Telemedicine journal and e-health : the official journal of the American Telemedicine Association
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Study Objective: Pain management in emergency department (ED) patients is challenging. Although both pharmacological and nonpharmacological therapies exist, they are often suboptimal. Immersive virtual reality (VR) uses distraction and possible other methods to reduce perceptions of pain. ⋯ Linear regression analysis revealed that patients with higher levels of health/quality of life (QOL) had larger mean drop per unit predictor for anger (0.29 [0.09], p = 0.0013) and anxiety (0.22 [0.07], p = 0.001). Conclusions: VR applications are feasible for ED patients and may lead to reduced pain, anger, and anxiety levels. These outcomes are affected by subject ethnicity, educational status, and health/QOL although independent of the chief complaint.
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Background: Little is known about the adoption of telehealth services among family medicine residency programs. Introduction: Using the 2015 Council of Academic Family Medicine Educational Research Alliance Program Directors Fall Survey section on telehealth, the authors investigated how residency programs used telehealth services during calendar year 2015. Materials and Methods: The authors used bivariate analyses to examine how family medicine residency program characteristics vary by telehealth usage. Services provided through telehealth (live interactive video or e-visits and store-and-forward services), clinical purpose of use, frequency of use, and number of patients served were characterized. Results: Surveys reached 461 Family Medicine Residency program directors, and 207 surveys were eligible for analysis (44.9% response rate). ⋯ Most of the telehealth users reported providing only e-visits or store-and-forward services (70.6%), with 78% of the 106 programs indicating that they served as the sending site for these services. Altogether 29% of users reported providing visits using live interactive video, with ∼63% indicating that they served as the originating site for these services (i.e., where the patient is located). Discussion: Increasing and enhancing the use of telehealth services in residency programs might help increase telehealth use in other settings. Conclusions: Although the majority of family medicine residency programs indicated that they used telehealth services, the reported use was limited, with those who did use telehealth services doing so infrequently.
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Background: Our study aims to demonstrate through implementation of telepsychiatry for child psychiatry patients evaluated in the pediatric emergency room (PedsER); we can reduce length of stay (LOS) and reduce factors contributing to physician burnout through reduction of on-call travel burden. Introduction: Telepsychiatry has increased access to health care using real-time interactive videoconferencing, allowing clinicians and patients in separate locations to have a meaningful clinical encounter. Use has increased over the past several years given cost reduction and need for psychiatric specialty services in under-resourced systems. ⋯ Factors such as telepsychiatry can improve work efficiency and lend time to activities outside of work, mitigating the onset of this challenging issue. Conclusions: Telepsychiatry was shown to be effective in reducing dwell time and improving on-call burden. This study also showed promise in our system for improving access to other forms of specialized care consultation in PedsER settings.
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Introduction: Anxiety and depression are harmful to individuals suffering from these disorders, their caregivers, and the economy. Remote delivery of psychotherapy has been established as a viable alternative to traditional in-person psychotherapy for treating anxiety and depression. However, literature comparing and evaluating the variety of remote delivery modalities of psychotherapy has not yet been integrated. ⋯ However, there is less evidence for video-delivered psychotherapy for anxiety and depression compared with telephone-administered and online-administered modalities. Despite this, overall, the efficacy and practical benefits of remote psychotherapy interventions in treating anxiety and depression across a diverse range of patient groups suggested that it is an appropriate alternative for those who cannot access in-person psychotherapy. Conclusions: Further research evaluating the efficacy and practical benefits of video-delivered psychotherapy for anxiety and depression is much needed for patients with limited access to in-person psychological care.
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Randomized Controlled Trial
Transoceanic Telementoring of Tube Thoracostomy Insertion: A Randomized Controlled Trial of Telementored Versus Unmentored Insertion of Tube Thoracostomy by Military Medical Technicians.
Background: Tension pneumothorax is a frequent cause of potentially preventable death. Tube thoracostomy (TT) can obviate death but is invasive and fraught with complications even in experienced hands. We assessed the utility of a remote international virtual network (RIVN) of specialized mentors to remotely guide military medical technicians (medics) using wireless informatics. Methods: Medics were randomized to insert TT in training mannequins (TraumaMan; Abacus ALS, Meadowbrook, Australia) supervised by RIVN or not. ⋯ RTM was subjectively associated with high levels of satisfaction and self-reported self-confidence. Continued controlled and critical evaluation and refinement of telemedical techniques should continue. Trial Registration: ID ISRCTN/77929274.