Telerehabilitation: Policy Issues and Research Tools

The importance of public policy as a complementary framework for telehealth, telemedicine, and by association telerehabilitation, has been recognized by a number of experts. The purpose of this paper is to review literature on telerehabilitation (TR) policy and research methodology issues in order to report on the current state of the science and make recommendations about future research needs. An extensive literature search was implemented using search terms grouped into main topics of telerehabilitation, policy, population of users, and policy specific issues such as cost and reimbursement. The availability of rigorous and valid evidence-based cost studies emerged as a major challenge to the field. Existing cost studies provided evidence that telehomecare may be a promising application area for TR. Cost studies also indicated that telepsychiatry is a promising telepractice area. The literature did not reference the International Classification on Functioning, Disability and Health (ICF). Rigorous and comprehensive TR assessment and evaluation tools for outcome studies are tantamount to generating confidence among providers, payers, clinicians and end users. In order to evaluate consumer satisfaction and participation, assessment criteria must include medical, functional and quality of life items such as assistive technology and environmental factors. Keywords: Telerehabilitation, Telehomecare, Telepsychiatry, Telepractic

Työelämän muutosten vaikutus rekrytointiin : Konsulttinäkökulma rekrytointialan uusiin haasteisiin

Siirretty Doriast

A Systematic Review of Research Studies Examining Telehealth Privacy and Security Practices Used By Healthcare Providers

The objective of this systematic review was to systematically review papers in the United States that examine current practices in privacy and security when telehealth technologies are used by healthcare providers. A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). PubMed, CINAHL and INSPEC from 2003 – 2016 were searched and returned 25,404 papers (after duplications were removed). Inclusion and exclusion criteria were strictly followed to examine title, abstract, and full text for 21 published papers which reported on privacy and security practices used by healthcare providers using telehealth.  Data on confidentiality, integrity, privacy, informed consent, access control, availability, retention, encryption, and authentication were all searched and retrieved from the papers examined. Papers were selected by two independent reviewers, first per inclusion/exclusion criteria and, where there was disagreement, a third reviewer was consulted. The percentage of agreement and Cohen’s kappa was 99.04% and 0.7331 respectively. The papers reviewed ranged from 2004 to 2016 and included several types of telehealth specialties. Sixty-seven percent were policy type studies, and 14 percent were survey/interview studies. There were no randomized controlled trials. Based upon the results, we conclude that it is necessary to have more studies with specific information about the use of privacy and security practices when using telehealth technologies as well as studies that examine patient and provider preferences on how data is kept private and secure during and after telehealth sessions.Keywords: Computer security, Health personnel, Privacy, Systematic review, Telehealth

The Future of Library Services for & with Teens: A Call to Action

As part of the year-long National Forum on Libraries and Teens effort, YALSA has released a report, "The Future of Library Services for and with Teens: A Call to Action" providing direction on how libraries need to adapt and change to meet the needs of 21st century teens.The report is a call to action for the library community. It provides recommendations on how libraries must address challenges and re-envision their teen services in order to meet the needs of their individual communities and to collectively ensure that the nation's 40+ million teens develop the skills they need to be productive citizens. By acting on this call, the library community can work within their own local communities to create the kind of spaces, services, and opportunities that today's teens need in order to succeed in school and in life

Executive Summary for The Future of Library Services for and with Teens: A Call to Action

As part of the year-long National Forum on Libraries and Teens effort, YALSA has released a report, "The Future of Library Services for and with Teens: A Call to Action" providing direction on how libraries need to adapt and change to meet the needs of 21st century teens. The report is a call to action for the library community. It provides recommendations on how libraries must address challenges and re-envision their teen services in order to meet the needs of their individual communities and to collectively ensure that the nation's 40+ million teens develop the skills they need to be productive citizens. By acting on this call, the library community can work within their own local communities to create the kind of spaces, services, and opportunities that today's teens need in order to succeed in school and in life

Do mammographic tumor features in breast cancer relate to breast density and invasiveness, tumor size, and axillary lymph node involvement?

Breast density and mammographic tumor features of breast cancer may carry prognostic information. The potential benefit of using the combined information obtained from breast density, mammographic tumor features, and pathological tumor characteristics has not been extensively studied

A comparison of trained and untrained caregivers' behaviors with varied infant-adult ratios

It was the purpose of this study to compare two trained and two untrained caregivers as they cared for groups of infants under 18 months. Each caregiver worked in a one adult to five infant ratio and a one adult to eight infant ratio. The trained and untrained caregivers were compared in six behavioral areas as reflected by the following goals: (1) facilitation of language, (2) positive social-emotional behaviors with infants, (3) adult negative social-emotional behaviors with infants, (4) providing caregiving functions such as feeding and diapering, (5) performing necessary housekeeping tasks, and (6) providing motoric and kinesthetic experiences for infants (Honig & Lally, 1973). The subjects were 16 infants under 18 months of age and their four caregivers. The study took place in two locations. Eight infants and their two caregivers were observed at Creative World, Inc., located in Wilmington, North Carolina. The comparison group of eight infants and their two caregivers were observed at The Infant Care Center in the Department of Child Development and Family Relations in the School of Home Economics at The University of North Carolina at Greensboro, North Carolina

Long-term prognosis of early-onset breast cancer in a population-based cohort with a known BRCA1/2 mutation status.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.All women in the South Sweden Health Care Region with breast cancer diagnosed aged less than 41 during the period between 1990 and 1995 were contacted in 1996 and offered germline mutation analysis of the BRCA1 and BRCA2 genes. Mutation carriers (n = 20) were compared with noncarriers (n = 201) for overall survival (OS) and risk of contralateral breast cancer (CBC). Mutation carriers were younger at diagnosis and more likely to have ER-negative, PgR-negative and grade III tumors. Median follow-up was 19 years. The 5-, 10-, 15-, and 20-year OS were 60, 45, 39, and 39 % for mutation carriers and 82, 70, 59, and 53 % for noncarriers, respectively (5-year log-rank P = 0.013; 10-year P = 0.008; 15-year P = 0.020; and 20-year P = 0.046). In univariable analysis, there was a trend for an inferior OS for mutation carriers (HR 1.8; 95 % CI 1.0-3.3). When stratified for use of (neo)adjuvant chemotherapy, an inferior OS was significant only for the subgroup of patients who did not receive chemotherapy (HR 3.0; 95 % CI 1.2-7.7). In multivarible analysis, BRCA1/2 mutation status was a significant predictor of OS when adjusting for tumor stage, age, and use of chemotherapy, but not when ER status was also included in the model. The 15-year cumulative risk of CBC was 53 % for mutation carriers and 10 % for noncarriers (HR 5.9; 95 % CI 1.9-18.6); among the noncarriers the risks were 5, 22, and 30 % for patients without close relatives having breast cancer, with second-degree relatives having breast cancer, and with firstdegree relatives with breast cancer, respectively. In conclusion, the poor prognosis of young BRCA1/2 mutation carriers with breast cancer is mainly explained by the prevalent occurrence of negative prognostic factors rather than mutation status per se, and can to at least some extent be abrogated by the use of chemotherapy.Skane County Counsil's Research and Development Foundation The Swedish Breast Cancer Association (BRO) BioCAR