scholarly journals Physical rehabilitation using telemedicine

2007 ◽  
Vol 13 (5) ◽  
pp. 217-220 ◽  
Author(s):  
Trevor G Russell
Keyword(s):  
Single Case ◽  
Health Care Systems ◽  
Cost Benefit ◽  
Small Sample ◽  
Physical Rehabilitation ◽  
Rehabilitation Services ◽  
Speech Pathology ◽  
Large Patient ◽  
Care Systems ◽  
Potential Benefits

Telerehabilitation is the provision at a distance of rehabilitation services such as physiotherapy, speech pathology or occupational therapy. The primary aim is to provide equitable access to rehabilitation services. Broadly speaking, the technologies used for telemedicine-based physical rehabilitation can be classified as: (1) image-based telerehabilitation; (2) sensor-based telerehabilitation; and (3) virtual environments and virtual reality telerehabilitation. To date, much of the research has been technology focused, and has consisted of single case or small sample research designs. The next step is to demonstrate viable telerehabilitation services in real world environments using well controlled research methodologies with large patient cohorts. In addition, the broader issues of cost-benefit and cost-effectiveness require investigation. If this can be done, then the undoubted potential benefits of telerehabilitation, for both the patient and health-care systems, can be realized.

scholarly journals COVID-19: Rethinking the Lockdown Groupthink

2021 ◽  
Vol 9 ◽  
Author(s):  
Ari R. Joffe
Keyword(s):  
Public Health ◽  
High Risk ◽  
Cost Benefit Analysis ◽  
Health Care Systems ◽  
Herd Immunity ◽  
Cost Benefit ◽  
Risk Groups ◽  
School Closures ◽  
Trade Offs ◽  
Care Systems

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

Complementary, Alternative, and Integrative Medicine

2019 ◽  
Author(s):  
Helene M. Langevin
Keyword(s):  
Alternative Medicine ◽  
Health Care Systems ◽  
Academic Research ◽  
The United States ◽  
Evidence Base ◽  
Potential Harm ◽  
Therapeutic Massage ◽  
Care Systems ◽  
Potential Benefits ◽  
Alternative Sources

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Common CAM practices (e.g., acupuncture, meditation, and therapeutic massage) are gradually becoming incorporated into conventional care in response to patients looking to alternative sources for information and advice about health matters and increased understanding of various CAM methods through evidence-based testing. However, although the claims of some methods are supported with academic research, well-founded concerns remain in many popularized CAM practices regarding the lack of evidence and placebo effects. It is thus imperative for physicians to be comfortable in discussing CAM-related topics with patients and be able to appropriately and informatively guide them in a way that harnesses potential benefits and avoids potential harm. In this review, the major CAM therapies in the United States are examined, including the settings in which they are being used, evidence base status, and efficacy of some of the most commonly used modalities.  This review contains 5 figures, 21 tables, and 123 references. Keywords: Alternative medicine, complementary medicine, acupuncture, homeopathy, osteopathy, chiropractic, massage therapy, naturopathy

Complementary, Alternative, and Integrative Medicine

2019 ◽  
Author(s):  
Helene M. Langevin
Keyword(s):  
Alternative Medicine ◽  
Health Care Systems ◽  
Academic Research ◽  
The United States ◽  
Evidence Base ◽  
Potential Harm ◽  
Therapeutic Massage ◽  
Care Systems ◽  
Potential Benefits ◽  
Alternative Sources

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Common CAM practices (e.g., acupuncture, meditation, and therapeutic massage) are gradually becoming incorporated into conventional care in response to patients looking to alternative sources for information and advice about health matters and increased understanding of various CAM methods through evidence-based testing. However, although the claims of some methods are supported with academic research, well-founded concerns remain in many popularized CAM practices regarding the lack of evidence and placebo effects. It is thus imperative for physicians to be comfortable in discussing CAM-related topics with patients and be able to appropriately and informatively guide them in a way that harnesses potential benefits and avoids potential harm. In this review, the major CAM therapies in the United States are examined, including the settings in which they are being used, evidence base status, and efficacy of some of the most commonly used modalities.  This review contains 5 figures, 21 tables, and 123 references. Keywords: Alternative medicine, complementary medicine, acupuncture, homeopathy, osteopathy, chiropractic, massage therapy, naturopathy

Complementary, Alternative, and Integrative Medicine

2019 ◽  
Author(s):  
Helene M. Langevin
Keyword(s):  
Alternative Medicine ◽  
Health Care Systems ◽  
Academic Research ◽  
The United States ◽  
Evidence Base ◽  
Potential Harm ◽  
Therapeutic Massage ◽  
Care Systems ◽  
Potential Benefits ◽  
Alternative Sources

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Common CAM practices (e.g., acupuncture, meditation, and therapeutic massage) are gradually becoming incorporated into conventional care in response to patients looking to alternative sources for information and advice about health matters and increased understanding of various CAM methods through evidence-based testing. However, although the claims of some methods are supported with academic research, well-founded concerns remain in many popularized CAM practices regarding the lack of evidence and placebo effects. It is thus imperative for physicians to be comfortable in discussing CAM-related topics with patients and be able to appropriately and informatively guide them in a way that harnesses potential benefits and avoids potential harm. In this review, the major CAM therapies in the United States are examined, including the settings in which they are being used, evidence base status, and efficacy of some of the most commonly used modalities.  This review contains 5 figures, 21 tables, and 123 references. Keywords: Alternative medicine, complementary medicine, acupuncture, homeopathy, osteopathy, chiropractic, massage therapy, naturopathy

Complementary, Alternative, and Integrative Medicine

2019 ◽  
Author(s):  
Helene M. Langevin
Keyword(s):  
Alternative Medicine ◽  
Health Care Systems ◽  
Academic Research ◽  
The United States ◽  
Evidence Base ◽  
Potential Harm ◽  
Therapeutic Massage ◽  
Care Systems ◽  
Potential Benefits ◽  
Alternative Sources

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Common CAM practices (e.g., acupuncture, meditation, and therapeutic massage) are gradually becoming incorporated into conventional care in response to patients looking to alternative sources for information and advice about health matters and increased understanding of various CAM methods through evidence-based testing. However, although the claims of some methods are supported with academic research, well-founded concerns remain in many popularized CAM practices regarding the lack of evidence and placebo effects. It is thus imperative for physicians to be comfortable in discussing CAM-related topics with patients and be able to appropriately and informatively guide them in a way that harnesses potential benefits and avoids potential harm. In this review, the major CAM therapies in the United States are examined, including the settings in which they are being used, evidence base status, and efficacy of some of the most commonly used modalities.  This review contains 5 figures, 21 tables, and 123 references. Keywords: Alternative medicine, complementary medicine, acupuncture, homeopathy, osteopathy, chiropractic, massage therapy, naturopathy

scholarly journals COVID-19: Rethinking the Lockdown Groupthink

2020 ◽  
Author(s):  
Ari Joffe
Keyword(s):  
Public Health ◽  
Cost Benefit Analysis ◽  
Health Care Systems ◽  
Herd Immunity ◽  
Cost Benefit ◽  
Risk Groups ◽  
Health Goal ◽  
Public Health Goal ◽  
Care Systems ◽  
Work Education

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population’s movements, work, education, gatherings, and general activities in attempt to ‘flatten the curve’ of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. First, I explain how the initial modeling predictions induced fear and crowd-effects [i.e., groupthink]. Second, I summarize important information that has emerged relevant to the modeling, including about infection fatality rate, high-risk groups, herd immunity thresholds, and exit strategies. Third, I describe how reality started sinking in, with information on significant collateral damage due to the response to the pandemic, and information placing the number of deaths in context and perspective. Fourth, I present a cost-benefit analysis of the response to COVID-19 that finds lockdowns are far more harmful to public health than COVID-19 can be. I close with some suggestions for moving forward.

scholarly journals Paying for improvements in quality: recent experience in the NHS in England

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Rachel Meacock ◽  
Søren Kristensen ◽  
Matt Sutton
Keyword(s):  
Financial Incentives ◽  
Best Practice ◽  
Pay For Performance ◽  
Financial Incentive ◽  
Health Care Systems ◽  
Cost Effective ◽  
Quality Improvement Initiative ◽  
Recent Experience ◽  
Large Patient ◽  
Care Systems

There is a long-term international trend towards linking payments more closely to providers’ performance. The US and England have been at the forefront of the design and introduction of such pay-for-performance (P4P) schemes. England’s experience is, however, likely to have greater salience for the Nordic countries’ health care systems due to the publicly funded finance structure. We review the development of five of England’s major schemes and summarise the available evidence on their impacts. These schemes are: the Quality and Outcomes Framework (QOF); Advancing Quality; the Commissioning for Quality and Innovation (CQUIN) framework; Best Practice Tariffs; and the newest ‘non-payment’ policies. Much of the evidence is limited by the non-experimental way in which the schemes have been introduced, with limited data available prior to the introduction of the schemes and no experimentally unexposed providers to serve as controls. Nonetheless, the existing evidence suggests that P4P can result in modest short-term improvements in the incentivised aspects of performance. There is little evidence of effort diversion, yet some to suggest positive spillovers of these schemes onto non-incentivised aspects of performance. While there is some evidence of gaming and inequitable consequences, these do not appear to be widespread. The gains that can accrue across large patient populations as a result of relatively small financial incentives mean that P4P schemes can be cost-effective. P4P programmes are likely to be most effective when introduced as a supporting part to a wider quality improvement initiative, and when results are published to encourage a reputational as well as a financial incentive for improvement. Though the accumulation of evidence to support P4P has not been systematic or especially robust, it remains a popular policy tool with decision-makers in England, with its reach set to increase further in the future.

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