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Alshahrani NS, Hartley A, Howard J, Hajhosseiny R, Khawaja S, Seligman H, Akbari T, Alharbi BA, Bassett P, Al-Lamee R, Francis D, Kaura A, Kelshiker MA, Peters NS, Khamis R. Randomized Trial of Remote Assessment of Patients After an Acute Coronary Syndrome. J Am Coll Cardiol 2024; 83:2250-2259. [PMID: 38588928 DOI: 10.1016/j.jacc.2024.03.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post-acute coronary syndrome (ACS). OBJECTIVES TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS. METHODS Patients were suitable for inclusion with at least 1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat. RESULTS A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (HR: 0.24; 95% CI: 0.13-0.44; P < 0.001) and ED attendance (HR: 0.59; 95% CI: 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs 9% in standard therapy arm). The occurrence of chest pain (9% vs 24%), breathlessness (21% vs 39%), and dizziness (6% vs 18%) at 6 months was lower in the telemedicine group. CONCLUSIONS The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634).
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Affiliation(s)
- Nasser S Alshahrani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; King Khalid University, Abha, Saudi Arabia
| | - Adam Hartley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Reza Hajhosseiny
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Henry Seligman
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tamim Akbari
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Badr A Alharbi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; King Khalid University, Abha, Saudi Arabia
| | - Paul Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amit Kaura
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mihir A Kelshiker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
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Amirova A, Fteropoulli T, Ahmed N, Cowie MR, Leibo JZ. Framework-based qualitative analysis of free responses of Large Language Models: Algorithmic fidelity. PLoS One 2024; 19:e0300024. [PMID: 38470890 PMCID: PMC10931535 DOI: 10.1371/journal.pone.0300024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Today, with the advent of Large-scale generative Language Models (LLMs) it is now possible to simulate free responses to interview questions such as those traditionally analyzed using qualitative research methods. Qualitative methodology encompasses a broad family of techniques involving manual analysis of open-ended interviews or conversations conducted freely in natural language. Here we consider whether artificial "silicon participants" generated by LLMs may be productively studied using qualitative analysis methods in such a way as to generate insights that could generalize to real human populations. The key concept in our analysis is algorithmic fidelity, a validity concept capturing the degree to which LLM-generated outputs mirror human sub-populations' beliefs and attitudes. By definition, high algorithmic fidelity suggests that latent beliefs elicited from LLMs may generalize to real humans, whereas low algorithmic fidelity renders such research invalid. Here we used an LLM to generate interviews with "silicon participants" matching specific demographic characteristics one-for-one with a set of human participants. Using framework-based qualitative analysis, we showed the key themes obtained from both human and silicon participants were strikingly similar. However, when we analyzed the structure and tone of the interviews we found even more striking differences. We also found evidence of a hyper-accuracy distortion. We conclude that the LLM we tested (GPT-3.5) does not have sufficient algorithmic fidelity to expect in silico research on it to generalize to real human populations. However, rapid advances in artificial intelligence raise the possibility that algorithmic fidelity may improve in the future. Thus we stress the need to establish epistemic norms now around how to assess the validity of LLM-based qualitative research, especially concerning the need to ensure the representation of heterogeneous lived experiences.
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Affiliation(s)
- Aliya Amirova
- Population Health Sciences, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | | | - Nafiso Ahmed
- Division of Psychiatry, University College London, London, United Kingdom
| | - Martin R. Cowie
- Royal Brompton Hospital, London, London, United Kingdom
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Joel Z. Leibo
- Google DeepMind, London, London, United Kingdom
- Department of Informatics, Faculty of Natural, Mathematical & Engineering Sciences, King’s College London, London, United Kingdom
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Queiroz C, Guerreiro C, Oliveira-Santos M, Ferreira D, Fontes-Carvalho R, Ladeiras-Lopes R. Digital health and cardiovascular healthcare professionals in Portugal: Current status, expectations and barriers to implementation. Rev Port Cardiol 2024:S0870-2551(24)00073-8. [PMID: 38460748 DOI: 10.1016/j.repc.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/19/2023] [Accepted: 10/13/2023] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Digital health (DH) is a broad concept, bringing together technology and healthcare, that is playing an increasingly important role in the daily routine of healthcare professionals (HCPs) and promises to contribute to the prevention and treatment of cardiovascular disease. There are no solid data on the position of Portuguese HCPs toward the implementation of DH in cardiovascular medicine. This national cross-sectional study aims to provide a snapshot of DH implementation in Portuguese cardiovascular HCP routines and to identify both expectations and barriers to its adoption. METHODS An 18-question survey was created specifically for this study and distributed to 1174 individuals on the Portuguese Society of Cardiology mailing list. RESULTS We collected 117 valid responses (response rate 10%). Almost all participants had smartphones and laptops, and two-thirds had tablets. Electronic medical information systems were the most used DH tool (84% of respondents) and were considered the most important for improving cardiovascular care. Implantable technologies (sensors and devices), telemedicine and social media were used by more than two out of three respondents and considered «very important» or «extremely important» by most of them. Most participants showed positive expectations regarding the impact of DH in cardiovascular medicine: 78% agreed that DH could improve health outcomes, 64% that it promotes health literacy and 63% that it could decrease healthcare costs. The top-rated barriers were patients' inability to use smartphones, limited access to electronic devices, and lack of legal regulation of DH. CONCLUSION Most Portuguese cardiovascular HCPs had at least three electronic devices (mainly smartphones, laptops and tablets) and showed positive expectations regarding DH's current and future impact on cardiovascular medicine. Patient DH literacy, technology adoption, and DH regulation were identified as the most important barriers to increasing the adoption of DH tools in cardiovascular medicine.
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Affiliation(s)
| | - Cláudio Guerreiro
- Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Daniel Ferreira
- Intensive Care Unit, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Ricardo Ladeiras-Lopes
- Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.
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Peinado-Rubia AB, Verdejo-Herrero A, Obrero-Gaitán E, Osuna-Pérez MC, Cortés-Pérez I, García-López H. Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:903. [PMID: 38339621 PMCID: PMC10857255 DOI: 10.3390/s24030903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The aim of this systematic review with meta-analysis was to assess the effectiveness of non-immersive virtual reality (niVR) active videogames in patients who underwent cardiac rehabilitation (CR). METHODS A systematic review with meta-analysis, according to the PRISMA guidelines and previously registered in PROSPERO (CRD42023485240), was performed through a literature search in PubMed (Medline), SCOPUS, WOS, and PEDro since inception to 21 November 2023. We included randomized controlled trials (RCTs) that assessed the effectiveness of an niVR intervention, in comparison with conventional CR and usual care, on aerobic capacity and cardiovascular endurance (physical function), anxiety, depression, and quality of life (QoL). The risk of bias in individual studies was assessed using the Cochrane risk of bias tool. Effect size was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. RESULTS Nine RCT that met the inclusion criteria were included in the meta-analysis. The meta-analysis showed a moderate-to-large effect favoring niVR active videogames included in CR in increasing aerobic capacity and cardiovascular endurance (SMD = 0.74; 95% CI 0.11 to 1.37; p = 0.021) and reducing anxiety (SMD = -0.66; 95% CI -1.13 to -0.2; p = 0.006). Only 4.8% of patients reported adverse events while performing niVR active videogames. CONCLUSIONS Inclusion of niVR active videogames in CR programs is more effective than conventional CR in improving aerobic capacity and cardiovascular endurance and in reducing anxiety.
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Affiliation(s)
- Ana Belén Peinado-Rubia
- Asociación de Fibromialgia de Jaén (AFIXA), C/Baltasar de Alcázar 5, 23008 Jaén, Spain;
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - Alberto Verdejo-Herrero
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Ctra. Sacramento s/n, 04120 Almería, Spain; (A.V.-H.); (H.G.-L.)
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (M.C.O.-P.)
| | - Héctor García-López
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Ctra. Sacramento s/n, 04120 Almería, Spain; (A.V.-H.); (H.G.-L.)
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5
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Alavi R, Wang Q, Gorji H, Pahlevan NM. A machine learning approach for computation of cardiovascular intrinsic frequencies. PLoS One 2023; 18:e0285228. [PMID: 37883430 PMCID: PMC10602266 DOI: 10.1371/journal.pone.0285228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/17/2023] [Indexed: 10/28/2023] Open
Abstract
Analysis of cardiovascular waveforms provides valuable clinical information about the state of health and disease. The intrinsic frequency (IF) method is a recently introduced framework that uses a single arterial pressure waveform to extract physiologically relevant information about the cardiovascular system. The clinical usefulness and physiological accuracy of the IF method have been well-established via several preclinical and clinical studies. However, the computational complexity of the current L2 optimization solver for IF calculations remains a bottleneck for practical deployment of the IF method in real-time settings. In this paper, we propose a machine learning (ML)-based methodology for determination of IF parameters from a single carotid waveform. We use a sequentially-reduced Feedforward Neural Network (FNN) model for mapping carotid waveforms to the output parameters of the IF method, thereby avoiding the non-convex L2 minimization problem arising from the conventional IF approach. Our methodology also includes procedures for data pre-processing, model training, and model evaluation. In our model development, we used both clinical and synthetic waveforms. Our clinical database is composed of carotid waveforms from two different sources: the Huntington Medical Research Institutes (HMRI) iPhone Heart Study and the Framingham Heart Study (FHS). In the HMRI and FHS clinical studies, various device platforms such as piezoelectric tonometry, optical tonometry (Vivio), and an iPhone camera were used to measure arterial waveforms. Our blind clinical test shows very strong correlations between IF parameters computed from the FNN-based method and those computed from the standard L2 optimization-based method (i.e., R≥0.93 and P-value ≤0.005 for each IF parameter). Our results also demonstrate that the performance of the FNN-based IF model introduced in this work is independent of measurement apparatus and of device sampling rate.
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Affiliation(s)
- Rashid Alavi
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Qian Wang
- Beijing Computational Science Research Center, Beijing, China
| | - Hossein Gorji
- Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dubendorf, Switzerland
| | - Niema M. Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California, United States of America
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA, United States of America
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
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6
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Lam CSP, Docherty KF, Ho JE, McMurray JJV, Myhre PL, Omland T. Recent successes in heart failure treatment. Nat Med 2023; 29:2424-2437. [PMID: 37814060 DOI: 10.1038/s41591-023-02567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
Remarkable recent advances have revolutionized the field of heart failure. Survival has improved among individuals with heart failure and a reduced ejection fraction and for the first time, new therapies have been shown to improve outcomes across the entire ejection fraction spectrum of heart failure. Great strides have been taken in the treatment of specific cardiomyopathies such as cardiac amyloidosis and hypertrophic cardiomyopathy, whereby conditions once considered incurable can now be effectively managed with novel genetic and molecular approaches. Yet there remain substantial residual unmet needs in heart failure. The translation of successful clinical trials to improved patient outcomes is limited by large gaps in implementation of care, widespread lack of disease awareness and poor understanding of the socioeconomic determinants of outcomes and how to address disparities. Ongoing clinical trials, advances in phenotype segmentation for precision medicine and the rise in technology solutions all offer hope for the future.
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Affiliation(s)
- Carolyn S P Lam
- Duke-NUS Medical School, Singapore, Singapore.
- National Heart Centre Singapore, Singapore, Singapore.
- University Medical Center Groningen, Groningen, the Netherlands.
| | - Kieran F Docherty
- University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John J V McMurray
- University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK
| | - Peder L Myhre
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
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7
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Reich C, Meder B. The Heart and Artificial Intelligence-How Can We Improve Medicine Without Causing Harm. Curr Heart Fail Rep 2023; 20:271-279. [PMID: 37291432 PMCID: PMC10250175 DOI: 10.1007/s11897-023-00606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW The introduction of Artificial Intelligence into the healthcare system offers enormous opportunities for biomedical research, the improvement of patient care, and cost reduction in high-end medicine. Digital concepts and workflows are already playing an increasingly important role in cardiology. The fusion of computer science and medicine offers great transformative potential and enables enormous acceleration processes in cardiovascular medicine. RECENT FINDINGS As medical data becomes smart, it is also becoming more valuable and vulnerable to malicious actors. In addition, the gap between what is technically possible and what is allowed by privacy legislation is growing. Principles of the General Data Protection Regulation that have been in force since May 2018, such as transparency, purpose limitation, and data minimization, seem to hinder the development and use of Artificial Intelligence. Concepts to secure data integrity and incorporate legal and ethical principles can help to avoid the potential risks of digitization and may result in an European leadership in regard to privacy protection and AI. The following review provides an overview of relevant aspects of Artificial Intelligence and Machine Learning, highlights selected applications in cardiology, and discusses central ethical and legal considerations.
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Affiliation(s)
- Christoph Reich
- Department of Internal Medicine III, Precision Digital Health, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Informatics for Life, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Heidelberg, Germany
| | - Benjamin Meder
- Department of Internal Medicine III, Precision Digital Health, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- Informatics for Life, Heidelberg, Germany.
- German Center for Cardiovascular Research (DZHK), Heidelberg, Germany.
- Department of Genetics, Genome Technology Center, Stanford University, Stanford, CA, USA.
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8
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Baldassarre D, Iacoviello L, Baetta R, Roncaglioni MC, Condorelli G, Remuzzi G, Gensini G, Frati L, Ricciardi W, Conaldi PG, Uccelli A, Blandini F, Bosari S, Scambia G, Fini M, Di Malta A, Amato M, Veglia F, Bonomi A, Klersy C, Colazzo F, Pengo M, Gorini F, Auteri L, Ferrante G, Baviera M, Ambrosio G, Catapano A, Gialluisi A, Malavazos AE, Castelvecchio S, Corsi-Romanelli MM, Cardani R, La Rovere MT, Agnese V, Pane B, Prati D, Spinardi L, Liuzzo G, Arbustini E, Volterrani M, Visconti M, Werba JP, Genovese S, Bilo G, Invitti C, Di Blasio A, Lombardi C, Faini A, Rosa D, Ojeda-Fernández L, Foresta A, De Curtis A, Di Castelnuovo A, Scalvini S, Pierobon A, Gorini A, Valenti L, Luzi L, Racca A, Bandi M, Tremoli E, Menicanti L, Parati G, Pompilio G. Rationale and design of the CV-PREVITAL study: an Italian multiple cohort randomised controlled trial investigating innovative digital strategies in primary cardiovascular prevention. BMJ Open 2023; 13:e072040. [PMID: 37451717 PMCID: PMC10351259 DOI: 10.1136/bmjopen-2023-072040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Prevention of cardiovascular disease (CVD) is of key importance in reducing morbidity, disability and mortality worldwide. Observational studies suggest that digital health interventions can be an effective strategy to reduce cardiovascular (CV) risk. However, evidence from large randomised clinical trials is lacking. METHODS AND ANALYSIS The CV-PREVITAL study is a multicentre, prospective, randomised, controlled, open-label interventional trial designed to compare the effectiveness of an educational and motivational mobile health (mHealth) intervention versus usual care in reducing CV risk. The intervention aims at improving diet, physical activity, sleep quality, psycho-behavioural aspects, as well as promoting smoking cessation and adherence to pharmacological treatment for CV risk factors. The trial aims to enrol approximately 80 000 subjects without overt CVDs referring to general practitioners' offices, community pharmacies or clinics of Scientific Institute for Research, Hospitalization and Health Care (Italian acronym IRCCS) affiliated with the Italian Cardiology Network. All participants are evaluated at baseline and after 12 months to assess the effectiveness of the intervention on short-term endpoints, namely improvement in CV risk score and reduction of major CV risk factors. Beyond the funded life of the study, a long-term (7 years) follow-up is also planned to assess the effectiveness of the intervention on the incidence of major adverse CV events. A series of ancillary studies designed to evaluate the effect of the mHealth intervention on additional risk biomarkers are also performed. ETHICS AND DISSEMINATION This study received ethics approval from the ethics committee of the coordinating centre (Monzino Cardiology Center; R1256/20-CCM 1319) and from all other relevant IRBs and ethics committees. Findings are disseminated through scientific meetings and peer-reviewed journals and via social media. Partners are informed about the study's course and findings through regular meetings. TRIAL REGISTRATION NUMBER NCT05339841.
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Affiliation(s)
- Damiano Baldassarre
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, Italy
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Luigi Frati
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Walter Ricciardi
- Istituti Clinici Scientifici Maugeri IRCCS Pavia, Pavia, Italy
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
| | - Pier Giulio Conaldi
- IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | | | - Fabio Blandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvano Bosari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Mauro Amato
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Veglia
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | | | - Catherine Klersy
- Unit of Clinical Epidemiology & Biostatistic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Martino Pengo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Alberico Catapano
- IRCCS Multimedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, Italy
| | - Alexis Elias Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Massimiliano Marco Corsi-Romanelli
- UOC SMEL-1, IRCCS POLICLINICO SAN DONATO, San Donato Milanese, Italy
- Department of Health and Biomedical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rosanna Cardani
- BioCor Biobank, UOC SMEL-1 of Clinical Pathology, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | | | - Valentina Agnese
- IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Bianca Pane
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Spinardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Liuzzo
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Eloisa Arbustini
- Centro Malattie Genetiche Cardiovascolari - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Volterrani
- Cardio Pulmonary Department, IRCCS San Raffaele, Rome, Italy
- Exercise Science and Medicine, San Raffaele Open University, Rome, Italy
| | - Marco Visconti
- Co.S. (Consorzio Sanità) Study Center, Italy, Soresina, Italy
| | | | | | - Grzegorz Bilo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Carolina Lombardi
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Andrea Faini
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Debora Rosa
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luisa Ojeda-Fernández
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andreana Foresta
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | | | | | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri IRCCS Montescano, Montescano, Italy
| | - Alessandra Gorini
- Istituti Clinici Scientifici Maugeri IRCCS Milano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Valenti
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Fisiopatologia e Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Livio Luzi
- IRCCS Multimedica, Milan, Italy
- Department of Health and Biomedical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Annarosa Racca
- Federfarma Lombardia & Fondazione Guido Muralti, Milan, Italy
| | - Manuela Bandi
- Federfarma Lombardia & Fondazione Guido Muralti, Milan, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
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9
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Iliuță L, Andronesi AG, Rac-Albu M, Furtunescu FL, Rac-Albu ME, Scafa-Udriște A, Moldovan H, Panaitescu E. Challenges in Caring for People with Cardiovascular Disease through and beyond the COVID-19 Pandemic: The Advantages of Universal Access to Home Telemonitoring. Healthcare (Basel) 2023; 11:1727. [PMID: 37372846 DOI: 10.3390/healthcare11121727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Cardiovascular prevention was left in second place during the COVID-19 pandemic and the use of telemedicine turned out to be very useful. We aimed to evaluate the effectiveness of a telemedicine application for remote monitoring and treatment adjustments in terms of improving cardiovascular prevention. (2) Methods: A prospective study of 3439 patients evaluated between the 1st of March 2019 and the 1st of March 2022, in the pre-pandemic period by face-to-face visits and during the pandemic by teleconsultations or hybrid follow-up. We compared four periods: pre-pandemic-Pre-P (1 March 2019-1 March 2020), lockdown-Lock (1 March-1 September 2020), restrictive-pandemic-Restr-P (1 September 2020-1 March 2021), and relaxed-pandemic-Rel-P (1 March 2021-1 March 2022). (3) Results: The average values of total cholesterol (TC), LDL cholesterol, triglycerides, uric acid, and glucose had an increasing trend during Lock and Restr-P, and they decreased close to the baseline level during the Rel-P, with the exception of glucose which remained elevated in Rel-P. The number of patients with newly discovered DM increased significantly in the Rel-P, and 79.5% of them had mild/moderate forms of COVID-19. During Lock and Res-P, the percentage of obese, smoking, or hypertensive patients increased, but probably through the use of telemedicine, we managed to reduce it, although it remained slightly higher than the pre-pandemic level. Physical activity decreased in the first year of the pandemic, but in Rel-P people became more active than before the pandemic. (4) Conclusions: The use of telemedicine for cardiovascular prevention seems to yield favorable results, especially for secondary prevention in the very high-risk group and during the second year.
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Affiliation(s)
- Luminita Iliuță
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Andreea Gabriella Andronesi
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Marius Rac-Albu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Florentina Ligia Furtunescu
- Department of Public Health and Management, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Mădălina-Elena Rac-Albu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Department of Cardiology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Horațiu Moldovan
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania
- Academy of Romanian Scientist (AOSR), 3 Ilfov Street, 050044 Bucharest, Romania
| | - Eugenia Panaitescu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
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10
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Krzesiński P. Digital Health Technologies for Post-Discharge Care after Heart Failure Hospitalisation to Relieve Symptoms and Improve Clinical Outcomes. J Clin Med 2023; 12:2373. [PMID: 36983375 PMCID: PMC10058646 DOI: 10.3390/jcm12062373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
The prevention of recurrent heart failure (HF) hospitalisations is of particular importance, as each such successive event may increase the risk of death. Effective care planning during the vulnerable phase after discharge is crucial for symptom control and improving patient prognosis. Many clinical trials have focused on telemedicine interventions in HF, with varying effects on the primary endpoints. However, the evidence of the effectiveness of telemedicine solutions in cardiology is growing. The scope of this review is to present complementary telemedicine modalities that can support outpatient care of patients recently hospitalised due to worsening HF. Remote disease management models, such as video (tele) consultations, structured telephone support, and remote monitoring of vital signs, were presented as core components of telecare. Invasive and non-invasive monitoring of volume status was described as an important step forward to prevent congestion-the main cause of clinical decompensation. The idea of virtual wards, combining these facilities with in-person visits, strengthens the opportunity for education and enhancement to promote more intensive self-care. Electronic platforms provide coordination of tasks within multidisciplinary teams and structured data that can be effectively used to develop predictive algorithms based on advanced digital science, such as artificial intelligence. The rapid progress in informatics, telematics, and device technologies provides a wide range of possibilities for further development in this area. However, there are still existing gaps regarding the use of telemedicine solutions in HF patients, and future randomised telemedicine trials and real-life registries are still definitely needed.
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Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine-National Research Institute, Szaserow Street 128, 04-141 Warsaw, Poland
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11
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Leiner J, König S, Mouratis K, Kim I, Schmitz P, Joshi T, Schanner C, Wohlrab L, Hohenstein S, Pellissier V, Nitsche A, Kuhlen R, Hindricks G, Bollmann A. A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences. JMIR Form Res 2023; 7:e41115. [PMID: 36867450 PMCID: PMC10029859 DOI: 10.2196/41115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients' quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. OBJECTIVE Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. METHODS The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). RESULTS With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform's functionality and usability. CONCLUSIONS TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth.
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Affiliation(s)
- Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sebastian König
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Konstantinos Mouratis
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Igor Kim
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Pia Schmitz
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Tanvi Joshi
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Carolin Schanner
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Lisa Wohlrab
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Anne Nitsche
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Ralf Kuhlen
- Helios Health GmbH, Berlin, Germany
- Helios Health Institute, Berlin, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
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12
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Zwack CC, Smith C, Poulsen V, Raffoul N, Redfern J. Information Needs and Communication Strategies for People with Coronary Heart Disease: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1723. [PMID: 36767091 PMCID: PMC9914653 DOI: 10.3390/ijerph20031723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.
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Affiliation(s)
- Clara C. Zwack
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Carlie Smith
- National Heart Foundation of Australia, Brisbane, QLD 4006, Australia
| | - Vanessa Poulsen
- National Heart Foundation of Australia, Adelaide, SA 5000, Australia
| | - Natalie Raffoul
- National Heart Foundation Australia, Sydney, NSW 2011, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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13
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Zhang Z, Chen J. The Enterprise's Willingness to Use Remote Monitoring Technology Under the Background of Green Operation and Service-Oriented Manufacturing. J ORGAN END USER COM 2023. [DOI: 10.4018/joeuc.316165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The current development of remote monitoring technology (RMT) has become increasingly mature. The key to implementing this technology lies in the user's willingness to use it. In order to study the influencing factors of using RMT in green operation and service-oriented manufacturing enterprises, based on organizational behavior, this exploration discusses the reasons that affect the introduction of new technologies into enterprises from the perspectives of perceived risk, conformity and technology acceptance. Moreover, a series of data is obtained through the questionnaire and the results are obtained by analyzing the data. Suggestions to improve the use of RMT in enterprises are put forward. The results show that technology itself, external environment and organizational characteristics can all affect the decision-making of enterprises on new technology.
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Affiliation(s)
- Zhe Zhang
- Shandong University of Finance and Economics, China
| | - Jin Chen
- University of International Business and Economics, China
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14
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Warule P, Mishra SP, Deb S. Significance of voiced and unvoiced speech segments for the detection of common cold. SIGNAL, IMAGE AND VIDEO PROCESSING 2022; 17:1785-1792. [PMID: 36408330 PMCID: PMC9664442 DOI: 10.1007/s11760-022-02389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 05/24/2023]
Abstract
This work investigates the significance of the voiced and unvoiced region for detecting common cold from the speech signal. In literature, the entire speech signal is processed to detect the common cold and other diseases. This study uses a short-time energy-based approach to segment the voiced and unvoiced region of the speech signal. Then, frame-wise mel frequency cepstral coefficients (MFCC) features are extracted from the voiced and unvoiced segments of each speech utterance, and statistics (mean, variance, skewness, and kurtosis) are calculated to get the feature vector for each speech utterance. The support vector machine (SVM) is utilized to analyze the performance of features extracted from the voiced and unvoiced region. Result shows that the feature extracted from voiced segments, unvoiced segments, and complete active speech (CAS) gives almost similar results using the MFCC features and SVM classifier. Therefore, rather than processing the CAS, we can process the unvoiced speech segments, which have fewer frames compared to CAS and voiced regions of speech. The processing of solely unvoiced segments can reduce the time and computation complexity of a speech signal-based common cold detection system.
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Affiliation(s)
- Pankaj Warule
- Department of Electronics Engineering, Sardar Vallabhbhai National Institute of Technology, Surat, 395007 India
| | - Siba Prasad Mishra
- Department of Electronics Engineering, Sardar Vallabhbhai National Institute of Technology, Surat, 395007 India
| | - Suman Deb
- Department of Electronics Engineering, Sardar Vallabhbhai National Institute of Technology, Surat, 395007 India
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15
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Guasti L, Dilaveris P, Mamas MA, Richter D, Christodorescu R, Lumens J, Schuuring MJ, Carugo S, Afilalo J, Ferrini M, Asteggiano R, Cowie MR. Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e-Cardiology. ESC Heart Fail 2022; 9:2808-2822. [PMID: 35818770 DOI: 10.1002/ehf2.14022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022] Open
Abstract
Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance across the world. This Consensus document discusses the potential implementation of digital health technology in older adults, suggesting a practical approach to general cardiologists working in an ambulatory outpatient clinic, highlighting the potential benefit and challenges of digital health in older patients with, or at risk of, cardiovascular disease. Advancing age may lead to a progressive loss of independence, to frailty, and to increasing degrees of disability. In geriatric cardiology, digital health technology may serve as an additional tool both in cardiovascular prevention and treatment that may help by (i) supporting self-caring patients with cardiovascular disease to maintain their independence and improve the management of their cardiovascular disease and (ii) improving the prevention, detection, and management of frailty and supporting collaboration with caregivers. Digital health technology has the potential to be useful for every field of cardiology, but notably in an office-based setting with frequent contact with ambulatory older adults who may be pre-frail or frail but who are still able to live at home. Cardiologists and other healthcare professionals should increase their digital health skills and learn how best to apply and integrate new technologies into daily practice and how to engage older people and their caregivers in a tailored programme of care.
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Affiliation(s)
- Luigina Guasti
- University of Insubria - Department of Medicine and Surgery; ASST-settelaghi, Varese, Italy
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | | | | | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefano Carugo
- University of Milan, Cardiology, Policlinico di Milano, Milan, Italy
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University; Centre for Clinical Epidemiology, Jewish General Hospital; Division of Cardiology, Jewish General Hospital, McGill University; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Riccardo Asteggiano
- University of Insubria - Department of Medicine and Surgery; ASST-settelaghi, Varese, Italy.,LARC (Laboratorio Analisi e Ricerca Clinica), Turin, Italy
| | - Martin R Cowie
- Royal Brompton Hospital (Guy's& St Thomas' NHS Foundation Trust) & Faculty of Lifesciences & Medicine, King's College London, London, UK
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16
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Cardiovascular Diseases in the Digital Health Era: A Translational Approach from the Lab to the Clinic. BIOTECH 2022; 11:biotech11030023. [PMID: 35892928 PMCID: PMC9326743 DOI: 10.3390/biotech11030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/19/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Translational science has been introduced as the nexus among the scientific and the clinical field, which allows researchers to provide and demonstrate that the evidence-based research can connect the gaps present between basic and clinical levels. This type of research has played a major role in the field of cardiovascular diseases, where the main objective has been to identify and transfer potential treatments identified at preclinical stages into clinical practice. This transfer has been enhanced by the intromission of digital health solutions into both basic research and clinical scenarios. This review aimed to identify and summarize the most important translational advances in the last years in the cardiovascular field together with the potential challenges that still remain in basic research, clinical scenarios, and regulatory agencies.
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17
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McBeath KCC, Angermann CE, Cowie MR. Digital Technologies to Support Better Outcome and Experience of Care in Patients with Heart Failure. Curr Heart Fail Rep 2022; 19:75-108. [PMID: 35486314 PMCID: PMC9051015 DOI: 10.1007/s11897-022-00548-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this article, we review a range of digital technologies for possible application in heart failure patients, with a focus on lessons learned. We also discuss a future model of heart failure management, as digital technologies continue to become part of standard care. RECENT FINDINGS Digital technologies are increasingly used by healthcare professionals and those living with heart failure to support more personalised and timely shared decision-making, earlier identification of problems, and an improved experience of care. The COVID-19 pandemic has accelerated the acceptability and implementation of a range of digital technologies, including remote monitoring and health tracking, mobile health (wearable technology and smartphone-based applications), and the use of machine learning to augment data interpretation and decision-making. Much has been learned over recent decades on the challenges and opportunities of technology development, including how best to evaluate the impact of digital health interventions on health and healthcare, the human factors involved in implementation and how best to integrate dataflows into the clinical pathway. Supporting patients with heart failure as well as healthcare professionals (both with a broad range of health and digital literacy skills) is crucial to success. Access to digital technologies and the internet remains a challenge for some patients. The aim should be to identify the right technology for the right patient at the right time, in a process of co-design and co-implementation with patients.
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Affiliation(s)
- K C C McBeath
- Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK
| | - C E Angermann
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - M R Cowie
- Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK.
- School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, London, UK.
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18
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Pfattner R, Laukhina E, Li J, Zaffino RL, Aliaga-Alcalde N, Mas-Torrent M, Laukhin V, Veciana J. Emergent Insulator-Metal Transition with Tunable Optical and Electrical Gap in Thin Films of a Molecular Conducting Composite. ACS APPLIED ELECTRONIC MATERIALS 2022; 4:2432-2441. [PMID: 35647553 PMCID: PMC9134344 DOI: 10.1021/acsaelm.2c00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Composites exhibit unique synergistic properties emerging when components with different properties are combined. The tuning of the energy bandgap in the electronic structure of the material allows designing tailor-made systems with desirable mechanical, electrical, optical, and/or thermal properties. Here, we study an emergent insulator-metal transition at room temperature in bilayered (BL) thin-films comprised of polycarbonate/molecular-metal composites. Temperature-dependent resistance measurements allow monitoring of the electrical bandgap, which is in agreement with the optical bandgap extracted by optical absorption spectroscopy. The semiconductor-like properties of BL films, made with bis(ethylenedithio)-tetrathiafulvalene (BEDT-TTF or ET) α-ET2I3 (nano)microcrystals as two-dimensional molecular conductor on one side and insulator polycarbonate as a second ingredient, are attributed to an emergent phenomenon equivalent to the transition from an insulator to a metal. This made it possible to obtain semiconducting BL films with tunable electrical/optical bandgaps ranging from 0 to 2.9 eV. A remarkable aspect is the similarity close to room temperature of the thermal and mechanical properties of both composite components, making these materials ideal candidates to fabricate flexible and soft sensors for stress, pressure, and temperature aiming at applications in wearable human health care and bioelectronics.
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Affiliation(s)
- Raphael Pfattner
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
- Networking
Research Center on Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Campus UAB, 08193 Bellaterra, Spain
| | - Elena Laukhina
- Networking
Research Center on Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Campus UAB, 08193 Bellaterra, Spain
| | - Jinghai Li
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
| | - Rossella L. Zaffino
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
| | - Núria Aliaga-Alcalde
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
- ICREA−Institució
Catalana de Recerca i Estudis Avançats, Passeig Lluis Companys 23, 08010 Barcelona, Spain
| | - Marta Mas-Torrent
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
- Networking
Research Center on Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Campus UAB, 08193 Bellaterra, Spain
| | - Vladimir Laukhin
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
- Networking
Research Center on Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Campus UAB, 08193 Bellaterra, Spain
- ICREA−Institució
Catalana de Recerca i Estudis Avançats, Passeig Lluis Companys 23, 08010 Barcelona, Spain
| | - Jaume Veciana
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Spain
- Networking
Research Center on Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Campus UAB, 08193 Bellaterra, Spain
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Park SH, Shin JH, Park J, Choi WS. An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010583. [PMID: 34682329 PMCID: PMC8535932 DOI: 10.3390/ijerph182010583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022]
Abstract
Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM’s inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339–0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209–0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107–1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.
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Affiliation(s)
- Sang-Hyun Park
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Korea; (S.-H.P.); (J.-H.S.)
| | - Jong-Ho Shin
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Korea; (S.-H.P.); (J.-H.S.)
| | - Joowoong Park
- Research Strategy Division, Korea Aerospace Research Institute (KARI), Daejeon 34133, Korea;
| | - Woo-Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
- Keyu Internal Medicine Clinic, Daejeon 35250, Korea
- Correspondence: ; Tel.: +82-42-483-7554; Fax: +82-42-485-7554
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Role of Digital Health During Coronavirus Disease 2019 Pandemic and Future Perspectives. Card Electrophysiol Clin 2021; 14:115-123. [PMID: 35221080 PMCID: PMC8556539 DOI: 10.1016/j.ccep.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Vervoort D, Tam DY, Wijeysundera HC. Health Technology Assessment for Cardiovascular Digital Health Technologies and Artificial Intelligence: Why Is It Different? Can J Cardiol 2021; 38:259-266. [PMID: 34461229 DOI: 10.1016/j.cjca.2021.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
Innovations in health care are growing exponentially, resulting in improved quality of and access to care, as well as rising societal costs of care and variable reimbursement. In recent years, digital health technologies and artificial intelligence have become of increasing interest in cardiovascular medicine owing to their unique ability to empower patients and to use increasing quantities of data for moving toward personalised and precision medicine. Health technology assessment agencies evaluate the money spent on a health care intervention or technology to attain a given clinical impact and make recommendations for reimbursement considerations. However, there is a scarcity of economic evaluations of cardiovascular digital health technologies and artificial intelligence. The current health technology assessment framework is not equipped to address the unique, dynamic, and unpredictable value considerations of these technologies and highlight the need to better approach the digital health technologies and artificial intelligence health technology assessment process. In this review, we compare digital health technologies and artificial intelligence with traditional health care technologies, review existing health technology assessment frameworks, and discuss challenges and opportunities related to cardiovascular digital health technologies and artificial intelligence health technology assessment. Specifically, we argue that health technology assessments for digital health technologies and artificial intelligence applications must allow for a much shorter device life cycle, given the rapid and even potentially continuously iterative nature of this technology, and thus an evidence base that maybe less mature, compared with traditional health technologies and interventions.
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Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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22
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Tudor Car L, Kyaw BM, Nannan Panday RS, van der Kleij R, Chavannes N, Majeed A, Car J. Digital Health Training Programs for Medical Students: Scoping Review. JMIR MEDICAL EDUCATION 2021; 7:e28275. [PMID: 34287206 PMCID: PMC8339984 DOI: 10.2196/28275] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. The COVID-19 pandemic has contributed to this swift and widespread transition to digital health and education. However, the need for digital health competencies goes beyond the COVID-19 pandemic because they are becoming essential for the delivery of effective, efficient, and safe care. OBJECTIVE This review aims to collate and analyze studies evaluating digital health education for medical students to inform the development of future courses and identify areas where curricula may need to be strengthened. METHODS We carried out a scoping review by following the guidance of the Joanna Briggs Institute, and the results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 6 major bibliographic databases and gray literature sources for articles published between January 2000 and November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussions between the authors. The findings were analyzed using thematic analysis and presented narratively. RESULTS A total of 34 studies focusing on different digital courses were included in this review. Most of the studies (22/34, 65%) were published between 2010 and 2019 and originated in the United States (20/34, 59%). The reported digital health courses were mostly elective (20/34, 59%), were integrated into the existing curriculum (24/34, 71%), and focused mainly on medical informatics (17/34, 50%). Most of the courses targeted medical students from the first to third year (17/34, 50%), and the duration of the courses ranged from 1 hour to 3 academic years. Most of the studies (22/34, 65%) reported the use of blended education. A few of the studies (6/34, 18%) delivered courses entirely digitally by using online modules, offline learning, massive open online courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in-person observations, and online assessments. Most of the studies (30/34, 88%) evaluated courses mostly by using an uncontrolled before-and-after design and generally reported improvements in students' learning outcomes. CONCLUSIONS Digital health courses reported in literature are mostly elective, focus on a single area of digital health, and lack robust evaluation. They have diverse delivery, development, and assessment approaches. There is an urgent need for high-quality studies that evaluate digital health education.
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Affiliation(s)
- Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rishi S Nannan Panday
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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