Browsing by Author "Armfield, Nigel R"
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- ItemClinicians' perceptions of telemedicine for remote neonatal consultation.(2010-12-30) Armfield, Nigel R; Donovan, Tim; Smith, Anthony CTelemedicine may have a useful role in neonatal care particularly in regionalised health care systems where there may be impediments to access Following the development of a system for neonatal teleconsultation we assessed its efficacy usability and preliminary effectiveness While results were positive uptake in routine clinical use was less than expected The study described in this paper examined aspects of clinicians perceptions of telemedicine in neonatal care Overall clinicians had positive perceptions of telemedicine Further work is required to understand the negative perceived usefulness of telemedicine held by some clinicians and to determine whether this may be overcome
- ItemThe effectiveness of telemedicine for paediatric retrieval consultations: rationale and study design for a pragmatic multicentre randomised controlled trial.(2014-11-10) Armfield, Nigel R; Coulthard, Mark G; Slater, Anthony; McEniery, Julie; Elcock, Mark; Ware, Robert S; Scuffham, Paul A; Bensink, Mark E; Smith, Anthony CBackgroundIn many health systems specialist services for critically ill children are typically regionalised or centralised Studies have shown that high risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality In acute cases where distance and time impede access to specialist care clinical advice may be provided remotely by telephone Emergency retrieval services attended by medical and nursing staff may be used to transport patients to specialist centres Even with the best quality retrieval services stabilisation of the patient and transport logistics may delay evacuation to definitive care Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children However no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval Methods DesignThe study is a pragmatic multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit We aim to recruit 160 children for whom a specialist retrieval consultation is required The primary outcome measure is stabilisation time time spent on site at the referring hospital by the retrieval team adjusted for initial risk Secondary outcome measures are change in patient s physiological status repeated measure two time points scored using the Children s Emergency Warning Tool change in diagnosis repeated measure taken at three time points change in destination of retrieved patients at the tertiary hospital general ward or paediatric intensive care unit retrieval decision and length of stay in the Paediatric Intensive Care Unit for retrieved patients The trial has been approved by the Human Research Ethics Committees of Children s Health Services Queensland and The University of Queensland Australia DiscussionHealth services are adopting telemedicine however formal evidence to support its use in paediatric acute care is limited Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000156886
- ItemThe effectiveness of telemedicine interventions to address maternal depression: A systematic review and meta-analysis.(0000-00-00) Nair, Uthara; Armfield, Nigel R; Chatfield, Mark D; Edirippulige, SisiraIntroduction Maternal depression MD is an overarching term for depression affecting pregnant women and mothers for up to 12 months postpartum Because MD may have chronic and long lasting effects it is an important public health concern The extent to which telemedicine may be an effective way to provide services to sufferers of MD is unknown therefore this review aimed to assess the available evidence Methods We conducted a search of The Cochrane Library PubMed MEDLINE PsycINFO and EMBASE for relevant randomised controlled trials published between 2000 and 2018 we then conducted a systematic review and meta analysis Results We identified 10 studies for inclusion Therapeutic strategies involved cognitive behavioural therapy CBT behavioural activation and other psychoeducation Eight trials reported significant improvement in depression scores post intervention four studies that conducted post intervention follow up found that these improvements continued However high attrition rates and lack of blinding were common problems Discussion This review found limited evidence supporting the delivery of CBT for the treatment of MD and anxiety using telemedicine However most of the evidence only studied improvements in postpartum depression indicating that use of telemedicine to provide MD intervention is still small and an under researched area
- ItemHome telemedicine for paediatric palliative care.(2010-12-30) Bradford, Natalie; Herbert, Anthony; Walker, Rick; Pedersen, Lee-Anne; Hallahan, Andrew; Irving, Helen; Bensink, Mark E; Armfield, Nigel R; Smith, Anthony CChildren with life limiting conditions require intensive complex management of the physical psychosocial and spiritual issues that evolve for the child and their family as the focus of care moves from curative treatment to palliation Optimal palliative care for children can be limited by the lack of health professionals with the necessary skills and experience to confidently and competently manage the care of both the child and the family The University of Queensland s Centre for Online Health has been working closely with the Paediatric Palliative Care Service PPCS at the Royal Children s Hospital RCH in Brisbane Australia to investigate the potential of telemedicine for the delivery of specialist support in the home or local community Research conducted in Queensland has shown how telemedicine can be effectively used to link the specialist paediatric palliative care team into the home of families caring for a child receiving palliative care regardless of their physical distance from the RCH This qualitative report describes two case studies each illustrating the value of home telemedicine for families at this vulnerable and distressing time This work should provide a useful insight for other specialty disciplines contemplating home telemedicine applications
- ItemHumour sans frontieres: the feasibility of providing clown care at a distance.(2011-05-26) Armfield, Nigel R; Bradford, Natalie; White, Megan M; Spitzer, Peter; Smith, Anthony CClown care has been shown to have health related benefits and is a well established part of the routine in many children s hospitals However children who have been admitted to general hospitals or who are being cared for at home cannot usually enjoy visits by Clown Doctors Therefore the aim of this work was to investigate whether an existing telemedicine network could be used to improve equity of access to humor for sick children specifically those who are hospitalized away from the nearest clown enabled hospital or who are being cared for at home Using videoconferencing we conducted regular clown outreach links from The Royal Children s Hospital in Brisbane Australia to children in regional hospitals and to sick children in their homes Using a program of performance which was modified for delivery by videoconference teleclowning was found to be feasible Further work is required to determine whether the health related benefits that accrue from in person clowning are successfully translated to the video based modality
- ItemPaediatric palliative care by video consultation at home: a cost minimisation analysis.(2014-08-11) Bradford, Natalie K; Armfield, Nigel R; Young, Jeanine; Smith, Anthony CIn the vast state of Queensland Australia access to specialist paediatric services are only available in the capital city of Brisbane and are limited in regional and remote locations During home based palliative care it is not always desirable or practical to move a patient to attend appointments and so access to care may be even further limited To address these problems at the Royal Children s Hospital RCH in Brisbane a Home Telehealth Program HTP has been successfully established to provide palliative care consultations to families throughout Queensland
- ItemPrinciples of a paediatric palliative care consultation can be achieved with home telemedicine.(2014-11-17) Bradford, Natalie K; Armfield, Nigel R; Young, Jeanine; Herbert, Anthony; Mott, Christine; Smith, Anthony CWe compared the records of paediatric palliative consultations undertaken face to face with telemedicine consultations undertaken in patients homes A convenience sample of consecutive paediatric palliative care patients was identified from the hospital s palliative care database A total of 100 consultations was reviewed 50 telemedicine consultations during home visits and 50 face to face consultations according to 14 established principles and components of a paediatric palliative care consultation In the telemedicine group there was a higher proportion of patients in a stable condition 58 vs 7 and a lower proportion of patients in terminal phase 2 vs 17 Discussion about pain and anorexia were significantly more common in the telemedicine group Discussion about follow up was significantly more common in the telemedicine group 86 vs 56 whilst resuscitation planning was more common in deteriorating patients receiving inpatient care All other components and principles of a palliative care consultation were documented equally regardless of method of consultation The findings confirm that palliative consultations via telemedicine are just as effective as face to face consultations in terms of the documented components of the consultation
- ItemTelemedicine--a bibliometric and content analysis of 17,932 publication records.(2014-08-27) Armfield, Nigel R; Edirippulige, Sisira; Caffery, Liam J; Bradford, Natalie K; Grey, Joanne W; Smith, Anthony CWe aimed to provide an up to date contemporary bibliometric view of the telemedicine and telehealth literature and a longitudinal analysis of changes in content themes
- ItemTelemedicine--is the cart being put before the horse?(2014-05-19) Armfield, Nigel R; Edirippulige, Sisira K; Bradford, Natalie; Smith, Anthony CA large literature base on telemedicine exists but the evidence base for telemedicine is very limited There is little practical or useful information to guide clinicians and health policymakers Telemedicine is often implemented based on limited or no prior formal analysis of its appropriateness to the circumstances and adoption of telemedicine by clinicians has been slow and patchy Formal analysis should be conducted before implementation of telemedicine to identify the patients conditions and settings that it is likely to benefit Primary studies of telemedicine tend to be of insufficient quality to enable synthesis of formal evidence Methods typically used to assess effectiveness in medicine are often difficult expensive or impractical to apply to telemedicine Formal studies of telemedicine should examine efficacy effectiveness economics and clinician preferences Successful adoption and sustainable integration of telemedicine into routine care could be improved by evidence based implementation
- ItemThe use of telemedicine for delivering healthcare to bariatric surgery patients: A literature review.(0000-00-00) Coldebella, Belinda; Armfield, Nigel R; Bambling, Matthew; Hansen, Julie; Edirippulige, SisiraIntroduction Bariatric weight loss surgery is one of the most effective treatments for severe obesity Research shows that the availability of healthcare services pre and post bariatric surgery improves behavioural change and weight loss outcomes The aim of this systematic review is to assess the evidence relating to the use of telemedicine for providing health services to bariatric surgery patients Methods A search was conducted using PubMed EMBASE CINAHL PsycNET and SCOPUS Original research relating to telemedicine for bariatric surgery patients published in peer reviewed journals were included Results Database search returned 258 references and a total of 10 studies were included in the review Six studies assessed use feasibility and acceptance of telemedicine by patients practitioners Studies also examined the use of telemedicine for weight loss changes in physical activity diet eating or other behavioural changes Two studies were randomised controlled trials one showed a significant difference in outcomes between intervention and control group Discussion This review suggests that telemedicine may be a potential method for providing healthcare services to bariatric surgery patients However the current evidence base does not allow for definitive conclusions