Investigating the Emotional Context of Pediatric Critical Care Telemedicine Consultations

Patient-present physician-to-physician telemedicine consultations have been shown to be effective, yet diffusion is not widespread. While much prior research has investigated how computer anxiety affects acceptance and usage of telemedicine and other systems, few prior studies have addressed the impact of situational anxiety (e.g., anxiety caused by the stress of treating a critically-ill child under time pressure) or other emotions on telemedicine acceptance and ongoing use. We report on findings from an embedded-cases study of four hospitals that participate in a telemedicine consultation service provided by a rural tertiary-care hospital. Interviews revealed that telemedicine can help clinicians cope with emotions such as anxiety, grief, and anger that arise from the high-stakes pediatric critical care context. Study findings point to design principles for telemedicine and for collaborative systems in other domains, in and beyond health care

Evaluating the feasibility and impact of a synchronous health technology innovation in the provision of pediatric health care in a University Hospital.

La prestation de soins critiques et d'orthophonie en milieu pédiatrique nécessite beaucoup de travail pour atteindre le niveau de soins souhaité. Plusieurs facteurs contribuent à ce problème, parmi lesquels la pénurie de ressources, les besoins pressants et l’augmentation du nombre d’enfants malades. Parmi les solutions proposées, beaucoup pensent que la télémédecine synchrone peut être utile en donnant un accès virtuel immédiat aux compétences à distance. Ainsi, l'expertise pourrait être instantanément disponible via une plateforme permettant une communication efficace et capable de soutenir les soins pédiatriques. La télémédecine s’est beaucoup développée dans la prestation des soins critiques et de réadaptation pédiatriques, et ce aux plans diagnostique et thérapeutique. Pourtant, peu d’études ont examiné la faisabilité et évalué l’impact de la télémédecine sur la qualité des soins critiques et de réadaptation pédiatrique. L'objectif principal de cette thèse était d'évaluer la faisabilité de la télémédecine synchrone dans deux contextes pédiatriques, critique et réadaptation, et d'évaluer son influence sur le processus de prestation de soins pédiatriques. Le premier article présente les résultats d'une revue systématique qui synthétisait des études évaluant l'impact des modèles de télémédecine synchrone sur les résultats cliniques dans les établissements de soins de courte durée en pédiatrie. Les résultats ont révélé que l’utilisation de la télémédecine synchrone avait pour effet d’améliorer la qualité des soins, de diminuer le taux de transfert, de réduire de la durée du séjour, de modifier ou renforcer le plan de soins médicaux, de réduire les complications et la gravité de la maladie, et de diminuer le taux de mortalité hospitalière et standardisé. Cependant, la revue de l’état de connaissances a révélé que la qualité des études incluses était faible et que des preuves de haute qualité étaient nécessaires. Le deuxième article, fondé sur un devis pré/post, évalue la faisabilité de la télémédecine à domicile en orthophonie et son impact sur la satisfaction des enfants et orthophonistes, le coût économique, et les performances vocales. Cette étude a montré que la télémédecine en orthophonie était faisable et que les enfants et les orthophonistes étaient satisfaits du service. En outre, l'utilisation de la télémédecine en orthophonie a permis d'améliorer la voix et de faire économiser de l'argent aux parents. Le troisième article évalue la faisabilité de la mise en place d’une plate-forme de télémédecine synchrone dans l’unité des soins intensifs pédiatriques (USIP). Pour qu'une solution de télémédecine synchrone à l’USIP soit faisable, elle nécessite une bonne préparation préalable à la mise en œuvre de la plate-forme de télémédecine synchrone pour être réellement utile. Avec des médecins résidents compétents et autonomes, l’utilité d’une plate-forme de télémédecine synchrone reliant les intensivistes pédiatriques hors site et les médecins résidents sur site à l’USIP est faible. Cette étude a ajouté qu'un tel service pourrait être plus bénéfique que le modèle traditionnel des soins (face à face) pour les communications avec d'autres établissements de soins de santé éloignés, où le besoin d'expertise d'un intensiviste en soins intensifs pédiatriques est plus important. Ces trois études permettent de conclure que la télémédecine synchrone est réalisable et peut avoir un impact sur la qualité des soins intensifs et de réadaptation pédiatrique. On peut déduire de cette thèse qu'il est important de prendre en compte le contexte dans lequel la technologie sera mise en œuvre. Traiter le contexte de l’USIP et celui de réadaptation de la même manière n'aboutit pas aux mêmes résultats et une innovation technologique pourrait réussir dans un contexte et échouer dans un autre.Delivering critical and speech-language pathology care in pediatric settings requires much hard work to reach the desired level of care for children. Several factors contribute to this problem, including resources shortage, pressing needs, and the growing number of ill children. Among the proposed solutions, many believe that synchronous telemedicine can play a role by providing virtual and immediate access to remote skills, with expertise could be made instantly available through a platform that allows efficient communication and is able to support pediatric care. Telemedicine has developed significantly in the provision of critical care and pediatric rehabilitation in terms of diagnosis and therapy. Yet, few studies have examined the feasibility and evaluated the impact of telemedicine on the quality of pediatric critical care and rehabilitation. The main objective of this dissertation was to assess the feasibility of synchronous telemedicine in two pediatric settings—critical care and rehabilitation—and to evaluate its influence on the process of providing pediatric care. The first article presented the results of a systematic review that synthesized studies evaluating the impacts of synchronous telemedicine models on clinical outcomes in pediatric acute care settings. The findings revealed that the use of synchronous telemedicine improved quality of care and resulted in a lower transfer rate, a shorter length of stay, a change in or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital standardized mortality rate. However, the review of the state of knowledge revealed that the quality of the included studies was weak, so more high-quality evidences is needed. The second article, which used a pre/post design, assesses the feasibility assessed the feasibility of home-based telepractice in speech-language pathology (TSLP) and its impact on satisfaction among the children and speech-language pathologists, economic cost, and voice performance. This study showed that TSLP is feasible and that both the children and the speech-language pathologists were satisfied with the service. In addition, the use of TSLP demonstrated more voice improvement at less cost to the parents. The third article evaluated the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). For a STEP-PICU to be feasible and truly helpful, it needs good preparation for the implementation of the telemedicine solution. With competent and autonomous fellows (a fellow is a physician who has completed their residency and elects to complete further training in a subspecialty), the usefulness of an synchronous telemedicine (STM) platform linking off-site pediatric intensivists and on-site fellows in a PICU is limited. This study added that such a service could be more beneficial than the traditional model of care (face to face) for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist. These three studies allow us to conclude that STM is feasible and can have an impact on the quality of pediatric intensive care and rehabilitation. This thesis underscores the importance of taking into consideration the context in which the technology will be implemented. Treating the PICU and the rehabilitation contexts in the same way does not lead to the same results, and a technological innovation that succeeds in one setting may fail in another

Investigating the cost-effectiveness of videotelephone based support for newly diagnosed paediatric oncology patients and their families: design of a randomised controlled trial

BACKGROUND: Providing ongoing family centred support is an integral part of childhood cancer care. For families living in regional and remote areas, opportunities to receive specialist support are limited by the availability of health care professionals and accessibility, which is often reduced due to distance, time, cost and transport. The primary aim of this work is to investigate the cost-effectiveness of videotelephony to support regional and remote families returning home for the first time with a child newly diagnosed with cancer METHODS/DESIGN: We will recruit 162 paediatric oncology patients and their families to a single centre randomised controlled trial. Patients from regional and remote areas, classified by Accessibility/Remoteness Index of Australia (ARIA+) greater than 0.2, will be randomised to a videotelephone support intervention or a usual support control group. Metropolitan families (ARIA+ ≤ 0.2) will be recruited as an additional usual support control group. Families allocated to the videotelephone support intervention will have access to usual support plus education, communication, counselling and monitoring with specialist multidisciplinary team members via a videotelephone service for a 12-week period following first discharge home. Families in the usual support control group will receive standard care i.e., specialist multidisciplinary team members provide support either face-to-face during inpatient stays, outpatient clinic visits or home visits, or via telephone for families who live far away from the hospital. The primary outcome measure is parental health related quality of life as measured using the Medical Outcome Survey (MOS) Short Form SF-12 measured at baseline, 4 weeks, 8 weeks and 12 weeks. The secondary outcome measures are: parental informational and emotional support; parental perceived stress, parent reported patient quality of life and parent reported sibling quality of life, parental satisfaction with care, cost of providing improved support, health care utilisation and financial burden for families. DISCUSSION: This investigation will establish the feasibility, acceptability and cost-effectiveness of using videotelephony to improve the clinical and psychosocial support provided to regional and remote paediatric oncology patients and their families

Assessment of Staff Comfort with Sexual Assault Examination after Implementation of TeleSANE Program

Introduction: Utilization of telehealth to provide a trained sexual assault nurse examiner (SANE) to rural facilities during sexual assault examinations (SAEs) has shown documented success increasing healthcare access and cost savings. SANE consult results in better evidence collection, injury identification, and better medical and legal outcomes for patients presenting with complaints of sexual assault (SA).Methods: Literature searches were conducted in CINAHL, EBSCOhost, and IAFN journal to find evidence supporting telehealth interventions and staff or patient comfort. Twenty articles supported the clinical question. Seven of the articles met high-quality criteria; 11 of the articles were considered good quality with reasonably consistent results. Two articles were graded lower quality due to small sample size. Gaps: There is a need for more concrete and objective exploration of the implications of a TeleSANE program on staff comfort. There are no consistent approaches or validated tools to address staff comfort with SAEs.Recommendation for practice: SANEs are necessary to obtain the best outcomes for the vulnerable populations affected by SA. Telehealth is pioneering efforts to provide specialized nursing care to patients affected by SA. SANE consults may reduce revictimization, sequelae of trauma in survivors of sexual violence, and improve comfort for all

ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes

info:eu-repo/semantics/publishedVersio

Power, Gender, and Trust in Experiences of Pediatric Emergency Physician Teleconsultation and Maternal Antenatal Anxiety in Pakistan

Background: In Pakistan, innovative strategies for improving access to health care, such as telemedicine (TM) and task shifting, are growing rapidly to address critical gaps in maternal and child health (MCH). Qualitative studies of social and contextual factors can help improve the development or implementation of such interventions. Objectives: This dissertation closely examines constructs of power, gender, and trust in the contexts of two populations: (1) pediatric emergency medicine (PEM) providers in a novel TM program applying synchronous expert teleconsultation to improve quality of care, and (2) pregnant women with experiences of anxiety informing the content of a psychological intervention by non-specialists. Methods: Manuscript one uses the TM Theory of Use framework to thematically analyze 20 in-depth interviews covering experiences or perspectives of doctors, nurses, and TM program administrators, while Manuscript two draws on conversation analysis methods to examine transcripts of 88 PEM teleconsultations. Manuscript three is a secondary analysis applying a women’s empowerment framework to formative research interviews on sources and mitigators of antenatal anxiety in 19 symptomatic women. Data for the qualitative TM program evaluation were collected from October 2019 to January 2020 at Sindh government hospitals, while formative research interviews on antenatal anxiety were conducted between September 2017 and August 2018 at Holy Family Hospital in Rawalpindi. Results: Perceived levels of asymmetric power and mutual trust in TM produced widely divergent and conflicting theories of use among PEM providers, while some gender-based opportunities in TM contributed to emergent social functions beyond its intended aims. Although teleconsultants accounted for a disproportionate share of asking questions and controlling topic, closer examination revealed strategic ambiguity and reciprocity as means of negotiating power and building trust in TM-mediated clinical discourse, particularly by women teleconsultants. For antenatal anxiety, gender norms and women’s disempowerment were key contextual factors contributing to women’s symptoms and limiting pregnancy-related agency and available coping strategies. Conclusion: Efforts to expand access to high quality care for mothers and children must include studies of context, whether the sociotechnical context of TM innovations or the cultural context of psychosocial interventions, to understand associated opportunities, constraints, successes, and failures in improving MCH

Satisfaction with pediatric telehealth according to the opinions of children and adolescents during the COVID-19 pandemic: A literature review

ObjectiveTo review satisfaction with telehealth among children and adolescents based on their own opinions during the COVID-19 pandemic.MethodsIn the PubMed, CINAHL, PsycINFO, and Embase databases, we searched for peer-reviewed studies in English on satisfaction with telehealth among children and adolescents (rather than parents). Both observational studies and interventions were eligible. The review was categorized as a mini review because it focused on the limited time frame of the COVID-19 pandemic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers extracted information from each study and assessed risk of bias.ResultsA total of 14 studies were eligible. Studies were conducted in Australia, Canada, Italy, Israel, Poland, South Korea, the United Kingdom, and the United States. They focused on a variety of health conditions. Two of the 14 studies were interventions. Participants expressed high satisfaction with video and telephone visits and home telemonitoring while also preferring a combination of in-person visits and telehealth services. Factors associated with higher satisfaction with telehealth included greater distance from the medical center, older age, and lower anxiety when using telehealth. In qualitative studies, preferred telehealth features among participants included: a stable Internet connection and anonymity and privacy during telehealth visits.ConclusionTelehealth services received favorable satisfaction ratings by children and adolescents. Randomized-controlled trials on the effectiveness of pediatric telehealth services compared to non-telehealth services may assess improvements in satisfaction and health outcomes

Allied health video consultation services

Many Australians have limited access to health care services due to a range of barriers including living a considerable distance from health services. Furthermore, there are significant shortages of healthcare workers in many rural and remote areas. Traditionally, many people have had to either travel long distances to access healthcare, or go without. Telehealth is an alternative approach, using telecommunications and information technology to supplement face-to-face delivery of healthcare services