Impact of a Telehealth Program That Delivers Remote Consultation and Longitudinal Mentorship to Community HIV Providers

Background.  To increase human immunodeficiency virus (HIV) care capacity in our region, we designed a distance mentorship and consultation program based on the Project ECHO (Extension for Community Healthcare Outcomes) model, which uses real-time interactive video to regularly connect community providers with a multidisciplinary team of academic specialists. This analysis will (1) describe key components of our program, (2) report types of clinical problems for which providers requested remote consultation over the first 3.5 years of the program, and (3) evaluate changes in participants' self-assessed HIV care confidence and knowledge over the study period. Methods.  We prospectively tracked types of clinical problems for which providers sought consultation. At baseline and regular intervals, providers completed self-efficacy assessments. We compared means using paired-samples t test and examined the statistical relationship between each survey item and level of participation using analysis of variance. Results.  Providers most frequently sought consultation for changing antiretroviral therapy, evaluating acute symptomatology, and managing mental health issues. Forty-five clinicians completed a baseline and at least 1 repeat assessment. Results demonstrated significant increase (P < .05) in participants' self-reported confidence to provide a number of essential elements of HIV care. Significant increases were also reported in feeling part of an HIV community of practice and feeling professionally connected to academic faculty, which correlated with level of program engagement. Conclusions.  Community HIV practitioners frequently sought support on clinical issues for which no strict guidelines exist. Telehealth innovation increased providers' self-efficacy and knowledge while decreasing professional isolation. The ECHO model creates a virtual network for peer-to-peer support and longitudinal mentorship, thus strengthening capacity of the HIV workforce.

Children and computer use in the home: workstations, behaviors and parental attitudes

This study examines the home computer use of 26 children (aged 6-18) in ten upper middle class families using direct observation, typing tests, questionnaires and semi-structured interviews. The goals of the study were to gather information on how children use computers in the home and to understand how both parents and children perceive this computer use. Large variations were seen in computing skills, behaviors, and opinions, as well as equipment and workstation setups. Typing speed averaged over 40 words per minute for children over 13 years old, and less than 10 words per minute for children younger than 10. The results show that for this sample, Repetitive Stress Injury (RSI) concerns ranked very low among parents, whereas security and privacy concerns ranked much higher. Meanwhile, children's behaviors and workstations were observed to place children in awkward working postures. Photos showing common postures are presented. The greatest opportunity to improve children's work postures appears to be in providing properly-sized work surfaces and chairs, as well as education. Possible explanations for the difference between parental perception of computing risks and the physical reality of children's observed ergonomics are discussed and ideas for further research are proposed.