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BACKGROUND: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. OBJECTIVE: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. METHODS: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. RESULTS: Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. CONCLUSIONS: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation.
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Inteligência Artificial , Saúde Digital , Humanos , Alemanha , Tanzânia , Organização Mundial da SaúdeRESUMO
BACKGROUND: Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65. METHODS: A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling. RESULTS: The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use. CONCLUSIONS: Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).
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Vida Independente , Tecnologia Assistiva , Humanos , Idoso , Estudos Transversais , Atividades Cotidianas , Teorema de Bayes , ComunicaçãoRESUMO
BACKGROUND: Disease prevention and health promotion in and for old age have become increasingly more important. Nevertheless, more (national) research and implementation in practice is needed, as the international comparison shows. OBJECTIVE: To develop guiding principles for research and practice on prevention and health promotion in and for old age. MATERIAL AND METHODS: As part of an iterative process, members of the German Society of Gerontology and Geriatrics came together in workshops and symposia to formulate key guiding principles and fields of action for prevention and health promotion. RESULTS: The following were worked out: 1) prevention and health promotion are useful and possible up to oldest age, 2) prevention and health promotion for advanced age should start early, 3) prevention and health promotion must take into account the diversity and heterogeneity of the life situations of old people, 4) prevention and health promotion promote and demand self-determination and participation, 5) prevention of multiple illnesses must be given greater attention, 6) prevention of the need for long-term care and prevention in long-term care must be treated equally, 7) prevention and health promotion must be thought of in terms of life worlds and across sectors, paying particular attention to aspects of social inequality and a focus on resources, 8) prevention and health promotion and the related research must be interdisciplinary and transdisciplinary and be applied at different levels, from molecular to societal. DISCUSSION: The guiding principles outline the focal points of future-oriented ageing, health and healthcare research and open up fields of action but also show the limits of this approach for political decision-makers, researchers and practitioners.
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BACKGROUND: One measure national governments took to react to the acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic was mobile applications (apps). This study aims to provide a high-level overview of published reviews of mobile apps used in association with coronavirus disease 19 (COVID-19), examine factors that contributed to the success of these apps, and provide data for further research into this topic. METHODS: We conducted a systematic review of reviews (also referred to as an umbrella review) and searched two databases, Medline and Embase, for peer-reviewed reviews of COVID-19 mobile apps that were written in English and published between January 1st 2020 and April 25th 2022. RESULTS: Out of the initial 17,611 studies, 24 studies were eligible for the analysis. Publication dates ranged from May 2020 to January 2022. In total, 54% (n = 13) of the studies were published in 2021, and 33% (n = 8) were published in 2020. Most reviews included in our review of reviews analyzed apps from the USA, the UK, and India. Apps from most of the African and Middle and South American countries were not analyzed in the reviews included in our study. Categorization resulted in four clusters (app overview, privacy and security, MARS rating, and miscellaneous). CONCLUSIONS: Our study provides a high-level overview of 24 reviews of apps for COVID-19, identifies factors that contributed to the success of these apps, and identifies a gap in the current literature. The study provides data for further analyses and further research.
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A comprehensive geriatric assessment (CGA) encompasses medical, psychosocial, and functional aspects that facilitate comprehensive treatment planning and therapy for older adults. It goes beyond a simple screening and typically includes evaluating functionality, mobility, cognition, and emotions, with additional dimensions being relevant based on specific goals. In essence, CGA is suitable for recognizing and evaluating the complexity of frailty and devising suitable interventions.CGA represents a structured way to map the complexity of frail older adults. Employing a multidimensional strategy, it enables the early identification of frailty, facilitating tailored treatment plans, risk assessment and the monitoring of changes over time. A CGA can be conducted in different settings, including acute geriatric wards, in form of a consultation in non-geriatric wards, or directly in outpatient settings and has proven effective in improving care among frail patients.A recent trend in CGA programs involves the use of virtual assessments through telemedicine. Communication occurs via telephone or electronic health records, with each evaluation being checked by a physician. The latest evidence indicates substantial research potential in automated data collection and AI-driven analysis.
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Idoso Fragilizado , Fragilidade , Humanos , Idoso , Fragilidade/diagnóstico , Cognição , Medição de Risco , Avaliação Geriátrica/métodosRESUMO
Many mHelath applications have been developed, and the Mobile App Rating Scale (MARS) is a common tool for assessing them. This study aims to provide mean values for MARS scores found in recent literature. We systematically searched for literature in which MARS was used and analyzed them. MARS values for 5,920 applications from 215 studies were compiled. The mean MARS Quality Score is 3.51. The highest average score was achieved in the Functionality category (3.98), followed by Aesthetics (3.52), Information (3.33), Engagement (3.18) and Subjective (2.72). To the best of our knowledge, this is the first study to calculate average values for the five categories of the MARS and the MARS score based on such an extensive collection of data. The study shows that the overall quality of the applications is above the average value of 2.5.
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Aplicativos Móveis , Humanos , TelemedicinaRESUMO
INTRODUCTION: The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term. METHODS: A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal-Wallis test adjusted for multiple testing, and the significance level was set at p < 0.01. RESULTS: The results revealed not only a significant decrease in the case volume by 31% (2020) and 23% (2021) during the COVID-19 crisis years, but also significant time delays in various process steps; e.g. the median patient's OR occupancy time (column time) rose from 65 min (2019) to 87 min (2020) and remained elevated (72 min in 2021 and 74 min in 2022, respectively). Even in 2022, beyond the pandemic, the net anaesthesia time was permanently enhanced by 9 min per case. Furthermore, both, the incision-to-closure time and surgeon attachment time were each significantly prolonged by 7 additional minutes, and the time from the end of anaesthesia to the release of the next patient was extended by 4 min. Selected standardized index operations showed only a trend towards these changes, even with a decrease in the incision-to-closure time over time. CONCLUSION: Overall, long-term changes were found in essential perioperative process times even after retraction of the COVID-19 restrictions, indicating some processual "slow down" after the Covid-19-induced "shut down". Further analyses are needed to determine the appropriate targeted control measures to improve processing times and increase the process quality.
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Given the conference's focus on innovative healthcare solutions, our investigation into robotic assistance systems highlights crucial advancements in early motor rehabilitation, aligning closely with emerging healthcare priorities. In combination with conventional therapy, the assistance systems offer new possible therapy programs. They can be used to mobilize and move patients as early as possible. The paper discusses the possibilities that arise from their use and considers the obstacles that arise. As part of a qualitative survey, nine expert interviews from different fields were conducted to guide them on robotic assisted living systems. The results obtained were summarized by coding into categories and evaluated. Our analysis of 148 coding points from nine expert interviews reveals significant insights into the strengths and weaknesses of robotic systems in neurorehabilitation. Each point was meticulously categorized to reflect its impact on both practice and patient outcomes, highlighting the practical implications of our findings. The results of the survey and the literature indicate a positive effect of robotic assistance systems in early rehabilitation. Their use requires intensive monitoring and studies on the long-term application of the systems.
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Reabilitação Neurológica , Robótica , Humanos , Reabilitação Neurológica/instrumentaçãoRESUMO
STUDY OBJECTIVE: We examine functional profiles and presence of geriatric syndromes among older patients attending 13 emergency departments (EDs) in 7 nations. METHODS: This was a prospective observational study of a convenience sample of patients, aged 75 years and older, recruited sequentially and mainly during normal working hours. Clinical observations were drawn from the interRAI Emergency Department Screener, with assessments performed by trained nurses. RESULTS: A sample of 2,282 patients (range 98 to 549 patients across nations) was recruited. Before becoming unwell, 46% were dependent on others in one or more aspects of personal activities of daily living. This proportion increased to 67% at presentation to the ED. In the ED, 26% exhibited evidence of cognitive impairment, and 49% could not walk without supervision. Recent falls were common (37%). Overall, at least 48% had a geriatric syndrome before becoming unwell, increasing to 78% at presentation to the ED. This pattern was consistent across nations. CONCLUSION: Functional problems and geriatric syndromes affect the majority of older patients attending the ED, which may have important implications for clinical protocols and design of EDs.
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Atividades Cotidianas , Serviço Hospitalar de Emergência , Avaliação Geriátrica , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Feminino , Humanos , Masculino , Sumários de Alta do Paciente Hospitalar , Estudos Prospectivos , Resultado do TratamentoRESUMO
Cardiovascular disease is one of the leading causes of death worldwide. Scarce resources and rising costs are pushing healthcare systems to their limits. There is an urgency to develop, optimize and evaluate technologies that provide more effective care for patients. Modern technologies, such as mobile health (mHealth) applications, can provide relief as a key strategy. To integrate digital interventions into care structures, a detailed impact assessment of all professional mHealth applications is needed. The aim of this study is to analyze the standardized tools used in the field of cardiovascular disease. The results show that questionnaires, usage logs, and key indicators are predominantly used. Although the identified mHealth interventions are specific to cardiovascular disease and thus require particular questions to evaluate apps, the user readiness, usability, or quality of life criteria are non-specific. Therefore, the results contribute to understanding how different mHealth interventions can be assessed, categorized, evaluated, and accepted.
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Doenças Cardiovasculares , Aplicativos Móveis , Telemedicina , Humanos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Qualidade de Vida , TecnologiaRESUMO
Researchers frequently face ethical and privacy challenges on health applications. Ethics is a branch of moral philosophy and deals with the "right" and "good" actions of humans, which often leads to dilemmas. Reasons for this are social and societal dependencies of the respective norms. Data protection is regulated by law throughout Europe. This poster provides guidance on these challenges.
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Princípios Morais , Telemedicina , Humanos , Europa (Continente) , Privacidade , PesquisadoresRESUMO
A quantitative approach in the form of an online questionnaire was used to identify challenges and desires related to the Care Records Transmission Process and Care Transition Records (CTR). The questionnaire was sent to nurses, nursing assistants, and trainees working in ambulatory, acute inpatient, or long-term care settings. The survey revealed that creating CTRs is time-consuming, and the lack of standardization of CTRs makes the process even more cumbersome. In addition, most facilities transmit the CTR by physically handing it over to the patient or resident, resulting in little or no preparation time for the individual(s) receiving care. The key findings also suggest that most respondents are only partially satisfied with the completeness of the CTRs and that they must conduct additional interviews to obtain missing information. However, most respondents hoped that digital transmission of CTRs would lead to less administrative burden and that standardization of CTRs would be encouraged.
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Hospitais , Transferência de Pacientes , Humanos , Alemanha , Mãos , Pacientes InternadosRESUMO
INTRODUCTION: Geriatric co-management is known to improve treatment of older adults in various clinical settings, however, widespread application of the concept is limited due to restricted resources. Digitalization may offer options to overcome these shortages by providing structured, relevant information and decision support tools for medical professionals. We present the SURGE-Ahead project (Supporting SURgery with GEriatric co-management and Artificial Intelligence) addressing this challenge. METHODS: A digital application with a dashboard-style user interface will be developed, displaying 1) evidence-based recommendations for geriatric co-management and 2) artificial intelligence-enhanced suggestions for continuity of care (COC) decisions. The development and implementation of the SURGE-Ahead application (SAA) will follow the Medical research council framework for complex medical interventions. In the development phase a minimum geriatric data set (MGDS) will be defined that combines parametrized information from the hospital information system with a concise assessment battery and sensor data. Two literature reviews will be conducted to create an evidence base for co-management and COC suggestions that will be used to display guideline-compliant recommendations. Principles of machine learning will be used for further data processing and COC proposals for the postoperative course. In an observational and AI-development study, data will be collected in three surgical departments of a University Hospital (trauma surgery, general and visceral surgery, urology) for AI-training, feasibility testing of the MGDS and identification of co-management needs. Usability will be tested in a workshop with potential users. During a subsequent project phase, the SAA will be tested and evaluated in clinical routine, allowing its further improvement through an iterative process. DISCUSSION: The outline offers insights into a novel and comprehensive project that combines geriatric co-management with digital support tools to improve inpatient surgical care and continuity of care of older adults. TRIAL REGISTRATION: German clinical trials registry (Deutsches Register für klinische Studien, DRKS00030684), registered on 21st November 2022.
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Inteligência Artificial , Geriatras , Humanos , Idoso , HospitalizaçãoRESUMO
Mobile Health (mHealth) applications have seen strong growth in recent years, but they are often not systematically evaluated. A Delphi survey was conducted to identify key elements for the evaluation of mHealth applications. Sixteen experts participated in the study, and the study yielded a list of 79 key elements with expert consensus. Thirty-two elements were in the category of structure quality, 29 in process quality, and 18 in outcome quality. The number of key elements highlights the complexity of conducting systematic evaluations of mHealth applications.
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Aplicativos Móveis , Telemedicina , Consenso , Técnica DelphiRESUMO
Healthcare systems are challenged by increasing costs. Digital technology can help to combat this trend. Evaluation of these technologies is uncommon or incomplete. Scholars have called for a standardized and holistic evaluation. We provide a synthesis of an online panel on medical informatics (MI) and stipulate a discussion on new guidelines for medical informatics project evaluations. The panel consisted of presentations and a discussion. The presentations gave the participants an overview of evaluation methods currently used in different medical informatics domains and their shortcomings. The presenters highlighted new evaluation methods such as a roadmap for economic analysis of eHealth projects and the German Digital Healthcare Act methods. Participants discussed the shortcomings of RCTs and methods that need to be included in eHealth evaluation and called for new evaluation methods. The discussion showed weaknesses of the currently used methods and underlined the need for a new, holistic evaluation standard for MI.
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Informática Médica , Telemedicina , Atenção à Saúde , HumanosRESUMO
Objective: The purpose of this study is to provide an overview of apps to help control the spread of Covid-19 in Germany and rate them according to standardized instruments. Materials and methods: The Apple App Store and Google Play Store were systematically searched to identify apps dealing with Covid-19 in Germany. The German Mobile App Rating Scale (MARS-G) was used to independently assess app quality by 2 trained reviewers. Results: Overall, the quality of the 6 rated apps was good with a mean score of 4.15 (3.88-4.34). The best-rated apps were NINA app (4.34) and Corona Health App (4.29). The best-rated sections were functionality (4.40), aesthetic (4.25), and information (4.25). In contrast, the worst-rated section was engagement (3.63). Even though some of the apps were used by more people than others, there was no correlation between the MARS-G rating and app store rating. In addition, the MARS-G proved to be effective even with rating apps, which have different goals and methods to achieve them. Conclusions: To our knowledge, this is the first study that identified and evaluated German Covid-19 mobile health apps available in the German app stores. The review shows that despite the excellent quality in aspects like information and functionality, there is still a gap in the engagement section. To motivate more people to use the Covid-19 apps, new ideas are needed, besides more information and education about the functionality of the apps, to gain trust in app developers and raise the number of downloads.
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The Institute DigiHealth of the University of Applied Sciences Neu-Ulm is planning ELSI guidelines and legal policies on data protection and making ethics requests for the CARE REGIO project, founded by the Bavarian State Ministry for Health and Care. CARE REGIO's joint project aims at reforming the care system with digital solutions.
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Robotic assistance systems offer new therapeutic perspectives for patient mobilization. This work aims to investigate the chances and risks of robotic assistance systems in early neurological rehabilitation. Nine professionals working in physiotherapy and nursing were interviewed on their opinion on robotic assistance systems. The experts were recruited in three different clinics, one of which has already established robot-assisted rehabilitation. 171 individual codes were extracted from the interviews. Based on the professionals' statements and the literature, the most significant added value of robotic assistance systems is seen in the expected relief of employees. The study results and the literature confirm the potential of robotic systems for early neurological rehabilitation.
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Reabilitação Neurológica , Procedimentos Cirúrgicos Robóticos , Reabilitação do Acidente Vascular Cerebral , Humanos , Modalidades de Fisioterapia , Reabilitação do Acidente Vascular Cerebral/métodosRESUMO
Smart mobile devices such as smartphones or tablets have become an important factor for collecting data in complex health scenarios (e.g., psychological studies, medical trials), and are more and more replacing traditional pen-and-paper instruments. However, simply digitizing such instruments does not yet realize the full potential of mobile devices: most modern smartphones have a variety of different sensor technologies (e.g., microphone, GPS data, camera, ...) that can also provide valuable data and potentially valuable insights for the medical purpose or the researcher. In this context, a significant development effort is required to integrate sensing capabilities into (existing) data collection applications. Developers may have to deal with platform-specific peculiarities (e.g., Android vs. iOS) or proprietary sensor data formats, resulting in unnecessary development effort to support researchers with such digital solutions. Therefore, a cross-platform mobile data collection framework has been developed to extend existing data collection applications with sensor capabilities and address the aforementioned challenges in the process. This framework will enable researchers to collect additional information from participants and environment, increasing the amount of data collected and drawing new insights from existing data.
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Telemedicina , Coleta de Dados , Humanos , Smartphone , Telemedicina/métodosRESUMO
Even though the "user characteristics" (UC) can influence "acceptance" and "the continuance intention to use" of information systems such as electronic medical records (EMR), the effect of UC has not been adequately evaluated in post-adoption models. This study seeks to examine the effect of UC on post-usage of EMR using the expectation confirmation model (ECM). A total of 450 questionnaires was collected by a survey to extend ECM by integrating UC using structural equation modeling (SEM). Data were analyzed using LISREL through confirmatory factor analysis. A path analysis test was also performed to fit and confirm the model fit. The UC affects the "confirmation of expectations" directly and the "continuance intention to use" indirectly. The findings of the present study can provide a new path for further research on the extending of the ECM model. Moreover, end users' characteristics should be considered in the preparation and training phases of EMR implementation.