Measuring the 'success' of telehealth interventions

Despite substantial investment over recent years in telehealth there appears to be little consensus regarding what a successful implementation should achieve. However, defining success is often controversial and complex due to differing views from the large number of stakeholders involved, the local environment where telehealth is deployed and the scope, or size, of any planned initiative. Nevertheless, a number of generic measures are proposed in this paper which then provides a framework for the measurement of success. The local context can then be applied to determine the exact emphasis on specific measures, but it is proposed that all of the measures should be included in the holistic measurement of success. Having considered what constitutes success attention is then given to how success should be quantified. Robust evaluation is fundamental and there is much debate as to whether the �gold standard� Randomised Control Trial (RCT) is the most appropriate methodology for telehealth. If the intervention, technology and system, can be maintained in a stable state then the RCT may well provide the most authoritative evidence for decision makers. However, ensuring such stability, in what is still a novel combination of technology and service, is difficult and consequently other approaches may be more appropriate when stability is unlikely to be maintained

Are assistive technologies an enhancement to the present health, care, and support mechanisms

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Emotive computing may have a role in telecare

This brief paper sets out arguments for the introduction of new technologies into telecare and lifestyle monitoring that can detect and monitor the emotive state of patients. The significantly increased use of computers by older people will enable the elements of emotive computing to be integrated with features such as keyboards and webcams, to provide additional information on emotional state. When this is combined with other data, there will be significant opportunities for system enhancement and the identification of changes in user status, and hence of need. The ubiquity of home computing makes the keyboard a very attractive, economic and non-intrusive means of data collection and analysis

Developing a systems and informatics based approach to lifestyle monitoring within eHealth:part I - technology and data management

Lifestyle monitoring forms a subset of telecare in which data derived from sensors located in the home is used to identify variations in behaviour which are indicative of a change in care needs. Key to this is the performance of the sensors themselves and the way in which the information from multiple sources is integrated within the decision making process. The paper therefore considers the functions of the key sensors currently deployed and places their operation within the context of a proposed multi-level system structure which takes due cognisance of the requisite informatics framework

eHealth and the Internet of Things

To respond to an ageing population, eHealth strategies offer significant opportunities in achieving a balanced and sustainable healthcare infrastructure. Advances in technology both at the sensor and device levels and in respect of information technology have opened up other possibilities and options. Of significance among these is what is increasingly referred to as the Internet of Things, the interconnection of physical devices to an information infrastructure. The paper therefore sets out to position the Internet of Things at the core of future developments in eHealt

Linking recorded data with emotive and adaptive computing in an eHealth environment

Telecare, and particularly lifestyle monitoring, currently relies on the ability to detect and respond to changes in individual behaviour using data derived from sensors around the home. This means that a significant aspect of behaviour, that of an individuals emotional state, is not accounted for in reaching a conclusion as to the form of response required. The linked concepts of emotive and adaptive computing offer an opportunity to include information about emotional state and the paper considers how current developments in this area have the potential to be integrated within telecare and other areas of eHealth. In doing so, it looks at the development of and current state of the art of both emotive and adaptive computing, including its conceptual background, and places them into an overall eHealth context for application and development

N<i>e</i>XOS – the design, development and evaluation of a rehabilitation system for the lower limbs

Recent years have seen the development of a number of automated and semi-automated systems to support for physiotherapy and rehabilitation. These deploy a range of technologies from highly complex purpose built systems to approaches based around the use of industrial robots operating either individually or in combination for applications ranging from stroke to mobility enhancement. The NeXOS project set out to investigate an approach to the rehabilitation of the lower limbs in a way which brought together expertise in engineering design and mechatronics with specilists in rehabilitation and physiotherapy. The resulting system has resulted in a prototype of a system which is capable in operating in a number of modes from fully independent to providing direct support to a physiotherapist during manipulation of the limb. Designed around a low cost approach for an implementation ultimately capable of use in a patients home using web-baased strategies for communication with their support team, the prototype NeXOS system has validated the adoption of an integrated approach to its development. The paper considers this design and development process and provides the results from the initial tests with physiotherapists to establish the operational basis for clinical implementation

Ovarian carcinosarcoma is highly aggressive compared to other ovarian cancer histotypes

Background: Ovarian carcinosarcoma (OCS) is an unusual ovarian cancer type characterized by distinct carcinomatous and sarcomatous components. OCS has been excluded from many of the pan-histotype studies of ovarian carcinoma, limiting our understanding of its behavior.Methods: We performed a multi-cohort cross-sectional study of characteristics and outcomes in ovarian cancer patients from Scotland (n=2082) and the Surveillance, Epidemiology and End Results Program (SEER, n=44946) diagnosed with OCS or one of the other major histotypes: high grade serous (HGSOC), endometrioid (EnOC), clear cell (CCOC), mucinous (MOC) or low grade serous ovarian carcinoma (LGSOC). Differences in overall survival were quantified using Cox regression models to calculate hazard ratios (HR).Results: Across both cohorts, OCS patients were significantly older at diagnosis compared to all other histotypes (median age at diagnosis 69 and 67 in Scottish and SEER cohorts) and demonstrated the shortest survival time upon univariable analysis. Within the Scottish cohort, 59.3% and 16.9% of OCS patients presented with FIGO stage III and IV disease, respectively; this was significantly higher than in EnOC, CCOC or MOC (P&lt;0.0001 for all), but lower than in HGSOC (P=0.004). Multivariable analysis accounting for other prognostic factors identified OCS as independently associated with significantly shorter survival time compared to HGSOC, EnOC, LGSOC and MOC in both the Scottish (multivariable HR vs OCS: HGSOC 0.45, EnOC 0.39, LGSOC 0.26, MOC 0.43) and SEER cohorts (multivariable HR vs OCS: HGSOC 0.59, EnOC 0.34, LGSOC 0.30, MOC 0.81). Within the SEER cohort, OCS also demonstrated shorter survival compared to CCOC (multivariable HR 0.63, 95% CI 0.58-0.68), but this was not replicated within the Scottish cohort (multivariable HR for CCOC: 1.05, 95% CI 0.74-1.51). Within early-stage disease specifically (FIGO I-II or SEER localized stage), OCS was associated with the poorest survival of all histotypes across both cohorts. In the context of late-stage disease (FIGO III-IV or SEER distant stage), OCS, MOC and CCOC represented the histotypes with poorest survival.Conclusion: OCS is a unique ovarian cancer type that affects older women and is associated with exceptionally poor outcome, even when diagnosed at earlier stage. New therapeutic options are urgently required to improve outcomes

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