Internet videoconferencing for patient-clinician consultations in long-term conditions : a review of reviews and applications in line with guidelines and recommendations

Introduction The use of internet videoconferencing in healthcare settings is widespread, reflecting the normalisation of this mode of communication in society and current healthcare policy. As the use of internet videoconferencing is growing, increasing numbers of reviews of literature are published. Methods The authors conducted a review of the existing reviews of literature relating to the use of internet videoconferencing for consultations between healthcare professionals and patients with long-term conditions in their own home. The review was followed with an assessment of UK National Institute for Health and Clinical Excellence guidelines for patient care in the context of common long-term illnesses to examine where videoconferencing could be implemented in line with these recommendations. Results The review of reviews found no formal evidence in favour of or against the use of internet videoconferencing. Patients were satisfied with the use of videoconferencing but there was limited evidence that it led to a change in health outcomes. Evidence of healthcare professional satisfaction when using this mode of communication with patients was limited. The review of guidelines suggested a number of opportunities for adoption and expansion of internet videoconferencing. Implementing videoconferencing in line with current evidence for patient care could offer support and provide information on using a communication channel that suits individual patient needs and circumstances. The evidence base for videoconferencing is growing, but there is still a lack of data relating to cost, ethics and safety. Conclusions While current evidence base for the internet videoconferencing is equivocal, it is likely to change as more research is undertaken and evidence published. With more videoconferencing services added in more contexts, research needs to explore how internet videoconferencing can be implemented in ways that it is valued by patients and clinicians, and how it can fit within organizational and technical infrastructure of the healthcare services

Achieving provider engagement: providers' perceptions of implementing and delivering integrated care

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda

Isospin dependence of the eta' meson production in nucleon--nucleon collisions

According to the quark model, the masses of eta and eta' mesons should be almost equal. However, the empirical values of these masses differ by more than the factor of two. Similarly, though the almost the same quark-antiquark content, the total cross section for the creation of these mesons close to the kinematical thresholds in the pp --> ppX reaction differs significantly. Using the COSY-11 detection setup we intend to determine whether this difference will also be so significant in the case of the production of these mesons in the proton-neutron scattering. Additionally, the comparison of the pp --> pp eta' and pn --> pn eta' total cross sections will allow to learn about the production of the eta' meson in the channels of isospin I = 0 and I = 1 and to investigate aspects of the gluonium component of the eta' meson.Comment: Presented at LEAP05: International conference on Low Energy Antiproton Physics, Bonn - Juelich, Germany, May 16-22, 200

COSY-11: an experimental facility for studying meson production in free and quasi-free nucleon-nucleon collisions

The COSY-11 experimental setup is an internal facility installed at the COoler SYnchrotron COSY in Juelich. It allows to investigate meson production in free and quasi-free nucleon-nucleon collisions, eg. pp --> pp meson and pd --> p_sp np meson reactions. Drift chambers and scintillators permit to measure outgoing protons, separated in magnetic field of COSY-11 dipole. Neutrons are registered in the neutron modular detector installed downstream the beam. Recently, the experimental setup has been extended with spectator detector, deuteron drift chamber and polarization monitoring system, and since then meson production can be investigated also as a function of spin and isospin of colliding nucleons.Comment: Presented at LEAP05: International conference on Low Energy Antiproton Physics, Bonn - Juelich, Germany, May 16-22, 200

Ethical implications of digital communication for the patient-clinician relationship : analysis of interviews with clinicians and young adults with long term conditions (the LYNC study)

Background: Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. Methods: A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Results: Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. Conclusions: The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to

Isospin dependence of the eta prime meson production in nucleon-nucleon collisions

A comparison of the close-to-threshold total cross section for the eta prime production in pp --> pp eta prime and pn --> pn eta prime reactions constitutes a tool to investigate the eta prime meson structure and the reaction mechanism in the channels of isospin I=0 and I=1 and may provide insight into the flavour-singlet (perhaps also into gluonium) content of the eta prime meson. In this contribution we present preliminary results of measurement of the quasi-free production of the eta prime meson in the proton-neutron collisions conducted using the COSY-11 facility.Comment: Presented at 10th International Workshop on Meson Production, Properties and Interaction (MESON 2008), Cracow, Poland, 6 - 10 June 200

Eta and eta' mesons production at COSY-11

The low emittance and small momentum spread of the proton and deuteron beams of the Cooler Synchrotron COSY combined with the high mass resolution of the COSY-11 detection system permit to study the creation of mesons in the nucleon-nucleon interaction down to the fraction of MeV with respect to the kinematical threshold. At such small excess energies, the ejectiles possess low relative momenta and are predominantly produced with the relative angular momentum equal to zero. Taking advantage of these conditions we have performed investigations aiming to determine the mechanism of the production of eta and eta' mesons in the collision of hadrons as well as the hadronic interaction of these mesons with nucleons and nuclei. In this proceedings we address the ongoing studies of the spin and isospin dependence for the production of the eta and eta' mesons in free and quasi-free nucleon-nucleon collisions. New results on the spin observables for the vec(p)p --> pp eta reaction, combined with the previously determined total cross section isospin dependence, reveal a statistically significant indication that the excitation of the nucleon to the S11(1535) resonance, the process which intermediates the production of the eta meson in the nucleon-nucleon interactions, is predominantly due to the exchange of the pi meson between the colliding nucleons.Comment: Invited talk at MESON 2006: 9th International Workshop on Meson Production, Properties and Interactions, Cracow, Poland, 9-13 Jun 200

Near threshold eta meson production in dp collisions

Preliminary results of recent measurements of the near threshold eta meson production in the dp-->dp eta reaction are presented. The experiment was performed at the COSY-Juelich accelerator with the use of the COSY-11 detection system. Data were taken for three values of deuteron beam momenta corresponding to excess energies of 3.2, 6.1 and 9.2 MeV. The energy dependence of the total cross section confirms a strong effect of the final state interaction.Comment: Talk given at 9th International Workshop on Meson Production, Properties and Interaction, Cracow, Poland, 9-13 June 2006. 5 pages, 3 figure