-
International Journal of Telemedicine... 2024The Virtual Clinic Mobile Application (VCMA) is a valuable tool for managing and remotely monitoring patients with various medical conditions. It can alleviate the... (Review)
Review
The Virtual Clinic Mobile Application (VCMA) is a valuable tool for managing and remotely monitoring patients with various medical conditions. It can alleviate the strain on outpatient services and offer follow-up options for patients who do not require a physical examination. A thorough understanding of recent literature can assist in identifying suitable functionalities for new development and future improvement of current applications (apps). This review study is aimed at identifying functional and nonfunctional requirements for VCMA. This study conducted a systematic search using databases such as PubMed, Scopus, ISI Web of Science, Science Direct, ProQuest, and IEEE to gather requirements of VCMA articles published in English from the inception of the databases up to April 2022. Out of a total of 1223 articles, 76 met the inclusion criteria. These articles were then analyzed using conventional content analysis to extract and categorize their requirements. Two main themes and 8 subthemes in terms of VCMA requirements were extracted as follows: (1) functional requirements with 3 subthemes (demographic data documentation, health record, general features of the user interface (UI)); (2) nonfunctional requirements with 5 subthemes (usability, accessibility, compatibility, efficiency, and security). The findings highlight the importance of mHealth solutions for virtual care and the need for the development of apps based on the extracted functional and nonfunctional requirements for VCMA; however, controlled trials are necessary. It is recommended that transparent reporting of mHealth interventions be prioritized to enable effective interpretation of the extracted data.
PubMed: 38899062
DOI: 10.1155/2024/7800321 -
Health Science Reports Jun 2024Stroke is the third most common cause of disability and the second most common cause of death worldwide. Prognosis assessment in acute ischemic stroke is challenging for...
BACKGROUND
Stroke is the third most common cause of disability and the second most common cause of death worldwide. Prognosis assessment in acute ischemic stroke is challenging for clinicians. The development of simple and easily performed prognostic markers that correlate with the outcome of patients can be of immense benefit. The aim of this study was to find out the prognostic significance of total leukocyte count, red cell distribution width and erythrocyte sedimentation rate in patients with acute ischemic stroke.
METHODS
A descriptive cross-sectional study was conducted in a tertiary center after ethical approval from the Institutional Review Committee. The study period spanned from April 18, 2022 to June 17, 2023, a period of 14 months. 136 patients diagnosed with acute ischemic stroke with total leukocyte count (TLC), red cell distribution width (RDW), erythrocyte sedimentation rate (ESR), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) were included in the study after fulfilling the inclusion criteria. The modified Rankin Scale (mRS) was obtained 28 days following admission. Data was collected and analyzed through Microsoft Excel 365 and SPSS version 22. Spearman Correlation and multivariate regression analysis were used to analyze the association.
RESULTS
TLC, RDW, and ESR were significantly associated with an mRS at 28 days showing a positive correlation between them. Total in-hospital mortality has been significantly associated with TLC only ( < 0.05).
CONCLUSIONS
The prognostic value of TLC, RDW, and ESR in patients with acute ischemic stroke was found to be significant and similar to the studies done in similar settings.
PubMed: 38899003
DOI: 10.1002/hsr2.2168 -
Frontiers in Public Health 2024American Indian/Alaska Native (AI/AN) communities are more likely to suffer negative consequences related to substance misuse. The COVID-19 pandemic exacerbated the...
INTRODUCTION
American Indian/Alaska Native (AI/AN) communities are more likely to suffer negative consequences related to substance misuse. The COVID-19 pandemic exacerbated the opioid poisoning crisis, in combination with ongoing treatment barriers resulting from settler-colonialism, systemic oppression and racial discrimination. AI/AN adults are at greatest risk of COVID-19 related serious illness and death. In collaboration with an Indigenous community advisory board and Tribal leadership, this study explored AI/AN treatment provider perceptions of client-relatives' (i.e., SUD treatment recipients) experiences during the pandemic from 2020 to 2022.
METHODS
Providers who underwent screening and were eligible to participate ( = 25) represented 6 programs and organizations serving rural and urban areas in Washington, Utah, and Minnesota. Participants engaged in audio-recorded 60-90 min semi-structured individual interviews conducted virtually via Zoom. The interview guide included 15 questions covering regulatory changes, guidance for telemedicine, policy and procedures, staff communication, and client-relatives' reactions to implemented changes, service utilization, changes in treatment modality, and perceptions of impact on their roles and practice. Interview recordings were transcribed and de-identified. Members of the research team independently reviewed transcripts before reaching consensus. Coding was completed in Dedoose, followed by analyses informed by a qualitative descriptive approach.
RESULTS
Five main domains were identified related to client-relative experiences during the COVID-19 pandemic, as observed by providers: (1) accessibility, (2) co-occurring mental health, (3) social determinants of health, (4) substance use, coping, and harm reduction strategies, and (5) community strengths. Providers reported the distinctive experiences of AI/AN communities, highlighting the impact on client-relatives, who faced challenges such as reduced income, heightened grief and loss, and elevated rates of substance use and opioid-related poisonings. Community and culturally informed programming promoting resilience and healing are outlined.
CONCLUSION
Findings underscore the impact on SUD among AI/AN communities during the COVID-19 pandemic. Identifying treatment barriers and mental health impacts on client-relatives during a global pandemic can inform ongoing and future culturally responsive SUD prevention and treatment strategies. Elevating collective voice to strengthen Indigenous informed systems of care to address the gap in culturally-and community-based services, can bolster holistic approaches and long-term service needs to promote SUD prevention efforts beyond emergency response efforts.
Topics: Humans; COVID-19; Alaska Natives; Opioid-Related Disorders; Adult; Female; Male; Substance-Related Disorders; Indians, North American; American Indian or Alaska Native; SARS-CoV-2; Middle Aged; United States; Qualitative Research
PubMed: 38898893
DOI: 10.3389/fpubh.2024.1356033 -
BMC Medical Informatics and Decision... Jun 2024Digital health is being used as an accelerator to improve the traditional healthcare system, aiding countries in achieving their sustainable development goals. Burkina...
BACKGROUND
Digital health is being used as an accelerator to improve the traditional healthcare system, aiding countries in achieving their sustainable development goals. Burkina Faso aims to harmonize its digital health interventions to guide its digital health strategy for the coming years. The current assessment represents upstream work to steer the development of this strategic plan.
METHODS
This was a quantitative, descriptive study conducted between September 2022 and April 2023. It involved a two-part survey: a self-administered questionnaire distributed to healthcare information managers in facilities, and direct interviews conducted with software developers. This was complemented by a documentary review of the country's strategic and standards documents on digital transformation.
RESULTS
Burkina Faso possesses a relatively comprehensive collection of governance documents pertaining to digital transformation. The study identified a total of 35 digital health interventions. Analysis showed that 89% of funding originated from technical and financial partners as well as the private sector. While the use of open-source technologies for the development of the applications, software, or platforms used to implement these digital health interventions is well established (77%), there remains a deficiency in the integration of data from different platforms. Furthermore, the classification of digital health interventions revealed an uneven distribution between the different elements across domains: the health system, the classification of digital health interventions (DHI), and the subsystems of the National Health Information System (NHIS). Most digital health intervention projects are still in the pilot phase (66%), with isolated electronic patient record initiatives remaining incomplete. Within the public sector, these records typically take the form of electronic registers or isolated specialty records in a hospital. Within the private sector, tool implementation varies based on expressed needs. Challenges persist in adhering to interoperability norms and standards during tool design, with minimal utilization of the data generated by the implemented tools.
CONCLUSION
This study provides an insightful overview of the digital health environment in Burkina Faso and highlights significant challenges regarding intervention strategies. The findings serve as a foundational resource for developing the digital health strategic plan. By addressing the identified shortcomings, this plan will provide a framework for guiding future digital health initiatives effectively.
Topics: Burkina Faso; Humans; Delivery of Health Care; Telemedicine; Digital Health
PubMed: 38898435
DOI: 10.1186/s12911-024-02574-4 -
Psoriasis healthcare during the COVID-19 pandemic: a survey among psoriasis patients (PsoCovidCare).The Journal of Dermatological Treatment Dec 2024During the COVID-19 pandemic, psoriasis care underwent significant changes in consultation methods and treatment management. However, comprehensive data on these changes...
BACKGROUND
During the COVID-19 pandemic, psoriasis care underwent significant changes in consultation methods and treatment management. However, comprehensive data on these changes and patient perceptions are limited.
AIMS
To evaluate the pandemic's implications on psoriasis patients, focusing on access to information, consultation methods, patient satisfaction, disease control assessment, and treatment management changes.
METHODS
A multicenter cross-sectional survey was performed in psoriasis patients from 4 dutch hospitals during the second wave of the pandemic.
RESULTS
Among 551 respondents, approximately 55% received information their treatment in relation to COVID-19 from their treating physician, while 16.3% sought information online. Consultation methods were shifted to remote formats for 43.6% of patients, primarily phone and the shift was often initiated by physicians. Overall patient satisfaction during the pandemic scored high (8.0), with remote consultations scoring between 8.0-9.0. Patients on biological treatment reported better disease control (8.0), compared to those on topical (6.0) or conventional systemic treatments (7.0). However, within the systemic treatment group and biologics group, a notable percentage interrupted (16.3% resp. 12.9%) or discontinued treatment (14.1 resp. 10.6%) during the pandemic. Disease control was moderate-to-good assessed by 75% of patients receiving face-to-face and 68% receiving remote consultations.
CONCLUSION
Remote care appears to be a viable alternative to face-to-face consultations, with potential benefits in enhancing access to information provided by treating physicians.
Topics: Humans; Psoriasis; COVID-19; Cross-Sectional Studies; Male; Female; Middle Aged; Patient Satisfaction; Netherlands; Adult; Surveys and Questionnaires; SARS-CoV-2; Telemedicine; Aged; Remote Consultation
PubMed: 38897615
DOI: 10.1080/09546634.2024.2369616 -
JMIR MHealth and UHealth Jun 2024The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial.
BACKGROUND
The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence.
OBJECTIVE
We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country.
METHODS
A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication.
RESULTS
Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score.
CONCLUSIONS
The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157.
Topics: Humans; Female; Male; Hypertension; Medication Adherence; Pakistan; Middle Aged; Telemedicine; Adult; Single-Blind Method; Antihypertensive Agents; Treatment Outcome; Aged
PubMed: 38896837
DOI: 10.2196/50248 -
Revista Da Associacao Medica Brasileira... 2024The aim of this study was to understand the dynamics of families with children with myelomeningocele undergoing intrauterine fetal surgery.
OBJECTIVE
The aim of this study was to understand the dynamics of families with children with myelomeningocele undergoing intrauterine fetal surgery.
METHODS
A retrospective cohort pilot study was carried out with 11 mothers of children who had undergone intrauterine myelomeningocele repair. Participants in this study responded to an electronic questionnaire (via Google Forms), developed by the study authors, that consisted of 22 multiple-choice questions, of which 17 were closed-ended and 5 had a standardized format.
RESULTS
The mean (± standard deviation) of the mothers' age was 37.6 (± 3.5) years. The median of gestational age at delivery and birthweight were 34.9 (range, 33 to 36.1) weeks and 2,300 (range, 1,950 to 2,763) g, respectively. The majority of mothers were white (81.8%), had university degree (81.8%), were Catholic (63.6%), and were married (100%). The majority of mothers rated their relationship with their husband, family, and friends as excellent (54.5, 72.7, and 54.5%, respectively). All 11 mothers reported that the newborn with myelomeningocele was born <37 weeks gestation and the birthweight most often<2,500 g. Approximately 64% of the mothers reported that their child required adaptations or had special needs, of which walking aids (50%) and bladder control (50%) were the most common ones.
CONCLUSION
Telemedicine proved to be a useful tool in the long-term follow-up of children who underwent intrauterine surgery to correct myelomeningocele.
Topics: Humans; Meningomyelocele; Pilot Projects; Female; Adult; Retrospective Studies; Mothers; Telemedicine; Surveys and Questionnaires; Pregnancy; Infant, Newborn; Family Relations; Gestational Age
PubMed: 38896734
DOI: 10.1590/1806-9282.20231327 -
Ciencia & Saude Coletiva Jun 2024Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to... (Review)
Review
Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.
Topics: Humans; Primary Health Care; COVID-19; Chronic Disease; Telemedicine; Delivery of Health Care; Information Technology
PubMed: 38896673
DOI: 10.1590/1413-81232024296.07022023 -
Frontiers in Digital Health 2024The Research Program (Program) is an ongoing epidemiologic cohort study focused on collecting lifestyle, health, socioeconomic, environmental, and biological data from...
INTRODUCTION
The Research Program (Program) is an ongoing epidemiologic cohort study focused on collecting lifestyle, health, socioeconomic, environmental, and biological data from 1 million US-based participants. The Program has a focus on enrolling populations that are underrepresented in biomedical research (UBR). Federally Qualified Health Centers (FQHCs) are a key recruitment stream of UBR participants. The Program is digital by design where participants complete surveys via web-based platform. As many FQHC participants are not digitally ready, recruitment and retention is a challenge, requiring high-touch methods. However, high-touch methods ceased as an option in March 2020 when the Program paused in-person activities because of the pandemic. In January 2021, the Program introduced Computer Assisted Telephone Interviewing (CATI) to help participants complete surveys remotely. This paper aims to understand the association between digital readiness and mode of survey completion (CATI vs. web-based platform) by participants at FQHCs.
METHODS
This study included 2,089 participants who completed one or more surveys via CATI and/or web-based platform between January 28, 2021 (when CATI was introduced) and January 27, 2022 (1 year since CATI introduction).
RESULTS AND DISCUSSION
Results show that among the 700 not-digitally ready participants, 51% used CATI; and of the 1,053 digitally ready participants, 30% used CATI for completing retention surveys. The remaining 336 participants had "Unknown/Missing" digital readiness of which, 34% used CATI. CATI allowed survey completion over the phone with a trained staff member who entered responses on the participant's behalf. Regardless of participants' digital readiness, median time to complete retention surveys was longer with CATI compared to web. CATI resulted in fewer skipped responses than the web-based platform highlighting better data completeness. These findings demonstrate the effectiveness of using CATI for improving response rates in online surveys, especially among populations that are digitally challenged. Analyses provide insights for NIH, healthcare providers, and researchers on the adoption of virtual tools for data collection, telehealth, telemedicine, or patient portals by digitally challenged groups even when in-person assistance continues to remain as an option. It also provides insights on the investment of staff time and support required for virtual administration of tools for health data collection.
PubMed: 38895514
DOI: 10.3389/fdgth.2024.1379290 -
Journal of Public Health Research Jan 2024With the progressive digitization of health services and the current spread of Telemedicine and e-Health, it became clear that promoting Digital health equity (DHE) is...
Digital determinants of health as a way to address multilevel complex causal model in the promotion of Digital health equity and the prevention of digital health inequities: A scoping review.
BACKGROUND
With the progressive digitization of health services and the current spread of Telemedicine and e-Health, it became clear that promoting Digital health equity (DHE) is necessary to support health potential, to avoid that some individuals can incur in unintended inequities. In this paper, we address the complex causal process(es) that may generate risk of inequities, considering the so-called "Digital Determinants of health" (DDoH) and their relationship with determinants of health (DoH).
DESIGN AND METHODS
We conducted a scoping review, according to methodological framework proposed in PRISMA-ScR guidelines, on the definition of DDoH (Scopus, Pubmed and Web of Science electronic databases). Inclusion criteria: papers on the definition of DDoH, no time limits, all study designs eligible.
RESULTS
There is an agreement on the link between DDoHs and "digital divide" and on their effects on a wide range of health, functioning outcomes, both as barriers and as facilitators. Authors proposed to modify or integrate with DDoHs the "Rainbow model" or other conceptual models on DoH. To promote DHE, authors suggest considering a multidimensional complex causal model, with interdependence among the different levels and the mutually reinforcing effects.
CONCLUSION
To study DDoH and their relationship with main determinants of health could be a way to address the complex causal model in the promotion of DHE. However, as they act in a multidimensional causal context, any intervention may consider the interdependence among different involved levels, within them, and the mutually reinforcing effects. Further research is needed to gain a more complete picture of the field.
PubMed: 38895154
DOI: 10.1177/22799036231220352