Telehealth Facilities Research Articles

СУЧАСНИЙ СТАН ДИТЯЧОЇ ПСИХІАТРІЇ В УКРАЇНІ: ОСВІТА ТА ПРАКТИКА

The article discusses the challenges that Ukrainian paediatric mental health services faced during the COVID-19 pandemic and the full-scale invasion of military forces to Ukraine. The features of the psychiatric service organization, such as the concentration of these services in large cities exacerbated by the staff shortages, lowlevel telehealth facilities development, and lack of mental health education on the community level that were exacerbated by stigma in the society negatively affected the access to specialized child mental health services during the pandemic. The situation significantly worsened due to war, that was related to the unprecedented rate of violence toward the civil population, destruction of critical infrastructure, lack of access to medication, and evacuation of medical personnel that in turn resulted in a crisis in Ukrainian child and adolescent psychiatry To address these challenges, a recent paper highlight the need for systemic reforms and collaboration among experts in the field of child healthcare, medical education, social services, and government agencies. The author recommends creating a comprehensive training program for child psychiatrists and incorporating child psychiatry into the postgraduate training of medical professionals, providing training in child psychiatry for pediatricians and family doctors and promoting digital services. Furthermore, the authors propose deinstitutionalization for child psychiatric services and their movement to multidisciplinary childcare facilities with the developing of community- based forms of psychiatric and psychological care for children to ensure better access to mental healthcare services and their destigmatization.

COVID-19 Rehab Fright Management.

Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords “Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words”. Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.

Role of pharmacists during the COVID-19 pandemic in China-Shanghai experiences.

The roles and contributions of pharmacists in Shanghai during the coronavirus disease 2019 (COVID‐19) pandemic are described in this report. Five pharmacists have been appointed as members of an expert interdisciplinary health care team tasked with taking care of all adult patients with COVID‐19 in Shanghai in a designated hospital, the Shanghai Public Health Clinical Center (SPHCC). They work with pharmacists at SPHCC, having responsibilities that include drug supplies, dispensing, pharmacy intravenous admixture services (PIVAS), prescription audits, medication reconciliations, pharmacotherapy, therapeutic drug monitoring, and patient education. Due to the pandemic, pharmacy operations in all hospitals are modified to adhere to guidelines for infection risk mitigation and personnel protection. Community pharmacies serve as the public access point to health care and medical supplies, providing services beyond dispensing and medication counselling. The establishment of internet hospitals (telehealth facilities) provide new opportunities for delivering pharmaceutical care and working with health care professionals. Pharmacists also participate in evaluating new treatments and keeping health care teams informed of new findings for potential treatment considerations. In response to the critical need for health care professionals in Wuhan, 68 pharmacists from different parts of the country went there to work with the local pharmacists. Through assuming new roles and adapting existing practice, pharmacists have acquired invaluable experiences for future practice advancement. In order to assume these responsibilities effectively, pharmacists need to be equipped with the necessary skills for meeting the evolving health care challenges.

The impact of COVID-19 pandemic on orthopaedic specialty in Malaysia: A cross-sectional survey.

This study aims to investigate further how the coronavirus disease 2019 (COVID-19) pandemic is affecting orthopaedic surgeon in Malaysia in terms of exposure, general perceptions of risk, and the impact on their current and future practice. Orthopaedic surgeons nationwide were invited through email and text messages to answer an online self-administered questionnaire collecting demographic information, COVID-19 exposure experience, perception of risk, and impact on orthopaedic practice. Of the respondents, 4.7% and 14.0% were involved in frontline treatment for COVID-19 patients with non-orthopaedic and orthopaedic problem, respectively. Respondents working in Ministry of Health had highest percentage of involvement as frontliner, 7.8% (8/103) and 20.4% (21/103) for non-orthopaedic and orthopaedic related COVID-19 treatment, respectively (not significant). Their main concern was an infection of family members (125/235, 53.2%). Majority of respondents were still working (223/235, 94.9%), running outpatient clinics (168/223, 75.3%), and continued with their semi-emergency (190/223, 85.2%) and emergency surgeries (213/223, 95.5%). Of the surgeons, 11.2% (25/223) did not screen their patients for COVID-19 prior to elective surgeries, 30.9% (69/223) did not have any training on proper handling of personal protective equipment (PPE), 84.8% (189/223) make decision to manage more conservatively due to COVID-19 and 61.9% (138/223) had their income affected. Of the surgeons, 19.3% (43/223) started using telehealth facilities. Direct exposure to treatment of COVID-19 patients among the respondent is low and the main concern was infecting their family member. There are still several surgeons who did not conduct preoperative COVID-19 screening and practice without proper PPE training.

A new diffusion and substitution based cryptosystem for securing medical image applications

Due to the rising privilege for tele-health facilities have sophisticated responsiveness in the usage of medicinal image safeguard proficiency. It mainly compact with patient records that are secretive and must only available to legal person. So the medical image safety becomes a very significant problem, when patient evidence is conveyed through the public network. In this paper, a secret key of 128-bits size is generated by an image histogram. Initially, the photo sensitive feature of digital imaging and communications in medicine image is decomposed by the mixing process. The resulting image is distributed in key reliant blocks and further, these blocks are passed through key reliant diffusion and substitution processes. A total of five rounds are used in the encryption method. Finally the generated secret key is embedded within the encrypted image in the process of steganography. This also enhances the security of proposed cipher. At the receiver side the secret key was recovered from the embedded image and decryption operation was performed in inverse format. Performance analysis designates that the proposed cipher is more secure.

A new diffusion and substitution based cryptosystem for securing medical image applications

Due to the rising privilege for tele-health facilities have sophisticated responsiveness in the usage of medicinal image safeguard proficiency. It mainly compact with patient records that are secretive and must only available to legal person. So the medical image safety becomes a very significant problem, when patient evidence is conveyed through the public network. In this paper, a secret key of 128-bits size is generated by an image histogram. Initially, the photo sensitive feature of digital imaging and communications in medicine image is decomposed by the mixing process. The resulting image is distributed in key reliant blocks and further, these blocks are passed through key reliant diffusion and substitution processes. A total of five rounds are used in the encryption method. Finally the generated secret key is embedded within the encrypted image in the process of steganography. This also enhances the security of proposed cipher. At the receiver side the secret key was recovered from the embedded image and decryption operation was performed in inverse format. Performance analysis designates that the proposed cipher is more secure.

Mothers’ Perspectives of a Webcam Service for Children who Stammer

The aim of this study is to explore the advantages and limitations of using a web-cam service to access a specialist service for children who stammer (CWS) and what influences a parent's decision to use this medium. Information gathered will be used to inform the development of a web-cam service to increase access to specialist assessment and therapy services for CWS. There is evidence in the medical literature that tele-health facilities can be a viable option as a medium for delivering healthcare to families who are geographically distant from the source of provision (Karp et al., 2000). Those accessing services using web-cam services have indicated that they considered the reduced financial costs to be beneficial (Hughes et al., 2012), that the experience was acceptable and one that they would use it in future (Karp et al., 2000, Hughes et al., 2012; Kully, 2000). Research into using tele-health facilities with adults who stammer indicates no significant differences in therapy outcomes whether delivered face to face or via web-cam (Kully, 2000; O’Brian, Packman & Onslow, 2008). A reduction in stammering behaviour was reported in a case study of 3 adolescents accessing therapy via webcam (Carey, O’Brian, Onslow, Packman & Menzies, 2012) and Lewis, Packman, Onslow, Simpson & Jones, 2008 found a reduction in stammering when delivering the Lidcombe Program using the telephone. There have been no published studies, however, that give an insight into the delivery of speech and language therapy to children who stammer using a web-cam. All families who were due to attend the Michael Palin Centre for an assessment or review appointment were offered the option of having the session conducted via Skype. Twelve mothers have been recruited, six of whom chose to use Skype and six chose face-to-face contact. Semi-structured qualitative interviews are being conducted. These are being orthographically transcribed and analyzed using NVIVO and themes identified. The study is still in progress and full analysis is not yet complete. The following themes are emerging as influencing the choice of medium:•mothers attitude to technology,•child being more at ease at home,•mother's opinion that face to face contact in required to build a therapeutic relationship,•practical considerations such as distance from the centre and time off work.Emerging themes will inform clinicians about the strengths and limitations of working with families using tele-health technology and will help to refine these services and protocols so that they can be most successfully employed. It will also contribute to a clinician's informed decision making process about whether such services might be efficacious and cost effective for their own clients. The findings of this study will inform the development of a larger scale project about the use of tele-health as a viable medium for therapy and implications to service delivery will be discussed.

The genetic post mortem: Issues and successes in a regional genetics unit

can be problematic. We therefore trialled a ‘virtual’ clinic model, where a team comprising a Cardiologist, Geneticist, Genetic Counsellor, Senior Scientist in Molecular Diagnostics, and Forensic Pathologist meet monthly to review cases referred for cardiac genetic testing. The discursive format promotes rapid education of all involved, but functions effectively to provide uniform recommendations and support for families and referrers. Three months in, every case referred for cardiac genetic advice is reviewed by this service. Telehealth facilities allow the provision of first hand genetic advice by the team to outreach areas, while ongoing cardiac phenotyping, surveillance and treatment remain with the referring cardiologist. This process has allowed us to rapidly identify issues to be addressed before a face-to-face clinic is established, but also the unique strengths of this team which includes considerable experience in Cancer Genetics, a very similar field. This is a flexible and useful model for emerging services in similar regional areas.

An audit of cardiac genetic testing costs in a regional genetics unit

can be problematic. We therefore trialled a ‘virtual’ clinic model, where a team comprising a Cardiologist, Geneticist, Genetic Counsellor, Senior Scientist in Molecular Diagnostics, and Forensic Pathologist meet monthly to review cases referred for cardiac genetic testing. The discursive format promotes rapid education of all involved, but functions effectively to provide uniform recommendations and support for families and referrers. Three months in, every case referred for cardiac genetic advice is reviewed by this service. Telehealth facilities allow the provision of first hand genetic advice by the team to outreach areas, while ongoing cardiac phenotyping, surveillance and treatment remain with the referring cardiologist. This process has allowed us to rapidly identify issues to be addressed before a face-to-face clinic is established, but also the unique strengths of this team which includes considerable experience in Cancer Genetics, a very similar field. This is a flexible and useful model for emerging services in similar regional areas.

Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project

Palliative care (PC) and palliative radiotherapy (RT) consultation are integral to the care of patients with advanced cancer. These services are not universally available in rural areas, and travel to urban centers to access them can be burdensome for patients and families. The objectives of our study were to assess the feasibility of using videoconferencing to provide specialist multidisciplinary PC and palliative RT consultation to cancer patients in rural areas and to explore symptom, cost, and satisfaction outcomes. The Virtual Pain and Symptom Control and Palliative Radiotherapy Clinic was piloted from January 2008 to March 2011. Cancer patients in rural northern Alberta attended local telehealth facilities, accompanied by nurses trained in symptom assessment. The multidisciplinary team at the Cross Cancer Institute in Edmonton was linked by videoconference. Team recommendations were sent to the patients' family physicians. Data were collected on referral, clinical, and consultation characteristics and symptom, cost, and satisfaction outcomes. Forty-four initial consultation and 28 follow-up visits took place. Mean Edmonton Symptom Assessment Scale scores for anxiety and appetite were statistically significantly improved at the first follow-up visit (p < 0.01 and p = 0.03, respectively). Average per visit savings for patients seen by telehealth versus attending the CCI were 471.13 km, 7.96 hours, and Cdn $192.71, respectively. Patients and referring physicians indicated a high degree of satisfaction with the clinic. Delivery of specialist multidisciplinary PC consultation by videoconferencing is feasible, may improve symptoms, results in cost savings to patients and families, and is satisfactory to users.

An Evaluation of the Use of a Website and Telephonic Information Service as Public Education about Forgetfulness

There is increasing interest in telehealth as a potential new approach for healthcare delivery. To investigate whether telehealth is suitable to inform the older population about forgetfulness, we designed and compared two types of telehealth: Memory Website and the Memory Phone. The aim of this study was to analyze characteristics of the individuals who are interested in the Memory Phone and the Memory Website, to investigate the nature of the information in which the users were interested, and to evaluate the usefulness of the services. Participants were asked to answer several questions before and after visiting the main information menu of the telehealth facilities. Characteristics are given for all participants who used the facilities. In the evaluation period of 3 months, more individuals used the Memory Website (n = 2,631) than the Memory Phone (n = 228). The two services were used by different populations. Phone users were significantly older, more often female, and perceived themselves more often as forgetful. In the specific group of nonprofessional older individuals, general information about memory was more requested by Phone users compared with Website users (67% vs. 41%). Website users more often requested strategies and tips than Phone users (66% vs. 34%). The Phone and the Website were both considered useful. Overall, the Memory Website and the Memory Phone are two different types of evidence-based telehealth interventions, which are relevant for different populations, and are useful in informing the older population about forgetfulness and aging.

A Sabbatical Journey of Discovery: Patient Safety

This is the second in a series of reports to share key learnings from my sabbatical. In spring and summer of 2005, I took a three-month journey through Scandinavia, Europe, Ireland and the United Kingdom to observe innovation in nursing service delivery, in particular, nursing-led services; to explore outcome measurement as it relates to nursing services; to look at patient satisfaction and improving patients’ experience as a form of outcome measurement; to learn about palliative care; and to examine ways in which organizations, professional associations and policy makers are attempting to move nursing and healthcare services delivery into the future. I met with leaders in nursing and other health professions, policy makers, faculty and research units. During site visits, I spent time observing nurses at work. I visited teaching hospitals, district or community hospitals, community services, hospices and telehealth facilities. Our international colleagues extended a warm welcome, helped me gain exposure to things that might be of interest and were eager to learn about our practices in Canada. The focus of this report is patient safety, especially infection control and patient-centred care.