Stroke telemedicine: yesterday, today and tomorrow

The aim of the study was to analyse and systematise the scientific literature in the context of the development of telemedicine for stroke.Цель исследования – проанализировать и систематизировать данные научной литературы в контексте развития телемедицины инсульта

An electronic patient-reported outcome mobile app for data collection in type a hemophilia:Design and usability study

BACKGROUND: There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. OBJECTIVE: The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. METHODS: We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. RESULTS: The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. CONCLUSIONS: The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT0416513

Recommendations for developing a lifecycle, multidimensional assessment framework for mobile medical apps

Digital health and mobile medical apps (MMAs) have shown great promise in transforming health care, but their adoption in clinical care has been unsatisfactory, and regulatory guidance and coverage decisions have been lacking or incomplete. A multidimensional assessment framework for regulatory, policymaking, health technology assessment, and coverage purposes based on the MMA lifecycle is needed. A targeted review of relevant policy documents from international sources was conducted to map current MMA assessment frameworks, to formulate 10 recommendations, subsequently shared amongst an expert panel of key stakeholders. Recommendations go beyond economic dimensions such as cost and economic evaluation and also include MMA development and update, classification and evidentiary requirements, performance and maintenance monitoring, usability testing, clinical evidence requirements, safety and security, equity considerations, organizational assessment, and additional outcome domains (patient empowerment and environmental impact). The COVID‐19 pandemic greatly expanded the use of MMAs, but temporary policies governing their use and oversight need consolidation through well‐developed frameworks to support decision‐makers, producers and introduction into clinical care processes, especially in light of the strong international, cross‐border character of MMAs, the new EU medical device and health technology assessment regulations, and the Next Generation EU funding earmarked for health digitalization

Technological development in telemedicine: bibliometric analysis, research gaps, and literature trends

The aim of this article was to analyze the literature on technological development in telemedicine through bibliometrics, by identifying the state of the art, research gaps, and trends in the literature. The analysis covers a total of 67 articles related to the field of study, published between 2010-2020 in the Springer Link, Science Direct, Wiley Online Library, Web of Science, and Scopus databases. The data was processed using the software StArt, Excel, IBM SPSS Statistics, and Iramuteq. The results presented bibliometric analysis of the articles, classified into the areas of Management (52.2%), IT (25.4%), and Medicine (22.4%), along with a Table of 34 suggestions for future research. Literature trends encompassed six study clusters (health, study, service, technology, patient, and telemedicine), which further subdivided into nine research themes (digital platform, telemedicine service management, telemedicine service operation, end-user perception, business opportunities, healthcare professional perception, covid-19, regulation, and robotics). An observed outcome was a significant increase in the number of publications in the area due to covid-19

O impacto da covid-19 na adaptação do cliente de saúde ao contexto digital

São vários os desafios que, hoje, o mundo enfrenta. Por isso, é muito importante compreender e definir a revolução tecnológica. As novas tecnologias estão a alterar radicalmente os hábitos, os comportamentos, as formas de trabalhar e as relações do ser humano no geral. O setor da saúde é um dos setores onde mais tem impacto esta revolução tecnológica, e com a pandemia da COVID-19, esta revolução ainda acelerou mais. O objetivo geral desta investigação consiste em compreender o impacto da COVID-19 na adaptação do cliente ao contexto digital. Para além deste geral pretende-se chegar à conclusão de dos objetivos específicos, tais como avaliar a importância atribuída pelos consumidores portugueses à utilização de ferramentas digitais de saúde no período pré e durante a pandemia, identificar os benefícios e entraves reconhecidos pelos consumidores na utilização de ferramentas digitais durante a pandemia, reconhecer o nível de familiaridade dos consumidores quanto às tipologias de telemedicina avaliando as tipologias antes e durante a pandemia, identificar vantagens e desvantagens reconhecidas pelos portugueses relativamente às consultas presenciais e virtuais, identificar mudanças no comportamento dos consumidores de saúde em Portugal durante o estado de emergência, avaliar as preferências dos consumidores face às experiências digitais e presenciais no período pós-pandemia e verificar o grau de confiança dos consumidores portugueses nos profissionais de saúde ou organizações de saúde. Este estudo iniciou-se com o levantamento da informação acerca de duas temáticas, o Marketing na Saúde e as Tecnologias na Saúde. As Tecnologias de Saúde subdividem-se em dois grupos, as ferramentas digitais e a telemedicina. Para além disto, aborda-se o tema das tecnologias na saúde na pandemia da Covid-19. Esta investigação rege-se a uma metodologia quantitativa, onde os dados são recolhidos através de um questionário. A amostra contém 402 respostas válidas. Este questionário visa obter respostas aos objetivos definidos inicialmente, e, contribuir com conhecimento no setor. Por fim, foram ainda obtidas conclusões que permitiram explorar algumas recomendações à empresa que permitiu a realização deste estudo

Will applications on smartphones allow a generalization of telemedicine?

International audienceBackground: Telemedicine is one of the healthcare sectors that has developed the most in recent years. Currently, telemedicine is mostly used for patients who have difficulty attending medical consultations because of where they live (teleconsultation) or for specialist referrals when no specialist of a given discipline is locally available (telexpertise). However, the use of specific equipment (with dedicated cameras, screens, and computers) and the need for institutional infrastructure made the deployment and use of these systems expensive and rigid. Although many telemedicine systems have been tested, most have not generally gone beyond local projects. Our hypothesis is that the use of smartphones will allow health care providers to overcome some of the limitations that we have exposed, thus allowing the generalization of telemedicine. Main body: This paper addresses the problem of telemedicine applications, the market of which is growing fast. Their development may completely transform the organization of healthcare systems, change the way patients are managed and revolutionize prevention. This new organization should facilitate the lives of both patients and doctors. In this paper, we examine why telemedicine has failed for years to take its rightful place in many European healthcare systems although there was a real need. By developing the example of France, this article analyses the reasons most commonly put forth: the administrative and legal difficulties, and the lack of funding. We argue that the real reason telemedicine struggled to find its place was because the technology was not close enough to the patient. Conclusion: Finally, we explain how the development of smartphones and their current ubiquitousness should allow the generalization of telemedicine in France and on a global scale

Estudio del uso de dispositivos móviles para la monitorización de hábitos digitales y el seguimiento remoto de la progresión de la miopía y la presbicia

La era digital ha transformado la atención visual haciendo posible realizar consultas optométricas y test visuales a distancia (tele-optometría). Sin embargo, el uso excesivo de los dispositivos electrónicos podría causar la aparición o progresión de la miopía. Se realizan una serie de estudios que analizan el uso de los smartphones como herramienta, tanto para la medida de la iluminación ambiental, el tiempo y distancia de uso (hábitos digitales) y de sus posibles efectos en la miopía, como de seguimiento del posible cambio en agudeza visual (AV) y refractivo del usuario. En un primer estudio se tomaron medidas objetivas de hábitos digitales en un grupo de jóvenes en el que no se usaba ningún tipo de alerta (grupo pasivo) y en otro grupo en el que se usaron alertas de distancia mínima de uso o de iluminación (grupo activo). El grupo activo presentó un valor medio distancia de uso del dispositivo de 343 ± 32 mm frente al pasivo con 307 ± 57 mm (p = 0,019). No hubo diferencias (p = 0,461) en cuanto la iluminación ambiental entre grupos. Se encontró una correlación débil entre el equivalente esférico y los hábitos digitales. En un segundo estudio se analiza la exactitud de las medidas de iluminancia tomadas por el sensor de luz del dispositivo y se estudia un método original de medida de la iluminancia facial. Los resultados mostraron que el sensor de luz responde de una forma muy lineal a variación de la iluminancia (R2 > 0,98) aunque sobreestima o subestima los valores de luminancia según el tipo de fuente. Para una fuente típicamente de interiores, la medida de la iluminancia fue del 25% por debajo del valor real. El método propuesto permite una medida de la iluminación facial con un error medio del 27%. En un tercer estudio se realizaron varios experimentos con el fin de conocer si es posible medir con precisión la AV con un smartphone y una aplicación (app) que usa estímulos en luz blanca o en azul. En cuanto al uso de luz blanca, se encontró una diferencia de 0.01 logMAR (p > 0.47) entre la medida de la AV con un smartphone y la medida clínica. En cuanto al uso de la luz azul, tras la determinación de un valor medio de -0,67 ± 0,21 D para la aberración cromática longitudinal entre pixeles azules y blancos de pantallas OLED de un smartphone, se encontró en el 90% de los sujetos una AV de 0,15 logMAR mayor para luz blanca que en azul. Por último, en un cuarto estudio se tomaron medias del punto remoto (PR) con una app utilizando luz azul en sujetos a los que se les indujeron ciertos valores de miopía. Los resultados mostraron una buena correlación entre la miopía inducida y la obtenida a partir del PR medido con la app (R2 = 0,80). La diferencia media entre ambos métodos fue 0,46 ± 0,23 D. También se tomaron medidas de punto próximo (PP) en présbitas induciendo a los sujetos una cierta adición y se encontró una buena correlación entre la adición inducida y la obtenida a partir del PP medido con la app (R2 = 0,81). La diferencia media entre ambos métodos fue 0,03 ± 0,40 D. En conclusión, con los actuales smartphones es posible medir: los hábitos digitales y modificar al menos la distancia de uso del smartphone; la iluminancia facial dentro de los límites de precisión del sensor del dispositivo; la AV, aunque la AV en azul es ligeramente inferior a la obtenida clínicamente; la posición del punto remoto y el próximo de forma relativamente precisa.The digital age has transformed visual care making it possible to perform remote optometric consultations and visual tests (tele-optometry). However, excessive use of electronic devices could cause the onset or progression of myopia. A series of studies are carried out that analyze the use of smartphones as a tool, both for the measurement of illuminance, the time and distance of use (digital habits) and its possible effects on myopia, as well as monitoring the possible refractive change and visual acuity (VA) of the user. In a first study, objective measurements of digital habits were taken in a group of young people in which no type of alert was used (passive group) and in another group in which minimum use, distance or lighting alerts were used (active group). The active group presented a mean distance of use of the device of 343 ± 32 mm compared to the passive group with 307 ± 57 mm (p = 0.019). There were no differences (p = 0.461) in terms of illuminance between groups. A weak correlation was found between the spherical equivalent and digital habits. In a second study, the accuracy of the illuminance measurements taken by the device's light sensor was analyzed and an original method of facial illuminance measurement was studied. The results showed that the light sensor responds in a very linear way to illuminance variation (R2 > 0.98) although it overestimates or underestimates the luminance values depending on the type of light source. For a typical indoor light source, the illuminance measurement was 25% below the actual value. The proposed method allows a measurement of facial illumination with a mean error of 27%. In a third study, several experiments were carried out in order to find out if it is possible to accurately measure VA with a smartphone and a mobile application (app) that uses white or blue light stimuli. Regarding the use of white light, a difference of 0.01 logMAR (p > 0.47) was found between the VA measurement with a smartphone and the clinical measurement. Regarding the use of blue light, after determining a mean value of -0.67 ± 0.21 D for the longitudinal chromatic aberration between blue and white pixels of OLED screens of a smartphone, 90% of the subjects had a VA value that was 0.15 logMAR greater for white light than blue light. Finally, in a fourth study, far point (FP) measurements were taken with an app using blue light in subjects who had various amounts of induced myopia. The results showed a good correlation between induced myopia and that obtained from the FP measured with the app (R2 = 0.80). The mean difference between the two methods was 0.46 ± 0.23 D. Near point (NP) measurements were also taken in presbyopes, by inducing a certain addition in the subjects, and a good correlation was found between the induced addition and that obtained from the measured NP with the app (R2 = 0.81). The mean difference between both methods was 0.03 ± 0.40 D. The main conclusions of the work are that with current smartphones it is possible to measure: digital habits and modify at least the distance of use of the smartphone; facial illuminance within the accuracy limits of the device sensor; VA, although the VA in blue is slightly lower than that obtained clinically; the position of the far and near point with relatively accuracy

Научное обоснование эффективности дистанционного сопровождения диагностики и лечения больных с острыми нарушениями мозгового кровообращения

Цель исследования – доказать безопасность и эффективность лечения больных с острыми нарушениями мозгового кровообращения с помощью дистанционного сопровождения с применением валидизированных клиниметрик