Preliminary needs assessment of mobile technology use for healthcare among homeless veterans

Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans\u27 IT use. This study examines homeless veterans\u27 access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness. Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used. Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging. Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care

Utilizing Technology for Diet and Exercise Change in Complex Chronic Conditions Across Diverse Environments (U-DECIDE): Protocol for a Randomized Controlled Trial

BACKGROUND: The metabolic syndrome is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. OBJECTIVE: The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. METHODS: The study is a single-center, 26-week, randomized controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the metabolic syndrome. All participants will receive an individualized assessment and advice on diet quality from a dietitian, a wearable activity monitor, and standard care. Participants randomized to the intervention group will receive access to a suite of health technologies from which to choose, including common base components (text messages) and optional components (online and mobile app–based nutrition information, an online home exercise program, and group-based videoconferencing). Exposure to the optional aspects of the intervention will be patient-led, with participants choosing their preferred level of engagement. The primary outcome will be the feasibility of delivering the program, determined by safety, recruitment rate, retention, exposure uptake, and telehealth adherence. Secondary outcomes will be clinical effectiveness, patient-led goal attainment, treatment fidelity, exposure demand, and participant perceptions. Primary outcome data will be assessed descriptively and secondary outcomes will be assessed using an analysis of covariance. This study will provide evidence on the feasibility of the intervention in a tertiary setting for patients with complex chronic disease exhibiting features of the metabolic syndrome. RESULTS: The study was funded in 2019. Enrollment has commenced and is expected to be completed by June 2022. Data collection and follow up are expected to be completed by December 2022. Results from the analyses based on primary outcomes are expected to be submitted for publication by June 2023. CONCLUSIONS: The study will test the implementation of a health technology–assisted lifestyle intervention in a tertiary outpatient setting for a diverse group of patients with complex chronic conditions. It is novel in that it embeds patient choice into intervention exposure and will inform health service decision-makers in regards to the feasibility of scale and spread of technology-assisted access to care for a broader reach of specialist services. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12620001282976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337 INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/3755

Factors influencing the delivery of telerehabilitation for stroke: a systematic review

ObjectiveDespite the available evidence regarding effectiveness of stroke telerehabilitation, there has been little focus on factors influencing its delivery or translation from the research setting into practice. There are complex challenges to embedding telerehabilitation into stroke services and generating transferable knowledge about scaling up and routinising this service model. This review aimed to explore factors influencing the delivery of stroke telerehabilitation interventions, including platforms, technical requirements, training, support, access, cost, usability and acceptability.MethodsMEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library and Central Registry of Clinical Trials were searched to identify full-text articles of randomised controlled trials (RCTs) and protocols for RCTs published since a Cochrane review on stroke telerehabilitation services. A narrative synthesis was conducted, providing a comprehensive description of the factors influencing stroke telerehabilitation intervention delivery.ResultsThirty-one studies and ten protocols of ongoing studies were included. Interventions were categorised as synchronous telerehabilitation (n = 9), asynchronous telerehabilitation (n = 11) and tele-support (n = 11). Telephone and videoconference were the most frequently used modes of delivery. Usability and acceptability with telerehabilitation were high across all platforms, although access issues and technical challenges may be potential barriers to the use of telerehabilitation in service delivery. Costs of intervention delivery and training requirements were poorly reported.ConclusionsThis review synthesises the evidence relating to factors that may influence stroke telerehabilitation intervention delivery at a crucial timepoint given the rapid deployment of telerehabilitation in response to the COVID-19 pandemic. It recommends strategies, such as ensuring adequate training and technical infrastructure, shared learning and consistent reporting of cost and usability and acceptability outcomes, to overcome challenges in embedding and routinising this service model and priorities for research in this area

Apps médicas: uso y regulación.

Las Apps incluidas en los teléfonos móviles, actualmente son de uso común y su mercado se encuentra en plena expansión. Objetivo: El objetivo de este trabajo es realizar una revisión bibliográfica de las publicaciones actuales sobre el uso sanitario de Apps y exponer las actuales recomendaciones de las Agencias Reguladoras al respecto. Material y Métodos: Se realizan tres búsquedas independientes en Pubmed. Se incluye en el trabajo aquellos artículos que tengan relación con el uso de aplicaciones móviles en el campo de la medicina, como posibles métodos diagnósticos o complemento al tratamiento o como elemento formativo, así como los que intervenga en las relaciones entre profesionales sanitarios y con paciente. Resultados: Se han extraído un total de 55 articulos. 24 de ellos hacen referencia al uso directo de aplicaciones móviles, 9 revisan literatura sobre el uso de Apps, 6 son publicaciones sobre formación a través de estas aplicaciones, 9 versan sobre la regulación. 7 artículos tratan sobre la toma de datos a tiempo real. El término de m-Health es una garantía de control profesional. Todos los trabajos revisados coinciden en que esta tecnología acerca al paciente a su enfermedad, mejorando el control del tratamiento, la toma de medidas fisiológicas y la relación con el profesional. Por otro lado son herramienta útil para la realización de estudios epidemiológicos así como para el acercamiento entre profesionales sanitarios. La regulación es aún un punto a desarrollar. Conclusiones: Las aplicaciones móviles en el entorno sanitario es un tema que suscita un enorme interés. Han demostrado utilidad en la mejora del cuidado del paciente, facilitan estudios epidemiológicos, acercan la formación al profesional sanitario y además mejora la relación entre profesionales sanitarios y de estos con el paciente. Es, sin embargo, necesario mejorar la regulación normativa para asegurar aplicaciones móviles de calidad y garantizar sistemas de acceso universal

Risco de readmissão ao departamento de emergência em pacientes ambulatoriais com COVID-19 leve com acompanhamento de telessaúde

Introduction: To describe patients ́ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56,95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009).Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces. Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística. Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes re-consultaron a CEA, con una tasa de incidencia global a los14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009). Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente.Introdução: Descrever as características dos pacientes com COVID-19 com sintomas leves e altado Centro de Emergência de Adultos (CEA) e acompanhados ambulatorialmente por telemedicina. Estime as taxas de nova consulta ao CEA e de hospitalização e explore os fatores associados a esses resultados. Métodos: Coorte retrospectiva de junho a agosto de 2020 no Hospital Italiano de Buenos Aires, que incluiu COVID-19 com sintomas leves. Eles foram acompanhados por 14 dias até a ocorrência de nova consulta no CEA e / ou internação. Modelos de Kaplan-Meier e regressão logística foram usados. Resultados: De um total de 1.239 pacientes, com mediana de 41 anos e 53,82% homens, 167 pacientes consultaram novamente o CEA, com uma taxa de incidência global em 14 dias de 13,08% (IC95% 11,32 a 15,08). Destes, 83 necessitaram de hospitalização (média de 4,98 dias), 6% não estavam relacionados com COVID-19 e 5 pacientes morreram. Após o ajuste para fatores de confusão (idade ≥65, sexo, diabetes, hipertensão, ex-tabagismo, tabagismo ativo, febre, diarreia e saturação de oxigênio), encontramos associações significativas: tabagismo prévio (ORa 2,09, IC 95% 1,31-3,34, p0 = 0,002), febre (ORa 1,56, IC 95% 1,07-2,28, p = 0,002) e saturação de oxigênio (ORa 0,82, IC 95% 0,71-0,95, p = 0,009). Conclusão: A taxa de 13% de re-consulta ao CEA durante 14 dias de seguimento foi muito significativa para a gestão hospitalar, qualidade do desempenho e segurança do paciente.publishedVersionFil: Pedretti Ana. Hospital Italiano de Buenos Aires; Argentina.Fil: Marquez Fosser, Santiago. Hospital Italiano de Buenos Aires; Argentina.Fil: Pasquinelli, Rosario. Hospital Italiano de Buenos Aires; Argentina.Fil: Vallone, Marcelo. Hospital Italiano de Buenos Aires; Argentina.Fil: Plazzotta, Fernando. Hospital Italiano de Buenos Aires; Argentina.Fil: Luna, Daniel. Hospital Italiano de Buenos Aires; Argentina.Fil: Martínez, Bernardo. Hospital Italiano de Buenos Aires; Argentina.Fil: Rodríguez, Paz. Hospital Italiano de Buenos Aires; Argentina.Fil: Grande Ratti, María Florencia. Hospital Italiano de Buenos Aires. Área de Investigación en Medicina Interna; Argentina

Snapping Live: Exploring the Effects of Ephemerality Nature of Messaging in Social Media Settings

Ephemeral messaging apps such as Snapchat has become a very popular app with young adults. The Snapchat application defined as an instant messaging app that allows its users to take pictures, videos, add a captions, doodles and send the content to a friend or add it to the user’s story. Importantly, “the snaps” will self-destruct after a specified period of time. Further investigation regarding the effects of using ephemeral nature of messaging in Computer-Mediated Communication (CMC) is explored in the theoretical framework of Hyperpersonal. This study was designed to examine the role of ephemeral nature of messaging in social media settings. Using responses from an online survey regarding Snapchat intensity, Self-Disclosure, Self- Presentation, Social Presence, Self-Destructing Messages and synchronous communication scales were examined. Direct relationships were examined with simple correlation. Finally, a complete model was tested using structural equation modeling. Results demonstrate that Snapchat users mainly share selfies that are mostly taken at home and primarily for communication with close friends and family. Also, results of SEM model indicate that Snapchat intensity was significantly related to Hyperpersonal communication (Walther, 1996). However, it was found that Social Presence, Ephemerality: Self-Destructing Messages scales are positive predictors of Ephemerality: Synchronicity. The findings are seen as an attempt to adapt the framework of Hyperpersonal theory (Walther, 1996). The results of the study will allow the researcher to better understand and measure the Ephemerality: Synchronicity and Hyperpersonal constructs as well as increase researchers understanding of the role of ephemerality nature of messaging in social media platforms