Technology and inclusivity

In the current Health and Social Care system, the NHS needs to make better use of information and technology, if it is to meet the demands of an ageing population with increasingly expensive treatment requirements. In this month's Technology Pages, Jo Yaldren and Matthew Van Loo explore the issue of inclusivity as it relates to technology-enhanced care and learning. The themes of digital literacy, autonomy, competence and confidence will be considered, and the cultural and organisational context of this wide-scale change will be highlighted. </jats:p

Video consultation in healthcare:Receiving surgical medical specialist care at home

This thesis describes the implementation and scale up of video consultation at a tertiary referral center. Before video consultation can be implemented and used sustainably in healthcare, it is vital to involve patients and address their needs and requirements of receiving care over a video connection. Therefore the aim of this thesis was to provide the most optimal implementation strategy for video consultation in healthcare based on scientific research. We have researched patient- and provider needs in order to understand their preferences when it comes to digital care. Next, patient- and provider satisfaction with video consultation was evaluated when compared to both physical as telephone consultation. Based on this strategy video consultation was implemented at the surgical outpatient clinic. During the COVID-19 pandemic we were able to scale-up to all outpatient departments. Again, patient and provider satisfaction and willingness to use video consultation was evaluated. Both technical as workflow aspects of the scale up are described in detail. This thesis indicates that the use of video consultation for outpatient care appointments is feasible, and accepted by both patients as well as providers without a detriment to the quality of care provided. There are still a few difficulties that hamper the structural use of video consultation in clinical practice today. But as soon as “Why?” becomes, “Why did we not do this before?”, we can work towards a climate in which receiving care at the right moment, at the right place can be supported by the convenience of digital care

Telehealth in Heart Failure Care during COVID-19 Pandemic Lockdown in Argentina

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, virtual visits (VVs) were recommended as an innovative and necessary alternative for patients with heart failure (HF). To assess the feasibility and acceptability of VVs in patients with HF, pulmonary hypertension (PH), and heart transplant (HT). Methods: We designed a single-centre cohort study. Consecutive VVs performed in our HF unit were analysed. The period comprehended between January 1st and March 19th (before COVID-19) and March 20th and June 30th (during COVID-19) was compared. We assessed acceptability, feasibility and the need for diagnostic studies, in-person medical evaluation, and hospitalization at 30 days. Results: HF unit medical doctors conducted 22 VVs in the pre-COVID period and 416 VVs during the COVID period. The VV was able to be performed in all patients scheduled for it and 44% answered the survey. Ninety percent of the patients who answered the survey strongly agreed that VVs were easy to be carried out. All the patients “strongly agreed” or “agreed” that their health problem could be resolved. Most patients (95%) rated the global experience as very good or excellent, with an overall average rate of 9.76±0.5 out of 10. We found no differences regarding the requirement of diagnostic studies, in-person medical evaluation and hospitalization during the first month after VVs between the 2 periods. Conclusions: VVs were feasible, presented high acceptability, and the overall experience was positive in patients with HF, PH, and HT, being this modality a valuable tool that complements in-person care.Fil: Burgos, Lucrecia María. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Benzadón, Mariano. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Candiello, Alfonsina. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Cabral, Miguel Héctor. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Conde, Diego. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Alves de Lima, Alberto Enrique. Instituto Cardiovascular de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Belardi, Jorge. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Diez, Mirta. Instituto Cardiovascular de Buenos Aires; Argentin

Basic Pilates as a treatment for physiotherapy

El pilates es un método de entrenamiento muscular que es aplicado en la actualidad para el tratamiento de patologías de diversa índole en fisioterapia. Para ello, es necesario tener conocimiento pleno tanto de los principios básicos del pilates como de los ejercicios para principiantes. Para la correcta realización de los movimientos de pilates hay que mantener una buena activación del core y tener plena conciencia en los movimientos, ejecutándolos de manera lenta y precisa.Pilates is a method of muscle training that is currently applied to the treatment of pathologies of various kinds in physiotherapy. For this, it is necessary to have full knowledge of both the basic principles of Pilates and the exercises for beginners. For the correct realization of the movements of pilates, it is necessary to maintain a good activation of the core and be fully aware of the movements, executing them slowly and precisely

My Diabetes My Way:An Evolving National Data Driven Diabetes Self Management Platform

MyDiabetesMyWay (MDMW) is an award-wining national electronic personal health record and self-management platform for diabetes patients in Scotland. This platform links multiple national institutional and patient-recorded data sources to provide a unique resource for patient care and self-management. This review considers the current evidence for online interventions in diabetes and discusses these in the context of current and ongoing developments for MDMW. Evaluation of MDMW through patient reported outcomes demonstrates a positive impact on self-management. User feedback has highlighted barriers to uptake and has guided platform evolution from an education resource website to an electronic personal health record now encompassing remote monitoring, communication tools and personalized education links. Challenges in delivering digital interventions for long-term conditions include integration of data between institutional and personal recorded sources to perform big data analytics and facilitating technology use in those with disabilities, low digital literacy, low socioeconomic status and in minority groups. The potential for technology supported health improvement is great, but awareness and adoption by health workers and patients remains a significant barrier

Protocol for the CONNECT project: a mixed methods study investigating patient preferences for communication technology use in orthopaedic rehabilitation consultations.

INTRODUCTION: Technology has been placed at the centre of global health policy and has been cited as having the potential to increase efficiency and remove geographical boundaries for patients to access care. Communication technology may support patients with orthopaedic problems, which is one of the leading causes of disability worldwide. There are several examples of technology being used in clinical research, although uptake in practice remains low. An understanding of patient preferences will support the design of a communication technology supported treatment pathway for patients undergoing orthopaedic rehabilitation. METHODS AND ANALYSIS: This mixed methods project will be conducted in four phases. In phase I, a systematic review of qualitative studies reporting communication technology use for orthopaedic rehabilitation will be conducted to devise a taxonomy of tasks patients' face when using these technologies to access their care. In phase II, qualitative interviews will investigate how the work of being a patient changes during face-to-face and communication technology consultations and how these changes influence preference. In phase III, a discrete choice experiment will investigate the factors that influence preferences for the use of communication technology for orthopaedic rehabilitation consultations. Phase IV will be a practical application of these results. We will design a 'minimally disruptive' communication technology supported pathway for patients undergoing orthopaedic rehabilitation. ETHICS AND DISSEMINATION: The design of a pathway and underpinning patient preference will assist in understanding factors that might influence technology implementation for clinical care. This study requires ethical approval for phases II, III and IV. Approvals have been received for phase II (approval received on 4 December 2016 from the South Central-Oxford C Research Ethics Committee (IRAS ID: 255172, REC Reference 18/SC/0663)) and phase III (approval received on 18 October 2019 from the London-Hampstead Research Ethics Committee (IRAS ID: 248064, REC Reference 19/LO/1586)) and will be sought for phase IV. All participants will provide informed written consent prior to being enrolled onto the study. PROSPERO REGISTRATION NUMBER: CRD42018100896

Real-Time Tele-Auscultation Consultation Services over the Internet: Effects of the Internet Quality of Service

A real-time tele-auscultation over the Internet is effective medical services that increase the accessibility of healthcare services to remote areas. However, the quality of auscultation’s sounds transmitted over the Internet is the most critical issue, especially in real-time service. Packet loss and packet delay variations are the main factors. There is little knowledge of these factors affecting auscultation’s sounds transmitted over the Internet. In this work, we investigate the effects of packet loss and packet delay variations, in particular, heart and lung sounds with auscultation’s sound over the Internet in real-time services. We have found that both sounds are more sensitive to packet delay variations than packet loss. Lung sounds are more sensitive than heart sounds due to their timing interpretation. Some different levels of packet loss can be tolerated, e.g., 10% for heart sounds and 2% for lung sounds. Packet delay variation boundary of 50 msec is recommended. In addition, we have developed the real-time tele-auscultation prototype that tries to minimize the packet delay variation. We have found that real-time waveform of auscultation’s visualization can help physician’s confident level for sound interpreting. Some techniques for quality of service improvement are suggested, e.g., noise reduction and user interface (UI)

Nuevos sistemas de comunicación del método Pilates en embarazo y puerperio = New communications systems of Pilates Method in pregnancy and postpartum period

Resumen: Introducción: En los últimos años se ha incentivado a la mujer para realizar actividad física durante la gestación como método preventivo en las lesiones relacionadas con el suelo pélvico, destacando el método Pilates. Además, las nuevas tecnologías de la información y la comunicación (TICs) permiten el aprendizaje desde los domicilios. Objetivos: Mostrar los beneficios del método Pilates en el suelo pélvico. Conocer el uso y la satisfacción de las mujeres que usan este método durante la gestación y el puerperio, incorporando las nuevas tecnologías de la información y la comunicación (TICs). Material y método: Para el diseño del estudio se realizó una revisión bibliográfica en las diferentes bases de datos biosanitarias. Como resultado de la búsqueda y análisis de los documentos encontrados, se seleccionaron 18 artículos que se adecuaban a los criterios de inclusión y exclusión. Resultados: El Método Pilates produce numerosos beneficios aplicado durante la gestación y el puerperio. El uso de nuevos sistemas de comunicación genera mayor implicación de las embarazadas en su aprendizaje y la posterior continuación de su práctica. Discusión y conclusiones: El uso de este método incorporando las nuevas tecnologías es muy beneficioso, tanto en aspectos físicos como psicológicos de la mujer, previniendo numerosas patologías asociadas al embarazo, aportando mayor confianza a la mujer durante el período de parto.Palabras clave: Pilates, Suelo pélvico, Gestación, Salud, ComunicaciónAbstract: Introduction: Over the past years, women have been encouraged to practise physical activity during pregnancy as a preventive method to injuries related to the pelvic floor, mainly the Pilates Method. Besides, new information and communication technologies (TICs) allow learning it at home. Objectives: To show Pilates´ benefits on pelvic floor. To know the use and satisfaction of women who use this method during pregnancy and the postpartum period, incorporating new information and communication technologies (TICs). Material and Method: For the study design, a literature review was made in different biohealth data bases. As a result of the search and analysis of the literature, 18 articles that suited the inclusion and exclusion guidelines were selected and found. Results: The Pilates method produces a lot of benefits applied during pregnancy and the postpartum period. The use of new communication systems generates greater involvement of pregnant women in their learning and the continuation of its practice. Discussion and conclusions: The use of this method incorporating new technologies has very beneficial aspects in women, both physical as psychological, preventing many diseases associated with pregnancy, giving greater confidence to women during the period of childbirth.Keywords: Pilates, Pelvic floor, Pregnancy, Health, Communication