The case for home based telehealth in pediatric palliative care: a systematic review

Background: Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important

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

The workload of web-based consultations with atopic eczema patients at home

Abstract Background Atopic eczema is a chronic inflammatory non-contagious skin disease characterised by intensive itch and inflamed skin. Due to its chronic and relapsing course atopic eczema imposes a great burden on affected families. Review articles about home care telemedicine have indicated advantageous effects of home telehealth. However, few studies have investigated how home care telemedicine applications affect the workload of the clinician. Methods The use of a web-based counselling system was recorded through computerised logging. The doctor who answered the requests sent via the Internet recorded the amount of time needed for reading and answering 93 consecutive requests. Results The time needed by the physician to read and answer a request was less than 5 minutes in 60% of the cases. The doctor spent significantly more time to answer requests that had photographs attached compared to requests without photographs (P = 0.005). The time needed to answer requests received during the winter season (October-March) was significantly longer than the rest of the year (P = 0.023). There was no correlation between the answering time and the age of the patient. Conclusions Individual web-based follow-up of atopic eczema patients at home is feasible. The amount of time needed for the doctor to respond to a request from the patient appears to be small. The answering time seems to depend on whether photographs are supplied and also on seasonal variations of disease activity. Since the management of atopic eczema is complex involving many different types of treatments and educational aspects, we expect this type of communication to be useful also to other chronic disease patients requiring close follow-up.</p

Treatment patterns of patients with migraine eligible for anti-CGRP pathway monoclonal antibodies

IntroductionMigraine is a debilitating neurological disorder, with a wide range of symptoms and disease burden, underscoring the heterogeneity of patients’ disease characteristics and treatment needs. To characterize the profile of migraine patients in the US who may be eligible for preventive treatment with an anti-CGRP pathway mAb and to better understand treatment patterns and real-world use of acute and preventive medications for migraine, we conducted a retrospective cohort study of adult patients.MethodsThese patients were identified as having migraine using diagnosis codes or migraine-specific medication use (first = index) in the IQVIA PharMetrics® Plus database. Patients were required to have ≥ 12 months of continuous enrollment in medical and pharmacy benefits prior to index (baseline) and after index (follow-up). Patients were stratified into chronic migraine (CM) and non-chronic migraine (non-CM) by diagnosis codes. Based on acute migraine-specific medication dispensing data in the follow-up period, non-CM patients were divided into 3 cohorts: highest, middle, and lowest tertile of total units of dispensed acute migraine-specific medication (gepants, ditans, ergot derivatives, and triptans). Migraine medication use was captured in the baseline and follow-up periods.ResultsA total of 22,584 CM and 216,807 non-CM patients (72,269 patients in each tertile) were identified and included in the study. Over the follow-up, CM patients had a mean of 70 units of acute migraine-specific medications dispensed, while the highest, middle, and lowest tertile of non-CM patients had a mean of 92, 29, and 10 units, respectively. Anti-calcitonin gene-related peptide pathway mAbs were dispensed for 28.9% of CM patients, and for 6.9%, 4.1%, and 2.9% of non-CM patients in the highest, middle, and lowest tertiles, respectively.ConclusionA lower proportion of non-CM patients had use of anti-calcitonin gene-related peptide pathway mAbs compared to CM patients, confirming the unmet need with appropriate preventive medication. There appears to be a persistent gap in management of patients without a diagnosis of CM who are dispensed high quantities of acute migraine-specific medications

Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth

On morphogenesis of lettuce leaves in relation to light and temperature

The growth of leaves of some butterhead type varieties of lettuce has been investigated under different light intensities and temperatures, with special reference to the process of head formation. Most experiments were carried out with the varieties 'Meikoningin' and 'Rapide' in climatized growth rooms.In Chapter 1, a typical feature of lettuce leaves is demonstrated, viz ., that lamina extension may largely exceed that of the corresponding midrib, yielding the caracteristic folds and crinkles of the leaf blade (Plate II). Therefore, length and greatest width of the leaves have mainly been chosen as criteria for differences in leaf growth.In Chapter 3, the effects of different light intensities, light duration (daylength) and their interaction with temperature are presented. Leaf production increases both with light intensity and with temperature (fig. 3.1), but appears to remain fairly constant with plant age. Since subsequent leaf development occurs at a lower rate, a number of leaf primordia and young leaves of the plant accumulate with time (figs. 3.4 and 3.5). Results suggest that primordial growth is more affected by temperature than by light intensity (fig. 3.6).In many respects clear-cut differences are found between the response of leaf length and leaf width under various experimental conditions. Based on the maximum leaf dimensions reached, leaf width generally responds positively to increasing light energy, either given as a higher light intensity or a greater daylength (figs. 3.7 and 3.9.) In both cases relationships are represented by saturation curves which, for light intensity, tend to go through the origin. Effects of daylength become particularly evident for periods shorter than 12 hours.For leaf length, a positive relation to light energy is only found at a low intensity level, since at high light intensity midrib elongation appears clearly suppressed. Effects of different daylengths, also are only evident at a low light intensity (fig. 3.9).Temperature effects greatly depend on the prevailing light intensity: a negative response observed at low light intensity changes into a positive one at high light intensity, in particular for leaf width (fig. 3.11). This implies that the effect of temperature on leaf width is small at intermediate light intensities (fig. 3.12). It further appeared that light intensity effects on leaf width are especially manifest at high temperature, whereas for leaf length they are more pronounced at low temperature (fig. 3.11).Growth-time relationships appear to be quite different for leaf length and leaf width. Leaves elongate fast at low light intensity, but growth is maintained for a longer period at high light intensity. As a consequence hereof light intensity effects on the final length of the leaves remain restricted. In contrast to this, the effects on leaf width are much more pronounced, since both growth rate and growth duration are greatly reduced at low light intensity (fig. 3.16).From the linear, but greatly different length-width relationships, measured during leaf expansion at different light intensities (fig. 3.21), it may be concluded that an important factor in determining the ultimate shape of the leaves is the moment at which leaf blade expansion is initiated during primordial leaf development.In Chapter 4, the foregoing results are examined on the base of differences in number and size of epidermal cells in the midrib and the leaf blade. Both for the midrib and the leaf blade there is a positive relation between light intensity and cell number. Differences in cell number largely determine differences in leaf width, whereas in the midrib differences in cell length are much more important (figs. 4.3 and 4.7). In general, average cell length in the midrib decreases with increasing light intensity. This may explain the reduction of the midrib observed at high light intensities. Cell division appears restricted mainly to the early stage of growth.In chapter 5, results of some additional experiments are presented, concerning defoliation, extra CO 2 , and gibberellin application. Defoliation causes a temporary reduction of leaf width of subsequent leaves (fig. 5.1) which can also be brought about by a temporary reduction in light intensity (fig. 5.3). At a higher CO 2 concentration larger leaves are produced than in normal air. In all these cases, differences in leaf width are closely related to changes in cell number. Gibberellin, in particular, induces a strong elongation of the midrib which eventually may go at the expense of leaf blade development.It has been suggested that differences in leaf growth may be understood on the base of a balance between energetic and non-energetic processes. Both may operate as a limitation for further growth. Energetic processes (i.e. photosynthesis) seem to control to a large extent cell division, consequently expansion of the leaf blade, whereas non-energetic processes (e.g. hormon activity) seem important in particular for cell extension, and therefore play a major rôle in midrib elongation. In this respect it is tempting to assume that at high intensity a relatively higher hormonal activity is required to keep the cells in optimal condition for extension