Screening for Parkinson’s Disease with Response Time Barriers: A Pilot Study

Background: Although significant response time deficits (both reaction time and movement time) have been identified in numerous studies of patients with Parkinson’s disease (PD), few attempts have been made to evaluate the use of these measures in screening for PD. Methods: Receiver operator characteristic curves were used to identify cutoff scores for a unitweighted composite of two choice response tasks in a sample of 40 patients and 40 healthy participants. These scores were then cross-validated in an independent sample of 20 patients and 20 healthy participants. Results: The unit-weighted movement time composite demonstrated high sensitivity (90%) and specificity (90%) in the identification of PD. Movement time was also significantly correlated (r = 0.59, p \u3c 0.025) with the motor score of the Unified Parkinson’s Disease Rating Scale (UPDRS). Conclusions: Measures of chronometric speed, assessed without the use of biomechanically complex movements, have a potential role in screening for PD. Furthermore, the significant correlation between movement time and UPDRS motor score suggests that movement time may be useful in the quantification of PD severity

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Outlook Magazine, Summer 2018

https://digitalcommons.wustl.edu/outlook/1204/thumbnail.jp

Increasing the Capacity of Primary Care Through Enabling Technology.

Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow

Toward Universal Broadband in Rural Alaska

The TERRA-Southwest project is extending broadband service to 65 communities in the Bristol Bay, Bethel and Yukon-Kuskokwim regions. A stimulus project funded by a combination of grants and loans from the Rural Utilities Service (RUS), TERRA-Southwest has installed a middle-mile network using optical fiber and terrestrial microwave. Last-mile service will be through fixed wireless or interconnection with local telephone networks. The State of Alaska, through its designee Connect Alaska, also received federal stimulus funding from the National Telecommunications and Information Administration (NTIA) for tasks that include support for an Alaska Broadband Task Force “to both formalize a strategic broadband plan for the state of Alaska and coordinate broadband activities across relevant agencies and organizations.” Thus, a study of the impact of the TERRA project in southwest Alaska is both relevant and timely. This first phase provides baseline data on current access to and use of ICTs and Internet connectivity in rural Alaska, and some insights about perceived benefits and potential barriers to adoption of broadband. It is also intended to provide guidance to the State Broadband Task Force in determining how the extension of broadband throughout the state could contribute to education, social services, and economic activities that would enhance Alaska’s future. Results of the research could also be used proactively to develop strategies to encourage broadband adoption, and to identify applications and support needed by users with limited ICT skills.Connect Alaska. The National Telecommunications and Information Administration. General Communications Incorporated.Part 1: An Analysis of Internet Use in Southwest Alaska / Introduction / Previous Studies / Current Connectivity / Analytical Framework and Research Methodology / Demographics / Mobile Phones: Access and Use / Access to the Internet / Internet Useage / Considerations about Internet Service / Interest in Broadband / Sources of News / Comparison with National Data / Internet Use by Businesses and Organizations / What Difference may Broadband make in the Region? / Conclusiongs / Part 2 Literature Review / Reference

Occupational therapists’ views of using a virtual reality interior design application within the pre-discharge home visit process

This article has been made available through the Brunel Open Access Publishing Fund.Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment, to enable patients to function independently after hospital-home discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualise changes prior to implementing them. Customised VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration if developed effectively and integrated into the PHV process. Objective: To explore the perceptions of occupational therapists with regards to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilising the think-aloud protocol and subsequent semi-structured interviews were carried out with seven Occupational Therapists who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centring around the parameters that impact upon the acceptance, adoption and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communications and patient involvement, and improved patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully, however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customisations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Horizons and Perspectives eHealth

EHealth platform represents the combined use of IT technologies and electronic communications in the health field, using data (electronically transmitted, stored and accessed) with a clinical, educational and administrative purpose, both locally and distantly. eHealth has the significant capability to increase the movement in the direction of services centered towards citizens, improving the quality of the medical act, integrating the application of Medical Informatics (Medical IT), Telemedicine, Health Telematics, Telehealth, Biomedical engineering and Bioinformatics. Supporting the creation, development and recognition of a specific eHealth zone, the European Union policies develop through its programs FP6 and FP7, European-scale projects in the medical information technologies (the electronic health cards, online medical care, medical web portals, trans-European nets for medical information, biotechnology, generic instruments and medical technologies for health, ICT mobile systems for remote monitoring). The medical applications like electronic health cards ePrescription, eServices, medical eLearning, eSupervision, eAdministration are integral part of what is the new medical branch-eHealth, being in a continuous expansion due to the support from the global political, financial and medical organizations; the degree of implementation of the eHealth platform varying according to the development level of the communication infrastructure, allocated funds, intensive political priorities and governmental organizations opened to the new IT challenges.eHealth, telemedicine, telehealth, bioinformatics, telematics

The use of geographical applications for micro-planning school locations : the @SCHOOL app for preschools in Ghent, Belgium

Parallel with the increased use of internet technology, more and more data becomes freely accessible\ However, most of this data is only available in its raw form and centrally managed and thus not legible or applicable for non-professionals. Especially for primary needs such as health care or education, the availability of relevant information for inhabitants is crucial in improving their quality of life. Because education is one of the focal points in regional as well as in local policy, a dataset containing detailed information about school locations and characteristics was compiled on the regional level Flanders. However, this data is centrally owned and not made accessible for the public by a user-friendly tool. Therefore, a geographical application was developed, aimed at improving inhabitants' access to information concerning preschool locations in Ghent (Belgium). The combination of two open source programs (Google Docs and ESRI ArcGIS Online) makes it possible to centrally update the tool and make it available for all internet users in real-time. In the first phase, local authorities as well as civilians are able to request all relevant information (i.e. school name, school address, capacity, Google street view) about the selected nursery school in Ghent by implementing this user-friendly and open source tool. Furthermore, the tool can be used to determine which preschool is closest to a specific address. In the next phase, the dataset used in the application will be extended to contain information concerning all primary schools of the Flemish community. Today, the application is used by different local authorities as a tool for policy support and is available to inhabitants in Ghent in the process of enrolment ('Central Application Register' or CAR). The convenient and intuitive interface makes the tool inclusive for poorly-educated parents or internet illiterates