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Combined interventions for COPD admissions within an urban setting

Sudip Ghosh, Noel O'Kelly
Clinical director and divisional clinical Director at Leicester Partnership Trust. Professor Ghosh is also affiliated to De Montfort University.

Emma-Jane Roberts
Chief operating officer, Totally Health Ltd (previously the commissioner of the service at Leicester City CCG)

Chris Barker
Biomedical scientist and chief executive, Spirit Healthcare

Jim Swift
Health economist, Spirit Healthcare

Published Online: March 31, 2016

Aims: To evaluate the scale of impact of a combined intervention using telehealth (Clinitouch system) in parallel with clinical health coaching and specialist nurse interventions. This was triggered by biometric data from a redesigned service for patients with chronic obstructive pulmonary disease (COPD). Eligible patients had a history of two or more prior unscheduled COPD admissions in the previous 12 months.

Methods: Admissions data from University Hospitals of Leicester NHS Trust and interventions from Leicester Partnership Trust and Totally Health were received from Leicester City Clinical Commissioning Group (LC CCG). Data were analysed relating to the impact on admissions and overall resource use and compared to the previous 12 months with patients acting as their own controls.

Results: The number of admissions decreased from 3.13 to 1.02 admissions per patient over the 12-month period (p < 0.001). The overall net saving to the LC CCG over the 12-month period was £117 550.

Conclusions: All of the interventions were regressed in isolation and in conjunction, with the exception of telehealth (CliniTouch-Spirit Healthcare), which was accessed uniformly by all participants. Only the overall intervention including telehealth was statistically significant; correlation co-efficient 0.995 (p < 0.001), which indicated a strong correlation between accessing the interventions and reduced hospitalisations. In the analysis of variation, specialist nurse home visits and health coaching interventions, which had variable intensities trended towards significance (p < 0.36 and p < 0.17, respectively). Patient feedback suggested patients were more knowledgeable about their condition, more confident in managing it and motivated to change behaviour in a positive direction as a result of being involved in the intervention.

Keywords: Chronic obstructive pulmonary disease, Telemedicine, Patient readmission

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A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy

Sue Grogan-Johnson, Robin Alvares, Lynne Rowan, Nancy Creaghead, Department of Speech Pathology and Audiology, Kent State University, Ohio Speech Pathology and Audiology, University of Cincinnati, Ohio, USA

Correspondence: Sue Grogan-Johnson, Speech and Hearing Clinic, A104 Music and Speech Building, Kent State University, Kent, Ohio 44242, USA (Fax: +1 330 672 2643; Email:

We compared the progress made by school children in speech language therapy provided through videoconferencing and conventional face-to-face speech language therapy. The children were treated in two groups. In the first group, 17 children received telemedicine treatment for 4 months, and then subsequently conventional therapy for 4 months. In the second group, 17 children received conventional treatment for 4 months and then subsequently telemedicine treatment for 4 months.

The outcome measures were student progress, participant satisfaction and any interruptions to service delivery. Student progress reports indicated that the children made similar progress during the study whichever treatment method was used. There was no significant difference in GFTA-2 scores (Goldman-Fristoe Test of Articulation) between students in the two treatment groups. Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model. During the study, a total of 148 of the 704 possible therapy sessions was not completed (21%); the pattern of cancellations was similar to cancellations in US public schools generally. Videoconferencing appears to be a promising method of delivering speech language therapy services to school children.

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Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Kevin R. Tarlow, Carly E. McCord, Timothy R. Elliott, and Daniel F. Brossart

Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n = 94) had low health-related quality of life (HRQOL), often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n = 40) was associated with an improvement in mental health-related quality of life (d = 0.70, P < .001). These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

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A Wireless Emergency Telemedicine System for Patients Monitoring and Diagnosis

M. Abo-Zahhad, Sabah M. Ahmed, and O. Elnahas

Recently, remote healthcare systems have received increasing attention in the last decade, explaining why intelligent systems with physiology signal monitoring for e-health care are an emerging area of development. Therefore, this study adopts a system which includes continuous collection and evaluation of multiple vital signs, long-term healthcare, and a cellular connection to a medical center in emergency case and it transfers all acquired raw data by the internet in normal case. The proposed system can continuously acquire four different physiological signs, for example, ECG, SpO2, temperature, and blood pressure and further relayed them to an intelligent data analysis scheme to diagnose abnormal pulses for exploring potential chronic diseases. The proposed system also has a friendly web-based interface for medical staff to observe immediate pulse signals for remote treatment. Once abnormal event happened or the request to real-time display vital signs is confirmed, all physiological signs will be immediately transmitted to remote medical server through both cellular networks and internet. Also data can be transmitted to a family member's mobile phone or doctor's phone through GPRS. A prototype of such system has been successfully developed and implemented, which will offer high standard of healthcare with a major reduction in cost for our society.

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Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

Aimee M. Layton, James Whitworth, James Peacock, Matthew N. Bartels, Patricia A. Jellen and Byron M. Thomashow

The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients' medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group) and 53% (>31-day group) of the time, education material was read 44% (1–30) and 53% (>31) of the time, and physical activity was reported 25% (1–30) and 42% (>31) of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients.

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Web-Based Depression Screening and Psychiatric Consultation for College Students: A Feasibility and Acceptability Study

Aya Williams, Rachel LaRocca, Trina Chang, Nhi-Ha Trinh, Maurizio Fava, Joseph Kvedar, and Albert Yeung

Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9) online; those who screened positive (PHQ-9 ≥ 10) or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4%) students found the interview useful in helping them understand their depression. Fifteen (88.2%) students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality.

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Usability Study of a Wireless Monitoring System among Alzheimer's Disease Elderly Population

Stefano Abbate, * Marco Avvenuti and Janet Light

Healthcare technologies are slowly entering into our daily lives, replacing old devices and techniques with newer intelligent ones. Although they are meant to help people, the reaction and willingness to use such new devices by the people can be unexpected, especially among the elderly. We conducted a usability study of a fall monitoring system in a long-term nursing home. The subjects were the elderly with advanced Alzheimer's disease. The study presented here highlights some of the challenges faced in the use of wearable devices and the lessons learned. The results gave us useful insights, leading to ergonomics and aesthetics modifications to our wearable systems that significantly improved their usability and acceptance. New evaluating metrics were designed for the performance evaluation of usability and acceptability.

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Using Action Research and Peer Perspectives to Develop Technology That Facilitates Behavioral Change and Self-Management in COPD

Catherine McCabe, * John Dinsmore, Anne Marie Brady, Gabrielle Mckee, Sharon O'Donnell, and David Prendergast


Behavioural change and self-management in patients with chronic illness may help to control symptoms, avoid rehospitalization, enhance quality of life, and decrease mortality and morbidity.


Guided by action research principles and using mixed methods, the aim of this project was to develop peer based educational, motivational, and health-promoting peer based videos, using behavioural change principles, to support self-management in patients with COPD.


Individuals (n = 32) living with COPD at home and involved in two community based COPD support groups were invited to participate in this project. Focus group/individual interviews and a demographic questionnaire were used to collect data.


Analysis revealed 6 categories relevant to behavioural change which included self-management, support, symptoms, knowledge, rehabilitation, and technology. Participants commented that content needed to be specific, and videos needed to be shorter, to be tailored to severity of condition, to demonstrate “normal” activities, to be positive, and to ensure that content is culturally relevant.


This study demonstrated that detailed analysis of patient perspectives and needs for self-management is essential and should underpin the development of any framework, materials, and technology. The action research design principles provided an effective framework for eliciting the data and applying it to technology and testing its relevance to the user.

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Patients' Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas

Annette M. Johansson,* Inger Lindberg, and Siv Söderberg


Video consultation (VC) can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients' experiences with specialist care via VC encounters.


Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis.


The analysis resulted in two themes. The theme “confident with the technology” was constructed from the categories “possibilities and obstacles in using VC encounters” and “advantages and disadvantages of the technology.” The theme “personal satisfaction with the VC encounters” was constructed from the categories “support from the healthcare personnel,” “perceived security,” and “satisfaction with the specialist consultation.”


The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients' perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient's perception of security during the VC encounter.

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Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review

Birgitta Lindberg,* Carina Nilsson, Daniel Zotterman, Siv Söderberg, and Lisa Skär


Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering and giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies describing the use of ICT in home care for communication between patients, family members, and healthcare professionals. Methods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted, which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use of ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data, terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT was performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses in the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools used that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of their illness that promotes self-care.

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Development of a Wearable-Sensor-Based Fall Detection System

Falin Wu, Hengyang Zhao, Yan Zhao and Haibo Zhong


Fall detection is a major challenge in the public healthcare domain, especially for the elderly as the decline of their physical fitness, and timely and reliable surveillance is necessary to mitigate the negative effects of falls. This paper develops a novel fall detection system based on a wearable device. The system monitors the movements of human body, recognizes a fall from normal daily activities by an effective quaternion algorithm, and automatically sends request for help to the caregivers with the patient's location.

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Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation

Elizabeth C. Ward, Clare L. Burns, Deborah G. Theodoros and Trevor G. Russell


Emerging research supports the feasibility and viability of conducting clinical swallow examinations (CSE) for patients with dysphagia via telerehabilitation. However, minimal data has been reported to date regarding the implementation of such services within the clinical setting or the user perceptions of this type of clinical service. A mixed methods study design was employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management.

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