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Papers by Richard Scott
Studies in Health Technology and Informatics
Background: e-Health readiness has been described as the preparedness of healthcare institutions,... more Background: e-Health readiness has been described as the preparedness of healthcare institutions, communities, or individuals for the anticipated change brought by programmes related to ICT use. Assessment of e-health readiness prior to the implementation of e-health innovations can therefore facilitate the process of change for individuals and organisations to adopt e-health programmes and avoid disappointment. The literature shows that although many e-health readiness assessment frameworks and tools exist, none meet all the requirements for e-health readiness assessment in developing countries. The aim of this study was to develop an e-health readiness assessment framework applicable to developing countries. Methods: A three-step process gleaned from the e-health literature (literature review / material collection; analysis / content analysis; consolidation / conceptual framework synthesis), together with iterative and reflective processes based on prior research undertaken by thi...
South African Journal of Bioethics and Law
While telemedicine holds enormous promise for the provision of remote healthcare, it is not witho... more While telemedicine holds enormous promise for the provision of remote healthcare, it is not without its challenges. Recently, there has been a shift in the way in which healthcare is being practised globally. These new models of healthcare service provision ideally involve patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional boundaries. The World Health Organization (WHO) defines eHealth simply as 'the use of information and communication technologies [ICT] for health'; [1] telemedicine, as a subset of eHealth, is the practice and delivery of healthcare over a distance using ICT. [2] The focus of this article is telemedicine. However, the term eHealth will be applied when speaking of the use of ICT in healthcare generally, and telehealth where this term is applied by others, or when a slightly more generic perspective (one that includes telemedicine) is required. Although largely beneficial, there is growing reflection on the legal and ethical challenges and complexities posed by these newly unfolding eHealth measures. [3,4] There is a need for guidance with regard to the eHealth landscape in South Africa (SA). It is understood that the emergence of telemedicine has created various legal and ethical dilemmas. [5,6] The broad ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care; quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication. While various legal, regulatory, and governance measures offer potential solutions and remedies for rights protection, the furtherance of ethical direction may be achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. In SA, the Health Professions Council (HPCSA) spent several years developing the 'General ethical guidelines for good practice in telemedicine' (the HPCSA telemedicine guidelines), [7] a process which they found difficult. [8] Advances in technology and telemedicine have rendered several aspects of these guidelines, which focus largely on videoconference-based telemedicine, inappropriate. The guidelines are largely based on the World Medical Association (WMA)'s 2007 'Statement on the ethics of telemedicine' , which was rescinded in 2009, and replaced with a far more pragmatic statement on 'Guiding principles for the use of telehealth for the provision of healthcare' , which took recent advances in the field into account. [9] The field has since advanced further, with the growing use of mobile phones for telemedicine. The current shortcomings of the HPCSA guidelines need to be addressed if telemedicine is to meet the government's desire for telemedicine to improve both access to and quality of care for those in rural areas. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Clinical chemistry, 1988
Malignant melanoma, a disease that is increasing in occurrence and medical concern, is characteri... more Malignant melanoma, a disease that is increasing in occurrence and medical concern, is characterized by the excretion of melanogens. Two qualitative tests are recommended for melanogen detection, the Thormählen test and the ferric chloride test. We evaluated the laboratory and clinical performance of these tests by subsequently re-evaluating 201 urine samples that had been submitted for routine melanogen analysis. We used (a) Thormählen, (b) ferric chloride, (c) small-scale thin-layer chromatography, and (d) spectrophotometry. Nearly 30% of Thormählen test results were equivocal. The ferric chloride test was of no value in itself or in categorizing equivocal Thormählen results as positive or negative. The small-scale chromatography was irreproducible. Prompt scanning of the Thormählen reaction product was helpful in classifying equivocal results. History review of 121 histopathologically diagnosed melanoma patients indicated that these qualitative assays were of no clinical value in...
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2012
This study assessed the need and readiness of health care institutions in Kabul and Bamyan, Afgha... more This study assessed the need and readiness of health care institutions in Kabul and Bamyan, Afghanistan for successful implementation of information and communication technology in health care (eHealth). A mixed methods design was adopted at 2 institutions in the Aga Khan Development Network in Afghanistan: the French Medical Institute for Children in Kabul and Bamyan Provincial Hospital, Bamyan. Information for the needs assessment was obtained from interviews and focus groups and eHealth readiness was assessed using a validated survey tool. The needs of institutions in the Aga Khan Development Network in Afghanistan were categorized as follows: provision of care needs; learning needs; and information management needs. eHealth readiness on average was lower in Bamyan compared with Kabul in all areas of the readiness assessment. Other institutions in Afghanistan may benefit from adopting the model of needs and readiness assessment used for Aga Khan Development Network institutions.
Studies in Health Technology and Informatics
Background: Recently there has been a steady increase in the use of Instant Messaging (IM) as a m... more Background: Recently there has been a steady increase in the use of Instant Messaging (IM) as a means of providing health and healthcare services. This growth has been particularly rapid during the ongoing COVID-19 pandemic. Many reports indicate informal services using IM, in particular WhatsApp, have arisen spontaneously, in the absence of any formal guidelines and little consideration of consent. This study documents the consent practices of healthcare professionals using IM for clinical activities in District Hospitals in KwaZulu-Natal, South Africa and compares these practices with the literature. Methods: As part of a larger audit of telemedicine activity in KwaZulu-Natal a survey questioned clinicians’ use of IM, including consent practices and awareness of regulatory guidelines. Concomitantly multiple electronic databases were searched for papers on WhatsApp use in clinical service. Inclusion criteria were: papers written in English, reported on WhatsApp in clinical use or p...
Studies in Health Technology and Informatics
Background: e-Health readiness has been described as the preparedness of healthcare institutions,... more Background: e-Health readiness has been described as the preparedness of healthcare institutions, communities, or individuals for the anticipated change brought by programmes related to ICT use. Assessment of e-health readiness prior to the implementation of e-health innovations can therefore facilitate the process of change for individuals and organisations to adopt e-health programmes and avoid disappointment. The literature shows that although many e-health readiness assessment frameworks and tools exist, none meet all the requirements for e-health readiness assessment in developing countries. The aim of this study was to develop an e-health readiness assessment framework applicable to developing countries. Methods: A three-step process gleaned from the e-health literature (literature review / material collection; analysis / content analysis; consolidation / conceptual framework synthesis), together with iterative and reflective processes based on prior research undertaken by thi...
Background: eHealth programmes in African countries face fierce competition for scarce resources.... more Background: eHealth programmes in African countries face fierce competition for scarce resources. Such initiatives should not proceed without adequate appraisal of their probable impacts, thereby acknowledging their opportunity costs and the need for appraisals to promote optimal use of available resources. However, since there is no broadly accepted eHealth impact appraisal framework available to provide guidance, and local expertise is limited, African health ministries have difficulty completing such appraisals. The Five Case Model, used in several countries outside Africa, has the potential to function as a decision-making tool in African eHealth environments and serve as a key component of an eHealth impact model for Africa. Methods: This study identifies internationally recognised metrics and readily accessible data sources to assess the applicability of the model’s five cases to African countries. Results: Ten metrics are identified that align with the Five Case Model’s five ...
Background: Health, healthcare, and healthcare system problems within the developing world are we... more Background: Health, healthcare, and healthcare system problems within the developing world are well recognised. eHealth, the use of Information and Communications Technologies (ICT) for health, is frequently suggested as one means by which to ameliorate such problems. However, to identify and implement the most appropriate ehealth solutions requires development of a thoughtful and broadly evidence-informed strategy. Most published strategies focus on health informatics solutions, neglecting the potential for other aspects of ehealth (telehealth, telemedicine, elearning, and ecommerce). This study examined the setting in Botswana to determine the need for a telemedicine-specific strategy.Methods: A situational assessment of ehealth activities in Botswana was performed through a scoping review of the scientific and grey literature using specified search terms, an interview with the project manager of the major mhealth stakeholder, and benchtop review of policies and other relevant Gov...
International Journal of E-Health and Medical Communications
E-Health continues to be implemented despite continued demonstration that it lacks value. Specifi... more E-Health continues to be implemented despite continued demonstration that it lacks value. Specific guidance regarding research approaches and methodologies would be beneficial due to the value in identifying and adopting a single model or framework for any one ‘entity’ (healthcare organisation, sub-national region, country, etc.) so that the evidence-base accumulates more rapidly and interventions can be more meaningfully compared. This paper describes a simple and systematic approach to e-health evaluation in a real-world setting, which can be applied by an evaluation team and raises the quality of e-health evaluations. The framework guides and advises users on evaluation approaches at different stages of e-health development and implementation. Termed ‘Pragmatic Evaluation,’ the approach has five principles that unfold in a staged approach that respects the collective need for timely, policy relevant, yet meticulous research.
Environment and Water Resource Management / 837: Health Informatics / 838: Modelling and Simulation / 839: Power and Energy Systems, 2016
The use of Information and Communication Technologies (ICT) in health (e-health), has been propos... more The use of Information and Communication Technologies (ICT) in health (e-health), has been proposed as a useful tool to increase efficiency in provision of healthcare. However, application and integration of e-Health still has many challenges, often resulting in implementation failure. Interested healthcare institutions in countries such as Botswana must first ensure their preparedness for the anticipated challenges brought about by programmes related to ICT use. Such preparedness is termed e-Health Readiness. Any ICT use creates e-waste (or Waste Electrical and Electronic Equipment, WEEE), Therefore one criterion for judging a country's degree of e-Health Readiness should be how it handles its e-waste. Generation of large quantities of e-waste will be an inevitable result of increased ICT consumption by the healthcare sector. This study assesses the status of ewaste management in Botswana, as one of the indicators that could be used to determine the degree of e-health readiness of Botswana. The study design was based on a literature review, and initial use of an adapted e-waste assessment questionnaire developed by the Swiss company Empa (Appendix 1). This study shows Botswana still faces challenges with e-waste management. These challenges are similar to those faced by other developing countries: an absence of infrastructure for appropriate e-waste management, an absence of legislation dealing specifically with e-waste, an absence of a framework for end-of-life (EoL) product take-back or implementation of extended producer responsibility, limited public awareness about proper waste management and disposal practices, as well as limited technically skilled human resources to deal with issues such as e-waste recycling. This study has highlighted that Botswana needs an enhanced and enforced e-waste management strategy as a catalyst towards e-Health Readiness.
Journal of the International Society For Telemedicine and Ehealth, Aug 2, 2013
Studies in health technology and informatics, 1999
Healthcare managers and policy makers will, in the immediate and near future, make major decision... more Healthcare managers and policy makers will, in the immediate and near future, make major decisions about the allocation of scarce healthcare resources for telehealth 'solutions'. In our haste to capitalize on what technology can do we may be obscuring discussion and research about what technology should do. For example, currently much attention is being paid to standardization for technological aspects of telehealth. In contrast few efforts have been made to seek standardization in regards to a broad evaluation framework for telehealth. A body of opinion believes that missing in our rush into the on-line world is a systematic approach to research into the human, social, cultural, economic, and political factors associated with healthcare. As a result we lack the tools and experience necessary to assess the true value and implications of telehealth 'solutions'. Developing general guidelines for an evaluation framework, from needs assessment through integrated research...
Telemedicine and e-Health, 2013
Objective: The main objective of this study was to develop an ehealth evaluation tool based on a ... more Objective: The main objective of this study was to develop an ehealth evaluation tool based on a conceptual framework including relevant theories for evaluating use of technology in health programs. This article presents the development of an evaluation framework for e-health programs. Materials and Methods: The study was divided into three stages: Stage 1 involved a detailed literature search of different theories and concepts on evaluation of e-health, Stage 2 plotted e-health theories to identify relevant themes, and Stage 3 developed a matrix of evaluation themes and stages of e-health programs. Results: The framework identifies and defines different stages of e-health programs and then applies evaluation theories to each of these stages for development of the evaluation tool. This framework builds on existing theories of health and technology evaluation and presents a conceptual framework for developing an e-health evaluation tool to examine and measure different factors that play a definite role in the success of e-health programs. The framework on the horizontal axis divides e-health into different stages of program implementation, while the vertical axis identifies different themes and areas of consideration for e-health evaluation. Conclusions: The framework helps understand various aspects of e-health programs and their impact that require evaluation at different stages of the life cycle. The study led to the development of a new and comprehensive e-health evaluation tool, named the Khoja-Durrani-Scott Framework for e-Health Evaluation.
Mayo Clinic Proceedings, 1989
The biosynthesis of melanin from tyrosine is reviewed as the basis for assessment of laboratory t... more The biosynthesis of melanin from tyrosine is reviewed as the basis for assessment of laboratory tests that might potentially aid in the diagnosis and management of patients with malignant melanoma. These tests include qualitative and quantitative assays for the intermediates in metabolism of melanin and catecholamines, enzyme assays, metal ion analyses, and, most recently, immunoassays. Although currently no role exists for the clinical laboratory in the early diagnosis of malignant melanoma, serial quantitative analyses of total or individual melanogens or of catecholamine metabolites in urine or plasma specimens may be of value in the management of patients with this disorder. Immunologically based methods for the diagnosis and management of malignant melanoma hold some promise for the future.
Journal of Medical Internet Research, 2013
Significant investment in eHealth solutions is being made in nearly every country of the world. H... more Significant investment in eHealth solutions is being made in nearly every country of the world. How do we know that these investments and the foregone opportunity costs are the correct ones? Absent, poor, or vague eHealth strategy is a significant barrier to effective investment in, and implementation of, sustainable eHealth solutions and establishment of an eHealth favorable policy environment. Strategy is the driving force, the first essential ingredient, that can place countries in charge of their own eHealth destiny and inform them of the policy necessary to achieve it. In the last 2 years, there has been renewed interest in eHealth strategy from the World Health Organization (WHO), International Telecommunications Union (ITU), Pan American Health Organization (PAHO), the African Union, and the Commonwealth; yet overall, the literature lacks clear guidance to inform countries why and how to develop their own complementary but locally specific eHealth strategy. To address this gap, this paper further develops an eHealth Strategy Development Framework, basing it upon a conceptual framework and relevant theories of strategy and complex system analysis available from the literature. We present here the rationale, theories, and final eHealth strategy development framework by which a systematic and methodical approach can be applied by institutions, subnational regions, and countries to create holistic, needs- and evidence-based, and defensible eHealth strategy and to ensure wise investment in eHealth.
Clinical Biochemistry, 1987
Canadian Journal of Microbiology, 1986
The effect of trace metal nutrition on the functioning of the patulin biosynthetic pathway in sub... more The effect of trace metal nutrition on the functioning of the patulin biosynthetic pathway in submerged cultures of Penicillium urticae (NRRL 2159A) was examined by both chromatographic and enzymological means. Comprehensive metal ion analysis showed generally low levels of contaminating metal ions in media components. Of eight metal ions examined, only manganese strongly influenced secondary metabolite production. In control cultures or cultures deficient in calcium, iron, cobalt, copper, zinc, or molybdenum, pathway metabolites appeared in the medium at about 25 h after inoculation. The first pathway-specific metabolite, 6-methylsalicylic acid, accumulated only transiently before being converted to patulin whose concentration steadily increased. In manganese-deficient cultures, however, 6-methylsalicylic acid continued to accumulate, with only minor amounts of patulin being produced. Additionally, a marker enzyme for the pathway showed only 0–20% of control activity. Clear dose re...
Studies in Health Technology and Informatics
Background: e-Health readiness has been described as the preparedness of healthcare institutions,... more Background: e-Health readiness has been described as the preparedness of healthcare institutions, communities, or individuals for the anticipated change brought by programmes related to ICT use. Assessment of e-health readiness prior to the implementation of e-health innovations can therefore facilitate the process of change for individuals and organisations to adopt e-health programmes and avoid disappointment. The literature shows that although many e-health readiness assessment frameworks and tools exist, none meet all the requirements for e-health readiness assessment in developing countries. The aim of this study was to develop an e-health readiness assessment framework applicable to developing countries. Methods: A three-step process gleaned from the e-health literature (literature review / material collection; analysis / content analysis; consolidation / conceptual framework synthesis), together with iterative and reflective processes based on prior research undertaken by thi...
South African Journal of Bioethics and Law
While telemedicine holds enormous promise for the provision of remote healthcare, it is not witho... more While telemedicine holds enormous promise for the provision of remote healthcare, it is not without its challenges. Recently, there has been a shift in the way in which healthcare is being practised globally. These new models of healthcare service provision ideally involve patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional boundaries. The World Health Organization (WHO) defines eHealth simply as 'the use of information and communication technologies [ICT] for health'; [1] telemedicine, as a subset of eHealth, is the practice and delivery of healthcare over a distance using ICT. [2] The focus of this article is telemedicine. However, the term eHealth will be applied when speaking of the use of ICT in healthcare generally, and telehealth where this term is applied by others, or when a slightly more generic perspective (one that includes telemedicine) is required. Although largely beneficial, there is growing reflection on the legal and ethical challenges and complexities posed by these newly unfolding eHealth measures. [3,4] There is a need for guidance with regard to the eHealth landscape in South Africa (SA). It is understood that the emergence of telemedicine has created various legal and ethical dilemmas. [5,6] The broad ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care; quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication. While various legal, regulatory, and governance measures offer potential solutions and remedies for rights protection, the furtherance of ethical direction may be achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. In SA, the Health Professions Council (HPCSA) spent several years developing the 'General ethical guidelines for good practice in telemedicine' (the HPCSA telemedicine guidelines), [7] a process which they found difficult. [8] Advances in technology and telemedicine have rendered several aspects of these guidelines, which focus largely on videoconference-based telemedicine, inappropriate. The guidelines are largely based on the World Medical Association (WMA)'s 2007 'Statement on the ethics of telemedicine' , which was rescinded in 2009, and replaced with a far more pragmatic statement on 'Guiding principles for the use of telehealth for the provision of healthcare' , which took recent advances in the field into account. [9] The field has since advanced further, with the growing use of mobile phones for telemedicine. The current shortcomings of the HPCSA guidelines need to be addressed if telemedicine is to meet the government's desire for telemedicine to improve both access to and quality of care for those in rural areas. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Clinical chemistry, 1988
Malignant melanoma, a disease that is increasing in occurrence and medical concern, is characteri... more Malignant melanoma, a disease that is increasing in occurrence and medical concern, is characterized by the excretion of melanogens. Two qualitative tests are recommended for melanogen detection, the Thormählen test and the ferric chloride test. We evaluated the laboratory and clinical performance of these tests by subsequently re-evaluating 201 urine samples that had been submitted for routine melanogen analysis. We used (a) Thormählen, (b) ferric chloride, (c) small-scale thin-layer chromatography, and (d) spectrophotometry. Nearly 30% of Thormählen test results were equivocal. The ferric chloride test was of no value in itself or in categorizing equivocal Thormählen results as positive or negative. The small-scale chromatography was irreproducible. Prompt scanning of the Thormählen reaction product was helpful in classifying equivocal results. History review of 121 histopathologically diagnosed melanoma patients indicated that these qualitative assays were of no clinical value in...
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2012
This study assessed the need and readiness of health care institutions in Kabul and Bamyan, Afgha... more This study assessed the need and readiness of health care institutions in Kabul and Bamyan, Afghanistan for successful implementation of information and communication technology in health care (eHealth). A mixed methods design was adopted at 2 institutions in the Aga Khan Development Network in Afghanistan: the French Medical Institute for Children in Kabul and Bamyan Provincial Hospital, Bamyan. Information for the needs assessment was obtained from interviews and focus groups and eHealth readiness was assessed using a validated survey tool. The needs of institutions in the Aga Khan Development Network in Afghanistan were categorized as follows: provision of care needs; learning needs; and information management needs. eHealth readiness on average was lower in Bamyan compared with Kabul in all areas of the readiness assessment. Other institutions in Afghanistan may benefit from adopting the model of needs and readiness assessment used for Aga Khan Development Network institutions.
Studies in Health Technology and Informatics
Background: Recently there has been a steady increase in the use of Instant Messaging (IM) as a m... more Background: Recently there has been a steady increase in the use of Instant Messaging (IM) as a means of providing health and healthcare services. This growth has been particularly rapid during the ongoing COVID-19 pandemic. Many reports indicate informal services using IM, in particular WhatsApp, have arisen spontaneously, in the absence of any formal guidelines and little consideration of consent. This study documents the consent practices of healthcare professionals using IM for clinical activities in District Hospitals in KwaZulu-Natal, South Africa and compares these practices with the literature. Methods: As part of a larger audit of telemedicine activity in KwaZulu-Natal a survey questioned clinicians’ use of IM, including consent practices and awareness of regulatory guidelines. Concomitantly multiple electronic databases were searched for papers on WhatsApp use in clinical service. Inclusion criteria were: papers written in English, reported on WhatsApp in clinical use or p...
Studies in Health Technology and Informatics
Background: e-Health readiness has been described as the preparedness of healthcare institutions,... more Background: e-Health readiness has been described as the preparedness of healthcare institutions, communities, or individuals for the anticipated change brought by programmes related to ICT use. Assessment of e-health readiness prior to the implementation of e-health innovations can therefore facilitate the process of change for individuals and organisations to adopt e-health programmes and avoid disappointment. The literature shows that although many e-health readiness assessment frameworks and tools exist, none meet all the requirements for e-health readiness assessment in developing countries. The aim of this study was to develop an e-health readiness assessment framework applicable to developing countries. Methods: A three-step process gleaned from the e-health literature (literature review / material collection; analysis / content analysis; consolidation / conceptual framework synthesis), together with iterative and reflective processes based on prior research undertaken by thi...
Background: eHealth programmes in African countries face fierce competition for scarce resources.... more Background: eHealth programmes in African countries face fierce competition for scarce resources. Such initiatives should not proceed without adequate appraisal of their probable impacts, thereby acknowledging their opportunity costs and the need for appraisals to promote optimal use of available resources. However, since there is no broadly accepted eHealth impact appraisal framework available to provide guidance, and local expertise is limited, African health ministries have difficulty completing such appraisals. The Five Case Model, used in several countries outside Africa, has the potential to function as a decision-making tool in African eHealth environments and serve as a key component of an eHealth impact model for Africa. Methods: This study identifies internationally recognised metrics and readily accessible data sources to assess the applicability of the model’s five cases to African countries. Results: Ten metrics are identified that align with the Five Case Model’s five ...
Background: Health, healthcare, and healthcare system problems within the developing world are we... more Background: Health, healthcare, and healthcare system problems within the developing world are well recognised. eHealth, the use of Information and Communications Technologies (ICT) for health, is frequently suggested as one means by which to ameliorate such problems. However, to identify and implement the most appropriate ehealth solutions requires development of a thoughtful and broadly evidence-informed strategy. Most published strategies focus on health informatics solutions, neglecting the potential for other aspects of ehealth (telehealth, telemedicine, elearning, and ecommerce). This study examined the setting in Botswana to determine the need for a telemedicine-specific strategy.Methods: A situational assessment of ehealth activities in Botswana was performed through a scoping review of the scientific and grey literature using specified search terms, an interview with the project manager of the major mhealth stakeholder, and benchtop review of policies and other relevant Gov...
International Journal of E-Health and Medical Communications
E-Health continues to be implemented despite continued demonstration that it lacks value. Specifi... more E-Health continues to be implemented despite continued demonstration that it lacks value. Specific guidance regarding research approaches and methodologies would be beneficial due to the value in identifying and adopting a single model or framework for any one ‘entity’ (healthcare organisation, sub-national region, country, etc.) so that the evidence-base accumulates more rapidly and interventions can be more meaningfully compared. This paper describes a simple and systematic approach to e-health evaluation in a real-world setting, which can be applied by an evaluation team and raises the quality of e-health evaluations. The framework guides and advises users on evaluation approaches at different stages of e-health development and implementation. Termed ‘Pragmatic Evaluation,’ the approach has five principles that unfold in a staged approach that respects the collective need for timely, policy relevant, yet meticulous research.
Environment and Water Resource Management / 837: Health Informatics / 838: Modelling and Simulation / 839: Power and Energy Systems, 2016
The use of Information and Communication Technologies (ICT) in health (e-health), has been propos... more The use of Information and Communication Technologies (ICT) in health (e-health), has been proposed as a useful tool to increase efficiency in provision of healthcare. However, application and integration of e-Health still has many challenges, often resulting in implementation failure. Interested healthcare institutions in countries such as Botswana must first ensure their preparedness for the anticipated challenges brought about by programmes related to ICT use. Such preparedness is termed e-Health Readiness. Any ICT use creates e-waste (or Waste Electrical and Electronic Equipment, WEEE), Therefore one criterion for judging a country's degree of e-Health Readiness should be how it handles its e-waste. Generation of large quantities of e-waste will be an inevitable result of increased ICT consumption by the healthcare sector. This study assesses the status of ewaste management in Botswana, as one of the indicators that could be used to determine the degree of e-health readiness of Botswana. The study design was based on a literature review, and initial use of an adapted e-waste assessment questionnaire developed by the Swiss company Empa (Appendix 1). This study shows Botswana still faces challenges with e-waste management. These challenges are similar to those faced by other developing countries: an absence of infrastructure for appropriate e-waste management, an absence of legislation dealing specifically with e-waste, an absence of a framework for end-of-life (EoL) product take-back or implementation of extended producer responsibility, limited public awareness about proper waste management and disposal practices, as well as limited technically skilled human resources to deal with issues such as e-waste recycling. This study has highlighted that Botswana needs an enhanced and enforced e-waste management strategy as a catalyst towards e-Health Readiness.
Journal of the International Society For Telemedicine and Ehealth, Aug 2, 2013
Studies in health technology and informatics, 1999
Healthcare managers and policy makers will, in the immediate and near future, make major decision... more Healthcare managers and policy makers will, in the immediate and near future, make major decisions about the allocation of scarce healthcare resources for telehealth 'solutions'. In our haste to capitalize on what technology can do we may be obscuring discussion and research about what technology should do. For example, currently much attention is being paid to standardization for technological aspects of telehealth. In contrast few efforts have been made to seek standardization in regards to a broad evaluation framework for telehealth. A body of opinion believes that missing in our rush into the on-line world is a systematic approach to research into the human, social, cultural, economic, and political factors associated with healthcare. As a result we lack the tools and experience necessary to assess the true value and implications of telehealth 'solutions'. Developing general guidelines for an evaluation framework, from needs assessment through integrated research...
Telemedicine and e-Health, 2013
Objective: The main objective of this study was to develop an ehealth evaluation tool based on a ... more Objective: The main objective of this study was to develop an ehealth evaluation tool based on a conceptual framework including relevant theories for evaluating use of technology in health programs. This article presents the development of an evaluation framework for e-health programs. Materials and Methods: The study was divided into three stages: Stage 1 involved a detailed literature search of different theories and concepts on evaluation of e-health, Stage 2 plotted e-health theories to identify relevant themes, and Stage 3 developed a matrix of evaluation themes and stages of e-health programs. Results: The framework identifies and defines different stages of e-health programs and then applies evaluation theories to each of these stages for development of the evaluation tool. This framework builds on existing theories of health and technology evaluation and presents a conceptual framework for developing an e-health evaluation tool to examine and measure different factors that play a definite role in the success of e-health programs. The framework on the horizontal axis divides e-health into different stages of program implementation, while the vertical axis identifies different themes and areas of consideration for e-health evaluation. Conclusions: The framework helps understand various aspects of e-health programs and their impact that require evaluation at different stages of the life cycle. The study led to the development of a new and comprehensive e-health evaluation tool, named the Khoja-Durrani-Scott Framework for e-Health Evaluation.
Mayo Clinic Proceedings, 1989
The biosynthesis of melanin from tyrosine is reviewed as the basis for assessment of laboratory t... more The biosynthesis of melanin from tyrosine is reviewed as the basis for assessment of laboratory tests that might potentially aid in the diagnosis and management of patients with malignant melanoma. These tests include qualitative and quantitative assays for the intermediates in metabolism of melanin and catecholamines, enzyme assays, metal ion analyses, and, most recently, immunoassays. Although currently no role exists for the clinical laboratory in the early diagnosis of malignant melanoma, serial quantitative analyses of total or individual melanogens or of catecholamine metabolites in urine or plasma specimens may be of value in the management of patients with this disorder. Immunologically based methods for the diagnosis and management of malignant melanoma hold some promise for the future.
Journal of Medical Internet Research, 2013
Significant investment in eHealth solutions is being made in nearly every country of the world. H... more Significant investment in eHealth solutions is being made in nearly every country of the world. How do we know that these investments and the foregone opportunity costs are the correct ones? Absent, poor, or vague eHealth strategy is a significant barrier to effective investment in, and implementation of, sustainable eHealth solutions and establishment of an eHealth favorable policy environment. Strategy is the driving force, the first essential ingredient, that can place countries in charge of their own eHealth destiny and inform them of the policy necessary to achieve it. In the last 2 years, there has been renewed interest in eHealth strategy from the World Health Organization (WHO), International Telecommunications Union (ITU), Pan American Health Organization (PAHO), the African Union, and the Commonwealth; yet overall, the literature lacks clear guidance to inform countries why and how to develop their own complementary but locally specific eHealth strategy. To address this gap, this paper further develops an eHealth Strategy Development Framework, basing it upon a conceptual framework and relevant theories of strategy and complex system analysis available from the literature. We present here the rationale, theories, and final eHealth strategy development framework by which a systematic and methodical approach can be applied by institutions, subnational regions, and countries to create holistic, needs- and evidence-based, and defensible eHealth strategy and to ensure wise investment in eHealth.
Clinical Biochemistry, 1987
Canadian Journal of Microbiology, 1986
The effect of trace metal nutrition on the functioning of the patulin biosynthetic pathway in sub... more The effect of trace metal nutrition on the functioning of the patulin biosynthetic pathway in submerged cultures of Penicillium urticae (NRRL 2159A) was examined by both chromatographic and enzymological means. Comprehensive metal ion analysis showed generally low levels of contaminating metal ions in media components. Of eight metal ions examined, only manganese strongly influenced secondary metabolite production. In control cultures or cultures deficient in calcium, iron, cobalt, copper, zinc, or molybdenum, pathway metabolites appeared in the medium at about 25 h after inoculation. The first pathway-specific metabolite, 6-methylsalicylic acid, accumulated only transiently before being converted to patulin whose concentration steadily increased. In manganese-deficient cultures, however, 6-methylsalicylic acid continued to accumulate, with only minor amounts of patulin being produced. Additionally, a marker enzyme for the pathway showed only 0–20% of control activity. Clear dose re...