Validating standardized acquisition of digital dermatologic images for use in the national health and nutrition examination survey.
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Female↗
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Digital bridges need concrete foundations: lessons from the Health InterNetwork India.
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Delivery of Health Care↗
More versatile digital cameras: a useful tool for those in health promotion and education.
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Decision Making, Organizational↗
Maternity care in the bush: using the Internet to provide educational resources to isolated practitioners.
INTRODUCTION: Telecommunication infrastructure is being rolled out across Australia with little knowledge about the uptake by health professionals in remote areas. Computer mediated communication has the potential to offer educational support to remote practitioners; however, the viability of this is uncertain. The aim of this research was to establish and evaluate an internet-based resource library targeting the needs of remote area maternity service providers. METHODS: A participatory action research (PAR) approach was used to involve remote area maternity service providers in the Northern Territory of Australia. The evaluation of the resource library included its performance on reach, agency affiliation and richness, factors identified to affect the sustainability and utility of such a resource. An additional component of the evaluation framework documented the facilitators of and barriers to using an information technology strategy to reduce the isolation of remote area maternity service providers. RESULTS: Overall, the evaluation of the resource library was very positive. Feedback from the PAR team described the resource as contemporary, useful and relevant. Practitioners in leadership and education positions identified the resource library as a valuable tool that enabled them to access professional knowledge, which could then be distributed to any remote-based practitioners, who experienced difficulties with access themselves. The evaluation found that logistical issues were a major problem for potential users. Hardware inadequacies, access difficulties, unfamiliarity with computers, and a lack of management support for nursing and midwifery staff to utilise the resource, were all identified barriers. Remote-area practitioners highlighted education, training and 24 hour support as key priorities. CONCLUSIONS: Results from this research clearly showed the potential of web-based resources to offer educational support through access to clinical guidelines, reports and research, thus reducing the isolation of the remote practitioner. However, it highlighted the need for clear strategic direction at policy level, whereby all stakeholders unite to synchronise the rollout of information technology infrastructure with the necessary education, training and support as an integral component.
Attitude of Health Personnel↗
Purposes of health identification cards in belgium.
Although other alternatives might exist, identification cards have been chosen as an acceptable and adequate tool to be used to identify patients and health professionals.They are planned for a digital signature and for access to electronic health records as well as for health information exchange and for databases querying. Local applications might exist independently, but the Federal State has now developed BeHealth, a platform for health professionals, social security personnel as well as the great public to facilitate a common access to some health data. Security conditions have been defined and are described.
Belgium↗
AHEC library services: from circuit rider to virtual librarian. Area Health Education Centers.
The North Carolina Area Health Education Centers Library and Information Services (NC AHEC LIS) Network provides library outreach services to rural health care providers in all nine AHEC regions of North Carolina. Over the last twenty-five years, the AHEC and university-based librarians have collaborated to create a model program for support of community-based clinical education and information access for rural health care providers. Through several collaborative projects, they have supported Internet access for rural health clinics. The NC AHEC Digital Library--under development by NC AHEC, University of North Carolina at Chapel Hill, Duke University, East Carolina University, and Wake Forest University--will further extend access to electronic biomedical information and resources to health professionals in a statewide digital library.
Area Health Education Centers↗
Citizen centered health and lifestyle management via interactive TV: The PANACEIA-ITV health system.
In the context of an IST European project with acronym PANACEIA-ITV, a home care service provisioning system is described, based on interactive TV technology. The purpose of PANACEIA-ITV is to facilitate essential lifestyle changes and to promote compliance with scientifically sound self-care recommendations, through the application of interactive digital television for family health maintenance. The means to achieve these goals are based on technological, health services and business models. PANACEIA-ITV is looking for communication of monitoring micro-devices with I-TV set-top-boxes using infrared technology, and embodiment of analogous H/W and S/W in the I-TV set-top-boxes. Intelligent agents are used to regulate data flow, user queries as well as service provisions from and to the household through the satellite digital platform, the portal and the back-end decision support mechanisms, using predominantly the Active Service Provision (ASP) model. Moreover, interactive digital TV services are developed for the delivery of health care in the home care environment.
Computer Systems↗
A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy.
The objective of this study was to compare, using a 12-month time frame, the cost-effectiveness of a non-mydriatic digital tele-ophthalmology system (Joslin Vision Network) versus traditional clinic-based ophthalmoscopy examinations with pupil dilation to detect proliferative diabetic retinopathy and its consequences. Decision analysis techniques, including Monte Carlo simulation, were used to model the use of the Joslin Vision Network versus conventional clinic-based ophthalmoscopy among the entire diabetic populations served by the Indian Health Service, the Department of Veterans Affairs, and the active duty Department of Defense. The economic perspective analyzed was that of each federal agency. Data sources for costs and outcomes included the published literature, epidemiologic data, administrative data, market prices, and expert opinion. Outcome measures included the number of true positive cases of proliferative diabetic retinopathy detected, the number of patients treated with panretinal laser photocoagulation, and the number of cases of severe vision loss averted. In the base-case analyses, the Joslin Vision Network was the dominant strategy in all but two of the nine modeled scenarios, meaning that it was both less costly and more effective. In the active duty Department of Defense population, the Joslin Vision Network would be more effective but cost an extra 1,618 dollars per additional patient treated with panretinal laser photo-coagulation and an additional 13,748 dollars per severe vision loss event averted. Based on our economic model, the Joslin Vision Network has the potential to be more effective than clinic-based ophthalmoscopy for detecting proliferative diabetic retinopathy and averting cases of severe vision loss, and may do so at lower cost.
Cost-Benefit Analysis↗
Information and communication technologies and health in low income countries: the potential and the constraints.
This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.
Delivery of Health Care↗
Digital rectal examination to screen for prostatic cancer.
In a prospectively designed study 480 men, aged 45-67 years of age having routine medical examinations as part of the Occupational Health Service Program, underwent digital rectal examination to screen for early prostatic cancer. 26 men were referred to the Urology Service of the Aust-Agder Central Hospital for repeat examinations and further diagnostic procedures. Biopsies were performed on 16 patients, and transrectal ultrasound examination on 9. One patient was found to have prostate cancer. The value of an organized screening program for the detection of early prostatic cancer still seems to be under discussion.
Aged↗
Health benefits in 2004: four years of double-digit premium increases take their toll on coverage.
This paper reports changes in employer-based insurance during the past year and since 2001. From spring 2003 to spring 2004, premiums increased 11.2 percent (compared with 13.9 percent last year). Since 2000, premiums have increased 59 percent. Since 2001, employee contributions have grown by 57 percent for single coverage and 49 percent for family coverage, and the percentage of workers covered by their own employer's health plan has fallen from 65 percent in 2001 to 61 percent in 2004. The worst of the current round of premium inflation appears to be over, but employers plan to increase employee cost sharing next year [corrected]
Health Benefit Plans, Employee↗
Tele-Oncology in the Post-Pandemic Era: Clinical Integration, Access Disparities and Medico-Legal Accountability.
PURPOSE OF THE REVIEW: Tele-health has evolved from a marginal tool confined to rural populations and selected follow-up programs into a structurally integrated component of modern cancer care. Prior to COVID-19, its adoption was constrained by regulatory fragmentation, non-uniform reimbursement, and licensure barriers. This narrative review evaluates the evolutionary integration of tele-health in oncology post-COVID-19, examines digital disparities across patient populations, and addresses the medico-legal implications of this integration, with the objective of providing a comprehensive and clinically actionable framework for the governance of virtual oncology care. RECENT FINDINGS: The pandemic acted as a global catalyst, driving telehealth to over 50% of oncology outpatient encounters in some settings, before stabilising post-pandemic at approximately 10-20% of consultations within hybrid care models. Evidence supports meaningful clinical benefits - improved access to specialist services, reduced travel burden, and sustained continuity of care - with outcomes comparable to in-person care in postoperative follow-up, symptom monitoring, and survivorship. However, persistent disparities in device availability, connectivity, and digital literacy disproportionately affect older, rural, and socioeconomically disadvantaged patients, raising the risk that geographic inequalities are replaced by technological ones. From a medico-legal standpoint, the remote modality does not modify the applicable standard of care, yet restricted physical examination and reliance on patient-reported data introduce risks of diagnostic delay and incomplete clinical assessment, with direct implications for professional liability, data protection under HIPAA and GDPR, cross-border licensure, and multi-party accountability across physicians, institutions, and technology providers. Tele-oncology has become a permanent structural feature of modern cancer care, offering demonstrable benefits in access, continuity, and patient satisfaction. Yet its integration has been uneven, its governance remains fragmented, and its medico-legal landscape is still evolving. Realising the full potential of virtual oncology care - equitably and safely - requires coherent regulatory frameworks, sustained investment in digital infrastructure, and explicit attention to the populations at greatest risk of being left behind.
Humans↗
[Organizational and methodological approaches to using digital X-ray fluorography in the diagnosis of lung diseases in practical public health care of the Russian Federation].
On the basis of a great body of information, the authors propose the most reasonable and effective organizational and methodological approaches to further actively introducing digital lung fluography into Russia's practical public health care. The paper discusses a diversity of topical problems associated with the practical use of digital X-ray fluorography (DXF), such as the assessment of its use depending on the level (municipal or regional) of public health care, methodological issues of its performance, current relationships of DXF and film fluorography; a place of DXF in the screening and routine clinical diagnosis of lung diseases. Great emphasis is laid on the role of DXF in the diagnosis of tuberculosis and cancer of the lung. The place and role of Russian manufacturers of digital lung fluorographs in the further development of SXF in practical public health care of Russia are also touched upon. The authors emphasize that replacement of film fluorography by digital one will present difficulties if regional and municipal health administrators do not take an active part in this matter.
Adolescent↗
[Beliefs of men from Cali, Colombia, about digital rectal examination: findings of an exploratory study].
This study used the Health Beliefs Model to explore beliefs on digital rectal examination (DRE) to screen for prostrate cancer, prior to intent to submit to the examination, in men 45 to 64 years of age in Cali, Colombia. The 267 participants answered a questionnaire by means of prior selection through proportional sampling by quotas. A univariate and bivariate analysis showed that only 25.8% of the participants had submitted previously to digital rectal examination and that 68.1% intended to do so in the following 12 months. Significant differences (p < 0.05) were found between a history of DRE and schooling, socioeconomic status, health system coverage, perception of susceptibility to the disease, and perception of barriers and benefits. Significant differences (p < 0.05) were found between intent to submit to DRE and health system coverage, perception of severity of the disease, and perception of barriers. Given the low level of history of DRE and intent to submit to the examination, the results could help improve strategies to increase this practice at the local level.
Colombia↗
Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey.
The surgical modalities for the treatment of hemorrhoids are quite numerous due to the rapid diffusion of new surgical techniques and to the different approaches to the pathophysiology of the disease by the proctologists. Stapled hemorrhoidopexy, one of the most recent surgical options proposed, emphasizes the role of rectal internal mucosal prolapse (RIMP) as the main cause of the disease. We performed a national survey among the most important proctologists on this particular clinical condition, in order to better define the indications for the surgical treatment of hemorrhoids. A questionnaire concerning the main clinical features of RIMP was mailed to 84 coloproctology centers. Two-thirds of the 41 proctologists who responded found RIMP in a minority of patients with hemorrhoids, whereas only one-third found RIMP in more than half of their patients. A circumferential RIMP was identified by only 10% of the surgeons, whereas a coincidence between pre- and postoperative diagnoses of this condition was possible in half of proctologists' patients. RIMP is not frequently associated with hemorrhoids. Therefore, it is unlikely to be a cause of hemorrhoidal disease, and many surgeons still recognize it as a difficult clinical condition to define.
Attitude of Health Personnel↗
Where does informatics fit in health care organizations?
Why is medical informatics important to health care leaders? As an emerging science, informatics focuses on applying computing and communication technology to decision making for clinicians and managers. It enhances the understanding of how information and communication systems can impact the work health care managers must accomplish. As the cost of technology for digital information management continues to decline, organizations and individuals will look for ways to offset the human costs of managing and conveying information. The way of the paper medical record is being replaced by the less expensive and more efficient digital information systems. Leaders of health care organizations need to look for every opportunity to deploy networks and computers to reduce the labor costs of data collection, storage, retrieval, and analysis.
Computer Communication Networks↗
Adolescent girls' use of the Internet for health information: issues beyond access.
Whilst the "digital divide" in access to Internet technology has rightly concerned commentators on health inequalities, there are issues beyond physical access that must be tackled if adolescents and adults are to optimize the benefits of this developing medium. Emerging themes from an exploratory qualitative study of adolescents' use of the Internet for information about health and medicines describe four major challenges. Access issues persist if there are insufficient school computers that are unable to cope with increasing Web site sophistication. Software on school-based machines preventing exposure to material that is deemed to be unsuitable may also prohibit access to educational sites about sexual health and drug misuse. Strategies to manage the volume of available information are needed. The interplay of active and passive information seeking challenges whether the Internet can be truly useful during acute illness episodes. This exploration with future health service users highlights important questions for further study.
Adolescent↗
Who's using PDAs? Estimates of PDA use by health care providers: a systematic review of surveys.
BACKGROUND: Personal digital assistants (PDAs) find many uses in health care. Knowing rates of collective PDA use among health care providers is an important guiding step to further understanding those health care contexts that are most suited to PDA use and whether PDAs provide improved health outcomes. OBJECTIVES: The objectives of this study were to estimate current and future PDA use among health care providers and to discuss possible implications of that use on choice of technology in clinical practice and research. METHODS: This study was a systematic review of PDA usage surveys. Surveys were identified as part of an ongoing systematic review on the use of handheld devices. Reports from eight databases covering both biomedical sciences and engineering (1993-2006) were screened against distinct eligibility criteria. Data from included surveys were extracted and verified in a standardized way and were assessed descriptively. RESULTS: We identified 23 relevant surveys, 15 of which were derived from peer-reviewed journals. This cohort of surveys was published between 2000 and 2005. Overall, since 1999, there is clear evidence of an increasing trend in PDA use. The current overall adoption rate for individual professional use ranges between 45% and 85%, indicating high but somewhat variable adoption, primarily among physicians. CONCLUSIONS: Younger physicians and residents and those working in large and hospital-based practices are more likely to use a PDA. The adoption rate is now at its highest rate of increase according to a commonly accepted diffusion of innovations model. A common problem with the evaluation of information technology is that use frequently precedes research. This is the case here, in which PDA adoption rates are already high and projections are for rapid growth in the short term. In general, it appears that professional PDA use in health care settings involves more administrative and organizational tasks than those related to patient care, perhaps signaling where the growth in adoption is most likely to occur. We conclude that physicians are likely accustomed to using a PDA, and, therefore, technology expertise will probably not be a barrier to implementing PDA applications. However, there is an urgent need to evaluate the effectiveness and efficiency of specific tasks using handheld technology to inform those developing and those using PDA applications.
Age Factors↗