Use Of Telemedicine Technology Research Articles

An insight into the use of telemedicine technology for cancer patients during the Covid-19 pandemic: a scoping review

BackgroundThe use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic.MethodsThis was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively.ResultsA total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates.ConclusionThe findings provided valuable insights into the various telemedicine technologies, services, users’ perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users’ satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.

Challenges of Implementing Telemedicine Technology: A systematized Review.

Today, the technologies in the world are rapidly evolving, and global infrastructure of information is spreading rapidly. The health system of different countries is facing a variety of challenges in order to apply telemedicine services. The aim of this study was to determine the challenges facing the health system of different countries in the application of telemedicine. The present research was conducted in 2022 as a systematized review of studies related to challenges of telemedicine. In this study, Preferred Reporting Items for Systematic Reviews (PRISMA) and Critical Appraisal Skills Program (CASP) guidelines were used to assess the articles. The keywords "telemedicine," "telehealth," "E-health," and "tele care" were used in combination with the Boolean operators OR and AND. The ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley, and Google Scholar were searched. In this study, based on the search strategy, databases were searched from January 2012 to January 2022, and in the final stage, analysis was performed on 27 selected identified articles. The use of telemedicine technology faced major formality and legality, required bandwidth, development of multilingual systems, economic efficiency, available patterns, payment for services, moral barriers, social status, differences and national and legal contradictions in the world, lack of insurance coverage challenges, and so on. Recognizing gaps and challenges can provide a way to fill these gaps and create opportunities for improvement. Utilizing telemedicine technology can be considered as an effective step in the health system. This technology has weaknesses that may challenge it. Successful application of telemedicine technology cannot be very effective without removing these barriers.

Perception and Attitude of Pakistani Doctors Toward the Use of Telemedicine Technology.

Healthcare providers may improve healthcare delivery and make it available to more people by combining advanced technologies with high-quality network services. In this regard, telemedicine has improved healthcare providers' ability to provide services for a large number of individuals without their physical presence. Pakistan's healthcare system is a mix of government infrastructure, parastatal healthcare, the private sector, civil society, and charitable contributions. However, unawareness, poor education, lack of skills, lack of resources, and technical issues including internet connectivity, and load shedding have limited the accessibility of the Pakistani population towards advancement in the healthcare industry. It was a cross-sectional study conducted at a private tertiary care hospital from April to June 2022 in Karachi. To recruit the study participants, a purposive sampling technique was used. Practicing doctors (n=100), who were aware of telemedicine technology and agreed to participate in the study, were included as study participants. A self-developed proforma was administered to doctors to assess the study's objectives. Out of 100, 64% (n=64)of the participants have no experience working in telemedicine while only36% have worked with telemedicine for at least one year. When asked about the applicationof telemedicine technology only 46% of the doctors knew the technology used. While only 42% of the doctors were familiar with the telemedicine tools, including a virtual stethoscope, pulse oximeter, etc. views regarding continue using telemedicine,26% of the participants having no experience with telemedicine agreed that they would like to use telemedicine,35% agreed to use telemedicine with improvement whereas 3% of them do not want to use the telemedicine technology. The participants of the current study were aware of telemedicine technology and its advantages. However, despite their agreement, the majority of the doctors emphasized the improvement of the system to deliver better services by using this technology.

Use of Telemedicine Technology among General Practitioners during COVID-19: A Modified Technology Acceptance Model Study in Poland.

During the COVID-19 pandemic, telehealth became a popular solution for the remote provision of primary care by General Practitioners (GPs) in Poland. This study aimed to assess the GPs’ acceptance of telehealth during the COVID-19 pandemic in Poland and to explain the factors that drive GPs’ need to implement a telehealth system in primary care using the modified Technology Acceptance Model (TAM). In Poland, 361 GPs from a representative sample of 361 clinics drawn from 21,500 outpatient institutions in Poland participated in the empirical study. Structural equation modelling (SEM) was used to evaluate the causal relationships that were formulated in the proposed model. Research has shown that Polish GPs reported a positive perception and high acceptance of the telehealth system during the COVID-19 pandemic. Overall, the results show that the social factors (image, decision autonomy, perception of patient interaction) significantly positively influence the technological factors (perceived ease of use and perceived usefulness) that influence the need to implement a telehealth system. The proposed socio-technological model can serve as a theoretical basis for future research and offer empirical predictions for practitioners and researchers in health departments, governments, and primary care settings.

Clinician perception and readiness for use of telemedicine technology with respect to Southern Haryana

Telemedicine is disseminating health-related information and services using electronic technology and telecommunications. Telemedicine enables long-distance patient-clinician communication and care as well as reminders and education. It also permits remote admissions.Health care providers, patients, and the public may benefit from easier access to information via Telemedicine. Telehealth is frequently considered to save the health care system money because of its digital nature. However, there is a wide range of data to back this claim. In performing economic assessments of telehealth services, the personnel assessing them must be informed of the possible results and extra clinical advantages of the telehealth service.There are serval benefits of Telemedicine. During Covid-19, Telemedicine has become a huge platform for patients to interact with physicians with satisfactory telemedicine services. This review paperfocused on Telemedicine, its advantages and disadvantages, its importance, and patient satisfaction.

Telemedicine for Patient Management in Remote Areas and Underserved Populations.

Access to care services in remote areas is challenging. The use of telemedicine technology in these areas facilitates access to health care. This study aimed to summarize the current research on telemedicine in remote areas such as mountains and forests. A systematic search was conducted in databases including Medline (through PubMed), Scopus, IEEE Xplore Digital Library, and ISI Web of Science to identify relevant studies published until May 12, 2021. Screening of retrieved articles for selection and inclusion in the study was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR) checklist. A total of 807 articles were identified after removing duplicates, from which 20 studies meeting our inclusion criteria were selected. Challenges, opportunities, and equipment required to use telemedicine in remote areas were extracted from the selected studies. The results revealed that telemedicine implementation in remote areas had many challenges, including harsh weather conditions, Internet connectivity problems, difficult equipment transportation, and ethical issues. Telemedicine also has many benefits, such as cost and time savings for patients, improving patients' quality of life, and improving patient satisfaction. Telemedicine for inhabitants of forested and mountainous areas facilitates rapid access to health care and enhances patient satisfaction. Distinguishing advantages and barriers as well as reducing restrictions will have an essential role in accelerating the use of this technology.

Acceptance and use of telemedicine technology by health professionals: Development of a conceptual model.

Recent developments in information technology (IT) in health are extended to highly specialized services, an example is telemedicine technology, understood as the use of IT to enable the transfer of medical information for diagnostic purposes, therapeutic and educational. Despite the benefits of implementing such technology, healthcare professionals, as end users, do not fully utilize it. The Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT), are among the models applied to assess and predict the acceptance and use of telemedicine. This article aims to identify the relevant literature related to these two models, to review and summarize the methodologies and results, and propose a conceptual model for the acceptance and use of telemedicine technology by healthcare professionals.

Telemedicine during COVID-19 Pandemic in Saudi Arabia: Oral and Maxillofacial Surgeons’ Knowledge and Implementation

Telemedicine can significantly improve health care delivery for patients with limited access to medical services. Innovative uses of this kind of technology in the provision of healthcare is increasing with the emergence of the virus causing the disease COVID-19, there is an urgency to expand the use of technology to help people who need routine care. This study aimed to assess oral and maxillofacial surgeons' knowledge of telemedicine and its applications, and incorporation of telemedicine into their clinical practice during the COVID-19 pandemic.
 Methodology: This is a cross section, Questionnaire based study conducted among oral and maxillofacial surgeons in Saudi Arabia from November 2020 to January 2021. The study sample included 200 oral and maxillofacial surgeons from different regions in Saudi Arabia which has been calculated depend on reality of the Saudi health workforce during the next ten years 2018-2027 book and the total number of OMS and oral surgeons who was registered was approximately 300. The self-administered questionnaire (which was constructed after extensive reviewing of the literature in the same context) was distributed among the selected surgeons using online platform; the components of that questionnaire were: socio demographic characteristics, knowledge of telemedicine technology, using of telemedicine before and during COVID-19 and security of telemedicine technology. A Scoring Criteria used to indicate the knowledge of OMS and oral surgeons towards the use of telemedicine technology. All statistical analyses were performed using SPSS version 21.
 Results: A total of 69 OM surgeons were responded, of which 52.2% were females. The knowledge of the surgeons regarding telemedicine was moderate among 43.5% (mean: 11.6; SD: 4.12, out of 20 points). Surgeons who were working in the private clinic (F=2.982; p=0.027), those who had heard of telemedicine (t=4.987; p<0.001) and those who implemented telemedicine at a current workplace before COVID-19 (t=3.873; p<0.001) had significantly better knowledge score than the rest.
 Conclusion: Although there was an increased implementation of telemedicine use during the covid-19 pandemic, the oral and maxillofacial surgeon’s knowledge about it seems to be low.

Teleguidance Technology for Endotracheal Intubation: A Scoping Review.

Teleguidance facilitated intubation has recently reemerged during the coronavirus disease 2019 pandemic as a strategy to provide expert airway management guidance and consultation to practitioners in settings where such expertise is not readily available onsite or in-person. We conducted a scoping review to provide a synthesis of the available literature on teleguidance facilitated intubation. Specifically, we aimed to evaluate the feasibility, safety, and efficacy of teleguidance facilitated intubation given existing technology. A librarian-assisted search was performed using three primary electronic medical databases from January 2000 to November 2020. Articles that reported outcomes focused on implementing or evaluating the performance of teleguidance facilitated intubation were included. Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. Of 255 citations identified, 17 met eligibility criteria. Studies included prospective investigations and proof of technology reports. These studies were performed in clinical and simulation environments. Five of the prospective investigations that examined time to intubation and intubation success rates. Multiple different commercially available and noncommercial teleconference software systems were used in these studies. There is a limited body of literature evaluating the feasibility, safety, and efficacy of teleguidance facilitated intubation. Based on the studies available that examined a variety of technologies within simulation and clinical environments, teleguidance facilitated intubation appears to be feasible, safe, and efficacious. Given the exponential growth in the use of telemedicine technology during the coronavirus disease 2019 pandemic and the evidence supporting teleguidance facilitated intubation, there is a need to critically evaluate the most effective mechanisms to integrate and optimize these technologies across diverse practice settings.

Retrospective Study Evaluating Effect of Voxelotor Treatment on Acute Care Utilization during the Peak of COVID-19

IntroductionIn sickle cell disease (SCD), the polymerization of deoxygenated HbS fundamentally alters the structure of the erythrocyte, producing the sickle cell that is characteristic of the disease. Clinical manifestations often perceived in patients suffering from SCD include vaso-occlusion, anemia, and hemolysis. Due to these sequelae, patients frequent the emergency room (ER), urgent care clinic, and hospital. Voxelotor, an oral medication approved by the Food and Drug Administration (FDA) in 2019 for the treatment of SCD, directly targets the pathophysiology of SCD by inhibiting deoxygenated HbS polymerization. Results of the Phase III HOPE trial indicate that the drug can increase hemoglobin levels and reduce markers of hemolysis as well as the incidence of worsening anemia in patients with SCD (Vichinsky et al. N Engl J Med 2019).The COVID-19 pandemic has posed several challenges for patients with SCD in 2020. Amid the pandemic, patients continued to seek out acute medical care, including care in the ER, urgent care clinics, and hospital. The aim of this study was to determine whether utilization of acute medical care differed for patients who received voxelotor before and after therapy in 2020. We also evaluated the utilization of healthcare through telemedicine platforms to facilitate access to novel therapies such as voxelotor for patients with SCD.Methods13 patients (≥18 years of age as of January 1, 2020) with SCD who had begun treatment with voxelotor between January 1, 2020 and December 31, 2020 were included in the initial analysis. Six patients were excluded from final analysis: three discontinued treatment due to side effects, one was noncompliant with treatment, and two were lost to follow-up. Acute care utilization, measured by the number of times each patient visited the ER, urgent care clinic, and hospital was compared for each patient in the period six months prior to their first dose of voxelotor and in the period six months after their last dose of the drug in 2020 using paired t-tests and Wilcoxon matched-pairs signed rank tests. Demographic information and the type of visit at which patients agreed to proceed with voxeletor was recorded for each patient. Simple linear regressions and multiple regressions controlled for covariates, defined as sex, BMI, age, type of insurance coverage, and duration of treatment.ResultsAll seven (100%) patients discussed voxelotor treatment with their provider during a telehealth video visit. In the period before initiating treatment, patients frequented the ER an average of 2.71 (SD=6.75) times. In the six months after their last dose, patients visited the ER less than they had in the period prior to treatment, on average 0.57 (SD=0.79) times. This difference did not achieve statistical significance (p>0.9999). The mean number of visits to the urgent care clinic in the six months before treatment was 2.71 (SD=6.75) compared to 2 (SD=4) in the period after patients' last dose in 2020. This finding was not statistically significant (p>0.9999). Hospitalizations, on average, decreased significantly from 5.14 (SD=2.34) in the six months before starting treatment to 1.57 (SD=0.98) after ending therapy for 2020 (p=0.0015). Covariates did not have an effect on the differences in acute care utilization before treatment and after last treatment in 2020.ConclusionsThe findings of this study imply that treatment with voxelotor was associated with a decrease in the frequency of hospitalizations for the seven patients analyzed. This finding can potentially be attributed to the efficacy of voxelotor in improving anemia and reducing complications associated with SCD. While the difference between ER visits and urgent care visits before treatment and after the last dose in 2020 did not achieve statistical significance, likely due to small sample size, the data does suggest a reduction in both outcomes. In addition, the observation that all visits in which patient and provider discussed and initiated treatment were virtual support the use of telemedicine technology to improve access to multidisciplinary care and novel therapies for SCD patients. The impact of voxelotor treatment will continue to be assessed in SCD patients at our institution, and more data from clinical encounters will lead to a greater understanding of the efficacy of voxelotor. [Display omitted] DisclosuresJain: GBT: Speakers Bureau; Novartis: Speakers Bureau; Sanofi: Other: advisory board; Argenx: Other: advisory board; DOVA: Other: advisory board.

Pilot of a pharmacist‐integrated interprofessional team to optimize prescribing in a telemedicine palliative care clinic

AbstractIntroductionThe rapidly growing number of frail elderly patients is leading to a greater need for palliative care services. Palliative care clinical pharmacy specialists (CPSs) can improve quality of care through comprehensive symptom and medication management. Incorporating pharmacists into palliative care through telemedicine meets complex pharmacotherapy needs of Veterans who have difficulty accessing care due to advanced illness.ObjectivesThe primary objective of this quality improvement project was to pilot a pharmacist‐integrated palliative care team clinic utilizing telemedicine to optimize palliative prescribing for Veterans and to describe CPS outcomes related to pharmacotherapy changes implemented. A secondary outcome was to assess Veteran satisfaction with assessments completed via telephone post visit.MethodsA CPS was integrated into the existing palliative care team beginning December 1, 2019 with video and audio telemedicine clinic appointments offered through May 31, 2020. The CPS completed comprehensive medication regimen reviews, assessed symptoms, and addressed medication‐related concerns during the visit. Recommendations for deprescribing opportunities and symptomatic management were provided to the consulting provider and/or primary treatment team. Recommendations made and those implemented within 30 days of the appointment were documented. Veteran satisfaction assessments were completed via telephone 14‐30 days after the clinic visit.ResultsThe palliative care team integrated a CPS and completed 25 consults via telemedicine technology between December 2019 and May 2020. The pharmacotherapy implementation rate was 60% (119/200) including a deprescribing rate of 57% (72/126), decreasing polypharmacy and potentially resulting in a decrease in adverse drug events. Veterans were on average very satisfied with their visit, with an assessment response rate of 56% (14/25).ConclusionPharmacist involvement with the palliative care team decreased polypharmacy, optimized symptom management, and increased use of telemedicine technology. Veterans were overall satisfied with the care received by the palliative care team via telemedicine technology.

The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study.

With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine.

Pharmacists' experience, competence and perception of telepharmacy technology in response to COVID-19.

BackgroundIn the telepharmacy model, the pharmacist can play a pivotal role in delivering pharmaceutical services for patients. However, evidence of pharmacists’ impact on improving patient outcomes through disease outbreak through telepharmacy is sparse.ObjectivesThis study aims to examine pharmacists' attitudes towards clinical benefits and identify challenges regarding the use of telepharmacy during the COVID‐19 pandemic in Jordan.MethodA cross‐sectional survey design was used to recruit eligible participants from both hospital and community pharmacies.ResultsA total of 364 pharmacists agreed to participate in the study. The majority of the participants (70.6%) expressed favourable attitudes towards telepharmacy to accurately capture and report signs and symptoms of COVID‐19. Almost 91% agreed that patients can receive immediate medical feedback while using telepharmacy services. Pharmacists (87%) emphasised their role in the monitoring of physiological parameters when entered by patients using telepharmacy technology. However, more than half of the participants reported that lack of reimbursement and evidence‐based studies might hinder the use of telemedicine technology to deliver remote clinical services.ConclusionThe need for implementing telepharmacy technology has been further boosted because of its noticeable benefits in promoting convenient healthcare services remotely in emergency situations.

Perspective of Attending Physicians on the Use of Telemedicine in an Outpatient Arthroplasty Setting During the COVID-19 Pandemic

Background: During the worldwide COVID-19 pandemic, physicians had to improvise and adapt new ways to provide care to patients. Purposes: The purpose of this study was to assess physicians’ sentiments regarding telemedicine and its use in orthopedic practices. Methods: We performed a cross-sectional study of attending orthopedic physicians, the majority of whom integrated telemedicine into their practices from March to October 2020. A survey was sent to 517 physicians who had registered for an orthopedics conference. The survey included questions pertaining to various factors regarding telemedicine and each physician’s practice. Results: Of the 517 physicians who received the survey, 328 responded, for a 63.4% response rate. Of the 328 respondents, 84.1% did not use telemedicine in their practice prior to the COVID-19 pandemic. Even during the pandemic, the physicians most commonly responded that less than 5% of their practice was conducted by telemedicine (n = 103, 31.4%). The second most common response was that more than 20% of visits were done via telemedicine (n = 72, 22.0%); 43.0% of physicians noted that they would not use telemedicine technology in their practice after the pandemic, but 59.1% of physicians would be willing to do annual visits by telemedicine. Ability to examine the patient (2.0 ± 1.0) was rated worse, overall, than either the experience using the technology (3.2 ± 1.0) or the capacity to communicate with the patient (3.6 ± 1.0). Conclusions: Our survey of orthopedic surgeons demonstrates that while the use of telemedicine technology was minimal prior to the pandemic, its use was widely adopted during the pandemic. Nearly half of physicians said that they will continue to use telemedicine.

COVID-19 and Telehealth: Prevention of Exposure in a Medically Complex Patient With a Mild Presentation

The novel coronavirus disease-2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. We discuss a less common presentation of COVID-19 in a patient where the use of telemedicine technology prevented the exposure of the healthcare team in an academic general pediatrics clinic. A medically complex 20-year-old male presented via virtual visit for unilateral eye redness and discharge. He received topical ophthalmic antibiotics for presumed acute bacterial conjunctivitis and was counseled on return precautions. Three days later, the patient developed shortness of breath, fever to 102.6°F, and chest pain. COVID-19 testing returned positive. Conjunctivitis is a presenting symptom in 32% of COVID-19 cases. Current evidence suggests that these patients may transmit their illness at the time of presentation. Using telehealth, we avoided exposure to a COVID-19–positive patient who would not have met criteria for testing or droplet precautions. Telehealth allows providers to triage patients, identifying those who need to be seen in person, thereby minimizing exposure. Transitioning toward virtual practice, particularly during a pandemic, prepares for the possibility of healthcare workers being quarantined but still able to provide care and minimizes exposure to asymptomatic patients or those with atypical symptoms.

Optimizing telemedicine to facilitate amyotrophic lateral sclerosis clinical trials.

Amyotrophic lateral sclerosis (ALS) has the largest drug pipeline among neuromuscular diseases, with over 160 companies actively involved in ALS research. There is a growing need to recruit trial participants, but ALS patients often have limited mobility and most ALS trials are conducted in a small number of major centers. These factors effectively limit patient participation, particularly for those in rural areas. The current coronavirus disease 2019 (COVID-19) pandemic has necessitated the more widespread use of telemedicine technology for clinical care, and has prompted consideration of its increased use for clinical trials. In this opinion piece, we describe the current state of telemedicine for recruitment, consenting, and screening of participants for clinical trials. We also summarize the available data on remote administration of outcome measures. Current challenges include validation of outcome measures for remote assessment, as well as technological, regulatory, and licensure barriers.

Laying the Foundation for the National TeleNursing Center: Integration of the Quality-Caring Model Into TeleSANE Practice.

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.

Rationale and design of randomized controlled trial protocol of cardiovascular rehabilitation based on the use of telemedicine technology in the Czech Republic (CR-GPS).

Background:Cardiovascular diseases remain the most common causes of death in the world. Instructions for secondary prevention recommend multifaceted approach in cardiovascular diseases risk management. Center-based physical exercise training is considered as an important integral part of cardiac rehabilitation (CR). Despite all recognized benefits CR brings, active interest of patients remains low in many countries, including the Czech Republic. That is why there is a need to focus on more effective patients’ participation in CR with respect to their preferences and needs. One of possible approaches is using telemonitoring guidance based on obtaining data via technological equipment during home exercise training. The aim of this study is to compare effectiveness of both center- and home-based exercise training with focus on participants’ physical fitness and quality of life.Methods/design:This randomized control trial intends to monitor cardiorespiratory health indicators and quality of life of patients diagnosed with a coronary artery disease (CAD) at the University Hospital Brno, Czech Republic. These patients will be randomly separated into 2 groups—a regular outpatient group (ROT) and an intervention training group (ITG). Both groups undergo a 12-week rehabilitation training program. The ROT group will undergo center-based exercise trainings in the hospital and receive feedback and support directly by their coach. The ITG group will be telemonitored during exercise training in their home environment via a wrist sport tester and Internet application.All patients will be supposed to exercise at 70% to 80% of their heart rate reserve obtained from cardiopulmonary exercise test (CPX). The primary outcome is to measure and compare physical fitness values assessed at baseline and after 12 weeks of training. Physical fitness is expressed as peak oxygen uptake assessed by the CPX test. The secondary outcomes are patients, training adherence, and their quality of life.Discussion:This trial focuses on an up-to-date topic. As there have not been any similar trials in the Czech Republic yet, we expect it to bring great benefits not only for our hospital in Brno. In the long term, this method seems to be low-cost for all participants and brings a lot of benefits for those patients, who are for many reasons unable to participate in center-based CR provided by hospitals and other health care centers. Physical exercise therapy brings good results in reducing cardiovascular risk factors and improves its global impact. Thanks to its simplicity, it is expected to increase patients’ training adherence as well.

Telemedicine simulation in online family nurse practitioner education: Clinical competency and technology integration.

Assessment of clinical competency in distance education programs presents new challenges and yet is imperative to patient safety and continued success of the profession. Furthermore, employers increasingly expect a skill set in current informational technologies. Clinical competence has been assessed using high stakes, standardized patient simulation in traditional, on-campus educational programs. Telemedicine technology integrated with standardized patient simulations may provide a solution for teaching the essentials of information technology and provide a modality for clinical competency assessment in distance education. Telemedicine was introduced to students via a formative, didactic assignment. This preparation facilitated the use of telemedicine technology integrated with standardized patient simulations to assess clinical competency of online students. In addition, this format required students to apply the fundamentals of informational technologies. Combining the modality of telemedicine with high stakes, standardized patient simulation to assess clinical competence is innovative and ensures high standards in distant education while addressing the preparation of students in the use of emerging technologies. Telemedicine integrated with human standardized patient simulation is a promising modality for clinical competency assessment and determination of program progression in distance education. In addition, students become accustomed to the informational technologies encountered in the workplace.

Formulating Telemedicine Strategies in Isfahan University of Medical Sciences.

Introduction:The use of telemedicine technology can lead to an equitable distribution of specialized care. There are numerous influencing factors which should be identified for successful implementation and efficacy of telemedicine. The aim of this study was to evaluate current situation and internal and external environment of Isfahan University of Medical Sciences (IUMS) and prepare telemedicine development strategies for IUMS.Methods:This study was an applied cross-sectional mixed method study which was conducted between July 2014 to November 2016 and in five phases in IUMS. a) Evaluating Internal and external factors (IFE & EFE); b) Formulating goals; c) Identifying and prioritizing strategic problems; d) Setting objectives; and e) formulating the strategies to develop telemedicine in IUMS. The research sample included 147 of IUMS inner customers and stakeholders in the first phase (census) and 14 in the second phase (Purposive sampling based on more work experience). In the first phase, to analyze obtained data of two researcher-made questionnaires, measures of central tendency and dispersion (frequency, percent and mean) were calculated using SPSS. To evaluate internal and external factors and formulating strategies was used TOWS matrix. And finally, to select optimal strategies for telemedicine developing quantitative strategic planning matrix was used.Results:The final score of internal and external factors evaluation was 2.67 and 2.68, respectively. According to the strategic position and action evaluation (SPACE), telemedicine strategic planning in IUMS was in aggressive posture. Because the numbers were closer to 2.5 can be concluded that based on internal factors the organization was in moderate to strong and based on external factors was in a moderate level and neither have a serious positive feature for use the opportunities outside the organization and suffered a serious threat from the outside of organization. Finally, we formulated 14 strategies to develop telemedicine in IUMS as followings: 5 SO, 2 ST, 5 WO, and 2 WT strategies.Conclusion:Telemedicine development in IUMS is located in poor aggressive posture. Therefore, IUMS can develop telemedicine and subsequently, in this study, strategies were developed to preserve and retain healthcare workers, practical studies, data confidentiality and security programs, and other issues.