Using telemedicine in the care of newborn infants after discharge from a neonatal intensive care unit reduced the need of hospital visits

Aim: This study examined the use of telemedicine as a means to follow up infants discharged from a Swedish neonatal intensive care unit to home health care. Methods: Families were randomised to either a control group receiving standard home health care (n = 42 families) or a telemedicine group receiving home health care with telemedicine support (n = 47 families) after discharge from the hospital. Both groups had follow-up hospital appointments with the neonatal nurse. In the telemedicine group, appointments were supplemented by the use of a specially designed web page and video calls. Results: The use of the web page and video calls decreased the number of emergency visits to the hospital (p = 0.047). In the telemedicine group, 26% of the families felt they had more scheduled appointments than necessary, whereas only 6% of the families in the control group thought so (p = 0.037). The parents were highly satisfied with the use of telemedicine. Although the nurses were favourable to using telemedicine, the rigid organisation of the home healthcare programme and the nurses' schedules and work routines prevented its optimal use. Conclusion: The use of telemedicine decreased the need of hospital visits. Organisational adaptations would be necessary to make the best use of telemedicine

eHealth in Prehospital Acute Care : What's Next?

The number of eHealth initiatives, i.e. solutions where Information and Communication Technology (ICT)are employed to promote health or improve healthcare, is rapidly growing. Development within theeHealth sector is seen as one, in some instances even “the”, way to meet tomorrow’s healthcarechallenges significantly characterized by an increasing number of elderly with multiple chronic diseases.This and other trends in society will propel a carethat is further individualized, easier to access,and ofhigher quality compared to today’s situation

Sjukvård ombord : teknik och metodutveckling för akut omhändertagande

Sjöfart har alltid varit ett högriskyrke. Långa resor, extrema väderförhållanden, sjukdomar och olyckor kan påverka besättningen ombord på fartyg. De är inte bara utsatta för större risker, sjömän är också isolerade från de vanliga kanalerna till medicinsk vård och hjälp som finns tillgänglig på land. Ombord på fartyg råder andra förutsättningar än i land för att bedriva sjukvård. Tillgången till medicinskt utbildad personal som på ett adekvat sätt kan bistå kan inte tas för given och möjligheten till sjukvård försvåras ytterligare när fartygen befinner sig långt ut till havs. Ombord på fartyg utförs det akuta/semi-akuta medicinska omhändertagandet av personal med begränsad medicinsk utbildning och erfarenhet, och dessutom med begränsad tillgång till tekniska hjälpmedel och läkemedel. Syftet med denna förstudie är att beskriva de förutsättningar som finns ombord idag och jämföra med de resurser som finns inom prehospital sjukvård i land. Ytterligare avser studien göra en behovsanalys för att beskriva vilket behov som finns ombord för att kunna uppnå god kvalitet på vården och för att kunna förse rådgivande läkare i land med bättre förutsättningar för framgångsrik diagnosticering och vårdrekommendationer. Förslag på teknik och lösningar kommer redovisas för att möta dessa behov. Ytterligare syftar förstudien till att ta fram ett underlag för en större ansökan till ett projekt där t.ex. delar av tekniken som återfinns i land placeras ut på fartyg för att testas och utvärderas under en period

The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment

Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.PrehospI

On scene injury prediction (OSISP) algorithm for car occupants

Many victims in traffic accidents do not receive optimal care due to the fact that the severity of their injuries is not realized early on. Triage protocols are based on physiological and anatomical criteria and subsequently on mechanisms of injury in order to reduce undertriage. In this study the value of accident characteristics for field triage is evaluated by developing an on scene injury severity prediction (OSISP) algorithm using only accident characteristics that are feasible to assess at the scene of accident. A multi-variate logistic regression model is constructed to assess the probability of a car occupant being severely injured following a crash, based on the Swedish Traffic Accident Data Acquisition (STRADA) database. Accidents involving adult occupants for calendar years 2003–2013 included in both police and hospital records, with no missing data for any of the model variables, were included. The total number of subjects was 29 128, who were involved in 22 607 accidents. Partition between severe and non-severe injury was done using the Injury Severity Score (ISS) with two thresholds: ISS > 8 and ISS > 15. The model variables are: belt use, airbag deployment, posted speed limit, type of accident, location of accident, elderly occupant (>55 years old), sex and occupant seat position. The area under the receiver operator characteristic curve (AUC) is 0.78 and 0.83 for ISS > 8 and ISS > 15, respectively, as estimated by 10-fold cross-validation. Belt use is the strongest predictor followed by type of accident. Posted speed limit, age and accident location contribute substantially to increase model accuracy, whereas sex and airbag deployment contribute to a smaller extent and seat position is of limited value. These findings can be used to refine triage protocols used in Sweden and possibly other countries with similar traffic environments

Heart rate variability as an indicator for driver fatigue, different effects of time of day and time-on-task

Heart rate variability (HRV) has been considered as a potential physiological marker for driver fatigue. However, consensus has not been reached for how HRV changes during the development of fatigue, due to inconsistent results in the literature. One potential cause for inconsistent results is that different causal factors were used to introduce fatigue. The aim of this study is to investigate how HRV parameters change during driving in relation to fatigue caused by sleep related and task related factors. Data from a real road experiment, with 89 participants who drove four times over a 180 km route, were used for the analysis. We investigated how time of day and time-on-task factors influence HRV parameters. The result shows that different HRV parameters react differently in relation to time of day and time-on-task factors. The result emphasizes the importance of considering the causal factors when interpreting results from driver fatigue studies and when developing fatigue detectors based on physiological measures

Development of Verified Innovation Process for Healthcare Solutions (VIPHS): A Stepwise Model for Digital Health

Many digital health projects often stop in the pilot or test phase. Realisation of new digital health services is often challenging due to lack of guidelines for the step-by-step roll-out and implementation of the systems when changing work processes and procedures are needed. This study describes development of the Verified Innovation Process for Healthcare Solutions (VIPHS) – a stepwise model for digital health innovation and utilisation using service design principles. A multiple case study (two cases) involving participant observation, role play, and semi-structured interviews were conducted for the model development in prehospital settings. The model might be helpful to support realisation of innovative digital health projects in a holistic, disciplined, and strategic way