Delivering healthcare remotely to cardiovascular patients during COVID-19 : A rapid review of the evidence

Validation of the eHealth literacy scales: comparison between the shorter and longer versions

Digital service provision became necessary during and after the COVID-19 pandemic highlighting the technological disparity experienced by healthcare professionals and healthcare users. eHealth Literacy skills are mostly measured with the use of the eHeals, but recently more instruments have been developed to meet this need. The aim of the study was to validate and compare the two scales in Greek: the eHeals and the revised eHeals-Extended. In total, 401 participants replied to the eHeals, the revised eHeals-Extended, and the HLS-EU-Q16. The eHeals scales provided good psychometric properties. The validation of the eHeals confirmed the two dimensions with high internal consistency (total score α = .91, eHeals1 α = .88, eHeals2 α = .78). The revised eHeals-Extended exploratory analysis extracted five factors with satisfactory internal consistency (Cronbach's α = .62-.89): awareness and quality of resources online, understanding online information, smart on the net, accessing and validating online information and perceived efficiency. The use of the revised eHeals-Extended and eHeals validated in Greek, could be valuable tools in clinical and research settings. The eHeals could be used as an additional tool when eHealth Literacy is not the core concept measured and the revised eHeals-Extended can be used when researchers wish to measure eHealth Literacy concept more thoroughly.

A New Remote Monitoring System: Evaluation of the Efficiency and Accuracy of the Smart Emergency Medical System-Health Internet of Things Device

BACKGROUND

The remote medical monitoring system can facilitate monitoring patients with cardiac arrhythmia, and consequently, reduce mortality and complications in individuals requiring emergency interventions. Hence, it is necessary to evaluate new telemedicine devices and compare them with standard devices. Therefore, this study aimed to evaluate and compare the new remote monitoring system, Smart Emergency Medical System-Health Internet of Things (SEMS-HIOT) developed by the Health Technology Development Centre of Babol University of Medical Sciences on patients with different cardiac arrhythmias and compare it with the standard device.

MATERIALS AND METHODS

In this case-control study, 60 patients were divided into the six most common arrhythmia groups (n=10 per each group and equal gender) as atrial fibrillation, ventricular tachycardia, paroxysmal supraventricular tachycardia, premature ventricular contractions, atrial tachycardia, and premature atrial contractions. Also, 20 healthy individuals (including 10 men and 10 women) without any arrhythmia (normal rhythm) were considered as the control group. Three similar SEMS-HIOT devices were used as test devices and a standard cardiac monitoring device as the control device. The clinical parameters, including heart rate, pulse rate, oxygen saturation, body temperature, and cardiac electrical activity via electrocardiogram (ECG) lead-II were recorded.

RESULTS

Findings showed that the performance of the SEMS-HIOT test device was similar and in the same range for all indices in each group and there were no significant differences compared to the performance of the control device (P0.05). Also, the ECG records measured with SEMS-HIOT and standard device indicate no significant differences (P0.05).

CONCLUSION

Our study showed that the cardiac indices as well as ECG findings, which were measured with SEMS-HIOT and common standard devices confirmed the accuracy and reliability of the new telematics device for monitoring patients with cardiac diseases.

Impact of COVID-19 Pandemic on Dispensing of Cardiovascular Drugs in Norway: An Interrupted Time Series Study

INTRODUCTION

The COVID-19 pandemic resulted in changes in prescription patterns and fillings for certain medications, but little is known about its impact on the dispensing of cardiovascular drugs.

METHODS

Trends in dispensing of cardiovascular drugs before and during the pandemic were examined using a population-based cohort in Norway. Using interrupted time series analyses and considering March 1, 2020 as the interruption point, the impact of the pandemic on defined daily dose dispensing of prescribed cardiovascular drugs was estimated in a population of adults with and without pre-existing cardiovascular disease from January 2018 to December 2021. All data were analyzed in 2023.

RESULTS

In a total of 4,053,957 adults, 690,910 (17.0%) had pre-existing cardiovascular disease. Prior to the pandemic, there was a significant monthly increase in any cardiovascular drug dispensing among those with pre-existing cardiovascular disease (0.30 defined daily dose per month per adult), including prescription of diuretics, calcium channel blockers, and lipid-modifying agents. After controlling for preinterruption trends, there was a slight decrease in level change immediately after the start of the pandemic (2.5 defined daily dose per month per adult) but an increase in the postinterruption trend (0.06 defined daily dose per month per adult) for dispensing of cardiovascular prescriptions, although these changes were not significant.

CONCLUSIONS

Although the COVID-19 pandemic did not appear to result in significant changes in patterns of cardiovascular drug dispensing in Norway, continued access to cardiovascular drugs remains important to prevent further related morbidity.

Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience

Introduction: The coronavirus disease 2019 (COVID-19) pandemic made it necessary to practice social distancing and limited in-person encounters in health care. These restrictions created alternative opportunities to enhance patient access to care in the ambulatory setting. We hypothesized that by transforming clinics into centers that prioritize procedures and transitioning ambulatory appointments to telehealth, we could establish a secure, streamlined, and productive method for providing patient care. Methods: Clinic templates were restructured to allow the use of the physical space to perform procedure-based clinics exclusively, while switching to virtual telemedicine for all nonprocedural encounters. Staff members were given specific roles to support one of the patient care modalities for a given day (Procedures vs. Telehealth). Performance and patient satisfaction metrics were collected between two periods of time defined as P1 (February-June 2019) and P2 Post-COVID (February-June 2020) and compared. These served as proxies of periods when the clinic workflow and templates were structured in the traditional versus the emerging way. Statistical analysis was performed using bivariate analyses. Results: The percentage of procedures performed among all in-person visits were higher in P2 compared to P1 (45% vs. 29%, p < 0.001). Although total charges and relative value units were lower in P2, the overall revenue generated was higher compared to P1 ($4,597,846 vs. $4,517,427$, respectively). This increase in revenue was mainly driven by the higher relative income generated by procedures. Patient experience, reflected through patient-reported outcomes, was more favorable in P2 where patients seemed more likely to "Recommend this provider office" (90% vs. 85.7%, p = 0.01), report improved "Access overall" (56% vs. 49%, p = 0.02), and felt they were "Moving through your visit overall" (59% vs. 51%, p = 0.007). Conclusions: Our data suggest that reorganizing urology clinics into a space that is centered around outpatient procedures can represent a model that improves the patient's access to care and clinical experience, while simultaneously improving operational financial strength. This efficient care model could be considered for many practice settings and drive high-value outpatient care.

A web-based intervention for patients with an implantable cardioverter defibrillator - A qualitative study of nurses' experiences (Data from the ACQUIRE-ICD study)

Objective

The aim of this study was to explore cardiac nurses' experiences with a comprehensive web-based intervention for patients with an implantable cardioverter defibrillator.

Methods

We conducted an explorative qualitative study based on individual semi-structured interviews with 9 cardiac nurses from 5 Danish university hospitals.

Results

We found one overall theme: "Between traditional nursing and modern eHealth". This theme was derived from the following six categories: (1) comprehensive content in the intervention, (2) patient-related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were positive towards the web-based intervention and believe it holds a large potential. However, they felt challenged by not having in-person and face-to-face contact with patients, which they found valuable for assessing patients' wellbeing and psychological distress.

Conclusion

Specific training in eHealth communication seems necessary as web-based care entails a shift in the nursing role and requires a different way of communication.InnovationFocusing on the user experience in web-based care from the perspective of cardiac nurses is innovative, and by applying implementation science this leads to new knowledge to consider when developing and implementing web-based care.

Physician Perspectives on Telemedicine at an Integrated Health System During the COVID-19 Pandemic

Introduction: The use of telemedicine (TM) for patient care greatly increased during the COVID pandemic. This study presents data from a single health system regarding physician's perspectives on TM, which could ultimately determine how it is used in the future. Methods: A questionnaire was distributed to physicians throughout the health system. Physicians were divided based on the standard level of patient interaction in each specialty, as well as practice locations and years in practice. Physician perspectives were categorized by their opinions on different aspects of telehealth visits. Results: Of 1,794 physicians, 379 (20.7%) responded to the survey. Psychiatrists used TM significantly more than other groups and project the most future use. Surgeons were least likely to incorporate TM in the future. Ability to perform a physical examination via TM differed significantly by specialty and practice environment, but not by years in practice. Frequency of being able to complete a treatment plan via TM differed significantly by specialty, but not by years in practice or practice environment. Overall, 76.3% of physicians reported feeling "satisfied" with performing TM visits. Satisfaction with TM varied significantly by specialty and practice environment, but not by years in practice. There were no significant differences regarding physician expectations on reimbursement or billing for TM visits based on specialty, age, or practice environment. Conclusions: Discrepancies exist among physicians with respect to their satisfaction and expected future use of TM. Consensus may be difficult to reach regarding reimbursement for these visits, and further work is needed to clarify the optimal practice setting for TM.

Expectations of Tele-Yoga in Persons With Long-Term Illness: Qualitative Content Analysis

BACKGROUND

Yoga is a mind-body exercise that has demonstrated its feasibility and safety even for individuals with severe long-term illness. Engaging in yoga has the potential to yield positive effects on both physical and mental well-being. Tele-yoga is a novel approach to rehabilitation in which participants practice group yoga with a live-streamed yoga instructor digitally via a tablet. This is especially beneficial for individuals who may find it difficult to leave their homes to participate in an exercise session. As part of our ongoing evaluation of the tele-yoga intervention in individuals with long-term illness, we have undertaken an exploration of participants' expectations regarding yoga in general and tele-yoga specifically. Understanding these expectations is crucial, as they can significantly impact their satisfaction with treatment and care and influence overall intervention outcomes.

OBJECTIVE

This study aims to explore the expectations of tele-yoga among individuals with long-term illness before starting a tele-yoga intervention.

METHODS

The study employed an inductive qualitative design and is part of a process evaluation within an ongoing randomized controlled trial. A total of 89 participants were interviewed before the start of the tele-yoga intervention. The interview guide encompassed questions about their general perceptions of yoga and the specific expectations they held for the upcoming tele-yoga sessions. The interviews were transcribed and analyzed using inductive qualitative content analysis.

RESULTS

Participants expressed their expectations for tele-yoga, focusing on the anticipated improvements in physical function and overall health. These expectations included hopes for reduced respiratory issues; relief from discomfort, aches, and pains; as well as increased physical flexibility, coordination, and overall well-being. Besides, they expected to achieve improved psychological well-being and performance; to acquire strategies to manage stress, anger, and anxiety; and to have their motivational drive strengthened and influence other activities. Participants described tele-yoga as a new and exciting technical solution that would facilitate the delivery of yoga. A few participants remained a little hesitant toward the use of technology, with some expectations based on previous experiences. When asked about expectations, some had no idea about what to expect. Participants also had varying perspectives on yoga, with some finding it mysterious and difficult to understand. Participants expressed thoughts that they found the idea of tele-yoga taking place in groups exciting and enjoyable. They also had expectations that being part of a group would provide opportunities for mutual inspiration and encouragement among the group members.

CONCLUSIONS

Expectations before an intervention can provide valuable insights into understanding the factors influencing adherence to tele-yoga and its outcomes. Our findings provide a wide range of expectations for tele-yoga, spanning both physical and mental aspects. Moreover, the technology's potential to facilitate yoga delivery and the supportive nature of digital group interactions were evident from the results.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03703609; https://clinicaltrials.gov/ct2/show/NCT03703609.

Global blood pressure screening during the COVID-19 pandemic: results from the May Measurement Month 2021 campaign

BACKGROUND

Raised blood pressure (BP) remains the biggest risk factor contributing to the global burden of disease and mortality, despite the COVID-19 pandemic. May Measurement Month (MMM), an annual global screening campaign aims to highlight the importance of BP measurement by evaluating global awareness, treatment and control rates among adults with hypertension. In 2021, we assessed the global burden of these rates during the COVID-19 pandemic.

METHODS

Screening sites were set up in 54 countries between May and November 2021 and screenees were recruited by convenience sampling. Three sitting BPs were measured, and a questionnaire completed including demographic, lifestyle and clinical data. Hypertension was defined as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to impute the average BP when readings were missing.

RESULTS

Of the 642 057 screenees, 225 882 (35.2%) were classified as hypertensive, of whom 56.8% were aware, and 50.3% were on antihypertensive medication. Of those on treatment, 53.9% had controlled BP (<140/90 mmHg). Awareness, treatment and control rates were lower than those reported in MMM campaigns before the COVID-19 pandemic. Minimal changes were apparent among those testing positive for, or being vaccinated against COVID-19. Of those on antihypertensive medication, 94.7% reported no change in their treatment because of the COVID-19 pandemic.

CONCLUSION

The high yield of untreated or inadequately treated hypertension in MMM 2021 confirms the need for systematic BP screening where it does not currently exist.

Perspective of Artificial Intelligence in Disease Diagnosis: A Review of Current and Future Endeavours in the Medical Field

Artificial intelligence (AI) has demonstrated significant promise for the present and future diagnosis of diseases. At the moment, AI-powered diagnostic technologies can help physicians decipher medical pictures like X-rays, magnetic resonance imaging, and computed tomography scans, resulting in quicker and more precise diagnoses. In order to make a prospective diagnosis, AI algorithms may also examine patient information, symptoms, and medical background. The application of AI in disease diagnosis is anticipated to grow as the field develops. In the future, AI may be used to find patterns in enormous volumes of medical data, aiding in disease prediction and prevention before symptoms appear. Additionally, by combining genetic data, lifestyle data, and environmental variables, AI may help in the diagnosis of complicated diseases. It is crucial to remember that while AI can be a powerful tool, it cannot take the place of qualified medical personnel. Instead, AI ought to support and improve diagnostic procedures, enhancing patient care and healthcare results. Future research and the use of AI for disease diagnosis must take ethical issues, data protection, and ongoing model validation into account.

Investigating the implementation of telehealth and digital technologies during public health crisis: A qualitative review

Public health crises such as the Coronavirus disease 2019 (COVID-19) pandemic across the world overstrained the health care system. Accordingly, telehealth and digital technologies were implemented. Telehealth and digital technologies refer to the provision of health care at a distance using electronic means for diagnosis, evaluation, treatment, monitoring, and education of patients. This approach, while extremely useful, can be challenging for both patients and physicians, mainly as this is a new mode of health care to health practitioners and patients. Intrinsically, when managing the massive disruption to the routine of patient health care workflow, it is important to understand the important factors associated with an accelerated introduction of telehealth and digital technologies for the effective and safe continuation of healthcare during a public health crisis. Accordingly, this current study performed a qualitative review analysis of 40 scientific sources from 2019 to 2022. Findings present health practitioners that implemented telehealth and digital technologies during the public health emergency. Additionally, findings from this study presents a workflow approach for telehealth visit cycle and also discusses the current telehealth and virtual applications being implemented during public health crisis. This study provides implications to support health care managers and policymakers of health centres to be virtually informed regarding digital applications being implemented by patients and health practitioners on how to implement an effective telehealth system during public health crises.

Feasibility, Acceptability, and Intervention Description of a Mobile Health Intervention in Patients With Heart Failure

Mobile health (mHealth) is used to encourage and support self-management skills in patients with heart failure. The purpose of the study was to describe the feasibility, fidelity, usability, and acceptability of mHealth interventions. This pilot study used a randomized 3-group (enhanced usual care, mHealth, and mHealth plus, which included a nurse practitioner and community health worker) repeated-measure design to determine the feasibility of using a self-management behavior app and a Bluetooth-enabled scale for daily self-monitoring of weights and medications. In the 2 mHealth groups, of the 48 patients, 38 (79%) engaged partially in recording daily weights and medications, and of the 74 patients in the sample, we obtained partial to complete data on 63 (85%) of the patients during follow-up outcome phone calls. Most patients found the intervention to be feasible, usable, and acceptable, and (93%) patients in the mHealth group and 100% of patients in the mHealth plus group agreed or strongly agreed that they learned how to self-manage their heart failure using the app. The intervention was reasonable to implement and provided insight for future intervention improvements.

Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review

BACKGROUND

The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays.

OBJECTIVE

After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs).

METHODS

We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs.

RESULTS

Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events.

CONCLUSIONS

Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.

COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy)

Background

During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group).

Methods

The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life.

Results

Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group (p = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group (p = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test p = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) (p < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly (p < 0.0001). Patient satisfaction with the program was very high in all participants.

Conclusions

Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life.

Clinical trial registration

www.ClinicalTrials.gov, NCT04898179.

Effectiveness of a 12-week tele-exercise training program on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity

BACKGROUND

Exercise has positive impacts on cardiometabolic health. However, evidence regarding the effectiveness of tele-exercise training on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity remains limited.

AIMS

The aim of this study was to assess whether an assumed increase in physical activity (PA) after a 12-week tele-exercise training program improved cardiorespiratory fitness and heart rate recovery of patients with cardiometabolic multimorbidity.

METHODS

A parallel-group randomized controlled trial was conducted. Eligible patients with cardiometabolic multimorbidity (n = 83) were randomized 1:1 to either an experimental group (EG, received a 12-week tele-exercise training program with 3 sessions/week and 30 min/session and weekly remote monitoring for maintenance of exercise) or a control group (CG, usual care only). PA, cardiorespiratory fitness, and heart rate recovery were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

RESULTS

Sixty-eight participants (81.9%) completed the study, and 83 were included in the intention-to-treat analysis. The EG with higher vigorous-intensity PA (β = 714, p = .037), walking behavior (β = 750, p = .0007), and total amount of PA (β = 1748, p = .001) after the intervention had significantly elevated cardiorespiratory fitness, including VO2peak (β = 3.9, p = .042), workload (β = 17.9, p = .034), and anaerobic threshold (β = 2.1, p = .041), and increased one-min heart rate recovery (β = 5.3, p = .025), compared with the CG.

LINKING EVIDENCE TO ACTION

A 12-week tele-exercise training program was effective for increased PA, elevated cardiorespiratory fitness, and improved heart rate recovery for patients with cardiometabolic multimorbidity. These findings highlight the feasibility of better delivering lifestyle interventions for cardiometabolic health management.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

BACKGROUND

Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.

OBJECTIVE

In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.

METHODS

A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.

RESULTS

We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.

CONCLUSIONS

The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.

Challenges in Caring for People with Cardiovascular Disease through and beyond the COVID-19 Pandemic: The Advantages of Universal Access to Home Telemonitoring

(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.

Personalized smart voice-based electronic prescription for remote at-home feedback management in cardiovascular disease rehabilitation: a multi-center randomized controlled trial

Objective

To investigate the quality and efficacy of remote at-home rehabilitation for patients with cardiovascular disease (CVD) using personalized smart voice-based electronic prescription, and further explore the standardized health management mode of remote family cardiac rehabilitation. Trial design: A multicenter, randomized (1:1), non-blind, parallel controlled study.

Methods

A total of 171 patients with CVD who were admitted to 18 medical institutions in China from April 2021 to October 2022 were randomly divided into a treatment group (86 cases) and a control group (85 cases) in a non-blinded experiment, based on the sequence of enrollment. The control group received routine at-home rehabilitation training, and the treatment group received remote feedback-based at-home cardiac rehabilitation management based on routine at-home rehabilitation training. The primary outcome was the difference in VO2peak (mL/min/kg) after 12 weeks. A linear mixed model was developed with follow-up as the dependent variable. Age and baseline data were utilized as covariates, whereas hospital and patient characteristics were adjusted as random-effect variables. As the linear mixed model can accommodate missing data under the assumption of random missing data, there was no substitute missing value for quantitative data.

Results

A total of 171 participants, with 86 in the experimental group and 85 in the control group, were included in the main analysis. The analysis, which used linear mixing model, revealed significant differences in cardiopulmonary function indexes (VO2/kg peak, VO2peak, AT, METs, and maximum resistance) at different follow-up time (0, 4, and 12 weeks) in the experimental group (p < 0.05). In the control group, there was no significant difference in cardiopulmonary values at different follow-up time (0, 4, and 12 weeks; p > 0.05). VO2/kg peak (LS mean 1.49, 95%CI 0.09-2.89, p = 0.037) and other indicators of cardiopulmonary function (p < 0.05) were significantly different between the experimental group and the control group at week 12. The results were comparable in the complete case analysis.

Conclusion

The remote home cardiac rehabilitation management mode using personalized smart voice-based electronic prescription provides several benefits to patients, including improvements in muscle strength, endurance, cardiopulmonary function, and aerobic metabolism. It also helps reduce risk factors for cardiovascular disease and enhances patients' self-management abilities and treatment compliance.Clinical trial registration: http://www.chictr.org.cn, identifier ChiCTR2100044063.

Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic

Introduction

During the COVID-19 pandemic, a virtual telephone advanced nurse practitioner (ANP) led chest pain clinic was set up because face-to-face clinic visits had ceased.

Methods

This retrospective cohort analysis compared the ANP virtual chest pain clinic to the face-to-face nurse specialist-led clinic.

Results

Autonomous nursing management was significantly higher in the virtual clinic, and significantly fewer patients were referred for functional testing. Coronary arterial disease (CAD) diagnosis did not differ.

Conclusion

ANP autonomy and experience enabled continued chest pain assessment and CAD diagnosis via a virtual telephone clinic.

Exploring the delivery of phase II cardiac rehabilitation services in rural and remote Australia: a scoping review

Objective Phase II cardiac rehabilitation (CR) reduces cardiovascular risk factors, morbidity and mortality after a cardiac event. Traditional Australian CR programs are located in metropolitan areas and delivered by an expert, multidisciplinary team. Referral and uptake barriers for people living in rural and remote locations are significantly affected by geographical isolation. This scoping review aimed to explore how phase II CR services in rural and remote Australia are being delivered. Methods A scoping review was conducted to obtain all published literature relating to CR service delivery for people living in rural and remote Australia. A literature search of the following databases was performed in December 2021: Cumulative Index to Nursing and Allied Health Literature, Embase, the Physiotherapy Evidence Database, and PubMed. Results Six articles met the inclusion criteria. Study designs varied and included mixed methods, cross-sectional design and narrative review. Overall, literature relating to CR programs in rural and remote Australia was limited. Three themes were apparent: (1) barriers to the delivery of phase II CR in rural and remote Australia remain; (2) community centre-based programs do not reach all people in rural and remote Australia; and (3) alternative models of CR are underutilised. Conclusions Phase II CR programs in rural and remote Australia do not align with current recommendations for service delivery. The use of technology as a primary or adjunct model of delivery to support people living in rural and remote Australia needs to be further developed and implemented. Further research exploring barriers to the uptake of alternative models of CR delivery is recommended.

The association of electronic health literacy with behavioural and psychological coronary artery disease risk factors in patients after percutaneous coronary intervention: a 12-month follow-up study

Aims

Fundamental roadblocks, such as non-use and low electronic health (eHealth) literacy, prevent the implementation of eHealth resources. The aims were to study internet usage for health information and eHealth literacy in patients after percutaneous coronary intervention (PCI). Further, we aimed to evaluate temporal changes and determine whether the use of the internet to find health information and eHealth literacy were associated with coronary artery disease (CAD) risk factors at the index admission and 12-month follow-up of the same population.

Methods and results

This prospective longitudinal study recruited 2924 adult patients with internet access treated by PCI in two Nordic countries. Assessments were made at baseline and 12-month follow-up, including a de novo question Have you used the internet to find information about health?, the eHealth literacy scale, and assessment of clinical, behavioural, and psychological CAD risk factors. Regression analyses were used. Patients' use of the internet for health information and their eHealth literacy were moderate at baseline but significantly lower at 12-month follow-up. Non-users of the internet for health information were more often smokers and had a lower burden of anxiety symptoms. Lower eHealth literacy was associated with a higher burden of depression symptoms at baseline and lower physical activity and being a smoker at baseline and at 12-month follow-up.

Conclusion

Non-use of the internet and lower eHealth literacy need to be considered when implementing eHealth resources, as they are associated with behavioural and psychological CAD risk factors. eHealth should therefore be designed and implemented with high-risk CAD patients in mind.

Clinical trial registration

ClinicalTrials.gov NCT03810612 https://clinicaltrials.gov/ct2/show/NCT03810612.

Harnessing digital health to optimise the delivery of guideline-based cardiac rehabilitation during COVID-19: an observational study

BACKGROUND

The COVID-19 pandemic accelerated the uptake of digital health interventions for the delivery of cardiac rehabilitation (CR). However, there is a need to evaluate these interventions.

METHODS

We examined the impact of an evidence-based, digital CR programme on medical, lifestyle and psychosocial outcomes. Delivered by an interdisciplinary team of healthcare professionals, the core components of this 12-week programme included lifestyle modification, medical risk factor management, psychosocial and behavioural change support. To support self-management, patients were provided with a Fitbit, a home blood pressure (BP) monitor and an interactive workbook. Patients received access to a bespoke web-based platform and were invited to attend weekly, online group-based supervised exercise sessions and educational workshops. Outcomes were assessed at baseline, end of programme and at 6-month follow-up.

RESULTS

Over a 3-month period, 105 patients (88% with coronary heart disease) were referred with 74% (n=77) attending initial assessment. Of these, 97% (n=75) enrolled in the programme, with 85% (n=64) completing the programme, 86% (n=55) of completers attended 6-month follow-up. Comparing baseline to end of programme, we observed significant improvements in the proportion of patients meeting guideline-recommended targets for physical activity (+68%, p<0.001), BP (+44%, p<0.001) and low-density lipoprotein cholesterol (+27%, p<0.001). There were significant reductions in mean weight (-2.6 kg, p<0.001). Adherence to the Mediterranean diet score improved from 5.2 to 7.3 (p<0.001). Anxiety and depression levels (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The majority of these improvements were sustained at 6-month follow-up.

CONCLUSION

Outcomes from this study suggest that interdisciplinary digital CR programmes can be successfully implemented and help patients achieve guideline recommended lifestyle, medical and therapeutic targets.

Self-care in migrants with type 2 diabetes, during the COVID-19 pandemic

INTRODUCTION

Type 2 diabetes is increasing globally and particularly affects vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when infected with COVID-19. Diabetes-related complications can be prevented with good glycaemic control. In addition, good glycaemic control has been shown to be an important cornerstone for preventing severe illness in individuals infected with COVID-19. In order to maintain good glycaemic control, self-care is needed. The purpose of this article is to describe self-care maintenance and possible changes in self-care maintenance and to explore factors related to unchanged self-care maintenance in migrant patients with type 2 diabetes during the COVID-19 pandemic. The second aim is to describe well-being, social support, and the need for support from healthcare services during the COVID-19 pandemic in migrant patients with type 2 diabetes.

DESIGN/METHOD

A triangulation design with cross-sectional data collection was used. Both quantitative and qualitative data were collected and interpreted together in a triangulation design. Patients were selected by a diabetes nurse from a computer system at a health center in south-eastern Sweden and invited to participate in the study. A questionnaire was translated into the languages most commonly used at the clinic and sent out to 332 migrant patients who had been diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self-care maintenance for diabetes (questions inspired by the Self-Care of Diabetes Inventory), with questions added to every item to assess changes during the pandemic. When changes occurred, we asked the participants to elaborate. Open-ended questions asked the participants how they would like to receive information when there are changes in their healthcare. Descriptive statistical analyses were used for the quantitative data and qualitative data was analyzed using a directed approach to content analysis.

RESULTS

In total, 79 participants answered the questionnaire (mean age 69 ± 11, 51% male, 47% born in the Middle East). Of these, 76% stated a change in self-care. More than half (58%) stated changes in maintaining an active lifestyle, 40% had changed their physical exercise, and 38% had changed their behavior to avoid getting sick. Participants said that this change was due to staying at home or canceling social activities because they feared meeting people during the pandemic. Others were more physically active than before on a regular basis during the pandemic due to taking walks to get fit, as a precaution related to COVID-19, and having greater awareness about how to avoid getting sick. Approximately one-quarter of the participants experienced a change in contact with healthcare due to poorer access to care, with fewer doctors' appointments and care being postponed during the pandemic. More than half (58%) would like to receive information about healthcare changes by a letter in the regular mail. Social support had changed for 35% of the participants, with less support from family and friends due to the risk of being infected with COVID-19.

CONCLUSION

The COVID-19 pandemic led to societal restrictions that changed the way of life for many individuals. Migrant patients with type 2 diabetes, who are already a vulnerable group regarding self-care, had difficulties in maintaining good living habits during the pandemic. During crises such as COVID-19, support with self-care, such as closer contact with healthcare providers, is vital.

CLINICAL RELEVANCE

Knowledge about how the COVID-19 pandemic has affected migrants with type 2 diabetes can be used to support healthcare providers in identifying individuals who are at high risk of suffering from the consequences of their diabetes associated with the pandemic.

Ineffective health management in people with hypertension: Accuracy study

PURPOSE

To analyze the accuracy of the clinical indicators of the nursing diagnosis Ineffective Health Management in people with hypertension.

METHODS

This is a cross-sectional diagnostic accuracy study. The ineffective health management was investigated in 120 people with hypertension in a referral public outpatient clinic in Brazil between August and November 2020. The accuracy measures were analyzed using Rasch analysis, considering the difficulty of clinical indicator and person's ability.

RESULTS

Ineffective health management is probably present in 37.5% of people with hypertension. 'Failure to include treatment regimen in daily living' was the clinical indicator with the highest sensitivity value, and 'failure to take action to reduce risk factor' had the highest specificity value.

CONCLUSIONS

Rasch analysis demonstrated that all clinical indicators contribute significantly to estimating the presence of ineffective health management in people with hypertension in the outpatient scenario.

IMPLICATIONS FOR NURSING PRACTICE

This research contributes by providing accurate clinical indicators of ineffective health management, helping nurses prescribe and deliver the appropriate nursing interventions for people with hypertension by telenursing.

Developing a group-based virtual education curriculum for cardiac rehabilitation and the associated toolkit to support implementation in Canada and across the globe

BACKGROUND

To overcome the many barriers faced by the long-lasting pandemic, the development of new ways to deliver cardiac rehabilitation (CR)'s components was needed.

OBJECTIVE

This mixed-methods study describes the process to create a virtual education curriculum and assess the level of user engagement and acceptability in CR participants.

METHODS

A 4-phase approach was used to develop the new virtual education curriculum for CR and collect feedback regarding patients' engagement with and acceptability of the curriculum in a convenience sample of 80 CR participants. Data were analyzed using a reflexive thematic analysis approach and mapped to the evidence-based implementation strategies, followed by stakeholder engagement. Considering all information gathered and applying best practices in patient education and curriculum development, a 16-week virtual education curriculum was established.

RESULTS

Five themes were identified on how the current education could be improved: focus on self-management, emphasize emotional wellbeing, improve facilitation, incorporate existing resources, and improve content flow. The recommendations associated with each theme informed the new curriculum and a tailored implementation plan to support the use of virtual education as part of routine care within the program. A toolkit that included a screening tool for comfort with/access to technology, patient-centered manuals with weekly learning plans, and a facilitator's manual was created. Overall, all recommended weekly education was completed by more than 70% of the participants, with greater acceptability.

CONCLUSIONS

The present study offers an example of a collaborative approach to tailoring strategies for the development of a new group-based virtual education model of CR.

A comparative study on HIPAA technical safeguards assessment of android mHealth applications

Protecting personal health records is becoming increasingly important as more people use Mobile Health applications (mHealth apps) to improve their health outcomes. These mHealth apps enable consumers to monitor their health-related problems, store, manage, and share health records, medical conditions, treatment, and medication. With the increase of mHealth apps accessibility and usability, it is crucial to create, receive, maintain or transmit protected health information (PHI) on behalf of a covered entity or another business associate. The Health Insurance Portability and Accountability Act (HIPAA) provides guidelines to the app developers so that the apps must be compliant with required and addressable Technical Safeguards. However, most mobile app developers, including mHealth apps are not aware of HIPAA security and privacy regulations. Therefore, a research opportunity has emerged to develop an analytical framework to assist the developer to maintain a secure and HIPAA-compliant source code and raise awareness among consumers about the privacy and security of sensitive and personal health information. We proposed an Android source code analysis framework that evaluates twelve HIPAA Technical Safeguards to check whether a mHealth application is HIPAA compliant or not. The implemented meta-analysis and data-flow analysis algorithms efficiently identify the risk and safety features of mHealth apps that violate HIPAA regulations. Furthermore, we addressed API level checking for secure data communication mandated by recent CMS guidelines between third-party mobile health apps and EHR systems. Experimentally, a web-based tool has been developed for evaluating the efficacy of analysis techniques and algorithms. We have investigated 200 top popular Medical and Health & Fitness category Android apps collected from Google Play Store. We identified from the comparative analysis of the HIPAA rules assessment results that authorization to access sensitive resources, data encryption-decryption, and data transmission security is the most vulnerable features of the investigated apps. We provided recommendations to app developers about the most common mistake made at the time of app development and how to avoid these mistakes to implement secure and HIPAA-compliant apps. The proposed framework enables us to develop an IDE plugin for mHealth app developers and a web-based interface for mHealth app consumers.

A systematic review of telehealth screening, assessment, and diagnosis of autism spectrum disorder

There is a significant delay between parents having concerns and receiving a formal assessment and Autism Spectrum Disorder (ASD) diagnosis. Telemedicine could be an effective alternative that shortens the waiting time for parents and primary health providers in ASD screening and diagnosis. We conducted a systematic review examining the uses of telemedicine technology for ASD screening, assessment, or diagnostic purposes and to what extent sample characteristics and psychometric properties were reported. This study searched four databases from 2000 to 2022 and obtained 26 studies that met the inclusion criteria. The 17 applications used in these 26 studies were divided into three categories based on their purpose: screening, diagnostic, and assessment. The results described the data extracted, including study characteristics, applied methods, indicators seen, and psychometric properties. Among the 15 applications with psychometric properties reported, the sensitivity ranged from 0.70 to 1, and the specificity ranged from 0.38 to 1. The present study highlights the strengths and weaknesses of current telemedicine approaches and provides a basis for future research. More rigorous empirical studies with larger sample sizes are needed to understand the feasibility, strengths, and limitations of telehealth technologies for screening, assessing, and diagnosing ASD.

Safety of home-based cardiac rehabilitation: A systematic review

BACKGROUND

Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR.

OBJECTIVES

To examine the incidence and severity of adverse events of HBCR.

METHODS

The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome.

RESULTS

Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise.

CONCLUSION

The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly.

Self-Care Practices of Patients with Non-Communicable Diseases during the COVID-19 Pandemic: A Qualitative Study

Individuals with chronic non-communicable diseases (NCDs) have a higher risk of morbidity and mortality. This study explores the lived experience of patients with NCDs during the COVID-19 pandemic and the impact of COVID-19 on their self-care. An interpretive phenomenological analysis approach was used that involved in-depth interviews with patients who received medical services from a family medicine clinic, along with caregivers who responded on their behalf. An inductive thematic approach was utilized to analyze the data. Interview respondents included 17 patients with NCDs and four caregivers. The patients had a mean age of 65.7 ± 11.3 years and were diagnosed with an NCD, a mean of 4.8 ± 1.1 years previously. Self-care practices used during the pandemic were classified as therapeutic or preventive. Patients responded to changes in healthcare services by seeking in-person services for their acute illnesses and accepting remote services for underlying chronic conditions. The COVID-19 pandemic influenced the self-care practices of patients with NCDs. Most patients paid more attention to self-care during this time, while some became more concerned with other aspects of their life.

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring for atrial fibrillation management: data from the TeleCheck-AF project

AIMS

The aim of this TeleCheck-AF sub-analysis was to evaluate motivation and adherence to on-demand heart rate/rhythm monitoring app in patients with atrial fibrillation (AF).

METHODS AND RESULTS

Patients were instructed to perform 60 s app-based heart rate/rhythm recordings 3 times daily and in case of symptoms for 7 consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥3/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period.Data from 990 consecutive patients with diagnosed AF [median age 64 (57-71) years, 39% female] from 10 centres were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm [90 (53-100%) vs. 100 (64-100%), P < 0.001] compared with others. Older age and absence of diabetes were predictors of both optimal motivation and adherence [odds ratio (OR) 1.02, 95% coincidence interval (95% CI): 1.01-1.04, P < 0.001 and OR: 0.49, 95% CI: 0.28-0.86, P = 0.013, respectively]. Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were older age (OR: 1.02, 95% CI: 1.00-1.04, P = 0.014), female sex (OR: 1.70, 95% CI: 1.29-2.23, P < 0.001), previous AF ablation (OR: 1.35, 95% CI: 1.03-1.07, P = 0.028).

CONCLUSION

In the TeleCheck-AF project, more than one-fourth of patients had optimal motivation and adherence to app-based heart rate/rhythm monitoring. Older age and absence of diabetes were predictors of optimal motivation/adherence.

Spread of infection and treatment interruption among Japanese workers during the COVID-19 pandemic: A cross-sectional study

Background

The COVID-19 pandemic has resulted in treatment interruption for chronic diseases. The scale of COVID-19 in Japan has varied greatly in terms of the scale of infection and the speed of spread depending on the region. This study aimed to examine the relationship between local infection level and treatment interruption among Japanese workers.

Methods

Cross-sectional internet survey was conducted from December 22 to 26, 2020. Of 33,302 participants, 9,510 (5,392 males and 4,118 females) who responded that they required regular treatment were included in the analysis. The infection level in each participant's prefecture of residence was assessed based on the incidence rate (per 1,000 population) and the number of people infected. Age-sex and multivariate adjusted odds ratios (ORs) of regional infection levels associated with treatment interruption were estimated by multilevel logistic models, nested by prefecture of residence. The multivariate model was adjusted for sex, age, marital status, equivalent household income, educational level, occupation, self-rated health status and anxiety.

Results

The ORs of treatment interruption for the lowest and highest levels of infection in the region were 1.32 [95 % confidence interval (CI) were 1.09–1.59] for the overall morbidity rate (per 1,000) and 1.34 (95 % CI 1.10–1.63) for the overall number of people infected. Higher local infection levels were linked to a greater number of workers experiencing treatment interruption.

Conclusions

Higher local infection levels were linked to more workers experiencing treatment interruption. Our results suggest that apart from individual characteristics such as socioeconomic and health status, treatment interruption during the pandemic is also subject to contextual effects related to regional infection levels. Preventing community spread of COVID-19 may thus protect individuals from indirect effects of the pandemic, such as treatment interruption.

Emerging Artificial Intelligence-Empowered mHealth: Scoping Review

BACKGROUND

Artificial intelligence (AI) has revolutionized health care delivery in recent years. There is an increase in research for advanced AI techniques, such as deep learning, to build predictive models for the early detection of diseases. Such predictive models leverage mobile health (mHealth) data from wearable sensors and smartphones to discover novel ways for detecting and managing chronic diseases and mental health conditions.

OBJECTIVE

Currently, little is known about the use of AI-powered mHealth (AIM) settings. Therefore, this scoping review aims to map current research on the emerging use of AIM for managing diseases and promoting health. Our objective is to synthesize research in AIM models that have increasingly been used for health care delivery in the last 2 years.

METHODS

Using Arksey and O'Malley's 5-point framework for conducting scoping reviews, we reviewed AIM literature from the past 2 years in the fields of biomedical technology, AI, and information systems. We searched 3 databases, PubsOnline at INFORMS, e-journal archive at MIS Quarterly, and Association for Computing Machinery (ACM) Digital Library using keywords such as "mobile healthcare," "wearable medical sensors," "smartphones", and "AI." We included AIM articles and excluded technical articles focused only on AI models. We also used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) technique for identifying articles that represent a comprehensive view of current research in the AIM domain.

RESULTS

We screened 108 articles focusing on developing AIM models for ensuring better health care delivery, detecting diseases early, and diagnosing chronic health conditions, and 37 articles were eligible for inclusion, with 31 of the 37 articles being published last year (76%). Of the included articles, 9 studied AI models to detect serious mental health issues, such as depression and suicidal tendencies, and chronic health conditions, such as sleep apnea and diabetes. Several articles discussed the application of AIM models for remote patient monitoring and disease management. The considered primary health concerns belonged to 3 categories: mental health, physical health, and health promotion and wellness. Moreover, 14 of the 37 articles used AIM applications to research physical health, representing 38% of the total studies. Finally, 28 out of the 37 (76%) studies used proprietary data sets rather than public data sets. We found a lack of research in addressing chronic mental health issues and a lack of publicly available data sets for AIM research.

CONCLUSIONS

The application of AIM models for disease detection and management is a growing research domain. These models provide accurate predictions for enabling preventive care on a broader scale in the health care domain. Given the ever-increasing need for remote disease management during the pandemic, recent AI techniques, such as federated learning and explainable AI, can act as a catalyst for increasing the adoption of AIM and enabling secure data sharing across the health care industry.

A Scoping Review of Computer-Based and Telecommunication Technology Interventions to Address Drug and Alcohol Misuse and Smoking in Women

BACKGROUND

Computer-based and telecommunication technology has become increasingly common to address addiction among women. This review assessed the effect of technology-based interventions on substance misuse, alcohol use, and smoking outcomes among women.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guideline was used to conduct the scoping review. Four databases (PubMed, Web of Science, PsycINFO, and Scopus) were used to search for peer-reviewed articles published in English on computer-based and telecommunication technology use to address substance misuse, alcohol use, and smoking among women.

RESULTS

A total of 30 articles were selected after the final full-text review from the U.S., England, Japan, and the Netherlands. The types of technology used in the interventions included computer software (standalone or web-based), mobile applications, video calling, phone, and text messaging. Intervention outcomes included alcohol and other substance misuse reduction as polysubstance misuse (n = 5), smoking cessation (n = 10), substance misuse reduction only (n = 6), and alcohol use reduction only (n = 9). The populations reached included women who were pregnant (n = 13), postpartum (n = 4), or non-pregnant (n = 14) ranging from adolescent to adulthood. Interventions that targeted polysubstance misuse showed statistically significant reductions (p < .05).

CONCLUSION

Although effective in reducing alcohol and other substance misuse, mixed findings were identified for other outcomes targeting a single substance. Technology-based interventions might maximize their effects by targeting polysubstance misuse and addressing associated contextual issues in the form of a computer-delivered module(s).

Older Adults' Perceived Risk Regarding COVID-19 and Intention to Vaccinate: Role of Health-Related Literacy

The current cross-sectional descriptive study aimed to explore the association between coronavirus disease 2019 (COVID-19)-related health literacy, perceived risk, and intention to receive a COVID-19 vaccine. A sample of 414 older adults completed several questionnaires regarding COVID-19 risk perception, intention to vaccinate, and health literacy. Results revealed that more than one half of older adults demonstrated perceived high risk related to COVID-19 infection. Moreover, 31.6% of older adults noted their unwillingness to get vaccinated, and 39.4% demonstrated low health literacy regarding COVID-19. A significant positive correlation was found among older adults' perceived risk regarding COVID-19 infection, intention toward vaccination against COVID-19, and COVID-19-related health literacy. Findings serve to aid the Ministry of Health in planning proactive steps to increase COVID-19 vaccine uptake in older adults. [Research in Gerontological Nursing, 15(2), 57-67.].

Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria: A Mixed-Methods Study

OBJECTIVE

To assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients' physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.

DESIGN

Mixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.

SETTING

Outpatient CR centre in Salzburg, Austria.

PARTICIPANTS

Twenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.

OUTCOME MEASURES

Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews.

RESULTS

Exercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), p < 0.001; submaximal ergometer training 99 (40) vs. 97 (40), p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.

CONCLUSION

This study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward.

Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review

Background

Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions.

Objective

This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill.

Methods

Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results.

Results

Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment.

Conclusions

This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.

Evaluating the level of patient satisfaction with telehealth antenatal care during the COVID-19 pandemic at King Abdul-Aziz Medical City, Primary Health Care Center, Specialized Polyclinic

Aim:

To evaluate the client satisfaction with a phone-based antenatal care consultation and identify the associated factors during the COVID-19 pandemic at King Abdul-Aziz Medical City, Primary Health Care Center Specialized Polyclinic during 2020.

Method:

The study was a cross-sectional, retrospective study conducted with pregnant women attending the maternity clinic at the Specialized Polyclinic, Primary Health Care Center at King Abdul-Aziz Medical City, Jeddah. A self-administered questionnaire was sent via a text message (short message service) to collect the data after signed written consent.

Result:

Of 279 pregnant women, 262 (93.9%) attended phone clinic appointments one to five times. The total satisfaction level score was 73.4 ± 6.5, indicating a high level of satisfaction with the phone clinics, and 252 (90.3%) reported a high level of satisfaction. There was a significant difference in the total score regarding education, occupation, husband’s occupation, smoking, gravidity, parity, menstruation, gestational age, pregnancy complication, number of phone clinics during pregnancy, number of attending clinics during pregnancy, visiting another health facility, and reason of visiting phone clinic ( p < 0.0001, p < 0.0001, p < 0.0001, p = 0.015, p = 0.033, p < 0.0001, p < 0.0001, p = 0.027, p = 0.001, p < 0.0001, and p = 0.002).

Conclusion:

The study indicated a high level of satisfaction with the antenatal telephone clinics during the pandemic, which supports the trend of transition in the direction of the digitalization of antenatal care.

Cryptographic Engineering on COVID-19 Telemedicine: An Intelligent Transmission Through Recurrent Relation Based Session Key

Constraints imposed due to the cameo of the novel corona virus has abruptly changed the operative mode of medical sciences. Most of the hospitals have migrated towards the telemedicine mode of services for the non-invasive and non-emergency patients during the COVID-19 time. The advent of telemedicine services has remotely rendered health services to different types of patients from their isolates. Here, the patients' medical data has to be transmitted to different physicians/doctors in a safe manner. Such data are to be secured with a view to restore its privacy clause. Cardio vascular diseases (CVDs) are a kind of cardiac disease related to blockage of arteries and veins. Cardiac patients are more susceptible to the COVID-19 attacks. They are advised to be treated though cardiac telemedicine services. This paper presents an intelligent and secured transmission of clinical cardiac reports of the patients through recurrence relation based session key. Such reports were made through the following confusion matrix operations. The beauty of this technique is that confusion matrices are transferred to specified number of cardiologists with additional secret shares encapsulation. The case of robustness checking, transparency and cryptographic engineering has been tested under different set of inputs. The total cryptographic time observed here was noted as 469.92  ms, 3 ms 74.45 , 502.88 ms, 361.38 ms, 493.12 ms, and 660.16 ms, which is acceptable when compared with other classical techniques. The estimation of correlation coefficient in proposed variables has been recorded as -  0.362 . Different types of result and its analysis proves the efficiency of the proposed technique. It will provide more security in medical data transmission, especially in the needy hours of COVID-19 pandemic.

Telehealth is here to stay but not without challenges: a consultation of cardiac rehabilitation clinicians during COVID-19 in Victoria, Australia

Aims

Delivery of cardiac rehabilitation (CR) was challenged during the pandemic caused by the Coronavirus disease (COVID-19), due to government stay-at-home directives which restricted in-person programmes. The Australian state of Victoria experienced the longest and most severe COVID-19 restrictions and was in lockdown for ∼6 months of 2020. We aimed to explore (i) clinicians’ experiences and perceptions and (ii) identify barriers and enablers, for delivering CR during the COVID-19 pandemic.

Methods and results

Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online consultation in November 2020. An inductive thematic analysis was undertaken, before deductively applying the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR. Thirty members participated in a 106-min consultation. Seventeen members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, and physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, and rural n = 3). Four main themes were inductively identified: consequences of change; use of technology; capacity; and the way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with adopters (staff, patients, and carers) and with organizations.

Conclusion

The COVID-19 pandemic expedited significant changes to CR delivery models. While clinicians are eager to retain technology-enabled delivery in addition to resuming in-person CR, it is now timely to review remote models of care, tools used and plan how they will be integrated with traditional in-person programmes.

Achieving Spread, Scale Up and Sustainability of Video Consulting Services During the COVID-19 Pandemic? Findings From a Comparative Case Study of Policy Implementation in England, Wales, Scotland and Northern Ireland

Requirements for physical distancing as a result of COVID-19 and the need to reduce the risk of infection prompted policy supporting rapid roll out of video consulting across the four nations of the UK-England, Northern Ireland, Scotland and Wales. Drawing on three studies of the accelerated implementation and uptake of video consulting across the four nations, we present a comparative and interpretive policy analysis of the spread and scale-up of video consulting during the pandemic. Data include interviews with 59 national level stakeholders, 55 health and social care staff and 30 patients, 20 national documents, responses to a UK-wide survey of NHS staff and analysis of routine activity data. Sampling ensured variations in geography, clinical context and adoption progress across the combined dataset. Comparative analysis was guided by theory on policy implementation and crisis management. The pandemic provided a "burning platform" prompting UK-wide policy supporting the use of video consulting in health care as a critical means of managing the risk of infection and a standard mode of provision. This policy push facilitated interest in video consulting across the UK. There was, however, marked variation in how this was put into practice across the four nations. Pre-existing infrastructure, policies and incentives for video consulting in Scotland, combined with a collaborative system-level approach, a program dedicated to developing video-based services and resourcing and supporting staff to deliver them enabled widespread buy-in and rapid spread. In England, Wales and Northern Ireland, pre-existing support for digital health (e.g., hardware, incentives) and virtual care, combined with reduced regulation and "light touch" procurement managed to override some (but by no means all) cultural barriers and professional resistance to implementing digital change. In Northern Ireland and Wales, limited infrastructure muted spread. In all three countries, significant effort at system level to develop, review and run video consulting programs enabled a substantial number of providers to change their practice, albeit variably across settings. Across all four nations ongoing uncertainty, potential restructuring and tightening of regulations, along with difficulties inherent in addressing inequalities in digital access, raise questions about the longer-term sustainability of changes to-date.

A Framework of AI-Based Approaches to Improving eHealth Literacy and Combating Infodemic

The global COVID-19 pandemic has put everyone in an urgent need of accessing and comprehending health information online. Meanwhile, there has been vast amount of information/misinformation/disinformation generated over the Internet, particularly social media platforms, resulting in an infodemic. This public health crisis of COVID-19 pandemic has put each individual and the entire society in a test: what is the level of eHealth literacy is needed to seek accurate health information from online resources and to combat infodemic during a pandemic? This article aims to summarize the significances and challenges of improving eHealth literacy in both communicable (e.g., COVID-19) and non-communicable diseases [e.g., cancer, Alzheimer's disease, and cardiovascular diseases (CVDs)]. Also, this article will make our recommendations of a general framework of AI-based approaches to improving eHealth literacy and combating infodemic, including AI-augmented lifelong learning, AI-assisted translation, simplification, and summarization, and AI-based content filtering. This general framework of AI-based approaches to improving eHealth literacy and combating infodemic has the general advantage of matching the right online health information to the right people.

Assessing Orthopedic Patient Preferences for Mandated Virtual Care During the COVID-19 Pandemic and Elective Virtual Care in Non-Pandemic Circumstances

The purpose of this study was to compare orthopedic patient preferences for mandated virtual care during the coronavirus disease 2019 (COVID-19) pandemic and elective virtual care during non-pandemic circumstances. An orthopedic virtual care questionnaire was administered to adult orthopedic patients undergoing their first orthopedic virtual visit between March 15, 2020, and May 18, 2020. The questionnaire had 13 items rated on a 1-to-5 Likert scale ("strongly agree" to "strongly disagree"). Responses were compared using Kruskal-Wallis and nonparametric Wilcoxon rank-sum tests. Patients showed higher preferences for mandated virtual care during the pandemic when compared with elective virtual care during non-pandemic circumstances (2.25±1.31 vs 4.10±1.25, P<.0001) and also preferred virtual visits in other specialties compared with orthopedics (2.17±1.35 vs 2.79±1.42, P<.0001). Patients older than 50 years were more likely to view virtual care as the best option during the pandemic (2.06±1.25 vs 2.48±1.35, P<.0165) and equally as effective as in-person visits in non-pandemic circumstances (2.45±1.36 vs 2.83±1.18, P<.0150). Female patients were more likely to pursue future orthopedic virtual visits (2.61±1.37 vs 3.07±1.45, P<.0203) and view their virtual visit as equally effective as an in-person visit (2.47±1.33 vs 2.87±1.18, P<.0181). Orthopedic patient preference for mandated virtual care during the COVID-19 pandemic seems to be higher than for elective virtual care during non-pandemic circumstances, and older and female patients appear to favor virtual care. [Orthopedics. 2021;44(4):e471-e476.].

COVID-19 vaccination in patients with heart failure: a position paper of the Heart Failure Association of the European Society of Cardiology

Patients with heart failure (HF) who contract SARS‐CoV‐2 infection are at a higher risk of cardiovascular and non‐cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID‐19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID‐19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID‐19 vaccination scheme in patients with HF. COVID‐19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID‐19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID‐19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS‐CoV‐2 infection (including the COVID‐19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF.

Challenges to the development of the next generation of self-reporting cardiovascular implantable medical devices

Cardiovascular disease (CVD) is a group of heart and vasculature conditions which are the leading form of mortality worldwide. Blood vessels can become narrowed, restricting blood flow, and drive the majority of hearts attacks and strokes. Surgical interventions are frequently required; including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Despite successful opening of vessels and restoration of blood flow, often in-stent restenosis (ISR) and graft failure can still occur, resulting in subsequent patient morbidity and mortality. A new generation of cardiovascular implants that have sensors and real-time monitoring capabilities are being developed to combat ISR and graft failure. Self-reporting stent/graft technology could enable precision medicine-based healthcare by detecting the earliest features of disease, even before symptoms occur. Bringing an implantable medical device with wireless electronic sensing capabilities to market is complex and often obstructive undertaking. This critical review analyses the obstacles that need to be overcome for self-reporting stents/grafts to be developed and provide a precision-medicine based healthcare for cardiovascular patients. Here we assess the latest research and technological advancement in the field, the current devices and the market potential for their end-user implementation.

Curing Benign Paroxysmal Positional Vertigo (BPPV) Through Telehealth: A Case Series

Benign paroxysmal positional vertigo (BPPV) is a common medical condition in which the patient feels a spinning sensation when making certain head movements. There is evidence to support those free-floating calcium crystals in the semi-circular canals (the inner ear) may be the cause. BPPV can be a disabling condition. It can be easily diagnosed after taking a careful history and performing bedside examinations. BPPV can be treated successfully through a specific set of physical maneuvers leading to the removal of these crystals from the inner ear. We present three cases of BPPV, living in three different countries, treated successfully using telehealth via Zoom. This approach can be a particularly useful consultation stand during the coronavirus disease 2019 (COVID-19) pandemic.

Telehealth in Australian cardiology: insight into factors predicting the use of telephone versus video during the COVID-19 pandemic

BACKGROUND

The use of telehealth has increased dramatically in Australia in 2020 as a pragmatic response to the COVID-19 pandemic; however, differences between telehealth modalities have not been established.

AIM

To identify characteristics contributing to choosing telephone (TP) versus video consultation (VC) and assess patient outcomes between telehealth modalities.

METHODS

We conducted an observational study of cardiology outpatients at a tertiary hospital with appointments from 17 March 2020 to 12 August 2020. Demographic variables and appointment modality were compared between each group. Outcomes assessed were mortality, emergency department (ED) presentations and cross over between appointment modalities.

RESULTS

There were 1754 telemedicine encounters with 1188 patients seen by TP and 327 patients by VC. Consulting volume increased from previous years. Cardiac mortality was low (0.3%). There were no differences in mortality or ED presentations between telehealth modalities. Patients choosing TP over VC were older (P < 0.001), more likely to be female (P = 0.005), non-English-speaking (P = 0.041), living in metropolitan Melbourne (P < 0.0001), undertaking a first appointment (P = 0.002) and seeing particular cardiologists (P < 0.001). VC patients were more likely to have early review (P = 0.015), and this was likely to be TP (P < 0.0001). TP patients were more likely to follow up in person (P < 0.0001).

CONCLUSION

During COVID-19, we increased consultation volumes without adverse patient outcomes. We identified factors influencing the choice of telemedicine modality which did not translate into differences in mortality or ED presentations. Telemedicine is a growing platform with an important role of facilitating access to healthcare for diverse patient groups.

Impact of the COVID-19 Pandemic on Patients Affected by Non-Communicable Diseases in Europe and in the USA

An international online patient community, Carenity, conducted a patient study in two independent waves among adults affected by non-communicable diseases (NCDs) in Europe and in the United States of America (USA). The study aimed to assess the real time impact of the coronavirus disease 2019 (COVID-19) on the medical conditions of patients with NCDs, their access to health care, and their adaptation to daily life as well as to describe their sources of information on COVID-19 and their needs for specific information and support. During the pandemic, 50% of the patients reported a worsening of their medical condition, and 17% developed a new disease. Additionally, 26% of the respondents reported an impact of the pandemic on regular/long-term treatment intake. 54% of the patients felt very or completely socially isolated and reported a strong impact of the COVID-19 pandemic on their stress level and state of mind, with higher levels observed in the USA compared to Europe. 59% of the respondents wished to have received additional information regarding the risks associated to their medical condition during the pandemic. Television was the most used source of information, whereas physicians were the most trusted one. This study describes the substantial impact of the COVID-19 pandemic on NCD patients.

Effectiveness of Tele-rehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis

Background

Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR).

Methods and Results

We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I² = 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD -6.62; CI 95% [-11.40; -1.84]; I² = 99%). No major adverse events were reported during TR exercise.

Conclusion

TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.