[Utility of the Abeona Health® app for patient participation in the identification of chemotherapy-induced toxicity according to the CTCAE classification]. / Utilidad de la app Abeona Health® para la participación del paciente en la identificación de toxicidad inducida por quimioterapia según la clasificación CTCAE.

OBJECTIVE: Since 2003, the National Cancer Institute (NCI) of the United States of America has been one of the world leaders in classifying adverse effects (AEs). Currently, smartphones allow, among many other things, the monitoring of these AEs of chemotherapy from home to improve the safety and quality of life of patients. The aim was to perform a descriptive comparative analysis of the AEs content of the Abeona Health® app and the latest version of the CTCAE (Common Terminology Criteria for Adverse Events). METHODS: The Abeona Health® app and the CTCAE v5 guide were used. Subsequently, the most recurrent AEs in the existing chemotherapy treatment were analysed according to the NCI and the Spanish Society of Medical Oncology (SEOM) and finally, whether patients could identify them. RESULTS: The CTCAE v5 (collects 837 AEs), where two hundred and twenty-five are signs and symptoms. The NCI classifies fifty-five signs and symptoms as the most recurrent, and the SEOM sixteen, of which fifteen coincide with the NCI. The Abeona Health® application has seven AEs, all included in the CTCAE v5. Of these seven, six appear in the NCI lists of most recurrent AEs and four in the SEOM list, all identifiable by the patient. CONCLUSIONS: The Abeona Health® app is considered adequate for the patient participation in their self-care, although some fields could be expanded.

OBJECTIVE: Desde 2003, el Instituto Nacional del Cáncer (NCI) de los Estados Unidos de América ha sido uno de los líderes mundiales en la clasificación de los Efectos Adversos (EA). Actualmente, los teléfonos inteligentes permiten, entre otras muchas cosas, la monitorización de estos EA de la quimioterapia desde el domicilio para mejorar la seguridad y la calidad de vida de los pacientes. El objetivo de este estudio fue realizar un análisis comparativo descriptivo del contenido de los EA de la aplicación Abeona Health® y la última versión de los CTCAE (Common Terminology Criteria for Adverse Events). METHODS: Se utilizó la app Abeona Health® y la guía CTCAE v5. Posteriormente, se analizaron los EA más recurrentes en el tratamiento quimioterápico, según la NCI y la Sociedad Española de Oncología Médica (SEOM) y, finalmente, si los pacientes podían identificarlos. RESULTS: El CTCAE v5 recoge 837 EA, donde 225 son signos y síntomas. El NCI clasifica cincuenta y cinco signos y síntomas como los más recurrentes, y la SEOM dieciséis, de los cuales quince coinciden con el NCI. La aplicación Abeona Health® dispone de siete EA, y todos se incluyen en el CTCAE v5. De estos siete, seis aparecen en las listas de EA más recurrentes del NCI y cuatro en la de la SEOM, todos ellos identificables por el paciente. CONCLUSIONS: La app de Abeona Health® se considera adecuada para la participación del paciente en su autocuidado, si bien se podrían ampliar algunos campos.

Evaluation of the Effectiveness of Telemedicine Visits in a Pediatric Gastroenterology Service in the Context of COVID-19.

BACKGROUND: During the first months of COVID-19, the Gastroenterology, Hepatology and Nutrition service of the Hospital Sant Joan de Déu in Barcelona, a leading pediatric center in Spain, introduced a new model of non-face-to-face care. OBJECTIVE: To evaluate the impact of telephone consultations compared to those conducted face-to-face on healthcare utilization. METHODOLOGY: Two main indicators of effectiveness are used: the degree of resolution (percentage of first telemedicine visits that did not generate any new visits in the following 4 and 12 months) and the average number of subsequent visits. A distinction was made between visits for general pathologies (less complex) and those for pathologies treated in monographic consultations (chronic or complex pathologies). Effectiveness at 4 and 12 months was also compared. RESULTS: After 4 months from the first visit, the degree of resolution is lower in the first telemedicine visits than in face-to-face visits for both general pathologies and those of monographic agendas for chronic and complex pathologies. After twelve months, the first general telemedicine visits are less resolute than face-to-face visits, while the resolution rate is the same for chronic and complex pathology visits. Each telemedicine visit generates on average more visits than face-to-face visits. In the short term, 133.4% more in the case of general visits and 51.4% more in the case of chronic and complex visits. In the long term, general telemedicine visits generate 57.31% more visits, while no statistically significant difference is observed between chronic and complex face-to-face and telemedicine visits. CONCLUSION: The results of this study show that the resolution capacity of the non-face-to-face model in pediatric care in the pandemic context is generally lower and generates more successive visits than the face-to-face model. This lower performance of the telemedicine model should be counterbalanced with its advantages.

Introduction to the cognitive hospital.

The third industrial revolution has radically impacted the transformation of hospitals. Through the adoption of key digital technologies, hospitals have become more accessible, flexible, organised, responsive and able to deliver more personalised care. The digitalisation of patient health records, one of the most remarkable achievements to date in healthcare management, has enabled new opportunities, including the idea of hospitals evolving to become artificially intelligent. In parallel, the adoption of electronic and mobile internet technologies in hospitals has introduced new structural concepts, seeing a variety of terms blossom such as 'smart', 'intelligent', 'green' and 'liquid'. Now in the early fourth industrial revolution, driven by AI and internet-of-things technologies, this article unveils a new concept adapted to the upcoming era.

Pediatric Tele-Home Care Compared to Usual Care: Cost-Minimization Analysis.

BACKGROUND: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. OBJECTIVE: The aim of this study is to compare the average cost of a discharge by tele-home care with the usual care and to analyze the main drivers of the differential costs of both care models. METHODS: A cost-minimization analysis is conducted under a hospital's perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. RESULTS: A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. CONCLUSIONS: The cost analysis conducted under a hospital perspective shows that pediatric tele-home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.

[Descriptive analysis of the mobile applications for registering and monitoring the adverse effects of antineoplastic drugs according to the evaluation methodology of iSYSCore and the Tic Salut Social Foundation.] / Análisis descriptivo de las aplicaciones móviles del registro y seguimiento de los efectos adversos de los antineoplásicos según la metodología de evaluación del iSYSCore y de la Fundación Tic Salut Social.

OBJECTIVE: The daily use of mobile healthcare applications is already a reality around the world. Their supply and demand forecasts continue to increase exponentially due to the multiple facilities and improvements that they can offer to health management and patient-centered care, especially for the chronically ill. However, this exponential growth in the offer confuses when choosing the best mobile application to use due to the lack of scientific evidence on whether they meet the safety criteria for patients and professionals. The objective of this work was to analyze mobile applications to record and monitor the adverse effects of Available Oral Antineoplastic Treatments, to have a guide on which of these applications could be recommended with certainty by health professionals to cancer patients. METHODS: A search of mobile applications was carried out on the Android and iOS platforms in Spanish and English. Subsequently, each application is analyzed according to the accreditation criteria of the iSYSCore (Internet Health and Society) and the Tic Salut Social Foundation. RESULTS: Twelve applications were found for monitoring the adverse effects of ANEOs, eight of which could be safely recommended by healthcare professionals where the scores of the Tic Salut Social Foundation range from 31 to 32 points out of 40 and those of iSYSCore from 31 to 36 points out of 47. CONCLUSIONS: The e-Onco Salud® application stands out for its ability to improve health management and empower patients in the management of their disease.

OBJETIVO: El uso cotidiano de las aplicaciones sanitarias móviles es ya una realidad en todo el mundo. Las previsiones de su oferta y demanda siguen aumentando exponencialmente debido a las múltiples facilidades y mejoras que pueden ofrecer en la gestión de la salud y a la atención centrada en el paciente, especialmente para los enfermos crónicos. No obstante, este crecimiento exponencial de la oferta confunde a la hora de elegir la mejor aplicación móvil a utilizar debido a la falta de evidencia científica sobre si cumplen los criterios de seguridad para pacientes y profesionales. El objetivo de este trabajo fue analizar aplicaciones móviles para registrar y monitorizar los efectos adversos de los tratamientos antineoplásicos orales (ANEOs) disponibles, para tener una guía sobre cuáles de estas aplicaciones podrían ser recomendadas con certeza por los profesionales de la salud a los pacientes con cáncer. METODOS: Se realizó una búsqueda de las aplicaciones móviles en las plataformas Android y iOS en lengua castellana y en inglés. Posteriormente, se analizó cada aplicación de acuerdo con los criterios de acreditación del iSYSCore (Internet Salud y Sociedad) y de la Fundación "Tic Salut Social". RESULTADOS: Se encontraron doce aplicaciones para el seguimiento de los efectos adversos de los ANEOs, siendo ocho las que podrían ser recomendadas con seguridad por los profesionales sanitarios donde las puntuaciones de la Fundación "Tic Salut Social" oscilan de 31 a 32 puntos de 40 y las de iSYSCore de 31 a 36 puntos de 47. CONCLUSIONES: Se destaca la aplicación e-Onco Salud® por su capacidad para mejorar la gestión sanitaria y empoderar a los pacientes en el manejo de su enfermedad.

Incidence of Recurrent High-Grade Anal Dysplasia in HIV-1-Infected Men and Women Following Infrared Coagulation Ablation: A Retrospective Cohort Study.

This single-center, retrospective cohort study sought to estimate the cumulative incidence in HIV-1-infected patients of biopsy-proven high-grade anal intraepithelial neoplasia (HGAIN) recurrence after infrared coagulation (IRC) treatment. The study was based on data from a prospectively compiled database of 665 HIV-1-infected outpatients who attended a hospital Clinical Proctology/HIV Unit between January 2012 and December 2015. Patient records were checked to see which ones had received IRC treatment but later experienced a recurrence of HGAIN. Cytology samples were also checked for the presence of human papilloma virus (HPV). A total of 81 of the 665 patients (12%, 95%CI: 10-15%), of whom 65 were men and 16 women, were diagnosed with HGAIN and again treated with IRC. Of these 81, 20 (25%) experienced recurrent HGAIN, this incidence being true of both men (16/65, 95%CI: 19-57%) and women (4/16, 95%CI: 10-50%). The median time to recurrence was 6 (2-19) months overall, 6 (2-19) months in men, and 4 (2-6) months in women. HPV infection was detected in all patients except two, with HPV-16 being the most common genotype. This rate of incidence of recurrent HGAIN following IRC treatment is consistent with other reports and highlights the importance of continued post-treatment surveillance, particularly in the first year.

Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study.

BACKGROUND: Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. OBJECTIVE: The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. METHODS: This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. RESULTS: An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. CONCLUSIONS: The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory-based mHealth strategy.

Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study.

BACKGROUND: Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation service between primary care professionals and citizens in the public health care system, has already reached 1 million cases. Before the COVID-19 pandemic, the use of eConsulta was growing at a monthly rate of 7%, and the growth has been exponential from March 15, 2020 to the present day. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. OBJECTIVE: The aim of this study was to annotate a random sample of teleconsultations from eConsulta, and to evaluate the level of agreement between health care professionals with respect to the annotation. METHODS: Twenty general practitioners retrospectively annotated a random sample of 5382 cases managed by eConsulta according to three aspects: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. A total of 1217 cases were classified three times by three different professionals to assess the degree of consensus among them. RESULTS: The general practitioners considered that 79.60% (4284/5382) of the teleconsultations resulted in avoiding a face-to-face visit, and considered that 64.96% (3496/5382) of the time, the patient would have made a face-to-face visit in the absence of a service like eConsulta. The most frequent uses were for management of test results (26.77%, 1433/5354), management of repeat prescriptions (24.30%, 1301/5354), and medical enquiries (14.23%, 762/5354). The degree of agreement among professionals as to the annotations was mixed, with the highest consensus demonstrated for the question "Has the online consultation avoided a face-to-face visit?" (3/3 professionals agreed 67.95% of the time, 827/1217), and the lowest consensus for the type of use of the teleconsultation (3/3 professionals agreed 57.60% of the time, 701/1217). CONCLUSIONS: This study shows the ability of eConsulta to reduce the number of face-to-face visits for 55% (79% × 65%) to 79% of cases. In comparison to previous research, these results are slightly more pessimistic, although the rates are still high and in line with administrative data proxies, showing that 84% of patients using teleconsultations do not make an in-person appointment in the following 3 months. With respect to the type of consultation performed, our results are similar to the existing literature, thus providing robust support for eConsulta's usage. The mixed degree of consensus among professionals implies that results derived from artificial intelligence tools such as message classification algorithms should be interpreted in light of these shortcomings.

Primary Care Professionals' Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey.

While telemedicine services enjoy a high acceptance among the public, evidence regarding clinician's acceptance, a key factor for sustainable telemedicine services, is mixed. However, telemedicine is generally better accepted by both patients and professionals who live in rural areas, as it can save them significant time. The objective of this study is to assess the acceptance of medical record-based, store and forward provider-to-provider telemedicine among primary care professionals and to describe the factors which may determine their future use. This is an observational cross-sectional study using the Catalan version of the Health Optimum questionnaire; a technology acceptance model-based validated survey comprised of eight short questions. The online, voluntary response poll was sent to all 661 primary care professionals in 17 primary care teams that had potentially used the telemedicine services of the main primary care provider in Catalonia, in the Central Catalan Region. The majority of respondents rated the quality of telemedicine consultations as "Excellent" or "Good" (83%). However, nearly 60% stated that they sometimes had technical, organizational or other difficulties, which might affect the quality of care delivered. These negatively predicted their declared future use (p = 0.001). The quality of telemedicine services is perceived as good overall for all the parameters studied, especially among nurses. It is important that policymakers examine and provide solutions for the technical and organizational difficulties detected (e.g. by providing training), in order to ensure the use of these services in the future.

Monitoring Occupational Sitting, Standing, and Stepping in Office Employees With the W@W-App and the MetaWearC Sensor: Validation Study.

BACKGROUND: Replacing occupational sitting time with active tasks has several proposed health benefits for office employees. Mobile phones and motion sensors can provide objective information in real time on occupational sitting behavior. However, the validity and feasibility of using mobile health (mHealth) devices to quantify and modify occupational sedentary time is unclear. OBJECTIVE: The aim of this study is to validate the new Walk@Work-Application (W@W-App)-including an external motion sensor (MetaWearC) attached to the thigh-for measuring occupational sitting, standing, and stepping in free-living conditions against the activPAL3M, the current gold-standard, device-based measure for postural behaviors. METHODS: In total, 20 office workers (16 [80%] females; mean age 39.5, SD 8.1 years) downloaded the W@W-App to their mobile phones, wore a MetaWearC sensor attached to their thigh using a tailored band, and wore the activPAL3M for 3-8 consecutive working hours. Differences between both measures were examined using paired-samples t tests and Wilcoxon signed-rank tests. Agreement between measures was examined using concordance correlation coefficients (CCCs), 95% CIs, Bland-Altman plots (mean bias, 95% limits of agreement [LoA]), and equivalence testing techniques. RESULTS: The median recording time for the W@W-App+MetaWearC and the activPAL3M was 237.5 (SD 132.8) minutes and 240.0 (SD 127.5) minutes, respectively (P<.001). No significant differences between sitting (P=.53), standing (P=.12), and stepping times (P=.61) were identified. The CCC identified substantial agreement between both measures for sitting (CCC=0.98, 95% CI 0.96-0.99), moderate agreement for standing (CCC=0.93, 95% CI 0.81-0.97), and poor agreement for stepping (CCC=0.74, 95% CI 0.47-0.88). Bland-Altman plots indicated that sitting time (mean bias -1.66 minutes, 95% LoA -30.37 to 20.05) and standing time (mean bias -4.85 minutes, 95% LoA -31.31 to 21.62) were underreported. For stepping time, a positive mean bias of 1.15 minutes (95% LoA -15.11 to 17.41) was identified. Equivalence testing demonstrated that the estimates obtained from the W@W-App+MetaWearC and the activPAL3M were considered equivalent for all variables excluding stepping time. CONCLUSIONS: The W@W-App+MetaWearC is a low-cost tool with acceptable levels of accuracy that can objectively quantify occupational sitting, standing, stationary, and upright times in real time. Due to the availability of real-time feedback for users, this tool can positively influence occupational sitting behaviors in future interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092738; https://clinicaltrials.gov/ct2/show/NCT04092738.

Validation of a Short Questionnaire to Assess Healthcare Professionals' Perceptions of Asynchronous Telemedicine Services: The Catalan Version of the Health Optimum Telemedicine Acceptance Questionnaire.

Telemedicine is both effective and able to provide efficient care at a lower cost. It also enjoys a high degree of acceptance among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and is comprised of three dimensions: the individual context, the technological context and the implementation or organizational context. At present, no short, validated questionnaire exists in Catalonia to evaluate the acceptance of telemedicine services amongst healthcare professionals using a technology acceptance model. This article aims to statistically validate the Catalan version of the EU project Health Optimum telemedicine acceptance questionnaire. The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation with construct (exploratory factor analysis), consistency (Cronbach's alpha) and stability (test-retest) analysis. After deleting incomplete responses, calculations were made using 33 participants. The internal consistency measured with the Cronbach's alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79-0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852-0.964). The Kaiser-Meyer-Olkin test of sampling showed to be adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl = 28; p < 0.001). The questionnaire had two dimensions which accounted for 61.2% of the total variance: quality and technical difficulties relating to telemedicine. The findings of this study suggest that the validated questionnaire has robust statistical features that make it a good predictive model of healthcare professional's satisfaction with telemedicine programs.

Families' Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia.

BACKGROUND: Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children's care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. OBJECTIVE: This study aimed to assess families' degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. METHODS: A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children's characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. RESULTS: A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. CONCLUSIONS: Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents.

General Practitioners' Perceptions of Whether Teleconsultations Reduce the Number of Face-to-face Visits in the Catalan Public Primary Care System: Retrospective Cross-Sectional Study.

BACKGROUND: eConsulta is a teleconsultation service involving general practitioners (GPs) and patients. It is part of the information system belonging to Catalonia's primary care service. It has been in operation since the end of 2015 in conjunction with face-to-face consultations with Primary Care Teams as one of the services offered in the patient's Personal Health Folder. OBJECTIVE: This study aimed to assess the ability of using eConsulta to reduce the number of face-to-face visits to Primary Care Teams. METHODS: Using 13 categories proposed by the researchers, 18 GPs from the Central Catalonia Health Region retrospectively classified 2268 cases managed with eConsulta and indicated whether, in their opinion, the teleconsultations reduced the number of face-to-face visits. RESULTS: There was broad consensus among the GPs that eConsulta has the potential to resolve patient queries for every type of consultation. eConsulta avoided the need for a face-to-face visit in 87.9% of cases. In addition, the GPs reported that the ease of access increased the demand for health care support in 27.7% of cases; otherwise, the patient would not have initiated the queries. Therefore, based on the equation (88% x [1-28%]), eConsulta could replace 63%-88% of conventional appointments. The most frequent uses of the teleconsultation service were for management of test results (35.2%), medical enquiries (16.0%), and the management of repeat prescriptions (12.2%). On average, the teleconsultations consisted of a mean 1.57 messages (SD 0.54 messages); 45.9% (1040/2268) of the teleconsultations consisted of 1 message, and the majority of the remaining teleconsultations consisted of 2-5 interactions. The patient initiated 60.0% (1361/2268) of the teleconsultations. CONCLUSIONS: Based on the GPs' perceptions, eConsulta could replace 63%-88% of conventional appointments. Therefore, asynchronous teleconsultations between practitioners and patients in primary care could avoid interactions that have limited added clinical value.

A Cost-Minimization Analysis of a Medical Record-based, Store and Forward and Provider-to-provider Telemedicine Compared to Usual Care in Catalonia: More Agile and Efficient, Especially for Users.

BACKGROUND: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011, specializing in teledermatology, teleulcers, teleophthalmology and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits were recorded. OBJECTIVE: To analyze the differential costs between telemedicine and usual care in a semi-urban environment. METHODOLOGY: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user's costs, was carried out over a three-month period. RESULTS: Telemedicine saved € 780,397 over the period analyzed. A differential cost favorable to telemedicine of about € 15 per visit was observed, with the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. CONCLUSION: Allowing users to save time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favorable for the healthcare system, enabling it to provide a more agile service, which also benefits healthcare professionals.

Teleconsultations between Patients and Healthcare Professionals in Primary Care in Catalonia: The Evaluation of Text Classification Algorithms Using Supervised Machine Learning.

Background: The primary care service in Catalonia has operated an asynchronous teleconsulting service between GPs and patients since 2015 (eConsulta), which has generated some 500,000 messages. New developments in big data analysis tools, particularly those involving natural language, can be used to accurately and systematically evaluate the impact of the service. Objective: The study was intended to assess the predictive potential of eConsulta messages through different combinations of vector representation of text and machine learning algorithms and to evaluate their performance. Methodology: Twenty machine learning algorithms (based on five types of algorithms and four text representation techniques) were trained using a sample of 3559 messages (169,102 words) corresponding to 2268 teleconsultations (1.57 messages per teleconsultation) in order to predict the three variables of interest (avoiding the need for a face-to-face visit, increased demand and type of use of the teleconsultation). The performance of the various combinations was measured in terms of precision, sensitivity, F-value and the ROC curve. Results: The best-trained algorithms are generally effective, proving themselves to be more robust when approximating the two binary variables "avoiding the need of a face-to-face visit" and "increased demand" (precision = 0.98 and 0.97, respectively) rather than the variable "type of query" (precision = 0.48). Conclusion: To the best of our knowledge, this study is the first to investigate a machine learning strategy for text classification using primary care teleconsultation datasets. The study illustrates the possible capacities of text analysis using artificial intelligence. The development of a robust text classification tool could be feasible by validating it with more data, making it potentially more useful for decision support for health professionals.

Routine Screening of Anal Cytology in Persons With Human Immunodeficiency Virus and the Impact on Invasive Anal Cancer: A Prospective Cohort Study.

BACKGROUND: The efficacy of screening programs to prevent anal cancer in persons with human immunodeficiency virus 1 (HIV-1) is unclear. METHODS: To examine the impact of a screening program to detect anal cancer precursors on the incidence of cases of invasive anal squamous-cell carcinoma (IASCC) in persons with HIV-1, we performed a single-center, retrospective analysis of a prospective cohort of outpatients with HIV-1 attending a reference HIV unit from January 2005 onward. All participants were invited to participate in a continued structured screening program for anal cancer prevention. We estimated the incidence of IASCC and performed a comparative analysis between subjects enrolled in the screening program (screening group) and those who declined to participate (nonscreening group). To reduce any selection bias, a propensity score analysis was applied. RESULTS: We included 3111 persons with HIV-1 (1596 men-who-have-sex-with-men [MSM], 888 men-who-have-sex-with-women [MSW], 627 women; mean age, 41 years), with a median follow-up of 4.7 years (14 595 patient-years of follow-up); 1691 (54%) participated in the screening program. Ten patients were diagnosed with IASCC: 2 (MSM) in the screening group and 8 (4 MSM, 2 MSW, and 2 women) in the nonscreening group. The incidence rates of IASCC were 21.9 (95% confidence interval [CI], 2.7-70.3) and 107.0 (95% CI, 46.2-202.0) per 100 000 person-years, respectively. After a propensity score adjustment, the difference was significant in favor of the screening group (hazard ratio, 0.17; 95% CI, .03-.86). CONCLUSIONS: The number of cases of IASCC was significantly lower in persons with HIV engaged in an anal cytology screening program. These results should be validated in a randomized clinical trial.

Impact of a Telemedicine Program on the Reduction in the Emission of Atmospheric Pollutants and Journeys by Road.

This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants, thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019, a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time saving of 3779 h and a total fuel reduction of 11,754 L with an associated cost of €15,664. This represents an average reduction of 3248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles by reducing the number of journeys made for face-to-face visits, and thus contributing to environmental sustainability.

Natural History of Anal Squamous Intraepithelial Lesions in HIV-Positive Men with Normal Baseline Cytology.

The natural history of squamous intraepithelial lesions (SILs) in the anal canal of HIV-infected men is incompletely understood. We assessed the incidence and factors associated with SIL and invasive anal squamous cell carcinoma (IASCC) among HIV-infected men with normal cytology at baseline. We performed a single-center prospective cohort study [men who have sex with men (MSM) and men who have sex with women (MSW)]. The incidence of anal canal SIL (low grade and high grade) and IASCC were estimated and predictive factors analyzed. The study population comprised 297 HIV-infected men with a normal cytology result and no anal human papillomavirus (HPV)-related diseases. Of these, 251 (85%) had at least one evaluable set of cytology data during follow-up (172 MSM, 79 MSW). The median follow-up time was 4 years. The cumulative incidence of SIL was 43% (107/251): 52% in MSM (90/172) and 22% in MSW (17/79), p < 0.0001. The incidence rate of SILs was 109 (95% confidence interval = 90-132) per 1000 person-years: 142 in MSM and 49 in MSW, p < 0.0001. HPV infection, receiving antiretroviral treatment (ART), and being MSM were independently associated risk factors. The incidence of IASCC was 0.15 per 1000 person-years among MSM and 0 in MSW. HIV-infected men, both MSM and MSW, are at high risk of developing SIL despite having a normal anal cytology at baseline. The incidence of anal canal SIL was higher among MSM, but was also remarkable among MSW. Independent risk factors associated with SIL were being HIV-infected MSM at high risk for acquisition of STIs, time on ART, and HPV infection.

An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation.

BACKGROUND: "Digital Partners" is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users' digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. OBJECTIVE: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. METHODS: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants' satisfaction. RESULTS: The experience shows a broad satisfaction of both junior and senior users. The project's strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals' free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project's duration, if necessary. CONCLUSIONS: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion.

Trends in Scientific Reports on Cartilage Bioprinting: Scoping Review.

BACKGROUND: Satisfactory therapeutic strategies for cartilaginous lesion repair do not yet exist. This creates a challenge for surgeons and biomedical engineers and leads them to investigate the role of bioprinting and tissue engineering as viable treatments through orthopedic surgery, plastic surgery, and otorhinolaryngology. Recent increases in related scientific literature suggest that bioprinted cartilage may develop into a viable solution. OBJECTIVE: The objectives of this review were to (1) synthesize the scientific advances published to date, (2) identify unresolved technical problems regarding human application, and (3) identify more effective ways for the scientific community to transfer their findings to clinicians. METHODS: This scoping review considered articles published between 2009 and 2019 that were identified through searching PubMed, Scopus, Web of Science, and Google Scholar. Arksey and O'Malley's five-step framework was used to delimit and direct the initial search results, from which we established the following research questions: (1) What do authors of current research say about human application? (2) What necessary technical improvements are identified in the research? (3) On which issues do the authors agree? and (4) What future research priorities emerge in the studies? We used the Cohen kappa statistic to validate the interrater reliability. RESULTS: The 13 articles included in the review demonstrated the feasibility of cartilage bioprinting in live animal studies. Some investigators are already considering short-term human experimentation, although technical limitations still need to be resolved. Both the use and manufacturing process of stem cells need to be standardized, and a consensus is needed regarding the composition of hydrogels. Using on-site printing strategies and predesigned implants may allow techniques to adapt to multiple situations. In addition, the predictive capacity of implant behavior may lead to optimal results. CONCLUSIONS: Cartilage bioprinting for surgical applications is nearing its initial use in humans. Current research suggests that surgeons will soon be able to replace damaged tissue with bioprinted material.