Telemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients' acceptability of this technology and their rate of uptake.The aim of this study was to systematically review the current evidence on telemonitoring in the management of patients with long-term conditions and evaluate the patients' uptake and acceptability of this technology.MEDLINE, Scopus, and CENTRAL (the Cochrane Central Register of Controlled Trials) were searched from the date of inception to February 5, 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: intervention uptake and adherence; study retention; patient acceptability, satisfaction, and experience using the intervention; changes in physiological values; all-cause and cardiovascular-related hospitalization; all-cause and disease-specific mortality; patient-reported outcome measures; and quality of life. In total, 2 reviewers independently assessed the articles for eligibility.A total of 96 studies were included, and 58 (60%) were pooled for the meta-analyses. Meta-analyses showed a reduction in mortality (risk ratio=0.71, 95% CI 0.56-0.89; P=.003; I2=0%) and improvements in blood pressure (mean difference [MD]=-3.85 mm Hg, 95% CI -7.03 to -0.68; P=.02; I2=100%) and glycated hemoglobin (MD=-0.33, 95% CI -0.57 to -0.09; P=.008; I2=99%) but no significant improvements in quality of life (MD=1.45, 95% CI -0.10 to 3; P=.07; I2=80%) and an increased risk of hospitalization (risk ratio=1.02, 95% CI 0.85-1.23; P=.81; I2=79%) with telemonitoring compared with usual care. A total of 12% (12/96) of the studies reported adherence outcomes, and 9% (9/96) reported on satisfaction and acceptance outcomes; however, heterogeneity in the assessment methods meant that a meta-analysis could not be performed.Telemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalization rates and a lack of positive impact on patients' quality of life.PROSPERO CRD42021236291; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236291. 

/pdf/interactive-remote-patient-monitoring-devices-for-managing-3h3c84sl.pdf

Interactive Remote Patient Monitoring Devices for Managing Chronic Health Conditions: Systematic Review and Meta-analysis

IntroductionCurrently, there are only a small number of comprehensive study results on adherence and acceptance of telemonitoring applications (TMAs) regarding multi-morbid older patients. The ATMo...

https://journals.sagepub.com/doi/pdf/10.1177/1357633X20901400

Adherence and acceptance of a home-based telemonitoring application used by multi-morbid patients aged 65 years and older.

BACKGROUND: Compared with 10 years ago when our last survey was completed, the number of respiratory therapists (RTs) has increased markedly in mainland China. In addition, the education systems for RTs and the working environment have also changed. Thus, we aimed to describe the current situation of respiratory care in mainland China. METHODS: A nationwide survey was initiated from August 15, 2016, to September 2, 2016, through network platforms. RESULTS: We obtained responses from 196 RTs, of whom, 30.6% graduated from a bachelor9s degree program, 25.5% graduated from an associate9s degree program, and 43.9% were nurses who transitioned to be RTs through 6-month on-the-job training programs. Among the 3 groups, no significant differences existed in the basic job responsibility, such as mechanical ventilation and aerosol therapy; however, bachelor9s degree RT graduates participated more in bronchoscopy assistance (96% vs 78%, P = .002), extracorporeal membrane oxygenation management (42% vs 25%, P = .024), and pulmonary ultrasound (40% vs 15%, P CONCLUSIONS: In mainland China, degree programs for students and on-the-job training for Experienced ICU nurses were 2 major ways to train RTs. The absence of credential and/or licensure and the lack of recognition on the value of an RT were deemed as the 2 key obstacles in the development of respiratory care profession.

http://rc.rcjournal.com/content/respcare/early/2018/07/24/respcare.06217.full.pdf

Respiratory Care Education and Clinical Practice in Mainland China

Context: Respiratory physiotherapy plays a key role in the management and treatment of patients with respiratory diseases worldwide, yet this specialty is not well established in Saudi Arabia. Aims: To profile the attitudes among physicians and nurses toward physiotherapists working in respiratory care settings in Saudi Arabia. Methods: A cross-sectional questionnaire-based study was conducted. A questionnaire was developed consisting of 23 items, which was distributed both electronically and in paper form to physicians and nurses working in hospitals and health-care centers in Saudi Arabia. Physicians and nurses working outside of Saudi Arabia, and other health professionals, were excluded from the study. Results: A total of 284 questionnaires were returned (nurses: n = 158; physicians: n = 126). The majority believed that physiotherapists have the skills to be involved in respiratory care (79.9%, n = 226) and that physiotherapists are an important member of the Intensive Care Unit team (90.4%, n = 255). Most respondents (n = 232, 82.9%) felt in need of more information regarding the role of physiotherapy within respiratory care; significantly more nurses than physicians believed they needed additional education (P = 0.002). Specialized physicians were more likely than nonspecialized physicians to refer respiratory patients to physiotherapy (P Conclusion: Physiotherapy in respiratory care settings was positively regarded by nurses and physicians working in hospitals and health-care facilities in Saudi Arabia. The need for further education for physicians and nurses on the role of physiotherapy in respiratory care was highlighted; this would enable physiotherapy to develop and be further integrated into the respiratory care multidisciplinary team.

The emerging role of respiratory physiotherapy: A profile of the attitudes of nurses and physicians in Saudi Arabia.

Das Berufsbild des Atmungstherapeuten hat sich 10 Jahre nach seiner Einfuhrung in Deutschland gut etabliert. 600 Teilnehmer haben die berufsbegleitenden Weiterbildungskurse absolviert. Unsere Ziele sind eine hochwertige interprofessionelle Zusammenarbeit und Unterstutzung der Arzte durch besonders qualifizierte Mitarbeiter einschlieslich Delegation ursprunglich arztlicher Aufgaben. Vergleichbar hierzu ist das Berufsbild des chirurgisch-technischen Assistenten. Fur diesen gibt es unterschiedliche Qualifizierungswege: von der grundstandigen Ausbildung uber Weiterbildungslehrgange bis hin zum Bachelor-Studium des Physician Assistant. Die Bundesarztekammer hat in den letzten Jahren Rahmenvorgaben fur ein Delegationsmodell Physician Assistant zur Arztentlastung und -unterstutzung erarbeitet und auf dem diesjahrigen 120. Deutschen Arztetag verabschiedet. Es ist zu erwarten, dass nunmehr die Zahl der Physician Assistants deutlich steigt. Die Deutsche Gesellschaft fur Pneumologie und Beatmungsmedizin halt einen Physician Assistant mit Spezialfach Atmungstherapie fur grundsatzlich vorstellbar. Ob allerdings die bisherigen Weiterbildungslehrgange dadurch vollstandig ersetzt werden, erscheint fraglich. Zumindest vorubergehend werden evtl. Weiterbildungskonzepte auf unterschiedlichem Niveau nebeneinander existieren. Hinzu kommt, dass zwischenzeitlich in einem Bundesland eine staatlich anerkannte Pflegefachweiterbildung Atmungstherapie eingefuhrt wurde. Zukunftige Interessenten haben die Qual der Wahl.

[How to become a Respiratory Therapist in Germany - Status quo and Development Prospects].

Because of the expected significant growth in the elderly population and respiratory diseases, the topic of "delegation of physician's duties" is of increasing importance to the German health-care system. In 2004 the German Respiratory Society (Deutsche Gesellschaft fur Pneumologie und Beatmungsmedizin e. V. (DGP)) established the new profession: respiratory therapist. A curriculum was defined which offers training for certified nurses and physiotherapists. Respiratory therapists evaluate, treat, document and care for patients with pulmonary disorders. Under appropriate supervision a licensed respiratory therapist performs some of the work previously done by physicians at the same quality of care. The first respiratory therapists have finished their professional training in Germany. Most of these respiratory therapists are now employed in hospital-based positions requiring their specific skills. Generally, the increased medical responsibility and the increased degree of decision-making possibilities associated with the new profession contribute to a better job satisfaction. However, this is not yet true for all the newly employed respiratory therapists. Only few of the new graduate respiratory therapists were awarded higher salaries. It is a strongly recommendation to the heads of medical departments and the human resources managers of hospitals that they should recognise the increased qualifications of nurses and physiotherapists who become respiratory therapists by appropriate remuneration.

The respiratory therapist

H er un te rg el ad en v on : O rt ru d K ar g. U rh eb er re ch tli ch g es ch ut zt . 579 Originalarbeit | Original article Dtsch Med Wochenschr 2012; 137: 574–579 · O. Karg et al., Akzeptanz einer telemedizinischen ... tioned about their general acceptance of the telemonitoring intervention, their quality of life and the overall use of resources. Results: 36 patients (25 men, 11 women, mean age 67,9 ± 6,9; range 54 – 81 years) completed the protocol. All 43 patients were using the device (Health Buddy®) on two thirds of all possible working days (this had been predefined as full compliance). Especially the questions on technical functioning of the device, trust in the technique and data security, as well as the confidentiallity of communication with the physician via telemedicine were very positively answered. Health-related quality of life did not change and no rise of autonomy was noted. However, the objective of early detecting of acute exacerbations by daily measurements of vital parameters and assessment of symptoms was difficult to achieve because of inadequate definition of the parameters. Conclusion: This cohort of patients with advanced COPD was highly compliant in the use of the telemonitoring device. But clinical efficacy and economic effectiveness remain to be investigated.

Akzeptanz einer telemedizinischen Intervention bei Patienten mit chronisch-obstruktiver Lungenerkrankung Acceptance of a telemonitoring device in patients with chronic obstructive pulmonary disease

Fragestellung: Bei Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) sollte die Akzeptanz einer telemedizinischen Intervention erfasst werden. Mit Hilfe dieses Systems werden Vitalparameter ubertragen und Fragen zu Symptomen, Verhalten und krankheitsspezifischem Wissen gestellt. Methode: In einer einarmigen, nicht-randomisierten klinischen Prufung uber 3 Monate wurde bei 43 Patienten mit schwerer/sehr schwerer COPD als primare Zielgrose die Compliance im Gebrauch eines Telemonitoring-Systems (Health Buddy ® ) untersucht, sekundar erfolgte eine umfassendere deskriptive Betrachtung der Akzeptanz des Telemonitorings, der Lebensqualitat und sowie des Ressourcenverbrauchs. Ergebnisse: 36 der 43 Patienten erfullten das Protokoll (25 Manner, 11 Frauen, mittleres Alter 67,9 ± 6,9 [54 – 81] Jahre). Alle 43 Patienten waren compliant in dem Sinne, als sie an mindestens zwei Drittel der verfugbaren Werktage das System benutzten. Fragen nach der fehlerfreien Funktion des Systems, dem Vertrauen in Technik und Datensicherheit der Anwendung sowie der vertrauensvollen Kommunikation uber Telemedizin mit dem Arzt wurden besonders positiv beantwortet. Die gesundheitsbezogene Lebensqualitat anderte sich nicht, eine Steigerung der Selbststandigkeit war nicht erkennbar. Durch Messung von Vitalparametern und Symptom-Abfrage sollten akute Exazerbationen fruhzeitig erfasst werden; dies erwies sich jedoch wegen unzureichender Definitionen als schwierig. Folgerung: COPD-Patienten in fortgeschrittenen Krankheitsstadien zeigten sich sehr compliant bezuglich der Anwendung der telemedizinischen Intervention. Die Fragen nach einer klinischen Wirksamkeit oder okonomischen Effektivitat konnen mit dieser Pilotstudie nicht beantwortet werden.

Acceptance of a telemonitoring device in patients with chronic obstructive pulmonary disease

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The respiratory therapist

Akzeptanz einer telemedizinischen Intervention bei Patienten mit chronisch-obstruktiver Lungenerkrankung Acceptance of a telemonitoring device in patients with chronic obstructive pulmonary disease

Acceptance of a telemonitoring device in patients with chronic obstructive pulmonary disease