Experience and hopes for telehealth in Tokelau

The two key factors affecting healthcare in Tokelau are its small population and its great isolation. Both of these make telehealth a critical issue for the development of health services and it is hard to see how the services can develop to a modern standard without a larger component of telemedicine. The Tokelau islands consist of three roughly equal atolls usually served by 1-2 doctors who deal with all aspects of medical care. There is a small hospital on each atoll and each is staffed by a Nurse manager, two staff nurses and some nurse aides. There is a need for a communication facility for the nurse on the atoll(s) without a doctor to consult with a doctor about medical cases; doctors to consult each other; and for doctors to consult outside specialists about the management of cases. Distance education for health care staff is another perceived need. The current communications systems are still basic and although there is a PeaceSat terminal on each atoll it has largely failed to provide the above communication needs and most is still done by the costly telephone system. Recently ITC has been made a priority for the health department.     

实验室仪器设备管理工作的体会

近年来,随着我国疾病预防控制机构实验室仪器设备更新力度的加大和国内外卫生检测要求的提高,粗放式的实验室管理模式已越来越不能适应卫生检测工作的需要.作为专业性很强的仪器设备管理工作,其基础保障作用越来越重要.疾病预防控制机构实验室检测水平的高低,不仅取决于仪器设备的配置和人员的业务素质,更取决于仪器设备的整体管理水平.     

A laboratory for testing the interoperability of telehealth systems

Interoperability allows telehealth equipment to interact to achieve predictable results. To address the need for telehealth interoperability, the Alberta Research Council has been working with the Alberta Health and Wellness organization in Canada, and others, to create guidelines and a facility for testing telehealth equipment for compliance with technical interoperability standards. The laboratory consists of two rooms (7 m x 7 m) in a new building. The rooms are wired with easy-to-configure copper and fibre networks for telephone, Switch-56, ISDN, ATM, wireless and satellite services. One room specializes in teleconsultation and tele-education, while the other has facilities for teleradiology and telemonitoring. The rooms are interconnected in order to perform interoperability tests between realtime and store-and-forward equipment. The laboratory was piloted in the summer of 1999.     

Intensive telehealth management of five at-risk adolescents with diabetes

Five adolescents with diabetes participated in an intensive outpatient treatment programme designed to improve adherence to their regimen and improve metabolic control. Families reported blood sugar levels, injections and food intake daily by telephone. After four weeks they were offered a video-phone. Nine subjects were recruited but four of them dropped out. Of the remaining five, one subject used a video-phone and one subject reported blood sugar results by email. Most of the children improved their metabolic control and all five subjects showed reduced HbA(1c) levels during the three months of the study. The use of telehealth facilitated the treatment of adolescents with poor glycaemic control.     

Integrated telehealth and care management program for Medicare beneficiaries with chronic disease linked to savings

Treatment of chronically ill people constitutes nearly four-fifths of US health care spending, but it is hampered by a fragmented delivery system and discontinuities of care. We examined the impact of a care coordination approach called the Health Buddy Program, which integrates a telehealth tool with care management for chronically ill Medicare beneficiaries. We evaluated the program's impact on spending for patients of two clinics in the US Northwest who were exposed to the intervention, and we compared their experience with that of matched controls. We found significant savings among patients who used the Health Buddy telehealth program, which was associated with spending reductions of approximately 7.7-13.3 percent ($312-$542) per person per quarter. These results suggest that carefully designed and implemented care management and telehealth programs can help reduce health care spending and that such programs merit continued attention by Medicare. Meanwhile, mortality differences in the treatment and control groups suggest that the intervention may have produced noticeable changes in health outcomes, but we leave it to future research to explore these effects fully.     

远程医疗患者隐私风险识别与防控对策探讨

远程医疗重构了医患关系,为降低就医成本与获取高端诊疗资源带来了便利,但也对患者隐私风险保护带来了挑战.与传统医疗相比,远程医疗的患者隐私风险保护更为复杂多样.基于现有远程医疗的患者隐私困境特殊性视角进行切入,通过精准识别并分析出当前远程医疗患者面临的隐私风险,提出建立以法律保护为保障、流程优化为规范、技术手段为支撑及意...     

An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring

We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes. One group of patients was monitored weekly (n = 197), with more intensive evaluations, while the other was monitored daily (n = 100), but less intensively. Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline, they had different service utilization patterns during the 12-month pre-enrollment period. Over the 12-month study period, the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group, and increased in the weekly monitoring group, more or less doubling in the former and being halved in the latter. Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group. The differences between the two groups were significant (P < 0.01). There were no significant differences between the groups in the clinical outcomes. Future research should employ randomized controlled trial designs to determine if intensities of home monitoring lead to differences in service utilization and health outcomes.     

耐药结核病患者睡眠质量影响因素调查及管理对策分析

目的 对耐药结核病患者的睡眠质量进行评估,探讨该类患者睡眠管理的解决方案.方法 评估结核科住院治疗的耐药结核病患者睡眠质量,应用自制问卷调查对该类患者睡眠质量的影响因素,并制定针对性的睡眠管理措施进行干预,10d后比较患者干预前后的睡眠质量.结果 调查结果显示,病程、临床症状、药物副反应、对治疗的信心以及病房环境是影响耐药结核病患者睡眠质量的主要因素,经干预10 d后,患者的睡眠质量较干预前明显改善(P＜0.01).结论 加强对耐药结核病患者的睡眠质量管理,制订有效的管理干预措施,能够有效提高该类患者的睡眠质量,促进疾病康复.     

Home telehealth for children with special health-care needs

The U Special Kids (USK) programme at the University of Minnesota provides intensive care coordination and case management services to children with complex special health-care needs. We conducted a one-year pilot study to evaluate the feasibility of videoconferencing between the USK office and family homes. To ensure easy installation, families were provided with prepackaged equipment and software. However, the families had different Internet providers, different modems and/or routers and different firewall software, which required case-by-case resolution during home visits by the project coordinator. Five families participated in 3-5 videoconferencing sessions with a USK nurse. All connections with urban families had clear audio and video, whereas connections with rural families had clear audio, but unclear video. All of the scheduled virtual visits were rated by nurses as providing information that was similar to a telephone call. However, the unscheduled virtual visits were rated by the nurses as providing more information than a telephone call, suggesting that home-based videoconferencing may be useful in the management of children with complex special health-care needs.     

Experience with organizing regional genetic monitoring]

The necessity of conducting regional genetic monitoring (GM) is substantiated, an experience on its organization and the procedure of its carrying out with the help of computer technology is provided. The analysis of GM indicated that the incidence of developmental defects registered and listed is in the population limits. Proceeding from the example of anencephaly , the role of GM in the assessment of the effectiveness of comprehensive measures on prevention of birth of children with grave defects has been demonstrated.     

疾控实验室认证体会

文章总结了实验室认证工作实践经验。通过建立文件化管理体系;宣传培训,全员参与;做好记录,健全档案;加强仪器设备管理,保证量值溯源,完善实验室环境建设;开展内部审核,做好质量监督,保证质量管理体系正常有效运行;采取改进措施,不断完善体系文件等6方面来做实验室认证。通过6个方面的建设,提高了实验室检验检测能力,达到了实验室资质认证的目的。     

Optimal checking procedures for monitoring laboratory analyses.

Many clinical, environmental, and epidemiologic studies rely heavily upon biochemical data, and the quality of these data is of paramount importance to the validity of study conclusions. Traditionally, far more attention has been given to the analysis of study data than has been given to monitoring the quality of the data. In this paper we draw an analogy between monitoring a laboratory system and an industrial production process and discuss the limitations of industrial quality control plans when applied in a laboratory setting. We derive methods for computing optimal checking schedules for laboratory analyses. These schedules formalize traditional laboratory practices of periodic checking and provide guidelines for the frequency and placement of checks within a finite batch of analyses. When laboratory system failure can be reasonably approximated by an exponential or geometric distribution, optimal checking schedules are relatively easy to compute. For more complex failure distributions, we present a dynamic programming approach. We describe an application to the measurement of selenium status in plasma samples using an electrothermal atomic absorption spectrophotometry procedure.