Nurses' and community support workers' experience of telehealth: A longitudinal case study

Copyright © 2014 Sharma and Clarke; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This article has been made available through the Brunel Open Access Publishing Fund.Background - Introduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced. Methods - In a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation. Results - Users experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise. Conclusion - Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients

Clinical users' perspective on telemonitoring of patients with long term conditions: Understood through concepts of Giddens's structuration theory & consequence of modernity

This is the post-print version of the article - Copyright @ 2010 IOS.This study involves conducting focus group discussions with clinical users (nurses and technicians) prior to the launch of telehealth service in Nottingham, UK, to elicit their initial perceptions about the service. It describes the findings from preliminary phase of otherwise a larger longitudinal study. Using Giddens’s concepts from structuration theory and con-sequence of modernity, we were able to acknowledge trust and sense of security as two very salient aspects that govern adop-tion of new technological innovation. Unattended, these as-pects contribute to arousal of conflict and contradiction within a system. In order for successful telehealth implementa-tions in health care setting, providers of the service, need to focus on ways in which clinical users’ trust can be gained and sense of security can be promoted while using the telehealth service and technology.Funding was obained from MATCH (Multidisciplinary Assessment of Technologies Centre for Healthcare)

Quantification of coarse-graining error in Langevin and overdamped Langevin dynamics

In molecular dynamics and sampling of high dimensional Gibbs measures coarse-graining is an important technique to reduce the dimensionality of the problem. We will study and quantify the coarse-graining error between the coarse-grained dynamics and an effective dynamics. The effective dynamics is a Markov process on the coarse-grained state space obtained by a closure procedure from the coarse-grained coefficients. We obtain error estimates both in relative entropy and Wasserstein distance, for both Langevin and overdamped Langevin dynamics. The approach allows for vectorial coarse-graining maps. Hereby, the quality of the chosen coarse-graining is measured by certain functional inequalities encoding the scale separation of the Gibbs measure. The method is based on error estimates between solutions of (kinetic) Fokker-Planck equations in terms of large-deviation rate functionals

A robust and forward-Looking industrial production indicator

Against the backdrop of growing criticism of the index of industrial production, which provides information only about the past and sometimes fl uctuates wildly, this article seeks to provide a more robust and forward-looking economic indicator of industrial growth. Such an indicator, based on past IIP numbers, can also serve as a benchmark for future IIP numbers when they are released. Using data on the IIP's three sub-series - manufacturing, mining, and electricity - it seeks to isolate the "noise" from the "signal" in two steps, enabling predictions for the two past months and four months into the future using the latest available IIP numbers in any given month

Effect of Severe Protein-Energy Malnutrition on Circulating Thyroid Hormones

Protein energy malnutrition (PEM) is one of the most common health problems among Bangladeshi children. PEM is known to induce a wide variety of metabolic disorders and some of which may be mediated through alteration of endocrine functions. Both short-term and long-term alterations in nutritional state affect various aspects of thyroid hormone economy, especially peripheral hormone metabolism. Chronic malnutrition is associated with a decreased serum T3 concentration. Serum T4 levels also tend to be slightly decreased because of a modest decrease in iodothyronine binding protein. TSH concentrations and their response to exogenous TRH are usually normal. To identify the effects of severe protein energy malnutrition on circulating iodothyronines especially circulating T3 & T4 and to determine the level of TSH in severe PEM. To compare the levels of thyroid hormones before and after recovery from severe PEM and to identify any correlation with mortality and morbidity. A prospective cross-sectional comparative study was performed in Nutrition block, Department of Pediatrics, Chittagong Medical College Hospital from 01 Dec 2007 to 30 Nov 2008. Patient admitted to nutrition block with severe PEM were included in the study. The levels of T4, T3 and TSH measured by radioimmunoassay (RIA) method. TSH was measured by using Immunoradiometric Assay Kit, IMK-432 produced by Beijing Atom Hitech Co. Ltd, China. T3 and T4 were measured by using Radioimmunoassay Kit (PR), IMK-422 and IMK-419 respectively produced by Beijing Atom Hitech Co. Ltd, China. Data were presented as the percentage of total number of observation. SPSS- Version 15.0 was used for the analysis of data. Student’s t-test, Z-test, χ-square test and Pearson’s correlation test were used for statistical significance. ‘p’ value of < 0.05 were used as the  minimum level of significance. The effect of protein energy malnutrition (PEM) in the children on serum levels of total thyroxine (TT4), total triiodothyronine (TT3) and thyrotropin (TSH) were evaluated. There were 50 children aged 6 to 60 months in the malnutrition group and 22 healthy age and sex matched controls. Serum TT4 and TT3 were all reduced in the malnutrition group. This decrease in TT3 was more significant (p<0.001) in severe malnutrition than in mild PEM. Serum TSH levels in the malnutrition and control groups were similar. These results suggest that the children remained euthyroid and represent an adaptive response to protein energy malnutrition. The results of the above mentioned studies clearly demonstrate that thyroid functions are adversely affected in severe PEM. This was evidenced by reductions in T3 & T4 levels in comparison to control group. Keywords: Protein Energy Malnutrition; Thyroxine; Triiodothyronine; Thyrotropin

Standardization of Leaf Sampling Technique for Macronutrients in Apricot under Temperate Conditions

Macro- and micro-nutrient content influenced by position of leaf on the shoot and time of sampling was studied to determine leaf-sampling time for apricot grown in temperate region of the country. Results revealed that middle order leaves were the most suitable for determining nutrient needs in apricot trees. Leaf samples should be collected during June - July for determining N, K and Ca; first fortnight of July for P; and, from mid-June to mid-July for Mg

Neglected Heterogeneity and Dynamics in Cross-country Savings Regressions

This paper examines the extent to which the conclusions of cross-country studies of private savings are robust to allowing for the possible heterogeneity of savings behaviour across countries and for the inclusion of dynamics. It reviews the econometric implications of neglected slope heterogeneity and dynamics for the fixed effects estimators routinely used in such studies, and illustrates the nature and extent of the biases involved by a re-examination of time series data from 21 OECD countries. The paper shows that neglecting heterogeneity and dynamics in cross-country savings regressions can lead to misleading inferences about the key determinants of savings behaviour. The results indicate that among the many variables considered in the literature only the fiscal variables - the general government surplus as a proportion of GDP and the ratio of government consumption to GDP - seem to be the key determinants of private savings rates in the industrial countries in the post-World War II periodSavings behaviour, Cross-country studies. Slope heterogeneity, Dynamics, Panel data models

Superheavy nuclei in relativistic effective Lagrangian model

Isotopic and isotonic chains of superheavy nuclei are analyzed to search for spherical double shell closures beyond Z=82 and N=126 within the new effective field theory model of Furnstahl, Serot, and Tang for the relativistic nuclear many-body problem. We take into account several indicators to identify the occurrence of possible shell closures, such as two-nucleon separation energies, two-nucleon shell gaps, average pairing gaps, and the shell correction energy. The effective Lagrangian model predicts N=172 and Z=120 and N=258 and Z=120 as spherical doubly magic superheavy nuclei, whereas N=184 and Z=114 show some magic character depending on the parameter set. The magicity of a particular neutron (proton) number in the analyzed mass region is found to depend on the number of protons (neutrons) present in the nucleus.Comment: 26 pages, REVTeX, 10 ps figures; changed conten