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Introduction: Hearing loss (HL) affects people worldwide, many of whom are children. Especially in developing countries, epidemiological data on the prevalence of HL are insufficient to implement effective health promotion programs. In this preliminary study with young adults, we describe and validate a tablet-based hearing screening test developed for interactive remote hearing screening and compare the performance of an audiometry screening tablet application with conventional audiometry. In addition, the sensitivity, specificity, and predictive values of the tablet-based method and the concordance between the two methods were analyzed. Methods: Thirty volunteers participated in a double-blind study assessing two auditory threshold screening methods: tablet-based hearing screening and sweep audiometry. For both methods, a correct response to a minimum of two tones out of three emitted at 20 dBHL for the frequencies of 1, 2, and 4 kHz and 30 dBHL for 0.5 kHz in both ears, was considered a negative screening result (normal hearing), whereas hearing impairment was considered a positive screening result. Results: According to both methods, 26 participants had normal hearing and four had HL. The Kappa coefficient indicated perfect concordance between methods. The tabletbased hearing screening method had a sensitivity of 100% (confidence interval [CI]: 30.5-100.0), a specificity of 100% (CI: 87.1-100.0), a positive predictive value of 100% (CI: 30.5-100.0), and a negative predictive value of 100% (CI: 87.1-100.0). Conclusions: The tablet-based hearing screening test was shown to be a reliable and an accurate method for hearing screening that can be used effectively in places with Internet access and where local audiologists are not available. [ABSTRACT FROM AUTHOR]

Background: With the introduction of online health screenings, guidelines describing how to communicate about a person's health need to be adapted for a digital setting. This study aimed to uncover older adults' preferences regarding such online messages. Materials and Methods: Thirty older adults (aged 65 to 75 years) viewed four versions of the results message of a screening aimed at identifying frailty: a standard, empathic, tailored, or both empathic and tailored message. After each version, they were interviewed about what they (dis)liked about the message. They also ranked the four versions according to preference. Ranks were analyzed with a Friedman's test and a Wilcoxon's signed-rank test. Results: There was no significant difference for message-type preference when the outcome was positive. For the prefrail or frail outcome, message-type preferences differed (χ² = 10.51, p = 0.02 and χ2 = 13.56, p < 0.01, respectively). Overall, for the prefrail and frail outcome, the tailored version was appreciated most. Participants commented that the tailored version made them feel appreciated more as a person. Some found the empathic additions comforting, others found these unnecessary. Conclusions: When communicating the results of an online health screening to older adults via the Internet, one should primarily tailor the message toward personal characteristics. The effect of empathic elements in results messages appeared to be limited. Whether a message should be adapted depends on whether the outcome is positive or negative. [ABSTRACT FROM AUTHOR]

Background: Behavioral interventions can be delivered over the Internet, but nonurban subpopulations living with HIV may still have inadequate Internet access to make this feasible. Methods: We report on a survey conducted in 2015 among 150 patients receiving care at a university-based Infectious Disease Clinic serving a nonurban and rural population in central Virginia. Our aim was to determine the rate of computer, tablet, and smartphone usage, as well as Internet access, to inform the delivery of a novel intervention using Internet and mobile technology. Results: The participants' mean age was 46; 111 patients used computers, 101 used smartphones, and 41 used tablets. The results showed that 87% of patients had Internet access. Of those, 49 reported daily Internet use, while 18% reported weekly Internet use, and 33% reported less frequent Internet use. Conclusions: The survey study data suggest that Internet access among nonurban and rural patients with HIV is adequate to support trials testing Internet-delivered interventions. It is time to develop and deliver Internet interventions tailored for this often isolated subpopulation. [ABSTRACT FROM AUTHOR]

Background: The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China. Materials and Methods: In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis. Results: Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals). Conclusions: The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and costeffectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries. [ABSTRACT FROM AUTHOR]

Background: U.S. military families are experiencing high obesity rates similar to the civilian population. The Department of Defense's Military Health System (MHS) is one of the largest healthcare providers in the United States, serving approximately 9.2 million active duty service members, retirees, spouses, and children. The annual cost to the MHS for morbidities associated with being overweight exceeds $1 billion. The preschool age has been suggested as an opportune time to intervene for the prevention of obesity. Thus, this study investigated the current level of technology usage by military service member families and assessed their needs and interests in health/nutrition information. This needs assessment is crucial for researchers/educators to design further studies and intervention programs for obesity prevention in military families with young children. Materials and Methods: In total, 288 military parents (233 Army and 55 Air Force) at two military bases whose children were enrolled in military childcare centers in the southwestern United States participated in a Technology Usage in Military Family (TUMF) survey in 2013. Results and Conclusions: Overall, both bases presented similar technology usage patterns in terms of computer and mobile device usage on the Internet. Air Force base parents had a slightly higher knowledge level of nutrition/health information than Army base parents. The TUMF survey suggested practical ways such as mobile applications/Web sites, social networks, games, etc., that health educators can use to disseminate nutrition/health information for obesity prevention among military families with young children. [ABSTRACT FROM AUTHOR]

Objective: Web-based health information may be of particular value among the African American population due to its potential to reduce communication inequalities and empower minority groups. This study explores predictors of e-health behaviors and activities for African American Internet users. Materials and Methods: We used the 2010 Pew Internet and American Life Health Tracking Survey to examine sociodemographic and health status predictors of e-health use behaviors among African Americans. E-health use behaviors included searching for e-health information, conducting interactive health-related activities, and tracking health information online. Results: In the African American subsample, 55% (n=395) were at least 'occasional' Internet users. Our model suggests that searching for health information online was positively associated with being helped/knowing someone helped by online information (odds ratio [OR]=5.169) and negatively associated with lower income (OR=0.312). Interactive health activities were associated with having a college education (OR=3.264), being 65 years of age or older (OR=0.188), having a family member living with chronic conditions (OR=2.191), having a recent medical crisis (OR=2.863), and being helped/knowing someone helped by online information (OR=8.335). E-tracking behaviors were significantly stronger among African Americans who had health insurance (OR=3.907), were helped/knowing someone helped by online information (OR=4.931), and were social media users (OR=4.799). Conclusions: Findings suggest significant differences in e-health information-seeking behaviors among African American Internet users-these differences are mostly related to personal and family health concerns and experiences. Targeted online e-health resources and interventions can educate and empower a significant subset of the population. [ABSTRACT FROM AUTHOR]

Background: Online technologies offer the promise of an efficient, improved healthcare system. Patients benefit from increased access to care, physicians are afforded greater flexibility in care delivery, and the health system itself benefits from lower costs to provide such care. One method of incorporating online care into clinical practice, called electronic office visits or 'eVisits,' allows physicians to provide a consultation with patients online. We performed an analysis of the current published literature on eVisits as well as present emerging research describing the use of mobile platforms as the delivery model. We focused on the role of eVisits in acute primary care practice. Materials and Methods: A literature review was conducted using electronic databases with a variety of search terms related to the use of eVisits in primary care. Results: Several advantages to eVisit utilization in the primary care setting were identified, namely, improvements in efficiency, continuity of care, quality of care, and access to care. Barriers to eVisit implementation were also identified, including challenges with incorporation into workflow, reimbursement, physician technological literacy, patient health literacy, overuse, security, confidentiality, and integration with existing medical technologies. Conclusions: Only one study of patient satisfaction with eVisit acute primary care services was identified, and this suggests that previous analyses of eVisit utilization are lacking this key component of healthcare service delivery evaluations. The delivery of primary care via eVisits on mobile platforms is still in adolescence, with few methodologically rigorous analyses of outcomes of efficiency, patient health, and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Effective management of hypertension in chronic kidney disease and renal transplantation is a clinical priority and has societal implications in terms of preserving and optimizing the value of scarce organs. However, hypertension is optimally managed in only 37% of people with chronic kidney disease, and poor control can contribute to premature graft loss in renal transplant recipients. This article describes a telehealth system that incorporates home electronic blood pressure (BP) monitoring and uploading to a patient portal coupled with a Web-based dashboard that enables clinical pharmacist collaborative care in a renal transplant clinic. Materials and Methods: The telehealth system was developed and implemented as a quality improvement initiative in a renal transplant clinic in a large, 700-bed, urban hospital with the aim of improving BP in posttransplant patients. A convenience sample of 66 posttransplant patients was recruited by the clinical pharmacist from consecutive referrals to the Transplant Clinic. Results: Preliminary results show statistically significant reductions in average systolic and diastolic BP of 6.0 mm Hg and 3.0 mm Hg, respectively, at 30 days after enrollment. Two case reports describe the instrumental role of home BP monitoring in the context of medication therapy management. Conclusions: Optimizing BP control for both pre- and post-renal transplant patients is likely to benefit society in terms of preserving scarce resources and reducing healthcare costs due to premature graft failure. Connected health systems hold great promise for supporting team-based care and improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: This study determined the impact of an online lifestyle management program on obese individuals with type 2 diabetes in a large academic diabetes clinic. Subjects and Methods: Using a single cohort design, individuals with type 2 diabetes and a body mass index (BMI) of ≥30 kg/m2 were recruited to have access to the Virtual Lifestyle Management (VLM) program for 1 year, in addition to their routine care. Participants were assessed at baseline and at 6 and 12 months for the following outcomes: (a) glycated hemoglobin (A1C), (b) lipids (total cholesterol [TC] and TC/high-density lipid [HDL] ratio), (c) weight, (d) BMI, and (e) body fat percentage (BFP). Results: Seventy-eight individuals consented to the study, 66 (84%) logged onto the system two or more times, and 49 (62%) contributed data at the 1-year program. At baseline, the mean age of participants was 57.9 years of age, and 52% were female. At 12 months, mean differences from baseline were as follows: A1C, −0.3% (95% confidence interval [CI] −0.1, −0.5; P<0.05); TC/HDL, −0.2 (95% CI −0.01, −0.04; P<0.05); weight, −8.6 pounds (95% CI −3.7, −13.6; P<0.05); BMI, −1.5 kg/m2 (95% CI −0.7, −2.3; P<0.05); and BFP, −1.8% (95% CI −0.9, −2.7; P<0.05). After adjusting for program use, age, and sex, changes in BMI, BFP, and self-reported daily steps taken were statistically significant at 12 months. Conclusions: This before-after pilot study demonstrates that adding an Internet-based lifestyle modification program to usual care may improve clinically important outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on various studies related to use of information technology to treat diabetes published in various journals in 2012-2013. Topics include computer-based interventions for weight loss by L.S. Wieland and colleagues, published in "Cochrane Database of Systematic Reviews," school-based Internet obesity prevention programs by R. Whittemore and colleagues, published in "The Yale Journal of Biology and Medicine," and a study on technology use to reduce glycosylated hemoglobin.

Background: The Internet is a vital source of information for patients hoping to learn more about their disease. Health literacy of the general population is known to be poor, with the U.S. Department of Health and Human Services (USDHHS) recommending that patient-oriented literature be written at a fourth- to sixth-grade reading level to optimize comprehensibility. In this study we assessed the readability of online literature specifically for Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO). Methods: Readability of the content of the top 20 English-language GD patient-oriented online resources and top 30 of the equivalent TAO resources returned by Google search was analyzed. Web pages were identified using the Google search terms 'Graves' disease' and 'Thyroid-Associated Ophthalmopathy,' respectively. Extraneous text (e.g., hyperlinks, affiliations, disclaimers) was removed. Relevant text proceeded to readability analysis using four validated measures: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and Gunning-Fog Index. Readability was compared with USDHHS standards. Results: Overall, median word count (with interquartile range [IQR] and range) was 990 (IQR 846, 195-3867), with a median of 18 words per sentence (IQR 4.0, 7.5-28). Median Flesch Reading Ease Score was 46 (IQR 13, 24-64), Flesch-Kincaid Grade Level 11 (IQR 3.0, 7.2-17), Simple Measure of Gobbledygook 13 (IQR 2.0, 9.6-17), and Gunning-Fog Index 13 (IQR 3.0, 9.2-19), each equivalent to a reading level of >11th grade and 'difficult' on the USDHHS classification. None of the web pages evaluated had readability scores in accordance with published guidelines. There was no significant difference with the country of origin of each web page, website commercial status, or with pages predominantly focused on GD or TAO. Conclusions: Readability scores for online GD and TAO patient-focused materials are inferior to those recommended. Screening of this online material, as well as subsequent revision, is crucial to increase future patient knowledge, satisfaction, and compliance. [ABSTRACT FROM AUTHOR]

The electronic databases Cochrane, MEDLINE, and SCOPUS were searched to collect evidence on the impact of community-based Internet interventions for adult patients with osteoarthritis (OA) on health outcomes. Five studies met our review criteria. We found that Internet-based OA self-management interventions modestly but significantly improved four of six health status measures compared with usual care and have been met with high acceptance and high user satisfaction. Preventive physiotherapy exercise delivered via videoconferencing for patients with OA-related knee pain significantly improved health measures including pain, stiffness, and physical function compared with the initial health status. Postoperative rehabilitation performed by a physical therapist via videoconferencing and 'in-person' resulted in similar health measure improvements. The review findings show that the Internet may be successfully used as a medium for providing community-based self-management and rehabilitation interventions in OA. [ABSTRACT FROM AUTHOR]

Purpose: There is growing recognition that many physician-patient encounters do not require face-to-face contact. The availability of secure Internet portals creates the opportunity for online eVisits. Increasing numbers of health systems provide eVisits, and many health plans reimburse for eVisits. However, little is known on who chooses to seek care via an eVisit. Materials and Methods: At four primary care practices, we used the electronic medical record to identify all eVisits and office visits for sinusitis and urinary tract infections (UTIs) between January 2010 and May 2011. From the electronic medical record we abstracted the necessary information on patient demographics. The population studied included 5,165 sinusitis visits (9% of which were eVisits) and 2,954 UTI visits (3% eVisits). Results: In multivariate models controlling for other patient factors, the variables most strongly associated with a patient initiating an eVisit versus an office visit were age (18-44 years of age versus 65 years of age and older: sinusitis, odds ratio 1.65 [0.97-2.81]; UTI, 2.97 [1.03-8.62]) and longer travel distance to clinic (>10 miles from patient home to clinic versus 0-5 miles: sinusitis, odds ratio 6.54 [4.68-9.16]; UTI, odds ratio 3.25 [1.74-6.07]). Higher income was not associated with higher eVisit use. Conclusions: At these four primary care practices, eVisits accounted for almost 7% of visits for sinusitis and UTI. eVisits attract a younger patient population who might use eVisits for convenience reasons. [ABSTRACT FROM AUTHOR]

The article presents abstracts on telemedicine which include improvement in physician productivity by telemedicine, accessibility of mental health services in rural areas and the role of Internet in prenatal healthcare.

Background: Electronic health information is a new concept in the Lithuanian healthcare system. It gives the possibility of obtaining accurate medical information online by quick, convenient, and private access and presents to the patients the opportunity for better-informed decisions on their own health and greater participation in healthcare processes. The aim of this study is to assess the availability of health information for patients and to assess the factors affecting a patient's health-related information needs on the Internet. Subjects and Methods: A cross-sectional study design was used. Self-perceived needs for health-related information and health-related information on the Internet were evaluated by means of a questionnaire. The questionnaires were distributed to the patients during on-site visits to primary care physician. Cumulative numbers of health information searches were calculated. Results: The Internet was used by 63.2% of the respondents. Electronic health information search indicated 47.3% were Internet users. Internet users were statistically significantly more satisfied and informed about available electronic health services: registration for physician services (p <0.001), health information portal (p <0.001), electronic health record (p <0.001), clinical investigations (p =0.001), medical consultations (p =0.009), patient health education services (p =0.019), and patient self-help groups. A higher frequency of health information searches on the Internet was more associated with female patients (odds ratio [OR], 3.1; p =0.012), patients having chronic disease (p =0.013), living in couples (OR, 14.8; p =0.031), having e-health service experience (OR, 7.0; p <0.001), daily Internet user (OR, 6.7; p =0.054), and longer duration of Internet use per day (OR, 1.3; p =0.046). Conclusions: The Internet is an important source of health information. Internet users are more satisfied with available health information. Female patients, those having chronic disease, living as couples, and having e-health service experience, and daily Internet users are the most frequent users of health information on the Internet. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explain how perceived ability affects users' acceptance of online health information in Korea. Data were collected by a Web-based survey, and, in total, 449 samples were used for final analysis. The hypothetical model of this study was based on the Technology Acceptance Model. A structural equation modeling was used to evaluate the relationship between the included variables. The final model with appropriate relations exhibited an adequate fit to the data. This study provides evidence that perceived ease of use, perceived usefulness, and perceived credibility significantly affect how individuals use health information from the Internet. The subjective health knowledge and Internet efficacy exerted strong indirect effects on users' attitude and intention to use the online health information via the mediators of perceived ease of use, perceived usefulness, and perceived credibility. This study supports the hypothesis that the perceived ability of users is related to their acceptance of online health information. Users' perceived ability, including subjective health knowledge and Internet efficacy, was confirmed as a prerequisite for their health information use on the Internet. The results demonstrated that perceived ease of use, perceived usefulness, and perceived credibility are substantive mediators. Future research should consider a wider array of characteristics of health information and users and incorporate these characteristics for the provision of more useful, user-centered health information. [ABSTRACT FROM AUTHOR]

Background: Motor impairment and travel time have been shown to be important barriers to recruitment for Parkinson's disease (PD) clinical trials. This study determined whether use of Internet-based video communication for study visits would improve likelihood of participating in PD clinical trials. Subjects and Methods: University of Utah PD clinic patients were invited to complete a survey asking if they would be willing to participate in a hypothetical research study under four different scenarios. McNemar's test was used to test the hypothesis that remote assessments would improve willingness to participate. Results: Willingness to participate was 101/113 (87%) in the standard scenario. Willingness to participate was highest (93%; p= 0.046) with most visits occurring via telemedicine at a local clinic, followed by some visits occurring via telemedicine at a local clinic (91%; p= 0.157). Willingness to participate was lower with some (80%; p= 0.008) or most (82%; p= 0.071) visits occurring by home telemonitoring. Conclusions: Use of telemedicine may be an acceptable means to improve participation in clinical trials. This would need to be confirmed with the use of a larger-scale inquiry involving rural populations. Future research should assess subject or caregiver comfort and trainability with respect to computer-based technology in the home and systems barriers for wider implementation of telemedicine in neurology. [ABSTRACT FROM AUTHOR]

Research on the use of social networks for health-related purposes is limited. This study aims to characterize the purpose and use of Facebook and Twitter groups concerning colorectal cancer, breast cancer, and diabetes. We searched in Facebook () and Twitter () using the terms "colorectal cancer," "breast cancer," and "diabetes." Each important group has been analyzed by extracting its network name, number of members, interests, and Web site URL. We found 216 breast cancer groups, 171 colorectal cancer groups, and 527 diabetes groups on Facebook and Twitter. The largest percentage of the colorectal cancer groups (25.58%) addresses prevention, similarly to breast cancer, whereas diabetes groups are mainly focused on research issues (25.09%). There are more social groups about breast cancer and diabetes on Facebook (around 82%) than on Twitter (around 18%). Regarding colorectal cancer, the difference is less: Facebook had 62.23%, and Twitter 31.76%. Social networks are a useful tool for supporting patients suffering from these three diseases. Regarding the use of these social networks for disease support purposes, Facebook shows a higher usage rate than Twitter, perhaps because Twitter is newer than Facebook, and its use is not so generalized. [ABSTRACT FROM AUTHOR]

Objective: In developed countries, pharmacists play a crucial role in designing and implementing cancer treatments as part of a multidisciplinary oncology team. However, developing countries have a shortage of pharmacists, and their role is generally limited to dispensing and selling drugs. The aim of this study was to investigate the feasibility of providing clinical pharmacy educational activities via international teleconferencing to improve cancer care in developing countries. Materials and Methods: Meticulous preparation and intense promotion of the workshop were done in Egypt before the telepharmacy conferences began. Multiple connectivity tests were performed to resolve technical problems. Nine telepharmacy conferences were delivered during 3-h sessions that were held on three consecutive days. Talks were subsequently made available via Web streaming. Attendees were requested to complete a survey to measure their satisfaction with the sessions. Results: The teleconference was attended by a total of 345 persons, and it was subsequently reviewed online via 456 log-in sessions from 10 countries. Technical issues (e.g., poor auditory quality) were resolved on the first day of the event. The rate of attendees' responses on the survey was 30.1%, and satisfaction with the event was generally good. Conclusions: Telecommunication is a relatively inexpensive approach that may improve pharmacy practices, especially those used to treat patients with cancer in developing countries. Special attention to patient-based telepharmacy education, including the use of cost-effective technology, should be considered. [ABSTRACT FROM AUTHOR]

Objective: In order to maintain treatment gains achieved during multidisciplinary treatments for chronic back pain, patients are challenged to implement the behavioral changes they learned during treatment into their daily life. Offering support during the critical time after treatment conclusion helps patients deal with relapses, provides them with practical advice and social support, and helps to master this transfer. As in-person offerings are not always feasible, innovative concepts are needed to enable hospitals to provide aftercare to their patients. Subjects and Methods: An Internet-based aftercare intervention following multidisciplinary therapy for back pain was constructed, implemented, and evaluated. The aftercare program comprised two modules: (1) an individualized self-monitoring module and (2) a weekly, 90-min chat session moderated by a therapist whom participants already knew from treatment. A randomized controlled trial (n =75) was conducted that compared the post-treatment symptom developments of program participants with symptom developments of controls (treatment as usual [TAU]). Results: The program was proven to be feasible and well accepted by participants; on average, 68.2% of the participants rated the previous chat session as helpful. Intention-to-treat analyses demonstrated significant effects on post-treatment courses of disability. The largest effects were found for pain-related disability: for TAU participants, disability increased an average of 1.25 scale points (Roland-Morris Questionnaire) per 100 days; for program participants, disability decreased an average of 0.39 scale points (p <0.01). Conclusions: The aftercare intervention was shown to be feasible and well accepted. Its efficacy should be tested with a larger-scale randomized controlled trial. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic capability of a smartphone handset compared with a standard office computer workstation for teleophthalmology fundus photo assessments of diabetic retinopathy. Methods: Eligible, consenting participants' fundus images were acquired using a non-mydriatic camera. These images along with other medical data were transmitted 20 miles away through the Internet (gold standard) and also through an iPhone® (Apple, Cupertino, CA) to two ophthalmologists, who independently compared the images. Results: The κ coefficient between the gold standard workstation display and iPhone images to detect retinopathy-related changes for both readers was more than 0.9. The image quality of the iPhone was scored high by the ophthalmologists. Conclusions: Ophthalmic images transmitted through both smartphone and Internet techniques match well with each other. Despite current limitations, smartphones could represent as a tool for fundus photo assessments of diabetic retinopathy. Further studies are needed to investigate the economic and clinical feasibility of smartphones in ophthalmology. [ABSTRACT FROM AUTHOR]

Objective: Personal health records provide patients with ownership of their health information and allow them to share information with multiple healthcare providers. However, the usefulness of these records relies on patients understanding and using their records appropriately. My Healthe Vet is a Web-based patient portal containing a personal health record administered by the Veterans Health Administration. The goal of this study was to explore veterans' interest and use of My Healthe Vet to transfer and share information as well as to identify opportunities to increase veteran use of the My Healthe Vet functions. Materials and Methods: Two waves of data were collected in 2010 through an American Customer Satisfaction Index Web-based survey. A random sample of veterans using My Healthe Vet was invited to participate in the survey conducted on the My Healthe Vet portal through a Web-based pop-up browser window. Results: Wave One results (n= 25,898) found that 41% of veterans reported printing information, 21% reported saving information electronically, and only 4% ever sent information from My Healthe Vet to another person. In Wave Two (n =18,471), 30% reported self-entering medication information, with 18% sharing this information with their Veterans Affairs (VA) provider and 9.6% sharing with their non-VA provider. Conclusion: Although veterans are transferring important medical information from their personal health records, increased education and awareness are needed to increase use. Personal health records have the potential to improve continuity of care. However, more research is needed on both the barriers to adoption as well as the actual impact on patient health outcomes and well-being. [ABSTRACT FROM AUTHOR]

The effectiveness of e-health interventions varies greatly. Despite this, there has been relatively little formal consideration of how differences in the design of an intervention (i.e., how the content is delivered) may explain why some interventions are more effective than others. This review primarily examines the use of the Internet to provide educational and self-management interventions to promote health. The article develops hypotheses about how the design of these interventions may be associated with outcomes. In total, 52 published reports from both a diversity sample and a representative sample were reviewed using techniques from Critical Interpretive Synthesis. Four core interactive design features were identified that may mediate the effects of intervention design on outcomes: Social context and support, contacts with intervention, tailoring, and self-management. A conceptual framework to summarize the design of e-health interventions delivered using the Internet is proposed. The framework provides a guide for systematic research to identify the effects of specific design features on intervention outcomes and to identify the mechanisms underlying any effects. To optimize the design of e-health interventions more work is needed to understand how and why these design features may affect intervention outcomes and to investigate the optimal implementation and dosage of each design feature. [ABSTRACT FROM AUTHOR]

AbstractContext:The present study of current telemedicine users is a unique attempt to understand the barriers and motivational factors related to the utilization of telemedicine.Objective:A survey of emergency and critical care remote presence telemedicine users was conducted to determine the factors that motivate and the barriers that impede the acceptance and maintenance of a robotic telemedicine (RTM) program.Setting:The majority of the survey users were in the Emergency Department or in the Intensive Care Unit.Methods:E-mail invitations were sent to 483 individuals representing 63 healthcare institutions and groups in North America and Europe. Respondents were directed to a Web-based survey. The survey consisted of 96 separate questions, addressing user familiarity and 5-point Likert scales, addressing issues spanning the conceptual and practical issues surrounding adoption of telemedicine.Results:A total of 106 surveys were completed, representing an individual response rate of 21.9% but an institutional response rate of 60.3%. More than two-thirds of the respondents were physicians who participated in active RTM programs. Across seven different topics related to barriers to implementing RTM, the majority of all respondents indicated that cultural issues did not constitute meaningful hurdles, technological matters were generally favorable, and that most personnel were agreeable to both achieving the buy-in to start an RTM program and to maintaining RTM once started. However, respondents proclaimed that RTM''s success was still hampered by licensing, credentialing, and malpractice protection, as well as costs, billing, and reimbursement issues. Achieving immediate patient access, overcoming service gaps, improving quality, providing clinical support, maintaining patient satisfaction, and adhering to practice guidelines were viewed as significant motives for RTM implementation.Conclusions:The leading applications of RTM included emergency response and consultation. The patients, physicians, nurses, nor hospital executives served as barriers to implementation. However, licensing, costs for technology, and reimbursement for RTM continue to impede progress. [ABSTRACT FROM AUTHOR]

AbstractObjective:Ensuring good data quality within telemedicine and e-health systems in developing countries is resource intensive. We set out to evaluate an approach where in-built functionality within an electronic record system could identify data quality and integrity problems with little human input.Materials and Methods:We developed a robust data integrity module to identify, enumerate, and facilitate correction of errors within an e-health system that is in wide use in sub-Saharan Africa.Results:The data integrity module was successfully implemented within an electronic medical record system in Western Kenya. Queries were set to fail if one of more records did not meet defined criteria for data integrity. Only one of 14 data integrity checks implemented uncovered no errors. The other queries had errors or questionable results ranging from 51 records to 30,301 records. However, as a proportion of all patients and all observation, the identified records with likely data integrity problems only constituted a small percentage of all records (mean 0.96%, range 0–4.1%). Twelve of the 14 queries (86%) were executed in<15 s, with the longest query lasting 2 min and 18 s.Conclusion:A tool that allows for automatic data integrity and quality checks was successfully implemented within an e-health system in sub-Saharan Africa. The tool potentially reduces the burden of maintaining data quality by limiting the scale of manual reviews needed to identify electronic records with errors. [ABSTRACT FROM AUTHOR]

AbstractBarriers to report incident events using an online information system (IS) may be different from those of a paper-based reporting system. The nationwide online Patient-Safety Reporting System (PSRS) contains a value judgment behind use of the system, similar to the Value of Perceived Consequence (VPC), which is seldom discussed in ISs applications of other disciplines. This study developed a more adequate research framework by integrating the VPC construct into the well-known Unified Theory of Acceptance and Use of Technology (UTAUT) model as a theoretical base to explore the predictors of medical staff's intention to use online PSRS. The results showed that management support was an important factor to influence medical staff's intention of using PSRS. The effects of factors such as performance expectancy, perceived positive, and perceived negative consequence on medical staff's intention of using PSRS were moderated by gender, age, experience, and occupation. The results proved that the modified UTAUT model is significant and useful in predicting medical staff's intention of using the nationwide online PSRS. [ABSTRACT FROM AUTHOR]

AbstractBackground:Sub-Saharan Africa has a disproportionate burden of disease and an extreme shortage of health workers. There are already too few doctors to train doctors in specialities and sub-specialties. E-health is seen as a possible solution through distance education, telemedicine, and computerized health information systems but there are few people trained in e-health. We describe 12 years of experience at the University of KwaZulu-Natal (UKZ-N) in education and training in postgraduate medical disciplines, medical informatics, and telemedicine.Medical Education:Videoconferencing of seminars and grand rounds to regional training hospitals commenced in 2001 and has grown to 40 h of interactive conferencing taking place weekly during academic terms involving over 33,000 participants in 2010. Videoconferenced sessions are directly recorded to DVD and DVDs are sent to other medical schools in Africa that do not have the infrastructure to directly connect.E-health Education:Students and academic staff were initially sent to the United States for training in medical informatics and workshops were held in South Africa for people from sub-Saharan Africa. This led to the development of postgraduate academic programs in medical informatics and telemedicine at UKZ-N. African students were then brought to UKZ-N for training. The model was changed from UKZ-N to students and staff based at their home universities with the aim of building capacity in the staff at partner institutions so that they can in time offer their own e-health academic programs.Conclusions:The need for capacity development in all aspects of e-health in sub-Saharan Africa is great and innovative solutions are required. [ABSTRACT FROM AUTHOR]

AbstractObjective:Dysphagia (a swallowing disorder) is known to occur in numerous clinical populations, but unfortunately because of issues accessing speech pathology services, not all patients are able to receive dysphagia intervention and rehabilitation services in a timely manner. Existing research supports the use of telehealth technology for providing various aspects of speech pathology service; however, to date there is limited evidence to support the utilization of telerehabilitation in the assessment and management of dysphagia. The aim of this research was to provide pilot information on the basic feasibility and validity of conducting dysphagia assessments via telerehabilitation.Materials and Methods:Ten simulated patients, actors portraying patients with a range of swallowing difficulties, were used rather than actual patients to minimize any potential patient risk from unidentified aspiration. Dysphagia was assessed simultaneously by a face-to-face (FTF) and telerehabilitation speech pathologist (T-SP). Each simulated patient was assessed using a Clinical Swallowing Examination (CSE) protocol that was modified to suit a telerehabilitation environment. The CSE was administered with the support of an assistant via an Internet-based videoconferencing telerehabilitation system using a bandwidth of 128 kilobits per second.Results:Results revealed high to excellent levels of agreement between the T-SP and the FTF-SP across all parameters of the CSE. Agreement for aspiration risk was excellent.Conclusion:The pilot data indicate that the current model of administering a CSE via telerehabilitation has potential to be a feasible and valid method for the remote assessment of swallowing disorders. [ABSTRACT FROM AUTHOR]

AbstractObjective:The overall goal of the study was to understand the accuracy of self-reported weight over a 6-month Web-based obesity program.Materials and Methods:As part of a larger study, subjects (n=323; 93% female; 28% African American) were randomized to a 6-month Internet-based behavioral weight loss program with weekly group meetings delivered either: (1) entirely by online synchronous chats or (2) by a combination of online chats plus monthly in-person group sessions. Observed weights were obtained at 0 and 6 months for all participants. Self-reported weights were submitted weekly to the study Web site. Differences in Observed and Reported weights were examined by gender, race, and condition.Results:Observed and Reported weight were significantly correlated at 0 and 6 months (r=0.996 and 0.996, ps <0.001 respectively). However, Reported weight underestimated Observed weight by 0.86 kg (p<0.001) at 6 months. Further, there was a significant weight loss effect (p<0.001) with those losing more weight more accurately estimating their Reported weight at 6 months. Additionally, 6-month Reported weight change differed from Observed weight change (difference=0.72 kg,p<0.001), with weight change using Reported weights estimating a slightly larger weight loss than Observed weights.Conclusions:In general, the accuracy of self-reported weight is high for individuals participating in an Internet-based weight loss treatment program. Accuracy differed slightly by amount of weight lost and was not improved with periodic in-person assessment. Importantly, weight change by self-report was comparable to observed, suggesting that it is suitable for Web-based obesity treatment. [ABSTRACT FROM AUTHOR]

AbstractObjective:This study measured health literacy in a population of teens in treatment for asthma or diabetes and tested the association between health literacy and willingness to use online health resources.Materials and Methods:About 180 patients aged 13–18 years treated for asthma or diabetes in specialty care clinics completed assessments of demographic characteristics, health literacy, and Internet access and use. Teens were provided a resource page listing selected publically available health-related Web sites and asked about perceived ease of use, perceived usefulness, and intent to use the listed Web sites. The relationship between demographic characteristics, health literacy, and online health information use was tested using chi-squared or Fisher's exact test. Predictors of intent to use resource page Web sites were assessed using bivariate and multivariate ordinal logistic regression.Results:About 92% of participants had adequate health literacy. Over 50% of participants had previously searched online for health information. Older age was the only significant predictor of health information search. Most teens (79%) reported intent to use at least one Web site from the resource page at least occasionally within the next 3 months. Higher health literacy (odds ratio [OR]=6.24,p<0.01) and stronger perceived usefulness (OR=1.74,p=0.01) were associated with greater intent for regular use, after controlling for demographic and Internet access variables.Conclusions:Teens with lower health literacy searched online for health information as often as peers with higher literacy, but were less likely to express the intent to use recommended sites. Belief in the usefulness of a Web site is the strongest attitudinal predictor of intended future use. [ABSTRACT FROM AUTHOR]

AbstractWe analyzed the effect of e-health on medical expenditures in Nishi-aizu Town, Fukushima Prefecture, Japan, using panel data of medical expenditures for about 400 residents from 2002 to 2006. The Nishi-aizu Town system was introduced in 1994 and is still successfully operating as one of the longest running implementations of e-health in Japan. The town office maintains a register of receipts for medical expenditures paid by the National Health Insurance system and provides data on e-health users, allowing users and nonusers of e-health and their respective costs to be distinguished. Here, we focus on patients with lifestyle-related diseases such as high blood pressure, diabetes, stroke, heart failure, etc. This article postulates that e-health reduces medical expenditures via two mechanisms, decreasing travel expenses and preventing symptoms from worsening. The former implies that e-health monitoring allows patients at home to visit medical institutions less frequently, and the latter that the symptoms experienced by e-health users are less severe than those experienced by nonusers. We termed these the travel cost effect and opportunity cost effect, respectively. Chronic conditions tend not to occur singly, and many patients have more than one; for example, patients with high blood pressure or diabetes also likely have heart disease at the same time. This multiplicity of conditions hampers cost analysis. Among methodological issues, a number of recent empirical health analyses have focused on the endogenous problem of explanatory variables. Here, we solved this problem using the generalized method moments (GMM) system, which allows treatment of not only the endogenous problem of explanatory variables but also the dynamic relationship among variables, which arise due to the chronic time-lagged effect of lifestyle-related diseases on patients. We also examined a second important methodological problem related to reverse correlation between the medical expenditures of an outpatient and e-health and took sampling biases into consideration. We concluded that this control of endogeneity through system GMM confirms that the relationship between the medical expenditures of an outpatient and e-health shows causation rather than simple correlation and that e-health use, duration of e-health use, and frequency of e-health use can reduce outpatient medical expenditures for lifestyle-related diseases. [ABSTRACT FROM AUTHOR]

Committee MembersCo-ChairsDavid Brennan, M.B.E., Senior Research Engineer, National Rehabilitation Hospital, Washington, District of Columbia.Lyn Tindall, Ph.D., Speech-Language Pathologist, Department of Veterans Affairs Medical Center, Lexington, Kentucky.Writing CommitteeJanet Brown, M.A., CCC-SLP, Director, Health Care Services, American Speech-Language-Hearing Association, Rockville, Maryland.Mike Campbell, M.S., M.B.A., CCC-SLP, Director of the Speech and Hearing Program, The University of North Carolina at Greensboro, Browns Summit, North Carolina.Jana Cason, D.H.S., OTR/L, Assistant Professor, Auerbach School of Occupational Therapy, Louisville, Kentucky.Diana Christiana, M.A.T., CCC-SLP, President/CEO, Clinical Communications, Sugar Land, TX.Alan Lee, Ph.D., P.T., D.P.T., C.W.S., G.C.S., Associate Professor, Mount St. Mary''s College, Doctor of Physical Therapy Program, Los Angeles, California.David R. Smith, Director, Telehealth Resource Center, Marquette General Hospital, Marquette, Michigan.Deborah Theodoros, Ph.D., Associate Professor and Head, Division of Speech Pathology, School of Health and Rehabilitative Sciences, The University of Queensland, Queensland, Australia.ContributorsWorking Group Members [WG], Consultants [C], Reviewers [R], Telerehabilitation Special Interest Group Chair [TR], ATA Standards and Guidelines Committee Member [SG], and ATA Staff [S]Nina Antoniotti, R.N., M.B.A., Ph.D., Chair of SG, Director of Telehealth, Marshfield Clinic, Marshfield, Wisconsin.Jordana Bernard, M.B.A., S, Senior Director, Program Services, American Telemedicine Association, Washington, District of Columbia.Anne Burdick, M.D., M.P.H., SG, Associate Dean for Telemedicine and Clinical Outreach, Professor of Dermatology, Director, Leprosy Program, University of Miami Miller School of Medicine, Miami, Florida.Jerry Cavallerano, Ph.D., OD, SG, Staff Optometrist, Assistant to the Director, Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts.Ellen Cohn, Ph.D., CCC-SLP, TR, WG, Associate Dean for Instructional Development, School of Health and Rehabilitative Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.Paul Cox, MSEE, WG, President, PERL Research, Huntsville, Alabama.Mary Fran Delaune, P.T., MPT, R, Director, Practice Department, American Physical Therapy Association, Alexandria, Virginia.Matt Elrod, P.T., D.P.T., M.Ed., N.S.C., R, Associate Director, Practice Department, American Physical Therapy Association, Alexandria, Virginia.Brian Grady, M.D., [SG], VISN5 TMH Lead and Director, TeleMental Health, School of Medicine, University of Maryland, Baltimore, Maryland.Elizabeth Krupinski, Ph.D., Vice Chair of SG, Associate Director, Program Evaluation, University of Arizona, Arizona Telemedicine Program, Department of Radiology, Research Professor, Department of Radiology Research, Tucson, Arizona.Jonathan D. Linkous, MPA, S, Chief Executive Director, American Telemedicine Association, Washington, District of Columbia.Michael Pramuka, Ph.D., CRC, WG, Rehabilitation Counselor, Walter Reed Medical Center, Washington, District of Columbia.Richard Schein, Ph.D., WG, Postdoctoral Associate, Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania.Lou Theurer, SG, Grant Administrator, Burn Telemedicine Program, University of Utah Health Sciences Center, Salt Lake City, Utah.Jill Winters, Ph.D., R.N., WG, SG, Dean and Professor, Columbia College of Nursing, Milwaukee, Wisconsin. [ABSTRACT FROM AUTHOR]

AbstractThe main purpose of this study was to investigate the perceptions of the electromagnetic interference (EMI) caused by radio frequency identification (RFID) with medical devices among hospitals as well as to call the attention of medical institutions to the development of RFID applications. A survey sponsored by the Department of Health of Taiwan was conducted and the target subjects were every hospital in Taiwan (486 in total). The survey topics included testing of RFID interference with medical devices and perceptions of safety issues of RFID. The main targets of the survey were the Chief Information Officers (CIOs) or the main person responsible for RFID systems in each hospital. Of the original 486 questionnaires mailed, 273 were returned. A return rate of 56.17% was obtained. The survey results revealed that only six hospitals had carried out tests on interference by RFID with medical devices, and the results of these tests indicated that RFID does not interfere with medical devices. A majority of hospitals understood that RFID may interfere with medical devices but did not think that this would seriously harm patients. The application of RFID in the healthcare industry is certainly promising; however, EMI issues must be appropriately handled. This study asserts that most hospitals do not understand or pay insufficient attention to the issue of RFID interference with patient safety or medical devices. In addition, most hospitals believe that the problem of RFID should be resolved by RFID vendors. Therefore, this study argues that medical institutions should develop more understanding of RFID issues and that more attention should be given to the potential problems of RFID interference when developing RFID applications. [ABSTRACT FROM AUTHOR]

AbstractObjective:e-Health has become a major topic in the European Union (EU) Commission due to the assumption that it improves the quality and effectiveness of health services and, at the same time, promotes information and communications technologies in this emerging high-technology area. In 2004, the EU Commission adopted the first e-health Action Plan, which sets targets for member states in the adoption of telematics applications. This article aims at explaining the variance in the application of e-health tools across 24 EU member states.Methods:The study includes the implementation of 12 e-health policies as of early 2007. Each policy was coded on a binary scale distinguishing between implementation and nonimplementation. The summing up of all binary values created an additive index. We used several multiple linear regression models to estimate the impact of socio-economic, political and healthcare related variables on the scope of implementation.Results:The scope of implementation mostly depends on political factors, whereas economic and health-related variables scarcely account for cross-country variance. Only the scope and importance of the domestic information and communication technology market have a significant effect on the scope of implementation. In contrast, political variables constitute most of the variance in the implementation scope. The strength of left parties in government has a significant effect: an increase of left parties in government increases the total amount of e-health measures implemented.Conclusion:Governments that included e-health applications in policy documents rather early have adopted more telematics applications. [ABSTRACT FROM AUTHOR]

AbstractObjective:Internet-based medical visits, or “structured e-Visits,” allow patients to report symptoms and seek diagnosis and treatment from their doctor over a secure Web site, without calling or visiting the physician's office. While acceptability of e-Visits has been investigated, outcomes associated with e-Visits, that is, whether patients receiving diagnoses receive appropriate care or need to return to the doctor, remain unexplored.Materials and Methods:The first 156 e-Visit users from a large family medicine practice were surveyed regarding their experience with the e-Visit and e-Visit outcomes. In addition, medical records for patients making e-Visits were reviewed to examine need for follow-up care within 7 days.Results:Interviews were completed with 121 patients (77.6% participation). The most common type of e-Visit was for “other” symptoms or concerns (37%), followed by sinus/cold symptoms (35%). Back pain, urinary symptoms, cough, diarrhea, conjunctivitis, and vaginal irritation were each less frequent (<10%). A majority, 61% completed e-Visits with their own physician. The majority of patients (57.0%) reported receipt of a diagnosis without need for follow-up beyond a prescription; 75% of patients thought the e-Visit was as good as or better than an in-person visit, and only 11.6% felt that their concerns or questions were incompletely addressed. In a review of medical records, 16.9% had a follow-up visit within 7 days, mostly for the same condition. Four of these were on the same day as the e-Visit, including one emergency department visit.Conclusions:Outcomes for the e-Visit suggest that it is an appropriate and potentially cost-saving addition to in-person delivery of primary care. [ABSTRACT FROM AUTHOR]

AbstractObjectives:Because of lack of integrated databases for Chinese menus and the need for nutrition information by dietitians in Taiwan, we developed a Web-based platform for dietary analysis and recommendations. Methods:The fuzzy decision model was utilized to develop a Web-based support system that searches food composition databases, calculates dietary intake, and provides the guidance for decision making in nutrition counseling. Results:The online support system generated menu- or food-based recommendations using a fuzzy decision model. The homogeneity of food composition between five selected menus generated by the fuzzy decision model in a randomly selective case was strongly correlated with a correlation coefficient of 0.31–0.99. The correlation coefficients were 0.42–0.45 and 0.13–0.44 between food composition of five most correlated menus or five selected menus generated by the fuzzy decision model and nutrient requirements computed by the fuzzy decision model, respectively. The most correlated menus and the menus generated by the fuzzy decision model were also similar. Conclusions:The recommended menus generated by the fuzzy decision model are considerably reliable and valid, and the online support system for dietary analysis and recommendations can provide a Web-based and decision-making tool for dietitians in Taiwan. [ABSTRACT FROM AUTHOR]

AbstractObjective:The aim of this study was to describe the online transformation of an empirically validated, clinic-based, self-management (SM) program for rheumatoid arthritis.Materials and Methods:A cognitive-behavioral framework served as the theoretical basis for the intervention. As with the clinic-based approach, the psychoeducational program included educational modules, weekly homework assignments, and self-evaluation. The dynamic online environment included secure communication tools to support a virtual community for the participants to garner peer support. In addition to peer support, weekly follow-up support was provided by a trained clinician via telephone. We describe the process and structure of the online self-management (OSM) intervention. Administrative issues including clinical monitoring and management, data collection, and security safeguards are considered. Utilization and management data are provided and explored for 33 initial subjects.Results:Individuals who volunteer to participate in an online modality are eager to receive this home-based programming. They readily engaged with all aspects of the OSM program and experienced few difficulties navigating the environment.Conclusion:An OSM site provides a convenient, effective, and securely maintained health service, once restricted to clinic settings. The OSM application can be used to extend the benefits of SM programs to broad target audiences and serves as a model for the emerging generation of Internet-based clinical management/delivery systems. [ABSTRACT FROM AUTHOR]

A home monitoring system for amyotrophic lateral sclerosis patients with respiratory failure was tested in a clinic as a preliminary to installation in home care. The system digitally recorded parameters received from a bi-level ventilator with an internal modem directly connected to the Internet allowing bidirectional flexibility. Acceptance of the system was investigated with patients and all therapists involved. The instrument was found to be user-friendly and effective by the researchers, being practical for both patients and therapists. However, no quantitative data are supplied from what otherwise seems to have been a very fine safety and efficacy test for a critical need in home monitoring. [ABSTRACT FROM AUTHOR]

Objectives: This study was an anonymous Internet survey of individuals currently diagnosed with borderline personality disorder (BPD), where participants gave opinions about BPD criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR), and suggested modifications for BPD criteria to appear in the DSM-V (5th edition). Methods: Survey links were posted on 24 websites/Internet blogs that offered advice, education, or treatment of BPD. Demographic and clinical data pertaining to each participant were collected. Free-text responses were analyzed by frequencies of keywords and key phrases. Results: A total of 1,832 responses were downloaded between March 7 and June 6, 2009, and 646 responses were analyzable. Results indicated that the majority of the DSM-IV-TR criteria appeared to capture what participants were experiencing, even though a significant percentage of participants felt that something was missing from the current criteria. A significant percentage of participants felt that BPD should be renamed in the DSM-V; some combination of 'emotion(al)' and '(dys)regulation' was most commonly suggested to include in an alternative name. Conclusions: This Internet study highlighted the enthusiasm of individuals diagnosed with BPD to share their opinions on the DSM criteria with mental-health professionals. A significant percentage of participants in this study felt that BPD should be renamed in the DSM-V. Patient involvement during the DSM-V revision process remains controversial. [ABSTRACT FROM AUTHOR]

Limited English proficiency costs healthcare providers and payers through lower patient use of preventive care, misdiagnosis, increased testing, poor patient compliance, and increased hospital and emergency room admissions. Recently published literature and unpublished data documenting the use of telephonic and video interpretation methodologies to improve healthcare communication with the persons with limited English proficiency was reviewed. Utilization of the Internet provides access to translated documents, promising practices, step-by-step guides, planning tools, and research briefs. Such tools can add value to healthcare where language is a barrier. [ABSTRACT FROM AUTHOR]

Access to health information on the Internet has changed the way patients gain access to information about their health. This provided them a greater role in decisions, ultimately affecting their health. This article provides an overview of the impact of the Internet on patient knowledge management and education, and its subsequent impact upon the medical decision-making process between the patient and clinician. [ABSTRACT FROM AUTHOR]

The validity and reliability of an Internet-based videoconferencing system was studied for the assessment of children's literacy on a battery of standardized assessments. Twenty children aged 8–13 years were simultaneously assessed in real-time both face-to-face and over a 128-Kbps Internet link. The limits of agreement for the majority of raw scores fell within predetermined clinical criteria. Weighted kappa analyses on the tests' scaled scores indicated very good agreement for all parameters (κ = 0.92–1.00). Very good intra- and interrater reliability was determined for all online parameters (intraclass correlation coefficient = 0.98–1.00). [ABSTRACT FROM AUTHOR]

This study examined the feasibility and efficacy of three 1-year, multiple contact physical activity interventions (Tailored Internet, Tailored Print, Standard Internet) in a subsample of African American participants (n= 38) enrolled in a randomized controlled trial. Results suggest that computer-tailored and Internet-based interventions are able to produce long-term increases in physical activity and associated process variables among African American participants. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a major health concern and can result in lifelong disability. Fourteen individuals with documented TBI and memory impairments completed 60 sessions of Internet-based cognitive rehabilitation: 30 sessions of an active calendar intervention and 30 sessions of a control diary intervention. A four-question (seven-point Likert scale) satisfaction questionnaire was completed after 30 sessions and again after 60 sessions. No significant differences in satisfaction were found between time of assessment and treatment condition. These results suggest that persons with TBI are not only willing to use the Internet to receive cognitive rehabilitation treatment, but are generally highly satisfied with the treatment. [ABSTRACT FROM AUTHOR]

This study tested the effectiveness of incorporating Web-based application sharing of virtual medical simulation software within a multipoint video teleconference (VTC) as a training tool in graduate medical education. Resident at three locations and attending physicians participated in dosimetry teaching sessions held via VTC using Adobe®Acrobat®Connect™ application sharing. Residents compared this teaching technology with VTC-alone method. The teaching efficacy of multipoint VTC was perceived by medical residents to be more effective when complemented by application sharing softwares such as Adobe Acrobat Connect. [ABSTRACT FROM AUTHOR]

This article describes the design process for a personal health application (PHA), including architecture, workflow, and functionality. Focus groups with people who have diabetes (n= 21) were conducted to ascertain their needs for a PHA. An Internet-based prototype was developed. Feedback was provided on the design, which led to changes in the PHA's presentation and function. The prototype PHA retrieves data for diabetes self-management from a personal health record, displays those data using gadgets in the consumer's iGoogle page, and makes the data available to a decision-support component that provides lifestyle-oriented advice. This PHA can provide the backbone for a decision support system that can bring together the cornerstones of diabetes self-management and integrate them into the life of the person with diabetes. [ABSTRACT FROM AUTHOR]

As medical providers seek new ways to control costs, online visits have begun to receive serious consideration. The purpose of this study was to compare the odds of being a cost outlier during a 6-month period after either an online visit or a standard drop-in visit in a conventional medical office setting. Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Two groups of patients were studied: those who had an online visit ( N = 390) and a comparison group who had regular office care for same-day, acute visits ( N = 376). Case types were classified as either complex or common, with common being defined as treatment for pinkeye, sore throat, viral illness, bronchitis, or cough. Outliers were defined as patients for whom standard costs exceeded the 75th percentile during a 6-month period after the index visit. Multiple logistic regression analysis was used to adjust for differences between groups. The percentage of online visitors who were cost outliers was 21.2 (versus 28.5 in the standard visit group). Median standard costs were $161 for online visits and $219 for same-day acute visits. The adjusted odds of being a cost outlier was lower for the online visit group than for the standard visit group (odds ratio [OR] 0.52, 95% confidence interval [95% CI] 0.35–0.77) after adjusting for number of visits in the previous 6 months, age, sex, and case type. Outpatient visits in the previous 6 months were positively related to outlier status (OR 1.23, 95% CI 1.17–1.29). Online visits appeared to reduce medical costs for patients during a 6-month period after the visit. ( Population Health Management 2010;13:59–63) [ABSTRACT FROM AUTHOR]

Many HIV-positive persons use the Internet to address at least some of their needs for HIV-specific information and support. The aim of this multimethod study was to understand how a diverse sample of persons who were recently diagnosed with HIV (PRDH) used the Internet after an HIV diagnosis and their perceptions of online HIV-related information and resources. HIV-positive persons ( N = 63) who had been diagnosed since the year 2000 were recruited primarily through HIV-related websites and HIV medical clinics. One third of participants (33%, n = 21) were gay or bisexual men, 25% ( n = 16) were heterosexual men, 32% ( n = 20) were heterosexual women, and 10% ( n = 6) were transgender women (male to female). Semistructured interviews and brief postinterview surveys were used to collect qualitative and quantitative data. Qualitative findings suggested that the most appealing websites to PRDH included those that: (1) provided usable information on topics of immediate concern; (2) used accessible formats that were easy to navigate; (3) were perceived as trustworthy, and (4) provided access to diverse perspectives of persons living with HIV/AIDS. Topics that PRDH found most useful included various medical treatment-related issues, tools for coping with depression and fear, and learning how others cope with HIV. Incorporating the perspectives of HIV-positive persons into the design and content of HIV-related websites is important to enhance their appeal for this diverse and growing population. [ABSTRACT FROM AUTHOR]

AbstractHeart failure (HF) results in high hospitalization rates and healthcare costs. Telemonitoring of HF has been shown to result in improved outcomes but usually involves the use of expensive equipment. A more feasible alternative may be the use of a Web site. The purpose of this study is to investigate the use of a Web site designed for HF telemonitoring. Patients newly referred to a heart function clinic were screened for eligibility. Twenty participants were recruited and entered their weight and symptoms onto the Web site for 6 months. A nurse monitored the Web site for changes in participant health status and telephoned the participants as necessary. Self-care, quality of life, 6-minute walk test, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) were assessed. Interviews were conducted to assess intervention uptake. Seventeen participants completed the study. A significant change was observed on the maintenance subscale of the Self-Care of Heart Failure Index (p = 0.039). There was a trend toward improvement on the confidence subscale of the Self-Care of Heart Failure Index (p = 0.069), Minnesota Living With Heart Failure®Questionnaire (p = 0.337), 6-minute walk test (p = 0.124), and NT-proBNP (p = 0.210). Participants and nurses demonstrated a favorable uptake of the Web site. A Web site that facilitates the telemonitoring of patients with HF was favorably accepted and its use in this pilot study was associated with improved self-care skills. However, further investigation is warranted in a larger study population. [ABSTRACT FROM AUTHOR]

AbstractMajor government efforts to widen the use of health information technology and speed the translation of biomedical research discoveries into clinical practice are converging with the rapid growth of the Internet to create unprecedented opportunities to use telehealth networks to broaden access to high-quality healthcare and expand the scope and reach of clinical and translational research. Recognizing the dual potential of telehealth networks to improve health outcomes and reduce barriers to participation in research, particularly in medically underserved communities, the National Center for Research Resources (NCRR), part of the National Institutes of Health (NIH), convened a national conference at the NIH on June 25–26, 2009, titled “Future of Telehealth: Essential Tools and Technologies for Clinical Research and Care,” in collaboration with experts from the Health Resources and Services Administration, the Indian Health Service, the Department of Veterans Affairs, Internet2, and the NIH National Library of Medicine, National Institute of Biomedical Imaging and Bioengineering, and National Center for Minority Health and Health Disparities. The conference brought together over 400 subject matter experts from government, academia, and industry to discuss a wide range of issues in telehealth research and development. Its primary outcome is a set of short papers reporting on recommendations from thematic breakout sessions and some overarching recommendations that can, taken together, stimulate and help guide further research through new multi-agency, interdisciplinary collaborations. [ABSTRACT FROM AUTHOR]