A Guide to Measuring Heart and Respiratory Rates Based on Off-the-Shelf Photoplethysmographic Hardware and Open-Source Software.

The remote monitoring of vital signs via wearable devices holds significant potential for alleviating the strain on hospital resources and elder-care facilities. Among the various techniques available, photoplethysmography stands out as particularly promising for assessing vital signs such as heart rate, respiratory rate, oxygen saturation, and blood pressure. Despite the efficacy of this method, many commercially available wearables, bearing Conformité Européenne marks and the approval of the Food and Drug Administration, are often integrated within proprietary, closed data ecosystems and are very expensive. In an effort to democratize access to affordable wearable devices, our research endeavored to develop an open-source photoplethysmographic sensor utilizing off-the-shelf hardware and open-source software components. The primary aim of this investigation was to ascertain whether the combination of off-the-shelf hardware components and open-source software yielded vital-sign measurements (specifically heart rate and respiratory rate) comparable to those obtained from more expensive, commercially endorsed medical devices. Conducted as a prospective, single-center study, the research involved the assessment of fifteen participants for three minutes in four distinct positions, supine, seated, standing, and walking in place. The sensor consisted of four PulseSensors measuring photoplethysmographic signals with green light in reflection mode. Subsequent signal processing utilized various open-source Python packages. The heart rate assessment involved the comparison of three distinct methodologies, while the respiratory rate analysis entailed the evaluation of fifteen different algorithmic combinations. For one-minute average heart rates' determination, the Neurokit process pipeline achieved the best results in a seated position with a Spearman's coefficient of 0.9 and a mean difference of 0.59 BPM. For the respiratory rate, the combined utilization of Neurokit and Charlton algorithms yielded the most favorable outcomes with a Spearman's coefficient of 0.82 and a mean difference of 1.90 BrPM. This research found that off-the-shelf components are able to produce comparable results for heart and respiratory rates to those of commercial and approved medical wearables.

Effectiveness of the Lilly Connected Care Program in Improving Glycemic Management Among Patients With Type 2 Diabetes in China: Retrospective Real-world Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a worldwide public health concern. Mobile health management platforms could be a potential way to achieve effective glycemic control. OBJECTIVE: This study aimed to evaluate the real-world effectiveness of the Lilly Connected Care Program (LCCP) platform in glycemic control among patients with T2DM in China. METHODS: This retrospective study included Chinese patients with T2DM (aged ≥18 years) from April 1, 2017, to January 31, 2020, for the LCCP group and from January 1, 2015, to January 31, 2020, for the non-LCCP group. Propensity score matching was used to match the LCCP and non-LCCP groups to reduce confounding, with covariates including age, sex, the duration of diabetes, baseline hemoglobin A1c (HbA1c), and the number of oral antidiabetic medication classes. HbA1c reduction over 4 months, the proportions of patients achieving an HbA1c reduction of ≥0.5% or ≥1%, and the proportions of patients reaching to target HbA1c level of ≤6.5% or <7% were compared between the LCCP and non-LCCP groups. Multivariate linear regression was used to assess factors associated with HbA1c reduction. RESULTS: A total of 923 patients were included, among whom 303 pairs of patients were well matched after propensity score matching. HbA1c reduction during the 4-month follow-up was significantly larger in the LCCP group than the non-LCCP group (mean 2.21%, SD 2.37% vs mean 1.65%, SD 2.29%; P=.003). The LCCP group had a higher proportion of patients with an HbA1c reduction of ≥1% (209/303, 69% vs 174/303, 57.4%; P=.003) and ≥0.5% (229/303, 75.6% vs 206/303, 68%; P=.04). The proportions of patients reaching the target HbA1c level of ≤6.5% were significantly different between the LCCP and non-LCCP groups (88/303, 29% vs 61/303, 20.1%; P=.01), whereas the difference in the proportions of patients reaching the target HbA1c level of <7% was not statistically significant (LCCP vs non-LCCP: 128/303, 42.2% vs 109/303, 36%; P=.11). LCCP participation and higher baseline HbA1c were associated with a larger HbA1c reduction, whereas older age, longer diabetes duration, and higher baseline dose of premixed insulin analogue were associated with a smaller HbA1c reduction. CONCLUSIONS: The LCCP mobile platform was effective in glycemic control among patients with T2DM in China in the real world.

Creating a Telemedicine Network of Specialists in Maternal-Fetal Medicine: A Prospective Cohort Study.

Background: Even before coronavirus disease 2019, integrating telemedicine into routine health care has become increasingly attractive. Evidence regarding the benefits of telemedicine in prenatal care is still inconclusive. As one of the largest sectors of preventive medicine with a relative paucity of specialists in maternal-fetal medicine (MFM), the implementation of telemedicine solutions into prenatal care is promising. Our objective aimed at establishing a telemedicine network of specialists in MFM for interprofessional exchange regarding high-risk pregnancies. Furthermore, the aims were to evaluate the providers' attitude toward the telemedicine solutions and to quantify the number of inpatient appointments that were avoided through interprofessional video consultations. Methods: This prospective trial was part of a larger telemedicine project funded by the European Regional Development Fund. MFM experts were brought together using the ELVI software. A questionnaire was designed for the evaluation of video consultations. The responses were analyzed by the exact McNemar-Bowker test to compare planned procedures before and after video consultation. Results: An interprofessional network of specialists in prenatal ultrasound was established with a total of 140 evaluations for statistical analysis. Interprofessional video communication was viewed favorably by providers. Overall, 47% (33/70) of the scheduled visits were avoided after video consultation. The providers' tendency to refrain from sending their patients to the University Hospital Münster was statistically noticeable (p = 0.048). Conclusions: Interprofessional exchange through video consultation holds great potential in the context of prenatal care. More prospective research is needed to clearly establish the most beneficial standard of care for both patients and providers. Clinical trial registration number: 2019-683-f-S.

Musculoskeletal care - at the confluence of data science, sensors, engineering, and computation.

Data has always been integral to modern medicine in almost all aspects of patient care and the recent proliferation of data has opened up innumerable opportunities for all the stakeholders in trying to improve the quality of care and health outcomes including quality of life and rehabilitation. Greater usage and adoption of digital technologies have led to the convergence of health data in different forms - clinical, self-reported, electronic health records social media, etc. The application and utilization of patient data set continue to get broadened each day with greater availability and access. These are empowering newer cutting-edge solutions such as connected care and artificial intelligence, 3D printing and real-life mimicking prosthetics. The availability of data at micro and macro levels has the potential to act as a catalyst for personalized care based on behavioral, cultural, genetic, and psychological needs for patients with musculoskeletal disorders. Realistic algorithms coupled with biomarkers which can identify relevant interventions and alert the care providers regarding any deterioration. Although in the nascent stage currently, 3D printing, exoskeletons, and virtual rehabilitation hold tremendous potential of cost-effective, precise interventions for the patients.

Telemedicine in vascular surgery during the coronavirus disease-2019 pandemic: A multisite healthcare system experience.

OBJECTIVE: To assess the introduction of telemedicine as an alternative to the traditional face-to-face encounters with vascular surgery patients in the era of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A retrospective review of prospectively collected data on face-to-face and telemedicine interactions was conducted at a multisite health care system from January to August 2020 in vascular surgery patients during the COVID-19 pandemic. The end point is direct patient satisfaction comparison between face-to-face and telemedicine encounters/interactions prior and during the pandemic. RESULTS: There were 6262 patient encounters from January 1, 2020, to August 6, 2020. Of the total encounters, 790 (12.6%) were via telemedicine, which were initiated on March 11, 2020, after the World Health Organization's declaration of the COVID-19 pandemic. These telemedicine encounters were readily adopted and embraced by both the providers and patients and remain popular as an option to patients for all types of visits. Of these patients, 78.7% rated their overall health care experience during face-to-face encounters as very good and 80.6% of patients rated their health care experience during telemedicine encounters as very good (P = .78). CONCLUSIONS: Although the COVID-19 pandemic has produced unprecedented consequences to the practice of medicine and specifically of vascular surgery, our multisite health care system has been able to swiftly adapt and adopt telemedicine technologies for the care of our complex patients. Most important, the high quality of patient-reported satisfaction and health care experience has remained unchanged.

Nurse Engagement: What are the Contributing Factors for Success?

The concept of nurse engagement is often used to describe nurses' commitment to and satisfaction with their jobs. In reality, these are just two facets of engagement. Additional considerations include nurses' level of commitment to the organization that employs them, and their commitment to the nursing profession itself. Because nurse engagement correlates directly with critical safety, quality, and patient experience outcomes, understanding the current state of nurse engagement and its drivers must be a strategic imperative. This article will discuss the current state of nurse engagement, including variables that impact engagement. We also briefly describe the potential impact of compassion fatigue and burnout, and ways to offer compassionate connected care for the caregiver. Such insight is integral to the profession's sustainability under the weight of demographic, economic, and technological pressures being felt across the industry, and is also fundamental to the success of strategies to improve healthcare delivery outcomes across the continuum of care.

How to establish digital health ecosystems from the perspective of health service-organizations: A taxonomy developed based on expert interviews conducted as modified Delphi approach.

Objective: Digital health ecosystems may be the next revolution in improving citizens' well-being, health delivery, data management, and health system processes, but solutions have not yet been broadly established. Reasons could be that health service-organizations have misaligned interests or lack capabilities. This study investigates reasons from a multi-health-service-organization perspective, differentiating between payers, insurers, healthcare providers, and innovators, detailing the expected value-adds, preferred participation roles, and required capabilities including a rating assessment. Methods: Findings are based on a taxonomy development methodology, which combines a literature review with semi-structured qualitative expert interviews, conducted using a modified Delphi approach. Interviews were thematically analysed. Results: In total, 21 experts across the four health service-organization groups were interviewed. The capability taxonomy includes a total of 16 capabilities, categorized in three themes: 'Health market', 'organizational', and 'technology and informatic'. Providers expect a value-add from strengthening their health process economics through efficiency gains but reveal the largest capability gaps, especially in 'interoperability' and 'platform'. Innovators' 'technology and informatic' capabilities complement well with those of payers for the 'health market'. Conclusions: We present a health service-organization-specific three-stage approach for establishing digital health ecosystems. Payers and insurers should address their 'technology and informatic' capability gaps, using technical enablers or forming new entities to reduce dependencies from legacy information technology systems. Innovators should clarify their monetization models and create positive awareness for their services, possibly entering the market directly. Providers must address interoperability issues and may require incentives to encourage their participation. Findings suggest governmental policymakers to prioritize three health policy initiatives.

Process mining and customer journey mapping in healthcare: Enhancing patient-centred care in stroke rehabilitation.

Background: Patient-centred care and enhancing patient experience is a priority across Australia. Stroke rehabilitation has multiple consumer touchpoints that would benefit from a better understanding of customer journeys, subsequently impacting better patient-centred care, and contributing to process improvements and better patient outcomes. Customer journey mapping through process mining extracts process data from event logs in existing information systems discovering patient journeys, which can be utilized to monitor guideline compliance and uncover nonconformance. Methodology: Utilizing process mining and variant analysis, customer journey maps were developed for 130 stroke rehabilitation patients from referral to discharge. In total, 168 cases from the Australasian Rehabilitation Outcomes Centre dataset were matched with 6291 cases from inpatient stroke data. Variants were explored for age, gender, outcome measures, length of stay and functional independence measure (FIM) change. Results: The study illustrated the process, process variants and patient journey map in stroke rehabilitation. Process characteristics of stroke rehabilitation patients were extracted and represented utilizing process mining and results highlighted process variation, attributes, touchpoints and timestamps across stroke rehabilitation patient journeys categorized by patient demographics and outcome variables. Patients demonstrated a mean and median duration of 49.5 days and 44 days, respectively, across the patient journeys. Nine variants were discovered, with 78.46% (n = 102) of patients following the expected sequence of activities in their stroke rehabilitation patient journey. Relationships involving age, gender, length of stay and FIM change along the patient journeys were evident, with four cases experiencing stroke rehabilitation journeys of more than 100 days, warranting further investigation. Conclusion: Process mining can be utilized to visualize and analyse patient journeys and identify gaps in service quality, thus contributing to better patient-centred care and improved patient outcomes and experiences in stroke rehabilitation.

Driving time-based identification of gaps in specialised care coverage: An example of neuroinflammatory diseases in Germany.

Objective: Due to the growing complexity in monitoring and treatment of many disorders, disease-specific care and research networks offer patients certified healthcare. However, the networks' ability to provide health services close to patients' homes usually remains vague. Digital Health Technologies (DHTs) help to provide better care, especially if implemented in a targeted manner in regions undersupplied by specialised networks. Therefore, we used a car travel time-based isochrone approach to identify care gaps using the example of the neuroinflammation-focused German healthcare and research networks for multiple sclerosis (MS), myasthenia gravis (MG), myositis and immune-mediated neuropathy. Methods: Excellence centres were mapped, and isochrones for 30, 60, 90 and 120 minutes were calculated. The resulting geometric figures were aggregated and used to mask the global human settlement population grid 2019 to estimate German inhabitants that can reach centres within the given periods. Results: While 96.48% of Germans can drive to an MS-focused centre within one hour, coverage is lower for the rare disease networks for MG (48.3%), myositis (43.1%) and immune-mediated neuropathy (56.7%). Within 120 minutes, more than 80% of Germans can reach a centre of any network. Besides the generally worse covered rural regions such as North-Eastern Germany, the rare disease networks also show network-specific regional underrepresentation. Conclusion: An isochrone-based approach helps identify regions where specialised care is hard to reach, which might be especially troublesome in the case of an often disabled patient collective. Patient care could be improved by focusing deployments of disease-specific DHTs on these areas.

Integrating the experience: Principles for digital transformation across the patient journey.

As medical science advances and the population ages, the prevalence of chronic conditions has also grown. The traditional model of care, with its focus on acute and episodic issues within the office visit, is not designed to meaningfully address long-term patient needs. With COVID-19 has come unprecedented digital adoption, bringing health care delivery to a critical juncture. While digital tools and technologies present vast opportunities for democratizing and decentralizing care experiences, their piecemeal application to the existing "sick care" model and its information technology infrastructure will not only limit their value, but will inevitably add cost, inefficiency, and burden to care teams. In order to build upon this momentum and reap the full benefits of practice digitization, care model transformation must occur. This entails holistically reexamining how every component of the health care experience, from the digital tools to visit interactions, synchronizes to address the full continuum of patient needs throughout the journey. By doing this, care shifts away from one-size-fits-all, fragmented strings of visits, toward seamless experiences that adapt to patients' needs in real-time while integrating within their daily lives. Rather than acting as a substitute for care, technology instead is vital to promoting and amplifying the impact of all those involved. To achieve this, this paper outlines 10 principles for restructuring care to incorporate digital health capabilities. Each describes how all care model components work as a system that aligns with patient needs. By doing this, technology is now an integral in supporting relationships across the full continuum of care.

Virtual Endocrinology Care Emphasizing Data-Driven Insights and Continuous Engagement and Its Impact on Glycemic Outcomes in Patients With Uncontrolled Diabetes: A Real-world Retrospective Case Series.

BACKGROUND: Steady Health's novel virtual care model incorporates continuous glucose monitoring (CGM) and a multidisciplinary approach to timely person-centered diabetes care. OBJECTIVE: This real-world retrospective case series explores the early glycemic outcomes of its patients with uncontrolled diabetes. METHODS: All patients of Steady Health who had an initial time in range (TIR) below 70% from their first 4 weeks of available CGM data and who had completed onboarding by February 2021 were included in this analysis. We compared the change in TIR, time below range, and average blood glucose from their first 4 weeks with their latest 4 weeks of available CGM data. Hemoglobin A1c (HbA1c) values at baseline and at the end of the study were also compared. Patients completed a questionnaire assessing their satisfaction with Steady Health's intervention. RESULTS: A total of 53 patients (n=35, 66% with type 1 diabetes; n=44, 83% treated with insulin) were included in this analysis. This cohort had a median baseline TIR of 53.0% (IQR 40.9%, 61.7%) and saw a median change in TIR of +16.6% (IQR +6.0%, +27.9%; P<.001) over a median duration of care of 11 months, amounting to nearly 4 more hours spent between 70 to 180 mg/dL a day. Of the 27 patients who had both baseline and follow-up HbA1c results, their median baseline HbA1c was 8.6% (IQR 7.5%, 11.4%; 70 mmol/mol), while their median change in HbA1c was -1.2% (IQR -2.6%, -0.2%; P=.001). Importantly, these glycemic improvements were achieved with a median decrease in the time below range by -0.3% (IQR -1.1%, 0.0%; P<.001), regardless of whether patients were started on an automated insulin delivery system. A total of 40 (75.5%) patients improved TIR by ≥5%, and 27 (50.9%) achieved TIR≥70% by the end of the study. Glycemic improvements were greatest among patients with the lowest baseline TIR and those who collaborated most intensively with Steady Health's clinicians. A total of 25 of these patients responded to a questionnaire assessing levels of satisfaction with their care, and all of them agreed that Steady Health had a positive impact on their diabetes management. CONCLUSIONS: Our findings suggest that patients with uncontrolled diabetes can achieve significant glycemic improvements by working with a virtual multidisciplinary care team that uses CGM to provide continuous clinical feedback and support.

Global use and outcomes of the hearWHO mHealth hearing test.

Objectives: The objective of this study was to examine the uptake, user characteristics, and performance of the free WHO smartphone hearing screening test (hearWHO) as a global hearing health promotion initiative. Method: We retrospectively examined the data of 242 626 tests conducted by adults (> 18 years) on the hearWHO app between February 2019 and May 2021. Test uptake was evaluated by country, WHO world region, test date, and demographics of age and gender. Results: The hearWHO test was completed in nearly every country globally (n = 179/195), with the greatest uptake seen in China and India. Uptake was greatest in the Western Pacific (32.9%) and European (24.8%) WHO regions. There was a high uptake of tests (44%) by young adults under the age of 30 years. Referral rates were typically higher for older age groups in most WHO regions, except for the African and Eastern Mediterranean regions, where overall hearWHO test uptake was lowest. Most testing (49%) took place in March (2019-2021) coinciding with World Hearing Day (3rd of March) each year. Conclusions: Digital mhealth tools provide many benefits in healthcare, including health promotion, access to information, and services for hearing loss. The hearWHO test was mainly reaching younger adults, positioning it as an important measure for public health advocacy to prevent hearing loss. Since hearing loss is primarily age related, more targeted campaigns or community-based initiatives should be directed toward older adults.

Use of eHealth Platforms and Apps to Support Monitoring and Management of Home-Quarantined Patients With COVID-19 in the Province of Trento, Italy: App Development and Implementation.

BACKGROUND: Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. OBJECTIVE: In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. METHODS: TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. RESULTS: A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological-organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. CONCLUSIONS: The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance.

"Let me know when I'm needed": Exploring the gendered nature of digital technology use for health information seeking during the transition to parenting.

This paper presents results of a qualitative descriptive study conducted to understand parents' experiences with digital technologies during their transition to parenting (i.e. the period from pre-conception through postpartum). Individuals in southwest Ontario who had become a new parent within the previous 24 months were recruited to participate in a focus group or individual interview. Participants were asked to describe the type of technologies they/their partner used during their transition to parenthood, and how such technologies were used to support their own and their family's health. Focus group and interview transcripts were then subjected to thematic analysis using inductive coding. Ten focus groups and three individual interviews were conducted with 26 heterosexual female participants. Participants primarily used digital technologies to: (1) seek health information for a variety of reproductive health issues, and (2) establish social and emotional connections. The nature of such health information work was markedly gendered and was categorized by 2 dominant themes. First, "'Let me know when I'm needed'", characterizes fathers' apparent avoidance of health information seeking and resultant creation of mothers as lay information mediaries. Second, "Information Curation", captures participants' belief that gender biases built-in to popular parenting apps and resources reified the gendered nature of health and health information work during the transition to parenting. Overall, findings indicate that digital technology tailored to new and expecting parents actively reinforced gender norms regarding health information seeking, which creates undue burden on new mothers to become the sole health information seeker and interpreter for their family.

A Virtual Type 2 Diabetes Clinic Using Continuous Glucose Monitoring and Endocrinology Visits.

The Onduo Virtual Diabetes Clinic (VDC) telehealth technology/care model for adults with type 2 diabetes (T2D) combines connected devices, remote lifestyle coaching, and clinical support with a mobile App. Key differentiating program features are the availability of live video consultations with board-certified endocrinologists for medication management and real-time continuous glucose monitor use for higher-risk participants. Preliminary data (n = 740) suggest that participation was associated with a significant improvement in HbA1c with up to 6 months follow-up in those not meeting treatment targets. HbA1c decreased by 2.3% ± 1.9%, 0.7% ± 1.0%, and 0.2% ± 0.8% across baseline categories of >9.0%, 8.0%-9.0% and 7.0% to <8.0%, respectively (all P < .001). These findings suggest that the VDC has potential to support individuals with T2D and their clinicians in diabetes management between office visits.

Artificial Intelligence, Data Sensors and Interconnectivity: Future Opportunities for Heart Failure.

A higher proportion of patients with heart failure have benefitted from a wide and expanding variety of sensor-enabled implantable devices than any other patient group. These patients can now also take advantage of the ever-increasing availability and affordability of consumer electronics. Wearable, on- and near-body sensor technologies, much like implantable devices, generate massive amounts of data. The connectivity of all these devices has created opportunities for pooling data from multiple sensors - so-called interconnectivity - and for artificial intelligence to provide new diagnostic, triage, risk-stratification and disease management insights for the delivery of better, more personalised and cost-effective healthcare. Artificial intelligence is also bringing important and previously inaccessible insights from our conventional cardiac investigations. The aim of this article is to review the convergence of artificial intelligence, sensor technologies and interconnectivity and the way in which this combination is set to change the care of patients with heart failure.

Reframing Telehealth: Regulation, Licensing, and Reimbursement in Connected Care.

Complexity in regulation and reimbursement of telehealth across the United States yields inconsistent use and availability of services. Drivers of this variation stem from existing regulatory, licensing, and payment policy that was designed for face-to-face care. Emerging technology for connected care continues to outpace the rules that govern its use. This article explores the drivers of uncertainty around regulation and payment of remote care services, and provides a roadmap for fulfillment of the benefits of connected care.

A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development.

BACKGROUND: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. OBJECTIVE: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. METHODS: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. RESULTS: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. CONCLUSIONS: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19.

Emerging Technologies for Diabetes Care.

New therapies, monitoring, and revolutionary enabling technologies applied to healthcare represent an historic opportunity to improve the lives of people with diabetes. These advances enable more meaningful monitoring of blood glucose values with the facilitation of more optimal insulin dosing and delivery. Newer insulins and delivery systems are in development that seek to mitigate both hyperglycemia and hypoglycemia and increase time in range. Information systems now exist that may be leveraged to merge data from previously discrete systems into new models of connected care. This review highlights important developments that serve to increase effectiveness while reducing the burden of diabetes care in the near future.