Introducing New Treatments for Cancer: Practical, Ethical and Legal Problems
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Providers are increasingly moving from financial criteria for evaluation to a more holistic analysis based on performance, in which Heinzelmann et al saw a key role for telemedicine. The technology offers a mechanism for providing cost-effective, targeted care but, before it is universally accepted, its benefits need to be demonstrated to providers, patient advocate groups and, perhaps above all, patients.
Heinzelmann et al illustrated some of the major challenges facing telemedicine in an environment with increasing emphasis on self care and multidisciplinary care. Society is becoming increasingly dependent on advanced technology Liederman and Morefield, and this is reflected in attitudes towards telemedicine. Adopting telemedicine generates a more open environment where defensive medicine is reduced, care is enhanced and costs are better controlled. These factors present a compelling case for easing licensing restrictions for telemedicine across international borders Liederman and Morefield, Technical challenges are an ever-present issue.
To establish effective connectivity and to ensure that the technology works in remote communities, extensive bandwidth resources are required. Bandwidth is the transmission capacity of a system over a period of time. The term usually refers to the speeds of internet services; faster ones have a higher bandwidth than slower ones.
The view that bandwidth, like computer memory, doubles each year is optimistic.
Regular evaluation of telemedicine modalities should be conducted to ensure that bandwith for updates and modifications is adequate. There is some evidence that telemedicine provides adequate healthcare at a reasonable cost. In some situations the cost-effectiveness of telemedicine appears to be obvious, such as the doc HOME system that helps patients with chronic obstructive pulmonary disease self manage their condition Lomas, However, healthcare providers will want stronger evidence of its indirect economic benefits.
Metrics for telemedicine outcomes should be developed to demonstrate sufficient evidence of socioeconomic benefit to justify ongoing investment.
Evaluation should include social, cultural, organisational and policy aspects. It is evident it will decrease the cost per contact between patient and healthcare professional Field, Heinzelmann et al said that behaviours related to the use of technology are influenced by culture, knowledge, attitudes, beliefs, practices and routines. This is shown by the following:. To ensure that telemedicine improves healthcare provision, equipment, processes and procedures must be user friendly to enable its growth, acceptance and use Telemedicine Association of Oregon, Providers identified several trends in relation to telemedicine including: anticipated shortages in doctor and nursing workforces; professionals such as HCAs have a larger role; and increased need for communication among various providers Richards et al, ; Hibbert et al, ; Wood, The implementation, integration and improvement of telemedicine requires governments and healthcare organisations to develop rigorous policies, procedures and strategies.
According to Wootton et al , critical issues need to be addressed in such policies as part of a fourfold commitment to:.
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Bates DW et al Reducing the frequency of errors in medicine using information technology. Journal of the American Medical Informatics Association ; 8: 4, Brahams D The medicolegal implications of teleconsulting in the UK. Journal of Telemedicine and Telecare ; 1: 4, Briggs B Slicing through internet data: cardiovascular surgeons improve patient care and trim costs with an internet based electronic medical records system. Health Data Management ; 9: 1, London: BMA. Burmahl B The big picture.
Health Facilities Management ; 9, Craig J, Patterson V Introduction to the practice of telemedicine. In: Wootton R et al Introduction to Telemedicine. London: Royal Society of Medicine Press. Heinzelmann P et al Telemedicine in the future. Journal of Telemedicine and Telecare ; Thousand Oakes, CA: Sage.
Layman E Health informatics ethical issues. Health Care Manager ; 1, Journal of the American Medical Informatics Association ; Lomas C Nurse-led service is victim of cash squeeze despite savings potential.
Introducing New Treatment for Cancer. Practical, Ethical and Legal Problems
Nursing Times ; 37, 4. Mair F, Whitten P Systematic review of studies of patient satisfaction with telemedicine.
BMJ ; Nesbit TS et al Perceptions of local health care quality in 7 rural communities within telemedicine. Journal of Rural Health ; Randell CL et al Benefits of the worldwide government computer-based patient record framework. Journal of Healthcare Information Management ; 4, Richards H et al Remote working: survey of attitudes to ehealth of doctors and nurses in rural general practices in the United Kingdom.
Family Practice ; Sarhan F Telemedicine in healthcare 1: exploring its uses, benefits and disadvantages. Nursing Times ; 42, Telemedicine Association of Oregon Benefits of Telemedicine. Warner I Telemedicine in home health care: The current status of practice. Home Health Care Management and Practice ; 2, Wood DL The physician workforce: a medical school dilemma.
Health Affairs ; Wootton R et al Introduction to Telemedicine. Sign in or Register a new account to join the discussion. You are here: Nurse managers. Telemedicine in healthcare 2: the legal and ethical aspects of using new technology. Abstract Sarhan F Telemedicine in healthcare 2: the legal and ethical aspects of using new technology. Keywords: Telemedicine, Legal aspects, Ethical aspects, Ethics This article has been double-blind peer reviewed.
NEJM , Aspirin and other non-steroidal anti-inflammatory drugs decrease the activity of a signaling pathway called PI3K. Whole genome sequencing would enable clinicians to look for mutations across the entire genome simultaneously for a much larger number of diseases or conditions. Rapid whole genome sequencing has been shown to provide a useful differential diagnosis within 50 hours for children in the neonatal intensive care unit. Science , Currently, the only way to detect the onset of rejection is by performing an invasive tissue biopsy.
This novel approach only requires blood samples, and detects the levels of cell-free circulating DNA from the donor organ in the recipient's blood stream. This circulating DNA from the donor can be elevated for up to five months before rejection can be detected by biopsy, and the level of DNA correlates with the severity of the rejection event i.
New Regulations and Code of Ethics for Research in the 21st Century - Infectious Disease Advisor
As tumor cells die they release fragments of their mutated DNA into the bloodstream. Sequencing this DNA can give insights into the tumor and possible treatments, and even be used to monitor tumor progression as an alternative to invasive biopsies. For example, Alexis and Noah Beery, a pair of Californian twins, were misdiagnosed with cerebral palsy, but DNA sequencing pointed to a new diagnosis, as well as a treatment, to which both children are responding well. In another case, a young boy in Wisconsin, Nic Volker, was able to be cured of an extreme form of inflammatory bowel disease after his genome sequence revealed that a bone marrow transplant would likely be life-saving.
The translation of new genomic medicine discoveries is already making a difference to patient care. These demonstration projects incorporate genomic information into the electronic medical record and provide clinical decision support for implementation of appropriate interventions or clinical advice.
This resource is essential for advancing the goals of implementing genomics in clinical care and will improve the understanding of phenotypic and functional effects of genetic variants and their clinical value. PPAB has been working with payers both private insurers and also the Centers for Medicare and Medicaid Services on the issue of reimbursement for new genetic and genomic tests. PPAB has also been working with other federal agencies on the regulation of genomic tests, both in research and in clinical practice.
Surgeon General's Family History Initiative that helps you document your own family health history. Using any computer, an Internet connection and an up-to-date Web browser, you provide your health information to build a drawing of your family tree and a chart of your family health history.
Both the chart and the drawing can be printed and shared with your family members and your doctor. Risk assessment tools for diabetes and colon cancer are also available. The ISCC identifies the needs of these professional societies in filling gaps in evidence and knowledge, offering partnership and available expertise to guide development of educational initiatives and applications for clinically relevant advances in genomic science.