WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review

Enhancing security in patient medical information exchange: A qualitative study

BACKGROUND

The digital transition has changed the practice of exchanging patient medical information between health professionals. Challenges include the involvement of multiple professionals with varying communication styles, the exponential growth of diverse data types, interoperability issues due to non-integrated tools, and heightened security risks stemming from the use of unsecured applications and personal devices. Here, we aimed to understand how to help health surgeons to better consider security during data exchange.

METHODS

We conducted a qualitative research with 20 interviews with surgeons working in wards of several French institutions. The verbatims were analyzed manually by two researchers using an iterative thematic approach, resulting in a framework to improve practitioners' security awareness.

RESULTS

Our findings emphasize the necessity of a multifaceted strategy, as a single secure application is not sufficient. Effective solutions require combining tailored digital tools with educational initiatives and institutional support. The proposed application must meet specific requirements; and simultaneously, hospitals must provide clear regulations, financial investment, and continuous support to reduce professional constraints.

CONCLUSION

This study underscores the need for a holistic approach, spanning education, institutional backing, and advanced technology, to enhance data security in healthcare. Future studies could extend our framework by considering other healthcare settings and patient perspectives.

Developing and assessing MyTBCompanion - A tri-lingual integrated video observed therapy app for tuberculosis patient management in Malaysia and Indonesia

BACKGROUND

Limited studies have developed a mobile phone-based application that supports Asynchronous Video Observed Therapy (A-VOT) for Tuberculosis (TB) program. This study aimed to design, develop, and assess MyTBCompanion, a mobile phone-based digital health intervention to support A-VOT for TB management and care among low-income patients in Malaysia and Indonesia.

METHODS

MyTBCompanion was designed and developed under a partnership involving experts in information technology, respiratory disease, and linguistics. Pre and Post-test surveys were done to assess feedback on the existing TB strategies (Direct Observed Therapy (DOT) and/or VOT) and the usability of the tested A-VOT strategy using MyTBCompanion. We collected data on the patient's age, education level, current treatment strategy, and statements measuring four MyTBCompanion components: Engagement (how interesting, customizable, interactive and well-targeted to an audience an app is), Functionality (ease of use, app design, navigation), Aesthetic (the graphic design, overall visual appeal, color scheme, and stylistic consistency) and Information (content accuracy and relevance). The Mann-Whitney U test was performed for group comparisons, with results considered significant at p < 0.05.

RESULTS

In total, 49 patients with TB were recruited from Malaysia (n = 29) and Indonesia (n = 20). Most participants in both countries were 20-40 years old. Indonesian participants mainly had tertiary education (11/20, 55.0%), whereas most had secondary education level in Malaysia (17/29, 58.6%). Most Malaysian participants (19/29, 65.5%) were using VOT through WhatsApp, with fewer (10/29, 34.5%) using DOT. All participants from Indonesia (20/20, 100%) were using the DOT strategy. Overall, compared to the existing strategies, a higher mean agreement score was observed for MyTBCompanion, with Information scoring the highest agreement (4.57/5.0), followed by Engagement (4.53/5.0), Functionality (4.51/5.0) and Aesthetic (4.49/5.0).

CONCLUSION

Findings suggest an overall good agreement on the usability of A-VOT strategy using MyTBCompanion in terms of engagement, functionality, information and aesthetics, with many indicating their willingness to recommend it to others, marking an encouraging milestone in the app's development.

Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study

BACKGROUND

Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis.

OBJECTIVE

This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability.

METHODS

Primary care physicians (PCPs) from 20 upper-middle- and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V.

RESULTS

A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001).

CONCLUSIONS

Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/30099.

Digital solutions for migrant and refugee health: a framework for analysis and action

Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the internet; and access to health services for early intervention and follow-up. Digital technical solutions do not necessarily overcome problems that are political, social, or economic. There are major deficits with regard to (1) reliable data on the health needs of migrants and mobile populations and on how they can use digital tools to support their health; (2) evidence on effectiveness of solutions; and (3) a broad framework to guide future work. This article provides a wide socio-technical perspective, as a framework for analysis and developing coherent agendas across global-to-local spaces, with particular attention to the European region.

Nationwide cervical precancer screening in Ghana: concurrent HPV DNA testing and visual inspection under an expanded hub-and-spoke model

Cervical cancer continues to disproportionately burden women in sub-Saharan Africa, and is the commonest gynecological cancer in Ghana. The Cervical Cancer Prevention and Training Centre (CCPTC), Battor, Ghana spearheaded the Ghana arm of the mPharma 10,000 Women Initiative (mTTWI) between September 2021 and October 2022. The aim of this study was to examine the outcomes of nationwide concurrent screening using high-risk human papillomavirus (hr-HPV) DNA testing and visual inspection methods, as well as factors associated with the screening outcomes. We conducted a descriptive retrospective cross-sectional study to estimate the prevalence of hr-HPV infection (nationally and regionally) and cervical lesions among women screened by graduates of our training center in their own settings (spokes) with remote supervision and mentoring by CCPTC trainers (hub). We modeled factors associated with hr-HPV infection using nominal logistic regression. Among 5217 women screened (mean age, 40.1 years), the overall prevalence of hr-HPV infection and cervical lesions were 29.1% (95% confidence interval [CI] 27.9-30.3) and 3.7% (95% CI 3.2-4.2), respectively. The prevalence distribution varied widely among regions, with the highest recorded in the Oti Region (32.8%) and the lowest recorded in the Upper West (20.7%) and North-East (20.7%) regions. The most frequently detected HPV genotype was other hr-HPV type(s) only (non-HPV16, non-HPV18) (23.5%; 95% CI 22.3-24.7), followed by HPV16 only (1.5%; 95% CI 1.2-1.8), and mixed infection with HPV18 + other hr-HPV type(s) (1.2%; 95% CI 0.9-1.5). Factors found to be significantly associated with hr-HPV infection among women screened included age < 35 years, having a relationship status apart from married/cohabitation, nulliparity, and HIV positivity. Drawing from our implementation of this model within the mTTWI, we posit that while Ghana prepares for organized screening, coordinating opportunistic screening could enable a phased expansion of cervical precancer screening with the help of international and local partners. This approach, combined with concurrent testing (hr-HPV DNA testing and visual inspection), holds promise for mitigating loss to follow-up among women requiring additional evaluation and lesion management.

Navigating the wild west: a review of guidance on clinical communications using personal BYOD, IM and third-party apps in the UK and Ireland

Introduction

The ubiquity of Bring Your Own Device (BYOD) personal smartphones, Instant Messaging (IM), and third-party apps, has made these technologies compelling for efficient communications between clinicians regarding patient care. However, the sensitivity of patient-related information necessitates secure, GDPR compliant modalities that prevent unauthorised access and ensure confidentiality. This scoping review explores existing guidelines, policies, and regulations that advise clinicians in the UK and Ireland on the secure use of these digital communication tools.

Methods

Following the Joanna Briggs Institute (JBI) updated Framework for Scoping Reviews and the PRISMA ScR guidelines, this review examines the literature to identify relevant guidelines, policies, and regulations informing current clinical practice on the use of this technology. Academic databases including OneSearch, Embase, EBSCO, PubMed, Medline, and CINAHL were searched, in addition to hand searches of professional entities' websites, including trade unions, regulators, two national health systems, and several employers. Direct inquiries were made to 69 professional entities via telephone, email, websites, and X (formerly known as Twitter).

Results

The review identified 18 papers that broadly recognise the importance of secure communication however, a lack of information on the appropriate selection or configuration of these popular technologies was evident. Most guidelines emphasise general security and data protection standards rather than providing clear actionable recommendations for technology use, thereby leaving a significant gap in technical guidance for clinicians.

Discussion

There is a distinct lack of detailed, specific, consistent technical guidance available to clinicians. This review evidences an urgent requirement for enhanced guidelines that specify the most secure platforms, appropriate features, and configuration to maximise the security and confidentiality of clinical communications. Further research is recommended to develop comprehensive, actionable advice for clinicians.

Evaluating the performance of a virtual platform 'T-BOM' for mentorship in tropical diseases research among early career scientists: Insights from a pilot in Nigeria and other resource-limited settings

Background

Research mentorship plays a crucial role in advancing science. However, there are limited virtual platforms for cultivating mentorship among early career infectious diseases researchers in resource challenged settings. This study reports the findings from the utilization of a recently developed virtual mentorship platform, including its achievements, challenges and needs.

Methods

We developed a web-based application called Top-Bottom Open Mentorship (TBOM) freely accessible at www.tbommodel.com. The platform hosts mentors and allows mentees to send connection requests. In this paper, we present the utilization of this platform, including the opportunities and challenges encountered during the first year of implementation. Utilization data was generated monthly, while opportunities and challenges were captured using a users' perception survey. Data were analyzed in R software and summarized thematically as appropriate.

Results

Between October 2022 and November 2023, the platform registered 81 users, comprising 63 mentees [54.3 % males, 75 % graduate students] from five countries [Nigeria, Cameroon, Brazil, Sudan, and Ghana], and 18 mentors [78 % males] from six countries [Nigeria, USA, Cameroon, Kenya, Brazil, and Tanzania]. Platform engagement increased from 19.4 % (7 users out of 36 who registered) to 51 % (41 users out of 81 who registered) over the year. Also, a total of 16 mentorship cycles were completed, with 9 currently running. Mentees reported having access to job opportunities, enhanced skills in writing, time management, and grant sourcing, and improved research prospects. However, challenges identified include time zone differences, limited number of mentors, mentee's readiness, and associated internet connection issues.

Interpretation

The achievements of T-BOM over a period of one-year are challenged by intrinsic factors from both mentees and mentors, as well as erratic internet services in resource-limited settings. While the platform offers significant opportunities for improving research mentorship, these challenges need to be carefully addressed.

Towards 'Formalising' WhatsApp Teledermatology Practice in KZ-N District Hospitals: Key Informant Interviews

INTRODUCTION

District hospitals in KwaZulu-Natal Province, South Africa, do not have onsite specialist dermatology services. Doctors at these hospitals use WhatsApp instant messaging to informally seek advice from dermatologists and colleagues before possible referral. They have expressed the need to formalise WhatsApp teledermatology.

AIM

To determine the views and perspectives of clinicians on the feasibility and practicality of formalising the current WhatsApp-based teledermatology activities within the KwaZulu-Natal Department of Health Dermatology Service.

METHODS

Key informant interviews with 12 purposively selected doctors at district hospitals and all 14 dermatologists in the KwaZulu-Natal dermatology service. Their views and perspectives on formalising the current informal use of WhatsApp for teledermatology were recorded, transcribed, and thematically analysed.

RESULTS

Five primary themes (communication, usability, utility, process, and poor understanding of legal, regulatory, and ethical issues) and 22 sub-themes were identified. Clinicians wanted WhatsApp teledermatology to continue, be formalised, and be incorporated within the KwaZulu-Natal Department of Health, facilitated by the provision of practical guidelines addressing legal, regulatory, and ethical issues.

CONCLUSIONS

These findings will be used to develop a policy brief, providing recommendations and proposed guidelines for formalising the teledermatology service. The findings and methods will be relevant to similar circumstances in other countries.

The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study

BACKGROUND

Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being.

OBJECTIVE

The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines.

METHODS

Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed.

RESULTS

Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT.

CONCLUSIONS

Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.

Use of Instant Messaging Applications by General Practitioners During Overseas Deployment: A Survey of the French Military Health Service

INTRODUCTION

Instant messaging applications (MAs) represent a major component of modern telecommunications for data transmission. During overseas deployments, military doctors increasingly rely on MAs due to their availability and the urgent need to obtain advice from specialists for optimal patient management. In this study, we aimed to describe and analyze the context and usage characteristics of these MAs for transmitting medical data by military general practitioners (GPs) during overseas missions.

MATERIALS AND METHODS

This observational study was conducted between June 2020 and December 2020, based on a survey sent to GPs from the French Military Health Service who had been deployed overseas in military operations between 2010 and 2020.

RESULTS

We received 233 surveys of which 215 were analyzed. Among these, 141 military GPs used instant MAs to transmit medical data during deployment. Notably, WhatsApp was used by 97% of the participants. The military GPs mainly used these applications for the speed of exchanges (45%) and their ease of use (28%). The physician specialties predominantly involved in data sharing were trauma and orthopedic surgery (38%) and dermatology (31%). The correspondents were mainly military specialist physicians from French military teaching hospitals (85%). A response time of less than 1 h was reported in 78% of the cases. Additionally, 72 doctors (51%) undertook their last deployment in an isolated post.

CONCLUSION

MAs were extensively utilized communication tools among GPs during their overseas deployments. Although the use of these applications seems essential in telemedicine, it raises several legal and ethical questions. Thus, we recommend employing these tools while ensuring medical and military confidentiality.

Patient-centered radiology: a roadmap for outpatient imaging

Creating a patient-centered experience is becoming increasingly important for radiology departments around the world. The goal of patient-centered radiology is to ensure that radiology services are sensitive to patients' needs and desires. This article provides a framework for addressing the patient's experience by dividing their imaging journey into three distinct time periods: pre-exam, day of exam, and post-exam. Each time period has aspects that can contribute to patient anxiety. Although there are components of the patient journey that are common in all regions of the world, there are also unique features that vary by location. This paper highlights innovative solutions from different parts of the world that have been introduced in each of these time periods to create a more patient-centered experience. CLINICAL RELEVANCE STATEMENT: Adopting innovative solutions that help patients understand their imaging journey and decrease their anxiety about undergoing an imaging examination are important steps in creating a patient centered imaging experience. KEY POINTS: • Patients often experience anxiety during their imaging journey and decreasing this anxiety is an important component of patient centered imaging. • The patient imaging journey can be divided into three distinct time periods: pre-exam, day of exam, and post-exam. • Although components of the imaging journey are common, there are local differences in different regions of the world that need to be considered when constructing a patient centered experience.

Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial

Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.

Monitoring Patient Adherence and Follow-up in Option B+ Program: Understanding Healthcare Workers' Practices, Challenges, and Facilitators in Lilongwe, Malawi

BACKGROUND

Option B+ aims to prevent mother-to-child transmission of HIV by providing lifelong antiretroviral therapy (ART) to pregnant and breastfeeding women living with HIV (PBWHIV). Identifying and reengaging PBWHIV who disengage or fail to initiate ART is essential for the success of Option B+. However, the process is often suboptimal, leading to challenges such as misclassification of patients as lost to follow-up. Healthcare workers (HCWs) are pivotal for monitoring engagement, but little is known about their monitoring practices. This study aimed to explore how HCWs monitor women's engagement in Option B+ services.

METHODS

A qualitative study was conducted in five high-volume health facilities in Lilongwe, Malawi. Thirty HCWs responsible for monitoring women in Option B+ were purposively selected as key informants. Semistructured interviews were conducted between March and June 2021. Thematic analysis employing deductive and inductive coding methods was utilized. The Consolidated Framework for Implementation Research was used to map gaps, strategies, barriers, and facilitators of monitoring.

RESULTS

Monitoring was described as tracking a PBWHIV from HIV diagnosis to initiation of ART to subsequent ART visits for up to 2 years postpartum. The gaps included timing variations in tracing. No procedures to follow up formal transfer-outs or management of silent transfers during emergency ART refills were identified. Strategies identified included interfacility collaboration, record review, tracing, escorting women during initial visits, and self-reports. Technological innovations, such as WhatsApp groups, were highlighted as game changers in interfacility collaboration when tracking women's movements. Barriers included resource constraints (human and operational), poor work attitudes, and challenges faced by women (partner support, stigma, and HCW rapport). The facilitators included implementing partner support, leadership, and strategies such as education and tracing.

CONCLUSION

Addressing resource constraints, women's relationship dynamics for self-management, HCWs' attitudes, and standardizing tracing protocols are crucial for effective monitoring. Leveraging instant messaging for clinic coordination may enhance tracing. Further research and interventions should target identified gaps to promote effective monitoring in similar settings.

How WhatsApp is transforming health communication among frontline health workers: a mixed-method study among midwives in India

BACKGROUND

Limited literature exists in India on WhatsApp use for health communication among frontline health workers like Auxiliary Nurse Midwives (ANM). We conducted this study to assess the adoption of WhatsApp among ANMs and identify factors influencing its adoption. In addition, the study explored the perceptions of ANMs on WhatsApp use for sharing health information.

METHODS

We employed a mixed-method sequential explanatory design. We surveyed 259 ANMs, followed by in-depth interviews with 19 purposively sampled ANMs. We conducted multinomial logistic regression to identify factors associated with WhatsApp adoption and employed thematic analysis to analyze interviews.

RESULTS

257 ANMs responded to the survey questionnaire, of which 18.3%, 48.2%, and 33.5% had low, mid, and high levels of WhatsApp adoption, respectively. Education (AOR = 2.87 [95% CI = 1.20-6.85]), motivation (AOR = 6.31 [95% CI = 1.43-27.80]), and technical awareness (AOR = 2.91 [95% CI = 1.11-7.62]) were significantly associated with WhatsApp adoption. Thematic analysis of the interviews resulted in six themes describing perceptions and experiences of ANMs on WhatsApp use. They are: (i) a way of instant communication, (ii) provision for multimedia messaging, (iii) a quick fix tool for queries and concerns, (iv) make attendance and reporting easy (v) a way of reaching higher officials, and (vi) a cost-saving mechanism.

CONCLUSION

WhatsApp facilitated ANMs' communication and service delivery at the grassroots level. Measures to improve motivation, technical awareness, and digital education will likely improve WhatsApp adoption among health workers.

Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

BACKGROUND

One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up.

OBJECTIVE

To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients.

MATERIAL AND METHODS

A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent.

RESULTS

The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19.

CONCLUSIONS

Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.

Provision of Psychological Support to a 31-Year-Old Man with SARS-CoV2-Induced Pneumonia during and after Hospitalization: A Clinical Case Report

A 31-year-old man hospitalized during the first wave of the pandemic in 2020 suffering from severe psychological distress, requested psychological assistance as his condition progressively worsened, eventually requiring intubation. After being referred to the clinical psychology service by a ward physician, the patient was assisted remotely for two months for a total of 22 sessions during hospitalization and after discharge. A psychometric evaluation was carried out when the patient was close to discharge and longitudinally, for a total of four times, for depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder Scale-7 (GAD-7)), post-traumatic stress disorder (Impact of Event Scale-Revised (IES-R)) and insomnia (Insomnia Severity Index (ISI)). Support was provided remotely, mainly through audio and video calls, and text chats were also utilized when possible and as required. The initial psychometric evaluation indicated moderate depression, severe anxiety, the presence of post-traumatic stress disorder and sleep problems. Psychological distress decreased until reaching a situation of no distress in the final evaluation. Psychological interventions from which the patient benefitted were stress reduction and breathing techniques, empathic support, elaboration of the possibility of grief and cognitive restructuring regarding fears relative to his condition. Psychological support provided remotely and the monitoring of psychological status after discharge are highly advisable in pandemic emergency situations. The CARE checklist of information to include when writing a case report was utilized in the writeup of this case report.

Perceptions and attitudes toward the use of telemedicine for the postoperative outpatient urological care during the COVID-19 pandemic in an Academic Hospital in Southern Italy

INTRODUCTION

Telemedicine is a most used tools in various medical and surgical scenarios. The aim of the present study was to explore attitudes and perceptions by urologic patients toward the use of telemedicine in the context of patient-physicians communication during the post-operative follow-up in a large academic tertiary urology referral department in Italy.

MATERIALS AND METHODS

An anonymous questionnaire consisting of 15 multiple choice questions was designed including three sections: respondents' demographics, attitudes, and perceptions towards the use of telemedicine. Invitations to participate to this anonymous questionnaire was given to outpatients attended at Urology Department, University of Naples Federico II.

RESULTS

In total 697 responses were received (participation rate 73%). The frequency of telemedicine use was described as frequently, occasional, rarely, and never by 41.6%, 30.4%, 15.1%, and 12.6% of respondents, respectively. WhatsApp messenger used by 59.5% of respondents and telephone call (34.3%) were the most common type of tools. Satisfaction in using telemedicine was reported as very satisfied, satisfied, neutral, dissatisfied, and very dissatisfied by 39.6%,41.4%,10%,7% and 2% of respondents respectively. Overall, 43.7%% of participants individuated limited interaction and risk of misdiagnosis as the major limit of telemedicine.

CONCLUSIONS

Telemedicine represents the future of medical practice due to several benefits as well as convenience, increased access to care and decreased healthcare costs.

Shining a light on an additional clinical burden: work-related digital communication survey study - COVID-19 impact on NHS staff wellbeing

Work-related communication volume within the United Kingdom's National Health Service (NHS) has had little systematic research previously. The impact of communication volume on work-life balance of healthcare staff in the NHS is also not known and has not been an area of focus or governance. COVID-19 led to a shift to non-physical work, with greater reliance on digital communication for clinical decision making. We sought to elucidate the relationship between communication, work-life balance, and COVID-19. An online survey was conducted to assess the platforms used to communicate professionally, the volume of and time spent on work-related communications, how this has changed from before to during COVID-19, and the effect on work-life balance. A total of 3047 healthcare staff provided consent and evaluable data. Emails were reported as the most frequently used communication tool, and the majority of staff asked, reported increased work-related communications due to COVID-19. Staff estimated receiving 14 emails on an average day before COVID-19. During the pandemic, staff estimated getting approximately 17 emails on an average day and 29 emails on a busy day. Work communications reportedly took up increased amounts of family and home time during COVID-19. A large proportion (36%) of staff were unable to switch off from work-related communications already before COVID-19, worsening (57%) during the pandemic. Work-related digital communication is a vital component of working in the NHS. We provide the first detailed data on the types, volume, and impact of such communication on NHS staff during the COVID-19 pandemic, compared to pre-pandemic levels. We found that 82% of staff support the need for NHS guidance on work-related communications to help manage overload, protect emotional wellbeing, and increase resilience. Further work is urgently needed in this area to tackle the negative impact of communication technologies (technostress) on work-life balance to reduce staff stress, burnout, and turnover or early retirement of some staff.

A Survey of Telemedicine Use by Doctors in District Hospitals in KwaZulu-Natal, South Africa

There is anecdotal evidence of informal telemedicine activity in KwaZulu-Natal (KZ-N), South Africa.

AIM

To determine the current extent of telemedicine in district hospitals in KZ-N; the range of clinical activities and technologies used; additional services needed; current knowledge and practice regarding legal, ethical, and regulatory issues; and the need to formalise telemedicine activities.

METHOD

A cross-sectional survey of telemedicine use by 143 doctors working at 22 District hospitals in KZ-N.

RESULTS

Most doctors (96%) participated in some form of telemedicine across a spectrum of disciplines, but more than half did not consider their activities to constitute telemedicine. To meet their needs, doctors have started their own informal services with colleagues, using mostly instant messaging and chat groups (WhatsApp). Some doctors indicated the need to formalise these services and establish additional services. Few doctors were aware of the national telemedicine guidelines and the required written informed consent for telemedicine was seldom obtained. This could have serious legal, regulatory, and ethical implications.

CONCLUSIONS

Practical clinical and technical guidelines and standard operating procedures need to be developed with the active participation of the clinical workforce. These should encourage innovation and greater use of telemedicine, including the use of instant messaging apps.

Use of Instant Messaging Software in a German Hospital-An Exploratory Investigation among Physicians

Internationally, evidence exists that physicians use instant messaging services for communication tasks in everyday clinical practice However, there are only few data on physicians in Germany in this regard. Therefore, at the initiation of our project "DocTalk-Dialog meets Chatbot: Collaborative Learning and Teaching in the Process of Work", we conducted a stakeholder survey with an exploratory research approach. The aim was to gain initial insights into use of instant messaging software and attitudes towards data security and advantages and disadvantages before implementing a data-secure in-house messaging platform. N = 70 physicians at Charité-Universitätsmedizin Berlin completed an exploratory questionnaire with closed and open-ended questions. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. The use of messenger software was not widespread in the sample studied. Physicians most frequently used face-to-face contact for communication. On average, up to ten instant messages were exchanged per day, mainly among colleagues, to answer mutual questions, and to send pictures. With a high awareness of privacy-related restrictions among participating physicians, advantages such as fast and uncomplicated communication were also highlighted. An instant messenger solution that complies with the German data protection guidelines is needed and should be investigated in more detail.

An Audit and Survey of Informal Use of Instant Messaging for Dermatology in District Hospitals in KwaZulu-Natal, South Africa

Background. In KwaZulu-Natal (KZ-N), South Africa, recent reports have indicated that spontaneous use of smartphones has occurred, providing access to specialist dermatological care to remote areas. This informal use has raised a number of practical, legal, regulatory, and ethical concerns. Aim. To assess the nature and content of WhatsApp messages sent to dermatologists, to determine the referring doctors’ reasons for, and satisfaction with, their interactions, as well as their knowledge of legal, regulatory, and ethical requirements. Methods. A retrospective study of WhatsApp messages between referring doctors and dermatologists, as well as a cross-sectional survey of doctors working at district hospitals in KZ-N who used IM for teledermatology. Results. Use of IM (primarily WhatsApp) for teledermatology was almost universal, but often not considered ‘telemedicine’. Few referring doctors were aware of South Africa’s ethical guidelines and their requirements, and few of those who did followed them, e.g., the stipulated and onerous consent process and existing privacy and security legislations. No secure methods for record keeping or data storage of WhatsApp content were used. A desire to formalize the service existed. Conclusions. Based upon these findings, it was proposed that a number of described steps be followed in order to formalize the use of IM for teledermatology.

Medical Photography Usage Amongst Doctors at a Portuguese Hospital

Technological advancements in smartphones have made it possible to create high-quality medical photographs, with the potential to revolutionise patient care. To ensure the security of the patient’s data, it is important that medical professionals receive informed consent from the patient, that physical conditions are met to take a photograph, and that these medical images are stored correctly. This study aimed to determine if medical professionals of an academic hospital make use of medical photography, and how the content is obtained, stored, transferred, and used. Methods: A 30-question questionnaire was distributed across 29 medical departments at Centro Hospitalar Universitário de São João (CHUSJ), a tertiary referral and teaching hospital in Porto, Portugal, with approximately 900 medical professionals. Quantitative statistical methods were used to analyse questionnaire responses. Results: There were a total of 257 respondents. Of these, 93% used medical photography, 70% used it to document a patient’s clinical progress, 70% to ask for a second opinion, 56% for education, 65% for research and publication, and 68% to present at medical conferences. Medical photography was used by 33% weekly and 36% monthly, with 71% of respondents always asking for the patients’ consent before taking a photograph. Doctors aged 20−40 years used photography more often than doctors over 40 years of age to document the clinical progress of the patients (77% and 52%, respectively, p = 0.01) and to ask for a second opinion (78% and 52%, respectively, p < 0.001). Conclusions: Our study shows that medical photography is a common practice amongst medical doctors. However, appropriate measures need to be created to obtain patients’ consent, store images, and sure the security of patients’ information.

Challenges and prospects of neurosurgical teleconsultations in a developing country: a reality check

OBJECTIVE

The adoption of telemedicine became a necessity during the COVID-19 pandemic because patients found commuting to be difficult owing to travel restrictions. Initially, audio-based teleconsultations were provided. Later, on the basis of the feedback of patients and caregivers, the authors started to provide video-based teleconsultations via WhatsApp. The authors subsequently surveyed the patients and caregivers to determine their satisfaction levels with telemedicine services.

METHODS

An anonymized telephone survey of patients who had participated in teleconsultation was conducted with a structured questionnaire. The responses were analyzed and their correlations with the perceived benefits and limitations of audio and video teleconsultation were determined.

RESULTS

Three hundred respondents were included in the first round of surveys, of whom 250 (83.3%) consented to video teleconsultation. Among the respondents who participated in both audio and video teleconsultations (n = 250), paired analysis showed that video teleconsultation was perceived as better in terms of providing easier access to healthcare services (p < 0.001), saving time (p < 0.001), and satisfaction with the way patient needs were conveyed to healthcare providers (p = 0.023), as well as in terms of adequacy of addressing healthcare needs (p < 0.001) and consequently providing a higher rate of overall satisfaction (p < 0.001). For both audio and video teleconsultation, overall patient satisfaction was significantly related to only previous exposure to WhatsApp. However, for video consultation, longer call duration (p = 0.023) was an important independent factor. Video teleconsultation was preferable to face-to-face consultation irrespective of educational status, but higher education was associated with preference for video teleconsultation.

CONCLUSIONS

Both audio and video teleconsultation are viable cost-effective surrogates for in-person physical neurosurgical consultation. Although audio teleconsultation is more user-friendly and is not restricted by educational status, video teleconsultation trumps the former owing to a more efficient and satisfactory doctor-to-patient interface.