A qualitative study on patients’ and physicians’ perceptions

Funding: The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).Background: Digitization in everyday medical practice has gained importance along with the drive to expand teleconsultations arising from the COVID-19 pandemic. Previous qualitative research on teleconsultations has focused on synchronous communication between patients and clinicians. This study aims to explore physicians’ and patients’ perspectives on the adoption of teleconsultations between primary care and the referral cardiology department. Methods: Participants were recruited for semi-structured interviews between September 2019 and January 2020. The interviews were audio-recorded and pseudonymized. The transcribed interviews were stored, coded, and content analysis was performed in MAXQDA. Results: A total of 29 participants were interviewed. Patients and physicians merged in their views on ‘process’ issues, i.e., those concerning a better prioritization of patients and an improved collaborative practice, albeit with possible technological constraints. Physicians recognized that teleconsultations presented an educational opportunity for managing patients’ health problems. Our findings suggest that not all patients would require equally intensive collaborative activities across the health system. The barriers described included difficulties using the system (technical issues) and concerns about workload as a consequence of the disruption of traditional clinical routines. Increasing the range of collaborative strategies available to health care providers may require a broader assessment of the way that care processes are structured between levels of care. Patients revealed strong support for teleconsultation on the grounds of interprofessional collaboration and avoidance of unnecessary hospital visits. Conclusions: The implementation of teleconsultations between levels of care may be facilitated when patients, caregivers and physicians see the added value of this service, that adequate resources are put in place and that there is flexible implementation. This work adds an in-depth understanding of participants’ perceptions of this intervention in a case study. Obtaining context-dependent knowledge will help program leaders better understand how to establish telemedicine services as a real-world sustainable option.publishersversionpublishe

Using telemedicine in the care of newborn infants after discharge from a neonatal intensive care unit reduced the need of hospital visits

Aim: This study examined the use of telemedicine as a means to follow up infants discharged from a Swedish neonatal intensive care unit to home health care. Methods: Families were randomised to either a control group receiving standard home health care (n = 42 families) or a telemedicine group receiving home health care with telemedicine support (n = 47 families) after discharge from the hospital. Both groups had follow-up hospital appointments with the neonatal nurse. In the telemedicine group, appointments were supplemented by the use of a specially designed web page and video calls. Results: The use of the web page and video calls decreased the number of emergency visits to the hospital (p = 0.047). In the telemedicine group, 26% of the families felt they had more scheduled appointments than necessary, whereas only 6% of the families in the control group thought so (p = 0.037). The parents were highly satisfied with the use of telemedicine. Although the nurses were favourable to using telemedicine, the rigid organisation of the home healthcare programme and the nurses' schedules and work routines prevented its optimal use. Conclusion: The use of telemedicine decreased the need of hospital visits. Organisational adaptations would be necessary to make the best use of telemedicine

Atención domiciliaria en el recién nacido de bajo peso: revisión sistemática

[Resumen] Antecedentes: Según la Asociación Española de Pediatría (AEPED), entendemos por niño de bajo peso, aquel bebe cuyo peso al nacer es inferior a 2500g. La salud de estos niños es más susceptible de hospitalización y eventos infecciosos más prolongados y severos. Por ello es fundamental los cuidados que reciban. En los últimos años se están llevando a cabo servicios de atención domiciliaria neonatal (tanto de modo presencial como empleando las nuevas tecnologías), sin embargo, no existen estudios que nos determinen con seguridad su evidencia científica. Objetivos: Conocer si la atención domiciliaria neonatal enfermera en RN de bajo peso es más efectiva que la atención hospitalaria. Metodología: Se realizó una revisión sistemática sobre el tema de estudio. Hemos realizado la búsqueda de revisiones sistemáticas y ensayos clínicos en las principales bases de datos PUBMED, CINHAL, SCOPUS y WEB OF SCIENCE. Las principales variables de estudio han sido: aumento de peso, duración de lactancia materna, disminución de los reingresos y padres más seguros. La selección de estudios se realizó mediante una lectura por título, resumen y/o lectura del texto completo. Para la evaluación de la calidad se pasaron los checklist PRISMA y CONSORT reconocidos internacionalmente. Resultados: El bajo número de estudios enfermeros encontrados sobre este tema, la baja calidad de los mismos y la falta de datos en las variables estudiadas no nos han permitido llegar a un resultado que evidencien la efectividad de la AD frente a la AH. Conclusión: Es necesaria una mayor realización de estudios de calidad sobre la AD, en todas sus modalidades, en este ámbito por el aumento de nacimientos de RNBP y la demanda de cuidados enfermeros que generan.[Abstract] Background: According to the Spanish Association of Pediatrics (AEPED), we understand as a child of low weight, that baby whose birth weight is less than 2500g. The health of these children is more susceptible to hospitalization and longer and more severe infectious events. Therefore, the care they receive is fundamental. In recent years, neonatal home care services are being carried out (in person and using new technologies), however, there are no studies to determine with certainty their scientific evidence. Objectives: To know if neonatal nursing home care in low birth weight NB is more effective than inpatient care. Methods:A systematic review was made on the subject of the study. We have carried out the search of systematic reviews and clinical trials in the main PUBMED, CINHAL, SCOPUS and WEB OF SCIENCE databases. The main study variables were: weight gain, duration of breastfeeding, decrease in readmissions and parental security. The selection of studies was made through a reading by title, summary and / or reading of the complete text. For the quality evaluation, the PRISMA and CONSORT checklists recognized internationally were passed. Results: The low number of nursing studies found on this subject, the low quality of the same and the lack of data in the variables studied have not allowed us to reach a result that evidences the greater effectiveness of the AD against AH. Conclusion: It is necessary to carry out more quality studies on AD, in all its modalities, in this area due to the increase in RNBP births and the demand for nursing care that they generate.[Resumo] Antecedentes: Segundo a Asociación Española de Pediatría ( AEPED), entendemos por neno de baixo peso, aquel bebe cuxo peso ao nacer é inferior a 2500 g. A saúde destes nenos é máis susceptible de hospitalización e eventos infecciosos máis prolongados e severos. Por iso é fundamental os coidados que reciban. Nos últimos anos están a levarse a cabo servizos de atención domiciliaria neonatal (tanto de modo presencial como empregando as novas tecnoloxías), con todo, non existen estudos que nos determinen con seguridade a súa evidencia científica. Obxectivos: Coñecer se a atención domiciliaria neonatal enfermeira en RN de baixo peso é máis efectiva que a atención hospitalaria. Metodoloxía: Realizouse unha revisión sistemática sobre o tema de estudo. Realizamos a procura de revisións sistemáticas e ensaios clínicos nas principais bases de datos PUBMED, CINHAL, SCOPUS e WEB OF SCIENCE. As principais variables de estudo foron : aumento de peso, duración de lactación materna, diminución dos reingresos e pais máis seguros. A selección de estudos realizouse mediante unha lectura por título, resumo e/ou lectura do texto completo. Para a avaliación da calidade pasáronse os checklist PRISMA e CONSORT recoñecidos internacionalmente. Resultados: O baixo número de estudos enfermeiros atopados sobre este tema, a baixa calidade dos mesmos e a falta de datos nas variables estudadas non nos permitiron chegar a un resultado que evidencien a maior efectividade da AD fronte á AH. Conclusión: É necesaria unha maior realización de estudos de calidade sobre a AD, en todas as súas modalidades, neste ámbito polo aumento de nacementos de RNBP e a demanda de coidados enfermeiros que xeran.Traballo fin de grao (UDC.FEP). Enfermaría. Curso 2017/201

The collateral impact of COVID-19 emergency on neonatal intensive care units and family-centered care: Challenges and opportunities

The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality care. In particular, mitigation strategies adopted to combact the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of the COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staffs facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices

Systematic review of tube-fed preterm infants in the home supported within a family-centered program

There is a growing need and demand to redesign neonatal services to place a focus on family-centered care provided locally. Early discharge training programs that prepare parents to tube-feed and care for their preterm infant at home may offer a viable option, but these are understudied. A narrative review of relevant literature was undertaken. The key findings highlighted that within the discharge programs there was no increase in readmission rates caused through home tube-feeding, infant weight gain was adequate and parental satisfaction was reported as high when 24-hour access to staff was available. Further, an increased duration of breastfeeding was associated with a reduced risk of readmission. The review highlights the potential of this service as an alternative to in-patient care for infants requiring short-term tube-feeding during their transition to full oral-feeding

Morgendagens nyfødtomsorg: Hvordan erfares bruk av telemedisin i oppfølgningen av premature nyfødte som reiser tidlig hjem fra sykehus?

Å få et prematurt barn kan bety lange sykehusopphold, noe som kan ha negativ innvirkning på både foreldre og barn. For å korte ned opphold i sykehus, tilbyr mange sykehus en nyfødtambulerende tjeneste, der sykepleiere fra avdelingen kommer hjem til familiene flere ganger i uken. Dette er et godt tilbud for mange familier, men på sykehus som dekker store geografiske områder lar ikke dette seg gjøre. På bakgrunn av dette er tidlig hjemreise med oppfølging via telemedisin (THT) brakt på banen. Hensikten med oppgaven er å finne erfaringene til både foreldre og sykepleiere med bruk av telemedisin som oppfølging av premature nyfødte som reiser tidlig hjem fra sykehuset. Med dette ønsker vi å belyse og å bidra til økt kunnskap for hvordan man kan benytte telemedisin i oppfølgingen til familier med premature barn på en trygg og tilfredsstillende måte.

A Model for patient engagement integration in perinatal eHealth development and quality assurance

The aim of this study was to construct a model for patient engagement integration in perinatal eHealth development and quality assurance. The model was developed in four phases. The first three phases produced evidence for the development of a model. In the final phase, a qualitative interpretive synthesis was conducted using grounded theory to articulate a patient engagement model composed of three steps. The first phase was a scoping review aimed at describing the nature and range of patient engagement from the perspective of access, personalization, commitment, and therapeutic alliance within perinatal eHealth. A narrative synthesis was used to describe findings. Phase two consisted of two studies exploring engagement practices of pregnant users during their use of a self-monitoring health promotion eHealth system. A descriptive comparative analysis was completed to understand user engagement patterns based on physical use of the wearable device. A mixed-methods convergence evaluation was conducted to understand the process of accessing the health promotion eHealth system. In phase three a process evaluation tool for parent participation and collaboration (in the neonatal intensive care unit) was developed and psychometrically tested. For the interpretive synthesis, articles from the first three phases of this study were purposively sampled. A deductive codebook was developed using Donabedian’s model, and an adapted version of Lewin’s Action Research Cycle. Donabedian’s model consists of quality assurance through the examination of structure, process, and outcomes. Lewin’s Action Research Cycle informs iterative steps in development and implementation of health systems. Phase four resulted in a model for patient engagement integration in perinatal eHealth development and quality assurance. Three steps of the model were identified as being: Person-centered Perinatal eHealth program mapping; Process evaluation through monitoring of patient engagement processes; and Co-creation of perinatal eHealth programs through real-life testing of perinatal eHealth systems.Malli potilaan osallistumisesta perinataaliajan sähköisen terveydenhuollon kehittämiseen ja laadunvarmistukseen Tutkimuksen tavoitteena oli kehittää malli ohjaamaan potilaan osallistumista perinataaliajan sähköisen terveydenhuollon kehittämiseen ja laadunvarmistukseen. Malli kehitettiin neljässä vaiheessa. Kolmessa ensimmäisessä vaiheessa tuotettiin tutkimusnäyttöä kehittämisen tueksi. Viimeisessä vaiheessa laadullisen tulkitsevan synteesin avulla muodostettiin potilaan sitoutumisen malli. Ensimmäisessä vaiheessa tehtiin kartoittava kirjallisuuskatsaus, joka kuvasi potilaiden sähköiseen terveydenhuoltoon osallistumisen tavat ja laajuuden saatavuuden, yksilöllisyyden, sitoutumisen ja terapeuttisen hoitosuhteen näkökulmasta. Aineisto analysoitiin teorialähtöisellä sisällönanalyysillä ja tulokset kuvattiin narratiivisen synteesin avulla. Toinen vaihe muodostui kahdesta tutkimuksesta, jotka tarkastelivat itsemonitorointisysteemin avulla raskaana olevien henkilöiden osallistumistapoja terveydenedistämiseen. Tutkimuksissa odottajat käyttivät itsemonitorointisysteemiä. Osallistumistapoja analysoitiin puettavan laitteen käyttöajan pohjalta tehtyjen vertailevien analyysien avulla. Monimenetelmällisessä tutkimuksessa muodostettiin analyysin pohjalta ymmärrys itsemonitorointisysteemin saatavuuteen liittyvästä prosessista. Kolmannessa vaiheessa kehitettiin ja psykometrisesti testattiin prosessievaluaatiomittari arvioimaan vanhempien osallistumista ja yhteistyötä henkilökunnan kanssa vastasyntyneiden teho-osastolla. Viimeisen vaiheen tulkitsevaa synteesiä varten valittiin tarkoituksenmukaisia artikkeleita. Donabedianin terveydenhuollon laadunvarmistuksen malli ja Lewinin muokatun toimintatutkimuksen syklin pohjalta muodostettiin teorialähtöinen analyysirunko. Neljännen vaiheen tuloksena muodostettiin malli potilaan osallistumisesta perinataaliajan sähköisen terveydenhuollon kehittämiseen ja laadunvarmistukseen. Malli kostuu kolmesta askeleesta: Yksilökeskeisen sähköisen terveydenhuollon kartoitus, potilaan osallistumisprosessin monitorointiin perustuva prosessievaluaatio ja perinataaliajan sähköisen terveydenhuollon yhteiskehittäminen kliinisessä todellisuudessa

A randomized controlled study about the use of eHealth in the home health care of premature infants

<p>Abstract</p> <p>Background</p> <p>One area where the use of information and communication technology (ICT), or eHealth, could be developed is the home health care of premature infants. The aim of this randomized controlled study was to investigate whether the use of video conferencing or a web application improves parents’ satisfaction in taking care of a premature infant at home and decreases the need of home visits. In addition, nurses’ attitudes regarding the use of these tools were examined.</p> <p>Method</p> <p>Thirty-four families were randomized to one of three groups before their premature infant was discharged from the hospital to home health care: a control group receiving standard home health care (13 families); a web group receiving home health care supplemented with the use of a web application (12 families); a video group with home health care supplemented with video conferencing using Skype (9 families). Families and nursing staff answered questionnaires about the usefulness of ICT. In addition, semi-structured interviews were conducted with 16 families.</p> <p>Results</p> <p>All the parents in the web group found the web application easy to use. 83% of the families thought it was good to have access to their child’s data through the application. All the families in the video group found Skype easy to use and were satisfied with the video calls. 88% of the families thought that video calls were better than ordinary phone calls. 33% of the families in the web group and 75% of those in the video group thought the need for home visits was decreased by the web application or Skype. 50% of the families in the web group and 100% of those in the video group thought the web application or the video calls had helped them feel more confident in caring for their child. Most of the nurses were motivated to use ICT but some were reluctant and avoided using the web application and video conferencing.</p> <p>Conclusion</p> <p>The families were satisfied with both the web application and video conferencing. The families readily embraced the use of ICT, whereas motivating some of the nurses to accept and use ICT was a major challenge.</p

Increasing father involvement in the care of their infant using text messages: The DadRocks study

Studies have shown that interventions aimed at the transition to fatherhood can have benefits to fathers. Yet there are few studies specifically designed for fathers at their transition to parenthood, despite fathers having asked for resources specifically tailored for them. DadRocks is a minimalist (i.e., low-cost) intervention that uses text messages to address fathers as they transition to fatherhood. DadRocks has been successfully piloted with Vietnamese fathers, but not in a Western sample of fathers. In our pilot of DadRocks with Canadian fathers, SMS messages were sent to seventeen fathers 3-5 times a week. Messages provided developmentally appropriate information such as games to play with their infants, milestones to observe and links to credible websites for information. Fathers who had more positive attitudes towards father-infant relationship reported significantly more father-infant interaction. Father-infant interaction, especially play, increased between baseline, three months and six months. Fathers who reported more engagement with the messages had significantly more positive attitude and more affectionate behavior. First-time fathers felt most supported by the texts. Fathers with greater anxiety also reported using more recommended resources. Fathers generally liked the intervention, and provided suggestions for future messages. Our pilot data support the development of a more comprehensive experimental study of DadRocks. with a large community sample that could help determine the extent to which this low-cost intervention can improve father-infant relationships. Overall, our data suggest that text messages may be a lost-cost way to communicate with fathers in ways that promote and support positive paternal care

Using Pharmacist-Led Tele-Consultation to Review Patients with Chronic Obstructive Pulmonary Disease

The full text will be available at the end of the embargo period: 5th Nov 202