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The aim of this study was to systematically investigate existing literature on the costs of home-based telemedicine programs, and to further summarize how the costs of these telemedicine programs vary by equipment and services provided.
We undertook a systematic review of related literature by searching electronic bibliographic databases and identifying studies published from January 1, 2000, to November 30, 2017. The search was restricted to studies published in English, results from adult patients, and evaluation of home telemedicine programs implemented in the United States. Summarized telemedicine costs per unit of outcome measures were reported.
Twelve studies were eligible for our review. The overall annual cost of providing home-based telemedicine varied substantially depending on specific chronic conditions, ranging from USD1,352 for heart failure to USD206,718 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes as a whole. The estimated cost per-patient-visit ranged from USD24 for cancer to USD39 for CHF, COPD, or chronic wound care.
The costs of home-based telemedicine programs varied substantially by program components, disease type, equipment used, and services provided. All the selected studies indicated that home telemedicine programs reduced care costs, although detailed cost data were either incomplete or not presented in detail. A comprehensive analysis of the cost of home-based telemedicine programs and their determinants is still required before the cost efficiency of these programs can be better understood, which becomes crucial for these programs to be more widely adopted and reimbursed.
The management of patients in primary care is often complicated by the presence of multiple chronic conditions and psychosocial issues that increase the complexity of the encounter and have important impacts on care. There is a paucity of literature on this subject in the pediatric population.
The aim of this study was to quantify the burden of chronic conditions in pediatric primary care.
The problem lists of 3995 randomly selected patients from a community pediatric clinic and an academic hospital-based pediatric clinic in the same metropolitan area were analyzed for the presence and number of any chronic condition.
In total, 53% of patients suffered from at least one chronic problem, 25% had two or more chronic conditions and 5.1% had four or more conditions. Compared with the community clinic, the academic clinic had significantly more children with catastrophic complex conditions (P<0.001). A regression analysis showed a significant positive correlation between the number of chronic medical conditions and mental health diagnoses.
The burden of chronic disease in the pediatric primary care setting may be significantly higher than has been previously suggested. To ensure optimal quality of care, health planners should take into account the high burden of chronic illness, psychosocial issues and multimorbidity among patients in the pediatric primary care setting, as well as the higher complexity profile of patients attending academic clinics.
Volatile organic compounds (VOCs) can be hazardous to human health and can negatively impact the long-term stability of art objects. This research evaluated the VOC adsorbent properties of three materials commonly used in museums as humidity regulating or air filtering agents. Silica gel, activated charcoal, and zeolite powder, materials often placed in proximity to art objects, were analyzed using Thermal Desorption GC-MS to qualitatively identify adsorbed VOC’s from model environments. This research compared the adsorbing capabilities of these materials with a solid-phase micro-extraction (SPME) carboxen/polydimethyl siloxane fiber to frame their adsorbing powers. It was found that different adsorbents have very different ranges of adsorption for the chemicals tested. Silica gel powder and zeolite powder have the greatest sensitivity for acetic acid over a 24 hour exposure period. Zeolite powder and activated charcoal were more sensitive for identification of naphthalene. Silica gel powder proved to be the most sensitive adsorbent overall. This research discovered that the methods used to condition silica gel pellets for reuse need to be re-examined in light of fact they trap VOC’s, especially as it was observed that VOC’s desorb from the silica gel pellets under ambient conditions.
The adsorption of poly(l-lysine) (PLL) from aqueous solution to poly(tetrafluoroethylene-co-hexafluoropropylene) (FEP) is investigated. Adsorption is controlled by choice of solvent (and PLL solution conformation) or by FEP surface chemistry. PLL adsorbs from pH 11 buffer solution to FEP: PLL adsorption is concomitant with the liberation of water molecules from the FEP-water interface resulting in a decreased interfacial free energy between organic and aqueous phases. PLL does not adsorb from an aqueous pH 7 solution to FEP unless the FEP surface is carboxylic acid-functionalized (FEPCO2H):an ionic interaction between FEP-carboxylate and PLL-ammonium enhances adsorption.
The surface modifications are charaterized by attenuated total reflectance infrared spectroscopy (ATR IR), ultraviolet-visible spectrophotometry (UV-vis), contact angle, and quantitatively by x-ray photoelectron spectroscopy (XPS). The adsorbed amount of PLL to FEP (from pH 11) is proportional to molecular weight whereas the adsorbed amount of PLL to FEP-CO2H (pH 7) is independent of molecular weight and likely proportional to surface charge density. The modified film samples (relative to the unmodified film samples) show improved characteristics in terms of wettability, chemical reactivity, adhesion, cell growth.
Aim: The aim was to investigate whether high catecholamine (CA) excreters would respond less well to a group cognitive behaviour therapy (CBT) treatment for depression than others. Method: A sample of 70 adults with depression symptoms participated in a 12-week course of group CBT. Participants’ 24 hour urinary catecholamine levels at pre-therapy and post-therapy were used to classify them as High (N = 10); Low (N = 33) or Mixed (N = 27) according to a cut-off one standard deviation above a published mean for healthy adults. Beck Depression Inventory (BDI) and cognitions questionnaire (Automatic Thoughts Questionnaire; Beck Hopelessness Scale and Dysfunctional Attitudes Scale) were used. Results: Repeated measures ANOVA analyses showed an equal rate of mood improvement in all three groups over the course of CBT, despite the fact that the High excreters were on average more depressed throughout the study. Changes in depression symptoms were mirrored by improvements in cognitive measures in the three catecholamine groups. Conclusion: This study indicates that adults showing a biological marker of depression (elevated catecholamine levels) are equally able to benefit from CBT treatment as adults without this marker.
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