Decision support systems for antibiotic prescription in hospitals: a survey with hospital managers on factors for implementation.

BACKGROUND: Inappropriate antimicrobial use, such as antibiotic intake in viral infections, incorrect dosing and incorrect dosing cycles, has been shown to be an important determinant of the emergence of antimicrobial resistance. Artificial intelligence-based decision support systems represent a potential solution for improving antimicrobial prescribing and containing antimicrobial resistance by supporting clinical decision-making thus optimizing antibiotic use and improving patient outcomes. OBJECTIVE: The aim of this research was to examine implementation factors of artificial intelligence-based decision support systems for antibiotic prescription in hospitals from the perspective of the hospital managers, who have decision-making authority for the organization. METHODS: An online survey was conducted between December 2022 and May 2023 with managers of German hospitals on factors for decision support system implementation. Survey responses were analyzed from 118 respondents through descriptive statistics. RESULTS: Survey participants reported openness towards the use of artificial intelligence-based decision support systems for antibiotic prescription in hospitals but little self-perceived knowledge in this field. Artificial intelligence-based decision support systems appear to be a promising opportunity to improve quality of care and increase treatment safety. Along with the Human-Organization-Technology-fit model attitudes were presented. In particular, user-friendliness of the system and compatibility with existing technical structures are considered to be important for implementation. The uptake of decision support systems also depends on the ability of an organization to create a facilitating environment that helps to address the lack of user knowledge as well as trust in and skepticism towards these systems. This includes the training of user groups and support of the management level. Besides, it has been assessed to be important that potential users are open towards change and perceive an added value of the use of artificial intelligence-based decision support systems. CONCLUSION: The survey has revealed the perspective of hospital managers on different factors that may help to address implementation challenges for artificial intelligence-based decision support systems in antibiotic prescribing. By combining factors of user perceptions about the systems´ perceived benefits with external factors of system design requirements and contextual conditions, the findings highlight the need for a holistic implementation framework of artificial intelligence-based decision support systems.

[How much digital public health is in public health degree programs? A systematic analysis of module handbooks in German full-time study programs at public colleges and universities]. / Wie viel Digital Public Health steckt in Public-Health-Studiengängen? Eine systematische Modulhandbuchanalyse von Vollzeitstudiengängen an öffentlichen Hochschulen und Universitäten in Deutschland.

BACKGROUND: Professionals, especially in the field of digital public health (DiPH), are crucial for a successful digital transformation in social and health care. However, it is still unclear to what extent academic professionals are taught DiPH-related content in their public health (PH) studies. METHODS: This study used a systematic module handbook analysis to analyze accredited full-time PH-oriented degree programs at public colleges and universities in Germany for DiPH-related module content. Through the "Hochschulkompass" platform and the member programs of the German Public Health Association (DGPH), 422 programs were identified. Included module handbooks were evaluated by content analysis using MAXQDA. RESULTS: Only 10 bachelor and 6 master programs contain DiPH. They are heterogeneous in their focus and belong to different subfields of public health ("methods, definition, history, and social medicine" = 5; "health management" = 5; "digital health" = 3; "health services research" = 2; "health communication" = 1). Differences were found between the common understanding of DiPH in academia and the content in the module handbooks. The content identified in the analysis focuses mainly on technical areas. Social and health science content is only marginally present. DISCUSSION: The heterogeneous study programs with a connection to DiPH allow academic PH specialists to develop specific profiles. To achieve comprehensive competencies in DiPH, there is a need for further development of modules with relevance to the respective degree program. The results could be used for the (further) development of relevant modules and a core curriculum in DiPH.

Factors influencing the implementation of decision support systems for antibiotic prescription in hospitals: a systematic review.

BACKGROUND: Antibiotic resistance is a major health threat. Inappropriate antibiotic use has been shown to be an important determinant of the emergence of antibiotic resistance. Decision support systems for antimicrobial management can support clinicians to optimize antibiotic prescription. OBJECTIVE: The aim of this systematic review is to identify factors influencing the implementation of decision support systems for antibiotic prescription in hospitals. METHODS: A systematic search of factors impeding or facilitating successful implementation of decision support systems for antibiotic prescription was performed in January 2022 in the databases PubMed, Web of Science and The Cochrane Library. Only studies were included which comprised decision support systems in hospitals for prescribing antibiotic therapy, published in English with a qualitative, quantitative or mixed-methods study design and between 2011 and 2021. Factors influencing the implementation were identified through text analysis by two reviewers. RESULTS: A total of 14 publications were identified matching the inclusion criteria. The majority of factors relate to technological and organizational aspects of decision support system implementation. Some factors include the integration of the decision support systems into existing systems, system design, consideration of potential end-users as well as training and support for end-users. In addition, user-related factors, like user attitude towards the system, computer literacy and prior experience with the system seem to be important for successful implementation of decision support systems for antibiotic prescription in hospitals. CONCLUSION: The results indicate a broad spectrum of factors of decision support system implementation for antibiotic prescription and contributes to the literature by identifying important organizational as well as user-related factors. Wider organizational dimensions as well as the interaction between user and technology appear important for supporting implementation.

[Factors influencing the implementation of AI-based decision support systems for antibiotic prescription in hospitals: a qualitative analysis from the perspective of health professionals]. / Faktoren für die Implementierung von KI-basierten Entscheidungsunterstützungssystemen zur Antibiotikavorhersage im Krankenhaus ­ eine qualitative Analyse aus der Perspektive von ärztlichem Personal.

BACKGROUND: Decision support systems based on artificial intelligence might optimize antibiotic prescribing in hospitals and prevent the development of antimicrobial resistance. The aim of this study was to identify impeding and facilitating factors for successful implementation from the perspective of health professionals. METHODS: Problem-centered individual interviews were conducted with health professionals working in hospitals. Data evaluation was based on the structured qualitative content analysis according Kuckartz. RESULTS: Attitudes of health professionals were presented along the Human-Organization -Technology-fit model. Technological and organizational themes were the most important factors for system implementation. Especially, compatibility with existing systems and user-friendliness were seen to play a major role in successful implementation. Additionally, the training of potential users and the technical equipment of the organization were considered essential. Finally, the importance of promoting technical skills of potential users in the long term and creating trust in the benefits of the system were highlighted. CONCLUSION: The identified factors provide a basis for prioritizing and quantifying needs and attitudes in a next step. It becomes clear that, beside technological factors, attention to context-specific and user-related conditions are of fundamental importance to ensure successful implementation and system trust in the long term.

[Digital Applications in the Planning and Implementation of Structural Health Promotion and Prevention Settings: Results of a Scoping Review]. / Digitale Anwendungen in der Planung und Umsetzung von verhältnisorientierter Gesundheitsförderung und Prävention in Settings: Ergebnisse eines Scoping Reviews.

BACKGROUND AND OBJECTIVES: In health promotion and prevention, digital applications, especially for behavioral changes, are being increasingly researched and applied. The aim of this study was to investigate possible uses of digital applications in the context of structurally oriented interventions in these settings. METHODS: This is a supplementary analysis of the results of a scoping review. Eight scientific databases were searched for digital structural primary prevention and health promotion in settings from 2010-2020. RESULTS: A total of 34 articles were included. Digital applications were found to be used only marginally for structural change in health promoting settings. They served as tools for project management, networking, problem identification, consensus building or participation. Participatory methods and projects were used, as well as tools such as labeling, placement, prompting, incentives, nudges, and political strategies. CONCLUSIONS: More evidence is needed on how digital applications can be used to change structures in health promoting settings. Public health or sociological methods and theories can play a supporting role. The interdisciplinary and participatory development and implementation of health promoting technologies is of high relevance.

[Future trends and possible applications of digital technologies in setting-based prevention and health promotion-a Delphi survey]. / Zukunftstrends und Einsatzmöglichkeiten digitaler Technologien in der settingbezogenen Prävention und Gesundheitsförderung ­ eine Delphi-Befragung.

BACKGROUND: Digital technologies show a high potential for health promotion and prevention, but an analysis throughout the planning, implementation, and evaluation phases of setting-based health promotion has not yet taken place. It also remains unclear to what extent digital technologies promote participation, partnerships, empowerment, and equity in settings. PURPOSE: This study is aimed at exploring future trends and possible uses of technologies throughout the phases of setting-based health promotion over the next 5 years. Further, it discusses the use of technologies to build participation, partnerships, empowerment, and equity in settings, and highlights the differences in the predictions of experts from science and practice. METHOD: A two-stage web-based Delphi survey with experts in setting-based health promotion/prevention was conducted. We conducted a content analysis for open questions and a quantitative analysis for closed questions. RESULTS: According to the experts (N = 42, complete participation in the first round of the survey), digital transformation will increasingly find its way into the various process phases over the next 5 years. In particular, technologies for behavioral change in hybrid formats are expected. The use of technology in the future can lead to more participation, partnerships, empowerment, and equity in settings on the one hand, but on the other hand can also reinforce exclusion and injustice if no suitable underlying conditions are provided. DISCUSSION: Research is needed on technologies for changing setting structures. The development of digital competencies and infrastructures in settings is essential to support the development of health-promoting settings digitally.

Digital Health Promotion and Prevention in Settings: Scoping Review.

BACKGROUND: Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings. OBJECTIVE: This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps. METHODS: The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting-based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace. RESULTS: From 8888 records, the search resulted in 200 (2.25%) included publications. We identified a huge diversity of literature regarding digital setting-based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5%) and neighborhoods or communities (24/200, 12%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5%), nutrition (45/200, 22.5%), and sexual health (34/200, 17%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention. CONCLUSIONS: The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings.

[Telemedicine in Rehabilitation Aftercare for Women with Breast Cancer - A Systematic Literature Review]. / Telemedizin in der rehabilitativen Nachsorge von Frauen mit Brustkrebs ­ Eine systematische Übersicht.

BACKGROUND: Breast cancer continues to be the most common maligned tumor disease in women. Diagnosis and treatment-related side effects affect functioning of women in the long run. The provision of rehabilitation aftercare services for breast cancer survivors is often limited by resources and access. Telemedicine seems to be a potential way of the remote delivery of rehabilitation aftercare. The aim of this systematic review is to examine the efficacy of telemedicine-based aftercare interventions for breast cancer survivors regarding specific outcomes of functioning. METHODS: A systematic search was conducted in April to May 2020 in the databases Pubmed and The Cochrane Library and has been updated in August 2020. Only randomized controlled trials were considered, that examined the efficacy of telemedicine-based interventions for the aftercare of women with breast cancer. RESULTS: In total, 11 publications of 10 intervention studies were identified and included in this review. No study was found from Germany. In general, studies were classified as psychosocial interventions and interventions for lifestyle changes. Regarding the between-study heterogeneity the results indicate positive effects in certain parameters of functioning (therapy-induced menopausal symptoms, fatigue, sleep functions, adherence). However, for certain of the outcomes (mental functions like emotional and cognitive functions, health-related quality of life) there is no sufficient evidence for the efficacy of telemedicine-based interventions in the aftercare for women with breast cancer. CONCLUSION: The results indicate the need of an evidence-based practice in telemedicine-based interventions in the aftercare for women with breast cancer. In future, well-designed randomized controlled trials are needed in Germany to systematically explore the efficacy of telemedicine-based aftercare interventions.

[Information needs of family caregivers regarding new technologies for dementia care at home: A qualitative study]. / Informationsbedürfnisse pflegender Angehöriger zu neuen Technologien der häuslichen Versorgung bei Demenz.

Information needs of family caregivers regarding new technologies for dementia care at home: A qualitative study Abstract. Background: New technologies can support family caregivers in the home care of people with dementia but are unknown to many. To reduce the information deficit, the information needed by caregivers must be determined. Aim: The aim of this study is to investigate the information needs of family caregivers regarding new technologies for dementia care at home, taking into account experiences in past research and future information needs. Methods: Episodic interviews were conducted with eight family caregivers of people with dementia and analyzed according to thematic coding. Results: Caregivers used both media-based and interpersonal channels for technology-related research and made heterogeneous experiences. The researched information content and causes of research varied across respondents. The amount of available online information was a barrier in some cases. With regard to future information needs, the diversity of information channels and the quality of information are of high importance. Conclusions: The individual situation-specific needs of family caregivers must be taken into account in the development of new information and counseling services so that information deficits can be eliminated, and the potential of new technologies can be exploited in the home care of people with dementia. Further research is needed on the information needs of people with dementia.

Digitization and health inequality and equity in nursing.

Background: The use of information and communication technologies (ICT) in health care is increasing attention. To describe health inequalities and equity with regard to the use of digital health technologies in a care context and to understand interrelationships, it is of particular importance for the field of care research to use models and theories that explain health inequalities and equity in the use of digital technologies. Aims: This article aims to identify models and theories from the field of nursing and health research that explain the phenomenon of health inequalities and the influence of digital health technologies on the emergence of inequalities. Methods: Relevant articles were searched in electronic databases (MEDLINE, CINAHL & SocINDEX) between July and August 2019 in German and English, within the methodological framework of a scoping review. The systematic literature search and data extraction were performed by 2 reviewers. The description of data refers to standard criteria by 8-1Christiansen and Baum (1997). Results: From a total of 25 relevant articles, 2 were identified for inclusion in the current overview. One model is focusing on ICT for health and the other model focuses on eHealth. No nursing theory could be identified in the context of describing the phenomenon of digital inequality. Conclusions: In both models, there is a lack of discussion about the impact of nursing aspects on the use and acceptance of eHealth technologies. One point should also be the development of models and theories that consider the user perspective of vulnerable groups.

[Teleconsultation for vascular- and diabetes-associated chronic wounds : A systematic review of health-related and economic implications]. / Telekonsultation bei vaskulär und diabetisch bedingten chronischen Wunden : Eine systematische Übersicht der gesundheitlichen und ökonomischen Implikationen.

BACKGROUND: In addition to lowering the quality of life of those affected, long periods of treatment and high recurrence rates of chronic wounds cause major economic costs for health care systems. Furthermore, inadequate health care and undersupply of care can be observed in Germany. Thus, new forms of care such as teleconsultation are being discussed increasingly. Recent changes in the remuneration system and macerations in the ban of remote treatment support those trends. METHODS: A systematic review was conducted in July 2018 using PubMed and CENTRAL databases for randomized controlled trials between 2008 and 2018. Only randomized clinical trials in which patients with chronic wound who received treatment and follow-up by teleconsultation using information and communication technology to share data were included. In total, 6 international clinical trials were identified. RESULTS: Regarding the current state of research, there is no definite evidence that teleconsultation can improve the care of chronic wound patients. Most likely, wound healing time was positively influenced. No correlation was found between mortality and hospitalizations when teleconsultation was used. CONCLUSION: On the basis of the included studies, the evidence for the care of chronic wounds by teleconsultation is unclear. Further research is needed to examine the health-related and economic benefits of teleconsultation to support integration into health care systems.

[Online therapy for depressive disorders : An acceptance-based analysis from the perspective of therapists]. / Onlinetherapie bei depressiven Störungen : Eine Akzeptanzanalyse aus der Perspektive der Behandelnden.

BACKGROUND: The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. METHODS: In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. RESULTS: Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. CONCLUSION: The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation.

[Implementation and participatory design of digital health interventions]. / Implementierung und partizipative Gestaltung digitaler Gesundheitsinterventionen.

There are dynamic interactions between (digital) technologies and society. Digital technologies have a (re-)structuring effect on social relationships and social innovations in a variety of ways. Because of these characteristics, technological innovations affect our individual lifestyles and living environments. In particular, the development and implementation of interventions with digital (health) technologies is attracting increasing national and international attention (e.g. telematics GP consultations and app-supported patient education programs).Digital health technologies enable new forms of interaction and knowledge-based reproduction in the field of health. The integration of potential users in the development process of digital health technologies and interventions requires the discussion of new research approaches. The interests, needs, and requirements of users may influence the nonuse of digital health technologies. It is above all the successful implementation, involving potential users, that can have an influence on acceptance and integrative use in the later course of care. The discourse on the participatory development and implementation of interventions with digital health technologies in the field of digital public health presents itself as a complex process characterized by various theoretical approaches and methodological procedures and requiring representation, evaluation, and classification.

[Telematics in ambulatory care: Exploring the nurses' perspective]. / Telematische Anwendungen in der ambulanten Pflege: Die Perspektive von Pflegekräften.

Telematics in ambulatory care: Exploring the nurses' perspective Abstract. BACKGROUND: In the context of demographic change, the use of information and communications technology in home care has the aim of ensuring the quality of nursing care in the future. The acceptance of telematic applications by all users is crucial in this regard. AIM: The aim of this study was to assess the subjective attitudes and intentions of nursing staff on telematic applications in home care. METHODS: Based on the "Unified Theory of Acceptance and Use of Technology" (UTAUT), an online survey was conducted in which nursing staff as well as nursing students throughout Germany were surveyed. 371 questionnaires have been included in the analysis. RESULTS: Nursing students as well as nurses stated inadequate information and insufficient technical competence. Referring to performance expectations, both groups hope for improving care process transparency and communication inside and outside sectors. For effort expectancy, higher costs, training efforts and technology dependency were named. CONCLUSIONS: The results show the relevance of the attitudes and demands of users for a successful implementation. In the future, training and further education should increasingly promote the technological competence of nursing staff.

[Acceptance of Online-based Therapy by Patients with Light to Moderate Depressive Disorders]. / Akzeptanz onlinebasierter Therapieangebote bei Patientinnen und Patienten mit leichten bis mittelgradigen depressiven Störungen.

OBJECTIVES: Over the past few years, there has been a considerable increase in online-based therapeutic services for people affected by depressive disorders. The efficacy and efficiency of these programmes is well documented by now. User acceptance is considered as a significant factor of success in establishing this new patient-centered care. Theory-based acceptance surveys can provide valuable scientific knowledge regarding long-term introduction. METHODS: A nationwide online survey was conducted to determine the attitude towards web-based psychotherapy services for depressive disorders, the current state of knowledge and the intention of 186 participants (124 female and 62 male participants; aged 21 and above) to use these services. The participants were recruited from support groups for depressive disorders. The determinants of the intention to use online therapy, which is included in the binary logistic regression, are based upon the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS: Nearly two-thirds of the respondents could conceive making use of online-based therapeutic services in the near future. The perceived performance and expected effort proved to be significantly influential predictors regarding the intention to use. Specifically, these included an evaluation of the use of E-Mental Health to assist disease management, and better assessment of the course of one's disease. CONCLUSION: The actual contribution of E-Mental Health is closely connected to technical and jurisprudential assessments. But also, it significantly depends on evidence-based issues as well as user orientation in research, development and implementation. The results offer an initial theory-based approach to an increased user-oriented technology research in health care, with further diversity criteria to be taken into account in the future.

Factors Facilitating and Inhibiting the Implementation of Telerehabilitation-A Scoping Review.

Due to the coronavirus pandemic, telerehabilitation has become increasingly important worldwide. While the effectiveness of telerehabilitation is considered proven for many indications, there is comparatively little knowledge about the implementation conditions. Therefore, this scoping review summarises the current state of facilitating and inhibiting factors that may influence the uptake of telerehabilitation. The review follows the JBI methodology for scoping reviews. The article search was carried out in five databases (MEDLINE, EMBASE, Web of Science, Cochrane and Psyndex) in May 2022, with an update in October 2023. Two independent researchers identified relevant studies according to the inclusion and exclusion criteria. The Consolidated Framework for Implementation Research served as the theoretical basis for the categorisation of the facilitating and inhibiting criteria in the organisational context. A total of 28 studies (timespan 2012 to 2023) have been included. The most relevant barriers identified are technical issues and a lack of technical skills. The factors considered most favourable for implementation are patients' motivation and the involvement of high-level leaders. The results provide clear indications of factors that inhibit and facilitate implementation, but also show that further research is needed.

Competencies required by patients and health professionals regarding telerehabilitation: A scoping review.

Background: Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care. Objective: The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies. Methods: We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home. Results: One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear. Conclusions: Telerehabilitation requires a variety of different competencies from patients and health professionals - going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.

Impact of virtual reality applications in the treatment of anxiety disorders: A systematic review and meta-analysis of randomized-controlled trials.

BACKGROUND AND OBJECTIVES: Anxiety disorders are the most prevalent mental disorders worldwide. Virtual reality (VR) treatment approaches have increasingly been studied. Before clinical implementation, it is necessary to evaluate the treatment effect of VR applications. The objective is to evaluate the treatment effect of virtual reality applications in the treatment of anxiety disorders compared to conventional therapy. METHODS: A systematic literature review with meta-analysis was conducted. Four databases were used to identify randomized controlled trials published between April 2011 and April 2021 which compare VR applications with non-VR interventions or waiting lists. Study characteristics, pre- and post-treatment data were extracted. Hedges g was calculated as effect size. Primary outcome was anxiety symptoms. RESULTS: Data from 17 studies from 827 participants was extracted. The studies examined specific phobia (n = 9), social anxiety disorder (n = 4), agoraphobia (n = 2) and panic disorder (n = 2). 16 out of 17 studies used head-mounted displays as VR application. A non-significant effect size with significant heterogeneity was observed in favor of the use of VR applications in anxiety symptoms (g, 0.33; 95%-CI, -0.20-0.87). Compared to passive control groups, VR applications are associated significant with lower anxiety symptoms (g, 1.29; 95%-CI, 0.68-1.90). LIMITATIONS: The study and patient characteristics varied between the individual studies which is reflected in a high statistical heterogeneity of the effect sizes. CONCLUSIONS: The added value of VR applications over waiting-list or psychoeducation only control groups is obvious. VR applications can be used as part of the treatment of anxiety disorders, especially when conventional therapy is unavailable.

Integration of the Vision of People With Diabetes Into the Development Process to Improve Self-management via Diabetes Apps: Qualitative Interview Study.

BACKGROUND: Diabetes is a major global epidemic and serious public health problem. Diabetes self-management is a 24/7 challenge for people with type 1 diabetes that influences their quality of life (QoL). Certain apps can support the self-management of people with diabetes; however, current apps do not meet the needs of people with diabetes appropriately, and their safety is not ensured. Moreover, there are a multitude of hardware and software problems associated with diabetes apps and regulations. Clear guidelines are required to regulate medical care via apps. In Germany, apps must undergo 2 examination processes to be listed in the Digitale Gesundheitsanwendungen directory. However, neither examination process considers whether the medical use of the apps is sufficient for users' self-management. OBJECTIVE: This study aims to contribute to the technology development process of diabetes apps by exploring individual perspectives on desired features and content of diabetes apps among people with diabetes. The vision assessment conducted is a first step toward creating a shared vision among all relevant stakeholders. To ensure adequate research and development processes for diabetes apps in the future, guiding visions from all relevant stakeholders are required. METHODS: In a qualitative study, 24 semistructured interviews with patients with type 1 diabetes were conducted, among whom 10 (42%) were currently using an app. To clarify the perceptions of people with diabetes regarding the functions and content of diabetes apps, a vision assessment was conducted. RESULTS: People with diabetes have concrete ideas of features and content in apps to improve their QoL and allow them to live as comfortably as possible, such as informative predictions through artificial intelligence, improvements in signal loss and value delay through smartwatches, improved communication and information-sharing capabilities, reliable information sources, and user-friendly and discreet messaging options through smartwatches. In addition, according to people with diabetes, future apps should show improved sensors and app connectivity to avoid incorrect values being displayed. They also wish for an explicit indication that displayed values are delayed. In addition, personalized information was found to be lacking in apps. CONCLUSIONS: People with type 1 diabetes want future apps to improve their self-management and QoL and reduce stigma. Desired key features include personalized artificial intelligence predictions of blood glucose levels, improved communication and information sharing through chat and forum options, comprehensive information resources, and smartwatch alerts. A vision assessment is the first step in creating a shared vision among stakeholders to responsibly guide the development of diabetes apps. Relevant stakeholders include patient organizations, health care professionals, insurers, policy makers, device manufacturers, app developers, researchers, medical ethicists, and data security experts. After the research and development process, new apps must be launched while considering regulations regarding data security, liability, and reimbursement.

Virtual Reality for Upper Extremity Rehabilitation-A Prospective Pilot Study.

Applications related to virtual reality are a rapidly growing area. Thus, these technologies are also increasingly used in the field of medicine and rehabilitation. The primary objective of this prospective pilot study was to investigate the feasibility, user experience and acceptance of a virtual-reality-based system for upper extremity rehabilitation. The study was conducted as a single-center trial over 16 weeks. The eligibility criteria included rehabilitants with upper extremity injuries of at least 18 years of age who were fluent in spoken and written German. After detailed instruction, each participant was asked to complete daily 30 min exercises over 15 training sessions with the virtual reality system consisting of three different training modules. Outcomes were assessed pre-study and post-study using standardized clinical measures. In addition, qualitative interviews with rehabilitants as well as therapists regarding user experience and acceptance were conducted. Six participants were recruited for the pilot study, of which five underwent virtual-reality-based rehabilitation. Overall, the clinical measures showed a positive tendency over the course of the study, even if the results were not significant. Furthermore, the virtual-reality-based training was well accepted by the participants as well as therapists. Given these findings, it will be beneficial to evaluate virtual reality for rehabilitation in further research.