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By J. Tukash. State University of New York at Binghamton.

Voice response technolo- gies are likely to play an important order 500 mg keppra free shipping medications you can take when pregnant, augmenting role in connecting patients and people at risk to the health system. During the Inter- net frenzy, many observers dismissed the voice channel of telephone communication, assuming that most of it would be displaced by digital data. The software algorithm at the heart of Eliza is so sophisticated that it can recognize and respond to millions of responses to the question, “Is this Jeff Gold- smith? Eliza is so warm and accepting that patients or family members will reliably return its calls if they are not at home to receive the initial call. However, no one would quarrel with the assertion that no technology since the invention of the telephone has created such a sensation as the Internet. The Internet enabled instantaneous and asynchronous commu- nication between any parties connected at first to an existing tele- phone network and later using cable, ground-based wireless, and satellite modalities, allowing the Internet to be accessed in auto- mobiles, airplanes, or literally anywhere in the world where one can receive a wireless signal. With increased bandwidth has come 28 Digital Medicine the ability to transmit virtually any form of digital information, including sound and both still and streaming video files. People who use the Internet are on a mission; they actively use the Internet to seek knowledge and connection to others. Society seemed to awaken in the mid-1990s to discover that it had grown a whole new nervous system. The connections spawned by the Internet have resulted in the spontaneous formation of what futurist Howard Rheingold dubbed “virtual communities” revolv- ing around common interests and issues. Six million people use the Internet to seek health information every day, just in the United States,37 and according to the Pew Trust Internet American Life Project, 62 per- cent of adults connected to the Internet sought health information through it. Internet applications have empowered consumers to define their own medical reality and to reframe and broaden their relationships to physicians. The Internet and Health Plans As discussed in Chapter 6, the Internet has also brought a host of powerful new applications to health plans to communicate with their vast and diffuse networks of subscribers, corporate customers, and the health system itself. These applications form the core of an emerging “consumer directed” model of health insurance. The Internet and Healthcare Delivery Internet applications have less direct saliency to hospitals and other healthcare delivery institutions, where improving clinical and fi- nancial operations is the most immediate management challenge. However, Internet technologies will be used to make hospitals and the information they contain more accessible to patients and fam- ilies. The Internet will enable the birth of a huge new industy of business process outsourcing in healthcare. Overall Effects of the Internet on Healthcare What the Internet has provided is affordable and nearly universal connectivity, enabling physicians and consumers to connect to one another and to the rest of the health system through their existing communications channels, such as the telephone line or cable. By democratizing connectivity, the Internet has brought the health system and its users closer together. The Internet has also provided a new communications back- bone to speed transactions and reduce clerical expenses in the vast bureaucratic sprawl that the American health system has become. As discussed earlier in this chapter, it has also provided a readily usable platform for projecting clinical information across different care sites. One way to think about the Internet is as a technology enabler or, in military jargon, a force multiplier, that helps lower 30 Digital Medicine communications and transaction cost, time, and complexity. It is also a lubricant of information flow and a solvent of organizational boundaries. It may take at least another decade before the health system realizes the full extent of its transformative potential. However, the reason why digi- tizing vital health information is important is that it enables this information to be assembled electronically and directed to the point of medical decisions. Early experimenters included academic health centers like the University of Indiana and Boston’s Brigham and Women’s Hospital and multihospital systems like Utah’s Intermountain Health Care. These early efforts involved creating a clinical data repository into which medical record in- formation was entered for later retrieval and analysis. Physicians and other caregivers could then enter orders electronically and get test results and other clinical data on their patients.

These include image enhancing drugs (steroids) and volatiles (fuel discount keppra 250mg amex medicine to help you sleep, paint and aerosols). Poly-drug use is also a significant concern and strategies that address this can be very effective at reducing harm. Tobacco smoking also carries the highest burden of drug-related costs on the Australian 73 community. Australia’s implementation of a range of multifaceted tobacco control measures has been effective in reducing smoking rates over recent decades, with daily smoking for those aged 14 years or older declining in Australia from 24. Smokers are also having fewer cigarettes 74 per week (96 in 2013 compared to 111 in 2010). Challenges remain for tobacco, including addressing the inequality in smoking rates between some disadvantaged populations and the broader community. In addition, it is important to maintain low smoking rates and expand smoke-free areas to protect people from second hand smoke. Responding to the introduction of e-cigarettes is also a matter currently faced by Australian jurisdictions. In 2010, the cost of alcohol-related harm (including harm to others) was reported to be $36 billion. Alcohol is also 77 associated with 3,000 deaths and 65,000 hospitalisations every year. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. National Drug Strategy 2016-2025 31 While the burden of alcohol harms in the community remains high, some gains have been made. The proportion of people aged 14 or older who consumed alcohol daily declined between 2004 (8. The proportion of people exceeding the lifetime risk guidelines has reduced from 20. In the 2013 National Drug Strategy Household Survey, respondents were asked if anyone under the influence of or affected by alcohol had perpetrated verbal abuse, physical abuse or put them in fear in the preceding 12 months. Research suggests that there were 90 ‘one-punch’ deaths in Australia between the years 80 2000 to 2012. Stimulants can be taken orally, smoked, snorted/inhaled and dissolved in water and injected. Some of the harms that can arise from the use of methamphetamines and other stimulants include mental illness, cognitive impairment, cardiovascular problems and 81 overdose. This figure has remained stable since 2007, but is lower 83 than the prevalence recorded between 1998 and 2004. However, among those who use amphetamine, the use of the powder form of the drug decreased significantly from 51% in 2010 to 29% in 2013, while the use of crystal-methamphetamine more than doubled since 2010 (from 22% to 50% in 2013) amongst methamphetamine users. There was also a significant increase in the proportion of users consuming methamphetamine daily or weekly (from 9% in 2010 to 16% in 2013). In addition, 16% of Australians identified methamphetamine as the illicit drug of most concern to the community (an increase from 10% in 2012). Violent behaviour is also more than six times as likely to occur among methamphetamine dependent people when they are using the drug, compared to 84 when they are not using the drug. As the most widely used of the illicit drugs in Australia, cannabis carries a significant burden of 87 disease. In particular, cannabis dependence among young adults is correlated with, and probably 88 contributes to, mental disorders such as psychosis. The harms that can arise as a result of the use of pharmaceutical drugs 90 depend on the drug used, but can include fatal and non-fatal overdose. Harms also include infection and blood vessel occlusion from problematic routes of administration, memory lapses, coordination impairments and aggression. There has been a significant increase in the misuse of pharmaceutical drugs in Australia.