Rules or consequences? The role of ethical mindsets in moral dynamics

Recent research on the dynamics of moral behavior has documented two contrasting phenomena - moral consistency and moral balancing. Moral balancing refers to the phenomenon whereby behaving (un)ethically decreases the likelihood of doing so again at a later time. Moral consistency describes the opposite pattern - engaging in (un)ethical behavior increases the likelihood of doing so later on. Three studies support the hypothesis that individuals' ethical mindset (i.e., outcome-based versus rule-based) moderates the impact of an initial (un)ethical act on the likelihood of behaving ethically in a subsequent occasion. More specifically, an outcome-based mindset facilitates moral balancing and a rule-based mindset facilitates moral consistency.moral balancing, moral consistency, ethical mindsets, ethical behavior

The Taxonomy of Telemedicine

The purpose of this article is to present a taxonomy for telemedicine. The field has markedly grown, with an increasing number of applications, a variety of technologies, and newly introduced terminology. A taxonomy would serve to bring conceptual clarity to this burgeoning set of alternatives to in-person healthcare delivery. The article starts with a brief discussion of the importance of taxonomy as an information management strategy to improve knowledge sharing, facilitate research and policy initiatives, and provide some guidance for the orderly development of telemedicine. We provide a conceptual context for the proliferation of related concepts, such as telehealth, e-health, and m-health, as well as a classification of the content of these concepts. Our main concern is to develop an explicit taxonomy of telemedicine and to demonstrate how it can be used to provide definitive information about the true effects of telemedicine in terms of cost, quality, and access. Taxonomy development and refinement is an iterative process. If this initial attempt at classification proves useful, subject matter experts could enhance the development and proliferation of telemedicine by testing, revising, and verifying this taxonomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90498/1/tmj-2E2011-2E0103.pd

A study of urgent and emergency referrals from NHS Direct within England

Objectives: The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-healthcare can manage urgent and emergency care. Setting: NHS Direct, England, UK Participants: NHS Direct anonymised call data (N=1 415 472) were extracted over a 1-year period, during the combined month July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269 558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ2 test independence with cross-tabulations used to test within-group differences. Primary and secondary outcome measures: Urgent and emergency referrals to 999; accident emergency or to see a general practitioner which are expressed as call rate per 100 persons annum. Outcomes related to symptom variations patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day). Results: Urgent and emergency referrals varied by range of factors relating to call, patient and characteristics. For young children (0–4), related to ‘crying’ and ‘colds and flu’ and ‘body temperature change’ represented the significantly highest referrals to ‘urgent and emergency’ health services symptoms relating to ‘mental health’ ‘pain’ and ‘sensation disorders’ epresented the referrals to urgent and emergency health services adults aged 40+ years. Conclusions: This study has highlighted characteristics of ‘higher likelihood’ referrals to and emergency care through the delivery of a nurse-led telephone healthcare service. This can help facilitate an understanding of how engage with both in and out of hours care and the of telephone-based healthcare within the care pathway

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. Methods: A selective review of the credible literature during the past decade (2005?2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140295/1/tmj.2016.0149.pd

Guest Editorial: Compelling Issues in Telemedicine

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140280/1/tmj.2013.9998.pd

The Empirical Evidence for Telemedicine Interventions in Mental Disorders

Problem and objectiveThis research derives from the confluence of several factors, namely, the prevalence of a complex array of mental health issues across age, social, ethnic, and economic groups, an increasingly critical shortage of mental health professionals and the associated disability and productivity loss in the population, and the potential of telemental health (TMH) to ameliorate these problems. Definitive information regarding the true merit of telemedicine applications and intervention is now of paramount importance among policymakers, providers of care, researchers, payers, program developers, and the public at large. This is necessary for rational policymaking, prudent resource allocation decisions, and informed strategic planning. This article is aimed at assessing the state of scientific knowledge regarding the merit of telemedicine interventions in the treatment of mental disorders (TMH) in terms of feasibility/acceptance, effects on medication compliance, health outcomes, and cost.Materials and methodsWe started by casting a wide net to identify the relevant studies and to examine in detail the content of studies that met the eligibility criteria for inclusion. Only studies that met rigorous methodological criteria were included. Necessary details include the specific nature and content of the intervention, the research methodology, clinical focus, technological configuration, and the modality of the intervention.ResultsThe published scientific literature on TMH reveals strong and consistent evidence of the feasibility of this modality of care and its acceptance by its intended users, as well as uniform indication of improvement in symptomology and quality of life among patients across a broad range of demographic and diagnostic groups. Similarly, positive trends are shown in terms of cost savings.ConclusionThere is substantial empirical evidence for supporting the use of telemedicine interventions in patients with mental disorders

Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia

Importance: International literature has shown that teledermoscopy referral may be a viable method for skin cancer referral, however no economic investigations have occurred in Australia. Objective: To assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia. Design: Cost-effectiveness analysis using a decision-analytic model. Setting: Primary care. Participants: Australian general population (modelled). Intervention: We compared the costs of teledermoscopy referral (electronic referral containing digital dermoscopic images) versus usual care (a written referral letter) for specialist dermatologist review of a suspected skin cancer. Main outcome measures: Cost and time in ‘days to clinical resolution’, where clinical resolution was defined as diagnosis by a dermatologist or excision by a general practitioner. Probabilistic sensitivity analysis was performed to examine the uncertainty of the main results. Results: Time to clinical resolution was 26 days earlier with teledermoscopy referral compared with usual care alone (95%Credible interval (CrI) 13 to 38). The estimated mean cost difference between teledermoscopy referral ($318.39) versus usual care ($263.75) was $54.64 (95$22.69 to $97.35) per person. The incremental cost per day saved to clinical resolution was$2.10 (95%CrI $0.87 to$5.29). Conclusion and Relevance: Using teledermoscopy for skin cancer referral and triage in Australia will cost $54.64 extra per case on average, but will result in clinical resolution 26 days sooner than usual care. Implementation recommendations depend on the preferences of the Australian health system decision makers for either lower cost or expedited clinical resolution. Further research around the clinical significance of expedited clinical resolution and its importance for patients could inform implementation recommendations for the Australian setting

The Effects of TeleWound Management on Use of Service and Financial Outcomes

This study investigated the effects of a TeleWound program on the use of service and financial outcomes among homebound patients with chronic wounds. The TeleWound program consisted of a Web-based transmission of digital photographs together with a clinical protocol. It enabled homebound patients with chronic pressure ulcers to be monitored remotely by a plastic surgeon. Chronic wounds are highly prevalent among chronically ill patients in the United States (U.S.). About 5 million chronically ill patients in the U.S. have chronic wounds, and the aggregate cost of their care exceeds $20 billion annually. Although 25% of home care referrals in the U.S. are for wounds, less than 0.2% of the registered nurses in the U.S. are wound care certified. This implies that the majority of patients with chronic wounds may not be receiving optimal care in their home environments. We hypothesized that TeleWound management would reduce visits to the emergency department (ED), hospitalization, length of stay, and visit acuity. Hence, it would improve financial performance for the hospital. A quasi-experimental design was used. A sample of 19 patients receiving this intervention was observed prospectively for 2 years. This was matched to a historical control group of an additional 19 patients from hospital records. Findings from the study revealed that TeleWound patients had fewer ED visits, fewer hospitalizations, and shorter length of stay, as compared to the control group. Overall, they encumbered lower cost. The results of this clinical study are striking and provide strong encouragement that a single provider can affect positive clinical and financial outcomes using a telemedicine wound care program. TeleWound was found to be a credible modality to manage pressure ulcers at lower cost and possibly better health outcomes. The next step in this process is to integrate the model into daily practice at bellwether medical centers to determine programmatic effectiveness in larger clinical arenas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63389/1/tmj.2007.9971.pd

When Voice Matters: A Multilevel Review of the Impact of Voice in Organizations

The conventional wisdom is that voice leads to desirable outcomes for organizations. However, this is most certainly an oversimplification. Of the over 1,000 studies examining the impact of voice in organizations, the implications of voice vary by the level of the organization (individual, group, organization) as well as the outcome of interest (e.g., group harmony vs. job satisfaction). In this article, we draw from the diverse literatures examining the impact of voice to integrate the theoretical frameworks and empirical results for voice outcomes across organizational levels. To do so, we start with a discussion of the definition and development of voice as a construct, beginning with Hirschman’s seminal work on voice/exit/loyalty. We then review the theoretical frameworks within each level that explain the effect of voice on outcomes, highlight the role of mediating or moderating mechanisms, and discuss directions for future research. Finally, we emphasize emerging trends in the study of voice and suggest areas in which the various literatures may benefit from borrowing across fields and levels of interest to produce a more comprehensive, theoretically grounded, and cohesive body of work.</jats:p