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1
Zhang, Chao. "Remote Medical Monitoring System in Wireless Sensor Networks." International Journal of Online Engineering (iJOE) 12, no. 11 (November 24, 2016): 58. http://dx.doi.org/10.3991/ijoe.v12i11.6239.
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<p class="Abstract"><span lang="EN-US">In order to solve the problem of monitoring remote medical care to identify good medical services, a medical service recommendation system based on privacy-preserved reputation scoring is designed. This system enables medical service users to get a reputation score of a Medical Service Provider before engaging in any services. The experiment results show that the proposed scheme is significantly more efficient in batch verification of digital signatures, making it a suitable practical solution to Mobile Health Care applications, while the third solution shows that the system is able to provide reputation scores as well as recommendation while preserving privacy as desired.</span></p>
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Tatham, Peter, Frank Stadler, Abigail Murray, and Ramon Z. Shaban. "Flying maggots: a smart logistic solution to an enduring medical challenge." Journal of Humanitarian Logistics and Supply Chain Management 7, no. 2 (August 7, 2017): 172–93. http://dx.doi.org/10.1108/jhlscm-02-2017-0003.
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Purpose Whilst there is a growing body of research which discusses the use of remotely piloted aircraft systems (RPAS) (otherwise known as “drones”) to transport medical supplies, almost all reported cases employ short range aircraft. The purpose of this paper is to consider the advantages and challenges inherent in the use of long endurance remotely piloted aircraft systems (LE-RPAS) aircraft to support the provision of medical supplies to remote locations – specifically “medical maggots” used in maggot debridement therapy (MDT) wound care. Design/methodology/approach After introducing both MDT and the LE-RPAS technology, the paper first reports on the outcomes of a case study involving 11 semi-structured interviews with individuals who either have experience and expertise in the use of LE-RPAS or in the provision of healthcare to remote communities in Western Australia. The insights gained from this case study are then synthesised to assess the feasibility of LE-RPAS assisted delivery of medical maggots to those living in such geographically challenging locations. Findings No insuperable challenges to the concept of using LE-RPAS to transport medical maggots were uncovered during this research – rather, those who contributed to the investigations from across the spectrum from operators to users, were highly supportive of the overall concept. Practical implications The paper offers an assessment of the feasibility of the use of LE-RPAS to transport medical maggots. In doing so, it highlights a number of infrastructure and organisational challenges that would need to be overcome to operationalise this concept. Whilst the particular context of the paper relates to the provision of medical support to a remote location of a developed country, the core benefits and challenges that are exposed relate equally to the use of LE-RPAS in a post-disaster response. To this end, the paper offers a high-level route map to support the implementation of the concept. Social implications The paper proposes a novel approach to the efficient and effective provision of medical care to remote Australian communities which, in particular, reduces the need to travel significant distances to obtain treatment. In doing so, it emphasises the importance in gaining acceptance of both the use of MDT and also the operation of RPAS noting that these have previously been employed in a military, as distinct from humanitarian, context. Originality/value The paper demonstrates how the use of LE-RPAS to support remote communities offers the potential to deliver healthcare at reduced cost compared to conventional approaches. The paper also underlines the potential benefits of the use of MDT to address the growing wound burdens in remote communities. Finally, the paper expands on the existing discussion of the use of RPAS to include its capability to act as the delivery mechanism for medical maggots.
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Jennings, Natasha, Grainne Lowe, and Kathleen Tori. "Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities." Australian Journal of Primary Health 27, no. 1 (2021): 1. http://dx.doi.org/10.1071/py20103.
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With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours ‘on-call’ care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.
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Kurti, Linda, Susan Rudland, Rebecca Wilkinson, Dawn DeWitt, and Catherine Zhang. "Physician's assistants: a workforce solution for Australia?" Australian Journal of Primary Health 17, no. 1 (2011): 23. http://dx.doi.org/10.1071/py10055.
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Significant medical workforce shortages, particularly in rural and remote locations, have prompted a range of responses in Australia at both state and Commonwealth levels. One such response was a pilot project to test the suitability of the Physician Assistant (PA) role in the Australian context. Five US-trained and accredited PAs were employed by Queensland Health and deployed in urban, rural and remote settings across Queensland. A concurrent mixed-method evaluation was conducted by Urbis, an independent research firm. The evaluation found that the PAs provided quality, safe clinical care under the supervision of local medical officers. The majority of nurses and doctors who worked with the PAs believed that the PAs made a positive contribution to the health care team by increasing capacity to meet patient needs; reducing on-call requirements for doctors; liaising with other clinical team members; streamlining procedures for efficient patient throughput; and providing continuity during periods of doctor changeover. The Pilot demonstrated that a delegated PA role can provide safe, quality health care by augmenting an established healthcare team. The PA role has the potential to benefit the community by increasing the capacity of the health care system, and to improve recruitment and retention by providing an additional professional pathway. The small size of the Pilot limits the ability to generalise regarding the future efficacy of the PA role in Australia. Further research is required to test training and deployment of PAs in a wider range of Australian clinical settings, including general practice and rural health clinics.
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Mushcab, Hayat, William George Kernohan, Jonathan Wallace, Roy Harper, and Suzanne Martin. "Self-Management of Diabetes Mellitus with Remote Monitoring." International Journal of E-Health and Medical Communications 8, no. 1 (January 2017): 52–61. http://dx.doi.org/10.4018/ijehmc.2017010104.
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Purpose: The efficacy of one remote monitoring system was reviewed in order to explore if optimal self-management of diabetes was achieved. Methods: Medical records of 214 patients with diabetes were reviewed from seven diabetes clinics within a single Health & Social Care trust using a remote monitoring solution to help patients self-manage their condition. Data on HbA1c, blood glucose, blood pressure and body mass index were obtained from the patient's medical record, before and after using the remote monitoring solution. Results: The average age of users was 61 years: 60% of the sample were male. The average time living with diabetes was 14 years; the mean duration with remote telemonitoring was 147 days. A greater reduction in HbA1c was seen with female users compared to males 2.37% and 0.87%, respectively. Conclusion: Remote telemonitoring provided the opportunity to collect comprehensive data, allowing patients to be maintained at home, while showing significant improvement in their HbA1c and better overall management of their diabetes
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Pereira, Filipe, Vítor Carvalho, Filomena Soares, José Machado, Karolina Bezerra, Rui Silva, and Demétrio Matos. "Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects." Journal of Engineering 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/3591059.
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This work is developed in the context of Ambient Assisted Living (AAL) and has as main objective the development of a mechatronic system that allows the care of bedridden patients with ongoing medical care handled by a single person. The developed Medical Care Terminal (MCT) improves autonomy in home care, safety, comfort, and hygiene of bedridden patients. The MCT has six biomedical sensors and four environmental sensors. Data acquisition and processing is performed using Arduino and LabVIEW platforms, respectively. The proposed solution has, as main feature, its adaptability to the patient needs. One of the MCT functionalities is the remote access to the patient data through the web. The caregiver may request help from a specialist who sends back information in real time to perform first aid assistance. This device has a flexible configuration allowing a fast and cheap reconfiguration according the specific needs of the patient. The proposed mechatronic system intends to meet the needs of bedridden patients improving their quality of life, health, safety, and comfort, while enabling the remote monitoring of the patients.
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Karpov, Andrey B., Erzhena R. Badmaeva, Andjey V. Skobelsky, and Sergey A. Antipov. "Problems of organizing of medical care at remote industrial sites in the Russia." HEALTH CARE OF THE RUSSIAN FEDERATION 65, no. 1 (March 5, 2021): 54–61. http://dx.doi.org/10.47470/0044-197x-2021-65-1-54-61.
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The article describes the main problems of managing medical care for industrial enterprises’ staff, including remote industrial sites (RIS), and the options for health care for this category of the employed population. The search for publications was conducted on all available bibliographic and abstract databases (The Russian Science Citation Index, Scopus, Web of Science, CyberLeninka, eLibrary, PubMed) containing the Russian publications. The data of industrial injuries and the country’s working population’s occupational morbidity in recent years are given. As a result, the authors point out the need to transition to risk management in the workplace. The disadvantages of the assessment system of the health status of employees during routine medical examinations are identified. The main problems of creating a medical support system for RIS workers were analyzed, and the relevance of creating a remote industrial healthcare system in the Russian Federation is substantiated. The paper presents the existing disadvantages in the current legislative framework. In particular, it is established that today in Russia, there is no standard for the provision of medical care for RIS workers, no algorithm for the actions of medical staff, no sanitary rules for managing health posts at RIS. The characteristics of the problems in medical evacuation and the ways of their solution are presented. The necessity of the introduction of telemedicine technologies and conditions for ensuring this process nationwide is substantiated. The spectrum of factors negatively affecting the health of RIS workers is characterized. The need to take these factors into account when creating a health care system for this category of the working population is substantiated.
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LUDWIG, SIMONE A. "SENSOR GRID ARCHITECTURE FOR REMOTE PATIENT HEALTH CARE MONITORING." International Journal of Semantic Computing 03, no. 03 (September 2009): 291–309. http://dx.doi.org/10.1142/s1793351x0900077x.
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Recent advancement in wireless sensor network technology has completely changed the way the physicians and other health professionals monitor and access patients' health status records in real time, interact with each other, and access the past and present medical records of patients. However, the sensor nodes used in a wireless sensor network to monitor patients' health are resource constraint in nature with limited processing and communication capability. In future, an increase of wireless sensor networks to monitor and analyze patients' health records is envisioned and therefore, the resource constraint nature of wireless sensor networks needs to be addressed. In this paper, an architecture to overcome the limitations of wireless sensor networks is introduced using Grid computing technology. Sensor Grid technology combines these two technologies by extending the Grid computing paradigm to the sensor resources in wireless sensor networks. This paper outlines how the Sensor Grid technology provides a solution for remote patient monitoring to address the resource constraint nature of the sensor devices in a wireless sensor network.
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van der Walt, Anneke, Helmut Butzkueven, Robert K. Shin, Luciana Midaglia, Luca Capezzuto, Michael Lindemann, Geraint Davies, Lesley M. Butler, Cristina Costantino, and Xavier Montalban. "Developing a Digital Solution for Remote Assessment in Multiple Sclerosis: From Concept to Software as a Medical Device." Brain Sciences 11, no. 9 (September 21, 2021): 1247. http://dx.doi.org/10.3390/brainsci11091247.
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There is increasing interest in the development and deployment of digital solutions to improve patient care and facilitate monitoring in medical practice, e.g., by remote observation of disease symptoms in the patients’ home environment. Digital health solutions today range from non-regulated wellness applications and research-grade exploratory instruments to regulated software as a medical device (SaMD). This paper discusses the considerations and complexities in developing innovative, effective, and validated SaMD for multiple sclerosis (MS). The development of SaMD requires a formalised approach (design control), inclusive of technical verification and analytical validation to ensure reliability. SaMD must be clinically evaluated, characterised for benefit and risk, and must conform to regulatory requirements associated with device classification. Cybersecurity and data privacy are also critical. Careful consideration of patient and provider needs throughout the design and testing process help developers overcome challenges of adoption in medical practice. Here, we explore the development pathway for SaMD in MS, leveraging experiences from the development of Floodlight™ MS, a continually evolving bundled solution of SaMD for remote functional assessment of MS. The development process will be charted while reflecting on common challenges in the digital space, with a view to providing insights for future developers.
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Agrafioti, Foteini, Francis M. Bui, and Dimitrios Hatzinakos. "Secure Telemedicine: Biometrics for Remote and Continuous Patient Verification." Journal of Computer Networks and Communications 2012 (2012): 1–11. http://dx.doi.org/10.1155/2012/924791.
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The technological advancements in the field of remote sensing have resulted in substantial growth of the telemedicine industry. While health care practitioners may now monitor their patients’ well-being from a distance and deliver their services remotely, the lack of physical presence introduces security risks, primarily with regard to the identity of the involved parties. The sensing apparatus, that a patient may employ at home, collects and transmits vital signals to medical centres which respond with treatment decisions despite the lack of solid authentication of the transmitter’s identity. In essence, remote monitoring increases the risks of identity fraud in health care. This paper proposes a biometric identification solution suitable for continuous monitoring environments. The system uses the electrocardiogram (ECG) signal in order to extract unique characteristics which allow to discriminate users. In security, ECG falls under the category ofmedical biometrics, a relatively young but promising field of biometric security solutions. In this work, the authors investigate the idiosyncratic properties of home telemonitoring that may affect the ECG signal and compromise security. The effects of psychological changes on the ECG waveform are taken into consideration for the design of a robust biometric system that can identify users based on cardiac signals despite physical or emotional variations.
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Howell, C. K., Jesse Jacob, and Steve Mok. "Remote Antimicrobial Stewardship: A Solution for Meeting The Joint Commission Stewardship Standard?" Hospital Pharmacy 54, no. 1 (April 10, 2018): 51–56. http://dx.doi.org/10.1177/0018578718769240.
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Purpose: The purpose of this study was to determine the time required for antimicrobial stewardship (AS) activities at a small community hospital (SCH) as well as barriers to remote AS to satisfy The Joint Commission (TJC)’s AS standard. Methods: This was a prospective chart review and time study conducted in patients identified by a clinical decision support application as potential opportunities for antimicrobial therapy modification at a SCH between December 12, 2016, and March 31, 2017. Potential interventions were communicated electronically to the clinical pharmacy specialist, who would then communicate the recommendations to the patient’s provider. The primary endpoint was a time study for stewardship activities. Secondary endpoints included describing barriers encountered to remote AS as well as a cost-benefit analysis of remote AS. Results: The time study revealed an average of 11 alerts per day, 9 chart reviews per day, 8 interventions per day, and 5 minutes per chart. Seven hundred twenty-four alerts were evaluated with the most common alerts constituting opportunities for de-escalation (29%), targeted drugs (22%), positive blood cultures (18%), Intravenous (IV) to oral (PO) (17%), and antimicrobial renal monitoring (8%).Interventions were accepted (11%), accepted modified (6%), rejected (35%), or undetermined (48%). Barriers to implementation included workflow and indirect communication. For patients with accepted interventions, there was an average savings of $279.82 per patient in pharmacy charges. Conclusion: Through remote AS, a SCH can have an antimicrobial stewardship program that is in compliance with the basic elements of the TJC standard MM.09.01.01, performs daily chart review by an infectious diseases trained pharmacist to increase the quality of patient care, and achieves a mean savings of $279.82 in pharmacy charges and $1,126.26 in hospital charges per patient with accepted interventions.
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Noreen, Khola, Muhammad Umar, and Arshad Ali Sabir. "Opportunities and Development of Telemedicine in Response to COVID-19: Experience from Public Sector Medical University." BioMedica 36, no. 2S (June 24, 2020): 73–77. http://dx.doi.org/10.51441/biomedica//biomedica/5-374.
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<p>Over the past six months, the world has undergone drastic changes related to unprecedented emergence of deadly virus namely novel Coronavirus, COVID-19. Telemedicine service provides excellent platform for technology based remote patient care in the time of current pandemic crisis. It is emerging as an effective and sustainable solution if current pandemic continues for long time. Telemedicine is revolutionising patient care and help to support the health system of country by reducing the impact of pandemic. There is a need to create the multidisciplinary team of health professionals striving to serve the patients by provision of quality health care service delivery.</p>
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Nakajima, Isao. "Cross-Border Medical Care and Telemedicine." International Journal of E-Health and Medical Communications 3, no. 1 (January 2012): 46–61. http://dx.doi.org/10.4018/jehmc.2012010104.
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Globalization is making cross-border medical care a reality. Cross-border medical care has three aspects: information, patients, and practitioners. The outsourcing of diagnostic imaging via communication lines has begun, and information on treatment poised to cross borders. However, the latter possibility raises issues concerning legal medical qualifications. Japanese legislation bans medical practice by persons not licensed by the Minister of Health, Labour and Welfare. The Ministry of Health, Labour and Welfare recently issued a bulletin regarding the medical activities of foreign licensed physicians and an interpretation of Article 17 of the Medical Practitioner’s Act, permitting foreign licensed physicians to provide medical care in the event of disasters. European countries have established a system for mutual recognition of national medical licenses, and cross-border medical care has achieved a solid foothold there. Based on these societal factors, Japan must revise its legal systems or conclude bilateral medical license recognition agreements. This paper describes the various difficulties and obstacles confronting Japan as it modifies its legal systems to achieve cross-border remote medical care and medical tourism and proposes some concrete solutions.
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FERREIRA, RYAN PINTO, Fernando Oliveira Andrade, Anderson Alberto Ramos, Rodrigo Bernardes, and Saide Jorge Calil. "The Logistics of medical devices for indigenous health care attending in remote sites at Brazilian Amazon Rain Forest." Global Clinical Engineering Journal 2, no. 2 (March 1, 2020): 26–36. http://dx.doi.org/10.31354/globalce.v2i2.49.
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BACKGROUND AND OBJECTIVE: There are in Brazil 896.917 indigenous and 47% of them dwell in the Amazon rainforest region. In order to avoid expensive displacement for this population, especially for surgeries such as hernias and cataracts, the Expedicionários da Saúde NGO attends this specific population three times a year since 2003 organized as a work party regime. This attending is done through a Field Hospital (FH) and is supported by Clinical Engineering (CE). This article presents the characteristics of logistics as well as operation of medical and hospital devices in remote sites of Amazon region. The object of this paper is to describe the transportation processes, installation, operation and maintenance used to ensure safe use of medical devices in one FH in the Amazon forest and to present solutions to proposed adverse conditions throughout the course of several expeditions.
MATERIAL AND METHODS: It was Initially done a survey of the processes of transportation, installation, operation and maintenance of medical devices collected from 24 expeditions to the Amazon forest in a period of 8 years, since the implementation of CE team. A Task Analysis processes was performed to systematically identifying the process used for plan, prepare, transport and operate the medical devices in those past expeditions. Understanding the complexity and the specificities of each expedition a evolutive planning process based on Software Development Spiral Model was used to describes a continuous activity flow, prone to implement and test improvements in each new expedition. Besides the continuous improvement the model also takes in consideration budget solutions once all the work done by the ONG is voluntary. The efficacy of the method was evaluated from indicators of use of medical equipment, the assessment of reported adverse events and the interviews with the professionals of the EC team, users of the medical devices and opinion of the responsible for the managing of the expedition.
RESULTS: Several improvements were observed speciality in the transporting and installation processes, mainly through the adoption of customized packages and manuals for assembly and disassembly of the parts of the medial equipment. Further enhancements were obtained through customizations and adaptations of the devices to the hostile characteristics of the environment. Both physicians and nurses were satisfied with the performance of the devices, and few procedures for repair and calibrate were required after the equipments were installed.
CONCLUSION: The CE team is crucial to the implementation of FHs, being essential in the management of medical technology and in the planning and operation of this type of health structure. The spiral planning method were shown to be very satisfactory mainly because it takes into account the experiences and needs of the past expeditions and for allowing the continuous improvement of the already used processes. Given the great complexity of the RainForest environment in which the technologies will be used and the unpredictability of the risks and challenges to be faced by the EC team the evolutionary work approach presents itself as an applicable solution to planning of future expeditions.
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Annis, Tucker, Susan Pleasants, Gretchen Hultman, Elizabeth Lindemann, Joshua A. Thompson, Stephanie Billecke, Sameer Badlani, and Genevieve B. Melton. "Rapid implementation of a COVID-19 remote patient monitoring program." Journal of the American Medical Informatics Association 27, no. 8 (July 27, 2020): 1326–30. http://dx.doi.org/10.1093/jamia/ocaa097.
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Abstract Objective The study sought to evaluate early lessons from a remote patient monitoring engagement and education technology solution for patients with coronavirus disease 2019 (COVID-19) symptoms. Materials and Methods A COVID-19–specific remote patient monitoring solution (GetWell Loop) was offered to patients with COVID-19 symptoms. The program engaged patients and provided educational materials and the opportunity to share concerns. Alerts were resolved through a virtual care workforce of providers and medical students. Results Between March 18 and April 20, 2020, 2255 of 3701 (60.93%) patients with COVID-19 symptoms enrolled, resulting in over 2303 alerts, 4613 messages, 13 hospital admissions, and 91 emergency room visits. A satisfaction survey was given to 300 patient respondents, 74% of whom would be extremely likely to recommend their doctor. Discussion This program provided a safe and satisfying experience for patients while minimizing COVID-19 exposure and in-person healthcare utilization. Conclusions Remote patient monitoring appears to be an effective approach for managing COVID-19 symptoms at home.
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Sapci, A. Hasan, and H. Aylin Sapci. "Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review." JMIR Aging 2, no. 2 (November 29, 2019): e15429. http://dx.doi.org/10.2196/15429.
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Background The increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults’ daily activities and health-related issues might prevent medical emergencies. Objective The primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems. Methods A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people’s care, independent living, and novel assistive technologies were included in the study. Results A total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal. Conclusions The use of ubiquitous in-home monitoring and smart technologies for aged people’s care will increase their independence and the health care services available to them as well as improve frail elderly people’s health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults.
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Katsiri, Eleftheria, and Konstantinos Moschou. "A pervasive computing system for the remote management of hospital waste." Journal of Communications Software and Systems 12, no. 1 (March 22, 2016): 53. http://dx.doi.org/10.24138/jcomss.v12i1.91.
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Waste generated by health care activities includes a broad range of materials, from used needles and syringes to soiled dressings, body parts, diagnostic samples, medical devices and radioactive materials. As a result of poor practice and large volumes, only a very small percentage ofmedical waste is actually disposed of properly in final reception units while the rest is unaccounted for potentially exposing the community at large to infection, toxic effects and injuries, and risking polluting the environment.This paper discusses, Greenactions, a novel Pervasive Computing system for the remote end-to-end management of hazardous medical waste. Greenactions provides real-time trace-ability for 100% of medical waste, by continually monitoring the full life cycle of each waste container, from their delivery to the hospitals, through to their collection and disposal, and providing remedial action in real-time, whenever an incident occurs. This is achieved by employing both fixed and handheld RFID and sensortechnology, supported by a state-machine model that knows at any time the current and next state of each waste container. Deployed together with a small fleet of appropriately modified vehicles for waste collection, Greenactions provides an integrated solution can be applied in any waste collection and tracking scenario, without requiring any costly, proprietary infrastructure thus alleviating the burden of medical waste management fromhealth-care units. A prototype system was developed using open source technology that is ready to be deployed to pilot healthcare units in Athens, while a set of KPIs were implemented for evaluating the efficiency of the system.
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Pavlyuk, E. I., M. V. Ionov, A. S. Alieva, N. G. Avdonina, A. N. Yakovlev, and N. E. Zvartau. "Integrated solution for very high cardiovascular risk patients. Rationale and design of a pilot study." Russian Journal of Cardiology 26, no. 7 (August 8, 2021): 4608. http://dx.doi.org/10.15829/1560-4071-2021-4608.
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Coronary artery disease (CAD) is the most common cardiovascular disease and the leading cause of morbidity and mortality. Acute coronary syndrome (ACS) as an abrupt destabilization of CAD, multiplies the risk of cardiovascular events. To reduce the incidence of recurrent cardiovascular events, timely tackling potentially reversible risk factors such as hypertension and/or hyperglycemia is imperative. However, a solid basis for a secondary prevention lies in the treatment of dyslipidemia and begins in the first hours of hospital admission. Despite considerable evidence regarding the efficacy and safety of lipid-lowering therapy, averagely only one third of patients maintain control of lipids. The main challenges are low adherence, poor continuity of medical care, and the lack of an ambulatory routine follow-up. Telehealth solutions are believed to address these barriers and may be considered as an add-on to in-person patient care. Telemonitoring of vital and laboratory parameters, remote patient counseling can be introduced into routine care delivery. Telemedicine shows promise for fostering better clinical effect, and provides health-related quality of life improvement.It is planned to conduct a pilot observational study aimed to create and to test an integrated solution, i.e. telemonitoring and remote counseling in patients of very high cardiovascular risk with ACS followed by myocardial revascularization. The goal is to determine the clinical effectiveness, i.e achievement of target values of blood pressure, lipid profile and glycemia, and patient-centeredness of this approach.
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Houtchens, B. A. "Medical-care systems for long-duration space missions." Clinical Chemistry 39, no. 1 (January 1, 1993): 13–21. http://dx.doi.org/10.1093/clinchem/39.1.13.
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Abstract As in the opening of frontiers on Earth, human physiological maladaptation, illness, and injury--rather than defective transportation systems--are likely to be the pace-limiting variables in efforts to expand the presence of humans into the solar system. Because of the inability of individuals to return to Earth rapidly and conveniently, the capability of delivering medical care on site will be key to the success of a manned space station, lunar base, and Mars mission. Spaceflight medical care equipment must meet stringent constraints of size, weight, and power requirements, and then must function accurately in remote, self-contained, microgravity settings after extended intervals of storage, with neither expert operators nor repair technicians on site. Satisfying these unusually rigorous requirements will require sustained direct involvement of clinically up-to-date health-care providers, medical scientists, and biomedical engineers, as well as astronauts and aerospace engineers and managers. Solutions will require validation in clinical settings with real patients, as well as in simulated operational settings.
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Chhaybi, Akram, and Saiida Lazaar. "Definition of a lightweight cryptographic solution to secure health data on IoT and cloud." General Letters in Mathematics 10, no. 2 (June 2021): 54–60. http://dx.doi.org/10.31559/glm2021.10.2.6.
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The Internet of Things (IoT) and the Cloud Computing are among the main technologies influencing the quality and efficiency of our social and economic activities. Their importance is quite notable in several areas such as remote medical care and healthcare monitoring systems. These later face difficulties most of them are the expensive costs for the chronic diseases and the hospitals charges specially during the pandemic time. All these issues have led to the creation of new solutions for enhancing the quality of the healthcare systems. In this paper, we focus on the network architecture security including healthcare monitoring systems based on IoT and Cloud Computing. We present a recent review on the research field and we propose a secure solution based on lightweight cryptography in accordance with the limited resource environments within which health data are exchanged. The proposed solution is guaranteeing data confidentiality and ensuring integrity and authenticity.
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Walter, Silke, Henry Zhao, Damien Easton, Cees Bil, Jonas Sauer, Yang Liu, Martin Lesmeister, et al. "Air-Mobile Stroke Unit for access to stroke treatment in rural regions." International Journal of Stroke 13, no. 6 (August 2018): 568–75. http://dx.doi.org/10.1177/1747493018784450.
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Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites. We describe technical solutions for an Air-Mobile Stroke Unit (Air-MSU) concept, where an aircraft is customized with the ability to perform multimodal computed tomography, in addition to onboard laboratory equipment and telemedicine connection. The Air-MSU is envisioned not only to allow intravenous thrombolysis in the field but also to allow prehospital triage to a comprehensive stroke center through use of contrast intracerebral vascular imaging. Several options for the Air-MSU approach are described, and issues regarding the potential medical benefit, optimal operating environment, technical realization, and integration in pre-existing solutions (e.g., flying doctor service) are addressed. Conclusion The Air-MSU may represent a novel tool to reduce treatment disparity for stroke patients in rural and remote areas. However, this approach requires further implementation research to determine the overall benefit to these communities.
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Zeghari, Radia, Rachid Guerchouche, Minh Tran Duc, François Bremond, Maria Pascale Lemoine, Vincent Bultingaire, Kai Langel, et al. "Pilot Study to Assess the Feasibility of a Mobile Unit for Remote Cognitive Screening of Isolated Elderly in Rural Areas." International Journal of Environmental Research and Public Health 18, no. 11 (June 5, 2021): 6108. http://dx.doi.org/10.3390/ijerph18116108.
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Background: Given the current COVID-19 pandemic situation, now more than ever, remote solutions for assessing and monitoring individuals with cognitive impairment are urgently needed. Older adults in particular, living in isolated rural areas or so-called ‘medical deserts’, are facing major difficulties in getting access to diagnosis and care. Telemedical approaches to assessments are promising and seem well accepted, reducing the burden of bringing patients to specialized clinics. However, many older adults are not yet adequately equipped to allow for proper implementation of this technology. A potential solution could be a mobile unit in the form of a van, equipped with the telemedical system which comes to the patients’ home. The aim of this proof-of-concept study is to evaluate the feasibility and reliability of such mobile unit settings for remote cognitive testing. Methods and analysis: eight participants (aged between 69 and 86 years old) from the city of Digne-Les-Bains volunteered for this study. A basic neuropsychological assessment, including a short clinical interview, is administered in two conditions, by telemedicine in a mobile clinic (equipped van) at a participants’ home and face to face in a specialized clinic. The administration procedure order is randomized, and the results are compared with each other. Acceptability and user experience are assessed among participants and clinicians in a qualitative and quantitative manner. Measurements of stress indicators were collected for comparison. Results: The analysis revealed no significant differences in test results between the two administration procedures. Participants were, overall, very satisfied with the mobile clinic experience and found the use of the telemedical system relatively easy. Conclusion: A mobile unit equipped with a telemedical service could represent a solution for remote cognitive testing overcoming barriers in rural areas to access specialized diagnosis and care.
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Kim, Yesul, Christopher Groombridge, Lorena Romero, Steven Clare, and Mark Christopher Fitzgerald. "Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review." Journal of Medical Internet Research 22, no. 12 (December 8, 2020): e18959. http://dx.doi.org/10.2196/18959.
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Background Telemedicine offers a unique opportunity to improve coordination and administration for urgent patient care remotely. In an emergency setting, it has been used to support first responders by providing telephone or video consultation with specialists at hospitals and through the exchange of prehospital patient information. This technological solution is evolving rapidly, yet there is a concern that it is being implemented without a demonstrated clinical need and effectiveness as well as without a thorough economic evaluation. Objective Our objective is to systematically review whether the clinical outcomes achieved, as reported in the literature, favor telemedicine decision support for medical interventions during prehospital care. Methods This systematic review included peer-reviewed journal articles. Searches of 7 databases and relevant reviews were conducted. Eligibility criteria consisted of studies that covered telemedicine as data- and information-sharing and two-way teleconsultation platforms, with the objective of supporting medical decisions (eg, diagnosis, treatment, and receiving hospital decision) in a prehospital emergency setting. Simulation studies and studies that included pediatric populations were excluded. The procedures in this review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The Risk Of Bias In Non-randomised Studies–of Interventions (ROBINS-I) tool was used for the assessment of risk of bias. The results were synthesized based on predefined aspects of medical decisions that are made in a prehospital setting, which include diagnostic decision support, receiving facility decisions, and medical directions for treatment. All data extractions were done by at least two reviewers independently. Results Out of 42 full-text reviews, 7 were found eligible. Diagnostic support and medical direction and decision for treatments were often reported. A key finding of this review was the high agreement between prehospital diagnoses via telemedicine and final in-hospital diagnoses, as supported by quantitative evidence. However, a majority of the articles described the clinical value of having access to remote experts without robust quantitative data. Most telemedicine solutions were evaluated within a feasibility or short-term preliminary study. In general, the results were positive for telemedicine use; however, biases, due to preintervention confounding factors and a lack of documentation on quality assurance and protocol for telemedicine activation, make it difficult to determine the direct effect on patient outcomes. Conclusions The information-sharing capacity of telemedicine enables access to remote experts to support medical decision making on scene or in prolonged field care. The influence of human and technology factors on patient care is poorly understood and documented.
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Corrado, Ann Marie. "The ethical concerns of physician recruitment from Africa to the global North." University of Western Ontario Medical Journal 86, no. 2 (December 3, 2017): 30–31. http://dx.doi.org/10.5206/uwomj.v86i2.2003.
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For decades, medical recruitment agencies have tried to deal with physician shortages in rural and remote areas of developed countries by recruiting physicians from areas of scarce health human resources in the global South. In South Africa alone, one-third to one-half of medical school graduates migrate to the global North every year, with the majority settling down in Canada, the United States, and the United Kingdom.1 This review paper aims to bring attention to the unethical practice of physician recruitment from Africa to the global North. In particular, it will explore how physician recruitment negatively impacts the donor countries’ economies, compromises the quality of care they can give their citizens, and provides only a short term solution to the recipient country. It is critical that this practice is prohibited and that countries in the global North look for sustainable solutions within their own borders to solve workforce shortages.
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Shephard, Mark, Anne Shephard, Susan Matthews, and Kelly Andrewartha. "The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia." Archives of Pathology & Laboratory Medicine 144, no. 11 (October 27, 2020): 1372–80. http://dx.doi.org/10.5858/arpa.2020-0105-ra.
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Context.— Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high. Objective.— To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology. Data Sources.— Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currently managed by the International Centre for Point-of-Care Testing at Flinders University are used to highlight the experience gained and the lessons learned from these networks and, where possible, describe innovative solutions to address the current barriers to the uptake of POC testing, which include governance, staff turnover, maintaining training and competency, connectivity, quality testing, sustainable funding mechanisms, and accreditation. Conclusions.— Point-of-care testing can provide practical and inventive opportunities to revolutionize the delivery of pathology services in rural and remote sectors where clinical need for this technology is greatest. However, many barriers to POC testing still exist in these settings, and the full potential of POC testing cannot be realized until these limitations are addressed and resolved.
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Bleda, Maestre, Corral, and Ruiz. "A Quality and Ergonomic Heart Monitoring Device with User-Friendly App for Telemedicine." Proceedings 31, no. 1 (November 21, 2019): 67. http://dx.doi.org/10.3390/proceedings2019031067.
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During recent decades, the elderly population has grown rapidly, and the number of patients with chronic heart-related diseases has exploded. Many of them (e.g., congestive heart failure, some types of arrhythmia) require close medical supervision, imposing a major burden on healthcare resources in most western economies. Telemedicine is clearly emerging as a viable solution for health care to become sustainable by enabling medical monitoring at home without direct professional help, which would greatly reduce assistance costs. Specifically, continuous or frequent arterial blood pressure (ABP) and electrocardiogram (ECG) monitoring are important tools in the follow-up of many of these patients. A multipurpose (e.g. ABP and ECG) monitoring device that requires no medical assistance is highly desirable and would be of great value to patients. One such solution is presented and validated in this work. This paper presents the details of the proposed remote heart self-monitoring system, the testing procedure, and test results.
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Petrellis, Nikos, and George K. Adam. "Symptom Tracking and Experimentation Platform for Covid-19 or Similar Infections." Computers 10, no. 2 (February 7, 2021): 22. http://dx.doi.org/10.3390/computers10020022.
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Remote symptom tracking is critical for the prevention of Covid-19 spread. The qualified medical staff working in the call centers of primary health care units have to take critical decisions often based on vague information about the patient condition. The congestion and the medical protocols that are constantly changing often lead to incorrect decisions. The proposed platform allows the remote assessment of symptoms and can be useful for patients, health institutes and researchers. It consists of mobile desktop applications and medical sensors connected to cloud infrastructure. The unique features offered by the proposed solution are: (a) dynamic adaptation of Medical Protocols (MP) is supported (for the definition of alert rules, sensor sampling strategy and questionnaire structure) covering different medical cases (pre- or post-hospitalization, vulnerable population, etc.), (b) anonymous medical data can be statistically processed in the context of the research about an infection such as Covid-19, (c) reliable diagnosis is supported since several factors are taken into consideration, (d) the platform can be used to drastically reduce the congestion in various healthcare units. For the demonstration of (b), new classification methods based on similarity metrics have been tested for cough sound classification with an accuracy in the order of 90%.
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Ruf, Benjamin, Phillip Jenkinson, David Armour, Mhairi Fraser, and Angus JM Watson. "Videoconference clinics improve efficiency of inflammatory bowel disease care in a remote and rural setting." Journal of Telemedicine and Telecare 26, no. 9 (June 5, 2019): 545–51. http://dx.doi.org/10.1177/1357633x19849280.
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Introduction Patients with inflammatory bowel disease (IBD) require long-term secondary care with periodic specialist follow-up. This can be especially challenging for patients living in remote areas. One possible solution is the implementation of videoconference (VC) clinics as a distance-management tool. Here we assessed the use of VC clinics for IBD in terms of patient safety and economic benefit for patients with IBD living in rural areas in the Scottish Highlands and Islands. Methods Eighty-eight patients participating in the IBD specialist nurses VC clinic administered via Raigmore Hospital, Inverness, Scotland, UK, between January 2016 and June 2017 were included in this study. A total of 229 appointments were assessed. Results We found the use of a VC clinic to be safe and effective as only 0.9% of appointments required urgent medical assessment and 92% of the VC clinic appointments resulted in further VC clinic follow-up. A total travelling distance of 72,245.3 km and a total travelling time of 71,688 minutes were saved in this patient cohort. It was shown that an average of US$36.61 of potential travelling cost could be saved per appointment. Discussion VC clinics represent a patient-centred participatory model of care for IBD patients living in remote areas with enormous time- and cost-saving potential while being safe and effective. Further investigations into patient satisfaction and the combination with other telemedicine tools such as telephone conferencing and mobile phone applications are needed to evaluate the full potential of the concept.
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Joshi, Aditi U., and Resa E. Lewiss. "Telehealth in the time of COVID-19." Emergency Medicine Journal 37, no. 10 (August 4, 2020): 637–38. http://dx.doi.org/10.1136/emermed-2020-209846.
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Telehealth or using technology for a remote medical encounter has become an efficient solution for safe patient care during the severe acute respiratory syndrome coronavirus 2 or COVID-19 pandemic. This medium allows patient immediate healthcare access without the need for an in-person visit. We designed a time-sensitive, practical, effective and innovative scale-up of telehealth services as a response to the demand for COVID-19 evaluation and testing. As more patients made appointments through the institution’s telehealth programme, we increased the number of clinicians available. JeffConnect, the acute care telehealth programme, was expanded to increase staffing from a standing staff of 37–187 doctors within 72 hours. Telehealth care clinicians primarily trained in emergency medicine, internal medicine and family medicine followed a patient decision pathway to risk stratify patients into three groups: home quarantine no testing, home quarantine with outpatient COVID-19 testing and referral for in-person evaluation in the ED, for symptomatic and potentially unstable patients.
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Patel, Pious D., Jared Cobb, Deidre Wright, Robert W. Turer, Tiffany Jordan, Amber Humphrey, Adrienne L. Kepner, Gaye Smith, and S. Trent Rosenbloom. "Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results." Journal of the American Medical Informatics Association 27, no. 7 (June 10, 2020): 1116–20. http://dx.doi.org/10.1093/jamia/ocaa065.
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Abstract The COVID-19 national emergency has led to surging care demand and the need for unprecedented telehealth expansion. Rapid telehealth expansion can be especially complex for pediatric patients. From the experience of a large academic medical center, this report describes a pathway for efficiently increasing capacity of remote pediatric enrollment for telehealth while fulfilling privacy, security, and convenience concerns. The design and implementation of the process took 2 days. Five process requirements were identified: efficient enrollment, remote ability to establish parentage, minimal additional work for application processing, compliance with guidelines for adolescent autonomy, and compliance with institutional privacy and security policies. Weekly enrollment subsequently increased 10-fold for children (age 0–12 years) and 1.2-fold for adolescents (age 13–17 years). Weekly telehealth visits increased 200-fold for children and 90-fold for adolescents. The obstacles and solutions presented in this report can provide guidance to health systems for similar challenges during the COVID-19 response and future disasters.
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Di Onofrio, Valeria, Renato Gesuele, Angela Maione, Giorgio Liguori, Renato Liguori, Marco Guida, Roberto Nigro, and Emilia Galdiero. "Prevention of Pseudomonas aeruginosa Biofilm Formation on Soft Contact Lenses by Allium sativum Fermented Extract (BGE) and Cannabinol Oil Extract (CBD)." Antibiotics 8, no. 4 (December 10, 2019): 258. http://dx.doi.org/10.3390/antibiotics8040258.
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Two natural mixtures, Allium sativum fermented extract (BGE) and cannabinol oil extract (CBD), were assessed for their ability to inhibit and remove Pseudomonas aeruginosa biofilms on soft contact lenses in comparison to a multipurpose Soft Contact Lens-care solution present on the Italian market. Pseudomonas aeruginosa (ATCC 9027 strain) and Pseudomonas aeruginosa clinical strains isolated from ocular swabs were tested. Quantification of the biofilm was done using the microtiter plate assay and the fractional inhibitory concentration index was calculated. Both forms of Pseudomonas aeruginosa generated biofilms. BGE at minimal inhibitory concentration (MIC) showed inhibition percentages higher than 55% for both strains, and CBD inhibited biofilm formation by about 70%. The care solution at MIC inhibited biofilm formation by about 50% for both strains tested. The effect of BGE on the eradication of the microbial biofilm on soft contact lenses at MIC was 45% eradication for P. aeruginosa ATCC 9027 and 36% for P. aeruginosa clinical strain. For CBD, we observed 24% biofilm eradication for both strains. For the care solution, the eradication MICs were 43% eradication for P. aeruginosa ATCC 9027 and 41% for P. aeruginosa clinical strain. It was observed that both the test soft contact lenses solution/BGE (fractional inhibitory concentration index: 0.450) and the test soft contact lenses solution/CBD (fractional inhibitory concentration index: 0.153) combinations exhibited synergistic antibiofilm activity against most of the studied bacteria. The study showed that BGE and CBD have good effect on inhibition of biofilm formation and removal of preformed biofilms, which makes them promising agents that could be exploited to develop more effective care solutions.
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Bouteraa, Yassine, Ismail Ben Abdallah, Atef Ibrahim, and Tariq Ahamed Ahanger. "Development of an IoT-Based Solution Incorporating Biofeedback and Fuzzy Logic Control for Elbow Rehabilitation." Applied Sciences 10, no. 21 (November 3, 2020): 7793. http://dx.doi.org/10.3390/app10217793.
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The last few years have seen significant advances in neuromotor rehabilitation technologies, such as robotics and virtual reality. Rehabilitation robotics primarily focuses on devices, control strategies, scenarios and protocols aimed at recovering sensory, motor and cognitive impairments often experienced by stroke victims. Remote rehabilitation can be adopted to relieve stress in healthcare facilities by limiting the movement of patients to clinics, mainly in the current COVID-19 pandemic. In this context, we have developed a remote controlled intelligent robot for elbow rehabilitation. The proposed system offers real-time monitoring and ultimately provides an electronic health record (EHR). Rehabilitation is an area of medical practice that treats patients with pain. However, this pain can prevent a person from positively interacting with therapy. To cope with this matter, the proposed solution incorporates a cascading fuzzy decision system to estimate patient pain. Indeed, as a safety measure, when the pain exceeds a certain threshold, the robot must stop the action even if the desired angle has not yet been reached. A fusion of sensors incorporating an electromyography (EMG) signal, feedback from the current sensor and feedback from the position encoder provides the fuzzy controller with the data needed to estimate pain. This measured pain is fed back into the control loop and processed to generate safe robot actions. The main contribution was to integrate vision-based gesture control, a cascade fuzzy logic-based decision system and IoT (Internet of Things) to help therapists remotely take care of patients efficiently and reliably. Tests carried out on three different subjects showed encouraging results.
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Silver, David F., Steven M. Aukers, and Melissa A. Simon. "A "continuously connected team support" model to facilitate high-quality gynecologic cancer care in rural and remote regions." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 51. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.51.
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51 Background: Quality gynecologic cancer care (GCC) in rural and remote regions (RRR) of the U.S. is limited by poor access to gynecologic oncology expertise (GOE). While a variety of telehealth programs in other specialties have enhanced healthcare in RRR, none have resulted in provision of the comprehensive medical and surgical services required to treat gynecologic cancer patients. We propose a model to improve access and quality for comprehensive GCC in RRR. Methods: PubMed, Medline, and Google searches identified and characterized: 1) core quality components of GCC models; 2) RRR lacking GOE; and 3) current models for delivering healthcare services in remote regions. A new model was developed addressing needs of RRR. Results: Characteristics observed in high-performing GCC models include: 1) gynecologic oncologists (GO) guide all aspects of GCC, 2) care is performed by high-volume providers (HVP), and 3) multidisciplinary provider teams (MDT) address all patient needs. Without equal access to GO, HVP, or MDT, patients in RRR do not share benefits of high-quality outcomes. Integrating components of successful telementoring models with identified high-quality characteristics of traditional GCC, our model is developed to address the comprehensive and ongoing unique GCC needs of RRR. This Continuously Connected Team Support (CCTS) model utilizes a semi-remote GO to facilitate quality GCC through mentorship and education of a local MDT, transforming it into a transdisciplinary team (TDT). Off-site activities include 24/7 availability via phone or HIPAA-compliant videoconferencing. The GO’s on-site activities include proctoring the TDT in surgeries, mentoring and educating in clinical conferences, and continuous quality improvement activities. Long-term, regular on-site and remote interactions with the local TDT makes CCTS unique in its commitment and service beyond that of itinerant surgeons, locum tenens, international surgical charity efforts or established telehealth programs. Conclusions: Deployment of CCTS in RRR offers an innovative solution for the facilitation of high-quality comprehensive GCC in RRR lacking GOE. Further outcomes research is warranted.
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Pluymaekers, Nikki A. H. A., Rachel M. J. van der Velden, Astrid N. L. Hermans, Monika Gawalko, Saskia Buskes, Joyce J. H. M. W. Keijenberg, Bianca Vorstermans, Harry J. G. M. Crijns, Jeroen M. Hendriks, and Dominik Linz. "On-Demand Mobile Health Infrastructure for Remote Rhythm Monitoring within a Wait-and-See Strategy for Recent-Onset Atrial Fibrillation: TeleWAS-AF." Cardiology 146, no. 3 (2021): 392–96. http://dx.doi.org/10.1159/000514156.
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Recently, we introduced the TeleCheck-AF approach, an on-demand mobile health (mHealth) infrastructure using app-based heart rate and rhythm monitoring for 7 days, to support long-term atrial fibrillation (AF) management through teleconsultation. Herein, we extend the mHealth approach to patients with recent-onset AF at the emergency department (ED). In the proposed TeleWAS-AF approach, on-demand heart rate and rhythm monitoring are used to support a wait-and-see strategy at the ED. All stable patients who present to the ED with recent-onset symptomatic AF and who are able to use mHealth solutions for heart rate and rhythm monitoring are eligible for this approach. Patients will receive both education on AF and instructions on the use of the mHealth technology before discharge from the ED. A case coordinator will subsequently check whether patients are able to activate the mHealth solution and to perform heart rate and rhythm measurements. Forty hours after AF onset, the first assessment teleconsultation with the physician will take place, determining the need for delayed cardioversion. After maximal 7 days of remote monitoring, a second assessment teleconsultation may occur, in which the rhythm can be reassessed and further treatment strategy can be discussed with the patients. This on-demand mHealth prescription increases patient involvement in the care process and treatment decision-making by encouraging self-management, while avoiding excess data-load requiring work-intensive and expensive data management. Implementation of the TeleWAS-AF approach may facilitate the management of AF in the ED and reduce the burden on the ED system, which enhances the capacity for health care utilization.
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Kamecka, Karolina, Anna Rybarczyk-Szwajkowska, Anna Staszewska, Per Engelseth, and Remigiusz Kozlowski. "Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty." International Journal of Environmental Research and Public Health 18, no. 19 (September 27, 2021): 10135. http://dx.doi.org/10.3390/ijerph181910135.
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The importance of telemedicine technologies around the world has been growing for many years, and it turned out to be a particularly important issue for conducting some medical procedures during the SARS-CoV-2 pandemic. It is necessary to create interdisciplinary teams to design and implement improved procedures using telemedicine tools. The aim of the article is to develop original, improved posthospital patient care process after total hip arthroplasty (THA) with the use of telemedicine technologies. In the study, a literature review and empirical research were used. The conducted research resulted in the designing an original posthospital patient care process after THA that uses telematics technologies. Due to the use of analyzed telemedicine technologies, the designed patient care process brings a possibility to increase the patient′s safety by monitoring life parameters, allowing for regular, remote contact with specialists and to be supervised remotely. All this may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs. The designed model is ready for further clinical research with the participation of medical staff, patients after THA and patient caregivers.
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Tokareva, Julia, and Elena Lysenko. "Study of Factors Influencing the Transformation of Medical Staff’s Well-being in the Context of the COVID-19 Pandemic." SHS Web of Conferences 92 (2021): 01049. http://dx.doi.org/10.1051/shsconf/20219201049.
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Research background: The pandemic caused by COVID-19 is one of such situations that required urgent, anti-crisis solutions on organizing medical-care and support for the life of people. Special attention in scientific research of scientists from different countries is paid to medical workers, as the main participants in the elimination of the pandemic, whose external and internal working conditions have changed to a greater extent. Purpose of the article: to investigate factors those affect the well-being of health care workers in the workplace during the COVID-19 pandemic. Methods: The basis of the tools of empirical sociological research was the author’s method of studying 3 groups of factors that affect the well-being of employees: informing of the situation associated with the pandemic, changes in the nature and conditions of work; specifics of working in remote mode in connection with the pandemic. Findings & Value added: The study revealed the importance of informing employees about the situation, as well as a high level of its reliability and timeliness. The most significant changes in the work were the need to control contacts, the use of special protective equipment and the appearance of a large number of stressful factors. The main consequence of working in a pandemic environment, both for employees working in the previous mode and for employees working in remote mode – is a decrease in the level of material well-being. The study of the transformation of work in remote mode, in addition to technical parameters, showed deterioration in working conditions and communication.
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Gelman, V. Ya, and M. A. Dokhov. "Problems of Development of Health Monitoring at Residential Settings." Medicina 8, no. 2 (2020): 50–60. http://dx.doi.org/10.29234/2308-9113-2020-8-2-50-60.
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Due to its rapid development, telemonitoring technologies in the field of healthcare significantly outstripped the possibilities of implementation in real practice. Therefore, there is a need for the active development of this area of prevention and treatment of chronic patients, identifying emerging problems and finding possible solutions. The aim of this work was to assess the status and development prospects of monitoring of patient health in residential settings and analyze the problems of its inclusion in the existing health care system. Based on the analysis of scientific publications and expert assessments, the existing at-home telemonitoring systems, the main pathologies observed, and the organization of medical care for chronic patients under remote monitoring are examined. It was shown that the on-line treatment of monitored patients in the current health care system is very difficult due to its unpreparedness for the introduction of such technologies and the undeveloped concept of clinical and economic efficiency of their use. The article proposes to carry out special training of patients on effective participation in the process of remote monitoring, and it is also proposed to provide in the treatment and prevention institutions the position of a consultant (general practitioner, with an appropriately equipped workstation) for conducting remote patient consultations.
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Ieronimakis, Kristina M., Christopher J. Colombo, Justin Valovich, Mark Griffith, Konrad L. Davis, and Jeremy C. Pamplin. "The Trifecta of Tele-Critical Care: Intrahospital, Operational, and Mass Casualty Applications." Military Medicine 186, Supplement_1 (January 1, 2021): 253–60. http://dx.doi.org/10.1093/milmed/usaa298.
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ABSTRACT Introduction Tele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency. Materials and Methods The investigators piloted simultaneous TCC support to the MTF during three field exercises: (1) TCC concurrently monitored the ICU during a remote mass casualty exercise: the TCC physician monitored a high-risk ICU patient while the nurse monitored 24 simulated field casualties; (2) TCC concurrently monitored the garrison ICU and a remote military medical field exercise: the physician provided tele-mentoring during prolonged field care for a simulated casualty, and the nurse provided hospital ICU TCC; (3) the TCC nurse simultaneously monitored the ICU while providing reach-back support to field hospital nurses training in a simulation scenario. Results TCC proved feasible during multiple exercises with concurrent tele-mentoring to different care environments including physician and nurse alternating operational and hospital support roles, and an ICU nurse managing both simultaneously. ICU staff noted enhanced quality and safety of bedside care. Field exercise participants indicated TCC expanded multipatient monitoring during mass casualties and enhanced novice caregiver procedural capability and scope of patient complexity. Conclusions Tele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.
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Russell-Roberts, Paul, and Diane Kay. "Using validated assessment tools in stoma care: a case study of an ileostomate with an inward body profile." Gastrointestinal Nursing 19, no. 2 (March 2, 2021): 20–27. http://dx.doi.org/10.12968/gasn.2021.19.2.20.
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The impact of having a stoma on an individual's quality of life (QoL) can be significantly worsened by leakage and consequent peristomal skin complications. Therefore, ostomates require individualised, person-centred and evidence-based care. Stoma care nurses can facilitate this using stoma-specific validated assessment tools, including the Body Profile Assessment Tool, Stoma Quality of Life Tool, Ostomy Skin Tool and Ostomy Leakage Impact Tool. These provide precise, repeatable quantitative data, which avoids reliance on vague language and allows for baseline comparisons to measure progression. This case study describes a female ileostomate who faced a number of stoma-related complications, including body image and confidence. Initial trial-and-error attempts to find an effective combination of products were fragmentary and failed to provide an effective long-term solution. During the COVID-19 pandemic, the patient underwent a remote telephone consultation, aided by digital photography. The stoma care nurse used validated assessment tools to determine the patient's needs. Based on this, she was recommended a new pouching routine suited to her inward body profile, and her progress was measured using the assessment tools. These showed sustained and considerable improvements in peristomal skin health, mental wellbeing and overall QoL. The patient's prescription costs were also dramatically reduced.
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Khan, Muhammad Bilal, Mubashir Rehman, Ali Mustafa, Raza Ali Shah, and Xiaodong Yang. "Intelligent Non-Contact Sensing for Connected Health Using Software Defined Radio Technology." Electronics 10, no. 13 (June 28, 2021): 1558. http://dx.doi.org/10.3390/electronics10131558.
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The unpredictable situation from the Coronavirus (COVID-19) globally and the severity of the third wave has resulted in the entire world being quarantined from one another again. Self-quarantine is the only existing solution to stop the spread of the virus when vaccination is under trials. Due to COVID-19, individuals may have difficulties in breathing and may experience cognitive impairment, which results in physical and psychological health issues. Healthcare professionals are doing their best to treat the patients at risk to their health. It is important to develop innovative solutions to provide non-contact and remote assistance to reduce the spread of the virus and to provide better care to patients. In addition, such assistance is important for elderly and those that are already sick in order to provide timely medical assistance and to reduce false alarm/visits to the hospitals. This research aims to provide an innovative solution by remotely monitoring vital signs such as breathing and other connected health during the quarantine. We develop an innovative solution for connected health using software-defined radio (SDR) technology and artificial intelligence (AI). The channel frequency response (CFR) is used to extract the fine-grained wireless channel state information (WCSI) by using the multi-carrier orthogonal frequency division multiplexing (OFDM) technique. The design was validated by simulated channels by analyzing CFR for ideal, additive white gaussian noise (AWGN), fading, and dispersive channels. Finally, various breathing experiments are conducted and the results are illustrated as having classification accuracy of 99.3% for four different breathing patterns using machine learning algorithms. This platform allows medical professionals and caretakers to remotely monitor individuals in a non-contact manner. The developed platform is suitable for both COVID-19 and non-COVID-19 scenarios.
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Neubeck, Lis, Tina Hansen, Tiny Jaarsma, Leonie Klompstra, and Robyn Gallagher. "Delivering healthcare remotely to cardiovascular patients during COVID-19." European Journal of Cardiovascular Nursing 19, no. 6 (May 7, 2020): 486–94. http://dx.doi.org/10.1177/1474515120924530.
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Background Although attention is focused on addressing the acute situation created by the COVID-19 illness, it is imperative to continue our efforts to prevent cardiovascular morbidity and mortality, particularly during a period of prolonged social isolation which may limit physical activity, adversely affect mental health and reduce access to usual care. One option may be to deliver healthcare interventions remotely through digital healthcare solutions. Therefore, the aim of this paper is to bring together the evidence for remote healthcare during a quarantine situation period to support people living with cardiovascular disease during COVID-19 isolation. Methods The PubMed, CINAHL and Google Scholar were searched using telehealth OR digital health OR mHealth OR eHealth OR mobile apps AND COVID-19 OR quarantine search terms. We also searched for literature relating to cardiovascular disease AND quarantine. Results The literature search identified 45 potentially relevant publications, out of which nine articles were included. Three overarching themes emerged from this review: (1) preparing the workforce and ensuring reimbursement for remote healthcare, (2) supporting mental and physical health and (3) supporting usual care. Conclusion To support people living with cardiovascular disease during COVID-19 isolation and to mitigate the effects of quarantine and adverse effect on mental and physical well-being, we should offer remote healthcare and provide access to their usual care.
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Gensini, Gian Franco, Camilla Alderighi, Raffaele Rasoini, Marco Mazzanti, and Giancarlo Casolo. "Value of Telemonitoring and Telemedicine in Heart Failure Management." Cardiac Failure Review 3, no. 2 (2017): 1. http://dx.doi.org/10.15420/cfr.2017:6:2.
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The use of telemonitoring and telemedicine is a relatively new but quickly developing area in medicine. As new digital tools and applications are being created and used to manage medical conditions such as heart failure, many implications require close consideration and further study, including the effectiveness and safety of these telemonitoring tools in diagnosing, treating and managing heart failure compared to traditional face-to-face doctor–patient interaction. When compared to multidisciplinary intervention programs which are frequently hindered by economic, geographic and bureaucratic barriers, non-invasive remote monitoring could be a solution to support and promote the care of patients over time. Therefore it is crucial to identify the most relevant biological parameters to monitor, which heart failure sub-populations may gain real benefits from telehealth interventions and in which specific healthcare subsets these interventions should be implemented in order to maximise value.
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Veazey, Sena, Maria SerioMelvin, David E. Luellen, Angela Samosorn, Alexandria Helms, Allison McGlasson, Craig Fenrich, Patricia Colston, and Jose Salinas. "41 Enhancing Burn Medical Care During a Disaster Using a Novel Augmented-Reality Application." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S31. http://dx.doi.org/10.1093/jbcr/irab032.045.
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Abstract Introduction In disaster or mass casualty situations, access to remote burn care experts, communication, or resources may be limited. Furthermore, burn injuries are complex and require substantial training and knowledge beyond basic clinical care. Development and use of decision support (DS) technologies may provide a solution for addressing this need. Devices capable of delivering burn management recommendations can enhance the provider’s ability to make decisions and perform interventions in complex care settings. When coupled with merging augmented reality (AR) technologies these tools may provide additional capabilities to enhance medical decision-making, visualization, and workflow when managing burns. For this project, we developed a novel AR-based application with enhanced integrated clinical practice guidelines (CPGs) to manage large burn injuries for use in different environments, such as disasters. Methods We identified an AR system that met our requirements to include portability, infrared camera, gesture and voice control, hands-free control, head-mounted display, and customized application development abilities. Our goal was to adapt burn CPGs to make use of AR concepts as part of an AR-enabled burn clinical decision support system supporting four sub-applications to assist users with specific interventional tasks relevant to burn care. We integrated relevant CPGs and a media library with photos and videos as additional references. Results We successfully developed a clinical decision support tool that integrates burn CPGs with enhanced capabilities utilizing AR technology. The main interface allows input of patient demographics and injuries with step-by-step guidelines that follow typical burn management care and workflow. There are four sub-applications to assist with these tasks, which include: 1) semi-automated burn wound mapping to calculate total body surface area; 2) hourly burn fluid titration and recommendations for resuscitation; 3) medication calculator for accurate dosing in preparation for procedures and 4) escharotomy instructor with holographic overlays. Conclusions We developed a novel AR-based clinical decision support tool for management of burn injuries. Development included adaptation of CPGs into a format to guide the user through burn management using AR concepts. The application will be tested in a prospective research study to determine the effectiveness, timeliness, and performance of subjects using this AR-software compared to standard of care. We fully expect that the tool will reduce cognitive workload and errors, ensuring safety and proper adherence to guidelines.
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Blue, Heather, Ashley Dahly, Susan Chhen, Julie Lee, Adam Shadiow, Anna G. Van Deelen, and Laura C. Palombi. "Rural Emergency Medical Service Providers Perceptions on the Causes of and Solutions to the Opioid Crisis: A Qualitative Assessment." Journal of Primary Care & Community Health 12 (January 2021): 215013272098771. http://dx.doi.org/10.1177/2150132720987715.
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Introduction: The continuing opioid crisis poses unique challenges to remote and often under-resourced rural communities. Emergency medical service (EMS) providers serve a critical role in responding to opioid overdose for individuals living in rural or remote areas who experience opioid overdoses. They are often first at the scene of an overdose and are sometimes the only health care provider in contact with an overdose patient who either did not survive or refused additional care. As such, EMS providers have valuable perspectives to share on the causes and consequences of the opioid crisis in rural communities. Methods: EMS providers attending a statewide EMS conference serving those from greater Minnesota and surrounding states were invited to take a 2-question survey asking them to reflect upon what they believed to be the causes of the opioid crisis and what they saw as the solutions to the opioid crisis. Results were coded and categorized using a Consensual Qualitative Research approach. Results: EMS providers’ perceptions on causes of the opioid crisis were categorized into 5 main domains: overprescribing, ease of access, socioeconomic vulnerability, mental health concerns, and lack of resources and education. Responses focused on solutions to address the opioid crisis were categorized into 5 main domains: need for increased education, enhanced opioid oversight, increased access to treatment programs, alternative therapies for pain management, and addressing socioeconomic vulnerabilities. Conclusion: Along with the recognition that the opioid crisis was at least partially caused by overprescribing, rural EMS providers who participated in this study recognized the critical role of social determinants of health in perpetuating opioid-related harm. Participants in this study reported that education and increased access to treatment facilities and appropriate pain management, along with recognition of the role of social determinants of health in opioid dependency, were necessary steps to address the opioid crisis.
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Donati, Massimiliano, Alessio Celli, Alessio Ruiu, Sergio Saponara, and Luca Fanucci. "A Telemedicine Service System Exploiting BT/BLE Wireless Sensors for Remote Management of Chronic Patients." Technologies 7, no. 1 (January 18, 2019): 13. http://dx.doi.org/10.3390/technologies7010013.
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The management of the increasing number of patients affected by cardiovascular, pulmonary, and metabolic chronic diseases represents a major challenge for the National Health System (NHS) in any developed country. Chronic diseases are indeed the main cause of hospitalization, especially for elderly people, leading to sustainability problems due to the huge amount of resources required. In the last years, the adoption of the chronic care model (CCM) as assistive model improved the management of these patients and reduced the related healthcare costs. The diffusion of wireless sensors, portable devices and connectivity enables to implement new information and communication technology (ICT)-based innovative applications to further improve the outcomes of the CCM. This paper presents a telemedicine platform for data acquisition, distribution, processing, presentation, and storage, aimed to remotely monitor the clinical status of chronic patients. The proposed solution is based on monitoring kits, with wireless Bluetooth (BT)/ Bluetooth low energy (BLE) sensors and a gateway (i.e., smartphone or tablet) connected to a web-based cloud application that collects and makes available the clinical information to the medical staff. The platform allows clinicians and practitioners to monitor at distance their patients, according to personalized treatment plans, and to act promptly in case of aggravations, reducing hospitalizations and improving patients’ quality of life.
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Ionov, M. V., N. E. Zvartau, A. O. Konradi, and E. V. Shlyakhto. "Blood pressure telemonitoring and remote counseling of hypertensive patients: pros and cons." Russian Journal of Cardiology 25, no. 10 (November 18, 2020): 4066. http://dx.doi.org/10.15829/1560-4071-2020-4066.
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Home blood pressure monitoring (HBPM) is strongly recommended by current guidelines as an effective out-of-office diagnostic and monitoring tool in patients with hypertension (HTN). However, there are personal, cultural, logistic difficulties owing to low effectiveness of HBPM. These put HBPM at a disadvantage in routine clinical practice. As such, telehealth solutions are of special interest nowadays, particularly blood pressure telemonitoring (BPTM) with or without remote counseling. BPTM might become something of digital assistant in the long-term patients’ follow-up and it fits well into the practice of continuity of medical care. The purpose of this review is to highlight not only the benefits of BPTM, but important discrepancies that may impede its widespread implementation in everyday clinical work. Critical comments address the lack of long-term, high-quality studies, absence of hard clinical outcomes and uncertainty on the best technical performance.
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Prime, Matthew Stewart, Chaohui Guo, and Francoise Blanchard. "The evaluation of a digital solution to improve the implementation of NCCN guidelines." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13542-e13542. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13542.
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e13542 Background: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are the most commonly used guidelines in the US and globally, and aim to improve and facilitate quality, effective, efficient and accessible cancer care. The guidelines are constantly updated, as such, the number, scope, length and detail have continuously increased, which has placed challenges for clinicians to remain up to date. Solutions are highly needed to improve the usability and implementation of the NCCN Guidelines. The NAVIFY Guidelines application was developed to provide digitised NCCN Guidelines, to facilitate navigation, and to enable the real-time capture of clinical decisions, including reasons for deviation from guidelines. We assessed the usability and performance of the NAVIFY Guidelines application. Methods: A 60-minute remote, semi-structured interview and task-based user test was undertaken with 10 medical oncologists from diverse geographies (6 US, 2 UK, 2 Germany). No participants had prior experience with the digital solution. Participants tested the experience of using the NAVIFY Guidelines application on their computer by completing tasks for one of 3 tumor types (breast, lung or AML). Screen and audio activities were recorded via Zoom. At the end of the test, participants were asked to rate the performance of NAVIFY Guidelines and complete statements on a System Usability Scale (SUS) questionnaire. Results: NAVIFY Guidelines SUS score was on average 82.3 (80.8 – 84.0), classified as A score (i.e., excellent; NPS [net promoter score]: promoter level). Success ratings across all 6 tasks was 86%, as shown in Table1. The overall impression from participants was largely positive. "Ease of use" was the most salient theme followed by “logical structure” and the “value of being integrated with patient data”. Participants identified that the key value of NAVIFY Guidelines was improving communication between the care team and improving the documentation of guideline adherence. 3 participants saw the potential in teaching settings. Conclusions: NAVIFY Guidelines has been developed to support clinicians to apply the latest clinical recommendations, improve the documentation of decisions and to facilitate better communication between specialists, and with patients. Preliminary research has shown that NAVIFY Guidelines has excellent usability (score A) & high NPS. Overall NAVIFY Guidelines was perceived as easy to use, valuable to improve communication between care teams and helpful at easing documentation burdens.
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Cashman, Colette, Sandra G. Downing, and Darren Russell. "Women’s experiences of accessing a medical termination of pregnancy through a Queensland regional sexual health service: a qualitative study." Sexual Health 18, no. 3 (2021): 232. http://dx.doi.org/10.1071/sh20220.
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Abstract Background An estimated 25% of Australian women will undergo induced abortion. Few studies have explored Australian women’s experiences of accessing medical termination of pregnancy (MToP). This study explored the experiences of women accessing MToP through a regional sexual health service in North Queensland. It aimed to determine the aspects of the process from seeking information about abortion to completion that worked well and to identify areas for improvement. Methods. Semi-structured telephone interviews with 11 women who accessed MTOP at Cairns Sexual Health Service (CSHS) were conducted. Interviews were recorded and transcribed verbatim. A deductive analysis approach was used to analyse the data. Results. Most women had little prior knowledge of MToP or access options and used the Internet to source information. Accessing MToP through a sexual health service was considered positive, non-judgemental, discrete and low-cost despite challenges of fitting in with appointment times and obtaining off-site ultrasound. GPs did not always provide referral; some women described experiences of stigma, discrimination and judgemental care during consultation and when obtaining ultrasounds. Concern for women living in more rural/remote areas was raised. Potential solutions including increased provision through rural general practitioners (GPs) and telehealth. Conclusion. Our study highlights the need for greater awareness of abortion options and access points among the community and healthcare providers. Access through sexual health clinics in regional settings is accepted; however, other options such as increased provision through rural GPs, primary health clinics, telehealth and nurse-led models of care could help overcome some of the barriers faced by rural and remote women.
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Ajami, Mcheick, and Mustapha. "A Pervasive Healthcare System for COPD Patients." Diagnostics 9, no. 4 (October 1, 2019): 135. http://dx.doi.org/10.3390/diagnostics9040135.
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Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems worldwide. Pervasive computing technology creates a new opportunity to redesign the traditional pattern of medical system. While many pervasive healthcare systems are currently found in the literature, there is little published research on the effectiveness of these paradigms in the medical context. This paper designs and validates a rule-based ontology framework for COPD patients. Unlike conventional systems, this work presents a new vision of telemedicine and remote care solutions that will promote individual self-management and autonomy for COPD patients through an advanced decision-making technique. Rules accuracy estimates were 89% for monitoring vital signs, and environmental factors, and 87% for nutrition facts, and physical activities.
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Fleet, R., C. Turgeon-Pelchat, F. K. Tounkara, J. Trottier, and J. Ouellet. "MP029: Mobilizing citizens, decision-makers and healthcare professionals to find solutions for improving emergency care in a remote Northern emergency department: a pilot study." CJEM 18, S1 (May 2016): S76. http://dx.doi.org/10.1017/cem.2016.170.
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Introduction: Our national study of rural EDs showed they have limited access to CT scans, ICU, and most specialities, while Level 1 and Level 2 trauma centers are on average 300 km away. However, equivalent information on Northern/remote EDs is scarce. Objectives: This pilot study aimed to: 1) describe local access to services; and 2) mobilize citizens, decision-makers and healthcare professionals to envisage solutions to improving emergency care in a Northern/remote hospital. Methods: This descriptive, qualitative study was performed in a northern ED in Quebec. The head nurse received a prevalidated questionnaire about access to specific services, ED and patient characteristics (Objective 1). Focus groups (5) and individual interviews (11) were conducted with citizens/patients, decision-makers, physicians, nurses, paramedics, pharmacists, and mental health workers (Objective 2). Descriptive statistics are reported as means, medians and percentages for Objective 1. A thematic analysis was conducted for Objective 2. Results: Objective 1: The city (population 2875) is a mining community 962 km from Quebec City. The 2010 annual ED census was 6692. Proportions of patient visits at triage levels 1-5 were 0.2%, 3.2%, 13.4%, 25.4% and 56.7% respectively. The ED was staffed by one physician and two nurses per shift. The hospital had 24/7 access to basic X-ray and laboratory but no local access to speciality care, ICU, CT scan or ultrasound, with nearest services 28 km away. Objective 2: Analysis of qualitative data highlighted concerns for personal safety; telecommunication problems; lengthy transports; limited access to in-service training, advanced imaging, and consultants; and recruitment and retention difficulties. Solutions included pre-hospital training, telemedicine, protocols, and networking with academic centers/medical schools, North Shore colleagues, and Labrador City Hospital. Conclusion: This isolated northern ED has limited access to services. Valuable qualitative information obtained enabled us to better understand the challenges and explore solutions towards improving Northern/remote emergency care.