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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2013)

Special Issue Editor

Guest Editor
Prof. Dr. George Crooks

Scottish Centre for Telehealth and Telecare, NHS 24, Caledonia House, 140 Fifty Pitches Road, Glasgow G51 4EB, UK
Website | E-Mail

Special Issue Information

Dear Colleagues,

Health and care systems around the world are facing a number of wicked challenges.  The increase in the number of older people, the significant increasing incidence of long-term conditions coupled with significant societal challenges are all beginning to challenge conventional health and care delivery systems.  When you add into this mix the increasing financial constraints being felt by most economies around the world it was clear that something must change.

Technology has always been a fundamental companion in the delivery of high quality health care.  However, the time lag between invention to widespread implementation remains far too long.  Increasingly there is a body of opinion that recognises that we must not simply empower patients to participate in their own care but through the appropriate and targeted use of technology become deliverers of their own care (co-production) and that the burden of informal caring often shouldered by family, friends or neighbours becomes much easier.  Through innovative service redesign, supported by the appropriate deployment of technologies we can help deliver the necessary integration of health and social care.  It is that integration that will improve quality for patients and their carers but also improve effectiveness and drive efficiencies within health and care systems.

Papers on any aspect of telehealth care are sought, we are particularly interested in papers highlighting best practice, innovative service models, successful incentives and barriers to deployment.

Professor George Crooks
Guets Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed Open Access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs).

Keywords

  • telehealth care
  • innovation
  • service redesign
  • best practice
  • co-production

Published Papers (19 papers)

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Research

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Open AccessArticle A Telemonitoring Tool based on Serious Games Addressing Money Management Skills for People with Intellectual Disability
Int. J. Environ. Res. Public Health 2014, 11(3), 2361-2380; doi:10.3390/ijerph110302361
Received: 20 September 2013 / Revised: 8 February 2014 / Accepted: 11 February 2014 / Published: 25 February 2014
Cited by 5 | PDF Full-text (786 KB) | HTML Full-text | XML Full-text
Abstract
This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based
[...] Read more.
This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based on Serious Games are proposed to the user using a multitouch device. On the other hand, the psychologists and specialist who work with them, can access to the Serious Games results using an online application in order to evaluate their evolution. The results are measured according to the number of errors they have during the proposed activities, the time they need to complete them and the score. The article show the results of an experiment made with a clinical sample of 12 users with ID between 12 and 15 years, taking into account that all of them are capable of correct oral communication and they do not have severe physical coordination problems. Only two users completed all the games without errors. Males obtained a mean of 28.25 errors, whereas females obtained a mean of 17.75. The results show significant difference between the selection of games 1, 2 or 3, because all of them prefer the game 1 related with “Payments” probably because it permits more interaction using the multitouch device. The authors also made a qualitative evaluation and the results have been very promising and satisfactory. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
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Open AccessArticle Pre-Hospital ECG E-Transmission for Patients with Suspected Myocardial Infarction in the Highlands of Scotland
Int. J. Environ. Res. Public Health 2014, 11(2), 2346-2360; doi:10.3390/ijerph110202346
Received: 16 December 2013 / Revised: 29 January 2014 / Accepted: 13 February 2014 / Published: 21 February 2014
Cited by 4 | PDF Full-text (386 KB) | HTML Full-text | XML Full-text
Abstract
Patients with ST elevation myocardial infarction (STEMI) require prompt treatment, best done by primary percutaneous coronary intervention (PPCI). However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT) is the best alternative. Evidence indicates that diagnostic and management support for staff increases
[...] Read more.
Patients with ST elevation myocardial infarction (STEMI) require prompt treatment, best done by primary percutaneous coronary intervention (PPCI). However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT) is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS) staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU) nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle A Review of Telehealth Service Implementation Frameworks
Int. J. Environ. Res. Public Health 2014, 11(2), 1279-1298; doi:10.3390/ijerph110201279
Received: 20 November 2013 / Revised: 24 December 2013 / Accepted: 25 December 2013 / Published: 23 January 2014
Cited by 10 | PDF Full-text (289 KB) | HTML Full-text | XML Full-text
Abstract
Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can
[...] Read more.
Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can contribute to the success rate of future endeavors. After a thorough discussion of these frameworks, this paper outlines the development methodologies in terms of theoretical background, methodology and validation. Finally, the common themes and formats are identified for consideration in future implementation. It was confirmed that a holistic implementation approach is needed, which includes technology, organizational structures, change management, economic feasibility, societal impacts, perceptions, user-friendliness, evaluation and evidence, legislation, policy and governance. Furthermore, there is some scope for scientifically rigorous framework development and validation approaches. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Adaptive Tele-Therapies Based on Serious Games for Health for People with Time-Management and Organisational Problems: Preliminary Results
Int. J. Environ. Res. Public Health 2014, 11(1), 749-772; doi:10.3390/ijerph110100749
Received: 7 October 2013 / Revised: 16 December 2013 / Accepted: 17 December 2013 / Published: 7 January 2014
Cited by 4 | PDF Full-text (1038 KB) | HTML Full-text | XML Full-text
Abstract
Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an
[...] Read more.
Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decision trees within Django, a high-level Python Web framework. The technologies and techniques used were selected so as to boost user involvement and to enable the system to be easily customised. This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD. To do so, we relied on the collection of parameters and the conduct of surveys for assessing time management skills, as well as measuring system usability and availability. The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively. The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100. The creation of a customisable tool capable of working with different skills, in conjunction with the replication of the current study, may help to understand these users’ needs, as well as boosting time management skills among teenagers with and without ADHD. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Elderly Healthcare Monitoring Using an Avatar-Based 3D Virtual Environment
Int. J. Environ. Res. Public Health 2013, 10(12), 7283-7298; doi:10.3390/ijerph10127283
Received: 3 September 2013 / Revised: 12 December 2013 / Accepted: 12 December 2013 / Published: 17 December 2013
Cited by 4 | PDF Full-text (1511 KB) | HTML Full-text | XML Full-text
Abstract
Homecare systems for elderly people are becoming increasingly important due to both economic reasons as well as patients’ preferences. Sensor-based surveillance technologies are an expected future trend, but research so far has devoted little attention to the User Interface (UI) design of such
[...] Read more.
Homecare systems for elderly people are becoming increasingly important due to both economic reasons as well as patients’ preferences. Sensor-based surveillance technologies are an expected future trend, but research so far has devoted little attention to the User Interface (UI) design of such systems and the user-centric design approach. In this paper, we explore the possibilities of an avatar-based 3D visualization system, which exploits wearable sensors and human activity simulations. We present a technical prototype and the evaluation of alternative concept designs for UIs based on a 3D virtual world. The evaluation was conducted with homecare providers through focus groups and an online survey. Our results show firstly that systems taking advantage of 3D virtual world visualization techniques have potential especially due to the privacy preserving and simplified information presentation style, and secondly that simple representations and glancability should be emphasized in the design. The identified key use cases highlight that avatar-based 3D presentations can be helpful if they provide an overview as well as details on demand. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Can Smartphones Enhance Telephone-Based Cognitive Assessment (TBCA)?
Int. J. Environ. Res. Public Health 2013, 10(12), 7110-7125; doi:10.3390/ijerph10127110
Received: 28 August 2013 / Revised: 3 December 2013 / Accepted: 4 December 2013 / Published: 12 December 2013
Cited by 1 | PDF Full-text (205 KB) | HTML Full-text | XML Full-text
Abstract
TBCA has emerged to solve the limitations of administering cognitive assessments face-to-face. The recent development of telephones and knowledge advances in the area of cognitive impairment may affect the development of TBCA. The purpose of this paper is to discuss how smartphones can
[...] Read more.
TBCA has emerged to solve the limitations of administering cognitive assessments face-to-face. The recent development of telephones and knowledge advances in the area of cognitive impairment may affect the development of TBCA. The purpose of this paper is to discuss how smartphones can be used to enhance the applicability of TBCA, which has previously been administered by conventional telephone. This paper will first review, describe and critique the existing TBCA instruments. It will then discuss the recent developments in tele-technology, the popularity of tele-technology among the elderly, potential benefits and challenges in using smartphones for cognitive assessment, and possible future developments in this technology. In the systematic review, eighteen TBCA instruments were identified. They were found to be valid in differentiating between people with and without dementia. TBCA was previously found to be launched on a conventional telephone platform. The advances in understanding of cognitive impairment may demand that telephones be equipped with more advanced features. Recently, the development and penetration of smartphones among the elderly has been rapid. This may allow the smartphone to enhance its TBCA applicability by overcoming the limitations of the conventional telephone, rendering the TBCA more efficient in addressing the increasing demand and complexity of cognitive assessments in the future. However, more research and technology developments are needed before smartphones can become a valid platform for TBCA. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Participatory Research to Design a Novel Telehealth System to Support the Night-Time Needs of People with Dementia: NOCTURNAL
Int. J. Environ. Res. Public Health 2013, 10(12), 6764-6782; doi:10.3390/ijerph10126764
Received: 11 September 2013 / Revised: 15 November 2013 / Accepted: 18 November 2013 / Published: 4 December 2013
Cited by 2 | PDF Full-text (630 KB) | HTML Full-text | XML Full-text
Abstract
Strategies to support people living with dementia are broad in scope, proposing both pharmacological and non-pharmacological interventions as part of the care pathway. Assistive technologies form part of this offering as both stand-alone devices to support particular tasks and the more complex offering
[...] Read more.
Strategies to support people living with dementia are broad in scope, proposing both pharmacological and non-pharmacological interventions as part of the care pathway. Assistive technologies form part of this offering as both stand-alone devices to support particular tasks and the more complex offering of the “smart home” to underpin ambient assisted living. This paper presents a technology-based system, which expands on the smart home architecture, orientated to support people with daily living. The system, NOCTURNAL, was developed by working directly with people who had dementia, and their carers using qualitative research methods. The research focused primarily on the nighttime needs of people living with dementia in real home settings. Eight people with dementia had the final prototype system installed for a three month evaluation at home. Disturbed sleep patterns, night-time wandering were a focus of this research not only in terms of detection by commercially available technology but also exploring if automated music, light and visual personalized photographs would be soothing to participants during the hours of darkness. The NOCTURNAL platform and associated services was informed by strong user engagement of people with dementia and the service providers who care for them. NOCTURNAL emerged as a holistic service offering a personalised therapeutic aspect with interactive capabilities. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle A mHealth Application for Chronic Wound Care: Findings of a User Trial
Int. J. Environ. Res. Public Health 2013, 10(11), 6199-6214; doi:10.3390/ijerph10116199
Received: 13 September 2013 / Revised: 12 November 2013 / Accepted: 13 November 2013 / Published: 19 November 2013
Cited by 11 | PDF Full-text (877 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore) documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will
[...] Read more.
This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore) documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will be an increasing public health concern as the population ages. Electronic information systems are being explored to improve consistency and accuracy of documentation, improve patient and caregiver experience and ultimately improve patient outcomes. A software application was developed for Android Smartphones and tablets and was trialed in a personal care home in Western Canada. The software application provides an electronic medical record for chronic wounds, replacing nurses’ paper-based charting and is positioned for integration with facility’s larger eHealth framework. The mHealth application offers three intended benefits over paper-based charting of chronic wounds, including: (1) the capacity for remote consultation (telehealth between facilities, practitioners, and/or remote communities), (2) data organization and analysis, including built-in alerts, automatically-generated text-based and graph-based wound histories including wound images, and (3) tutorial support for non-specialized caregivers. The user trial yielded insights regarding the software application’s design and functionality in the clinical setting, and highlighted the key role of wound photographs in enhancing patient and caregiver experiences, enhancing communication between multiple healthcare professionals, and leveraging the software’s telehealth capacities. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Attitudes of COPD Patients towards Tele-Rehabilitation: A Cross-Sector Case Study
Int. J. Environ. Res. Public Health 2013, 10(11), 6184-6198; doi:10.3390/ijerph10116184
Received: 31 August 2013 / Revised: 11 November 2013 / Accepted: 12 November 2013 / Published: 15 November 2013
Cited by 10 | PDF Full-text (257 KB) | HTML Full-text | XML Full-text
Abstract
The aim of this paper is to describe patients’ attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients’ behavior when performing tele-rehabilitation activities in home surroundings. A total of
[...] Read more.
The aim of this paper is to describe patients’ attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients’ behavior when performing tele-rehabilitation activities in home surroundings. A total of 111 COPD patients were included in the study, and they were randomized into an intervention group (n = 60) and a control group (n = 51). However, a non-randomized design was used to analyze the qualitative perspectives of the patients’ attitudes towards tele-rehabilitation. From the intervention group, 22 COPD patients were selected for qualitative interviews and participant observation in their homes. The theoretical framework for this study is based on learning theory and the “communities of practice” approach inspired by Etienne Wenger. COPD patients exhibit four types of attitudes about their tele-rehabilitation: indifference, learning as part of situations in everyday life, feeling of security and motivation for performing physical training. The patients express the view that they circulate between these attitudes depending on their physical and emotional state as they perform their training. The COPD patients and healthcare professionals have created a community of tele-rehabilitation across sectors, exchanging experiences, stories and strategies for how to manage rehabilitation in home surroundings. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Use of a Time-of-Flight Camera With an Omek Beckon™ Framework to Analyze, Evaluate and Correct in Real Time the Verticality of Multiple Sclerosis Patients during Exercise
Int. J. Environ. Res. Public Health 2013, 10(11), 5807-5829; doi:10.3390/ijerph10115807
Received: 2 September 2013 / Revised: 8 October 2013 / Accepted: 22 October 2013 / Published: 4 November 2013
Cited by 2 | PDF Full-text (1115 KB) | HTML Full-text | XML Full-text
Abstract
Any person with Multiple Sclerosis (MS), regardless of the severity of their disability, needs regular physical activity. Poorly performed exercises could aggravate muscle imbalances and worsen the patient’s health. In this paper, we propose a human body verticality detection system using a time-of-flight
[...] Read more.
Any person with Multiple Sclerosis (MS), regardless of the severity of their disability, needs regular physical activity. Poorly performed exercises could aggravate muscle imbalances and worsen the patient’s health. In this paper, we propose a human body verticality detection system using a time-of-flight camera as a tool to detect incorrect postures and improve them in real time. The prototype uses Omek’s Beckon™ Framework to analyze and evaluate the position of patients during exercise. Preliminary results, based on objective questionnaires, indicate an improvement in patients’ evolution through better positions and performance of the exercises. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation
Int. J. Environ. Res. Public Health 2013, 10(11), 5671-5682; doi:10.3390/ijerph10115671
Received: 12 September 2013 / Revised: 23 October 2013 / Accepted: 24 October 2013 / Published: 31 October 2013
Cited by 9 | PDF Full-text (292 KB) | HTML Full-text | XML Full-text
Abstract
Born in the early nineteen nineties, evidence-based medicine (EBM) is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in
[...] Read more.
Born in the early nineteen nineties, evidence-based medicine (EBM) is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle A Telerehabilitation Program Improves Postural Control in Multiple Sclerosis Patients: A Spanish Preliminary Study
Int. J. Environ. Res. Public Health 2013, 10(11), 5697-5710; doi:10.3390/ijerph10115697
Received: 15 September 2013 / Revised: 25 October 2013 / Accepted: 28 October 2013 / Published: 31 October 2013
Cited by 13 | PDF Full-text (240 KB) | HTML Full-text | XML Full-text
Abstract
Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical
[...] Read more.
Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Fifty patients were recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received monitored telerehabilitation treatment via videoconference using the Xbox 360® and Kinect console. Experimental group attended 40 sessions, four sessions per week (20 min per session).The treatment schedule lasted 10 weeks for both groups. A computerized dynamic posturography (Sensory Organization Test) was used to evaluate all patients at baseline and at the end of the treatment protocol. Results showed an improvement over general balance in both groups. Visual preference and the contribution of vestibular information yielded significant differences in the experimental group. Our results demonstrated that a telerehabilitation program based on a virtual reality system allows one to optimize the sensory information processing and integration systems necessary to maintain the balance and postural control of people with multiple sclerosis. We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Patients’ Acceptance towards a Web-Based Personal Health Record System: An Empirical Study in Taiwan
Int. J. Environ. Res. Public Health 2013, 10(10), 5191-5208; doi:10.3390/ijerph10105191
Received: 1 August 2013 / Revised: 10 September 2013 / Accepted: 1 October 2013 / Published: 17 October 2013
Cited by 10 | PDF Full-text (437 KB) | HTML Full-text | XML Full-text
Abstract
The health care sector has become increasingly interested in developing personal health record (PHR) systems as an Internet-based telehealthcare implementation to improve the quality and decrease the cost of care. However, the factors that influence patients’ intention to use PHR systems remain unclear.
[...] Read more.
The health care sector has become increasingly interested in developing personal health record (PHR) systems as an Internet-based telehealthcare implementation to improve the quality and decrease the cost of care. However, the factors that influence patients’ intention to use PHR systems remain unclear. Based on physicians’ therapeutic expertise, we implemented a web-based infertile PHR system and proposed an extended Technology Acceptance Model (TAM) that integrates the physician-patient relationship (PPR) construct into TAM’s original perceived ease of use (PEOU) and perceived usefulness (PU) constructs to explore which factors will influence the behavioral intentions (BI) of infertile patients to use the PHR. From ninety participants from a medical center, 50 valid responses to a self-rating questionnaire were collected, yielding a response rate of 55.56%. The partial least squares (PLS) technique was used to assess the causal relationships that were hypothesized in the extended model. The results indicate that infertile patients expressed a moderately high intention to use the PHR system. The PPR and PU of patients had significant effects on their BI to use PHR, whereas the PEOU indirectly affected the patients’ BI through the PU. This investigation confirms that PPR can have a critical role in shaping patients’ perceptions of the use of healthcare information technologies. Hence, we suggest that hospitals should promote the potential usefulness of PHR and improve the quality of the physician-patient relationship to increase patients’ intention of using PHR. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Detection of Human Impacts by an Adaptive Energy-Based Anisotropic Algorithm
Int. J. Environ. Res. Public Health 2013, 10(10), 4767-4789; doi:10.3390/ijerph10104767
Received: 10 July 2013 / Revised: 22 September 2013 / Accepted: 22 September 2013 / Published: 10 October 2013
PDF Full-text (3436 KB) | HTML Full-text | XML Full-text
Abstract
Boosted by health consequences and the cost of falls in the elderly, this work develops and tests a novel algorithm and methodology to detect human impacts that will act as triggers of a two-layer fall monitor. The two main requirements demanded by socio-healthcare
[...] Read more.
Boosted by health consequences and the cost of falls in the elderly, this work develops and tests a novel algorithm and methodology to detect human impacts that will act as triggers of a two-layer fall monitor. The two main requirements demanded by socio-healthcare providers—unobtrusiveness and reliability—defined the objectives of the research. We have demonstrated that a very agile, adaptive, and energy-based anisotropic algorithm can provide 100% sensitivity and 78% specificity, in the task of detecting impacts under demanding laboratory conditions. The algorithm works together with an unsupervised real-time learning technique that addresses the adaptive capability, and this is also presented. The work demonstrates the robustness and reliability of our new algorithm, which will be the basis of a smart falling monitor. This is shown in this work to underline the relevance of the results. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle The Patient’s Perspective of in-Home Telerehabilitation Physiotherapy Services Following Total Knee Arthroplasty
Int. J. Environ. Res. Public Health 2013, 10(9), 3998-4011; doi:10.3390/ijerph10093998
Received: 16 July 2013 / Revised: 15 August 2013 / Accepted: 16 August 2013 / Published: 30 August 2013
Cited by 8 | PDF Full-text (284 KB) | HTML Full-text | XML Full-text
Abstract
This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to
[...] Read more.
This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle A Seamless Ubiquitous Telehealthcare Tunnel
Int. J. Environ. Res. Public Health 2013, 10(8), 3246-3262; doi:10.3390/ijerph10083246
Received: 20 June 2013 / Revised: 22 July 2013 / Accepted: 24 July 2013 / Published: 2 August 2013
Cited by 2 | PDF Full-text (631 KB) | HTML Full-text | XML Full-text
Abstract
Mobile handheld devices are rapidly using to implement healthcare services around the World. Fundamentally, these services utilize telemedicine technologies. A disconnection of a mobile telemedicine system usually results in an interruption, which is embarrassing, and reconnection is necessary during the communication session. In
[...] Read more.
Mobile handheld devices are rapidly using to implement healthcare services around the World. Fundamentally, these services utilize telemedicine technologies. A disconnection of a mobile telemedicine system usually results in an interruption, which is embarrassing, and reconnection is necessary during the communication session. In this study, the Stream Control Transmission Protocol (SCTP) is adopted to build a stable session tunnel to guarantee seamless switching among heterogeneous wireless communication standards, such as Wi-Fi and 3G. This arrangement means that the telemedicine devices will not be limited by a fixed wireless connection and can switch to a better wireless channel if necessary. The tunnel can transmit plain text, binary data, and video streams. According to the evaluation of the proposed software-based SCTP-Tunnel middleware shown, the performance is lower than anticipated and is slightly slower than a fixed connection. However, the transmission throughput is still acceptable for healthcare professionals in a healthcare enterprise or home care site. It is necessary to build more heterogeneous wireless protocols into the proposed tunnel-switching scheme to support all possible communication protocols. In addition, SCTP is another good choice for promoting communication in telemedicine and healthcare fields. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Care Networking: A Study of Technical Mediations in a Home Telecare Service
Int. J. Environ. Res. Public Health 2013, 10(7), 3072-3088; doi:10.3390/ijerph10073072
Received: 22 May 2013 / Revised: 5 July 2013 / Accepted: 9 July 2013 / Published: 22 July 2013
Cited by 4 | PDF Full-text (190 KB) | HTML Full-text | XML Full-text
Abstract
This article examines the processes of technical mediation within familial care networks based on a study of home telecare targeted at older people. Supported by contributions from the actor—network theory as part of the social psychology of science and technology, these processes of
[...] Read more.
This article examines the processes of technical mediation within familial care networks based on a study of home telecare targeted at older people. Supported by contributions from the actor—network theory as part of the social psychology of science and technology, these processes of technical mediation are analyzed using a qualitative approach. The data were gathered through six focus groups and four in-depth interviews; the participants in the study included users, relatives and formal carers. Thematic analysis techniques encompassing the information were used, revealing the effects on the patterns of caring relationships. The results show the interplay between presence-absence made possible by the devices; the two-way direction of care between the older people and the artifacts; and the process of sustaining care using the technology. We conclude that care should be seen as a socio-technical network where technology plays an active role in sustaining family relationships. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)

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Open AccessReview How Technology in Care at Home Affects Patient Self-Care and Self-Management: A Scoping Review
Int. J. Environ. Res. Public Health 2013, 10(11), 5541-5564; doi:10.3390/ijerph10115541
Received: 9 September 2013 / Revised: 17 October 2013 / Accepted: 17 October 2013 / Published: 29 October 2013
Cited by 7 | PDF Full-text (648 KB) | HTML Full-text | XML Full-text
Abstract
The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review
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The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)

Other

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Open AccessCommentary Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced?
Int. J. Environ. Res. Public Health 2013, 10(12), 6472-6484; doi:10.3390/ijerph10126472
Received: 5 October 2013 / Revised: 13 November 2013 / Accepted: 14 November 2013 / Published: 28 November 2013
Cited by 14 | PDF Full-text (333 KB) | HTML Full-text | XML Full-text
Abstract
Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as
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Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)

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