Usability and Reliability of Autism Diagnostic Observation Schedule (ADOS) Module 4 Remote Administration

Autism Spectrum Disorder (ASD) is characterized by impairments in social interaction, impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities. The Autism Diagnostic Observation Schedule (ADOS) Module 4 is a semi-structured diagnostic assessment tool designed for verbally fluent adolescents and adults with possible ASD. Due to a lack of available clinical expertise, it can be difficult for adults to receive an accurate ASD diagnostic assessment, especially those residing in rural areas. An ADOS teleassessment system was developed using the Versatile and Integrated System for Telerehabilitation (VISYTER). VISYTER consists of computer stations at the client site and clinician site, and a web portal server for managing and coordinating all elements of the assessment process. Clinician usability and fidelity to standard, face-to-face administration, was assessed. After improvements to the system were made, a study was conducted to determine the reliability of the ADOS module 4 administrations delivered remotely. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote and face-to-face ADOS were administered. Weighted kappa was calculated for all 31 ADOS items. There was substantial agreement on 11 items and almost perfect or perfect agreement on 10 items. Intraclass correlations (ICCs) were calculated for algorithm subtotals. ICCs were greater than .75 for three out of four subtotals. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely, Po=83%; ĸ =.772, ICC=.92. Non-agreement may have been due to outside factors or practice effect despite a washout period. Finally, usability and satisfaction of the remote assessment system was evaluated from the participants’ perspectives. Participant satisfaction with the remote ADOS delivery system was high. The results of these studies demonstrate that an ASD assessment designed to be delivered face-to-face can be reliably administered remotely using an integrated web-based system

The role of health kiosks: a scoping review

Background: Health kiosks are publicly accessible computing devices that provide access to services including health information provision, clinical measurement collection, patient self-check-in, telemonitoring and teleconsultation. While the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow. Objectives: We sought to clarify the current and future roles of health kiosks by investigating: (a) the setting, role, and clinical domains in which kiosks are used; (b) whether usability evaluations of health kiosks are being reported and if so, what methods are being utilized; and (c) what the barriers and facilitators are for the deployment of kiosks. Methods: We conducted a scoping review by a bibliographic search of the Google Scholar, PubMed and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers describe the implementation, either as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and through querying key informants. For each article we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and inclusion of usability testing. We then summarized the data in frequency tables. Results: A total of 141 articles were included, 134 primary studies and seven reviews. 47% of the primary studies described kiosks in secondary care settings, other settings included community (23.9%), primary care (17.9%), and pharmacies (6.0%). The most common roles of health kiosks were providing health information (35.1%), taking clinical measurements (20.9%), screening (12.7%), telehealth (8.2%), and patient registration (6.0%). The five most frequent health domains were multiple conditions (24.6%), Human Immunodeficiency Virus (HIV) (7.5%), hypertension (7.5%), pediatric injuries (5.2%), health and wellbeing (4.5%) and drug monitoring (4.5%). Kiosks were integrated in the clinical pathway in 70.1%, opportunistic kiosks accounted for 23.9% and 6.0% were being used in both. Usability evaluations of the kiosk were reported in 20.1% of the papers. Barriers (use of expensive proprietary software) and enablers (handling on-demand consultations) to deploying health kiosks were identified. Conclusions: Health kiosks still play a vital role in the healthcare system, including collecting clinical measurements and providing access to online health services and information to those with little or no digital literacy skills, and others without personal internet access. We identified research gaps, such as training needs for teleconsultations, and scant reporting on usability evaluation methods

J Am Geriatr Soc

Background:Disparities in healthcare access and delivery caused by transportation and health workforce difficulties negatively impact individuals living in rural areas. These challenges are especially prominent in older adults.Design:We systematically evaluated the feasibility, acceptability and effectiveness in providing telemedicine searching the English-language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO).Participants:Older adults (mean age 6565 and none were less than 60 years)Interventions:Interventions consisted of live, synchronous, two-way video-conferencing communication in non-hospital settings. All medical interventions were included.Measurements:Quality assessment using the Cochrane Collaboration\u2019s Risk of Bias Tool was applied on all included articles, including a qualitative summary of all articles.Results:Of 6,616 citations, we reviewed the full text of 1,173 articles, excluding 1,047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]) with cohort sizes ranging from 3\u2013844 (median 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that telemedicine can improve health outcomes in older adults and that it could be used in this population.Conclusions:Telemedicine is feasible and acceptable in delivering care to older adults. Research should focus on well-designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using telemedicine in routine practice to overcome barriers of distance and access to care.NCATS UL1TR001086/AG/NIA NIH HHS/United StatesP30 CA023108/CA/NCI NIH HHS/United StatesUL1 TR001086/TR/NCATS NIH HHS/United StatesP30 DA029926/DA/NIDA NIH HHS/United StatesCDC U48DP005018/AG/NIA NIH HHS/United StatesU48DP005018/ACL/ACL HHS/United StatesK23AG051681/AG/NIA NIH HHS/United StatesK23 AG051681/AG/NIA NIH HHS/United StatesNCI P30CA023108-37/AG/NIA NIH HHS/United StatesNIDA P30DA029926/AG/NIA NIH HHS/United States2020-08-01T00:00:00Z31066916PMC66844098081vault:3367

Holistic System Design for Distributed National eHealth Services

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THE USE OF TELEPRACTICE FOR COMMUNICATION AND BEHAVIORAL CHALLENGES FOR INDIVIDUALS WITH ASD AND ID

Currently, the rate of individuals with autism spectrum disorder (ASD) is growing and further research is needed to understand what evidence-based practices are effective for this population. To contribute further to the already existing literature, the three studies expand on previous reviews and studies by adding information on whom these intervention best serve. The first review is a meta-analysis, which examines four moderators for individuals with ASD and intellectual disability (ID). The authors evaluated the effects of dosage, feedback, age, and years of training for interventionists on social communication and challenging behavior for individuals with ASD and ID. Although there were no statistically significant differences within the moderators, further inspection is warranted. Findings indicate moderate or small effect on social communication or challenging behavior for individuals with ASD and ID. Limitations and future research is discussed. The second study reviews the quality of single case and group design studies using Standards for Excellence in Education Research (SEER) and an adaptation of What Works Clearinghouse (WWC) for 30 studies. The studies included individuals with ASD or ID who were working towards improving their social communication skills or decreasing challenging behavior. Several implications for practitioners and researchers were expanded on. The third was a single case study with three parent-child dyads who are from Spanish speaking homes and have ASD as a diagnosis. Parents were taught a multimodal communication intervention using telepractice as a delivery mode in their own natural environment

Opportunities And Challenges of E-Health and Telemedicine Via Satelite

The introduction of Information and Communication Technology (ICT) in the health scenario is instrumental for the development of sustainable services of direct benefit for the European citizen. The setting up of satellite based applications will enhance rapidly the decentralisation and the enrichment of the European territory driving it towards a homogenous environment for healthcare

Smart and Pervasive Healthcare

Smart and pervasive healthcare aims at facilitating better healthcare access, provision, and delivery by overcoming spatial and temporal barriers. It represents a shift toward understanding what patients and clinicians really need when placed within a specific context, where traditional face-to-face encounters may not be possible or sufficient. As such, technological innovation is a necessary facilitating conduit. This book is a collection of chapters written by prominent researchers and academics worldwide that provide insights into the design and adoption of new platforms in smart and pervasive healthcare. With the COVID-19 pandemic necessitating changes to the traditional model of healthcare access and its delivery around the world, this book is a timely contribution