Implementation of a Web-Based Communication System for Primary Care Providers and Cancer Specialists.

Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to examine PCPs' experiences of implementing eOncoNote and how access to the system influenced communication between PCPs and cancer specialists. As part of a larger study, we collected and analyzed system usage data and administered an end-of-discussion survey to understand the perceived value of using eOncoNote. eOncoNote data were analyzed for 76 shared patients (33 patients receiving treatment and 43 patients in the survivorship phase). Thirty-nine percent of the PCPs responded to the cancer specialist's initial eOncoNote message and nearly all of those sent only one message. Forty-five percent of the PCPs completed the survey. Most PCPs reported no additional benefits of using eOncoNote and emphasized the need for electronic medical record (EMR) integration. Over half of the PCPs indicated that eOncoNote could be a helpful service if they had questions about a patient. Future research should examine opportunities for EMR integration and whether additional interventions could support communication between PCPs and cancer specialists.

"Finding a General Surgeon: Self-Referral in the Digital Era".

BACKGROUND: As technology becomes more prominent in today's society, more patients turn to the Internet to self-refer for a range of surgical problems. Frequently, patients search a nearby hospital's website in order to find a physician. We hypothesized that the variability in hospital websites would make it difficult for patients to find a general surgeon for their care. METHODS: We used the US News and World Report's Hospital Rankings 2018-2019 for this study. The "Find A Doctor" page within each hospital's website was searched for the following conditions: "hernia" and "gallbladder." Information on all suggested providers was collected, including medical specialty and gender. Descriptive statistics were used to analyze the data. RESULTS: The median number of providers listed in each search was 18 (range: 1-204). For "hernia," general surgeons were not the majority of providers suggested at 12/16 institutions. For "gallbladder," general surgeons were not the majority of providers suggested at 14/16 institutions, and 3/16 institutions did not suggest any. All 16 institutions suggested a strong majority of male providers (range: 62-100% male; median: 83% male). DISCUSSION: Considerable variation exists in the suggestion of medical providers for common general surgical problems among the top academic hospitals. Most notably, general surgeons are not listed as the primary providers for these conditions which they commonly manage. Health systems need to examine how their website suggest providers and ensure that patients can easily find the physician most suitable for their care.

Google Trends en Gastroenterología / Google Trends in Gastroenterology

Google Trends (GT) is an online portal that provides data on user search patterns. It is currently widely used in the vast majority of medical specialties. Objective: to analyze publications in gastroenterology that have used GT as an epidemiological tool. Methods: Using PubMed, Lilacs, Google Schoolar Academic and Scopus, we searched for gastroenterology articles that contained GT in their title or abstract between the years 2011 to 2021. Titles/abstracts had to also include at least one out of 49 terms related to digestive diseases from symptoms to treatments. Results: The 30 articles selected addressed topics such as symptoms, different pathologies including infectious, diagnostic methods and diets, among others. Conclusions: GT is a very useful tool to measure what people search for on the Internet and allows us to detect epidemic outbreaks, evaluate the impact of the days dedicated to some pathology as well as the impact of publications on the network of the public and doctors.

Google Trends (GT) es un portal en línea que proporciona datos sobre patrones de búsqueda de los usuarios. Actualmente muy utilizado en la gran mayoría de las especialidades médicas. Objetivo: analizar las publicaciones en gastroenterología que han usado a GT como herramienta epidemiológica. Material y Método: Mediante PubMed, Lilacs, Google Schoolar Academic y Scopus buscamos los artículos de gastroenterología que contenían a GT en su título o en el resumen entre los años 2011 a 2021. Los títulos/resúmenes debían incluir además, al menos uno de 49 términos relacionados a enfermedades digestivas desde síntomas hasta tratamientos. Resultados: Los 30 artículos seleccionados abordan temas como síntomas, distintas patologías incluyendo infecciosas, métodos diagnósticos y dietas, entre otras. Conclusiones: GT es una herramienta de gran utilidad para medir lo que las personas buscan en internet y permite detectar brotes epidémicos, evaluar el impacto de los días dedicados a de alguna patología así como el impacto de publicaciones en la red del público y médicos.

Digital media use among older adults during the COVID-19 pandemic: a scoping review / O uso das mídias digitais entre idosos durante a pandemia de COVID-19: revisão de escopo

To identify and map the purpose of digital media use among older adults during the coronavirus disease (COVID-19) pandemic. Methods: A scoping review was conducted using the Joanna Briggs Institute methodology involving a search of 7 databases for relevant articles in English, Spanish, and Portuguese published between 2020 and 2021. Most studies were retrieved from the SCOPUS and Web of Science databases. The inclusion criteria for this review were: participants ­ individuals aged ≥ 60 years; concept ­ digital media use during the pandemic; context ­ community-dwelling older adults. Results: The search led to the retrieval of 1992 studies. The titles and abstracts were screened by 2 independent reviewers. Full texts were then extracted according to the inclusion criteria, reaching a total of 12 articles for the review. The results showed that the main purposes of digital media use by older adults were to access and answer surveys sent by e-mail or posted on social media and virtual social networks (eg, Facebook, Instagram, and/or Twitter) and also for telemedicine consultations.

Identificar e mapear a finalidade do uso das mídias digitais entre idosos durante a pandemia. Metodologia: Realizou-se uma scoping review com a utilização da metodologia do Joanna Bringgs Institute, que envolveu uma busca em sete bases de dados de artigos relevantes em inglês, espanhol e português publicados entre 2020 e 2021. A maioria dos artigos recuperados foi: participantes ­ indivíduos com idade ≥ 60 anos; conceito ­ uso de mídia digital durante pandemia; contexto ­ idosos residentes na comunidade.

[Social media for continuing education in nephrology. Myth or reality?]

About 60% of the world population has access to the Internet in 2021, making it the main tool in fostering communication between people. Lately, digital information and communication have especially taken place on platforms known as Social Media (SoMe) or Social Networks. In the last decade the usefulness of these tools in carrying information aimed at updating professionals in Medicine and Nephrology has become evident. There are several examples of SoMe utilization in Nephrology, as demonstrated by the existing accounts or Pages operated by the main international nephrological Scientific Societies, or the most renowned specialized medical journals. Twitter, Facebook and YouTube are the most versatile SoMe for these objectives; however, other platforms such as Tik Tok, Linkedin, Instagram, and WhatsApp may serve the same purpose. This digital revolution in disseminating information has proved very useful during the recent COVID-19 pandemic, even though some inappropriate uses have emerged, such as the diffusion of fake news, which has favored the emergence of "adverse effects" or a surge of antiscientific positions. In this review, we examine how physicians and nephrologists can take advantage of digital information for their continuing education. We quote the main resources in the international scenario and illustrate some specific national examples, such as the Journal Club of the Nephrology post-graduate program of the University of Milan and the Facebook group "Medical and Nephrology Community".

Accessibility of Telehealth Services During the COVID-19 Pandemic: A Cross-Sectional Survey of Medicare Beneficiaries.

INTRODUCTION: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults. METHODS: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy. RESULTS: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment. CONCLUSION: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.

Limited Technology Access Among Residents of Affordable Senior Housing During the COVID-19 Pandemic.

While U.S. adults living in affordable senior housing represent a vulnerable population during the COVID-19 pandemic, affordable housing may provide a foundation for interventions designed to improve technology access to support health. To better understand technology access among residents of affordable senior housing, we surveyed members of a national association of resident service coordinators to assess their experiences working with residents during the pandemic (n = 1,440). While nearly all service coordinators report that most or all residents have reliable phone access, under a quarter report that most or all have reliable internet access; they also report limited access to technology for video calls. Lack of internet access and technology literacy are perceived as barriers to medical visits and food procurement for low-income older adult residents of affordable housing. Policies to expand internet access as well as training and support to enable use of online services are required to overcome these barriers.

Connection to... Addressing Digital Inequities in Supporting the Well-Being of Young Indigenous Australians in the Wake of COVID-19.

(1) Background: This article examines whether connection to digital technologies helps connect young Indigenous people in Australia to culture, community and country to support good mental health and well-being and protect against indirect and potentially long-term effects of COVID-19. (2) Method: We reviewed literature published between February and November 2020 and policy responses related to digital strategies. We searched PubMed, Google Scholar, government policy websites and key Indigenous literature sources, identifying 3460 articles. Of these, 30 articles and 26 policy documents were included and analysed to identify existing and expected mental health outcomes among Indigenous young people associated with COVID-19 and more broadly. (3) Results: There are inequities in affordable access to digital technologies. Only 63% of Indigenous people have access to internet at home. Digital technologies and social media contribute to strong cultural identity, enhance connections to community and country and improve mental health and social and emotional well-being outcomes. (4) Discussion: Access to digital technologies can facilitate healing and cultural continuity, self-determination and empowerment for young people to thrive, not just survive, in the future. (5) Conclusion: More targeted policies and funding is urgently needed to promote digital technologies to enhance Indigenous young people's access to mental health and well-being services, maintain cultural connections and evaluate the effectiveness of these initiatives using Indigenous well-being indicators.

Demographic analysis of difficulties related to remote education in Poland from the perspective of adolescents during the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVE: Due to the COVID-19 pandemic all schools in Poland were closed and obliged to conduct lessons remotely. The aim of the study is to present the demographic analysis of difficulties with remote learning, as perceived by students during coronavirus pandemic in Poland. MATERIAL AND METHODS: In April 2020, a nationwide online survey was conducted among adolescents aged 11-18 (N=2408). Quantitative and qualitative data were used. Teenagers were asked about the problems connected with remote learning. In order to examine the overall level of remote learning difficulties, a scale of remote learning difficulties (RLD) was devised (range 0-23 points). Differences connected with gender, age and place of residence were analysed. RESULTS: More than a half of the teenagers surveyed rated the increased demands from teachers as a major problem. This answer appeared statistically more often among girls than boys (59.6% v. 53.2%). Almost every third adolescent saw the lack of consultation (31.6%) as a significant problem. Difficulties related to learning in the remote system were most often described as considerable by the oldest students (17-18-years-old) and those living in rural areas. The big problem for them was usually much higher requirements of teachers and poor organization of distance learning. The mean level on the scale of remote learning burden was M=11.9 (SD=7.1). Technical difficulties and insufficient skills in using software constituted additional problems most frequently mentioned by students. CONCLUSIONS: There is a need to pay particular attention to organizing appropriate technical conditions for remote learning, especially in rural areas, where students have complained more often than in cities about equipment and problems with access to the Internet during the pandemic.

Digital inequality, faculty communication, and remote learning experiences during the COVID-19 pandemic: A survey of U.S. undergraduates.

AIMS: The COVID-19 pandemic forced closure of most U.S. university campuses in March 2020, obliging millions of students to finish their semesters via remote learning. This study examines whether and how students' prior and current experiences of digital inequality-defined as constrained access to the internet and internet-connecting devices-were associated with their remote learning experiences. METHOD: An anonymous, online survey of 2,913 undergraduate college students from 30 U.S. universities completing their spring term remotely was conducted between April and May 2020. Hypothesis testing utilized a structural equation model with cluster-bootstrapped standard errors and p-values, to account for students being clustered by university. RESULTS: Findings revealed that students' challenges with internet connectivity and digital devices during remote learning were associated with lower remote learning proficiency (RLP). Difficulty communicating with professors and teaching assistants was also associated with lower RLP. Prior experience with online coursework was associated with higher RLP, and digital inequality challenges during the year prior to the pandemic with lower RLP. Moreover, students who reported greater financial hardship since the start of the pandemic experienced significantly more connectivity, device, and faculty communication challenges during remote learning, and had significantly lower RLP. CONCLUSIONS: Many students will continue to learn remotely in some form until the pandemic recedes. We identify key factors associated with students' remote learning proficiency: (1) consistent, high-speed internet connectivity and functioning devices to connect to it, and (2) the ability to relate to and communicate easily with professors and teaching assistants. This study identifies potential barriers to effective remote learning, as well as possible opportunities to improve students' experiences.

Casting a Health Equity Lens on Endocrinology and Diabetes.

As endocrinologists we have focused on biological contributors to disparities in diabetes, obesity and other endocrine disorders. Given that diabetes is an exemplar health disparity condition, we, as a specialty, are also positioned to view the contributing factors and solutions more broadly. This will give us agency in contributing to health system, public health, and policy-level interventions to address the structural and institutional racism embedded in our medical and social systems. A history of unconsented medical and research experimentation on vulnerable groups and perpetuation of eugenics theory in the early 20th century have resulted in residual health care provider biases toward minority patients and patient distrust of medical systems, leading to poor quality of care. Historical discriminatory housing and lending policies resulted in racial residential segregation and neighborhoods with inadequate housing, healthy food access, and educational resources, setting the foundation for the social determinants of health (SDOH) contributing to present-day disparities. To reduce these disparities we need to ensure our health systems are implementing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care to promote health equity. Because of racial biases inherent in our medical systems due to historical unethical practices in minority communities, health care provider training should incorporate awareness of unconscious bias, antiracism, and the value of diversity. Finally, we must also address poverty-related SDOH (eg, food and housing insecurity) by integrating social needs into medical care and using our voices to advocate for social policies that redress SDOH and restore environmental justice.

A Double Burden of Exclusion? Digital and Social Exclusion of Older Adults in Times of COVID-19.

The COVID-19 pandemic has excluded older adults from a society based on physical social contact. Vulnerable populations like older adults also tend to be excluded from digital services because they opt not to use the internet, lack necessary devices and network connectivity, or inexperience using the technology. Older adults who are frail and are not online, many of whom are in long-term care facilities, struggle with the double burden of social and digital exclusion. This paper discusses the potential outcomes of this exclusion and provides recommendations for rectifying the situation, with a particular focus on older adults in long-term care facilities.

Teledermatology: Improving Access or Widening Healthcare Disparities?

Teledermatology, the form of telemedicine directed toward dermatology patients, is one of the earliest technological innovations that advanced remote medical care. Developed in 1995, teledermatology was established with the mission of increasing healthcare access among patients in rural geographic locations who had limited access to specialist care.1.

The Relationship between Online Sexual Solicitation and Internet Addiction in Adolescents.

The purpose of this study is to investigate the association between online sexual solicitation (OSS) and internet accessibility, usage, and addiction in adolescents. The study was conducted with 48 adolescents who had been exposed to OSS and 48 age- and sex-matched adolescents who had not been exposed to OSS. Internet addiction (IA) was determined by the Young Internet Addiction Scale. The groups were compared in terms of socio-demographic characteristics, internet access facilities, internet use characteristics, psychiatric disorders, and IA. The results showed that the duration of daily internet use, the purpose of internet use, and the rate of IA were significantly higher in the OSS-exposed group than in the control group. Depressive disorder and post-traumatic stress disorder were more common in the OSS group than in the control group. Results revealed that the association between OSS and IA is independent of psychiatric disorders. In conclusion, the evaluation of adolescents exposed to OSS, in terms of IA and the measures and interventions to be taken in this regard, will contribute to the prevention of new exposures. Additionally, considering that OSS may be among the possible negative consequences of IA, evaluating adolescents with IA in terms of OSS will provide significant benefits.

Digital habits of PR service-users: Implications for home-based interventions during the COVID-19 pandemic.

Remote models of pulmonary rehabilitation (PR) are vital with suspension of face-to-face activity during the COVID-19 pandemic. We surveyed digital access and behaviours and PR delivery preferences of current PR service users. There was significant heterogeneity in access to and confidence in using the Internet with 31% having never previously accessed the Internet, 48% confident using the Internet and 29% reporting no interest in accessing any component of PR through a Web-based app. These data have implications for the remote delivery of PR during the COVID-19 pandemic and raise questions about the current readiness of service users to adopt Web-based delivered models of PR.

Nurse Educators as Agents of Change in the SARS-CoV-2 Pandemic.

The coronavirus pandemic caused a rapid and seismic shift in the provision of nursing education. In this commentary, I provide examples of how faculty and students at my university made the shift and what we have learned from the experience thus far.

Del acceso a la Internet a las competencias infocomunicacionales, un comparativo de resultados estadísticos para el periodo 2015 a 2017 entre Brasil, Colombia y España / From access to the Internet to the info-communication literacies, a comparison of statistical results for the period 2015 to 2017 between Brazil, Colombia and Spain

Resumen Este trabajo es el resultado de la comparación de indicadores asociados a la Internet entre Brasil, Colombia y España, con el objeto de realizar una discusión analítica, en lo concerniente al acceso, los usos o aplicaciones, y las razones de no acceso. Así se profundiza la discusión en las barreras que tienen las personas en Internet como herramienta de acceso a la información y la comunicación, llevando la discusión hacia las competencias infocomunicacionales, factor base para la inclusión y participación social hoy en día. Para esto se tomaron datos de fuentes nacionales e internacionales, como DANE, CETIC, INE, ITU y, EUROSTAT, usando informes entre 2015 y 2017 que registran o estudian el comportamiento de las personas en Internet, identificando variables comunes en el tiempo para los procesos comparativos realizados. Los datos muestran que el acceso mejora en cada país, con diferencias en la calidad del tipo de servicio recibido en la conexión de Internet. Sin embargo, el aprovechamiento está más orientado a la generación de mensajes dentro de contextos sociales, sin pasar al siguiente nivel que implica utilizar las potencialidades de Internet en la generación de bienestar económico o social. Se puede concluir que no todos los usuarios logran transformar la información y usar los medios de comunicación en beneficio grupal o individual, es decir, el desarrollo de la competencia infocomunicacional no es del todo evidente plenamente. Además, falta información que permita demostrar de forma concreta estos avances en las competencias a nivel país. Los usos y motivos varían, así como las formas de acceso en cada país, junto al seguimiento que hace cada Gobierno, todo influenciado por las políticas públicas nacionales que allí se desarrollan y los factores económicos que afectan un Estado.

Abstract. This work is the result of the comparison of indicators associated with the Internet between Brazil, Colombia and Spain, in order to carry out an analytical discussion regarding access, uses or applications and the reasons for non-access. In this way, the discussion deepens in the barriers that people have in the use of the Internet as a tool for access to information and communication, leading to discussion for the infocommunication competitions, a basic factor for inclusion and social participation today. For this, data from national and international sources, such as DANE, CETIC, INE, ITU and EUROSTAT, were taken between 2015 and 2017 that record or study the behavior of people on the Internet, identifying common variables over time for the comparative processes carried out. The data shows that access improves in each country with differences in the quality of the type of service received in the Internet connection. However, the use is more oriented in the generation of messages within social contexts, without going to the next level that involves using the potential of the Internet in the generation of economic or social welfare. It can be concluded that not all users manage to transform the information into a group or individual benefit, so the development of infocomunicational competences is not fully evident. In addition, there is a lack of information to demonstrate in a concrete way these advances in the competences at the country level. The uses and motives vary, as well as the forms of access in each country, together with the monitoring carried out by each Government, all influenced by the national public policies developed there and the economic factors that affect a State.