eHealth in TB clinical management

HumanInsight eHealth in TB clinical management

Int J Tuberc Lung Dis. 2022 Dec 1;26(12):1151-1161. doi: 10.5588/ijtld.21.0602.


BACKGROUND: The constant expansion of internet and mobile technologies has created new opportunities in the field of eHealth, or the digital delivery of healthcare services. This TB meta-analysis aims to examine eHealth and its impact on TB clinical management in order to formulate recommendations for further development.METHODS: A systematic search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework in PubMed and Embase of articles published up to April 2021. Screening, extraction and quality assessment were performed by two independent researchers. Studies evaluating an internet and/or mobile-based eHealth intervention with an impact on TB clinical management were included. Outcomes were organised following the five domains described in the WHO "Recommendations on Digital Interventions for Health System Strengthening" guideline.RESULTS: Search strategy yielded 3,873 studies, and 89 full texts were finally included. eHealth tended to enhance screening, diagnosis and treatment indicators, while being cost-effective and acceptable to users. The main challenges concern hardware malfunction and software misuse.CONCLUSION: This study offers a broad overview of the innovative field of eHealth applications in TB. Different studies implementing eHealth solutions consistently reported on benefits, but also on specific challenges. eHealth is a promising field of research and could enhance clinical management of TB.

PMID:36447317 | DOI:10.5588/ijtld.21.0602

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Telehealth care system for chronic disease management of middle-aged and older adults in remote areas

HumanInsight Telehealth care system for chronic disease management of middle-aged and older adults in remote areas

Health Informatics J. 2022 Oct-Dec;28(4):14604582221141835. doi: 10.1177/14604582221141835.


BACKGROUND: With the global spread of the coronavirus disease pandemic, governments have become more interested in applying telehealth technology in 2020.

OBJECTIVE: This study integrates the technology acceptance model and information system success model to explore the influence of satisfaction, attitudes, and continued use of telehealth systems among middle-aged and older people in remote areas.

METHODS: The study participants were patients over 40 years (inclusive) who lived in remote townships in eastern Taiwan, were diagnosed with diabetes or hypertension, and used the telehealth care system. In total, 545 questionnaires were returned, resulting in a recovery rate of 99%.

RESULTS: Accepting the hypothesized structural equation model, this study found that information, system, and service quality were influenced by the mediating effect of perceived ease of use and the perceived usefulness of the technology acceptance model. The use of telehealth care systems among chronic patients increased significantly.

PMID:36447304 | DOI:10.1177/14604582221141835

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A scoping review of applications of the Consolidated Framework for Implementation Research (CFIR) to telehealth service implementation initiatives

HumanInsight A scoping review of applications of the Consolidated Framework for Implementation Research (CFIR) to telehealth service implementation initiatives

BMC Health Serv Res. 2022 Nov 30;22(1):1450. doi: 10.1186/s12913-022-08871-w.


BACKGROUND: The Consolidated Framework for Implementation Research (CFIR), introduced in 2009, has the potential to provide a comprehensive understanding of the determinants of implementation-effectiveness of health service innovations. Although the CFIR has been increasingly used in recent years to examine factors influencing telehealth implementation, no comprehensive reviews currently exist on the scope of knowledge gained exclusively from applications of the CFIR to telehealth implementation initiatives. This review sought to address this gap.

METHODS: PRISMA-ScR criteria were used to inform a scoping review of the literature. Five academic databases (PUBMED, PROQUEST, SCIDIRECT, CINAHL, and WoS) were searched for eligible sources of evidence from 01.01.2010 through 12.31.2021. The initial search yielded a total of 18,388 records, of which, 64 peer-reviewed articles met the inclusion criteria for the review. Included articles were reviewed in full to extract data, and data collected were synthesized to address the review questions.

RESULTS: Most included articles were published during or after 2020 (64%), and a majority (77%) were qualitative or mixed-method studies seeking to understand barriers or facilitators to telehealth implementation using the CFIR. There were few comparative- or implementation-effectiveness studies containing outcome measures (5%). The database search however, revealed a growing number of protocols for implementation-effectiveness studies published since 2020. Most articles (91%) reported the CFIR Inner Setting domain (e.g., leadership engagement) to have a predominant influence over telehealth implementation success. By comparison, few articles (14%) reported the CFIR Outer Setting domain (e.g., telehealth policies) to have notable influence. While more (63%) telehealth initiatives were focused on specialty (vs primary) care, a vast majority (78%) were focused on clinical practice over medical education, healthcare administration, or population health.

CONCLUSIONS: Organized provider groups have historically paid considerable attention to advocating for telehealth policy (Outer Setting) reform. However, results suggest that for effective telehealth implementation, provider groups need to refocus their efforts on educating individual providers on the complex inter-relationships between Inner Setting constructs and telehealth implementation-effectiveness. On a separate note, the growth in implementation-effectiveness study protocols since 2020, suggests that additional outcome measures may soon be available, to provide a more nuanced understanding of the determinants of effective telehealth implementation based on the CFIR domains and constructs.

PMID:36447279 | DOI:10.1186/s12913-022-08871-w

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Breast cancer-related apps in Google Play and App store: evaluate their functionality and quality

HumanInsight Breast cancer-related apps in Google Play and App store: evaluate their functionality and quality

J Cancer Surviv. 2022 Nov 30. doi: 10.1007/s11764-022-01290-0. Online ahead of print.


AIM: This study aimed to evaluate the functionality and quality of breast cancer apps that can be accessed from Turkey.

METHODS: In this study, a systematic search strategy was used to identify free mobile apps on breast cancer available in the App and Google Play stores. According to the study's PRISMA flowchart, 707 apps met the inclusion criteria. The Mobile App Rating Scale (MARS) assessed the quality of the apps.

RESULTS: Mobile apps focused on the categories of communication, education, and treatment order/plan. The mean MARS quality score for all apps was 3.4, and according to the mean score of the subscales, they were categorized as functionality, aesthetics, information quality, and participation. In addition, the mean scores of the subscales were listed on MARS as functionality, aesthetics, knowledge quality, and participation.

CONCLUSION: Nowadays, "e-health" apps are attracting attention in the treatment of health problems. While the apps in download stores appear to provide basic information about breast cancer, they offer limited and personalized problem management related to prevention, early detection, and screening. Support from healthcare professionals and further efforts can be made to develop innovative technologies and apps that include evidence-based informational content about breast cancer.

IMPLICATIONS FOR CANCER SURVIVORS: In the process of breast cancer information, survivors can be encouraged to manage this process using e-health services.

PMID:36447005 | DOI:10.1007/s11764-022-01290-0

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Situation and activity of the liaison geriatrics units with nursing homes in the Community of Madrid

HumanInsight Situation and activity of the liaison geriatrics units with nursing homes in the Community of Madrid

Rev Esp Geriatr Gerontol. 2022 Nov 26:S0211-139X(22)00172-X. doi: 10.1016/j.regg.2022.11.001. Online ahead of print.


INTRODUCTION: In June 2020, after the first wave of the COVID-19 pandemic, Hospital-Based Liaison Geriatrics units and Primary Care nursing care units were created in the Community of Madrid to improve health care for residents in a coordinated manner.

OBJECTIVE: To analyze the situation and the activity of the Hospital-Based Liaison Geriatrics units.

MATERIAL AND METHODS: A cross-sectional study was conducted using an electronic survey prepared and sent to the liaison geriatricians in March 2022, including the following sections: available resources, areas of health care, reasons for consultation, care interventions, research and teaching activity, profiles of residents attended and coordination with other health professionals at that time. A descriptive analysis of the data was performed.

RESULTS: 100% of the existing Liaison Geriatrics units responded, describing essential differences in human resources, hours of care and volume of patients attended. Regarding the care activity of these units, they highlighted the telematic consultation, and the face-to-face assessment during hospitalization and in the emergency department. The main reasons for assessment were decision-making, acute pathology and geriatric syndromes; and the in-hospital drug management or orthoprosthetic aids among the interventions.

CONCLUSIONS: Despite the heterogeneity in the resources of the different Liaison Geriatric units, there is a similarity in their care activity and the use of telemedicine. It is common to request an assessment for decision-making, acute pathology or geriatric syndromes and interventions for managing in-hospital drugs and tests, orthoprosthetic aids and coordination with other specialists. Liaison Geriatrics units must continue leading quality health care coordinated with nursing homes, as well as continuity of care for residents.

PMID:36446658 | DOI:10.1016/j.regg.2022.11.001

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COVID-19 Telehealth Service Can Increase Access to the Health Care System and Become a Cost-Saving Strategy

HumanInsight COVID-19 Telehealth Service Can Increase Access to the Health Care System and Become a Cost-Saving Strategy

Telemed J E Health. 2022 Nov 23. doi: 10.1089/tmj.2022.0240. Online ahead of print.


Introduction: Data addressing the economic aspects of telehealth initiatives are incipient. This study aimed to evaluate the labor costs for running a COVID-19 telehealth system and its potential incremental access to health care service. Methods: From July 2020 to July 2021, data from a Brazilian teleconsultation service were analyzed. Labor costs were estimated by time-driven activity-based costing. A Generalized Reduced Gradient solving method was coded to maximize the mean incremental access rate and two scenarios were considered to compare the teleconsultation with the in-person consultation: (1) only the length of time that patients spent with a clinician in an in-person consultation was accounted and (2) in addition to the medical consultation, nursing screening was accounted. The mean incremental access rate of the teleconsultation service was defined as a maximization objective in the model. Results: Mean labor costs per medical and nursing teleconsultations are Int$ 24 and Int$ 10, based on data analyses from 25,258 patients. Telemonitoring a patient with a daily call for 7 days costs, on average, Int$ 14. COVID-19 teleconsultation service represents, on average, an incremental access to medical consultation rate of 35% to 52% (min 23% max 63%) for the scenarios (1) and (2), respectively, and considering the current consumed budget for this service. Discussion: A COVID-19 telehealth service contributes to increasing access to the health care system without increasing costs. These services can be included in the bundle of care strategies offered in a national public health care system that looks for more sustainable strategies to provide care.

PMID:36445772 | DOI:10.1089/tmj.2022.0240

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Use of Telehealth Among Cancer Survivors: A Scoping Review

HumanInsight Use of Telehealth Among Cancer Survivors: A Scoping Review

Telemed J E Health. 2022 Nov 23. doi: 10.1089/tmj.2022.0351. Online ahead of print.


Background: Long-term cancer survivors have specific needs that are frequently neglected. Telehealth, as a new form of health care, can benefit this growing population. Objective: To identify, analyze, and synthesize the existing evidence on the use of telehealth in the care of cancer survivors after the end of treatment. Methods: A scoping review was conducted in the databases PubMed, CINAHL, COCHRANE, SCIELO, DIALNET, and LILACS and reference institutions in cancer. Results: The initial search yielded 406 publications with 59 articles meeting the eligibility criteria. There are different types of telehealth (video calls, phone calls, websites, mobile applications, and short message services) used for the care of cancer survivors. Most telehealth interventions focus on improving the physical and mental spheres of quality of life in the extended survival phase (from 1 to 3 years postdiagnosis), with only two articles (3%) on long-term cancer survivors (>5 years postdiagnosis). Survivors are satisfied with telehealth interventions, noting the importance of improving comprehensibility, personalization of the platforms, and the lack of excessive information included. Conclusions: Telehealth is a feasible modality for cancer survival care. The scarcity of interventions aimed at long-term survivors stands out, as does the general neglect of the social and spiritual spheres of quality of life. Implications for Practice: Telehealth platforms must adapt their content, format, and items to the preferences reported by the survivors.

PMID:36445755 | DOI:10.1089/tmj.2022.0351

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The Impact of Consumer Wearable Devices on Physical Activity and Adherence to Physical Activity in Patients with Cardiovascular Disease: A Systematic Review of Systematic Reviews and Meta-Analyses

HumanInsight The Impact of Consumer Wearable Devices on Physical Activity and Adherence to Physical Activity in Patients with Cardiovascular Disease: A Systematic Review of Systematic Reviews and Meta-Analyses

Telemed J E Health. 2022 Nov 23. doi: 10.1089/tmj.2022.0280. Online ahead of print.


Objective: Consumer wearable devices allow physical activity to be measured objectively, which can be useful in remote cardiovascular disease management. This review aimed to summarize the effects of using wearable devices to monitor physical activity/adherence to physical activity in adults with cardiovascular disease. Methods: The review used The Cochrane Overview of Reviews Methodology. The databases searched were PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane Database of Systematic Reviews, the date of the last search was October 12, 2021. Risk of bias was assessed using the AMSTAR-2® tool. Results: Of the 767 records, we identified 6 systematic reviews (SRs) and meta-analyses (MA) that met our inclusion criteria. The individual SRs did not consistently favor the use of wearables, but the MA syntheses each found significant effects, favoring wearable devices in measures, including mean steps per day and mean time spent completing moderate-to-vigorous physical activity. The MA on adherence to cardiac rehabilitation (CR) found greater adherence to CR with the use of a mobile app than with no app support. Summary: Within this review, there were SRs demonstrating no difference and reviews indicating a positive impact with the use of wearables for physical activity/adherence measures in individuals with cardiovascular conditions, with no studies demonstrating a negative impact. The six SR/MAs included had methodological flaws, which introduced potential biases. Additionally, the MAs included a small number of studies, which limits their generalizability. The protocol for this review was registered on PROSPERO, the international prospective register of systematic reviews (#CRD42021286699).

PMID:36445750 | DOI:10.1089/tmj.2022.0280

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Artificial Intelligence-Driven Serious Games in Health Care: Scoping Review

HumanInsight Artificial Intelligence-Driven Serious Games in Health Care: Scoping Review

JMIR Serious Games. 2022 Nov 29;10(4):e39840. doi: 10.2196/39840.


BACKGROUND: Artificial intelligence (AI)-driven serious games have been used in health care to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state to plan on how to leverage them in the current and future health care needs.

OBJECTIVE: This study aimed to explore the features of AI-driven serious games in health care as reported by previous research.

METHODS: We conducted a scoping review to achieve the abovementioned objective. The most popular databases in the information technology and health fields (ie, MEDLINE, PsycInfo, Embase, CINAHL, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched using keywords related to serious games and AI. Two reviewers independently performed the study selection process. Three reviewers independently extracted data from the included studies. A narrative approach was used for data synthesis.

RESULTS: The search process returned 1470 records. Of these 1470 records, 46 (31.29%) met all eligibility criteria. A total of 64 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games were used for rehabilitation in most of the studies. The most common genres of serious games were role-playing games, puzzle games, and platform games. Unity was the most prominent game engine used to develop serious games. PCs were the most common platform used to play serious games. The most common algorithm used in the included studies was support vector machine. The most common purposes of AI were the detection of disease and the evaluation of user performance. The size of the data set ranged from 36 to 795,600. The most common validation techniques used in the included studies were k-fold cross-validation and training-test split validation. Accuracy was the most commonly used metric for evaluating the performance of AI models.

CONCLUSIONS: The last decade witnessed an increase in the development of AI-driven serious games for health care purposes, targeting various health conditions, and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. Although the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

PMID:36445731 | DOI:10.2196/39840

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Changing landscape of living kidney donation and the role of telemedicine

HumanInsight Changing landscape of living kidney donation and the role of telemedicine

Curr Opin Nephrol Hypertens. 2023 Jan 1;32(1):81-88. doi: 10.1097/MNH.0000000000000848. Epub 2022 Oct 21.


PURPOSE OF REVIEW: There has been a decline in living kidney donation over the last two decades. Donors from low-income families or racial/ethnic minorities face greater disproportionate geographic, financial, and logistical barriers to completing lengthy and complex evaluations. This has contributed to the decreased proportion of these subgroups. The authors view telemedicine as a potential solution to this problem.

RECENT FINDINGS: Since the initial decline of donors in 2005, biologically related donors have experienced a lack of growth across race/ethnicity. Conversely, unrelated donors have emerged as the majority of donors in recent years across race/ethnicity, except for unrelated black donors. Disparities in access to living kidney donation persist. Telemedicine using live-video visits can overcome barriers to access transplant centers and facilitate care coordination. In a U.S. survey, nephrologists, surgeons, coordinators, social workers, and psychologists/psychologists across transplant centers are favorably disposed to use telemedicine for donor evaluation/follow-up beyond the coronavirus disease 2019 pandemic. However, with the waning of relaxed telemedicine regulations under the Public Health Emergency, providers perceive payor policy and out-of-state licensing as major factors hindering telemedicine growth prospects.

SUMMARY: Permanent federal and state policies that support telemedicine services for living kidney donation can enhance access to transplant centers and help overcome barriers to donor evaluation.

PMID:36444666 | DOI:10.1097/MNH.0000000000000848

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