The hospital telemedicine TELEMED database: Providing information on evidence-based telemedicine services to hospital managers and healthcare professionals

Background Increased use of telemedicine in the healthcare system is a political goal in Denmark. Although the number of hospital patients using interventions such as the video consultation has increased in recent years only a small proportion of the outpatient and inpatient visits involve telemedicine. The TELEMED database ( https://telemedicine.cimt.dk/ ) has been launched at the Center for Innovative Medical Technologies in Denmark to ensure that hospital managers and healthcare professionals have access to information about telemedicine services and their effectiveness. This article describes the development and the content of the TELEMED database. Methods A structured literature search was made in the PubMed Database for randomised controlled trials or observational studies with a control group that investigated the effect of telemedicine interventions for hospital patients. Data were extracted from each article on the clinical effectiveness, patient perceptions, economic effects and implementation challenges. As the database should only provide inspiration to healthcare professionals regarding possibilities for use of telemedicine, the risk of bias in the studies was not assessed. Results The literature search resulted in 2825 hits. Based on full text assessment, 331 articles were included for data extraction and assessment. These articles present telemedicine services used in 22 different medical specialities. Forty-eight percent of the studies found a positive, statistically significant clinical effect, while 47% showed no statistically significant difference. In 48% of the studies, patients’ experiences were examined and of these 68% found positive patient experiences. Fifty-four percent of the articles included information on the economic effects and, of these, 51% found reduction in healthcare utilization. In the majority of studies between two and four types of implementation challenges were found. Conclusions and recommendations: The TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services for use by hospital managers and health professionals, who whish to to implement telemedicine. The database is freely available and expected to be continuously improved and broadened over time.

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Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children

Diagnostics ◽

10.3390/diagnostics10110935 ◽

2020 ◽

Vol 10 (11) ◽

pp. 935

Author(s):

Joanna Jaworska ◽

Anna Komorowska-Piotrowska ◽

Andrzej Pomiećko ◽

Jakub Wiśniewski ◽

Mariusz Woźniak ◽

...

Keyword(s):

Literature Review ◽

Delphi Method ◽

Literature Search ◽

Lung Ultrasound ◽

Point Of Care ◽

Evidence Based ◽

Assessment Development ◽

Pubmed Database ◽

On Line

This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)—adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging.

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A single centre study assessing the effectiveness of active monitoring, using telemedicine, in preventing heart failure admissions and death in a primary care population with systolic heart failure.

10.21203/rs.3.rs-24702/v1 ◽

2020 ◽

Author(s):

Nicola Bowers ◽

Ben Lodge ◽

Charlie Clifford ◽

Ricardo Pio Monti ◽

Marc Phippen ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Active Group ◽

Control Group ◽

P Value ◽

Evidence Based ◽

Significant Difference

Abstract BackgroundPatients with systolic heart failure are at high risk of admission to hospital and death. This can be reduced by ensuring that they are receiving all evidence-based heart failure medications and by detecting early signs of deterioration in their condition.MethodsWe recruited 209 primary care patients with echocardiographically proven left ventricular systolic dysfunction (ejection fraction < 40%). 84 patients consented to be actively monitored by the heart failure team using telemedicine. 125 patients consented to receiving usual care but allowing access to their medical records. The primary end-point was cardiovascular death or admission to hospital for heart failure at 1 year. Secondary end-points included the prescription of evidence-based heart failure medications and patient satisfaction at the end of the study.ResultsThere was no difference in the mortality rate between the groups (6.02% in the active group and 5.56% in control). There was a significant difference in hospital admission (10.84% in the active group and 1.59% in control; p-value of 0.0078). At the end of the study, in the active group v control group, 92% v 52% of patients were on a beta-blocker, 92% v 48% on ACE-I/ARB, and 60% v 30% on an MRA. There were no differences in the final doses achieved.ConclusionsActive telemonitoring in an elderly population with systolic heart failure did not reduce cardiovascular mortality or admission to hospital for heart failure over the 1 year of the study. It did result in more patients receiving evidence based heart failure medications.Trial registrationThis trial received ethical approval from the Health Research Authority London-City Road and Hampstead Research Ethics Committee (REC Reference: 16/L0/0070, IRAS project ID: 173818). The ClinicalTrials.gov Identifier number is: NCT04371731. This trial was retrospectively registered on 30/4/2020 and this study adheres to CONSORT guidelines

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Assessing the Effect of Virtual Education on Information Literacy Competency for Evidence-based Practice of the Undergraduate Nursing Students

10.21203/rs.3.rs-75619/v1 ◽

2020 ◽

Author(s):

Maryam Shamsaee ◽

Parvin Magholian ◽

Leila Ahmadian ◽

Jamileh Farokhzadian ◽

Farhad Fatehi

Keyword(s):

Nursing Students ◽

Information Literacy ◽

Information Seeking ◽

Search Strategy ◽

Evidence Based Practice ◽

Intervention Group ◽

Virtual Education ◽

Control Group ◽

Evidence Based ◽

Significant Difference

Abstract Background: Information literacy is one of the important prerequisites for an effective evidence-based practice (EBP). Therefore, it is necessary to pay attention to curricular development and use new educational methods such as virtual education to strengthen information literacy competency in nursing students. This study investigated the effect of virtual education on nursing students’ information literacy competency for EBP.Methods: This interventional study was performed with two groups of intervention and control and a pretest and posttest design. Seventy-nine nursing students were selected and assigned into the intervention or control groups by random sampling. Virtual education of the information literacy was uploaded on a website in the form of seven modules delivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used to collect data before and one month after the virtual education.Results: The results showed no significant difference between the control and intervention groups in all dimensions of information literacy competency in the pre-test stage. In the post-test, the virtual education improved some dimensions of information literacy competency for EBP including information seeking skills (t= 3.144, p= 0.002) and knowledge about search operators (t= 39.84, p= 0.001) in the intervention groups compared with the control group. Virtual education of the information literacy did not have any significant effect on nursing students in terms of use of different information resources and development of search strategy and frequency of the correct answer to the question of formulating a search strategy in intervention group (p>0.05). Conclusion: Virtual education had a significant effect some demotions of the information literacy competency for EBP in nursing students. Nursing professors and educators are recommended to train information literacy by integrating virtual and face-to-face education. Researchers should also examine the effectiveness of these interventions, their barriers and facilitators.

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Medical students as adverse drug event managers, learning about side effects while improving their reporting in clinical practice

Naunyn-Schmiedeberg s Archives of Pharmacology ◽

10.1007/s00210-021-02060-y ◽

2021 ◽

Author(s):

M. Reumerman ◽

J. Tichelaar ◽

M.C. Richir ◽

M.A. van Agtmael

Keyword(s):

Medical Students ◽

Adverse Drug Event ◽

Healthcare Professionals ◽

Intervention Group ◽

Drug Event ◽

Control Group ◽

Before And After ◽

Hospital Patients ◽

Almost All ◽

Event Managers

AbstractManaging adverse drug reactions (ADRs) is a challenge, especially because most healthcare professionals are insufficiently trained for this task. Since context-based clinical pharmacovigilance training has proven effective, we assessed the feasibility and effect of a creating a team of Junior-Adverse Drug Event Managers (J-ADEMs). The J-ADEM team consisted of medical students (1st–6th year) tasked with managing and reporting ADRs in hospitalized patients. Feasibility was evaluated using questionnaires. Student competence in reporting ADRs was evaluated using a case-control design and questionnaires before and after J-ADEM program participation. From Augustus 2018 to Augustus 2019, 41 students participated in a J-ADEM team and screened 136 patients and submitted 65 ADRs reports to the Netherlands Pharmacovigilance Center Lareb. Almost all patients (n = 61) found it important that “their” ADR was reported, and all (n = 62) patients felt they were taken seriously by the J-ADEM team. Although attending physicians agreed that the ADRs should have been reported, they did not do so themselves mainly because of a “lack of knowledge and attitudes” (50%) and “excuses made by healthcare professionals” (49%). J-ADEM team students were significantly more competent than control students in managing ADRs and correctly applying all steps for diagnosing ADRs (control group 38.5% vs. intervention group 83.3%, p < 0.001). The J-ADEM team is a feasible approach for detecting and managing ADRs in hospital. Patients were satisfied with the care provided, physicians were supported in their ADR reporting obligations, and students acquired relevant basic and clinical pharmacovigilance skills and knowledge, making it a win-win-win intervention.

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Interactive, Web-based Information Skills Tutorial Well Received by Graduate Students in Health and Social Care Research

Evidence Based Library and Information Practice ◽

10.18438/b81p4g ◽

2007 ◽

Vol 2 (1) ◽

pp. 144

Author(s):

Marcy L. Brown

Keyword(s):

Graduate Students ◽

Literature Search ◽

Evidence Based Practice ◽

Evidence Based ◽

Web Based ◽

Search Results ◽

Ovid Medline ◽

Significant Difference ◽

Information Skills ◽

First Session

Objective – To determine whether a newly developed interactive, Web-based tutorial on OVID MEDLINE was acceptable to students, and to identify whether the tutorial improved students’ information skills. Design – Objective and subjective assessment within a small cohort study. Setting – An evidence based practice module within a Master's in Research (MRes) program at the University of Salford, UK. Subjects – A total of 13 usable evaluations were received from graduate students who took an evidence based practice module as part of their MRes coursework. Methods – Information skills (IS) were taught in weeks two and three of a 12-week module on evidence based practice. Each of the two IS sessions lasted approximately three hours. At the beginning of the first session, baseline skills were assessed by asking the students to perform a literature search on either the effectiveness of nursing interventions for smoking cessation, or the effectiveness of rehabilitation after stroke. The OVID MEDLINE tutorial was introduced at the first session, and guided hands-on practice was offered. Homework was given, and between-session use of the tutorial was encouraged. At the end of the second session, students were asked to complete another search in order to assess short-term impact of the tutorial. Both sets of search results were scored using a checklist rubric that looked for Boolean operators, use of MeSH terms, use of limits, number and relevance of references, and other assessment criteria. The rubric was a modified version of a tool published by Rosenberg et al. The tutorial remained available throughout the 12-week module, at which time a systematic literature review was assigned in order to measure longer-term impact. As an additional subjective measurement, a questionnaire regarding the information skills sessions and tutorial was given at the end of the second IS session (week 3). Main Results – Thirteen objective assessments (literature search results) were returned and usable. According to the scored pre-training search, two students could use multiple search techniques correctly and in a systematic manner. The post-training search results indicated that six students could systematically search, which is triple the original number. At the end of the 12-week EBP module, that number had increased to seven students. This demonstrated a significant difference between pre-training and post-training scores (P = 0.040), as well as a significant difference between post-training and post-module scores (P = 0.008). Eight of the subjective questionnaires, which measured perceptions on a five-point scale, were returned. All responses indicated that “the sessions were useful, well structured and interesting” (83). Seven of the eight were entirely positive, either agreeing or strongly agreeing with each of the eleven questions about things such as search skill improvement, information skills knowledge, and confidence in searching. The small sample size made it difficult to generalise these results. Ad hoc comments varied and sometimes contradicted each other, such as one request for simpler tutorial instructions in contrast with the comment that the “tutorial ‘couldn’t be simpler’” (84). Conclusions – Students rated the IS sessions positively, including the Web-based MEDLINE tutorial. Search skills improved, as was demonstrated by comparing pre-training search results with post-training and end-of-module searches. Continuing feedback indicates that the tutorial is used within other departments and programs as a standalone tutorial.

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The Preschool Stuttering Screen for Health Care Professionals

Perspectives on Fluency and Fluency Disorders ◽

10.1044/ffd21.2.59 ◽

2011 ◽

Vol 21 (2) ◽

pp. 59-62

Author(s):

Joseph Donaher ◽

Christina Deery ◽

Sarah Vogel

Keyword(s):

Risk Factors ◽

Health Care ◽

Differential Diagnosis ◽

Preschool Children ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Evidence Based ◽

Developmental Profile

Healthcare professionals require a thorough understanding of stuttering since they frequently play an important role in the identification and differential diagnosis of stuttering for preschool children. This paper introduces The Preschool Stuttering Screen for Healthcare Professionals (PSSHP) which highlights risk factors identified in the literature as being associated with persistent stuttering. By integrating the results of the checklist with a child’s developmental profile, healthcare professionals can make better-informed, evidence-based decisions for their patients.

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Levels of Prothrombin Fragment F1+2 in Patients with Hyperhomocysteinemia and a History of Venous Thromboembolism

Thrombosis and Haemostasis ◽

10.1055/s-0038-1665405 ◽

1997 ◽

Vol 78 (05) ◽

pp. 1327-1331 ◽

Cited By ~ 21

Author(s):

Paul A Kyrle ◽

Andreas Stümpflen ◽

Mirko Hirschl ◽

Christine Bialonczyk ◽

Kurt Herkner ◽

...

Keyword(s):

Venous Thromboembolism ◽

Thrombin Generation ◽

Oral Anticoagulant Therapy ◽

Oral Anticoagulants ◽

Control Group ◽

Prothrombin Fragment ◽

Hemostatic System ◽

Significant Difference ◽

System Activation ◽

One Year

SummaryIncreased thrombin generation occurs in many individuals with inherited defects in the antithrombin or protein C anticoagulant pathways and is also seen in patients with thrombosis without a defined clotting abnormality. Hyperhomocysteinemia (H-HC) is an important risk factor of venous thromboembolism (VTE). We prospectively followed 48 patients with H-HC (median age 62 years, range 26-83; 18 males) and 183 patients (median age 50 years, range 18-85; 83 males) without H-HC for a period of up to one year. Prothrombin fragment Fl+2 (Fl+2) was determined in the patient’s plasma as a measure of thrombin generation during and at several time points after discontinuation of secondary thromboprophylaxis with oral anticoagulants. While on anticoagulants, patients with H-HC had significantly higher Fl+2 levels than patients without H-HC (mean 0.52 ± 0.49 nmol/1, median 0.4, range 0.2-2.8, versus 0.36 ± 0.2 nmol/1, median 0.3, range 0.1-2.1; p = 0.02). Three weeks and 3,6,9 and 12 months after discontinuation of oral anticoagulants, up to 20% of the patients with H-HC and 5 to 6% without H-HC had higher Fl+2 levels than a corresponding age- and sex-matched control group. 16% of the patients with H-HC and 4% of the patients without H-HC had either Fl+2 levels above the upper limit of normal controls at least at 2 occasions or (an) elevated Fl+2 level(s) followed by recurrent VTE. No statistical significant difference in the Fl+2 levels was seen between patients with and without H-HC. We conclude that a permanent hemostatic system activation is detectable in a proportion of patients with H-HC after discontinuation of oral anticoagulant therapy following VTE. Furthermore, secondary thromboprophylaxis with conventional doses of oral anticoagulants may not be sufficient to suppress hemostatic system activation in patients with H-HC.

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Viscosity and Red Cell Deformity in Arterial Disease

10.1055/s-0038-1665789 ◽

1979 ◽

Author(s):

G Cella ◽

H de Haas ◽

M Rampling ◽

V Kakkar

Keyword(s):

Vascular Disease ◽

Blood Viscosity ◽

Whole Blood ◽

Arterial Disease ◽

Plasma Viscosity ◽

Control Group ◽

Fibrinogen Concentration ◽

Red Cell ◽

Whole Blood Viscosity ◽

Significant Difference

Haemorrheological factors have been shown to be affected in many kings of vascular disease. The present study was undertaken to correlate these factors in normal subjects and patients suffering from peripheral arterial disease. Twenty-two patients were investigated; they had moderate or severe intermittent claudication, extent of disease being confirmed by aorto-arteriography and ankle-systolic pressure studies. Twenty-five controls with no symptoms or signs of arterial disease were selected with comparable age and sex distribution. Whole blood viscosity was measured at shear rates of 230 secs-1 and 23 secs-lat 37°c using a Wells Brookfield cone plate microvisco meter. Plasma viscosity was also measured in an identical manner. Erythrocyte flexibility was measured by centrifuge technique and fibrinogen concentration as well as haematocrit by standard techniques. The fibrinogen concentration appeared to be the only significant parameter; the mean concentration in patients with peripheral vascular disease of 463 ± 73mg/l00ml in the control group ( < 0.05). Although whole blood viscosity was high in patients, when corrected to a common haematocrit, there was no significant difference between patients and controls. The same megative correlation was found for plasma viscosity. The red cell flexibility was found to be increased in patients as compared to the control group, but this effect appeared to be simply proportional to the fibrinogen concentration.

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Is perioperative antibiotic necessary in straightforward implant placement procedures?

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00282 ◽

2020 ◽

Author(s):

Elçin Bedeloğlu ◽

Mustafa Yalçın ◽

Cenker Zeki Koyuncuoğlu

Keyword(s):

Clavulanic Acid ◽

Dental Implant ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Implant Failure ◽

Control Group ◽

Implant Placement ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p >0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p <0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

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PENGARUH MODEL PEMBELAJARAN PROBING PROMPTING BERBANTUAN MULTIMEDIA TERHADAP HASIL BELAJAR IPA

Jurnal Imiah Pendidikan dan Pembelajaran ◽

10.23887/jipp.v2i3.16232 ◽

2018 ◽

Vol 2 (3) ◽

pp. 336

Author(s):

Ni Pt Rasni Karwati ◽

Km Ngurah Wiyasa ◽

I Kt Ardana

Keyword(s):

Elementary School ◽

Elementary Schools ◽

Science Learning ◽

Learning Model ◽

Test Method ◽

Fifth Grade ◽

Control Group ◽

Fifth Grade Students ◽

School Year ◽

Significant Difference

This research aims to determine the significance of the difference in science learning results between the group of fifth-grade students in Gugus I Elementary Schools, North Kuta District, in the school year of 2017/2018, that take lessons with the multimedia-assisted probing-prompting learning model and the group of students that take lessons with the conventional learning. The design of this research is a quasi-experimental research with the nonequivalent control group design. The population of this research are all the fifth-grade students of Gugus I Elementary Schools in North Kuta District that still implement the KTSP, which consists of 10 classes with a total of 339 students. The sampling is conducted using the random sampling technique. The sample in this research are the students of class VB in SD (Elementary School) No.7 Dalung, with 36 students as the experiment group and the students of class VB in SD No.4 Dalung with 28 students as the control group. The data collection is conducted using the test method in the form of the multiple choice objective test. The science learning results are analyzed using the t-test. Based on the average the experiment groups =80,89 > the control group =72,85, which means that the multimedia-assisted probing-prompting learning model has an influence on the science learning result. Based on the hypothesis test, tvalues =4,517> ttable =2,000, with dk=62 and a significance level of 5%. Based on the test criteria, H0 is rejected and Ha is accepted. Thus, it can be interpreted there is a significant difference the science learning result between the group of students that were taught using the multimedia-assisted probing-prompting learning model and the students that were taught using the conventional learning. It can be concluded that the the multimedia-assisted probing-prompting learning model has an influence on the science learning result of the fifth-grade students in Gugus I Elementary School, North Kuta District, in the school year of 2017/2018. Keywords : probing prompting, multimedia, science learning result

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