Chapter 8: Executive Summary

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63118/1/15305620252933437.pd

Global Diffusion of the Internet X: The Diffusion of Telemedicine in Ethiopia: Potential Benefits, Present Challenges, and Potential Factors

Delivery of healthcare services presents many challenges for governments in most developing countries. Some of these challenges include financial and human resources issues that might affect governments\u27 ability to manage and transform scarce resources to meet healthcare needs. Telemedicine, a healthcare delivery technology where physicians examine patients from distant locations using information technologies, is reported to be increasingly helpful in meeting the needs of the healthcare sector in developing nations such as those in sub-Saharan Africa. This conceptual study reports on the sectoral adoption of telemedicine in Ethiopia, a sub-Saharan African country. We examine the potential benefits of telemedicine diffusion in Ethiopia, addressing the country\u27s healthcare needs, and discussing the obstacles and challenges. Based on previous literature, as well as experiences drawn from other developing nations, we address three potential factors that could influence the diffusion of telemedicine in Ethiopia: active participation of institutions of higher education, Ethiopian foreign alliances, and government involvement. Although the initial successes are relatively small and involve isolated projects, they have been promising and have set the stage for researchers to investigate prevailing projects so as to gain better understanding of the aforementioned factors. Our study does not claim that telemedicine can solve all of Ethiopia\u27s medical challenges; however, we contend that it is a starting point to reach Africans that live in areas with limited medical facilities and personnel. Hence, our study could have far reaching implications as the world looks to help this country, and by extension, other developing countries, to overcome their medical challenges and join the information society

Evaluating a Web-Based Interface for Internet Telemedicine

The objective is to introduce the usability engineering methodology, heuristic evaluation, to the design and development of a web-based telemedicine system. Using a set of usability criteria, or heuristics, one evaluator examined the Spacebridge to Russia web-site for usability problems. Thirty-four usability problems were found in this preliminary study and all were assigned a severity rating. The value of heuristic analysis in the iterative design of a system is shown because the problems can be fixed before deployment of a system and the problems are of a different nature than those found by actual users of the system. It was therefore determined that there is potential value of heuristic evaluation paired with user testing as a strategy for optimal system performance design

Psychiatric Case Record

Bipolar Disorder-Mania: Patient was apparently normal one-month back, Then all of a sudden he developed sleep disturbances –mainly difficult in initiation of sleep. He also started abusing his family members for unwanted things. Subsequently, he started talking excessively and irritable. Sometimes he sings film songs and dances. He used to say that God Supreme exists in himself and so he has all the powers of Almighty. With that superior power he says that he can solve all the problems in this world. He also says that he has invented herbs to keep people young. For the past one week, he talks excessively without having an hour of sleep & wanders here and there & found excessively smoking. He becomes excessively spiritual and goes to near by villages for offering prayers to God. He takes only a little food everyday and he is very much keen in personal cleanliness. Paranoid Schizophrenia: She was apparently normal 8 months back, then she developed sleep disturbances in the form of difficult in falling asleep. She was found talking & smiling to herself at night & day with mirror gazing. She started saying that her neighbour & relatives are planning to kill herself by poisoning. In this context she had frequent quarrels with them and she refused to take food prepared by her mother in law. She left the home at night without informing any one and started wandering in the road side near her home. She was complaining that she hears voices as if her neighbour & relatives were talking about her among themselves She was not doing house hold activities for past 6 months and she was not taking care of her child. Her personal hygiene was very much deteriorated slowly as she used to take bath & brush, only if she was asked to do so. She started abusing & assaulting the strangers and family members. Generalised Anxiety Disorder: Six months back he was apparently normal. He is working as a system analyst in a private bank . He had once, made a mistake in his bank work for which he was given charges by his employer, followed this event he becomes very tense and afraid whenever his boss called him. He is very cautious that he should not commit any mistakes. Even though he is not doing so, he fears that he may commit some mistake in his work. At that moment he develops palpitation, giddiness, breathlessness, excessive sweating over palms and soles. Slowly these symptoms present through out the day even when he was not in his office, and he could not control his fearfulness. For the past 6 months he didn’t sleep well. His sleep is disturbed by bad dreams. Recurrent Depressive Disorder: Patient was apparently alright 2 months back. Then she developed sleep disturbances particularly early morning awakening, she use to wake up by 3.00 am and use to brood about herself and started crying. She was not doing her domestic work as before, as she felt excess tiredness and use to take frequent rests. She developed poor communication. She had lost her interest in pleasurable activities and was not interested in watching TV, and attending family gatherings. She stayed aloof most of the time & calm, quiet and withdrawn. She was expressing her helplessness and hopelessness about the future. She started to have decline in maintaining self care. 15 days back, she frequently expressed suicidal ideas and she had attempted suicide by hanging herself and was rescued by neighbours. 5 days back, she started talking in an irrelevant manner. She was smiling to self. She was assaulting her family members. She was suspicious that her neighbour had done black magic on her and also saying that people are talking about her. She reported hearing the voice of her neighbour scolding and threatening her. Organic Brain Syndrome – Dementia: Ten months back he was apparently alright. Then his relatives noticed himself frequently misplaces things inside his home. Then he started behaving aggressively. He was beating his wife without reason. He was roaming here and there, running out of home and wandering aimlessly. He was not able to come back home when he goes out. He was brought back to home by his relatives. Slowly he developed fearfulness and tremulousness while he was staying alone. He also started saying that his family members & neighbours were talking about himself, in this context he would make frequent quarrels with them. He also started hearing voices of known male voices abusing himself in third person. He sleeps for few hour only. He is passing urine and motion inside the house. He is asking about his brother and mother-in-law who were expired long back. He behaves abnormally such as pouring water in the plate while eating. And his relatives found the symptoms were worsened by evening. All these symptoms started insidiously, increased in severity through time and attained the present state. No history of loss of appetite / crying spells / suicidal tendencies / convulsions / fever / head injury

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

The potential impact of 5G telecommunication technology on ophthalmology

Published online: 17 March 2021Advances in information and communication technology (ICT) are having an increasing impact on the practice of ophthalmology. Successive generations of 4G networks have provided continued improvements in bandwidth and download speeds. Fibre-optic networks were promised as the next step in the development of a faster and more reliable network. However, due to considerable delays in their widespread implementation, original expectations have not been met. Currently, the new 5G network is on the verge of widespread release and aims to offer previously unparalleled bandwidth, speed, reliability and access. This review aims to highlight the potential profound impact near instantaneous communication (the 5G network) may have on ophthalmology and the delivery of eyecare to the global population. Conversely, if the new network fails to deliver as intended, the wireless network itself may become yet another obstacle to adopting next-generation technologies in eyecare.Gurfarmaan Singh, Robert Casson, WengOnn Cha

What factors are associated with the use of teletrauma in northern British Columbia?

Despite the existence of universal health care for Canadians, health inequalities persist. Those residing in rural regions of Canada may be at a disadvantage for accessing appropriate services. To enhance access, a teletrauma program was implemented in the Robson Valley, connecting rural clinicians during emergency cases. This study was undertaken to better understand the experiences of teletrauma users and why teletrauma is utilized. Data were gathered from 14 interviews with clinicians, health administrators, a researcher, and a health executive. Guided by interpretive description methodology, four major themes emerged, including: teletrauma affects the entire system of care; teletrauma enables a network of care built on interprofessional relationships; reasons clinicians use teletrauma are multifaceted and interrelated; and, interconnectedness of the healthcare system. Information from this study provides insight into the role and function of teletrauma in northern British Columbia and how it may better serve the needs of rural clinicians

Avantages et inconvénients de la formation médicale continue virtuelle : une étude de la portée

Introduction: With the COVID-19 pandemic, most continuing medical education activities became virtual (VCME). The authors conducted a scoping review to synthesize the advantages and disadvantages of VCME to establish the impact of this approach on inequities that physicians face along the intersections of gender, race, and location of practice. Methods: Guided by the methodological framework of Arksey and O’Malley, the search included six databases and was limited to studies published between January 1991 to April 2021. Eligible studies included those related to accredited/non-accredited post-certification medical education, conferences, or meetings in a virtual setting focused on physicians. Numeric and inductive thematic analyses were performed.   Results: 282 studies were included in the review. Salient advantages identified were convenience, favourable learning formats, collaboration opportunities, effectiveness at improving knowledge and clinical practices, and cost-effectiveness. Prominent disadvantages included technological barriers, poor design, cost, lack of sufficient technological skill, and time. Analysis of the studies showed that VCME was most common in the general/family practice specialty, in suburban settings, and held by countries in the Global North. A minority of studies reported on gender (35%) and race (4%).  Discussion: Most studies report advantages of VCME, but disadvantages and barriers exist that are contextual to the location of practice and medical subspecialty. VCME events are largely organized by Global North countries with suboptimized accessibility for Global South attendees. A lack of reported data on gender and race reveals a limited understanding of how VCME affects vulnerable populations, prompting potential future considerations as it evolves. Introduction : Par suite de la pandémie de la COVID-19, la plupart des activités de formation médicale continue ont été offertes en ligne. Les auteurs ont effectué une revue de la portée visant à synthétiser les avantages et les inconvénients de la formation médicale continue en mode virtuel (FMCV) et à examiner les effets de cette approche sur les inégalités qui affectent les médecins en fonction du sexe, de la race et du lieu d’exercice. Méthodes : Suivant le cadre méthodologique d’Arksey et O’Malley, nous avons effectué une recherche dans six banques de données, que nous avons limitée aux études publiées entre janvier 1991 et avril 2021. Les études incluses étaient celles relatives à la formation médicale post-certification, accréditée ou non, aux conférences et aux réunions destinées aux médecins qui se sont déroulées dans un cadre virtuel. Une analyse numérique et une analyse thématique inductive ont été réalisées. Résultats : Au total, 282 articles ont été inclus dans l’étude. Les principaux avantages identifiés sont la commodité, les formats favorables à l’apprentissage, les possibilités de collaboration, l’efficacité pour l’amélioration des connaissances et des pratiques cliniques et le rapport coût-efficacité. Les principaux inconvénients sont les obstacles technologiques, les défauts de conception, le coût, les compétences technologiques insuffisantes et le manque de temps. L’analyse des études a montré que la FMCV était la plus courante dans la spécialité de la médecine générale/familiale, dans les banlieues et dans les pays du Nord. Quelques études considèrent les facteurs sexe (35 %) et race (4 %). Discussion : La plupart des études évoquent les avantages de la FMCV, mais il existe des inconvénients et des obstacles liés au lieu d’exercice et à la sous-spécialité médicale. La plupart des activités de FMCV sont organisées dans les pays du Nord et leur accessibilité n’est pas optimale pour les participants provenant des pays du Sud. Le manque de données sur le sexe et la race pose une limite à notre compréhension de la façon dont la FMCV affecte les populations vulnérables. Ces facteurs seraient à prendre en considération dans les recherches futures sur le sujet et au fur et à mesure que la FMCV évolue.