Towards an integrated and interoperable platform for telehealth and telecare

Copyright @ 2012 International Journal of Integrated Care (IJIC). This work is licensed under a (http://creativecommons.org/licenses/by/3.0) Creative Commons Attribution 3.0 Unported License.We present experience of implementing and evaluating a platform purpose designed to integrate interoperable telehealth and telecare. We chose the IEEE 11073 standards for all devices and used ZigBee wireless to support many devices concurrently and exploit its mesh networking to extend range around the entire house. We designed the home gateway to be unobtrusive; in project Hydra we used the smart meter and in other projects (Reaction, inCasa) we have developed a purpose designed plugtop ZigBee to GPRS gateway. All use common protocols and are interoperable. Technically the projects have been a success, and we have already implemented a wide range of devices on the common platform (BP, weight, SpO2, glucose, PIR, medication monitor, bed/chair sensor). Immediate feedback from participants has confirmed our goal of simplicity and convenience of use (and thus encourage adherence); and it is interesting that in discussion they then focus on the data rather than the technology. Our current goal is to exploit the potential for combination of physiological and environmental data to determine if change of habits can be detected and how this correlates with change in health. We are using this functionality to manage the frail elderly within project inCasa and we propose to present preliminary findings

Quality of life: Conceptual challenges in exploring the role of ICT in active ageing

The chapter aims to examine the definitional challenges associated with the term quality of life, measurement challenges, the challenges associated with enhancing quality of life, and the role of information and communication technologies (ICT) in quality of life in old age, and finally comments on the challenges of a modern information society for older people. The term quality of life started as a social scientific index of the relative well-being of whole populations, i.e. the state of states. Nowadays quality of life is more likely to be viewed as an individualized aspect of the modern psyche. This shift in conceptualization is problematic in that, if quality of life is individualized, it cannot be meaningful to assess it in the same way for everyone. Nevertheless, over the years a vast range of methods of measuring quality of life has emerged, leading to several measurement challenges. Wealth, health and social relations have all been found to be prime determinants of subjective quality of life; for ICT to enhance quality of life for older people they need to mediate the relationships between these three important factors and quality of life. To date there is relatively little evidence that ICT has improved the quality of life of older people. Suggestions are made as to why ICT is unlikely to influence life quality for older citizens. The chapter is drawn to a close by asking if quality of life is a meaningless term and if the future is bleak for old people in a modern information society. The answer to both questions is no

Assessing trainee secondary teachers on school placement: Subject knowledge and overall teaching grades.

Schools and Initial Teacher Training/Education providers have joint responsibility for developing trainee subject knowledge. Due to the current curriculum and training emphasis placed upon the importance of subject knowledge, the relationship between it and overall teaching grades is of interest when monitoring trainee assessment data collated from school mentors in placement schools. This paper reports a statistical analysis of numerical grades awarded on progress review forms completed by mentors using the teaching competencies described in the Teachers’ Standards. It includes the assessment data gathered from two consecutive cohorts of secondary Post Graduate Diploma in Education trainees whilst on school placement experience. All the schools were in partnership with a single Higher Education provider in the North West of England. The focus for the analysis was the distribution of grades assigned to trainees in English National Curriculum core subjects for overall teaching and two standards with descriptors covering aspects of teacher subject knowledge. Of twenty-four comparisons, only six indicated significant differences. In these instances, more high grades than expected were assigned for the standard describing teacher subject content and curriculum knowledge compared to the standard describing pedagogy and/or overall teaching

Can effect sizes give any clues to the way mentors ascribe numerical grades when assessing secondary trainee teachers against the Teachers’ Standards in England?

Some teacher educators use numerical grades when assessing teaching competencies. In this situation, statistical analysis can be used to monitor consistency and look for correlations between assessment outcomes across teacher training partnerships and at different stages in training. Another approach is to calculate effect size metrics. These do not claim statistical significance but do seek to explain the practical impact of patterns in quantitative data. This study looks at number grade assessment data from a large secondary initial teacher education programme across schools working in partnership with a higher education provider in the Northwest of England. The proportion of variance between numerical grades for individual Teachers’ Standards and overall teaching was calculated at each formal review point over three consecutive years. Despite the complex process involved in assessing teaching competencies against performance criteria and the potential for subjective variation between individual assessors, the data consistently demonstrated underlying patterns. These suggested that quality assurance and management of assessment issues could have been a major influence on the assessors

Health information needs, source preferences and engagement behaviours of women with metastatic breast cancer across the care continuum: protocol for a scoping review

INTRODUCTION: The health information needs, information source preferences and engagement behaviours of women with metastatic breast cancer (mBC) depend on personal characteristics such as education level, prior knowledge, clinical complications, comorbidities and where they are in the cancer journey. A thorough understanding of the information behaviours of women living with mBC is essential to the provision of optimal care. A preliminary literature review suggests that there is little research on this topic, but that there may be lessons from a slightly broader literature. This review will identify what is known and what is not known about the health information needs, acquisition and influences of women with mBC across the care continuum. Findings will help to identify research needs and specific areas where in-depth systematic reviews may be feasible, as well as inform evidence-based interventions to address the health information needs of female patients with mBC with different demographics and characteristics and across the mBC journey. METHODS AND ANALYSIS: A scoping review will be performed using the guidelines of Arksey and O'Malley as updated by subsequent authors to systematically search scientific and grey literature for articles in English that discuss the health information needs, source preferences, engagement styles, and associated personal and medical attributes of women ≥18 years living with mBC at different stages of the disease course. A variety of databases (including Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Excerpta Medica Database (EMBASE), Academic Search Premier, Cochrane Database of Systematic Reviews, PsycINFO, Health Source: Nursing/Academic Edition, and PQDT Open), oncology, patient advocacy and governmental websites will be searched from inception to present day. Research and non-research literature will be included; no study designs will be excluded. The six-stage Arksey and O'Malley scoping review methodological framework involves: (1) identifying the research question; (2) searching for relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results; and (6) consulting with stakeholders to inform or validate study findings (optional). Data will be extracted and analysed using a thematic chart and descriptive content analysis. ETHICS AND DISSEMINATION: Being a secondary analysis, this research will not require ethics approval. Results will be disseminated through patient support organisations and websites and publications targeting healthcare professionals, advocates and patients

Patients’ experience of a regional allergy service

<em>Background</em>. The principle reason for referral to specialist allergy clinics is to establish diagnoses and provide treatment plans to help patients manage their allergy. If patients do not accept, understand, or remember diagnoses or treatment, clinic visits may have been a waste of time. Few specialist allergy clinics follow up patients after diagnosis.<br /><em>Design and Methods</em>. This was a postal survey to assess patients’ i) perception of usefulness of specialist allergy clinic visits, ii) under- standing of their allergy, iii) confidence in managing it, and iv) response to joining a regional online forum. Data for patients with confirmed allergy who attended the Peninsula Allergy Service (PAS) from 1998-2009 were extracted from consultant letters to general practitioners. Postal questionnaires were sent to 933 patients; 39% (336) responded.<br /><em>Results</em>. Two-thirds (63%) thought their clinic visit useful and resulted in them being more in control of their allergy; 9% thought it useful but they still had problems, 26% thought it had not been much use. One in six (16%, 55) respondents had major differences in their view of their allergy compared to that recorded by PAS. Over half (56%) had had further symptoms since their clinic visit and 120 patients, who were not confident in coping with their allergy, listed aspects of their lives that gave concern.<br /><em>Conclusions</em>. Specialist clinics need routine feedback from patients if they are to monitor their effectiveness and some better form of follow up for patients is needed to reinforce education and support patients. Public education is important.<br /

Development and implementation of a decision pathway for general practitioners for the management or referral of suspected allergy.

Many patients with suspected allergy are referred to specialist care inappropriately. We aimed to develop and implement an online decision pathway to aid General Practitioners' (GPs) management decisions in suspected allergy. Our study involved 1487 GPs, 3 referral management centres, 5 GP system suppliers, 4 primary care trusts, and 1 specialist allergy clinic. The pathway was implemented by 3/5 GP system suppliers, published to Map of Medicine and on a specialist clinic website. In the first year, the pathway ranked in the top 10/160 local care maps accessed via Map of Medicine and was viewed 900 times. Only 96 GPs registered to use the clinic website. Only 110 (7%) GPs responded to the feedback request, of which 13/110 (12%) had used the pathway; nearly all thought it useful. It was used by referral management centres as explanation of rejected referrals. Alternative approaches to embed its use are required. Significance for public healthOne in three people in the UK are affected by allergies during their lifetime. Early diagnosis and appropriate management can improve quality of life and reduce emergency hospitalisation. However, referring patients to secondary care is costly in terms of time and resources. We developed a pathway algorithm to support General Practitioners' (GPs) allergy management and referral decisions to ensure that all referrals to specialist clinics were appropriate. The study illustrates a real world implementation with lessons for those seeking to improve the primary-secondary care interface, implementing pathways in various formats. In the UK, Map of Medicine seems to be the most used software. We demonstrated the difficulty of reaching GPs to encourage adoption of online decision support and suggest new ways forward by expanding care pathways into more detailed protocols for use directly by patients

Phase 1 pilot study of e-mail support for people with long term conditions using the Internet.

BACKGROUND: Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group. METHODS: Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes. RESULTS: Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable. CONCLUSION: E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs

Undergraduate Nurses’ and Midwives’ Participation and Satisfaction with Live Interactive Webcasts

INTRODUCTION: E-Learning methods such as webcasting are being used increasingly in healthcare education, including that of nurses and midwives. Webcasting means live synchronous broadcasting over the internet, where students participate simultaneously in text ‘chat room’ interactive discussions when logged on to a webpage where they can see and hear a presentation such as a PowerPoint lecture, a list of other participants, and access ‘chat rooms’. AIMS: This paper reports student participation and satisfaction with the use of webcasting in a third year undergraduate nursing and midwifery research methods module in one higher education institution faculty of health and social work in the southwest of England, with students from distributed geographical locations. MATERIALS AND METHODS: Students chose either webcasts or face-to-face lectures. Following each of the four webcasts, a web-based evaluation questionnaire was administered in a cross-sectional survey design. RESULTS: Two thirds of students took part in webcasts and found them to be an acceptable teaching and learning strategy. Travel and cost savings were noted through not travelling to the main university campus, and these were statistically significantly correlated with students’ perception of gaining from the module and their overall satisfaction with webcasting. Across the four webcasts 5446 purposeful messages were posted indicating engagement with the material under study. CONCLUSIONS AND RECOMMENDATIONS: Webcasting is an effective teaching and learning strategy which is popular with students, allows remote access to teaching and learning, and offers time and cost savings to students. Further research is required to investigate the educational potential of this new technology

Ethical perceptions towards real-world use of companion robots with older people and people with dementia: survey opinions among younger adults

Contains fulltext : 221334.pdf (publisher's version ) (Open Access)Background: Use of companion robots may reduce older people's depression, loneliness and agitation. This benefit has to be contrasted against possible ethical concerns raised by philosophers in the field around issues such as deceit, infantilisation, reduced human contact and accountability. Research directly assessing prevalence of such concerns among relevant stakeholders, however, remains limited, even though their views clearly have relevance in the debate. For example, any discrepancies between ethicists and stakeholders might in itself be a relevant ethical consideration while concerns perceived by stakeholders might identify immediate barriers to successful implementation. Methods: We surveyed 67 younger adults after they had live interactions with companion robot pets while attending an exhibition on intimacy, including the context of intimacy for older people. We asked about their perceptions of ethical issues. Participants generally had older family members, some with dementia. Results: Most participants (40/67, 60%) reported having no ethical concerns towards companion robot use when surveyed with an open question. Twenty (30%) had some concern, the most common being reduced human contact (10%), followed by deception (6%). However, when choosing from a list, the issue perceived as most concerning was equality of access to devices based on socioeconomic factors (m = 4.72 on a scale 1-7), exceeding more commonly hypothesized issues such as infantilising (m = 3.45), and deception (m = 3.44). The lowest-scoring issues were potential for injury or harm (m = 2.38) and privacy concerns (m = 2.17). Over half (39/67 (58%)) would have bought a device for an older relative. Cost was a common reason for choosing not to purchase a device. Conclusions: Although a relatively small study, we demonstrated discrepancies between ethical concerns raised in the philosophical literature and those likely to make the decision to buy a companion robot. Such discrepancies, between philosophers and ‘end-users’ in care of older people, and in methods of ascertainment, are worthy of further empirical research and discussion. Our participants were more concerned about economic issues and equality of access, an important consideration for those involved with care of older people. On the other hand the concerns proposed by ethicists seem unlikely to be a barrier to use of companion robots.10 p