Search

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

Telehealth is defined as the delivery of health-related services and information via telecommunications technologies. According to the American Telemedicine Association (ATA), “telehealth” is a broad term used to describe the use of electronic communications to deliver clinical services as well as other types of health information.1 In rehabilitation, telehealth is defined by the American Physical Therapy Association (APTA) as the use of electronic communications to provide and deliver a host of health-related information and health care services, including, but not limited to, physical therapy–related information and services, over large and small distances.2 Telehealth may be used to provide health education and advice, communicate patient reminders, monitor clinical status, or deliver interventions. Other rehabilitation disciplines, such as occupational therapy and speech therapy, utilize the terms “telerehabilitation”3 and “telepractice”4 as terms to define telehealth in their respective disciplines. The Patient Protection and Affordable Care Act (Public Law 111–148) (PPACA),5 signed into law on March 23, 2010, addresses the use of telehealth as a means of delivering efficient and effective health care in the United States. The national health care reform6 presents a unique opportunity for physical therapists to become identified as clinicians eligible to provide telehealth physical therapy services. However, there are several barriers to overcome if telehealth as a means of health care delivery for physical therapist practice is to become a reality. The objectives of this health policy perspective article are: (1) to describe the development of the telehealth field from a rehabilitation perspective, thereby highlighting some of the potential applications by physical therapists; (2) to discuss current barriers to adoption of telehealth technology by physical therapists; and (3) to identify an overall strategy to achieve long-term adoption of telehealth practices for physical therapists. The earliest applications of telehealth used technology to monitor cardiac …

Glandless cotton plants (Gossypium hirsutum L. cv. Coker 100) were subjected to the influence of high CO(2)-bicarbonate. The content of protein decreased with no accompanying increase in its degraded products. The decrease in protein was correlated with the low content of chlorophyll and also with the reduced activity of carbonic anhydrase. The initiation of these correlations coincided with the time when the control leaves contained the highest enzyme activity during leaf growth. The high concentration of bicarbonate directly restricted the rate of photophosphorylation and that of the Hill reaction in isolated chloroplasts. The amount of ATP in leaves treated in vivo also diminished. High CO(2) as bicarbonate, however, did not directly inhibit the activity of carbonic anhydrase in vitro.

Investigation was made for the effect of fluoride on plant growth, acid soluble nucleotides, and RNA in germinating corn seedling roots. Fluoride suppresses root growth as measured by changes in fresh weight. Column chromatographic analyses demonstrated that fluoride modifies ratios of acid soluble nucleotide species. The relative amount of nucleotides is altered mainly due to triphosphate nucleotides of which ATP is most accumulated. Paper chromatographic analyses showed that fluoride induces changes of RNA structure. The RNA is characterized by lowered relative content of cytosine and by increased ratio of cytosine to guanine. Adenine is depressed significantly only in the root tissue treated by the highest fluoride concentration.

Fluoride-polluted navel orange leaves, Citrus sinensis (Linn.) Osbeck, were fractionated into the subcellular components in hexane/carbon tetrachloride mixtures having various densities. Fluoride was determined at each fraction. Analyses were also made for the subcellular distribution of chlorophyll, nitrogen, and DNA to assess the extent of cross-contamination of each component. The fraction containing cell wall, nuclei, and partly broken cells apparently contained a major amount of fluoride. However, if allowance was made for the cross-contamination of chloroplasts and chloroplast fragments, the fraction of chloroplasts was found to be the site of the highest fluoride accumulation. When each particulate component was washed with water after drying, the combined washings contained more than 50% of the total fluoride of the isolated fractions. The usual method of subcellular fractionation with aqueous solvent shifted the major site of fluoride accumulation from the fraction of chloroplasts to that of the supernatant.