The use of computer-based learning tools for teaching and clinical purposes: Interactive computing strategy for Iraq

Medical universities and teaching hospitals in Iraq are facing a lack of professional staff due to the ongoing violence that forces them to flee the country. The professionals are now distributed outside the country which reduces the chances for the staff and students to be physically in one place to continue the teaching and limits the efficiency of the consultations in hospitals. A survey was done among students and professional staff in Iraq to find the problems in the learning and clinical systems and how Information and Communication Technology could improve it. The survey has shown that 86% of the participants use the Internet as a learning resource and 25% for clinical purposes while less than 11% of them uses it for collaboration between different institutions. A web-based collaborative tool is proposed to improve the teaching and clinical system. The tool helps the users to collaborate remotely to increase the quality of the learning system as well as it can be used for remote medical consultation in hospitals

Evaluation of the use of an "ask-the-expert" e-consultation service for support on health-related requests

E-consultation in health care can be used to respond to an increasing demand for care by offering support on health-related requests. In this study we evaluated the use of an Ask-the-expert e-consultation service in order to assess whether the service is efficient and useful. A content analysis of e-mail exchange between clients and online health professionals was performed to gain insight in the purposes of use of the service. Our findings show that the service was used for e-mails requests on not urgent, minor ailments. Clients asked for health information to increase knowledge on the cause of their injury or disease, its consequences, self-care solutions and treatment options. Decision support on assessing the necessity to visit a doctor for a certain health problem was another important reason to use the service. We believe that web-based triage systems could be used to more easily assess whether certain symptoms need to be investigated

Better Ways to Cope with Increasingly Common Diseases: The Impact of Telemedicine on the Management of Pregnancy Complicated by Diabetes

none3To review the importance of a telemedicine approach in the management of pregnancy complicated by diabetesnoneNino Cristiano;Maria Grazia;Annunziata LapollaNino, Cristiano; Grazia, Maria; Lapolla, Annunziat

Revisión sistemática de la literatura sobre evaluación de la e-salud

El propósito del documento es presentar una síntesis de los mecanismos para la medición de la e-Salud (definida como el uso de las TIC en el sector de la salud) publicados en la literatura científica como punto de partida para la elaboración de un modelo evaluativo que sirva como referencia para la medición de la e-Salud. Para lograr este propósito, se desarrolló una revisión sistemática de literatura de los documentos publicados entre los años 2004 y 2014 enfocada en los siguientes cinco objetivos, construir un marco conceptual que permita explicar qué es e-salud y sus características más importantes. planear la revisión sistemática, estableciendo las preguntas de investigación, el alcance de la revisión y los criterios a considerar para la selección y clasificación de los documentos, buscar los documentos en las bases de datos seleccionadas utilizando para ello una ecuación de búsqueda depurada, seleccionar los documentos a ser analizados a través de una evaluación de calidad de los mismos, realizar el análisis de los documentos seleccionados y presentar una síntesis de los resultados obtenidos, el principal resultado de este estudio fue la identificación de 22 procesos o frameworks de evaluación, 16 tipos de factores de evaluación, 11 tipos de variables y 6 tipos de indicadores para la medición de la e-Salud. También se encontraron 8 aspectos sometidos a evaluación, distribuidos en los documentos de la siguiente manera: 7.29% a la implementación, el 11.46% a la adopción, 3.13% a la factibilidad, el 11.46% a la satisfacción, el 9.38% a la calidad, el 26.04% al uso y el 35.42% a otros aspectos generales

An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance

Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts

Telerreabilitação em tempo real em doenças respiratórias crônicas e pós-COVID-19: revisão sistemática e metanálise

INTRODUCTION: Pulmonary rehabilitation (PR) is an intervention that improves both physical and psychological aspects of individuals with chronic respiratory diseases (CRD). However, adherence to in-person PR programs is low due to barriers to access and participation. Telerehabilitation (TR) is an alternative model that may facilitate access and adherence for these individuals. Due to the significant heterogeneity of existing TR studies, it is still necessary to identify the most effective, safe, and cost-effective remote strategy for clinical implementation. Additionally, it is essential to clarify the level of supervision required during physical exercise, which can impact patient safety, adherence to PR, and the quality of exercise execution and intensity progression. OBJECTIVES: To determine the effects of real-time supervised TR on exercise capacity, health-related quality of life, dyspnea, healthcare utilization, and mortality when compared to usual care, in-person rehabilitation, or asynchronous TR. METHODS: A search for randomized controlled trials (RCTs) and controlled clinical trials was conducted in the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform up to 30 April 2023, with no restriction on language or type of publication. Clinical trials of TR that included at least 50% of real-time supervised sessions in adult individuals with a diagnosis of any CRD or post-COVID-19 were included. Two review authors independently performed study selection, data extraction and risk of bias assessment. Only RCTs were included in the meta-analyses, and other studies were presented descriptively. The certainty of evidence for each comparison was assessed using GRADE. RESULTS: Twelve studies with 1540 participants (75% with COPD, 21% post-COVID-19, and 4% with other CRDs) were included. The mean age of participants ranged from 64 to 75 years. In all studies, participants in the intervention group underwent a minimum of 4 weeks of real-time supervised TR via video conferencing. Very-low to moderate certainty evidence showed no difference between TR and in-person PR regarding exercise capacity, quality of life, healthcare utilization, depression, adherence and mortality. The analysis of dyspnea at the end of the follow-up period (> 5 months) showed a mean difference of -0.39 in the mMRC score in favor of TR, but this difference did not reach the minimum clinically important difference. There was no difference between the interventions regarding the number of adverse events. The studies included in this review reported high adherence rates to TR (between 79% and 92% of scheduled sessions). The completion rate ranged from 62% to 93% in the TR group, with no difference compared to in- person PR. When compared to usual care, the results of this review provide low-quality evidence that TR may have a potential effect on exercise capacity at the end of the intervention. Regarding the other evaluated outcomes, no better results were observed in this population with TR compared to usual care. No studies comparing real-time TR with asynchronous TR were found. CONCLUSION: This review suggests that TR is safe and promotes similar effects to inperson PR in exercise capacity, quality of life, dyspnea and healthcare utilization in individuals with CRD and post-COVID-19. However, the certainty of this evidence was limited, and it is not possible to guarantee that the interventions are equivalent. Therefore, TR may be offered as an alternative to traditional PR models for patients with geographical, socioeconomic and symptomatic barriers, as well as in cases where traditional PR programs are not available. This review provides a clear definition of real-time TR, including physical exercise, with the same level of supervision and assistance in all TR groups and using the same standard of technology in all included studies, which facilitates result interpretation and clinical applicability.INTRODUÇÃO: A reabilitação pulmonar (RP) é uma intervenção que promove melhora tanto em aspectos físicos quanto psicológicos de indivíduos com doenças respiratórias crônicas (DRC). A adesão à programas de RP presenciais é baixa devido à barreiras de acesso e participação. A telerreabilitação (TR) é um modelo alternativo que pode facilitar o acesso e adesão destes indivíduos. Devido a grande heterogeneidade dos estudos de TR existentes, ainda é necessário identificar a estratégia remota mais eficaz, mais segura e com melhor custobenefício para implementação clínica. Além disso, é preciso esclarecer qual o nível de supervisão necessária durante a realização do exercício físico, o que pode impactar na segurança do paciente, na adesão à RP e na qualidade de execução e progressão da intensidade dos exercícios. OBJETIVOS: Determinar a segurança e os efeitos da TR com supervisão em tempo real na capacidade de exercício, qualidade de vida relacionada à saúde, dispneia, utilização do sistema de saúde e mortalidade quando comparada à reabilitação tradicional (RPT), TR assíncrona ou tratamento usual sem reabilitação. MÉTODOS: Foi realizada uma busca por ensaios clínicos controlados randomizados (ECR) e não randomizados (ECC) e ensaios clínicos controlados nas base de dados Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, plataforma de registro de ensaios clínicos da OMS e Clinical Trial, sem restrições de idioma ou tipo de publicação até 30 de abril de 2023. Foram incluídos ensaios clínicos de TR que tenham realizado pelo menos 50% das sessões de TR com supervisão em tempo real em indivíduos adultos com diagnóstico de qualquer DRC ou pós COVID-19. Dois revisores independentes realizaram a seleção dos estudos, extração dos dados e avaliação dos risco de viés. Somente ECR foram incluidos nas metanálises, e os demais estudos foram apresentados descritivamente. O nível de certeza das evidências para cada comparação foi avaliado utilizado o GRADE. RESULTADOS: Foram incluídos 12 estudos com 1540 participantes (75% de indivíduos com DPOC, 21% de indivíduos pós COVID-19 e 4% de indivíduos com outras DRC). A média de idade dos participantes variou entre 64 e 75 anos. Em todos os estudos os participantes do grupo intervenção foram submetidos à, no mínimo, 4 semanas de TR supervisionada em tempo real através de videoconferência. Evidências de certeza muito baixa à moderada mostraram que não há diferença entre a TR e a RPT quanto a capacidade de exercício, qualidade de vida, utilização do sistema de saúde, depressão, adesão e mortalidade. Na análise da dispneia ao final do período de acompanhamento (> 5 meses), foi observado uma diferença média de -0,39 na pontuação do mMRC em favor da TR, porém esta diferença não alcançou a mínima diferença clinicamente significante. Não houve diferença entre as intervenções quanto ao número de eventos adversos. Os estudos incluídos nesta revisão reportaram boas taxas de adesão à TR (entre 79% e 92% das sessões programadas). A taxa de conclusão variou entre 62% e 93% no grupo de TR, não havendo diferença neste desfecho quando comparado com a RPT. Quando comparada ao tratamento usual, os resultados desta revisão fornecem evidências de baixa certeza de que a TR pode ter um potencial efeito sobre a capacidade de exercício ao final da intervenção. Quanto aos demais desfechos avaliados, não foram observados melhores resultados nesta população com a TR quando comparada ao tratamento usual. Não foi encontrado nenhum estudo comparando a TR em tempo real com a TR assíncrona. CONCLUSÃO: Esta revisão sugere que a TR é segura e promove efeitos similares aos da RPT na capacidade de exercício, qualidade de vida, dispneia e utilização dos serviços de saúde em indivíduos com DRC e pós COVID-19. No entanto a certeza destas evidências foi limitada, não sendo possível garantir que as intervenções são equivalentes. Portanto, a TR pode ser oferecida como alternativa aos modelos tradicionais de TR para pacientes que apresentem barreiras geográficas, socioeconômicas e sintomatológicas, além de poder ser oferecida nos casos em que não houver programas de RP tradicional disponíveis

A multicomponent behavioral intervention in tertiary education delivered through a social network: An experimental evaluation

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Psicología, Departamento de Psicología Biológica y de la Salud. Fecha de Lectura: 13-12-202

Evaluation of teleconsultation systems

The aim of this study was to identify criteria used for evaluation of teleconsulatation systems in evaluation studies, and to estimate trend of their changes. Evaluation of teleconsultation (TC) systems was made on the basis of 82 evaluation studies from the inventory of evaluation studies in medical informatics consisting of all the information and communication technology (ICT) evaluation studies published in 1982-2002. In order to estimate trend of changes in using evaluation criteria, the whole period with at least one evaluation study, it means the period of 1995-2002 was divided to 2 of 4 years, 1995-1998 and 1999-2002. Proportions of evaluation studies according to any single criterion were calculated. Index of changes I(ci) for ith criterion was defined as difference of proportion of studies evaluating teleconsultation by using a certain criterion in the second period and the same proportion in the first period divided by the number of all studies evaluating teleconsultation systems. This research showed that hardware and technical aspects were the leading evaluation criterion, but it has been decreasing (from 74.2% in the first period to 43.1% in the second one). Satisfactions of both health care provider and patient achieved the highest increase in the second period (from 3.2 to 19.6% and from 0 to 15.7%, respectively). Appropriateness and cost of patient care were on the second place (from 22.6 to 33.3% and from 16.1 to 23.5%, respectively). Considering defined index of changes it can be concluded that there are four criteria for evaluation of teleconsultation systems, having a positive trend (in frequency of evaluation studies): user satisfaction (Ic=0.20), satisfaction of patient with patient care (Ic=0.19), appropriateness of patient care (Ic=0.13) and cost of patient care (Ic=0.09). Hardware and technical aspects shows negative trend in the number of evaluation studies (Ic=-0.38), as well as cost of IT (Ic=-0.10)