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Biomedical subjects

Bonnie J Wakefield

Publications and source records attributed to Bonnie J Wakefield.

6 recordsLinked to original sources
PubMed2004

Interactive video specialty consultations in long-term care.

OBJECTIVES: To assess provider and resident satisfaction with and outcomes of specialist physician consultations provided via interactive video to residents of a long-term care (LTC) center. DESIGN: Cross-sectional survey. SETTING: Two Veterans Affairs Medical Centers (VAMC) and a state LTC center. PARTICIPANTS: Physicians (n=12) at the VAMC and nurses (n=30) and residents (n=62) at the LTC center. INTERVENTION: Interactive video conferencing to provide physician specialty visits to residents at the LTC center. MEASUREMENTS: Satisfaction ratings and record review to determine changes in treatment plan and follow-up care. RESULTS: Data were collected on 76 individual consultations in six clinics. The most frequent outcome was a change in treatment plan with the resident remaining at the LTC setting (n=29, 38%) or no change in treatment (n=26, 34%). Physicians' ratings were 78% good to excellent for usefulness in developing a diagnosis, 87% good to excellent for usefulness in developing a treatment plan, 79% good to excellent for quality of transmission, and 86% good to excellent satisfaction with the consult format. Overall, 72% of residents were satisfied with the consult format, and 92% felt that it was easier to obtain medical care via telemedicine. Nurses felt that the telemedicine clinics were a good use of their time and skills (100%). CONCLUSION: There was a high rate of physician, patient, and nurse satisfaction with interactive video conferencing. Care delivered to residents of LTC settings via video conferencing offers a number of potential advantages, including avoidance of travel for patient and provider and potentially greater continuity of care.

Cross-Sectional Studies↗
PubMed2004

Nurse and patient communication via low- and high-bandwidth home telecare systems.

We examined nurse-patient communication on two videoconferencing systems: a video-phone (PSTN video) and a PC-based system (IP video). The former used data transmission via a modem at 33.6 kbit/s and the latter via a local-area network at up to 512 kbit/s. Twenty-six nurses and 18 volunteers (simulated patients) participated. On each video system nurse-patient dyads completed scripted interactions; they then completed questionnaires to assess communication. Of the participants, 84% (n=37) preferred IP video and 14% (n=6) preferred PSTN video (one expressed no preference). IP video was rated significantly higher in all communication quality areas except self-consciousness/embarrassment. Although participants' overall ratings were higher for the IP video system, two important advantages of the PSTN video system were identified by both nurses and patients: first, it provided superior visualization of the medication bottle, insulin syringe and the patient's skin; and second, it was easier to use. Video quality and audio quality are important determinants of patient and provider perceptions, but ease of use, clinical appropriateness, and the need for training and support must not be forgotten.

Adult↗
PubMed2002

Behaviors and outcomes of acute confusion in hospitalized patients.

The purpose of this study was to describe behaviors associated with acute confusion (AC) in hospitalized patients and to determine whether acutely confused patients experience more adverse outcomes compared with their nonconfused counterparts. Using a prospective design, 117 subjects were followed throughout hospital stay. Subjects who developed AC were more likely to fall, be incontinent, have a urinary catheter, and experience functional decline. Mortality was higher in subjects with AC. Contrary to popular belief, acutely confused patients exhibited decreased psychomotor activity. Nurses can be trained to recognize AC using a standardized protocol to improve outcomes for this vulnerable population.

Acute Disease↗
PubMed2002

Telehealth for elders and their caregivers in rural communities.

The use of technological strategies in providing care for patients and their families at distant locations has been available since the 1950s. Today's telehealth approaches are proposed to offer considerable promise for enhanced service delivery in rural and other underserved communities. Technology-based delivery methods, such as videophone skill training, and one- and two-way interactive computer networks, are envisioned as contributors for improving rural residents' access to services, individualizing rural health care, increasing rural health practitioners' continuing education opportunities, and improving quality and cost-efficiency of care.

Age Factors↗
PubMed2002

Risk for acute confusion on hospital admission.

Elderly individuals are at risk for acute confusion (AC) during hospitalization. Using a prospective design, this study assessed the relationship between admission risk factors and subsequent development of AC in 117 elderly hospitalized patients. AC was ascertained using the NEECHAM Confusion Scale. Other measures included demographic data, cognitive status, physical function, laboratory data, medications, infections, activity, pain, and nursing acuity. The cumulative incidence estimate was 14%. Patients who developed AC were more likely to be admitted to the hospital from somewhere other than home, to have lower admission NEECHAM and MMSE scores, and to have restricted activity levels, an infection, and abnormal lab values. These patients were more cognitively and physically frail and may have been chronically undernourished and dehydrated on admission to the hospital. Nurses can be trained to routinely assess for acute confusion using easily implemented instruments incorporated into a research-based protocol.

Acute Disease↗