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Bansal A, Cherbuin N, Davis DL, Peek MJ, Wingett A, Christensen BK, Carlisle H, Broom M, Schoenaker DAJM, Dahlstrom JE, Phillips CB, Vardoulakis S, Nanan R, Nolan CJ. Heatwaves and wildfires suffocate our healthy start to life: time to assess impact and take action. Lancet Planet Health 2023; 7:e718-e725. [PMID: 37558352 DOI: 10.1016/s2542-5196(23)00134-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
Adverse environmental exposures in utero and early childhood are known to programme long-term health. Climate change, by contributing to severe heatwaves, wildfires, and other natural disasters, is plausibly associated with adverse pregnancy outcomes and an increase in the future burden of chronic diseases in both mothers and their babies. In this Personal View, we highlight the limitations of existing evidence, specifically on the effects of severe heatwave and wildfire events, and compounding syndemic events such as the COVID-19 pandemic, on the short-term and long-term physical and mental health of pregnant women and their babies, taking into account the interactions with individual and community vulnerabilities. We highlight a need for an international, interdisciplinary collaborative effort to systematically study the effects of severe climate-related environmental crises on maternal and child health. This will enable informed changes to public health policy and clinical practice necessary to safeguard the health and wellbeing of current and future generations.
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Affiliation(s)
- Amita Bansal
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Deborah L Davis
- Midwifery, University of Canberra, ACT, Australia; ACT Government, Health Directorate, ACT, Australia
| | - Michael J Peek
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; The Canberra Hospital, Canberra Health Services, ACT, Australia
| | - Amanda Wingett
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia
| | - Bruce K Christensen
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hazel Carlisle
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; The Canberra Hospital, Canberra Health Services, ACT, Australia
| | - Margaret Broom
- Midwifery, University of Canberra, ACT, Australia; The Canberra Hospital, Canberra Health Services, ACT, Australia
| | - Danielle A J M Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Jane E Dahlstrom
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; The Canberra Hospital, Canberra Health Services, ACT, Australia
| | - Christine B Phillips
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Companion House Refugee Medical Service, Canberra, ACT, Australia
| | - Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Ralph Nanan
- Sydney Medical School and Charles Perkins Center Nepean, University of Sydney, NSW, Australia
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; The Canberra Hospital, Canberra Health Services, ACT, Australia.
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Gomes DL, da Silva ECB, Reis AL, Carvalhal MMDL, Kikuchi JLD, Uliana GC, Berino TN. Adherence to Online Nutritional Monitoring Was Associated with Better Food Habits in People with T1DM during the COVID-19 Pandemic in Brazil. Nutrients 2023; 15:2121. [PMID: 37432251 DOI: 10.3390/nu15092121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 07/12/2023] Open
Abstract
Until this moment, no research has been found that has assessed adherence to online nutritional monitoring by adults with Diabetes Mellitus Type 1 (T1DM) during the pandemic. This article aims to analyze the association between eating habits and adherence to nutritional online care by adults with T1DM during social distancing because of the COVID-19 pandemic in Brazil. A cross-sectional study was carried out in July 2020. An online form was used to collect sociodemographic data, financial status, eating habits, carrying out online nutritional monitoring, and adherence to social distancing. Pearson's chi-squared test was performed with adjusted residual analysis and binomial logistic regression analysis (p < 0.05). Out of the 472 adults, only 8.9% had consulted with a nutritionist. Doing nutritional monitoring online during social distancing was associated with a reduction in the consumption of ultra-processed foods (p = 0.021), eating more servings of fruit (p = 0.036), and doing carbohydrate counting (CC) more frequently (p = 0.000). Doing nutritional monitoring online increased adherence to carbohydrate counting by 2.57 times and increased the consumption of fruits by 0.423 times. Therefore, nutritional monitoring, even if performed remotely, can influence the acquisition and maintenance of healthier eating habits, in addition to assisting adherence to the practice of CC.
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Affiliation(s)
- Daniela Lopes Gomes
- Postgraduate Program in Neuroscience and Behavior, Behavior Theory and Research Nucleus, Federal University of Pará, Belém 66075-110, Brazil
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Aline Leão Reis
- Postgraduate Program in Neuroscience and Behavior, Behavior Theory and Research Nucleus, Federal University of Pará, Belém 66075-110, Brazil
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Jeane Lorena Dias Kikuchi
- Postgraduate Program in Neuroscience and Behavior, Behavior Theory and Research Nucleus, Federal University of Pará, Belém 66075-110, Brazil
| | - Gabriela Correia Uliana
- Postgraduate Program in Neuroscience and Behavior, Behavior Theory and Research Nucleus, Federal University of Pará, Belém 66075-110, Brazil
| | - Talita Nogueira Berino
- Postgraduate Program in Neuroscience and Behavior, Behavior Theory and Research Nucleus, Federal University of Pará, Belém 66075-110, Brazil
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Seah JJ, Zhao J, Wang DY, Lee HP. Review on the Advancements of Stethoscope Types in Chest Auscultation. Diagnostics (Basel) 2023; 13:diagnostics13091545. [PMID: 37174938 PMCID: PMC10177339 DOI: 10.3390/diagnostics13091545] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Stethoscopes were originally designed for the auscultation of a patient's chest for the purpose of listening to lung and heart sounds. These aid medical professionals in their evaluation of the cardiovascular and respiratory systems, as well as in other applications, such as listening to bowel sounds in the gastrointestinal system or assessing for vascular bruits. Listening to internal sounds during chest auscultation aids healthcare professionals in their diagnosis of a patient's illness. We performed an extensive literature review on the currently available stethoscopes specifically for use in chest auscultation. By understanding the specificities of the different stethoscopes available, healthcare professionals can capitalize on their beneficial features, to serve both clinical and educational purposes. Additionally, the ongoing COVID-19 pandemic has also highlighted the unique application of digital stethoscopes for telemedicine. Thus, the advantages and limitations of digital stethoscopes are reviewed. Lastly, to determine the best available stethoscopes in the healthcare industry, this literature review explored various benchmarking methods that can be used to identify areas of improvement for existing stethoscopes, as well as to serve as a standard for the general comparison of stethoscope quality. The potential use of digital stethoscopes for telemedicine amidst ongoing technological advancements in wearable sensors and modern communication facilities such as 5G are also discussed. Based on the ongoing trend in advancements in wearable technology, telemedicine, and smart hospitals, understanding the benefits and limitations of the digital stethoscope is an essential consideration for potential equipment deployment, especially during the height of the current COVID-19 pandemic and, more importantly, for future healthcare crises when human and resource mobility is restricted.
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Affiliation(s)
- Jun Jie Seah
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jiale Zhao
- Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore
| | - Heow Pueh Lee
- Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore
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Lokmic-Tomkins Z, Bhandari D, Bain C, Borda A, Kariotis TC, Reser D. Lessons Learned from Natural Disasters around Digital Health Technologies and Delivering Quality Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4542. [PMID: 36901559 PMCID: PMC10001761 DOI: 10.3390/ijerph20054542] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
As climate change drives increased intensity, duration and severity of weather-related events that can lead to natural disasters and mass casualties, innovative approaches are needed to develop climate-resilient healthcare systems that can deliver safe, quality healthcare under non-optimal conditions, especially in remote or underserved areas. Digital health technologies are touted as a potential contributor to healthcare climate change adaptation and mitigation, through improved access to healthcare, reduced inefficiencies, reduced costs, and increased portability of patient information. Under normal operating conditions, these systems are employed to deliver personalised healthcare and better patient and consumer involvement in their health and well-being. During the COVID-19 pandemic, digital health technologies were rapidly implemented on a mass scale in many settings to deliver healthcare in compliance with public health interventions, including lockdowns. However, the resilience and effectiveness of digital health technologies in the face of the increasing frequency and severity of natural disasters remain to be determined. In this review, using the mixed-methods review methodology, we seek to map what is known about digital health resilience in the context of natural disasters using case studies to demonstrate what works and what does not and to propose future directions to build climate-resilient digital health interventions.
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Affiliation(s)
- Zerina Lokmic-Tomkins
- School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Melbourne, VIC 3800, Australia
| | - Dinesh Bhandari
- School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Melbourne, VIC 3800, Australia
| | - Chris Bain
- Digital Health Theme, Department of Human-Centered Computing, Faculty of Information Technology, Monash University, Melbourne, VIC 3800, Australia
| | - Ann Borda
- Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Information Studies, University College London, London WC1E 6BT, UK
| | - Timothy Charles Kariotis
- School of Computing and Information System, The University of Melbourne, Melbourne, VIC 3010, Australia
- Melbourne School of Government, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - David Reser
- Graduate Entry Medicine Program, Monash Rural Health-Churchill, Churchill, VIC 3842, Australia
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Knörr V, Dini L, Gunkel S, Hoffmann J, Mause L, Ohnhäuser T, Stöcker A, Scholten N. Use of telemedicine in the outpatient sector during the COVID-19 pandemic: a cross-sectional survey of German physicians. BMC PRIMARY CARE 2022; 23:92. [PMID: 35461212 PMCID: PMC9034069 DOI: 10.1186/s12875-022-01699-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany. METHODS The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians. RESULTS The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients. CONCLUSION The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.
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Affiliation(s)
- Vera Knörr
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Lorena Dini
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Gunkel
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Jan Hoffmann
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Laura Mause
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Tim Ohnhäuser
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Arno Stöcker
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany.
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Yedulla NR, Faraj MT, Koolmees DS, Battista EB, Montgomery ZA, Day CS. Assessing Orthopedic Patient Preferences for Mandated Virtual Care During the COVID-19 Pandemic and Elective Virtual Care in Non-Pandemic Circumstances. Orthopedics 2021; 44:e471-e476. [PMID: 34292825 DOI: 10.3928/01477447-20210618-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare orthopedic patient preferences for mandated virtual care during the coronavirus disease 2019 (COVID-19) pandemic and elective virtual care during non-pandemic circumstances. An orthopedic virtual care questionnaire was administered to adult orthopedic patients undergoing their first orthopedic virtual visit between March 15, 2020, and May 18, 2020. The questionnaire had 13 items rated on a 1-to-5 Likert scale ("strongly agree" to "strongly disagree"). Responses were compared using Kruskal-Wallis and nonparametric Wilcoxon rank-sum tests. Patients showed higher preferences for mandated virtual care during the pandemic when compared with elective virtual care during non-pandemic circumstances (2.25±1.31 vs 4.10±1.25, P<.0001) and also preferred virtual visits in other specialties compared with orthopedics (2.17±1.35 vs 2.79±1.42, P<.0001). Patients older than 50 years were more likely to view virtual care as the best option during the pandemic (2.06±1.25 vs 2.48±1.35, P<.0165) and equally as effective as in-person visits in non-pandemic circumstances (2.45±1.36 vs 2.83±1.18, P<.0150). Female patients were more likely to pursue future orthopedic virtual visits (2.61±1.37 vs 3.07±1.45, P<.0203) and view their virtual visit as equally effective as an in-person visit (2.47±1.33 vs 2.87±1.18, P<.0181). Orthopedic patient preference for mandated virtual care during the COVID-19 pandemic seems to be higher than for elective virtual care during non-pandemic circumstances, and older and female patients appear to favor virtual care. [Orthopedics. 2021;44(4):e471-e476.].
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Mehta P, Stahl MG, Germone MM, Nagle S, Guigli R, Thomas J, Shull M, Liu E. Telehealth and Nutrition Support During the COVID-19 Pandemic. KOMPASS NUTRITION & DIETETICS 2021; 1:1-3. [PMCID: PMC8678265 DOI: 10.1159/000519959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Pooja Mehta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marisa G. Stahl
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Monique M. Germone
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sadie Nagle
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rebecca Guigli
- Data Science to Patient Value (D2V), Aurora, Colorado, USA
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, Colorado, USA
| | - Mary Shull
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Edwin Liu
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Gallagher JJ, Adamski J. Mass Casualties and Disaster Implications for the Critical Care Team. AACN Adv Crit Care 2021; 32:76-88. [PMID: 33725109 DOI: 10.4037/aacnacc2021235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Preparing for disasters both natural and anthropogenic requires assessment of risk through hazard vulnerability analysis and formulation of facility and critical care-specific disaster plans. Disaster surge conditions often require movement from conventional to contingency or crisis-level operations to meet the needs of the many under our care. Predisaster planning for modification of critical care space, staffing, and supplies is essential to successful execution of operations during a surge. Expansion of intensive care unit beds to nonconventional units such as perioperative areas, general care units, and even external temporary units may be necessary. Creative, tiered staffing models as well as just-in-time education of noncritical care clinicians and support staff are important to multiply capable personnel under surge conditions. Finally, anticipation of demand for key equipment and supplies is essential to maintain stockpiles, establish supply chains, and sustain operations under prolonged disaster scenarios.
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Affiliation(s)
- John J Gallagher
- John J. Gallagher is Professor, Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15213
| | - Jennifer Adamski
- Jennifer Adamski is Adult-Gerontology Acute Care Nurse Practitioner Program Director and Assistant Professor, Emory University, Atlanta, GA; and Critical Care Nurse Practitioner, Critical Care Flight Team, Cleveland Clinic, Cleveland, Ohio
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Murren-Boezem J, Solo-Josephson P, Zettler-Greeley CM. On-Demand, Virtual Health Care During COVID-19: Clinician Redeployment and Telemedicine Utilization in a Children's Health System. Telemed J E Health 2020; 27:1111-1116. [DOI: 10.1089/tmj.2020.0461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joanne Murren-Boezem
- Nemours Children's Hospital, Center for Health Delivery Innovation, Orlando, Florida, USA
- Section on Telehealth Care, American Academy of Pediatrics, Itasca, Illinois, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Patricia Solo-Josephson
- Nemours Children's Hospital, Center for Health Delivery Innovation, Orlando, Florida, USA
- Section on Telehealth Care, American Academy of Pediatrics, Itasca, Illinois, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
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Belcher RH, Phillips J, Virgin F, Werkhaven J, Whigham A, Wilcox L, Wootten CT. Pediatric Otolaryngology Telehealth in Response to COVID-19 Pandemic: Lessons Learned and Impact on the Future Management of Pediatric Patients. Ann Otol Rhinol Laryngol 2020; 130:788-795. [PMID: 33238714 PMCID: PMC7691763 DOI: 10.1177/0003489420976163] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Since the start of the COVID-19 pandemic outpatient medicine has drastically been altered how it is delivered. This time period likely represents the largest volume of telehealth visits in the United States health care history. Telehealth presents unique challenges within each subspecialty, and pediatric otolaryngology is no different. This retrospective review was designed to evaluate our division of pediatric otolaryngology’s experience with telehealth during the COVID19 pandemic. Methods: This study was approved by the Institutional Review Board at Vanderbilt University Medical Center. All telehealth and face-to-face visits for the month of April 2020 completed by the Pediatric Otolaryngology Division were reviewed. A survey, utilizing both open-ended questions and Likert scaled questions was distributed to the 16 pediatric otolaryngology providers in our group to reflect their experience with telehealth during the 1-month study period. Results: In April, 2020 our outpatient clinic performed a total of 877 clinic visits compared to 2260 clinic visits in April 2019. A total of 769 (88%) were telehealth visits. Telemedicine with video comprised 523 (68%) and telephone only comprised 246 (32%). There were 0 telehealth visits in April 2019. Interpretive services were required in 9.3% (N = 211) clinic visits in April 2019 and 7.5% (N = 66) of clinic visits in April 2020. The survey demonstrated a significant difference (P < .00002) in provider’s anticipated telehealth experience (mean 3.94, 95% CI [3.0632, 4.8118] compared to their actual experience after the study period (mean 7.5, 95% CI [7.113, 7.887]. Conclusions: Despite low initial expectations for telehealth, the majority of our providers felt after 1 month of use that telehealth would continue to be a valuable platform post-pandemic clinical practice. Limited physical exam, particularly otoscopy, nasal endoscopy, and nasolaryngoscopy present challenges. However, with adequate information and preparation for the parents and for the physician some of the obstacles can be overcome.
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Affiliation(s)
- Ryan H Belcher
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
| | - James Phillips
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Frank Virgin
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Jay Werkhaven
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Amy Whigham
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Lyndy Wilcox
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Christopher T Wootten
- Pediatric Otolaryngology - Head and Neck Surgery at Vanderbilt Children's Hospital, Nashville, TN, USA
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Mehta P, Stahl MG, Germone MM, Nagle S, Guigli R, Thomas J, Shull M, Liu E. Telehealth and Nutrition Support During the COVID-19 Pandemic. J Acad Nutr Diet 2020; 120:1953-1957. [PMID: 32792328 PMCID: PMC7359781 DOI: 10.1016/j.jand.2020.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022]
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Scott BK, Miller GT, Fonda SJ, Yeaw RE, Gaudaen JC, Pavliscsak HH, Quinn MT, Pamplin JC. Advanced Digital Health Technologies for COVID-19 and Future Emergencies. Telemed J E Health 2020; 26:1226-1233. [PMID: 32456560 DOI: 10.1089/tmj.2020.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has led to a national health care emergency in the United States and exposed resource shortages, particularly of health care providers trained to provide critical or intensive care. This article describes how digital health technologies are being or could be used for COVID-19 mitigation. It then proposes the National Emergency Tele-Critical Care Network (NETCCN), which would combine digital health technologies to address this and future crises. Methods: Subject matter experts from the Society of Critical Care Medicine and the Telemedicine and Advanced Technology Research Center examined the peer-reviewed literature and science/technology news to see what digital health technologies have already been or could be implemented to (1) support patients while limiting COVID-19 transmission, (2) increase health care providers' capability and capacity, and (3) predict/prevent future outbreaks. Results: Major technologies identified included telemedicine and mobile care (for COVID-19 as well as routine care), tiered telementoring, telecritical care, robotics, and artificial intelligence for monitoring. Several of these could be assimilated to form an interoperable scalable NETCCN. NETCCN would assist health care providers, wherever they are located, by obtaining real-time patient and supplies data and disseminating critical care expertise. NETCCN capabilities should be maintained between disasters and regularly tested to ensure continual readiness. Conclusions: COVID-19 has demonstrated the impact of a large-scale health emergency on the existing infrastructures. Short term, an approach to meeting this challenge is to adopt existing digital health technologies. Long term, developing a NETCCN may ensure that the necessary ecosystem is available to respond to future emergencies.
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Affiliation(s)
- Benjamin K Scott
- Department of Anesthesiology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Geoffrey T Miller
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stephanie J Fonda
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,Estenda Solutions, Inc., Conshohocken, Pennsylvania, USA
| | - Ronald E Yeaw
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - James C Gaudaen
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Holly H Pavliscsak
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Matthew T Quinn
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Jeremy C Pamplin
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA.,Departments of Medicine, and Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
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13
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Ethical, Legal, and Social Challenges in the Development and Implementation of Disaster Telemedicine. Disaster Med Public Health Prep 2020; 15:649-656. [PMID: 32364096 PMCID: PMC7387787 DOI: 10.1017/dmp.2020.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In recent years, advances in communications technology and market factors have led to a substantial expansion of telemedicine practice. One potential use of telemedicine is in disaster response, both as a resource for responders as well as a direct link to patients. The advantages of using telehealth to assist in disaster response are accompanied by important questions related to social impact, ethical implications, and regulatory oversight. A narrative review of several of these issues is presented here. The next steps in the development of a robust disaster telemedicine system will include the development of best practices and ethical guidelines agreed upon by all stakeholders, as well as the development of public-private partnerships geared at providing the highest quality disaster telemedicine to the greatest possible number of patients.
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14
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Use of Telehealth to Improve Access to Care at the United States Department of Veterans Affairs During the 2017 Atlantic Hurricane Season. Disaster Med Public Health Prep 2020; 17:e6. [PMID: 32279689 DOI: 10.1017/dmp.2020.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This brief report examines the shift from in-person care to US Department of Veterans Affairs (VA) telehealth services during 3 devastating hurricanes in 2017 (Harvey, Irma, and Maria). METHODS VA administrative data were used to analyze the number and percentage of telehealth services 30 d pre- and 30 d post- the 2017 hurricanes for 3 hurricane-impacted VA medical centers (VAMCs): Houston (Texas), Orlando (Florida), and San Juan (Puerto Rico). RESULTS All 3 VAMCs remained open during the hurricanes. For the Houston VAMC, during the first week post-Harvey, in-person patient visits decreased while telehealth visits increased substantially. Similarly, for the Orlando VAMC, during the 1-wk post-Irma, telehealth use increased substantially. For the San Juan VAMC, there were many interruptions in the use of telehealth due to many power outages, resulting in a modest increase in the use of telehealth post-Irma/Maria. The most commonly used telehealth services at Houston and Orlando VAMCs during the hurricanes were: primary care, triage, mental health, and home health. CONCLUSIONS Telehealth has the potential to improve post-disaster access to and coordination of care. However, more information is needed to better understand how telehealth services can be used as a post-disaster health-care delivery tool, particularly for patients receiving care outside of systems such as VA.
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15
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Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, Caffery LJ. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020; 26:309-313. [PMID: 32196391 PMCID: PMC7140977 DOI: 10.1177/1357633x20916567] [Citation(s) in RCA: 955] [Impact Index Per Article: 238.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.
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Affiliation(s)
- Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia.,Hans Christian Andersen Children's Hospital, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark, Denmark.,Centre for Health Services Research, The University of Queensland, Australia
| | - Emma Thomas
- Centre for Online Health, The University of Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Australia
| | - Helen Haydon
- Centre for Online Health, The University of Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Australia
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, USA
| | - Jane Clemensen
- Hans Christian Andersen Children's Hospital, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Australia
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16
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Abstract
The COVID-19 crisis has accelerated the adoption of telemedicine, presenting challenges and opportunities for clinicians trying to manage diverse, and not only pandemic-related, health conditions. Here, we consider some limitations of telemedicine and offer a perspective on how clinicians can adapt to working in different health-care delivery systems.
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17
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Hurricane Impact on Emergency Services and Use of Telehealth to Support Prehospital Care. Disaster Med Public Health Prep 2019; 14:39-43. [DOI: 10.1017/dmp.2019.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThe impact of hurricanes on emergency services is well-known. Recent history demonstrates the need for prehospital and emergency department coordination to serve communities during evacuation, storm duration, and cleanup. The use of telehealth applications may enhance this coordination while lessening the impact on health-care systems. These applications can address triage, stabilization, and diversion and may be provided in collaboration with state and local emergency management operations through various shelters, as well as during other emergency medical responses.
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18
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Murren-Boezem J, Solo-Josephson P, Zettler-Greeley CM. A Pediatric Telemedicine Response to a Natural Disaster. Telemed J E Health 2019; 26:720-724. [PMID: 31549909 DOI: 10.1089/tmj.2019.0100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hurricane Irma, a catastrophic Category 4 storm, made landfall in Florida on September 10, 2017. Nemours CareConnect (NCC) offered direct-to-consumer (DTC) pediatric telemedicine during Hurricane Irma. Introduction: Although other programs have examined disaster response and postdisaster recovery by using telemedicine, no studies report use of a pediatric-specific, DTC platform during all three phases of disaster management. Materials and Methods: This IRB-approved study is a retrospective analysis of NCC's audio-visual telemedicine encounters performed on September 8-16, 2017. Results: From September 8 to 16, 2017, NCC recorded 262 completed telemedicine visits. The mean wait time was 12.23 ± 14.4 min. The mean length of the telemedicine encounter was 10.12 ± 4.42 min. Most telemedicine visits occurred on the day before the storm (27.9%), followed by the day after the storm (19.5%). Most common chief complaints were upper respiratory symptoms (33.6%), skin-related concerns (19.1%), fever (16.8%), and gastrointestinal concerns (6.5%). Patient satisfaction remained high during the storm, for the provider as well as the platform. Discussion: During Hurricane Irma, NCC offered accessible and efficient care to families who were impacted by the storm throughout Florida. Results suggest a differential pattern of use before the storm's arrival, during, and immediately after the storm, which may be informative to other telemedicine providers. Conclusion: Further research is needed on the integration of telemedicine into the disaster preparedness plans at a local, state, and national level to ensure maximum support for those families in need.
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Affiliation(s)
- Joanne Murren-Boezem
- Nemours Children's Hospital, Orlando, Florida, USA.,Section on Telehealth Care, American Academy of Pediatrics, Itasca, Illinois, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Patricia Solo-Josephson
- Nemours Children's Hospital, Orlando, Florida, USA.,Section on Telehealth Care, American Academy of Pediatrics, Itasca, Illinois, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
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19
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Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate recent literature on the use of telepsychiatry in mental crises or emergency situations. RECENT FINDINGS Results from recent studies which evaluated the implementation of a telepsychiatric consultation model in emergency departments point at a reduction of length of stay and a drop in admissions, increased cost-effectiveness, and improved satisfaction of patients and staff. There was almost no empirical evidence on videoconferencing in crisis intervention within the context of crisis resolution teams or online therapies. No study reporting on telepsychiatry videoconferencing in the context of disasters was found. There is still very little but increasing empirical evidence supporting the implementation of telepsychiatry in emergencies. Other mental crisis-related implementation settings remain to be researched. The implications and future research potential are discussed.
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20
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Nakagawa K, Kvedar J, Yellowlees P. Retail Outlets Using Telehealth Pose Significant Policy Questions For Health Care. Health Aff (Millwood) 2018; 37:2069-2075. [DOI: 10.1377/hlthaff.2018.05098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Keisuke Nakagawa
- Keisuke Nakagawa is a postdoctoral scholar in the Department of Psychiatry and Behavioral Sciences, University of California Davis, in Sacramento
| | - Joseph Kvedar
- Joseph Kvedar is vice president for connected health, Partners Healthcare, and a professor of dermatology, Harvard Medical School, both in Boston, Massachusetts
| | - Peter Yellowlees
- Peter Yellowlees is a professor of psychiatry, Department of Psychiatry and Behavioral Sciences, University of California Davis, in Sacramento
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21
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Yamada M, Nakada TA, Nakao S, Hira E, Shinozaki K, Kawaguchi R, Mizushima Y, Matsuoka T. Novel information and communication technology system to improve surge capacity and information management in the initial hospital response to major incidents. Am J Emerg Med 2018; 37:351-355. [PMID: 29887196 DOI: 10.1016/j.ajem.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
Affiliation(s)
- Mami Yamada
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka 598-8577, Japan
| | - Taka-Aki Nakada
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka 598-8577, Japan; Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan.
| | - Shota Nakao
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka 598-8577, Japan
| | - Eiji Hira
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka 598-8577, Japan; Shimane University Faculty of Medicine, Department of Acute Care Surgery, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Koichiro Shinozaki
- Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan; The Feinstein Institute for Medical Research, Northwell Health, 350 Community Dr., Manhasset, NY 11030, United States
| | - Rui Kawaguchi
- Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan
| | - Yasuaki Mizushima
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka 598-8577, Japan
| | - Tetsuya Matsuoka
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka 598-8577, Japan
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22
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Stănescu A, Gordon PE, Copotoiu SM, Boeriu CM. Moving Toward a Universal Digital Era in Mass Casualty Incidents and Disasters: Emergency Personnel's Perspective in Romania. Telemed J E Health 2018; 24:283-291. [DOI: 10.1089/tmj.2017.0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adrian Stănescu
- Department of Radiology and Medical Imaging, Tîrgu Mureş Emergency Clinical County Hospital, Tîrgu Mureş, Romania
| | - Peter Eliot Gordon
- Department of Emergency Medicine, Albany Medical Center, Albany, New York
| | - Sanda Maria Copotoiu
- Department of Anesthesia and Intensive Care, Tîrgu Mureş Emergency Clinical County Hospital, Tîrgu Mureş, Romania
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Cristian Marius Boeriu
- Department of Emergency Medicine, Tîrgu Mureş Emergency Clinical County Hospital, Tîrgu Mureş, Romania
- Department of Anesthesia and Intensive Care 2 and Emergency Medicine, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
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23
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Der-Martirosian C, Griffin AR, Chu K, Dobalian A. Telehealth at the US Department of Veterans Affairs after Hurricane Sandy. J Telemed Telecare 2018; 25:310-317. [PMID: 29384428 DOI: 10.1177/1357633x17751005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. METHODS This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. RESULTS During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. CONCLUSION Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and confidentiality, all of which are critical to telehealth success during disasters and other crises.
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Affiliation(s)
| | - Anne R Griffin
- 1 Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, USA
| | - Karen Chu
- 1 Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, USA
| | - Aram Dobalian
- 1 Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, USA.,2 Division of Health Systems Management and Policy, University of Memphis, USA
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24
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Augusterfer EF, Mollica RF, Lavelle J. A review of telemental health in international and post-disaster settings. Int Rev Psychiatry 2016; 27:540-6. [PMID: 26576720 DOI: 10.3109/09540261.2015.1082985] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Telemental health (TMH) is an important component in meeting critical mental health needs of the global population. Mental health is an issue of global importance; an estimated 450 million people worldwide have mental or behavioural disorders, accounting for 12% of the World Health Organization's (WHO) global burden of disease. However, it is reported that 75% of people suffering from mental disorders in the Developing World receive no treatment or care. In this paper, the authors review global mental health needs with a focus on the use of TMH to meet mental health needs in international and post-disaster settings. Telemedicine and TMH have the capacity to bring evidence-based best practices in medicine and mental health to the under-served and difficult to reach areas of the world, including post-disaster settings. The authors will also report on the mental health impact of the Haiti 2010 earthquake and on the limited use of telemedicine in post-disaster Haiti. The paper will underscore the point that published papers on the use of TMH in post-disaster settings are lacking. Finally, the paper will review considerations before working in TMH in international and post-disaster settings.
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Affiliation(s)
| | - Richard F Mollica
- a Harvard Program in Refugee Trauma , Cambridge, Massachusetts , USA , and.,b Department of Psychiatry , Harvard Medical School , Cambridge, Massachusetts , USA
| | - James Lavelle
- a Harvard Program in Refugee Trauma , Cambridge, Massachusetts , USA , and
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