contexte. L'informatique ubiquitaire offre une nouvelle opportunité pour remodeler la forme des solutions conventionnelles en fournissant des services personnalisés en fonction des situations contextuelles de chaque environnement. Des centaines d'architectures théoriques ont été développées dans le but de mettre en oeuvre l'idée de systèmes sensible au contexte. Cependant, l'informatique ubiquitaire est encore pratiquement non applicable en raison de nombreux défis, surtout que les architectures proposées se présentent toujours comme une solution générale qui permet de satisfaire n'importe quel type d'application et toutes sortes d'utilisation. OBJECTIFS: Cette thèse vise à concevoir et valider un modèle contextuel pour les systèmes de soins de santé ubiquitaires et spécifiquement destinés à aider les patients souffrant de la maladie pulmonaire obstructive chronique (MPOC). LA MÉTHODE: Les informations contextuelles sont très importantes pour les applications de soins de santé sensibles au contexte, en particulier celles utilisées pour surveiller les patients atteints de maladies chroniques qui sont affectées par des conditions concevables. Dans cette thèse, nous proposons une nouvelle classification de contexte pour le domaine médical qui couvre tous les aspects influençant la santé des patients. La grande échelle de cette classification le rend apte pour être une référence générale pour de divers projets de recherche s'intéressant au contexte médical. Ensuite, nous proposons un modèle contextuel à base d’ontologies capable de gérer la structure complexe du domaine de la MPOC de manière cohérente, en proportion de la nature dynamique de cet environnement. Ce nouveau modèle ontologique constitue le noyau de notre perception pour la mise en oeuvre de la solution de soins de santé ubiquitaire. Le modèle présenté examine son efficacité dans la gestion de l’une des maladies les plus vulnérables au contexte, où il prouve ainsi sa capacité à adapter les services de soins de santé à titre personnel et en fonction des conditions actuelles et prévues. Le modèle proposé a montré des résultats prometteurs dépassant 85% approuvé par un groupe de spécialistes expérimentés dans le domaine des maladies pulmonaires. Ubiquitous computing is considered one of the most impactful scientific achievements in the last decade. This conception created tremendous revolution in the end-user interactions through the concept of context-awareness. Ubiquitous computing offers a new opportunity to redesign the pattern of conventional solutions where it can easily tailor its processes upon existing contextual situations. Hundreds of theoretical architectures have been developed to enable context-awareness computing in pervasive settings. However, ubiquitous computing is still practically not feasible due to many challenges, but most importantly, that the proposed models always present themselves as a general solution to all kinds of real-life applications. OBJECTIVES: This thesis aims to design and validate a contextual model for health-care context-aware systems to support patients suffer from Chronic Obstructive Pulmonary Disease (COPD). METHODS: The contextual information is important for developing Context-Aware Healthcare Applications, especially those used to monitor patients with chronic diseases which are affected by perceived conditions. In this thesis, we propose a novel context categorization within the medical domain which covers all the context aspects. Then, we propose an ontology-based model able to handle the complex contextual structure of the COPD domain coherently, and in proportion to the dynamic nature of that environment. This new ontological context is the core of our perception for implementing the ubiquitous healthcare solution. The presented model examines its effectiveness in managing one of the most context-sensitive diseases, thereby demonstrating its ability to adapt health care services on a personal basis and in accordance with current and projected events. The proposed model has shown promising results exceeding 85% approved by a group of experienced specialists in respiratory and lung diseases

Dispositivos e sistemas de Telemonitorização: Panorama atual e tendências futuras

A prevalência de doenças crónicas está a aumentar a par do aumento da esperança média de vida ao nascimento. No futuro, o número de idosos e doentes crónicos será bastante elevada e em muitos casos os idosos serão também doentes crónicos e a patologia existirá em muitos casos em comorbidade. A par desta realidade, existirá um decréscimo de recursos de saúde o que leva à procura de soluções já hoje em dia para que no futuro sejam postas em prática de forma plena. Aliar a telemonitorização ao acompanhamento por parte dos profissionais de saúde a diversas doenças crónicas é já uma realidade, existindo no mercado mundial diversas ofertas de dispositivos e sistemas de telemonitorização utilizados em doenças como a Diabetes mellitus, Doença pulmonar obstrutiva crónica (DPOC) e asma, Doença renal, Doenças tromboembólicas e Insuficiência cardíaca. Estes dispositivos e sistemas de telemonitorização apresentam uma solução para o problema crescente de incapacidade dos sistemas de saúde de dar resposta ao aumento de doentes crónicos. A massificação do uso dos dispositivos e sistemas de telemonitorização está dependente do seu aperfeiçoamento, sendo a falta de interoperabilidade de sistemas de apoio à saúde a maior falha nestes dispositivos e sistemas. A tendência futura passa pela incorporação desta capacidade nos dispositivos e sistemas de modo a massificar a sua utilização trazendo grandes vantagens tanto ao doente crónico como aos sistemas de saúde.The prevalence of chronic diseases is increasing along with the increase in the average life expectancy at birth. In the future, the number of the elderly and the chronically ill will be quite high and in many cases the elderly will also be chronically ill and the pathology will exist in many cases in Comorbidity. Alongside this reality, there will be a decrease in health resources, which leads to the research for solutions nowadays, so that they can be fully implemented in the future. Allying telemonitoring to the treatment of various chronic diseases is already a reality, and in the world market there are several offers of devices and telemonitoring systems used in diseases such as Diabetes mellitus, Chronic obstructive pulmonary disease and asthma, Renal disease, Thromboembolic diseases and Heart failure. These devices and telemonitoring systems provide a solution for the growing problem of the inability of health systems in order to provide better protocols to react to the increase in chronic patients. The widespread use of telemonitoring devices and systems is dependent on their improvement, and the lack of interoperability of health support systems is the greatest failure in these devices and systems. The future trend is to combine this ability into devices and systems in order to improve their use, bringing great benefits to both the chronic patient and health systems

Human Body Effects on RF Electronics

Wireless sensors require radio frequency (RF) circuits to operate at close proximity to the human body. For successful design of body worn applications of electronics the study of the effect of human body on RF interconnects and simple RF circuits has been undertaken through measurements and simulations in the frequency band of 50 MHz to 9 GHz. Coplanar waveguide (CPW) transmission lines are adopted to commence the investigation. The fact that in CPW structures the ground resides in the same plane as the signal trace enables the fabrication of thin structures apt for constructing. The test structures have been fabricated using inkjet technology which being an additive and low temperature process enables the printing of transmission lines and circuit structures at which in turn enables the fabrication of test structures on thin flexible Polyethylene naphthalate (PEN) substrate. In order to discern the effect of muscle on the RF interconnections, distributed parameters, effective relative permittivity, effective loss tangent, attenuation constant and characteristic impedance are extracted using a multiline extraction process. The extraction method was also used to successfully separate the dielectric and conductor losses. The simulations have been performed using the AWR Microwave Office commercial RF simulator. The validity of the simulations and measurements has been assessed with the agreement of the simulations with measurements. It is deduced from simulations and measurements that above 1 mm distance the losses become equal to that of free space and at 0.5 mm gap losses are close to free space as well. However, when the distance is less than 0.5 mm the losses are significant. In order to mitigate the effect of body on RF interconnects narrow gap width and center line width should be used above 4 GHz. Bending the RF interconnects did not produce any significant change in the scattering parameters of the coplanar wave guide transmission lines, illustrating that bends do not detune the circuit performance considerably. The effect of body on the RF circuits is analyzed using simple RF circuits of different sizes. Multiline Thru-Reflect-Line calibration has been used to extract scattering parameters of the discrete components used in the circuits. The on body simulations with AWR library components and extracted discrete component values reveal that as the length of the circuit is increased the measured components provided better convergence with measured results. The experiments performed illustrate that body has significant effect on the RF interconnects and RF circuits and the effects needs to be taken in account for proper performance of the RF circuits. The findings from the investigations are used to attain guidelines for body worn electronics design

Human Body Effects on RF Electronics

Wireless sensors require radio frequency (RF) circuits to operate at close proximity to the human body. For successful design of body worn applications of electronics the study of the effect of human body on RF interconnects and simple RF circuits has been undertaken through measurements and simulations in the frequency band of 50 MHz to 9 GHz. Coplanar waveguide (CPW) transmission lines are adopted to commence the investigation. The fact that in CPW structures the ground resides in the same plane as the signal trace enables the fabrication of thin structures apt for constructing. The test structures have been fabricated using inkjet technology which being an additive and low temperature process enables the printing of transmission lines and circuit structures at which in turn enables the fabrication of test structures on thin flexible Polyethylene naphthalate (PEN) substrate. In order to discern the effect of muscle on the RF interconnections, distributed parameters, effective relative permittivity, effective loss tangent, attenuation constant and characteristic impedance are extracted using a multiline extraction process. The extraction method was also used to successfully separate the dielectric and conductor losses. The simulations have been performed using the AWR Microwave Office commercial RF simulator. The validity of the simulations and measurements has been assessed with the agreement of the simulations with measurements. It is deduced from simulations and measurements that above 1 mm distance the losses become equal to that of free space and at 0.5 mm gap losses are close to free space as well. However, when the distance is less than 0.5 mm the losses are significant. In order to mitigate the effect of body on RF interconnects narrow gap width and center line width should be used above 4 GHz. Bending the RF interconnects did not produce any significant change in the scattering parameters of the coplanar wave guide transmission lines, illustrating that bends do not detune the circuit performance considerably. The effect of body on the RF circuits is analyzed using simple RF circuits of different sizes. Multiline Thru-Reflect-Line calibration has been used to extract scattering parameters of the discrete components used in the circuits. The on body simulations with AWR library components and extracted discrete component values reveal that as the length of the circuit is increased the measured components provided better convergence with measured results. The experiments performed illustrate that body has significant effect on the RF interconnects and RF circuits and the effects needs to be taken in account for proper performance of the RF circuits. The findings from the investigations are used to attain guidelines for body worn electronics design