Telehealth involves the application of technology to deliver services over a geographi- cal distance. Studies in which telehealth procedures were used in the training or coaching of parents with young children (aged 6 years and under) who were diagnosed with autism were reviewed. Scoping searches identified two studies that met the inclusion criteria. These studies were evaluated in terms of the: 1) characteristics of the participants; 2) technology utilized; 3) services delivered via telehealth; 4) research methodology; and 5) results and conclusions of the study. Telehealth was used by speech-language pathologists and university researchers to provide training to parents on specific intervention approaches to facilitate targeted com - munication initiations and responses by gestures, picture pointing, or verbalizations, as well as the delivery and evaluation of the Early Start Denver Model. While the available literature is limited on this topic, this review suggests that the use of telehealth is a viable means to provide training to parents with young children diagnosed with autism.

Over the last 30 years, diabetes mellitus has changed from being seen as a relatively mild ailment associated with aging and the elderly (just a touch of sugar) to one of the major contemporary causes of premature mortality and morbidity in most countries. In virtually every developed society, diabetes is ranked among the leading causes of blindness, renal failure, and lower limb amputation. Through its effects on cardiovascular disease (70%-80% of people with diabetes die of cardiovascular disease), it is also now one of the leading causes of death. Even diabetes mellitus seems to be dealt with due to innovative information and communication tech- nologies, along with new forms of service delivery organization such as home care and remote monitoring. This paper provides a review of the innovative concept of using mobile phones for diabetes monitoring starting with a brief introduction, continuing with an analysis of health and lifestyle related data that record the patient-health-professional's interaction and decision making, and concluding with a general discussion section followed by an extended bibliography.

With the aging of the world's population and the rise of chronic illness such as heart failure (HF), the economic burden, number of hospitalizations, and penalties imposed for failure to meet hospital readmission expectations will continue to rise, thus increasing pressure on clinicians to utilize successful HF monitoring interventions to improve these measures. Telephone monitoring in patients with chronic HF utilizes a proactive approach in the care of such patients, and for this review is grouped into three categories, ie, structured telephone support, telemonitoring, and remote implantable device monitoring. Earlier studies on structured telephone support and telemonitoring suggested a clear benefit on mortality and HF admissions, although several recent large, randomized controlled studies have been neutral. Optimizing medical therapy requires an accurate assessment of volume status by the clinician; therefore, symptom report and weight monitoring alone are often challenging in the identification of true HF decompensation because they are not very sensitive markers. The use of remote monitoring technology for follow-up of patients with implantable devices, including implantable cardiac defibrillators and cardiac resynchronization therapy devices, can aid in identifying HF decompensation. Self-care or self-management is an essential component of a chronic illness such as HF, and it is important for such patients to be engaged in their health care to best utilize the telephone monitoring intervention. System design, adequate staffing, patient satisfaction, and treatment adherence are important for success of the telemonitoring system. Telephone monitoring seems to be an effective approach in the chronic HF population. In the future, large-scale telemonitoring programs may come into place as well as additional remote implantable monitoring devices.

The use of wound telemedicine systems in the home care environment has been expanding for the last decade. These systems can generally be grouped into two main types: store and forward systems and video conference type systems; additionally, there are also hybrid systems available that include elements of both. Evidence to date suggests that these systems provide significant benefits to patients, clinicians, and to the health care system generally. Reductions in resource use, visit substitution, costs, and high patient and clinician satisfaction have been reported; however, there is a lack of integration with existing health care technology and no clearly defined technical or clinical standards as yet. Similarly, the legalities associated with wound telemedicine and remote consultation remain unclear. As wound telemedicine systems continue to evolve and be deployed in different locations, there remains significant potential to harness their power to benefit patients being treated at home.

mHealth medication and blood pressure self-management program in Hispanic hypertensives: a proof of concept trial John C Sieverdes,1 Mathew Gregoski,1 Sachin Patel,1 Deborah Williamson,1 Brenda Brunner-Jackson,1 Judith Rundbaken,1 Eveline Treiber,1 Lydia Davidson,1 Frank A Treiber1,21Technology Applications Center for Healthful Lifestyles, College of Nursing, 2College of Medicine, Medical University of South Carolina, Charleston, SC, USAAbstract: Patient nonadherence to medication regimens and provider therapeutic inertia (failure to respond in timely manner to clinical data) are two primary contributors to ineffective chronic disease management. This 3-month proof of concept trial used an iterative design approach guided by self-determination theory and the technology acceptance model to develop a culturally sensitive, patient-centered, and provider-centered mobile health medication and blood pressure self-management program. Cellular connected electronic medication trays provided reminder signals for patients to take medications and smartphone messaging reminded patients to take at-home blood pressures using a Bluetooth-enabled monitor. Providers were given bimonthly feedback. Motivational and reinforcement text and audio messages were sent based upon medication adherence rates and blood pressure levels. Ten Hispanics with uncontrolled essential hypertension were randomized to standard care and Smartphone Medication Adherence Stops Hypertension (SMASH) intervention groups. Primary outcomes of provider and patient acceptability of the program were found to be high. Retention rates for the 3-month program were 100%, with mean ± standard deviation overall medication adherence for the SMASH group at 97.2% ± 2.8%, with all strongly believing the program helped them remember to take their medication. SMASH participants measured their blood pressure every 3 days 83.2% ± 6.0% of the time and completed 89.2% ± 19.06% of the expected readings. Nonparametric tests showed statistical significance for resting blood pressure changes between groups at months 2 (P = 0.016) and 3 (P = 0.008), with a pre-intervention to 3-month mean systolic blood pressure reduction of 47.2 mmHg for the SMASH group compared with a reduction of 12 mmHg for the standard care group. Change in scores between pre-intervention and months 1, 2, and 3 for ambulatory blood pressure values found that the SMASH group exhibited consistently greater reductions for 24-hour, wake, and sleep categories compared with little change in the standard care group, although statistical significance was not reached. Principles of patient-centered care highlight partnering with intended users and implementers are important when developing a culturally sensitive intervention that is meaningful and effective.Keywords: medication adherence, clinical inertia, self-determination theory, mHealth, blood pressure control, essential hypertension, Hispanics

Background: Alcohol and tobacco use are major causes of the disease burden in most countries of the world. Mobile phone text messaging is very popular among adolescents and young adults and has the potential to deliver individualized information to large population groups at low costs. Objective: To provide a narrative review on studies testing the appropriateness and effectiveness of text messaging-based programs to reduce alcohol and tobacco use in young people. Results: Two published studies on text message-based programs for the reduction of problem drinking and two studies on programs for enhancing smoking cessation were identified. A US-American pilot experimental study tested the feasibility and initial efficacy of a text messaging-based assessment and brief intervention among young adults identified during their emergency department visit with hazardous drinking. It demonstrated the feasibility of the text messaging-based program to collect drinking data in young adults after emergency department discharge. A Swiss pre–post study tested the appropriateness and initial effectiveness of a combined, individually tailored web- and text messaging (SMS)-based program to reduce problem drinking in vocational school students. It provided evidence for the appropriateness of the intervention and initial evidence for its efficacy to reduce problem drinking. One of the two studies addressing smoking cessation was a US-American pilot randomized controlled trial. Participants were recruited via online advertisements and received text messages tailored according to their quitting stage. The intervention significantly affected self-reported quitting rates at 4 weeks but not at 3 months after the quit date. Within a cluster-randomized controlled trial conducted in Switzerland, smoking students were proactively recruited within vocational school classes and received text messages tailored to demographic and smoking-related variables. The program was accepted very well by the target group. It did not affect smoking abstinence rates at 6-months follow-up but resulted in significant lower cigarette consumption.