Tibetan medicine and integrative health: validity testing and refinement of the constitutional self-assessment tool and lifestyle guidelines tool.

CONTEXT: Tibetan medicine offers an ancient, timely model for the promotion of health and treatment of disease by teaching individuals to make healthy lifestyle choices. This holistic model consists of analyzing one's unique constitution and recommending supportive lifestyle modifications. An experienced Tibetan medicine practitioner is the gold standard for constitutional assessment. Because few Tibetans practice Tibetan medicine in the United States, research-based tools with content and criterion validity are needed for self-assessment. OBJECTIVE: To test the validity of and refine the Constitutional Self-Assessment Tool (CSAT) and Lifestyle Guidelines Tool (LGT). DESIGN: Mixed methods pilot study conducted in three phases. SETTING: Tibetan Medical Institute (TMI) of His Holiness the Dalai Lama, Dharamsala, India and the University of Minnesota, a U.S. research University. PARTICIPANTS: Six TMI senior faculty; 88 students at the university. METHODS: Phase 1: TMI faculty evaluated the tools' content validity. Phase 2: 59 students completed the CSAT, had a Tibetan medicine consultation, completed the LGT, and answered qualitative questions. Phase 3: 29 students studying Tibetan medicine followed a modified phase 2 method. Quantitative and phenomenological analyses were performed to investigate the CSAT's criterion validity (agreement of CSAT results and consultations) and refine the tools. RESULTS: The tools were shown to have high content validity. Phase 2 CSAT had 51% agreement and 0.24 kappa statistic, suggesting fair criterion validity. Phase 3-refined CSAT had 76% agreement and 0.50 kappa statistic, suggesting moderate criterion validity. CONCLUSION: The refined CSAT and LGT in Appendix A and B demonstrate the potential for additional research and use in integrated care.

Screening fetal echocardiography by telemedicine: efficacy and community acceptance.

OBJECTIVE: Our aim was to assess whether tertiary level screening fetal echocardiography can be extended to primary care facilities with telemedicine assistance. METHODS: Assessment of image quality and the adequacy of fetal echocardiograms recorded after random transmission at 128, 384, or 768 kbits/s was performed. Live fetal echocardiograms were transmitted at 384 kbits/s (3 integrated services digital network lines) from the remote primary care center. Patient satisfaction was assessed by surveys obtained after office-based and telemedicine consultations. RESULTS: A total of 58 recorded normal studies had similar image quality and adequacy on transmission at 384 and 768 kbits/s (P =.08 and.49, respectively) and were significantly better than 128 kbits/s (P <.01). During live screening transmitted at 384 kbits/s from the primary care center, 3 of 34 fetuses were diagnosed with heart disease. Surveys from patients with direct physician contact and by telemedicine showed a high satisfaction with telemedicine-assisted screening and counseling. CONCLUSION: Adequate screening for fetal heart disease is technically feasible at or above data transmission rates of 384 kbits/s. Community acceptance for telemedicine-assisted screening and counseling is not adversely affected by a lack of direct personal contact with the specialist.