Journal of medical Internet research
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J. Med. Internet Res. · Sep 2011
Institutionalizing telemedicine applications: the challenge of legitimizing decision-making.
During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. ⋯ We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.
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J. Med. Internet Res. · May 2011
Comparative StudyA smartphone client-server teleradiology system for primary diagnosis of acute stroke.
Recent advances in the treatment of acute ischemic stroke have made rapid acquisition, visualization, and interpretation of images a key factor for positive patient outcomes. We have developed a new teleradiology system based on a client-server architecture that enables rapid access to interactive advanced 2-D and 3-D visualization on a current generation smartphone device (Apple iPhone or iPod Touch, or an Android phone) without requiring patient image data to be stored on the device. Instead, a server loads and renders the patient images, then transmits a rendered frame to the remote device. ⋯ The smartphone client-server teleradiology system appears promising and may have the potential to allow urgent management decisions in acute stroke. However, this study was retrospective, involved relatively few patient studies, and only two readers. Generalizing conclusions about its clinical utility, especially in other diagnostic use cases, should not be made until additional studies are performed.
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J. Med. Internet Res. · Apr 2011
Randomized Controlled TrialEffects of a multilingual information website intervention on the levels of depression literacy and depression-related stigma in Greek-born and Italian-born immigrants living in Australia: a randomized controlled trial.
Little is known about the efficacy of Internet-based information interventions in increasing depression literacy or reducing depression stigma and depressive symptoms in people from non-English-speaking backgrounds. ⋯ Current results suggested that the Internet may be a feasible and effective means for increasing depression knowledge and decreasing personal stigma in non-English-speaking immigrant populations residing in English-speaking countries. The lack of change in perceived stigma in this trial is consistent with results in other trials examining online depression stigma interventions in English-speaking groups.
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J. Med. Internet Res. · Feb 2011
Comparative StudyThe use of physician-patient email: a follow-up examination of adoption and best-practice adherence 2005-2008.
Improved communication from physician- patient emailing is an important element of patient centeredness. Physician-patient email use has been low; and previous data from Florida suggest that physicians who email with patients rarely implement best-practice guidelines designed to protect physicians and patients. ⋯ Email use between physicians and patients has changed little between 2005 and 2008. However, future physician interest in using email with patients has decreased. More troubling is the decrease in adherence to best practices designed to protect physicians and patients when using email. Policy makers wanting to harness the potential benefits of physician-patient email should devise plans to encourage adherence to best practices. These plans should also educate physicians on the existence of best practices and methods to incorporate these guidelines into routine workflows.
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J. Med. Internet Res. · Jan 2011
Protected health information on social networking sites: ethical and legal considerations.
Social networking site use is increasingly common among emerging medical professionals, with medical schools even reporting disciplinary student expulsion. Medical professionals who use social networking sites have unique responsibilities since their postings could violate patient privacy. However, it is unknown whether students and residents portray protected health information and under what circumstances or contexts. ⋯ While students and residents in this study are posting photographs that are potentially violations of patient privacy, they only seem to make this lapse in the setting of medical mission trips. Trainees need to learn to equate standards of patient privacy in all medical contexts using both legal and ethical arguments to maintain the highest professional principles. We propose three practical guidelines. First, there should be a legal resource for physicians traveling on medical mission trips such as an online list of local laws, or a telephone legal contact. Second, institutions that organize medical mission trips should plan an ethics seminar prior the departure on any trip since the legal and ethical implications may not be intuitive. Finally, at minimum, traveling physicians should apply the strictest legal precedent to any situation.