Alcuni abstract di articoli che trattano argomenti relativi all'eHealth

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Multimorbidity research in Sub-Saharan Africa: Proceedings of an interdisciplinary workshop

As life expectancies rise globally, the number of people living with multiple chronic health conditions – commonly referred to as ‘multimorbidity’ – is rising. Multimorbidity has been recognised as especially challenging to respond to in countries whose health systems are under-funded, fragmented, and designed primarily for acute care, including in sub-Saharan Africa. A growing body of research in sub-Saharan Africa has sought to better understand the particular challenges multimorbidity poses in the region and to develop context-sensitive responses. However, with multimorbidity still crystallising as a subject of enquiry, there remains considerable heterogeneity in conceptualising multimorbidity across disciplines and fields, hindering coordinated action. In June 2022, 60 researchers, practitioners, and stakeholders with regional expertise from nine sub-Saharan African countries gathered in Blantyre, Malawi to discuss ongoing multimorbidity research across the region. Drawing on insights from disciplines including epidemiology, public health, clinical medicine, anthropology, history, and sociology, participants critically considered the meaning, singular potential, and limitations of the concept of multimorbidity in sub-Saharan Africa. The workshop emphasised the need to move beyond a disease-centred concept of multimorbidity to one foregrounding patients’ values, needs, and social context; the importance of foregrounding structures and systems rather than behaviour and lifestyles; the value of a flexible (rather than standard) definition of multimorbidity; and the need to leverage local knowledge, expertise, resources, and infrastructure. The workshop further served as a platform for exploring opportunities for training, writing, and ongoing collaboration

Deriving Facilitators for Electronic Health Record Implementation: A Systematic Literature Review of Opportunities and Challenges

Electronic Health Records aim to remove information asymmetries between healthcare providers and contribute to improved healthcare quality and safety. Nevertheless, the successful and comprehensive implementation remains challenging and complex. Recently, increased interest of patients in their healthcare and enhanced technological opportunities led to new challenges and an emerging amount of research. To achieve an overarching overview of facilitators for EHR implementation, the perspectives of relevant stakeholders were considered. Therefore, we conducted a multidisciplinary systematic literature review involving five databases from public health, information systems, and interdisciplinary research. As a result, we first identified opportunities and challenges according to the stakeholder groups, environmental context, and implementation stages. Second, we derived five facilitators (individual stakeholder readiness, change management, accessibility and ownership, EHR structure, and external factors). Therefore, we lay a state-of-the-art foundation for EHR implementation for scientific studies and development activities in practice with our research

Framework for overcoming barriers of complementary and alternative medicine acceptance into conventional healthcare system

Health disparities have been widely recognized as a problem throughout the world. This paper provided a strengthened collaborative virtual framework for overcoming barriers towards accepting complementary and alternative medical practice into conventional healthcare system. Quantitative and qualitative data were gathered with semi-structured questionnaires and interviews from General Practitioners (GPs) with Complementary and Alternative Medicine (CAM) knowledge, CAM Practitioners with biomedicine knowledge, CAM patients, and scholars. 2,760 semi-structured questionnaires exploring knowledge, attitudes, and skills’ barriers to integrative medical collaboration efforts were administered. Focus group discussions were held interviewing GPs, CAM practitioners, and others claiming effective prescriptions. Practitioners’ team meetings, retreats, interaction, and prescription operations were observed. In this study, a videoconferencing-based healthcare services delivery system was developed and implemented for seamless exchange of healthcare information. 2,591 (93.5%) questionnaires representing 657 physicians (23.80%), 997 CAM practitioners (36.12%), 855 patients (30.98%), and 82 healthcare researchers (2.97%) responded, while 169 (6.12%) declined response. Fifty-two percent of the 657 GPs still referred patients for CAM treatments. Patients found complementary approaches more aligned with “their own values, beliefs, and philosophical orientations”. Non-medical acceptance of CAM (43.27%) continued impeding CAM growth in Nigeria. CAM practitioners require evidence-based knowledge towards finding solutions and suggestions for seamlessly integrating CAM with modern healthcare practices. Key words: Collaboration, complementary and alternative medicine, integrated delivery system, videoconferencing

The OCareCloudS project: toward organizing care through trusted cloud services

The increasing elderly population and the shift from acute to chronic illness makes it difficult to care for people in hospitals and rest homes. Moreover, elderly people, if given a choice, want to stay at home as long as possible. In this article, the methodologies to develop a cloud-based semantic system, offering valuable information and knowledge-based services, are presented. The information and services are related to the different personal living hemispheres of the patient, namely the daily care-related needs, the social needs and the daily life assistance. Ontologies are used to facilitate the integration, analysis, aggregation and efficient use of all the available data in the cloud. By using an interdisciplinary research approach, where user researchers, (ontology) engineers, researchers and domain stakeholders are at the forefront, a platform can be developed of great added value for the patients that want to grow old in their own home and for their caregivers

Primary health care nurses caring for people with diabetes: An integrative review of the literature

The aim of this integrative literature review was to analyse and synthesize findings from primary empirical studies concerning how nurses in primary care, care for people with diabetes (PWD). Diabetes is a recognized health priority in United Kingdom (UK) and New Zealand (NZ). Health policies are directing a shift in diabetes services from secondary to primary care. New Zealand primary health care (PHC) nurses are playing an increasing role in caring for a growing number of people with diabetes (PWD) and as such, need to be positioned effectively to contribute to preventing or minimizing associated long term diabetes complications. This research project has identified contrasted and highlighted similarities or differences in breadth and context in NZ nursing practice with UK practice and established important concepts and subsequent implications for this emerging role in NZ. The findings of this integrated review indicate that PHC nurses have developed extended and in some instances advanced specialised practice in caring for PWD across the breadth of the wellness disease continuum. Contextual factors have had a significant influence on how the role has emerged in both countries. The role is more evident in the UK and findings from the UK literature have implications for this emerging specialised PHC nursing role in NZ, particularly in relation to nurses increased role in medicine management of PWD. Recommendations are that new diabetes policies or programmes of care have structures that promote and support effective relationships and collaboration between all providers of the diabetes team. Education for this role should be provided at a nationally agreed standard where nurses’ competencies are measured. Furthermore appropriately qualified diabetes PHC nurses should have an increased role in medicine management and/or prescribing in NZ primary care similar to UK nurses. Finally, contribution of the emerging role of the diabetes PHC nurse should seriously be considered within the context of ‘Better, Sooner, More Convenient Primary Care’ structures that are designed to address chronic disease management and health inequities within the NZ population

Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems

Making morbidity multiple: History, legacies, and possibilities for global health

Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the single disease became integral not only to disease control but to the extension of biopolitical power. Multimorbidity, we observe, is hoped to challenge single disease approaches but is assembled from the same problematic, historically-loaded categories that it exposes as breaking down. Next, we highlight the consequences of such classificatory legacies in everyday lives and suggest why frameworks and interventions to integrate care have tended to have limited traction in practice. Finally, we argue that efforts to align priorities and disciplines around a standardised biomedical definition of multimorbidity risks retracing the same steps. We call for transdisciplinary work across the field of global health around a more holistic, reflexive understanding of multimorbidity that foregrounds the culture and history of translocated biomedicine, the intractability of single disease thinking, and its often-adverse consequences in local worlds. We outline key domains within the architecture of global health where transformation is needed, including care delivery, medical training, the organisation of knowledge and expertise, global governance, and financing