General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease:implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

<strong>Objective</strong> The Scottish Care Information - Diabetes Collaboration (SCI-DC) developed a computer- based information system to create a shared electronic record for use by all involved in the care of patients with diabetes mellitus. The objectives of this study were to understand primary care practitioners' views towards screening for diabetic foot disease and their experience of the SCI-DC system. <strong>Method</strong> We conducted an exploratory study using qualitativemethods. Semi-structured interviews were audiotape-recorded, transcribed and subjected to thematic analysis. Seven practice nurses and six general practitioners (GPs) with special responsibility for diabetes care inNHS Lothian participated. <strong>Results</strong> Primary care clinicians reported good systems in place to screen for diabetes-related complications and to refer their patients to specialist care. Foot ulceration was rarely observed; other diabetesrelated conditions were seen as a higher priority. Most had heard of the SCI-DC foot assessment tool, but its failure to integrate with other primary care information technology (IT) systems meant it was not used in these general practices. <strong>Conclusions</strong> Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption

A Priority-based Fair Queuing (PFQ) Model for Wireless Healthcare System

Healthcare is a very active research area, primarily due to the increase in the elderly population that leads to increasing number of emergency situations that require urgent actions. In recent years some of wireless networked medical devices were equipped with different sensors to measure and report on vital signs of patient remotely. The most important sensors are Heart Beat Rate (ECG), Pressure and Glucose sensors. However, the strict requirements and real-time nature of medical applications dictate the extreme importance and need for appropriate Quality of Service (QoS), fast and accurate delivery of a patient’s measurements in reliable e-Health ecosystem. As the elderly age and older adult population is increasing (65 years and above) due to the advancement in medicine and medical care in the last two decades; high QoS and reliable e-health ecosystem has become a major challenge in Healthcare especially for patients who require continuous monitoring and attention. Nevertheless, predictions have indicated that elderly population will be approximately 2 billion in developing countries by 2050 where availability of medical staff shall be unable to cope with this growth and emergency cases that need immediate intervention. On the other side, limitations in communication networks capacity, congestions and the humongous increase of devices, applications and IOT using the available communication networks add extra layer of challenges on E-health ecosystem such as time constraints, quality of measurements and signals reaching healthcare centres. Hence this research has tackled the delay and jitter parameters in E-health M2M wireless communication and succeeded in reducing them in comparison to current available models. The novelty of this research has succeeded in developing a new Priority Queuing model ‘’Priority Based-Fair Queuing’’ (PFQ) where a new priority level and concept of ‘’Patient’s Health Record’’ (PHR) has been developed and integrated with the Priority Parameters (PP) values of each sensor to add a second level of priority. The results and data analysis performed on the PFQ model under different scenarios simulating real M2M E-health environment have revealed that the PFQ has outperformed the results obtained from simulating the widely used current models such as First in First Out (FIFO) and Weight Fair Queuing (WFQ). PFQ model has improved transmission of ECG sensor data by decreasing delay and jitter in emergency cases by 83.32% and 75.88% respectively in comparison to FIFO and 46.65% and 60.13% with respect to WFQ model. Similarly, in pressure sensor the improvements were 82.41% and 71.5% and 68.43% and 73.36% in comparison to FIFO and WFQ respectively. Data transmission were also improved in the Glucose sensor by 80.85% and 64.7% and 92.1% and 83.17% in comparison to FIFO and WFQ respectively. However, non-emergency cases data transmission using PFQ model was negatively impacted and scored higher rates than FIFO and WFQ since PFQ tends to give higher priority to emergency cases. Thus, a derivative from the PFQ model has been developed to create a new version namely “Priority Based-Fair Queuing-Tolerated Delay” (PFQ-TD) to balance the data transmission between emergency and non-emergency cases where tolerated delay in emergency cases has been considered. PFQ-TD has succeeded in balancing fairly this issue and reducing the total average delay and jitter of emergency and non-emergency cases in all sensors and keep them within the acceptable allowable standards. PFQ-TD has improved the overall average delay and jitter in emergency and non-emergency cases among all sensors by 41% and 84% respectively in comparison to PFQ model

Building consensus about eHealth in Slovene primary health care: Delphi study

<p>Abstract</p> <p>Background</p> <p>Slovenia's national eHealth strategy aims to develop an efficient, flexible and modern health care informatics framework that would be comparable to the most successful EU countries. To achieve this goal, the gap between availability and usage of information and communication technology by primary care physicians needs to be reduced.</p> <p>As recent efforts show, consensus on information and communication technology purpose and usage in primary care needs to be established before any national information and communication technology solutions are developed.</p> <p>The aim of this study was to identify the most appropriate measures in implementation of Slovene national eHealth strategy and to suggest an appropriate model for success by using the three round Delphi study.</p> <p>Methods</p> <p>An e-mail based, three-round Delphi study was undertaken to achieve consensus from a selected sample of nationally recognized experts from the fields of primary health care and medical informatics. The aim of this study was to identify the most appropriate measures and key obstacles in implementation of eHealth in Slovene primary health care by using the Delphi study.</p> <p>Results</p> <p>High levels of consensus on the majority of suggested measures were achieved among all study participants, as well as between the subgroups of experts from primary health care and medical informatics. All aims of the three-round Delphi study on eHealth implementation in Slovenian primary health care were achieved.</p> <p>Conclusions</p> <p>The three round decision Delphi process has proven to be effective for developing outcomes, ranking key priorities in primary care eHealth development, and achieving consensus among the most influential experts in that field. This consensus is an important contribution to future national eHealth strategies in the field of primary health care.</p

Using Mobile Devices as a Supportive Tool to Engage and Interest Young Students in e-Health

Master's thesis Multimedia and Educational Technology MM500 - University of Agder 2019This thesis explores if mobile devices could be used as a supportive elementto engage and interest young students in e-health by developing a prototypeto handle simulations of e-health scenarios in a serious game setting. Theprototype was to be used as a supportive tool for the research projectHighSchool Students as Co-researchers in eHealth. An iterative design processwas deployed to develop the prototype, going through multiple steps periteration, focusing on design and development, testing, and evaluation. Theresults from all of the testing were examined, and compared with the researchquestions regarding whether or not mobile devices are useful as supportivetools to engage and interest students. It is hoped that the study encouragesfuture use of mobile devices in education and learning

Personal State and Emotion Monitoring by Wearable Computing and Machine Learning

One of the major scientific undertakings over the past few years has been exploring the interaction between humans and machines in mobile environments. Wearable computers, embedded in clothing or seamlessly integrated into everyday devices, have an incredible advantage to become the main gateway to personal health management. Current state of the art devices are capable in monitoring basic physical or physiological parameters. Traditional health systems procedures depend on the physical presence of the patient and a medical specialist that not only is a reason of overall costs but also reduces the quality of patients' lives, particularly elderly patients. Usually, patients have to go through the following steps for the traditional procedure: Firstly, patients need to visit the clinic, get registered at reception, wait for the turn, go to the lab for the physiological measurement, wait for the medical experts call, to finally receive feedback from the medical expert. In this work, we examined how to utilize existing technology in order to develop an e-health monitoring system especially for heart patients. This system should support the interaction between the patient and the physician even when the patient is not in the clinic. The supporting wearable health monitoring system WHMS should recognize physical activities, emotional states and transmit this information to the physician along with relevant physiological data; in this way patients do not need to visit the clinic every time for the physician's feed-back. After the discussion with medical experts, we identified relevant physical activities, emotional states and physiological data needed for the patients' examinations. A prototype of this concept for a health monitoring system of the proposed solution was implemented taking into account physical activities, emotional states and physiological data

An Exploration of How Health Professionals Create eHealth and mHealth Education Interventions

The purpose of this study was to explore how health education professionals create ehealth and mhealth education interventions. Three research questions led this qualitative study. The first research question focused on the use of learning theories, instructional models, and instructional design models. The second research question focused on the use of elearning and mlearning design principles. The third research question focused on the use of health behavior theories and models. Twelve health professionals selected for their involvement in the creation of ehealth and mhealth education interventions participated in this study. The themes emerging from the research questions showed a variability in how the participants used education theories and models, principles of elearning and mlearning design, and health behavior and health education theories and models to create ehealth and mhealth interventions. On education theories and models, the participants used elements of instructional design (i.e., analysis, design, evaluation) but did not use any specific instructional design model. Moreover, they invested efforts in creating instructional strategies that reflected instructional models of different learning theories but did not specify particular models or theories. Four themes emerged on the instructional strategies they used in the interventions: (1) connections to behaviorist approaches to learning, (2) connections to cognitivist approaches to learning, (3) connections to constructivist approaches to learning, and (4) unspecified learning theories. On the use of elearning design principles, seven patterns emerged: (1) interaction, (2) learner control, (3) provision of help, (4) use of multimedia, (5) engagement, (6) user friendliness, and (7) visual appeal. On the use of health behavior theories and models, three themes emerged (1) no use of health behavior theory or model, (2) use of a mix of health behavior theories or models, and (3) use of a particular health behavior theory or model. The variability of the findings and the resulting themes suggested implications for practice and further research. These implications concern all health professionals creating ehealth and mhealth interventions as well as scholars in the field of instructional design and health education and heath behavior. The implications and limitations of the study were also discussed

eHealth for family planning in Botswana: acceptability and feasibility

BACKGROUND: As many as 50% of pregnancies in Botswana are unintended, but only half of women in the country are currently using contraception. This thesis explores the barriers and facilitators for provision, choice and use of contraception in Botswana, and the feasibility and potential for an eHealth intervention in the field of family planning to address them. METHODS: I conducted a narrative review of factors influencing contraceptive choice, uptake and use in Botswana, and qualitative, semi-structured interviews with Batswana women (n=22), healthcare providers and key policy stakeholders in family planning (n=14), and Botswanabased eHealth experts (n=11). FINDINGS: Many Batswana women lack accurate, in-depth family planning knowledge, and experience extreme clinical and social barriers in accessing contraception. Socio-cultural barriers are more influential than physical access or availability, with partner control and patriarchal attitudes towards sex and gender the most prominent reason for women’s non-use of contraception, exacerbated by urban-rural disparity and education level. Botswana’s HIV epidemic has heavily dominated sexual health services and policy, leading to conflict between national approaches towards HIV and family planning. Key challenges for eHealth innovation in Botswana are related to inconsistent Wi-Fi infrastructure, a lack of national policy, and a reliance on external partners leading to unsustainable design and implementation of interventions. Suggestions for an eHealth intervention in family planning include using a range of media platforms to address varied levels of technological knowledge and access, and ensuring content is culturally appropriate and useful to intended users. CONCLUSION: There is a need, and desire, for more detailed, balanced, up-to-date family planning information for women, their partners, and the providers who counsel them. An eHealth intervention that adheres to the realities of technology and infrastructure limitations, and is Botswana-led in terms of content, design, and implementation, could be highly effective in addressing this gap

Innovation in Healthcare, An analysis of the regional preconditions in Skåne for innovation in digital healthcare.

The upcoming changes in the demographic structure will put pressure on the healthcare system in Skåne. Tax financed hospitals with more beds, doctors, nurses and other personnel will not be the solution to cope with the upcoming demands. Increasing healthcare productivity is one way, where digital healthcare is a potential part of the solution. One of the major limitations of the digital healthcare market is not the shortage of technology but rather the innovation-uptake is slow in healthcare compared to other sectors. The problem is to understand why the technology uptake is slow, which barriers prevents uptake and what decelerate continued innovation in the healthcare sector. Purpose: The main purpose aim to describe and analyze the regional preconditions in Skåne for innovation in digital healthcare. The goal has been to identify strengths, opportunities and various barriers that prevents or delay innovation in the region. Identifying and proposing innovative health strategies with the TOWS-framework. Sub purposes are to identify upcoming global trends in healthcare and gather a list of digital healthcare projects in the region. Methodology: The methodology for gathering data for this master thesis consists of a combination of primary and secondary data. Collected from secondary research, explorative quantitative survey study, semi structured interviews with key actors, attending and observing national and local eHealth events. Conclusions: The region of Skåne in the south of Sweden got the possibilities for a good climate for innovation in healthcare. There is a possibility to gather ideas and projects for incremental innovation in the region. Both the healthcare professionals and patients are sitting with valuable expertise and knowledge, which at this time is not fully utilized. To get a more radical change in the healthcare sector some barriers need to be broken down. These changes need a more strategic and political approach, many of them need to be brought up on a national level. Today security laws regulation the use of information need to be modified to allow the use of unidentified healthcare data. Making it easier for the academia and companies to use this information would allow them to pursue new research areas and possible innovations. For new entrepreneurs and businesses there is need to learn how to use the reimbursement model to support their business plans. It is also important that the way into the healthcare sector, procurements, is built to handle and promote these new ventures. Skåne has a gap in expertise regarding semantic interoperability, both in the business and academic sector. This is not a unique problem for Skåne and can be seen in other regions as well. Collaborations with other regions and worldwide expertise is needed to fill this gap and promote advances in this field. Comparing to other countries, Sweden are ranked 3rd on the list of innovation uptake in healthcare just beaten by Denmark and Estonia. Third place in digital healthcare solution implementation is good but we can’t sit down and be satisfied with the result. Even if you are in first place you need to constantly revaluate your position and look for areas to improve. The region have most of the building blocks to get a good climate for innovation in digital healthcare. Region Skåne have to join the blocks together, here is a unique opportunity to facilitate cross-border meetings, be a collaborate voice, and put digital healthcare on the agenda. There is a need for a link into healthcare to get providers, doctors and nurses to share their ideas and needs to business, entrepreneurs, and the academia. Lobbying to politicians and policymakers should be done to raise the awareness and try to change some regulations and laws that acts as barriers for innovation today