Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years

Published version. Source at https://doi.org/10.1186/s12913-016-1743-5 . License CC BY 4.0.Background: Although Norway is well known for its early use of telemedicine to provide services for people in rural and remote areas in the Arctic, little is known about the pace of telemedicine adoption in Norway. The aim of the present study was to explore the statewide implementation of telemedicine in Norwegian hospitals over time, and analyse its adoption and level of use. Methods: Data on outpatient visits and telemedicine consultations delivered by Norwegian hospitals from 2009 to 2013 were collected from the national health registry. Data were stratified by health region, hospital, year, and clinical specialty. Results: All four health regions used telemedicine, i.e. there was 100 % adoption at the regional level. The use of routine telemedicine differed between health regions, and telemedicine appeared to be used mostly in the regions of lower centrality and population density, such as Northern Norway. Only Central Norway seemed to be atypical. Twenty-one out of 28 hospitals reported using telemedicine, i.e. there was 75 % adoption at the hospital level. Neurosurgery and rehabilitation were the clinical specialties where telemedicine was used most frequently. Despite the growing trend and the high adoption, the relative use of telemedicine compared to that of outpatient visits was low. Conclusions: Adoption of telemedicine is Norway was high, with all the health regions and most of the hospitals reporting using telemedicine. The use of telemedicine appeared to increase over the 5-year study period. However, the proportion of telemedicine consultations relative to the number of outpatient visits was low. The use of telemedicine in Norway was low in comparison with that reported in large-scale telemedicine networks in other countries. To facilitate future comparisons, data on adoption and utilisation over time should be reported routinely by statewide or network-based telemedicine service

Regional Electronic Markets: A Tale of 2Cities.com

This paper reviews the concept of electronic marketplaces and, in particular, their relevance for SMEs. A specific example of a Regional Electronic Marketplace (REM) using a Community Web model is examined within this context. The authors review the underlying philosophy for the project and the planning which preceded implementation. A review of the case highlights the issues which are critical for successful implementation and provides a framework to guide future REM developments. Finally, the case is analysed within an e-community context and recommendations made for future portal developments

Adoption of telemedicine: from pilot stage to routine delivery

<p>Abstract</p> <p>Background</p> <p>Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery.</p> <p>Discussion</p> <p>We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur.</p> <p>Summary</p> <p>The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and professional incentives for potential telemedicine users and understand their importance for widespread adoption.</p

mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review

Background: Reducing maternal mortality, neonatal mortality and under 5-year mortality are important targets addressed by the United Nations' Sustainable Development Goals. Despite studies reported an improvement in maternal and child health indicators, the progress achieved is not uniform across regions. Due to the increasing availability of mobile phones in low and middle-income countries, mHealth could impact considerably on reducing maternal and child mortality and maximizing women's access to quality care, from the antenatal stage to the post-natal period. Methods: A systematic literature review of mHealth interventions aimed at reducing maternal and child mortality in Sub-Saharan Africa and Southern Asia. Primary outcomes were maternal mortality, neonatal mortality, and under-five mortality. Secondary outcomes were skilled birth attendance, antenatal care (ANC) and post-natal care (PNC) attendance, and vaccination/immunization coverage. We searched for articles published from January 2010 to December 2020 in Embase, Medline and Web of Science. Quantitative comparative studies were included. The protocol was developed according to the PRISMA Checklist and published in PROSPERO [CRD42019109434]. The Quality Assessment Tool for Quantitative Studies was used to assess the quality of the eligible studies. Results: 23 studies were included in the review, 16 undertaken in Sub-Saharan Africa and 7 in Southern Asia. Most studies used SMS or voice message reminders for education purposes. Only two studies reported outcomes on neonatal mortality, with positive results. None of the studies reported results on maternal mortality or under-five mortality. Outcomes on skilled birth attendance, ANC attendance, PNC attendance, and vaccination coverage were reported in six, six, five, and eleven studies, respectively. Most of these studies showed a positive impact of mHealth interventions on the secondary outcomes. Conclusion: Simple mHealth educational interventions based on SMS and voice message reminders are effective at supporting behavior change of pregnant women and training of health workers, thus improving ANC and PNC attendance, vaccination coverage and skilled birth attendance. Higher quality studies addressing the role of mHealth in reducing maternal and child mortality in resource-limited settings are needed, especially in Southern Asia

QUOTA DI RISERVA E FAMILY PROVISION A CONFRONTO: LA SUCCESSIONE NECESSARIA IN UNA PROSPETTIVA DI COMPARAZIONE TRA IL SISTEMA ITALIANO ED IL MODELLO INGLESE

The aim of this work is to compare the \u201cprovision for family and dependants\u201d in English legal system with the Italian discipline of forced-succession. The Italian Legal system establishes some fixed limits to one\u2019s testamentary freedom, because of the fact that the \u201cdeceased person\u201d is called to look after his/her relatives and to take care of their needs. On the other hand, in England the succession rule is the testamentary freedom. In 1938 the Inheritance Family Provision Act and in 1975 the Inheritance Provision for Family and Dependants Act introduced some limits to this testamentary freedom: the relatives of the deceased person, who did not received any amount from the \u201cdeceased re\u201d can act and claim to receive a reasonable provision; however, this \u201cprovision\u201d does not consist in a certain amount, but can be fixed by the judge case by case, considering all the relevant circumstances. The Inheritance Provision for Family and Dependants Act allows the dependant and the person who has been maintained by the deceased to ask for the provision, so that the right to have a provision is not limited to parents, sons and wife/husband. As it concerns the amount of the provision, if the Italian system establishes fixed amounts, the English legal system has much more flexibility than the Italian one and many factors have to be considered in determining the amount to be given to the plaintiff. Those factors are: if the plaintiff who asks the provision has his own goods and work or not, if the deceased had any debt towards the plaintiff or not, what is the value of the deceased \u201cre\u201d, if the plaintiff has psychological or physical problems or weakness, how the plaintiff treated the deceased when he/she was alive, how many years the marriage lasted, in case the plaintiff is wife or husband of the deceased. English law does not establish neither a minimum, nor a maximum for the provision, but the amount of it is up to the judge to be determined. The study of English case law can lead us to discover if the attribution of family provision is so frequent as one could expect it to be or if the provision is rarely allowed because of the uncertainty about the amount which can be obtained and about the possibility of obtaining it. The final aim of this work is to point out how family provision is used in English case law and if the \u201ccommon law-way of thinking\u201d is so far from the civil law one, to exclude an hypothetical harmonisation of the two \u201cforced- succession disciplines\u201d

Are Physical Activity and Benefits Maintained After Long-Term Telerehabilitation in COPD?

This study investigated whether physical activity levels and other outcomes were maintained at 1-year from completion of a 2-year telerehabilitation intervention in COPD. During the post-intervention year, nine patients with COPD (FEV1 % of pred. 42.4±19.8%; age 58.1±6 years) were encouraged to exercise on a treadmill at home and monitor daily symptoms and training sessions on a webpage as during the intervention. Participants were not provided supervision or motivational support. Physical activity levels decreased from 3,806 steps/day to 2,817 steps/day (p= 0.039). There was a decline in time spent on light physical activity (p=0.009), but not on moderate-to-vigorous activity (p=0.053). Adherence to registration of symptoms and training sessions decreased significantly. Other outcomes including health status, quality of life, anxiety and depression, self-efficacy, and healthcare utilization did not change significantly. In conclusion, provision of equipment for self-management and unsupervised home exercise might not be enough to maintain physical activity levels

Tourette syndrome and nutritional implications

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder defined by multiple motor tics and at least one sound tic. Various behavioural symptoms are associated with GTS, especially obsession and compulsion behaviours (OCBs), attention-deficit/hyperactivity disorder (ADHD) and poor impulse control. These comorbid conditions have a high impact on patients quality of life, including eating attitudes and body image perception. Nutritional implications, together with sleepiness and sexual asthenia, are the principal side effects of the pharmacological therapy. Actually, drugs may compromise the nutritional status of patients producing appetite increase, dry mouth, constipation, glucose and lipid metabolism abnormalities, metabolic syndrome, mild transient dysphagia and nausea. About 40% of GTS patients experience hyperphagia because of drug side effects, OCBs, ADHD, or poor impulse control. Consequently, in these cases an overweight status can occur, complicating the management of the symptoms. Therefore, an increase body weight should be considered one of the most relevant factors increasing GTS drug-related bad compliance, which may consequently cause in some patients the discontinuation/interruption of the pharmacological therapy

Multiple retrospective analysis of survival and evaluation of 4 cardiac death predictors in a population of dogs affected by 5 degenerative mitral valve disease in ACVIM class C treated 6 with different therapeutic protocols

Clinical records of dogs with spontaneous degenerative mitral valve disease (DMVD) with clinical signs related to congestive heart failure (CHF) that had been recruited during routine clinical practice, between 2001 and 2018 at the Cardiology Unit of the Veterinary Teaching Hospital (University of Milan) were included in this retrospective cohort study. Baseline echocardiographic data were evaluated. Median survival times (MSTs) were calculated. Data on therapeutic treatment, ISACHC or ACVIM classes were reviewed based on the inclusion period and type of endpoint (i.e. cardiac death or death for other causes). The main goal of this data review was to retrospectively evaluate 259 clinical records of subjects belonging to ACVIM C class examined between 2001 to 2018 together with the 202 examined between 2010 to 2018. The MSTs of these subjects was 531 d (2001-2018) and 335.5 d (2010-2018), respectively. Univariate survival regression analysis for subjects included from 2010 to 2018 showed the following variables as being significantly related to cardiac death (CD): LA/Ao ratio (HR 2.754, p=0.000), E wave (HR 2.961, p=0.000), E/A ratio (HR 1.372, p=0.000), EDVI (HR 1.007, p=0.000), ESVI (HR 1.012, p=0.026), Allo(d) (HR 4.018, p=0.000) andAllo(s) (HR 2.674, p=0.049), age (HR 1.006, p=0.009) and PH severity (HR=1.309, p=0.012). Multivariate analysis, adjusted for age, showed that the only variable that determined a statistically significant difference in MST was PH severity (HR 1.334, p=0.033). The type of therapeutic treatment within this class was not significant for the MST of the subjects

Long-term exercise maintenance in COPD via telerehabilitation: a two-year pilot study

Submitted manuscript version. Published version available at https://doi.org/10.1177/1357633X15625545. Introduction - Pulmonary rehabilitation (PR) is an integral part of the management of chronic obstructive pulmonary disease (COPD). However, many patients do not access or complete PR, and long-term exercise maintenance has been difficult to achieve after PR. This study aimed to investigate feasibility, long-term exercise maintenance, clinical effects, quality of life and use of hospital resources of a telerehabilitation intervention. Methods - Ten patients with COPD were offered a two-year follow-up via telerehabilitation after attending PR. The intervention consisted of home exercise, telemonitoring and self-management via a webpage combined with weekly videoconferencing sessions. Equipment included a treadmill, a pulse oximeter and a tablet. Data collected at baseline, one year and two years were six-minute walking distance (6MWD), COPD assessment test (CAT), EuroQol 5 dimensions (EQ-5D), hospitalisations and outpatient visits. Results - No dropout occurred. Physical performance, lung capacity, health status and quality of life were all maintained at two years. At one year, 6MWD improved by a mean of 40 metres from baseline, CAT decreased by four points and EQ visual analogue scale (EQ VAS) improved by 15.6 points. Discussion - Long-term exercise maintenance in COPD via telerehabilitation is feasible. Results are encouraging and suggest that telerehabilitation can prevent deterioration and improve physical performance, health status and quality of life.<p