Unpacking Sociotechnical Discourses on Telehealth Use and Data Protection: A Path Towards Digital Health Value Creation

BACKGROUND

Telehealth uptake will remain sub-optimal without consumer trust. Safeguarding the security and privacy of health information plays an important role in building trust and acceptance of telehealth.

OBJECTIVES

This study seeks to unpack the sociotechnical discourses on the use of telehealth with a focus on privacy and security in the context of United States health services.

METHODS

A search of the media outlets facilitated via the Factiva database was conducted. Using a qualitative method, thematic analysis was performed on the news texts to identify the key themes and provide contextual explanations.

RESULTS

The analysis led to the identification of three key themes: 'data protection practice', 'clinical resilience', and 'digital health business value' perspectives. These themes focus on various concepts of telehealth use including data privacy, security, public health emergency, compliance activities in the use of telehealth, meeting stakeholders' needs, reducing costs of service delivery, the potential of telehealth for informed action, and improving users' experience. Among these themes, 'data protection practice' was directly associated with privacy compliance and telehealth use. Other thematic discourses have provided an indirect reflection on the role of privacy compliance, with a greater emphasis placed on health service delivery and market dynamics rather than compliance in practice.

CONCLUSION

Our study revealed the importance of the COVID-19 pandemic in telehealth use, highlighting the move towards 'good faith' and responsible use of telehealth.

Digital Health for Myocardial Infarction: Research Topics and Trends

We aimed to map the topics and trends of research on digital health for myocardial infarction over the past ten years. This can inform future research directions and newly emerging topics for myocardial infarction care, diagnosis and monitoring. The Web of Science database was searched for papers related to digital health for myocardial infarction. 1,344 retrieved records were used for visualisation through bibliometrics and co-occurrence network analysis of keywords. Our mapping revealed several emerging topics in recent years, including artificial intelligence and deep learning. Higher emphasis on automated and artificially intelligent digital health systems in recent years can inform future clinical practice and research directions for myocardial infarction.

The effect of using a sports application on the quality of sleep in patients with heart failure: a randomized clinical trial study

BACKGROUND

Patients with heart failure often suffer from sleep disorders. Due to the side effects of medications used to treat this disorder, non-pharmacological methods may be used to improve these patients' sleep quality. This study aimed to determine the effect of a sports application on sleep quality in patients with heart failure.

METHODS

In this single-blinded randomized clinical trial, 60 patients aged 30-70 referred to Shafa Hospital in Kerman were randomly assigned to control (n = 30) and intervention (n = 30) groups based on convenience sampling. The intervention group used the sports application for eight consecutive weeks. Data was collected using a demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI). An independent t-test and a Mann-Whitney U test were used for comparisons between groups and paired t-tests and Wilcoxon tests were used for comparisons within groups.

RESULTS

The data analysis revealed a significant difference in sleep quality scores between the two groups after the intervention, meaning that the intervention group had better sleep quality than the control group (P < 0.05).

CONCLUSIONS

As a result of the study, it was found that the sport application improved the quality of sleep in patients with heart failure. Our recommendation is for healthcare providers to use this sports application to present educational content related to physical activity and improve the sleep quality of patients.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT. 2019123045475N1." Registered 16 December 2019.

Telemedicine: Niche or mainstream? A bibliometric analysis and review of the output of highly ranked clinical journals

Historically, telemedicine research is predominantly published in discipline-specific telemedicine journals. However, in recent times the number of publications on telemedicine in clinical journals has increased. Acceptance of telemedicine research by clinical journals indicates a maturing of the telemedicine field. This bibliometric study reviewed telemedicine-related literature published in clinical journals from 2008 to 2018. A search was conducted in PubMed using two types of clinical outlets. (1) Top 20 journals with highest Impact Factor in the field of Medicine. (2) Top five journals with highest Impact Factor in most common Medical Specialty Areas. Analysis showed that there is a steady growth of literature relating to research and non-research publications appearing in clinical journals. Top five journals in the field of Medicine - BMJ, JAMA, Cochrane database, Medical Journal of Australia and Lancet have published 64% (n = 270) of telemedicine-related articles for the study period. Disease areas associated with telemedicine publications are consistent with global disease priorities. The review demonstrated that the most significant increase in telemedicine research published in clinical journals was focused on patient care.

Bibliometric analysis of COVID-19 publications shows the importance of telemedicine and equitable access to the internet during the pandemic and beyond

BACKGROUND

Pandemics highlight the increasing role of information and communications technology for improving access to health care. This study aimed to present a bibliometric analysis of the concept of digital divide reported in the published articles concerning the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

To conduct this bibliometric analysis of research topics and trends, we used VOSviewer software. We developed a search strategy to retrieve peer-reviewed publications related to 'digital divide in the COVID-19 era' from the Scopus database.

RESULTS

In total, 241 publications on the topic of digital divide and COVID-19 were retrieved from Scopus database between 2020 and 2021. The analysis of keywords co-occurrence of research topics revealed four main clusters including: 'telemedicine', 'Internet access and Internet use', 'e-learning' and 'epidemiology'. Seven characteristic categories were examined in these research topics, including: sociodemographic, economic, social, cultural, personal, material and motivational.

CONCLUSION

'Telemedicine' and 'Internet access and Internet use' as the largest clusters are connected to topics addressing inequalities in online health care access. Thus, policymakers should develop or modify policies in more egalitarian Internet access for all community members not only during a pandemic like the COVID-19 but also at regular times.

The effect of diabetes training through social networks on metabolic control of individuals with type 2 diabetes; a randomized controlled trial

Background

Due to spread of smart phones, opportunity to train patients with diabetes and communicate with them using social media is rising. Aim of this study was to evaluate the effect of training through two popular social networks in Iran ("Telegram" and "Soroush") and the metabolic control of people with Type 2 diabetes.

Methods

In this randomized controlled trial, we recruited 134 patients with type 2 diabetes, which randomly allocated into two groups: the intervention and the control group on a 1:1 basis. The studied tools included demographic information and awareness of diabetes and international physical activity questionnaires. The intervention comprised a training package that delivered to the intervention group via social media for 45 days. The primary outcome measures included awareness of diabetes management and physical activity level while secondary outcome measures were HbA1c and lipid profile.

Results

Social network training led to the increase of the patients' awareness (44.31 ± 2.78 to 46.88 ± 2.25 in intervention group vs 44.14 ± 3.85 to 44.41 ± 3.87 in control group) and physical activities level (23.64 ± 8.46 to 31.68 ± 7.12 in intervention group vs 26.20 ± 9.39 to 30.20 ± 8.11 in control group) (p-value < 0.001). Besides, LDL and HDL levels, and HbA1c (8.19 ± 2.10 to 8.05 ± 1.96 in intervention group vs. 7.53 ± 1.67 to 7.45 ± 1.34 in control group) decreased significantly (p-value < 0.05).

Conclusions

Changes in lifestyle and challenges of the patients' attendance in diabetes training sessions, declared that use of social networks can be useful to train diabetes patients remotely, and it is feasible to send training messages to help them improve their diabetes care.

Patients' perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients

INTRODUCTION

Despite the fact that telemedicine can eliminate geographical and time limitations and offer the possibility of diagnosing, treating, and preventing diseases by sharing reliable information, many individuals still prefer to visit medical centers for in-person consultations. The aim of this study was to determine the level of acceptance of telemedicine compared to in-person visits, identify the perceived advantages of telemedicine over in-person visits, and to explore the reasons why patients choose either of these two types of visits.

METHODS

We developed a questionnaire using the rational method. The questionnaire consisted of multiple-choice questions and one open-ended question. A total of 2059 patients were invited to participate in the study. Chi-square tests and descriptive statistics were employed for data analysis. To analyze the data from the open-ended question, we conducted qualitative content analysis using MAXQDA 18.

RESULTS

Out of the 1226 participants who completed the questionnaire, 865 (71%) preferred in-person visits, while 361 (29%) preferred telemedicine. Factors such as education level, specific health conditions, and prior experience with telemedicine influenced the preference for telemedicine. The participants provided a total of 183 different reasons for choosing either telemedicine (108 reasons) or in-person visits (75 reasons). Avoiding infectious diseases, saving cost, and eliminating and overcoming geographical distance barriers were three primary telemedicine benefits. The primary reasons for selecting an in-person visit were: more accurate diagnosis of the disease, more accurate and better examination of the patient by the physician, and more accurate and better treatment of the disease.

CONCLUSION

The results demonstrate that despite the numerous benefits offered by telemedicine, the majority of patients still exhibit a preference for in-person visits. In order to promote broader acceptance of telemedicine, it becomes crucial for telemedicine services to address patient preferences and concerns effectively. Employing effective change management strategies can aid in overcoming resistance and facilitating the widespread adoption of telemedicine within the population.

Mobile health interventions for cancer patient education: A scoping review

INTRODUCTION

Mobile health (mHealth) is using mobile devices and applications to deliver health information and services. mHealth has been increasingly applied in cancer care to support patients in various aspects of their disease journey. This scoping review aimed to explore the current evidence on the use of mHealth interventions for cancer patient education.

METHODS

This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We searched four electronic databases (PubMed, Web of Science, CINAHL, and Cochrane) using a combination of keywords related to mHealth, cancer, and education. After finding articles at the initial search the screening has been done based on the inclusion and exclusion criteria. We included only original research articles and excluded all other types of publications, such as review papers, reports, editorials, letters to the editor, book reviews, short communications, conference proceedings, graduate dissertations, protocols, and commentaries. We extracted data on the characteristics and outcomes of the included studies using a standardized form. We conducted a narrative synthesis and inductive content analysis to summarize and categorize the evidence.

RESULTS

Out of 2131 records found in the initial search, 28 full-text articles reported on the use of mHealth educational interventions for cancer patients. The majority of the studies focused on breast cancer patients (n = 21, 75%). The most common type of mHealth intervention was exercise-based education delivered through various media such as text messages, videos, audio, images, and social networks. The main objectives of mHealth educational interventions were to enhance self-management skills, improve psychological well-being, and promote healthy lifestyle behaviors among cancer patients. The reported outcomes of mHealth interventions included reduced chemotherapy-related side effects, improved mental health, improved quality of life and lifestyle, and better pain management.

CONCLUSION

This scoping review showed that mHealth is a promising and feasible modality for delivering educational interventions to cancer patients. However, more rigorous and diverse studies are needed to evaluate the effectiveness and cost-effectiveness of mHealth interventions for different types of cancers, stages, and settings.

Digital Health Secondary Prevention Using Co-Design Procedures: Focus Group Study With Health Care Providers and Patients With Myocardial Infarction

BACKGROUND

Myocardial infarction (MI) is a debilitating condition and a leading cause of morbidity and mortality worldwide. Digital health is a promising approach for delivering secondary prevention to support patients with a history of MI and for reducing risk factors that can lead to a future event. However, its potential can only be fulfilled when the technology meets the needs of the end users who will be interacting with this secondary prevention.

OBJECTIVE

We aimed to gauge the opinions of patients with a history of MI and health professionals concerning the functions, features, and characteristics of a digital health solution to support post-MI care.

METHODS

Our approach aligned with the gold standard participatory co-design procedures enabling progressive refinement of feedback via exploratory, confirmatory, and prototype-assisted feedback from participants. Patients with a history of MI and health professionals from Australia attended focus groups over a videoconference system. We engaged with 38 participants across 3 rounds of focus groups using an iterative co-design approach. Round 1 included 8 participants (4 patients and 4 health professionals), round 2 included 24 participants (11 patients and 13 health professionals), and round 3 included 22 participants (14 patients and 8 health professionals).

RESULTS

Participants highlighted the potential of digital health in addressing the unmet needs of post-MI care. Both patients with a history of MI and health professionals agreed that mental health is a key concern in post-MI care that requires further support. Participants agreed that family members can be used to support postdischarge care and require support from the health care team. Participants agreed that incorporating simple games with a points system can increase long-term engagement. However, patients with a history of MI emphasized a lack of support from their health care team, family, and community more strongly than health professionals. They also expressed some openness to using artificial intelligence, whereas health professionals expressed that users should not be aware of artificial intelligence use.

CONCLUSIONS

These results provide valuable insights into the development of digital health secondary preventions aimed at supporting patients with a history of MI. Future research can implement a pilot study in the population with MI to trial these recommendations in a real-world setting.

Novel behaviour change frameworks for digital health interventions: A critical review

Digital health interventions - interventions delivered over digital media to support the health of users - are becoming increasingly prevalent. Utilising an intervention development framework can increase the efficacy of digital interventions for health-related behaviours. This critical review aims to outline and review novel behaviour change frameworks that guide digital health intervention development. Our comprehensive search for preprints and publications used PubMed, PsycINFO, Scopus, Web of Science and the Open Science Framework repository. Articles were included if they: (1) were peer-reviewed; (2) proposed a behaviour change framework to guide digital health intervention development; (3) were written in English; (4) were published between 1/1/19 and 1/8/2021; and (5) were applicable to chronic diseases. Intervention development frameworks considered the user, intervention elements and theoretical foundations. However, the timing and policy of interventions are not consistently addressed across frameworks. Researchers should deeply consider the digital applicability of behaviour change frameworks to improve intervention success.

A virtual training program for improving cultural competence among academic nurse educators

BACKGROUND

Everyday, nursing students interact with culturally diverse clients. Nursing education recognizes that cultural competence is a necessary outcome of nursing programs. Nurse educators expect all nursing students to provide culturally congruent care to multicultural clients. Therefore, nurse educators must be culturally competent in order to prepare culturally competent nursing students for clinical practice. This study aimed to evaluate the effect of virtual training program on the cultural competence of academic nurse educators.

METHODS

This randomized controlled study included nurse educators working in six nursing schools affiliated with medical universities of Kerman province in southeastern Iran. Sixty-nine nurse educators were randomly assigned to the intervention (n = 35) and control (n = 34) groups. The training program consisted of three 2-hour sessions for a month. Cultural Diversity Questionnaire for Nurse Educators Revised (CDQNE-R) was used to evaluate the cultural competence of educators before and one month after the virtual training program.

RESULTS

Both the intervention (3.29 ± 0.58) and control (3.24 ± 0.58) groups demonstrated a similar level of cultural competence before the training program (t = 0.05, p = 0.95). After the training, the intervention group showed a significant increase in cultural competence (3.80 ± 0.7) compared to the control group (3.23 ± 0.67). This improvement resulted in culturally competent participants becoming culturally proficient, as evidenced by a large effect size (t = -4.76, p = 0.001).

CONCLUSION

The virtual training program had a positive impact on the cultural competence of nurse educators. Given the importance of cultural competence in nursing education, continuing education programs that focus on strengthening the cultural competence of nurse educators should be prioritized. The experiences gained from implementing virtual training programs can serve as a valuable resource for nurse educators seeking to enhance their cultural competence.

Artificial intelligence for secondary prevention of myocardial infarction: A qualitative study of patient and health professional perspectives

BACKGROUND

Artificial intelligence (AI) has potential to improve self-management of several chronic conditions. However, the perspective of patients and healthcare professionals regarding AI-enabled health management programs, which are key to successful implementation, remains poorly understood.

PURPOSE

To explore the opinions of people with a history of myocardial infarction (PHMI) and health professionals on the use of AI for secondary prevention of MI.

PROCEDURE

Three rounds of focus groups were conducted via videoconferencing with 38 participants: 22 PHMI and 16 health professionals.

FINDINGS

We identified 21 concepts stemming from participants' views, which we classified into five categories: Trust; Expected Functions; Adoption; Concerns; and Perceived Benefits. Trust covered the credibility of information and safety to believe health advice. Expected Functions covered tailored feedback and personalised advice. Adoption included usability features and overall interest in AI. Concerns originated from previous negative experience with AI. Perceived Benefits included the usefulness of AI to provide advice when regular contact with healthcare services is not feasible. Health professionals were more optimistic than PHMI about the usefulness of AI for improving health behaviour.

CONCLUSIONS

Altogether, our findings provide key insights from end-users to improve the likelihood of successful implementation and adoption of AI-enabled systems in the context of MI, as an exemplar of broader applications in chronic disease management.

Pregnant women's use and attitude toward Mobile phone features for self-management

BACKGROUND

This study aimed to examine the current use of mobile phones by pregnant women and their attitudes towards the use of a variety of prenatal care services through mHealth.

METHODS

This descriptive cross-sectional study was conducted in Iran in 2021. The study population included 168 pregnant women who referred to specialist obstetrics and gynecology clinic. The data collection tool was a questionnaire that included the demographics of the participants, their current mobile phone usage, and their attitudes toward mobile phone use for prenatal care services. The data were analyzed in SPSS with descriptive and analytical statistics.

RESULTS

The majority of participants (84.2%) had a smartphone and access to mobile internet. More than half of the respondents (58.9%) used their mobile phone for (only) phone calls, and 36.7% occasionally used mobile internet to access prenatal care services. To get information about the pregnancy and to communicate with other pregnant women, the participants mainly used social media, and to get reminders, they preferred phone calls.

CONCLUSIONS

In this study, pregnant women have a positive attitude towards using mobile phones for obtaining health services and prefer social media to seek prenatal care services. There seems to be a need for pregnant women to have high levels of digital health literacy and be advised by healthcare providers on using this technology to access prenatal care services.

Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review

BACKGROUND

Health care systems have become increasingly more reliant on patients' ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations.

OBJECTIVE

This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people.

METHODS

A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool.

RESULTS

Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants' views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others.

CONCLUSIONS

This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health.

Exploring public opinion about telehealth during COVID-19 by social media analytics

While COVID-19 catalyzed the acceptance and use of telehealth, our understanding of how it is perceived by multi-stakeholders such as patients, clinicians, and health authorities is limited. Drawing on social media analytics, this research examines social media discourses and users' opinions about telehealth during the COVID-19 pandemic. It applies natural language processing and deep learning to explore word of mouth on telehealth with a contextualized focus on the COVID-19 pandemic. We conducted topic modeling, sentiment analysis, and emotion analysis (fearful, happy, sad, surprised, and angry emotions). The topic modeling analysis led to the identification of 18 topics, representing 6 themes of digital health service delivery, pandemic response, communication and promotion, government action, health service domains (e.g. mental health, cancer, aged care), as well as pharma and drug. The sentiment analysis revealed that while most opinions expressed in tweets were positive, the public expressed mostly negative opinions about certain aspects of COVID-19 such as lockdowns and cyberattacks. Emotion analysis of tweets showed a dominant pattern of fearful and sad emotions in particular topics. The results of this study that inductively emerged from our social media analysis can aid public health authorities and health professionals to address the concerns of telehealth users and improve their experiences.

A qualitative analysis of the needs and wishes of people with type 2 diabetes and healthcare professionals for optimal diabetes care

AIM

Globally, type 2 diabetes care is often fragmented and still organised in a provider-centred way, resulting in suboptimal care for many individuals. As healthcare systems seek to implement digital care innovations, it is timely to reassess stakeholders' priorities to guide the redesign of diabetes care. This study aimed to identify the needs and wishes of people with type 2 diabetes, and specialist and primary care teams regarding optimal diabetes care to explore how to better support people with diabetes in a metropolitan healthcare service in Australia.

METHODS

Our project was guided by a Participatory Design approach and this paper reports part of the first step, identification of needs. We conducted four focus groups and 16 interviews (November 2019-January 2020) with 17 adults with type 2 diabetes and seven specialist clinicians from a diabetes outpatient clinic in Brisbane, Australia, and seven primary care professionals from different clinics in Brisbane. Data were analysed using reflexive thematic analysis, building on the Capability, Opportunity, Motivation and Behaviour model.

RESULTS

People with diabetes expressed the wish to be equipped, supported and recognised for their efforts in a holistic way, receive personalised care at the right time and improved access to connected services. Healthcare professionals agreed and expressed their own burden regarding their challenging work. Overall, both groups desired holistic, personalised, supportive, proactive and coordinated care pathways.

CONCLUSIONS

We conclude that there is an alignment of the perceived needs and wishes for improved diabetes care among key stakeholders, however, important gaps remain in the healthcare system.

Assessing the online search behavior for COVID-19 outbreak: Evidence from Iran

Introduction

Google Trends (GT) is an important free tool for online search behavior analysis, which provides access to Internet search patterns in Google. In recent decades, this database has been used for predicting the outbreak of epidemics and pandemics in different regions of the world. The present study aimed to evaluate Iranian users’ COVID-19-related online search behavior.

Methods

This longitudinal study was conducted in 2021. The data of Iranian users’ COVID-19-related online search behavior (trend) were collected from the GT website, and the epidemiological data of the COVID-19 outbreak in Iran from 16 February 2020 to 2 January 2021 were sourced from the Iranian ministry of health and medical education, as well as the World Health Organization. The data were analyzed in SPSS using descriptive and inferential statistics.

Results

All the COVID-19-related search terms in Iran gained their highest popularity value (relative search volume = 100) in the first 8 weeks of the pandemic, and then this value assumed a decreasing trend over time. Based on factor analysis, relative search volume (RSV) of factor 1 terms (related to corona [in Persian] and corona) have a low significance relationship with COVID-19 epidemiological data in one-, two-, and three-week time lags. Although, RSV of factor 2 terms (related to COVID [in Persian], COVID-19, and coronavirus) correlated with the total weekly number of COVID-19 cases in mentioned time lags.

Conclusion

COVID-19-related search terms were popular among Iranian users at the beginning of the pandemic. The online search queries and the key terms searched by Iranian users varied during the COVID-19 pandemic. This study provides evidence in favor of the adoption of GT as an epidemiological surveillance tool but, it is necessary to consider that mass media and other confounders can significantly influence RSVs.

Development and Usability Evaluation of a Telemedicine System for Management and Monitoring of Patients with Diabetic Foot

Objectives: The aim of the present study was to develop and evaluate the usability of a telemedicine system for management and monitoring of patients with diabetic foot.Methods: This study was conducted in four phases. In the first phase, the information needs and characteristics required to design the telemedicine system were identified based on a literature review. Then, in a two-stage Delphi survey, 15 experts approved the identified information needs and characteristics. The prototype telemedicine system was then designed. In the third phase, system usability was evaluated through a semi-structured interview. In the fourth phase, users’ satisfaction with the designed system was analyzed.Results: Out of 115 information needs and required characteristics, 95 were considered in the system design. Eight main pages for enabling patient-physician interactions and physician-physician interactions, monitoring the patient and controlling the disease process, providing medical consultation, and prescribing medications were considered. In the third phase, 26 distinct problems were identified. However, 75% of the participants were very satisfied with the system.Conclusions: This study presents an attempt to design and evaluate a telemedicine system for the management and monitoring of patients with diabetic foot. In this system, patients receiving medical services or physicians who encounter rare cases can send the complete medical history, clinical test results, and videos and images related to the foot to specialist physicians. After examining the medical history or images and videos, the physician can provide the necessary medication prescriptions and laboratory tests or other recommendations.

The most used questionnaires for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health

Background

Various questionnaires are used for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health (mHealth) services. Using the best one to meet the needs of an mHealth study is a challenge for researchers. Therefore, this study aimed to review and determine the frequently used questionnaires for evaluating the mentioned outcomes of mHealth services.

Methods

The PubMed database was searched for conducting this review in April 2021. Papers that used a referenced questionnaire to evaluate the satisfaction, usability, acceptance, or quality outcomes of mHealth were included. The first author’s name, year of publication, evaluation outcome, and evaluation questionnaire were extracted from relevant papers. Data were analyzed using descriptive statistics.

Results

In total, 247 papers were included in the study. Questionnaires were used for usability (40%), quality (34.5%), acceptance (8.5%), and satisfaction (4%) outcomes, respectively. System usability scale (36.5%), mobile application rating scale (35.5%), post study system usability questionnaire (6%), user mobile application rating scale (5%), technology acceptance model (4.5%), computer system usability questionnaire (2.5%), net promoter score (2%), health information technology usability evaluation scale (2%), the usefulness, satisfaction, and ease of use (1.5%), client satisfaction questionnaire (1.5%), unified theory of acceptance and use of technology (1.5%), questionnaire for user interaction satisfaction (1%), user experience questionnaire (1%), and after-scenario questionnaire (1%) were the most used questionnaires, respectively.

Conclusion

Despite the existence of special questionnaires for evaluating several outcomes of mHealth, general questionnaires with fewer items and higher reliability have been used more frequently. Researchers should pay more attention to questionnaires with a goal-based design.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01764-2.

Cory COVID-Bot: An Evidence-Based Behavior Change Chatbot for COVID-19

Cory COVID-Bot is an artificial intelligence chatbot designed and built by a multisector collaboration to help people safely step towards COVID normal. Achieving COVID normal and avoiding unnecessary adverse health outcomes requires effective communication to the public regarding COVID safe behaviors, but reaching young, culturally and linguistically diverse members of the community is challenging for government. Cory COVID-Bot was developed to directly engage with difficult to reach populations in English and Vietnamese. In order to resolve public ambiguity and uncertainty about public health guidelines, and to stimulate safe behavior, Cory COVID-Bot provides updated recommendations and behavior change interventions, which emphasize the importance of COVID safe behaviors.

A Novel Model for Implementing Internet of Things (IoT) in Iranian Hospitals

The Internet of Things (IOT) has led to ground-breaking changes in the healthcare industry as a promising technological solution. Yet, despite its many benefits, its application has always proven to be challenging. Hence, the purpose of this study is to identify the challenges of using the IOT with the intention of proposing a model for implementing Internet of Things in Iranian hospitals. This study was performed in three phases. In the first phase, the challenges of using the IoT were outlined and introduced. In the second phase the challenges of using the Internet of Things in Iranian hospitals (according to experts) was established during the completion of a two-round Delphi. In the last phase, a novel model for implementing the IoT in Iranian hospitals was proposed. The identified primary model consisted of six groups, namely privacy and security, Big data, hardware, network, software, and organizational-cultural and environmental issues with 78 challenges. Out of the 78 identified challenges, 46 were approved by experts as essential elements for providing IoT patterns in Iranian hospitals. The highest and lowest averages were related to the subgroups "Failure to provide regular IoT rules and programs by governments" and "Absence of single, integrated and efficient platforms with high data transfer capacity and fast processing", respectively. The final model for implementing IoT in Iranian hospitals was designed and presented using Edraw Max10.0.4+Portable software. Providing this model can provide a sufficient basis, information and knowledge for policymakers, government authorities and managers of organizations to use the IoT in hospitals of Iran and other countries. Also, the application of the proposed model can result in the improved special capabilities in the realm of system design, and offer grounds for saving time and money as well as reducing failures in the initial design of IoT projects.

Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting

BACKGROUND

Early warning tools identify patients at risk of deterioration in hospitals. Electronic medical records in hospitals offer real-time data and the opportunity to automate early warning tools and provide real-time, dynamic risk estimates.

OBJECTIVE

This review describes published studies on the development, validation, and implementation of tools for predicting patient deterioration in general wards in hospitals.

METHODS

An electronic database search of peer reviewed journal papers from 2008-2020 identified studies reporting the use of tools and algorithms for predicting patient deterioration, defined by unplanned transfer to the intensive care unit, cardiac arrest, or death. Studies conducted solely in intensive care units, emergency departments, or single diagnosis patient groups were excluded.

RESULTS

A total of 46 publications were eligible for inclusion. These publications were heterogeneous in design, setting, and outcome measures. Most studies were retrospective studies using cohort data to develop, validate, or statistically evaluate prediction tools. The tools consisted of early warning, screening, or scoring systems based on physiologic data, as well as more complex algorithms developed to better represent real-time data, deal with complexities of longitudinal data, and warn of deterioration risk earlier. Only a few studies detailed the results of the implementation of deterioration warning tools.

CONCLUSIONS

Despite relative progress in the development of algorithms to predict patient deterioration, the literature has not shown that the deployment or implementation of such algorithms is reproducibly associated with improvements in patient outcomes. Further work is needed to realize the potential of automated predictions and update dynamic risk estimates as part of an operational early warning system for inpatient deterioration.

Same goals, different challenges: A systematic review of perspectives of people with diabetes and healthcare professionals on Type 2 diabetes care

AIMS

To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care.

METHODS

A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted.

RESULTS

We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self-management requires a trustful PWD-HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self-manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence-based guidelines are important but can detract from personalised care.

CONCLUSION

We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals.

Strengthening positive social pathways via digital social applications in individuals with social skills deficits: A scoping review

BACKGROUND

Effective digital social capital interventions have great potential to establish trusted social pathways to access supportive services and to enable talking about issues contributing to distress.

AIM

This review explores the digital social capital interventions used in individuals with social skills deficits, and the best social health outcomes achieved.

METHOD

Four databases (PubMed, CINAHL, PsychINFO, and Web of Science) were used with no time limitation, and 33 papers were included.

RESULTS

A diverse range of digital social programs was used for social capital improvement based on individuals' characteristics (e.g. age range and illnesses). Programs ranged from digitally-enhanced self-help or self-guided treatment (to enhance the self-efficacy of individuals), to group treatments and/or web-based caregiver support services. They comprised mobile social apps, video blogging, video-communication system/video-conferencing, and online social communication, to more advanced techniques such as virtual reality. All of these modalities were shown to be beneficial for improving the social health of individuals. Interventions targeted two aspects of social capital: (1) cognitive social capital, focusing on enhancing trust and control, self-efficacy on life. Some examples were cognitive behavioural therapy, and increasing the received and more importantly perceived social support. (2) structural social capital, focusing on individuals' relationships with family/carers, friends, peers to other connections at the macro level, such as health care providers and their community as a whole. The two interconnected aspects of social capital play a role in decreasing fears of being judged by others, general fears in social interactions and interpersonal problems.

CONCLUSION

Guided digital social support interventions result in open and flexible access to various resources through supportive social networks, for patients and their family members/carers.

Comparing antiviral strategies against COVID-19 via multiscale within-host modelling

Within-host models of COVID-19 infection dynamics enable the merits of different forms of antiviral therapy to be assessed in individual patients. A stochastic agent-based model of COVID-19 intracellular dynamics is introduced here, that incorporates essential steps of the viral life cycle targeted by treatment options. Integration of model predictions with an intercellular ODE model of within-host infection dynamics, fitted to patient data, generates a generic profile of disease progression in patients that have recovered in the absence of treatment. This is contrasted with the profiles obtained after variation of model parameters pertinent to the immune response, such as effector cell and antibody proliferation rates, mimicking disease progression in immunocompromised patients. These profiles are then compared with disease progression in the presence of antiviral and convalescent plasma therapy against COVID-19 infections. The model reveals that using both therapies in combination can be very effective in reducing the length of infection, but these synergistic effects decline with a delayed treatment start. Conversely, early treatment with either therapy alone can actually increase the duration of infection, with infectious virions still present after the decline of other markers of infection. This suggests that usage of these treatments should remain carefully controlled in a clinical environment.

Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation

Background

As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis.

Objective

This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers.

Methods

The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire.

Results

The developed mobile app includes modules that support several features. A person’s data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician’s portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app.

Conclusions

Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up.

Infodemic, Misinformation and Disinformation in Pandemics: Scientific Landscape and the Road Ahead for Public Health Informatics Research

In response to epidemics and pandemics, access to authentic sources of information plays a critical role in informing public health practices. However, infodemic, i.e., an overabundance of health information, misinformation, and disinformation, impede implementing best public health policies during a public health crisis such as COVID-19. In this bibliometric study, we aim to report on concept mapping of infodemic literature, and in line with the World Health Organization (WHO)'s repeated calls for actions in managing infodemic, we highlight fruitful avenues for future directions. Through a visualization approach on a set of 414 records, a concept mapping was carried out. This map revealed 42 infodemic-related nodes in five clusters. We also propose an infodemic research platform in which a combination of the research nodes (e.g., COVID, pandemic, disinformation, fake news, post-truth, fact-checking, social networks, Facebook, WhatsApp, and lockdown) with impactful questions suggest future directions.

Improving nurses' readiness for evidence-based practice in critical care units: results of an information literacy training program

BACKGROUND

One of the most important prerequisites for nurses' readiness to implement Evidence-Based Practice (EBP) is to improve their information literacy skills. This study aimed to evaluate the impact of a training program on nurses' information literacy skills for EBP in critical care units.

METHODS

In this interventional study, 60 nurses working in critical care units of hospitals affiliated to Kerman University of Medical Sciences were randomly assigned into the intervention or control groups. The intervention group was provided with information literacy training in three eight-hour sessions over 3 weeks. Data were collected using demographic and information literacy skills for EBP questionnaires before and 1 month after the intervention.

RESULTS

At baseline, the intervention and control groups were similar in terms of demographic characteristics and information literacy skills for EBP. The training program significantly improved all dimensions of information literacy skills of the nurses in the intervention group, including the use of different information resources (3.43 ± 0.48, p < 0.001), information searching skills and the use of different search features (3.85 ± 0.67, p < 0.001), knowledge about search operators (3.74 ± 0.14, p < 0.001), and selection of more appropriate search statement (x2 = 50.63, p = 0.001) compared with the control group.

CONCLUSIONS

Nurses can learn EBP skills and apply research findings in their nursing practice in order to provide high-quality, safe nursing care in clinical settings. Practical workshops and regular training courses are effective interventional strategies to equip nurses with information literacy skills so that they can apply these skills to their future nursing practice.

Health Data Privacy in the COVID-19 Pandemic Context: Discourses on HIPAA

BACKGROUND

Considering the impacts of the COVID-19 pandemic on health service delivery, the US Office for Civil Rights (OCR) updated the policies on health data processing, and Health Insurance Portability and Accountability Act (HIPAA).

OBJECTIVES

In this study, we investigated discourses on HIPAA in relation to COVID-19.

METHODS

Through a search of media sources in the Factiva database, relevant texts were identified. We applied a text mining approach to identify concepts and themes in these texts.

RESULTS

Our analysis revealed six central themes, namely, Health, HIPAA, Privacy, Security, Patients, and Need, as well as their associated concepts. Among these, Health was the most frequently discussed theme. It comprised concepts such as public, care, emergency, providers, telehealth, entity, use, discretion, OCR, Health and Human Services (HHS), enforcement, business, and services.

CONCLUSION

Our discourse analysis of media outlets highlights the role of health data privacy law in the response to global public health emergencies and demonstrates how discourse analysis and computational methods can inform health data protection policymaking in the digital health era.

Health Pandemic and Social Media: A Content Analysis of COVID-Related Posts on a Telegram Channel With More Than One Million Subscribers

BACKGROUND

Mobile-based social media play an important role in the dissemination of information during public health emergencies.

OBJECTIVES

This study aimed to analyze the contents and trends of public messages posted on Telegram during Coronavirus Disease 2019 (COVID-19) pandemic.

METHODS

A content analysis of the 1781 messages, posted in a public Telegram channel with more than one million subscribers performed over 9-weeks. The messages were categorized into seven categories.

RESULTS

In total, 39% (n=703) of all messages were related to COVID-19. With the official confirmation of the case of COVID-19 in Iran, the number of COVID-related massages started to rise. Overall, the most frequent messages were of joke and humor (n=292, 41.5%), followed by educational messages (n=140, 19.9%).

CONCLUSION

Our study showed that the most popular messages during first weeks of COVID pandemic were satirical, indicating that people may not had taken the risks of this pandemic seriously. It is crucial for health organizations to develop strategies for dissemination of reliable health information through social media.

COVID-19 on Instagram: A content analysis of selected accounts

OBJECTIVE

This study aimed to characterize the representation of public health information related to COVID-19 posted on Instagram in 2020.

METHODS

This qualitative content analysis study was conducted in Iran as one of the countries with the highest number of confirmed cases of COVID-19. Data were collected from the contents published from February 19 to April 3, 2020, on Instagram. The search feature of the Instagram app was used to find the posts related to Coronavirus or COVID-19. Overall, 1612 posts from 92 accounts were retrieved and analyzed using thematic analysis.

RESULTS

A total of 23 themes emerged from the analysis of the retrieved posts. These themes include epidemiology and statistics, training and caring, general prevention guidelines, hygiene, healthy diet and lifestyle, patients, diagnosis and treatment, personal protective equipment, traditional medicine, psychology, children, cultural aspects, socio-cultural impacts, religious, misinformation, and wrong behaviors, animals, satire, condition of the healthcare system, politics, quarantine, operations of the Iranian National Disaster Management Organization (NDMO), economic impacts, and world news.

CONCLUSION

The contents analysis of Instagram posts during a public health crisis can provide new and realistic insights into the crisis and identify the topics of interest or concern of the public. Furthermore, the information collected in this way can help policymakers identify the most critical issues from the public perspective and utilize the gained knowledge to manage the ongoing and future pandemics.

Assessing the effect of virtual education on information literacy competency for evidence-based practice among the undergraduate nursing students

Background

Information literacy competency is one of the requirements to implement Evidence-Based Practice (EBP) in nursing. It is necessary to pay attention to curricular development and use new educational methods such as virtual education to strengthen information literacy competency in nursing students. Given the scarcity of the studies on the effectiveness of virtual education in nursing, particularly in Iran, and the positive university atmosphere regarding the use of virtual education, this study investigated the effect of virtual education on the undergraduate nursing students’ information literacy competency for EBP.

Methods

This interventional study was performed with two groups of intervention and control and a pretest and posttest design. Seventy-nine nursing students were selected and assigned to the intervention or control groups by random sampling. Virtual education of the information literacy was uploaded on a website in the form of six modules delivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used to collect data before and one month after the virtual education.

Results

The results showed no significant difference between the control and intervention groups in all dimensions of information literacy competency in the pre-test stage. In the post-test, the virtual education improved dimensions of information seeking skills (t = 3.14, p = 0.002) and knowledge about search operators (t = 39.84, p = 0.001) in the intervention groups compared with the control group. The virtual education did not have any significant effect on the use of different information resources and development of search strategy with assessing the frequency of selecting the most appropriate search statement in the intervention group.

Conclusion

Virtual education had a significant effect on information seeking skills and knowledge about search operators in nursing students. Nurse educators can benefit from our experiences in designing this method for the use of virtual education programs in nursing schools. Given the lack of effectiveness of this program in using different information resources and development of search strategy, nurse educators are recommended to train information literacy for EBP by integrating several approaches such as virtual (online and offline) and face-to-face education.

Digital health interventions for chronic diseases: a scoping review of evaluation frameworks

Background

Monitoring and evaluations of digital health (DH) solutions for the management of chronic diseases are quite heterogeneous and evidences around evaluating frameworks are inconsistent. An evidenced-based framework is needed to inform the evaluation process and rationale of such interventions. We aimed to explore the nature, extent and components of existing DH frameworks for chronic diseases.

Methods

This review was conducted based on the five steps of Arksey and O’Malley’s scoping review methodology. Out of 172 studies identified from, PubMed, Embase and Web of Science, 11 met our inclusion criteria. The reviewed studies developed DH frameworks for chronic diseases and published between 2010 and 2018.

Results

According to WHO guidelines for monitoring and evaluation of DH interventions, we identified seven Conceptual frameworks, two Results frameworks, one Logical framework and one Theory of change. The frameworks developed for providing interventions such as self-management, achieving personal goals and reducing relapse for cardiovascular disease, diabetes, chronic obstructive pulmonary disease and severe mental health. A few studies reported evaluation of the frameworks using randomised clinical trials (n=3) and feasibility testing via Likert scale survey (n=2). A wide range of outcomes were reported including access to care, cost-effectiveness, behavioural outcomes, patient–provider communications, technology acceptance and user experience.

Conclusion

There is a lack of evidence on the application of consistent DH frameworks. Future research should address the use of evidence-based frameworks into the research design, monitoring and evaluation process. This review explores the nature of DH frameworks for the management of chronic diseases and provides examples to guide monitoring and evaluation of interventions.

What is Digital Health? Review of Definitions

Digital technologies are transforming the health sector all over the world, however various aspects of this emerging field of science is yet to be properly understood. Ambiguity in the definition of digital health is a hurdle for research, policy, and practice in this field. With the aim of achieving a consensus in the definition of digital health, we undertook a quantitative analysis and term mapping of the published definitions of digital health. After inspecting 1527 records, we analyzed 95 unique definitions of digital health, from both scholar and general sources. The findings showed that digital health, as has been used in the literature, is more concerned about the provision of healthcare rather than the use of technology. Wellbeing of people, both at population and individual levels, have been more emphasized than the care of patients suffering from diseases. Also, the use of data and information for the care of patients was highlighted. A dominant concept in digital health appeared to be mobile health (mHealth), which is related to other concepts such as telehealth, eHealth, and artificial intelligence in healthcare.

Health Data Privacy: Research Fronts, Hot Topics and Future Directions

Health data privacy is an important research stream due to the high impacts on the success of digital health transformation and implementation. Neglecting to safeguard data confidentially and integrity and mitigate risks associated with unauthorized access will lead to failures in materializing benefit from digital health. This study aims to present a bibliometric analysis of health data privacy and provide a platform for future directions. We conducted a literature search between 2010 and 2020 in the Web of Science (WoS) database, resulted in 1,752 records. As part of the bibliometric analysis, concept mapping of health data privacy researches was depicted by network visualization and overlay visualization. These two visualizations represent five research fronts and emerging topics (e.g., digital health, blockchain, the internet of things (IoT)). Finally, we chart directions for future research on health data privacy, highlighting emerging topics, and boundary-breaking alternatives (e.g., GDPR, contact tracing apps in the context of pandemics).

A review and content analysis of national apps for COVID-19 management using Mobile Application Rating Scale (MARS)

The expansion of mobile health apps for the management of COVID-19 grew exponentially in recent months. However, no study has evaluated these apps. The objective of this study was to develop a reliable measure and rate the quality of COVID-19 mobile health apps, to eventually provide a roadmap for future mHealth app development. In this study, we used COVID-related keywords to identify apps for iOS and Android devices. 13 apps (13.5% of the total number of apps identified) were selected for evaluation. App quality was assessed independently using MARS by two reviewers. Search queries yielded a total of 97 potentially relevant apps, of which 13 met our final inclusion criteria. Kendall's coefficient of concordance value for the inter-rater agreement was 0.93 (p = .03). COVID-19 GOV PK app had the highest average MARS score (4.7/5), and all of the apps had acceptable MARS scores (> 3.0). This study suggests that most COVID-related apps meet acceptable criteria for quality, content, or functionality, and they must highlight esthetic and interesting features for overall quality improvement to be welcomed by users.

Use of eHealth in the management of pulmonary arterial hypertension: review of the literature

Background

Pulmonary arterial hypertension (PAH) is a severe chronic condition associated with poor quality of life and high risks of mortality and hospitalisation. The utilisation of novel diagnostic technologies has improved survival rates although the effectiveness of Electronic Health (eHealth) interventions in patients with a chronic cardiopulmonary disease remains controversial. As the effectiveness of eHealth can be established by specific evaluation for different chronic health conditions, the aim of this study was to explore and summarise the utilisation of eHealth in PAH.

Method

We searched PubMed, CINAHL and Embase for all studies reporting clinical trials on eHealth solutions for the management of PAH. No limitations in terms of study design or date of publication were imposed.

Results

18 studies (6 peer-reviewed journal papers and 12 conference papers) were identified. Seven studies addressed the accuracy, safety or reliability of eHealth technologies such as intra-arterial haemodynamic monitoring of the pulmonary artery pressure, self-administered 6-Minute walk test App, computerised step-pulse oximeter and ambulatory impedance cardiography. Two studies evaluated eHealth as part of the medical management and showed a reduction in hospitalisation rate.

Conclusions

The evidence of eHealth supporting the management of people with PAH is limited and only embraced through a few studies of small sample size and short-term duration. Given the proposed clinical benefits in heart failure, we postulate that the evaluation of eHealth for the clinical management of PAH is highly warranted.

Education and Training on Electronic Medical Records (EMRs) for health care professionals and students: A Scoping Review

BACKGROUND AND OBJECTIVES

The ability of health care providers and students to use EMRs efficiently can lead to achieving improved clinical outcomes. Training policies and strategies play a major role in successful technology implementation and ongoing use of the EMR systems. To provide evidence-based guidance for developing and implementing educational interventions and training, we reviewed and summarized the current literature on EMR training targeting both healthcare professionals (HCP) and students.

METHODS

We used the Joanna Briggs Institute (JBI) approach for scoping reviews and the PRISMA extension of scoping reviews (PRISMA-ScR) checklist for reporting our review. 46 full-text articles that met the eligibility criteria were selected for the review. Narrative synthesis was performed to summarize the evidence using numerical and descriptive analysis. We used inductive content analysis for categorizing the training methods. Also, the modified version of the Kirkpatrick's levels model was used for abstracting the training outcome.

RESULTS

Five types of training methods were identified: one-on-one training, peer-coach training, classroom training (CRT), computer-based training (CBT), and blended training. A variety of CBT platforms were used, including a prototype academic electronic medical record system (AEMR), AEMR/simulated EMR (Sim-EMR), mobile based AEMR, eLearning, and electronic educational materials. Each training intervention could have resulted in several outcomes. Most outcomes were related to levels 1-3 of the Kirkpatrick model that involves learners (n = 108), followed by level 4a that involves organizations (n = 7), and lastly level 4b that involves patients (n = 1). The outcomes related to participants' knowledge (level 2b) was the most often measured training outcome (n = 44).

CONCLUSIONS

This review presents a comprehensive synthesis of the evidence on EMR training. A variety of training methods, participants, locations, strategies, and outcomes were described in the studies. Training should be aligned with the particular training needs, training objectives, EMR system utilized, and organizational environment. A training plan should include an overall goal and SMART (Specific, Measurable, Achievable, Realistic, Tangible) training objectives, that would allow a more rigorous evaluation of the training outcomes.

Adult-onset very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD)

BACKGROUND AND PURPOSE

Very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD) is a hereditary disorder of mitochondrial long-chain fatty acid oxidation that has variable presentations, including exercise intolerance, cardiomyopathy and liver disease. The aim of this study was to describe the clinical and genetic manifestations of six patients with adult-onset VLCADD.

METHODS

In this study, the clinical, pathological and genetic findings of six adult patients (four from Iran and two from Serbia) with VLCADD and their response to treatment are described.

RESULTS

The median (range) age of patients at first visit was 31 (27-38) years, and the median (range) age of onset was 26.5 (19-33) years. Parental consanguinity was present for four patients. Four patients had a history of rhabdomyolysis, and the recorded CK level ranged between 67 and 90 000 IU/l. Three patients had a history of exertional myalgia, and one patient had a non-fluctuating weakness. Through next-generation sequencing analysis, we identified six cases with variants in the ACADVL gene and a confirmed diagnosis of VLCADD. Of the total six variants identified, five were missense, and one was a novel frameshift mutation identified in two unrelated individuals. Two variants were novel, and three were previously reported. We treated the patients with a combination of L-carnitine, Coenzyme Q10 and riboflavin. Three patients responded favorably to the treatment.

CONCLUSION

Adult-onset VLCADD is a rare entity with various presentations. Patients may respond favorably to a cocktail of L-carnitine, Coenzyme Q10, and riboflavin.

Virtual Reality Therapy for Social Phobia: A Scoping Review

Virtual reality (VR) has become an interesting alternative for the treatment of social phobia. This scoping review explored the impact of VR technologies in the treatment of social phobia (25 papers were included). Treatment approaches to social phobia included virtual reality exposure therapy, cognitive behaviour therapy, exposure group therapy, in vivo exposure therapy, and waiting list. VR was identified as the most successful approach, not only in improving social phobia, but also resulting in real life changes such as improvement in occupational success. VR Head Mounted Displays were used in most of studies (76%), followed by VR-based Specific Systems (24%). Although VR techniques indicated positive impact on patients to reduce their anxiety, it is paramount to consider variables such as the way therapists control the environment as well as individuals' characteristics for achieving the best outcome.

General Data Protection Regulation (GDPR) in Healthcare: Hot Topics and Research Fronts

General Data Protection Regulation came into effect across the European Union in May 2018 but its implications in healthcare are yet to be fully understood. The aim of this study was to identify the fronts and hot topics in research on GDPR in healthcare. We analyzed the relevant records in Scopus through bibliometric and scientometric approach and visualization techniques. A set of 155 records was obtained and processed for co-occurrence analysis of key terms and concept mapping. The number of published papers showed a steep rise in the past two years, mainly by European countries. Analysis of the abstract of the papers showed that data protection, privacy, and big data were the most frequently used terms. Three dominant research fronts of GDPR are 1) general implications of GDPR, 2) technology aspects of GDPR, and 3) GDPR in healthcare service. Blockchain and machine learning are among the remerging topics of GDPR research.

Role of Telehealth in the Management of COVID-19: Lessons Learned from Previous SARS, MERS, and Ebola Outbreaks

Concerns about the prevention and management of COVID-19 are on the rise, as it is crucial in contagious epidemics that travel and transfer of the patients be minimal for diagnosis, treatment, and follow-ups. Telemedicine or telehealth can play an important role, especially with previous successful experiences in the management of acute infectious respiratory epidemics such as SARS and MERS. In order to better control the rapid spread of coronavirus and manage the COVID-19 crisis, both developed and developing countries can improve the efficiency of their health system by replacing a proportion of face-to-face clinical encounters with telehealth. Recent technological advancement facilitates this reform, but there is a need for national or state-wide rules and regulations to be adapted accordingly.