Necessary Skills and Knowledge for Staff Providing Telehealth Services

Background Although motor abnormalities have been flagged as potentially the most sensitive and specific clinical features for predicting the future progression to Parkinson's disease, little work has been done to characterize gait and balance impairments in idiopathic rapid eye movement sleep behavior disorder (iRBD). Objective The objective of this study was to quantitatively determine any static balance as well as gait impairments across the 5 independent domains of gait in polysomnography-confirmed iRBD patients using normal, fast-paced, and dual-task walking conditions. Methods A total of 38 participants (24 iRBD, 14 healthy controls) completed the following 5 different walking trials across a pressure sensor carpet: (1) normal pace, (2) fast pace, (3) while counting backward from 100 by 1s, (4) while naming as many animals as possible, (5) while subtracting 7s from 100. Results Although no gait differences were found between the groups during normal walking, there were significant differences between groups under the fast-paced and dual-task gait conditions. Specifically, in response to the dual tasking, healthy controls widened their step width without changing step width variability, whereas iRBD patients did not widen their step width but, rather, significantly increased their step width variability. Similarly, changes between the groups were observed during fast-paced walking wherein the iRBD patients demonstrated greater step length asymmetry when compared with controls. Conclusions This study demonstrates that iRBD patients have subtle gait impairments, which likely reflect early progressive degeneration in brainstem regions that regulate both REM sleep and gait coordination. Such gait assessments may be useful as a diagnostic preclinical screening tool for future fulminant gait abnormalities for trials of disease-preventive agents. (c) 2019 International Parkinson and Movement Disorder Societ

The International Digital Transformation of Healthcare: Telehealth Development in the Global Community

Using advances in information and communication technologies (ICT), telemedicine and eHealth are providing a means to transform systems of care for people throughout the world by providing greater access to clinical service, consultation, sharing knowledge, education and training, public and community health, health systems development, epidemiology and research. Leap-frogging over prior barriers, rapid advances in information communication technologies (ICT), computing, and wireless networks are offering greater continuity in access to these services in both developed and developing countries. The use of telehealth must be put in the context of the critical health needs in each country, cultural perspectives, current and future communication infrastructure, other supportive resources, and likelihood for sustainability. Furthermore, these telehealth efforts should be aimed at improving the local capacity in providing ongoing health services in each country and blend into that country’s current and future health care strategies. As the world continues to “shrink”, developing this international telehealth “network of networks” offers an opportunity for cooperation, collaboration, knowledge sharing and improving the health of every individual in the world, applying information technologies for peace and the betterment of mankind. The time is now for open and constructive dialogue designed to facilitate that coordination between key stakeholders and other international organisations. These types of international exchange experiences enhanced with telehealth offer significant opportunities for understanding the common denominators, as well as unique differences, related to global health among countries and cultures around the world. These programs can promote international understanding and mutual respect in a manner that can improve the health of the entire global community