derness on palpation at McBurneys point and pain on forward flexion of hip , with no rebound tenderness .
Results : A STAT CT abdomen and pelvis with contrast was ordered for suspicion of ovarian cyst rupture versus diverticular disease . CT demonstrated diverticulosis , prominent in the cecum with adjacent pericecal edema and trace free fluid compatible with uncomplicated diverticulitis . Adjacent appendix was shown to be normal .
Conclusions : Telemedicine is most limited by the provider ’ s inability to complete a “ hands-on ” physical exam . Instead , in situations like this , the physician must walk the patient through a clinically reliable physician-guided exam . The efficacy of a physician-guided exam was demonstrated by the diagnostic outpatient imaging ordered by the physician , which confirmed suspected diverticulitis . This case is an example of the opportunity for broader application of telemedicine in assessing acute medical problems by e-visit .
21 . Telemedicine in Chronic Disease : Case Series of Type 2 Diabetes Mellitus Management by e-Visit
Rachel Nordstrom , BS 1 , 2 , Justin Fazio , BS , MS 1 , 2 , Heather Watters , RN , BS , BSN , CPN 2 , Priya Radhakrishnan , MD , FACP 2
1 Creighton University School of Medicine , 2 St . Joseph ’ s Hospital & Medical Center
Background : The application of telemedicine in chronic disease management allows for more frequent physician-patient interaction which can help improve patient compliance with diet , exercise , and medication regimens . In patients with diabetes , it has been shown that these “ e-visits ” can lead to maintenance of lower blood sugar levels and ultimately help patients decrease their Hgb A1c values . In this report , we describe the use of telemedicine in the management of three patients with type 2 diabetes mellitus .
Methods : 67 year old male presenting with poorly controlled type 2 diabetes currently taking Lantus 18 units qAM and 20 units qHS and glipizide 7.5mg . His fasting blood sugars ran < 120 , pre-prandial > 200 , and post-prandial > 200 . He denied any signs or symptoms of hypoglycemia .
68 year old male with a past medical history of liver transplantation presenting by e-visit with well controlled type 2 diabetes on glipizide . Patient denied episodes of hypoglycemia and checked blood sugar levels three times daily .
51 year old male with a past medical history of congestive heart failure presenting by e-visit with type 2 diabetes mellitus on Humalog 5-10 units with meals , Novolog , Lantus 35 units qHS . His fasting blood sugars ran between 120-150 at home .
Results : Guided physical exam was used to assess patients for diabetic foot ulcers . Each patient received diabetic education . Each patient showed an improvement in either blood sugar logs or HBA1c values at follow-up .
Conclusions : Management of type 2 diabetes mellitus is limited by patient compliance with medications and blood sugar testing . E-visits provide a more convenient avenue for patients to meet with their providers than conventional in-office appointments . This can improve compliance and create opportunity for physician guidance and motivational counseling . In our patients , telemedicine allowed for modification of medications and diabetic education , resulting in improvement of patient ’ s blood sugar control .
22 . Developing a Mobile Dementia Caregiver Outreach Program Myonghwa Park , PhD , RN , GNP
Chungnam National University and Arizona State University
Recently , mobile interventions to provide education or support to individuals with dementia and to their family caregivers have been actively developed and shown to be effective . The purpose of this study was to develop the mobile support program for dementia family caregivers . The individualized mobile education and support program was developed collaboratively by experts including the content experts , a mobile web designer , a database programmer , and a multimedia designer . The contents were designed to address a range of various issues including understanding the dementia stage , treatment of dementia , coping behavioral problem , assisting daily living , and living a pleasant life . The selected family caregivers reviewed the storyboards and provided the feedback . This feedback was incorporated into the final storyboards . Core modules such as understanding the dementia stage was provided to every user . Optional modules were provided according to the results of the family caregiver ’ s need assessment . Formative evaluation to assess usability of the program was conducted . Family caregivers were very satisfied with the amount of information , the content of mobile interactive activity , and the design of site . The use of animation has been shown to improve family caregivers ’ interest and understanding of the contents . An active participation of family caregivers with their higher level of satisfaction was gained compared with traditional support programs with written material and group based approach . The use of mobile support program offers users the opportunity to participate in a support program at their own time and pace . Results from this study demonstrate support to move forward with this program . These programs can be applied to various settings such as home care settings , outpatient clinics , and community centers .* This research was supported by Basic Science Research
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