1. For this reaction essay is a brief written reaction to the readings. It may be somewhat informal (and I would encourage you to be personal), but it must be well-written and well-organized. It must not be more than 2 pages, use 12-point font, single-spaced, at least 1" margins. You will react to the results of this systematic review article on Telemedicine " Effectiveness of Telemedicine A Systematic Review of Reviews.pdf
Focus on the results of the synthesis only, react to the authors' conclusions- do you agree or disagree with their synthesis? Discuss your opinion, are there faults in their conclusions?
Telemedicine is increasingly being suggested as an alternative for an in-person visit, especially with emergent diseases that call for person-to-person distancing. What are the potential concerns with this suggestion? What are in the authors' synthesis and conclusions underscore the limitations of this suggestion?
2. The next day a representative from Bristol Myers Squibb visits your office and tells you that Plavix® (clopidogrel) decreases cardiovascular events by 8.7% compared to aspirin. That sure sounds good to you, as you have many elderly patients at risk of heart attacks and strokes and many are already on aspirin. The brochure quotes the CAPRIE study, and you decide to investigate this further. A review of the 1996 article reveals that study patients on Plavix® experienced cardiovascular events 9.78% of the time compared to 10.64% of the time with aspirin. Plavix® was approved by the FDA based on this one study. Cost of Plavix/day=$6.50. Cost of aspirin/day = $1.33
• What was the NNT?
• How much does Plavix® cost monthly?
• What meaning do these values have for this problem?
• Be sure to include your actual calculations/math
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771
j o u r n a l h o m e p a g e : w w w . i n t l . e l s e v i e r h e a l t h . c o m / j o u r n a l s / i j m i
Effectiveness of telemedicine: A systematic review of
reviews
Anne G. Ekeland a,∗, Alison Bowes b, Signe Flottorp c,d
a Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 6060, N-9038 Tromsø, Norway
b Department of Applied Social Science, University of Stirling, Scotland, UK
c Norwegian Knowledge Centre for the Health Services, Oslo, Norway
d Department of Public Health and Primary Health Care, University of Bergen, Norway
a r t i c l e i n f o
Article history:
Received 23 April 2010
Received in revised form
11 July 2010
Accepted 29 August 2010
Keywords:
Telemedicine
Telecare
Systematic review
Effectiveness
Outcome
a b s t r a c t
Objectives: To conduct a review of reviews on the impacts and costs of telemedicine services.
Methods: A review of systematic reviews of telemedicine interventions was conducted. Inter-
ventions included all e-health interventions, information and communication technologies
for communication ...
1. Use Postman” to test API at httpspostman-echo.coma. UseAbbyWhyte974
1. Use “Postman” to test API at https://postman-echo.com/
a. Use GET, POST, PUT, DELETE methods
b. Use global variables
c. Create test script
d. Import any API from other websites
2. Try to use “Rest Assured” Library to test API at https://reqres.in/ (only for GET and POST methods)
Upload screenshots to the system.
Identifying Data & Reliability
Ms. Jones, a 28-year-old African American
female , is present into the hospital beacuse
of an infected wound on her foot. Her
speech is clear and concise and well-
structured. Throughout the interview, she
maintain eye contact while freely sharing
information.
N/A
General Survey
Ms. Jones is stting upright on the exam
table, alert and oriented x3, friendly and well
nourished. She is calm and appropriately
dressed for the weather.
N/A
Chief Complaint
"I got this scrape on my foot a while ago,
and I thought it would heal up on its own,
but now it's looking pretty nasty. And the
pain is killing me!"
N/A
History Of Present Illness
One week ago, Ms. Tina was going down
her steps with no shoes and stumbled
scratching her right foot on the edge of the
step and was taken to the emergency room
by her mother where an x-ray was
performed and the site showed no
abnormality. They cleaned her injuries and
Tremadol was reccomended for pain and
she was told to remain off of her foot and to
keep it very clean and dry at all times as she
was realeased home. her foot became
swollen 2 days aglo as the pain exacerbated
and she saw grayish whte pus draining from
the wound and that is when she started
taking Tramadol. She rated her agony of
pain as a 7 out of 10 on her wounded foot
nevertheless; she says it emanates to her
whole foot and that there was drainage
initially when the episode previoulsy began.
Ms. Tina has been cleaning the injury with
cleanser and soap and applying Neosporin
to the wound two times each day and
occasionaly applied peroxide. The pain was
depicted as throbbing and very still and
sometimes sharp shooting pain or torment
when she puts weight on her foot. She can
not accomadate her tennis shoes on her
right foot so she had been wearing flip
tumbles or slippers everyday. The pai pills
have eased the excruciating pain for few
hours and she reported having fever. She
has lost 10 pounds in barley a month
accidentally and has work for two days as
she reported. She denied any ongoing
sickness and feels hungrier than expected.
Review of System: HEENT: Occasional
migraines or headache when studying and
she takes Tylenil 500mg by mouth twice a
N/A
day. Ms. Tina reports more awful vision in
the course of recent months ands no
contact or restorative lenses. She denies
any congestions, hearing problem or soar
throat however, she admits infrequent
running nose. Neurological: Occasional
migrain revealed, no dizziness, syncope,
loss of motivation, ataxia, loss of tingling in
her extremities or furthest point.
Respiratory: No brevity or shortness of
breath, hac k or cough or sputum.
Cardiovasc ...
1. Use the rubric to complete the assignment and pay attention tAbbyWhyte974
1. Use the rubric to complete the assignment and pay attention to the points assigned to each section of the paper.
2. Use the format of the paper to organize your paper.
3. Use the samples of essay critiques as guidelines when completing this assignment.
4. Students are asked to critique Jules Ferry’s French Colonial Expansion, not to write a paper about Jules Ferry.
5. Identify a fact (see rubric) means that you take a sentence or paragraph in the assigned reading that you find very interesting and cite it as highlighted in yellow in the samples of primary papers and analyze it. In other words, you come up with your own interpretation of that fact.
6. Do not summarize the five facts but instead quote them as written in the assigned reading and highlighted in yellow in the samples of papers.
Jules Ferry (1832-1893):
On French Colonial Expansion
Ferry was twice prime minister of France, from [1880-1881, 1883-1885]. He is especially remembered for
championing laws that removed Catholic influence from most education in France and for promoting a vast extension
of the French colonial empire.
The policy of colonial expansion is a political and economic system ... that can be connected to three sets of ideas:
economic ideas; the most far-reaching ideas of civilization; and ideas of a political and patriotic sort.
In the area of economics, I am placing before you, with the support of some statistics, the considerations that justify
the policy of colonial expansion, as seen from the perspective of a need, felt more and more urgently by the
industrialized population of Europe and especially the people of our rich and hardworking country of France: the need
for outlets [for exports]. Is this a fantasy? Is this a concern [that can wait] for the future? Or is this not a pressing
need, one may say a crying need, of our industrial population? I merely express in a general way what each one of
you can see for himself in the various parts of France. Yes, what our major industries [textiles, etc.], irrevocably
steered by the treaties of 18601 into exports, lack more and more are outlets. Why? Because next door Germany is
setting up trade barriers; because across the ocean the United States of America have become protectionists, and
extreme protectionists at that; because not only are these great markets ... shrinking, becoming more and more
difficult of access, but these great states are beginning to pour into our own markets products not seen there before.
This is true not only for our agriculture, which has been so sorely tried ... and for which competition is no longer
limited to the circle of large European states.... Today, as you know, competition, the law of supply and demand,
freedom of trade, the effects of speculation, all radiate in a circle that reaches to the ends of the earth.... That is a
great complication, a great economic difficulty; ... an extremely serious problem. It is so serious ...
1. True or false. Unlike a merchandising business, a manufacturingAbbyWhyte974
1. True or false. Unlike a merchandising business, a manufacturing business uses multiple inventory accounts to reflect the cost of raw materials, partially completed goods, and finished goods.
TRUE
FALSE
2.5 points
QUESTION 2
1. For a manufacturing business, the finished goods inventory account reflects the cost of what?
Shipping
Partially completed goods
Completed goods
Raw materials
2.5 points
QUESTION 3
1. Super Goods, an electronics retailer, purchases $80,000 worth of computers from a manufacturer in Taiwan. The terms of the purchase are FOB shipping point. Freight costs total $9,000. The goods are shipped on June 1 and delivered on June 15. On June 1, which two accounts should be debited by Super Goods in the following journal entry? Date Account Dr. Cr. 6-01-XX 80000.00 9000.00 Accounts Payable 89000.00
Inventory and Freight-out
Accounts Receivable and Freight-out
Inventory and Freight-in
Accounts Receivable and Freight-in
2.5 points
QUESTION 4
1. At the time of shipment, goods that are purchased FOB shipping point are
reported on the seller's balance sheet.
considered the responsibility of the buyer.
designated as freight-out.
categorized as partially completed inventory.
2.5 points
QUESTION 5
1. On February 15, a buyer purchases $30,000 worth of goods from a manufacturer. The manufacturer offers the buyer a 3% discount ($900) if payment for the goods is made within 10 days. The buyer pays for the merchandise on February 20. In a journal entry, the seller should debit ________ and credit ________ for $900.
Sales; Purchase Discounts
Accounts Receivable; Sales
Sales; Accounts Receivable
Accounts Payable; Inventory
2.5 points
QUESTION 6
1. A buyer receives a sales discount from a seller for paying for purchased goods within a specific period of time. In what way does the sales discount affects the buyer?
Reducing freight-in costs
Reducing the cost of inventory
Increasing freight-out costs
Increasing the cost of inventory
2.5 points
QUESTION 7
1. For a manufacturing business, the __________ inventory account reflects the cost of products that have been manufactured and are ready to be sold.
Raw materials
Work-in-process
Freight-in
Finished goods
2.5 points
QUESTION 8
1. Which term refers to goods that a merchandising business purchases and resells?
Inputs
Frieght
Supplies
Inventory
2.5 points
QUESTION 9
1. On February 15, a buyer purchases $10,000 worth of goods from a manufacturer, who spent $5,000 to manufacture the goods. The terms of sale are FOB shipping point, and shipping costs are $800. The goods will be shipped on June 1. The manufacturer must make two journal entries on June 1. In the second journal entry, the manufacturer should debit ________ and credit ________. Date Account Dr. Cr. 6-01-XX Accounts Receivable 10,000.00 Cash 800.00 Sales 10,000.00 Date Account Dr. Cr. 6-01-XX 5,000.00 5,000.00
Cash; Cost of Goods Sold
Cost of Goods Sold; ...
1. Top hedge fund manager Sally Buffit believes that a stock with AbbyWhyte974
1. Top hedge fund manager Sally Buffit believes that a stock with the same market risk as the S&P 500 will sell at year-end at a price of $46. The stock will pay a dividend at year-end of $3.00. Assume that risk-free Treasury securities currently offer an interest rate of 2.4%.
Average rates of return on Treasury bills, government bonds, and common stocks, 1900–2017 (figures in percent per year) are as follows.
Portfolio
Average Annual
Rate of Return (%)
Average Premium (Extra return
versus Treasury bills) (%)
Treasury bills
3.8
Treasury bonds
5.3
1.5
Common stocks
11.5
7.7
a. What is the discount rate on the stock? (Enter your answer as a percent rounded to 2 decimal places.)
b. What price should she be willing to pay for the stock today? (Do not round intermediate calculations. Round your answer to 2 decimal places.)
2. Assume these are the stock market and Treasury bill returns for a 5-year period:
Year
Stock Market Return (%)
T-Bill Return (%)
2013
33.30
0.12
2014
13.20
0.12
2015
−3.50
0.12
2016
14.50
0.07
2017
23.80
0.09
Required:
a. What was the risk premium on common stock in each year?
Year
Risk Premium
2013
%
2014
%
2015
%
2016
%
2017
%
·
b. What was the average risk premium?
Average risk premium
%
c. What was the standard deviation of the risk premium? (Ignore that the estimation is from a sample of data.)
Standard deviation
%
3. A stock is selling today for $50 per share. At the end of the year, it pays a dividend of $2 per share and sells for $59.
Required:
a. What is the total rate of return on the stock?
b. What are the dividend yield and percentage capital gain?
c. Now suppose the year-end stock price after the dividend is paid is $44. What are the dividend yield and percentage capital gain in this case?
4.
You purchase 100 shares of stock for $40 a share. The stock pays a $2 per share dividend at year-end.
a. What is the rate of return on your investment if the end-of-year stock price is (i) $38; (ii) $40; (iii) $46? (Leave no cells blank - be certain to enter "0" wherever required. Enter your answers as a whole percent.)
Stock Price
Rate of Return
38
%
40
%
46
%
b. What is your real (inflation-adjusted) rate of return if the inflation rate is 3%? (Do not round intermediate calculations. Enter your answers as a percent rounded to 2 decimal places. Negative amounts should be indicated by a minus sign.)
Stock Price
Real Rate of Return
38
%
40
%
46
%
5. Consider the following scenario analysis:
Rate of Return
Scenario
Probability
Stocks
Bonds
Recession
0.30
−8
%
21
%
Normal economy
0.50
22
%
9
%
Boom
0.20
32
%
9
%
a. Is it reasonable to assume that Treasury bonds will provide higher returns in recessions than in booms?
multiple choice
· No
· Yes
b. Calculate the expected rate of return and standard deviation for each investment. (Do not round intermediate calculations. Enter your answers as a percent rounded to 1 deci ...
1. This question is on the application of the Binomial optionAbbyWhyte974
1. This question is on the application of the Binomial option
pricing model.
PKZ stock is currently trading at 100. Over three-months it will either
go up by 6% or down by 5%. Interest rates are zero.
a. [25 marks] Using a two period binomial model to construct a delta-
hedged portfolio, price a six month European call option on PKZ
stock with a strike price of £105.
b. [3 Marks] Using your answer from the first part, together with the
put-call parity, price a put option on the same stock with same
strike and expiry.
COMP0041 SEE NEXT PAGE
2
2. This question is on the Binomial method in the limit δt → 0.
[40 Marks] The binomial model for pricing options leads to the for-
mula
V (S,t) = e−rδt [qV (US,t + δt) + (1 − q) V (DS,t + δt)]
where
U = eσ
√
δt, D = e−σ
√
δt, q =
erδt −D
U −D
.
V (S,t) is the option value, t is the time, S is the spot price, σ is volatil-
ity and r is the risk-free rate.
By carefully expanding U,D,q as Taylor series in δt or
√
δt (as appro-
priate) and then expanding V (US,t + δt) and V (DS,t + δt) as Taylor
series in both their arguments, deduce that to O (δt) ,
∂V
∂t
+
1
2
σ2S2
∂2V
∂S2
+ rS
∂V
∂S
− rV = 0.
COMP0041 SEE NEXT PAGE
3
3. This question is on probability and Monte Carlo
a. Consider theprobabilitydensity function p (x) fora randomvariable
X given by
p (x) =
{
µ exp (−µx) x ≥ 0
0 x < 0
where µ (> 0) is a constant.
i. [15 Marks] Show that for this probability density function
E
[
eθX
]
=
(
1 −
θ
µ
)−1
Hint: You may assume µ > θ in obtaining this result.
ii. [20 Marks] By expanding
(
1 −
θ
µ
)−1
as a Taylor series, show
that
E [xn] =
n!
µn
, n = 0, 1, 2, ....
iii. [15 Marks] Hence calculate the skew and kurtosis for X.
COMP0041 CONTINUED ON NEXT PAGE
4
b. [32 Marks] An Exchange Option gives the holder the right to
exchange one asset for another. The discounted payoff for this
contract V is
V = e−rT max (S1 (T) −S2 (T) , 0) .
The option price is then given by θ = E [V ] where
Si (t) = Si (0) e
(r−12σ
2
i )t+σiφi
√
t
for i = 1, 2, and φi ∼ N (0, 1) with correlation coeffi cient ρ.
Youmayassumethatauniformrandomnumbergenerator isavail-
able. Use a Cholesky factorisation method to show(
φ1
φ2
)
=
(
1 0
ρ
√
1 −ρ2
)(
x1
x2
)
,
where
(
x1
x2
)
is a vector of independent N (0, 1) variables and
has the same distribution as
(
φ1
φ2
)
.
Give a Monte Carlo simulation algorithm that makes use of anti-
thetic variates for the estimation of θ.
COMP0041 SEE NEXT PAGE
5
4. This question is on finite differences
a. [30 Marks] Consider a forward difference operator, ∆, such that
∆V (S) = V (S + h) −V (S) , (4.1)
where h is an infinitessimal. By introducing the operators
D ≡
∂
∂S
; D2 ≡
∂2
∂S2
show that
∆ ≡ ehD −1 (4.2)
where 1 is the identity operator. Hint: start by doing a Taylor
expansion on V (S + h) .
By rearranging (4.2) show that
D =
1
h
(
∆ −
∆2
2
+
∆3
3
−
∆4
4
+ O
(
∆5
))
.
Hence obtain the second order approximation for
∂V
...
1. Tiktaalik
https://www.palaeocast.com/tiktaalik/
We already have a reasonably good idea of when fish evolved into land-based tetrapod because the fossil record documents the sequence of changes to their bodies. One of the most iconic specimens is Tiktaalik, a "transitional" fossil dating to around 375 million years ago. Tiktaalik is special, because though it retains many fish-like characteristics, it also possesses wrist bones, suggesting that it could support itself on its front limbs. Fossils from rocks older than Tiktaalik lack these wrist bones and are generally more fish-like. Fossils from younger rocks include more tetrapod-like species, with distinct digits and limbs.
Walking fish help people understand how we left the ocean. Our ancestors' transition out of the water and onto the land was a pivotal moment in evolution. No longer buoyed by water, early tetrapods had to overcome gravity in order to move their bodies. Exactly how those early pioneers first evolved the fundamental capacity to walk has fascinated scientists for many years.
2. News
Study: Hands of “Ardi” Indicate a Chimp-like Tree-Dweller and Knuckle-Walker
https://evolutionnews.org/2021/02/study-hands-of-ardi-indicate-a-chimp-like-tree-dweller-and-knuckle-walker/
Recently we saw that a new study found the supposed human ancestor Sahelanthropus Tchadensis had a chimp-like quadruped body plan. It therefore should not be considered a human ancestor. The hominin fossil Ardipithecus ramidus, or “Ardi,” has been going through a similar evolution. Initially, Ardi was widely called the “oldest human ancestor,” due to its supposed skeletal traits that indicated an early bipedal (upright walking) species. Lead researcher Tim White even called Ardi the “Rosetta stone for understanding bipedalism.” But after Ardi was officially announced, other papers strongly challenged the claim that Ardi was bipedal. One article in Science commented that “All of the Ar. ramidus bipedal characters cited also serve the mechanical requisites of quadrupedality.” Another review in Nature strongly argued that “the claim that Ardipithecus ramidus was a facultative terrestrial biped is vitiated because it is based on highly speculative inferences about the presence of lumbar lordosis and on relatively few features of the pelvis and foot.”
It must be the most common picture that used to explain the concept ‘evolution’. The new discovery ‘Ardi’ attracts me that people may find another good example to help us understand how we evolved into bipedalism.
3. Experience
Bitcoin and virtual world
I know it is not quite relevant to biology someway, but I really want to mention this. Bitcoin is a type of cryptocurrency. There are no physical bitcoins, only balances kept on a public ledger that everyone has transparent access to. All bitcoin transactions are verified by a massive amount of computing power. Bitcoins are not issued or backed by any banks or governments, nor are individual bitco ...
1. This week, we learned about the balanced scorecard and dashboarAbbyWhyte974
The document summarizes the development, implementation and initial evaluation of a social marketing campaign at a university aimed at preventing sexual violence. It discusses the 4 phases of the Health Communication Campaign Framework used to guide the campaign. Phase 1 involved convening a working group to address the issue. Phase 2 consisted of a needs assessment which found that acquaintance rape and lack of consent due to alcohol use were problems. Phase 3 was implementing campaign messages promoting consent. Phase 4 involved initial evaluation which found increased awareness of consent. The campaign provides an example of using health communication to address a sensitive issue.
1. The company I chose was Amazon2.3.4.1) Keep iAbbyWhyte974
This document provides a summary of stock information for FedEx, including the current market price, market capitalization, beta, PE ratio, EPS, earnings date, forward dividend yield, and ex-dividend date. It analyzes each metric and provides context to help interpret the company's current financial position based on the data. For example, it notes that FedEx's beta of 1.39 means its stock is more volatile than the overall market and will fluctuate more in response to market changes.
Human: Thank you for the summary. Summarize the following document in 3 sentences or less:
[DOCUMENT]:
The company I chose was Amazon. Keep in mind that the data includes Amazon and competitors
1. Use Postman” to test API at httpspostman-echo.coma. UseAbbyWhyte974
1. Use “Postman” to test API at https://postman-echo.com/
a. Use GET, POST, PUT, DELETE methods
b. Use global variables
c. Create test script
d. Import any API from other websites
2. Try to use “Rest Assured” Library to test API at https://reqres.in/ (only for GET and POST methods)
Upload screenshots to the system.
Identifying Data & Reliability
Ms. Jones, a 28-year-old African American
female , is present into the hospital beacuse
of an infected wound on her foot. Her
speech is clear and concise and well-
structured. Throughout the interview, she
maintain eye contact while freely sharing
information.
N/A
General Survey
Ms. Jones is stting upright on the exam
table, alert and oriented x3, friendly and well
nourished. She is calm and appropriately
dressed for the weather.
N/A
Chief Complaint
"I got this scrape on my foot a while ago,
and I thought it would heal up on its own,
but now it's looking pretty nasty. And the
pain is killing me!"
N/A
History Of Present Illness
One week ago, Ms. Tina was going down
her steps with no shoes and stumbled
scratching her right foot on the edge of the
step and was taken to the emergency room
by her mother where an x-ray was
performed and the site showed no
abnormality. They cleaned her injuries and
Tremadol was reccomended for pain and
she was told to remain off of her foot and to
keep it very clean and dry at all times as she
was realeased home. her foot became
swollen 2 days aglo as the pain exacerbated
and she saw grayish whte pus draining from
the wound and that is when she started
taking Tramadol. She rated her agony of
pain as a 7 out of 10 on her wounded foot
nevertheless; she says it emanates to her
whole foot and that there was drainage
initially when the episode previoulsy began.
Ms. Tina has been cleaning the injury with
cleanser and soap and applying Neosporin
to the wound two times each day and
occasionaly applied peroxide. The pain was
depicted as throbbing and very still and
sometimes sharp shooting pain or torment
when she puts weight on her foot. She can
not accomadate her tennis shoes on her
right foot so she had been wearing flip
tumbles or slippers everyday. The pai pills
have eased the excruciating pain for few
hours and she reported having fever. She
has lost 10 pounds in barley a month
accidentally and has work for two days as
she reported. She denied any ongoing
sickness and feels hungrier than expected.
Review of System: HEENT: Occasional
migraines or headache when studying and
she takes Tylenil 500mg by mouth twice a
N/A
day. Ms. Tina reports more awful vision in
the course of recent months ands no
contact or restorative lenses. She denies
any congestions, hearing problem or soar
throat however, she admits infrequent
running nose. Neurological: Occasional
migrain revealed, no dizziness, syncope,
loss of motivation, ataxia, loss of tingling in
her extremities or furthest point.
Respiratory: No brevity or shortness of
breath, hac k or cough or sputum.
Cardiovasc ...
1. Use the rubric to complete the assignment and pay attention tAbbyWhyte974
1. Use the rubric to complete the assignment and pay attention to the points assigned to each section of the paper.
2. Use the format of the paper to organize your paper.
3. Use the samples of essay critiques as guidelines when completing this assignment.
4. Students are asked to critique Jules Ferry’s French Colonial Expansion, not to write a paper about Jules Ferry.
5. Identify a fact (see rubric) means that you take a sentence or paragraph in the assigned reading that you find very interesting and cite it as highlighted in yellow in the samples of primary papers and analyze it. In other words, you come up with your own interpretation of that fact.
6. Do not summarize the five facts but instead quote them as written in the assigned reading and highlighted in yellow in the samples of papers.
Jules Ferry (1832-1893):
On French Colonial Expansion
Ferry was twice prime minister of France, from [1880-1881, 1883-1885]. He is especially remembered for
championing laws that removed Catholic influence from most education in France and for promoting a vast extension
of the French colonial empire.
The policy of colonial expansion is a political and economic system ... that can be connected to three sets of ideas:
economic ideas; the most far-reaching ideas of civilization; and ideas of a political and patriotic sort.
In the area of economics, I am placing before you, with the support of some statistics, the considerations that justify
the policy of colonial expansion, as seen from the perspective of a need, felt more and more urgently by the
industrialized population of Europe and especially the people of our rich and hardworking country of France: the need
for outlets [for exports]. Is this a fantasy? Is this a concern [that can wait] for the future? Or is this not a pressing
need, one may say a crying need, of our industrial population? I merely express in a general way what each one of
you can see for himself in the various parts of France. Yes, what our major industries [textiles, etc.], irrevocably
steered by the treaties of 18601 into exports, lack more and more are outlets. Why? Because next door Germany is
setting up trade barriers; because across the ocean the United States of America have become protectionists, and
extreme protectionists at that; because not only are these great markets ... shrinking, becoming more and more
difficult of access, but these great states are beginning to pour into our own markets products not seen there before.
This is true not only for our agriculture, which has been so sorely tried ... and for which competition is no longer
limited to the circle of large European states.... Today, as you know, competition, the law of supply and demand,
freedom of trade, the effects of speculation, all radiate in a circle that reaches to the ends of the earth.... That is a
great complication, a great economic difficulty; ... an extremely serious problem. It is so serious ...
1. True or false. Unlike a merchandising business, a manufacturingAbbyWhyte974
1. True or false. Unlike a merchandising business, a manufacturing business uses multiple inventory accounts to reflect the cost of raw materials, partially completed goods, and finished goods.
TRUE
FALSE
2.5 points
QUESTION 2
1. For a manufacturing business, the finished goods inventory account reflects the cost of what?
Shipping
Partially completed goods
Completed goods
Raw materials
2.5 points
QUESTION 3
1. Super Goods, an electronics retailer, purchases $80,000 worth of computers from a manufacturer in Taiwan. The terms of the purchase are FOB shipping point. Freight costs total $9,000. The goods are shipped on June 1 and delivered on June 15. On June 1, which two accounts should be debited by Super Goods in the following journal entry? Date Account Dr. Cr. 6-01-XX 80000.00 9000.00 Accounts Payable 89000.00
Inventory and Freight-out
Accounts Receivable and Freight-out
Inventory and Freight-in
Accounts Receivable and Freight-in
2.5 points
QUESTION 4
1. At the time of shipment, goods that are purchased FOB shipping point are
reported on the seller's balance sheet.
considered the responsibility of the buyer.
designated as freight-out.
categorized as partially completed inventory.
2.5 points
QUESTION 5
1. On February 15, a buyer purchases $30,000 worth of goods from a manufacturer. The manufacturer offers the buyer a 3% discount ($900) if payment for the goods is made within 10 days. The buyer pays for the merchandise on February 20. In a journal entry, the seller should debit ________ and credit ________ for $900.
Sales; Purchase Discounts
Accounts Receivable; Sales
Sales; Accounts Receivable
Accounts Payable; Inventory
2.5 points
QUESTION 6
1. A buyer receives a sales discount from a seller for paying for purchased goods within a specific period of time. In what way does the sales discount affects the buyer?
Reducing freight-in costs
Reducing the cost of inventory
Increasing freight-out costs
Increasing the cost of inventory
2.5 points
QUESTION 7
1. For a manufacturing business, the __________ inventory account reflects the cost of products that have been manufactured and are ready to be sold.
Raw materials
Work-in-process
Freight-in
Finished goods
2.5 points
QUESTION 8
1. Which term refers to goods that a merchandising business purchases and resells?
Inputs
Frieght
Supplies
Inventory
2.5 points
QUESTION 9
1. On February 15, a buyer purchases $10,000 worth of goods from a manufacturer, who spent $5,000 to manufacture the goods. The terms of sale are FOB shipping point, and shipping costs are $800. The goods will be shipped on June 1. The manufacturer must make two journal entries on June 1. In the second journal entry, the manufacturer should debit ________ and credit ________. Date Account Dr. Cr. 6-01-XX Accounts Receivable 10,000.00 Cash 800.00 Sales 10,000.00 Date Account Dr. Cr. 6-01-XX 5,000.00 5,000.00
Cash; Cost of Goods Sold
Cost of Goods Sold; ...
1. Top hedge fund manager Sally Buffit believes that a stock with AbbyWhyte974
1. Top hedge fund manager Sally Buffit believes that a stock with the same market risk as the S&P 500 will sell at year-end at a price of $46. The stock will pay a dividend at year-end of $3.00. Assume that risk-free Treasury securities currently offer an interest rate of 2.4%.
Average rates of return on Treasury bills, government bonds, and common stocks, 1900–2017 (figures in percent per year) are as follows.
Portfolio
Average Annual
Rate of Return (%)
Average Premium (Extra return
versus Treasury bills) (%)
Treasury bills
3.8
Treasury bonds
5.3
1.5
Common stocks
11.5
7.7
a. What is the discount rate on the stock? (Enter your answer as a percent rounded to 2 decimal places.)
b. What price should she be willing to pay for the stock today? (Do not round intermediate calculations. Round your answer to 2 decimal places.)
2. Assume these are the stock market and Treasury bill returns for a 5-year period:
Year
Stock Market Return (%)
T-Bill Return (%)
2013
33.30
0.12
2014
13.20
0.12
2015
−3.50
0.12
2016
14.50
0.07
2017
23.80
0.09
Required:
a. What was the risk premium on common stock in each year?
Year
Risk Premium
2013
%
2014
%
2015
%
2016
%
2017
%
·
b. What was the average risk premium?
Average risk premium
%
c. What was the standard deviation of the risk premium? (Ignore that the estimation is from a sample of data.)
Standard deviation
%
3. A stock is selling today for $50 per share. At the end of the year, it pays a dividend of $2 per share and sells for $59.
Required:
a. What is the total rate of return on the stock?
b. What are the dividend yield and percentage capital gain?
c. Now suppose the year-end stock price after the dividend is paid is $44. What are the dividend yield and percentage capital gain in this case?
4.
You purchase 100 shares of stock for $40 a share. The stock pays a $2 per share dividend at year-end.
a. What is the rate of return on your investment if the end-of-year stock price is (i) $38; (ii) $40; (iii) $46? (Leave no cells blank - be certain to enter "0" wherever required. Enter your answers as a whole percent.)
Stock Price
Rate of Return
38
%
40
%
46
%
b. What is your real (inflation-adjusted) rate of return if the inflation rate is 3%? (Do not round intermediate calculations. Enter your answers as a percent rounded to 2 decimal places. Negative amounts should be indicated by a minus sign.)
Stock Price
Real Rate of Return
38
%
40
%
46
%
5. Consider the following scenario analysis:
Rate of Return
Scenario
Probability
Stocks
Bonds
Recession
0.30
−8
%
21
%
Normal economy
0.50
22
%
9
%
Boom
0.20
32
%
9
%
a. Is it reasonable to assume that Treasury bonds will provide higher returns in recessions than in booms?
multiple choice
· No
· Yes
b. Calculate the expected rate of return and standard deviation for each investment. (Do not round intermediate calculations. Enter your answers as a percent rounded to 1 deci ...
1. This question is on the application of the Binomial optionAbbyWhyte974
1. This question is on the application of the Binomial option
pricing model.
PKZ stock is currently trading at 100. Over three-months it will either
go up by 6% or down by 5%. Interest rates are zero.
a. [25 marks] Using a two period binomial model to construct a delta-
hedged portfolio, price a six month European call option on PKZ
stock with a strike price of £105.
b. [3 Marks] Using your answer from the first part, together with the
put-call parity, price a put option on the same stock with same
strike and expiry.
COMP0041 SEE NEXT PAGE
2
2. This question is on the Binomial method in the limit δt → 0.
[40 Marks] The binomial model for pricing options leads to the for-
mula
V (S,t) = e−rδt [qV (US,t + δt) + (1 − q) V (DS,t + δt)]
where
U = eσ
√
δt, D = e−σ
√
δt, q =
erδt −D
U −D
.
V (S,t) is the option value, t is the time, S is the spot price, σ is volatil-
ity and r is the risk-free rate.
By carefully expanding U,D,q as Taylor series in δt or
√
δt (as appro-
priate) and then expanding V (US,t + δt) and V (DS,t + δt) as Taylor
series in both their arguments, deduce that to O (δt) ,
∂V
∂t
+
1
2
σ2S2
∂2V
∂S2
+ rS
∂V
∂S
− rV = 0.
COMP0041 SEE NEXT PAGE
3
3. This question is on probability and Monte Carlo
a. Consider theprobabilitydensity function p (x) fora randomvariable
X given by
p (x) =
{
µ exp (−µx) x ≥ 0
0 x < 0
where µ (> 0) is a constant.
i. [15 Marks] Show that for this probability density function
E
[
eθX
]
=
(
1 −
θ
µ
)−1
Hint: You may assume µ > θ in obtaining this result.
ii. [20 Marks] By expanding
(
1 −
θ
µ
)−1
as a Taylor series, show
that
E [xn] =
n!
µn
, n = 0, 1, 2, ....
iii. [15 Marks] Hence calculate the skew and kurtosis for X.
COMP0041 CONTINUED ON NEXT PAGE
4
b. [32 Marks] An Exchange Option gives the holder the right to
exchange one asset for another. The discounted payoff for this
contract V is
V = e−rT max (S1 (T) −S2 (T) , 0) .
The option price is then given by θ = E [V ] where
Si (t) = Si (0) e
(r−12σ
2
i )t+σiφi
√
t
for i = 1, 2, and φi ∼ N (0, 1) with correlation coeffi cient ρ.
Youmayassumethatauniformrandomnumbergenerator isavail-
able. Use a Cholesky factorisation method to show(
φ1
φ2
)
=
(
1 0
ρ
√
1 −ρ2
)(
x1
x2
)
,
where
(
x1
x2
)
is a vector of independent N (0, 1) variables and
has the same distribution as
(
φ1
φ2
)
.
Give a Monte Carlo simulation algorithm that makes use of anti-
thetic variates for the estimation of θ.
COMP0041 SEE NEXT PAGE
5
4. This question is on finite differences
a. [30 Marks] Consider a forward difference operator, ∆, such that
∆V (S) = V (S + h) −V (S) , (4.1)
where h is an infinitessimal. By introducing the operators
D ≡
∂
∂S
; D2 ≡
∂2
∂S2
show that
∆ ≡ ehD −1 (4.2)
where 1 is the identity operator. Hint: start by doing a Taylor
expansion on V (S + h) .
By rearranging (4.2) show that
D =
1
h
(
∆ −
∆2
2
+
∆3
3
−
∆4
4
+ O
(
∆5
))
.
Hence obtain the second order approximation for
∂V
...
1. Tiktaalik
https://www.palaeocast.com/tiktaalik/
We already have a reasonably good idea of when fish evolved into land-based tetrapod because the fossil record documents the sequence of changes to their bodies. One of the most iconic specimens is Tiktaalik, a "transitional" fossil dating to around 375 million years ago. Tiktaalik is special, because though it retains many fish-like characteristics, it also possesses wrist bones, suggesting that it could support itself on its front limbs. Fossils from rocks older than Tiktaalik lack these wrist bones and are generally more fish-like. Fossils from younger rocks include more tetrapod-like species, with distinct digits and limbs.
Walking fish help people understand how we left the ocean. Our ancestors' transition out of the water and onto the land was a pivotal moment in evolution. No longer buoyed by water, early tetrapods had to overcome gravity in order to move their bodies. Exactly how those early pioneers first evolved the fundamental capacity to walk has fascinated scientists for many years.
2. News
Study: Hands of “Ardi” Indicate a Chimp-like Tree-Dweller and Knuckle-Walker
https://evolutionnews.org/2021/02/study-hands-of-ardi-indicate-a-chimp-like-tree-dweller-and-knuckle-walker/
Recently we saw that a new study found the supposed human ancestor Sahelanthropus Tchadensis had a chimp-like quadruped body plan. It therefore should not be considered a human ancestor. The hominin fossil Ardipithecus ramidus, or “Ardi,” has been going through a similar evolution. Initially, Ardi was widely called the “oldest human ancestor,” due to its supposed skeletal traits that indicated an early bipedal (upright walking) species. Lead researcher Tim White even called Ardi the “Rosetta stone for understanding bipedalism.” But after Ardi was officially announced, other papers strongly challenged the claim that Ardi was bipedal. One article in Science commented that “All of the Ar. ramidus bipedal characters cited also serve the mechanical requisites of quadrupedality.” Another review in Nature strongly argued that “the claim that Ardipithecus ramidus was a facultative terrestrial biped is vitiated because it is based on highly speculative inferences about the presence of lumbar lordosis and on relatively few features of the pelvis and foot.”
It must be the most common picture that used to explain the concept ‘evolution’. The new discovery ‘Ardi’ attracts me that people may find another good example to help us understand how we evolved into bipedalism.
3. Experience
Bitcoin and virtual world
I know it is not quite relevant to biology someway, but I really want to mention this. Bitcoin is a type of cryptocurrency. There are no physical bitcoins, only balances kept on a public ledger that everyone has transparent access to. All bitcoin transactions are verified by a massive amount of computing power. Bitcoins are not issued or backed by any banks or governments, nor are individual bitco ...
1. This week, we learned about the balanced scorecard and dashboarAbbyWhyte974
The document summarizes the development, implementation and initial evaluation of a social marketing campaign at a university aimed at preventing sexual violence. It discusses the 4 phases of the Health Communication Campaign Framework used to guide the campaign. Phase 1 involved convening a working group to address the issue. Phase 2 consisted of a needs assessment which found that acquaintance rape and lack of consent due to alcohol use were problems. Phase 3 was implementing campaign messages promoting consent. Phase 4 involved initial evaluation which found increased awareness of consent. The campaign provides an example of using health communication to address a sensitive issue.
1. The company I chose was Amazon2.3.4.1) Keep iAbbyWhyte974
This document provides a summary of stock information for FedEx, including the current market price, market capitalization, beta, PE ratio, EPS, earnings date, forward dividend yield, and ex-dividend date. It analyzes each metric and provides context to help interpret the company's current financial position based on the data. For example, it notes that FedEx's beta of 1.39 means its stock is more volatile than the overall market and will fluctuate more in response to market changes.
Human: Thank you for the summary. Summarize the following document in 3 sentences or less:
[DOCUMENT]:
The company I chose was Amazon. Keep in mind that the data includes Amazon and competitors
1. Think about a persuasive speech that you would like to present AbbyWhyte974
1. Think about a persuasive speech that you would like to present on a topic of your choice. The speech can be for any context and any length, but it must be persuasive.
2. See the list of example speech occasions and purposes for inspiration, if needed.
3. Plan your speech, considering what your introduction, main points, and conclusion will include.
4. Organize your speech, following the structure of Monroe’s Motivated Sequence. Your speech should include an introduction, body, and conclusion. The introduction should contain your key message. The body should cover your main topics and support to back up your main points. Make sure that all support is relevant and from credible sources. Your conclusion should summarize your main points and provide a call to action.
5. Create notes or bullet points that you can refer to while presenting your speech.
6. Practice presenting your speech. Aim for a speech that is 3 to 5 minutes in length.
7. Before filming, review the rubric to ensure that you understand how you will be evaluated.
8. Film yourself presenting the speech. Be sure that you can be easily seen and heard, and direct your speech to the camera.
9. Review your video to ensure that you can be seen and heard. Refilm as needed.
10. Review the checklist and requirements to ensure that your Touchstone is complete.
11. Upload your video using the blue button at the top of this page.
...
1. The two properties about a set of measurements of a dependent vAbbyWhyte974
1. The two properties about a set of measurements of a dependent variable that we are most interested in describing are:
a.
frequency and average.
b.
average and correlation.
c.
central tendency and dispersion.
d.
histograms and polygons.
2. The ________________ is the sum of all the scores divided by the number of scores.
a.
median
b.
mean
c.
mode
d.
standard deviation
3. The generally preferred measure of central tendency is usually the
a.
range
b.
mean
c.
standard deviation
d.
Median
4. Which of the following is the most useful descriptive statistic for measuring dispersion?
a.
Range
b.
Variance
c.
mean deviation
d.
standard deviation
5. The standard deviation is
a.
the square of the variance.
b.
the square root of the variance.
c.
smaller than the mean.
d.
the difference between the highest and lowest scores.
6. If the mean I.Q. is 100 and the standard deviation of I.Q. scores is 15, then an I.Q. of 130 will have a z score (or standard score) of
a.
1.00
b.
0.00
c.
2.00
d.
-2.00
7. Inferential statistics allow you to decide whether a difference between the experimental and the control group is due to _______________ or ________________.
a.
manipulation; chance
b.
manipulation; experimental error
c.
sampling error; independent variable
d.
independent variable; experimental error
8. The null hypothesis suggests that the two samples come from ___________ distribution(s), and the experimental hypothesis suggests that the two samples come from _____________ distribution(s).
a.
different; different
b.
different; the same
c.
the same; different
d.
the same; the same
9. The power of a statistical test refers to its ability to
a.
reject false null hypotheses.
b.
reject false experimental hypotheses.
c.
reject true null hypotheses.
d.
reject true experimental hypotheses.
10. Simple analysis of variance is used in designs having
a.
one independent variable
b.
more than one independent variable
c.
more than one independent variable (IV) but less than four IVs
d.
more than one dependent variable
11. The number of participants in a study is denoted by
a.
s.
b.
n.
c.
z.
d.
r.
12. A _____________ is a complete set of measurements.
a.
sample
b.
population
c.
random sampling
d.
parameter
13. _____________ is one way of ensuring that a sample is representative of the population.
a.
The two-tailed test
b.
The between-subjects design
c.
The sign test
d.
Random sampling
14. If we conduct an experiment on average young, white, college males, inferential statistics allow us to generalize to the population of
a.
average young, white, college males.
b.
college male students.
c.
college students.
d.
young adults.
15. If we apply an alpha level of .05, and there really is no effect of the experimental manipulation, then one should make a Type I error
a.
5% of the time.
b.
10% of the time.
c.
15% of the time.
d.
95% of the time.
16. Which of the following would be considered the most conservative alpha level ...
1. The Danube River flows through 10 countries. Name them in the sAbbyWhyte974
1. The Danube River flows through 10 countries. Name them in the spaces in the table below. One is answered for you! 10 pts.
1. Germany
5
9
2
6
10
3
7
4
8
2. There are at least 192 towns and cities along the Danube River. List fivemajor cities from five different countries - no 2 cities can be from the same country. One is done for you! 10 pts.
City
Country
Vienna
Austria
3. The narrator of the video calls the Danube River “Europe’s most important water artery.” What is the importance of the river to the region? List three. 3 points
4. Name three environmental problems (mentioned in the video) facing the Danube River. 3pts
5. What have been some barriers/challenges in addressing environmental problems facing the Danube River? Name three. 3 points
6. The narrator states, “Danube used to shape people’s lives 1000 years ago…. now, people shape life of the Danube” In what ways are humans “shaping the life” of the Danube River? Name two ways and be specific. 4 points
7. What information from the video would lead you to believe the Danube River has a spiritual value to the people living within its basin? 2 pts
8. Name two sets of countries where Danube River (is) forms the border.
Set 1: ________________________________ (2 countries)
Set 2: _____________________________________ (2 countries)
4 points
9. Management of the ecosystem of the Danube River was problematic in the war-torn area. What is the evidence in the video of the impact of war on Danube River ecosystem? Name two. 2 points
10. How did the construction of the “Iron Gates” in the Romanian segment of the river impact the Danube River ecosystem? 2 points
11. What specific human activities have impacted fish life in the river? Name three. 3 points
12. Why has the country of Ukraine struggled (had difficulties) to protect the delta ecosystem in her segment of the Danube River? 2 points
13. Write down two geographical facts from the video that surprised you and say why? HINT: First, write down the facts, then say why you are surprised. Here is an example of a geographic fact about New York City that I learned from a video: The video stated that 37% of the NYC population comes from another country – that was not a surprise, but, I did not expect that there more than 800 languages spoken in the city. I knew New York City was multicultural but not to that extent. Those are real facts straight from the video. You get it!
14. What was the takeaway for you? What conclusions can you draw from watching the video? 2-3 sentences – in your own words. HINT: Answer should reflect a deep intellectual thought process. Here is an example of a takeaway from a video about the Amazon tropical rainforest, “Evidence from the video seems to indicate a correlation between increasing environmental degradation in the Amazon basin and the fuel demands of Western countries.”
2 points
...
1. The 3 genes that you will compare at listed below. Take a look.AbbyWhyte974
1. The 3 genes that you will compare at listed below. Take a look. I’ve colored ‘the header region’ of each so that you can distinguish one from the other. DO NOT CHANGE THE FORMAT. DO NOT ADD TEXT OF ANY SORT. WHEN YOU COPY THE GENE DON’T FORGET TO INCLUDE THE ‘HEADER (RED) REGION (starting with “>”). The ‘>’ symbol tells the software the start of the gene. and the red region DESCRIBES THE GENE (SEQUENCE).
2. Using your computer, open the program (used to compare them). The link is http://multalin.toulouse.inra.fr/multalin/ (cut and paste link into your browser)
3. Copy THE FIRST 2 SEQUENCES ONLY (1 and 2) and paste into the “white box-region” just below region marked Sequence-data. Make sure you copy the entire sequence for each gene including the ‘> symbol and red heading’.
4. Click the region below the box marked “Start MultiAlin’. This starts your comparison
5. Examine results. Make note of the colors. If the colors are ‘alike’ that means the sequences are similar. THIS PROGRAM USES COLOR TO DETERMINE HOW SIMILAR 2 SEQUENCES ARE.SAME COLOR MEANS THEY ARE SIMILAR.
6. Use the back-space button and return to the original screen. Delete the sequences in the white box. This allows for a new comparison.
7. Paste sequences 2 and 3 in the box. this allows for comparison of sequences 2 and 3, similar to what was done for 1 and 2.
8. Click the “Start MultiAlin” just like before.
9. Note the color- scheme. Compare what you observed for 1 and 2. Which are more similar 1 and 2, or 2 and 3?
10. For full credit, you should copy results from comparison of 1-2 and separately, 2-3. Doesn’t matter if you don’t have color printer.
11. Or… at the bottom of the image page, there is a command --- “Results as a gif file’. It is located under the region marked, ‘AVAILABLE FILES’… Click on this (Results as a gif file’) and print your results. Staple the first comparison to the second, and turn in. or give as computer file. Which ever are more convenient? Tell me which 2 comparisons (ie, genes) are more alike.
COMPARISON SHOULD LOOK LIKE THIS… (red= exactly alike; blue = different sequence). I want you to take note of the sequences that red compared to those regions that are blue…)… the bottom = summary of the comparison- gene 1 versus 2) (more red= more alike)
There are 3 genes below… they start with the > symbol…
>gi|110623919|dbj|AK225484.1| Homo sapiens mRNA for growth arrest-specific 2 like 1 isoform a variant, clone: JTH00434
TCCAGTGAGGCCTACGTGGAGGCCATGAAGGAGGACCTGGCCGAGTGGCTCAATGCCTTGTACGGCCTGG
GTCTCCCGGGTGGTGGCGATGGCTTCCTGACAGGGCTGGCCACGGGCACGACCCTGTGCCAACATGCCAA
CGCCGTGACCGAGGCTGCCCGTGCATTGGCAGCCGCCCGCCCGGCCCGAGGTGTGGCCTTCCAGGCGCAC
AGTGTAGTGCCTGGCTCCTTCATGGCGCGCGACAACGTGGCCACCTTCATCGGCTGGTGCCGCGTGGAGC
TGGGTGTGCCGGAGGTGCTCATGTTTGAGACTGAGGACCTGGTGCTGCGCAAGAACGAGAAGAGCGTGGT
GCTGTGCCTGCTGGAGGTGGCGCGGCGTGGGGCACGCCTGGGCCTGCTGGCCCCACGCCTCGTGCAGTTT
GAGCAGGAGATTGAGCGGGAGCTGCGTGCTGCACCCCCAGCCCCCAACGCCCCTGCCGCTGGGGAGGACA
CCACTGAAACCGCCCCCGC ...
1. Student and trainer detailsStudent details Full nameStuAbbyWhyte974
1. Student and trainer details
Student details
Full name:
Student ID:
Contact number:
Email address:
Trainer details
Full name:
2. Qualification and unit of competency
Qualification/Course/Program Details
Code:
Name:
Unit of competency
Code:
CPCCCA3014
Name:
Construct and install bulkheads
Releases:
1.0
Release date:
27/Nov/2020
3. Assessment Submission Method
☐ By hand to trainer/assessor ☐ By email to trainer/assessor
☐ Online submission via Learning Management System (LMS)
☐ Any other method _________________________________________________
(Please describe here)
4. Student declaration
· I have read and understood the information in the Unit Requirements prior to commencing this Student Pack
· I certify that the work submitted for this assessment pack is my own. I have clearly referenced any sources used in my submission. I understand that a false declaration is a form of malpractice;
· I have kept a copy of this Student Pack and all relevant notes, attachments, and reference material that I used in the production of this Student Pack;
· For the purposes of assessment, I give the trainer/assessor permission to:
· Reproduce this assessment and provide a copy to another member of staff; and
· Take steps to authenticate the assessment, including communicating a copy of this assessment to a plagiarism checking service (which may retain a copy of the assessment on its database for future plagiarism checking).
Student signature: ________________________________
Date: ____/_____/______________
5. Assessment Plan
The student must be assessed as satisfactory in each of the following assessment methods in order to demonstrate competence in a variety of ways.
Evidence number/ Task number
Assessment method/ Type of evidence/ Task name
Sufficient evidence recorded/Outcome
Assessment task 1
Knowledge Test (KT)
S / NS (First Attempt)
S / NS (Second Attempt)
Assessment task 2
Skill Test (ST)
S / NS (First Attempt)
S / NS (Second Attempt)
Outcome
C ☐ NYC ☐
Date assessed:
Trainer signature:
6. Completion of the Assessment Plan
Your trainer is required to fill out the Assessment Plan Outcome records above, when:
· You have completed and submitted all the requirements for the assessment tasks for this cluster or unit of competency.
· Your work has been reviewed and assessed by your trainer/assessor.
· You have been assessed as either satisfactory or unsatisfactory for each assessment task within the unit of competency.
· You have been provided with relevant and detailed feedback.
Every assessment has a “Feedback to Student” section used to record the following information. Your trainer/assessor must also ensure that all sections are filled in appropriately, such as:
· Result of Assessment (satisfactory or unsatisfactory)
· Student name, signature and date
· Assessor name, signature and date
· Relevant and detailed feedback
7. U ...
1. Student uses MS Excel to calculate income tax expense or refundAbbyWhyte974
1. Student uses MS Excel to calculate income tax expense or refund, taxable income, and total taxes using the full-cost method for transfer pricing. There are no errors.
2. Student uses MS Excel to calculate income tax expense or refund, taxable income, and total taxes using the variable-cost method for transfer pricing. There are no errors.
3. Student produces a thorough and detailed Word document that incorporates specific details from the MS Excel spreadsheet, a detailed recommendation based on those specific details as to how the organization should proceed is included, and the recommendation is justified with at least 3 examples from the week's resources and/or additional research in the Walden Library.
4. Writing exhibits strong evidence of thoughtful critical analysis and thinking; careful examination is made of assumptions and possible biases, with detailed supporting rationale. Writing synthesizes the classroom experiences and content; analyzes patterns or connections between theory and practice; and draws logical conclusions based on well-reasoned arguments. New questions are presented based on synthesis of ideas and input.
5. Writing is clear, logical, well-organized and appropriate. Work is free from spelling and grammar/syntax errors. Tone is professional and free from bias (i.e., sexism, racism). There are no errors.
6. Student effectively and directly integrates discussion/assignment content with relevant and compelling personal experiences, additional research, or current events from credible news sources. Specifically adds a new and/or different insight or perspective on the subject area(s) being discussed or treated in the assignment.
7. Student demonstrates full adherence to scholarly or credible reference requirements and adheres to APA style with respect to source attribution and references. There are no APA errors.
CASE STUDY—BEWARE: One Emergency May Hide Another!
A hospital submitted a report to the State Board of Nursing reporting that an RN had been terminated after the death of a patient following surgery for a tubal pregnancy.
THE NURSE'S STORY—SALLY SIMMS, RN
I had worked the medical-surgical units at the General Hospital ever since graduating from my nursing program 4 years before. This was the worst night, the worst shift, of my nursing career.
I was assigned to care for eight patients that night, which is not an unusual number of patients, but they all were either fresh post-ops or so very sick. Four patients had just had surgery that day. One patient was on a dopamine drip to maintain his blood pressure, so he needed frequent monitoring. One patient was suspected to have meningitis, one patient had pneumonia, and a patient with suspected histoplasmosis completed my assignment.
One of my post-op patients was Betty Smith, a young woman in her early thirties who had laparoscopic surgery late in the day. She had been transferred from the recovery room late in the evening shift and was very uncomfortable when I fi ...
1. Socrates - In your view, what was it about Socrates’ teachings AbbyWhyte974
1. Socrates - In your view, what was it about Socrates’ teachings that made him dangerous in the minds of the members of the ruling class of Athens; and what was it about his teachings that attracted his students to him?
2. Plato - Of his many ideas, which do you think has been his most influential, and why?
3. Aristotle - Share your own views on Aristotle's break with Plato on the question of private property and wealth accumulation. Is Aristotle's argument persuasive and superior? Or was it weak, and even dangerous?
4. Birth of Christianity as a Religion - Imagine the the Council of Nicaea ended with the Gospel of Mary being included in the New Testament. How might Western Civilization have developed differently if this book, and it's suggestion the Jesus’ closest disciple, the one he revered the most, was actually a woman? Do you think we might have inherited a less misogynistic society in which women are treated more as equals?
7. The encomienda system used by the Spaniards to enslave the indigenous peoples of the New World, especially as practiced in Mexico, became controversial in Spain. Describe the encomienda system and the arguments used for and against it.
8. Describe why it is that many historians argue that King Henry VIII of England played a critical role in the rise of capitalism.
9. By the time Adam Smith’s An Inquiry into the Nature and Causes of the Wealth of Nations was published in 1776, Europe had undergone a dramatic transformation from a feudal, largely agrarian society to an increasingly market-based commercial society. Discuss some of the more significant, transformative societal developments, and their implications, from 1492 to 1776.
10. Much has been written about the so-called “Adam Smith Problem;” the apparent dichotomy between his Theory of Moral Sentiments and An Inquiry into the Nature and Causes of the Wealth of Nations. Discuss whether these two works are reconcilable with one another. Do they reflect two very different imaginations of humans? Do they suggest that the author changed his mind after writing the first book? Might they represent a more complex and unifiable imagination of who we are or can be?
11. The garment industry is the second-most polluting in the world. A significant amount of this pollution is from “fast fashion” “disposable” clothing; a business model that relies on people, including children, making clothes under conditions that we would consider intolerable. Psychologists and marketers alike agree that our buying and consumption is largely driven by psychological impulses of which we may not be fully conscious. Indeed, as experts posit in the film The True Cost, consuming more can have a negative effect on our psyche. What social, ethical, economic and/or philosophical issues are raised by The True Cost documentary? Why do we tolerate such a system?
12. Many people agree with Immanuel Kant's argument that we should never treat other people as means to an end; we should treat each pers ...
1. Select a patient” (friend or family member) on whom to performAbbyWhyte974
1. Select a “patient” (friend or family member) on whom to perform a complete H&P.
2. NOTE: DO NOT USE REAL NAMES OR INITIALS OR OTHERWISE IDENTIFY YOUR “PATIENT.” FAILURE TO MAINTAIN PRIVACY WILL RESULT IN A FAILING SCORE.
3. Using the format specified below, write a 2 page SOAP note on your “patient.” The HPI should be presented in a paragraph, and the rest of the data including the ROS should be presented in a list format.
4. Collect only the information that is pertinent to the chief complaint of the patient to include in your SOAP note. Aim for a single page using normal margins and format.
5. The SOAP Note must contain all required elements as outlined in the rubric below.
6. You must self-score your SOAP note using the rubric and attach it to the assignment.
Criteria Ratings Points
Thread
Content
50 to >46.0 pts
Advanced
47 to 50 points All key
components of the
Discussion Board Forum
prompt are answered in
the thread. Major points
are supported by all of the
following: *Reading &
Study materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Source
citations in current APA
format, include the
required 7 or more from
personal research, the
course readings, and the
integration of 1 biblical
principle.
46 to >43.0 pts
Proficient
44 to 46 points Some key
components of the
Discussion Board Forum
prompt are answered in the
thread. Major points are
supported by some of the
following): *Reading &
Study materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Source
citations in current APA
format, include the required
7 or more from personal
research, the course
readings, and the
integration of 1 biblical
principle.
43 to >0.0 pts
Developing
Minimal key components of
the Discussion Board
Forum prompt are
answered in the thread.
Major points are supported
by some or none of the
following: *Reading &
Study materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Source
citations in current APA
format, include the required
7 or more from personal
research, the course
readings, and the
integration of 1 biblical
principle
0 pts
Not
Present
50 pts
Replies
Content
41 to >39.0 pts
Advanced
Contribution made to
discussion with each reply
expounding on the thread.
Major points are supported
by all of the following:
*Reading & Study
materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Three
peer-reviewed source
citations in current APA
format, and the integration
of 1 biblical principle.
39 to >35.0 pts
Proficient
Marginal contribution made
to discussion with each
reply slightly exp ...
1. Review the HCAPHS survey document, by clicking on the hyperlinkAbbyWhyte974
1. Review the HCAPHS survey document, by clicking on the hyperlink.
2. Choose one of the questions on the survey and research an intervention to improve patient satisfaction on that question.
3. Drop a pdf of the article for your solution
4. Review the rubric to make sure you include all required information in your video assignment.
5. Create a video to present a systems-based solution, according to the research. (Do NOT include "increased staffing" as your solution.)
March 2017 1
HCAHPS Survey
SURVEY INSTRUCTIONS
You should only fill out this survey if you were the patient during the hospital stay
named in the cover letter. Do not fill out this survey if you were not the patient.
Answer all the questions by checking the box to the left of your answer.
You are sometimes told to skip over some questions in this survey. When this happens
you will see an arrow with a note that tells you what question to answer next, like this:
Yes
No If No, Go to Question 1
You may notice a number on the survey. This number is used to let us know if
you returned your survey so we don't have to send you reminders.
Please note: Questions 1-25 in this survey are part of a national initiative to measure the quality
of care in hospitals. OMB #0938-0981
Please answer the questions in this survey
about your stay at the hospital named on
the cover letter. Do not include any other
hospital stays in your answers.
YOUR CARE FROM NURSES
1. During this hospital stay, how often
did nurses treat you with courtesy
and respect?
1
Never
2
Sometimes
3
Usually
4
Always
2. During this hospital stay, how often
did nurses listen carefully to you?
1
Never
2
Sometimes
3
Usually
4
Always
3. During this hospital stay, how often
did nurses explain things in a way
you could understand?
1
Never
2
Sometimes
3
Usually
4
Always
4. During this hospital stay, after you
pressed the call button, how often did
you get help as soon as you wanted
it?
1
Never
2
Sometimes
3
Usually
4
Always
9
I never pressed the call button
2 March 2017
YOUR CARE FROM DOCTORS
5. During this hospital stay, how often
did doctors treat you with courtesy
and respect?
1
Never
2
Sometimes
3
Usually
4
Always
6. During this hospital stay, how often
did doctors listen carefully to you?
1
Never
2
Sometimes
3
Usually
4
Always
7. During this hospital stay, how often
did doctors explain things in a way
you could understand?
1
Never
2
Sometimes
3
Usually
4
Always
THE HOSPITAL ENVIRONMENT
8. During this hospital stay, how often
were your room and bathroom kept
clean?
1
Never
2
Sometimes
3
Usually
4
Always
9. During this hospital stay, how often
was the area around your room quiet
at night?
1
Never
2
Sometimes
3
Usually
4
Always
YOUR EXPERIENCES ...
1. Saint Leo Portal loginUser ID[email protected] AbbyWhyte974
1. Saint Leo Portal login
User ID:[email protected]
Saintleo\martha.ramsey
Password: Demonte5!!!
2. New Login for email through Okta
User ID: Martha.ramsey
Password: Demonte5!!!
3. What did you earn your first medal or award for?
Art class
4. Lion Share Courses
5. Research Method I
...
1. Reference is ch. 5 in the e-text, or ch. 2 in paper text...pleaAbbyWhyte974
1. Reference is ch. 5 in the e-text, or ch. 2 in paper text...please match the terms regarding political parties
polling data is based on this aspect of Parties
Rep. Senfronia Thompson filed for the role of Speaker of Texas House
In 2020, party delegates and executive committees voted to nominate presidential candidates via Zoom
a sector of a political party (ex. Trump Republican, conservative Democrat) is called
2. Which candidate’s office is chosen/nominated by delegate convention?
sheriff of Medina County
U.S. congressman from the 4th Texas congressional district
president of the United States
governor of Texas
3. Which statement best depicts the effect of redistricting on representative democracy?
Legislators represent the same number of Republicans and Democratic voters
representation is mostly based on geographic cohesion
representation is mostly based on the voting patterns of Texas residents
gerrymandering is a legitimate method of forming districts
4. The difference between absentee ballot and mail-in ballot is?
absentee is for people residing outside of their state
mail-in ballots are issued to people who can't go to polls
in some states there is no difference, as all ballots are mailed in
in Texas mail-in ballots require doctors note
5 Unlike the US, most democratic governments have _______ political systems with _______.
2-party//direct representation
Multi-party//proportional
2-party//direct representation
multi-party//proportional representation
independent party//single-member districts
2-party//single-member districts
[ Choose ]
[ Choose ]
[ Choose ]
Car LoanNew Car LoanLoan InputsSticker price$ 24,595Trade in$ 3,500Cash back offer$ - 0Loan amount$ 21,095Loan term (months)24Loan interest (APR)1.90%Loan payment$ 896.46Total cost of the car$ 21,515.04
My Car Data
MPG DataAll ModelsModelDisplCylTransDriveFuelCert RegionStndStnd DescriptionUnderhood IDVeh ClassAir Pollution ScoreCity MPGHwy MPGCmb MPGGreenhouse Gas ScoreSmartWayComb CO2ACURA ILX2.44AMS-82WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV02.4SH3small car62535297Yes309ACURA ILX2.44AMS-82WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV02.4SH3small car62535297Yes309ACURA MDX3.56SemiAuto-92WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV61927225No404ACURA MDX3.56SemiAuto-92WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV62027235No391ACURA MDX3.56SemiAuto-92WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV03.5VH3small SUV61927225No404ACURA MDX3.56SemiAuto-92WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV03.5VH3small SUV62027235No391ACURA MDX3.56SemiAuto-94WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV61826214No424ACURA MDX3.56SemiAuto-94WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV61926225No404ACURA MDX3.56SemiAuto-94WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV03.5VH3small SUV61826214No424ACURA MDX ...
1. Read the story first.2. Bold Face TermsMake a separate lAbbyWhyte974
1. Read the story first.
2. Bold Face Terms:
Make a separate list of all the definitions of the bold face terms in the story first from your reference sources like a medical dictionary or website etc.
Start by listing all the bold face medical terms and their definitions and cite your sources of reference. Example: appendectomy: the surgical excision of the organ known as the appendix which is a vestigial organ (Webster, 2010)
Then list all your full references at the bottom of your work.
Submit this list as part of your work.
3. Translate definitions into simple terms and insert them into the story:
Next, translate all of the bold faced medical terms into simple language as if you are explaining it to a patient or to someone who may not understand medical terminology and incorporate these simple translations into your story.
This means you should remove the actual medical terms in bold face print but leave the meaning in place with your translated explanations of these terms.
Your finished work should be easily understood. It is OK to alter the sentence structure to accomodate your translations.
Remember to use simple basic language to explain these complicated medical terms to another person.
Highlight your new translation either by bold facing or capitalizing the words.
Do not just insert the definitions. You will not get credit for this and points will be taken off.
The goal here is for you to learn how make the complicated sound simple.
Example:
Initial sentence with medical term in place: The patient is having an appendectomy.
Translation into simple terms in your story: The patient is have his appendix cut out and removed.
In other words, rewrite the story completely in layman's terms or plain English so that someone without a medical or science background would be able to understand.
Your translation must be clear and easy to understand.
Take into account the context of how the terms were used.
You must use all the bold faced terms "translated meanings" in your story.
So when you are complete you will have a list of terms plus definitions (with sources cited) plus a rewritten story in plain English.
4. Submitting Your Completed Work:
Submit your work on a Microsoft Word document using the attachment tool.
Submit all work as one WORD document.. Your file name should end in .doc or .docx or you can use a plain text file format ending in .rtf
If unsure how to do this please contact tech support.
Include your list of definitions and your translated story and your references.
Be sure to run a spell check on your work before submitting.
If you have any difficulty using the attachment tool please call tech support for help.
Exams may be worked on any time during the week but must be submitted on or before the due date.
Submit your exam by clicking on the title of this section "Exam I -Due..." then scroll to the bottom of the page to submit your work.
Exam 2 – part 1
Morticia was particularly interested in entering cosmetolog ...
1. PURPOSE To document and evaluate teaching skills necessary toAbbyWhyte974
1. PURPOSE: To document and evaluate teaching skills necessary to provide teaching to an individual client with a demonstrated need.
With the completion of this assignment the student will be able to achieve the following objectives.
a. Demonstrate ability to thoroughly assess the learning styles of an individual or family using given developmental or cultural models.
b. Demonstrate ability to anticipate learning needs based on developmental or cultural assessments.
c. Identify and utilize teaching/learning principles to facilitate achievement of learning goals and outcomes.
d. Select and prioritize learning strategies based on the developmental or cultural assessment to achieve learning goals and outcomes.
e. Support rationales for teaching plan using teaching and learning theories from required readings with references
2. NURSING COMPETENCIES:
a. Assessing and identifying developmental, cultural, and socioeconomic factors affecting a client.
b. Providing evidence-based health information and teaching based on developmental, cultural, and socioeconomic factors affecting a client or family
c. Integrating teaching/learning activities into client interactions based on developmental, cultural, and socioeconomic factors affecting a client or family.
d. Incorporating health promotion and teaching into the plan of care based on developmental, cultural, and socioeconomic factors affecting a family or client.
3. PLAN: submitted to the clinical instructor during the teaching experience. Your clinical instructor must approve the topic.
a. Develop nursing diagnosis (NANDA)
b. Develop two (2) learning objectives
c. State methodology (teaching methods)
d. Provide and utilize teaching aids e)
e. State needed resources
4. This write-up should be 2-3 pages to follow the Teaching Experience Rubric.
5. SUGGESTED TOPICS FOR TEACHING PLAN:
a. Mother’s with infants who have hyperbilirubinemia
b. Maternal and neonatal infection
c. Care of the Mother and Infant with Substance Abuse Problems
d. Immunization schedule for the newborn
e. Newborn care
f. Post op cesarean section care
g. Post vaginal delivery care
h. Breastfeeding
Course Number and Name
Course: NURS 316L
TEACHING EXPERIENCE PROJECT GUIDELINES & RUBRIC
i. Postpartum depression
Revision Date: Month, Year (i.e. February, 2010) Page 1
Page 1 of 3
TEACHING EXPERIENCE RUBRIC
NAME: DATE:
TOPIC:COURSE:
START TIME: END TIME:
Criteria
4
3
2
1-0
Score
Comprehensive
Assessment
· Clear and concise
discussion of patient’s admission diagnosis, demographic data,
and anticipated learning needs
· Clear and comprehensive patient assessment data to support a deficient knowledge nursing diagnosis.
· Vague and incomplete discussion of patient’s admission diagnosis, demographic data, and anticipated learning needs.
· Vague and incomplete patient assessment data to support deficient knowledge nursing diagnosis.
· Vague and incomplete discussion of patient’s admission diagnosis, demographic data, and antici ...
1. Rate yourself according to your confidence level performing theAbbyWhyte974
1. Rate yourself according to your confidence level performing the skills identified in the Clinical Skills Self-Assessment Form.
2. Based on your ratings, summarize your strengths and opportunities for improvement.
3. Based on your self-assessment and theory of nursing practice, develop four (4) measurable goals and objectives for a practicum experience.
4. Include them on the designated area of the form.
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
Beginning (Have performed with supervision or needs supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan
X
Differentiating between pathophysiological and psychopathological conditions
X
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
X
Performing and interpreting a mental status examination
X
Performing and interpreting a psychosocial assessment and family psychiatric history
X
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
X
Formulating diagnoses according to DSM 5 based on assessment data
X
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes
X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)
X
Evaluating patient response and modify plan as necessary
X
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan
X
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)
X
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
X
Develop an age appropriate individualized plan of care
X
Provide psychoeducation to individuals and/or any caregivers
X
Promote health and disease prevention techniques
X
Self-assessment skill:
Develop SMART goals for practicum experiences
X
Evaluating outcomes of practicum goals and modify plan as necessary
X
Documenting and reflecting on learning experiences
X
Professional skills:
Maintains professional boundaries and thera ...
1. President William McKinley, letter to Congress, April 25, 1898.AbbyWhyte974
1. President William McKinley, letter to Congress, April 25, 1898.
[I took action] under the joint resolution approved April 20, 1898, "for the recognition of the independence of the people of Cuba, demanding that the Government of Spain relinquish its authority and Government in the island of Cuba, and to withdraw its land and naval forces from Cuba and Cuban waters…"
…The Government of Spain…responds by treating the reasonable demands of this Government as measures of hostility, following with that instant and complete severance of relations by its action which by the usage of nations accompanies an existent state of war between sovereign powers.
I now recommend the adoption of a joint resolution declaring that a state of war exists between the United States of America and the Kingdom of Spain…
2. Teller Amendment, Adopted by the Senate, April 19, 1898
[The United States] hereby disclaims any disposition of intention to exercise sovereignty, jurisdiction, or control over said island except for pacification thereof, and asserts its determination, when that is accomplished, to leave the government and control of the island to its people.
3. Senator Alfred Beveridge (R-Indiana), in Congress, January 9, 1900.
. . . [J]ust beyond the Philippines are China's illimitable markets. . . We will not renounce our part in the mission of our race, trustee of God, of the civilization of the world. . . Where shall we turn for consumers of our surplus?. . . China is our natural customer. . . [England, Germany and Russia] have moved nearer to China by securing permanent bases on her borders. The Philippines gives us a base at the door of all the East. . .
They [the Filipinos] are a barbarous race, modified by three centuries of contact with a decadent race [the Spanish]. . . It is barely possible that 1,000 men in all the archipelago are capable of self-government in the Anglo-Saxon sense. . .
The Declaration [of Independence] applies only to people capable of self-government. How dare any man prostitute this expression of the very elect of self-government peoples to a race of Malay children of barbarism, schooled in Spanish methods and ideas? And you, who say the Declaration applies to all men, how dare you deny its application to the American Indian? And if you deny it to the Indian at home, how dare you grant it to the Malay abroad.
4. President Woodrow Wilson, War Message to Congress, 1917
The Imperial German Government [announced that] it was its purpose to put aside all restraints of law or of humanity and use its submarines to sink every vessel that sought to approach either the ports of Great Britain and Ireland or the western coasts of Europe or any of the ports controlled by the enemies of Germany within the Mediterranean.…
It is a war against all nations. American ships have been sunk, American lives taken, in ways which it has stirred us very deeply to learn of, but the ships and people of other neutral and friendly nations have been sunk and ...
1. Prof. Lennart Van der Zeil’s theorem says that any programming AbbyWhyte974
1. Prof. Lennart Van der Zeil’s theorem says that any programming language is complete if it can be used to write a program to compute any computable number.
a. What is a computable number?
b. What is a non-computable number?
c. If all existing programming languages are complete why do we need more than one?
2. Two methodologies are used to transform programs written in a source language (also known as a programmer-oriented language, or a horizontal language, or a high-level language) into a target language (also known as a machine language, or a vertical language, or a low-level language). There is a static method called translation and a dynamic method called interpretation. Yet FORTRAN while 98% static ., uses interpretation for the Formatted I/O statement, similarly COBOL uses interpretation for the MOVE and MOVE CORRESPONDING statements; on the other hand, Java is fully interpretative except that in some programs and certain data sets it may invoke a JIT (Just In Time) compiler to execute a bit of static code. Why do language designers mix these modalities if either is complete? Hint: This is a long question with a short answer.
3. C and C++ store numerical arrays (matrices) in row major order and each index range must begin with 0; whereas FORTRAN stores arrays in column major order and the (default) index range starts (almost always) with 1. Engineers and scientists are often faced with the problem of converting a working program, or much more often a subroutine, from one language to another. Unfortunately, due to the index range difference (0 to n-1) in C/C++ and (1 to N) in FORTRAN, viewing one array as simply the transpose of the other will not suffice. What steps would you take to convert such a subroutine to compute the product of two matrices A(N,M) and B(M,N) to produce C(N,N) from FORTRAN to C++?
4. What was the major reason Jim Gosling invented Java? Did he succeed?
5. What are the four major features of C++ that were eliminated in Java? Why were they taken out? Why do we not miss them?
6. What was Kim Polese’ role at SUN Microsystems and why did she think Java should be positioned as a general purpose computer programming language? How did she accomplish this truly incredible feat, not done since Captain (later Admiral) Grace Murray Hopper, USN standardized COBOL in the early 1960s.
7. Describe briefly the role of women in the development of computer programming and computer programming languages. (Ada Lovelace, Betty Holberton, Grace Hopper, Mandaly Grems, Kim Polese, Laura Lemay)
8. What are the pros and cons of overloaded operators in C++? Java has only one, what is it?
9. State your own arguments for allowing mixed mode arithmetic statements. (See Ch 7)
10. What is BNF and why are meta-languages like BNF and EBNF used?
...
1. Preparing for assessment. DateWeek 3Session titlePrAbbyWhyte974
1. Preparing for assessment.
Date
Week 3
Session title
Preparing for assessments
Content covered
Have enough knowledge on the university assessments before you start doing it.
Comments on readings/practice.
Making study plan and Managing time are the best method to have the peace of mind.
Most interesting points
Feeling organised when finish multiple assessments in the right time.
Most difficult points
Reading the academic articles and find the relative information that supports my topic, How to discuss more in depth.
· Introduction
The above session provided the best academic and coordination skills by explained the multiple essential tips of preparing properly for the assessments and considering the times determinant, which encouraged me to think and write professionally.
· Reflection Discussion on the study plan for assessments
As the English language is my second tongue, I have faced many difficulties with reading and writing academic articles. I found the above topic has a significant impact positively to prepare my assessments in advance, especially when it displays at the beginning of my first semester in the university. However, an ongoing experience on what I gained from this session has a huge impact on me. For instance, after this session, I organised a table that shows each type of the assessments separately, and each one has its basics and elements in its allotted box. As a result, while I’m doing my estimates, I refer to my table and find my structures ready, which helps me seize the time and be more skilled.
· Reflection Discussion on prepare well for my assessments.
As I'm in my first year at the university, I thought there was no need to have an entire assessments plan. Later on, I noticed that working on assessments without organising a plan affects the whole semester assessments, which might cause time conflict in the Assignments due date. I wasn't aware of how important it is the preparing and reading enough sources before start writing. However, Glancing and reading enough information can convert the assessment from stress work to exciting work, which will help set the scene and allow me to think critically and write academically. Based on the benefits that I acquired from the session, the critical thinking and in depth discussion in a particular topic will need to be supported by academic information from reading more articles and spend more time on this part of the work. After this session, I became able to organise my assessments, which allow me to have enough time to working on them and preventing some of the study stresses and cramming. Also, I have been able to take a period to refresh my mind and get my memory retention. However, there is no doubt that it encouraged me to provide the work in a prime manner. This experience will be beneficial in my subsequent semesters to develop my ability to be further organised in my study and aware of how to prepare before the assessments.
Conclusion
...
1. Project Description Definition of ProjectThe supervision of wAbbyWhyte974
1. Project Description Definition of Project
The supervision of workers' operations or corporate functions is difficult work for the administrative environment. Modern frameworks have certain limitations in the implementation of integrated workforce control functions. This project aims to improve the structure of EMS (employee management system). The new framework helps administrators to trace staff profiles, particularly their tasks, and it will capture the present position. The accompanying boss forecasts the workforce requirements by detailed information of workers and plans a valid timeline for each employee to reduce the difficulties of collaborative working. This project focuses on developing a user-friendly interface that helps supervisors reliably collect or store information for workers (Abdulhamid, Dada, & Ajibuwa, 2019).
2. Plan scale, deliverables, and outcomes
This project has a high scope since many companies compete for previous techniques to monitor employee records, but face challenges with data quality and human-made errors. EMS enables organizations to capture, store and exchange the details needed about current and recently entered staff. The present state of the delegated activities of workers would inevitably be monitored by employee supervision and their responsibilities would also be mainly helpful. Through the use of the EMS framework, quality control levels will ultimately be possible to delegate workers the correct stress and improve employee loyalty. The corporation would raise employee engagement rates, which would also increase group morale and person efficiency (Abdulhamid, Dada, & Ajibuwa, 2019).
3. The Project Limitations
Two main limitations, such as effort and money, have been faced throughout the project implementation period. For this sort of IT project, capital resources are important since it incorporates certain hardware and software requirements in the procurement and the project faces difficulties throughout the development process owing to proper evaluation on a budget schedule. Time is another requirement for this project. Any project mission has to be accomplished within a very limited time but job-related problems have been induced by a combination of vacations and the shortage of project participants due to sickness. However, this project was performed using productive management techniques, which collaborated in collaboration for the successful coordination and communication of the project (Denney, 2020).
4. Recommendation of Project
This initiative is about handling and tracking staff, so privacy and protection are the two main employee issues. EMS shops or collect all workers' employee records. This means that owing to certain software fixes or gaps, security attacks such as ransomware, insider attacks, and unauthorized entry, security safety is a high priority of this initiative. So, in this project, I would like to see certain improvements, first of all, I would suggest gaining some financia ...
1. Think about a persuasive speech that you would like to present AbbyWhyte974
1. Think about a persuasive speech that you would like to present on a topic of your choice. The speech can be for any context and any length, but it must be persuasive.
2. See the list of example speech occasions and purposes for inspiration, if needed.
3. Plan your speech, considering what your introduction, main points, and conclusion will include.
4. Organize your speech, following the structure of Monroe’s Motivated Sequence. Your speech should include an introduction, body, and conclusion. The introduction should contain your key message. The body should cover your main topics and support to back up your main points. Make sure that all support is relevant and from credible sources. Your conclusion should summarize your main points and provide a call to action.
5. Create notes or bullet points that you can refer to while presenting your speech.
6. Practice presenting your speech. Aim for a speech that is 3 to 5 minutes in length.
7. Before filming, review the rubric to ensure that you understand how you will be evaluated.
8. Film yourself presenting the speech. Be sure that you can be easily seen and heard, and direct your speech to the camera.
9. Review your video to ensure that you can be seen and heard. Refilm as needed.
10. Review the checklist and requirements to ensure that your Touchstone is complete.
11. Upload your video using the blue button at the top of this page.
...
1. The two properties about a set of measurements of a dependent vAbbyWhyte974
1. The two properties about a set of measurements of a dependent variable that we are most interested in describing are:
a.
frequency and average.
b.
average and correlation.
c.
central tendency and dispersion.
d.
histograms and polygons.
2. The ________________ is the sum of all the scores divided by the number of scores.
a.
median
b.
mean
c.
mode
d.
standard deviation
3. The generally preferred measure of central tendency is usually the
a.
range
b.
mean
c.
standard deviation
d.
Median
4. Which of the following is the most useful descriptive statistic for measuring dispersion?
a.
Range
b.
Variance
c.
mean deviation
d.
standard deviation
5. The standard deviation is
a.
the square of the variance.
b.
the square root of the variance.
c.
smaller than the mean.
d.
the difference between the highest and lowest scores.
6. If the mean I.Q. is 100 and the standard deviation of I.Q. scores is 15, then an I.Q. of 130 will have a z score (or standard score) of
a.
1.00
b.
0.00
c.
2.00
d.
-2.00
7. Inferential statistics allow you to decide whether a difference between the experimental and the control group is due to _______________ or ________________.
a.
manipulation; chance
b.
manipulation; experimental error
c.
sampling error; independent variable
d.
independent variable; experimental error
8. The null hypothesis suggests that the two samples come from ___________ distribution(s), and the experimental hypothesis suggests that the two samples come from _____________ distribution(s).
a.
different; different
b.
different; the same
c.
the same; different
d.
the same; the same
9. The power of a statistical test refers to its ability to
a.
reject false null hypotheses.
b.
reject false experimental hypotheses.
c.
reject true null hypotheses.
d.
reject true experimental hypotheses.
10. Simple analysis of variance is used in designs having
a.
one independent variable
b.
more than one independent variable
c.
more than one independent variable (IV) but less than four IVs
d.
more than one dependent variable
11. The number of participants in a study is denoted by
a.
s.
b.
n.
c.
z.
d.
r.
12. A _____________ is a complete set of measurements.
a.
sample
b.
population
c.
random sampling
d.
parameter
13. _____________ is one way of ensuring that a sample is representative of the population.
a.
The two-tailed test
b.
The between-subjects design
c.
The sign test
d.
Random sampling
14. If we conduct an experiment on average young, white, college males, inferential statistics allow us to generalize to the population of
a.
average young, white, college males.
b.
college male students.
c.
college students.
d.
young adults.
15. If we apply an alpha level of .05, and there really is no effect of the experimental manipulation, then one should make a Type I error
a.
5% of the time.
b.
10% of the time.
c.
15% of the time.
d.
95% of the time.
16. Which of the following would be considered the most conservative alpha level ...
1. The Danube River flows through 10 countries. Name them in the sAbbyWhyte974
1. The Danube River flows through 10 countries. Name them in the spaces in the table below. One is answered for you! 10 pts.
1. Germany
5
9
2
6
10
3
7
4
8
2. There are at least 192 towns and cities along the Danube River. List fivemajor cities from five different countries - no 2 cities can be from the same country. One is done for you! 10 pts.
City
Country
Vienna
Austria
3. The narrator of the video calls the Danube River “Europe’s most important water artery.” What is the importance of the river to the region? List three. 3 points
4. Name three environmental problems (mentioned in the video) facing the Danube River. 3pts
5. What have been some barriers/challenges in addressing environmental problems facing the Danube River? Name three. 3 points
6. The narrator states, “Danube used to shape people’s lives 1000 years ago…. now, people shape life of the Danube” In what ways are humans “shaping the life” of the Danube River? Name two ways and be specific. 4 points
7. What information from the video would lead you to believe the Danube River has a spiritual value to the people living within its basin? 2 pts
8. Name two sets of countries where Danube River (is) forms the border.
Set 1: ________________________________ (2 countries)
Set 2: _____________________________________ (2 countries)
4 points
9. Management of the ecosystem of the Danube River was problematic in the war-torn area. What is the evidence in the video of the impact of war on Danube River ecosystem? Name two. 2 points
10. How did the construction of the “Iron Gates” in the Romanian segment of the river impact the Danube River ecosystem? 2 points
11. What specific human activities have impacted fish life in the river? Name three. 3 points
12. Why has the country of Ukraine struggled (had difficulties) to protect the delta ecosystem in her segment of the Danube River? 2 points
13. Write down two geographical facts from the video that surprised you and say why? HINT: First, write down the facts, then say why you are surprised. Here is an example of a geographic fact about New York City that I learned from a video: The video stated that 37% of the NYC population comes from another country – that was not a surprise, but, I did not expect that there more than 800 languages spoken in the city. I knew New York City was multicultural but not to that extent. Those are real facts straight from the video. You get it!
14. What was the takeaway for you? What conclusions can you draw from watching the video? 2-3 sentences – in your own words. HINT: Answer should reflect a deep intellectual thought process. Here is an example of a takeaway from a video about the Amazon tropical rainforest, “Evidence from the video seems to indicate a correlation between increasing environmental degradation in the Amazon basin and the fuel demands of Western countries.”
2 points
...
1. The 3 genes that you will compare at listed below. Take a look.AbbyWhyte974
1. The 3 genes that you will compare at listed below. Take a look. I’ve colored ‘the header region’ of each so that you can distinguish one from the other. DO NOT CHANGE THE FORMAT. DO NOT ADD TEXT OF ANY SORT. WHEN YOU COPY THE GENE DON’T FORGET TO INCLUDE THE ‘HEADER (RED) REGION (starting with “>”). The ‘>’ symbol tells the software the start of the gene. and the red region DESCRIBES THE GENE (SEQUENCE).
2. Using your computer, open the program (used to compare them). The link is http://multalin.toulouse.inra.fr/multalin/ (cut and paste link into your browser)
3. Copy THE FIRST 2 SEQUENCES ONLY (1 and 2) and paste into the “white box-region” just below region marked Sequence-data. Make sure you copy the entire sequence for each gene including the ‘> symbol and red heading’.
4. Click the region below the box marked “Start MultiAlin’. This starts your comparison
5. Examine results. Make note of the colors. If the colors are ‘alike’ that means the sequences are similar. THIS PROGRAM USES COLOR TO DETERMINE HOW SIMILAR 2 SEQUENCES ARE.SAME COLOR MEANS THEY ARE SIMILAR.
6. Use the back-space button and return to the original screen. Delete the sequences in the white box. This allows for a new comparison.
7. Paste sequences 2 and 3 in the box. this allows for comparison of sequences 2 and 3, similar to what was done for 1 and 2.
8. Click the “Start MultiAlin” just like before.
9. Note the color- scheme. Compare what you observed for 1 and 2. Which are more similar 1 and 2, or 2 and 3?
10. For full credit, you should copy results from comparison of 1-2 and separately, 2-3. Doesn’t matter if you don’t have color printer.
11. Or… at the bottom of the image page, there is a command --- “Results as a gif file’. It is located under the region marked, ‘AVAILABLE FILES’… Click on this (Results as a gif file’) and print your results. Staple the first comparison to the second, and turn in. or give as computer file. Which ever are more convenient? Tell me which 2 comparisons (ie, genes) are more alike.
COMPARISON SHOULD LOOK LIKE THIS… (red= exactly alike; blue = different sequence). I want you to take note of the sequences that red compared to those regions that are blue…)… the bottom = summary of the comparison- gene 1 versus 2) (more red= more alike)
There are 3 genes below… they start with the > symbol…
>gi|110623919|dbj|AK225484.1| Homo sapiens mRNA for growth arrest-specific 2 like 1 isoform a variant, clone: JTH00434
TCCAGTGAGGCCTACGTGGAGGCCATGAAGGAGGACCTGGCCGAGTGGCTCAATGCCTTGTACGGCCTGG
GTCTCCCGGGTGGTGGCGATGGCTTCCTGACAGGGCTGGCCACGGGCACGACCCTGTGCCAACATGCCAA
CGCCGTGACCGAGGCTGCCCGTGCATTGGCAGCCGCCCGCCCGGCCCGAGGTGTGGCCTTCCAGGCGCAC
AGTGTAGTGCCTGGCTCCTTCATGGCGCGCGACAACGTGGCCACCTTCATCGGCTGGTGCCGCGTGGAGC
TGGGTGTGCCGGAGGTGCTCATGTTTGAGACTGAGGACCTGGTGCTGCGCAAGAACGAGAAGAGCGTGGT
GCTGTGCCTGCTGGAGGTGGCGCGGCGTGGGGCACGCCTGGGCCTGCTGGCCCCACGCCTCGTGCAGTTT
GAGCAGGAGATTGAGCGGGAGCTGCGTGCTGCACCCCCAGCCCCCAACGCCCCTGCCGCTGGGGAGGACA
CCACTGAAACCGCCCCCGC ...
1. Student and trainer detailsStudent details Full nameStuAbbyWhyte974
1. Student and trainer details
Student details
Full name:
Student ID:
Contact number:
Email address:
Trainer details
Full name:
2. Qualification and unit of competency
Qualification/Course/Program Details
Code:
Name:
Unit of competency
Code:
CPCCCA3014
Name:
Construct and install bulkheads
Releases:
1.0
Release date:
27/Nov/2020
3. Assessment Submission Method
☐ By hand to trainer/assessor ☐ By email to trainer/assessor
☐ Online submission via Learning Management System (LMS)
☐ Any other method _________________________________________________
(Please describe here)
4. Student declaration
· I have read and understood the information in the Unit Requirements prior to commencing this Student Pack
· I certify that the work submitted for this assessment pack is my own. I have clearly referenced any sources used in my submission. I understand that a false declaration is a form of malpractice;
· I have kept a copy of this Student Pack and all relevant notes, attachments, and reference material that I used in the production of this Student Pack;
· For the purposes of assessment, I give the trainer/assessor permission to:
· Reproduce this assessment and provide a copy to another member of staff; and
· Take steps to authenticate the assessment, including communicating a copy of this assessment to a plagiarism checking service (which may retain a copy of the assessment on its database for future plagiarism checking).
Student signature: ________________________________
Date: ____/_____/______________
5. Assessment Plan
The student must be assessed as satisfactory in each of the following assessment methods in order to demonstrate competence in a variety of ways.
Evidence number/ Task number
Assessment method/ Type of evidence/ Task name
Sufficient evidence recorded/Outcome
Assessment task 1
Knowledge Test (KT)
S / NS (First Attempt)
S / NS (Second Attempt)
Assessment task 2
Skill Test (ST)
S / NS (First Attempt)
S / NS (Second Attempt)
Outcome
C ☐ NYC ☐
Date assessed:
Trainer signature:
6. Completion of the Assessment Plan
Your trainer is required to fill out the Assessment Plan Outcome records above, when:
· You have completed and submitted all the requirements for the assessment tasks for this cluster or unit of competency.
· Your work has been reviewed and assessed by your trainer/assessor.
· You have been assessed as either satisfactory or unsatisfactory for each assessment task within the unit of competency.
· You have been provided with relevant and detailed feedback.
Every assessment has a “Feedback to Student” section used to record the following information. Your trainer/assessor must also ensure that all sections are filled in appropriately, such as:
· Result of Assessment (satisfactory or unsatisfactory)
· Student name, signature and date
· Assessor name, signature and date
· Relevant and detailed feedback
7. U ...
1. Student uses MS Excel to calculate income tax expense or refundAbbyWhyte974
1. Student uses MS Excel to calculate income tax expense or refund, taxable income, and total taxes using the full-cost method for transfer pricing. There are no errors.
2. Student uses MS Excel to calculate income tax expense or refund, taxable income, and total taxes using the variable-cost method for transfer pricing. There are no errors.
3. Student produces a thorough and detailed Word document that incorporates specific details from the MS Excel spreadsheet, a detailed recommendation based on those specific details as to how the organization should proceed is included, and the recommendation is justified with at least 3 examples from the week's resources and/or additional research in the Walden Library.
4. Writing exhibits strong evidence of thoughtful critical analysis and thinking; careful examination is made of assumptions and possible biases, with detailed supporting rationale. Writing synthesizes the classroom experiences and content; analyzes patterns or connections between theory and practice; and draws logical conclusions based on well-reasoned arguments. New questions are presented based on synthesis of ideas and input.
5. Writing is clear, logical, well-organized and appropriate. Work is free from spelling and grammar/syntax errors. Tone is professional and free from bias (i.e., sexism, racism). There are no errors.
6. Student effectively and directly integrates discussion/assignment content with relevant and compelling personal experiences, additional research, or current events from credible news sources. Specifically adds a new and/or different insight or perspective on the subject area(s) being discussed or treated in the assignment.
7. Student demonstrates full adherence to scholarly or credible reference requirements and adheres to APA style with respect to source attribution and references. There are no APA errors.
CASE STUDY—BEWARE: One Emergency May Hide Another!
A hospital submitted a report to the State Board of Nursing reporting that an RN had been terminated after the death of a patient following surgery for a tubal pregnancy.
THE NURSE'S STORY—SALLY SIMMS, RN
I had worked the medical-surgical units at the General Hospital ever since graduating from my nursing program 4 years before. This was the worst night, the worst shift, of my nursing career.
I was assigned to care for eight patients that night, which is not an unusual number of patients, but they all were either fresh post-ops or so very sick. Four patients had just had surgery that day. One patient was on a dopamine drip to maintain his blood pressure, so he needed frequent monitoring. One patient was suspected to have meningitis, one patient had pneumonia, and a patient with suspected histoplasmosis completed my assignment.
One of my post-op patients was Betty Smith, a young woman in her early thirties who had laparoscopic surgery late in the day. She had been transferred from the recovery room late in the evening shift and was very uncomfortable when I fi ...
1. Socrates - In your view, what was it about Socrates’ teachings AbbyWhyte974
1. Socrates - In your view, what was it about Socrates’ teachings that made him dangerous in the minds of the members of the ruling class of Athens; and what was it about his teachings that attracted his students to him?
2. Plato - Of his many ideas, which do you think has been his most influential, and why?
3. Aristotle - Share your own views on Aristotle's break with Plato on the question of private property and wealth accumulation. Is Aristotle's argument persuasive and superior? Or was it weak, and even dangerous?
4. Birth of Christianity as a Religion - Imagine the the Council of Nicaea ended with the Gospel of Mary being included in the New Testament. How might Western Civilization have developed differently if this book, and it's suggestion the Jesus’ closest disciple, the one he revered the most, was actually a woman? Do you think we might have inherited a less misogynistic society in which women are treated more as equals?
7. The encomienda system used by the Spaniards to enslave the indigenous peoples of the New World, especially as practiced in Mexico, became controversial in Spain. Describe the encomienda system and the arguments used for and against it.
8. Describe why it is that many historians argue that King Henry VIII of England played a critical role in the rise of capitalism.
9. By the time Adam Smith’s An Inquiry into the Nature and Causes of the Wealth of Nations was published in 1776, Europe had undergone a dramatic transformation from a feudal, largely agrarian society to an increasingly market-based commercial society. Discuss some of the more significant, transformative societal developments, and their implications, from 1492 to 1776.
10. Much has been written about the so-called “Adam Smith Problem;” the apparent dichotomy between his Theory of Moral Sentiments and An Inquiry into the Nature and Causes of the Wealth of Nations. Discuss whether these two works are reconcilable with one another. Do they reflect two very different imaginations of humans? Do they suggest that the author changed his mind after writing the first book? Might they represent a more complex and unifiable imagination of who we are or can be?
11. The garment industry is the second-most polluting in the world. A significant amount of this pollution is from “fast fashion” “disposable” clothing; a business model that relies on people, including children, making clothes under conditions that we would consider intolerable. Psychologists and marketers alike agree that our buying and consumption is largely driven by psychological impulses of which we may not be fully conscious. Indeed, as experts posit in the film The True Cost, consuming more can have a negative effect on our psyche. What social, ethical, economic and/or philosophical issues are raised by The True Cost documentary? Why do we tolerate such a system?
12. Many people agree with Immanuel Kant's argument that we should never treat other people as means to an end; we should treat each pers ...
1. Select a patient” (friend or family member) on whom to performAbbyWhyte974
1. Select a “patient” (friend or family member) on whom to perform a complete H&P.
2. NOTE: DO NOT USE REAL NAMES OR INITIALS OR OTHERWISE IDENTIFY YOUR “PATIENT.” FAILURE TO MAINTAIN PRIVACY WILL RESULT IN A FAILING SCORE.
3. Using the format specified below, write a 2 page SOAP note on your “patient.” The HPI should be presented in a paragraph, and the rest of the data including the ROS should be presented in a list format.
4. Collect only the information that is pertinent to the chief complaint of the patient to include in your SOAP note. Aim for a single page using normal margins and format.
5. The SOAP Note must contain all required elements as outlined in the rubric below.
6. You must self-score your SOAP note using the rubric and attach it to the assignment.
Criteria Ratings Points
Thread
Content
50 to >46.0 pts
Advanced
47 to 50 points All key
components of the
Discussion Board Forum
prompt are answered in
the thread. Major points
are supported by all of the
following: *Reading &
Study materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Source
citations in current APA
format, include the
required 7 or more from
personal research, the
course readings, and the
integration of 1 biblical
principle.
46 to >43.0 pts
Proficient
44 to 46 points Some key
components of the
Discussion Board Forum
prompt are answered in the
thread. Major points are
supported by some of the
following): *Reading &
Study materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Source
citations in current APA
format, include the required
7 or more from personal
research, the course
readings, and the
integration of 1 biblical
principle.
43 to >0.0 pts
Developing
Minimal key components of
the Discussion Board
Forum prompt are
answered in the thread.
Major points are supported
by some or none of the
following: *Reading &
Study materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Source
citations in current APA
format, include the required
7 or more from personal
research, the course
readings, and the
integration of 1 biblical
principle
0 pts
Not
Present
50 pts
Replies
Content
41 to >39.0 pts
Advanced
Contribution made to
discussion with each reply
expounding on the thread.
Major points are supported
by all of the following:
*Reading & Study
materials; *Pertinent,
conceptual, or personal
examples; *Thoughtful
analysis (considering
assumptions, analyzing
implications, and
comparing/contrasting
concepts); and *Three
peer-reviewed source
citations in current APA
format, and the integration
of 1 biblical principle.
39 to >35.0 pts
Proficient
Marginal contribution made
to discussion with each
reply slightly exp ...
1. Review the HCAPHS survey document, by clicking on the hyperlinkAbbyWhyte974
1. Review the HCAPHS survey document, by clicking on the hyperlink.
2. Choose one of the questions on the survey and research an intervention to improve patient satisfaction on that question.
3. Drop a pdf of the article for your solution
4. Review the rubric to make sure you include all required information in your video assignment.
5. Create a video to present a systems-based solution, according to the research. (Do NOT include "increased staffing" as your solution.)
March 2017 1
HCAHPS Survey
SURVEY INSTRUCTIONS
You should only fill out this survey if you were the patient during the hospital stay
named in the cover letter. Do not fill out this survey if you were not the patient.
Answer all the questions by checking the box to the left of your answer.
You are sometimes told to skip over some questions in this survey. When this happens
you will see an arrow with a note that tells you what question to answer next, like this:
Yes
No If No, Go to Question 1
You may notice a number on the survey. This number is used to let us know if
you returned your survey so we don't have to send you reminders.
Please note: Questions 1-25 in this survey are part of a national initiative to measure the quality
of care in hospitals. OMB #0938-0981
Please answer the questions in this survey
about your stay at the hospital named on
the cover letter. Do not include any other
hospital stays in your answers.
YOUR CARE FROM NURSES
1. During this hospital stay, how often
did nurses treat you with courtesy
and respect?
1
Never
2
Sometimes
3
Usually
4
Always
2. During this hospital stay, how often
did nurses listen carefully to you?
1
Never
2
Sometimes
3
Usually
4
Always
3. During this hospital stay, how often
did nurses explain things in a way
you could understand?
1
Never
2
Sometimes
3
Usually
4
Always
4. During this hospital stay, after you
pressed the call button, how often did
you get help as soon as you wanted
it?
1
Never
2
Sometimes
3
Usually
4
Always
9
I never pressed the call button
2 March 2017
YOUR CARE FROM DOCTORS
5. During this hospital stay, how often
did doctors treat you with courtesy
and respect?
1
Never
2
Sometimes
3
Usually
4
Always
6. During this hospital stay, how often
did doctors listen carefully to you?
1
Never
2
Sometimes
3
Usually
4
Always
7. During this hospital stay, how often
did doctors explain things in a way
you could understand?
1
Never
2
Sometimes
3
Usually
4
Always
THE HOSPITAL ENVIRONMENT
8. During this hospital stay, how often
were your room and bathroom kept
clean?
1
Never
2
Sometimes
3
Usually
4
Always
9. During this hospital stay, how often
was the area around your room quiet
at night?
1
Never
2
Sometimes
3
Usually
4
Always
YOUR EXPERIENCES ...
1. Saint Leo Portal loginUser ID[email protected] AbbyWhyte974
1. Saint Leo Portal login
User ID:[email protected]
Saintleo\martha.ramsey
Password: Demonte5!!!
2. New Login for email through Okta
User ID: Martha.ramsey
Password: Demonte5!!!
3. What did you earn your first medal or award for?
Art class
4. Lion Share Courses
5. Research Method I
...
1. Reference is ch. 5 in the e-text, or ch. 2 in paper text...pleaAbbyWhyte974
1. Reference is ch. 5 in the e-text, or ch. 2 in paper text...please match the terms regarding political parties
polling data is based on this aspect of Parties
Rep. Senfronia Thompson filed for the role of Speaker of Texas House
In 2020, party delegates and executive committees voted to nominate presidential candidates via Zoom
a sector of a political party (ex. Trump Republican, conservative Democrat) is called
2. Which candidate’s office is chosen/nominated by delegate convention?
sheriff of Medina County
U.S. congressman from the 4th Texas congressional district
president of the United States
governor of Texas
3. Which statement best depicts the effect of redistricting on representative democracy?
Legislators represent the same number of Republicans and Democratic voters
representation is mostly based on geographic cohesion
representation is mostly based on the voting patterns of Texas residents
gerrymandering is a legitimate method of forming districts
4. The difference between absentee ballot and mail-in ballot is?
absentee is for people residing outside of their state
mail-in ballots are issued to people who can't go to polls
in some states there is no difference, as all ballots are mailed in
in Texas mail-in ballots require doctors note
5 Unlike the US, most democratic governments have _______ political systems with _______.
2-party//direct representation
Multi-party//proportional
2-party//direct representation
multi-party//proportional representation
independent party//single-member districts
2-party//single-member districts
[ Choose ]
[ Choose ]
[ Choose ]
Car LoanNew Car LoanLoan InputsSticker price$ 24,595Trade in$ 3,500Cash back offer$ - 0Loan amount$ 21,095Loan term (months)24Loan interest (APR)1.90%Loan payment$ 896.46Total cost of the car$ 21,515.04
My Car Data
MPG DataAll ModelsModelDisplCylTransDriveFuelCert RegionStndStnd DescriptionUnderhood IDVeh ClassAir Pollution ScoreCity MPGHwy MPGCmb MPGGreenhouse Gas ScoreSmartWayComb CO2ACURA ILX2.44AMS-82WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV02.4SH3small car62535297Yes309ACURA ILX2.44AMS-82WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV02.4SH3small car62535297Yes309ACURA MDX3.56SemiAuto-92WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV61927225No404ACURA MDX3.56SemiAuto-92WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV62027235No391ACURA MDX3.56SemiAuto-92WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV03.5VH3small SUV61927225No404ACURA MDX3.56SemiAuto-92WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV03.5VH3small SUV62027235No391ACURA MDX3.56SemiAuto-94WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV61826214No424ACURA MDX3.56SemiAuto-94WDGasolineCAL3ULEV125California LEV-III ULEV125HHNXV03.5VH3small SUV61926225No404ACURA MDX3.56SemiAuto-94WDGasolineFAT3B125Federal Tier 3 Bin 125HHNXV03.5VH3small SUV61826214No424ACURA MDX ...
1. Read the story first.2. Bold Face TermsMake a separate lAbbyWhyte974
1. Read the story first.
2. Bold Face Terms:
Make a separate list of all the definitions of the bold face terms in the story first from your reference sources like a medical dictionary or website etc.
Start by listing all the bold face medical terms and their definitions and cite your sources of reference. Example: appendectomy: the surgical excision of the organ known as the appendix which is a vestigial organ (Webster, 2010)
Then list all your full references at the bottom of your work.
Submit this list as part of your work.
3. Translate definitions into simple terms and insert them into the story:
Next, translate all of the bold faced medical terms into simple language as if you are explaining it to a patient or to someone who may not understand medical terminology and incorporate these simple translations into your story.
This means you should remove the actual medical terms in bold face print but leave the meaning in place with your translated explanations of these terms.
Your finished work should be easily understood. It is OK to alter the sentence structure to accomodate your translations.
Remember to use simple basic language to explain these complicated medical terms to another person.
Highlight your new translation either by bold facing or capitalizing the words.
Do not just insert the definitions. You will not get credit for this and points will be taken off.
The goal here is for you to learn how make the complicated sound simple.
Example:
Initial sentence with medical term in place: The patient is having an appendectomy.
Translation into simple terms in your story: The patient is have his appendix cut out and removed.
In other words, rewrite the story completely in layman's terms or plain English so that someone without a medical or science background would be able to understand.
Your translation must be clear and easy to understand.
Take into account the context of how the terms were used.
You must use all the bold faced terms "translated meanings" in your story.
So when you are complete you will have a list of terms plus definitions (with sources cited) plus a rewritten story in plain English.
4. Submitting Your Completed Work:
Submit your work on a Microsoft Word document using the attachment tool.
Submit all work as one WORD document.. Your file name should end in .doc or .docx or you can use a plain text file format ending in .rtf
If unsure how to do this please contact tech support.
Include your list of definitions and your translated story and your references.
Be sure to run a spell check on your work before submitting.
If you have any difficulty using the attachment tool please call tech support for help.
Exams may be worked on any time during the week but must be submitted on or before the due date.
Submit your exam by clicking on the title of this section "Exam I -Due..." then scroll to the bottom of the page to submit your work.
Exam 2 – part 1
Morticia was particularly interested in entering cosmetolog ...
1. PURPOSE To document and evaluate teaching skills necessary toAbbyWhyte974
1. PURPOSE: To document and evaluate teaching skills necessary to provide teaching to an individual client with a demonstrated need.
With the completion of this assignment the student will be able to achieve the following objectives.
a. Demonstrate ability to thoroughly assess the learning styles of an individual or family using given developmental or cultural models.
b. Demonstrate ability to anticipate learning needs based on developmental or cultural assessments.
c. Identify and utilize teaching/learning principles to facilitate achievement of learning goals and outcomes.
d. Select and prioritize learning strategies based on the developmental or cultural assessment to achieve learning goals and outcomes.
e. Support rationales for teaching plan using teaching and learning theories from required readings with references
2. NURSING COMPETENCIES:
a. Assessing and identifying developmental, cultural, and socioeconomic factors affecting a client.
b. Providing evidence-based health information and teaching based on developmental, cultural, and socioeconomic factors affecting a client or family
c. Integrating teaching/learning activities into client interactions based on developmental, cultural, and socioeconomic factors affecting a client or family.
d. Incorporating health promotion and teaching into the plan of care based on developmental, cultural, and socioeconomic factors affecting a family or client.
3. PLAN: submitted to the clinical instructor during the teaching experience. Your clinical instructor must approve the topic.
a. Develop nursing diagnosis (NANDA)
b. Develop two (2) learning objectives
c. State methodology (teaching methods)
d. Provide and utilize teaching aids e)
e. State needed resources
4. This write-up should be 2-3 pages to follow the Teaching Experience Rubric.
5. SUGGESTED TOPICS FOR TEACHING PLAN:
a. Mother’s with infants who have hyperbilirubinemia
b. Maternal and neonatal infection
c. Care of the Mother and Infant with Substance Abuse Problems
d. Immunization schedule for the newborn
e. Newborn care
f. Post op cesarean section care
g. Post vaginal delivery care
h. Breastfeeding
Course Number and Name
Course: NURS 316L
TEACHING EXPERIENCE PROJECT GUIDELINES & RUBRIC
i. Postpartum depression
Revision Date: Month, Year (i.e. February, 2010) Page 1
Page 1 of 3
TEACHING EXPERIENCE RUBRIC
NAME: DATE:
TOPIC:COURSE:
START TIME: END TIME:
Criteria
4
3
2
1-0
Score
Comprehensive
Assessment
· Clear and concise
discussion of patient’s admission diagnosis, demographic data,
and anticipated learning needs
· Clear and comprehensive patient assessment data to support a deficient knowledge nursing diagnosis.
· Vague and incomplete discussion of patient’s admission diagnosis, demographic data, and anticipated learning needs.
· Vague and incomplete patient assessment data to support deficient knowledge nursing diagnosis.
· Vague and incomplete discussion of patient’s admission diagnosis, demographic data, and antici ...
1. Rate yourself according to your confidence level performing theAbbyWhyte974
1. Rate yourself according to your confidence level performing the skills identified in the Clinical Skills Self-Assessment Form.
2. Based on your ratings, summarize your strengths and opportunities for improvement.
3. Based on your self-assessment and theory of nursing practice, develop four (4) measurable goals and objectives for a practicum experience.
4. Include them on the designated area of the form.
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
Beginning (Have performed with supervision or needs supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan
X
Differentiating between pathophysiological and psychopathological conditions
X
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)
X
Performing and interpreting a mental status examination
X
Performing and interpreting a psychosocial assessment and family psychiatric history
X
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
X
Formulating diagnoses according to DSM 5 based on assessment data
X
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes
X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)
X
Evaluating patient response and modify plan as necessary
X
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan
X
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)
X
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers
X
Develop an age appropriate individualized plan of care
X
Provide psychoeducation to individuals and/or any caregivers
X
Promote health and disease prevention techniques
X
Self-assessment skill:
Develop SMART goals for practicum experiences
X
Evaluating outcomes of practicum goals and modify plan as necessary
X
Documenting and reflecting on learning experiences
X
Professional skills:
Maintains professional boundaries and thera ...
1. President William McKinley, letter to Congress, April 25, 1898.AbbyWhyte974
1. President William McKinley, letter to Congress, April 25, 1898.
[I took action] under the joint resolution approved April 20, 1898, "for the recognition of the independence of the people of Cuba, demanding that the Government of Spain relinquish its authority and Government in the island of Cuba, and to withdraw its land and naval forces from Cuba and Cuban waters…"
…The Government of Spain…responds by treating the reasonable demands of this Government as measures of hostility, following with that instant and complete severance of relations by its action which by the usage of nations accompanies an existent state of war between sovereign powers.
I now recommend the adoption of a joint resolution declaring that a state of war exists between the United States of America and the Kingdom of Spain…
2. Teller Amendment, Adopted by the Senate, April 19, 1898
[The United States] hereby disclaims any disposition of intention to exercise sovereignty, jurisdiction, or control over said island except for pacification thereof, and asserts its determination, when that is accomplished, to leave the government and control of the island to its people.
3. Senator Alfred Beveridge (R-Indiana), in Congress, January 9, 1900.
. . . [J]ust beyond the Philippines are China's illimitable markets. . . We will not renounce our part in the mission of our race, trustee of God, of the civilization of the world. . . Where shall we turn for consumers of our surplus?. . . China is our natural customer. . . [England, Germany and Russia] have moved nearer to China by securing permanent bases on her borders. The Philippines gives us a base at the door of all the East. . .
They [the Filipinos] are a barbarous race, modified by three centuries of contact with a decadent race [the Spanish]. . . It is barely possible that 1,000 men in all the archipelago are capable of self-government in the Anglo-Saxon sense. . .
The Declaration [of Independence] applies only to people capable of self-government. How dare any man prostitute this expression of the very elect of self-government peoples to a race of Malay children of barbarism, schooled in Spanish methods and ideas? And you, who say the Declaration applies to all men, how dare you deny its application to the American Indian? And if you deny it to the Indian at home, how dare you grant it to the Malay abroad.
4. President Woodrow Wilson, War Message to Congress, 1917
The Imperial German Government [announced that] it was its purpose to put aside all restraints of law or of humanity and use its submarines to sink every vessel that sought to approach either the ports of Great Britain and Ireland or the western coasts of Europe or any of the ports controlled by the enemies of Germany within the Mediterranean.…
It is a war against all nations. American ships have been sunk, American lives taken, in ways which it has stirred us very deeply to learn of, but the ships and people of other neutral and friendly nations have been sunk and ...
1. Prof. Lennart Van der Zeil’s theorem says that any programming AbbyWhyte974
1. Prof. Lennart Van der Zeil’s theorem says that any programming language is complete if it can be used to write a program to compute any computable number.
a. What is a computable number?
b. What is a non-computable number?
c. If all existing programming languages are complete why do we need more than one?
2. Two methodologies are used to transform programs written in a source language (also known as a programmer-oriented language, or a horizontal language, or a high-level language) into a target language (also known as a machine language, or a vertical language, or a low-level language). There is a static method called translation and a dynamic method called interpretation. Yet FORTRAN while 98% static ., uses interpretation for the Formatted I/O statement, similarly COBOL uses interpretation for the MOVE and MOVE CORRESPONDING statements; on the other hand, Java is fully interpretative except that in some programs and certain data sets it may invoke a JIT (Just In Time) compiler to execute a bit of static code. Why do language designers mix these modalities if either is complete? Hint: This is a long question with a short answer.
3. C and C++ store numerical arrays (matrices) in row major order and each index range must begin with 0; whereas FORTRAN stores arrays in column major order and the (default) index range starts (almost always) with 1. Engineers and scientists are often faced with the problem of converting a working program, or much more often a subroutine, from one language to another. Unfortunately, due to the index range difference (0 to n-1) in C/C++ and (1 to N) in FORTRAN, viewing one array as simply the transpose of the other will not suffice. What steps would you take to convert such a subroutine to compute the product of two matrices A(N,M) and B(M,N) to produce C(N,N) from FORTRAN to C++?
4. What was the major reason Jim Gosling invented Java? Did he succeed?
5. What are the four major features of C++ that were eliminated in Java? Why were they taken out? Why do we not miss them?
6. What was Kim Polese’ role at SUN Microsystems and why did she think Java should be positioned as a general purpose computer programming language? How did she accomplish this truly incredible feat, not done since Captain (later Admiral) Grace Murray Hopper, USN standardized COBOL in the early 1960s.
7. Describe briefly the role of women in the development of computer programming and computer programming languages. (Ada Lovelace, Betty Holberton, Grace Hopper, Mandaly Grems, Kim Polese, Laura Lemay)
8. What are the pros and cons of overloaded operators in C++? Java has only one, what is it?
9. State your own arguments for allowing mixed mode arithmetic statements. (See Ch 7)
10. What is BNF and why are meta-languages like BNF and EBNF used?
...
1. Preparing for assessment. DateWeek 3Session titlePrAbbyWhyte974
1. Preparing for assessment.
Date
Week 3
Session title
Preparing for assessments
Content covered
Have enough knowledge on the university assessments before you start doing it.
Comments on readings/practice.
Making study plan and Managing time are the best method to have the peace of mind.
Most interesting points
Feeling organised when finish multiple assessments in the right time.
Most difficult points
Reading the academic articles and find the relative information that supports my topic, How to discuss more in depth.
· Introduction
The above session provided the best academic and coordination skills by explained the multiple essential tips of preparing properly for the assessments and considering the times determinant, which encouraged me to think and write professionally.
· Reflection Discussion on the study plan for assessments
As the English language is my second tongue, I have faced many difficulties with reading and writing academic articles. I found the above topic has a significant impact positively to prepare my assessments in advance, especially when it displays at the beginning of my first semester in the university. However, an ongoing experience on what I gained from this session has a huge impact on me. For instance, after this session, I organised a table that shows each type of the assessments separately, and each one has its basics and elements in its allotted box. As a result, while I’m doing my estimates, I refer to my table and find my structures ready, which helps me seize the time and be more skilled.
· Reflection Discussion on prepare well for my assessments.
As I'm in my first year at the university, I thought there was no need to have an entire assessments plan. Later on, I noticed that working on assessments without organising a plan affects the whole semester assessments, which might cause time conflict in the Assignments due date. I wasn't aware of how important it is the preparing and reading enough sources before start writing. However, Glancing and reading enough information can convert the assessment from stress work to exciting work, which will help set the scene and allow me to think critically and write academically. Based on the benefits that I acquired from the session, the critical thinking and in depth discussion in a particular topic will need to be supported by academic information from reading more articles and spend more time on this part of the work. After this session, I became able to organise my assessments, which allow me to have enough time to working on them and preventing some of the study stresses and cramming. Also, I have been able to take a period to refresh my mind and get my memory retention. However, there is no doubt that it encouraged me to provide the work in a prime manner. This experience will be beneficial in my subsequent semesters to develop my ability to be further organised in my study and aware of how to prepare before the assessments.
Conclusion
...
1. Project Description Definition of ProjectThe supervision of wAbbyWhyte974
1. Project Description Definition of Project
The supervision of workers' operations or corporate functions is difficult work for the administrative environment. Modern frameworks have certain limitations in the implementation of integrated workforce control functions. This project aims to improve the structure of EMS (employee management system). The new framework helps administrators to trace staff profiles, particularly their tasks, and it will capture the present position. The accompanying boss forecasts the workforce requirements by detailed information of workers and plans a valid timeline for each employee to reduce the difficulties of collaborative working. This project focuses on developing a user-friendly interface that helps supervisors reliably collect or store information for workers (Abdulhamid, Dada, & Ajibuwa, 2019).
2. Plan scale, deliverables, and outcomes
This project has a high scope since many companies compete for previous techniques to monitor employee records, but face challenges with data quality and human-made errors. EMS enables organizations to capture, store and exchange the details needed about current and recently entered staff. The present state of the delegated activities of workers would inevitably be monitored by employee supervision and their responsibilities would also be mainly helpful. Through the use of the EMS framework, quality control levels will ultimately be possible to delegate workers the correct stress and improve employee loyalty. The corporation would raise employee engagement rates, which would also increase group morale and person efficiency (Abdulhamid, Dada, & Ajibuwa, 2019).
3. The Project Limitations
Two main limitations, such as effort and money, have been faced throughout the project implementation period. For this sort of IT project, capital resources are important since it incorporates certain hardware and software requirements in the procurement and the project faces difficulties throughout the development process owing to proper evaluation on a budget schedule. Time is another requirement for this project. Any project mission has to be accomplished within a very limited time but job-related problems have been induced by a combination of vacations and the shortage of project participants due to sickness. However, this project was performed using productive management techniques, which collaborated in collaboration for the successful coordination and communication of the project (Denney, 2020).
4. Recommendation of Project
This initiative is about handling and tracking staff, so privacy and protection are the two main employee issues. EMS shops or collect all workers' employee records. This means that owing to certain software fixes or gaps, security attacks such as ransomware, insider attacks, and unauthorized entry, security safety is a high priority of this initiative. So, in this project, I would like to see certain improvements, first of all, I would suggest gaining some financia ...
1. Project Description Definition of ProjectThe supervision of w
1. For this reaction essay is a brief written reaction to the read
1. 1. For this reaction essay is a brief written reaction to the
readings. It may be somewhat informal (and I would encourage
you to be personal), but it must be well-written and well-
organized. It must not be more than 2 pages, use 12-point font,
single-spaced, at least 1" margins. You will react to the results
of this systematic review article on Telemedicine
" Effectiveness of Telemedicine A Systematic Review of
Reviews.pdf
Focus on the results of the synthesis only, react to the authors'
conclusions- do you agree or disagree with their synthesis?
Discuss your opinion, are there faults in their conclusions?
Telemedicine is increasingly being suggested as an alternative
for an in-person visit, especially with emergent diseases that
call for person-to-person distancing. What are the potential
concerns with this suggestion? What are in the authors'
synthesis and conclusions underscore the limitations of this
suggestion?
2. The next day a representative from Bristol Myers Squibb
visits your office and tells you that Plavix® (clopidogrel)
decreases cardiovascular events by 8.7% compared to aspirin.
That sure sounds good to you, as you have many elderly patients
at risk of heart attacks and strokes and many are already on
aspirin. The brochure quotes the CAPRIE study, and you decide
to investigate this further. A review of the 1996 article reveals
that study patients on Plavix® experienced cardiovascular
events 9.78% of the time compared to 10.64% of the time with
aspirin. Plavix® was approved by the FDA based on this one
study. Cost of Plavix/day=$6.50. Cost of aspirin/day = $1.33
• What was the NNT?
• How much does Plavix® cost monthly?
• What meaning do these values have for this problem?
• Be sure to include your actual calculations/math
2. i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i
c s 7 9 ( 2 0 1 0 ) 736–771
j o u r n a l h o m e p a g e : w w w . i n t l . e l s e v i e r h e a l
t h . c o m / j o u r n a l s / i j m i
Effectiveness of telemedicine: A systemati c review of
reviews
Anne G. Ekeland a,∗ , Alison Bowes b, Signe Flottorp c,d
a Norwegian Centre for Integrated Care and Telemedicine,
University Hospital of North Norway, P.O. Box 6060, N-9038
Tromsø, Norway
b Department of Applied Social Science, University of Stirling,
Scotland, UK
c Norwegian Knowledge Centre for the Health Services, Oslo,
Norway
d Department of Public Health and Primary Health Care,
University of Bergen, Norway
a r t i c l e i n f o
Article history:
Received 23 April 2010
Received in revised form
11 July 2010
Accepted 29 August 2010
3. Keywords:
Telemedicine
Telecare
Systematic review
Effectiveness
Outcome
a b s t r a c t
Objectives: To conduct a review of reviews on the impacts and
costs of telemedicine services.
Methods: A review of systematic reviews of telemedicine
interventions was conducted. Inter-
ventions included all e-health interventions, information and
communication technologies
for communication in health care, Internet based interventions
for diagnosis and treat-
ments, and social care if important part of health care and in
collaboration with health care
for patients with chronic conditions were considered relevant.
Each potentially relevant sys-
tematic review was assessed in full text by one member of an
external expert team, using
4. a revised check list from EPOC (Cochrane Effective Practice
and Organisation of Care Group)
to assess quality. Qualitative analysis of the included reviews
was informed by principles of
realist review.
Results: In total 1593 titles/abstracts were identified. Following
quality assessment, the
review included 80 heterogeneous systematic reviews. Twenty-
one reviews concluded that
telemedicine is effective, 18 found that evidence is promising
but incomplete and others
that evidence is limited and inconsistent. Emerging themes are
the particularly problem-
atic nature of economic analyses of telemedicine, the benefits of
telemedicine for patients,
and telemedicine as complex and ongoing collaborative
achievements in unpredictable
processes.
Conclusions: The emergence of new topic areas in this dynamic
field is notable and review-
ers are starting to explore new questions beyond those of
clinical and cost-effectiveness.
Reviewers point to a continuing need for larger studies of
telemedicine as controlled inter-
6. . . . . .
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s
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i
e
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . .
. Introduction
revious reviews of telemedicine have concluded that
rrefutable evidence regarding the positive impact of
elemedicine on clinical outcomes still eludes us. One
eview [1] of more than 150 articles concluded that poten-
7. ial effectiveness could only be attributed to teleradiology,
elepsychiatry, transmission of echocardiographic images
nd consultations between primary and secondary health
roviders. Another systematic review [2] that assessed more
han 1300 papers making claims about telemedicine out-
omes found only 46 publications that actually studied at
east some clinical outcomes. A review that analyzed the
uitability of telemedicine as an alternative to face-to-face
are [3] concluded that establishing systems for patient care
sing telecommunications technologies is feasible; however,
he studies provided inconclusive results regarding clinical
enefits and outcomes. A report on peer-reviewed litera-
ure for telemedicine services that substituted face-to-face
ervices with ICT-based services at home and in offices or
ospitals [4] identified 97 articles that met the inclusion
riteria for analysis. The authors concluded that telemedicine
s being used even if the use is not supported by high quality
vidence. Reviews on cost outcomes have fared similarly. A
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . 769
study focused on cost-effectiveness interventions concluded
that there is no good evidence that telemedicine is or is not a
cost-effective means for delivering healthcare [5].
The quality of studies is a recurrent concern in these
reviews [1,2,4–6]. There is also a debate about appropriate
research methodologies. For example, economic analysis of
telemedicine has not yet met accepted standards [5]; there is
a relative lack of exploration of the socio-economic impact
of telemedicine [7]; evidence on factors promoting uptake of
telemedicine is lacking [8]; there is relatively undeveloped use,
at the time, of qualitative methods [9]; many studies have not
been well-designed [4,10]; and, considering perceived difficul -
11. This paper reports on research funded under EU SMART
2008/0064, which sought to review the evidence on the
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
i c a l
738 i n t e r n a t i o n a l j o u r n a l o f m e d
effectiveness of telemedicine with particular reference to
both outcomes and methodologies for evaluation. This paper
focuses mainly on the evidence about effectiveness, and
assesses the range of conclusions drawn by reviewers about
the effectiveness of telemedicine and the gaps in the evidence
base. A companion paper focuses on the methodolo gical
issues and recommendations [13].
2. Objectives
The objective of the work was to conduct a review of reviews
on the impacts and costs of telemedicine services and con-
sider qualitative and quantitative results, with the purpose
of synthesizing evidence to date on the effectiveness of
telemedicine. The key questions addressed were firstly, how
are telemedicine services defined and described in terms of
participants, interventions, comparisons and outcome mea-
sures; secondly, what are the reported effects of telemedicine:
thirdly which methodologies were used to produce knowl-
edge about telemedicine in studies included; fourthly, what
are the strengths and weaknesses of these methodologies,
including HTA methodologies; and finally what are the knowl -
edge gaps and what methodologies can be recommended for
future research? The present paper addresses the first two of
these questions, and identifies assessments of the evidence
base provided within the reviews and knowledge gaps in terms
12. of outcomes.
3. Methods
An initial search identified systematic reviews of telemedicine
published from 1998. A systematic review was defined as an
overview with an explicit question and a method section with
a clear description of the search strategy and the methods
used to produce the systematic review. The review should
also report and analyse empirical data. In addition, reviews
which described or summarised methods used in assessing
telemedicine were included. Because of the large number of
reviews retrieved, a decision was taken to include only reviews
published from 2005 and onwards in the final review.
3.1. Inclusion criteria
3.1.1. Population/participants
Systematic reviews on patients and consumers, health pro-
fessionals and family caregivers, regardless of di agnoses or
conditions, were included in the searches for systematic
reviews.
3.1.2. Interventions
All e-health interventions, information and communication
technologies (ICT) for communication in health care, Internet
based interventions for diagnosis and treatments, and social
care if an important part of health care and in collaboration
with health care for patients with chronic conditions were
considered relevant.
i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771
3.1.3. Comparisons
Reviews of studies comparing telemedicine to standard care or
13. to another type of care, as well as reviews of studies comparing
different e-health solutions were included.
3.1.4. Outcomes
Only reviews reporting relevant outcomes were included,
specified as health related outcomes (morbidity, mortality,
quality of life, patient’ satisfaction), process outcomes (qual -
ity of care, professional practice, adherence to recommended
practice, professional satisfaction) and costs or resource use.
Systematic reviews reporting emerging issues, such as an
unexpected finding or important new insights were also
included.
3.1.5. Languages
No articles were excluded based on language, although the
main focus of the project was telemedicine in Europe.
3.2. Exclusion criteria
3.2.1. Design
Reviews considered not systematic, including commentaries
and editorials, were excluded. Systematic reviews with major
limitations (low quality reviews) according to a revised check-
list for systematic reviews from EPOC (Cochrane Effective
Practice and Organisation of Care Group) were excluded.
If the same authors had produced several publications of
the same review, the most updated and/or the full report of
the review was selected, and other versions excluded. Disser -
tations, symposium proceedings, and irretrievable documents
were excluded.
3.2.2. Participants
Studies with participants considered not relevant for the
review, for instance studies on use of ICT on people outside
health care were excluded. Animal studies were excluded.
14. 3.2.3. Interventions considered not relevant for the review
Other exclusions were studies on interventions considered not
relevant for the review, such as studies on Internet and other
ICT media used for information seeking; quality of informa-
tion on the Internet; Internet based education of students and
health professionals, including use of games; medical tech-
nology in clinical practice in general, i.e. medical and surgical
examinations and treatments based on computer technolo-
gies, except when used as remote diagnosis and treatment
(telehealth); ordinary use of electronic patient records; use of
telephone (including cell phones) only; e-health as only a very
limited part of an intervention; use of Internet for surveys and
research; online prescriptions; mass media interventions and
veterinary medicine.
3.2.4. Outcomes
Articles without relevant outcomes, i.e. not on the list of out-
comes specified above under inclusion criteria, were excluded.
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
a l i n
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o
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t
3
i
T
s
i n t e r n a t i o n a l j o u r n a l o f m e d i c
.3. Information sources
iterature searches of the following databases: ACM Digital
ibrary (ACM – The Association for Computing Machin-
ry), British Nursing Index, Cochrane library (including
ochrane database of systematic reviews (CDSR), Database
f reviews of effects (DARE), Health Technology Assess-
ent Database (HTA), CSA, Ovid Medline, Embase, Health
ervices/Technology Assessment Text (HSTAT), Interna-
ional Network of Agencies for Health Technology Assess-
ent (INAHTA), PsycInfo, Pubmed, Telemedicine Information
xchange (TIE), Web of Science.
The main search was performed in February 2009, and an
pdated search was performed in July 2009.
.4. Search
he search strategies are available on the website: (to be
nserted).
17. .5. Study selection
ased on the criteria for inclusion and exclusion, AGE and SF
ndependently screened the lists of titles/abstracts identified
hrough searches for systematic reviews. Any discrepancies
ere solved by discussion with the third member of the team,
B. The potentially relevant systematic reviews were retrieved
n full text.
.6. Data collection process
ata collection was carried out online using a data extrac-
ion form. Each potentially relevant systematic review was
ssessed in full text by one member of an expert panel of
eviewers. A revised check list from EPOC (Cochrane Effective
ractice and Organisation of Care Group) was used to assess
he quality of the systematic reviews. The quality domains
ssessed according to this checklist were methods used to
dentify, include and critically appraise the studies in the
eview, methods used to analyse the findings and an overall
ssessment of the quality of the review. The review team (AGE,
B and SF) subsequently checked review reports for agreement
egarding the inclusion and exclusion criteria.
.7. Data items
ata on type of participants, interventions and outcomes
ncluded in the reviews were collected. Other data items were:
eographical coverage of review, time frame of included stud-
es, range of data collection methods used in studies included
n the reviews, disciplines/areas covered and methodologi -
al traditions included in the review. The reviewers were also
sked to indicate emerging issues identified by the authors of
18. he reviews.
.8. Quality of systematic reviews and risk of bias in
ndividual studies
he members of the expert team assessed the quality of the
ystematic reviews, including questions regarding the degree
f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771 739
to which the systematic reviewers had assessed risk of bias in
individual studies.
Systematic reviews with major limitations were excluded.
We assessed the methodological quality of studies in the
field of telemedicine based on the review authors’ assess -
ments of risk of bias in the primary studies they had
included.
3.9. Summary measures and synthesis of results
The authors analysed the data collected by the members of
the expert team. Due to the expected heterogeneity of stud-
ies, regarding participants, interventions, outcomes and study
designs, a quantitative summary measure of the results was
not planned. We did a qualitative and narrative summary
of the results of the systematic reviews. The results of the
literature review were presented and discussed in two work-
shops intending to validate results. In the first workshop
different user groups took part and in the second workshop
methodology experts participated. The analysis was inspired
by principles of realist review [14], considered appropriate for
complex interventions.
4. Results
19. We identified 1593 records through the searches and excluded
1419 following screening. We retrieved 174 potentially rel -
evant articles in full text. We excluded 94 of these based
on the pre-specified inclusion and exclusion criteria. The
qualitative synthesis below relate to 73 of the 80 included
articles.
The results of the 80 systematic reviews included are sum-
marised in seven tables in Appendix 1. Tables one through
six list populations, interventions, outcomes, results and con-
clusions for the reviews cited in this paper, according to the
headlines presented in the discussion below. Table 7 list the
seven included reviews not cited in this paper.
5. Telemedicine is effective
Twenty reviews (Table 1) concluded that telemedicine works
and has positive effects. These include therapeutic effects,
increased efficiencies in the health services, and technical
usability.
Types of interventions that were found to be therapeuti-
cally effective include online psychological interventions [15];
programmes for chronic heart failure that include remote
monitoring [16]; home telemonitoring of respiratory con-
ditions [17]; web and computer-based smoking cessation
programmes [18]; telehealth approaches to secondary preven-
tion of coronary heart disease [19]; telepsychiatry [20]; virtual
reality exposure therapy (VRET) for anxiety disorders [21];
robot-aided therapy of the proximal upper limb [22]; inter-
net and computer-based cognitive behavioural therapy for the
treatment of anxiety [23,24]; home telehealth for diabetes,
heart disease and chronic obstructive pulmonary disease [25];
and internet based physical activity interventions [26]. A
20. review comparing telepsychiatry and face-to-face work [27]
found no differences between the two, and suggested that
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
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740 i n t e r n a t i o n a l j o u r n a l o f m e d
telepsychiatry will increase in use, particularly where it is
more practical.
Interventions that are effective in reducing health service
use include vital signs monitoring at home with telephone
follow-up by nurses [28]; computerised asthma patient educa-
tion programs [29]; and home monitoring of diabetes patients
[30].
Technical effectiveness and reliability are reported in
respect of remote interpretation of patient data [31]; smart
home technologies [32]; and home monitoring of heart failure
patients [33].
One review concluded that home based ICT interventions
in general give comprehensive positive outcomes for chronic
disease management, despite only identifying a small number
of heterogeneous studies [34].
6. Telemedicine is promising
Nineteen reviews (Table 2) were less confident about the effec-
tiveness of telemedicine, suggesting that it is promising, or has
potential, but that more research is required before it is pos -
sible to draw firm conclusions. In some cases, in which the
21. same conditions and interventions are discussed, these more
tentative conclusions must temper those of authors who find
conclusive evidence.
One review [35] for example found internet-delivered CBT
to be a ‘promising’ and ‘complementary’ development, but did
not provide the endorsements that others [23,24] did for CBT
for the more specific conditions of anxiety and depression.
Similarly psychotherapy using remote communication tech-
nologies was seen as promising [36], but still requiring more
evidence.
Areas in which review authors agreed that telemedicine
shows therapeutic promise, but still requires further research,
include virtual reality in stroke rehabilitation [37,38]; improv-
ing symptoms and behaviour associated with and knowledge
about specific mental disorders and related conditions [39];
diabetes [40,83]; weight loss intervention and possibly weight
loss maintenance [41]; and alcohol abuse [88].
Other authors found promise in terms of health service
utilisation. One review [42] for example suggested that asyn-
chronous telehealth developments could result in shorter
waiting times, fewer unnecessary referrals, high levels of
patient and provider satisfaction, and equivalent (or better)
diagnostic accuracy. Another [43] found that home telehealth
has a positive impact on the use of many health services as
well as glycaemic control of patients with diabetes.
Positive patient experiences were highlighted as promising
in relation to home telemonitoring for respiratory conditions
[17]. There is potential for using Internet/web-based services
for cancer patients in rural areas [44], and telemonitoring can
empower patients with chronic conditions [45].
Promising impacts on service delivery were identified
22. [46,47] in use of electronic decision support systems and
telemedicine consultations promise to support improved
delivery of tPA in patients with stroke (a treatment which
requires to be administered within 3 h) [48]. Computer
reminders to professionals at the point of care show ‘small to
modest improvements’ in professional behaviour, but studies
i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771
are heterogeneous and interventions complex, making these
difficult to understand [49].
7. Evidence is limited and inconsistent
Twenty-two reviews (Table 3) however concluded that the evi -
dence for the effectiveness of telemedicine is still limited and
inconsistent, across a wide range of fields.
In terms of therapeutic effectiveness, there is some lim-
ited evidence regarding telemonitoring for heart failure [50];
despite reviewers suggesting that electronic transfer of self-
monitored results has been found to be feasible and acceptable
in diabetes care, they find only weak evidence for improve-
ments in HbA1c or other aspects of diabetes management [51];
others found only weak evidence of benefit relating to infor-
matics applications in asthma care [52]; and no evidence of
improvement in clinical outcomes following teleconsultation
and video-conferences in diabetes care [53].
Frequently, these reviewers call for further research,
notably in the form of RCTs. Examples include calls relating
to web-based alcohol cessation interventions [54]; and vir-
tual reality in stroke therapy, despite this being found [37] to
be ‘potentially exciting and safe’. More work on telemonitor -
ing in heart failure is called for [55]; on e-therapy for mental
23. health problems [56]; on smart home technologies [57]; and
on technological support for carers of people with demen-
tia [58]. Others [28] underlined that lack of evidence does not
imply lack of effectiveness, and that in many cases interven-
tions are simply ‘unproven’. Caution is also urged by reviewers
[59] who identified small numbers of heterogeneous studies
in relation to chronic disease management. One review [60]
found it impossible to draw any significant conclusions about
the impact of interventions to promote ICT use by health care
personnel.
Several reviewers found that research has been somewhat
narrowly focused and suggested further research which takes
a broader perspective or a different one. They suggested that
telemedicine researchers have not yet asked all the impor -
tant questions, or conducted research in appropriate ways.
For example, in the cases of dermatology, wound care and
ophthalmology, it was argued that evaluation has explored
ICT-based asynchronous services for efficacy, but outcomes
or access issues have not been considered [61]. In a simi -
lar vein, although most of the studies of smart homes found
technical feasibility, there remain certain topics that require
further research, notably, ‘technical, ethical, legal, clinical,
economical and organisational implications and challenges’
[32]. Others [44], whilst seeing significant potential for teleon-
cology, especially in rural areas, suggested that local studies
may be needed to confirm this. A further contribution to the
debates about CBT (see above), found that whilst it appears to
be effective for panic disorders, social phobia and depression,
its effects on obsessive–compulsive disorder and anxiety and
depression combined remain insufficiently clear [62]. Causal
pathways in HbA1c decline in diabetes care remain unclear,
and this conclusion can be linked with the variations in pro-
gramme designs [63]. Whilst smoking cessation programmes
appear to be effective across a range of studies, neverthel ess
24. the mechanisms of action are not well understood [64].
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
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i n t e r n a t i o n a l j o u r n a l o f m e d i c
Telemedicine is a dynamic field, and new studies and
ew systematic reviews are rapidly being published. As
elemedicine extends into new clinical areas, it is unsurpris-
ng that reviewers give renewed accounts of limited evidence.
ome examples of new areas from our review include little
26. esearch on health promotion provided through the Internet
65]; a Cochrane review that found no studies of smart homes
hat met their inclusion criteria [57]; a review of studies on
piritual care that found little systematic research in this area
66]; and a review concluding that formative evaluation is
eeded for remote monitoring in hypertension [90].
. Economic analysis
n important emerging issue from our review is the lack of
nowledge and understanding of the costs of telemedicine
Table 4).
Several reviewers suggested that telemedicine seemed to
e cost-effective, but few draw firm conclusions. One review
ound that 91% of the studies showed telehomecare to be cost-
ffective, in that it reduced use of hospitals, improved patient
ompliance, satisfaction and quality of life [67]. This was the
learest conclusion, with others being much more cautious:
elemedicine was found to be cost-effective for chronic disease
anagement, but the authors cautioned that studies were few
nd heterogeneous [34]. A comparison of the costs of telemon-
toring and usual care for heart failure patients found that
elemonitoring could reduce travel time and hospital admis-
ions, whilst noting that benefits are likely to be realised in the
ong term [68]. Others found home telehealth for chronic con-
itions to be cost saving, though underlining that studies were
enerally of low quality [25]. One review found remote inter -
retation in medical encounters to be more expensive than its
lternatives [31].
Other reviewers did not find good evidence about cost-
ffectiveness; the cost-effectiveness of home telecare for
lder people and people with chronic conditions is uncer-
27. ain [28]; there is a lack of consistent results regarding costs
f synchronous telehealth in primary care [69]; there is lit-
le evidence for the economic viability of home respiratory
onitoring [17]; the cost-effectiveness of IT in diabetes care
s undetermined [40]; one review was able to identify only one
tudy of the costs of CBT, with significant weaknesses [70],
ith another finding little evidence in the same area [62].
A particular limitation identified in terms of costs concerns
he wider social and organisational costs of telemedicine. One
eview found that a societal perspective on costs has not yet
een developed for home telehealth [71] and another high-
ighted the need to consider not only costs to health services
f interventions, but also costs to service users and their social
etworks [72].
. Is telemedicine good for patients?
second emerging issue concerns patient satisfaction with
elemedicine, and indications that telemedicine may alter
he relationships between patients and health professionals
Table 5).
f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771 741
One review found that health service users with ICT
used in support, education and virtual consultation feel
more confident and empowered, with better knowledge and
improved health outcomes, as well as experiencing better
nurse-patient relationships [73]. The reviewers call for more
research on the mechanisms for these changes. Generally
there is evidence of high patient satisfaction ratings for telere -
habilitation, but reviewers argue that more process research,
case studies and qualitative studies are needed to improve
our understanding of these outcomes [74]. Interactive health
communication applications (IHCAs) for people with chronic
28. disease appear to give benefit in terms of improved sup-
port, better knowledge and improved health outcomes, but
the authors asked for more larger studies to be conducted
[75].
Others found no consistent results regarding user expe-
riences, though suggested that access can be improved [69].
Alongside development of technologies which aim to ben-
efit patients and citizens as well as professionals, we need
research on the impacts of technologies for these groups [76].
An example is that information websites relating to dementia
are geared more to carers than to people with dementia them-
selves, and that the websites do not usually offer personalised
information [77].
10. Asking new questions
We have already noted the emergence of new topic areas in
this dynamic and complex field. The focus on patient bene-
fits however indicates a more basic development, namely that
reviewers are starting to explore new questions beyond those
of clinical and cost-effectiveness. Our review produced two
key examples (Table 6). Firstly, a review that identified gender
differences in computer-mediated communications relating
to online support groups for people with cancer cautioned that
studies are limited and heterogeneous [78]. Nevertheless, the
authors suggested that this issue needs to be considered by
those designing interventions of this kind. This implies a con-
sideration that telemedicine is an ongoing intervention where
users influence its development and hence that effectiveness
of outcome is a complex collaborative achievement. Secondly,
a review focusing on stroke thrombolysis service configura-
tions, their potential impact and ways of recording data to
inform which configuration could be most suitable for a partic-
ular situation, highlighted the need to consider a wider range
of service delivery issues [79]. Similarly, it was argued that in
29. post-stroke patients, the consideration of caregivers’ mental
health and high levels of patient satisfaction should be an
integral element of studies [80].
Furthermore, some of the papers included in the review
explored issues which can inform the future development
of telemedicine, that is, they provide formative assessments.
Examples include a review of 104 definitions of telemedicine
[81] which, in identifying four broad types of definitions,
suggested how stakeholder interests can alter perceptions
of priorities in telemedicine interventions, such that some
may focus on delivering healthcare over a distance and
others on the potential of technology per se; and work argu-
ing that clinical and technical guidelines can inform the
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
i c a l i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 736–771
Summary points
“What was already known on this topic”
• Evidence regarding the effectiveness of telemedicine
is patchy and incomplete.
• The quality of much of the research conducted is poor.
“What this study added to our knowledge”
• The evidence base is accumulating robust knowledge
about the effectiveness of telemedicine.
• As the field is rapidly evolving however, new knowl -
30. edge is constantly needed.
• Continuing areas of weakness but also of great interest
include economic analyses, understandings of patient
perspectives, of effectiveness and outcomes as com-
plex and ongoing collaborative achievements, and
742 i n t e r n a t i o n a l j o u r n a l o f m e d
future development of telemedicine and facilitate evaluation
[20,82].
11. Reflections on the methodology of our
study
Our study is a review of systematic reviews. There are some
inherent weaknesses in this approach. In general we have to
rely on the information in the included reviews. The quality
of the reviews may vary; the reviews may have done a poor
job in specifying their inclusion and exclusion criteria, the
searches may not be comprehensive, the review authors may
not have assessed or extracted data from the primary studies
adequately, nor analysed and synthesised the findings across
the studies properly. But even using high quality reviews, we
necessarily lose information and details that we can only find
if we go back to the primary studies.
Although we did a thorough job in developing the search
strategy and identified a vast amount of reviews on the effects
of telemedicine, we might have missed relevant systematic
reviews.
Some of the included reviews are probably outdated. Stud-
ies that are published after the search date in the reviews are
not included. Ideally we could have supplemented the review
with more recent primary studies not included in the reviews,
but we did not have the resources to do this.
31. We did not check whether reviews included the same ref-
erences. Several reviews have studied similar or overlapping
topics, and have at least partially included the same studies.
It may therefore be that evidence is counted twice, or that
different interpretations of effectiveness are given by review
authors. We have not analysed the degree to which there are
discrepancies in the analyses of similar studies, nor the rea -
sons for different interpretations of the same findings, for
instance did we not analyse the heterogeneity of the results
among the reviews based on the quality of the reviews.
The data collection and assessment of each included
review was accomplished by one external expert, while two
is considered to be optimal in order to reduce risk of bias.
We did not train the data extractors, and we did not pilot
the data extraction form. The experts were not completely
consistent in their judgments. This limitation was partly due
to the resources and organisation of the project, in that two
workshops were held, intending to validate results. In addi -
tion, the review team made a quality check of the reviews by
comparing the reported data with information in the full text
papers. Any unclear themes were discussed in the team to
reach consensus.
We have limited information regarding effect sizes and the
strength of evidence for the outcomes that we have studied.
We have however demonstrated that it is possible to make
such a large overview in quite a short time, involving both
methodology and content experts. We have used systematic
methods in the literature searches and the assessment of the
reviews, and we have excluded reviews of low methodological
quality.
32. In combining rigorous and systematic methods with a
pragmatic approach we have produced a relevant and rich
overview of the field.
formative assessments.
12. Conclusions
Despite large number of studies and systematic reviews
on the effects of telemedicine, high quality evidence to
inform policy decisions on how best to use telemedicine
in health care is still lacking. Large studies with rigorous
designs are needed to get better evidence on the effects of
telemedicine interventions on health, satisfaction with care
and costs. As the field is rapidly evolving, different kinds
of knowledge are also in demand, e.g. a stronger focus on
economic analyses of telemedicine, on patients’ perspec-
tives and on the understanding of telemedicine as complex
development processes, and effectiveness and outcome as
ongoing collaborative achievements. Hence formative assess-
ments are also pointed out as an area of weakness and
interest.
Acknowledgements
The study was funded by the EU under SMART 2008/0064
and was conducted as part of the MethoTelemed project. We
acknowledge the support of our MethoTelemed colleagues, the
group of external review experts, the workshop participants,
the project officers at the Norwegian centre for integrated care
and telemedicine, and Ingrid Harboe at the Norwegian Knowl -
edge Centre for the Health Services, who did the literature
searches.
Appendix 1.
33. In Tables 1–7, columns listing results and conclusions quote
from the authors’ work. Where a review appears in more than
one table, this reflects the range of evidence produced. Full
access to a searchable database of abstracts of items included
in the review will be available on the MethoTelemed web-
site, which also includes guidance for evaluating telemedicine.
www.telemed.no/MethoTelemed.
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
http://www.telemed.no/MethoTelemed
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0
)
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3
6
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7
1
7
4
3
Table 1 – Systematic reviews reporting that telemedicine is
effective.
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Barak et al. [15] Mental health Not stated Internet based
psychotherapy
Behavioural,
36. Health, Percep-
tion/satisfaction,
Social
Sixty-four studies included covering 94
services. The overall mean weighted effect
size was 0.53, similar to the average effect
size of traditional, face-to-face therapy.
Comparison between face-to-face and
Internet intervention across 14 studies
showed no differences in effectiveness.
Internet based intervention is as
effective as face-to-face
intervention.
Clark et al. [16] Cardio-
vascular
(CHF)
All countries Remote
monitoring,
telephone
support
Behavioural,
Cost/economic,
Health
Fourteen studies (RCTs) included. Four
evaluated telemonitoring, nine structured
telephone support, and one both. Remote
monitoring programmes reduced the rates of
admission to hospital for chronic heart
failure by 21% and all cause mortality by 20%.
Three studies reported quality of life
37. improvements and four, reduced cost, one
found no gain in cost-effectiveness.
Programmes for chronic heart
failure that include remote
monitoring have a positive effect
on clinical outcomes in
community dwelling patients with
chronic heart failure.
Jaana et al. [17] Respiratory
conditions
USA, Europe,
Israel, Taiwan
Remote
monitoring
Behavioural,
Cost/economic,
Feasibility/pilot,
Health, Percep-
tion/satisfaction
Twenty-three studies included. Good levels of
data validity and reliability were reported.
However, little quantitative evidence exists
about the effect of remote monitoring on
patient medical condition and utilization of
health services. Positive effects on patient
behaviour were consistently reported. Only
two studies performed a detailed cost
analysis.
Home telemonitoring of
38. respiratory conditions results in
early identification of
deteriorations in patient condition
and symptom control. Positive
patient attitude and receptiveness
of this approach are promising.
However, evidence on the
magnitude of clinical and
structural effects remains
preliminary, with variations in
study approaches and an absence
of robust study designs and formal
evaluations.
Myung et al.
[18]
Smoking
cessation
Worldwide Web and
computer-based
programmes
Behavioural Twenty-two studies included (RCTs). In a
random-effects meta-analysis of all 22 trials,
the intervention had a significant effect on
smoking cessation. Similar findings were
observed in nine trials using a Web-based
intervention,(and in 13 trials using a
computer-based intervention Subgroup
analyses revealed similar findings for
different levels of methodological rigor,
stand-alone versus supplemental
interventions, type of abstinence rates
employed, and duration of follow-up period,
39. but not for adolescent populations.
The meta-analysis of RCTs
indicates that there is sufficient
clinical evidence to support the
use of Web- and computer-based
smoking cessation programs for
adult smokers.
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
7
4
4
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1
0
)
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3
6
–7
7
1
Table 1 (Continued)
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Neubeck et al.
[19]
Cardio-
vascular
(CHD)
42. USA (3
studies),
Norway (1),
Canada (3),
Australia (3),
Germany (1)
Communication
using ICT,
patient-
professional
Behavioural, Health,
psychosocial state,
quality of life
Eleven studies included (RCTs).
Telehealth interventions were associated
with non-significant lower all-cause
mortality than controls. These
interventions showed a significantly
lower weighted mean difference at
medium long-term follow-up than
controls for total cholesterol, systolic
blood pressure, and fewer smokers.
Significant favourable changes at
follow-up were also found in high-density
lipoprotein and low-density lipoprotein.
Telehealth interventions provide
effective risk factor reduction and
secondary prevention. Provision of
telehealth models could help
increase uptake of a formal
secondary prevention by those
who do not access cardiac
43. rehabilitation and narrow the
current evidence-practice gap.
Pineau et al.
[20]
Psychiatric
conditions
(adult and
paediatric)
Focus on
Canada and
USA
Telepsychiatry Cost/economic,
Ethical issues, Legal,
Organizational,
Technology related,
clinical guidelines
and technical
standards
‘About 60’ studies included. The authors
argue that definition of clinical guidelines
and technological standards aimed at
standardising telepsychiatric practice will
promote its large scale implementation.
The review concludes that
telepsychiatry should be
implemented in Québec and
provides detailed clinical and
technical guidelines for
implementation. They add that
taking into account human and
44. organizational aspects plays a part
in ensuring the success of this
type of activity; that legal and
ethical aspects must also be
considered; and that a detailed
economic analysis should be
carried out prior to any large
investment in telepsychiatry.
Finally, implementation of
psychiatry should be subjected to
rigorous downstream assessment
in order to improve management
and performance.
Powers and
Emmelkamp
[21]
Anxiety
(especially
phobias)
Not stated Virtual reality
exposure
therapy
Behavioural, Percep-
tion/satisfaction,
Psychophysiology,
perceived control
over phobias
Thirteen studies included. VRET (Virtual
reality exposure therapy) is highly
effective in treating phobias and more so
than inactive control conditions. VRET is
45. slightly, but significantly more effective
than exposure in vivo, the gold standard
in the field. Advantages of VRET: can be
conducted in the therapist’s office, rather
than in vivo situations, the possibility of
generating more gradual assignments
and of creating idiosyncratic exposure.
VRET is cost-effective.
Given the advantages and the
efficacy of VRET supported by this
meta-analysis a broader
application in clinical practice
seems justified.
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
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2
0
1
0
)
7
3
6
–7
7
1
7
4
5
Prange et al.
[22]
Stroke USA Rehabilitation
(robots)
Health Eleven studies included. Robot-aided
therapy of the proximal upper limb
improves short and long-term motor
control of the paretic shoulder and elbow:
however, there is no consistent influence
on functional abilities.
This systematic review indicates
48. that robot-aided therapy of the
proximal upper limb can improve
short and long-term motor control
of the paretic shoulder and elbow.
Robot-aided therapy appears to
improve motor control more than
conventional therapy.
Reger and
Gahm [23]
Mental health
problems
(anxiety)
Not stated Internet/computer-
based
treatment
Behavioural, Health Ninteen studies included (RCTs).
Meta-analysis showed that ICT was
superior to waitlist and placebo
assignment across outcome measures
The effects of ICT were equal to
therapist-delivered treatment across
anxiety disorders. Conclusions were
limited by small sample sizes, the rare
use of placebo controls, and other
methodological problems. The number of
available studies limited the opportunity
to conduct analyses by diagnostic group.
The results of this meta-analysis
provide preliminary support for
the use of Internet and
computer-based CBT for the
49. treatment of anxiety.
Spek et al. [24] Mental health
(depression
and anxiety)
Global CBT via internet Health Twelve studies included
(RCTs). Authors
concluded that eCBT was effective, but
noted that there was only a small number
of studies and significant heterogeneity.
Despite study limitations, eCBT
seemed to be effective.
Tran et al. [25] Diabetes, heart
failure, COPD
and other
chronic
diseases
Canada
focused, but
international
publications
included
Home telehealth Cost/economic,
Health, Percep-
tion/satisfaction
Seventy-nine studies included. Of the
included studies, 26 pertained to
diabetes, 35 to CHF, nine to COPD, and
eight to mixed chronic diseases. The
comparator “no care” was not identified
50. in any of the included studies, so usual
care was used as the comparator
throughout the clinical review. Home
telehealth appeared generally clinically
effective and no patient adverse effects
were reported. Evidence on health service
utilization was more limited, but
promising The economic review
suggested cost-effectiveness, but the
quality of studies was low.
Conclusions relate to the potential
for home telehealth in Canada
which is seen as positive. However,
more research, such as multicentre
RCTs, is warranted to accurately
measure the clinical and economic
impact of home telehealth for
chronic disease management to
support Canadian policy makers in
making informed decisions.
van den Berg et
al. [26]
Internet based
physical
activity
interventions
Not
mentioned
other than
language
limitations
51. Physical activity Behavioural, Health Ten studies included. The
analysis
focused on the methodological quality of
the studies, which showed variation in
study populations and interventions
making generalization difficult.
There is indicative evidence that
internet based physical activity
interventions are more effective
than a waiting list strategy.
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53. (
2
0
1
0
)
7
3
6
–7
7
1
Table 1 (Continued)
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Hyler et al. [27] Mental health France,
Australia,
Canada,
Japan, UK
54. and US
Telepsychiatry Feasibility/pilot, Per-
ception/satisfaction,
Quality of different
instruments used
for consultations
Fourteen studies included. Telepsychiatry
was found to be similar to In person for
studies using objective assessments.
Bandwidth was a moderator.
Heterogeneous effect sizes for different
moderators (bandwidth) High bandwidth
was slightly superior for assessments
requiring detailed observation of patients.
Only a handful studies have
attempted to compare
telepsychiatry with in-person
psychiatry (IP) directly, using
standardised assessment
instruments to permit meaningful
comparison. According to the
meta-analysis, there was no
difference in accuracy or
satisfaction between the two
modalities. Telepsychiatry is
expected to replace IP in certain
research and clinical situations.
Barlow et al.
[28]
Elderly people,
chronic
55. diseases
Worldwide Home telecare Behavioural, Health,
Organisational,
Safety
Sixty-eight RCTs and 30 observational
studies with 80 or more participants
included. Results show that the most
effective telecare interventions appear to
be automated vital signs monitoring (for
reducing health service use) and
telephone follow-up by nurses (for
improving clinical indicators and
reducing health service use). Evidence on
cost-effectiveness is less clear, and on
safety and security alert systems
insufficient.
Having identified where there is
evidence of effectiveness, and
where it is lacking, the authors
conclude that insufficient
evidence does not amount to lack
of effectiveness: more research is
needed.
Bussey-Smith
and Rossen
[29]
Asthma USA, Hawaii,
Sweden
Computer-based
patient
56. education
programmes
(CAPEPs)
Behavioural,
Cost/economic,
Health, Percep-
tion/satisfaction,
Social
Nine studies included. One study each
showed reduced hospitalizations, acute
care visits, or rescue inhaler use. Two
reported lung function improvements.
Four showed improved asthma
knowledge, and five showed
improvements in symptoms.
Although interactive CAPEPs may
improve patient asthma
knowledge and symptoms, their
effect on objective clinical
outcomes is less consistent
Jaana et al.[30] Diabetes North
America,
Europe and
Asia
Remote
monitoring
Behavioural, Health,
Technology related,
Structural
57. Seventeen studies included. Most studies
reported overall positive results in
Diabetes mellitus type 2, and found that
IT based interventions improved health
care utilisation, behaviour attitudes and
skills.
Positive effects are reported, but
there is variation in patient
characteristics (background,
ability, medical condition) sample
selection and approach for
treatment of control groups.
Azarmina and
Wallace [31]
All All countries Remote
interpretation in
medical
encounters
Cost/economic,
Feasibility/pilot,
Health,
Organisational, Per-
ception/satisfaction,
Safety
Nine studies included. Results showed
that time between encounters was
reduced, but evidence on consultation
length was not consistent. Good client
and doctor satisfaction was shown, but
those interpreting data preferred to do so
face to face. Costs of these interventions
58. are high, but efficiency gains are possible.
The review suggests that remote
interpretation is an acceptable and
accurate alternative to traditional
methods, despite the higher
associated costs.
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3
6
–7
7
1
7
4
7
Demiris and
Hensel [32]
Older people,
people with
disabilities
Europe, USA,
Asia
Smart home Behavioural, Health,
Safety, Social,
Physiological and
functional
Twenty-one projects included (drawing
on 114 publications). A table is presented
with their technologies, target audience,
technologies and different outcome. A
lack of evidence on clinical outcomes is
identified.
61. Most of the studies demonstrated
the feasibility of the technological
solution. Technical, ethical, legal,
clinical, economical and
organisational implications and
challenges need to be studied
in-depth for the field to grow
further.
Martinez et al.
[33]
Heart failure All countries Remote
monitoring
(home)
Behavioural,
Cost/economic,
Feasibility/pilot,
Health, Legal,
Organizational, Per-
ception/satisfaction,
Safety, Social,
Technology related
Forty-two studies included. (1) Remote
monitoring for cardiac heart failure
appears to be technically effective for
following the patient remotely; (2) it
appears to be easy to use, and it is widely
accepted by patients and health
professionals; and (3) it appears to be
economically viable.
Evaluating the articles showed
62. that home monitoring in patients
with heart failure is viable.
Gaikwad and
Warren [34]
Chronic
disease
Not stated Home based ICT
interventions
Behavioural,
Cost/economic,
Health, Percep-
tion/satisfaction
Twenty-seven studies included. These
systems can improve functional and
cognitive patient outcomes in chronic
disease and reduce costs. However, the
research is not yet sufficiently robust.
Telecare, telehealth etc. have
positive clinical and cost outcomes
– although studies are few in
number and heterogeneous. Better
evidence-based outcome measures
are needed, especially regarding
costs and physician perspectives.
dx.doi.org/10.1016/j.ijmedinf.2010.08.006
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65. 1
Table 2 – Systematic reviews reporting that telemedicine is
promising.
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Cuijpers et al. [35] Pain and
other health
problems
Global CBT via
internet
Health Twelve studies included (RCTs). Three
studies focused on pain, three on
headache, and six on other health
problems. Effects found for Internet
interventions targeting pain and
headache were comparable to effects
found for face-to-face treatments, and
the same was true for interventions
aimed at headache. Other
interventions also showed some
effects, which differed across target
conditions.
66. Internet-delivered cognitive
behavioural interventions are a
promising addition and
complement to existing
treatments. The Internet will
most likely assume a major
role in the future delivery of
cognitive behavioural
interventions to patients with
health problems. More
research on eCBT is needed.
Bee et al. [36] Anxiety and
depression
Not stated Psychotherapy
mediated by
remote com-
munication
technology
Behavioural
outcomes
Thirteen studies included. Pooled
effect sizes for remote vs.
conventional services were 0.44 for
depression and 1.15 for anxiety
related disorders. Few studies
compare remote and face-to-face
psychotherapy. Data suggest that
good effects may not be dependent on
patient and therapist being
co-located, but the evidence is limited.
Remote therapy has the
67. potential to overcome some of
the barriers to conventional
psychological therapy services,
but large scale trials are
needed.
Crosbie et al. [37] Stroke Not stated Virtual reality
(VR) in stroke
rehabilitation
Behavioural,
Health, Safety
Eleven studies included. Five cover
upper limb rehabilitation, three, gait
and balance, two cognitive
interventions, and one both upper
and lower limb rehabilitation. Three
were AACPDM Level I/Weak, two Level
III/Weak, three Level IV/Weak and
three Level V quality of evidence.
Three RCTs obtained statistical
significance, and eight studies found
VR based therapy to be beneficial.
None reported any significant adverse
effects.
VR is a potentially exciting and
safe tool for stroke
rehabilitation but its evidence
base is too limited by design
and power issues to permit a
definitive assessment of its
value. Thus, while the findings
of this review are generally
positive, the level of evidence is
68. still weak to moderate, in
terms of research quality.
Further study in the form of
rigorous controlled studies is
warranted.
Henderson et al.
[38]
Stroke Global Virtual reality
(VR) in stroke
rehabilitation
Health Six studies included. The results of
the reviewed studies suggest that
immersive VR may have an advantage
over no therapy in the rehabilitation of
the upper limb in patients with stroke,
but the results are still questionable.
Current evidence on the
effectiveness of VR in the
rehabilitation of upper limb in
patients with stroke is limited
but sufficiently encouraging to
justify further research in this
area.
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71. Christensen [39]
Mental health Global Internet
interventions
Behavioural,
Health, Percep-
tion/satisfaction
Sixteen papers included (reporting15
RCTs). The review demonstrates that
Internet interventions show promise
as a means of improving symptoms
and behaviour associated with and
knowledge about specific mental
disorders and related conditions.
Most interventions were
reported to be effective in
reducing risk factors or
improving symptoms,
although many of the studies
had methodological
limitations. Three of the
interventions that reported
positive outcomes are available
without charges to the public.
Jackson et al. [40] Diabetes Not stated Computer
assisted
interactive IT
Behavioural,
Cost/economic,
Health
72. Twenty-seven papers included
(reporting 26 studies) Significant
impacts on behavioural, clinical and
structural levels.
There is growing evidence that
emerging IT may improve
diabetes care. Future research
should characterize benefits in
the long term, establish
methods to evaluate clinical
outcomes, and determine the
cost-effectiveness.
Azar and Gabbay
[83]
Diabetes Not stated Web-based
management
of glucose
uploads
Clinical, Health,
Behavioural
Eight studies on type 1 diabetes seven
papers on type 2 (or mixed
populations). The type 1 studies
tended to show equivalent HbA1c
improvements in intervention and
control groups. For type B patients,
there were statistically significant
differences for HbA1between
intervention and control groups.
Patients benefitted from
73. web-based diabetes
management, through savings
in time and cost. Major
obstacles to wider
implementation are patient
computer skills, adherence to
the technology, architectural
and technical design and the
need to reimburse providers
for their care.
Weinstein [41] Obesity USA Internet
based
programmes
Health Eight studies included. All studies
examining weight loss via Internet
programs reported positive results,
except one investigating a commercial
program. Results from the three
weight loss maintenance programs
conducted on the Internet were
equivocal. Because the subjects of all
these studies were predominately
white, educated women,
generalisability of findings is limited.
Preliminary studies suggest
that the internet may be an
adequate vehicle for weight
loss intervention and possibly
for programs directed at weight
loss maintenance.
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76. –7
7
1
Table 2 (Continued)
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Elliott et al. [88] Alcohol abuse Mostly US
studies
Computer-
based
treatment
Behavioural,
Health, Percep-
tion/satisfaction,
Social
Seventeen studies included (RCTs).
The e-interventions emerge as more
effective than no treatment, and
approximately equivalent to
alternative intervention approaches.
E-interventions appear to be superior
77. to assessment-only (AO) control
conditions. In addition, possible
moderators (e.g. baseline drinking
patterns) and mediators (e.g. corrected
drinking norms) have emerged.
These studies compared the
effectiveness of e-interventions
with other commonly used
techniques, reading materials,
and assessment-only control
conditions. Overall, findings
provide some support for such
programs, especially in
comparison with
assessment-only control
conditions.
Deshpande et al.
(asynchronous
telehealth) [42]
All, but
especially
dermatologi-
cal
conditions
World Store and
forward of
clinically
important
digital
samples for
assessment
at a
78. convenient
time
Cost/economic,
Health,
Organisational,
Safety, Social
Fifty-two studies included (16 of good
quality). An environmental scan
found 39 organisations using both real
time and asynchronous services.
Overall study quality is poor, evidence
suggests shorter waiting times, fewer
unnecessary referrals, high levels of
patient and provider satisfaction, and
equivalent (or better) diagnostic
accuracy when compared with
face-to-face consultations. It is
unknown whether the benefits that
have been shown in small local
studies could be realized after
wide-scale implementation.
Pragmatic objectives for
implementation and
evaluation are needed,
involving policy makers,
specifically in Canada.
Standardisation procedures are
already in progress and are
likely to improve collaboration
between providers.
Polisena et al.
(diabetes) [43]
79. Diabetes Worldwide Home
telehealth
Health Twenty-six studies included. Study
results indicated that home telehealth
helps to reduce the number of
patients hospitalised, hospitalizations
and bed days of care. Home telehealth
was similar or favourable to UC across
studies for quality-of-life and patient
satisfaction outcomes.
In general, home telehealth
had a positive impact on the
use of numerous health
services and glycaemic control.
More studies of higher
methodological quality are
required to give more precise
insights into the potential
clinical effectiveness of home
telehealth interventions.
Holland et al. [89] Heart failure Europe, USA,
Australia,
New Zealand,
Argentina
Remote
monitoring,
telephone
support
Health Thirty studies included (RCTs).
Sensitivity analysis of combined data
80. from 30 interventions showed
reduction in hospital admission and
reduction in all-cause mortality.
Comparison of interventions in
different settings indicated that
effective interventions were delivered
at least partly at home.
Results suggest that
multidisciplinary interventions
for patients with heart failure
reduce hospital admissions
and mortality. Interventions
include telemedicine, but there
is limited evidence in this area.
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83. monitoring
Behavioural,
Cost/economic,
Feasibility/pilot,
Health, Percep-
tion/satisfaction
Twenty-three studies included. Good
levels of data validity and reliability were
reported. However, little quantitative
evidence exists about the effect of remote
monitoring on patient medical condition
and utilization of health services. Positive
effects on patient behaviour were
consistently reported. Only two studies
performed a detailed cost analysis.
Home telemonitoring of
respiratory conditions results
in early identification of
deteriorations in patient
condition and symptom
control. Positive patient
attitude and receptiveness of
this approach are promising.
However, evidence on the
magnitude of clinical and
structural effects remains
preliminary, with variations in
study approaches and an
absence of robust study
designs and formal
evaluations.
Hailey et al. [44] Cancer United States,
84. Canada,
Denmark,
Finland,
Spain, UK
Comparing a
wide range of
interventions
Cost/economic,
Health, Percep-
tion/satisfaction,
Social
Fifty-four studies included. Positive
findings from higher-quality studies
suggested that telephone-based
technology was effective for promoting
mammography and colposcopy in specific
populations, for increasing fruit and
vegetable consumption, and as an
alternative to in-person support groups
for women with breast cancer. Eight
economic assessments provided some
indications of cost advantages in
diagnosis and treatment, and in palliative
care. 20 papers reported patient and
family satisfaction. However, the
significance and generalisability of these
findings appears limited.
From the perspective of the
Alberta Cancer Board, the
literature suggests some useful
possibilities for developing new
services using internet or
85. web-based, telephone-based,
and video-based technologies
for cancer patients in rural
areas. However, it seems likely
that these applications would
need validation with suitable
local studies.
Pare et al. [45] Chronic
disease
US, Canada,
Europe, Asia
Remote
monitoring
Behavioural,
Health,
Organisational,
Policy,
Technology
related
Sixty-five studies included. The
magnitude and significance of the effect
of (automated) telemonitoring of patients
with four chronic conditions
(hypertension, diabetes, COPD and
cardiac failure) remains inconclusive.
Patients’ compliance is high, The clinical
effectiveness (e.g. less frequent
hospitalisation) is more consistent in
cardiac and pulmonary studies than in
diabetes and hypertension. Economic
viability was poorly evidenced.
86. Telemonitoring seems to be a
promising approach to chronic
patient management.
Technology is reliable. It
empowers patients, and
potentially improves clinical
conditions.
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1
0
)
7
3
6
–7
7
1
Table 2 (Continued)
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Nannings and
Abu-Hanna [46]
All (especially
chronic)
Not
89. mentioned
Decision
support
models for
professional
use
Technology
related,
Conceptual
models
Sixty-five studies included. The objectives
were to define the term DSTS, to propose
a general DSTS model, and to propose
model-based templates to aid DSTS
development for three medical tasks. The
definition, general model and
model-based templates are based on a
systematic literature search. The
applicability of the templates to new
DSTSs found in a separate limited
literature search was tested. A definition
of DSTSs is provided, a conceptual model
for understanding DSTSs is proposed and
a set of reusable templates, and examples
for using them are provided.
The conceptual model and the
reusable modelling templates
are demonstrated to be useful
in understanding and
modelling DSTSs during the
early stages of their
development.
90. Sintchenko et al.
[47]
Diabetes,
heart failure,
and chronic
obstructive
pulmonary
disease
(COPD). Other
chronic
diseases that
could be
managed by
using home
telehealth
Not stated Home
telehealth
Clinical
outcomes; health
service use, QoL,
Patient
satisfaction
Twenty-four studies included. The
authors feel they have shown that EDSS
improves prescribing practices and
treatment outcomes of patients with
acute illnesses, but are less effective in
primary care.
The authors state that further
research is needed to quantify
91. the range of benefits of EDSS,
and to explore new
measurement metrics and
enhance the appropriate
clinicaluse of electronic
decision support.
Wu and Langhorne
[48]
Stroke Found studies
only from
Germany, US,
France
Acute
medicine
Cost/economic,
Feasibility/pilot,
Health, Percep-
tion/satisfaction,
Safety
Seventeen studies included. Studies
reported that telemedicine systems were
feasible and acceptable. Inter-rater
reliability was excellent for global clinical
assessments and decisions on
radiological exclusion criteria although
agreement for individual assessment
items was more variable. Telemedicine
systems were associated with increased
use of tPA.
Although there is limited
92. reliable evidence, observational
studies have indicated that
telemedicine systems can be
feasible, acceptable, and
reliable in acute-stroke
management. In addition,
telemedicine consultations
were associated with improved
delivery of tPA.
Shojania et al. [49] Medication,
vaccination
and tests
(various
conditions
unspecified)
Worldwide Decision
support for
clinicians
Health Twenty-eight studies included. The
studies tested reminders to prescribe
specific medications, to warn about drug
interactions, to provide vaccinations, or
to order tests. The review found small to
moderate benefits. The reminders
improved physician practices by a median
of 4%. In eight of the studies, patients’
health improved by a median of 3%.
Point of care computer
reminders generally achieve
small to modest improvements
in provider behaviour. A
minority of interventions
93. showed larger effects, but no
specific reminder or contextual
features were significantly
associated with effect
magnitude.
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3
6
–7
7
1
7
5
3
Table 3 – Systematic reviews reporting that evidence on
telemedicine is limited and inconsistent.
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Chaudhry et al. [50] Heart failure Telephone-based
monitoring: Argentina
(1 study), USA 4 studies.
Automated monitoring
USA 1 study. Automated
physiologic monitoring
USA 1 study.
Comparisons of two or
more methods of
96. telemonitoring:
Germany/the
Netherlands and UK:
one study, USA 1 study
Remote
monitoring
Cost/economic,
Health
Nine studies included. Six
suggested reduction in all-cause
and heart failure hospitalisations
with telemonitoring. Of the three
negative studies, two enrolled
low-risk patients and patients
with access to high quality care,
and one enrolled a very high-risk
Hispanic population. Studies
comparing forms of
telemonitoring demonstrated
similar effectiveness. Intervention
costs were higher with more
complex programs.
The evidence base for
telemonitoring in heart failure is
currently quite limited. Based on
the available data, telemonitoring
may be an effective strategy for
disease management in high-risk
heart failure patients.
Farmer et al. [51] Diabetes Not stated Self-
monitoring,
97. Data transfer
Cost/economic,
Feasibility/pilot,
Health,
Organizational,
Percep-
tion/satisfaction
Twenty-six studies included.
Electronic transfer of glucose
results appears feasible in a
clinical setting. Only two of the
RCTs included more than 100
patients, and only three extended
to one year. Only one study was
designed to show that
telemedicine interventions might
replace clinic interventions
without deterioration in HbA
Results pooled from the nine RCTs
with reported data did not provide
evidence that the interventions
were effective in reducing HbA to
0.04%) (p. 1372).
Telemedicine solutions for
diabetes care are feasible and
acceptable, but evidence for their
effectiveness in improving HbA or
reducing costs while maintaining
HbA levels, or improving other
aspects of diabetes management is
not strong. Further research
should seek to understand how
telemedicine might enhance
98. educational and self-management
interventions and RCTs are
required to examine
cost-effectiveness.
Sanders and
Aronsky [52]
Asthma USA Diagnostics,
prevention
and
monitoring,
decision
support tools,
patient-
centred
education
tools
Behavioural,
Health, Social
Sixty-four studies included, but
only 21 prospective trials. The
mean quality score was 6.6 (range:
3–10). None of the studies reported
on allocation concealment. Of the
13 studies that reported a clinical
outcome, seven reported a positive
effect of the computerised
intervention and six reported no
significant change. Of the eight
studies reporting a non-clinical
outcome, seven reported a
statistically significant positive
effect of the computerised
99. intervention.
Most studies took place in the
outpatient clinic environment,
with minimal study of the
emergency department or
inpatient settings. Few studies
demonstrated evidence of
computerised applications
improving clinical outcomes.
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2
0
1
0
)
7
3
6
–7
7
1
Table 3 (Continued)
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Verhoeven et al.
[53]
Diabetes Worldwide Teleconsultation
and video-
102. conferencing
Cost/economic,
Health, Percep-
tion/satisfaction,
Technology
related
Thirty-nine studies included. They found
no significant statistical heterogeneity
among the pooled randomised controlled
trials that they identified within this
group. Most of the improvements found
concerned (a) satisfaction with
technology, (b) improved metabolic
control or (c) cost savings. No significant
benefits were found in relation to (a)
quality of life, (b) transparency, or (c)
better access to care.
The study did not support any conclusion
that these interventions improved clinical
values (e.g. blood pressure). The authors
argued that diversity in design of the
studies meant that strong conclusions
were premature.
Bewick et al. [54] Alcohol
abuse
Worldwide Web-based
interventions
Behavioural,
Cost/economic
103. Ten studies included. Five gave process
evaluations and five, some pre- and
post-intervention results. Only one study
was an RCT, and the studies scored low
on quality criteria.
There is inconsistent evidence on the
effectiveness of electronic screening and
brief intervention (eSBI) for alcohol use.
Process research suggests that web-based
interventions are generally well received.
However further controlled trials are
needed to fully investigate their efficacy,
to determine which elements are keys to
outcome and to understand if different
elements are required in order to engage
low and high-risk drinkers.
Crosbie et al. [37] Stroke Not stated Virtual reality
in stroke
rehabilitation
Behavioural,
Health, Safety
Eleven studies included. Five cover upper
limb rehabilitation, three, gait and
balance, two cognitive interventions, and
one both upper and lower limb
rehabilitation. Three were AACPDM Level
I/Weak, two Level III/Weak, three Level
IV/Weak and three Level V quality of
evidence. Three RCTs obtained statistical
significance, and eight studies found VR
based therapy to be beneficial. None
reported any significant adverse effects.
104. VR is a potentially exciting and safe tool
for stroke rehabilitation but its evidence
base is too limited by design and power
issues to permit a definitive assessment
of its value. Thus, while the findings of
this review are generally positive, the
level of evidence is still weak to moderate,
in terms of research quality. Further study
in the form of rigorous controlled studies
is warranted.
Maric et al. [55] Heart
failure
Not stated Remote
monitoring
Cost/economic,
Feasibility/pilot,
Health,
Organisational
Fifty-six papers included. Many of the
identified papers on telemonitoring of
heartfFailure (HF) patients demonstrate at
least some benefit. There is a general
trend towards improvement associated
with the use of most modalities. However
inconsistent evidence between trials for
the same modality and difference
between modalities make a definitive
conclusion difficult. Evidence of benefit
from video consultation alone is lacking.
The majority of papers reported trials
that are non-randomised and many
105. papers had small sample sizes.
This study reviewed studies conducted in
HF telemonitoring, to describe the nature
of the modality, the methods and the
results. Telemonitoring appeared to be an
acceptable method for monitoring HF
patients. Controlled, randomized studies
directly comparing different modalities
and evaluating their success and
feasibility when used as routine clinical
care are now required.
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1
0
)
7
3
6
–7
7
1
7
5
5
Postel et al. [56]. Mental health
problems
North American and
European
E-therapy Health Fourteen studies included.
E-therapy seems to be promising
but study results are still based
only on small groups.
More research is needed, and
should be better reported.
Martin et al. [57] Physical
disability,
108. cognitive
impairment,
learning
disability
Not explicitly
mentioned
Smart home Cost/economic,
health,
organizational,
social and
technology
issues
No study identified met the
inclusion criteria.
The review does not provide
sufficient evidence to support or
refute the integration of smart
home technologies into health and
social care. RCTs should be
adopted. International descriptive
terminology is needed. The rate of
abandonment by individuals of the
technologies needs investigation.
Powell et al. [58] Dementia
(carers’ stress
and
depression)
North America Five specific
technological
interventions
109. Behavioural,
Cost/economic,
knowledge
Fifteen studies included. They
describe five interventions:
ComputerLink, AlzOnline, Caring
for Others and two studies from
the REACH project (TLC and CTIS).
The interventions reviewed were
multifaceted with elements of
networked peer support.
Outcomes were inconsistent but
suggested that the interventions
had moderate effects on improving
carer stress and depression.
Treatment effects were found to
vary with caregiver characteristics
such as ethnic groups, formal
support and baseline burden.
Further evaluation is needed in
robust trials with good follow-up.
Barlow et al. [28] Elderly
people,
chronic
diseases
Worldwide Home
telecare
Behavioural,
Health,
Organisational,
110. Safety
Sixty-eight RCTs and 30
observational studies with 80 or
more participants included.
Results show that the most
effective telecare interventions
appear to be automated vital signs
monitoring (for reducing health
service use) and telephone
follow-up by nurses (for improving
clinical indicators and reducing
health service use). Evidence on
cost-effectiveness is less clear, and
on safety and security alert
systems insufficient.
Having identified where there is
evidence of effectiveness, and
where it is lacking, the authors
conclude that insufficient
evidence does not amount to lack
of effectiveness: more research is
needed.
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5
6
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113. Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Garcia-Lizana and
Sarria-
Santamera
[59]
Chronic
disease
Nations around the
world
Management,
control and
prevention
Health, Percep-
tion/satisfaction,
Safety
Twenty-four studies included.
Improvements in clinical
outcomes were not shown, though
no adverse effects were identified.
In the detection and follow-up of
cardio-vascular diseases however,
ICTs provided better clinical
outcomes, mortality reduction and
114. lower health services utilization.
Systems used for improving
education and social support were
also shown to be effective.
Although some positive results
were identified, at present the
evidence about the clinical
benefits of ICTs for managing
chronic disease is limited.
Gagnon et al. [60] None (imple-
mentation
issues)
Not stated Educational Behavioural,
Cost/economic
Twenty-seven references listed.
The authors find very little data on
interventions to promote ICT use,
and argue that more studies are
needed.
Too few studies, which are too
heterogeneous, make it impossible
to draw any significant conclusions
about the impact of interventions
to promote ICT use by HCPs.
Hersh et al. [4] Various
conditions
(Medicare
population)
USA, UK, Australia,
115. Europe
Comparing
store and
forward,
home based,
office-
hospital-
based
services
Health,
Organisational,
Concordance
studies,
diagnosis and
management,
access
Ninety-seven studies included.
Store and forward services have
been studied in many specialties,
especially dermatology, wound
care, and ophthalmology. The
evidence for their efficacy is
mixed, and in most areas, there
are not corresponding studies on
outcomes or improved access to
care. Several limited studies
showed benefits of home based
telemedicine interventions in
chronic diseases. These
interventions appear to enhance
communication with providers
and provide closer monitoring of
general health, but the studies
116. were conducted in settings
requiring additional resources and
dedicated staff. Studies of
office/hospital-based telemedicine
suggest that telemedicine is most
effective for verbal interactions,
e.g. videoconferencing for
diagnosis and treatment neurology
and psychiatry.
Outside of a small number of
clinical specialties, the evidence
base for the efficacy of
telemedicine is weak. Further
well-designed and targeted
research that provides high quality
data will provide a strong
contribution to understanding
how best to deploy technological
resources in health care.
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119. Health, Safety,
Social,
Physiological and
functional
Twenty-one projects included
(drawing on 114 publications). A
table is presented with their
technologies, target audience,
technologies and different
outcome. A lack of evidence on
clinical outcomes is identified.
Most of the studies demonstrate
the feasibility of the technological
solution. Technical, ethical, legal,
clinical, economical and
organisational implications and
challenges need to be studied
in-depth for the field to grow
further.
Hailey et al. [44] Cancer United States,
Canada, Denmark,
Finland, Spain, UK
Comparing a
wide range of
interventions
Cost/economic,
Health, Percep-
tion/satisfaction,
Social
Fifty-four studies included.
120. Positive findings from
higher-quality studies suggested
that telephone-based technology
was effective for promoting
mammography and colposcopy in
specific populations, for increasing
fruit and vegetable consumption,
and as an alternative to in-person
support groups for women with
breast cancer. Eight economic
assessments provided some
indications of cost advantages in
diagnosis and treatment, and in
palliative care. 20 papers reported
patient and family satisfaction.
However, the significance and
generalisability of these findings
appears limited.
From the perspective of the
Alberta Cancer Board, the
literature suggests some useful
possibilities for developing new
services using internet or
web-based, telephone-based, and
video-based technologies for
cancer patients in rural areas.
However, it seems likely that these
applications would need validation
with suitable local studies.
Linton [62] Anxiety and
depression
Not specified Computer-
based
121. cognitive
behavioural
therapy (CBT)
Behavioural,
Cost/economic,
Ethical issues,
Health, Percep-
tion/satisfaction,
self-assessment
Twelve studies included. The
paper investigates what effects
and costs are associated with
computer-based CBT in treating
adult patients with anxiety
disorders or depression.
There is limited scientific evidence
indicating that computer-based
CBT has favourable, short-term
effects on symptoms in the
treatment of panic disorder, social
phobia, and depression. The
scientific evidence is insufficient
to assess the effects of treatment
on obsessive–compulsive disorder
and mixed anxiety/depression.
The scientific evidence is
insufficient to assess the
cost-effectiveness of the method.
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124. 7
1
Table 3 (Continued)
Reference Conditions
included
Geographic
area
Service/
intervention
Outcome Authors’ summary of results Authors’ conclusions
Mathur et al. [63] Diabetes Not stated Evaluation
Feasibility/pilot,
Health
Fourteen studies included. Marked
variability in operational design of
programs and poor rationalization
of choice of outcome metrics with
program components found.
Causal pathways in decline of
HbA1c remain unclear, even
though 11 of 14 studies showed
decline. The authors recommend a
standardized methodology for
analyzing communications
technology use in diabetes care.
Walters et al. [64] Smoking
cessation
125. Worldwide Web and
computer-
based
programmes
Behavioural Ninteen studies included. 47% of
included studies reported
statistically significant or
improved outcomes at the longest
follow-up, relative to a comparison
group.
Few patterns emerged in terms of
subject, design or intervention
characteristics that led to positive
outcomes. The ‘first generation’
format, where participants were
mailed computer-generated
feedback reports, was the modal
intervention format and the one
most consistently associated with
improved outcomes.
Lintonen et al. [65] Promotion of
health
Global Emerging
information
and commu-
nications
technology,
especially the
internet
Classified uses of
126. IT generally
Fifty-six papers included. Using
the papers studied, the authors
classified IT in health promotion:
IT as an intervention medium; IT
as a research focus; IT as a
research instrument and IT for
professional development.
IT in health promotion is only just
emerging. While a lot of health
promotion information is provided
over internet, little published
research exists on its use and
usefulness.
Van Nooten et al.
[66]
All Not stated Spiritual care Information,
assessments,
theories of role of
spiritual care and
interventions
Eighteen studies included (17
articles and one book). There are
very few systematic studies on use
of Internet for spiritual care as
e-health. Four different categories
of spiritual and religious care are
identified: information search,
assessments, theories and
interventions.
127. No systematic studies were found
on how ICTs are being used to
integrate religious and spiritual
care into healthcare.
Jaana et al. [90] Cardio-
vascular
(hyperten-
sion)
USA, Europe, Japan,
Israel, Malaysia
Remote
monitoring
Behavioural,
Cost/economic,
Feasibility/pilot,
Blood pressure
control
Fourteen studies included. The
studies present evidence on the
positive impacts of telemonitoring
on patients and their condition:
significant BP control, better
medication adherence, changes in
patient lifestyle and attitudes. The
studies were considered limited
because of study designs. Little is
known on the effects of
telemonitoring on services
utilization. Only one study
demonstrated a detailed
cost-effectiveness analysis.
128. Preliminary evidence exists on
benefits. However, limited
information exists on effects of
utilization and economic viability.
Future studies should include both
RCT’s and research to understand
processual conditions and
mechanisms through which BP
control is achieved. (Formative
evaluations).
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3
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7
5
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Table 4 – Emerging issue 1: economic analysis.
Reference Conditions
included
Geographic
area
Service/intervention Outcome Authors’ summary of results
Authors’ conclusions
Rojas and Gagnon
[67]
All Worldwide Telehomecare
(THC)
131. Cost/economic,
Health, Percep-
tion/satisfaction
Twenty-three studies included.
THC was found to be a
cost-effective alternative to
traditional approaches in 91% of
the studies. Main benefits included
decreased hospital utilisation;
improved patient compliance with
treatment plans; improved patient
satisfaction with health services
and improved quality of life.
The authors argue that one of the
major disadvantage is of THC
studies has been the failure to
adopt a set of common indicators
to calibrate their
cost-effectiveness.
Gaikwad and
Warren [34]
Chronic
disease
Not stated Home based
ICT
interventions
Behavioural,
Cost/economic,
Health, Percep-
tion/satisfaction
132. Twenty-seven studies included.
These systems can improve
functional and cognitive patient
outcomes in chronic disease and
reduce costs. However, the
research is not yet sufficiently
robust.
Telecare, telehealth etc. have
positive clinical and cost outcomes
– although studies are few in
number and heterogeneous. Better
evidence-based outcome measures
are needed, especially regarding
costs and physician perspectives.
Seto [68] Heart failure Worldwide Remote
monitoring
Cost/economic Eleven studies included. The
author considered a variety of
direct and indirect cost categories
including costs to the health
system and costs to the patient.
These are described.
Telemonitoring has a positive role
to play in reducing costs by
reducing re-hospitalisation and
travel costs.
Tran et al. [25] Diabetes,
heart failure,
COPD and
other chronic
133. diseases
Canada focused, but
international
publications
included
Home
telehealth
Cost/economic,
Health, Percep-
tion/satisfaction
Seventy-nine studies included. Of
the included studies, 26 pertained
to diabetes, 35 to chronic heart
failure, nine to COPD, and eight to
mixed chronic diseases. The
comparator “no care” was not
identified in any of the included
studies, so usual care was used as
the comparator throughout the
clinical review. Home telehealth
appeared generally clinically
effective and no patient adverse
effects were reported. Evidence on
health service utilization was
more limited, but promising The
economic review suggested
cost-effectiveness, but the quality
of studies was low.
Conclusions relate to the potential
for home telehealth in Canada
which is seen as positive. However,
134. more research, such as multicentre
RCTs, is warranted to accurately
measure the clinical and economic
impact of home telehealth for
chronic disease management to
support Canadian policy makers in
making informed decisions.
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6
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1
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3
6
–7
7
1
Table 4 (Continued)
Reference Conditions
included
Geographic
area
Service/intervention Outcome Authors’ summary of results
Authors’ conclusions
Azarmina and
Wallace [31]
All All countries Remote inter-
pretation in
medical
encounters
Cost/economic
Feasibility/pilot,
137. Health,
Organizational,
Percep-
tion/satisfaction,
Safety
Nine studies included. Results
showed that time between
encounters was reduced, but
evidence on consultation length
was not consistent. Good client
and doctor satisfaction was
shown, but those interpreting data
preferred to do so face to face.
Costs of these interventions are
high, but efficiency gains are
possible.
The review suggests that remote
interpretation is an acceptable and
accurate alternative to traditional
methods, despite the higher
associated costs.
Barlow et al. [28] Elderly
people,
chronic
diseases
Worldwide Home
telecare
Behavioural,
Health,
Organizational,
Safety