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Healthcare, Volume 2, Issue 2 (June 2014) – 8 articles , Pages 150-252

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53 KiB  
Editorial
Telemedicine, Telehealth and m-Health: New Frontiers in Medical Practice
by Elizabeth A. Krupinski and Ronald S. Weinstein
Healthcare 2014, 2(2), 250-252; https://doi.org/10.3390/healthcare2020250 - 13 Jun 2014
Cited by 7 | Viewed by 7776
Abstract
Telemedicine is changing the practice of medicine. It is part of the ever-growing use of communications technology in health care being used in prevention, disease management, home health care, long-term (chronic) care, emergency medicine, remote medical imaging, and many other applications. The pace [...] Read more.
Telemedicine is changing the practice of medicine. It is part of the ever-growing use of communications technology in health care being used in prevention, disease management, home health care, long-term (chronic) care, emergency medicine, remote medical imaging, and many other applications. The pace at which telemedicine is being adopted and integrated into the healthcare enterprise is exponential and, for many (even those in the field!), it is often difficult to keep up with all of the changes occurring. Thus, it is useful periodically to stand back and summarize recent advances, to take stock, analyze where we have been, and project where we are headed. [...] Full article
257 KiB  
Review
Update and Review on the Surgical Management of Primary Cutaneous Melanoma
by Solmaz Niknam Leilabadi, Amie Chen, Stacy Tsai, Vinaya Soundararajan, Howard Silberman and Alex K. Wong
Healthcare 2014, 2(2), 234-249; https://doi.org/10.3390/healthcare2020234 - 10 Jun 2014
Cited by 17 | Viewed by 7772
Abstract
The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin [...] Read more.
The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits. Full article
(This article belongs to the Special Issue Melanoma and Neoplasms of Skin)
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107 KiB  
Review
Mobile Tele-Mental Health: Increasing Applications and a Move to Hybrid Models of Care
by Steven Richard Chan, John Torous, Ladson Hinton and Peter Yellowlees
Healthcare 2014, 2(2), 220-233; https://doi.org/10.3390/healthcare2020220 - 06 May 2014
Cited by 81 | Viewed by 18377
Abstract
Mobile telemental health is defined as the use of mobile phones and other wireless devices as applied to psychiatric and mental health practice. Applications of such include treatment monitoring and adherence, health promotion, ecological momentary assessment, and decision support systems. Advantages of mobile [...] Read more.
Mobile telemental health is defined as the use of mobile phones and other wireless devices as applied to psychiatric and mental health practice. Applications of such include treatment monitoring and adherence, health promotion, ecological momentary assessment, and decision support systems. Advantages of mobile telemental health are underscored by its interactivity, just-in-time interventions, and low resource requirements and portability. Challenges in realizing this potential of mobile telemental health include the low penetration rates of health applications on mobile devices in part due to health literacy, the delay in current published research in evaluating newer technologies, and outdated research methodologies. Despite such challenges, one immediate opportunity for mobile telemental health is utilizing mobile devices as videoconferencing mediums for psychotherapy and psychosocial interventions enhanced by novel sensor based monitoring and behavior-prediction algorithms. This paper provides an overview of mobile telemental health and its current trends, as well as future opportunities as applied to patient care in both academic research and commercial ventures. Full article
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118 KiB  
Article
PNI Biomarkers and Health Outcomes in College Women
by Shih-Yu Lee, Mugdha Vasireddi, Yu Ping Chen, Yong Tai Wang and Julia Hilliard
Healthcare 2014, 2(2), 207-219; https://doi.org/10.3390/healthcare2020207 - 28 Apr 2014
Cited by 2 | Viewed by 5709
Abstract
Sleep disturbance has been found to trigger a stress response with a subsequent activation of the psychoneuroimmunological (PNI) pathway associated with adverse health outcomes. This study aimed to assess the association among selected PNI biomarkers, sleep disturbances, and adverse health outcomes (depressive symptoms, [...] Read more.
Sleep disturbance has been found to trigger a stress response with a subsequent activation of the psychoneuroimmunological (PNI) pathway associated with adverse health outcomes. This study aimed to assess the association among selected PNI biomarkers, sleep disturbances, and adverse health outcomes (depressive symptoms, physical symptoms). A stratified, quota sample (14 poor sleepers and 15 good sleepers) was drawn from a pool of healthy college women from a larger scale of study. The participants reported their sleep, stress, depressive, and physical symptoms. Wrist actigraphy was used to collect objective sleep data, and the Enzyme-Linked ImmunoSorbent Assay was used to assess PNI biomarkers. Poor sleep quality, higher stress perception, elevated serum serotonin, and lower serum interleukin-10 explained 75.3% of the variances for the depressive symptoms. Poor sleep quality along with delayed peak activity rhythms accounted 31.4% of the physical symptoms. High serotonin and tumor necrosis factor-α were the significant predictors for poor sleep efficiency, and serotonin was the single significant predictor for poor daytime functioning. Stress and sleep disturbances negatively impact the health of college women and should be as part of regular check-ups on campus. PNI effects on health outcomes should be further explored. Educational materials in the areas of sleep hygiene, health impacts from sleep disturbances, and strategies to maintain synchronized circadian rhythms should be mandatorily included in the college curriculum. Full article
(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
108 KiB  
Review
University-Based Teleradiology in the United States
by Tim B. Hunter and Elizabeth A. Krupinski
Healthcare 2014, 2(2), 192-206; https://doi.org/10.3390/healthcare2020192 - 15 Apr 2014
Cited by 8 | Viewed by 5719
Abstract
This article reviews the University of Arizona’s more than 15 years of experience with teleradiology and provides an overview of university-based teleradiology practice in the United States (U.S.). In the U.S., teleradiology is a major economic enterprise with many private for-profit companies offering [...] Read more.
This article reviews the University of Arizona’s more than 15 years of experience with teleradiology and provides an overview of university-based teleradiology practice in the United States (U.S.). In the U.S., teleradiology is a major economic enterprise with many private for-profit companies offering national teleradiology services (i.e., professional interpretation of radiologic studies of all types by American Board of Radiology certified radiologists). The initial thrust for teleradiology was for after-hours coverage of radiologic studies, but teleradiology has expanded its venue to include routine full-time or partial coverage for small hospitals, clinics, specialty medical practices, and urgent care centers. It also provides subspecialty radiologic coverage not available at smaller medical centers and clinics. Many U.S. university-based academic departments of radiology provide teleradiology services usually as an additional for-profit business to supplement departmental income. Since academic-based teleradiology providers have to compete in a very demanding marketplace, their success is not guaranteed. They must provide timely, high-quality professional services for a competitive price. Academic practices have the advantage of house officers and fellows who can help with the coverage, and they have excellent subspecialty expertise. The marketplace is constantly shifting, and university-based teleradiology practices have to be nimble and adjust to ever-changing situations. Full article
410 KiB  
Article
Antifungal Effect of Non-Woven Textiles Containing Polyhexamethylene Biguanide with Sophorolipid: A Potential Method for Tinea Pedis Prevention
by Hiromi Sanada, Gojiro Nakagami, Kimie Takehara, Taichi Goto, Nanase Ishii, Satoshi Yoshida, Mizuyuki Ryu and Yuichiro Tsunemi
Healthcare 2014, 2(2), 183-191; https://doi.org/10.3390/healthcare2020183 - 08 Apr 2014
Cited by 15 | Viewed by 9693
Abstract
Tinea pedis is a preventable skin disease common in elderly or diabetic patients. Daily foot washing is effective for prevention, but can be difficult for many patients. Additionally, conventional methods cannot eliminate fungi within the stratum corneum, a common site for fungal invasion. [...] Read more.
Tinea pedis is a preventable skin disease common in elderly or diabetic patients. Daily foot washing is effective for prevention, but can be difficult for many patients. Additionally, conventional methods cannot eliminate fungi within the stratum corneum, a common site for fungal invasion. This study investigates the antifungal effects, cytotoxicity, permeability, and efficacy of non-woven textiles containing polyhexamethylene biguanide (PHMB) mixed with sophorolipid. Permeability of PHMB with varying concentrations of sophorolipid was assessed via a cultured skin model. Stratum corneum PHMB concentration was quantified by polyvinylsulphuric acid potassium salt titration and cytotoxicity was assayed via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. Antifungal effects were evaluated via a new cultured skin/Trichophyton mentagrophytes model, with varying PHMB exposure duration. Clinically-isolated Trichophyton were applied to the feet of four healthy volunteers and then immediately treated with the following methods: washing with soap, a non-woven textile with PHMB, the textile without PHMB, or without washing. Fungal colony forming units (CFUs) were evaluated after one of these treatments were performed. Sophorolipid with various concentrations significantly facilitated PHMB permeation into the stratum corneum, which was not in a dose-dependent manner. Significant PHMB antifungal effects were achieved at 30 min, with low cytotoxicity. Textiles containing PHMB significantly reduced CFU of fungi in healthy volunteers to levels comparable to soap washing. Our results indicate the utility of this product for tinea pedis prevention in clinical settings. Full article
(This article belongs to the Special Issue Wound Care)
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132 KiB  
Review
Obesity and Serious Mental Ill Health: A Critical Review of the Literature
by Tim Bradshaw and Hilary Mairs
Healthcare 2014, 2(2), 166-182; https://doi.org/10.3390/healthcare2020166 - 01 Apr 2014
Cited by 43 | Viewed by 9010
Abstract
Individuals who experience serious mental ill health such as schizophrenia are more likely to be overweight or obese than others in the general population. This high prevalence of obesity and other associated metabolic disturbances, such as type 2 diabetes and cardiovascular disease, contribute [...] Read more.
Individuals who experience serious mental ill health such as schizophrenia are more likely to be overweight or obese than others in the general population. This high prevalence of obesity and other associated metabolic disturbances, such as type 2 diabetes and cardiovascular disease, contribute to a reduced life expectancy of up to 25 years. Several reasons have been proposed for high levels of obesity including a shared biological vulnerability between serious mental ill health and abnormal metabolic processes, potentially compounded by unhealthy lifestyles. However, emerging evidence suggests that the most significant cause of weight gain is the metabolic side effects of antipsychotic medication, usual treatment for people with serious mental ill health. In this paper we review the prevalence of obesity in people with serious mental ill health, explore the contribution that antipsychotic medication may make to weight gain and discuss the implications of this data for future research and the practice of mental health and other professionals. Full article
(This article belongs to the Special Issue The Burden of Obesity in Health Care)
125 KiB  
Article
Changing Body Image and Well-Being: Following the Experience of Massive Weight Loss and Body Contouring Surgery
by Jo Gilmartin, Andrew F. Long and Mark Soldin
Healthcare 2014, 2(2), 150-165; https://doi.org/10.3390/healthcare2020150 - 27 Mar 2014
Cited by 10 | Viewed by 7428
Abstract
This paper reports on the perception of changing body image and well-being for patients who had undergone plastic surgery following massive weight loss. The exploratory, qualitative study was undertaken with 20 patients from one teaching hospital in the south of England. Semi-structured interviews [...] Read more.
This paper reports on the perception of changing body image and well-being for patients who had undergone plastic surgery following massive weight loss. The exploratory, qualitative study was undertaken with 20 patients from one teaching hospital in the south of England. Semi-structured interviews were carried out and a thematic analysis of the data undertaken. The results provide important insights regarding body contouring influencing body image change and the adjustment process involved. The ability to pursue self-esteem and the accruing social benefits is emphasized in the interrelated sub themes including social acceptance, undoing depression and sexual vitality. Body contouring surgery following massive weight loss appears to facilitate improvement in body image and well-being. Adjustment to the changing body image is both empowering and challenging. Supportive educational programmes need to be developed to assist this transition to a more positive body image and appreciation; these could usefully include access to and involvement with patient support groups. Full article
(This article belongs to the Special Issue The Burden of Obesity in Health Care)
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